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Biomedical subjects

R A Frantz

Publications and source records attributed to R A Frantz.

At least 19 recordsLinked to original sources
PubMed2001

An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH).

BACKGROUND: Currently, there is no instrument that provides an accurate and simple method of monitoring pressure ulcer healing in clinical practice. This article reports the two studies that were conducted to assess the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor healing of stage II-IV pressure ulcers. METHODS: Subjects in both studies (N = 103 and N = 269) were elderly (mean Study 1, 75 years, mean Study 2, 80 years), and the majority were women (Study 1, 51%, Study 2, 70%). Study data were extracted from patients' permanent records. RESULTS: Principal components analysis confirmed that the PUSH tool accounted for 58% to 74% of the wound healing variance over a 10-week period in Study 1 and 40% to 57% of the wound healing variance over a 12-week period in Study 2. In addition, multiple regression analysis, used to measure the sensitivity of the model to total healing, showed PUSH accounted for 39% of the variance in 6 weeks and 31% of the variance over 12 weeks (p <.001; Studies 1 and 2, respectively). CONCLUSIONS: Data from these two studies confirmed that the PUSH tool, with the components of length times width, exudate amount, and tissue type, is a valid and sensitive measure of pressure ulcer healing. It is a practical approach that provides clinically valid data regarding pressure ulcer healing. Further testing is needed to confirm these findings.

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PubMed2001

How accurate are chronic wound assessments using interactive video technology?

This project examined the accuracy of chronic wound assessments made using an interactive, video telecommunications system (Teledoc 5000, NEC America, Inc., Irving, TX) by comparing a nurse expert's in-person wound assessments with wound assessments made from taped Teledoc sessions. Wound assessments determined the absence or presence of nine wound characteristics instrumental in guiding treatment (e.g., tunneling, undermining, granulation tissue, necrotic tissue, epithelial tissue, purulent exudate, erythema, edema, induration). A sample of 13 paired wound observations was analyzed. The accuracy of the Teledoc technology was examined by calculating the amount of agreement between the in-person assessments and the taped Teledoc assessments for each of the nine characteristics. Agreement for eight of the nine wound characteristic exceeded 75%, suggesting this telehealth medium does not alter wound assessment data, which are essential in guiding treatment decisions. In addition to connecting the remotely based nurse with nursing expertise to improve patient care, telehealth technology seemed to increase the remotely-based nurses' knowledge of wound assessment and treatment as well.

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PubMed2001

A nursing application of telecommunications. Measurement of satisfaction for patients and providers.

Consumer and provider satisfaction is key to the continued use and expansion of telehealth technology. This pilot study compared satisfaction of providers and patients with wound consultations done in person with those done via real-time interactive video technology. Eleven telehealth consultations with a nurse expert were immediately followed by an in-person consultation with a second nurse expert. Satisfaction questionnaires were administered to patients, referring nurses, and the consultant nurse expert following both the in-person consultation and the telehealth consultation. The referring nurses (100%) were satisfied with both the telehealth and in-person consultations, noting the ability to provide better care for their patients. The patients (55%) were "very satisfied" with the telehealth consultations versus 40% satisfied with the in-person consultations. Difficulty in hearing for the patients was equal in both groups, which resulted in changes in the consultation process. The patients' difficulty in seeing the telehealth consultant was addressed through larger screens and strategic positioning to provide easier viewing for the patient and providers. The telehealth nurse consultant was satisfied overall but had some difficulty communicating. This pilot study helped provide useful information for both the telehealth and in-person consultations.

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PubMed2001

A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability.

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.

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PubMed2000

Do oxygen-enriched atmospheres exist beneath surgical drapes and contribute to fire hazard potential in the operating room?

The purposes of this study were to (1) describe the microenvironment in terms of oxygen concentration beneath the drapes of healthy subjects who were simulating patients undergoing minor surgical procedures with supplemental oxygen and to (2) evaluate the efficacy of using a scavenger system beneath the drapes. A convenience sample of 12 healthy volunteer subjects was studied in an ambulatory surgery center operating room, which was ventilated with 25 air exchanges per hour. The study was carried out in 2 parts. Each subject was supine, and oxygen was applied by a standard nondivided nasal cannula. The subjects were draped as routinely done for ophthalmic procedures. Oxygen concentrations were measured by using an Ohmeda Rascal II gas analyzer beneath the drapes and at the hypothetical surgical site with oxygen flow rates of 0, 1, 2, 3, and 4 L/min, allowing 5 minutes to elapse after a change in flow rate was made. Following a 10-minute break, the subjects were redraped, and the procedure was repeated using a scavenger system consisting of a suctioning system connected to wall suction at 170 to 190 mm Hg. Although the mean +/- SD oxygen saturation never fell below 95% (97.75% +/- 1.54%), mean +/- SD oxygen concentrations beneath the drapes were lower than normal room air concentrations (19.08% +/- 0.51%) when no oxygen was delivered to the patient. With supplemental oxygen and no scavenger system, oxygen concentrations beneath the drapes were consistently elevated (as high as 45% with 4 L/min) compared with normal ambient concentrations (21%) or with concentrations obtained at the surgical site (as high as 23.4%). With the scavenger system in place, mean +/- SD oxygen concentrations reached 34.08% +/- 5.52% beneath the drapes. Statistical analyses revealed that significantly higher oxygen concentrations occurred beneath the drapes with each incremental change in oxygen flow rate, and regardless of the oxygen flow rate used, oxygen concentrations beneath the drapes were significantly reduced with the use of the scavenger system.

