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Original paper Fizjoterapia / Physiotherapy 2016, 24 (2), 19–22 The impact of compression garments on the quality of life in patients with chronic venous disease DOI: 10.1515/physio-2016-0011 Iwona Demczyszak 1, Edyta Sutkowska 1, Magdalena Jasiak 2, Małgorzata Fortuna 3, Justyna Mazurek 1 1 Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland2 Department of Physiotherapy, Wroclaw Medical University, Poland3 Karkonosze College in Jelenia Góra, Poland AbstractIntroduction. Assessment of quality of life in patients suffering from chronic veno us disease of the lower extremity who were treated with compression garments. Methods. Patients of both sexes aged 30–75 years with chronic venous disease and at least varices, but without active ulceration, were qualified for the study. To assess the quality of life, the CIVIQ-20 questionnaire was used before and after 4 weeks of compression therapy with second class compre ssion. Results. The combined results of the CIVIQ scale rose from 61.49% before compres sion to 75.17% after 4 weeks of compression therapy (p 0.01). No correlation was found between sex, age, career status or type of work and the averaged CIVIQ score. Conclusions. Compression therapy with special garments significantly improves the quality of life in patients with chronic venous disease. Larger studies are still needed in this field. Key words: quality of life, compression therapy, chronic venous insufficiency Introduction Epidemiological studies carried out in Poland have indicated that chronic venous disease (CVD) affects 47% of women and 37% of men. The frequency of CVD occurrence increases with age, and in the 60–70-year-old cohort it rises even up to 60% [1, 2]. The disease has been known for 3500 years. As our knowl – edge about venous diseases has grown throughout ages, so did our understanding of their treatment. One of the CVD conservative treatment methods, compression therapy, was for the first time mentioned in the works of Hippocrates. In 1525, Ambroise Paré described, as an effective method for venous ulcer treatment, wrapping the distal part of the lower limb, from the foot to the knee. In 1676, Wiseman made first compression stockings out of leather. The next major step followed in 1854 in Vienna when Unna’s boot was applied to the treatment of venous insufficiency [3]. Currently, compres – sion therapy is considered the gold standard for prophylaxis and treatment of venous and lymphatic system diseases. CVD, because of its symptoms, not only impacts the pa – tient’s everyday functioning, but also constitutes a serious health and socio-economic hazard, as well as therapeutic challenge. The advancing course of the disease and chronic character of the treatment may significantly impact the pa- tients’ quality of life (QoL) [4, 5]. Data related to the QoL for patients using compression garments is scarce because the medical community has been concentrated only on the effec – tiveness of compression therapy (reduction of oedema or size of varices, healing of ulceration) for many years, not taking into account the patients’ perception or acceptance of the pro- posed therapy. Furthermore, lack of objective tools for QoL assessment put into question the usefulness of such analyses. Currently, specific questionnaires are applied to assess QoL, which investigate the most pertinent issues relating to everyday life, as well as consider symptoms characteristic of specific illnesses. Everyday functioning of the patient, their physical, social, and psychological conditions are all taken into account. Only this comprehensive assessment does reveal a full picture of the disease and its effects on QoL. The aim of our study was to evaluate the QoL of patients suf – fering from CVD of the lower limbs who were treated with com – pression garments. The hypothesis was put forward that the application of properly selected compression therapy signifi – cantly reduced pain, improved local symptoms, and, conse – quently, raised the QoL, despite the chronic nature of the therapy. Subjects and methods Patients of both sexes, without comorbidities which could in – fluence the perception of compression therapy (leg ischaemia, leg deformities, skin inflammation), aged 30–75 years, who during the specialist consultation (vascular medicine) were prescribed 2 nd class compression therapy because of the occurrence of at least varices (2C according to the clinical, aetiological, anatomical, and pathological [CEAP] classifi- cation) [6, 7] were qualified to the study. The exclusion criteria were venous disorders of a degree lower than 2C or active venous ulceration (6C according to Brought to you by | Lynchburg College/YBP Authenticated Download Date | 7/26/17 6:52 AM Iwona Demczyszak et al. Quality of life with venous diseaseFizjoterapia / Physiotherapy 2016, 24 (2) 20 CEAP). Patients with comorbidities which could influence the perception of compression therapy, such as leg ischaemia, leg deformities, or skin inflammation, were also excluded. Patients were recruited in the first quarter of 2014 in the Specialist Surgical Practice in Zgorzelec, Poland. All partici – pants were informed about the aim and regulations of the experiment and provided their written informed consent to participate. To assess the patients’ QoL, the Polish version of the Chronic Venous Insufficiency Questionnaire (CIVIQ-20) [8] was used. The evaluation carried out twice: before the com – pression therapy and four weeks after its implementation. The patients were instructed about the rules of the com- pression garments usage: every morning before they started their daily activity, with a break for the sleep period. They re – ceived a prescription for appropriate garments on the basis of the recorded results (morning