Efficacy, safety of and adherence to adjustable compression wraps in the control phase of breast cancer-related lymphedema: A randomized controlled trial.

OBJECTIVE: To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema. DESIGN AND SETTING: Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil. PARTICIPANTS: Women in control phase of the breast cancer-related lymphedema. INTERVENTIONS: Compared use of ACWs versus compressive mesh. MAIN MEASURES: Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval. RESULTS: Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome-excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times. CONCLUSIONS: Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

Uso de la miel en el manejo de las úlceras crónicas de miembros inferiores en el adulto. Revisión sistemática / Use of honey in the management of chronic leg ulcers in adults. Systematic review. / Uso de mel no tratamento de úlceras crônicas dos membros inferiores no adulto. Revisão sistemática

Introducción: las úlceras en miembros inferiores hacen parte de las enfermedades crónicas que afectan a la población mundial, las cuales generan deterioro en la calidad de vida de quienes las padecen. La miel es un alimento natural utili-zado a lo largo de la historia de la humanidad con fines curativos para el manejo de las lesiones en la piel; sin embargo, el beneficio de su uso en el tratamiento de las úlceras de miembros inferiores no ha sido definido, ya que la evidencia actual es controversial. Objetivo: evaluar la mejor evidencia científica disponible para determinar los beneficios de la miel en el tratamiento de las úlceras crónicas de miembros inferiores en la población adulta. Metodología: se realizó una revisión sistemática de la literatura de ensayos clínicos controlados, aleatorizados en las bases de datos PubMed, Ovid, ProQuest, EBSCO, BIREME. Se incluyeron 9 ensayos clínicos controlados. Se evaluó la calidad metodológica según los parámetros de PeDro y se utilizaron criterios de la colaboración Cochrane para definir la presencia de sesgos de cada estudio. Resultados: ocho de los 9 estudios incluidos reportaron desenlaces favorables en el uso de la miel. Los estudios conta- ron con buena calidad metodológica en su desarrollo, pero evidenciaron un riesgo poco claro de sesgo. Conclusión: la evidencia disponible no permite establecer la utilidad de la miel en el manejo de las úlceras de miembros inferiores. La evidencia actual muestra poca claridad en términos de sesgos, por lo que es necesario realizar nuevos ensayos clínicos, con mejores criterios de intervención, para poder establecer el beneficio del uso de la miel en esta enfermedad

Background: Leg ulcer are part of chronic diseases that affect word population, generating a big burden in quality of life. Honey is a natural food used along humanity history as a topic medicine for skin conditions. The benefits of using honey as a treatment of chronic leg ulcers has not been clarified because off controversial evidence. Objectives: This review assess the best scientific evidence to establish the benefits of using honey in chronic leg ulcers in adult population. Methods: A systematic Review of randomized clinical trials was made in PubMed, Ovid, ProQuest, EBSCO and BIREME databases. 9 controlled clinical trials were included. Methodological quality was assessed using PeDro criteria. Risk of bias was assessed using Cochrane parameters. Results: Eight of nine clinical trials included reported beneficial outcomes using honey in chronical leg ulcers treatment. Trials were made with good methodological quality however their had unclear risk of bias. Conclusion: Available evidence does not let define the usefulness of applying honey in chronic leg ulcers. Data is unclear in terms of bias; thus, it is necessary to perform new randomized clinical trials with better intervention criteria to define if using topical honey in chronic leg ulcers is beneficial or not compared with conventional treatment

