Recherche de publication

OBJECTIVE

To analyze the effects of lower limb muscle strengthening on interface pressure (IP), static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) in older adults undergoing inelastic compression therapy.

METHOD

Forty-three healthy older adults of both sexes (Age: 66.2 ± 4.4 years) met the eligibility criteria and completed all stages of the study (Resistance Training - RT: N = 20; Control - CONT: N = 23). Body composition, strength and functional mobility of lower limbs, IP, SSI, DSI, and WPA were evaluated before and after intervention.

RESULTS

The two-way ANOVA with repeated measures demonstrated a significant time-group interaction effect on muscular strength for 1-RM [F (1, 41) = 21.091; p ≤ 0.001], IP in the orthostatic position [F (1, 41) = 5.124; p ≤ 0.05], minimum WPA [F (1, 41) = 10.999; p ≤ 0.05], maximum WPA [F (1, 41) = 8.315; p ≤ 0.05], DSI minimum (F (1, 41) = 4.608; p ≤ 0.05), DSI maximum (F (1, 41) = 8.926; p ≤ 0.05), and on the delta DSI (F (1, 41) = 7.891; p ≤ 0.05).

CONCLUSIONS

In RT group, the increase in lower limb muscle strength was accompanied by an increase in IP in foot dorsiflexion and plantar flexion maneuvers, both in the standing position (DSI) and during gait (WPA).

BACKGROUND

Negative-pressure-wound-therapy (NPWT) has become a widely used tool for the coverage and active treatment of complex wounds, including burns. This study aimed to evaluate the effectiveness of NPWT in acute burns of upper and lower extremities and to compare results to the standard-of-care (SOC) at our institution.

METHODS

Patients that were admitted to our institution between May 2019 and November 2021 with burns on extremities between 0.5 % and 10 % of the total body surface area (%TBSA) were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received additional NPWT after grafting independent on the initial group allocation.

RESULTS

Sixty-five patients suffering from burn injury between May 2019 and November 2021 were randomized into treatment with NPWT (n = 33) or SOC (n = 32); of these, 33 patients (NPWT) and 28 patients (SOC) had complete data sets and were included in the analysis. Both groups were similar regarding age (39.8 ± 13.7 vs. 44.8 ± 16.2 years,p = 0.192), total burn size (3.1 ± 2.3 vs. 3.4 ± 2.8 %TBSA,p = 0.721) and treated wound size (1.9 ± 1.2 vs. 1.5 ± 0.8 %TBSA,p = 0.138). We found no differences regarding healing time (11.0 ± 4.9 vs. 8.6 ± 3.8,p = 0.074, and significant differences in a number of dressing changes throughout the study (2.4 ± 1.5 vs 4.2 ± 1.9,p < 0.001). The Kaplan-Meier time-to-event analysis exhibited no statistically significant difference in the time to healing or skin grafting (p = 0.085) in NPWT group compared with SOC group. The median time to healing or skin grafting was 10(8-11) days for NPWT and 9(7-11) days for SOC. The hazard ratio for healing or skin graft was HR= 0.64(0.38-1.08). The results of the time-to-event analysis as well as the Kaplan-Meier curve on the PPS confirmed this result. We found no differences in secondary surgical operations 15.2 vs 21.4 % pain or functional outcomes.

CONCLUSIONS

In this study, we found no significant difference between the two groups in terms of time to detect wound healing. We also found no difference regarding further operations for wound closure, pain and/or scarring. However, dressing changes were significantly less frequent for patients that were treated with NPWT, which may be a psychological and logistical advantage.

Increasing pressures on healthcare resources require constant evaluation of the efficiency and effectiveness of provision, particularly for the rising number of vulnerable, elderly and obese patients. Practices regarding compression are arguably often ingrained due to its historical usage, with evidence from managing chronic venous insufficiency (CVI) underpinning its effectiveness. This evaluation explores the clinical benefit, impact, outcomes and cost-efficiencies of using an adjustable compression wrap system instead of previous care. ‘Before-after design’ observation of 50 patients captured baseline resource use, costs and outcomes (clinical and patient) at the time of assessment and again at a maximum of six-month follow-up. Data after using the adjustable compression wrap showed significantly improved clinician-reported outcomes: presence of wounds/leg ulceration (from 56% to 21%), incidence of cellulitis (halved), and reduced complexity/severity of lymphoedema. Additionally, patient- reported outcomes, visual analogue scale (VAS) health score and LYMPROM© scores for pain, heaviness, shopping for shoes and clothes, and body image significantly improved. The mean number of community nurse visits per patient reduced from 11.6. to 9.1, but was not statistically significant (p-value 0.09). However, this evaluation found that over six months there was a mean cost reduction of over £383.70 per patient, which included the purchase price of the adjustable compression wrap system.

OBJECTIVE

To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema.

DESIGN AND SETTING

Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil.

