Dehydrated human amnion/chorion membrane treatment of venous leg ulcers: correlation between 4-week and 24-week outcomes.

OBJECTIVE: To evaluate correct correlation between an intermediate rate of wound reduction (40% wound area reduction after 4-weeks treatment) and complete healing at 24 weeks in patients with a venous leg ulcer (VLU). METHOD: A retrospective follow-up study of patients completing a multicenter randomised controlled trial (RCT) comparing the number of patients achieving at least 40% healing of their VLU within 4-weeks of treatment with either dehydrated human amnion/chorion membrane (dHACM) allograft or multilayer compression only was conducted. Outcomes assessed were rates of complete healing within 24 weeks of enrolment and days to healing. Data were divided into two groups based on status at RCT completion (healed at least 40% yes or no). Correct correlation with status at 4 weeks and complete healing within 24 weeks was determined. Clinical characteristics were also compared for patients with and without correct correlation between 4-week and 24-week status. RESULTS: We identified 55 patients at 5 study sites. Some 47 without complete healing during the initial study were eligible. As three patients were lost to follow-up we evaluated 44 records. Of these, 20 (45.4%) had reduced wound size of ≥40% and 24 (55%) had <40% reduction during the initial study. Complete healing occurred in 16/20 (80%) of the ≥40% group at a mean of 46 days, p=0.0027 and 8/24 (33.3%) of the <40% group at a mean of 103.6 days, p=0.0023. Overall, correct correlation of status at 4 weeks and ultimate healing status of VLU occurred in 32/44 patients (73%). CONCLUSION: These results confirm that the intermediate outcome used in our initial study is a viable predictor of ultimate VLU healing.

Pneumatic compression device treatment of lower extremity lymphedema elicits improved limb volume and patient-reported outcomes.

OBJECTIVES: Examine the effectiveness of an advanced pneumatic compression device (APCD) in reducing limb volume (LV), and to evaluate clinician and patient-reported outcomes. DESIGN: Device registry study. MATERIALS AND METHODS: Data were collected prospectively for 196 lower extremity lymphedema patients prescribed an APCD. Baseline and post-treatment LVs were calculated and clinical outcomes (skin changes, pain, and function) were assessed. Patient-reported outcomes and satisfaction utilizing a pre- and post-treatment survey were also evaluated. RESULTS: 90% of APCD-treated patients experienced a significant reduction in LV with 35% enjoying a reduction >10%. Mean LV reduction was 1,150 mL or 8% (p < .0001). Greater baseline LV and BMI were strong predictors of LV reduction (p < .0001). Clinician assessment indicated that the majority of patients experienced improvement in skin fibrosis and function. Patient-reported outcomes showed a significant increase in ability to control lymphedema through APCD treatment, with an increase in function and a reduction in the interference of pain. 66% were "very satisfied" with the APCD treatment. CONCLUSION: APCD use is associated with consistent reductions in LV, with favorable patient-reported outcomes. Results demonstrate that reduction in LV and pain, combined with functional improvement and patient satisfaction can be achieved, providing tangible benefit for lower extremity patients.

Use of and satisfaction with a browser-based nurse teaching tool in a surgical intensive care unit.

Our goal was to determine if a computerized teaching tool is an effective teaching method for nurses in a high-stress fast-paced intensive care unit. We also measured the level of satisfaction with this method of instruction. Thirty-six surgical intensive care nurses used a Web-based Microsoft PowerPoint presentation located on the intranet at nursing stations located on the surgical intensive care unit (SICU). The presentation was designed to provide instruction regarding the methodology and use of APACHE III prior to its implementation. Paired t-tests were performed to compare the results of a pretest and posttest. The questions were divided into two types: methodology and use. After the nurses completed their training sessions, they were asked to complete a questionnaire. The questionnaire questions were rated one a 1 to 5 scale. The average scores were higher on the posttest compared to the pretest (63.2% vs. 69.1%, p = 0.03). The methodology scores were higher on the posttest (74.3% vs. 88.2%, p = 0.001), while the use scores remained the same at 78.1% vs. 75.0%. Our Web-based teaching tool is an effective way to train nurses to understand the APACHE III medical system. The tool was effective at conveying the APACHE III medical systems methodology but was not effective in explaining the usefulness of the system. Most important, the nurses thought the browser-based teaching tool was easily accessible and an effective way to communicate new material to the medical staff.