The experience of wearing compression garments after burn injury: "On the inside it is still me".

BACKGROUND: Compression garments are widely used for the management of hypertrophic scars, however, the patient experience of wearing compression garments remains minimally explored. OBJECTIVE: To gain an understanding of the patient experience of wearing compression garments post burn injury, including why patients remove their garments. METHOD: Interpretive description was the methodological approach used in this study. Semi-structured interviews and a focus group were used to gain in-depth insights into the lived experience of wearing compression garments. Thematic analysis revealed key themes across the data and member checking confirmed data interpretation. RESULTS: Three main themes related to wearing compression garments were identified: what it feels like to wear compression garments, what it is like to be a patient within a burns service and the impact of garments on patients' lives and recovery. CONCLUSIONS: The results highlighted a variety of influences that affected the individual experience of garment wear, highlighting the need for a patient centred approach by burn service providers.

How to improve compression garment wear after burns: Patient and therapist perspectives.

BACKGROUND: Compression garments are a widely used intervention for the management of hypertrophic scar and recent research demonstrates the varied experiences of patients wearing compression garments. However, the patient and therapist perspective on how to improve the experience of wearing compression garments remains unexplored. OBJECTIVE: To gain an understanding of the patient and therapist perspective of potential improvements to the provision of compression garments after burns. METHOD: A qualitative research design with an interpretive description approach was utilised in this study. Data was collected from patients through semi-structured interviews and a focus group and therapists by a focus group. Thematic analysis was completed to reveal the key themes across the data. RESULTS: Two main themes were identified: "what patients want" and "access to professional development". The first theme "what patients want" described three suggested improvements including education, peer support, and increased participation in garment prescription. CONCLUSIONS: The reported patient and therapist perspectives highlight the need for further research into service improvement to enhance the patient experience of wearing compression garments after burns.

Patient Experience of Wearing Compression Garments Post Burn Injury: A Review of the Literature.

This review was conducted to critically appraise the literature regarding the patient's lived experience of, and adherence to, wearing compression garments post burn injury. Scholarly articles were identified from searches of the following databases: Pubmed, Cochrane Central, CINAHL, PsycINFO, and OT Seeker. Combinations of key words including compression therapy/garment, pressure therapy/garment, burn(s), adherence, and patient experience were utilized. Retrieved studies were included in the review if they were written in English, reported on adult burn populations, and the patient's lived experience of wearing compression garments. Included studies were critically appraised and content analysis was completed on the results sections of the two qualitative studies. Nine studies investigating patient's lived experiences were retained: one systematic review, one randomized controlled trial, five cross-sectional surveys, and two qualitative studies. An adherence framework provided a conceptual basis to categorize reported patient's lived experiences. Results identified a strong focus on patient and treatment-related experiences with limited investigation of condition, patient-provider and health care system experiences. Minimal investigation has been completed regarding the impact of these patient's lived experiences on the adherence to wearing compression garments. Additional research using qualitative methods is required to gain a deep understanding of patient's experiences and perspectives of wearing compression garments and how these experiences influence on their adherence to wearing them. Identification of key experiences that lead to patients removing their compression garments may lead to modification of treatment and system approaches to better align with patients' needs and development of potential interventions that promote adherence.

Substituting poly- and mono-unsaturated fat for dietary carbohydrate reduces hyperinsulinemia in women with polycystic ovary syndrome.

OBJECTIVE: Hyperinsulinemia is a prevalent feature of polycystic ovary syndrome (PCOS), contributing to metabolic and reproductive manifestations of the syndrome. Weight loss reduces hyperinsulinemia but weight regain is the norm, thus preventing long-term benefits. In the absence of weight loss, replacement of dietary carbohydrate (CHO) with mono/polyunsaturated fat reduces ambient insulin concentrations in non-PCOS subjects. The current study evaluated whether this dietary intervention could ameliorate hyperinsulinemia in women with PCOS. DESIGN/SETTING/PATIENTS: Obese women with PCOS (BMI 39 ± 7 kg/m2) and insulin resistance completed a crossover study (Stanford University Clinical Research Center) comparing two isocaloric diets, prepared by research dietitians, containing 60% CHO/25% fat versus 40% CHO/45% fat (both 15% protein and ≤7% saturated fat). After 3 weeks on each diet, daylong glucose, insulin, and fasting lipid/lipoproteins were measured. RESULTS: Daylong glucose did not differ according to diet. Daylong insulin concentrations were substantially (30%) and significantly lower on the low CHO/higher fat diet. Beneficial changes in lipid profile were also observed. CONCLUSIONS: Replacement of dietary CHO with mono/polyunsaturated fat yields clinically important reductions in daylong insulin concentrations, without adversely affecting lipid profile in obese, insulin-resistant women with PCOS. This simple and safe dietary intervention may constitute an important treatment for PCOS. ClinicalTrials.gov Identifier: NCT00186459.

Clinical characteristics and pituitary dysfunction in patients with metastatic cancer to the sella.

OBJECTIVE: Metastatic disease to the sella is uncommon and there are limited available data regarding the clinical aspects of this disease. We therefore sought to characterize the clinical demographics of sellar metastases. METHODS: Retrospective chart review of adults treated at Stanford University Medical Center from 1980 to 2011 with metastatic disease to the sella. RESULTS: A total of 13 subjects were identified (9 females). The mean age at diagnosis was 55 years (range, 25 to 73 years). A total of 6 patients (46%) had breast carcinoma, 3 (23%) had renal cell carcinoma, 2 (15%) had squamous cell carcinoma of the head and neck, 1 had bronchoalveolar carcinoma of the lung, and 1 had nodular sclerosing Hodgkin's lymphoma. The most common presenting signs and symptoms were headache (58%), followed by fatigue (50%), polyuria (50%), visual field defects (42%), and ophthalmoplegia (42%). Seventy-five percent of patients presented with at least one pituitary hormone insufficiency, which included 6 patients (50%) with diabetes insipidus (DI). Eight (67%) subjects had secondary hypothyroidism and 5 (45%) had secondary adrenal insufficiency. Of the patients with stalk involvement, 86% had DI. All patients had a prior diagnosis of malignancy, with a mean duration of 95 months. CONCLUSION: The most common neoplastic sources to the sella were breast and renal cell carcinomas. Secondary hypothyroidism was the most common endocrine abnormality, followed by DI and adrenal insufficiency. New-onset central hypothyroidism and DI along with known malignancy in a patient with a sellar lesion should raise the suspicion of a metastatic source.

Systematic reviews informing occupational therapy.

OBJECTIVE: We sought to identify and describe the number, topics, and publishing trends of systematic reviews relevant to occupational therapy indexed in the OTseeker database. METHOD: We performed a cross-sectional survey of the systematic reviews contained in OTseeker in December 2011. RESULTS: Of the 1,940 systematic reviews indexed in OTseeker, only 53 (2.7%) were published in occupational therapy journals. The most common diagnostic categories were stroke (n = 195, 10.1%) and affective disorders (n = 204, 10.5%). The most common intervention categories were consumer education (n = 644, 33.2%) and psychosocial techniques (n = 571, 29.4%). Only 390 (20.1%) of the 1,940 systematic reviews specifically involved occupational therapy. CONCLUSION: Occupational therapists need to search broadly to locate relevant systematic reviews or, alternatively, to use databases such as OTseeker. Clarity about the involvement of occupational therapy in reports of future research will improve the ability to identify occupational therapy research for all stakeholders. Finally, occupational therapy practitioners need to read systematic reviews critically to determine whether review conclusions are justified.