Les bandes de compression, couramment utilisées pour le traitement de l’insuffisance veineuse, appliquent une pression sur la jambe, appelée pression d’interface, qui est le principe actif du traitement. L'objectif était de mieux comprendre les mécanismes influençant la pression exercée par une bande de compression sur le membre inférieur.En lien avec des médecins et un industriel, l’approche biomécanique proposée était composée d’une part expérimentale (mesures de pression d'interface) et d'une part numérique (modélisation éléments-finis de la pose d'une bande). Deux études préliminaires, expérimentale et numérique, ont montré la limite de l'utilisation de la Loi de Laplace (standard actuel) pour le calcul des pressions d’interface. Ces études ont soulevé des interrogations concernant l'éventuel impact des propriétés de surface des bandes (coefficient de frottement bande-bande) sur la pression. Elles ont aussi montré l’importance des déformations des tissus mous de la jambe induite par l'application de la bande. Deux méthodes de caractérisation mécanique ont donc été mises en place pour l’identification personnalisée des propriétés mécaniques des tissus mous de la jambe et la mesure du coefficient de frottement bande-bande.Un nouvel outil de prédiction des pressions d’interface a été développé grâce à la combinaison de la simulation numérique de la pose d’une bande et de la paramétrisation géométrique de la jambe puis il a été confronté aux mesures expérimentales.Finalement, une étude clinique a été réalisée pour étudier la pression exercée par la superposition de deux bandes de compression (pratique clinique très courante pour le traitement de l'ulcère veineux). / Compression bandages are commonly used for the treatment of chronic venous insufficiency. They apply a pressure onto the leg, called interface pressure, which is one of the key aspects of the treatment. The objective was to better understand the mechanisms impacting interface pressure applied by compression bandage on the lower leg. In collaboration with clinicians and a medical devices manufacturer, a biomechanical approach was proposed. This approach was composed of experimental pressure measurements and the numerical simulation of bandage application. Two preliminary studies, experimental and numerical, showed the limitations of the use of Laplace’s Law (current standard) for interface pressure computation. These studies also questioned the possible impact of bandage surface properties (bandage-to-bandage friction coefficient) on interface pressure. They also showed the need to consider soft tissues deformation induced by bandage application. Two characterization methods were designed for the identification of patient-specific soft tissue mechanical properties and the measurement of bandage-to-bandage friction coefficient. A new methodology for the prediction of interface pressure was developed thanks to the combination of the numerical simulation of bandage application and the leg geometry parametrization. The results were then confronted to experimental measurements. Finally, a clinical study was designed to investigate the pressure applied by superimposed compression bandages (very common in clinical practice for the treatment of venous ulcers).

This study investigated possible solutions to the current wartime problem of junctional hemorrhaging, or massive traumatic hemorrhaging in non-tourinquetable areas such as the neck, groin, or armpit. Junctional hemorrhaging has been identified as a major contributor to potentially survivable deaths seen on the battlefield today and therefore is a priority for the U.S. armed and coalition forces (Kragh et al., 2011a; Bozeman, 2011). Common tourniquets today are standard issue and carried by soldiers in the military, but are limited to distal extremity trauma. As the battlefield has changes however, trauma has transformed from commonly seen gunshot wounds to more extreme trauma such as dismounted complex blast injuries which typically includes loss of one or more appendages. These newly found situations render the traditional tourniquet ineffective. Thus, the development of a new tourniquet to control hemorrhaging from regions such as the neck, armpit, and groin has been deemed necessary. The development of a new tourniquet for hemorrhage control included market research, preliminary testing to determine design restraints, design ideation, finite element analysis, manufacturing a prototype, and prototype testing. Research and comparisons were done of the strengths and weaknesses of tourniquets already approved by the Food and Drug Administration (FDA). Next, design limitations were found using preliminary testing on a blood-flow replicate model developed by Tracey Cheung. The results from this testing provided a framework for designing a new tourniquet. A new approach to control junction hemorrhaging was then designed, built, and tested on the Cheung model. To verify the design, simplified models were analyzed using finite element analysis. The prototype was then tested and compared against the FDA approved tourniquets, listing the advantages and possible shortcomings.

