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British Medical Journal Feb 1979Eighty patients who had undergone routine meniscectomy were divided into two groups for postoperative management. The first 40 patients were treated by the traditional... (Clinical Trial)
Clinical Trial Comparative Study
Eighty patients who had undergone routine meniscectomy were divided into two groups for postoperative management. The first 40 patients were treated by the traditional method of a compression bandage with a backsplint, followed by a 10-day stay in hospital. In the other 40 patients a compression bandage was applied, reinforced by a plaster cylinder. Weight-bearing was allowed with the aid of crutches, and patients were discharged after four days in hospital. Adequate splintage and early ambulation was more convenient and comfortable for postoperative management, and no complications ensued. Less time was needed for physiotherapy, and earlier return to work and resumption of normal activities were made easier.
Topics: Adult; Bandages; Early Ambulation; Female; Humans; Length of Stay; Male; Menisci, Tibial; Postoperative Care; Rehabilitation; Splints
PubMed: 581856
DOI: 10.1136/bmj.1.6161.449 -
Ostomy/wound Management Jan 2006Within the last 3 to 5 years, many silver-based antimicrobial dressings have become available and more are on the way. However, sometimes dressing manufacturers and... (Review)
Review
Within the last 3 to 5 years, many silver-based antimicrobial dressings have become available and more are on the way. However, sometimes dressing manufacturers and authors make claims and send messages that conflict with data and conclusions in the literature, creating confusion for clinicians. A literature review of six relevant and frequently discussed topics was conducted. Pre-clinical and clinical study data suggest that: a) bacterial resistance to silver may occur, b) silver dissociation is affected by the test medium used, c) bactericidal activity differences may be a function of the bacterial strain used for testing, d) higher rather than lower levels of silver may be needed because Ag+ binds to proteins and nucleic acids, e) rapid delivery of silver (ie, rate of kill) may be a positive factor when considering prevention of silver resistance and biofilm formation, and f) based on the vast majority of in vivo studies available, silver does not adversely effect viable cells; thus, is not cytototoxic. Continued research into the implications of the data is warranted.
Topics: Anti-Infective Agents, Local; Bandages; Biofilms; Carboxymethylcellulose Sodium; Carrier Proteins; Cell Survival; Drug Resistance, Bacterial; Evidence-Based Medicine; Humans; Hydrogels; Polyesters; Polyethylenes; Research Design; Silver Compounds; Skin Care; Time Factors; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 16464989
DOI: No ID Found -
Applied Health Economics and Health... Aug 2019Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The... (Review)
Review
Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The dressings are used in addition to standard care protocols for pressure ulcer prevention. The National Institute for Health and Care Excellence (NICE) selected Mepilex Border Sacrum and Heel dressings for evaluation. The External Assessment Centre (EAC) critiqued the company's submission. Thirteen studies (four randomised controlled trials and nine nonrandomised comparative studies) were included. The majority of studies compared Mepilex Border Sacrum dressings (plus standard care) with standard care alone. Comparative evidence for Mepilex Border Heel dressings was limited. A meta-analysis indicated a non-statistically significant difference in favour of Mepilex Border Sacrum dressings for pressure ulcer incidence [RR 0.51 (95% CI 0.22-1.18)]. The company produced a de novo cost model, which was critiqued by the EAC. After the EAC updated input parameters, cost savings of £19 per patient compared with standard care alone for pressure ulcer prevention were estimated with Mepilex Border dressings predicted to be cost saving in 57% of iterations. The Medical Technologies Advisory Committee reviewed the evidence and judged that, although Mepilex Border Heel and Sacrum dressings have potential to prevent pressure ulcers in people who are considered to be at risk in acute care settings, further evidence is required to address uncertainties around the claimed benefits of the dressings and the incidence of pressure ulcers in an NHS acute-care setting. After a public consultation, NICE published this as Medical Technology Guidance 40.
Topics: Bandages; Heel; Humans; Pressure Ulcer; Sacrum; Treatment Outcome
PubMed: 30820871
DOI: 10.1007/s40258-019-00465-8 -
The Western Journal of Medicine Feb 1975
Topics: Adult; Bandages; Child, Preschool; Constriction; Female; Fingers; Humans; Ischemia; Male
PubMed: 1114815
DOI: No ID Found -
Biomaterials Advances Dec 2022Nanotechnologies are being increasingly applied as systems for peptide and nucleic acid macromolecule drug delivery. However systemic targeting of these, or efficient...
