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Lian Y, Anderson I, Keevil VL, Gohel M. A point prevalence audit of inpatients with leg ulcers eligible for compression therapy in a large university NHS hospital. J Wound Care 2022; 31:590-597. [PMID: 35797261 DOI: 10.12968/jowc.2022.31.7.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression in the community. However, little is known about the leg ulcer population and use of compression therapy in the hospital setting, where it is not often part of inpatient care. This study aimed to evaluate the proportion of inpatients with leg ulceration eligible for compression therapy. METHOD A point prevalence audit was undertaken using three methods: patient electronic live report; a leg ulcer audit form; and an electronic record search. The following data were retrieved: patient age, sex, primary reason for admission, diabetes, mobility status, history of dementia, Clinical Frailty Scale score and presence of oedema. Ankle-brachial pressure index was measured to determine patients' eligibility for compression therapy. RESULTS The audit identified 80/931 (8.5%) inpatients as having confirmed, active leg ulceration. A total of 36/80 (45%) inpatients were assessed for eligibility for compression, of whom 25/36 (69.4%) were eligible for full compression, 2/36 (5.6%) reduced compression and 9/36 (25%) were not eligible for compression therapy. CONCLUSION The audit demonstrated that a significant proportion of hospital inpatients with leg ulcers were eligible for compression therapy and that this patient population were heterogenous in terms of comorbidity profile, mobility, frailty and dementia, among other factors. Further research is required to explore the most feasible and effective compression options for inpatients with leg ulcers.
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Affiliation(s)
- Yaping Lian
- Tissue Viability Team, Cambridge University Hospitals NHS Foundation Trust (CUH), Cambridge Biomedical Campus, Hills Road, Cambridge, UK
| | - Irene Anderson
- University of Hertfordshire, School of Health and Social Work, Department of Nursing, Health and Wellbeing, College Lane, Hatfield, Hertfordshire, UK
| | - Victoria L Keevil
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.,Senior Research Associate in Geriatric Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Manj Gohel
- Tissue Viability Team, Cambridge University Hospitals NHS Foundation Trust (CUH), Cambridge Biomedical Campus, Hills Road, Cambridge, UK.,Honorary Senior Lecturer, Imperial College London and University of Cambridge, UK
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Mościcka P, Cwajda-Białasik J, Szewczyk MT, Jawień A. Healing Process, Pain, and Health-Related Quality of Life in Patients with Venous Leg Ulcers Treated with Fish Collagen Gel: A 12-Week Randomized Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7108. [PMID: 35742357 PMCID: PMC9223011 DOI: 10.3390/ijerph19127108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
The aim of the study was to assess the effectiveness of fish skin collagen and its impact on healing, pain intensity, and quality of life in patients with venous leg ulcers (VLUs). This study included 100 adults with VLUs. Eligible patients were randomized to either tropocollagen gel treatment (group A, n = 47) or placebo alone (group B, n = 45). We applied the gel to the periwound skin for 12 weeks. All groups received standard wound care, including class 2 compression therapy and wound hygiene procedures. We assessed the healing rate (cm2/week) and quality of life (QoL) using the Skindex-29 and CIVIQ scales. In group A, more ulcers healed, and the healing rate was faster. In both study groups, patients showed a significant improvement in quality of life after the intervention, but there was a greater improvement in the tropocollagen group. In group A, the greatest improvement was related to physical symptoms and the pain dimension. This study showed that the application of fish collagen gel to the periwound skin improves the healing process and QoL in patients with VLUs. The 12-week treatment with collagen reduced the severity of physical complaints, pain, and local skin symptoms, which determined the quality of life in patients with VLUs to the greatest extent.
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Affiliation(s)
- Paulina Mościcka
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (J.C.-B.); (M.T.S.)
| | - Justyna Cwajda-Białasik
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (J.C.-B.); (M.T.S.)
| | - Maria Teresa Szewczyk
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (J.C.-B.); (M.T.S.)
| | - Arkadiusz Jawień
- Department of Vascular Surgery and Angiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
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Araújo WAD, Assis WC, Vilela ABA, Boery RNSDO, Rodrigues VP, Rocha RM. Meanings of living with a chronic wound: a meta-synthesis study. ESTIMA 2020. [DOI: 10.30886/estima.v18.936_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: explore qualitative research on the meanings of living with a chronic wound. Method: it is a qualitative meta-synthesis. 13 articles were included, totaling a sample of 248 individuals who self-reported living with a chronic wound. The Critical Appraisal Skills Program instrument was used to evaluate the eligible articles, and to report the qualitative synthesis, the recommendations of Enhancing transparency in reporting the synthesis of qualitative research were followed. The analysis and extraction of information and construction of the synthesis were carried out by two independent reviewers, with the assistance of a third expert reviewer. Results: living with a chronic wound involves initial concerns and the appearance of symptoms, especially marked pain. They report that the increase in pain led to low functional capacity, as well as weakened social relationships and financial conditions. The experiences illustrate the challenges of emotional burden and the implications of illness, which contributed to social isolation. Religiosity and spirituality were the main coping strategies. Conclusion: living with a chronic wound means a condition of pain, limits physical and functional capacity, causes negative feelings and emotions that result in people’s isolation.
