Wear Compression Research Articles

Antibacterial finishing of compression fabrics based on Ti3C2Tx-APTES material

Patients with hyperplastic scarring need to wear compression garments for long periods of time during treatment with compression therapy. Compression garment fabrics (CGFs) are prone to bacterial growth during use, leading to patient infections. It is essential to apply antibacterial functional finishing to the CGFs. In this study, antibacterial CGFs based on Ti3C2Tx and amino-functionalized silane coupling agent (3-aminopropyl) triethoxysilane composite material (APTES) were prepared by dip-coating method. The binding mechanism between the Ti3C2Tx-APTES and the CGF was explored, and the antibacterial rate, wash fastness, and wearability of the antibacterial fabric were investigated. The addition of APTES resulted in the formation of covalent bonds between the CGF and the antibacterial agent. The unwashed CGF exhibited antibacterial rates of 99.9% against Staphylococcus aureus (S. aureus, AATCC 25922) and 99.76% against Escherichia coli (E. coli, AATCC 6538), respectively. The wash fastness of antibacterial CGF met industry standard AA level, and the wearability of the treated fabric could basically satisfy daily wear requirements. The Ti3C2TX-APTES antimicrobial CGF prepared in this study provides an effective solution for the development of antimicrobial fabrics for sports and medical applications.

Skin Grafting in Post burn contractures of Groin and perineum in patients

Background: Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Material and Methods: This is prospective and descriptive study conducted in the Department of Plastic Surgery at Tertiary Care Teaching Hospital over a period of 1 Year. First dressing was seen on third or fourth postoperative day and percentage of graft take/loss was noted. Complications, if any, were recorded. Indwelling urinary catheter drainage was instituted for 3 to 4 days postoperatively. Once the graft stabilized, patients were discharged and advised to wear compression garments. Results: In our study, 77.1% of the patients, post burn contractures of the groin and perineum were because of Open chulla. Other less common causes were hot water (14.3%) and flame burn (8.6%). Majority of the patients were brought with complaints of difficulty in squatting (80.0%) followed by limitation of movements of hip joints (71.4%) and (44.3%) impairment of walking. In our series of 70 patients two types of operative procedures were performed: (1) release of contracture with split thickness skin grafting; (2) release of contracture and closure by multiple Zplasties. Moreover, 30 (42.9%) patients having bilateral groin contractures underwent release of contracture with split thickness skin grafting. 29 (41.4%) patients underwent release of unilateral groin contracture with split thickness skin grafting and 4 (5.7%) patients underwent release of unilateral groin contracture and closure by multiple Zplasties.Conclusion: To conclude, recuperation from perineal burns, both in acute period and chronic phase in case contracture occurs, is a difficult challenge physically and mentally. The agony that a burn patientendures during treatment is evident even to an onlooker.

The effect of compression on repetitive behaviors and task participation in children with autism spectrum disorder.

Compression clothes are marketed to relieve anxiety and decrease hyperactivity in children with autism. However, few studies have examined the impact of compression for individuals with autism spectrum disorder (ASD). In this study, nine children with autism were observed during Applied Behavioral Analysis therapy sessions while wearing compression clothing. The participants were randomly assigned to wear compression clothing for either their first five sessions or their last five sessions. Videos of the therapy sessions were reviewed and each child's "off task" behavior was identified in the following domains: motor, verbal, and visual. In addition, frequency of the child's repetitive behaviors and external visual stimuli were recorded. The compression clothes failed to increase task participation or reduce the participants' repetitive behavior suggesting that the clothing may not contribute to professional practice of ABA therapy.

The Effect of Video Education on the Risk of Development of Venous Thrombo Embolia in the Lower Extremıty After Coronary Bypass Surgery: A Quasi-Experimental Study

Objective: This study was conducted as a quasi-experimental study to evaluate the effect of video training on the prevention of the risk of developing venous thromboembolism in the lower extremities after coronary bypass surgery. Materials and Methods: 42 patients were included in the experimental group and 42 patients in the control group according to the sample selection in groups with a certain population. Data were collected with the Patient Information Form, Venous Circulation Evaluation Form, and Wearing Compression Elastic Stocking Evaluation Form. Video-assisted training was given to the experimental group, and the training that existed in the clinical routine was delivered to the control group. Results: There was no redness, pain, or burning in the extremities of the patients in the experimental group (p