Adult↗
PubMed1998

Nursing assessment: impact on type and cost of interventions to prevent pressure ulcers.

OBJECTIVE: To describe pressure ulcer preventive interventions and their cost, and to compare the preventive intervention use and cost with level of risk. DESIGN: Comparative, descriptive design. SETTING AND SUBJECTS: A large midwestern Veteran's Affairs Medical Center with 260 long-term care beds. Thirty-one chair- or bed-bound residents from 1 long-term care unit comprised the study sample. MAIN OUTCOME MEASURES: The outcome variables included demographic information (patient record), Braden Risk Assessment score, institutional risk assessment score (Pressure Ulcer Risk Tool), type and frequency of preventive interventions, and the related costs. METHODS: Subjects were assessed on a weekly basis for type and frequency of preventive intervention and for the development of a pressure ulcer. Each subject was observed until death, discharge, pressure ulcer formation, or the end of the 3-month study period. RESULTS: The 3-month pressure ulcer incidence rate was 13%. All subjects were at risk for pressure ulcer development according to Braden scores; whereas only 74% were assessed at risk with use of the facility's risk assessment tool. Preventive measures included regular repositioning (87%); 67% were placed on mattress support surfaces. There was no relationship between level of risk (facility risk tool score) and type of prevention used. The total cost of pressure ulcer prevention to the nursing unit was $14,926, representing a mean of $497 per subject, and $5.55 per subject per day. CONCLUSION: As compared with previous studies, the higher cost of prevention described in this study may be attributed to inadequate linkage of preventive interventions to risk level.

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PubMed1998

Pressure ulcer research: pressure ulcer treatment. A monograph from the National Pressure Ulcer Advisory Panel.

The AHCPR guideline on Treatment of Pressure Ulcers was released in December 1994. This guideline was based on the best available scientific evidence published between 1966 and May 1, 1993. Over 45,000 abstracts were reviewed in the literature analysis. Yet only 63.2% of the guideline recommendations were based on research of any type, and only 4.5% of the recommendations were supported by two or more randomized clinical trials. A more recent literature review (covering articles on pressure ulcers listed in the MEDLINE database between May 1, 1993, and December 1, 1996), revealed minimal advances in the scientific body of knowledge on pressure ulcer treatment. Advances have been made in the knowledge of electrical therapy and growth factors, and efforts are under way to enhance tools for monitoring healing. In an era of limited research funding, we need to carefully target our research efforts to maximize the advancement of our knowledge of pressure ulcer treatment. It is the hope of the NPUAP that this monograph will guide the research needed to ensure the most efficient utilization of funds to improve patient outcomes.

Evidence-Based Medicine↗
PubMed1997

Adjuvant therapy for ulcer care.

Adjuvant therapies, specifically electrotherapy, hyperbaric oxygen, ultrasound, and hydrotherapy, are considered increasingly for use with conventional local wound care to support healing of pressure ulcers. This article describes the characteristics of these modalities, their physiologic effects on the healing process, and the research to evaluate their efficacy.

Combined Modality Therapy↗
PubMed1997

Pressure ulcer healing: what is it? What influences it? How is it measured?

Defining healing requires a set of measurements that quantify the physical factors that change during healing. Such a list of measures gives a de facto definition of what constitutes pressure ulcer healing and what influences it. This paper attempts to answer a more specific question: Which measurements are strong candidates for inclusion in a tool for monitoring pressure ulcer healing? Three sets of clinical measurements are analyzed--the assessment proposed by the Agency for Health Care Policy and Research Guideline Development Panel for the Treatment of Pressure Ulcers; the recommendations of the Wound Healing Society; and the Pressure Sore Status Tool. The validity of the 11 clinical measures common across these assessment methods is examined using empiric evidence from studies of wound healing.

Anthropometry↗
PubMed1995

Adoption of a research-based practice for treatment of pressure ulcers.

Evaluation of a skin care protocol for the treatment of pressure ulcers in this institution showed that practitioners did adopt research-based practice. This change in practice was associated with a corresponding decrease in costs for treatment. More pressure ulcers received treatment after implementation of the protocol. Furthermore, the majority of pressure ulcers were being treated with wound care modalities identified by research as supportive of healing. Use of antiseptic agents harmful to the healing process declined as did use of topical agents with little research base to support their efficacy. The shift to practice patterns that were more consistent with research findings was associated with a corresponding decrease in costs for pressure ulcer treatment. Factors in this situation that lead to the positive outcome of knowledge utilization were an organizational model that promoted accountability of individual practitioners, staff participation in decision making, agency regard for research, and consultation with a nurse expert. Informal individual utilization of knowledge related to the treatment of pressure ulcers reinforced use of the research-based practice and expedited formal implementation of a policy/procedure related to their treatment. The process of knowledge utilization that occurred in this institution provides a prototype of how research can be translated into practice. Although limited to one specific clinical problem, the results of this process can be applied to any clinical condition where there are sufficient research findings to support development of recommendations for practice.

