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Biomedical subjects

R A Frantz

Publications and source records attributed to R A Frantz.

At least 37 records · Page 2Linked to original sources
PubMed1991

The cost of treating pressure ulcers in a long-term care facility.

Although there is rising concern with the cost of pressure ulcer treatment, actual expenditures have not been quantified in many settings. A retrospective research design was used to describe the costs incurred by an 830-bed long-term care facility to treat 240 pressure ulcers over a five-year period. The total cost was $116,416 for the study period. The mean cost of treatment was $5.35/pressure ulcer/day. These costs are substantially lower than the costs of pressure ulcer treatment in acute care. Further study to compare treatment costs with prevention costs would provide useful information on the cost benefits of prevention.

Adult↗
PubMed1989

Characteristics of skin blood flow over the trochanter under constant, prolonged pressure.

Although laboratory studies have documented that externally applied pressure disrupts circulation, in clinical practice little is known about the characteristics of blood flow over bony prominences as a function of time. The purpose of this study was to describe the pattern of blood flow over the trochanter when subjected to a constant interface pressure for a prolonged period of time. A quasi-experimental design was used to measure skin blood flow over the left trochanter in a sample of 19 healthy adults. With the use of laser doppler flowmetry, the pattern of blood flow was monitored continuously while subjects lay on a supportive air mattress. Measurement of blood flow was described for three periods: preload with subjects supine, loading with subjects in the left lateral position and hyperemia after subjects returned to the supine position. Rate of blood flow under loading showed a gradual increase from preload. There was a marked initial increase in flow during hyperemia that gradually tapered off, but failed to reach preload levels within 30 min. Individual blood flow tracings revealed an inconsistent pattern of response to loading, suggesting the presence of a range of physiological response to compressive surface pressure. Given the individual variation in response to a common external pressure, further research is recommended to evaluate the pattern of blood flow over bony prominences subjected to known interface pressure.

Adult↗
PubMed1988

Adjustment problems of spouses of patients undergoing coronary artery bypass graft surgery during early convalescence.

Our purpose was to assess the social adjustment of spouses of patients who had undergone coronary artery bypass surgery during the patients' early convalescence. Specifically the study focused on social support and social activities, affective responses, and financial, marital, and sexual difficulties. Following an exploratory descriptive design, we conducted a semistructured interview using Benson's (1984) Social Adjustment Scale. A sample of 26 spouses were interviewed in a cardiology clinic 4 to 10 weeks after their mate's bypass surgery. Associations between demographic characteristics and the level of adjustment were determined by chi-square (adjusted for continuity) analysis. Nineteen spouses reported a high level of vigilance, with 13 reporting that this was a change since their mate's surgery. Ten spouses reported their economic level to be highly inadequate, and all of those stated that their economic situation had changed since surgery. A small number of subjects rated their mate as being dependent on them, and they had feelings of anxiety, fear, and depression. All of those subjects described this as a change since surgery. The majority of subjects had a low level of marital friction and a high level of communication with their spouse. Those married 30 years or longer were generally those satisfied with their level of social support.

Adult↗
PubMed1985

Age-related changes in sebaceous wax ester secretion rates in men and women.

Sustainable rates of sebaceous wax ester secretion were measured on the foreheads of 109 men and 167 women, aged 15-97. Each measurement was made after first depleting the cutaneous sebum reservoir by overnight absorption of lipid into a layer of bentonite clay. Lipid was then absorbed for 3 h into fresh clay in which two 2-cm cloth disks were embedded. The absorbed lipid was extracted from the disks with ether and analyzed for wax esters by thin-layer chromatography. For both men and women there was a wide range of wax ester secretion rates at all ages. Rates were highest in the 15- to 35-year-olds and appeared to decline continuously throughout the adult age range. Values of log(wax esters) were better correlated with age than the untransformed values of wax ester secretion. The equations of best fit of log(wax esters) vs age suggested that sebum secretion declines about 23% per decade in men and 32% per decade in women.

Adolescent↗
PubMed1981

Sequential hemodynamic and oxygen transport responses in hypovolemia, anemia, and hypoxia.

Sequential cardiorespiratory measurements were made in 30 mongrel dogs during controlled hypovolemia, normovolemic anemia, and hypoxia. The responses to each of these three types of O2 deprivation were studied both as a function of time and of the rate of O2 delivery (normalized cardiac output x arterial O2 content). With progressively decreasing O2 delivery, compensations appeared, reached a maximum, and fell before the final circulatory deterioration. O2 extraction increased in each experiment, but there was differences in the hemodynamic responses to the three types of O2 deprivation; e.g., cardiac output increased in the anemic dogs, and there were greater increases in systemic and pulmonary resistances after hemorrhage. The striking finding was that O2 consumption (VO2) remained relatively constant until the preterminal stage. At this time O2 delivery had fallen from about 27 to less than 10 ml . min-1 . kg-1, blood volume was less than 50%, hematocrit was less than 8%, and arterial O2 tension was less than 30 Torr at an average fractional inspired O2 concentration of 8%, for the hypovolemic, anemic, and hypoxic groups, respectively. Then VO2 dropped precipitously and death rapidly occurred. These results suggest that VO2 represents a physiological marker of impending death in the face of progressively diminishing O2 delivery.

