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Chen B, Liu Y, Liu Y, Xu S. Distribution characteristics of pathogens in different stages of pressure ulcers and the therapeutic effect of linear polarized polychromatic light combined with silver sulfadiazine cream. Medicine (Baltimore) 2023; 102:e35772. [PMID: 37861479 PMCID: PMC10589588 DOI: 10.1097/md.0000000000035772] [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: 04/11/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
To investigate the distribution characteristics of pathogens in different stages of pressure ulcers and observe the application of linear polarized polychromatic light (LPPL) combined with silver sulfadiazine cream in treating varying stages of pressure ulcers. This study comprised 88 patients with pressure ulcers who were enrolled in the department of burn and plastic surgery of our hospital from April 2019 to April 2022. The wound exudates from patients were collected, followed by analyzing the distribution of pathogens in different stages of pressure ulcers. Patients were randomly divided into 2 groups. The first group (n = 44) received LPPL combined with silver sulfadiazine. The other group was intervened with LPPL group only for 2 weeks. The clinical efficacy, condition, and pain in the 2 groups, as well as the healing timeframes for patients were measured at different stages. The findings showed that among 88 patients with pressure ulcers, 62 were infected, and the infection rate was 70.45%. The pathogens that were observed in stage II and III to IV pressure ulcers were mainly Gram-negative bacteria. The total effective rate in the combined group was 90.91%, which was much higher than that of LPPL group (70.45%). Compared with LPPL group, the pressure ulcer scale for healing and visual analogue scale scores in the combined group were markedly lower (P < .05). It is important to note that in LPPL group, the healing time of patients in stage II and stage III to IV in the combined arm were 9.76 ± 2.38 days and 13.19 ± 2.54 days, respectively. The corresponding time in the LPPL group was prolonged to 13.20 ± 3.76 and 18.82 ± 4.17 days, respectively. The main pathogens associated with wound infection in patients with pressure ulcers are Gram-negative bacteria. The curative effects of LPPL combined with sulfadiazine silver cream on patients with pressure ulcer is obviously improved, and the recovery and pain relief are faster while the healing time of pressure ulcer is shorter.
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Affiliation(s)
- Binxiong Chen
- Department of Burn and Plastic Surgery, Shenzhen Longhua District Central Hospital, Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, China
| | - Yang Liu
- Department of Burn and Plastic Surgery, Shenzhen Longhua District Central Hospital, Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, China
| | - Yueming Liu
- Department of Burn and Plastic Surgery, Shenzhen Longhua District Central Hospital, Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, China
| | - Shi Xu
- Department of Burn and Plastic Surgery, Shenzhen Longhua District Central Hospital, Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, China
- Department of Medical Laboratory, Shenzhen Longhua District Central Hospital, Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, China
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Zúñiga-González GM, Martínez-Sánchez JO, Zamora-Perez AL, Gallegos-Arreola MP, Torres-Mendoza BM, Gutiérrez-Sevilla JE, Sánchez-Parada MG, Barros-Hernández A, Gómez-Meda BC. Micronuclei analysis in mice peripheral blood exposed to polarized polychromatic noncoherent light (Bioptron® Light). JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2023. [DOI: 10.1016/j.jpap.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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3
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Taha MM, El-Nagar MM, Elrefaey BH, Elkholy RM, Ali OI, Alkhamees N, Felaya ESEES. Effect of Polarized Light Therapy (Bioptron) on Wound Healing and Microbiota in Diabetic Foot Ulcer: A Randomized Controlled Trial. Photobiomodul Photomed Laser Surg 2022; 40:792-799. [PMID: 36315226 DOI: 10.1089/photob.2021.0175] [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: 11/06/2022] Open
Abstract
Background: Diabetic foot ulcer (DFU) complications are the most common cause of morbidity in diabetic patients. Bioptron light therapy is a new adjuvant therapy for wound healing. This study aimed to investigate the effect of polarized light therapy on the healing and microbial nature of DFUs. Methods: Forty type 2 diabetic patients with Wagner grade 1 or 2 DFUs were randomly assigned to one of two groups: the light therapy group, which received Bioptron light therapy using the Bioptron lamp for 12 min three times per week, plus standard wound care, or the control group, which received standard wound care only. Both interventions were given over a 2-month period. Wound surface area, volume, and ulcer microbial cultures were all measured before and after the study period. Results: There was a significant reduction in ulcer surface area between groups in favor of the light therapy group, with a relative ulcer size reduction of 51.44% ± 23.76% compared with 24.5% ± 9.6% in the control group (p < 0.001). Besides, a significant difference was observed between groups in the microbial cultures (p = 0.02); by the end of the 8th week, the number of patients with negative ulcer culture was 12 (60%) in the light therapy group compared with 3 (15%) in the control group. Conclusions: Bioptron light therapy seems to be an effective therapeutic intervention combined with standard care in decreasing wound size and reducing ulcer microbiota for DFUs. It reduces ulcer bacterial infection and speeds up ulcer healing. Trial registration: ClinicalTrials.gov: NCT04446767.