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Araújo WAD, Assis WC, Vilela ABA, Boery RNSDO, Rodrigues VP, Rocha RM. Significados de viver com ferida crônica: estudo de metassíntese. ESTIMA 2020. [DOI: 10.30886/estima.v18.936_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: explorar pesquisas qualitativas sobre os significados de viver com ferida crônica. Método: trata-se de uma metassíntese qualitativa. Foram incluídos 13 artigos, totalizando uma amostra de 248 indivíduos que autorreportaram viver com ferida crônica. Utilizou-se o instrumento do Critical Appraisal Skills Programme para avaliação dos artigos elegíveis, e para relatar a síntese qualitativa, seguiram-se as recomendações do Enhancing transparency in reporting the synthesis of qualitative research. A análise e extração das informações e construção da síntese foram feitas por dois revisores independentes, sob o auxílio de um terceiro revisor especialista. Resultados: viver com ferida crônica envolve preocupações iniciais e aparecimento dos sintomas, especialmente dor marcante. Relatam que o aumento da dor levou à baixa capacidade funcional, bem como relações sociais e condição financeira fragilizadas. As experiências ilustram os desafios da carga emocional e das implicações do adoecimento, que contribuíram para o isolamento social. A religiosidade e espiritualidade foram as principais estratégias de enfrentamento. Conclusão: viver com ferida crônica significa uma condição de dor, limita a capacidade física e funcional, provoca sentimentos e emoções negativas que resultam no isolamento das pessoas.
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Lian Y, Stather P, Gohel M. A comparison of inpatients with leg ulceration using published randomised controlled trials. ACTA ACUST UNITED AC 2020; 29:S14-S18. [PMID: 32167819 DOI: 10.12968/bjon.2020.29.5.s14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Leg ulcers are a significant burden and reduce patients' quality of life. In recent years, a plethora of information has been issued regarding leg ulcer management and 'the demographics of patients affected in the community. However, little is known about the leg ulcer population and how these patients should be managed in acute hospitals. AIM To compare the demographic data of inpatients with leg ulcers referred to the tissue viability service in a large teaching hospital with data on leg ulcer populations in acute and community settings. METHODS Inpatient demographic data were retrospectively obtained from electronic patient records. A literature search identified studies regarding leg ulcer populations in acute and community settings. RESULTS The patient population in acute settings is around 10 years older than that in community settings, with much greater levels of comorbidity and higher mortality rates. CONCLUSION An improved understanding of inpatients with leg ulcers would allow investigations and interventions to be targeted better, enabling evidence-based, patient-centred referral and care pathways. Further research is required to understand the aetiology and outcomes of leg ulcers for the inpatient population.
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Affiliation(s)
- Yaping Lian
- Tissue Viability Nurse Specialist, Tissue Viability Team, Cambridge University Hospitals NHS Foundation Trust
| | | | - Manj Gohel
- Vascular Surgeon, Consultant Vascular and Endovascular Surgeon, Honorary Senior Lecturer, Department of Vascular Surgery, Addenbrooke's Hospital
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Leren L, Johansen E, Eide H, Falk RS, Juvet LK, Ljoså TM. Pain in persons with chronic venous leg ulcers: A systematic review and meta-analysis. Int Wound J 2020; 17:466-484. [PMID: 31898398 PMCID: PMC7948710 DOI: 10.1111/iwj.13296] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 01/01/2023] Open
Abstract
Pain is a serious problem for patients with leg ulcers. Research mainly focuses on dressing‐related pain; however, chronic background pain may be just as devastating. Our main objective was to describe the prevalence and characteristics of wound‐related background pain in persons with chronic venous leg ulcers. We performed a systematic review to synthesise data from quantitative studies. Studies were eligible if they reported original baseline‐ or cross‐sectional data on background pain in chronic venous leg ulcers. The initial search identified 2454 publications. We included 36 descriptive and effect studies. The pooled prevalence of wound‐related background pain (from 10 studies) was 80% (95% CI 65‐92%). The mean pain intensity score (from 27 studies) was 4 (0‐10 numeric rating scale) (95% CI 3.4‐4.5). Other pain characteristics could not be synthesised. We identified few sufficiently high‐quality studies on prevalence and intensity of wound‐related background pain in patients with chronic venous leg ulcers. Four of five persons experience mild to moderate pain. Because of poor quality of pain assessment and report, we believe that the available research does not provide a sufficiently nuanced understanding of background pain in this patient group.