circumference and length) of the limb measurement. All participants were also instructed about the possible benefit from physical activity, avoiding constipation, cool showers, as well as leg elevation. The CIVIQ-20 form consists of 20 questions relating to the patient’s subjective assessment of QoL, self-esteem, and health status during the disease. The questions describe the func- tioning and QoL of the patient in terms of perceived pain (ques – tions 1–4), physical acuity (questions 5–7, 9), social functioning (questions 8, 10, 11), and psychological condition (questions 12–20). According to the QoL research guidelines from 1996 [8], each of the 20 questions receives points on the Likert scale, ranging from 1 to 5. In the cases of blank answers to a question, the accepted value is 1, and when there are two answers, the higher value is accepted. An analogue scale (from 0 = worst to 100 = best) is used to assess the QoL, as well as self- esteem of the patient [9]. The acquired research data were analysed together with demographic information (age group, sex, career, sitting or standing work), which, in the researchers’ opinion, could sig – nificantly impact the results. The linear regression function was applied to assess the correlation between variables. The Pearson correlation co- efficient was used to indicate the correlation level. The chi- squared test was employed to analyse the hypothesis. The statistical significance was set at the value of p 0.01. The study was performed in accordance with the ethical standards of the Declaration of Helsinki. Results The total of 47 patients were recruited and then included in the study: 25 women and 22 men, aged 30–75 years. The average age was 54.4 years (52.3 years for women and 56.7 years for men). In the studied group, 51–60-year-olds formed the majority (Table 1). None of the recruited patients had contraindications to use compression therapy. During the physical examination, all of the patients presented varices and declared swelling after their daily activity (3C in the Cli – nical classification according to CEAP). All participants denied previous deep venous thrombosis (DVT) and the observed pathology was considered idiopathic by the surgeon (E P in Ethiology according to CEAP). There was no information in the subjects’ medical records about deep vein patency (no ultrasonographic assessment before the decision to apply compression therapy) as none of the patients presented signs or symptoms of DVT (A nPn according to CEAP). Compression therapy is routinely prescribed to patients with CVD despite the deep venous status and the pathophysiology of the ob- served disturbances. As far as their professional work is concerned, 46.8% of the participants were employed, 29.8% were retired, and 23.4% were unemployed. Additionally, the employed patients were further subdivided according to the work type (standing work, 54.5%; sitting work, 45.5%). The declared compliance (everyday usage of the garments) was 100%. The combined value of points achieved in the CIVIQ scale in the assessed group was 2890 points (61.49%) before the compression therapy and 3533 points (75.17%) after the treatment (p 0.01) (Table 2). No statistically significant correlations between sex, age, career status, or type of work and the averaged CIVIQ score were found (Table 3). Discussion Until now, studies about QoL in patients with venous insuf- ficiency have been carried out mostly among patients with advanced disease. The research [5, 10] proves that patients with CVD and chronic ulcerations are characterized by dis- turbed functioning in everyday life, not only owing to physical pain, but also social problems (e.g. maintaining employment), which significantly decreases their QoL. That is why the Eu- ropean Society for Vascular Surgery recommends QoL as- sessment as a routine practice for the purposes of evaluat- ing the total disease burden of the patient [11]. Prevention of the most advanced form of CVD, venous ulcer, is the basis for each patient care. Compression therapy reduces CVD symptoms through improving the function of the venous system and increasing the venous return; cur- rently, it forms the foundation of conservative therapy in this group of patients. Unfortunately, each degree of venous in – sufficiency (not only the most advanced ones) can become a cause of reduced QoL. In the case of small changes, i.e. spider veins, the problem is more cosmetic in nature but oede – ma or ulceration are more burdensome because of pain or social difficulties. Each of the mentioned changes may have a significant impact on the everyday life, as well as QoL of the patients, depending on their expectations. This also re- lates to the chronic nature of the treatment and its potentially cumbersome applications, such as the everyday usage of compression garments. Psychological problems are common in patients with CVD, most often taking the form of anxiety, depression, low self-esteem, and social exclusion [12]. These issues are often ignored during traditional therapeutic pro- cedures [13–15], whereas the full knowledge about the pa- tient and their attitude to the disease and to the proposed treatment has a tremendous influence on maintaining the patient’s compliance [10]. Table 1. Number of patients according to the age range Age range (years) Number of patients Women MenTotal 30–40 415 (10.6%) 41–50 639 (19.1%) 51–60 101121 (44.7%) 61–70 4610 (21.3%) > 70 112 (4.3%) Total 252247 (100%) Brought to you by | Lynchburg College/YBP Authenticated Download Date | 7/26/17 6:52 AM Iwona Demczyszak et al. Quality of life with venous disease Fizjoterapia / Physiotherapy 2016, 24 (2) 21 In this study, we observed that regular, properly performed short-term compression therapy significantly improved QoL in all its aspects in patients suffering