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Affiliation(s)
- Mona Mohamed Taha
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mai M El-Nagar
- Department of Epidemiology, Internal and Geriatric Ganzour Hospital, Shebin El-Kom, Egypt
| | - Basant Hamdy Elrefaey
- Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Medical Rehabilitation Sciences, College of Applied Medicine, King Khaled University, Abha, Kingdom of Saudi Arabia
| | - Reem Mohsen Elkholy
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Olfat Ibrahim Ali
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Physical Therapy Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Nouf Alkhamees
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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M Allam N, Eladl HM, Eid MM. Polarized Light Therapy in the Treatment of Wounds: A Review. INT J LOW EXTR WOUND 2022:15347346221113991. [PMID: 35833323 DOI: 10.1177/15347346221113991] [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: 11/16/2022]
Abstract
The most prevalent type of photo therapies are low-level laser therapy (LLLT) and ultraviolet (UV) treatments, which are distinguished by the physical properties of the light employed. However, in latest years, it has been suggested that polarization and an extensive light band including all light spectra are essential aspects in light treatment. Light waves are filtered to align and vibrate in a single plane, resulting in polarized light (PL). Light that has been polarized can penetrate tissues more deeply than light that has not been polarized. The visible light spectrum is very broad. PL varies from other types of light therapy in that it uses a considerably wider spectrum of wavelengths than LLLT or UV. As a result, PLT devices are often less expensive and simple to operate. Since the late 1960s, light therapy has been used to treat anything from neonatal jaundice to psoriasis and vitiligo. Fenyö created a PL source and found that it can stimulate wound healing in a similar way to the low-energy laser. In comparison to the laser, this source of light had numerous gains: lesser prices, fewer hazards, a greater area to be treated, and no sophisticated user expertise. Despite several findings from fundamental research (in vitro, in vivo, and animal trials), practitioners continue to have reservations regarding PL's potency and utility in treating musculoskeletal problems. It is even largely believed that the commercial use of these therapies is validated by a sufficient amount of scientific evidence based on reliable clinical papers. The major goal of this study is to gather information on the use of PL for treatment of various wound types in animal and human investigations.
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Affiliation(s)
- Nesma M Allam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Jouf City, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, 531226Cairo University, Giza, Egypt
| | - Hadaya Mosaad Eladl
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Jouf City, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, 531226Cairo University, Giza, Egypt
| | - Marwa M Eid
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, 531226Cairo University, Giza, Egypt
- Department of Physical Therapy, 248389College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
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5
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Wang F, Chen M, Du J. Effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing: A meta-analysis. Int Wound J 2022; 19:2031-2038. [PMID: 35396823 DOI: 10.1111/iwj.13803] [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: 03/08/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed-influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94-8.95, P < .001), and curative ratio post-treatment (OR, 4.79; 95% CI, 2.62-8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post-treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.
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Affiliation(s)
- Feida Wang
- Department of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Zhejiang, China
| | - Mingxu Chen
- Department of Rehabilitation Medicine, Hangzhou Xiacheng Hospital of integrated Traditional Chinese and Western Medicine, Zhejiang, China
| | - Jia Du
- Department of Acupuncture, Tongde Hospital of Zhejiang Province, Zhejiang, China
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Dos Santos Mendes-Costa L, de Lima VG, Barbosa MPR, Dos Santos LE, de Siqueira Rodrigues Fleury Rosa S, Tatmatsu-Rocha JC. Photobiomodulation: systematic review and meta-analysis of the most used parameters in the resolution diabetic foot ulcers. Lasers Med Sci 2020; 36:1129-1138. [PMID: 33190161 DOI: 10.1007/s10103-020-03192-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
The most common photobiomodulation parameters used to aid in the treatment of diabetic foot ulcers were investigated in this paper. The databases MEDLINE, LILACS, MEDCARIB, PAHO-IRIS, and WHOLIS were searched with the following descriptors: diabetic foot ulcers AND low-level laser therapy OR low-level therapy AND wound healing; this search was conducted from January of 2014 to December of 2019. Inclusion criteria were randomized clinical trials on humans. Exclusion criteria were systematic reviews, literature reviews, studies with animals, studies lacking photobiomodulation parameters, and studies with non-diabetic individuals. The Jadad scale was used in order to analyze the methodological quality of the matching papers. There were seventeen studies found on PubMed and four on LILACS. Among these, seven were selected, according to the inclusion and exclusion criteria. Two out of the seven matching studies obtained a high score, and five obtained a low score, on the Jadad scale. The studies settled on the use of 600-nm and 800-nm wavelength spectrum. Most of the analyzed papers on photobiomodulation on diabetic foot ulcers did not describe the detailed parameters in their methodology. None of the studies featured the maximum score with regard to the Jadad scale for methodological quality. The relations of energy versus wavelength and power versus wavelength were divergent among the parameters on the papers. Therefore, it is necessary to analyze the parameters for an optimized power value in order to improve the results of the treatment.