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PubMed1994

Elderly skin care: principles of chronic wound care.

1. Chronic wounds are a frequently encountered problem in elders. Chronic wounds are characterized by loss of skin or underlying soft tissue and do not progress toward healing with conventional wound care treatment. 2. There are four basic principles of chronic wound care: remove debris and cleanse the wound; provide a moist wound healing environment through the use of proper dressings; protect the wound from further injury; and provide substrates essential to the wound healing process. 3. Underlying the care of chronic wounds is the necessity to assess the wound on an ongoing basis. Changes in wound care must be based on changing wound parameters, and timely, complete, and accurate wound assessments must be documented.

Aged↗
PubMed1993

Dermal blood flow response to constant pressure in healthy older and younger subjects.

This study compared the dermal blood flow response to low levels of compressive pressure in healthy older and younger subjects. Dermal blood flow was measured over the left trochanter of 19 younger (21-45 yrs) and 22 older (> or = 60 yrs) subjects using a laser-Doppler velocitometer. Interface pressure, baseline flow, and flow during 60 minutes of left-side lying on an air mattress were measured. Baseline dermal blood flow did not differ significantly between the older and younger groups. Both groups showed a significant increase in blood flow over time during the 60 minutes of compression. The change in dermal blood flow over time was not significantly different between the two groups. This study demonstrated that healthy persons, regardless of their age, exhibited an increase in dermal blood flow over time at low levels of compressive pressure.

Adult↗
PubMed1993

Physical impairments in the elderly population.

The model presented here provides a starting point for considering the physical impediments that accompany biologic aging. The scientific challenge for the future is to identify how specific modifiable variables can attenuate these physical impediments and distinguish them from those changes that are truly irreversible accompaniments of aging. The humanitarian challenge facing all health care professionals is to provide compassionate care, emotional support, and unfailing commitment to aging persons as they experience changes in physical function and role performance.

Activities of Daily Living↗
PubMed1992

A comparison of patient risk for pressure ulcer development with nursing use of preventive interventions.

OBJECTIVE: (1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention. DESIGN: Cross-sectional study. SETTING: Six hundred-bed, state-supported, long-term care facility. PATIENTS: War veterans who were 82% male and 97% caucasian, mean age 73. MEASUREMENTS: (1) Patients were categorized as at-risk or not-at-risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at-risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependent variable. RESULTS: Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at-risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at-risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention. CONCLUSIONS: The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment.

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PubMed1992

Adoption of research-based practice for treatment of pressure ulcers in long-term care.

Implementation of a clinical trial to evaluate the effectiveness of electrotherapy on pressure ulcer healing provided the stimulus for adoption of research-based innovations for pressure ulcer treatment in one long-term care facility. A five-year retrospective study conducted prior to introduction of the clinical trial revealed that 72 different treatments were applied to pressure ulcers. Forty-two percent of the pressure ulcers were left open to the air or covered with a dry gauze dressing and 64% were treated with some type of antiseptic solution. Since implementation of the clinical trial and the accompanying access to wound healing research knowledge it provided in this setting, the prevailing treatment for pressure ulcers has become moist physiologic dressings.

Adult↗
PubMed1991

A comparison of changes in the transcutaneous oxygen tension and capillary blood flow in the skin with increasing compressive weights.

Two measures are being advocated to evaluate physiologic changes associated with compression of skin: transcutaneous oxygen tension (tcO2) and laser-Doppler blood flow. This study asked: 1) What changes occur in tcO2 and laser-Doppler blood flow with increasing compressive weight; and 2) do these measures respond differently to increasing weight? An indenter was used to apply incremental weight to the trochanter of healthy volunteers. During the first session, tcO2 was measured, and laser-Doppler blood flow was measured during the second session. The mean values of tcO2 and laser-Doppler blood flow were analyzed for significant changes over the range of applied weight. If significant change occurred, the polynomial that best described the data was determined. Mean values for tcO2 showed a significant decrease with increasing compressive weight. Its decrease was described by a second degree polynomial (quadratic). The weight that resulted in the tcO2 reaching zero for individual subjects ranged from 400-1000. Mean values for laser-Doppler blood flow showed a significant decrease with increased weight. The decrease was best described by a first degree polynomial (line), which is a different pattern from the tcO2. Laser-Doppler blood flow continued to decline with increasing weight beyond the point where tcO2 reached zero. During low-flow states, tissue oxygen utilization may exceed oxygen delivery and lead to ischemia even though capillary closure has not occurred.

Adult↗