Perceived health in a randomised trial of treatment for chronic venous ulceration.
STUDY OBJECTIVE: To observe changes in perceived health in patients during a clinical trial of treatments for venous leg ulceration. DESIGN: Randomised prospective factorial trial in patients with venous ulceration. Each patient randomised to a bandage, dressing and a drug. Perceived health assessed at entry and after 24 weeks. SETTING: Outpatient departments and patient's home. PATIENTS: Two hundred patients presenting to two vascular services in Falkirk and Edinburgh with chronic (duration > 2 months) non-healing venous ulceration. STATISTICAL ANALYSIS AND MAIN RESULTS: Analysis using the Nottingham Health Profile revealed that after 24 weeks there were significant improvements in all subscores (p < 0.01) with the exception of social isolation (p = 0.081). Patients with healed ulceration had improved in energy, pain, emotion, sleep and mobility compared with those whose ulceration failed to heal (p < 0.05). Patients randomised to four layer bandaging had significantly better energy (diff = 7.9, 95% CI 0.2, 15.6, p = 0.04) and mobility (diff = 4.5, 95% CI 0.0, 9.0, p = 0.046). This difference could be explained largely by the improved healing of patients randomised to this bandage system (67/97 vs. 50/103, OR = 2.37, 95% CI 1.31, 4.27). CONCLUSIONS: Improvements in perceived health were significantly greater in patients whose ulcers had completely healed. Methods of treatment which offer improved healing for patients with venous leg ulceration are likely to improve patients' perceived health status. (+info)
High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic.
PURPOSE: Deep vein thrombosis (DVT) is a preventable cause of morbidity and mortality in patients who are hospitalized. An important part of the mechanism of DVT prophylaxis with intermittent pneumatic compression (IPC) is reduced venous stasis with increased velocity of venous return. The conventional methods of IPC use low pressure and slow inflation of the air bladder on the leg to augment venous return. Recently, compression devices have been designed that produce high pressure and rapid inflation of air cuffs on the plantar plexus of the foot and the calf. The purpose of this study is to evaluate the venous velocity response to high-pressure, rapid-inflation compression devices versus standard, low-pressure, slow-inflation compression devices in healthy volunteers and patients with severe post-thrombotic venous disease. METHOD: Twenty-two lower extremities from healthy volunteers and 11 lower extremities from patients with class 4 to class 6 post-thrombotic chronic venous insufficiency were studied. With duplex ultrasound scanning (ATL-Ultramark 9, Advanced Tech Laboratory, Bothell, Wash), acute DVT was excluded before subject evaluation. Venous velocities were monitored after the application of each of five IPC devices, with all the patients in the supine position. Three high-pressure, rapid-compression devices and two standard, low-pressure, slow-inflation compression devices were applied in a random sequence. Maximal venous velocities were obtained at the common femoral vein and the popliteal vein for all the devices and were recorded as the mean peak velocity of three compression cycles and compared with baseline velocities. RESULTS: The baseline venous velocities were higher in the femoral veins than in the popliteal veins in both the volunteers and the post-thrombotic subjects. Standard and high-pressure, rapid-inflation compression significantly increased the popliteal and femoral vein velocities in healthy and post-thrombotic subjects. High-pressure, rapid-inflation compression produced significantly higher maximal venous velocities in the popliteal and femoral veins in both healthy volunteers and patients who were post-thrombotic as compared with standard compression. Compared with the healthy volunteers, the patients who were post-thrombotic had a significantly attenuated velocity response at both the popliteal and the femoral vein levels. CONCLUSION: High-pressure, rapid-inflation pneumatic compression increases popliteal and femoral vein velocity as compared with standard, low-pressure, slow-inflation pneumatic compression. Patients with post-thrombotic venous disease have a compromised hemodynamic response to all IPC devices. However, an increased velocity response to the high-pressure, rapid-inflation compression device is preserved. High-pressure, rapid-inflation pneumatic compression may offer additional protection from thrombotic complications on the basis of an improved hemodynamic response, both in healthy volunteers and in patients who were post-thrombotic. (+info)
Intermittent compression for the treatment of the oedematous hand in hemiplegic stroke: a randomized controlled trial.
