151
|
Bobbink P, Morin D, Probst S. Evaluation of needs and treatment benefits in outpatient care for leg ulcer patients: a pilot study. J Wound Care 2018; 27:527-533. [DOI: 10.12968/jowc.2018.27.8.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul Bobbink
- Lecturer, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva
| | - Diane Morin
- Professor Emeritus, Faculty of Nursing, Laval University, Quebec, Canada, Faculty of Biology and Medicine, Lausanne University, Switzerland
| | - Sebastian Probst
- Professor of Tissue Viability and Wound Care, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva
| |
Collapse
|
152
|
General practitioners' perceptions of their role and their collaboration with district nurses in wound care. Prim Health Care Res Dev 2018; 20:e39. [PMID: 30021662 PMCID: PMC6536755 DOI: 10.1017/s1463423618000464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim To explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare. Background Earlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs’ understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP’s perspective. Methods Semi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data. Results Four themes were identified. The first theme: ‘role as consultant and coordinator’ shows how the GPs perceived their role in wound care. In the second theme: ‘responsibility for diagnosis’ the GPs’ views on responsibility for wound diagnosis is presented. The third theme: ‘desire for continuity’ is based on the GPs’ desire for continuity concerning various aspects. In the fourth theme: ‘collaboration within the organisation’ the importance of the organisation for collaboration between GPs and DNs is presented. Conclusions The GP’s often work on a consultation-like basis and feel that they become involved late in the patients’ wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.
Collapse
|
153
|
Team V, Bugeja L, Weller CD. Barriers and facilitators to participant recruitment to randomised controlled trials: A qualitative perspective. Int Wound J 2018; 15:929-942. [PMID: 29974634 DOI: 10.1111/iwj.12950] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 11/29/2022] Open
Abstract
Low recruitment rates for randomised controlled trials (RCTs) are a common issue. Information on barriers and facilitators to recruitment for RCTs may inform researchers on how to improve the recruitment rate. The aim of this qualitative project was to identify barriers and facilitators to participant recruitment for a randomised double-blinded placebo-controlled trial on the clinical effectiveness of aspirin as an adjunct to compression therapy in healing chronic venous leg ulcers. We have conducted interviews with health professionals and project workers to understand their perspective on low recruitment rate, barriers to, and facilitators of recruitment. NVivo 11 software was used for data management and coding. Thematic analysis was applied as a method of data analysis. Although strict recruitment criteria were the main barrier, there were other recruitment barriers that should be considered when planning RCTs. We have further developed a framework of factors influencing the recruitment rate. The main recruitment barriers, including study-related, participant-related, practitioner-related, collaboration-related, ethics-related, practice-related, and health system-related barriers, should be considered for inclusion in the "Other Information" section of Consolidated Standards of Reporting Trials Statement to improve the quality of reporting and ensure the strategic planning of future RCTs.
Collapse
Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Lyndal Bugeja
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Carolina D Weller
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
154
|
Todd M. Assessment and management of older people with venous leg ulcers. Nurs Older People 2018; 30:39-48. [PMID: 29917335 DOI: 10.7748/nop.2018.e1004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 11/09/2022]
Abstract
A venous leg ulcer (VLU) is defined as the loss of skin below the knee on the leg or foot in the presence of venous disease, which takes more than two weeks to heal. The prevalence of VLUs is increasing, especially in older people, which will increase the demand for nursing care. Development of a lower leg ulcer should trigger immediate assessment of risk factors for chronic venous disease followed by action to identify the cause and initiate treatment, which should prevent progression to more complex and chronic problems. Justification for choice of appropriate wound management and application of compression therapy should be based on the assessment and diagnosis. Management of patients with VLUs can be cyclical and lifelong, which highlights the importance of helping patients to understand the rationale for management strategies so that cooperation in self-care is achieved.
Collapse
Affiliation(s)
- Marie Todd
- Specialist Lymphoedema Clinic, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| |
Collapse
|
155
|
Green J, Jester R, McKinley R, Pooler A. Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template. Br J Community Nurs 2018; 23:S20-S30. [PMID: 29799794 DOI: 10.12968/bjcn.2018.23.sup6.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked.
