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Protz K, Dissemond J, Augustin M, Janke TM. [Acquisition, status and transfer of knowledge in compression therapy : Cross-sectional study in healthcare professions using phlebological compression therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:476-485. [PMID: 38413502 DOI: 10.1007/s00105-024-05314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Due to scientific progress, healthcare professionals should regularly undergo appropriate continuing education. For this, knowledge transfer is essential. Therefore, the aim of this cross-sectional study was to investigate the acquisition, status and transfer of knowledge of professional groups applying phlebological compression therapy in Germany. MATERIALS AND METHODS Healthcare professionals (physicians, nurses and medical assistants) received a questionnaire developed for this study, which queried different aspects of acquisition, status and transfer of knowledge. RESULTS Responses from 522 participants were analysed. The topic of compression therapy was not taught in the nursing or medical education of 43.3%. Specialist journals that address compression therapy were read regularly (at least 6 times/year) by 16.1% of the participants; 63.0% had no specialist books on this subject. Only 6.7% were aware of AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") guidelines on the topic and 16.3% of the corresponding DNQP ("Deutsches Netzwerk für Qualitätsentwicklung in der Pflege") expert standard. In all, 41.2% participated in at least one internal training on compression therapy per year, 72.0% in external training and 19.2% in online training. A total of 30.7% stated that they did not use any information sources to acquire knowledge. CONCLUSIONS Possible sources of knowledge about compression therapy in Germany are insufficiently known within the investigated healthcare professional groups studied or are not regularly used. The result is a considerable knowledge deficit with a discrepancy between the current state of science and practice.
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Affiliation(s)
- Kerstin Protz
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Deutschland
| | - Matthias Augustin
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Toni Maria Janke
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Hagenström K, Protz K, Petersen J, Augustin M. Development of a model to predict closure of chronic wounds in Germany: Claims data analysis. Int Wound J 2022; 19:76-85. [PMID: 33949101 PMCID: PMC8684882 DOI: 10.1111/iwj.13599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022] Open
Abstract
Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time-to-event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c-statistics. This requires future data linkage between SHI and primary studies (eg, registers).
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Affiliation(s)
- Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Jana Petersen
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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3
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Lin HC, Fang CL, Hung CC, Fan JY. Potential predictors of quality of life in patients with venous leg ulcers: A cross-sectional study in Taiwan. Int Wound J 2021; 19:1039-1050. [PMID: 34611998 PMCID: PMC9284624 DOI: 10.1111/iwj.13700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross‐sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing.
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Affiliation(s)
- Hsiao-Ching Lin
- Department of Surgery, Division of Plastic Surgery, Wound Care Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chien-Liang Fang
- Department of Surgery, Division of Plastic Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Tai-Chung City, Taiwan
| | - Chang-Chiao Hung
- Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chia-Yi, Taiwan
| | - Jun-Yu Fan
- Division of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan, Taiwan
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Goh OQ, Ganesan G, Graves N, Ng YZ, Harding K, Tan KB. Incidence of chronic wounds in Singapore, a multiethnic Asian country, between 2000 and 2017: a retrospective cohort study using a nationwide claims database. BMJ Open 2020; 10:e039411. [PMID: 32978205 PMCID: PMC7520842 DOI: 10.1136/bmjopen-2020-039411] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Chronic wounds are common, costly and impair quality of life, yet epidemiological data are scarce. We aimed to estimate the incidence trend of a multiethnic Asian population. DESIGN Retrospective cohort study. SETTING Singapore's nationwide claims database. PARTICIPANTS Singaporeans and permanent residents. OUTCOMES Patients were identified by International Classification of Disease, Ninth Revision, Australian Modification (ICD-9-AM) and ICD-10-AM codes from all admissions between 2000 and 2017, and categorised according to aetiology: venous, arterial, diabetic and pressure. Comorbidities were extracted from a national database of Charlson Comorbidity Index scores. RESULTS Between 2000 and 2017, 124 023 wound-related claims among 86 631 patients were identified. Age-specific rate (ASR) and age-adjusted incidence rates of all wounds increased over 18 years, with greatest increases among those aged ≥80. In 2017, the median age of patients was 74 (IQR 63-84). Half were male (51%). 70% were ethnic Chinese, 15% Malay and 9% Indian. In 2017, the crude incidence rate (CIR) was 15 per 100 000 persons (95% CI 14 to 16) for venous wounds, 56 (95% CI 53 to 58) for arterial, 168 (95% CI 164 to 173) for diabetic and 183 (95% CI 179 to 188) for pressure wounds. The CIR of any chronic wound was 296 (95% CI 291 to 301). ASRs were greatest in patients aged ≥80: 92 (95% CI 74 to 112) for venous, 478 (95% CI 436 to 522) for arterial, 1791 (95% CI 1710 to 1876) for diabetic, 3647 (95% CI 3530 to 3766) for pressure and 4277 (95% CI 4151 to 4407) for any wound. Compared with the Chinese, Indians had thrice the ASRs of venous and arterial wounds and double the ASR of diabetic wounds. Malays had double the ASRs of arterial and diabetic wounds. CONCLUSIONS Chronic wounds are common in the elderly with significant ethnic disparities in this Asian cohort. With the incidence expected to rise with ageing populations, it is crucial to address health disparities and evaluate utilisation and cost to inform clinical practice and health policy.
