Application Of Cold Therapy Research Articles

Low-value and high-value care recommendations in nursing: Asystematic assessment of clinical practice guidelines.

The World Health Organization defines quality of care as providing effective, evidence-based care, and avoiding harm. Low-value care provides little or no benefit to the patient, causes harm, and wastes limited resources. In 2017, shortly after the start of the International Choosing Wisely campaign, the first Dutch nursing "Do-not-do" list was published and has become a widely used practical tool for nurses working in daily practice. However, over the last years new guidelines are published. Therefore, an update of the list is necessary with an addition of high-value care recommendations as alternative care practices for low-value care. In this study, a combination of designs was used. First, we searched Dutch clinical practice guidelines for low-value or high-value care recommendations. All nursing care recommendations were assessed and specified to several healthcare sectors, including hospital care, district care, nursing home care, disability care, and mental health care. Second, a prioritization among nurses regarding low-value care recommendations was done by a cross-sectional survey for each healthcare sector. In total, 66 low-value care recommendations were found, for example, "avoid unnecessary layers under the patient at risk of pressure ulcers" and "never flush the bladder to prevent urinary tract infection." Furthermore, 414 high-value care recommendations were selected, such as "use the Barthel Index to assess and to evaluate the degree of ADL independence" and "application of cold therapy may be considered for oncological patients with pain." In total, 539 nurses from all healthcare sectors prioritized the low-value care recommendations, resulting in a top five low-value care practices per healthcare sector. The top five low-value care recommendations differed per healthcare sector, although "do not use physical restraints in case of a delirium" was prioritized by four out of five sectors. Assessing low-value and high-value care recommendations for nurses will help and inspire nurses to deliver fundamental care for their patients. These initiatives regarding low-value and high-value care are essential to generate a culture of continuous quality improvement based on evidence. This is also essential to meeting the current challenges of the healthcare delivery system. This paper provides an update of low-value care recommendations for nurses based on Dutch guidelines from 2017 to 2023, specified to five healthcare sectors, including hospital care, district care, nursing home care, disability care and mental health care, with an accompanying prioritization of these low-value care recommendations to facilitate de-implementation. This paper provides a first overview of high-value care recommendations to reflect on and create alternative care practices for low-value care. The recommendations regarding low-value and high-value care are essential to generate a culture of continuous improvement of appropriateness based on evidence, finally leading to better quality of care and improving patient outcomes.

An Investigation into Cold-Therapy of the Equine Metacarpus, Following Temperature Changes with Exercise as Well as Post Intervention

There is some discussion as to whether exercise-induced hyperthermia of the superficial digital flexor tendon (SDFT) affects tenocyte viability and pre-disposes to injury. Cold-therapy is commonly used as a preventative measure and treatment for acute tendon injuries, but only a few studies have evaluated the effect of cold-therapy on metacarpal temperatures in the horse. For this reason, this study has measured skin surface temperatures after moderate exercise and after application of cold-therapy, and additionally monitored the duration of any effects. Four horses were recruited into a semi blinded controlled study with repeated measurements that involved lunged exercise for 16 minutes at moderate intensity. Skin surface temperature was measured using a thermographic camera before and after lunging, and every 40 minutes for two hours post cold-therapy. Cold-therapy was applied using a Jacks Whirlpool Boot with ice-water immersion at a level just distal to the carpus for 20 minutes. The right leg was treated, and the left leg was used as an untreated control. The experiment was conducted twice on all four horses. Moderate exercise resulted in an increase in skin surface temperature of 10°C. Application of cold-therapy for 20 minutes resulted in a reduction in skin surface temperature by 14°C. The effect of cold-therapy persisted for at least 40 minutes post treatment. It is concluded that exercise leads to an increase in skin surface temperature which is counteracted by the application of cold-therapy. These findings would seem to indicate that cold-therapy can be used after exercise to counteract hyperthermia within the metacarpal region of the horse’s leg.

Efficacy of Cold Therapy and Passive Stretching to Improve Gait in Spastic Diplegic Cerebral Palsy Children

Background One of the most common causes of severe physical disability in childhood is cerebral palsy (CP). Mobility is one of the most important functions to fulfill the activities of daily living. We aimed to determine the effectiveness of cold application to improve the ambulation in spastic diplegic CP children. Materials and Methods In this clinical trial study, 40 subjects were included for the study. They were divided into two groups, namely experimental (n=20), and conventional group (n=20). Study was carried out in Holy Cross College, Department of Rehabilitation Science, Tiruchirappalli, India. Conventional group was given regular conventional training and experimental group was given cold therapy, passive stretching in both legs before training. Both groups received training for 45 minutes, 3 times a week for a duration of 6 weeks. Modified Ashworth scales were used to measure spasticity step length, stride length and Cadences were used to measure the gait parameters, and Timed Up and Go test (TUG) was used to measure the functional activity. Results Significant effect was observed in decrease in spasticity, there was increase in gait parameters and timed up and go test in two studied groups. The post-test mean values of all the variables of cold therapy, passive stretching in experimental group are improved compared with that of conventional group. The experiment improved with stride length, step length, cadence, timed up and go test and Modified Ashworth scale (p<0.05). Conclusion Based on the derived results, there was decreased tone in spastic muscles and improvement in gait parameters and functional ability in children with diplegic CP after application of cold therapy and passive stretching.

Thermodynamic effects of commercially available ice boots.