from CVD. The level of QoL in patients with CVD of the lower limbs improved as a result of applying compression garments by 22.25% in all the assessed aspects of life. It was no surprise that the largest improvement was noted in terms of functioning and QoL with regard to pain (44.31%). Compression therapy with the use of compression gar- ments has an accepted position as an effective form of CVD therapy and forms the basis of conservative treatment for this disease. However, data in the literature are ambiguous. Staszkiewicz et al. [4], who assessed the effects of treatment on the improvement of QoL in patients with CVD of the lower limb, indicated that (besides pharmacological therapy) com – pression therapy significantly contributed to better QoL. Studies by Özdemir et al. [13] confirmed that even short-term (4-week) compression therapy might improve QoL, which was linked with the diminishment of ‘venous symptoms’. Charles [14] studied the effect of lower leg ulceration and compression therapy on the QoL of 65 patients by the use of the SF-36 ques – tionnaire. He confirmed that proper treatment of the venous ulcer with compression therapy significantly improved QoL in two groups of patients: with healed and with unhealed ul – cerations. However, there are also reports which do not seem as enthusiastic. Renner et al. [15] did not find a statistically significant improvement in QoL even in patients (treated with compression garments) who had healed ulcerations. They attributed the result to the numerous comorbidities in the studied group. Because of the limited and ambiguous nature of to-date studies, it is necessary to expand the subject research to a wider scale. In the current model of therapy, patients are en – couraged to actively participate in their treatment. Without analysing if the effect of therapy, as well as its form are accept – able to the patients and lead to improve their status and/or QoL, we cannot expect good compliance. At present, because of the lack of large scale clinical studies, smaller ones may have a significant contribution to the medical knowledge and may attempt to answer the question if the effective treatment pertains to every aspect of the patients’ lives. Limitation Owing to the small size of the treated group, the study should be considered a pilot one, possibly requiring corrections of several methodological aspects in the future. This refers to both the number of participants and the follow-up time. It can – not be ruled out that the necessity of everyday therapy appli – cation will have a negative effect on the results in a longer follow-up despite the objective decrease of CVD signs. As mentioned above, an improvement in the local or general status (in our study, the perception of pain), as well as poten – tial side effects of the therapy may play a significant role in the patients’ perception. Therefore, despite the objective improve – ment in the patients’ status, certainly being significant, the subjective QoL experience should not be disregarded. Table 2. CIVIQ values expressed in percentage of points before (A) and after (B) the compression therapy, according to the socio-demographic characteristics of the subjects Socio-demographic characteristics CIVIQ points (%) Median Standard deviation A B AB AB Total 61.4975.17 61757.45 7.24 Sex Women 61.4475.80 60758.21 7.52 Men 61.5574.45 6174.5 6.897.02 Age 30–40 68.2084.60 70865.07 8.81 41–50 61.6776.22 61757.47 5.58 51–60 61.4075.33 61756.80 5.87 61 –75 60.1071.90 62.572.58.877.14 Professional status Employed 62.6476.14 61.5 755.53 5.43 Unemployed 63.0979.09 61788.98 7.20 Retired 59.4370.57 56.570.58.687.78 Type of work Standing 62.5076.50 61766.11 6.46 Sitting 62.8075.70 62.5 745.05 4.21 CIVIQ – Chronic Venous Insufficiency Questionnaire Table 3. Correlation and linear regression function for CIVIQ according to the socio-demographic variables Socio-demographic characteristics Correlation r xy Linear regressiony = ax + b Sex Women 0.89y = 0.82x + 21.41 Men 0.94y = 0.96x + 15.12 Age 30–40 0.85y = 0.68x + 37.89 41–50 0.88y = 0.66x + 35.48 51–60 0.93y = 0.81x + 25.87 61–75 0.95y = 0.77x + 25.77 Professional status Employed 0.86y = 0.85x + 22.88 Unemployed 0.95y = 0.76x + 30.86 Retired 0.95y = 0.88x + 20.78 Type of work Standing 0.93y = 0.99x + 14.76 Sitting 0.73y = 0.88x – 3.59 CIVIQ – Chronic Venous Insufficiency Questionnaire Brought to you by | Lynchburg College/YBP Authenticated Download Date | 7/26/17 6:52 AM Iwona Demczyszak et al. Quality of life with venous diseaseFizjoterapia / Physiotherapy 2016, 24 (2) 22References 1. Żmudzińska M, Czarnecka-Operacz M. Chronic venous insufficiency – current knowledge. Part II – prophylaxis, conservative treatment [in Polish]. Post Dermatol Aler- gol. 2005;5:239–243. 2. Krasiński Z, Aniukiewicz K, Krasińska A, Czyżak W. Chronic venous insufficiency – epidemiology and pharma – cological treatment [in Polish]. Prz Flebol. 2014;22:1–16. 3. Durakiewicz M. Historic milestones in the management of lower limb varicose veins. Acta Angiol. 2008;14(4): 159–172. 4. Staszkiewicz W, Raciborski W, Słowiński P, Dąbek P. Change in the quality of life in patients with chronic venous disease after 8 weeks of treatment with Diosminex [in Polish]. Chir Pol. 2011;13(1):5–10. 5. Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fro- nek A. Quality of life in patients with chronic venous dis – ease: San Diego population study. J Vasc Surg. 2003; 37(5):1047–1053; doi: 10.1067/mva.2003.168. 6. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Glo – viczki P, Kistner RL, et al. Revision of the CEAP classifi- cation for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248–1252; doi: 10.1016/j. jvs.2004.09.027. 7. Rabe E, Pannier F. Clinical, aetiological, anatomical and pathological classification (CEAP): gold standard and limits. Phlebology. 