Biomedical subjects
K R Vowden
Publications and source records attributed to K R Vowden.
The K-Four bandage system: evaluating its effectiveness on recalcitrant venous leg ulcers.
This evaluation examined the effectiveness of the K-Four (Parema) high compression bandage system on 50 patients with recalcitrant 'hard-to-heal' venous leg ulcers and relates the outcome to an earlier randomised study which compared three other four-layer bandage systems. Twelve-week healing rates were 53.2% in the current series, which included patients with poor mobility, large ulcers and long pretreatment ulcer duration, rising to 69.5% at 20 weeks. When account was taken of known risk factors for delayed ulcer healing, no significant difference could be identified between between either K-Four or the earlier evaluated bandages, which included the original Charing Cross system, where the overall healing rates were 64.5% and 80%, respectively, at 12 and 20 weeks. It would seem more likely that treatment outcome is related to patient risk factors for delayed healing and bandaging expertise than to the bandage system employed.
Comparison of the healing rates and complications of three four-layer bandage regimens.
This randomised controlled study compares the healing rates, complications and patient and staff acceptability of three four-layer bandage regimens for leg ulcers. A total of 149 patients were recruited into the study, of whom 50 received the original Charing Cross system (CX4L), 50 a modified Charing Cross system (Parema) and 49 a commercially available kit, Robinson Ultra Four (Robinson). No significant difference was found in the healing rates of the three systems. Overall 12 weeks' healing was 65%, while the 20-week healing rates for the individual systems were 87% (CX4L), 84% (Parema) and 83% (Robinson). Analysis of known risk factors for delayed healing showed that no bandaging system had an advantage over the others. Staff familiarity resulted in an initial preference for the CX4L but there was no bandage preference by the end of the study. The data suggest that none of the systems has an advantage over the others and that cost savings can be made by pursuing a competitive pricing policy.
Wound debridement, Part 1: Non-sharp techniques.
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Wound debridement, Part 2: Sharp techniques.
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A 'one-stop' vascular clinic: initial experience of an out-patient immediate-access radioisotope limb blood flow service.
The availability of an 'immediate-access' nuclear medicine service has facilitated the introduction of a 'one-stop' vascular clinic, enabling radioisotope limb blood flow and Doppler ankle:brachial index tests to be performed within 2 h of each other for new patient referrals. The test results are available to assist clinical management decisions during the same clinical session. A patient satisfaction survey was undertaken in 71 patients to assess their perspective of this service provision. Fifty-one (72%) patients returned the questionnaire. All respondents preferred to have attended the 'one-stop' clinic to having to return for investigations on a separate occasion. The patient satisfaction survey has identified patient perceived advantages of improved diagnostic efficiency, reduced number of visits, reduced patient worry and the minimization of patient travel costs. During the study period, 83% of allocated gamma-camera imaging slots were utilized, demonstrating that immediate-access nuclear medicine service provision linked to specific clinics can be a practicable solution to reducing waiting times for investigative tests. This is believed to be the first reported immediate-access nuclear medicine service, as opposed to the emergency investigations normally offered to clinically urgent requests.
Measurement of the volume of a leg ulcer using a laser scanner.
Effective management of leg ulcer healing depends on accurate and reliable measurements of wound size. Current techniques usually rely on estimates of surface area or circumference which do not fully describe the healing process. A novel instrument has been developed that is capable of measuring the variations in the surface contours (topography) of a solid object. Its primary application is to measure the size of a leg ulcer by scanning a laser displacement sensor over the affected area. There is no contact with the wound and scanning takes approximately 2 minutes to perform. Volume is calculated by subtracting the measured topography from one calculated using an algorithm to reconstruct a healthy leg surface. A study was carried out where patients had their ulcers scanned during their visits to the leg ulcer clinic. Data are presented from two venous leg ulcers showing the calculated volume reducing over time.
Leg ulcer management in a nurse-led, hospital-based clinic.
This paper describes the clinical outcomes from a nurse-led leg ulcer clinic over a period of three and a half years. Leg ulcers were assessed in a structured way and venous ulcers were treated with four-layer compression bandaging. The study involved retrospective analysis of 159 patients with 180 venous leg ulcers. Overall healing rates were 64.5% at 12 weeks, 84.1% at 24 weeks and 91.4% at 36 weeks. Healing rates were not affected by a history of previous ulceration or by bilateral limb ulceration. However, healing rates varied with previous ulcer duration, ulcer size and patient mobility.
Peripheral arterial disease.
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Arterial disease: reversible and irreversible risk factors.
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Hand-held doppler assessment for peripheral arterial disease.
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ABPI: correct technique essential.
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Measuring leg ulcers using a laser displacement sensor.
A non-contact method for the measurement of a skin ulcer's area and volume has been developed. A commercially available laser displacement sensor is scanned across the ulcer's surface to produce a displacement image. From this image the healthy normal skin's surface is reconstructed and the area and volume found. Results of measurements made with phantom ulcers show that the method has a precision and accuracy +/- 5% of the total size. This compares favourably with results from other non-contact methods that have been published. The method of measurement is simple and reliable. At present, the time taken to produce a displacement image is lengthy but this is due to a limitation in the instrumentation, rather that a failing of the technique. The result of a preliminary measurement made on a patient's leg ulcer is presented.