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Affiliation(s)
- Luan Dos Santos Mendes-Costa
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil
| | - Vanessa Garcia de Lima
- Center for Health Sciences, Physiotherapy Department, University of Fortaleza, Fortaleza, Brazil
| | - Maria Paula Ribeiro Barbosa
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil
| | | | | | - José Carlos Tatmatsu-Rocha
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil. .,Post-Graduate Program of Biomedical Engineering, University of Brasília, Brasília, Brazil.
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Palmieri B, Vadalà M, Laurino C. Electromedical devices in wound healing management: a narrative review. J Wound Care 2020; 29:408-418. [PMID: 32654604 DOI: 10.12968/jowc.2020.29.7.408] [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] [Indexed: 01/03/2023]
Abstract
Wound healing is the sum of physiological sequential steps, leading to skin restoration. However, in some conditions, such as diabetes, pressure ulcers (PU) and venous legs ulcers (VLU), healing is a major challenge and requires multiple strategies. In this context, some electromedical devices may accelerate and/or support wound healing, modulating the inflammatory, proliferation (granulation) and tissue-remodelling phases. This review describes some helpful electromedical devices including: ultrasonic-assisted wound debridement; electrotherapy; combined ultrasound and electric field stimulation; low-frequency pulsed electromagnetic fields; phototherapy (for example, laser therapy and light-emitting diode (LED) therapy); biophotonic therapies, and pressure therapies (for example, negative pressure wound therapy, and high pressure and intermittent pneumatic compression) The review focuses on the evidence-based medicine and adequate clinical trial design in relation to these devices.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
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8
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Feehan J, Tripodi N, Fraser S, Mikkelsen K, Thewlis A, Kiatos D, Husaric M, Apostolopoulos V. Polarized light therapy: Shining a light on the mechanism underlying its immunomodulatory effects. JOURNAL OF BIOPHOTONICS 2020; 13:e201960177. [PMID: 31816155 PMCID: PMC7065605 DOI: 10.1002/jbio.201960177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
This study investigates the immunomodulatory effects of polychromatic polarized light therapy (PLT) on human monocyte cells. While there is some evidence demonstrating a clinical effect in the treatment of certain conditions, there is little research into its mechanism of action. Herein, U937 monocyte cells were cultured and exposed to PLT. The cells were then analyzed for change in expression of genes and cell surface markers relating to inflammation. It was noted that 6 hours of PLT reduced the expression of the CD14, MHC I and CD11b receptors, and increased the expression of CD86. It was also shown that PLT caused downregulation of the genes IL1B, CCL2, NLRP3 and NOD1, and upregulation of NFKBIA and TLR9. These findings imply that PLT has the capacity for immunomodulation in human immune cells, possibly exerting an anti-inflammatory effect.
