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Pfortmueller CA, Dabrowski W, Wise R, van Regenmortel N, Malbrain MLNG. Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review. Ann Intensive Care 2024; 14:115. [PMID: 39033219 PMCID: PMC11264678 DOI: 10.1186/s13613-024-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes. While the relationship between FAS and ICU outcomes is well described, uncertainty exists regarding its diagnosis, monitoring and treatment. A stepwise approach is suggested to prevent and treat FAS in patients with septic shock, including minimizing fluid intake (e.g., by limiting intravenous fluid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fluid output (e.g., with diuretics, or renal replacement therapy). Current literature implies the need for a multi-tier, multi-modal approach to de-resuscitation, combining a restrictive fluid management regime with a standardized early active de-resuscitation, maintenance fluid reduction (avoiding fluid creep) and potentially using physical measures such as compression stockings.Trial registration: Not applicable.
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Affiliation(s)
- Carmen Andrea Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Rob Wise
- Department of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Intensive Care Department, John Radcliffe Hospital, Oxford University Trust Hospitals, Oxford, UK
| | - Niels van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg/Cadix, Antwerp, Belgium
- Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
- Medical Data Management, Medaman, Geel, Belgium
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Tan M, Urbanek T, Rabe E, Gianesini S, Parsi K, Davies AH. Compression therapy in the management of varicose veins. Phlebology 2024; 39:276-279. [PMID: 38101949 PMCID: PMC10993631 DOI: 10.1177/02683555231222679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Kurosh Parsi
- Department of Dermatology, St Vincent’s Hospital, Sydney, Australia
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - on behalf of UIP
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Medical University of Silesia, Katowice, Poland
- Department of Dermatology, University of Bonn, Bonn, Germany
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Dermatology, St Vincent’s Hospital, Sydney, Australia
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Joassard O, Kerveillant AL, Sellal C, Coatantiec E, Jabbour V, Desjeux G, Braithwaite B, Elias A, Fauconnier A. Evaluation of Elastic Venous Compression Device dispensation in pregnant and post-partum women using the French National Health Insurance Claims Database: The ProFIL retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 296:342-348. [PMID: 38531180 DOI: 10.1016/j.ejogrb.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES To describe the real-world use of Elastic Venous Compression Devices (EVCDs) during pregnancy and post-partum using data from a representative subset of the French National Health Insurance Claims Database (the Echantillon Généraliste des Bénéficiaires, EGB). STUDY DESIGN Women aged 15-49 who were pregnant between 1st July 2017 and 15th June 2018 were identified in the EGB using pregnancy-specific acts (certain prenatal examinations or deliveries). Subgroups were defined by age, presence of Venous Thrombo-Embolism (VTE) risk factors, history of VTE, delivery type and time period. EVCD dispensations (format, prescriber, and date) were identified among those for "standard orthotics" using their unique reimbursement tariffs. Dispensation rates were computed for all subgroups, overall and by format and were compared. RESULTS 15,528 pregnant women were included: 7,252 [46.7 %] deliveries (5,796 vaginal [79.9 %], 482 planned cesarean sections (C-sections) [6.7 %] and 974 unplanned C-Sections [13.4 %]), 2,734 (17.6 %) terminations and 5,542 (35.7 %) unknown outcomes. Overall, 4,919 (31.7 %) women were dispensed at least one EVCD. Ante-partum dispensation occurred in 43.1 % (n = 3,122) of women whose pregnancy led to a delivery. Dispensation rates were 17.3 % (n = 1,005), 46.7 % (n = 225) and 44.1 % (n = 430) after vaginal delivery, planned C-sections or unplanned C-sections, respectively. Overall, dispensation rates significantly increased with age, the presence of VTE risk factors, and a history of VTE (p < 0.01). EVCD dispensation was most frequent (17.0 %) during the 5th month of pregnancy. Among pregnant women who were dispensed at least one EVCD during ante- or post-partum, 69.0 % had one or two units of compression (27.1 % [one unit], 41.9 % [two units]). Stockings (48.6 %, n = 6,038) were dispensed significantly more frequently than socks (36.9 %, n = 4,586) and tights (14.5 %, n = 1,806) (p < 0.01). The main contributors to mechanical VTE prophylaxis were gynecologists (26.3 % of dispensations, n = 2,280), general practitioners (20.2 %, n = 1,749) and midwives (15.1 %, n = 1,314). CONCLUSIONS Low observed dispensation rates highlight a discrepancy between the French National Authority for Health (Haute Autorité de Santé, HAS), recommending EVCDs use during pregnancy and after delivery, and the real-life use of EVCD. Prescription sensitization combined with targeted information campaigns for pregnant women would be beneficial to contribute to the prevention of VTE, a health problem for pregnant women.
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Affiliation(s)
- Olivier Joassard
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | | | - Claire Sellal
- Midwife practice, 14 Rue du Chapeau Rouge, 44000 Nantes, France.
| | - Erwana Coatantiec
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Violaine Jabbour
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Guillaume Desjeux
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Ben Braithwaite
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Antoine Elias
- Department of Vascular Medicine, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France; Clinical research department, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France.
| | - Arnaud Fauconnier
- Obstetrics and Gynecology department, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, BP 3082, 78303 Poissy CEDEX, France; Paris-Saclay university, UVSQ, research unit 7285 "Risk and safety in clinical medicine for women and perinatal health (RISCQ), 2 Avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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Stevenson EM, Coda A, Bourke MDJ. Investigating low rates of compliance to graduated compression therapy for chronic venous insufficiency: A systematic review. Int Wound J 2024; 21:e14833. [PMID: 38522455 PMCID: PMC10961173 DOI: 10.1111/iwj.14833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.
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Affiliation(s)
- Elise M. Stevenson
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
| | - Michael D. J. Bourke
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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Zhao Y, Li B, Qin H, Li Y, Zhang X, Fu F, Tang X. Knowledge of deep vein thrombosis among nursing interns: A cross-sectional study. Nurse Educ Pract 2024; 75:103915. [PMID: 38340481 DOI: 10.1016/j.nepr.2024.103915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
AIM The aims of this study were: (1) to validate whether the Knowledge and Practices of Nurses on Deep Vein Thrombosis Risks and Prophylaxis Knowledge (KPNDVT-K) subscale could effectively measure the level of DVT knowledge of nursing interns; (2) to determine the level of DVT knowledge of nursing interns; and (3) to analyse the factors affecting the level of DVT knowledge of nursing interns. BACKGROUND The effective prevention of deep vein thrombosis (DVT) in patients requires nursing staff to have a solid knowledge base of DVT. The level of knowledge about DVT among nursing interns ultimately affects their ability to play an important role in DVT prevention as a qualified nurse. To improve DVT prevention, the current level of knowledge needs to be explored. DESIGN This was a cross-sectional survey. METHODS Basic information was collected from the nursing interns. The KPNDVT-K subscale was used to assess the level of knowledge of DVT among nursing interns. RESULTS The KPNDVT-K subscale was used to measure the DVT knowledge of nursing interns with good reliability and validity (difficulty p=0.304-0.426; differentiation D=0.422-0.540; Cronbach's alpha =0.724-0.950; R=0.766). The passing rate for the nursing interns' DVT knowledge was 75.1%, which was in the middle level. Sex (β=-1.471, P=0.007), Home location (β=-0.627, P=0.014), Understanding of channels (hospital teachers) (β=0.688, P=0.008), Internship (β=-1.625, P=0.035; β=-1.435, P=0.038) were the main influences on nursing interns' knowledge of DVT. CONCLUSIONS The KPNDVT-K subscale has high applicability in the measurement of DVT knowledge of nursing interns. The knowledge of DVT among nursing interns was satisfactory and the knowledge related to DVT preventive measures was good. Nursing educators should take active measures in both schools and hospitals to improve the DVT knowledge of nursing interns to reduce the occurrence of DVT in patients.
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Affiliation(s)
- Yue Zhao
- Nursing Department of Xinjiang Medical University, China; Health Care Research Center for Xinjiang Regional population, China.
| | - Boya Li
- Nursing Department of Xinjiang Medical University, China
| | - Huaqing Qin
- Nursing Department of Xinjiang Medical University, China
| | - Yinglan Li
- Nursing Department of Xinjiang Medical University, China; Health Care Research Center for Xinjiang Regional population, China; Xiang Ya Hospital, Central South University, China.
| | - Xiumin Zhang
- Xinjiang Uygur Autonomous Region People's Hospital, China
| | - Feng Fu
- Nursing Department of Xinjiang Medical University, China
| | - Xiaogui Tang
- Nursing Department of Xinjiang Medical University, China
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Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 2024; 12:101670. [PMID: 37652254 DOI: 10.1016/j.jvsv.2023.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually noncontroversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Parts I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, Rex Vascular Specialists, UNC Health, Raleigh, NC
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Jose Almeida
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ruth L Bush
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | - Monika L Gloviczki
- Department of Internal Medicine and Gonda Vascular Center, Rochester, MN
| | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Källman U, Fallenius M, Bååth C. A new compression stocking with well-defined pressure-a randomized controlled pilot study. Phlebology 2023; 38:683-694. [PMID: 37696041 DOI: 10.1177/02683555231200974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND To evaluate an innovative class I compression stocking with predetermined uniform pressure in comparison to a graduated class III compression stocking system, regarding edema reduction, interface pressure, and patient comfort. METHOD Twenty-five patients with chronic venous disease, were randomized: 12 to investigational stocking, 13 to comparator stocking. Data collected at baseline and after 14 days. RESULTS Edema was significantly equal reduced to follow-up; mean -129.0 cm3 (SD 105; p = .004, Class I) and -223.7 cm3 (SD 120; p = .002, Class III), respectively. The investigational stocking lost significantly less compression pressure than the comparator stocking (p ≤ .013). Participants in both groups perceived significant improvement regarding leg heaviness, leg swelling, and feelings of tightness and tingling (p ≤ .016). CONCLUSION The innovative investigational class I stocking appears to offer similar edema reduction and benefits to the comparator class III stocking. However, a larger and prolonged study is required. The study was registered in the ISRCTN-registry, ISRCTN17356077, https://www.isrctn.com/ISRCTN17356077.
