Interface pressures with compression systems: relevance to clinical practice

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.

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Clinical Effectiveness of Gingival Depigmentation Using Conventional Surgical Scrapping and Diode Laser Technique: A Quasi Experimental Study

Global Journal of Health Science ◽

10.5539/gjhs.v9n3p296 ◽

2016 ◽

Vol 9 (3) ◽

pp. 296 ◽

Cited By ~ 1

Author(s):

Reddy Nagati Raghavendra ◽

M. Ragul ◽

Al-Qahtani Nabeeh ◽

K. S. Ravi ◽

S. Tikare ◽

...

Keyword(s):

Diode Laser ◽

Statistical Difference ◽

Clinical Effectiveness ◽

Patient Comfort ◽

Patient Acceptance ◽

P Value ◽

Laser Technique ◽

Gingival Bleeding ◽

Gingival Depigmentation

Excessive gingival pigmentation is a major aesthetic concern in modern society, though it is not a medical problem they consider it as a negative attribute. Patients with gingival hyperpigmentation usually complain and request cosmetic therapy, particularly if the pigmentation is visible during speaking and smiling. Various depigmentation methods, including burr abrasion, cryosurgery, electro-surgery, split thickness flap excision and surgical scraping techniques have been used with varying degrees of success. Recently, lasers have been used to ablate cells containing and producing the melanin pigment. The present study was undertaken to compare the clinical effectiveness and patient comfort of surgical scrapping and diode laser technique used for gingival depigmentation for a follow up period of 6 months.20 subjects participated in this split mouth study. The clinical evaluation parameters included Extent and Intensity of gingival hyperpigmentation, post-operative gingival bleeding and pain. On follow up examination at 6th month there was no statistical difference in repigmentation extent and intensity between diode laser and surgical scraping techniques. The mean pain scores for treated sites with diode laser were significantly lower than surgical scrapping technique at 24 hours (t-value=2.430, p-value=0.02). The postoperative gingival bleeding at end of procedure was significantly lower with diode laser than surgical scrapping technique (p-value=<0.0001). There was no statistical difference in postoperative re-pigmentation and clinical efficacy among the subjects between surgical scraping and diode laser technique at 6th month follow up. Diode laser technique provides better haemostasis and good visibility at the surgical site. The post-operative patient comfort is better at the surgical sites treated with diode laser than surgical scrapping method. Hence, both the techniques are used for depigmentation procedures depending on the severity and gingival biotype and patient acceptance.

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Adding stewed apricot juice to sena improves the right-side and overall colon cleansing quality for colonoscopy preparation

Functional Foods in Health and Disease ◽

10.31989/ffhd.v7i1.314 ◽

2017 ◽

Vol 7 (1) ◽

pp. 54

Author(s):

Bulent Yasar ◽

Evren Abut ◽

Huseyin Kayadibi ◽

Fatih Akdoğan ◽

Can Gonen

Keyword(s):

Adverse Events ◽

Patient Comfort ◽

Patient Acceptance ◽

Colonoscopic Examination ◽

Colon Cleansing ◽

Patient Tolerance ◽

Bowel Cleansing ◽

The Right ◽

Colonoscopy Preparation

Background: To achieve optimal colonoscopic examination, the bowel must be sufficiently cleansed. However, none of the currently available colonoscopy preparation regimens is safe, efficient and comfortable. The aim of this study was to determine whether adding stewed apricot juice to senna increased patient comfort and improved bowel cleansing during colonoscopy preparation.Methods: Outpatients of both genders, aged over 18 years, who were referred for elective colonoscopy were randomly allocated to drink stewed apricot juice with senna or senna alone. The quality of colon cleansing was evaluated using the Ottawa scale. The evaluation of patient tolerance and adverse events was made through completion of a questionnaire. Results: The study included a total of 128 patients in the randomization procedure. A significantly greater effect of cleansing was determined with stewed apricot juice plus senna in the right and transverse colon (p= 0.038, p=0.037, respectively). It was also determined that in the stewed apricot juice plus senna group, overall cleansing was superior (p<0.001), total colonoscopy (17.6 min vs 22.8 min, p=0.048) and cecal intubation (7.4 min vs 11.2 min, p=0.042) times were shorter, and the colonoscopy procedure was easier (79.4%vs 49.2%, p<0.001). No difference was determined between the groups in respect of patient acceptance, compliance and adverse events (p>0.05). In the stewed apricot juice plus senna group, 91.2% of patients stated willingness to receive the same regimen in the future compared with 80% of the patients in thesenna alone group (p=0.037).Conclusion: The addition of natural, stewed apricot juice to senna significantly improves cleansing outcomes without additional adverse events.Keywords: bowel cleansing, colonoscopy, stewed apricot juice, senna.