The Effect of Superficial Venous Incompetence Treatment on Combined Segmental Deep Venous Reflux

The aim of this study was to assess the role of treatment of superficial venous reflux (SVR) in patients with combined deep segmental venous reflux as regards clinical symptoms as well as reflux improvement of the deep veins. We reviewed 80 patients, retrospectively selected on the inclusion criteria and having combined SVR and segmental deep venous reflux who underwent SVR ablation. The contralateral limb of 44 patients was used as a control group, asked to wear compression stockings for 3months during day time with no surgical intervention. Duplex ultrasounds follow-up was performed at 3, 6, and 12months postoperatively. Clinical severity of venous disease was graded from C1 to C6 according to the CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification. Duplex ultrasound was done in both supine and standing positions with non-weight-bearing of the examined limb. The venous reflux time, the venous flow volume and the peak venous flow velocity were registered. Removal of SVR was performed using either conventional surgery or radiofrequency ablation. The patient was required to wear compression stockings during the day time for the following weeks. During the follow-up period, all patients were improved clinically as regards pain, edema, and ulcer healing. All patients included in this study had no signs of residual SVR. Corrected deep venous segment reflux was in 36 (45%). Similar data at 3, 6, and 12months postoperatively after SVR removal. The popliteal vein reflux responded less than the femoral vein reflux did. Treatment of the SVR eliminates segmental deep venous reflux in a good percentage of patients regardless of the treatment modality. Also, symptoms improvement and ulcer healing were documented, and hence, more studies are recommended to evaluate this role.

Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials

BackgroundPost thrombotic syndrome (PTS) is a serious complication of deep venous thrombosis (DVT). There were always debates on the efficacy of elastic compression stockings (ECS) in prevention for post thrombotic syndrome. ObjectiveTo assess effects of elastic compression stockings and ECS's wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. MethodsPubMed, Cochrane Library, Embase, Web of Science were last searched on 23 November 2022 for studies assessing effects of elastic compression stockings or theirs wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. Results9 randomized controlled trials were included. Wearing elastic compression stockings was associated with a statistically reduction in the overall post thrombotic syndrome rate (RR 0.73, 95 % CI 0.53 to 1.00; P = 0.05; I2 = 82 %). No significant difference in severe post thrombotic syndrome rate, recurrent deep venous thrombosis rate, and death rate was seen whether wearing elastic compression stockings or not. The pooled effect of studies comparing different wearing time of elastic compression stockings showed no significant difference in post thrombotic syndrome rate, severe and moderate post thrombotic syndrome rate, recurrent deep venous thrombosis syndrome rate and death rate. ConclusionsWearing ECS can reduce the risk of developing PTS after DVT and a wearing time of less than or equal to 1 year is comparable to 2 years wearing. The results support ECS's role as a foundation therapy for preventing PTS.

Barriers and facilitators to use of compression therapy by people with venous leg ulcers: A qualitative exploration.

To explore barriers to, and facilitators of, adherence to compression therapy, from the perspective of people with venous leg ulcers. An interpretive, qualitative, descriptive study involving interviews with patients. Participants were purposively sampled from respondents to a survey exploring attitudes to compression therapy in people with venous leg ulcers. Sampling continued until data saturation: 25 interviews between December 2019 and July 2020. Inductive thematic analysis of interview transcripts was undertaken to create a framework for the data, followed by deductive analysis informed by the Common-Sense Model of Self-Regulation. A range of knowledge and understanding about the cause of venous leg ulcers and the mechanisms of compression therapy was demonstrated, which was not particularly related to adherence. Participants talked about their experience with different compression methods and their concerns about the length of time healing could take. They also spoke about aspects of the organization of services which affected their care. Identifying specific, individual barriers/facilitators to compression therapy is not simple, rather factors combine to make adherence more or less likely or possible. There was no clear relationship between an understanding of the cause of VLUs or the mechanism of compression therapy and adherence; different compression therapies presented different challenges for patients; unintentional non-adherence was frequently mentioned; and the organization of services could impact on adherence. Ways in which people could be supported to adhere to compression therapy are indicated. Implications for practice include issues relating to communication with patients; taking into account patients' lifestyles and ensuring that they know about useful 'aids'; providing services that are accessible and provide continuity of appropriately trained staff; minimizing unintentional non-adherence; and acknowledging that healthcare professionals will always need to support/advise those who cannot tolerate compression. Compression therapy is a cost-effective, evidence-based treatment for venous leg ulcers. However, there is evidence that patients do not always adhere to this therapy and there is limited research investigating reasons why patients do not wear compression. The study found no clear relationship between an understanding of the cause of VLUs or the mechanism of compression therapy and adherence; that different compression therapies presented different challenges for patients; that unintentional non-adherence was frequently mentioned and that the organization of services could impact on adherence. Attending to these findings offers the opportunity to increase the proportion of people undergoing appropriate compression therapy and achieving complete wound healing, the main outcome desired by this group. A patient representative sits on the Study Steering Group, contributing to the work from developing the study protocol and interview schedule to interpretation and discussion of findings. Members of a Wounds Research Patient and Public Involvement Forum were consulted about interview questions.