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Affiliation(s)
- Ulrika Källman
- Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
- Institute of Health and Care Sciences, Faculty of Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Melina Fallenius
- Department of Dermatology, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Carina Bååth
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Faculty of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
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Świątek Ł, Stępak H, Krasiński Z. The role of compression therapy after endovenous laser ablation (EVLA) - review. POLISH JOURNAL OF SURGERY 2023; 96:109-113. [PMID: 38348974 DOI: 10.5604/01.3001.0053.9855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> Chronic venous disease (CVD) is a rising problem in western countries. There are several stages of CVD that can be treated with different ways. One of the methods of treating varicosity, C2 stage of CVD, is still developing endovenous laser ablation (EVLA). This method is popular due to its short operation time, less bleeding, quick recovery and no surgical scars. The compression therapy in form of compression stockings has been widely used as a conservative treatment of early stage CVD and it's also used after EVLA. However there are no strong recommendations towards using compression therapy after this kind of surgery.</br> <b><br>Aim and Method:</b> This paper is aimed to review existing knowledge about compression therapy benefits and its recommended time period after EVLA. Search engines used in review: Pubmed and Cochrane.</br> <b><br>Results:</b> Studies focusing on the compression therapy after EVLA of varicose veins have questioned the prolonged use of compression therapy as it brings no additional benefits and might be difficult for patients to adhere. The existing studies recommended the time period no greater than 1-2 weeks. There are no significant changes in reoccurrence rate and return to normal activities between compression and non-compression group. It is proven that compression therapy significantly reduces the postoperative pain and consumption of analgesics.</br> <b><br>Discussion:</b> Compression therapy seems as a safe option for low pain management. There is a need for further research involving the impact of the compression therapy after EVLA, especially in group of low energy delivered settings as the results of treatment are promising.</br>.
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Affiliation(s)
- Łukasz Świątek
- Student's Scientific Section of Vascular Surgery, Poznan University of Medical Sciences, Poland
| | - Hubert Stępak
- 2 Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, University Hospital of Lord's Transfiguration, Poznan, Poland
| | - Zbigniew Krasiński
- 2 Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, University Hospital of Lord's Transfiguration, Poznan, Poland
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Cacchio A, Calvisi V, Di Carlo G, Petralia G, Angelozzi M. Efficacy and Safety of the Phytochemical Product Linfadren in the Management of Patients With Persistent Ankle Edema Following Trauma or Surgery: A Randomized Controlled Trial. Foot Ankle Int 2023; 44:972-982. [PMID: 37724868 DOI: 10.1177/10711007231189679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Persistent posttraumatic/postsurgery ankle edema (PPAE) is edema that persists from 2 weeks to 3 months after injury or surgery. PPAE has negative effects on the healing process and quality of life. This study aimed to evaluate the efficacy of a phytochemical product containing diosmin, coumarin, and arbutin (Linfadren) in addition to the conventional treatment, in patients with PPAE. METHODS Between October 2018 and February 2020, 60 outpatients with PPAE (42 with ankle fractures and 18 with ankle sprains) were enrolled and randomized (1:1 ratio) to receive either 6-week conventional treatment plus Linfadren (study group) or conventional treatment alone (control group). Primary outcome was ankle edema as measured by the "figure-of-8-20" method. Secondary outcomes were ankle function measured by the Lower Extremity Functional Scale (LEFS), and patient's overall perceived treatment efficacy. Tolerability of Linfadren was also evaluated. Assessments were performed at baseline, at end of treatment (6 weeks after baseline), and 3 months after the end of treatment (follow-up). A subgroup analysis was also conducted for the injury type (fracture/sprain) to identify if this factor affected the results of the primary outcome measure. RESULTS At the end of treatment, the study group had a significantly greater improvement in ankle edema, improved ankle function, and more patients who considered this treatment effective compared with the control group. The measured difference in circumference by the figure-of-8-20 method averaged 4% at 6 weeks and 5% at 3 months. No difference between groups was seen in rescue medication. No adverse events were recorded. Subgroup analysis revealed no significant influence of the injury type on the primary outcome measure. CONCLUSION Linfadren in addition to conventional treatment was more effective than conventional treatment alone in patients with PPAE. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Angelo Cacchio
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Vittorio Calvisi
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giancarlo Di Carlo
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Petralia
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Massimo Angelozzi
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
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Messmer A, Pietsch U, Siegemund M, Buehler P, Waskowski J, Müller M, Uehlinger DE, Hollinger A, Filipovic M, Berger D, Schefold JC, Pfortmueller CA. Protocolised early de-resuscitation in septic shock (REDUCE): protocol for a randomised controlled multicentre feasibility trial. BMJ Open 2023; 13:e074847. [PMID: 37734896 PMCID: PMC11148668 DOI: 10.1136/bmjopen-2023-074847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Fluid overload is associated with excess mortality in septic shock. Current approaches to reduce fluid overload include restrictive administration of fluid or active removal of accumulated fluid. However, evidence on active fluid removal is scarce. The aim of this study is to assess the efficacy and feasibility of an early de-resuscitation protocol in patients with septic shock. METHODS All patients admitted to the intensive care unit (ICU) with a septic shock are screened, and eligible patients will be randomised in a 1:1 ratio to intervention or standard of care. INTERVENTION Fluid management will be performed according to the REDUCE protocol, where resuscitation fluid will be restricted to patients showing signs of poor tissue perfusion. After the lactate has peaked, the patient is deemed stable and assessed for active de-resuscitation (signs of fluid overload). The primary objective of this study is the proportion of patients with a negative cumulative fluid balance at day 3 after ICU. Secondary objectives are cumulative fluid balances throughout the ICU stay, number of patients with fluid overload, feasibility and safety outcomes and patient-centred outcomes. The primary outcome will be assessed by a logistic regression model adjusting for the stratification variables (trial site and chronic renal failure) in the intention-to-treat population. ETHICS AND DISSEMINATION The study was approved by the respective ethical committees (No 2020-02197). The results of the REDUCE trial will be published in an international peer-reviewed medical journal regardless of the results. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04931485.
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Affiliation(s)
- Anna Messmer
- Intensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Urs Pietsch
- Department of operative Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Philipp Buehler
- Department of Intensive Care Medicine, Cantonal Hospital Winterthu, Winterthur, Switzerland
| | - Jan Waskowski
- Intensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Dominik E Uehlinger
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Alexa Hollinger
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Miodrag Filipovic
- Department of operative Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - David Berger
- Intensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Joerg C Schefold
- Intensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Carmen A Pfortmueller
- Intensive Care Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
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11
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Shargall Y, Wiercioch W, Brunelli A, Murthy S, Hofstetter W, Lin J, Li H, Linkins LA, Crowther M, Davis R, Rocco G, Morgano GP, Schünemann F, Muti-Schünemann G, Douketis J, Schünemann HJ, Litle VR. Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery. J Thorac Cardiovasc Surg 2023; 165:794-824.e6. [PMID: 36895083 DOI: 10.1016/j.jtcvs.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. OBJECTIVE These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. METHODS The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. RESULTS The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. CONCLUSIONS The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35 days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis.
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Affiliation(s)
- Yaron Shargall
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Hui Li
- Department of Thoracic Surgery, Capital Medical University, Beijing, China
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger Davis
- Patient Representative, Burlington, Ontario, Canada
| | - Gaetano Rocco
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Giovanna Muti-Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, Mass
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12
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Turner BRH, Jasionowska S, Machin M, Javed A, Gwozdz AM, Shalhoub J, Onida S, Davies AH. Systematic review and meta-analysis of exercise therapy for venous leg ulcer healing and recurrence. J Vasc Surg Venous Lymphat Disord 2023; 11:219-226. [PMID: 36202303 DOI: 10.1016/j.jvsv.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE National guidelines in the United Kingdom have recommended regular exercise for individuals with venous leg ulceration. However, data on the effects of exercise on ulcer healing and recurrence are sparse. In the present study, we aimed to quantify the evidence for exercise regarding venous ulcer healing with respect to the primary outcomes of the proportion of healed ulcers and rate of ulcer recurrence. The secondary outcomes were improvement in ulcer symptoms, ulcer healing time, quality of life, compliance, and adverse events reported. METHODS The review followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines using a registered protocol (CRD42021220925). The MEDLINE and Embase databases and Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial Number registries were searched up to April 6, 2022 and included studies comparing exercise therapy and compression vs compression alone. Data for the proportion of healed ulcers were pooled using a fixed effects meta-analysis. RESULTS After screening 1046 reports, 7 were included, with 121 participants allocated to exercise therapy and 125 to compression alone. All the reports were of randomized controlled trials and had reported ulcer healing at 12 weeks, with a pooled relative risk of ulcer healing of 1.38 for exercise vs compression (95% confidence interval, 1.11-1.71). Only one study had reported on recurrence; thus, data pooling was not performed. No differences between exercise and usual care were demonstrated. Compliance with exercise ranged from 33% to 81%. The included studies demonstrated low enrollment and a high risk of bias. Also, most of the trials had failed to demonstrate any differences in activity completed between the intervention and control arms. CONCLUSIONS A paucity of studies has examined leg ulcer recurrence after exercise programs, with no evidence to show that exercise is beneficial. Furthermore, the quality of evidence supporting exercise as an adjunct to ulcer healing is very low, and the trials demonstrated serious methodologic flaws, chiefly in recording the activity undertaken by the participants in the intervention arm. Future randomized controlled trials should implement activity monitoring and standardize the reporting of key patient, ulcer, and reflux characteristics to enable future meaningful meta-analyses to determine the role of exercise as an adjunct to venous leg ulceration healing.
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Affiliation(s)
- Benedict R H Turner
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Sara Jasionowska
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Matthew Machin
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Azfar Javed
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Adam M Gwozdz
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Sarah Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom.