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Meaning of innovative technologies for improvement of results in treating burned patients

Medical alphabet ◽

10.33667/2078-5631-2020-13-44-47 ◽

2020 ◽

pp. 44-47

Author(s):

A. A. Alekseev ◽

A. E. Bobrovnikov ◽

V. V. Bogdanov

Keyword(s):

Clinical Practice ◽

Medical Care ◽

Clinical Effectiveness ◽

High Tech ◽

Comprehensive Treatment ◽

Case Histories ◽

Innovative Technologies ◽

Treatment Technologies ◽

Burn Disease ◽

Complications And Mortality

In order to include innovative technologies in clinical recommendations, confirmation of their clinical effectiveness in comprehensive treatment of burned patients is necessary. 1,696 case histories of patients with burns were audited, which are divided into two groups depending on peculiarities of treatment. The use of innovative treatment technologies for burned patients has reduced the incidence of burn disease complications and mortality. Introduction of innovative technologies in treating burned patients into broad clinical practice improves results of provision of specialized, high-tech medical care for victims of burns.

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Measuring Earwax Cortisol Concentration Using a Non-Stressful Method (Preprint)

10.2196/preprints.19383 ◽

2020 ◽

Author(s):

Andrés Herane-Vives

Keyword(s):

Cortisol Level ◽

Local Stress ◽

Extraction Methods ◽

Cortisol Concentration ◽

The Novel ◽

Sampling Device ◽

Related Factors ◽

Novel Device ◽

Cortisol Levels ◽

The Right

BACKGROUND “Short-term” samples are not the most appropriate for reflecting Chronic Cortisol Concentration (CCC). Although hair is used for reflecting the systemic cortisol level over “long-term”, its use appears clinically problematic. Local stress and non-stress related factors may release a circumscribed cortisol secretion that is accumulated in hair. Non-stressful earwax extraction methods may provide a more accurate specimen to measure CCC. OBJECTIVE Correlate cortisol levels using hair, serum and earwax samples METHODS Earwax from both ears of 37 controls were extracted using a clinical procedure commonly associated with local pain. One month later, earwax from the left ear side was extracted using the same procedure, and earwax from the right ear side was comfortably extracted, using an earwax self-sampling device. Participants also provided one centimetre of hair that represented the retrospective month of cortisol output, and one serum sample that reflected the effect of systemic stressors on cortisol levels. Earwax (ECC), Hair (HCC) and Serum (SCC) Cortisol Concentration were correlated and compared. Confounders´ effect on cortisol levels were studied. RESULTS Serum showed the largest and hair the lowest cortisol concentration (p<0.01). Left-ECC was larger than Right-ECC (p=0.03). Right-ECC was the only sample unaffected by confounders (all p>0.05). Right-ECC and HCC showed the only significant association (r=0.39; p=0.03). CONCLUSIONS The self-sampling device did not represent a local stressor for the ceruminous glands. It provided the cortisol level with the least likely to be affected by confounding factors over the previous month. ECC using the novel device may constitute another accurate, but more suitable and affordable specimen for measuring CCC.

