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Rajhathy EM, Hill MC, Tran DL, Huang RW, Chiu ES, Sibbald RG, Ayello EA. Debridement options for the interprofessional team. Nursing 2024; 54:30-38. [PMID: 38386448 DOI: 10.1097/01.nurse.0001006292.75909.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses the different normal tissue components that are critical to safe debridement practice, various methods of wound debridement for nurses, and the importance of an interprofessional team and consulting a wound specialist.
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Affiliation(s)
- Erin M Rajhathy
- Erin Rajhathy is a doctoral student at Örebro University, Örebro, Sweden. Mary Hill is an RN in Alberta, Canada. David Tran is a postdoctoral research fellow at the NYU Grossman School of Medicine. Ren-Wen Huang is an attending physician at Linkou Chang Gung Memorial Hospital in Taiwan. Ernest Chiu is a professor of plastic surgery at the NYU Grossman School of Medicine in New York, NY. Gary Sibbald is a professor of medicine and public health at the University of Toronto. Elizabeth Ayello is a faculty emeritus of Excelsior University School of Nursing in Albany, N.Y., and is a member of the Nursing2024 editorial board
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Sodré SLS, Nogueira GDA, Abreu AMD, Marta CB, Peregrino AADF, Silva RCLD. Análise de custo-efetividade do tratamento com terapia compressiva na cicatrização de úlceras venosas. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6017.3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Objetivo: analisar a custo-efetividade e calcular a razão de custoefetividade incremental do tratamento compressivo multicamadas em relação ao inelástico (bota de Unna e curto estiramento) de acordo com a literatura atual. Método: estudo quantitativo sobre custo-efetividade por meio de modelagem com auxílio do software TreeAge® para a construção da árvore de decisão. Os pressupostos anunciados foram obtidos pelo uso de dados secundários de literatura para estimativa do custo e efetividade dos parâmetros assumidos. Para tal, foi realizada uma revisão sistemática de literatura com metanálise. Resultados: a árvore de decisão, após Roll Back mostrou que a terapia multicamadas dominou as alternativas no caso-base, representando custo intermediário por aplicação, porém, com a maior efetividade. O gráfico da análise de custo-efetividade também mostrou uma dominância estendida da bota de Unna em relação à bandagem de curto estiramento. A análise de sensibilidade mostrou que a bandagem multicamadas permanece como alternativa mais custo-efetiva, dentro do limiar de disposição para pagar. Conclusão: a alternativa com maior custo-efetividade foi a bandagem multicamadas, considerada padrão ouro na literatura. A segunda alternativa mais custo-efetiva foi a bota de Unna, terapia mais utilizada no Brasil.
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Sodré SLS, Nogueira GDA, Abreu AMD, Marta CB, Peregrino AADF, Silva RCLD. Cost-effectiveness analysis of the treatment with compressive therapy in the healing of venous ulcers. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6017.3840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Objective: to analyze the cost-effectiveness and calculate the incremental cost-effectiveness ratio of multilayer compressive treatment in relation to inelastic (Unna boot and short stretch) therapy according to the current literature. Method: quantitative study about cost-effectiveness through modeling with the aid of TreeAge® software for construction of the decision tree. The anticipated assumptions were obtained by using secondary literature data to estimate the cost and effectiveness of the assumed parameters. A systematic literature review with meta-analysis was performed for this end. Results: the decision tree after Roll Back showed that the multilayer therapy dominated the alternatives in the base case, representing an intermediate cost per application, although with the highest effectiveness. The cost-effectiveness analysis graph also showed extended dominance of the Unna boot in relation to the short stretch bandage. The sensitivity analysis showed that multilayer bandage remains a more cost-effective alternative, within the threshold of willingness to pay. Conclusion: the most cost-effective alternative was multilayer bandage, considered the gold standard in the literature. The second most cost-effective alternative was the Unna boot, the most used therapy in Brazil.
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Probst S, Saini C, Gschwind G, Stefanelli A, Bobbink P, Pugliese M, Cekic S, Pastor D, Gethin G. Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis. Int Wound J 2023; 20:3906-3921. [PMID: 37293810 PMCID: PMC10588327 DOI: 10.1111/iwj.14272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.
