RESUMO
BACKGROUND AND DESIGN: Pulsed low-intensity direct current (300 to 600 microA) has been used in a double-blind placebo multicenter study in the treatment of stage II and stage III chronic decubitus ulcers. RESULTS: Seventy-four ulcers were treated in four centers. Forty-three patients were selected for the experimental group, and 31 control subjects used the sham instrument (placebo group). In the treated group, 25 ulcers (58%) healed in 8 weeks, whereas in the placebo group, only one ulcer (3%) healed and most ulcers increased in size. Statistical analysis, based on surface area and ulcer depth before and after treatment, showed that low-intensity direct current had a significant influence on the healing rates for these ulcers (P < .0001). Experiments with guinea pigs (n = 10) showed that pulsed low-intensity direct current caused a rapid calcium flux in the epidermis. CONCLUSIONS: Pulsed low-intensity direct current represents a useful approach for the treatment of stage II and stage III chronic decubitus ulcers by increasing the healing rate. The growth of fibroblasts and keratinocytes may be enhanced by pulsed low-intensity direct current due to changes in calcium homeostasis.
Assuntos
Terapia por Estimulação Elétrica , Úlcera por Pressão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Doença Crônica , Protocolos Clínicos , Método Duplo-Cego , Terapia por Estimulação Elétrica/instrumentação , Feminino , Cobaias , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/metabolismo , Úlcera por Pressão/fisiopatologia , Estudos Prospectivos , Tiorredoxina Dissulfeto Redutase/metabolismo , CicatrizaçãoAssuntos
Terapia por Estimulação Elétrica , Úlcera por Pressão/terapia , Idoso , Feminino , Humanos , Masculino , CicatrizaçãoRESUMO
A program in the state of Maryland which introduces psychiatric residents to community psychiatry is described. Since 1958, 80 senior psychiatric residents worked one day a week for a year as psychiatric consultants to Maryland county health departments. The program embodies the principle of inductive education, introduced into American medicine by Franklin Paine Mall and transplanted here to the developing field of education for community psychiatry. Supervision is more consultative and supportive than didactic, and residents and program directors engage in a mutual educational endeavor. This method can adequately prepare psychiatrists for work in the community.