Assessment Of Laboratory Devices For Estimating Body Composition In A Hispanic Population

PURPOSE: To determine the agreement between dual-energy x-ray absorptiometry (DXA) and multi-frequency bioelectrical impedance analysis (BIA) for estimating body fat percentage (BF%), fat mass (FM), and fat-free mass (FFM) in a Hispanic population. METHODS: One-hundred eighty-one individuals (males: n = 84; females: n = 97) of Hispanic descent had body composition estimated via DXA and BIA. Participants completed all testing wearing compression gear and provided a urine sample to assess hydration status. Adequate hydration was considered at a urine specific gravity value <1.029. Agreement between DXA and MF-BIA BF%, FM, and FFM was assessed using Pearson correlations, linear regression, and Bland-Altman analyses. Analyses yielded the standard error of the estimate (SEE), constant error (CE), 95% limits of agreement (LOA), and proportional bias for the entire group and within sexes. RESULTS: For BF%, BIA displayed similar CE ± 95% LOA for the sample (-3.17 ± 5.45%), males (-3.2 ± 5.5%), and females (-3.2 ± 5.4%) compared to DXA. Correlation analyses indicated near-perfect associations (sample: r = 0.96, males: r = 0.93, and females: r = 0.93); however, a moderate proportional bias was present for females (r = 0.48). The sample (r = 0.22) and males (r = -0.04) had trivial-to-no proportional bias. Regarding FM, BIA exhibited CE ± 95% LOA values of -1.4 ± 4.2 kg for the sample, -1.9 ± 4.6 kg for males, and -0.9 ± 3.6 kg for females. All groups displayed near-perfect associations (sample: r = 0.99, males: r = 0.97, and females: r = 0.99), despite a strong proportional bias for females (r = 0.68) and moderate bias for the sample (r = 0.36). No proportional bias was observed for males (r = -0.02). For FFM, males demonstrated the largest CE ± 95% LOA (1.6 ± 4.6 kg), compared to the sample (1.2 ± 3.9 kg) and females (0.9 ± 3.4 kg) when BIA was compared to DXA. Near-perfect associations were observed for all groups (sample: r = 0.98; males: r = 0.97; females: r = 0.97). No proportional biases existed for the sample (r = -0.01) or males (r = -0.10); however, females exhibited a moderate, negative bias (r = -0.38). CONCLUSIONS: Due to the observed moderate-to-strong proportional biases within body composition estimates, particularly for Hispanic females, the need for ethnic-specific algorithms is warranted.

The Efficacy of Compression Stockings on Patients With Nocturia: A Single-Arm Pilot Study