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Affiliation(s)
- Sebastian Probst
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Care DirectorateUniversity Hospital GenevaGeneva University HospitalsGenevaSwitzerland
- Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
| | - Camille Saini
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Géraldine Gschwind
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Alessio Stefanelli
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Paul Bobbink
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Faculty of Biology and Medicine, University Institute of Higher Education and Research in HealthcareUniversity of LausanneLausanneSwitzerland
| | - Marie‐Thérèse Pugliese
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Sezen Cekic
- Department of PsychologyUniversity of GenevaGenevaSwitzerland
| | - Damien Pastor
- Department of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | - Georgina Gethin
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Alliance for Research and Innovation in WoundsUniversity of GalwayGalwayIreland
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Chan KS, Lo ZJ, Wang Z, Bishnoi P, Ng YZ, Chew S, Chong TT, Carmody D, Ang SY, Yong E, Chan YM, Ho J, Graves N, Harding K. A prospective study on the wound healing and quality of life outcomes of patients with venous leg ulcers in Singapore-Interim analysis at 6 month follow up. Int Wound J 2023; 20:2608-2617. [PMID: 36915237 PMCID: PMC10410353 DOI: 10.1111/iwj.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
Venous leg ulceration results in significant morbidity. However, the majority of studies conducted are on Western populations. This study aims to evaluate the wound healing and quality of life for patients with venous leg ulcers (VLUs) in a Southeast Asian population. This is a multi-centre prospective cohort study from Nov 2019 to Nov 2021. All patients were started on 2- or 4-layer compression bandage and were reviewed weekly or fortnightly. Our outcomes were wound healing, factors predictive of wound healing and the EuroQol 5-dimensional 5-level (EQ-5D-5L) health states. Within our cohort, there were 255 patients with VLU. Mean age was 65.2 ± 11.6 years. Incidence of diabetes mellitus was 42.0%. Median duration of ulcer at baseline was 0.30 years (interquartile range 0.136-0.834). Overall, the median time to wound healing was 4.5 months (95% confidence interval [CI]: 3.77-5.43). The incidence of complete wound healing at 3- and 6-month was 47.0% and 60.9%, respectively. The duration of the wound at baseline was independently associated with worse wound healing (Hazard ratio 0.94, 95% CI: 0.89-0.99, P = .014). Patients with healed VLU had a significantly higher incidence of perfect EQ-5D-5L health states at 6 months (57.8% vs 13.8%, P < .001). We intend to present longer term results in subsequent publications.
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Affiliation(s)
- Kai Siang Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | | | - Zifei Wang
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Priya Bishnoi
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Stacy Chew
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Tze Tec Chong
- Department of Vascular SurgerySingapore General HospitalSingaporeSingapore
| | - David Carmody
- Department of EndocrinologySingapore General HospitalSingaporeSingapore
| | - Shin Yuh Ang
- Nursing DivisionSingapore General HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Yam Meng Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Jackie Ho
- Department of Cardiac, Thoracic & Vascular SurgeryNational University HospitalSingaporeSingapore
| | - Nicholas Graves
- Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