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Affiliation(s)
- Orlanda Q Goh
- Policy and Research Division, Ministry of Health, Singapore
- Department of Internal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Ganga Ganesan
- Policy and Research Division, Ministry of Health, Singapore
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Zhen Ng
- Wound Care Innovation for the Tropics Programme, Skin Research Institute of Singapore, A*STAR, Singapore
| | - Keith Harding
- Wound Care Innovation for the Tropics Programme, Skin Research Institute of Singapore, A*STAR, Singapore
| | - Kelvin Bryan Tan
- Policy and Research Division, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Hrynyschyn R, Dockweiler C, Iltner J, Hornberg C. [Teleconsultation for vascular- and diabetes-associated chronic wounds : A systematic review of health-related and economic implications]. Hautarzt 2019; 71:114-123. [PMID: 31659390 DOI: 10.1007/s00105-019-04498-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.
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Affiliation(s)
- Robert Hrynyschyn
- Centre for ePublic Health Research, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
| | - Christoph Dockweiler
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Jessica Iltner
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Claudia Hornberg
- Medizinische Fakultät, Universität Bielefeld, Bielefeld, Deutschland
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Comparison of EQ-5D-5L and SPVU-5D for measuring quality of life in patients with venous leg ulcers in an Australian setting. Qual Life Res 2019; 28:1903-1911. [PMID: 30778889 DOI: 10.1007/s11136-019-02128-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Given the importance of measuring health-related quality of life (HRQoL) for cost-utility studies, this study aimed to determine the validity and responsiveness of two preference-based HRQoL instruments, the EuroQol-five dimensions-five levels questionnaire (EQ-5D-5L) and the Sheffield Preference-based Venous Ulcer questionnaire (SPVU-5D) in patients with venous leg ulcers (VLUs) in an Australian setting. METHODS This study analysed de-identified data collected from 80 patients with VLUs recruited by a prospective study in Brisbane, Queensland, Australia. Patients were asked to complete EQ-5D-5L and SPVU-5D surveys at baseline, 1-month, 3-month and 6-month follow-up as part of the prospective study. Baseline data and follow-up data were pooled to test the construct validity and level of agreement of the two instruments. Follow-up data were used to test the responsiveness. RESULTS The ceiling effects were negligible for EQ-5D-5L and SPVU-5D utility scores. Both instruments were able to discriminate between healed VLU and unhealed VLU and showed great responsiveness when healing status changed over time. Weak to strong correlations were found between dimensions of EQ-5D-5L and SPVU-5D. The utility scores produced from EQ-5D-5L were generally lower. CONCLUSIONS This study found that both EQ-5D-5L and SPVU-5D were valid and responsive in detecting change of VLU healing status among a small Australian population. Both instruments may be used in economic evaluation studies that involve patients with healed or unhealed VLUs. However, given the limitations presented in this study, further research is necessary to make sound recommendations on the preferred instrument in economic evaluation of VLU-related interventions.