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Affiliation(s)
- Jack Feehan
- Osteopathy Group, College of Health and BiomedicineVictoria UniversityVictoriaAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)University of Melbourne and Western HealthSt AlbansVictoriaAustralia
| | - Nicholas Tripodi
- Institute for Health and SportVictoria UniversityVictoriaAustralia
- First Year CollegeVictoria UniversityVictoriaAustralia
| | - Sarah Fraser
- Institute for Health and SportVictoria UniversityVictoriaAustralia
| | | | - April Thewlis
- Osteopathy Group, College of Health and BiomedicineVictoria UniversityVictoriaAustralia
| | - Dimitrios Kiatos
- Osteopathy Group, College of Health and BiomedicineVictoria UniversityVictoriaAustralia
- Institute for Health and SportVictoria UniversityVictoriaAustralia
| | - Maja Husaric
- Institute for Health and SportVictoria UniversityVictoriaAustralia
- First Year CollegeVictoria UniversityVictoriaAustralia
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9
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Shahimoridi D, Shafiei SA, Yousefian B. The Effectiveness of the Polarized Low-Level Laser in the Treatment of Patients With Myofascial Trigger Points in the Trapezius Muscles. J Lasers Med Sci 2020; 11:14-19. [PMID: 32099622 DOI: 10.15171/jlms.2020.04] [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: 12/20/2022]
Abstract
Introduction: This study assessed the effect of polarized low-level laser therapy (PLLLT) on the treatment of myofascial trigger points (MTrPs) in the trapezius muscles. Its effectiveness in pain reduction was compared to low-level laser therapy (LLLT). Methods: Sixty-four patients with MTrPs were randomly divided into 2 groups, namely PLLLT and LLLT. Each patient received treatment for a period of 2 weeks, 5 sessions a week. The intensity of laser irradiation to the skin surface was 6 J/cm2 . The system exit power was 160 mw at a 755 nm wavelength. The visual analog scale (VAS) for the 1st, 5th and 10th sessions was analyzed through two-way repeated measures ANOVA. Results: Increasing the number of treatment sessions was effective in reducing pain intensity (P>0.05). The effect of LLLT on pain reduction was significantly greater than that of PLLLT (P>0.05). Referred pain (RP), the limitation of neck movement (LNM), the presence of muscular taut band (PMTB) and the sensitivity of muscular taut band (SMTB) were reduced significantly by the end of the 10th session, compared with participants' condition at the beginning of the 1st session in both groups. Conclusion: PLLLT and LLLT can effectively treat MTrPs in the trapezius muscles and they reduce RP, LNM, PMTB, and SMTB in particular. However, the effect of the LLLT was significantly greater than that of PLLLT. In accordance with the observed results, LLLT is recommended as an effective method for treating MTrPs.
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Affiliation(s)
- Dadollah Shahimoridi
- Department of Basic Sciences, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyed Ali Shafiei
- Neuroscience Research Center, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Bahram Yousefian
- Department of Radiology, School of Allied Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Leguina-Ruzzi A, Raichura KR, Tonks SK, Kwabi S, Leitner C. Treatment of non-atopic dermatitis with polarized UV-free polychromatic light: A case report. Clin Pract 2019; 9:1161. [PMID: 31579495 PMCID: PMC6763707 DOI: 10.4081/cp.2019.1161] [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: 04/18/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
Non-atopic dermatitis is a common inflammatory condition, which is potentially debilitating and can compromise life quality. Polarized ultraviolet-free polychromatic light is used as therapeutic option for the treatment of wound healing and dermatological conditions. It has not yet been tested in the management of non-atopic dermatitis. In this case report, we present a 67- year-old female patient who had suffered with moderate non-atopic dermatitis for the past 20 years, and had undergone multiple treatments during that time without significant improvement or relief from her symptoms. She was treated for six weeks only with daily light therapy applications (10 minutes/area). Our results showed that light therapy offered a significant reduction in erythema of the affected zones with a concomitant reduction in pruritus and dehydration of the skin, without side effects or discomfort.
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Affiliation(s)
- Alberto Leguina-Ruzzi
- Department of Mitochondrial Physiology, Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic
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11
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Therapeutic applications of polarized light: Tissue healing and immunomodulatory effects. Maturitas 2018; 116:11-17. [DOI: 10.1016/j.maturitas.2018.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/07/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
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Hughes M, Moore T, Manning J, Wilkinson J, Watson S, Samraj P, Dinsdale G, Roberts C, Rhodes LE, Herrick AL, Murray A. A feasibility study of a novel low-level light therapy for digital ulcers in systemic sclerosis. J DERMATOL TREAT 2018; 30:251-257. [PMID: 29862855 PMCID: PMC6484448 DOI: 10.1080/09546634.2018.1484875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Locally acting, well-tolerated treatments for systemic sclerosis (SSc) digital ulcers (DUs) are needed. Objectives: Our primary aim was to investigate the safety, feasibility, and tolerability of a novel low-level light therapy (LTTT). A secondary aim was to tentatively assess efficacy. Methods: A custom-built device comprising infrared (850 nm), red (660 nm), and violet (405 nm) LEDs was utilized. DUs were irradiated with 10 J/cm2 twice weekly for 3 weeks, with follow-up at weeks 4 and 8. Any safety concerns were documented. Patient opinion on time to deliver, feasibility, and pain visual analogue score (VAS; 0–100, 100 most severe) was collected. Patient and clinician DU global assessment VAS were documented. DUs were evaluated by laser Doppler perfusion imaging pre- and post-irradiation. Results: In all, 14 DUs in eight patients received a total of 46 light exposures, with no safety concerns. All patients considered LTTT ‘took just the right amount of time’ and was ‘feasible’, with a low associated mean pain VAS of 1.6 (SD: 5.2). Patient and clinician global DC VAS improved during the study (mean change: –7.1 and –5.2, respectively, both p < .001). DU perfusion significantly increased post-irradiation. Conclusions: LTTT for DUs is safe, feasible, and well tolerated. There was an early tentative suggestion of treatment efficacy.