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Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

Palliative Medicine ◽

10.1177/02692163211032114 ◽

2021 ◽

pp. 026921632110321

Author(s):

Florence Reedy ◽

Mark Pearson ◽

Sarah Greenley ◽

Joseph Clark ◽

David C Currow ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

A Priori ◽

Synthesis Method ◽

Patient Characteristics ◽

Severe Illness ◽

Pharmacological Interventions ◽

Eligibility Criteria ◽

Treatment Regimens ◽

Appraisal Tool

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

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The Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020834 ◽

2021 ◽

Vol 18 (2) ◽

pp. 834

Author(s):

Mike Armour ◽

Debra Betts ◽

Kate Roberts ◽

Susanne Armour ◽

Caroline A. Smith

Keyword(s):

Clinical Practice ◽

Women’S Health ◽

Women's Health ◽

Clinical Decision ◽

Health Conditions ◽

Case Histories ◽

Research Literacy ◽

The Right ◽

Practice Methods

Background: Surveys of acupuncture practitioners worldwide have shown an increase in the use of acupuncture to treat women’s health conditions over the last ten years. Published studies have explored the effectiveness of acupuncture for various conditions such as period pain, fertility, and labor induction. However, it is unclear what role, if any, peer-reviewed research plays in guiding practice. Methods: Acupuncturists with a significant women’s health caseload were interviewed online in three small groups to explore factors that contribute to acupuncturists’ clinical decision made around treatment approaches and research. Results: Eleven practitioners participated in the focus groups. The overarching theme that emerged was one of ‘Not mainstream but a stream.’ This captured two themes relating to acupuncture as a distinct practice: ‘working with what you’ve got’ as well as ‘finding the right lens’, illustrating practitioners’ perception of research needing to be more relevant to clinical practice. Conclusions: Acupuncture practitioners treating women’s health conditions reported a disconnect between their clinical practice and the design of clinical trials, predominantly due to what they perceived as a lack of individualization of treatment. Case histories were popular as a learning tool and could be used to support increasing research literacy.

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EUROPEAN PAEDIATRIC ONCOLOGY OFF-PATENT MEDICINES CONSORTIUM (EPOC): A PHARMACOKINETIC STUDY OF DOXORUBICIN IN CHILDREN WITH CANCER

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.14 ◽

2015 ◽

Vol 101 (1) ◽

pp. e1.6-e1

Author(s):

Miriam Krischke ◽

Alan V Boddy ◽

Georg Hempel ◽

Swantje Völler ◽

Nicolas André ◽

...

Keyword(s):

Pharmacokinetic Study ◽

Cardiac Troponin ◽

Troponin T ◽

Paediatric Oncology ◽

Patient Acceptance ◽

Pharmacokinetic Parameters ◽

Blood Levels ◽

Population Pharmacokinetic ◽

Older Children ◽

Treatment Regimens

BackgroundDoxorubicin is a key component of a number of treatment regimens used in paediatric oncology. The pharmacology data on which current dosing regimens are based are very limited.MethodsWe conducted a multicentre, multinational pharmacokinetic study investigating age-dependency in the clearance of doxorubicin in children with solid tumours and leukaemia. Blood samples for measurement of doxorubicin and its metabolite doxorubicinol were collected after 2 administrations, with 5 samples collected in children 3 yrs. A population pharmacokinetic approach was used for analysis, including pharmacogenetic covariates. NT-proBNP and cardiac troponin T were measured to evaluate their role as early indicators of cardiotoxicity.Results101 children could be recruited including 27 patients less than 3 years and among those 5 infants younger than 1 year. Overall, the patient acceptance of the trial was very good.Age dependence of doxorubicin clearance was demonstrated, with children less than 3 years having a lower clearance (21.1±5.8 l/h/m2) than older children (26.6±6.7 l/h/m2) (p=0.0004), after correcting for body weight. Pharmacogenetic variants, including those in transporters and drug metabolizing enzymes, had little influence on pharmacokinetic parameters.Natriuretic peptides plasma levels increased significantly shortly after doxorubicin administration, whereas cardiac troponin levels increased only with the administered cumulative anthracycline dose. Only limited correlation could be observed between their blood levels and doxorubicin pharmacokinetics.ConclusionThe paediatric need concerning missing PK-data could be addressed with limited burden for the patients. Empirically used dose adaptations for infants were found to be justified based on our PK analyses.

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