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13
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Shargall Y, Wiercioch W, Brunelli A, Murthy S, Hofstetter W, Lin J, Li H, Linkins LA, Crowther M, Davis R, Rocco G, Morgano GP, Schünemann F, Muti-Schünemann G, Douketis J, Schünemann HJ, Litle VR. Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6889652. [PMID: 36519935 DOI: 10.1093/ejcts/ezac488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. OBJECTIVE These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. METHODS The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. RESULTS The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. CONCLUSIONS The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35 days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis. (J Thorac Cardiovasc Surg 2022;▪:1-31).
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Affiliation(s)
- Yaron Shargall
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hui Li
- Department of Thoracic Surgery, Capital Medical University, Beijing, China
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger Davis
- Patient Representative, Burlington, Ontario, Canada
| | - Gaetano Rocco
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Giovanna Muti-Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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14
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Chadwick SE. The use of leg elevation in the treatment of chronic peripheral oedema. Br J Community Nurs 2022; 27:S28-S32. [PMID: 36205412 DOI: 10.12968/bjcn.2022.27.sup10.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Chronic peripheral oedema is a common long-term condition, with conflicting evidence on how it is best managed. It is crucial to establish the cause of the oedema to decide on the most appropriate intervention for its management. If the oedema is not managed, it can lead to unwanted complications for the service user. The District Nurse (DN) is pivotal in the management of patients with long-term conditions, both directly and indirectly. It is important that a multi-disciplinary approach is used, although nurses are now more autonomous due to advances in practice. The present study focuses on leg elevation as a form of intervention in the treatment of chronic peripheral oedema. As with any intervention, there are some risks with leg elevation that must be considered. This should be disseminated and monitored effectively.
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15
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Ong BS, Dotel R, Ngian VJJ. Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis? Int J Gen Med 2022; 15:6561-6572. [PMID: 35983462 PMCID: PMC9379124 DOI: 10.2147/ijgm.s326459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. Conditions that increase the risk of recurrence include chronic edema, venous disease, dermatomycosis and obesity. These risk factors should be actively managed as further episodes of cellulitis increases the risk of recurrence. The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed.
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Affiliation(s)
- Bin S Ong
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ravindra Dotel
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Vincent Jiu Jong Ngian
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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16
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Lawton R, Hunt BJ, Norrie J, Shalhoub J, Thapar A, Davies AH. Compression Hosiery to Avoid Post-Thrombotic Syndrome (CHAPS) Trial. Eur J Vasc Endovasc Surg 2022; 64:431-432. [PMID: 35961624 DOI: 10.1016/j.ejvs.2022.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Rebecca Lawton
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Beverley J Hunt
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Ankur Thapar
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, United Kingdom.
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17
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Hall JD, Farzaneh S, Babakhani Galangashi R, Pujari A, Sweet DT, Kahn ML, Jiménez JM. Lymphoedema conditions disrupt endothelial barrier function in vitro. J R Soc Interface 2022; 19:20220223. [PMID: 36000230 PMCID: PMC9399713 DOI: 10.1098/rsif.2022.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Lymphatic vessel contractions generate net antegrade pulsatile lymph flow. By contrast, impaired lymphatic vessels are often associated with lymphoedema and altered lymph flow. The effect of lymphoedema on the lymph flow field and endothelium is not completely known. Here, we characterized the lymphatic flow field of a platelet-specific receptor C-type lectin-like receptor 2 (CLEC2) deficient lymphoedema mouse model. In regions of lymphoedema, collecting vessels were significantly distended, vessel contractility was greatly diminished and pulsatile lymph flow was replaced by quasi-steady flow. In vitro exposure of human dermal lymphatic endothelial cells (LECs) to lymphoedema-like quasi-steady flow conditions increased intercellular gap formation and permeability in comparison to normal pulsatile lymph flow. In the absence of flow, LECs exposed to steady pressure (SP) increased intercellular gap formation in contrast with pulsatile pressure (PP). The absence of pulsatility in steady fluid flow and SP conditions without flow-induced upregulation of myosin light chain (MLCs) regulatory subunits 9 and 12B mRNA expression and phosphorylation of MLCs, in contrast with pulsatile flow and PP without flow. These studies reveal that the loss of pulsatility, which can occur with lymphoedema, causes LEC contraction and an increase in intercellular gap formation mediated by MLC phosphorylation.
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Affiliation(s)
- Joshua D. Hall
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Sina Farzaneh
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Reza Babakhani Galangashi
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Akshay Pujari
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Daniel T. Sweet
- Department of Medicine and Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark L. Kahn
- Department of Medicine and Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Juan M. Jiménez
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
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18
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Olsen J, Day S, Dupan S, Nazarpour K, Dyson M. Does Trans-radial Longitudinal Compression Influence Myoelectric Control? CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2022; 5:37963. [PMID: 37614635 PMCID: PMC10443505 DOI: 10.33137/cpoj.v5i2.37963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Existing trans-radial prosthetic socket designs are not optimised to facilitate reliable myoelectric control. Many socket designs pre-date the introduction of myoelectric devices. However, socket designs featuring improved biomechanical stability, notably longitudinal compression sockets, have emerged in more recent years. Neither the subsequent effects, if any, of stabilising the limb on myoelectric control nor in which arrangement to apply the compression have been reported. METHODOLOGY Twelve able-bodied participants completed two tasks whilst wearing a longitudinal compression socket simulator in three different configurations: 1) compressed, where the compression strut was placed on top of the muscle of interest, 2) relief, where the compression struts were placed either side of the muscle being recorded and 3) uncompressed, with no external compression. The tasks were 1) a single-channel myoelectric target tracking exercise, followed by 2), a high-intensity grasping task. The wearers' accuracy during the tracking task, the pressure at opposing sides of the simulator during contractions and the rate at which the limb fatigued were observed. FINDINGS No significant difference between the tracking-task accuracy scores or rate of fatigue was observed for the different compression configurations. Pressure recordings from the compressed configuration showed that pressure was maintained at opposing sides of the simulator during muscle contractions. CONCLUSION Longitudinal compression does not inhibit single-channel EMG control, nor improve fatigue performance. Longitudinal compression sockets have the potential to improve the reliability of multi-channel EMG control due to the maintenance of pressure during muscle contractions.
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Affiliation(s)
- J Olsen
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, UK
| | - S Day
- National Centre for Prosthetics and Orthotics, Strathclyde University, UK
| | - S Dupan
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, The University of Edinburgh, UK
| | - K Nazarpour
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, The University of Edinburgh, UK
| | - M Dyson
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, UK
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19
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Jamshaid H, Mishra RK, Ahmad N, Nadeem M, Muller M, Kolar V. Exploration of Effects of Graduated Compression Stocking Structures on Performance Properties Using Principal Component Analysis: A Promising Method for Simultaneous Optimization of Properties. Polymers (Basel) 2022; 14:polym14102045. [PMID: 35631928 PMCID: PMC9143032 DOI: 10.3390/polym14102045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 02/01/2023] Open
Abstract
This paper focuses on the comfort properties of graduated and preventive compression stockings for people who work long hours in standing postures and for athletes for proper blood circulation. The present study was conducted in order to investigate the effects of the yarn insertion density and inlaid stitches on the performance of the compression stockings. The effects of these parameters on the thermo-physiological comfort properties were tested with standard and developed methods of testing. All compression stockings were maintained with class 1 pressure as per German standards. The structural parameters of the knitted fabric structures were investigated. The stretching and recovery properties were also investigated to determine the performance properties. The theoretical pressure was predicated using the Laplace’s law by testing the stockings’ tensile properties. The compression interface pressures of all stockings were also investigated using a medical stocking tester (MST) from Salzmann AG, St. Gallen, Switzerland. Correlation between the theoretical pressures and pressures measured using the MST system were also assessed. The current research used a multi-response optimization technique, i.e., principal component analysis (PCA), to identify the best structure based on the optimalization of the above-mentioned properties. The results also revealed that samples with higher insertion density levels exhibit better comfort properties. The results showed that sample R1 was the best sample, followed by R2 and P. In addition, all developed stocking samples exhibited better comfort properties than the control sample from the market.
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Affiliation(s)
- Hafsa Jamshaid
- Faculty of Textile Engineering, National Textile University, Faisalabad 37610, Pakistan; (H.J.); (N.A.); (M.N.)
| | - Rajesh Kumar Mishra
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, Kamycka 129, 165 00 Prague, Czech Republic; (M.M.); (V.K.)
- Correspondence:
| | - Naseer Ahmad
- Faculty of Textile Engineering, National Textile University, Faisalabad 37610, Pakistan; (H.J.); (N.A.); (M.N.)
| | - Muhammad Nadeem
- Faculty of Textile Engineering, National Textile University, Faisalabad 37610, Pakistan; (H.J.); (N.A.); (M.N.)
| | - Miroslav Muller
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, Kamycka 129, 165 00 Prague, Czech Republic; (M.M.); (V.K.)
| | - Viktor Kolar
- Department of Material Science and Manufacturing Technology, Faculty of Engineering, Czech University of Life Sciences Prague, Kamycka 129, 165 00 Prague, Czech Republic; (M.M.); (V.K.)
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20
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Zhuang Z, Ai D, Yao Y, Zheng L, Qin J, Chen D, Chai S, Lu J, Jiang Q, Li X. The changes of the calf-vein deformation and femoral vein peak velocity during ankle pump exercise with or without graduated compression stockings. BMC Musculoskelet Disord 2022; 23:435. [PMID: 35538467 PMCID: PMC9088108 DOI: 10.1186/s12891-022-05400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To analyze the changes of lower limb hemodynamics parameters before and after wearing graduated compression stockings (GCS) during ankle pump exercise in patients preparing for arthroplastic surgery. Method The leg veins of 16 patients awaiting arthroplasty were analyzed using a Sonosite M-Turbo ultrasound system during ankle pump exercise with or without GCS. The age of them was 70 ± 7 years (mean ± SD) (range 56—82 years) and body mass index was 25.8 ± 3.0 kg/m2 (range 18.0—30.5 kg/m2). Measured data including the cross-sectional area (CSA), anteroposterior (AP) diameter and lateromedial (LM) diameter of the soleus vein (SV), posterior tibial vein (PTV) and great saphenous vein (GSV). Additionally, the peak velocities of femoral vein (FV) were also measured. Results GCS could significantly decrease the cross-sectional area of SV, PTV and GSV in supine position at rest and maximum ankle plantar flexion. But the compression effect of GCS to SV and GSV was not observed during maximum ankle dorsiflexion. It was found that GCS application reduced the peak flow velocity of the femoral vein from 61.85 cm/s (95% CI = 50.94–72.75 cm/s) to 38.01 cm/s (95% CI = 28.42–47.59 cm/s) (P < 0.001) during ankle plantar flexion and decreased the femoral vein in these patients from 80.65 cm/s (95% CI = 70.37–90.92 cm/s) to 51.15 cm/s (95% CI = 42.58–59.73 cm/s) (P < 0.001) during ankle dorsiflexion. But this effect was not significant in supine position at rest. Conclusions GCS could significantly reduce the peak flow velocity of the femoral vein during ankle pump exercise in the patients preparing for arthroplastic surgery.