Collapse
Affiliation(s)
- Julie Green
- Queen's Nurse, Royal College of Nursing Professional Nursing Committee member, Royal College of Nursing District Nurse Forum Chair and member of the Association of District Nurse Educators Director of Postgraduate Studies and Senior Lecturer, Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG
| | - Rebecca Jester
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Robert McKinley
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Alison Pooler
- Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
| |
Collapse
|
156
|
Green J, Jester R, McKinley R, Pooler A. Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation. Br J Community Nurs 2018; 23:S30-S38. [PMID: 29493307 DOI: 10.12968/bjcn.2018.23.sup3.s30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.
Collapse
Affiliation(s)
- Julie Green
- Queen's Nurse, Royal College of Nursing, Professional Nursing Committee member, Royal College of Nursing, District Nurse, Forum Chair and member of the Association of District Nurse Educators: Director of Postgraduate Studies and Senior Lecturer, Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG
| | - Rebecca Jester
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Robert McKinley
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Alison Pooler
- Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
| |
Collapse
|
157
|
Jindal R, Dekiwadia DB, Krishna PR, Khanna AK, Patel MD, Padaria S, Varghese R. Evidence-Based Clinical Practice Points for the Management of Venous Ulcers. Indian J Surg 2018; 80:171-182. [PMID: 29915484 DOI: 10.1007/s12262-018-1726-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022] Open
Abstract
Venous ulcer is an extremely common aetiology of lower extremity ulceration, which affects approximately 1% population in most of the countries, and the incidence rate increases with age and female gender. Proper assessment and diagnosis of both the patient and ulcer are inevitable in order to differentiate venous ulcers from other lower extremity ulceration and to frame an adequate and individualised management plan. Venous ulcers generally persist for weeks to many years and are typically recurrent in nature. This consensus aims to present an evidence-based management approach for the patients with venous ulcers. Various management options for venous ulcers include compression therapy, minimally invasive procedures like sclerotherapy and ablation techniques, surgical procedures, debridement and medical management with micronised purified flavonoid fraction (MPFF). Compression therapy is the mainstay treatment for venous ulcer. However, in failure cases, surgery can be preferred. Medical management with MPFF as an adjuvant therapy to standard treatment has been reported to be effective and safe in patients with venous ulcer. In addition to standard therapy, diet and lifestyle modification including progressive resistance exercise, patient education, leg elevation, weight reduction, maintaining a healthy cardiac status and strong psychosocial support reduces the risk of recurrence and improves the quality of life in patients with venous ulcer.
Collapse
Affiliation(s)
| | | | | | - Ajay K Khanna
- 4Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Shoaib Padaria
- Jaslok Hospital, Breach Candy Hospital, Sir H.N. Hospital, Saifee Hospital, Mumbai, India
| | - Roy Varghese
- 7Daya Hospital, Jubilee Mission Medical College, Trichur, Kerala India
| |
Collapse
|
158
|
Redmond C, Davies C, Cornally D, Adam E, Daly O, Fegan M, O'Toole M. Using reusable learning objects (RLOs) in wound care education: Undergraduate student nurse's evaluation of their learning gain. NURSE EDUCATION TODAY 2018; 60:3-10. [PMID: 28987896 DOI: 10.1016/j.nedt.2017.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 08/25/2017] [Accepted: 09/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Both nationally and internationally concerns have been expressed over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. This project describes the educational evaluation of a series of Reusable Learning Objects (RLOs) as a blended learning approach to facilitate undergraduate nursing students learning of wound care for competence development. Constructivism Learning Theory and Cognitive Theory of Multimedia Learning informed the design of the RLOs, promoting active learner approaches. Clinically based case studies and visual data from two large university teaching hospitals provided the authentic learning materials required. Interactive exercises and formative feedback were incorporated into the educational resource. METHODS Evaluation of student perceived learning gains in terms of knowledge, ability and attitudes were measured using a quantitative pre and posttest Wound Care Competency Outcomes Questionnaire. The RLO CETL Questionnaire was used to identify perceived learning enablers. Statistical and deductive thematic analyses inform the findings. RESULTS Students (n=192) reported that their ability to meet the competency outcomes for wound care had increased significantly after engaging with the RLOs. Students rated the RLOs highly across all categories of perceived usefulness, impact, access and integration. CONCLUSION These findings provide evidence that the use of RLOs for both knowledge-based and performance-based learning is effective. RLOs when designed using clinically real case scenarios reflect the true complexities of wound care and offer innovative interventions in nursing curricula.
