A Comparison of Nurse Practitioner and Physician Management of Lower Extremity Wounds

2.50
Hdl Handle:
http://hdl.handle.net/10755/154743
Type:
Presentation
Title:
A Comparison of Nurse Practitioner and Physician Management of Lower Extremity Wounds
Abstract:
A Comparison of Nurse Practitioner and Physician Management of Lower Extremity Wounds
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Gramse, Carol, PhD
P.I. Institution Name:Medgar Evers College
Title:Associate Professor
Objective: Compare differences in nurse practitioner and physician use of supportive measures in management of diabetic lower extremity wounds. Design: retrospective record review. Population/Sample/Setting/Years: Outpatient clinic/diabetic lower extremity wounds/wound center clinic visits/6 months. Outcome Variables: wound assessment; measurement of wound area and wound volume; percentage change and percentage difference in wound size; wound area healing rates and volume healing rates; use of supportive strategies recommended in AHCPR guidelines for pressure sore management. Methods: Over a sequential 12 week period, cases were assigned to one each of two groups (NP or MD and with or without vitamin therapy. Average wound characteristics and values for beginning, ending, and change in wound size, days treated, healing rate, percentage change (initial minus final/initial x 100), percentage difference (difference in percentage change) were calculated. Chi-square, 2 tail Fisher's Exact test, 2 tail alternate t-test and Mann Whitney U test were used to test for a difference between the two with/without vitamin therapy groups and also with respect to the percentage change in wound area and wound volume over the duration of the study. Significance was set at alpha .05. Findings: Significant differences existed among physician (n=56) and nurse practitioner (n=93) documentation of use of vitamins in the management of lower extremity wounds. Observed Chi-square=11.75, Table Chi-square=3.841, df=1, (p<0.05). Of the groups who received vitamin therapy, the average area healing rate of 0.16 cm2/day reflected a 32.5% percentage change in average reduced wound area. Despite a greater average days treated, the group who received vitamin therapy had a >45% healing rate. Similarly, the average volume healing rate of 1.26 cm3/day for those who received vitamin therapy reflected a 49.7% percentage change in average reduced wound volume. With less average days treated, the group who received vitamin therapy had a >16% healing rate. Of the group who received vitamin therapy, the analysis of the percentage change from initial width assessment to last width measurement at week 12 showed a 41.6% percentage change in average wound width. The group who received vitamin therapy had a significant >13% percentage difference in average reduced wound width (Observed t 3.06**, Observed df 148, Table df=150, t=1.976, p<.05, Fisher's t test for differences between correlated pairs of means). The reduction from initial average length assessment to last average length measurement was not significant, whether or not vitamin therapy was received. Of the group who received vitamin therapy, the analysis of the percentage change from initial volume assessment to last volume measurement at week 12 showed a 49.7% percentage change in average wound volume. The group who received vitamin therapy had a significant >34% percentage difference in average reduced wound volume (Observed t 4.26**, Observed df 62, Table df=60, t=2.000, p<.05; t=2.609, p<.01, Fisher's t test for differences between correlated pairs of means). Conclusions: In the management of lower extremity wounds in diabetics, a supportive measure is use of vitamin therapy, specifically, the use of Vitamin A 20,000 units po od, Vitamin C 500 mg po bid, Folic acid1 mg po od, and Zinc elemental 50 mg po od, in doses recommended by AHCPR. NPs more often than MDs used vitamin therapy as a supportive therapy, p<.05. When vitamin therapy is used: area healing rates are 45% greater; volume healing rates are 16% greater; changes in reduced wound width are 13% greater, p<.01; measurements of wound length show a trend in decreased length; changes in reduced wound volume are 34% greater, p<.01. Nursing Implications: Continue wound area and volume measurement at each clinic visit. Continue to recommend use of vitamin therapy, specifically, use of Vitamin A 20,000 units po od, Vitamin C 500 mg po bid, Folic acid1 mg po od, and Zinc elemental 50 mg po od, when treating diabetics with lower extremity wounds. Assess whether healing rates differ among wound type, wound locations, wound size, duration of wound, Ankle Brachial Index, Body Mass Index, gender, and age. Compare the influence of different treatment therapy types, specifically, compression therapy, wet-to-dry dressings, antibiotics, debridement, and revascularization.