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Wong NSQ, Tan AHM, Chan KS, Goh KCC, Lai P, Muthuveerappa S, Mohamed Nasir MMB, Liang S, Hong Q, Yong E, Lo ZJ. A prospective study on the efficacy of sequential treatment of technology Lipido-Colloid Impregnated with Silver and Technology Lipido-Colloid Nano-Oligosaccharide Factor in the management of venous leg ulcers. Health Sci Rep 2023; 6:e1488. [PMID: 37636288 PMCID: PMC10447879 DOI: 10.1002/hsr2.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background and Aims Venous leg ulcers (VLUs) are associated with significant morbidity and poor quality of life (QOL). Compression therapy and wound dressing are the mainstay treatment options. Technology Lipido-Colloid Impregnated with Silver (TLC-Ag) reduces bacterial load and Technology Lipido-Colloid Nano-Oligosaccharide Factor (TLC-NOSF) reduces elevated matrix metalloproteinases and improve wound healing. However, evidence is scarce on the role of sequential therapy. This study aims to evaluate if sequential treatment with TLC-Ag and TLC-NOSF improves VLU wound healing and QOL. Methods This is a prospective cohort study from May 2020 to October 2021 on patients with VLUs who received sequential therapy, consisting of 2 weeks of TLC-Ag followed by two-layer compression bandage (2LB) with TLC-NOSF until complete wound healing. Participants were followed-up with weekly dressing changes. Our primary outcomes were wound area reduction (WAR) and Pressure Ulcer Scale of Healing (PUSH) score. Our secondary outcomes were QOL measures. Results There were 28 patients with 57.1% males (n = 16) with a mean age of 65.3 years. Mean duration of VLU was 13.9 ± 11.7 weeks before the initiation of sequential therapy. Mean baseline wound area was 8.44 cm2. Median time to wound healing was 10 weeks. 57.1% of patients achieved complete wound closure at 3 months. There was significant WAR after 1 month (mean area 8.44-5.81 cm2, 31.2% decrease) and after 3 months (mean area 8.44-2.53 cm2, 70.0% decrease). Mean monthly WAR was 28.9%. PUSH score also decreased at 1 month (16.5% decrease, p < 0.001) and 3 months (63.3% decrease, p < 0.001) marks following the sequential therapy. EuroQol Visual Analog Scale (EQ-VAS) improved following sequential therapy (baseline: 69.0 ± 15.0, week 13: 80.2 ± 13.2, p < 0.001). Conclusion Sequential therapy with TLC-Ag followed by TLC-NOSF and 2LB is feasible, with good wound healing and improvement in QOL of patients with VLUs.
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Affiliation(s)
- Natalie Shi Qi Wong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Audrey Hui Min Tan
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | - Kai Siang Chan
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Karine C. C. Goh
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | - Peiting Lai
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | | | | | - Shanying Liang
- Department of Surgery, Vascular SurgeryWoodlands HealthSingaporeSingapore
| | - Qiantai Hong
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Zhiwen Joseph Lo
- Department of Surgery, Vascular SurgeryWoodlands HealthSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- Skin Research Institute of SingaporeAgency for Science Technology and ResearchSingaporeSingapore
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Sodré SLS, Nogueira GDA, de Abreu AM, Marta CB, Peregrino AADF, da Silva RCL. Cost-effectiveness analysis of the treatment with compressive therapy in the healing of venous ulcers. Rev Lat Am Enfermagem 2023; 31:e3839. [PMID: 36995850 PMCID: PMC10077846 DOI: 10.1590/1518-8345.6017-3839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/13/2022] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE to analyze the cost-effectiveness and calculate the incremental cost-effectiveness ratio of multilayer compressive treatment in relation to inelastic (Unna boot and short stretch) therapy according to the current literature. METHOD quantitative study about cost-effectiveness through modeling with the aid of TreeAge® software for construction of the decision tree. The anticipated assumptions were obtained by using secondary literature data to estimate the cost and effectiveness of the assumed parameters. A systematic literature review with meta-analysis was performed for this end. RESULTS the decision tree after Roll Back showed that the multilayer therapy dominated the alternatives in the base case, representing an intermediate cost per application, although with the highest effectiveness. The cost-effectiveness analysis graph also showed extended dominance of the Unna boot in relation to the short stretch bandage. The sensitivity analysis showed that multilayer bandage remains a more cost-effective alternative, within the threshold of willingness to pay. CONCLUSION the most cost-effective alternative was multilayer bandage, considered the gold standard in the literature. The second most cost-effective alternative was the Unna boot, the most used therapy in Brazil.