2012;27(Suppl. 1):114–118; doi: 10.1258/ phleb.2012.012S19. 8. Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996; 5(6):539–554. 9. Biemans AA, van der Velden SK, Bruijninckx CM, Buth J, Nijsten T. Validation of the chronic venous insufficiency quality of life questionnaire in Dutch patients treated for varicose veins. Eur J Vasc Endovasc Surg. 2011;42(2): 246–253; doi: 10.1016/j.ejvs.2011.04.007. 10. Koupidis SA, Paraskevas KI, Stathopoulos V, Mikhaili- dis DP. The impact of lower extremity venous ulcers due to chronic venous insufficiency on quality of life. Open Cardiovasc Med J. 2008;2:105–109; doi: 10.2174/187 4192400802010105. 11. Wittens C, Davies AH, Bækgaard N, Broholm R, Ca- vezzi A, Chastanet S, et al. Editor’s choice – management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737; doi: 10.1016/j.ejvs.2015.02.007. 12. Sritharan K, Lane TR, Davies AH. The burden of depres – sion in patients with symptomatic varicose veins. Eur J Vasc Endovasc Surg. 2012;43(4):480–484; doi: 10.1016/ j.ejvs.2012.01.008. 13. Özdemir ÖC, Sevim S, Duygu E, Tuğral A, Bakar Y. The effects of short-term use of compression stockings on health related quality of life in patients with chronic venous insufficiency. J Phys Ther Sci. 2016;28(7):1988–1992; doi: 10.1589/jpts.28.1988. 14. Charles H. Does leg ulcer treatment improve patients’ quality of life? J Wound Care. 2004;13(6):209–213; doi: 10.12968/jowc.2004.13.6.26670. 15. Renner R, Gebhardt C, Simon JC, Seikowski K. Changes in quality of life for patients with chronic venous insuf- ficiency, present or healed leg ulcers. J Dtsch Dermatol Ges. 2009;7(11):953–961; doi: 10.1111/j.1610-0387.2009. 07082.x. Received: 02.04.2017 Revised: 20.05.2017 Accepted: 29.05.2017 Address for correspondence Iwona Demczyszak Department and Division of Medical Rehabilitation Wroclaw Medical University ul. Borowska 213 50-556 Wrocław, Poland e-mail: [email protected] Conclusions Compression therapy with special garments significantly im – proves QoL in patients with CVD. Larger studies are needed to support the results. Conflict of interest statement: Authors state no conflict of interest. Brought to you by | Lynchburg College/YBP Authenticated Download Date | 7/26/17 6:52 AM Copyright ofPhysiotherapy /Fizjoterapia isthe property ofPhysiotherapy anditscontent may notbecopied oremailed tomultiple sitesorposted toalistserv without thecopyright holder’s expresswrittenpermission. However,usersmayprint, download, oremail articles for individual use.
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In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Use the practice problem and a quantitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment. Practice Problem: In Elderly patients ages 65 and older, with venous stasis, how effective are compression devises such as compression socks, versus compression wraps such as Unna boot therapy, 2 way or 3-way compression, to combat against venous stasis leading to lower extremity edema, wounds, Deep vein thrombosis and infection and work for patients comfort and functionality. Peer reviewed Article: Demczyszak, I., Sutkowska, E., Jasiak, M., Fortuna, M., & Mazurek, J. (2017). The impact of compression garments on the quality of life in patients with chronic venous disease. Physiotherapy / Fizjoterapia, 24(2), 19–22. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=124301098&site=eds-live&scope=site
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Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below. PICOT Statement  Revise the PICOT statement you wrote in the Topic 1 assignment. The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). Research Critiques In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions. The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement. Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper. Proposed Evidence-Based Practice Change Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Please see attached paper from the first essay I wrote to help complete this paper, the research critique guidelines is also attached
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Running head: Picot Statement with resources 0 Nursing research: PICOT statement with resources Molly F. Keller Grand Canyon University NRS-433V-0504 Professor Cherryl Llanos February 24, 2019 Nursing research: PICOT statement with resources PICOT statement and Question In Elderly patients ages 65 and older, with venous stasis, how effective are compression devises such as compression socks, versus compression wraps such as Unna boot therapy, 2 way or 3-way compression, to combat against venous stasis leading to lower extremity edema, wounds, Deep vein thrombosis and infection and work for patients comfort and functionality. Venous stasis Venous stasis effects millions of people every year. The older we get combined with medical problems many face, add to decreased blood flow and leave patients with decreased circulation. This leads to edema in the lower extremities, leaving patients uncomfortable, vulnerable to venous stasis ulcers, deep vein thrombosis and infection. Through compression therapy patients can find relief by increasing the movement of fluid out of the lower extremities, decrease their risk of developing a DVT, and lower their risk for ulcers and infections. Comfort and function There are multiple styles and forms of compression therapy in use today. Elderly patients often find applying compression socks hard to do but find other compression methods such as compression wraps uncomfortable. Others prefer one over the other, while some are not able to afford one compression system over another. In this you also have to account for providers preferring one compression over another. The question is which compression do patients tolerate