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Affiliation(s)
- M Hughes
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - T Moore
- b Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - J Manning
- b Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - J Wilkinson
- c Research and Development , Salford Royal NHS Foundation Trust , Salford , UK
| | - S Watson
- d Medical Physics Department and University of Manchester , Manchester Academic Health Science Centre , Salford Royal NHS Foundation Trust , UK
| | - P Samraj
- e Medical Physics Department , Salford Royal NHS Foundation Trust , UK
| | - G Dinsdale
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - C Roberts
- f Centre for Biostatistics , Institute of Population Health, School of Medicine, The University of Manchester , Manchester , UK
| | - L E Rhodes
- g Photobiology Unit, Dermatology Centre, Division of Musculoskeletal and Dermatological Sciences , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - A L Herrick
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,h NIHR Manchester Musculoskeletal Biomedical Research Centre , Central Manchester NHS Foundation Trust , Manchester Academic Health Science Centre , UK
| | - A Murray
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,i Photon Science Institute , The University of Manchester , UK
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Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev 2017; 6:CD011947. [PMID: 28639707 PMCID: PMC6481609 DOI: 10.1002/14651858.cd011947.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers. Such a review would ideally help people with pressure ulcers and health professionals assess the best treatment options. This review is a network meta-analysis (NMA) which assesses the probability of complete ulcer healing associated with alternative dressings and topical agents. OBJECTIVES To assess the effects of dressings and topical agents for healing pressure ulcers in any care setting. We aimed to examine this evidence base as a whole, determining probabilities that each treatment is the best, with full assessment of uncertainty and evidence quality. SEARCH METHODS In July 2016 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, guidelines and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) comparing the effects of at least one of the following interventions with any other intervention in the treatment of pressure ulcers (Stage 2 or above): any dressing, or any topical agent applied directly to an open pressure ulcer and left in situ. We excluded from this review dressings attached to external devices such as negative pressure wound therapies, skin grafts, growth factor treatments, platelet gels and larval therapy. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. We conducted network meta-analysis using frequentist mega-regression methods for the efficacy outcome, probability of complete healing. We modelled the relative effectiveness of any two treatments as a function of each treatment relative to the reference treatment (saline gauze). We assumed that treatment effects were similar within dressings classes (e.g. hydrocolloid, foam). We present estimates of effect with their 95% confidence intervals for individual treatments compared with every other, and we report ranking probabilities for each intervention (probability of being the best, second best, etc treatment). We assessed the certainty (quality) of the body of evidence using GRADE for each network comparison and for the network as whole. MAIN RESULTS We included 51 studies (2947 participants) in this review and carried out NMA in a network of linked interventions for the sole outcome of probability of complete healing. The network included 21 different interventions (13 dressings, 6 topical agents and 2 supplementary linking interventions) and was informed by 39 studies in 2127 participants, of whom 783 had completely healed wounds.We judged the network to be sparse: overall, there were relatively few participants, with few events, both for the number of interventions and the number of mixed treatment contrasts; most studies were small or very small. The consequence of this sparseness is high imprecision in the evidence, and this, coupled with the (mainly) high risk of bias in the studies informing the network, means that we judged the vast majority of the evidence to be of low or very low certainty. We have no confidence in the findings regarding the rank order of interventions in this review (very low-certainty evidence), but we report here a summary of results for some comparisons of interventions compared with saline gauze. We present here only the findings from evidence which we did not consider to be very low certainty, but these reported results should still be interpreted in the context of the very low certainty of the network as a whole.It is not clear whether regimens involving protease-modulating dressings increase the probability of pressure ulcer healing compared with saline gauze (risk ratio (RR) 1.65, 95% confidence interval (CI) 0.92 to 2.94) (moderate-certainty evidence: low risk of bias, downgraded for imprecision). This risk ratio of 1.65 corresponds to an absolute difference of 102 more people healed with protease modulating dressings per 1000 people treated than with saline gauze alone (95% CI 13 fewer to 302 more). It is unclear whether the following interventions increase the probability of healing compared with saline gauze (low-certainty evidence): collagenase ointment (RR 2.12, 95% CI 1.06 to 4.22); foam dressings (RR 1.52, 95% CI 1.03 to 2.26); basic wound contact dressings (RR 1.30, 95% CI 0.65 to 2.58) and polyvinylpyrrolidone plus zinc oxide (RR 1.31, 95% CI 0.37 to 4.62); the latter two interventions both had confidence intervals consistent with both a clinically important benefit and a clinically important harm, and the former two interventions each had high risk of bias as well as imprecision. AUTHORS' CONCLUSIONS A network meta-analysis (NMA) of data from 39 studies (evaluating 21 dressings and topical agents for pressure ulcers) is sparse and the evidence is of low or very low certainty (due mainly to risk of bias and imprecision). Consequently we are unable to determine which dressings or topical agents are the most likely to heal pressure ulcers, and it is generally unclear whether the treatments examined are more effective than saline gauze.More research is needed to determine whether particular dressings or topical agents improve the probability of healing of pressure ulcers. The NMA is uninformative regarding which interventions might best be included in a large trial, and it may be that research is directed towards prevention, leaving clinicians to decide which treatment to use on the basis of wound symptoms, clinical experience, patient preference and cost.
