BACKGROUND:Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors.METHODS:100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics / patient knowledge and attitudes regarding SCDs / and patient self-reported bother with SCDs.RESULTS:Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance.CONCLUSIONS:Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

This thesis describes the successful development and initial evaluation of a proof-of-concept wireless monitoring system for improving the effectiveness and safety of pneumatic compression therapy to help prevent deep vein thrombosis (DVT). In the development, an important objective was to make feasible the practical and commercial deployment of such improved therapy systems in future, by focusing on a cost-effective design and implementation. Over the years, pneumatic compression has been shown to be an effective solution for the prevention of DVT. However, different problems and complications related to the use of commercial pneumatic compression de-vices that typically include automatic pressure controllers and pneumatic compression sleeves have been reported. For example, one study reported a high percentage of improperly applied or nonfunctional pneumatic compression devices in routine usage. Technical problems, non-compliance, and human error were identified as the causes behind the failed therapies. Also, it was reported that dedicated in-service instruction did not improve the proper use of the pneumatic compression controllers and sleeves. In another study, significant unanticipated variations between expected and delivered pneumatic compression therapy were reported: expected therapy delivered only an average of 77.8% of the time during the therapy, and much of the time key values related to the outcome of the therapy were found to have variations great than 10%. Specific hazards have also been reported. For example, one patient developed acute compartment syndrome after wearing a pair of pneumatic compression sleeves with faulty pressure release valves. In another case, epidural analgesia masked a malfunction resulting from a reversed connection between four-way plastic tubing of the sleeves and the controller, exposing a patient to a hazardous pressure of around 300mmHg,blocking all blood flow for a prolonged period of time. Newer models of pneumatic compression sleeves and controllers from various manufacturers claim to improve therapy by, for example, increasing the peak blood flow velocity. However, there is no evidence in the published literature to support such claims. A published review of the literature from1970-2002 reached the conclusion that the most important factors in im-proving therapy with pneumatic compression devices, particularly during and after surgery, were the degree of conformance of delivered therapy to the prescribed therapy, patient compliance, and the appropriateness of the site of compression. The inability to monitor delivered therapy and patient compliance remains a problem in efforts to improve pneumatic compression therapy. The above-described problems were addressed in the successful development of the innovative prototype described in this thesis. This wireless monitoring system should improve the effectiveness and safety of pneumatic compression therapy. Also, innovative aspects of the system design allow for cost-effective integration into existing commercial controllers and sleeves. For example, an innovative and potentially patentable usage and reprocess indicator was developed for pneumatic compression sleeves to significantly improve their safety and to reduce their cost of use per patient.

This thesis describes the successful development and initial evaluation of a proof-of-concept wireless monitoring system for improving the effectiveness and safety of pneumatic compression therapy to help prevent deep vein thrombosis (DVT). In the development, an important objective was to make feasible the practical and commercial deployment of such improved therapy systems in future, by focusing on a cost-effective design and implementation. Over the years, pneumatic compression has been shown to be an effective solution for the prevention of DVT. However, different problems and complications related to the use of commercial pneumatic compression de-vices that typically include automatic pressure controllers and pneumatic compression sleeves have been reported. For example, one study reported a high percentage of improperly applied or nonfunctional pneumatic compression devices in routine usage. Technical problems, non-compliance, and human error were identified as the causes behind the failed therapies. Also, it was reported that dedicated in-service instruction did not improve the proper use of the pneumatic compression controllers and sleeves. In another study, significant unanticipated variations between expected and delivered pneumatic compression therapy were reported: expected therapy delivered only an average of 77.8% of the time during the therapy, and much of the time key values related to the outcome of the therapy were found to have variations great than 10%. Specific hazards have also been reported. For example, one patient developed acute compartment syndrome after wearing a pair of pneumatic compression sleeves with faulty pressure release valves. In another case, epidural analgesia masked a malfunction resulting from a reversed connection between four-way plastic tubing of the sleeves and the controller, exposing a patient to a hazardous pressure of around 300mmHg,blocking all blood flow for a prolonged period of time. Newer models of pneumatic compression sleeves and controllers from various manufacturers claim to improve therapy by, for example, increasing the peak blood flow velocity. However, there is no evidence in the published literature to support such claims. A published review of the literature from1970-2002 reached the conclusion that the most important factors in im-proving therapy with pneumatic compression devices, particularly during and after surgery, were the degree of conformance of delivered therapy to the prescribed therapy, patient compliance, and the appropriateness of the site of compression. The inability to monitor delivered therapy and patient compliance remains a problem in efforts to improve pneumatic compression therapy. The above-described problems were addressed in the successful development of the innovative prototype described in this thesis. This wireless monitoring system should improve the effectiveness and safety of pneumatic compression therapy. Also, innovative aspects of the system design allow for cost-effective integration into existing commercial controllers and sleeves. For example, an innovative and potentially patentable usage and reprocess indicator was developed for pneumatic compression sleeves to significantly improve their safety and to reduce their cost of use per patient.