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Affiliation(s)
- Sarah Lopes Silva Sodré
- Hospital Universitário Graffre Guinle, Centro de Terapia Intensiva, Rio de Janeiro, RJ, Brasil
- Hospital Central da Aeronáutica, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Alcione Matos de Abreu
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brasil
| | - Cristiano Bertolossi Marta
- Universidade do Estado do Rio de Janeiro, Departamento de Enfermagem Fundamental, Rio de Janeiro, RJ, Brasil
- Universidade Veiga de Almeida, Faculdade de Enfermagem, Rio de Janeiro, RJ, Brasil
| | - Antônio Augusto de Freitas Peregrino
- Universidade Veiga de Almeida, Faculdade de Enfermagem, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de Janeiro, Departamento de Ciências Radiológicas, Rio de Janeiro, RJ, Brasil
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Guest JF, Fuller GW. Relative cost-effectiveness of three compression bandages in treating newly diagnosed venous leg ulcers in the UK. J Wound Care 2023; 32:146-158. [PMID: 36930185 DOI: 10.12968/jowc.2023.32.3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To assess the clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2, 3M, US) compared with a two-layer compression system (TLCS; KTwo, Urgo, France) and a cohesive inelastic bandage system (CIBR; Actico, L&R, Germany) in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). METHOD This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU randomly extracted from the The Health Improvement Network (THIN) database who were treated with TLCCB, TLCS or CIBR. No significant differences were detected between the groups. Nevertheless, analysis of covariance was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. RESULTS There were 250 patients in each group. Time from wound onset to starting compression was a mean of two months. The healing distribution of the TLCCB-treated patients was significantly different from that of the other two cohorts (p=0.003); the probability of healing at 12 months was 0.62, 0.51 and 0.49 in the TLCCB, TLCS and CIBR groups, respectively. Patients treated with TLCCB experienced better health-related quality of life (HRQoL) over 12 months (0.86 quality-adjusted life years (QALYs) per patient), compared with those treated with TLCS and CIBR (0.83 and 0.82 QALYs per patient, respectively). The 12-month NHS wound management cost was £3693, £4451 and £4399 per patient in the TLCCB, TLCS and CIBR groups, respectively. CONCLUSION Within the model's limitations, treating newly diagnosed VLUs with TLCCB instead of the other two compression systems appears to afford a more cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in increased healing, better HRQoL and a lower wound management cost for the NHS.
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Qiu Y, Osadnik CR, Team V. Planning exercise interventions as an adjunct treatment in managing venous leg ulcers: A qualitative study of nurses’ perspectives. J Tissue Viability 2023; 32:279-285. [PMID: 37032305 DOI: 10.1016/j.jtv.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/16/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives regarding strategies to support exercise interventions for people with venous leg ulcers. DESIGN 1:1 interview was guided by the Behaviour Change Wheel (BCW) to collect thoughts from clinicians with experiences in managing venous leg ulcers. SETTINGS Clinical nurses in metropolitan/regional Victoria, Australia. PARTICIPANTS A convenience sample of 21 nurses (mean clinical experience 14 years) was recruited. METHODS We conducted semi-structured remote interviews. Transcripts were coded and analysed using a theory-driven thematic analysis, and interventions to support the implementation of exercise interventions were mapped across the BCW. RESULTS Strategies related to capability, opportunity and motivation components from the BCW were identified. The strategies reported to be important included: i) education of patients and family members; ii) the provision of consistent and clear exercise advice; iii) setting realistic and meaningful goals in light of challenges encountered by patients; iv) flexibility in how exercise programmes were organised/structured, particularly to facilitate rapid adoption; and v) clinician education. CONCLUSIONS In-depth qualitative interviews of nurses working with people with venous leg ulcers in Australia revealed multifactorial issues that potentially affect prescription of care regarding physical exercise. In order to improve and standardise future clinical practice, a clear focus of future research should address such issues.
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Affiliation(s)
- Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia.