PARTICIPANTS

Women in control phase of the breast cancer-related lymphedema.

INTERVENTIONS

Compared use of ACWs versus compressive mesh.

MAIN MEASURES

Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval.

RESULTS

Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome-excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times.

CONCLUSIONS

Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

These eight case studies describe patients with complex and hard-to-heal wounds who were treated with Suprasorb Liquacel Pro (standard test dressing) or Suprasorb Liquacel Ag (test dressing with silver nanoparticles) as a primary dressing. These absorptive gelling-fibre dressings are designed to manage wound exudate levels and promote moist wound healing, with the test dressing with silver nanoparticles having additional antimicrobial properties.

The cases describe the progress of the patient’s wound healing from start to conclusion of a study period lasting around 4 weeks, with some variation based on patient availability for follow up. They explore the potential impacts of the test dressings, while also considering the viewpoints of both the healthcare professional (HCP) administering treatment and the patients receiving care. Unless otherwise described, all patients underwent best-practice treatment of their wound’s underlying aetiology according to standard of care and experienced no product-related adverse events.

BACKGROUND

Suprasorb Liquacel Pro (standard test dressing) and Suprasorb Liquacel Ag (test dressing with silver nanoparticles) are absorptive gelling-fibre dressings designed to manage wound exudate levels and promote moist wound healing, with the latter having additional antimicrobial properties.

AIMS

To assess the impact of the test dressing on healing, exudate levels and signs of infection.

METHODS

Patients with moderately-to-highly exuding hard-to-heal wounds of any type were dressed with the standard test dressing or the test dressing with silver nanoparticles if they showed covert or overt signs of local infection. Comparative data were collected at baseline and 4-week conclusion. Adverse events and patient and professional opinions were also reported and collated.

FINDINGS

There were 19 patients with lower-limb wounds of various types present for a mean of 26 months. At baseline, most wounds were deteriorating or static (68%), while at conclusion most were improving or healed (84%), with additional indicators of improved healing. The number of patients with moderate-to-high exudate levels decreased from 84% to 53%. The 15 patients using the test dressing with silver nanoparticles saw reductions in covert signs of infection from 93% to 80%, overt signs of infection from 33% to 13% and antibiotic use from 13% to 7%.

CONCLUSIONS

On average, the test dressings were effective in managing and reducing the barriers to healing, including high exudate, infection and biofilm, and in restarting stalled healing.

Gelling-fibre dressings have been found to be a rapid and effective tool for exudate management. Suprasorb Liquacel Pro is a soft, conformable non-woven dressing made from sodium carboxymethyl cellulose and strengthening cellulose fibres. When it comes into contact with wound exudate or blood, the absorbent dressing forms a gel, creating a moist wound environment. Cell debris and bacteria in the exudate are retained inside the fibre dressing and removed during the dressing change. The high vertical absorption of exudate into the fibre dressing protects the wound environment and the wound edge, thus supporting the healing process. Suprasorb Liquacel Ag has additional antimicrobial abilities with the inclusion of nanosilver technology, shown to be effective in killing bacteria and managing bioburden.

Background: ReadyWrap® Calf, Rosidal® Sys and Urgo K2® respond to the same physical laws. But they were studied with different methods. This makes it difficult to compare them. ReadyWrap® Calf has an estimated stretch of 60 %. After 5 hours of wear in healthy volunteers, its static stiffness index (SSI) is around 15 mmHg when applied with a resting pressure of 40 mmHg. The SSI of Rosidal® Sys and Urgo K2® remains constant before and after a 30-minute treadmill test (25 mmHg for Rosidal® Sys and 15 mmHg for Urgo K2®). The aim of this trial is to study these compression devices using the same method, with a view to carrying out comparative clinical trials at a later date. Aim of the study: The purpose of this pilot study was to compare the interface pressures and stiffness indices of three compression devices (ReadyWrap® Calf, Urgo K2® and Rosidal® Sys) on volunteer subjects before and after a 15 min treadmill test. Materials and methods: We selected 40 volunteer subjects treated with ReadyWrap® Calf after randomization on one leg and on the other leg with 20 with Rosidal® Sys or 20 with Urgo K2®. We measured interface pressures in standing, lying position and during ankle dorsiflexion. We calculated the SSI and Dynamic Stiffness Index (DSI) before and after a 15 min treadmill test. We also carried out a VAS on comfort. Results: Interface pressures decreased after the treadmill test with all three compression devices. ReadyWrap® Calf and Urgo K2® pressures, SSI and DSI before and after the treadmill test were not statistically different. Their static Stiffness Indices are in the order of 13-14 mmHg. Only Rosidal® Sys has a significantly higher SSI. Comfort is found very comfortable under the 3 compression devices. Conclusion: The adjustable compression wrap, Readywrap® Calf, behaves like a stiff bandage when applied with a pressure of around 40 mmHg. Its different pressures and stiffnesses are comparable to the bandage kit Urgo K2®.