Wound Management
Author
Institution
Case 1
Arterial Ulcer
Holistic assessment
Wound examination
Wound is located on lower right leg and is infected
Type of wound
Chronic wound
Cause of wound
Poor blood supply to lower right leg (detail is mentioned above)
Further investigation
Wound swab is taken and sent to pathology, results from pathology shows that the wound is infected. No further investigation is required.
Wound management principle
Debridement of necrotic tissues, improve blood circulation by providing thinner blood, proper dressing, moist wound bed, and also pain control.
Evaluation
Wound examination
Punched out wound with infection
Wound bed status
Wound bed is pale, yellow in color with sign of infection, and exudate is present.
Wound characteristics
According to the history wound is existed for a long time and is infected as well, it will take more time to heal.
It is located on the lower right leg where blood flow is lower as compare to the other parts of the body
Other characteristics that effects the healing process is mentioned below.
Wound measurement
Length: 2.1 cm
Width: 2 cm
(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Surrounding skin is dry and rough due to dead tissues in the area.
Wound exudate
Sanguineous drainage
Further assessment
No further assessment is needed. Although taking weight of a patient is recommended. As weight can also play a role in treating the wound and there is no information provided on the weight of this patient in this report.
Expectation of healing process
It takes time to heal arterial ulcer. It is located at lower part of leg, where the blood flow is apparently low. His age (77 years), history of diabetes, difficulty in mobility, and poor oral intake results in slow healing process of the wound. To overcome these obstacles, various steps and recommendations are discussed in wound and pain management section.
Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).
Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply and by increasing chances of infection so it impairs wound healing.
Mobility: Mobility improves blood circulation so it improves healing. Patient has difficulty in moving so it affects the healing process of the wound
Nutrition: Due to poor oral intake, his body lack zinc and vitamin C it slows his healing process.
Wound management Plan
Moist wound healing
Moist wound healing is must for healing arterial ulcer wound. In addition to that wound temperature should be kept warm for better management.
Skin & risk assessment
Skin assessment includes factors like temperature, color, pulse, hair distribution, and skin appearance
In this case all signs show decreased blood supply with dry ragged discolored skin.
Risk assessment: Arterial ulcer accounts for 5 to 20% of all leg ulcers in diabetic patient CITATION Doy16 \l 1033 (Doyle, 2016).
Wound cleansing
Wound can be cleaned with water (not in excess). Cadexomer iodine ointments should be applied around the wound margins. This ointment draws out the exudate and also fights the bacteria present at wound site.
Pressure support and relieving devices
No pressure support and relieving devices are needed in treating this wound.
Prevention program
List of things that should be prevented in treating this wound are:
Quit smoking if the patient is smoker
Protect legs and feet from injuries
Avoid Prolonged sitting and standing
Avoid cold temperatures
Dressing product
Ketanserin ointment with moist dressing should be applied on the wound. This dressing should be changed twice a day CITATION For15 \l 1033 (Forster R, 2015).
Secondary dressing
No Need
Pain management time frames
Usually arterial ulcer wound takes long time to heal. In our case due to many factors mentioned above, healing of the wound can take more time than normal or maybe it will never healed at all. In one year period, pain can be reduced to 3 times by following the step mentioned in wound cleaning and dressing product section.
Health education for the patient
Chronic Disease: Being a diabetic patient, his glucose level should be maintained.
Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active. In addition physio like ultrasound treatment and compression therapy are recommended. Compression therapy will induce thermal effect which is good for wound healing
Weight: Patient should also lose weight (not provided with case study) if he is overweight.
Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound
Addition wound care: wound should be kept moist CITATION Pál09 \l 1033 (Pálsdóttir, 2009).
Pain management
Medication
Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.
Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).
Frequency and dose
Dose of Endone should be remained same i.e; 10mg (tds).
Zinc - 30mg (tds)
Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)
Reason for medication
To relief pain and excelling the healing process
Patient’s education
As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.
Daily physical activity should be planned in future, because mobility plays an important role in the healing of arterial ulcer.
Protect the patient from any injuries in future
Medicines prescribed/ advised are important for his recovery
Smoking is very dangerous for the patient in his current condition
Diabetic Foot Ulcer
Holistic assessment
Wound examination
Located of left toe, requires debridement
Type of wound
Chronic wound
Cause of wound
Poor blood and oxygen supply to lower body due to tightening of arteries and vessels because of high glucose level.
Further investigation
No deep tissue infection found. A sample should be collected from the wound for culture.
