Ostomy/wound management
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Ostomy/wound management · Nov 2008
Early versus late initiation of negative pressure wound therapy: examining the impact on home care length of stay.
Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. ⋯ After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (beta = 0.96, P <0.0001 [pressure ulcers]; beta = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.
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Ostomy/wound management · Oct 2008
Controlled Clinical TrialA clinical trial to investigate the effect of silver nylon dressings on mediastinitis rates in postoperative cardiac sternotomy incisions.
Mediastinitis is a rare but serious postoperative complication of cardiac surgery that increases mortality rates, hospital length of stay, and medical costs. A clinical trial was conducted to investigate whether the type of postoperative surgical dressing (silver nylon or standard gauze) affects the rate of mediastinal infections. The sample consisted of 1,600 surgical cardiac patients. ⋯ In the prospective treatment arm of the study, the wounds of all consecutive surgical patients (n = 365) were covered with a silver nylon dressing and patients were assessed during the 3-week postoperative visit. Thirteen (13) patients in the control group (1%) and none of the patients in the treatment group developed mediastinitis (chi2 [1, N = 1,600] = 3.88, P <0.05). Study findings support the need for a large, prospective, controlled clinical study to confirm the effects of these dressings on mediastinitis, resultant morbidity, and costs of care.
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Ostomy/wound management · Mar 2008
Acoustic pressure wound therapy for management of mixed partial- and full-thickness burns in a rural wound center.
Infection, pain, and cosmetically unacceptable scarring frequently complicate full-thickness burns. Outpatient management can be difficult without specialized care. A retrospective case series study was conducted in a rural wound center lacking specialized burn care to assess the clinical effectiveness of acoustic pressure wound therapy, a noncontact low-frequency, nonthermal ultrasound wound therapy that accelerates healing through positive pressure, stimulating fibroblasts, clearing bacteria and debris, and relieving pain. ⋯ Scars available for follow-up (71%) remained unchanged. Acoustic pressure wound therapy with standard burn care was found to heal mixed partial- and full-thickness burns and reduced pain in outpatients, resulting in cosmetically acceptable scarring without infectious complications, surgery, or skin grafts and may prove beneficial for inpatient management of extensive full-thickness burns. Further study is warranted.
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Use of compression stockings has been demonstrated to be effective in helping heal venous leg ulcers and in reducing associated pain. During the past 5 years or more, patients suffering from edema, varices, or ulcers at the Taipei Veterans General Hospital and Taipei Vein Center, Taiwan, have been encouraged to use compression stockings. ⋯ This new device has been used successfully on at least 90 patients, who report enhanced willingness to use compression therapy and/or improved ease of stocking use as compared to previously used products or not using an assistive device. The design and use of this stocking aid is described.
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Ostomy/wound management · Sep 2007
Comparative Study Clinical TrialA comparison and cost-effectiveness analysis of peripheral catheter dressings.
Peripheral catheter dressing use is common but information about cost-effectiveness remains limited. A prospective, descriptive 3-month study was conducted to 1) assess the cost-effectiveness of two dressings used for peripheral venous catheters and 2) identify statistical associations between the effectiveness variables and the patient's gender and age, category of the professional involved in care, and length of time the dressing was in place. The study was conducted among a homogenous sample of 120 adult patients; the majority (71/59.2%) were women, mean age 54.5 (+/- 18.8) years. ⋯ The rate of complications in each group was similar. Results confirm that traditional dressings may be used for short-term use catheter care (approximately 3 days); whereas, film dressings may be more cost-effective for longer-term use. Larger studies assessing the cost-effectiveness of various dressings to secure longer-term use catheters are needed.