The limb of the equine athlete is subjected to all types of various stressors during exercise. To ensure the health of the horse and to prevent the possibility of lameness, it has been a common practice to apply cold therapy to the distal limb of the horse pre- and post-exercise. Commercially available boots are widely available for the application of cold therapy. To test the effectiveness of the boot, 6 healthy performance level sport type horses were exercised at a walk, trot, and canter in a round-pen and then subjected to the application of the ice boot for 20 minutes on a treatment leg, and no ice boot on an untreated leg. Thermal images were taken of the 3rd metacarpal region pre-exercise, post-exercise, post-ice boot, and every 2 minutes after until the difference between the temperatures of the control leg and the treatment leg became zero. The images were analyzed using an analysis software (FLIR Tools) to determine the average temperature of the 3rd metacarpal region at each time point. The measured temperatures between treatments were found to be significantly different due to the application of the ice boot, providing evidence that the boot sufficiently cools the leg (P<.01). Thereafter, a 95% confidence interval was created to depict the average time it took for the cooled leg to return to average temperature post-ice boot, suggesting that it takes about 14.67 minutes for the difference between the temperatures of the cooled leg versus the non-cooled leg to become zero. This finding is significant to horse owners, trainers, and veterinarians that use this commonly available tool. These findings lend evidence to support the common practice of using cold therapy in treatment of disease in the horse.

Transdermal silicone patch for improving comfort in loupe‐aided surgery

Loupe magnification is widely used in surgery. Hand surgeons, in particular, use magnification for virtually all cases. The physical examination is more effective with magnification including improved tissue and foreign body identification.1 They are useful in replantations down to the palmar arch and free flaps with vessels more than 1.5 mm, such as the latissimus, fibula, serratus, radial forearm, rectus abdominis, dorsalis pedis, omentum, and jejunum.2 However, loupes are indicated in all interventions which require accuracy in identifying and handling small anatomical structures, as for example in pediatric surgery. Several factors should be taken into account when choosing surgical loupes. First of all, resolution of the loupes is obviously important. Another important consideration is the width of the loupe field. Usually, surgeons prefer a large field width, since a wider loupe field allows the surgeon to keep his instruments in perspective with the area of focus. Other important roles are played by the working angle of the loupes and the weight of the instrument (most surgeons prefer lighter frames to minimize strain). Loupes must be comfortable for the operator and therefore the weight of the loupes is an important consideration. If the loupes are too heavy they can be uncomfortable to wear—especially during long procedures. Loupes are usually mounted on spectacle frames and a good quality frame will distribute the weight evenly around the nose bridge and ears. However, all the surgeons who make frequent use of loupes have experienced, particularly during long operations, a discomfort due to the weight of the loupes and in some cases real pain. It's common to see the application of patches at the back of the nose to reduce the trauma at the level of support points of loupes. However, upon removal of the patch is frequently de-epithelization and traumatism in this site. For this reason we suggest a little trick to minimize discomfort during prolonged use of microsurgical loupes. It's common practice for anesthesiologists to place a transdermal silicone eye mask, that could be refrigerated, to reduce the risk of ocular trauma to the patient during surgery and anesthetic procedures. This product is also used after plastic surgeries and cosmetic treatments that involve the eye/upper nose area. The immediate application of cold therapy is beneficial for reducing post-operative swelling by constricting the capillary vessels and slowing down the flow of blood and other fluids to the injured or operated area and reduce the hematoma risk. It is possible to cut out the central fragment from this reusable silicone mask that perfectly fit the contour of the nasal dorsum as shown in Figures 1 and 2. The weight is then distributed over the nose and the particular consistency of the silicone avoids traumatizing the epidermis. The central fragment from this reusable silicone eye mask is cut. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] The fragment perfectly fit the contour of the nasal dorsum greatly improving the comfort of the surgeon. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] With this little trick the comfort of the surgeon will be greatly improved. Finocchi Valerio M.D.*, Tambasco Damiano M.D.*, * Division of Plastic and Reconstructive Surgery Catholic University of the Sacred Heart Rome, Italy

Domiciliary application of CryoCuff in severe haemophilia: qualitative questionnaire and clinical audit

The acute management of haemophilic bleeding episodes in the home setting is based on the concept of immediate factor replacement therapy and the PRICE regime--an acronym representing the concepts of Protection, Rest, Ice, Compression and Elevation [1,2]. Integral to this regime is the application of cold therapy, and yet little is known regarding the safe periods of application, or the relative safety of cryotherapy devices such as the CryoCuff when used in the home setting by patients suffering from severe haemophilia and related bleeding disorders. This study examines the subjective patient response to the application of the CryoCuff device in the home setting in terms of the effect on pain, joint swelling and the return to 'pre-bleed status' of the knee, ankle or elbow in patients with severe haemophilia A/B or type III von Willebrand's disease (VWD) immediately following haemarthrosis, and any potential adverse effects related to the device or recommended duration of application as stated in the PRICE guideline (Fig. 1). Twelve patients, either with severe haemophilia A/B or with VWD were recruited and asked to use the CryoCuff device as part of the PRICE regime immediately following the onset of knee-, ankle- or elbow bleeds for the next one year. Each subject was then sent a qualitative questionnaire to determine subjective responses to the device. All patients reported that the application protocol was easy to follow, they were able to apply the device as per the PRICE regime and they were able to tolerate it for the recommended period. Whereas, all the patients felt that the device had a significant impact on alleviation of pain and return to pre-bleed status, 78% of the patients felt that the device led to a significant reduction in swelling around the affected joint. There was no conclusive evidence that the device resulted in any reduction in the amount of factor used to treat the acute bleeding episode, however, no patients reported any perceived delay in achieving haemostasis or required extra factor replacement therapy consequent to the usage of the device. No other adverse effects were reported by participants in this study.