Wound management principle
Drainage and surgical debridement, improve blood circulation and also pain control. Wound should be treated with antibiotics and proper dressing.
Evaluation
Wound examination
Grade 2 Open ulcer wound with no deep tissue infection
Wound bed status
Pale yellow outer skin, dark red from inside, no sign of exudate, with sign of infection and necrotic tissue.
Wound characteristics
According to the patient’s history wound is existed for a long time and is infected as well, it will take more time to heal.
It is located on left toe Other characteristics like wound size, depth, edge are mentioned below
Wound measurement
Length: 3 cm
Width: 3.6 cm
(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Surrounding skin is normal.
Wound exudate
Not present
Further assessment
A sample should be collected from wound for culture.
Expectation of healing process
At his age (77 years) along with the history of diabetes and poor oral intakes, wound will take time to heal wound is located at left toe, poor blood circulation may results in slowing the healing process
Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).
Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply in the area. There is a risk of increase in infection.
Mobility: Mobility improves blood circulation which improves the healing process. Patient has difficulty in moving so it affects the healing process of the wound
Nutrition: Due to poor oral intake, his body lack zinc and vitamin C it slows his healing process.
Wound management Plan
Moist wound healing
After surgical debridement provide moist wound care for healing.
Skin & risk assessment
Skin assessment Poor blood supply with hard skin at wound edge. Surrounding skin is normal.
Risk assessment: Risk factors includes bacteriology, wound care choices, type of debridement, and wound dressing
It should be examined whether the patient feels numbness and has he loss protective sensation. In addition foot deformity and injuries may result in additional risk.
Patient with history of diabetes has 15 to 20% risk of developing Diabetic foot ulcer CITATION Nal05 \l 1033 (Nalini Singh, David G. Armstrong, & Benjamin A. Lipsky, 2005)
Wound cleansing
Treatment process should start with careful drainage and sharp surgical debridement. Debridement will not only clear the necrotic tissues but will also help clean the wound. After than wound should be cleaned with using saline.
Pressure support and relieving devices
No pressure support and relieving devices are needed in treating this wound.
Prevention program
List of things that should be prevented in treating this wound are:
Quit smoking if the patient is smoker
Protect legs and feet from injuries
Avoid Prolonged sitting and standing
Avoid cold temperatures
Dressing product
Silver releasing dressing
Secondary dressing
silicon impregnated dressing along with hyperbaric oxygen therapy
Pain management time frames
Wound should be frequently assessed throughout the treatment as it will take long to recover. Once the treatment is started, healing time of the wound can be estimated by taking etiology and wound size into account. With proper nutrition and antibiotics pain can be reduced during the healing process.
In our case due to many factors mentioned above, healing of the wound can take more time than normal. Pain can be reduced to 3 times by following the step mentioned in wound cleaning and dressing product section. In addition intermitted pain due to wound debridement and frequent change of dressing will remain throughout the process of healing.
Health education for the patient
Chronic Disease: Being a diabetic patient, his glucose level should be maintained.
Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active.
Weight: Patient should also lose weight (not provided with case study), if he is overweight.
Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound
Pain management
Medication
Same as Arterial ulcer
Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.
Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).
Frequency and dose
Same as arterial ulcer
Dose of Endone should be remained same i.e; 10mg (tds).
Zinc - 30mg (tds)
Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)
Reason for medication
To relief pain and excelling the healing process
Patient’s education
As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.
Daily physical activity should be planned in future, because mobility plays an important role in the healing of arterial ulcer.
Protect the patient from any injuries in future
Medicines prescribed/ advised are important for his recovery
Smoking is very dangerous for the patient in his current condition
Pressure Ulcer
Holistic assessment
Wound examination
Stage 3 pressure ulcer located on patient’s sacrum bone
Type of wound
Chronic wound
Cause of wound
Due to his inability to move without assistance, patient stays in one position for a long time. This prolonged stay in one position produces pressure on the sacrum bone affecting blood circulation to lower part of the body and resulting into a pressure ulcer.
Further investigation
Subcutaneous tissue exposed, with no sign of infection. A sample should be collected from the wound for culture.
Wound management principle
Wound debridement for the removal of dead tissue.
Improve blood circulation by frequently moving the patient
Pain control
Wound should be treated with antibiotics and proper dressing.
Evaluation
Wound bed status
Skin loss with damage to necrosis of subcutaneous tissue.