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7
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Engelberg WL, Dörler M, Stücker M, Reich-Schupke S. Impact of Gram-negative bacteria on the treatment of venous leg ulcers. Int Wound J 2018; 15:958-965. [PMID: 30079579 DOI: 10.1111/iwj.12955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 12/29/2022] Open
Abstract
Gram-negative germs with and without multi-resistance are garnering more and more importance. The aim of this study was to investigate the frequency and rate of resistance against antibiotics and to clarify the impact of Gram-negative bacteria, especially with high rates of resistance, for the treatment of venous leg ulcers. This is a retrospective, monocentric, non-randomised open study. Included were all data within 1 year of bacterial swabs of venous leg ulcers. We performed summarization, pooling, and descriptive analysis for frequencies and crossover. We analysed 679 swabs of 285 patients with venous leg ulcers. The mean patient age was 69.78 years. There were 76.1% Gram-positive and 58.2% Gram-negative germs detected; 56.5% of the swabs showed multi-resistance. Gram-negative bacteria were associated with more pain. Exacerbation and relevant aggravation of wounds that led to stationary treatment occurred more frequently. With polihexanid treatment, we saw less Gram-negative flora. This study showed an immediate impact of Gram-negative germs on the patient's pain, the risk for aggravation, and the choice of treatment. Further studies for prophylaxis and treatment of Gram-negative germs in venous leg ulcer therapy are needed.
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Affiliation(s)
- Wibke L Engelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Germany
| | - Martin Dörler
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Germany
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Germany
| | - Stefanie Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Germany
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Körber A, Jockenhöfer F, Sondermann W, Stoffels-Weindorf M, Dissemond J. [First manifestation of leg ulcers : Analysis of data from 1000 patients]. DER HAUTARZT 2018; 68:483-491. [PMID: 28280910 DOI: 10.1007/s00105-017-3950-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than 1 million people in Germany suffer from leg ulcers. The diagnosis leg ulcer summarizes many different etiologies. The therapy of leg ulcers is an interdisciplinary and interprofessional challenge. Early identification of the cause of the leg ulcer and initiation of a causal therapy are essential for healing. OBJECTIVES The aim of this study was to investigate the initial manifestation age of patients with causally associated leg ulcers. Afterwards we calculated the most common etiologies according to decade. PATIENTS AND METHODS A prospective database at the University Hospital Essen, dermatological wound care center, was used to identify patients with chronic leg ulcers between 2002 and 2014. Clinical data of 1000 patients with chronic leg ulcers were analyzed in this monocentric study. RESULTS A total of 29 different etiologies were differentiated. Approximately 70% of etiologies were of vascular origin, while 30% were rare causes. The count of different etiologies showed significant differences related to the onset and the occurrence in individual decades of life. In particular, nonvascular etiologies such as pyoderma gangrenosum or necrobiosis lipoidica are relatively more common in younger patients than in the aged. CONCLUSION Based on the findings of our study, it is possible to limit the underlying etiology on the basis of the age of first manifestation of the leg ulcer in order to make targeted diagnostics more effective. Thus, this information can help to optimize scarce time resources in daily practice and improve the prediction probability of leg ulcers.
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Affiliation(s)
- A Körber
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - F Jockenhöfer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - W Sondermann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - M Stoffels-Weindorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Protz K, Heyer K, Dissemond J, Temme B, Münter KC, Verheyen-Cronau I, Klose K, Hampel-Kalthoff C, Augustin M. Compression therapy - current practice of care: level of knowledge in patients with venous leg ulcers. J Dtsch Dermatol Ges 2018; 14:1273-1282. [PMID: 27992134 DOI: 10.1111/ddg.12938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Compression therapy is a mainstay in the causal treatment of patients with venous leg ulcers. It facilitates healing, reduces pain and recurrences, and increases quality of life. Up until now, there is a scarcity of scientific data with respect to the level of care and the specific knowledge of patients with venous leg ulcers. PATIENTS AND METHODS At first presentation, patients with venous leg ulcers anonymously answered a standardized questionnaire. Participating facilities nationwide included 55 outpatient care services, 32 medical practices, four wound centers, and one specialized care center. RESULTS Overall, 177 patients (mean age of 69.4; 75.1 % women) participated in the study. The average duration of florid venous leg ulcers was 17 months. With regard to compression therapy, 31.1 % of patients received none; 40.1 % used bandages; 28.8 % used stockings. Of the latter, 13.7 % were treated with compression class III; 67.4 %, with compression class II; and 19.6 %; with compression class I. While 70.6 % put on their stockings after getting out of bed in the morning, 21.1 % wore them day and night. In 39.2 % of individuals, the stockings caused them discomfort. Merely 11.7 % owned a donning device. On average, bandages were worn for 40.7 weeks, and 69 % were used without underpadding. In 2.8 % of patients, ankle and calf circumference was measured to monitor therapeutic success. 45.9 % reported doing leg exercises. CONCLUSIONS Although it is considered a basic therapeutic measure in venous leg ulcers, one-third of all patients received no compression treatment. Moreover, given the long duration of ulcers, adequate product selection and correct use have to be questioned, too. Our findings indicate that improvements in the level of knowledge among users and prescribers as well as patient training are required.