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Affiliation(s)
- Zaikai Zhuang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Dongmei Ai
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yao Yao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Liming Zheng
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Jianghui Qin
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Dongyang Chen
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Senlin Chai
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Jun Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China. .,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China.
| | - Xinhua Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China. .,Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China.
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21
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Saliba-Júnior OA, Rollo HA, Saliba O, Sobreira ML. Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes. J Vasc Bras 2022; 21:e20210101. [PMID: 35399341 PMCID: PMC8958436 DOI: 10.1590/1677-5449.210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema. Objectives To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them. Methods This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings. Results Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again. Conclusions Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.
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Affiliation(s)
| | | | - Orlando Saliba
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
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22
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Joensuu J, Mustajoki PP, Mustonen PK, Kaila M, Koskela T. Prevention of leg cramps by using compression stockings or magnesium supplements in the 50-84 age group: study protocol for a randomised controlled trial. Trials 2021; 22:860. [PMID: 34844641 PMCID: PMC8628416 DOI: 10.1186/s13063-021-05753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Leg cramps are painful sensations of tightening in the muscles of the legs that commonly appear during the night and are often associated with secondary insomnia. They are common especially in older age. There is no evidence that any method of prevention of nocturnal leg cramps is both safe and effective. There are no previous trials concerning cramp prevention by using compression stockings. The objective of this study is to assess in a prospective randomised controlled trial whether leg cramps can be prevented by the daily use of knee-length compression stockings or magnesium supplements. Methods The study will be set in Finland, and 50–84-year-old volunteers will be recruited through Google Ads, the Finnish health library website and Finnish primary health care centres. The participants must have a minimum of two episodes of leg cramps per week for the past 4 weeks to be included in the study. The participants (n = 225) will be allocated to three equal groups: the compression stocking arm, the magnesium supplement arm and the placebo arm. The participants will go through 4 weeks of follow-up without intervention and then another 4 weeks of follow-up with the assigned intervention. The material for the study will be collected through electronic questionnaires. Discussion This protocol describes a study that compares compression stockings, magnesium supplements and placebo for the prevention of leg cramps. The results of this study can significantly improve knowledge on the methods of preventing leg cramps. Trial registration ClinicalTrials.gov NCT04694417. Registered on Jan 4, 2021.
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23
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Galanaud JP, Abdulrehman J, Lazo-Langner A, Le Gal G, Shivakumar S, Schulman S, Kahn S. MUFFIN-PTS trial, Micronized Purified Flavonoid Fraction for the Treatment of Post-Thrombotic Syndrome: protocol of a randomised controlled trial. BMJ Open 2021; 11:e049557. [PMID: 34518263 PMCID: PMC8438950 DOI: 10.1136/bmjopen-2021-049557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION After deep vein thrombosis, up to 50% of patients develop post-thrombotic syndrome (PTS). PTS is a chronic condition that reduces quality of life (QOL). Cornerstones of PTS treatment include the use of elastic compression stockings but this treatment is usually incompletely effective and is burdensome. Venoactive drugs have been reported to be effective to treat chronic venous insufficiency (CVI). However, the level of evidence supporting their use in CVI in general and in PTS in particular is low. METHODS AND ANALYSIS The MUFFIN-PTS trial is an academic, publically funded, multicentre randomised placebo-controlled trial assessing the efficacy of micronised purified flavonoid fraction (MPFF, Venixxa), a venoactive drug, to treat PTS. Eighty-six patients with PTS (Villalta score (VS) ≥5) and experiencing at least two of the following PTS manifestations among daily leg heaviness, cramps, pain or oedema will be randomised to receive 1000 mg of oral MPFF or a similar appearing placebo for 6 months, in addition to their usual PTS treatment. Total study follow-up will be 9 months, with visits at inclusion/baseline, 3, 6 and 9 months. Primary outcome is the proportion of patients with improvement in VS in each group, where improvement is defined as a decrease of at least 30% in VS or a VS <5 in the PTS-affected leg. Main secondary outcomes include QOL and patient satisfaction. ETHICS AND DISSEMINATION Primary ethics approval was received from Centre intégré universitaire de santé et de services sociaux (CIUSSS) West-Central Montreal Research Ethics Board. Results of the study will be disseminated via peer-reviewed publications and presentations at scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03833024); Pre-results.
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Affiliation(s)
| | | | | | - Grégoire Le Gal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Sam Schulman
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Kahn
- Medicine, McGill University, Montreal, Quebec, Canada
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24
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Randomized controlled trial on Dryland And Thermal Aquatic standardized exercise protocol for chronic venous disease (DATA study). J Vasc Surg Venous Lymphat Disord 2021; 9:1226-1234.e2. [DOI: 10.1016/j.jvsv.2020.12.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
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25
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Saucedo D, Evans N, Lim CS. Initiating compression therapy for those living with heart failure. Br J Community Nurs 2021; 26:S12-S17. [PMID: 34473543 DOI: 10.12968/bjcn.2021.26.sup9.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression therapy is used to treat leg symptoms arising from chronic venous disease and lymphoedema. Heart failure, which is traditionally regarded as a contraindication for compression therapy, is prevalent among patients with such leg symptoms. This article aims to assess the evidence on the safety and effectiveness of compression therapy, as well as recommending the assessment and measures required when initiating compression therapy in patients with heart failure. Recent evidence suggests that initiating compression therapy in patients with stable and compensated heart failure is safe if appropriate precautionary measures are undertaken. However, there is still insufficient evidence to support the safety of compression therapy in patients with severe and decompensated heart failure. A standardised, evidence-based guideline on compression therapy in patients with heart failure will help medical and nursing professionals and improve informed consent for the patients.
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Affiliation(s)
- Dumitriu Saucedo
- Senior Clinical Fellow in Vascular Surgery, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - Nicholas Evans
- Clinical Nurse Specialist in Vascular Surgery, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - Chung Sim Lim
- Consultant Vascular Surgeon, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
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26
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Predicting Compression Pressure of Knitted Fabric Using a Modified Laplace's Law. MATERIALS 2021; 14:ma14164461. [PMID: 34442988 PMCID: PMC8401858 DOI: 10.3390/ma14164461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study is to develop a mathematical model for the prediction of compression pressure based on fabric parameters, such as engineering stress, engineering strain and engineering modulus of elasticity. Four knitted compression fabrics with different fibrous compositions and knit structures were used. Rectangular-cut strips were employed for the force–elongation characterization of the fabrics. The experimental pressure values between the fabric and rigid cylinder were assessed using a Picopress pressure measuring device. The mechanical and physical parameters of the fabric that influence the interface pressure, such as strain, elasticity modulus/stress and thickness, were determined and integrated into Laplace’s law. A good correlation was observed between the experimental and calculated pressure values for all combinations of fabrics, mounted with variable tension on the cylinder. Over the considered range of pressures, the difference between the two datasets was generally less than 0.5 mmHg. The effect of washing after five, ten and fifteen washing cycles on the fabric–cylinder interface pressure was found to be significant.
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27
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Muldoon J, Hampton S, Gray S, Cosham T. Compression hosiery for venous disorders and oedema: a question of balance. Br J Community Nurs 2021; 25:S26-S32. [PMID: 32886551 DOI: 10.12968/bjcn.2020.25.sup9.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.
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Affiliation(s)
| | | | - Sarah Gray
- Tissue Viability Nurse Consultant; Bowel and Bladder Nurse Specialist, East Sussex
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28
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Hwang BY, Mampre D, Boesch JR, Huang J, Anderson WS. Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive? JOURNAL OF SURGICAL EDUCATION 2021; 78:1295-1304. [PMID: 33419691 DOI: 10.1016/j.jsurg.2020.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Hydration and nutrition are critical to achieving optimal performance. This study aimed to assess the impact of limited oral intake in the operating room environment on surgical resident health, well-being, and performance. DESIGN Electronic survey was sent to 94 surgical trainees at our institution in 2020. Chi-square analyses were performed to assess for differences in survey responses by sex. SETTING A single tertiary-care institution. PARTICIPANTS Surveys were sent to surgical residents and fellows in general surgery, neurosurgery, and orthopedic surgery. Seventy-nine (80%) of the 94 residents and fellows responded. RESULTS Of the 79 responses, most trainees (79%) experienced dehydration within 6 hours of operating. Forty-four (56%) reported no fluid intake for greater than 6 hours on average, and 39 (49%) reported that they frequently had difficulty rehydrating in between cases. Most of the respondents (70%) frequently experienced symptoms of dehydration, including orthostasis, headache, and constipation. Fifty-six (71%) believed that dehydration frequently affected their performance. Compared to men, women were more likely to feel dehydrated within 4 hours of operating (58% vs. 25%, p = 0.005). Women were also more likely to have difficulty rehydrating in between cases (75% vs. 38%, p = 0.0026), experience symptoms of dehydration (92% vs. 60%, p = 0.0049), and report that dehydration affects surgical performance (88% vs. 64%, p = 0.0318). CONCLUSIONS Prolonged fasting and dehydration are common issues that may negatively impact performance and wellbeing of surgical trainees. Also, dehydration may affect men and women differently.