Red granulation tissue exposed
No sign of exudate
Wound characteristics
According to the patient’s history, he was unaware of the wound so it was not treated in time. It may take time to heal and depends on the assistance required in changing position while lying down.
It is located on his sacrum bone
Other characteristics like wound size, depth, edge are mentioned below
Wound measurement
Length: 3.2 cm
Width: 3.1 cm
(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Maceration of surrounding skin is observed
Wound exudate
Not present
Further assessment
A sample should be collected from wound for culture.
Expectation of healing process
Due to his inability to move resulting in pressure and poor blood circulation, healing process will take long.
Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).
Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply in the area. There is a risk of developing infection.
Mobility: Mobility improves blood circulation which improves the healing process. It will also reduce the pressure in the region of wound. Patient has difficulty in moving so it affects the healing process of the wound.
Nutrition: Due to poor oral intake, his body lack zinc and vitamin C. It slows his healing process.
Wound management Plan
Moist wound healing
After cleaning of the wound, moist saline or iodine gauze can be used as a dressing.
Make sure that no pressure is applied in the area when the wound is dressed.
Surrounding skin should be dry
Skin & risk assessment
Skin assessment Full skin loss and subcutaneous tissue is visible.
Risk assessment: Although the risk of pressure ulcer should be assessed before its development, in our case the ulcer is already developed and is in stage 3.
Norton risk assessment will be used as its parameters are useful for pre and post ulcer development. Loss score should be greater than 14 CITATION eun09 \l 1033 (eunice park-lee, 2009).
Norton risk assessment parameters include mobility, activity, mental condition, physical condition, and incontinence
Wound cleansing
Wound should not be cleaned with plain water and soap, use saline solution instead.
Pressure support and relieving devices
Alternating pressure surfaces which includes specially designed bed, cushion, and mattress should be used.
These devices will provide support and also act as a pressure relieving.
Prevention program
List of things that should be prevented in treating this wound are:
Quit smoking if the patient is smoker
Provide adequate padding while sitting
Surrounding skin should be kept dry as the skin maceration of skin is present
Patient should be proper fitted into wheelchair with padding on pressure points
Avoid Prolonged sitting and standing
Avoid cold temperatures
Dressing product
As there is no exudate present, silver releasing dressing should be used
Secondary dressing
Honey or foam dressing
Pain management time frames
The pain associated with pressure ulcers depends on deep infection, moisture related incontinence, pre-ulcer irritation, and friction/shear.
In our case due to pain is directly associated with the location of the wound, patient’s poor nutrition, and his inability to move will. Wound should be frequently assessed throughout the treatment as it will take long to recover. Swear pain will remain through the process of healing. Main focus is to reduce the healing time with proper care.
Pain can be reduce with time with proper care, precaution, and wound management explained in this table.
Health education for the patient
Chronic Disease: Being a diabetic patient, his glucose level should be maintained.
Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active.
Weight: Patient should also lose weight (not provided with case study), if he is overweight.
Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound
Pain management
Medication
Same as Arterial and diabetic foot ulcer
Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.
Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).
Secondary medication: antibiotic should be given depending on the result from culture.
Frequency and dose
Same as arterial ulcer and foot ulcer
Dose of Endone should be remained same i.e; 10mg (tds).
Zinc - 30mg (tds)
Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)
Reason for medication
To relief pain and excelling the healing process
Patient’s education
As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.
Daily physical activity should be planned in future, because mobility plays an important role in the healing of pressure ulcer.
Proper padding should be used on pressure points.
Avoid lying in supine position.
Medicines prescribed/ advised are important for his recovery
Smoking is very dangerous for the patient in his current condition
Second Degree Burn
Holistic assessment
Wound examination
2nd degree on his left hand.
Type of wound
2nd degree burn
Cause of wound
He spilled a coffee on his hand
Further investigation
Not needed
Wound management principle
Clean gently with soap and water
If the blister is break during the treatment, it should be drained and cleaned properly
Apply petroleum based ointments
Evaluation
Wound bed status
Epidermis and Dermis layers of the skin are effected and the affected area is swelled up, appears shiny, surrounding are shows redness, and the area is painful to touch
Wound characteristics
Size of the wound is nominal, blister is formed on top layer, surrounding skin shows redness, and the wound is not deep.
Other characteristics like wound size and the nature of surrounding are mentioned below
Wound measurement
Length: 2 cm
Width: 1.4 cm
(this is calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Burning causes redness in surrounding skin
Wound exudate
Not present
Further assessment
No need
Expectation of healing process
With proper care and treatment, wound can be healed in two to three weeks period. Scar may form during the healing process depending upon the nature of skin and management plan.