OBJECTIVE: To evaluate the efficacy of intermittent pneumatic compression in treating oedema in the hemiplegic hand of stroke patients. DESIGN: Single-blind randomized control trial. SETTING: acute and rehabilitation elderly care wards in a teaching district. SUBJECTS: 37 Subjects with a first ever hemisphere stroke were randomized to treatment with standard physiotherapy either alone or combined with intermittent pneumatic compression. MAIN OUTCOME MEASURES: The effect of treatment on oedema was assessed using measures of the hand volume of the hemiplegic hand. The impact on function was assessed using the motricity index. RESULTS: The treated group showed no change in the mean stroke hand volume. In the control group the mean stroke hand volume decreased by 3.2 ml. There was no statistically significant difference between the groups. The median scores for the motricity index increased for both groups but there was no significant difference between the groups and any improvement in motor function was independent of any treatment effects. CONCLUSION: Intermittent pneumatic compression at the prescribed pressure and duration of this study is not an effective treatment for the oedematous stroke hand. (+info)
Movement-related variation in forces under compression stockings.
OBJECTIVES: Compression therapy is widely used in the treatment of venous leg ulcers, but the efficacy of this treatment is variable. Assessment of variation in compression forces associated with movement may help to elucidate the mechanism of action of compression therapy. The aim of this study was to develop and apply a system to investigate forces under compression stockings during movement. METHOD: Three sensors were placed on the medial aspect of the left leg on six healthy volunteers to monitor forces under class 2 (Continental European classification) compression stockings. Data were recorded during dorsiflexion and plantar flexion of the left foot and also during short periods of walking. RESULTS: Changes in pressure were observed, associated with dorsiflexion and plantar flexion of the foot. These changes were dependent on sensor position. Changes in pressure during walking were also position-dependent and of variable duration. CONCLUSIONS: The system enables forces associated with compression therapy to be examined during movement and may thus be of value in further understanding its mechanism of action. Foot movement can be associated with clear changes in pressure under compression stockings and rapid changes in pressure may occur during walking. (+info)
Trachoma: can trichiasis be treated with a sticking-plaster? A randomized clinical trial in China.
Trachoma is the most frequent cause of preventable blindness in the world. At the trichiasis/entropion stage, lid surgery is recommended, but many patients only use epilation, which does not prevent loss of vision. We developed a new treatment that should be more accessible than lid surgery and more effective than epilation: a sticking plaster that forces eyelashes back to their correct position. The first randomized controlled trial was conducted in Shanghai with 57 patients to compare the plaster method with epilation. After 3 months of follow-up, with no attrition, 67% of those treated by the new method presented a good clinical status, vs none of those treated by epilation (P < 0.001). The new treatment was well tolerated and lid function remained normal. Although our results show overwhelming benefit of this new, simple treatment for trachoma at the trichiasis stage, more research is needed at the primary health care level and in other settings to determine the potential use of the new method on a large scale and by nonspecialists. (+info)
Intermittent compression units for severe post-phlebitic syndrome: a randomized crossover study.