Objectives: Behavioral treatment for nocturia includes wearing compression stockings. However, a reading of the cited literature for evidence shows that there is not enough research data to support this recommendation, and it is controversial. The present study aimed to investigate and supplement evidence on the effects of wearing compression stockings during the daytime in patients with nocturia.Methods: This was a single-arm prospective study to investigate the effects of compression stockings on nocturia for four weeks. Patients were asked to record a frequency-volume chart and complete various questionnaires at baseline and after four weeks, and also provide feedback on treatment satisfaction. The primary endpoint was a change in night-time frequency in the frequency-volume chart from the baseline to the end of treatment.Results: Thirty-four patients (19 men and 15 women; age: 72.3 ± 12.6 years) were included. Two patients dropped out because of pain associated with wearing compression stockings and one due to a refusal to wear compression stockings every day. Therefore 31 patients were analyzed. In the frequency-volume chart, night-time and 24-hour frequencies significantly decreased by 0.5 and 1.1 episodes, respectively (P = 0.004 and P = 0.035, respectively). The hours of undisturbed sleep significantly increased by 0.8 h (P = 0.013). No significant differences were observed in nocturnal or 24-h urine volumes, the number of urgency or urinary incontinence episodes, the mean or maximum voided volume, the nocturnal polyuria index, or the first night-time voided volume. The total overactive bladder symptom score significantly decreased (P = 0.006). Significant reductions were also observed in all overactive bladder symptom score subscores, except for the daytime frequency score.Conclusion: The present results suggest the effectiveness of wearing compression stockings during the day was satisfactory in most patients with nocturia, and the treatment was safely continued in patients who experienced no pain when wearing the stockings. Based on the results of this study, we believe that it is worth considering as a treatment for nocturia.

Safety and Feasibility of a Kinesiotape Application for Secondary Hand Lymphedema: A Case Series.

Background: The safety and feasibility of using kinesiotape as a short-term alternative treatment to compression garments or gloves for hand lymphedema have not been examined. The aim of this study was to examine if kinesiotape could maintain size and extracellular fluid (ECF) volume of the hand and forearm, as well as upper limb function and quality of life for women with secondary hand lymphedema. Methods and Results: Six women with secondary hand lymphedema underwent pretreatment measurements, including hand and digit size using a tape measure; ECF volume using bioimpedance spectroscopy; and patient-reported outcome measurements of upper limb function and quality of life. Kinesiotape was then applied to the dorsum of the hand and left for 48 h, during which participants were asked not to wear compression garments. Posttreatment measurements were completed after kinesiotape removal. Changes in measurements were compared to the smallest detectable change (SDC). Hand size did not change more than the SDC; however, a single affected digit increased in circumference by more than the SDC. Changes of the whole arm ECF volume were less than the SDC. The ECF volume of the dorsum of the hand increased in one and decreased in another participant. The forearm ECF volume decreased in two participants. Upper limb function and quality of life did not change. No adverse event was reported. Conclusion: Short-term kinesiotape use appears to be safe in maintaining the physical presentation of hand lymphedema. However, these results should be examined in a larger sample. The feasibility of using kinesiotape as an alternative treatment to compression requires further investigation. Clinical Trial Registration number: ACTRN12618001232224p, July 23, 2018 retrospectively registered.

Comparison of outcome of compression dressing for two days Vs seven days after varicose surgery.

Incompetence of the great saphenous vein (GSV) is a global issue and the most prevalent cause of chronic venous disease of the leg. Clinical manifestations range from moderate to severe, including tiredness, heaviness, and irritation, as well as hyperpigmentation and leg ulcers. A study was conducted to address this controversy,1 i.e. to determine the outcome of compression dressing after varicose vein surgery in terms of postoperative pain, on the Surgical floor, of Mayo Hospital, Lahore, from October 1, 2020, to April 1, 2021. A total of 60 patients with Primary varicose veins were enrolled in this study, fulfilling the inclusion criteria after obtaining approval from the ethical committee of the hospital. The patients were divided in two groups. Group A wore compression dressing for two days after surgery and Group B wore compression dressing for seven days after surgery. All the patients received 1gm Paracetamol I/V eight hourly followed by tablet Paracetamol 500mg P/O eight hourly. Then the outcome of compression dressing was analysed in the form of mean postoperative pain. The mean pain score was assessed on one week. Data were entered in SSPS v23.0. Stratification of pain score was done against age, gender, and grades of varicose veins. A comparison of the two groups was done by applying a t-test. A p-value of ≤ 0.05 was considered significant. Prescribing compression stockings for longer than two days after Trendelenburg's procedure leads to reduced pain and improved physical function during the first week after treatment.

