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Kelechi TJ, Mueller M, Dooley M. Sex differences in symptom severity and clusters in patients with stage C4 and stage C5 chronic venous disease. Eur J Cardiovasc Nurs 2016; 16:28-36. [PMID: 26888961 DOI: 10.1177/1474515116634526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple symptoms associated with chronic venous disease (CVD) are poorly understood, under-recognized, and ill-managed. AIMS The aim of this study was to determine whether there are differences in symptoms and symptom clusters between men and women with stage C4 and stage C5 CVD. METHODS Data were collected via interviews with 264 patients using a demographic survey and an 11-item VEINES-SYM questionnaire. ANALYSIS An intrinsic scoring algorithm was developed to calculate the overall t scores for each item by sex. Exploratory factor analysis identified symptom clusters using oblique rotation to account for correlations between factors. RESULTS The average age was 61.7 years; 54.5% of the patients were women, 58% were African American or black, and 60.6% had diabetes. The top three symptoms for women in order of frequency were achy legs, swelling, and pain; for men, these were swelling, achy legs, and heavy legs. For the total group, two symptom clusters emerged: distressful and discomfort. There was no statistically significant difference in factor score between the sexes. Different factor loadings for symptom clusters were observed: women reported hurting and annoying clusters; and men reported nagging and irritating clusters. CONCLUSION The data suggest differences in CVD symptoms and clusters by sex. Symptoms in the two clusters were different; however, there was consistency in the factors associated with each cluster. Co-morbid conditions and sex differences in pain responses may play a part in symptom presentation. This study supports the need for increased sex-delineated clinical assessment and consideration of the potential differences between the sexes in the management of CVD symptoms.
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Affiliation(s)
- Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Mary Dooley
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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Kelechi TJ, Mueller M, King DE, Madisetti M, Prentice M. Impact of daily cooling treatment on skin inflammation in patients with chronic venous disease. J Tissue Viability 2015; 24:71-9. [PMID: 25703058 DOI: 10.1016/j.jtv.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
People with chronic venous disease are at high risk for developing venous leg ulcers. Inflammation is posited as a pathological factor for this chronic condition as evidenced by persistently elevated skin temperature. As part of a larger trial to test the effects of a cooling regimen on leg ulcer prevention, the objective of this preliminary study was to evaluate the first 30 days of intense daily cooling. Compared to a placebo control cuff, a gel cuff applied to the most severely affected lower leg skin for 30 min daily showed no statistically significant differences between temperatures taken in the home at baseline compared to those measured at the 1 month follow up visit. There were also no differences in temperatures noted between the two groups, although the temperatures in the treatment group were lower 30 min after treatment, an indication of adherence. There was no discernable decrease or increase in temperature at a given time point during the 30 day treatment period compared to the control group. It may be better to have patients monitor skin temperature on a daily basis and then apply the cuff as necessary, rather than requiring daily cooling based on baseline measurement. This "prn" approach may provide a sufficient cooling milieu to prevent escalation of inflammation and thwart ulcer occurrence or recurrence. Clinical trials registration #NCT01509599.
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Affiliation(s)
- Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA.