This thesis describes the successful development and initial evaluation of a proof-of-concept wireless monitoring system for improving the effectiveness and safety of pneumatic compression therapy to help prevent deep vein thrombosis (DVT). In the development, an important objective was to make feasible the practical and commercial deployment of such improved therapy systems in future, by focusing on a cost-effective design and implementation. Over the years, pneumatic compression has been shown to be an effective solution for the prevention of DVT. However, different problems and complications related to the use of commercial pneumatic compression de-vices that typically include automatic pressure controllers and pneumatic compression sleeves have been reported. For example, one study reported a high percentage of improperly applied or nonfunctional pneumatic compression devices in routine usage. Technical problems, non-compliance, and human error were identified as the causes behind the failed therapies. Also, it was reported that dedicated in-service instruction did not improve the proper use of the pneumatic compression controllers and sleeves. In another study, significant unanticipated variations between expected and delivered pneumatic compression therapy were reported: expected therapy delivered only an average of 77.8% of the time during the therapy, and much of the time key values related to the outcome of the therapy were found to have variations great than 10%. Specific hazards have also been reported. For example, one patient developed acute compartment syndrome after wearing a pair of pneumatic compression sleeves with faulty pressure release valves. In another case, epidural analgesia masked a malfunction resulting from a reversed connection between four-way plastic tubing of the sleeves and the controller, exposing a patient to a hazardous pressure of around 300mmHg,blocking all blood flow for a prolonged period of time. Newer models of pneumatic compression sleeves and controllers from various manufacturers claim to improve therapy by, for example, increasing the peak blood flow velocity. However, there is no evidence in the published literature to support such claims. A published review of the literature from1970-2002 reached the conclusion that the most important factors in im-proving therapy with pneumatic compression devices, particularly during and after surgery, were the degree of conformance of delivered therapy to the prescribed therapy, patient compliance, and the appropriateness of the site of compression. The inability to monitor delivered therapy and patient compliance remains a problem in efforts to improve pneumatic compression therapy. The above-described problems were addressed in the successful development of the innovative prototype described in this thesis. This wireless monitoring system should improve the effectiveness and safety of pneumatic compression therapy. Also, innovative aspects of the system design allow for cost-effective integration into existing commercial controllers and sleeves. For example, an innovative and potentially patentable usage and reprocess indicator was developed for pneumatic compression sleeves to significantly improve their safety and to reduce their cost of use per patient. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate

Bakgrund: Venduplex har på senare år vuxit fram som den mest använda metoden vid diagnostik av venös insufficiens eftersom det är en ofarlig, kostnadseffektiv, non-invasiv metod med hög sensitivitet och specificitet där både den anatomiska placeringen av insufficiensen samt den funktionella förändringen av venen kan påvisas direkt vid undersökningen. Olika manövrar kan genomföras för att påfresta venklaffarna och därmed framkalla en eventuell reflux, men det är oklart om de olika manövrerna kan påverka den reflux som provoceras fram och därmed också påverkar bedömningen av insufficiensgraden. Syfte: Syftet med studien var att undersöka om det förelåg skillnad i graderingen av insufficiensen samt om den maximala refluxhastigheten påverkades beroende på vilken manöver som användes för att framkalla en reflux. Metod: 20 v. saphena magna mitt på låret med påvisad reflux deltog i studien. Två upprepade mätningar genomfördes där venklaffarna provocerades med hjälp av en blodtrycksmanschett över vaden, med en manuell kompression över låret samt med en manuell kompression över vaden. Resultat: Den maximala refluxhastigheten blev 0,33±0,20m/s när en blodtrycksmanschett över vaden användes, 0,31±0,22m/s när en manuell handkompression över vaden användes samt 0,17±0,16m/s när en manuell lårkompression genomfördes. Slutsats: Ingen signifikant skillnad på maximal refluxhastighet kunde konstateras när en automatisk uppblåsbar blodtrycksmanschett över vaden jämfördes med en manuell handkompression över vaden. En signifikant högre maximal refluxhastighet konstaterades när en manuell vadkompression jämfördes med en manuell lårkompression.

Thesis--University of Oklahoma. / Bibliography: leaves 53-59.

No / Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling due to lymphoedema. This review analyses the evidence for the effectiveness of IPC as a treatment for venous leg ulcers. OBJECTIVES: To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (December 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4, 2007; Ovid MEDLINE - 2006 to November Week 2 2007; Ovid EMBASE - 2006 to 2007 Week 49 and Ovid CINAHL - 2006 to December Week 1 2007. SELECTION CRITERIA: Randomised controlled studies either comparing IPC with control (sham IPC or no IPC) or comparisons between IPC treatment regimens, in venous ulcer management were included. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by one author and checked by a second. MAIN RESULTS: Seven randomised controlled trials (including 367 people in total) were identified. Only one trial reported both allocation concealment and blinded outcome assessment. In one trial (80 people) more ulcers healed with IPC than with dressings (62% vs 28%; p=0.002). Four trials compared IPC with compression against compression alone. The first of these trials (45 people) found increased ulcer healing with IPC plus compression than with compression alone (relative risk for healing 11.4, 95% Confidence Interval 1.6 to 82). The remaining three trials (122 people) found no evidence of a benefit for IPC plus compression compared with compression alone. One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone. One trial compared different ways of delivering IPC (104 people) and found that rapid IPC healed more ulcers than slow IPC (86% vs 61%; log rank p=0.003). AUTHORS' CONCLUSIONS: IPC may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages, or if it can be used instead of compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine whether IPC increases the healing of venous leg ulcers when used in modern practice where compression therapy is widely used.

No description available.

No description available.

In order to address the long-term complications that arise from poor venous return, a hallmark of the Fontan physiology, we assessed the feasibility of a non-invasive, home therapy that will improve the health of the patient during the heart transplant waiting period and ameliorate the quality of life. In order to achieve this goal we tested a device that applies pressure to the lower extremities of the body (legs and abdomen) in a pulsating fashion with the goal of augmenting systemic blood flow to the pulmonary arteries. This treatment will enhance flow from the great veins and through the lungs and serve as adjunctive clinical treatment of single ventricle physiology. The specific aim of this study was to show improvements in cardiorespiratory measurements after applying external pressure as a proxy for improved health in the Fontan patient. Various studies have shown the impaired exercise capacity of post-operative Fontan patients, but very little data exists focusing on a period much later after the surgery. Our results among the two subjects completed so far have shown a moderately beneficial improvement in exercise capacity after the compression therapy. Subjects performed a treadmill exercise stress test at VCU that was followed by six days of applied external pressure treatment and finished with a final post-treatment stress test. Cardiorespiratory data was collected and analyzed for improvements from base level. Overall an improvement in exercise duration time, VO2 peak, ventilatory threshold, and OUES was observed, with only VE / VCO2 slope having mixed results. Both subjects seem to be relatively healthy Fontan patients, as indicated by their VO2 peak, VE/VCO2 slope and OUES. As a result, benefits of treatment may vary among a cohort of Fontan patients with poor health condition; a failing Fontan physiology for instance. The improvement in exercise capacity suggests that this therapy could be very beneficial to Fontan patients. These results warrants follow up studies to explore the extent of the clinical benefits of compression treatment among the Fontan population.