Anemia↗
PubMedDate not supplied

Effect of electrical stimulation on chronic wound healing: a meta-analysis.

The purpose of this meta-analysis was to quantify the effect of electrical stimulation on chronic wound healing. Fifteen studies, which included 24 electrical stimulation samples and 15 control samples, were analyzed. The average rate of healing per week was calculated for the electrical stimulation and control samples. Ninety-five percentage confidence intervals were also calculated. The samples were then grouped by type of electrical stimulation device and chronic wound and reanalyzed. Rate of healing per week was 22% for electrical stimulation samples and 9% for control samples. The net effect of electrical stimulation was 13% per week, an increase of 144% over the control rate. The 95% confidence intervals of the electrical stimulation (18-26%) and control samples (3.8-14%) did not overlap. Electrical stimulation was most effective on pressure ulcers (net effect = 13%). Findings regarding the relative effectiveness of different types of electrical stimulation device were inconclusive. Although electrical stimulation produces a substantial improvement in the healing of chronic wounds, further research is needed to identify which electrical stimulation devices are most effective and which wounds respond best to this treatment.

Electric Stimulation Therapy↗
PubMedDate not supplied

The validity of the clinical signs and symptoms used to identify localized chronic wound infection.

It is uncertain how accurately classic signs of acute infection identify infection in chronic wounds, or if the signs of infection specific to secondary wounds are better indicators of infection in these wounds. The purpose of this study was to examine the validity of the "classic" signs (i.e., pain, erythema, edema, heat, and purulence) and the signs specific to secondary wounds (i.e., serous exudate, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown). Thirty-six chronic wounds were assessed for these signs and symptoms of infection with interobserver reliability ranging from 0.53 to 1.00. The wounds were then quantitatively cultured, and 11 (31%) were found to be infected. Increasing pain, friable granulation tissue, foul odor, and wound breakdown showed validity based on sensitivity, specificity, discriminatory power, and positive predictive values. The signs specific to secondary wounds were better indicators of chronic wound infection than the classic signs with a mean sensitivity of 0.62 and 0.38, respectively. None of the signs or symptoms was a necessary indicator of infection, but increasing pain and wound breakdown were both sufficient indicators with specificity of 100%.

Adult↗
PubMedDate not supplied

Translating pressure ulcer guidelines into practice: it's harder than it sounds.

OBJECTIVE: To determine the cost-effectiveness of a guideline-based pressure ulcer prevention protocol over time. DESIGN: Retrospective and prospective quasi-experimental longitudinal design. Costs are presented from the long-term-care facility perspective. Data collection occurred for 3 periods: the first 6 months of 1994 (prior to protocol implementation), the first 6 months of 1995 (immediately following implementation) and the first 6 months of 1997 (2 years following implementation). SETTING: 77-bed long-term-care facility PATIENTS/PARTICIPANTS: Subjects were ulcer-free facility residents at the start of each data collection period. There were 69 subjects in the 1994 sample, 63 in the 1995 sample, and 71 in the 1997 sample. INTERVENTIONS: A guideline-based pressure ulcer prevention protocol was implemented during the last 3 months of 1994. The protocol consisted of specific policies for pressure ulcer prevention and treatment, intensive staff education on pressure ulcer care, and monitoring with regular performance feedback to staff. MEASUREMENTS AND MAIN RESULTS: Time to ulcer development varied among the 3 groups (log rank = 8.81, P = .01), with longer time to ulcer development in 1995 compared with 1994; no difference was seen between 1997 and 1994. The time for ulcers to heal decreased over the 3 years (log rank = 9.49, P <.01), with ulcer healing time being shorter in 1995 and 1997 compared with 1994. Total costs were unchanged during the 3 years (F = 0.2, P =.81). Costs of treatment declined significantly from 1994 to 1995 and 1997 (F = 5.5, P <.01) and costs of prevention increased significantly from 1994 to 1995 and 1997(F = 15, P <.01). From 1994 to 1997, the cost for 1 day of ulcer-free life was $3.50. CONCLUSIONS: Implementation of a pressure ulcer prevention protocol showed mixed results. Initial reductions in pressure ulcer incidence were lost over time. Clinical results of ulcer treatment, however, improved and treatment costs fell during the 3 years. Implementation of preventive programs poses a major leadership challenge.

Aged↗
PubMedDate not supplied

Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes.