Collapse
Affiliation(s)
- Catherine Redmond
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Carmel Davies
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | | | - Ewa Adam
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Orla Daly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Marianne Fegan
- St Michael's Hospital, Dun Laoighre, Co. Dublin, Ireland.
| | | |
Collapse
|
159
|
Dolibog P, Dolibog P, Franek A, Brzezińska-Wcisło L, Arasiewicz H, Wróbel B, Chmielewska D, Ziaja J, Błaszczak E. Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy. Int J Med Sci 2018; 15:1275-1285. [PMID: 30275753 PMCID: PMC6158659 DOI: 10.7150/ijms.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/30/2018] [Indexed: 11/05/2022] Open
Abstract
Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy. Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment. Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC). Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05). Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.
Collapse
Affiliation(s)
- Patrycja Dolibog
- Chair and Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia
| | - Paweł Dolibog
- Chair and Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia
| | - Andrzej Franek
- Chair and Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia
| | | | - Hubert Arasiewicz
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia
| | - Beata Wróbel
- Chair and Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia
| | - Daria Chmielewska
- Department of Basics of Physiotherapy, Faculty of Physiotherapy, Academy of Physical Education in Katowice
| | - Jacek Ziaja
- Department of General, Vascular and Transplant Surgery, School of Medicine in Katowice, Medical University of Silesia
| | - Edward Błaszczak
- Chair and Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia
| |
Collapse
|
160
|
Lusher JM, Murray E, Chapman-Jones D. Changing the way we think about wounds: A challenge for 21st century medical practice. Int Wound J 2017; 15:311-312. [PMID: 29266777 DOI: 10.1111/iwj.12866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joanne M Lusher
- Institute for Research in Healthcare Policy and Practice, University of the West of Scotland, London Campus, UK
| | - Esther Murray
- Institute of Health Sciences Education at Queen Mary University of London
| | - David Chapman-Jones
- Institute for Research in Healthcare Policy and Practice, University of the West of Scotland, London Campus, UK
| |
Collapse
|
161
|
Smith D, Team V, Barber G, O'Brien J, Wynter K, McGinnes R, Tsiamis E, Weller CD. Factors associated with physical activity levels in people with venous leg ulcers: A multicentre, prospective, cohort study. Int Wound J 2017; 15:291-296. [PMID: 29266735 DOI: 10.1111/iwj.12868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022] Open
Abstract
Increasing levels of physical activity among people with venous leg ulcers (VLUs) can potentially reduce the health cost burden, improve functional aspects of patients' lives and increase ulcer healing rates. The aim of this study was to investigate factors associated with physical activity levels in patients with VLUs. Data from 2016 to 2017 Aspirin for Venous Leg Ulcer cohort study were analysed for the present study. Ninety participants were recruited from 5 outpatient specialist wound clinics across Victoria, Australia between August 2016 and April 2017. There was a statistically significant association between diabetes and physical activity, with a higher proportion of people with type 2 diabetes in the sedentary category. Further, there was a statistically significant association between patient-reported VLU education and physical activity levels. An indirect advantage of relevant, easy-to-understand education about VLUs may increase physical activity levels, which may facilitate improved time to healing of VLUs.
Collapse
Affiliation(s)
- Daisy Smith
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Georgina Barber
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Jane O'Brien
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, Monash University, Clayton, VIC, Australia
| | - Rosemary McGinnes
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Ellie Tsiamis
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Carolina D Weller
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| |
Collapse
|
162
|
Mitchell A. Assessing the value of practice-based leg ulcer education to inform recommendations for change in practice. Br J Community Nurs 2017; 22:S28-S34. [PMID: 29189067 DOI: 10.12968/bjcn.2017.22.sup12.s28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts.