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Affiliation(s)
- Brian Y Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John R Boesch
- 160th Special Operations Aviation Regiment (Airborne), U.S. Army Special Operations Command, Fort Campbell, Kentucky
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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29
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Orhurhu V, Chu R, Xie K, Kamanyi GN, Salisu B, Salisu-Orhurhu M, Urits I, Kaye RJ, Hasoon J, Viswanath O, Kaye AJ, Karri J, Marshall Z, Kaye AD, Anahita D. Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review. Cardiol Ther 2021; 10:111-140. [PMID: 33704678 PMCID: PMC8126535 DOI: 10.1007/s40119-021-00213-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE OF REVIEW Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease. RECENT FINDINGS Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated with chronic venous sufficiency, compression devices and various pharmacologic agents have emerged as safe and effective treatments for pain in these patients. In patients for whom these measures are insufficient, recently developed minimally invasive vascular surgical techniques have been shown to reduce postsurgical complications and recovery time, although additional research is necessary to characterize long-term outcomes of these procedures. This review discusses the latest findings concerning the pathophysiology of pain in chronic venous insufficiency, conservative and medical management, and surgical strategies for pain relief, including minimally invasive treatment strategies.
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Affiliation(s)
- Vwaire Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Robert Chu
- Johns Hopkins School of Medicine, Baltimore, MA, USA
| | | | | | | | - Mariam Salisu-Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Jamal Hasoon
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport Shreveport, Shreveport, LA, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Aaron J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Zwade Marshall
- Regenerative Spine and Pain Specialist, Fayetteville, GA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport Shreveport, Shreveport, LA, USA
| | - Dua Anahita
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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30
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Cox A, Bousfield C. Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review. Br J Community Nurs 2021; 26:S10-S20. [PMID: 34106008 DOI: 10.12968/bjcn.2021.26.sup6.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.
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Affiliation(s)
- Amy Cox
- Respiratory Registered Nurse, Royal Derby Hospital-University Hospitals of Derby and Burton
| | - Chrissie Bousfield
- Associate Professor, School of Health Sciences, University of Nottingham
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31
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Lee DCW, Sheridan S, Ali A, Sutanto D, Wong SHS. Wearing compression tights post-exercise enhances recovery hemodynamics and subsequent cycling performance. Eur J Appl Physiol 2021; 121:2091-2100. [PMID: 33835198 DOI: 10.1007/s00421-021-04661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate sports compression garment (CG)-induced recovery hemodynamics and their potential impact on subsequent cycling performance. METHODS In a randomized crossover design, 13 physically active men (20.9 ± 1.4 years; 65.9 ± 7.8 kg; 173.3 ± 4.8 cm; peak power output 254.2 ± 27.2 W) underwent 2 experimental trials. During each experimental trial, the subjects performed 20-min fatiguing preload cycling followed by 60-min passive recovery wearing either a sports CG (28.6 ± 9.4 mmHg) or gymnastic pants (CON). A 5-min all-out cycling performance test was subsequently conducted and power output and cadence were recorded. Cardiac output (CO) and stroke volume (SV) were measured using Doppler ultrasound (USCOM®). Heart rate (HR), blood lactate [BLa-], ratings of perceived exertion (RPE), leg muscle soreness (LMS), mean arterial pressure (MAP) and systemic vascular resistance (SVR) were monitored at 5, 15, 30, 45, 60 min during passive recovery. RESULTS During the subsequent 5-min all-out cycling performance test, power output (215.2 ± 24.0 vs. 210.8 ± 21.5 W, CG vs. CON) and cadence (72.5 ± 3.8 vs. 71.2 ± 4.8 rpm, CG vs. CON) were higher in CG than CON (P < 0.05). SV was higher at 15, 30 and 45 min (P < 0.05), CO was higher at 5 and 45 min (P < 0.05), HR was lower at 15 and 30 min (P < 0.05) and [BLa-] was lower at 5 and 15 min (P < 0.05) during passive recovery, while LMS was lower at all time-points (P < 0.05) compared with CON. CONCLUSION Sports CG improves subsequent cycling performance by enhancing hemodynamic responses and attenuating perceived muscle soreness during passive recovery in physically active men.
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Affiliation(s)
- Daniel C W Lee
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong.,Elite Training Science and Technology Division, Hong Kong Sports Institute, Shatin, Hong Kong
| | - Sinead Sheridan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ajmol Ali
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Damien Sutanto
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Stephen H S Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong.
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32
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Multi-Parametric Analysis of Below-Knee Compression Garments on Delayed-Onset Muscle Soreness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073798. [PMID: 33917286 PMCID: PMC8038710 DOI: 10.3390/ijerph18073798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023]
Abstract
To investigate below-knee compression garments during exercise and a post-exercise period of 6 h on clinical, functional, and morphological outcomes in delayed-onset muscle soreness (DOMS). Eighteen volunteers (age: 24.1 ± 3.6, BMI 22.7 ± 2.7 kg/m2) were enrolled. Measures were acquired at baseline, 6 h, and 48 h after eccentric and plyometric exercise, with wearing a compression garment (21-22 mmHg) on a calf during and for the first 6 h after exercise. 3T MRI was performed for quantification of intramuscular edema (T2 signal intensity (SI), T2 time, and manual volume segmentation); jump height, calf circumference, ankle dorsiflexion (DF), creatine kinase (CK), and muscle soreness were assessed. DOMS was confirmed in all participants after 48 h, with an increase in soreness (p < 0.001) and CK (p = 0.001), decrease in jump height (p < 0.01), and the presence of intramuscular edema (p < 0.01) in both the compressed and non-compressed limbs. No differences between the compressed and non-compressed limbs were observed for muscle soreness and jump height. MRI T2 SI, T2 time, soreness, and manual segmentation revealed no effect of the compression treatment. The assessment of calf circumference and DF showed no changes in either the compression or non-compression limb (p = 1.0). Wearing compression garments during combined eccentric and plyometric exercise and for 6 h post-exercise has no effect on clinical signs of DOMS, jump performance, or the development of intramuscular edema.
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33
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Kadhum M, Elniel AR, Furniss D. Is venous thromboembolism prophylaxis beneficial in upper limb major joint replacement surgery? A systematic review. Shoulder Elbow 2021; 13:119-130. [PMID: 33897843 PMCID: PMC8039759 DOI: 10.1177/1758573219896279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Upper limb arthroplasty is an increasingly used treatment modality for end-stage joint disease of the shoulder, elbow and wrist. Whilst complications have been reported, the risk of venous thromboembolism has received less attention when compared to the lower limb. Guidance to aid clinical decision-making remains limited. This review aims to ascertain whether venous thromboembolism prophylaxis is beneficial after upper limb major joint replacement surgery. METHODS A systematic review was performed in April 2019, utilising EMBASE, MEDLINE, Cochrane and Google Scholar. All clinical studies reporting venous thromboembolism incidence and risk reduction (after prophylaxis) in upper limb joint replacement were included. RESULTS Twenty-four observational studies were identified. The reported incidence of venous thromboembolism ranged from 0.2% to 16% (weighted mean 0.68%) and 0.2% to 0.8% (weighted mean 0.49%) in shoulder and elbow arthroplasty, respectively. No records for wrist arthroplasty were found. In the literature, baseline venous thromboembolism risk of patients without an operation is reported as 0.5%. DISCUSSION There is a lack of good quality evidence regarding the risks and benefits of venous thromboembolism prophylaxis in upper limb major joint replacement surgery. We recommend further research, ideally formal randomised controlled trials to guide recommendations. Although venous thromboembolism is rare in upper limb surgery, surgeons should remain vigilant to this possibility.
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Affiliation(s)
- Murtaza Kadhum
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of
Oxford, Oxford, UK
| | | | - Dominic Furniss
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of
Oxford, Oxford, UK
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34
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Gürdal Karakelle S, Ipek Y, Tulin O, Alpagut İU. The efficiency of exercise training in patients with venous insufficiency: A double blinded, randomized controlled trial. Phlebology 2021; 36:440-449. [PMID: 33423620 DOI: 10.1177/0268355520985759] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exercise training (ET) is current treatment method for venous insufficiency (VI). The comprehensive effect of ET in addition to compression therapy (CT) in VI is not clear. METHOD Twenty-four patients with VI were randomly divided into exercise group (EG) and control group (CG). While CG received only CT, EG was applied ET consisting of aerobic, strengthening and stretching exercises in addition to CT for 2 days/week, 6 weeks at hospital under the supervision of physiotherapist. All the patients were assessed with Chronic Venous Disease Quality Of Life Questionnaire-20, Short Form-36, Duplex Doppler Ultrasonography, Venous Clinical Severity Score, hand-held dynamometer, Visual Analogue Scale, circumference measurements, 6 minute-walking test, and 10-meter-walking test before and after the treatment. RESULT Except of hemodynamic status and edema (p > 0.05), all parameters were significantly different in favor of EG (p < 0.05). CONCLUSION ET in addition to CT was more effective and safe treatment in VI.
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Affiliation(s)
- Saliha Gürdal Karakelle
- Department of Physiotherapy and Rehabilitation, Institute of Postgraduate Education, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yeldan Ipek
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozalhas Tulin
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - İbrahim Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Hu J, Browne JD, Baum JT, Robinson A, Arnold MT, Reid SP, Neufeld EV, Dolezal BA. Lower Limb Graduated Compression Garments Modulate Autonomic Nervous System and Improve Post-Training Recovery Measured via Heart Rate Variability. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2020; 13:1794-1806. [PMID: 33414888 PMCID: PMC7745918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Prior studies have examined the benefits of graduated compression garments (GCG) with regards to diverse exercise regimens; however, the relationship between GCG and the autonomic nervous system (ANS) has not been fully explored. The aim of this study was to examine Heart Rate Variability (HRV) trends-a proxy for ANS modulation-in response to donning GCG during a progressive overload training regimen designed to induce overtraining. Ten college-aged male novice runners were recruited for the 8-week crossover study. After three weeks of monitored free living, participants were randomized and blinded to an intervention group that donned a lower-body GCG during a two-week exercise regimen or a control group that donned a visually identical but non-compressive sham during identical training. No significant difference in HRV was calculated by the natural logarithm of the root mean square of successive RR-interval differences (lnRMSSD) between the 3-week free-living baseline and GCG intervention periods (P = 0.3040). The mean lnRMSSD was greater during the free-living phase and GCG intervention compared to the sham placebo (P < 0.001 and <0.001 respectively). With regard to the daily fluctuation of lnRMSSD, no significant differences were found between free-living and intervention (P = 1.000). Conversely, the intervention period demonstrated reduced daily fluctuation of lnRMSSD relative to the Sham placebo group (P = 0.010). These novel findings posit that post training use of a commercially available graduated compression garment in novice runners may be effective in counteracting some deleterious effects from overtraining while attenuating its effects on vagally-mediated HRV.