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Building B, Peninsula Campus, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia
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Guest JF, Fuller GW. Cohort study assessing the impact of COVID-19 on venous leg ulcer management and associated clinical outcomes in clinical practice in the UK. BMJ Open 2023; 13:e068845. [PMID: 36806131 PMCID: PMC9944296 DOI: 10.1136/bmjopen-2022-068845] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on venous leg ulcer (VLU) management by the UK's health services and associated outcomes. DESIGN Retrospective cohort analysis of the electronic records of patients from The Health Improvement Network database. SETTING Clinical practice in primary and secondary care. PARTICIPANTS A cohort of 1946 patients of whom 1263, 1153 and 733 had a VLU in 2019, 2020 and 2021, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical outcomes and wound-related healthcare resource use. RESULTS VLU healing rate in 2020 and 2021 decreased by 16% and 42%, respectively, compared with 2019 and time to heal increased by >85%. An estimated 3% of patients in 2020 and 2021 had a COVID-19 infection. Also, 1% of patients in both years had VLU-related sepsis, 0.1%-0.2% developed gangrene and 0.3% and 0.6% underwent an amputation on part of the foot or lower limb in 2020 and 2021 (of whom 57% had diabetes), respectively. The number of community-based face-to-face clinician visits decreased by >50% in both years and >35% fewer patients were referred to a hospital specialist. In 2020 and 2021, up to 20% of patients were prescribed dressings without compression compared with 5% in 2019. The total number of wound care products prescribed in 2020 and 2021 was >50% less than that prescribed in 2019, possibly due to the decreased frequency of dressing change from a mean of once every 11 days in 2019 to once every 21 days in 2020 and 2021. CONCLUSIONS There was a significant trend towards decreasing care during 2020 and 2021, which was outside the boundaries considered to be good care. This led to poorer outcomes including lower VLU healing rates and increased risk of amputation. Hence, the COVID-19 pandemic appears to have had a deleterious impact on the health of patients with a VLU.
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Abstract
Patients with advanced illness may present to palliative care or hospice with unmanaged symptoms that may be exacerbated by the presence of a wound. The wound can be a constant reminder to the patient and caregiver of the underlying illness. Distressing symptoms such as wound pain, odor, bleeding, and/or excessive exudate may impede the patients' ability to spend quality time with loved ones when they need them the most. Although patients may present with wounds of varying etiologies, the most common wounds seen in this patient population are pressure-related injuries. However, there is a shortage of both wound and palliative specialized clinicians. Telehealth and the use of other technology can be a way to address this shortage. This will grant access to a broader number of patients to ensure appropriate wound care plans are in place to meet the goals of care. Although wound healing may not always be possible in this patient population, having access to specialized wound and palliative experts can improve the quality of life for patients and their caregivers.
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Affiliation(s)
- Anne Walsh
- Anne Walsh, ANP-BC, CWOCN, ACHPN, is Visiting Nurse Service of New York Hospice & Palliative Care
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Maida V, Shi RB, Fazzari FGT, Zomparelli L. Topical cannabis-based medicines - A novel adjuvant treatment for venous leg ulcers: An open-label trial. Exp Dermatol 2021; 30:1258-1267. [PMID: 34013652 DOI: 10.1111/exd.14395] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
Venous leg ulcers are highly prevalent lower limb integumentary wounds that remain challenging to heal despite the use of evidence-based compression therapies. A multitude of adjuvant treatments has been studied but none have demonstrated enough efficacy to gain adoption into treatment guidelines. Global attention on Cannabis-Based Therapies is increasing and has been driven by quantum scientific advancements in the understanding of the endocannabinoid signalling system. Topical Cannabis-Based Medicines represent a novel treatment paradigm for venous leg ulcers in terms of promoting wound closure. Fourteen complex patients with sixteen recalcitrant leg ulcers were treated with Topical Cannabis-Based Medicines in conjunction with compression bandaging, every second day, to both wound bed and peri-wound tissues. The cohort had a mean age of 75.8 years and was medically complex as reflected by a mean M3 multimorbidity index score of 2.94 and a mean Palliative Performance Scale score of 67.1%. Complete wound closure, defined as being fully epithelialized, was achieved among 11 patients (79%) and 13 wounds (81%) within a median of 34 days. All three remaining patients demonstrated progressive healing trends but were lost to follow-up. The treatments were well tolerated, and no significant adverse reactions were experienced. The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that Topical Cannabis-Based Medicines may become effective adjuvants in conjunction with compression therapy. This may also indicate that they may have an even broader role within integumentary and wound management. Therefore, this treatment paradigm warrants being subjected to controlled trials.
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Affiliation(s)
- Vincent Maida
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada.,Division of Supportive & Palliative Care, William Osler Health System, Toronto, ON, Canada
| | - Runjie Bill Shi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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