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Affiliation(s)
- Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Marta O Soares
- University of YorkCentre for Health EconomicsAlcuin 'A' BlockHeslingtonYorkUKYO10 5DD
| | - Nikki Stubbs
- Leeds Community Healthcare NHS Trust, St Mary's HospitalWound Prevention and Management Service3 Greenhill RoadLeedsUKLS12 3QE
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
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Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2015; 162:370-9. [PMID: 25732279 DOI: 10.7326/m14-1568] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations based on the comparative effectiveness of treatments of pressure ulcers. METHODS This guideline is based on published literature on this topic that was identified by using MEDLINE, EMBASE, CINAHL, EBM Reviews, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the Health Technology Assessment database through February 2014. Searches were limited to English-language publications. The outcomes evaluated for this guideline include complete wound healing, wound size (surface area, volume, and depth) reduction, pain, prevention of sepsis, prevention of osteomyelitis, recurrence rate, and harms of treatment (including but not limited to pain, dermatologic complications, bleeding, and infection). This guideline grades the quality of evidence and strength of recommendations by using ACP's clinical practice guidelines grading system. The target audience for this guideline includes all clinicians, and the target patient population is patients with pressure ulcers. RECOMMENDATION 1 ACP recommends that clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound size. (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 2 ACP recommends that clinicians use hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size. (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 3 ACP recommends that clinicians use electrical stimulation as adjunctive therapy in patients with pressure ulcers to accelerate wound healing. (Grade: weak recommendation, moderate-quality evidence).
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Affiliation(s)
- Amir Qaseem
- From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania; Oregon Health & Science University, Portland, Oregon; and Carilion Clinic, Roanoke, Virginia
| | - Linda L. Humphrey
- From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania; Oregon Health & Science University, Portland, Oregon; and Carilion Clinic, Roanoke, Virginia
| | - Mary Ann Forciea
- From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania; Oregon Health & Science University, Portland, Oregon; and Carilion Clinic, Roanoke, Virginia
| | - Melissa Starkey
- From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania; Oregon Health & Science University, Portland, Oregon; and Carilion Clinic, Roanoke, Virginia
| | - Thomas D. Denberg
- From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania; Oregon Health & Science University, Portland, Oregon; and Carilion Clinic, Roanoke, Virginia
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Vélez-Díaz-Pallarés M, Lozano-Montoya I, Abraha I, Cherubini A, Soiza RL, O'Mahony D, Montero-Errasquín B, Cruz-Jentoft AJ. Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The SENATOR-ONTOP Series). J Am Med Dir Assoc 2015; 16:448-69. [PMID: 25737261 DOI: 10.1016/j.jamda.2015.01.083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pressure ulcers (PUs) are more frequent in older patients, and the healing process is usually challenging. Nonpharmacologic interventions may play a role in the treatment of older people with PUs, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures. OBJECTIVE To summarize and critically appraise the evidence from SRs of the primary studies on nonpharmacologic interventions to treat PUs in older patients. DESIGN SR and meta-analysis of comparative studies. METHODS PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL (from inception to October 2013) were searched. A new search for updates in the Cochrane Database was launched in July 2014. SRs that included at least 1 comparative study evaluating any nonpharmacologic intervention to treat PUs in older patients, in any health care setting, were included. Any primary study with experimental design was then identified and included. From each primary study, quality assessment was undertaken as specified by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. Interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis, using complete ulcer healing as the outcome measure. RESULTS One hundred ten SRs with 45 primary studies satisfied the inclusion criteria. The most frequent interventions explored in these trials were support surfaces (13 studies), nutrition (8), and electrotherapy (6). High or moderate quality of evidence was found in none of the interventions, mainly because of the very serious risk of bias of most studies and imprecision in the treatment effect. Evidence grade is very low or insufficient to support the use of any support surface, nutrition intervention, multicomponent interventions, repositioning or other adjunctive therapy (ultrasound, negative pressure, laser, electromagnetic, light, shock wave, hydrotherapy, radiofrequency, or vibration therapy) to increase the rates of PU healing in older patients. Electrotherapy showed some beneficial effect in the treatment of PUs, although the quality of evidence is low. CONCLUSIONS In older patients with PUs, evidence to use any nonpharmacologic therapy to increase the rates of wound healing is inconclusive, except for low quality evidence that supports the use of electrotherapy. This situation is especially alarming for interventions that are usually standard clinical practice (repositioning, support surfaces). Although there is some evidence in younger populations and other types of ulcers, studies in older populations with PUs using sound methodology are needed.