Wound management Plan
Moist wound healing
Dressing should be soaked in water before applying
Skin & risk assessment
Skin assessment Visible blister with redness in surrounding skin.
Risk assessment: Burn may leave a scar during the healing. Proper and in time treatment may reduce the risk of scar.
It the blister is break, there is a risk of getting infection. It should drained properly and should be cleaned periodically.
Wound cleansing
Wash gently with soap and water.
Pressure support and relieving devices
No need
Prevention program
List of things that should be prevented in treating this wound are:
Extreme hot temperature
Avoid scratching
Dressing product
Moist dressing with presence of saline
Secondary dressing
No need
Pain management time frames
Wound is expected to heal within 2 to 3 weeks. And pain will remaining until the wound is completely healed.
Saline dressing will reduce the pain with time.
Health education for the patient
Educate the patient about healing process.
Avoid scratching
Wash the wound with cool with cool water (avoid cool water contact to his ulcer wounds)
Dressing should be changed at least twice a day
Pain management
Medication
Petroleum ointment and saline dressing
No pain killer as the patient
Frequency and dose
At least twice a day
Reason for medication
To relief the pain and heal the wound.
Patient’s education
In future, always use capped container for drinking hot beverages
Drink excess water as the burn causes the body to lose fluid
Case 2
Malignant Wound
Holistic assessment
Wound examination
Malignant wound on groin area.
Type of wound
Chronic wound
Cause of wound
The patient has cervical cancer. Therefore cancerous cells infiltrate the skin and the blood and lymph vessels supporting it which cause a loss in vascularity leading to tissue death causing a malignant wound on the groin area.
Further investigation
The wound was oozing pus and developed into a sinus,
As the main goal is to improve the quality of life, no further investigation regarding wound is required.
Wound management principle
The patient should be given pain killers prior to any treatment.
The patients wound are chronic hence it is important that they do not tear while dressing, therefore blood thinners like aspirin can be given.
The dressing shall be soaked in water before removal.
The wound has a very odor and is releasing puss therefore it should cleaned with saline water and frequent change of dressing is advised.
Evaluation
Wound bed status
Infected wound bed with moderate to high exudate with presence of sinus as well
A regular change in pads to control the blood from discharge is required.
The bed linens should also be regularly changed to avoid infection from malignant wounds puss.
Wound characteristics
Raised irregular margins with infected wound base and erythema all around the wound
Surrounding skin also shows signs of infection
Moderate amount of exudate also seen
Wound measurement
Length: 4 to 5 cm
Width: 2.5 cm
(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Erythema of surrounding skin is observed
Wound exudate
Moderate amount seen along with fouls smelling discharge from the sinus
Further assessment
A sample should be collected from wound for culture and sensitivity under aseptic conditions
Expectation of healing process
Because we are treating patient on palliative lines, so the main goal is to keep the patient pain and smell free. Since healing process in this patient is not much expected.
Improving pain management techniques and keeping the wound clean are the main goals
Wound management Plan
Moist wound healing
Protection and prevention of the damage skin by controlling exudate, protecting surrounding skins by barrier ointments.
Prevention of odor management by local cleansing (saline irrigation), gentle removal of necrotic tissue. Use of topical antibiotics activated charcoal dressing.
Essential oil or other aroma therapies
Skin & risk assessment
Skin assessment Raised irregular margins with infected wound base and erythema all around the wound. Surrounding skin also shows signs of infection. Moderate amount of exudate also seen
Risk assessment: low immunity due to malignancy, poor oral intake, lack of self-care on account of weakness and malignant disease are the main risk factor involved that need to be kept in mind while managing the patient.
Wound cleansing
Cleansing of wound by saline
And cleansing of exudate by absorbent hydro fiber and absorbent cover dressings with high absorbent capacity
If exudate is still not controlled, then consider pouching or consultation with enterostomal therapy nurse.
Pressure support and relieving devices
Not needed
Prevention program
Not applicable because we giving her palliative care
Dressing product
hydro fiber and absorbent cover dressings with high absorbent capacity
Secondary dressing
Layered dressing or consultation with enterostomal therapy nurse
Pain management time frames
Pain management is the main goal for this patient.
Pain is of mixed etiology, monitoring of pain level and providing analgesia whether topical or systemic along with relaxation therapies and emotional support.
Health education for the patient
Emotional support and relaxation techniques along with spiritual healing techniques are the main helping factors for this patient.