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Comparison of Nurse Practitioner and Physician Management of Lower Extremity Woundsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/154743-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Comparison of Nurse Practitioner and Physician Management of Lower Extremity Wounds</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gramse, Carol, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Medgar Evers College</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">cgramse@hotmail.com</td></tr><tr><td colspan="2" class="item-abstract">Objective: Compare differences in nurse practitioner and physician use of supportive measures in management of diabetic lower extremity wounds. Design: retrospective record review. Population/Sample/Setting/Years: Outpatient clinic/diabetic lower extremity wounds/wound center clinic visits/6 months. Outcome Variables: wound assessment; measurement of wound area and wound volume; percentage change and percentage difference in wound size; wound area healing rates and volume healing rates; use of supportive strategies recommended in AHCPR guidelines for pressure sore management. Methods: Over a sequential 12 week period, cases were assigned to one each of two groups (NP or MD and with or without vitamin therapy. Average wound characteristics and values for beginning, ending, and change in wound size, days treated, healing rate, percentage change (initial minus final/initial x 100), percentage difference (difference in percentage change) were calculated. Chi-square, 2 tail Fisher's Exact test, 2 tail alternate t-test and Mann Whitney U test were used to test for a difference between the two with/without vitamin therapy groups and also with respect to the percentage change in wound area and wound volume over the duration of the study. Significance was set at alpha .05. Findings: Significant differences existed among physician (n=56) and nurse practitioner (n=93) documentation of use of vitamins in the management of lower extremity wounds. Observed Chi-square=11.75, Table Chi-square=3.841, df=1, (p&lt;0.05). Of the groups who received vitamin therapy, the average area healing rate of 0.16 cm2/day reflected a 32.5% percentage change in average reduced wound area. Despite a greater average days treated, the group who received vitamin therapy had a &gt;45% healing rate. Similarly, the average volume healing rate of 1.26 cm3/day for those who received vitamin therapy reflected a 49.7% percentage change in average reduced wound volume. With less average days treated, the group who received vitamin therapy had a &gt;16% healing rate. Of the group who received vitamin therapy, the analysis of the percentage change from initial width assessment to last width measurement at week 12 showed a 41.6% percentage change in average wound width. The group who received vitamin therapy had a significant &gt;13% percentage difference in average reduced wound width (Observed t 3.06**, Observed df 148, Table df=150, t=1.976, p&lt;.05, Fisher's t test for differences between correlated pairs of means). The reduction from initial average length assessment to last average length measurement was not significant, whether or not vitamin therapy was received. Of the group who received vitamin therapy, the analysis of the percentage change from initial volume assessment to last volume measurement at week 12 showed a 49.7% percentage change in average wound volume. The group who received vitamin therapy had a significant &gt;34% percentage difference in average reduced wound volume (Observed t 4.26**, Observed df 62, Table df=60, t=2.000, p&lt;.05; t=2.609, p&lt;.01, Fisher's t test for differences between correlated pairs of means). Conclusions: In the management of lower extremity wounds in diabetics, a supportive measure is use of vitamin therapy, specifically, the use of Vitamin A 20,000 units po od, Vitamin C 500 mg po bid, Folic acid1 mg po od, and Zinc elemental 50 mg po od, in doses recommended by AHCPR. NPs more often than MDs used vitamin therapy as a supportive therapy, p&lt;.05. When vitamin therapy is used: area healing rates are 45% greater; volume healing rates are 16% greater; changes in reduced wound width are 13% greater, p&lt;.01; measurements of wound length show a trend in decreased length; changes in reduced wound volume are 34% greater, p&lt;.01. Nursing Implications: Continue wound area and volume measurement at each clinic visit. Continue to recommend use of vitamin therapy, specifically, use of Vitamin A 20,000 units po od, Vitamin C 500 mg po bid, Folic acid1 mg po od, and Zinc elemental 50 mg po od, when treating diabetics with lower extremity wounds. Assess whether healing rates differ among wound type, wound locations, wound size, duration of wound, Ankle Brachial Index, Body Mass Index, gender, and age. Compare the influence of different treatment therapy types, specifically, compression therapy, wet-to-dry dressings, antibiotics, debridement, and revascularization.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T13:14:33Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T13:14:33Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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