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Affiliation(s)
| | | | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Roy L Soiza
- Department of Medicine for the Elderly, NHS Grampian, Aberdeen, United Kingdom
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
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Abstract
BACKGROUND A pressure ulcer is defined as "an area of localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear". The use of phototherapy - that is, light (or laser) used as an adjuvant, non-surgical intervention, with the aim of having a therapeutic effect on healing - has increased recently. OBJECTIVES To determine the effects of phototherapy on the healing of pressure ulcers. SEARCH METHODS In January 2014, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid EMBASE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); and EBSCO CINAHL. We did not restrict the search by language or publication date. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effects of phototherapy (in addition to standard treatment) with sham phototherapy (in addition to standard treatment), another type of phototherapy (in addition to standard treatment) or standard or conventional treatment alone. DATA COLLECTION AND ANALYSIS Two review authors assessed studies for relevance and design according to the selection criteria, extracted data and evaluated study quality. The authors made attempts to obtain missing data by contacting study authors. Disagreement was resolved by consensus and discussion with a third review author. MAIN RESULTS We identified seven RCTs involving 403 participants. All the trials were at unclear risk of bias. Trials compared the use of phototherapy with standard care only (six trials) or sham phototherapy (one trial). Only one of the trials included a third arm in which another type of phototherapy was applied. Overall, there was insufficient evidence to determine the relative effects of phototherapy for healing pressure ulcers. Time to complete healing was reported in three studies. Two studies showed the ultraviolet (UV) treated group had a shorter mean time to complete healing than the control group (mean difference -2.13 weeks (95% CI -3.53 to -0.72, P value 0.003)). One study reported that the laser group had a longer mean time to complete healing than the control group (mean difference 5.77 weeks; 95% CI -0.25 to 11.79). However, this result should be interpreted with caution, as these were small studies and the findings may have been due to chance. Three studies reported proportions of ulcers healed with a variety of results. One study reported a different outcome measure, and the other two studies had different treatment durations. These variations did not allow us to pool the studies and draw any conclusions as to whether phototherapy is effective or not. Adverse effects were reported in only two studies that compared phototherapy with control; the risk ratio for adverse events was imprecise. One study reported risk ratio (RR) 0.72 (95%CI 0.18 to 2.80). However, another study reported RR 0.89 (95% CI: 0.71 to 1.12) based on the number of events in each group, rather than the number of people with events. Among five studies reporting the rate of change in ulcer area, three studies found no statistically significant difference between the two groups. Pooling was not undertaken because of differences in outcome measures reported. The results were based on data from trials with unclear risk of bias for which generation of the randomisation sequence, concealment allocation and blinding of outcome assessors were unclear. No studies reported on quality of life, length of hospital stay, pain or cost. AUTHORS' CONCLUSIONS We are very uncertain as to the effects of phototherapy in treating pressure ulcers. The quality of evidence is very low due to the unclear risk of bias and small number of trials available for analysis. The possibility of benefit or harm of this treatment cannot be ruled out. Further research is recommended.