577 Expanding Outpatient Burn Therapy Services to Address Social Determinants of Health

IntroductionOccupational and Physical Therapist provide acute services to burn-injured patients and continue treatment well into their functional recovery for mobility, strengthening, scar management, contracture prevention and return of independence. Unfortunately, we recognized that patients encountered obstacles when attempting to access these services in the outpatient setting. It was evident that these impediments frequently coincided with social determinants of health (SDOH). According to Healthy People 2020, SDOH represent the cumulative influences of individual, cultural, community and societal attributes on health and quality-of-life. Self-pay patients accounted for 12% of clinic patients. However, patients with coverage were not always receiving adequate therapy due to lack of burn knowledge among community-based therapist. By expanding outpatient burn clinic services, we are better positioned to meet the needs of all burn-injured patients in our community.MethodsA plan was outlined to increase the presence of Occupational and Physical Therapy (OT/PT) in the outpatient burn clinic. Pertinent literature was reviewed, and a presentation was developed to establish need and outline a model for integration of services. The inpatient OT/PT department managers collaborated with the Burn Director and Burn APRN on projecting staffing and equipment needs. Multidisciplinary cost analysis was completed. Guidelines for outpatient burn rehabilitative therapy staffing and a description of services were developed.ResultsAfter much collaboration and effort, and with community support, our PT/OT inpatient burn staff provide rehabilitative therapy to all patients attending outpatient burn clinic two days weekly. Additionally, educational material, hands on range of motion training and free new and donated compression garments are readily available during all four burn clinics weekly. The new outpatient burn clinic opened in 2021, equipped with two large showers and a designated therapy room, ready to wear compression garments, putty, and assistive devices designed to further support burn recovery. Attendance for burn outpatient visits increased significantly from 2015 to 2018.ConclusionsTransportation, childcare, employment restrictions, individual health and wellness beliefs, lack of funding and access to technology represent examples of blockades to healthcare care. This multidisciplinary effort increased the availability and scope of rehabilitative services in the outpatient burn clinic patient, allowing patients to receive comprehensive burn wound care and rehabilitative therapy in one location to promote healing, manage pain, improved function, maximizes independence and reintegrate into their family and community.

Determinants of Quality of Life in Patients with Post-Thrombotic Syndrome

Chronic post-thrombotic syndrome (PTS) may develop in up to 50% of patients after deep vein thrombosis (DVT), and may reduce patients' quality of life (QoL). We aimed to evaluate the association of PTS severity with QoL in patients with proximal DVT submitted for medical treatment and also to identify modifiable and non-modifiable risk factors related to PTS. Patients with iliac or femoropopliteal DVT observed in Vascular Surgery consultation in our institution from 1year period with unilateral DVT were selected. Patients with total vein recanalization were excluded. Villalta scale was applied to assess PTS degree and VEINES-QoL/Sym questionnaire was used as a disease-specific QoL measure. Correlation between PTS degree and VEINES-QoL/Sym score and predictors of PTS were determined. Fifty-six patients were accepted to enter the study. From those, 66.1% were female, 64.3% (n=36) had iliac and 35.7% (n=20) femoropopliteal DVT. PTS was present in 52.8% of iliac and 65.0% of femoropopliteal DVT patients observed for consultation (P=0.41). There was a significant correlation with PTS degree and both VEINES-QoL and VEINES-Sym scores (P<0.01). Major depression (odds ratio OR=5.63, P=0.04) and regular wear of compressing stockings (OR=4.69, P=0.04) were the only independent factors associated with PTS. Patients with depression had lower QoL scores, while patients with PTS who wear compression stockings had similar QoL scores compared to patients without PTS. Ultrasound alterations (OR=3.28, P=0.17), age, gender, iliac DVT, multiple DVT and time after DVT (P>0.20) were not associated with PTS syndrome. VEINES-QoL/Sym had moderate inverse correlation with PTS degree. Depression was associated with both PTS and lower QoL scores. Patients with PTS criteria compliant to wearing compressing stockings had similar QoL scores to patients without PTS.