better, which compression works the best, and is there a happy medium providers can use to achieve a worthy result. One of the main concerns I have are what system with work for a patient to use daily and be functional within their lives. References Resource: Onuigbo, M. A. C. (2010). Bilateral Lower Extremity Sequential Compression Devices (SCDs): A Novel Approach to the Management of Intra-Dialytic Hypotension in the Outpatient Setting—Report of a Case Series. Renal Failure, 32(1), 32–35. https://doi-org.lopes.idm.oclc.org/10.3109/08860220903367478 Abstract: Aim Intra-dialytic hypotension (IDH) affects as many as 15–50% of patients during hemodialysis. Several treatment approaches and preventative methods are available. These therapeutic options are often ineffective and cumbersome, and some of the causative factors such as poor cardiac reserve is commonly not amenable to any therapy. Background/Method Enhanced external counter pulsation (EECP) is increasingly being utilized by cardiology services as an adjunct to the long-term management of chronic congestive heart failure as well as in the management of otherwise refractory angina. EECP works by mechanistically improving venous return, enhancing peripheral resistance, and ultimately improving the cardiac index. We speculated that bilateral lower extremity sequential compression devices (SCDs), commonly used in the inpatient setting for DVT prophylaxis, could indeed serve as mini-EECP devices. Method We carried out an outpatient pilot study of its use to prevent IDH in three patients who otherwise had failed other treatment approaches. The SCDs were effective, convenient, and safe. Results We were able to achieve ultrafiltration (UF) goals of 1–3 kg during hemodialysis sessions in all three patients, consistently, for months, a feat that was not possible previously. Conclusion This novel modality of managing IDH is complementary to other standard therapies. Larger multi-center studies are warranted. [ABSTRACT FROM AUTHOR]   Copyright of Renal Failure is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) Resource: Wu, S. C., Crews, R. T., Skratsky, M., Overstreet, J., Yalla, S. V., Winder, M., … Andersen, C. A. (2017). Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks. Diabetes Research and Clinical Practice, 127, 35–43. https://doi-org.lopes.idm.oclc.org/10.1016/j.diabres.2017.02.025 Abstract: Aim Mild compression may be effectively and safely used in diabetes patients with LE edema.•Mild-compression diabetic socks significantly decreased calf and ankle circumferences.•Lower extremity circulation well maintained throughout the study.   Background Persons with diabetes frequently present with lower extremity (LE) edema; however, compression therapy is generally avoided for fear of compromising arterial circulation in a population with a high prevalence of peripheral arterial disease. This double blind randomized controlled trial (RCT) assessed whether diabetic socks with mild compression could reduce LE edema in patients with diabetes without negatively impacting vascularity.   Method Eighty subjects with LE edema and diabetes were randomized to receive either mild-compression knee high diabetic socks (18–25mmHg) or non-compression knee high diabetic socks. Subjects were instructed to wear the socks during all waking hours. Follow-up visits occurred weekly for four consecutive weeks. Edema was quantified through midfoot, ankle, and calf circumferences and cutaneous fluid measurements. Vascular status was tracked via ankle brachial index (ABI), toe brachial index (TBI), and skin perfusion pressure (SPP).   Results Seventy-seven subjects (39 controls and 38 mild-compression subjects) successfully completed the study. No statistical differences between the two groups in terms of age, body mass index, gender, and ethnicity. Repeated measures analysis of variance and Sidak corrections for multiple comparisons were used for data analyses. Subjects randomized to mild-compression diabetic socks demonstrated significant decreases in calf and ankle circumferences at the end of treatment as compared to baseline. LE circulation did not diminish throughout the study with no significant decreases in ABI, TBI or SPP for either group.   Conclusion Results of this RCT suggest that mild compression diabetic socks may be effectively and safely used in patients with diabetes and LE edema Resource: Eze, A. R., Comerota, A. J., Cisek, P. L., Holland, B. S., Kerr, R. P., Veeramasuneni, R., & Comerota, J. A. J. (1996). Intermittent calf and foot compression increase lower extremity blood flow. The American Journal of Surgery, 172, 130–135. https://doi-org.lopes.idm.oclc.org/10.1016/S0002-9610(96)00134-1 Abstract: Aim Purpose Although foot compression increases foot skin perfusion and calf compression increases popliteal artery blood flow, these compression techniques have not been evaluated in combination. Background The purpose of this study was to evaluate whether calf and foot compression applied separately and simultaneously increase popliteal artery blood flow and/or foot skin perfusion, and to assess the relative merits of compression in patients with superficial femoral artery occlusion. Method Twenty-two legs from 12 normal volunteers with ankle/brachial indices (ABIs) > 0.96, and 10 legs from 7 claudicator patients with angiographically documented superficial femoral artery (SFA) occlusion and patent popliteal arteries with ABIs <0.8 were studied in the sitting position. Calf and foot cuffs connected to a rapidly inflating and deflating timed-pressure pump (Art-Assist-AA 1000; ACI Medical Inc., San Marcos, California) were applied to the subject in the sitting position. Skin blood flow of the great toe was measured with a laser doppler (Laserflo model BPM 403A; TSI Inc., St. Paul, Minnesota), and