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Affiliation(s)
- Jonathan Hu
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jonathan D Browne
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Jaxon T Baum
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- School of Medicine, Texas Tech University of Health Sciences, Lubbock, TX, USA
| | - Anthony Robinson
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael T Arnold
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sean P Reid
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eric V Neufeld
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Shalhoub J, Lawton R, Hudson J, Baker C, Bradbury A, Dhillon K, Everington T, Gohel MS, Hamady Z, Hunt BJ, Stansby G, Warwick D, Norrie J, Davies AH. Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT. Health Technol Assess 2020; 24:1-80. [PMID: 33275096 DOI: 10.3310/hta24690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients admitted to hospital for surgery are at an increased risk of venous thromboembolism. Pharmaco-thromboprophylaxis and mechanical prophylaxis (usually graduated compression stockings or intermittent pneumatic compression) have been shown to reduce the incidence of venous thromboembolism. The evidence base supporting the National Institute for Health and Care Excellence's recommendation for the use of graduated compression stockings for venous thromboembolism prevention in the UK has recently been challenged. It is unclear if the risks and costs associated with graduated compression stockings are justified for deep-vein thrombosis prevention in moderate- and high-risk elective surgical inpatients receiving low-dose low-molecular-weight heparin pharmaco-thromboprophylaxis. OBJECTIVES The primary objective was to compare the venous thromboembolism rate in elective surgical inpatients at moderate or high risk of venous thromboembolism who were receiving either graduated compression stockings and low-dose low-molecular-weight heparin (standard care) or low-dose low-molecular-weight heparin alone (intervention). DESIGN This was a pragmatic, multicentre, prospective, non-inferiority, randomised controlled trial. SETTING This took place in secondary care NHS hospitals in the UK. PARTICIPANTS Patients aged ≥ 18 years who were assessed to be at moderate or high risk of venous thromboembolism according to the NHS England venous thromboembolism risk assessment tool (or the trust equivalent based on this form) and who were not contraindicated to low-molecular-weight heparin or graduated compression stockings were deemed eligible to take part. INTERVENTIONS Participants were randomised 1 : 1 to either low-molecular-weight heparin or low-molecular-weight heparin and graduated compression stockings. MAIN OUTCOME MEASURES The primary outcome measure was venous thromboembolism up to 90 days after surgery. A combined end point of duplex ultrasound-proven new lower-limb deep-vein thrombosis (symptomatic or asymptomatic) plus imaging-confirmed symptomatic pulmonary embolism. Secondary outcomes included quality of life, compliance with graduated compression stockings and low-molecular-weight heparin during admission, and all-cause mortality. RESULTS A total of 1905 participants were randomised and 1858 were included in the intention-to-treat analysis. A primary outcome event occurred in 16 out of 937 (1.7%) patients in the low-molecular-weight heparin-alone arm compared with 13 out of 921 (1.4%) patients in the low-molecular-weight heparin plus graduated compression stockings arm. The risk difference between low-molecular-weight heparin and low-molecular-weight heparin plus graduated compression stockings was 0.30% (95% confidence interval -0.65% to 1.26%). As the 95% confidence interval did not cross the non-inferiority margin of 3.5% (p < 0.001 for non-inferiority), the results indicate that non-inferiority of low-molecular-weight heparin alone was shown. LIMITATIONS In total, 13% of patients did not receive a duplex ultrasound scan that could have detected further asymptomatic deep-vein thrombosis. However, missing scans were balanced between both trial arms. The subpopulation of those aged ≥ 65 years assessed as being at a moderate risk of venous thromboembolism was under-represented in the study; however, this reflects that this group is under-represented in the general population. CONCLUSIONS For elective surgical patients at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings. These findings indicate that graduated compression stockings may be unnecessary for most elective surgical patients. FUTURE WORK Further studies are required to evaluate whether or not adjuvant graduated compression stockings have a role in patients receiving extended thromboprophylaxis, beyond the period of hospital admission, following elective surgery or in patients undergoing emergency surgical procedures. TRIAL REGISTRATION Current Controlled Trials ISRCTN13911492. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 69. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rebecca Lawton
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Christopher Baker
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Bradbury
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karen Dhillon
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Everington
- Department of Haematology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Manjit S Gohel
- Department of Surgery and Cancer, Imperial College London, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zaed Hamady
- Southampton HPB Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beverly J Hunt
- Department of Thrombosis and Haemostasis, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Gerard Stansby
- Northern Vascular Unit, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Warwick
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, London, UK
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Park Y, Kwon K, Kwak SS, Yang DS, Kwak JW, Luan H, Chung TS, Chun KS, Kim JU, Jang H, Ryu H, Jeong H, Won SM, Kang YJ, Zhang M, Pontes D, Kampmeier BR, Seo SH, Zhao J, Jung I, Huang Y, Xu S, Rogers JA. Wireless, skin-interfaced sensors for compression therapy. SCIENCE ADVANCES 2020; 6:eabe1655. [PMID: 33277263 PMCID: PMC7821894 DOI: 10.1126/sciadv.abe1655] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/20/2020] [Indexed: 05/23/2023]
Abstract
Therapeutic compression garments (TCGs) are key tools for the management of a wide range of vascular lower extremity conditions. Proper use of TCGs involves application of a minimum and consistent pressure across the lower extremities for extended periods of time. Slight changes in the characteristics of the fabric and the mechanical properties of the tissues lead to requirements for frequent measurements and corresponding adjustments of the applied pressure. Existing sensors are not sufficiently small, thin, or flexible for practical use in this context, and they also demand cumbersome, hard-wired interfaces for data acquisition. Here, we introduce a flexible, wireless monitoring system for tracking both temperature and pressure at the interface between the skin and the TCGs. Detailed studies of the materials and engineering aspects of these devices, together with clinical pilot trials on a range of patients with different pathologies, establish the technical foundations and measurement capabilities.
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Affiliation(s)
- Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Kyeongha Kwon
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Sung Soo Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Da Som Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jean Won Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Ted S Chung
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Keum San Chun
- Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Jong Uk Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Hokyung Jang
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Hanjun Ryu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Sang Min Won
- Department of Electrical and Computer Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Michael Zhang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - David Pontes
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Brianna R Kampmeier
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Seon Hee Seo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Nano Hybrid Technology Research Center, Creative and Fundamental Research Division, Korea Electrotechnology Research Institute (KERI), Changwon 51543, Republic of Korea
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Inhwa Jung
- Department of Mechanical Engineering, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John A Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Xu Y, Wang W, Zhen K, Zhao J. Healthcare professionals' knowledge, attitudes, and practices regarding graduated compression stockings: a survey of China's big-data network. BMC Health Serv Res 2020; 20:1078. [PMID: 33238994 PMCID: PMC7690181 DOI: 10.1186/s12913-020-05933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background The accurate identification of venous thromboembolism prophylaxis implementation barriers is an important part of prophylaxis prevention. However, in China, data to help identify these barriers is limited. This study has two objectives: 1) to determine the knowledge, attitudes, and practices (KAPs) of healthcare professionals regarding graduated compression stockings (GCS) since the launch of the National Program for the Prevention and Management of Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) in October 2018 and 2) to identify the obstacles and assist the program. Methods This was a cross-sectional study of 5070 healthcare professionals in China. We used exploratory factor and reliability analyses to evaluate the researcher-designed questionnaire’s reliability and validity. The formal questionnaire, which included demographic data, knowledge, attitudes, and clinical practice patterns, was distributed to healthcare professionals. Results Of the 5070 respondents, 32.5% had a good knowledge of GCS, 78.5% had a positive attitude towards their use, and 34.0% exhibited normative behavior when applying them. The KAPs of healthcare professionals towards GCS were significantly correlated with one another. Binary logistic regression suggested that the training received by healthcare professionals was an important factor affecting their knowledge regarding GCS usage. Conclusions The training provided for the use of GCS in China cannot meet medical staff needs and deserves more attention from policy makers. This represents an obstacle for venous thromboembolism prophylaxis, which restricts the effective implementation of the National Program for Prevention and Management of PE and DVT.
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Affiliation(s)
- Yaping Xu
- Department of Orthopedics, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. .,Department of Nursing, China-Japan Friendship Hospital, Beijing, China.