Collapse
Affiliation(s)
- Aby Mitchell
- Lecturer Health Promotion, Public Health and Primary Care, University of West London
| |
Collapse
|
163
|
Dos Santos SDLV, Martins MA, do Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? JOURNAL OF VASCULAR NURSING 2017; 35:178-186. [PMID: 29153225 DOI: 10.1016/j.jvn.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
The selection of topical and systemic therapies for the treatment of venous ulcers with signs of infection is challenging and should be accompanied by specific precautionary measures to protect against cross-contamination in the presence of multidrug-resistant microorganisms. However, there are still no clinical indicators for this situation, and confirmation of resistant strains occurs through culture and sensitivity, which can take up to 14 days. During this period, protective measures may no longer be taken, contributing to the spread of these pathogens. This study aimed to analyze the relationship between clinical signs and symptoms of infection in venous ulcers and the presence of antimicrobial-resistant Staphylococcus aureus and/or Pseudomonas spp. A cross-sectional study was developed including 69 patients with 98 venous ulcers. Clinical observation protocol was applied to detect infection indicators established by the European Wound Management Association and microbiological analysis of samples of the lesions. Fisher's exact test and χ2 were used for analyses (P < 0.05). Two indicators of infection predominated (f >70%): discoloration of the opaque type and/or dark brick red and increased exudate volume; 31 (31.6%) ulcer samples showed positive culture for the bacteria studied. There was no relationship between signs and symptoms of infection and the presence of multidrug-resistant microorganisms. Taking into account the percentage of lesions with resistant strains, for safe care, contact precautionary measures should be implemented in the treatment rooms, in addition to standard precautions.
Collapse
Affiliation(s)
| | - Marlene Andrade Martins
- Professora Adjunto do Curso de Enfermagem da Universidade Federal de Goiás -Campus Jataí, Jataí, Goiás, Brazil
| | | | - José Verdú Soriano
- Profesor Titular de Facultad de Ciencias de la Salud, Universidad de Alicante, Espanha, Alicante, Spain
| | - Maria Márcia Bachion
- Professora Titular da Faculdade de Enfermagem da Universidade Federal de Goiás. Pesquisador CNPq 1D, Goiânia, Goiás, Brazil
| |
Collapse
|
164
|
Balcombe L, Miller C, McGuiness W. Approaches to the application and removal of compression therapy: A literature review. Br J Community Nurs 2017; 22:S6-S14. [PMID: 28961047 DOI: 10.12968/bjcn.2017.22.sup10.s6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Compression therapy is used in the treatment of venous disorders, lymphoedema and burns. Adherence to compression therapy is reported to be poor, due to a number of factors, including difficulty in applying and removing the compression garments. A literature review was conducted to identify aids, equipment and other approaches to ease the application and removal of compression therapy garments. Some 12 studies were identified. Most studies focused on chronic venous insufficiency and venous ulcers. Four methods of easing compression garment application and removal were identified: (1) devices to assist in application and removal; (2) altered compression stocking design; (3) adjustable compression wrap devices; and (4) education. Patients prescribed compression therapy should be educated on how to apply and remove the compression garments, and have application devices made available to them.
Collapse
Affiliation(s)
- Lauren Balcombe
- Undergraduate student, La Trobe University, Prahran, Australia
| | - Charne Miller
- Senior Lecturer, La Trobe University, Prahran, Australia
| | | |
Collapse
|
165
|
Meaume S, Dompmartin A, Lok C, Lazareth I, Sigal M, Truchetet F, Sauvadet A, Bohbot S. Quality of life in patients with leg ulcers: results from CHALLENGE, a double-blind randomised controlled trial. J Wound Care 2017; 26:368-379. [PMID: 28704156 DOI: 10.12968/jowc.2017.26.7.368] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We recently showed the superiority of a matrix metalloproteinase (MMP) modulating dressing (foam impregnated with NOSF, nano-oligosaccharide factor) compared with a lipidocolloid matrix (TLC) control dressing in median wound area reduction (WAR). Here we report the results from the same study assessing the performance and safety of TLC-NOSF in the