3. Bioadhesive Biomaterials’ Biomedical Applications

Bioadhesives are generally used in wound healing and hemostasis, and their use is incipient in other biomedical applications such as tissue engineering and regeneration. The incoherence between the tissue and the biomaterial is connected using the tissue adhesives in tissue regeneration [87].

Furthermore, while discussing the practical applications of bioadhesive biomaterial research in medical aspects, it is necessary to mention that over the past decade, a growing amount of attention has been paid to bone tissue engineering for research and development in bioadhesive biomaterials’ biomedical applications, and resource management, around the world to meet the societal challenges.

Accordingly, the progressive innovation in bioadhesive biomaterials has trended sharply upward, and is expected to double by 2020, especially with a focus on the application of bone tissue engineering. As such, to provide a quality healthcare service, microbially derived polysaccharides (MPs) are demanding, as they are sued for novel, multi-informant, operationally deployable, commercially exploitable and natural-origin raw materials for the production of commercially applicable products in the form of hydrogel and bio composites. These MPs are of bacterial origin (bacterial cellulose (Acetobacter xylinum); chitosan (Aspergillus niger) and Levan (Microbacterium laevaniformans)). Beside the applications of MP and MP-based bio-composites in the health and nano-biotechnology sectors (cell to-cell interactions, biofilm formation, and cell protection against environmental extremes), such polysaccharides are also used as thickeners, bioadhesives, stabilizers, probiotics, and gelling agents in the food and cosmetic industries, and as emulsifier, biosorbents and bioflocculants in the environmental sector.

Concerning the application of bacterial cellulose (BC), it is necessary to indicate that the application of BC has been observed in a broad spectrum, especially in different areas, such as the newspaper industry, electronics, and tissue engineering, due to its remarkable mechanical properties, conformability and porosity. This work has primarily focused on the issue of the biocompatibility of BC and BC nanocomposites and their biomedical aspects, such as surface modification for improving cell adhesion, and in vitro and in vivo studies that focus on the cellulose networks. In summation, the relevance of biocompatibility studies has also emphasized the development of BC-based biomaterials’ medical applications in bone, skin and cardiovascular tissue engineering [88].

On the other hand, as regards the biological properties’ influence on biomedical application, chitosan has many beneficial biomedical properties, such as biocompatibility, biodegradability, and no toxicity. Therefore, it has been observed that the biological activity of chitosan is closely related to its solubility. This also highlights the development and improvement of scaffolding, i.e., the support of biomaterials using a framework for regenerative medicine. Regarding biomaterials’ medical applications, it is obligatory to remark that scaffolds are one of the crucial factors for tissue engineering, such as scaffolds containing natural polymers that have recently been developed more quickly and have gained more popularity. These include chitosan, a copolymer derived from the alkaline deacetylation of chitin. In order to provide a quality healthcare nowadays, the expectations for the use of these types of scaffolds are increasing as the knowledge regarding their chemical and biological properties expands, and new biomedical applications are being investigated [89,90].

The protein-based adhesives materials are basically from animal sources which trigger an inflammatory response compared with human derived materials. Nowadays, various protein-based bioadhesive products are under development for clinical trials (phase III and phase IV), for example, as hemostatic sealants in cardiac surgery as vascular graft attachments, valve attachments, etc., drug delivery systems (as for example in the gastrointestinal tract, nasal delivery and ocular drug delivery), wound-healing dressings and military applications [87].

4. Implementation of Bioadhesive Biomaterials in Healthcare

In this contemporary age, bioadhesive biomaterials are considered as an innovative property oriented material that empower to build an intimate relationship with the living tissue. Currently, biomaterials are revolutionizing many aspects of preventive and therapeutic healthcare that plays an important role, especially, during the development of new medical devices, prostheses, tissue repair and replacement technologies, drug delivery systems and diagnostic techniques. Hence, due to advance biomaterials promising opportunities, presently the application of biomaterials in health sectors are the one of the main focus of major research efforts around the world. Research shows, that development in this field of research requires a multidisciplinary approach, where scientists interact with engineers, materials producers and manufacturers. On the other hand, it is necessary to mention that to face the recent challenges of healthcare management is often very demanding. Therefore, it has been observed that the required skills and resources are beyond the capabilities of a single organization, or even of a single country. Accordingly, collaborative research is thus becoming the key to achieving breakthrough results in order to bring leadership in the global marketplace [95]. “Bioadhesion of Biomaterials” covers the bioadhesion aspect of biomaterials as healthcare challenges via research and development of effective and low-cost. However, their application as medical devices were limited to the degradation [7].