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Kaiyuan Zhen
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
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Lee DCW, Ali A, Sheridan S, Chan DKC, Wong SHS. Wearing Compression Garment Enhances Central Hemodynamics? A Systematic Review and Meta-Analysis. J Strength Cond Res 2020; 36:2349-2359. [PMID: 33065703 DOI: 10.1519/jsc.0000000000003801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lee, DCW, Ali, A, Sheridan, S, Chan, DKC, and Wong, SHS. Wearing compression garment enhances central hemodynamics? a systematic review and meta-analysis . J Strength Cond Res XX(X): 000-000, 2020-Compression garments (CG) are believed to enhance exercise performance and recovery by improving central hemodynamic responses. However, evidence is inconclusive. We performed a systematic review and meta-analysis to determine the effect of wearing CG at rest or after a physiological challenge on central hemodynamic responses, including cardiac output, stroke volume (SV), heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and systemic vascular resistance in healthy individuals. The English language searches of the electronic databases SPORTDiscus, MEDLINE, and Web of Science were conducted from November 2018-February 2019. The studies involved were limited to the following: (a) original articles; (b) randomized controlled trials; (c) monitoring of central hemodynamic responses (either at rest or after a physiological challenge: maximal exercise or orthostatic challenge); and (d) healthy individuals. Of the 786 studies identified, 12 were included in the systematic review and meta-analysis. Meta-analysis was performed by the restricted maximum likelihood method. The results indicated that the effect size (ES) of wearing CG on improving central hemodynamic responses was large overall (Hedges' g = 0.55) and was large in SV (Hedges' g = 1.09) and HR (Hedges' g = 0.65). Subgroup analysis showed that the ESs in "post-physiological challenge" was large in overall (Hedges' g = 0.98), SV (Hedges' g = 1.78), HR (Hedges' g = 1.10), and DBP (Hedges' g = 0.75). Their ESs in "at rest" were not significant in all central hemodynamic responses, apart from a significant medium ES observed in SV (Hedges' g = 0.44). Healthy individuals who wear CG have marked improvement in central hemodynamic responses, particularly after a physiological challenge. More pronounced effects of CG are observed in increasing SV and reducing HR.
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Affiliation(s)
- Daniel C W Lee
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong.,Elite Training Science and Technology Division, Hong Kong Sports Institute, Hong Kong
| | - Ajmol Ali
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong.,School of Sport, Exercise, and Nutrition, Massey University, Auckland, New Zealand
| | - Sinead Sheridan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong
| | - Derwin K C Chan
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong
| | - Stephen H S Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong
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Elson SL, Furlotte NA, Hromatka BS, Wilson CH, Mountain JL, Rowbotham HM, Varga EA, Francke U. Direct-to-consumer genetic testing for factor V Leiden and prothrombin 20210G>A: the consumer experience. Mol Genet Genomic Med 2020; 8:e1468. [PMID: 32940023 PMCID: PMC7667316 DOI: 10.1002/mgg3.1468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/19/2023] Open
Abstract
Background Clinical genetic testing for inherited predisposition to venous thromboembolism (VTE) is common among patients and their families. However, there is incomplete consensus about which individuals should receive testing, and the relative risks and benefits. Methods We assessed outcomes of receiving direct‐to‐consumer (DTC) results for the two most common genetic risk factors for VTE, factor V Leiden in the F5 gene (FVL) and prothrombin 20210G>A in the F2 gene (PT). Two thousand three hundred fifty‐four customers (1244 variant‐positive and 1110 variant‐negative individuals) of the personal genetics company 23andMe, Inc., who had received results online for F5 and F2 variants, participated in an online survey‐based study. Participants responded to questions about perception of VTE risk, discussion of results with healthcare providers (HCPs) and recommendations received, actions taken to control risk, emotional responses to receiving risk results, and perceived value of the information. Results Most participants (90% of variant‐positive individuals, 99% of variant‐negative individuals) had not previously been tested for F5 and/or F2 variants. The majority of variant‐positive individuals correctly perceived that they were at higher than average risk for developing VTE. These individuals reported moderate rates of discussing results with HCPs (41%); receiving prevention advice from HCPs (31%), and making behavioral changes to control risk (e.g., exercising more, 30%). A minority (36%) of variant‐positive individuals worried more after receiving VTE results. Nevertheless, most participants reported that knowing their risk had been an advantage (78% variant‐positive and 58% variant‐negative) and were satisfied knowing their genetic probability for VTE (81% variant‐positive and 67% variant‐negative). Conclusion Consumers reported moderate rates of behavioral change and perceived personal benefit from receiving DTC genetic results for VTE risk. We assessed the consumer experience receiving direct‐to‐consumer (DTC) genetic risk for venous thromboembolism (VTE). 2354 customers (1244 variant‐positive and 1110 variant‐negative individuals) of the personal genetics company 23andMe, Inc., who had received results online for risk variants in clotting factor genes F2 and F5, participated in an online survey‐based study. Participants responded to questions about perception of VTE risk, discussion of results with healthcare providers and recommendations received, actions taken to control risk, emotional responses to receiving risk results, and perceived value of the information.
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Affiliation(s)
| | | | | | | | | | | | | | - Uta Francke
- 23andMe, Inc, Sunnyvale, CA, USA.,Department of Genetics, Stanford University Stanford, CA, USA
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Gianesini S, Raffetto JD, Mosti G, Maietti E, Sibilla MG, Zamboni P, Menegatti E. Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation. J Vasc Surg Venous Lymphat Disord 2020; 8:814-820. [DOI: 10.1016/j.jvsv.2019.12.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
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42
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Christensen LMR, Arnesen CE, Möller S, Hyldig N. The effect of compression therapy on post-surgical swelling and pain after total knee arthroplasty. Int J Orthop Trauma Nurs 2020; 41:100815. [PMID: 33339752 DOI: 10.1016/j.ijotn.2020.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the use of a graduated medical elastic thigh compression stocking for 14 days after total knee arthroplasty would reduce swelling by 2 cm and reduce pain among patients with a BMI ≥30 kg/m2. The aim of this pilot study was to provide preliminary data and information about feasibility. The specified objectives were to investigate: 1) the level of post-surgical swelling and, 2) the level of post-surgical pain, 14 days after surgery. METHODS In a randomized controlled pilot study, 44 patients were allocated to a graduated medical elastic thigh compression stocking or standard treatment for 14 days after total knee arthroplasty. Outcome measures were knee, calf, and ankle swelling and pain. Study feasibility included acceptable rates of written consent and compliance with the use of the compression stocking. Data was analyzed using two-sample t-test for equality of mean. RESULTS Overall, 68.8% of eligible patients gave written consent to participate in the study and 41.2% complied with use of the graduated medical elastic thigh compression stocking for 14 days post-surgery. No significant difference was found between the groups regarding knee, calf and ankle swelling or pain. INTERPRETATION Knee swelling was reduced in both groups after 14 days, but was slightly more in the intervention group. The result is not statistically significant but indicates that a graduated medical elastic thigh compression stocking may have a positive effect on reduction of swelling after total knee arthroplasty. Initiating a larger scale randomized controlled study to determine effectiveness requires a higher level of compliance.
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Affiliation(s)
| | | | - Sören Möller
- OPEN Open Patient data Explorative Network, Odense University Hospital, Denmark
| | - Nana Hyldig
- OPEN Open Patient data Explorative Network, Odense University Hospital, Denmark
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Kankariya N, Laing RM, Wilson CA. Textile-based compression therapy in managing chronic oedema: Complex interactions. Phlebology 2020; 36:100-113. [PMID: 32819205 DOI: 10.1177/0268355520947291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Compression is a common therapy for management of chronic disease, including oedema of the lower limb. Modern compression interventions exert pressure on the lower limb through use of one or more materials which exert pressure against the limb over time. Where these materials are textiles, they range from elastic to inelastic, and are produced using knitting, weaving, or other textile technologies which can be manipulated to control performance properties. Thus, understanding of both the materials/textiles and the human body is needed if the most appropriate compression device and treatment strategy is to be used. Neither is independent of the other. This review aims to enhance understanding of critical textile performance properties and how selection of textiles may affect treatment efficacy when managing chronic oedema of the lower limb. METHOD Relevant papers for review were identified via PubMed Central® library, and Google Scholar using keywords associated with textile-based treatments of the oedematous lower limb and wider interdisciplinary factors. RESULTS Assessment of the disorder, the severity of oedema, and location of fluid accumulation are required to inform treatment of chronic oedema. While the need to understand the patient is well established (e.g. age, sex, body mass index, skin thickness and colour, patient compliance with treatment), information about preferred compression systems and material structures, and inherent properties of these, is generally lacking. CONCLUSION Greater detail about materials used (e.g. fabric structure, number and order of layers, fibre content) and patient diagnosis (e.g. underlying cause, severity, location of oedema; patient age and sex; evidence of compliance with treatment; pressure exerted; lower leg shape, size, and properties of the tissue) is needed to facilitate advances in efficacy of compression treatment. Reduced limb swelling with a textile-based treatment occurs simultaneously with changes to the textile itself. Textiles cannot be considered inert.
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Affiliation(s)
- Nimesh Kankariya
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
| | - Raechel M Laing
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
| | - Cheryl A Wilson
- Centre for Materials Science and Technology, University of Otago, Dunedin, New Zealand
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Postsclerotherapy compression: A systematic review. J Vasc Surg Venous Lymphat Disord 2020; 9:264-274. [PMID: 32791308 DOI: 10.1016/j.jvsv.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compression after sclerotherapy is commonly used, although the evidence base for this practice is unclear. This study aims to summarize and assess the evidence for compression therapy after sclerotherapy to inform clinical practice. METHODS A systematic review was performed according to PRISMA guidelines via Medline and EMBASE databases (1946 to December 31, 2019) by two reviewers. Full-text, English-language studies comparing compression type and/or duration in adult chronic venous disease patients undergoing liquid or foam sclerotherapy were included. RESULTS Nine studies were identified: five using liquid sclerotherapy, three foam sclerotherapy and one using both. Studies had short follow-up periods (6-24 weeks) and reported on clinical outcomes, quality of life, side effects and complications. In C1 patients undergoing liquid sclerotherapy, any duration of stocking use significantly decreased telangiectasia and reticular vein number and size compared with no compression. No significant difference in clinical symptoms or quality of life was seen when comparing compression duration after liquid or foam sclerotherapy in tributary or truncal veins in C2 to C6 patients. Greater superficial vein resolution was seen with stockings compared with bandages in C2 patients undergoing liquid sclerotherapy to tributary veins. A comparison of stockings vs bandaging revealed differing thrombophlebitis rates but no significant difference in pigmentation. In C2 to C6 patients undergoing foam sclerotherapy, use of 35 mm Hg stockings significantly improved post-treatment symptoms compared with 23 mm Hg stockings. This review was limited by heterogeneity of outcome measurements and the variety of comparisons between compression types and durations. CONCLUSIONS Postsclerotherapy compression may have beneficial clinical outcomes at short-term follow-up; however, evidence is lacking regarding its type, class, length, and duration. Further trials are required to guide the optimal management of postsclerotherapy patients.