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Affiliation(s)
- Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Taipei Medical University - Wan Fang Hospital, No. 111, Section 3, Hsing-Long Rd, Tapei, Taiwan, 11696
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Nicolas B, Moiziard AS, Barrois B, Colin D, Michel JM, Passadori Y, Ribinik P. Which medical devices and/or local drug should be curatively used, as of 2012, for PU patients? How can granulation and epidermidalization be promoted? Developing French guidelines for clinical practice. Ann Phys Rehabil Med 2012; 55:489-97. [PMID: 23022367 DOI: 10.1016/j.rehab.2012.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Management of a patient with pressure ulcer sore(s) must associate local and general treatment. OBJECTIVES To determine which medical devices other than supports and which treatments may be used for pressure sore healing (granulation tissue and epithelization/epidermidalization) as of 2012. METHODS Systematic review of the literature querying the databases: PASCAL Biomed, PubMed, and Cochrane library from 2000 through 2010. RESULTS Data in the literature on granulation tissue and epithelisation/epidermidalization in pressure sore healing are poor. The level of evidence regarding the relative effectiveness of one modern dressing compared to another has remained low. However, the study data on the interest of hydrocolloid dressing compared with impregnated gases are more significant. DISCUSSION Studies with heterogeneous results and populations have shown low power. Meta-analyses are difficult due to the wide range of therapeutic aims. Further clinical studies with adequate methodology are needed prior to elaboration of more specific recommendations. CONCLUSION The use of hydrocolloid dressing may be recommended to improve granulation tissue development and epithelization/epidermidalization in pressure sore (Level B).
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Zhang QH, Sun ZR, Yue JH, Ren X, Qiu LB, Lv XL, Du W. Traditional Chinese medicine for pressure ulcer: a meta-analysis. Int Wound J 2012; 10:221-31. [PMID: 22512889 DOI: 10.1111/j.1742-481x.2012.00969.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To assess the effect of Traditional Chinese Medicine (TCM) [Chinese herbal medicine ointment (CHMO), acupuncture and moxibustion] on pressure ulcer. In this study, we searched MEDLINE, EMBASE, CENTER, CBM, CNKI, WAN FANG and VIP for articles published from database inception up to 4 April 2011. We included randomised controlled trials (RCTs), which compared the effects of TCM with other interventions. We assessed the methodological quality of these trials using Cochrane risk of bias criteria. Ten of 565 potentially relevant trails that enrolled a total of 893 patients met our inclusion criteria. All the included RCTs only used CHMO intervention, because acupuncture and moxibustion trials failed to meet the inclusive criteria. A meta-analysis showed beneficial effects of CHMO for pressure ulcer compared with other treatments on the total effective rate [risk ratio (RR): 1·28; 95% confidence interval (CI): 1·20-1·36; P = 0·53; I(2) = 0%), curative ratio (RR: 2·02; 95% CI: 1·73-2·35; P = 0·11; I(2) = 37%) and inefficiency rate (RR: 0·16; 95% CI: 0·02-0·80; P = 0·84; I(2) = 0%). However, the funnel plot indicated that there was publication bias in this study. The evidence that CHMO is effective for pressure ulcer is encouraging, but due to several caveats, not conclusive. Therefore, more rigorous studies seem warranted.
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Affiliation(s)
- Qin-Hong Zhang
- College of Basic Medical Sciences of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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Abstract
INTRODUCTION Studies on dressings frequently measure wound healing to demonstrate performance. Knowledge of existing methodologies available for wound healing assessment, including their advantages and limitations, is paramount when evaluating the literature on dressings. METHODOLOGY Medline and Cochrane databases were searched for wound healing assessment methodologies used in research or in clinical practice. RESULTS Twenty-nine methodologies were identified and classified into 8 categories: scales (n = 4), one-dimensional measurements (n = 2), area measurements (n = 4), volume measurements (n = 6), 3-dimensional wound reproduction systems (n = 5), methodologies based on wound physical characteristics (n = 3), rates and surrogates end point calculated from variation in wound dimensions (n = 4), and time to wound healing (n = 1). The main problems encountered during wound healing assessment include the following: boundary definition, assessor's contact with the wound, irregular wound shape, and difficulty in evaluating early healing. CONCLUSION At this time, an ideal methodology does not exist. Research in this area is lacking and should be the focus in wound healing evaluation.
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Broadbent J, Walsh T, Upton Z. Proteomics in chronic wound research: Potentials in healing and health. Proteomics Clin Appl 2010; 4:204-14. [DOI: 10.1002/prca.200900152] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 01/13/2023]
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Photomedicine and LLLT Literature Watch. Photomed Laser Surg 2009; 27:377-8. [DOI: 10.1089/pho.2009.9954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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