Masters Degrees (School of Nursing)
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Browsing Masters Degrees (School of Nursing) by Author "Gerber, Johannes Benjamin"
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Item Open Access Volgehoue versus intermitterende pneumatiese kompressie as behandelingsmodaliteite in pasiënte met veneuse onderbeenulkusse(University of the Free State, 2006-01) Gerber, Johannes Benjamin; Mulder, M.English: Epidemiological studies have shown that vascular diseases and specifically venous diseases are the cause of lower leg ulcers, that venous diseases are the cause of 70% of lower leg ulcers in the United Kingdom and 70 to 90% of all ulcers in North America and England. In North America 10 to 15% of ulcers are the result of a combination of venous and arterial insufficiency. Two treatment modalities are available for venous lower leg ulcers: - sustained compression and - intermittent pneumatic compression. The aim of this study was to compare the usefulness and effectiveness of intermittent pneumatic and sustained compression with each other. To attain this objective: - the profile of patients with venous lower leg ulcers was described. - the effectiveness of sustained versus intermittent pneumatic compression modalities regarding wound healing were compared. - the effectiveness of sustained versus intermittent pneumatic compression modalities regarding pain were compared. - The factors that influence the feasibility of the two treatment modalities were identified. This study consisted of two components. In the first place a descriptive study was undertaken of the patients with venous lower leg ulcers who visited the out-patient department of a Tertiary hospital in the greater Bloemfontein area. The second component was an experimental study in which the effectiveness of the two treatment modalities were compared. The patients in the experimental study were allocated to the experimental and control groups by means of a random list. Patients in the experimental group were treated with intermittent pneumatic compression for twelve weeks, while those in the control group were treated with four-layer compression bandages for the same period. The study lasted for 27 months until the desired sample size was reached. Data confirmed the information available in the literature regarding venous lower leg ulcers. Outstanding characteristics of the profile were the majority of the patients were obese and hypertensive. The misuse of topical antimicrobic drugs became clear from the patients’ history. It also appeared that many of the patients lacked knowledge of and insight into the causes and nature of venous lower leg ulcers, as well as their prevention and treatment. It became clear that the ulcers of more patients treated by means of sustained compression were healed than those with intermittent pneumatic compression. This difference in wound healing was, however, not statistically significant. The pain levels of the patients of both groups decreased with treatment between the first and last assessment. However, the difference between the pain levels of the experimental and control groups was not statistically significant. The most import factors that influence the feasibility of the two treatment modalities were the following: - A shortage of nursing staff and doctors were experienced due to the labour intensity of the study; - Communication problems (it was necessary to use an interpreter at times); - A shortage of wound dressings and bandages due to unforeseen circumstances; - The Department of Health under-estimated the cost implications of the treatment modalities; - Intermittent pneumatic compression as a treatment modality was available only to patients in the greater Bloemfontein area. Volgehoue versus intermitterende pneumatiese kompressie as behandelingsmodaliteite in pasiënte met veneuse onderbeenulkusse 35 - Sustained compression – patients from outside the greater Bloemfontein area missed a treatment session if they missed the ambulance that transported them to the hospital. - Patients experienced transport problems due to high taxi fares and transport was not always readily available on public holidays or over weekends. - The continuity of sustained compression had, in some cases, to be broken for some patients if the patient presented with clinical signs and symptoms of infection.