From the healthcare perception point of view, biomaterials can be demarcated as a “materials that mainly clasp with some innovative properties that facilitate to emanate in immediate contact with the living tissue without eliciting any adverse immune rejection reactions.” These types of biomaterials are envisioned for usage in healthcare especially, for the purpose of diagnosis of disease and for the treatment or for the prevention of other diseases in human body or other animals. Additionally, it is essential to express that this condition is normally not dependent upon being metabolized for the achievement of any of its principal intended purposes or not. Equally, these devices and or any type of biomaterials are typically used for physical replacement of some hard or soft tissue, which has suffered any accidental damage or destruction through some pathological processes [9].

In relation to biomaterials application in healthcare, it is known that biomaterials usage for health purpose is not a new concept. Application of biomaterials in health issues started from a long period of time. Though, the noticeable advancement of biomaterials application has been observed since 1940s but the substantial development has been detected over the past 25 years especially while applying therapeutic medical technologies and implant devices [9]. Furthermore, from the implementation of bioadhesive biomaterials application in healthcare, research shows that from the ancient periods, tissue adhesives and sealants application in healthcare have renovated a lot, especially in wound management and in traumatic and surgical injuries. For example, tissue adhesives and sealants application in healthcare is well-known to treat disorders of hemostasis, i.e.  is the physiological process that stops bleeding at the site of an injury while maintaining the normal blood flow circulation within the body [96]. Instead, various biological-driven glues and synthetic adhesives are clinically utilized either for the betterment of health as an adjunct to conventional hemostats and wound closure techniques, such as suturing, or as a replacement purpose. As a result, it can be said that this way of bioadhesive biomaterials set-up in healthcare gradually improve the ability of effectively and quickly controlling bleeding. Consequently, it helps in reducing the risk of complications due to severe blood loss that act as an important implement of medical adhesive, which is a highly suitable tool for wound management [97].

5. Redefining Healthcare Management in Relation to Bioadhesive Biomaterials Medical Application

To address the conceptualization of ‘redefining healthcare management’, it is significant to discuss about the idea of re-emerging “value-based healthcare” for healthy societal development. Currently, this value-based healthcare impression enforces researchers, mainly who are keen in innovative bioadhesive biomaterials application in healthcare due to its recent development in their formulation. Where, engineers, scientists (i.e. chemists, physicists, biologists, and medical experts) materials’ producers, and manufacturers combine their knowledge to reconsider all the aspects of health care management in order to provide and maintain the good health of a population. According to the report of the Economist Intelligence Unit [98], value-based healthcare can be considered as the formation and operation of a quality health system that explicitly prioritizes on quality health products. In this regard, it is necessary to say that bioadhesive biomaterial applications in healthcare deliver quality health through integrated and technologically sophisticated heath care delivery system. Modern healthcare also has four main principles such as: (i) evidence-based, patients centred and inclusive cares, (ii) the community, continuous and coordinated, (iii) ethically sound and (iv) regulated healthcare system [98, 99, 100]. This review article intends to describe in Figure.3 the contemporary indulgent about the significances of bioadhesive biomaterials for biomedical applications in healthcare for redefining healthcare management as a novel approach.

Figure 3. The Conceptual Approach of Redefining Healthcare Management.

Hence, the value-based healthcare concept, i.e. to redefine healthcare system particularly emphasized on proper health objective in order to increase the value. Research shows, that value is generated from health consequences which matter to the following three visions. The presented Figure.3 illustrate the conceptual approach of redefining healthcare that demonstrated the way to enhance quality healthcare as well as to maintain a programmatic approach, it is necessary to have  a Holistic state of physical, mental and social health condition or environment; need integrated and technologically sophisticated healthcare delivery system to provide unique patient circumstances; and care all-inclusive patients medical needs, including critical and chronic disease prevention as well as management of undesirable conditions’[100].

However, to redefine healthcare, transformations requisite to be done by both health providers and patients as well through  appropriate healthcare delivery, proper clinical data management by strengthening primary care, building integrated health systems, i.e., quality assurance for quality treatment and implementing appropriate health payment schemes, i.e. economy of healthcare system that will promote the value and reduce moral hazards, enabling health information technology, and creating a policy appropriate for healthy community [1].

The conceptual framework of redefining healthcare management in relation to bioadhesive biomaterials was developed based on the idea of care management conceptual model [99]. In this research, the main highlighted point is to highlight the importance of innovative bioadhesive biomaterials medical application to redefine all the aspects of health practice. This review article intended to raise the awareness of healthcare service providers, private research institutes, government authorities, public service boards, associations and academic initiatives to restructure the health care system that will not only create value for patients and increase satisfaction, but it will also create a healthier society. Therefore, based on the idea of care management conceptual model this study develops a thematic diagram (Figure.5) to define the linkage of redefining healthcare management in relation to bioadhesives for medical applications. Figure 5 represents this connection between the healthcare service providers, patients, and members, i.e. (research institutions, associations & academics). This schematic diagram demonstrates the critical element of the patient to this connection that influencing medical issue factors. By including the patient element in the framework, this study considers the potential influence of patient characteristics, i.e. effective self-care and the relationships of patients with clinics / clinicians and community resources, i.e. high quality clinical care.