local management of venous leg ulcers (VLUs) or mixed leg ulcers and determining its impact on the patient's health-related quality of life (HRQoL). METHOD A superiority randomised double-blind controlled trial was conducted on patients presenting with a non-infected leg ulcer (VLUs or mixed leg ulcers) of predominantly venous origin (ABPI >0.8), with a surface area ranging from 5 to 50cm2 and a duration of 6 to 36 months. Patients were randomly allocated to either the TLC-NOSF matrix foam (UrgoStart) dressing group or to the neutral TLC foam dressing group (UrgoTul Absorb). All received appropriate compression therapy and the wounds were assessed blindly (clinical examination, wound area tracing and photographic record) every 2 weeks for a period of 8 weeks, or until complete closure. A secondary endpoint, described here, was the patient's HRQoL, documented by the patient, through the EuroQol 5D tool (EQ-5D) questionnaire and visual analogue scale (VAS). RESULTS In total, 187 patients were randomised to either the TLC-NOSF group (n=94) or the control dressing group (n=93). The two groups were well balanced at baseline with regard to wound and patient characteristics. In the HRQoL questionnaire (EQ-5D), the pain/discomfort and anxiety/depression dimensions were significantly improved in the TLC-NOSF group versus the control one (pain/discomfort: 1.53±0.53 versus 1.74±0.65; p=0.022, and anxiety/depression: 1.35±0.53 versus 1.54±0.60, p=0.037). The VAS score was better in the test group compared with the control group (72.1±17.5 versus 67.3±18.7, respectively), without reaching significance (p=0.072). Acceptability and tolerance of the two products were similar in both groups. CONCLUSION The double-blind clinical trial has demonstrated that the TLC-NOSF matrix dressing promotes faster healing of VLUs and mixed leg ulcers and significantly reduces the pain/discomfort and anxiety/depression experienced by the patients. These results suggest that acceleration of VLU healing could improve the HRQoL of the patients and reduced the emotional and social burden of these chronic wounds.
Collapse
Affiliation(s)
- S Meaume
- Dermatologist and Geriatrician, Head of Geriatric Department and Wound Care Unit, Rothschild University Hospital, Paris, France
| | - A Dompmartin
- Dermatologist, Dermatology Department, Clemenceau University Hospital, Caen, France
| | - C Lok
- Head of Dermatology Department, South University Hospital, Amiens, France
| | - I Lazareth
- Department of Vascular Medicine, Saint-Joseph Hospital, Paris, France
| | - M Sigal
- Dermatologist, Head of Dermatology Department, Victor Dupouy Hospital, Argenteuil, France
| | - F Truchetet
- Head of Dermatology Department, Beauregard Hospital, Thionville, France
| | - A Sauvadet
- Clinical Research Department, Laboratoires URGO, Chenôve, France
| | - S Bohbot
- Clinical Research Department, Laboratoires URGO, Chenôve, France
| | | |
Collapse
|
166
|
Young K, Ng Chok H, Wilkes L. Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report. BMC Nurs 2017; 16:56. [PMID: 28943804 PMCID: PMC5607845 DOI: 10.1186/s12912-017-0250-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian "Gold Standard" treatment according to the Australian and New Zealand Wound Management Associations' (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients' home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting. CASE PRESENTATION This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression. CONCLUSION Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility.
Collapse
Affiliation(s)
- Katrina Young
- Nepean Hospital, Nepean Blue Mountains Local Health District, Derby Street, Kingswood, NSW 2747 Australia
| | - Harrison Ng Chok
- Western Sydney University/Nepean Blue Mountains Local Health District, Sydney, Australia.,Centre for Nursing Research and Practice Development, Nepean Hospital, First Floor - Court Building - Nepean Hospital, PO Box 63, Penrith, NSW 2751 Australia
| | - Lesley Wilkes
- School of Nursing and Midwifery, Western Sydney University/Nepean Blue Mountains Local Health District, Sydney, Australia.,Centre for Nursing Research and Practice Development, Nepean Hospital, First Floor - Court Building - Nepean Hospital, PO Box 63, Penrith, NSW 2751 Australia
| |
Collapse
|
167
|
Miller C, McGuiness W, Wilson S, Cooper K, Swanson T, Rooney D, Piller N, Woodward M. Concordance and acceptability of electric stimulation therapy: a randomised controlled trial. J Wound Care 2017; 26:508-513. [DOI: 10.12968/jowc.2017.26.8.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Miller