Pain management
Medication
As the patient is already taking fentanyl 200mcg and midazolam 10 mg, if needed topical pain killers can be added for local pain of the wound
Frequency and dose
patient is on syringe driver: Fentanyl 200 mcg + Midazolam 10 mg
and topical pain killer (sos)
Reason for medication
To relief pain and improve patient’s quality of life.
Patient’s education
Family should be explained clearly about the patient’s condition and they should also participate in improving the remaining time of her life.
They should be explained that only palliative care is being provided to this patient.
Venous Ulcer Wound
Holistic assessment
Wound examination
Venous ulcer on her leg
Type of wound
Chronic wound
Cause of wound
Venous insufficiency
Further investigation
Doppler ultrasound, venography, and ankle brachial index
Wound management principle
Primary goal in this patient is keeping the ulcer site infection free and alleviating edema of the sight.
Debridement to remove dead tissue.
Oral and topical antibiotics dressing
Surgical skin graft (since we are providing palliative care, it is less useful in this patient)
Compression therapy
Evaluation
Wound bed status
Infected edematous skin (wound bed not visible in the picture)
Wound characteristics
Infected
Erythematous
edematous
Wound measurement
Length: 8 cm
Width: 6 cm
(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)
Condition of surrounding skin
Erythema and edema of surrounding skin is observed
Wound exudate
Not present
Further assessment
Not applicable
Expectation of healing process
Because we are treating patient on palliative lines, so the main goal is to keep the patient pain and smell free. Since healing process in this patient is not much expected.
Improving pain management techniques and keeping the wound clean are the main goals
Wound management Plan
Moist wound healing
Wound debridement
Dressing (compression)
Oral and topical antibiotics dressing
Skin & risk assessment
Skin assessment Surrounding skin is erythematous and edematous.
Risk assessment:
Wound cleansing
Debridement of wound with saline solution and application of topical antibiotics along with compressing dressing will be used in wound cleaning.
Pressure support and relieving devices
Compression therapy
Maggots or biotherapy
Surgical skin graft
Prevention program
Avoid prolonged siting and standing
Protection from injury and infection
Avoid extreme temperature
Dressing product
Simple ascetic dressing
Secondary dressing
Compression dressing or therapy
Pain management time frames
Pain management is the main goal for this patient.
Pain is of mixed etiology, monitoring of pain level and providing analgesia whether topical or systemic along with relaxation therapies and emotional support.
Health education for the patient
Emotional support and relaxation techniques along with spiritual healing techniques are the main helping factors for this patient.
Pain management
Medication
As the patient is already taking fentanyl 200mcg and midazolam 10 mg, if needed topical pain killers can be added for local pain of the wound
Frequency and dose
patient is on syringe driver: Fentanyl 200 mcg + Midazolam 10 mg
and topical pain killer (sos)
Reason for medication
To relief pain and improve patient’s quality of life.
Patient’s education
Family should be explained clearly about the patient’s condition and they should also participate in improving the remaining time of her life.
They should be explained that only palliative care is being provided to this patient.
Examine wound regularly
Elevate leg regularly
References
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Black, J., Baharestani, M. M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D., … Panel (NPUAP), and T. N. P. U. A. (2007). National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System. Advances in Skin & Wound Care, 20(5), 269. https://doi.org/10.1097/01.ASW.0000269314.23015.e9
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Leonard, J. (2018, June 18). What to know about peripheral vascular disease. (M. M. Alana Biggers, Editor) Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/322182.php
Nalini Singh, M., David G. Armstrong, D. M., & Benjamin A. Lipsky, M. (2005, January 12). Preventing Foot Ulcers in Patients With Diabetes. JAMA, 217-228. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/200119
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Pálsdóttir, G. (2009). Chronic leg ulcers in Iceland; Prevalence, aetiology and management. University of Iceland, Faculty of Nursing. University of Iceland, faculty of Nursing. Retrieved from https://skemman.is/bitstream/1946/2296/1/Chronic%20leg%20ulcers%20in%20Iceland%3B%20Prevalence%2C%20aetiology%20and%20management_fixed-1.pdf
Soc, J. A. (2015, Sep 25). Chronic Wound Repair and Healing in Older Adults: Current Status and Future Research. PMC, 427-438. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582412/
Villines, Z. (2019, May 16). Second-degree burn: Everything you need to know. Retrieved May 27, 2019, from Medical News TOday: https://www.medicalnewstoday.com/articles/325189.php