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Baum JT, Carter RP, Neufeld EV, Dolezal BA. Donning a Novel Lower-Limb Restrictive Compression Garment During Training Augments Muscle Power and Strength. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2020; 13:890-899. [PMID: 32922631 PMCID: PMC7449345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The popularity of graduated compression garments (GCG) in sport and exercise is largely driven by the abundance of anecdotal claims suggesting their efficacy. A new line of compression apparel, restrictive compression garments (RCG), integrate novel resistance technology into lower-limb compression garments designed to provide variable resistance to movement. This study aimed to investigate the effect of donning an RCG during a 4-week training program on selected performance variables. Twelve college-aged males were recruited for four weeks of lower-body strength-power resistance training. Participants were randomized 1:1 and blinded to (i) an intervention group (RCG; n = 6) that donned a lower-body RCG during training or (ii) a control group (SHAM; n = 6) that donned a sham during identical training. Both groups demonstrated significant increases in 1-repetition maximum (1-RM) on a seated leg press after 4 weeks (both p < 0.001), with RCG showing a significantly greater increase compared SHAM (p = 0.005, g = 3.35). Similarly, RCG demonstrated significantly greater increases in jump height, peak power, and average power compared to SHAM (p = 0.032, g = 3.44; p < 0.001, g = 4.40; p < 0.001, g = 4.50, respectively). Donning a RCG while engaging in lower-body strength-power training may augment increases 1-RM on a seated leg press, jump height, peak and average power, compared with same exercise training without an RCG.
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Affiliation(s)
- Jaxon T Baum
- Exercise Physiology Research Laboratory, Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Robert P Carter
- Exercise Physiology Research Laboratory, Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Eric V Neufeld
- Exercise Physiology Research Laboratory, Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
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Haddad F, Eldine RN, Sawaf B, Jaafar RF, Hoballah JJ. Management of Vascular Infections in Low- and Middle-Income Countries. Surg Infect (Larchmt) 2020; 21:559-570. [PMID: 32678994 DOI: 10.1089/sur.2020.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Vascular infections are rare and challenging conditions with significant deaths and morbidity. Their management necessitates a multi-disciplinary approach and substantial human and financial resources. The management selected may be influenced by the available resources in low- and middle-income countries (LMICs), where such resources may be variable. Methods: We reviewed the published literature and reviewed the management options for various vascular infections with a focus on carotid, aortic, infrainguinal, and dialysis access infections. Results: Recommendations related to prevention and treatment will be offered from the perspective of LMICs. The general principles for prevention are in compliance with established surgical site infection guidelines and minimize the use of prosthetic material. Early detection and intervention by removing all infected prosthetic material, debridement, drainage, and coverage of the infected field with vascularized tissue are essential steps in the management of the infection. Revascularization using an extra-anatomic or in situ approach is individualized based on the resources and expertise available. Conclusions: The prevention and management of vascular infections in LMICs are effective by adhering to time-proven principles even with limited resources.
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Affiliation(s)
- Fady Haddad
- Vascular Surgery Division, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rakan Nasser Eldine
- Vascular Surgery Division, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bisher Sawaf
- Vascular Surgery Division, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola F Jaafar
- Vascular Surgery Division, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal J Hoballah
- Vascular Surgery Division, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Compression stockings attenuate the expression of proteins associated with vascular damage in human varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:428-434. [PMID: 32679199 DOI: 10.1016/j.jvsv.2020.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/01/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to analyze whether compression stocking therapy in the human varicose vein wall may change the levels of biomarkers associated with vein insufficiency. METHODS Dilated collateral varicose vein samples were obtained from patients showing chronic venous disease (class 2 of the Clinical, Etiology, Anatomy, and Pathophysiology classification). Before elective surgery, 12 patients underwent compression stocking therapy (for 1 month) and 9 patients did not (control group). Expression levels of biomarkers associated with endothelial functionality (nitric oxide synthase 3), inflammation (interleukin-6, interleukin-10), oxidative stress (Gp91phox subunit of NADPH oxidase), and coagulation (factor Xa) were determined. P-selectin, an inflammatory and thrombosis-related biomarker, was also measured. RESULTS Compression stockings increased the content of nitric oxide synthase 3 (control, 16.48 [16.04-17.40] AU; compression, 83.71 [67.70-91.85] AU; P < .001) in the varicose vein wall that was accompanied by reduction of both interleukin-6 levels (control, 38.72 [33.48-48.52] pg/μg protein; compression, 14.49 [11.05-17.41] pg/μg protein; P = .001) and the expression of Gp91phox subunit of NADPH oxidase (control, 63.24 [53.79-77.03] AU; compression, 36.85 [35.66-52.27] AU; P < .010). P-selectin (control, 77.37 [61.86-85.00] AU; compression, 54.31 [49.60-67.50] AU; P = .017) and factor Xa (control, 90.78 [75.02-100.00] AU; compression, 14.50 [13.77-36.20] AU; P < .001) were also reduced in the varicose vein wall of compression stocking-treated patients. However, P-selectin lost its statistical significance after adjustment by dyslipidemia. CONCLUSIONS In the varicose vein wall, compression stocking therapy improved the content levels of biomarkers associated with endothelial functionality, inflammation, oxidative stress, and coagulation.
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Compression Stocking Length Effects on Oedema, Pain, and Satisfaction in Nursing Students: A Pilot Randomized Trial. Healthcare (Basel) 2020; 8:healthcare8020149. [PMID: 32486025 PMCID: PMC7349745 DOI: 10.3390/healthcare8020149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
Professional practitioners who are required to stand for long periods of time frequently complain about vein-related symptoms. Compression stocking are effective for vein-related symptoms, but there is not enough evidence on the effect of the length of compression stockings for nursing students. To compare oedema, pain, and satisfaction according to different lengths of compression stockings worn by female nursing students. This study was conducted as a randomized clinical trial. The participants included 20 female nursing students in their first semester of clinical practice training. Compression stockings with 25–32 mmHg pressure were used in the study; the participants were divided into two groups based on the length of compression stocking: knee length and thigh length. Differences between groups regarding pain, oedema, and satisfaction were analysed using t-tests, paired t-tests, and Mann–Whitney U tests, when appropriate. There were no significant differences in pain, oedema, and satisfaction between the two groups. However, pain in right legs of the thigh-length stocking group significantly increased after clinical training shift compared with that before the shift (t = −2.377, p = 0.041). Both groups reported high satisfaction. There were no differences in pain, oedema, and satisfaction in both legs based on the length of compression stockings, but side effects appeared in participants wearing the thigh-length stockings; nevertheless, satisfaction was high in both groups. It may be important to suggest nursing students to wear knee-length compression stockings during clinical practice training.
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Validated 60-Second General Foot Screen: A Pilot Trial and Guide to Diagnoses and Treatment. Adv Skin Wound Care 2020; 32:490-501. [PMID: 31625965 DOI: 10.1097/01.asw.0000582624.75772.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To provide information on a 60-second General Foot Screen to assist in the prevention and/or identification and management of common foot problems. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Use the 60-second General Foot Screen to assist healthcare professionals in the recognition of common foot problems.2. Identify risk factors, causes, and treatment of selected foot problems. ABSTRACT Foot health is important to overall patient health. Early diagnosis and treatment of diabetes, neuropathy, fungal foot infections, foot deformity, and vascular disease/lower leg edema can improve patient quality of life. One way to achieve this is effective screening. To this end, researchers piloted a validated 10-item screening tool to assess foot health on 120 patients; 74.17% had at least one positive abnormality, demonstrating the critical importance of these early findings. Only 25.83% of individuals had completely low-risk feet. This easy-to-use tool can assist healthcare professionals in the recognition and treatment of common foot problems. The article also outlines the early signs of disease by screening item and provides a guide to treatment to enable effective prevention and quality care.
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Nandasiri GK, Ianakiev A, Dias T. Hyperelastic Properties of Platinum Cured Silicones and its Applications in Active Compression. Polymers (Basel) 2020; 12:polym12010148. [PMID: 31936039 PMCID: PMC7022899 DOI: 10.3390/polym12010148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 11/25/2022] Open
Abstract
This paper presents the fundamental research of design, development, and evaluation of an active compression system consisting of silicone based inflatable mini-bladders, which could be used in applying radial pressure for the treatment of venous disease. The use of mini-bladders will nullify the effect of radius of curvature and provide a higher resolution to the pressure distribution. They are designed with two elastomeric layers and inflation is limited only to one side. The mini-bladders apply a radial force onto the treated surface when inflated, and the pressure inside mini-bladders could be measured using the concept of back pressure, which provides the flexibility to inflate mini-bladders to a predefined pressure. The 3-D deformation profile of the mini-bladders was analysed using finite element method (FEM) and FEM simulations were validated with experimental data, which showed good agreement within pressure region required for the treatment of venous disease. Finally, the pressure transmission characteristics of mini-bladders were evaluated on a biofidellic lower leg surrogate and the results have shown that the mini-bladders could apply a uniform pressure irrespective of the location on the leg with a 60%–70% of inlet pressure successfully transmitted onto the leg surface, while 40%–50% was available after the fat layers.
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Affiliation(s)
- Gayani K. Nandasiri
- Advanced Textiles Research Group, School of Art and Design, Nottingham Trent University, Bonington Building, Dryden Street, Nottingham NG1 4 GG, UK
- Correspondence: (G.K.N.); (T.D.); Tel.: +44-94-77292-5855 (T.D.)
| | - Anton Ianakiev
- Department of Civil Engineering, School of Architecture Design and Built Environment, Nottingham Trent University, Nottingham NG1 4FQ, UK;
| | - Tilak Dias
- Advanced Textiles Research Group, School of Art and Design, Nottingham Trent University, Bonington Building, Dryden Street, Nottingham NG1 4 GG, UK
- Correspondence: (G.K.N.); (T.D.); Tel.: +44-94-77292-5855 (T.D.)
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