- La Trobe University, Melbourne, Australia
| | - W. McGuiness
- La Trobe University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - S. Wilson
- La Trobe University, Melbourne, Australia
| | - K. Cooper
- La Trobe University, Melbourne, Australia; Austin Health, Melbourne, Australia
| | - T. Swanson
- Nurse Practitioner Wound Management, South West Healthcare, Warrnambool. Australia
| | - D. Rooney
- Goulburn Valley Health, Shepparton, Australia
| | - N. Piller
- Flinders University, Adelaide, Australia
| | - M. Woodward
- The Melbourne University, Melbourne, Australia
| |
Collapse
|
168
|
Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines. J Eur Acad Dermatol Venereol 2017; 31:1562-1568. [DOI: 10.1111/jdv.14390] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Andriessen
- Radboud UMC; Nijmegen & Andriessen Consultants; Malden The Netherlands
- International Compression Club (ICC); Berndorf Austria
| | - J. Apelqvist
- Department of Endocrinology; University Hospital of Malmö; Malmö Sweden
| | - G. Mosti
- Department of Angiology; Clinica MD Barbantini; Lucca Italy
- International Compression Club (ICC); Berndorf Austria
| | - H. Partsch
- Medical University Vienna; Vienna Austria
- International Compression Club (ICC); Berndorf Austria
| | - C. Gonska
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
| | - M. Abel
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
- Patient Outcome Group (POG); European Wound Management Association (EWMA); Frederiksberg Denmark
- International Compression Club (ICC); Berndorf Austria
| |
Collapse
|
169
|
van Vuuren TM, Van Zandvoort C, Doganci S, Zwiers I, tenCate-Hoek AJ, Kurstjens RL, Wittens CH. Prediction of venous wound healing with laser speckle imaging. Phlebology 2017; 32:658-664. [PMID: 28669247 PMCID: PMC6375351 DOI: 10.1177/0268355517718760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Laser speckle imaging is used for noninvasive assessment of blood flow of cutaneous wounds. The aim of this study was to assess if laser speckle imaging can be used as a predictor of venous ulcer healing. Methods After generating the flux speckle images, three regions of interest (ROI) were identified to measure the flow. Sensitivity, specificity, negative predictive value, and positive predictive value for ulcer healing were calculated. Results In total, 17 limbs were included. A sensitivity of 92.3%, specificity of 75.0%, PPV of 80.0%, and NPV 75.0% were found in predicting wound healing based on laser speckle images. Mean flux values were lowest in the center (ROI I) and showed an increase at the wound edge (ROI II, p = 0.03). Conclusion Laser speckle imaging shows acceptable sensitivity and specificity rates in predicting venous ulcer healing. The wound edge proved to be the best probability for the prediction of wound healing.
Collapse
Affiliation(s)
- Timme Maj van Vuuren
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Carina Van Zandvoort
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Suat Doganci
- 3 Department of Cardiovascular Surgery, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ineke Zwiers
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arina J tenCate-Hoek
- 2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,4 Department of Thrombosis, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralph Lm Kurstjens
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,5 Department of Obstetrics and Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - Cees Ha Wittens
- 1 Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,2 Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,6 Department of Vascular Surgery, University Hospital RWTH Aachen, Nordrhein-Westfalen, Aachen, Germany
| |
Collapse
|
170
|
Fronzo C. Chronic venous disease and wound infection: approaches, prevention and outcome measures from EWMA. J Wound Care 2017; 26:350-351. [PMID: 28598763 DOI: 10.12968/jowc.2017.26.6.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In May, BSN medical hosted two clinical symposia at the 2017 EWMA conference. These described the challenges in reducing the costs of treatment for patients with chronic venous disease (CVD), the importance of compression therapy and physical activity in the management and prevention of leg ulcers, and the obstacles in treating wound infection, among other topics. Camila Fronzo, JWC chief sub editor, was there to summarise the main points of each session.
