BackgroundNegative-pressure wound therapy is a technique to achieve wound healing in patients with non-healing wounds of the lower limb; vacuum-assisted closure (VAC) therapy is a technique to accelerate the healing of non-healing ulcers that fail to heal on their own (primary healing) (Plast Reconstr Surg 117:193–209S, 2006).Delayed wound healing or non-healing of ulcers is a significant health problem, particularly in older adults.The efficacy of VAC dressings has been demonstrated in several randomized controlled studies, which have shown significantly faster wound healing rates compared to conventional wound therapy (Lancet 366:1704–10, 2005; J Wound Care 17:426–32, 2008). However, commercially available VAC is costly.The aim of using custom made VAC was decided by our team due to lower socio-economic status of patients taken for study who could not have afforded charges of commercially available VAC unit.ObjectiveObjective was to evaluate VAC therapy compared with conventional dressings in the treatment of non-healing lower limb ulcers in lower socio-economic patients.MethodsSixty patients of lower socio-economic status aged between 40 and 70 were prospectively studied for non-healing ulcers Wagner grade 2 or 3 and randomized into 2 groups. VAC dressing was kept for over a period of 2–7 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50-day period, whichever was earlier.ResultsBy seventh week, discharge disappeared in 96 % in VAC and only 54 % in conventional dressing group.Granulation tissue appeared in 100 % of patients in VAC group and only 63 % in conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 56 % in comparison to conventional dressing group which had average wound size reduction of 29 %.Majority of wounds in VAC group got closed in 7 weeks. Patient satisfaction was excellent in the majority of patients in VAC group compared to those in conventional dressing group.ConclusionThe application of VAC™ had shown good results in our study.
<p class="abstract"><strong>Background:</strong> There is high prevalence of psychiatric illness after major limb amputation and need for early recognition and treatment should be the goal but often is overlooked. Psychological support by the treating physician and the surgeon can help in adaptation to the disability but unfortunately is often overlooked.</p><p class="abstract"><strong>Methods:</strong> A total of 120 patients were screened for psychiatric disorder using HADS criteria Anxiety was found to be in 38 (32%) patients and depression was found to be in 27 (23%) (Table 1) (Figure 1) 55 patients had no psychiatric illness. Psychiatric illness either depression or anxiety was found to be in 65 patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our state which is a zone of conflict between two countries prevalence of anxiety was 32% and depressive symptoms were 23%, respectively. Causative factors associated with high prevalence of psychological symptoms included unmarried young females, lower socioeconomic status, single earning member, lack of social support, unemployment, traumatic amputation. These findings were confirmed by a significant reduction of anxiety and depression scores in patients who received social support, patients with amputation due to disease, and patients with above the knee amputation.</p><p><strong>Conclusions:</strong> Our study showed higher prevalence of psychological symptoms in association with lower socioeconomic status, single earning member, lack of social support, unemployment, traumatic amputation vs amputation secondary to chronic disease. Extensive rehabilitation with the use of an interdisciplinary team approach is one of the most successful ways to return the amputee to the work place. Surgeons should give proper attention to the psychological state of amputees. Because of high prevalence of psychiatric illness after major limb amputation. It is suggested that psychiatric evaluation and adequate rehabilitation should form a part of treatment.</p>
Background:Myths and misconceptions about illness and conventional disease modifying anti-rheumatic drugs directly influence adherence to the prescribed treatment. It is estimated that 30–50% of patients do not adhere to their prescribed treatment due to various reasons where the beliefs of the patients play a crucial role. At our centre we the specialist rheumatology nurse counsel the patients at every visit and try to remove their myths and negative beliefs about the disease as well as the medications.Objectives:•To explore the common myths and misconceptions of regarding their disease and regarding the csDMARDs.•To assess the efficacy of counseling in allaying their unfounded fear.Methods:A total of 450 patients with SIRDs at least 3 times attended the rheumatology out-patient clinic on csDMARDs were enrolled to complete a questionnaire that, besides demographic information, socio-economic status, and co- morbidities, had the following questions:1.Self reported adherence to medication2.Misbelieves regarding food items3.What kind of health-provider was consulted at the onset of the symptoms4.Their belief/knowledge regarding:A. The need for physiotherapy.B. Life style modification requirementC. About osteoarthritisD. Medication requirement during remissionE. Pregnancy and DMARDsF. The need of vaccinationG. Health hazards of smoking and alcohol useH. Harms of discontinuing treatment when they felt wellResults:A total of 450 patients included spondyloarthropathy 150(34%), rheumatoid arthritis 200(45.7%), psoriatic arthritis 45(10%), and others 25(5.5%).The following observations was made:1.Self-reported adherence to medication was in 250 (55%) patients; 200(45%) patient were non-adherent to treatment2.382/450 (85%) patients had misbelieves regarding different food items.3.225/450(50)% of the patients were not doing regular physiotherapy they were totally dependent on medications for symptoms relief.4.387/450 (86%) patients confused the symptoms of osteoarthritis with that of RA.5.315/450 (70 %) patients did not feel the requirement of continuing drugs during remission.6.135/450 (30%) patients believed that while on DMARDs they cannot contemplate pregnancy.7.351/450(78%) patients accept the need for vaccination when staring DMARDs8.360/450 (80%) patients aware about side effect of smoking in disease but only 40 % were able to quit.9.273/450 (60%) patients felt that more expensive medicines e.g.bDMARDs have more effects.10.360/450 (80%) patients believed that DMARDs were ‘steroids’ and they increased weight. On analysis one patient have more than two myths simultaneously.Conclusion:Increased awareness of the patient’s beliefs about medicines is needed among health care providers. We should encourage patients to express their views about medicines as well as disease in order to optimize and personalize the information process. This can stimulate concordance and adherence to medication and follow up.These myths are deeply rooted in our society, single sitting counseling is not enough, and reinforcement is needed.References:[1]Tom Greenhalgh. Facts about rheumatoid arthritis: 7 myths you may encounter. Rheumatology Advisor. March 28, 2019.Acknowledgments:noDisclosure of Interests:None declared
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