To estimate the resource costs of providing wound care for the 488,000 catchment population of the Bradford and Airedale primary care trust (PCT). METHOD: A wound survey was carried out over a one-week period in March 2007 covering three hospitals in two acute trusts, district nurses, nursing homes and residential homes within the geographical area defined by the PCT. The survey included information on the frequency of dressing change, treatment time and district nurse travel time. The resource costs of wound care in the PCT were estimated by combining this information with representative costs for the UK National Health Service and information on dressing spend. RESULTS: Prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. Of these, 11.6% were pressure ulcers, of which 66% were hospital-acquired. The attributable cost of wound care in 2006-2007 was pounds 9.89 million: pounds 2.03 million per 100,000 population and 1.44% of the local health-care budget. Costs included pounds 1.69 million spending on dressings, 45.4 full-time nurses (valued at pounds 3.076 million) and 60-61 acute hospital beds (valued at pounds 5.13 million). CONCLUSION: The cost of wound care is significant. The most important components are the costs of wound-related hospitalisation and the opportunity cost of nurse time. The 32% of patients treated in hospital accounted for 63% of total costs. Putting in place care pathways to avoid hospitalisation and avoiding the development of hospital-acquired pressure ulcers and other wound complications are important ways to reduce costs. DECLARATION OF INTEREST: John Posnett is an employee of Smith & Nephew.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Headaches are one of the most common clinical conditions in medicine, and 80% of these are tension-type headaches (TTH). TTH has a greater socioeconomic impact than any other type of headache due to its prevalence. Within the TTH category, episodic TTH are more prevalent than chronic TTH. The mainstay in the treatment of TTH are simple analgesics and NSAIDs. Unless contraindicated, NSAIDs are often the most effective treatment for ETTH. However patients suffering with TTH tend to relate their headaches to increased muscle stiffness in the neck and shoulders and thus the non-pharmacological treatment of ETTH could be directed at the associated musculoskeletal components of ETTH. It is therefore proposed that the Kinesio Taping® Method may have an effect in the treatment of the muscular component of ETTH. Method: This study was a prospective randomised clinical trial with two intervention groups (n=16) aimed at determining the relative effectiveness of a NSAID and the Kinesio Taping® Method in the treatment of ETTHs. The patients were treated at 5 consultations over a 3 week period. Feedback was obtained using the: NRS – 101, the CMCC Neck Disability Index and a Headache Diary. Results: The Headache Diary showed a reduction in the presence and number, mean duration and pain intensity of ETTH in both groups. These treatment effects were sustained after the cessation of treatment with the exception of mean pain intensity in the Kinesio Taping® Method group. The mean NRS score decreased in both groups but at a slightly faster rate in the Kinesio Taping® Method group. The CMCC showed an improvement in the functional ability of the patients in both groups. Conclusion: There seems to be no significant difference in the relative effectiveness of the treatment modalities. We can thus state that the overall short-term reduction in symptomatology supports the use of NSAIDs or Kinesio Taping® Method in the treatment of ETTH.