Third-Degree Burn on the Neuropathic Lower Extremity in a Patient With Diabetes While Wearing a Copper–Containing Compression Sock: A Case Report

Many patients who have diabetes and peripheral neuropathy wear compression socks, which are widely available and may be purchased with a copper component. There is also a well-documented history of patients with neuropathy developing thermal burns from heat sources. Patients with diabetes are at an increased risk of complications when they sustain burns. To describe a patient with diabetes and neuropathy who developed third-degree burns while wearing a copper-containing compression sock. A 68-year-old man with type 2 diabetes and peripheral neuropathy wore a copper-containing compression sock while sitting in the sun for several hours. Afterward, he noted severe blistering and was ultimately diagnosed with several areas of second- and third-degree burns. Wound treatment included sharp debridement, dressing management, and tubular compression. All wounds were healing well when the patient was lost to follow-up. This case report illustrates the risk of burn injury when wearing compression socks infused with copper in a situation in which the sock could absorb heat, especially in persons with neuropathy. This report and previous studies showing the increased risk of burn injury complications in persons with diabetes underscore the importance of burn prevention education in this population. Future research to examine the thermal conductivity of metal-containing clothing is recommended.

Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review

PurposePatient adherence to wearing compression stockings in the management of chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is low. Poor adherence with compression stockings contributes to recurrence and impaired healing of VLUs. As such, the purpose of this review was to report on the scientific evidence related to adherence and explore modifiable factors which impact adherence with compression stockings.MethodsA systematic search was conducted from inception to 31 October 2019. Following the PRISMA-ScR Checklist, PubMed, Medline, CINAHL, Cochrane, Embase, OT Seeker and Web of Science were explored using search terms: compression/compression stocking/compression garment/compression sock/stockings/garments and adherence/compliance/concordance.ResultsWe identified 2613 papers of which 125 full text papers were assessed for eligibility and 69 met inclusion criteria. Papers were grouped and charted by concepts relevant to the research questions and narratively synthesized. Several dominant themes emerged, and a conceptual framework was developed incorporating modifiable variables, adherence itself, and outcomes related to adherence. Specifically considering interventions to improve adherence, only five of 14 randomized controlled trials were able to demonstrate improvements in adherence through unidimensional approaches. All nine of the case studies/series demonstrated a positive impact on adherence, eight of which described a personalized multidimensional approach. A lack of consensus around defining, measuring, and quantifying adherence with compression stockings was identified, resulting in wide variation in reported adherence rates.ConclusionInconsistency in the definition and measurement of adherence limits meaningful interpretation of the literature. No individual intervention has consistently demonstrated improved adherence. Multidimensional interventions show promise but require further investigation with high-quality trials. Improving adherence appears to improve health outcomes in VLU /CVI populations but there is a lack of information directly linking improved adherence with cost outcomes.Trial RegistrationOpen Science Framework: ACTRN12620000544976p.

Orthostatic hypotension: Etiology, Pathogenesis, Clinical Symptoms, Diagnostics and Treatment

Viktorija Bleizgytė1 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas Abstract Background. Orthostatic hypotension is a decrease in systolic ABP ≥20 mmHg or a decrease in diastolic ABP ≥10 mmHg after standing up after first 3 minutes. This pathology is not common, but the incidence increases exponentially with age. The absence or poor expression of symptoms increases the risk of fall, as well as morbidity and mortality. The most common risk factors are age, high consumption of drugs, hypertension, diabetes, amyloidosis. OH may include weakness, tiredness, nausea, palpitations, headaches, dizziness, blurred vision, fainting. In a patient, who stood up from a supine position and had a decreased ABP within the first 3 minutes, established with orthostatic hypotension. Aim: to review and analyze the sources of scientific literature related to orthostatic hypotension, the causes of its development, main diagnostic methods and principles of treatment. Methods: scientific literature sources were searched in PubMed, UpToDate, Cohrane Library, ScienceDirect databases. During the literature review, articles related to orthostatic hypotension, its causes of development, diagnostic possibilities, and treatment principles were selected. Results. If it is not possible to measure the decreased ABP, but if OH is suspected, the ABP can be measured at 24 hours. The goal of OH treatment is to improve symptoms. Non-drug treatment is preferred. The fludrocortisone, midodrine, pyridostigmine can be used. It is recommended for the patient to wear compression clothing, increase physical activity, perform various exercises, consume more salt, drink about 1,5 – 2,5 liters of water. If OH symptoms occur, it is recommended to drink 500 ml of water as quick as possible and sleep with head raised 20 to 30 cm to increase orthostatic tolerance. Conclusion: this brief review of the scientific literature presents the main aspects of orthostatic hypotension, its etiology and pathogenesis, principles of diagnosis and treatment. Keywords: Orthostatic hypotension, decrease in arterial blood pressure, compensatory mechanism, venous stasis.

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study.