Collapse
Affiliation(s)
- Camila Fronzo
- JWC chief sub editor, was there to summarise the main points of each session
| |
Collapse
|
171
|
Tickle J, Ovens L, Mahoney K, Hunt S, Harris E, Hodgman L. A proven alternative to compression bandaging. J Wound Care 2017; 26:S1-S24. [PMID: 28437140 DOI: 10.12968/jowc.2017.26.sup4a.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joy Tickle
- Tissue Viability Specialist and Clinical Lead, Shropshire Community Health NHS Trust
| | - Liz Ovens
- Independent Tissue Viability Specialist Nurse and Associate Lecturer, Buckinghamshire New University
| | - Kirsten Mahoney
- Clinical Nurse Specialist, Wound Healing Cardiff and Vale University Health Board and Clinical Operational and Procurement Lead, Welsh Wound Innovation Centre
| | - Sharon Hunt
- Lead Advanced Nurse Practitioner and Independent Specialist Wound Care, Wellway Medical Group, Northumberland
| | | | - Laura Hodgman
- Vascular Nurse Specialist and Senior Clinical Education Facilitator, Royal Derby Hospital
| |
Collapse
|
172
|
Miller C, McGuiness W, Wilson S, Cooper K, Swanson T, Rooney D, Piller N, Woodward M. Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial. J Wound Care 2017; 26:88-98. [DOI: 10.12968/jowc.2017.26.3.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Miller
- La Trobe University, School of Nursing & Midwifery, La Trobe University, Australia
| | - W. McGuiness
- La Trobe University/Alfred Health, School of Nursing & Midwifery, La Trobe University, Australia
| | - S. Wilson
- La Trobe University, School of Nursing & Midwifery, La Trobe University, Australia
| | - K. Cooper
- La Trobe University/Austin Health, School of Nursing & Midwifery, La Trobe University, Australia
| | - T. Swanson
- Nurse Practitioner Wound Management, South West Healthcare, Warrnambool. Vic 3280, Australia
| | - D. Rooney
- Goulburn Valley Health, Home Nursing Services, Australia
| | - N. Piller
- Flinders University, Lymphoedema Clinical Research Unit, Department of Surgery, School of Medicine, Australia
| | - M. Woodward
- University of Melbourne, Continuing Care, Austin Health, Australia
| |
Collapse
|
173
|
Junka A, Wojtowicz W, Ząbek A, Krasowski G, Smutnicka D, Bakalorz B, Boruta A, Dziadas M, Młynarz P, Sedghizadeh PP, Bartoszewicz M. Metabolic profiles of exudates from chronic leg ulcerations. J Pharm Biomed Anal 2017; 137:13-22. [PMID: 28088662 DOI: 10.1016/j.jpba.2017.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/14/2016] [Accepted: 01/07/2017] [Indexed: 12/20/2022]
Abstract
Chronic leg ulceration is a disease usually associated with other comorbidities, and significantly reduces patient quality of life. Infected leg ulcers can lead to limb-threatening sequelae or mortality. Leg ulcerations are colonized by a number of microbes that are able to cause life-threating infections in susceptible patients. Wound exudate is a body fluid that collects metabolites from patient eukaryotic cells and from prokaryotic bacterial communities inhabiting the wound. This study aimed at identification of metabolites in exudates collected from chronic leg ulcers, and correlation of this metabolome with patient comorbidities and microbiological status of the wound. By means of NMR spectroscopy we detected 42 metabolites of microbial or patient origin. The metabolites that were in abundance in exudates analyzed were lactate, lysine, and leucine. Metabolites were associated with the presence of neutrophils in wounds and destruction of high quantities of microbes, but also with hypoxia typical for venous insufficiency. The combination of nuclear magnetic resonance spectroscopy technique and partial least squares discriminant analysis allowed us to further discriminate groups of metabolites with regards to potential clinical meaning. For example, to discriminate between S.aureus versus all other isolated microbial species, or between patients suffering from type I or II diabetes versus patients without diabetes. Therefore, wound exudate seems to be highly applicable material for discriminant analysis performed with the use of NMR technique to provide for rapid metabolomics of chronic wound status.
Collapse
Affiliation(s)
- Adam Junka
- Department of Pharmaceutical Microbiology and Parasitology, Wrocław Medical University, Borowska 211A Str., 50-556 Wrocław, Poland.