Made available in DSpace on 2015-07-22T20:50:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25 / Introdução: o cuidado com a ferida operatória é controverso na literatura, com recomendações diversas, desde não se colocar curativo, mantê-lo por 24 a 48h, ou mantê-lo até a retirada das suturas. Objetivo: Avaliar a influência do tempo de permanência do curativo após mamoplastia redutora na colonização cutânea, na infecção da ferida operatória e na opinião das pacientes. Métodos: 70 pacientes com indicação para mamoplastia redutora foram distribuídas aleatoriamente em dois grupos. No grupo PO1 o curativo foi retirado no 1o dia pós-operatório e no grupo PO6 o curativo foi retirado no 6º dia pós-operatório. A colonização cutânea foi verificada por meio de culturas de coletas em momentos padronizados. A avaliação da ferida operatória quanto à infecção seguiu os critérios definidos pelo Centers for Disease Control and Prevention (CDC). A opinião das pacientes quanto ao curativo foi verificada no 13º dia pós- operatório. Resultados: no 6º dia pós-operatório houve um maior número de unidades formadoras de colônias, no grupo PO1. Nove pacientes (12,9%) apresentaram infecção, sete no grupo PO1 (20%) e duas no grupo PO6 (6%). Das pacientes do grupo PO1, 66% prefeririam manter o curativo por um dia e do grupo PO6, 83% prefeririam manter o curativo por seis dias. Conclusões: a colonização no 6º dia pós-operatório foi maior no grupo PO1. Não houve diferença entre os grupos quanto à ocorrência de infecção da ferida operatória. As pacientes demonstraram preferência e acharam mais seguro a permanência do curativo até o sexto dia pós-operatório. / Background: There is controversy in the literature regarding the treatment of surgical wounds, which includes different approaches to wound management, such as “not to dress the wound” to “leave the dressing in place for 24-48 hours” or “until sutures are removed”. Objective: To evaluate the effect of the length of time the dressings were left in place after reduction mammaplasty on skin colonization, surgical site infection, and patient opinion. Methods: Seventy patients undergoing reduction mammaplasty were randomly divided into two groups: group PO1 (dressing was removed on the first postoperative day) and group PO6 (dressing was removed on the sixth postoperative day). Skin colonization was detected by culture of samples collected at predefined time points. Surgical site infections were classified according to the guidelines of the Centers for Disease Control and Prevention (CDC). Patient satisfaction was assessed on postoperative day 13. Results: A larger number of colony-forming units were measured in group PO1 on postoperative day 6. Nine (12.9%) patients had surgical site infection (seven from group PO1, and two from group PO2). In group PO1, 66% of the patients chose to keep the dressing for one day, while 83% of the patients in group PO6 chose to keep the dressing for six days. Conclusions: Higher colonization levels were observed in group PO1 on the sixth postoperative day. There was no difference in surgical site infection between groups. Most of the patients chose to keep the dressing in place for six days postoperatively, and felt it was safer. / TEDE / BV UNIFESP: Teses e dissertações

<p>UVOD. Sekundarni limfedem ruke je relativno česta komplikacija nakon lečenja raka dojke. Iako se kompleksna dekongestivna terapija smatra &ldquo;zlatnim standardom&ldquo; &quot;, jo&scaron; uvek postoji kontroverza o tome da li dodavanje presoterapije daje bolji terapijski efekat. Stoga je cilj ovog istraživanja bio uporediti efikasnost kompleksne dekongestivne fizikalne terapije (KDFT) u odnosu na kompleksnu dekongestivnu fizikalnu terapiju sa presoterapijom na funkcionalni status, nivo bola i kvalitet života kod pacijentkinja sa sekundarnim limfedemom ruke nakon lečenja raka dojke. MATERIJAL I METODE. Prospektivna, randomizovana, paralelna, nemaskirana studija je obuhvatila 108 pacijentkinja sa sekundarnim limfedemom ruke, prosečne starosti 56,8 &plusmn; 8,5 godina, koje su zavr&scaron;ile operativno lečenje raka dojke pre 57,4 &plusmn; 46,2 meseca. One su randomizovane u 2 grupe: KDFT grupa (kontrolna) ili KDFT+presoterapija grupa (eksperimentalna). Protokol KDFT se sastojao od nege kože, manuelne limfne drenaže, kratkoelastične vi&scaron;eslojne bandaže i vežbi. Osim toga, eksperimentalna grupa je primala presoterapiju (intermitentnu pneumatsku kompresiju), 30 minuta dnevno pri pritisku od 40 mm Hg. Oba protokola su se provodila jednom dnevno, pet dana sedmično