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Affiliation(s)
- Lena Leren
- University of South-Eastern Norway, Drammen, Norway
| | | | - Hilde Eide
- University of South-Eastern Norway, Drammen, Norway
| | - Ragnhild S Falk
- Oslo University Hospital, University of South-Eastern Norway, Oslo, Norway
| | - Lene K Juvet
- University of South-Eastern Norway, Drammen, Norway
| | - Tone M Ljoså
- University of South-Eastern Norway, Drammen, Norway
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Kadłubowska M, Bąk E, Marcisz C, Kózka M, Michalik A, Kolonko J, Krawczyk B, Dobrzyń-Matusiak D, Kapusta-Nowak Z. Perception vs pain and beliefs about pain control and Type A behavior pattern in patients with chronic ischemia of lower extremities or with rheumatoid arthritis. J Pain Res 2018; 11:3051-3059. [PMID: 30568486 PMCID: PMC6276602 DOI: 10.2147/jpr.s182703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective The study aimed at determining the experience of pain taking into consideration beliefs about pain control, Type A behavior pattern and sociodemographic factors in patients with chronic ischemia of the lower extremities or with rheumatoid arthritis (RA). Methods The study enrolled 100 patients with peripheral arterial disease (PAD) and 100 patients with RA. The subjective sensation of pain was assessed using the Visual Analog Scale (VAS); beliefs about pain control were analyzed using the Beliefs about Pain Control Questionnaire (BPCQ), taking into consideration internal factors, the influence of physicians and accidental events (chance); and Type A behavior features (haste and competition) were analyzed using the Framingham Type A Scale. The multiple regression model was used to assess associations between the experienced pain and the BPCQ value, the Framingham Type A Scale and sociodemographic factors. Results The pain intensity degree was found to be comparable in patients with PAD and with RA. The median determined using the VAS was 5.75 in both of the studied groups. In patients with PAD, lower VAS values were associated with the BPCQ – internal factors (P<0.05) whereas a higher VAS value was related to the BPCQ – physicians’ influence (P<0.001). In patients with RA, a higher VAS value was associated with BPCQ – physicians’ influence (P<0.05), disease duration (P<0.05) and smoking cigarettes (P<0.05). Conclusion Experiencing pain by patients with chronic ischemia of the lower extremities occurs at a moderate level and is beneficially connected with the internal factors and adversely connected with the external factors of beliefs about pain control. Patients with RA reported pain ailments of a moderate level in connection with the adverse influence of the external factors of beliefs about pain control, the duration of the disease and smoking cigarettes. Experiencing pain by patients with chronic ischemia of the lower extremities and RA does not seem to be related to Type A behavior.
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Affiliation(s)
- Monika Kadłubowska
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Ewelina Bąk
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Czesław Marcisz
- Medical University of Silesia, Department of Gerontology and Geriatric Nursing, School of Health Sciences, Katowice, Poland
| | - Maria Kózka
- Jagiellonian University Medical College, Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Cracow, Poland
| | - Anna Michalik
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Jolanta Kolonko
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Bożena Krawczyk
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Dorota Dobrzyń-Matusiak
- Medical University of Silesia, Department of Nursing Propaedeutics, School of Health Sciences, Katowice, Poland
| | - Zofia Kapusta-Nowak
- Medical University of Silesia, Department of Health Promotion and Community Nursing, School of Health Sciences, Katowice, Poland
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Influence of ulceration etiology on the global quality of life and its specific dimensions, including the control of pain, in patients with lower limb vascular insufficiency. Postepy Dermatol Alergol 2018; 34:471-477. [PMID: 29507563 PMCID: PMC5831284 DOI: 10.5114/ada.2017.71116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/24/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction The results of previous studies suggest that the quality of life in patients with lower limb ulcerations is markedly poorer than in the general population – with regard to physical, mental and social spheres. This complex character of that parameter necessitates comprehensive analyses of its specific aspects, including the level of the acceptance of illness and associated pain symptoms. Aim To compare the quality of life and its specific dimensions in patients with lower limb ulcerations of various etiology. Material and methods Patients with the ulcerations resulting from venous (n = 101) or arterial pathologies (n = 98), or having mixed etiology (n = 99) were examined with the: 1) Skindex-29 instrument, 2) Acceptance of Illness Scale, 3) Beliefs about Pain Control Questionnaire, and 4) Coping Strategy Questionnaire. Results The average quality of life related to physical symptoms was significantly higher in patients with venous ulcerations. Patients with ulcerations of arterial etiology more frequently used catastrophizing, and less often ignored pain sensations, used coping self-statements, and increased their activity levels; they were characterized by lower levels of control and poorer ability to decrease the pain. The internal locus of pain control increased proportionally to the global quality of life scores and levels of illness acceptance. Control over pain and ability to decrease the pain were more effective in individuals who used ignoring pain sensations, increasing the activity level, coping self-statements, and reinterpreting pain than in those using catastrophizing or praying and hoping strategies. Conclusions Physical complaints seem to be the basic determinant of the quality of life in patients with the lower limb ulceration, irrespective of its etiology.
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