Introdução: as úlceras nos membros inferiores fazem parte das doenças crônicas que afetam a po- pulação mundial, as quais geram deterioração na qualidade de vida daqueles que sofrem com elas. O mel é um alimento natural usado ao longo da história da humanidade para fins de cura no tratamento de lesões de pele; no entanto, o benefício de seu uso no tratamento de úlceras nos membros inferio- res não foi definido, pois a evidência atual é controversa. Objetivo: avaliar a melhor evidência científica disponível para determinar os benefícios do mel no tratamento de úlceras crônicas de membros inferiores na população adulta. Metodologia: foi realizada uma revisão sistemática da literatura de ensaios clínicos controlados, randomizados nas bases de dados PubMed, Ovid, ProQuest, EBSCO, BIREME. Nove ensaios clínicos controlados foram incluídos. A qualidade metodológica foi avaliada de acordo com os parâmetros PeDro e os critérios da Cochrane Collaboration foram utilizados para definir a presença de viés em cada estudo. Resultados: Oito dos 9 estudos incluídos relataram resultados favoráveis no uso do mel. Os estudos tiveram boa qualidade metodológica em seu desenvolvimento, mas mostraram um risco claro de viés. Conclusão: a evidência disponível não permite estabelecer a utilidade do mel no manejo de úlceras nos membros inferiores. A evidência atual mostra pouca clareza em termos de vieses, portanto, é ne- cessário realizar novos ensaios clínicos, com melhores critérios de intervenção, a fim de estabelecer o benefício do uso do mel nesta doença.

Compliance with compression therapy in primary chronic venous disease: Results from a tropical country.

OBJECTIVES: To describe compliance rates of compression therapy in a cohort of patients with chronic venous disease and also to describe frequent causes of non-compliance. METHODS: A total of 889 patients with primary chronic venous disease were prescribed compression therapy after being evaluated by vascular surgeons. Subjects had a first visit during which time compression therapy was prescribed in addition to a follow-up visit. Strength of compression, type, prescription duration, and reasons of non-compliance were queried at follow-up. RESULTS: Only 31.8% of the patients reported wearing compression therapy as prescribed, 31.4% reported wearing compression most days, 28.3% reported wearing compression intermittently, and 8.5% of the patients reported not wearing compression at all. The main reasons of non-compliance were: uncomfortable (49.4%), too difficult to put on (34.5%), skin problems (itching) (21.5%), and unattractive (19.8%). CONCLUSIONS: Compliance with compression therapy in chronic venous disease is still a subject of concern as most patients are not using compression therapy as prescribed.

Effectiveness of the strategies of an orientation programme for the lifestyle and wound-healing process in patients with venous ulcer: A randomised controlled trial.

This study aimed to evaluate the effect of strategies of a lifestyle orientation programme on patients with venous ulcer in elastic compression therapy. This was a single-blind, 2-arm, randomised clinical controlled trial. The primary outcome included the reduction of the wound surface area. The secondary outcomes included the perception of pain, questionnaire of ulcer status, and quality of life. Seventy-one patients with ulcers of venous aetiology were randomised into 2 arms: control group (CG) and intervention group (IG), with a 12-week follow up. The CG was provided with the routine guidelines of the health services. Meanwhile, the IG was provided with lifestyle guidelines regarding the physiopathology of a venous ulcer, importance of compression therapy, physical exercises and rest in 4 face-to-face and 2 telephone interviews. The IG had significant improvement on the wound healing on 30, 60, and 90 days of follow up when compared with the CG (P = .0197; P = .0472; P = .0116). There were no statistical differences between groups; both had improvement in the quality of life and pain perception. Our results demonstrated that elastic compression therapy along with guidelines on lifestyle is effective adjunctive treatment to promote wound healing in patients with leg ulcers.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome / Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Resumo O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome.

Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Manual lymphatic drainage and multilayer compression therapy for vulvar edema: a case series.

BACKGROUND AND OBJECTIVE: Vulvar edema is a condition rarely reported and without defined treatment that may result in functional limitation. The aim of the report is to describe a case series of patients with disabling vulvar edema of different etiologies that were treated with manual lymphatic drainage (MLD) and multilayer compression therapy (MCT). CASE SERIES: Four cases of vulvar edema are described: one in a woman with cervical cancer; one in a woman in the postoperative period of bilateral adrenalectomy for pheocromocytoma; and two in pregnant women with preeclampsia. All cases were treated with MLD and MCT during hospitalization. OUTCOMES: Total resolution of the edema occurred in 2 to 5 d of treatment. CONCLUSION: The present case series is the first to report the use of the MLD and MCT in the successful management of female genital edema. This report suggests that the vulvar edemas for these four patients treated with MLD and MCT seem to resolve faster than expected based on previously reported untreated edemas or edemas treated with different therapeutic approaches.