tokom 3 sedmice. Ispitanice su podučavane za nastavak samostalnog sprovođenja nege kože, manuelne limfne drenaže i vežbi, kao i za no&scaron;enje kompresivnog rukava, 3 meseca nakon zavr&scaron;etka lečenja. Mere ishoda. Obim ruke, obim pokreta u zglobu ramena, snaga stiska &scaron;ake, vizuelna analogna skala za bol, upitnik Nesposobnost ruke, ramena i &scaron;ake (DASH) za funkciju ruke i upitnik Funkcionalna analiza lečenja raka dojke dojke sa subskalom 4+ za ruku (FACT-B4+) za kvalitet života su ocenjeni pre, neposredno nakon i 3 meseca nakon zavr&scaron;etka lečenja. Za statističku obradu dobijenih podataka kori&scaron;ćene su deskriptivne metode, analiza varijanse (ANOVA) za ponovljena merenja, analiza kovarijanse, Man-Vitni test, hi-kvadrat test i Fi&scaron;erov egzaktni test, prema potrebi. REZULTATI. Od ukupno 108 randomizovanih ispitanica, analizirane su 102 (51 u svakoj grupi). Nije bilo značajnih razlika u demografskim i kliničkim karakteristikama između dve grupe. ANOVA je pokazala značajan uticaj vremena za sve ispitivane varijable (p &lt;0,01), ali ne i značajnu interakciju vreme-grupa (0,07 &le; p &le; 0,99). Tačnije, nije bilo značajne razlike između dve ispitivane grupe u stepenu smanjenja limfedema, obimu pokreta u ramenu, snazi stiska &scaron;ake, nivou bola, DASH skoru i skorovima kvaliteta života merenim FACT -B4+, na kraju tretmana, i nakon 3 meseca praćenja. ZAKLJUČAK. Dodavanje presoterapije kompleksnoj dekongestivnoj terapiji, ne doprinosi boljem ishodu lečenja kod pacijentkinja sa limfedemom ruke nakon operacije karcinoma dojke u poređenju sa samo dekongestivnom terapijom.</p> / <p>BACKGROUND. Secondary lymphedema of the arm is a relatively common complication after breast cancer surgery. Although complex decongestive therapy is considered the &ldquo;golden standard&rdquo;, there is still a controversy as to whether adding pressotherapy is of any value. Thus, the aim of this study was to compare the efficacy of complex decongestive therapy (CDT) against complex decongestive therapy combined with a pressotherapy on functional status, pain, and quality of life in patients with secondary lymphedema of the arm after breast cancer treatment. METHODS. In this prospective, randomized, parallel, non-blind study, we recruited 108 women, mean age 56.8&plusmn;8.5 years, with secondary arm lymphedema who completed breast cancer surgery 57.4&plusmn;46.2 months earlier. They were randomly assigned to a CDT group (control) or CDT+pressotherapy group (experimental). The CDT protocol consisted of skin care, manual lymphatic drainage, short stretch multi-layer compression bandages, and exercises provided by therapists. In addition to that, the experimental group received pressotherapy (intermittent pneumatic compression) for 30 minutes per day at a pressure of 40 mmHg. The treatments were administered once a day, five days a week, for 3 weeks. The subjects were instructed to continue administering the skin care, manual lymphatic drainage, compression sleeve and exercises on their own for 3 months after the end of treatment. Outcome measures. Arm circumference, shoulder range of motion, grip strength, visual analog scale for pain, Disability of the Arm, Shoulder and Hand questionnaire (DASH) for the overall arm function, and Functional Analysis of Cancer Treatment- Breast 4+ (FACT-B4+) for quality of life were assessed before, immediately after, and at 3 months after the end of treatment. The statistical analyses included descriptive methods, analysis of variance (ANOVA) for repeated measures, analysis of covariance, Mann-Whitney U- test, chi-square test, and Fisher&rsquo;s exact test, as appropriate. RESULTS. From a total of 108 subjects randomly assigned, 102 completed the entire protocol (51 in each group), and their data were analyzed. There were no significant differences in demographic and clinical characteristics between the two groups. The ANOVA revealed significant main effect of Time for all studied variables (p &lt; 0.01), but no significant group-by-time interaction (0.07 &le; p &le; 0.99). More specifically, there was no significant difference between the two groups in the degree of lymphedema reduction, shoulder range of motion, grip strength, pain, DASH score, and FACT-B4+ scores either at the end of treatment or at 3-month follow up. CONCLUSIONS. Combining CDT with pressotherapy is no more efficacious than providing CDT alone in patients who present with chronic arm lymphedema after completing breast cancer treatment.</p>

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.