popliteal artery blood flow was measured using duplex ultrasonography (ATL-Ultramark 9; Advanced Tech Laboratory, Bothell, Washington). Foot and calf compression was applied separately and simultaneously at 120 mm Hg pressure, with a 10-second inflation and 20-second deflation cycle. Popliteal artery blood flow and foot skin perfusion were recorded and the mean of 6 cycles calculated. Results Precompression popliteal artery blood flow (mL/min) for volunteers was 38.86±3.94, and for patients was 86.30±14.55 (P=0.001). Precompression foot skin perfusion (mL/min/ 100/g tissue) for volunteers was 1.67±0.29, and for patients was 4.00±0.92 (P= 0.01). With the application of calf, foot, and simultaneous calf and foot compression, the popliteal artery blood flow increased in volunteers by 124%, 54%, and 173%, respectively, and in patients by 76%, 13%, and 50%. Foot skin perfusion increased in volunteers by 260%, 500%, and 328%, respectively, and in patients by 116%, 246%, and 188%. Relative increases in popliteal artery blood flow and foot skin perfusion were higher in volunteers compared with patients during compression; however, the absolute values for foot skin perfusion and popliteal artery blood flow were consistently higher in patients. Conclusion Measured in the sitting position, the resting popliteal artery blood flow and foot skin perfusion are greater in patients with SFA occlusion compared with normal volunteers. Following compression, popliteal artery blood flow and foot skin perfusion increased in both groups, but relatively more in volunteers. Increases in popliteal artery blood flow are significantly higher with calf compression than with foot compression for both groups. A patent SFA allows for additive increases in popliteal artery blood flow with simultaneous foot and calf compression in normal persons, whereas this is not observed in patients. However, the increases in foot skin perfusion in patients with an occluded SFA parallel the increases shown in normal volunteers, with separate and simultaneous foot and calf compression Resource: Demczyszak, I., Sutkowska, E., Jasiak, M., Fortuna, M., & Mazurek, J. (2017). The impact of compression garments on the quality of life in patients with chronic venous disease. Physiotherapy / Fizjoterapia, 24(2), 19–22. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=124301098&site=eds-live&scope=site Abstract: Aim Introduction. Assessment of quality of life in patients suffering from chronic venous disease of the lower extremity who were treated with compression garments. Background/Method Patients of both sexes aged 30-75 years with chronic venous disease and at least varices, but without active ulceration, were qualified for the study. To assess the quality of life, the CIVIQ-20 questionnaire was used before and after 4 weeks of compression therapy with second class compression. Results The combined results of the CIVIQ scale rose from 61.49% before compression to 75.17% after 4 weeks of compression therapy (p 0.01). No correlation was found between sex, age, career status or type of work and the averaged CIVIQ score. Conclusion Compression therapy with special garments significantly improves the quality of life in patients with chronic venous disease. Larger studies are still needed in this field. ABSTRACT FROM AUTHOR Resource: Wu, S. C., Crews, R. T., Skratsky, M., Overstreet, J., Yalla, S. V., Winder, M., … Andersen, C. A. (2017). Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks. Diabetes Research & Clinical Practice, 127, 35–43. https://doi-org.lopes.idm.oclc.org/10.1016/j.diabres.2017.02.025 Abstract: Aim Persons with diabetes frequently present with lower extremity (LE) edema; however, compression therapy is generally avoided for fear of compromising arterial circulation in a population with a high prevalence of peripheral arterial disease. Background This double blind randomized controlled trial (RCT) assessed whether diabetic socks with mild compression could reduce LE edema in patients with diabetes without negatively impacting vascularity.Methods: Eighty subjects with LE edema and diabetes were randomized to receive either mild-compression knee high diabetic socks (18-25mmHg) or non-compression knee high diabetic socks. Method Subjects were instructed to wear the socks during all waking hours. Follow-up visits occurred weekly for four consecutive weeks. Edema was quantified through midfoot, ankle, and calf circumferences and cutaneous fluid measurements. Vascular status was tracked via ankle brachial index (ABI), toe brachial index (TBI), and skin perfusion pressure (SPP). Results Seventy-seven subjects (39 controls and 38 mild-compression subjects) successfully completed the study. No statistical differences between the two groups in terms of age, body mass index, gender, and ethnicity. Repeated measures analysis of variance and Sidak corrections for multiple comparisons were used for data analyses. Subjects randomized to mild-compression diabetic socks demonstrated significant decreases in calf and ankle circumferences at the end of treatment as compared to baseline. LE circulation did not diminish throughout the study with no significant decreases in ABI, TBI or SPP for either group. Conclusion Results of this RCT suggest that mild compression diabetic socks may be effectively and safely used in patients with diabetes and LE edema. Resource: de Lima, E. L., SalomÃ, , G. M., de Brito Rocha, M. J. A., & Ferreira, L. M. (2013). The impact of compression therapy with Unna’s boot on the functional status of VLU patients…Venous Leg Ulcer. Journal of Wound Care, 22(10), 558–561. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104146416&site=eds-live&scope=site Abstract: Aim Objective: To assess disability in patients with venous leg ulcers treated with compression therapy with Unna’s boot. Background/Method A descriptive analytic case control study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in interior Brazil. Fifty patients of both sexes, aged 18 years or above, who had had a venous leg ulcer for more than 1 year and a Doppler ankle-brachial index of 0.8-1.0 were selected for the study. Patients were treated with wound dressings and Unna’s boot. Disability was assessed using the 20-item Stanford Health Assessment Disability Scale (HAQ-20). Statistical analysis was performed using the Student’s t-test, the Kruskal-Wallis test and the chi-square test of independence, all at a significance level of 0.05 (p<0.05). Results The mean overall HAQ score at inclusion (baseline) was 2.98, indicating impaired functional capacity. After 8 and 12 months of compression treatment with Unna’s boot, the mean overall HAQ scores were 1.35 and 1.0, respectively, indicating good functional capacity. Conclusion Patients with venous leg ulcer reported severe difficulty or serious disability in their daily functioning at baseline; after 8 months of treatment with Unna’s boot, these patients were able to perform activities of daily living. Resource: Salome, G. M., de Brito, M. J. A., & Ferreira, L. M. (2014). Impact of compression therapy using Unna’s boot on the self-esteem of patients with venous leg ulcers. Journal of Wound Care, 23(9), 442–446. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103916638&site=eds-live&scope=site Abstract: Aim To assess self-esteem in patients with venous leg ulcers treated with Unna’s boot. Background/Method A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8–1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna’s boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna’s boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. Results The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score= 24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna’s boot. Conclusion Patients with venous leg ulcers treated with Unna’s boot for 12 months showed a significant improvement in self-esteem. Resource: Schonfeld WH, Villa KF, Fastenau JM, Mazonson PD, & Falanga V. (2000). An economic assessment of APLIGRAF (Graftskin) for the treatment of hard-to-heal venous leg ulcers. Wound Repair & Regeneration, 8(4), 251–257. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106991999&site=eds-live&scope=site Abstract: Aim Several recent advances in wound care may offer promise for the treatment of hard-to-heal venous leg ulcers. One such treatment is Apligraf (Graftskin), a bilayered, living human skin construct. Background To assess the economic impact of Graftskin, a model was constructed to compare the annual medical costs and cost-effectiveness of treating hard-to-heal venous leg ulcers with Graftskin vs. compression therapy using Unna’s boot. A semi-Markov model was used to describe the pattern of ulcer treatment, healing, and recurrence among patients with venous leg ulcers. Method Patients received 1 of 2 treatment regimens, Graftskin or Unna’s boot, and were followed in the model for a 12-month period. The analysis was done from the perspective of a commercial health plan; therefore, only direct medical costs were included. Health care resource use included the primary therapeutic intervention, additional compression dressings, physician office visits, home health visits, laboratory tests and procedures, management of adverse events, and hospitalizations. Results The model estimated the annual medical cost of managing patients with hard-to-heal venous leg ulcers to be $20,041 for those treated with Graftskin and $27,493 for those treated with Unna’s boot. In addition, treatment with Graftskin led to approximately 3 more months in the healed state per person per year than did treatment with Unna’s boot. Because patients treated with Graftskin experienced improved healing compared with those treated with compression therapy using Unna’s boot, they required fewer months of treatment for unhealed ulcers. Conclusion As a result, the use of Graftskin for treating hard-to-heal venous leg ulcers resulted in lower overall treatment costs. Resource: Mullins, M., Bock, K., & Bhatia, A. (2017). Extremit-Ease compression garment: A review and cases. British Journal of Community Nursing, 22, S41–S47. https://doi-org.lopes.idm.oclc.org/10.12968/bjcn.2017.22.Sup12.S41 Abstract: Aim The rates of chronic oedema in the US continue to grow from multiple causative factors. One such factor is the skyrocketing rates of morbid obesity. Background There are about 40 million obese people in the US today. Among those people, the prevalence rate of lymphoedema is 74% (Fife and Carter, 2008). Method Treatment usually involves some type of compression for life, but that is easier said than done. Results Many patients with chronic oedema have dexterity issues or have limited abilities to put on tight compression options. This article explores a product that has just been recently launched on the market: the Extremit-Ease® compression garment. Conclusion This article also looks at five case studies involving the product to evaluate its effectiveness in the treatment of this growing condition. We explore the increasing problem of chronic oedema, specifically oedema caused by lymphoedema and venous stasis, and how Extremit-Ease compression garments could assist patient compliance with the gold standard treatment Resource: Macintyre, L., Kent, K., & McPhee, D. (2013). Do anti-embolism stockings fit our legs? Leg survey and data analysis. International Journal of Nursing Studies, 50(7), 914–923. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2013.01.005 Abstract: Aim Anti-embolism stockings are commonly used worldwide to prevent the development of thrombosis in hospitalised patients. Patients are typically measured for, and fitted with, anti-embolism stockings during extended periods of non-ambulation. Anti-embolism stockings must critically fit the leg to achieve optimum blood flow and thus success of prophylaxis. Therefore, hospitals endeavour to maintain stock of antiembolism stockings that fit the majority of their patients. background The objective of this study was to establish whether popular styles/brands of anti-embolism stockings ”fitted” the legs of convenience sampled volunteers. Method Volunteer’s legs were measured at ankle, calf and thigh following guidance from British nurses and in accordance with brand instructions. Leg measurements were subsequently compared to the size charts of 10 anti-embolism stocking styles made by 4 different manufacturers. ”Fit” is defined as a volunteer’s leg measurements matching any stocking size in a range at all measurement points. Settings: Volunteers were measured in different settings around Scotland, including private homes, work places and shopping centres. Participants: A convenience sample of 471 volunteers (283 female, 188 male) were recruited on the basis of willingness to participate and being over 16 years old. Volunteers ranged from 17 years to 82 years old with an average age of 35. Results The 10 different styles of anti-embolism stockings, made by 4 different brands, examined for this paper had a size match coefficient ranging from 0% to 100% for our volunteer’s legs. The size match coefficient is strongly influenced by the Brand’s sizing policy. Conclusion The proportion of legs that ”fit” a particular brand of anti-embolism stockings can be increased through: (1) the reduction of the number of leg measurement points that need to be matched to the size chart of the stockings; (2) the use of open-ended size ranges; (3) the use of increased size range width and (4) the use of increased overlap between sizes. However, all but the last of these measures can have a potentially deleterious impact on the ability of the stocking to deliver the optimum graduated pressure profile to all legs that ”fit” the stocking, resulting in important implications to the efficacy of prophylaxis. Resource: Cooper, K. L. (2011). Care of the Lower Extremities in Patients With Acute Decompensated Heart Failure. Critical Care Nurse, 31(4), 21–29. https://doi-org.lopes.idm.oclc.org/10.4037/ccn2011337 Abstract: Aim Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Background Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. Method Nursing care is based on available evidence, findings on chest radiographs, and hemodynamic status. Medications that contribute to peripheral edema should be evaluated and discontinued if possible. Result An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient’s lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Conclusion Multilayer compression wraps should be avoided until the patient’s hemodynamic status is stable and the patient can get out of bed. Resource: Vesna Karanikolic, Aleksandar Karanikolic, Dejan Petrovic, & Milenko Stanojevic. (2015). Prognostic factors related to delayed healing of venous leg ulcer treated with compression therapy. Zhōnghuá Pífūkē Yīxué Zázhì, Vol 33, Iss 4, Pp 206-209 (2015), (4), 206. https://doi-org.lopes.idm.oclc.org/10.1016/j.dsi.2015.04.005 Abstract: Aims The basic goal of this research was to determine and evaluate the prognostic factors related to the delay of venous ulcer healing in patients treated with multilayer compression bandage. Background The research involved a group of 100 patients of both sexes with venous ulcerations of the lower extremities. Method Patients were monitored for 24 weeks from the very beginning of the treatment. Ulcerations were treated with the use of multiple layer compression bandages. Results: Of the total number of tested patients, 58 (58%) were females and 42 (42%) were males. The average age of patients was 62.7 ± 6.53 years, where the male population was older. Results During the 24-week monitoring period, 25 patients (25%) did not heal completely. Lipodermosclerosis has a significant positive prognostic significance in healing chronic venous ulcers (p < 0.05). The infection proved to be the most important prognostic factor in the delay of ulcer healing (p < 0.01). The number and surface of ulcerative changes show a significant positive correlation with delay of venous ulcer healing (p < 0.001). Conclusion The results of this study show a significant positive correlation between the number and surface of ulcerative changes and the delay of venous ulcer healing. Further trials are necessary to identify the best treatment options, especially for nonhealing ulcers.
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Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. Were the purpose and research questions related to the problem? Method of Study: Were qualitative methods appropriate to answer the research questions? Did the author identify a specific perspective from which the study was developed? If so, what was it? Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. Did the author evaluate or indicate the weaknesses of the available studies? Did the literature review include adequate information to build a logical argument? When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study What were the study findings? What are the implications to nursing? Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations Was the study approved by an Institutional Review Board? Was patient privacy protected? Were there ethical considerations regarding the treatment or lack of? Conclusion Emphasize the importance and congruity of the thesis statement. Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. Integrate a summary of the knowledge learned.

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