Nanotechnologies are being increasingly applied as systems for peptide and nucleic acid macromolecule drug delivery. However systemic targeting of these, or efficient topical and localized delivery remains an issue. A controlled release system that can be patterned and locally administered such as topically to accessible tissue (skin, eye, intestine) would therefore be transformative in realizing the potential of such strategies. We previously developed a technology termed GAG-binding enhanced transduction (GET) to efficiently deliver a variety of cargoes intracellularly, using GAG-binding peptides to mediate cell targeting, and cell penetrating peptides (CPPs) to promote uptake. Herein we demonstrate that the GET transfection system can be used with the moisturizing thermo-reversible hydrogel Pluronic-F127 (PF127) and methyl cellulose (MC) to mediate site specific and effective intracellular transduction and gene delivery through GET nanoparticles (NPs). We investigated hydrogel formulation and the temperature dependence of delivery, optimizing the delivery system. GET-NPs retain their activity to enhance gene transfer within our formulations, with uptake transferred to cells in direct contact with the therapy-laden hydrogel. By using Azowipe™ material in a bandage approach, we were able to show for the first-time localized gene transfer in vitro on cell monolayers. The ability to simply control localization of gene delivery on millimetre scales using contact-mediated transfer from moisture-providing thermo-reversible hydrogels will facilitate new drug delivery methods. Importantly our technology to site-specifically deliver the activity of novel nanotechnologies and gene therapeutics could be transformative for future regenerative medicine.
Topics: Hydrogels; Poloxamer; Cell-Penetrating Peptides; Bandages; Genetic Therapy
PubMed: 36371970
DOI: 10.1016/j.bioadv.2022.213177 -
Medicine Sep 2022Secondary lymphedema is a clinically incurable disease that commonly occurs following surgical cancer treatment and/or radiation. One of the most common forms of...
Secondary lymphedema is a clinically incurable disease that commonly occurs following surgical cancer treatment and/or radiation. One of the most common forms of lymphedema treatment is complete decongestive therapy (CDT). This study aimed to investigate the clinical effects of new compression bandages (Mobiderm® bandages) in patients with secondary lymphedema after cancer treatment. This study included 17 patients with ipsilateral limb lymphedema after cancer treatment (one male and 16 female patients; age, 45-80 years). Patients were divided into the Mobiderm® bandage group (n = 9) and classical bandage group (n = 8). The International Society of Lymphology (ISL) stage was also evaluated. Limb circumference was measured at 5 to 6 sites per limb to identify the maximal circumference difference (MCD) between the affected and unaffected limbs. Pre-and posttreatment MCD were analyzed. After intensive CDT, both the Mobiderm® bandage group (1.2 ± 0.56 cm) and classical bandage group (0.85 ± 0.40 cm) had a significant decrease in MCD compared to pretreatment (P < .05). However, in patients with ISL stage 2, the mean MCD decrease rate was greater in the Mobiderm® bandage group (22.82 ± 10.92 %) than in the classical bandage group (12.18 ± 8.1 1%)(P = .045). Both new bandages (Mobiderm® bandages and classical bandages) reduced the circumference of limb edema in patients with secondary lymphedema after cancer treatment. This study findings suggest that Mobiderm® bandages as an alternative modality for controlling ISL stage 2 lymphedema.
Topics: Aged; Aged, 80 and over; Chronic Disease; Compression Bandages; Extremities; Female; Humans; Lymphedema; Male; Middle Aged; Neoplasms; Pilot Projects
PubMed: 36107527
DOI: 10.1097/MD.0000000000030198 -
Sensors (Basel, Switzerland) Mar 2022This paper presents a feasibility study of using a passive millimeter-wave imaging (PMMWI) system to assess burn wounds and the potential for monitoring the healing...
This paper presents a feasibility study of using a passive millimeter-wave imaging (PMMWI) system to assess burn wounds and the potential for monitoring the healing process under dressing materials, without their painful removal. Experimental images obtained from ex vivo porcine skin samples indicate that a ThruVision passive imager operating over the band 232-268 GHz can be used for diagnosing burns and for potentially monitoring the healing under dressing materials. Experimental images show that single and multiple burns are observed throughout dressing materials. As the interaction of millimeter-wave (MMW) radiation with the human body is almost exclusively with the skin, the major outcomes of the research are that PMMWI is capable of discriminating burn-damaged skin from unburned skin, and these measurements can be made through bandages without the imager making any physical contact with the skin or the bandage. This highlights the opportunity that the healing of burn wounds can be assessed and monitored without the removal of dressing materials. The key innovation in this work is in detecting single and multiple burns under dressing materials in noncontact with the skin and without exposing the skin to any type of manmade radiation (i.e., passive sensing technology). These images represent the first demonstration of burns wound under dressing materials using a passive sensing imager.
Topics: Animals; Bandages; Burns; Diagnostic Imaging; Skin; Swine; Wound Healing
PubMed: 35408043
DOI: 10.3390/s22072428 -
Clinical Orthopaedics and Related... Apr 2011The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on... (Review)
Review
BACKGROUND
The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed.
