Nurse scientist offers hope to vulnerable population

For MUSC nurse scientist Teresa Kelechi, Ph.D., the choice is simple.

Spend less than $15 on supplies to treat a venous leg condition or let it go unmonitored and risk ulcers, pain, immobility and possible amputation at the cost of upwards of $40,000. Her primary focus as a nurse scientist is venous leg ulcer prevention. That’s why she’s involved with two studies to help a group of patients who are in many cases underserved, and in most cases, depressed, and in great need of effective, low-cost interventions.

This is the cause that drew Kelechi, R.N., from her love of clinical practice in 2008. “My practice was the dearest to my heart because patients were the dearest to my heart, but I couldn’t do it,” she said of her choice to give up her clinical practice to be able to focus on research, teaching and administration. “This has allowed me to do great things, for a much greater number of people.”

Her expertise: venous disease, something that’s not a “glamorous” cause but that has a huge societal impact, she said. About 10 percent of the population has venous disease and when that’s combined with other chronic conditions, such as diabetes and obesity, it can lead to a poor quality of life.

Venous disease occurs when valves in the veins that assist with blood flow to the heart become damaged, allowing the backward flow of blood in the legs. Over time, the increased pressure can cause other valves to fail, and if left untreated, lead to leg pain, swelling, ulcers and other health problems.

“This is not a disease that people really talk about,” she said. Her goal is to change that with the help of simple interventions that can give patients hope and prevent more serious conditions.

As a nurse scientist, Kelechi said her goal is to put patients in the best possible position for nature to heal.

To do that, she’s come up with two innovative studies.

One is MUSTCOOL, a home-based ulcer prevention intervention for patients with newly healed chronic venous leg and diabetic foot ulcers. “We have the technology, and it has gone from a wrap to a cuff and now to a pad. We’ve gone to more sophisticated monitoring.”

The focus for this study is to be much more patient-centered, driven by patient self assessment and self management.

“I can take an infrared image of the leg and see exactly the spot that’s inflamed, and I can find the highest temperature of that spot. Then we mark it for the patient, and that’s where we have them measure their temperature at home.”

The wound vision technology available is helping to transform wound care, she said.

“I can take an image of your leg, it will calculate the size of the wound, the area of damage and it will give me gradients of temperature. This gives me a full landscape of temperatures throughout the entire lower extremity and if there’s a wound there, it gives me all the measurement parameters of that wound.”

The data is uploaded to a computer and updated during each visit. She can analyze and record changes over time in the temperature gradient and wound characteristics.

Skin temperature is the key. Through her research, Kelechi learned temperature was the trick in measuring the inflammation that she knew people had to have in their skin.

Her previous research demonstrated that cooling the skin reduces inflammation and seems to prevent ulcer recurrence. In this new study involving around 200 patients, participants monitor their vulnerable “hot spots” with an infrared thermometer that dates and time stamps each reading. During the six-month randomized clinical trial, skin temperature is monitored daily, a maintenance dose of cooling gel pack or placebo is applied three times weekly to the affected skin, and a concentrated dose of cooling is applied for five consecutive days if the skin temperature becomes elevated.

“If we demonstrate that cooling prevents leg ulcers, this is what people need.”

The study’s effects on physical activity will be evaluated with an accelerometer. “We hypothesize that by improving the skin environment and reducing pain, patients will more likely be physically active and have better quality of life.”

That’s in line with the goal of another study called FOOTFIT, which is designed to help patients with leg ulcers who are minimally ambulatory and chronically ill.

This study explores whether mobile health technology can increase their physical activity. Obese patients with venous disease can develop what’s called venous hypertension, or vein hypertension, in the legs. The veins in the legs are not under any pressure like the arteries are, so they are dependent on the calf muscle and foot movement to squeeze the veins and force the blood up.

Blood can pool in the veins, which is called stasis, damaging blood vessels and causing inflammation that leads to irritating skin conditions and throbbing pain. It’s critically important to get these patients to where they can walk and exercise their legs, she said.

Her team developed and tested a tri-axial Bluetooth-enabled accelerometer and tracking device called BEAT, that is sensitive enough to capture small movements. It’s worn on the foot and used for a phased conditioning program to have patients increase movement in their lower legs.

These simple movements are a huge accomplishment for the patients, who at best only take a few steps at a time, she said. The study also is testing the feasibility and effectiveness of having a patient-provider communication link as part of the intervention, which will give patients access to their providers via emails, texts or direct calling. Forty patients will be targeted during the six-week study.

Kelechi said she is drawn to help these patients, many of whom are homebound and suffer from the negative psychological impact of chronic pain and immobility.

“A lot of these people are depressed. They have high fatigue, and some are irritable. They have low self-efficacy, meaning that they believe that anything they do won’t make a difference,” she said. “They’re thrilled to know that there’s something they can do and there’s expertise in this area, because they just gave up.”

Kelechi said her mission is to make sure researchers are focusing on patients in underrepresented, underserved populations.

“I believe that everybody has a right to be in a research study. I am committed to offering opportunities for patients to participate in studies who do not necessarily have access to big medical centers or big hospitals,” she said, explaining that she sets up the studies to reach people in rural places.

Kelechi said the goal is to get the word out that there’s help. “I want to reach people who are suffering with symptoms that are poorly monitored. I want to help them be proactive and be able to manage themselves.”