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
| | - Dana E King
- West Virginia University, Department of Family Medicine, Robert C. Byrd Health Sciences Center, P.O. Box 9152, Morgantown, WV 26506, USA
| | - Mohan Madisetti
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
| | - Margie Prentice
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
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Li Z, Roussakis E, Koolen PGL, Ibrahim AMS, Kim K, Rose LF, Wu J, Nichols AJ, Baek Y, Birngruber R, Apiou-Sbirlea G, Matyal R, Huang T, Chan R, Lin SJ, Evans CL. Non-invasive transdermal two-dimensional mapping of cutaneous oxygenation with a rapid-drying liquid bandage. BIOMEDICAL OPTICS EXPRESS 2014; 5:3748-64. [PMID: 25426308 PMCID: PMC4242015 DOI: 10.1364/boe.5.003748] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 05/22/2023]
Abstract
Oxygen plays an important role in wound healing, as it is essential to biological functions such as cell proliferation, immune responses and collagen synthesis. Poor oxygenation is directly associated with the development of chronic ischemic wounds, which affect more than 6 million people each year in the United States alone at an estimated cost of $25 billion. Knowledge of oxygenation status is also important in the management of burns and skin grafts, as well as in a wide range of skin conditions. Despite the importance of the clinical determination of tissue oxygenation, there is a lack of rapid, user-friendly and quantitative diagnostic tools that allow for non-disruptive, continuous monitoring of oxygen content across large areas of skin and wounds to guide care and therapeutic decisions. In this work, we describe a sensitive, colorimetric, oxygen-sensing paint-on bandage for two-dimensional mapping of tissue oxygenation in skin, burns, and skin grafts. By embedding both an oxygen-sensing porphyrin-dendrimer phosphor and a reference dye in a liquid bandage matrix, we have created a liquid bandage that can be painted onto the skin surface and dries into a thin film that adheres tightly to the skin or wound topology. When captured by a camera-based imaging device, the oxygen-dependent phosphorescence emission of the bandage can be used to quantify and map both the pO2 and oxygen consumption of the underlying tissue. In this proof-of-principle study, we first demonstrate our system on a rat ischemic limb model to show its capabilities in sensing tissue ischemia. It is then tested on both ex vivo and in vivo porcine burn models to monitor the progression of burn injuries. Lastly, the bandage is applied to an in vivo porcine graft model for monitoring the integration of full- and partial-thickness skin grafts.
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Affiliation(s)
- Zongxi Li
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
| | - Emmanuel Roussakis
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
| | - Pieter G. L. Koolen
- Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street Suite 5A, Boston, Massachusetts 02215,
USA
| | - Ahmed M. S. Ibrahim
- Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street Suite 5A, Boston, Massachusetts 02215,
USA
| | - Kuylhee Kim
- Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street Suite 5A, Boston, Massachusetts 02215,
USA
| | - Lloyd F. Rose
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Suite B, JBSA –Fort Sam Houston, Texas 78234-7767,
USA
| | - Jesse Wu
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Suite B, JBSA –Fort Sam Houston, Texas 78234-7767,
USA
| | - Alexander J. Nichols
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
- Harvard University Program in Biophysics, Building C2 Room 112, 240 Longwood Avenue, Boston, MA 02115,
USA
- Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue E25-519, Cambridge, MA 02139,
USA
| | - Yunjung Baek
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon 305-701,
South Korea
| | - Reginald Birngruber
- University of Lübeck, Institute of Biomedical Optics, Lübeck, Peter Monnik Weg 4, 23562 Lübeck,
Germany
| | - Gabriela Apiou-Sbirlea
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215,
USA
| | - Thomas Huang
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215,
USA
| | - Rodney Chan
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Suite B, JBSA –Fort Sam Houston, Texas 78234-7767,
USA
| | - Samuel J. Lin
- Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street Suite 5A, Boston, Massachusetts 02215,
USA
| | - Conor L. Evans
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129,
USA
- Harvard University Program in Biophysics, Building C2 Room 112, 240 Longwood Avenue, Boston, MA 02115,
USA
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Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med 2012; 20:291-8. [PMID: 22863643 DOI: 10.1016/j.ctim.2012.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 12/21/2011] [Accepted: 03/21/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Venous insufficiency is present in a large number of postmenopausal women, increasing their risk of disability. The objective of this study was to determine the effects of myofascial release therapy and conventional kinesiotherapy on venous blood circulation, pain and quality of life in postmenopausal patients with venous insufficiency. METHODS A randomised controlled trial was undertaken. We enrolled 65 postmenopausal women with stage I or II venous insufficiency on the clinical, aetiological, anatomical and physiopathological (CEAP) scale of venous disorders, randomly assigning them to a control (n=32) or experimental (n=33) group. The control and experimental group patients underwent physical venous return therapy (kinesiotherapy) for a 10-week period, during which the experimental group patients also received 20 sessions of myofascial release therapy. Main outcome measures determined pre- and post-intervention were blood pressure, cell mass, intracellular water, basal metabolism, venous velocity, skin temperature, pain and quality of life. RESULTS Basal metabolism (P<0.047), intracellular water (P<0.041), diastolic blood pressure (P<0.046), venous blood flow velocity (P<0.048), pain (P<0.039) and emotional role (P<0.047) were significantly higher in the experimental group than in the control group after the 10-week treatment programme. CONCLUSION The combination of myofascial release therapy and kinesiotherapy improves the venous return blood flow, pain and quality of life in postmenopausal women with venous insufficiency.
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