SYNOPSIS
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore.
“COMPARATIVE STUDY OF HYDROCOLLOID DRESSING VERSUS CONVENTIONAL DRESSING IN THE TREATMENT OF PRESSURE ULCERS”
Name of the Candidate : Dr. THOMAS JOE C.
Guide : Dr. EREL A.I. DIAZ.
Co Guide : Dr. ARAVIND L. RAO
Course and Subject : M.S. (GENERAL SURGERY)
Department of General Surgery,
Father Muller Medical College,
Kankanady, Mangalore–575002.
2013
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) /DR. THOMAS JOE C
POST GRADUATE RESIDENT,
FATHER MULLER MEDICAL COLLEGE HOSPITAL, KANKANADY,
MANGALORE-575002
2. / Name of the institution / FATHER MULLER MEDICAL COLLEGE
3. / Course of study and subject / M.S. GENERAL SURGERY
4. / Date of admission to the course / 03-06-2013
5. / Title of the topic:
“COMPARATIVE STUDY OF HYDROCOLLOID DRESSING VERSUS CONVENTIONAL DRESSING IN THE TREATMENT OF PRESSURE ULCERS ”
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Pressure ulcers are one of the most common surgical conditions a surgeon comes across in his day to day practice. The incidence of pressure ulcers is on rise today due to the increase in traumatic paraplegia due to vehicular accidents which have increased in the recent years due to the faster pace of life.
Pressure ulcers represent a significant economic burden both to the individual and the economy of the society as they might never heal whatever the management given or take years to do so causing patients and their family severe emotional and physical stress and create a significant financial burden on patients and the whole healthcare system
Despite advances in the field of medicine, surgery and other health care systems, improvement in the education of patient and care givers on the disease, pressure ulcers remain a major cause of morbidity and mortality, particularly for patients with impaired sensation and prolonged immobility.
The management of pressure ulcers is expensive in terms of medical care provider’s time, prolonged hospitalisation and dressing materials.
The most important principle in pressure ulcer dressing is to maintain a moist wound environment as it provides the optimum environment for healing. In the moist environment epithelial cells will migrate over living tissue and this process is delayed by dehydration. Studies have shown that maintaining a moist wound environment is associated with more rapid healing rates compared to dressings that are allowed to dry. (1)
A moist saline dressing is the historical standard dressing for pressure ulcers.
Hydrocolloid dressings provide a low moisture vapour transmission rate thereby providing a moist wound environment. Therefore this study is taken up to compare hydrocolloid dressing and conventional dressing(saline soaked gauze) in the treatment of pressure ulcers.
6.2 REVIEW OF LITERATURE:
In 2007 the National Pressure Ulcer Advisory Panel the term pressure ulcer was defined as a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear .(2)
A meta-analysis in which the efficacy of dressings in pressure ulcers was analyzed and published in a research by Bouza and his colleague’s (3) they concluded that comparisons showed greater efficacy of hydrocolloid dressings but failed to confirm advantages of other advanced dressings compared with conventional ones.
In a randomized clinical trial by Chang KW and co workers(4) in which they studied subjects with pressure ulcers , their study showed that hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings.
In another randomized clinical trial by Xakellis GC (5) which evaluated the cost effectiveness of using hydrocolloid dressings versus saline-gauze wet-to-moist dressings for treatment of pressure ulcers in a long-term care setting the results showed the median healing time was shorter for the hydrocolloid group than for the saline-gauze group.
An occlusive hydrocolloid dressing was compared with a conventional wet saline gauze dressing by Alm A(6) regarding the effect on ulcer cleansing and healing processes, experience of pain and the consumption of nursing time, in a controlled, randomized and partially single-blind study with parallel groups
of long-stay patients with pressure sores. Although the overall difference was non-significant the analysis of the healing distribution function showed the hydrocolloid dressing to be more effective.
6.3 OBJECTIVES OF THE STUDY:
· To compare the efficacy of hydrocolloid dressing and conventional dressing in pressure ulcer healing.
