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14 pages/≈3850 words
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Level:
Harvard
Subject:
Health, Medicine, Nursing
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Dissertation
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English (U.S.)
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Topic:

Evidence Based Review Franek et al 2004 (Level II) (Dissertation Sample)

Instructions:

the TASK INVOLVED EVALUATING VARIOUS RESEARCH ARTICLES BASED ON THEIR AIM,METHODS DISCUSSED,CRITICAL REVIEW AND LIMITATIONS, IN RELATION TO THE TOPIC.

source..
Content:


EVIDENCE BASED REVIEW
Name
Course
Tutor
Institution
Date
Evidence Based Review
Franek et al 2004 (Level II)
Franek, (2004) aimed at comparing two different intensities of ultrasound, 1.0 W/cm2 and 0.5 W/cm2, plus compressive therapy, and a third group who received topical pharmacological treatment and compressive therapy. The therapeutic range for the power density of ultrasound is between 0.1 and 3W/cm2.
The objective of the study was to comparatively determine which of the ultrasound power densities between 0.5 W/cm2 and 1W/cm2 was more effective at reducing the volume and area of leg ulceration. The study also made attempts in determining whether and which of the ultrasound densities used had significant impact on the granulation, self-debridement and epithelialization of the wound. This ensures that the different ultrasound causative factors and mechanisms are dominant along the range in various bands. These ranges directly influence the choice of the optimum application and technical parameters of ultrasound employed in enhancing the process of venous ulcers healing.
The study randomly divided the sampled 65 patients with venous ulcers into three groups named: A, B and C. The 22 patients in group A were treated with ultrasound set at 1W/cm2 combined with comprehensive therapy while the 21 patients in group B were subjected to ultrasound set at 0.5W/cm2 combined with comprehensive therapy. The 22 patients in group C, on the other hand, were given topical pharmacological treatment in combination with compressive therapy as well. This treatment was accompanied by local baths of potassium permanganate plus wet dressings of a solution of 0.1 copper sulphate. Compresses of chloramphenicol, gentamicin, fibrolan and colistin were also used. The drugs were administered alternatively after a few days for up to 3 weeks.
The two treatment groups A and B received ultrasound procedure in a water bath with a temperature of 34 degrees Celsius, time depended on wound size. Ultrasound was delivered daily for three weeks. The patients in group A and B were as well administered with topical wet dressings of an isotonic saline media. The group did not receive further phlebotropic or tropical drug treatments. The methods applied compressive therapy for group A and B by removing the dressing during the periods of treatment and reapplying them immediately after the treatment.
The method measured the changes observed in the ulcerated areas through planimetric measurements of the congruent, homothetic projections of these regions with the help of digitizing tablet. The depth of the ulcer was also measured using a precision-built mechanical micrometer.
The study further developed healing rate indicators to help in accurately presenting the progress of the process. The indicators were defined as below;
ωS=δs/tC
where ωS=weekly rate of change of relative ulcer area (% per week)
tC=total treatment time
δS=change of relative ulcer area (in %)
δS=(S1xS2) x100%/S1, where S1=ulcer baseline
area
S2=ulcer final area.
ωV=tC
where ωV=weekly rate of change of relative volume of the ulcers (% per week)
tC=total treatment time
δV=change of relative volume of the ulcers (in %)
δV=(V1xV2) x100%/V1, where V1=ulcer base
line volume
V2=ulcer final volume.
The self-debridement of wounds was represented by the rate of change of suppurate area and by the relative change of the suppurate area in percentages. The relative suppurate area was calculated as follows:
R1=r1/S1 x100%
where R1=relative suppurate area before treatment (in %)
r1=suppurate area before treatment
S1=ulceration area before treatment.
R2=r2/S2x100%
where R2=relative suppurate area after treatment (in %)
r2=suppurate area after treatment
S2=ulceration area after treatment.
The degree of granulation was evaluated by means of the granulation rate indicator and percentage change of granulated area. The relative granulation area was
calculated as follows:
Z1=z1/S1 x100%
where Z1=relative granulation area before treatment (in%)
z1=granulation area before treatment
S1=ulceration area before treatment.
Z2=z2/S2 x100%
where Z2=relative granulation area after treatment (in %)
z2=granulation area after treatment
S2=ulceration area after treatment.
Statistically significant reduction in ulcer area was found in all three groups. The average weekly change was fastest in the treatment group who received ultrasound at 0.5 W/cm2 plus compressive therapy. That application of ultrasound at 1.0 W/cm2 was not more beneficial than traditional methods. The application of ultrasound at 0.5 W/cm2 was found to be equal or better than traditional methods (p≤0.05). The physical findings for patients of various histories are shown in the table below:
Findings

Group A n (%)

Group B n (%)

Group C n (%)

Edema, hyper pigmentation lipodermatosclerosisof ulcerated extremity.

22(100)

21(100)

22(100)

Superficial varicosities of ulcerated extremity

7(32)

10(47.6)

6(27.3)

Previously known deep venous thrombosis in ulcerate d extremity

12(54.5

12(57.1)

6(27.3)

Overweight (BMI> 30 kg/m2)a

12 (55.5)

8(38.1)

5(27.8)

Smokers

6(27.2)

4(19)

4(18.2)

The following data was obtained using the Wilcoxon's pair sequence test:
Ulceration area before treatment (S1) (cm2)
Average A=15.62 B=15.57 C=23.74
Median A=12.51 B=6.71 C=11.72
Ulceration area after treatment (S2) (cm2)
Average A=14 B=9.29 C=20.58
Median A=11.14 B=3.78 C=9.86
Level of significancea pA=0.0001 pB=0.00006 pC=0.002
Volume of ulceration before treatment (V1) (cm3)
Average A=3.62 B=2.86 C=8.26
Median A=2.63 B=1.74 C=4.13
Volume of ulceration after treatment (V2) (cm3)
Average A=3.06 B=0.77 C=4.87
Median A=1.69 B=0.31 C=1.94
...

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