BACKGROUND: Although uncommon, severe post-phlebitic syndrome may be associated with persistent, intractable pain and swelling that interfere with work and leisure activities. This study was performed to determine whether intermittent compression therapy with an extremity pump benefits patients with this condition and, if so, whether the benefit is sustained. METHODS: The study was a randomized crossover trial. Over the period 1990 to 1996, all patients in the clinical thromboembolism program of an Ontario teaching hospital who had a history of deep vein thrombosis and intractable symptoms of post-phlebitic syndrome were recruited into the study. The study involved using an extremity pump twice daily for a total of 2 months (20 minutes per session). The patients were randomly assigned to use either a therapeutic pressure (50 mm Hg) or a placebo pressure (15 mm Hg) for the first month. For the second month, the patients used the other pressure. A questionnaire assessing symptoms and functional status served as the primary outcome measure and was administered at the end of each 1-month period. A symptom score was derived by summing the scores for individual questions. At the end of the 2-month study, patients were asked to indicate their treatment preference and to rate the importance of the difference between the 12 pressures. Treatment was considered successful if the patient preferred the therapeutic pressure and stated that he or she would continue using the extremity pump and that the difference between the therapeutic and placebo pressures was of at least slight importance. All other combinations of responses were considered to represent treatment failure. Patients whose treatment was classified as successful were offered the opportunity to keep the pump and to alter pressure, frequency and duration of pump use to optimize symptom management. In July 1996 the authors contacted all study participants whose treatment had been classified as successful to determine whether they were still using the pump and, if so, whether they were still deriving benefit. RESULTS: In total 15 consecutive patients (12 women and 3 men) were enrolled in the study. The symptom scores were significantly better with the therapeutic pressure (mean 16.5) than with the placebo pressure (mean 14.4) (paired t-test, p = 0.007). The treatment for 12 of the patients (80%, 95% confidence interval 52% to 96%) was considered successful. Of these, 9 patients continued to use the pump beyond the crossover study and to derive benefit. INTERPRETATION: The authors conclude that a trial of pump therapy is worthwhile for patients with severe post-phlebitic syndrome and that a sustained beneficial response can be expected in most such patients. (+info)
Adhesive tape and intravascular-catheter-associated infections.
Adhesive tape is placed in close contact with intravascular catheters for extended periods and could theoretically contribute to local infections. We found that 74% of specimens of tape collected in one hospital were colonized by pathogenic bacteria. However, only 5% of specimens had significant growth from an inner layer obtained by discarding the outside layer from each roll. We suggest that adhesive tape is a potential source of pathogenic bacteria and that discarding the outer layer from a partially used roll might be a simple method for reducing the risk of infection to patients. (+info)
The therapy of amblyopia: an analysis of the results of amblyopia therapy utilizing the pooled data of published studies.
CONTEXT: Although the treatment of amblyopia with occlusion has changed little over the past 3 centuries, there is little agreement about which regimes are most effective and for what reasons. OBJECTIVE: To determine the outcome of occlusion therapy in patients with anisometropic, strabismic, and strabismic-anisometropic amblyopia employing the raw data from 961 patients reported in 23 studies published between 1965 and 1994. DESIGN: Analysis of the published literature on amblyopia therapy results during the above interval, utilizing primary data obtained from the authors of these articles or tables published in the articles detailing individual patient outcomes. PARTICIPANTS: 961 amblyopic patients, participants in 23 studies, undergoing patching therapy for amblyopia from 1965 to 1994 with anisometropia, strabismus, or anisometropia-strabismus. MAIN OUTCOMES: In the pooled data set, success of occlusion therapy was defined as visual acuity of 20/40 at the end of treatment. RESULTS: Success by the 20/40 criteria was achieved in 512 of 689 (74.3%) patients. By category, 312 of 402 (77.6%) were successful in strabismic amblyopia, 44 of 75 (58.7%) in strabismic-anisometropic amblyopia, and 72 of 108 (66.7%) in anisometropic amblyopia. Success was not related to the duration of occlusion therapy, type of occlusion used, accompanying refractive error, patient's sex, or eye. Univariate analyses showed that success was related to the age at which therapy was initiated; the type of amblyopia; the depth of visual loss before treatment for the anisometropic patients and the strabismic patients, but not for the anisometropic-strabismic patients; and the difference in spherical equivalents between eyes, for the anisometropic patients. Logistic/linear regression revealed that 3 were independent predictors of a successful outcome of amblyopia therapy. CONCLUSIONS: Factors that appear most closely related to a successful outcome are age, type of amblyopia, and depth of visual loss before treatment. These may be related to factors, as yet undetermined in the pathogenesis of amblyopia. With present emphasis on the value of screening and prevention and the development of new screening tools, such a look at the results of amblyopia therapy in a large population seems indicated. (+info)