7. / MATERIAL AND METHODS:
7.1 SOURCE OF DATA:
All clinically diagnosed cases of grade 1 and grade 2 pressure ulcers at Father Muller Medical College Hospital.
7.2 METHOD OF COLLECTION OF DATA:
Type of study:
Prospective study.
Sampling Technique:
Purposive sampling based on inclusion and exclusion criteria.
Data will be collected for a period of 2 years from September 2013 to July 2015 with a minimum sample size of 30 patients. They will be randomly assigned into the conventional group and the test group. The test group will receive hydrocolloid dressings which will be changed once in 5 days and the control group will receive the conventional saline dressings twice daily. A brief history and clinical examination will be carried out in every patient. The necessary radiological biochemical investigations will be done whenever needed.
SELECTION CRITERIA:
Inclusion criteria:
• Patients with pressure ulcers who are admitted in Father Muller Medical
College Hospital..
• Both sexes above the age of 18 years and below the age of 70 years.
• Patients with Stage 1 and Stage 2 pressure ulcers.
Exclusion criteria:
• Patients not willing to participate in the study
• Age less than 18 years.
• Age more than 70 years.
• Ulcers more than 10 cms in the largest dimension.
· Stage 3, 4, pressure ulcers.
· Patients with deep tissue injury.
· Patients with co morbidities such as
o Uncontrolled Diabetes Mellitus
o Peripheral Vascular Disease.
o Immunosupression
The ulcers will be assessed for change in size, amount of exudate and type of tissue in ulcer bed, every 5 days for a period of 15 days.
DATA ANALYSIS:
Collected data will be analysed by ANOVA, Chi - Square test and t test.
7.3 Does the study require any investigation or interventions to be conducted on patients or other humans?
Yes.
7.4 Has ethical clearance been obtained from your institution?
Yes.
8. / LIST OF REFERENCES:
1. Thomas DR. Pressure Ulcers. Bope & Kellerman: Conn's Current Therapy 2013, 1st ed.
2. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009.
3. Bouza C, Saz Z, Muñoz A, Amate JM. Efficacy of advanced dressings in the treatment of pressure ulcers: a systematic review. J Wound Care. 2005 May;14(5):193-9.
4. Chang KW, Alsagoff S, Ong KT, Sim PH. Pressure ulcers--Randomised controlled trial comparing hydrocolloid and saline gauze dressings. Med J Malaysia. 1998 Dec;53(4):428-31.
5. Xakellis GC, Chrischilles EA. Hydrocolloid versus saline-gauze dressings in treating pressure ulcers: a cost-effectiveness analysis. Arch Phys Med Rehabil. 1992 May;73(5):463-9.
6. Alm A, Hornmark AM, Fall PA, Linder L, Bergstrand B, Ehrnebo M, Madsen SM, Setterberg G. Care of pressure sores: a controlled study of the use of a hydrocolloid dressing compared with wet saline gauze compresses. Acta Derm Venereol Suppl (Stockh). 1989;149:1-10.
9. / Signature of the candidate10. / Remarks of the guide / May proceed with the study
11. / Name Designation of (in block letters)
11.1Guide / DR. EREL A.I. DIAZ
MBBS, MS, MRCS
PROFESSOR AND HOD
DEPARTMENT OF GENERAL SURGERY,
FATHER MULLER MEDICAL COLLEGE,
KANKANADY
MANGALORE-575002
11.2 Signature
11.3 Remarks of the Co-Guide / May proceed with the study
11.4 Co-guide / DR. ARAVIND L. RAO
M.S., M.Ch.,
ASST. PROFESSOR;
DEPARTMENT OF PLASTIC SURGERY,
FATHER MULLER MEDICAL COLLEGE,
KANKANADY
MANGALORE-575002
11.5 Signature
11.6 Head of The Department / DR. EREL A. I. DIAZ
MBBS, MS, MRCS
PROFESSOR AND H.O.D
DEPARTMENT OF GENERAL SURGERY,
FATHER MULLER MEDICALCOLLEGE,
KANKANADY
MANGALORE-575002.
11.7 Signature
12. / 12.1 Remarks of the Chairman Principal
12.2 Signature
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