The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.

Recurrent venous leg ulcers: management in general practice

Venous leg ulcers commonly recur. Annemarie Brown highlights some self-care strategies that patients can use to reduce their risk Chronic venous leg ulcers are commonly seen in general practice and although healing rates for leg ulcers have improved, recurrence rates are high with around 60–70% reported to recur after healing. The primary prevention strategy is the life-long wearing of compression hosiery; however, compliance is low for several reasons including lack of understanding of the need to wear compression hosiery and difficulties applying and removing it. Self-care strategies such as physical exercise and mobility, leg elevation and appropriate skin care, can help to prevent recurrence of venous leg ulcers. Practice nurses are ideally placed to provide this advice, which can help improve patient's quality of life while reducing the financial burden of treating open ulceration for the NHS.

Compression stockings for preventing deep vein thrombosis in airline passengers.

Air travel might increase the risk of deep vein thrombosis (DVT). It has been suggested that wearing compression stockings might reduce this risk. This is an update of the review first published in 2006. To assess the effects of wearing compression stockings versus not wearing them for preventing DVT in people travelling on flights lasting at least four hours. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 1 April 2020. We also checked the bibliographies of relevant studies and reviews identified by the search to check for any additional trials. Randomised trials of compression stockings versus no stockings in passengers on flights lasting at least four hours. Trials in which passengers wore a stocking on one leg but not the other, or those comparing stockings and another intervention were also eligible. Two review authors independently selected trials for inclusion and extracted data. We sought additional information from trialists where necessary. One new study that fulfilled the inclusion criteria was identified for this update. Twelve randomised trials (n = 2918) were included in this review: ten (n = 2833) compared wearing graduated compression stockings on both legs versus not wearing them; one trial (n = 50) compared wearing graduated compression tights versus not wearing them; and one trial (n = 35) compared wearing a graduated compression stocking on one leg for the outbound flight and on the other leg on the return flight. Eight trials included people judged to be at low or medium risk of developing DVT (n = 1598) and two included high-risk participants (n = 1273). All flights had a duration of more than five hours. Fifty of 2637 participants with follow-up data available in the trials of wearing compression stockings on both legs had a symptomless DVT; three wore stockings, 47 did not (odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04 to 0.25, P < 0.001; high-certainty evidence). There were no symptomless DVTs in three trials. Sixteen of 1804 people developed superficial vein thrombosis, four wore stockings, 12 did not (OR 0.45, 95% CI 0.18 to 1.13, P = 0.09; moderate-certainty evidence). No deaths, pulmonary emboli or symptomatic DVTs were reported. Wearing stockings had a significant impact in reducing oedema (mean difference (MD) -4.72, 95% CI -4.91 to -4.52; based on six trials; low-certainty evidence). A further three trials showed reduced oedema in the stockings group but could not be included in the meta-analysis as they used different methods to measure oedema. No significant adverse effects were reported. There is high-certainty evidence that airline passengers similar to those in this review can expect a substantial reduction in the incidence of symptomless DVT and low-certainty evidence that leg oedema is reduced if they wear compression stockings. The certainty of the evidence was limited by the way that oedema was measured. There is moderate-certainty evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. We cannot assess the effect of wearing stockings on death, pulmonary embolism or symptomatic DVT because no such events occurred in these trials. Randomised trials to assess these outcomes would need to include a very large number of people.

Survey of lipoedema symptoms and experience with compression garments

Lipoedema is an incurable chronic disease causing limb deformity, painful skin and excessive ecchymosis. Compression garments are frequently recommended to manage symptoms, but the existing products are not designed specifically for lipoedema, and are for other medical conditions. A structured questionnaire was prepared in Online Surveys in October 2018 to investigate lipoedema symptoms and the use of compression garments to manage them. Some 279 people with lipoedema completed the survey; 70% wore compression garments in all four compression classes, of which class 2 was most common (58% of wearers). The top three reasons for wearing compression garments were to feel supported (73%), reduce lipoedema pain (67%) and improve mobility (54%). Most people with lipoedema who wore compression garments found compression helpful in managing their symptoms, but overall satisfaction was low. Problems with existing compression garments were so severe in some cases that the garments were not worn at all or used less often. The information collected in this survey might be useful for the design and development of compression garments specifically for lipoedema.