To define the relation to bioadhesive biomaterials medical application, it is necessary to denote that biomaterials are widely used in many kinds of medical devices. The biomaterials used can be protein, metal, polymer, ceramic or composites. Similarly, bio adhesion will be occurred when the medical device contact to biological surface.  Figure 3 demonstrates that bacterial cellulose, levan, and chitosan have excellent and praise-worthy applications in medical field (already explained in earlier part of this article).

But also protein-based adhesives play a vital role especially when using biological adhesives for medical applications. Remarkable thing is that since primeval eras, tissue adhesives and sealant applications in healthcare have renovated a lot, particularly in wound management and in traumatic and surgical injuries. Thus, based on our previous discussion, it can be said that the process of placing quality clinical care as well as patients’ effective self-care has a close connection that redefines the existing health care in order to avoid further risks and can receive needed preventive services. A linkage, therefore, represents the combined influence of all seven basic factors (health policies, providers, patients, members, bioadhesive biomaterials medical application, quality clinical care patients’ self-care) and their levels of collaboration that enable to achieve expected outcome, i.e. economic value-based healthcare for delivery of a preventive service.

Figure 4. Thematic diagram of redefining healthcare management in relation to bioadhesive biomaterials (based on the idea of care management conceptual model) [99].

6. Conclusion

Finally, it can be said that this review article delivers an understanding about the consequences of bioadhesion of biomaterials application and its implication for redefining healthcare management as a novel approach.  Even though some research has been performed in order to describe the polysaccharides based adhesives application at a micro level or at Nano level which, has been done for the preparation of molecularly smooth films for healthcare resolution. Hence, it is necessary to continue this research in this area in order to obtain a better understanding about the adhesive interactions beyond hydrogen bonding including mechanical interlocking, interpenetrating networks, and covalent linkages on a fundamental level to improve interfacial properties with thermoplastics, thermosets and biopolymers. Relating to this issue of bioadhesive biomaterials application in the healthcare system, this study exposes the presentation of progressive innovation in bioadhesion of biomaterials. Meanwhile, today innovative biomaterial applications tend sharply upward and are expected to double by 2020, especially with a focus on delivering quality healthcare. While redefining health, it is necessary in order to mention that health consists of three main domains namely, physical, mental, and social health that prioritized with value-based healthcare concept.

The analyses revealed some important research assumptions that were predictive of both healthcare management and innovative biomaterials application which states that bioadhesion of biomaterials for redefining healthcare management is not a new concept. Its implementation has been used for several years for medical applications such as dentistry and orthopedics’ and is now entering new fields, for example, tissue sealing and directed drug delivery systems. From the practical implication point of view, the results provide an important insight into the notion of involving healthcare delivery organizations, i.e. (health care service provider) in medical science for resource management that facilitates to cope up with the socio-economic challenges of Horizon 2020. As an outcome, it is assumed that government authorities and public service boards, research institutes, associations and academics to restructure health care system that will not only create value for patients and increase satisfaction, but it will also improve health outcomes through enabling new efficiencies and lowering costs.

Author Contributions: Conceptualization: Nibedita Saha, Nabanita Saha, Review of literature: Nibedita Saha, Nabanita Saha, Tomas Sáha, Ebru Toksoy Öner, Urška Vrabič Brodnjak and, Janek von Byern, Writing – original draft: Nibedita Saha, Nabanita Saha; Ebru Toksoy Öner, Urška Vrabič Brodnjak and, Janek von Byern Writing – review & editing Heinz Redl, Petr Sáha and Nibedita Saha; Conceptual/thematic diagram drawn: Nibedita Saha.

Author Contributions: Conceptualization: Nibedita Saha, Nabanita Saha, Review of literature: Nibedita Saha, Nabanita Saha, Tomas Sáha, Ebru Toksoy Öner, Urška Vrabič Brodnjak and, Janek von Byern, Writing – original draft: Nibedita Saha, Nabanita Saha; Ebru Toksoy Öner, Urška Vrabič Brodnjak and, Janek von Byern Writing – review & editing Heinz Redl, Petr Sáha and Nibedita Saha; Conceptual/thematic diagram drawn: Nibedita Saha.

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