The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol. Data regarding ulcer characteristics and type, frequency, and duration of treatments were collected. Subjects were followed until the ulcer healed, the subject died or was discharged, or the 1-year study period ended. Care environment attributes, including patient care hours, turnover and stability rates, salaries, decision-making structures, and facility mission were obtained from the facility's Human Resource Department and existing databases in the Nursing Services Department. Outcomes of protocol implementation were defined as ulcer healing and costs associated with treatment. Costs were calculated from the provider perspective and included cost of supplies and labor consumed in providing direct pressure ulcer care. Of the 46 incident ulcers treated during the one-year study period, 40 (87%) healed and five (11%) were unhealed when the subject died. One ulcer remained unhealed at the end of the study. The total cost for treatment of these incident ulcers was $18,688, with nursing labor comprising 80% of the total expenditures. Adherence to the protocol, which contained predominantly inexpensive moist wound healing treatment options, resulted in complete healing of most pressure ulcers at a relatively low cost to the facility. The organizational environment of the facility, which maintains staffing levels and salaries at higher than national averages and promotes staff nurse accountability and decision making, may have provided the necessary climate to overcome barriers to clinical integration and sustain the desired care practices.

Aged↗
PubMedDate not supplied

Variables associated with skin dryness in the elderly.

This study investigated whether sebum secretion and other external variables were associated with the occurrence of dry skin in the elderly. The sample consisted of 76 elderly white individuals ranging in age from 65 to 97 years who resided in retirement homes. Dry skin was measured through verbal report and verified by observation. Sebum was collected on dacron mesh disks and measured by quantitative thin layer chromatography. Other variables pertinent to the occurrence of dry skin were measured through structured interview. Dry skin was found in 59% of the subjects. Mean sebum secretion rate was .534 mg/10 sq cm/3 hr. Although sebum secretion rate was significantly lower in females than in males, p less than .001, sebum levels did not differ significantly as a function of dry skin for either sex. A significant association was found between severity of skin dryness and age, p less than .02. The findings refute the widely held, though untested belief, that the decreased sebaceous gland activity that accompanies aging is responsible for skin dryness in the elderly.

Age Factors↗
PubMedDate not supplied

The cost of treating pressure ulcers following implementation of a research-based skin care protocol in a long-term care facility.

Although concern for the costs associated with pressure ulcer treatments persists, studies that precisely quantify costs are limited. A retrospective research design was used to describe the costs incurred by an 830-bed, long-term care facility to treat 81 pressure ulcers over a one-year period following implementation of a research-based, skin care protocol. The total cost for the study period was $30,079 with 73% of these expenditures attributable to nursing care. Mean cost of treatment was $3.74/pressure ulcer/day, which was a reduction from the $5.35/pressure ulcer/day cost prior to implementation of the skin care protocol. These findings suggest that implementing a research-based, skin care protocol can promote a reduction in treatment costs.

Adult↗
PubMedDate not supplied

The cost-effectiveness of interventions for preventing pressure ulcers.

BACKGROUND: While there is scientific evidence to support the efficacy of preventive interventions for pressure ulcers, few empirical data are available on their cost-effectiveness. The aim of this study was to determine the cost-effectiveness of interventions to prevent pressure ulcers. METHODS: Cost of preventive interventions and days of ulcer-free survival were compared for two groups of patients. One group consisted of 250 patients from a geriatric unit of a British hospital (Norton sample). At the time of the study, no preventive measures were used. Data from the original report of the study were used to determine patients' attainment of one of three end points--ulcer formation, death, or discharge--from which a disease-free survival table was constructed. The second cohort of 420 patients consisted of residents of a long-term care facility in Iowa, where aggressive preventive measures were used (Iowa sample). Data were collected at the study onset and 3 months later. The types of preventive interventions used on each patient were assessed and their costs calculated. Cost of treatment for pressure ulcers was estimated from previous research performed at the Iowa facility. The cost-effectiveness of the preventive intervention was calculated by dividing the mean difference in cost between the two groups by mean difference in ulcer-free days. RESULTS: Survival analysis of days to ulcer development showed the Norton (no prevention) sample had a significantly shorter time to ulcer development than did Iowa sample (patients receiving preventive measures) (P < 0.0001). The mean cost for prevention and treatment of an ulcer was $167 +/- $307 for the Norton sample and $245 +/- $379 for the Iowa sample. The mean number of ulcer-free days was 21.0 -/+ 17.4 for the Norton sample and 78.5 +/- 11.0 for the Iowa sample. The cost per day of ulcer-free life gained was $1.36. CONCLUSION: The use of aggressive preventive measures in the long-term care setting is effective in reducing pressure ulcers and requires a relatively low level of institutional expenditures.

Aged↗
PubMedDate not supplied

Measuring prevalence and incidence of pressure ulcers.

The current competitive health care environment has intensified the need for data that provide a snapshot of the realities of clinical practice. As decision making moves from a clinically based perspective to one grounded in scientific data, health care providers are increasingly being challenged to document the extent of a problem and the effectiveness of its management. This is especially true with pressure ulcers, which are viewed as high-volume, high-risk problems in most health care settings. Moreover, in long-term care facilities, regulatory agencies have designated the development of pressure ulcers as an indicator of quality of care provided to patients. Thus, it is essential that data related to the scope and severity of pressure ulcers in a facility be gathered accurately. The aim of this article is to describe a methodology for determining prevalence and incidence of pressure ulcers that accurately measures the effectiveness of preventive intervention. The importance of risk assessment and of clear operational definitions of the population and a case will be addressed.

Epidemiologic Methods↗