| | - Wojciech Wojtowicz
- Department of Bioorganic Chemistry, Faculty of Chemistry, Wroclaw University of Technology, Wyspianskiego 27 Str. 50-534, Wrocław, Poland
| | - Adam Ząbek
- Department of Bioorganic Chemistry, Faculty of Chemistry, Wroclaw University of Technology, Wyspianskiego 27 Str. 50-534, Wrocław, Poland
| | | | - Danuta Smutnicka
- Department of Pharmaceutical Microbiology and Parasitology, Wrocław Medical University, Borowska 211A Str., 50-556 Wrocław, Poland
| | - Barbara Bakalorz
- Silesian Analytical Laboratories, Moniuszki 81 Str., 41-807 Zabrze, Poland
| | - Agnieszka Boruta
- Silesian Analytical Laboratories, Moniuszki 81 Str., 41-807 Zabrze, Poland
| | - Mariusz Dziadas
- Department of Bromatology and Dietetics, Wrocław Medical University, Borowska 211A Str, 50-556 Wrocław, Poland
| | - Piotr Młynarz
- Department of Bioorganic Chemistry, Faculty of Chemistry, Wroclaw University of Technology, Wyspianskiego 27 Str. 50-534, Wrocław, Poland
| | - Parish Paymon Sedghizadeh
- USC Center for Biofilms, Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, United States
| | - Marzenna Bartoszewicz
- Department of Pharmaceutical Microbiology and Parasitology, Wrocław Medical University, Borowska 211A Str., 50-556 Wrocław, Poland
| |
Collapse
|
174
|
Alcolea JM, Hernández E, Martínez-Carpio PA, Vélez M, Khomchenko V, Sola A, Trelles MA. Treatment of Chronic Lower Extremity Ulcers with A New Er:Yag Laser Technology. Laser Ther 2017; 26:211-222. [PMID: 29133969 DOI: 10.5978/islsm.17-or-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 06/26/2017] [Indexed: 11/06/2022]
Abstract
Chronic lower extremity ulcers (CLEUs) have a high prevalence and are difficult to treat due to their various aetiologies. The aim of this study is to evaluate the results achieved in treating CLEUs using an Erbium: YAG (Er:YAG) laser with RecoSMA technology. This laser emits thousands of microbeams of energy causing superficial epidermal ablation and a separation of dermal fibres due to a mechanical-acoustic and resonance effect. The evaluation of the results achieved was carried out by questionnaires completed by 18 patients enrolled in the study. Histological studies and photographs taken before each session (16 sessions in total) were analysed to visually monitor the clinical progress. The analyses were carried out with the help of computer software. The results after 16 treatment sessions showed the complete healing of ulcers or a decrease in their initial area of at least 55% in over 65% of the patients treated. The Student's t-test and Fisher's exact test were used for statistical analysis. The Er:YAG laser and RecoSMA technology ablates few epidermal cell layers, producing a mechanical-acoustic effect with resonance action leading to tissue regeneration mechanisms. This technology offers an effective and safe alternative for treating CLEUs.
Collapse
Affiliation(s)
- J M Alcolea
- Clínica Alcolea, Barcelona, Spain.,Instituto Médico Vilafortuny, Cambrils (Tarragona), Spain
| | - E Hernández
- Vascular Surgery Service, Hospital Viamed Monegal, Tarragona, Spain
| | - P A Martínez-Carpio
- Investilaser, Sabadell (Barcelona), Spain.,Instituto Médico Vilafortuny, Cambrils (Tarragona), Spain
| | - M Vélez
- Dermatology Service, Hospital del Mar, Barcelona, Spain.,Instituto Médico Vilafortuny, Cambrils (Tarragona), Spain
| | | | - A Sola
- Computer Engineering Department, University of Malaga, Spain
| | - M A Trelles
- Instituto Médico Vilafortuny, Cambrils (Tarragona), Spain
| |
Collapse
|
175
|
Ehmann S, Whitaker J, Hampton S, Collarte A. Multinational, pilot audit of a Velcro adjustable compression wrap system for venous and lymphatic conditions. J Wound Care 2016; 25:513-20. [DOI: 10.12968/jowc.2016.25.9.513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Ehmann
- Clinical Specialist, Carolinas HealthCare System Stanly
| | - J.C. Whitaker
- Director and Nurse Consultant, Senior Lecturer - University of Central Lancashire, Northern Lymphology Ltd
| | - S. Hampton
- Wound Care Consultant Nurse, 74 Battle Road, Hailsham, UK
| | - A. Collarte
- Tissue Viability Specialist Nurse, University of Central Lancashire UK
| |
Collapse
|
176
|
Treat infected venous leg ulcers with appropriate culture-based antimicrobials and usual wound care. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|