QUESTIONS/PURPOSES
I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus.
METHODS
A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search.
RESULTS
Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years.
CONCLUSIONS
The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.
Topics: Bandages; Evidence-Based Medicine; History, 19th Century; Humans; Orthopedic Procedures; Shoulder Fractures; Traction; Treatment Outcome
PubMed: 21136221
DOI: 10.1007/s11999-010-1707-8 -
International Wound Journal Dec 2006Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary... (Review)
Review
Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity.
Topics: Anti-Infective Agents, Local; Bacterial Infections; Bandages; Cross Infection; Humans; Silver; Treatment Outcome; Wound Infection
PubMed: 17199764
DOI: 10.1111/j.1742-481X.2006.00265.x -
Journal of Managed Care Pharmacy : JMCP Jun 2012In the United States, venous leg ulcers (VLUs) are commonly associated with substantial disability, impaired quality of life, and high economic costs. Compression... (Review)
Review
BACKGROUND
In the United States, venous leg ulcers (VLUs) are commonly associated with substantial disability, impaired quality of life, and high economic costs. Compression therapy, which has remained the standard care for VLUs over several decades, is often insufficient to heal VLUs in a timely manner. VLU-related treatment costs are directly related to time to achieve complete wound closure. Advanced wound care matrices (AWCMs) developed to stimulate wound healing may reduce VLU-related costs associated with delayed healing. Randomized controlled trials (RCTs) have evaluated the wound-healing efficacy of several AWCMs in patients with VLUs. However, comparisons of products' clinical and cost efficacy, which may guide clinical and formulary determinations, are lacking.
OBJECTIVE
To evaluate, in terms of number needed to treat (NNT), the comparative clinical and cost efficacy of targeted AWCMs as adjuncts to compression therapy for the treatment of chronic VLUs from the U.S. health care system (payer) perspective.
METHODS
A review of published articles (from the earliest available Medline publication date to June 1, 2011) identified RCTs evaluating complete wound closure rates for up to 24 weeks in patients with VLUs treated with targeted AWCMs (Apligraf, Oasis, or Talymed) plus compression therapy compared with compression therapy alone. The most favorable estimates of product efficacy (i.e., those that were statistically significant compared with compression therapy) were used. These included statistically adjusted results for Apligraf as reported in the product insert and the biweekly application for Talymed. Based on the reported efficacy of targeted AWCMs, we calculated the NNT to achieve 1 additional treatment success (i.e., complete wound closure) over that which was achieved with standard therapy alone; 95% CIs were estimated using the Wilson score method proposed by Newcombe. Cost efficacy, defined as the incremental cost per additional successfully treated patient, was then calculated by multiplying the NNT associated with each treatment by the product acquisition cost per treated VLU episode.
RESULTS
One study for each of 3 targeted AWCMs (Apligraf [n=130 treatment, n=110 control]; Oasis Wound Matrix [n=62 treatment, n=58 control]; and Talymed [n=22 treatment, n=20 control]) met inclusion criteria. Study designs and wound characteristics varied. Average VLU sizes were 1 cm2, 10-12 cm2, and 10-13 cm2 in the studies of Apligraf, Oasis, and Talymed, respectively. Ulcer duration exceeded 12 months for 50% of patients in the Apligraf study and was at least 7 months for 47% of patients in the Oasis study; patients with ulcers exceeding 6 months were excluded from the study of Talymed. Length of follow-up was 24 weeks for Apligraf, 12 weeks for Oasis, and 20 weeks for Talymed. NNT point estimates of clinical efficacy were 2 for Talymed, 5 for Oasis, and 6 for Apligraf; 95% CIs ranged from 2 to 8 for Talymed, 3 to 24 for Apligraf, and 3 to 39 for Oasis. Incremental costs (95% CIs) per additional successfully treated patient were $1,600 ($1,600-$6,400) for Talymed, $3,150 ($1,890-$24,570) for Oasis, and $29,952 ($14,976-$119,808) for Apligraf.
CONCLUSIONS
The most expensive AWCM for the treatment of VLUs did not appear to provide the greatest comparative clinical or cost efficacy. Conclusions must be tempered by the small number of available studies (n=3), variability in trial duration (from 12 to 24 weeks) and baseline wound characteristics, and limitations in study quality. Given the high prevalence, economic burden, and substantial disability of VLUs, and the wide variation in costs for AWCMs, payers need more high-quality head-to-head comparisons to guide coverage and reimbursement determinations for these products.
Topics: Bandages; Compression Bandages; Cost-Benefit Analysis; Humans; Randomized Controlled Trials as Topic; United States; Varicose Ulcer; Wound Healing
PubMed: 22663170
DOI: 10.18553/jmcp.2012.18.5.375