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Affiliation(s)
- Kerstin Protz
- University Medical Center Hamburg Eppendorf, Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, Hamburg, Germany
| | - Kristina Heyer
- University Medical Center Hamburg Eppendorf, Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, Hamburg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology, und Allergology, University Hospital Essen, Essen, Germany
| | - Barbara Temme
- Wound Practice Berlin, Surgery, Hospital Neukölln, Berlin, Germany
| | - Karl-Christian Münter
- Group Practice Bramfeld, General Medicine, Internal Medicine and Phlebology, Hamburg, Germany
| | - Ida Verheyen-Cronau
- District Hospital Frankenberg gGmbH, Training Center for Nursing Professions, Frankenberg, Germany
| | - Katharina Klose
- University Medical Center Hamburg Eppendorf, Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, Hamburg, Germany
| | | | - Matthias Augustin
- University Medical Center Hamburg Eppendorf, Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, Hamburg, Germany
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Protz K, Heyer K, Dissemond J, Temme B, Münter KC, Verheyen-Cronau I, Klose K, Hampel-Kalthoff C, Augustin M. Kompressionstherapie - Versorgungspraxis: Informationsstand von Patienten mit Ulcus cruris venosum. J Dtsch Dermatol Ges 2018; 14:1273-1283. [PMID: 27992143 DOI: 10.1111/ddg.12938_g] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022]
Abstract
HINTERGRUND UND ZIELE Eine Säule der kausalen Therapie bei Patienten mit Ulcus cruris venosum ist die Kompressionstherapie. Sie unterstützt die Abheilung, reduziert Schmerzen und Rezidive und steigert die Lebensqualität. Bislang existieren kaum wissenschaftliche Daten zu dem Versorgungsstand und fachspezifischem Wissen von Patienten mit Ulcus cruris venosum. PATIENTEN UND METHODIK Standardisierte Fragebögen wurden bundesweit in 55 Pflegediensten, 32 Arztpraxen, vier Wundzentren und -sprechstunden sowie einem Pflegetherapiestützpunkt von Patienten mit Ulcus cruris venosum bei Erstvorstellung anonym ausgefüllt. ERGEBNISSE Insgesamt nahmen 177 Patienten (Durchschnittsalter 69,4 Jahre; 75,1 % Frauen) teil. Ein florides Ulcus cruris venosum bestand im Mittel 17 Monate. 31,1 % hatten keine Kompressionstherapie, 40,1 % Binden und 28,8 % Strümpfe. Bei der Bestrumpfung hatten 13,7 % Kompressionsklasse III, 64,7 % Kompressionsklasse II und 19,6 % Kompressionsklasse I. 70,6 % legten die Strümpfe nach dem Aufstehen an, 21,1 % trugen sie Tag und Nacht. 39,2 % bereiteten die Strümpfe Beschwerden. Lediglich 11,7 % hatten eine An- und Ausziehhilfe. Die Binden wurden im Mittel 40,7 Wochen getragen und bei 69 % nicht unterpolstert. Bei 2,8 % wurde der Knöchel- und Waden-Umfang zur Erfolgskontrolle gemessen. Venensport machten 45,9 %. SCHLUSSFOLGERUNGEN Ein Drittel hatte keine Kompressionsversorgung, obwohl diese eine Basismaßnahme der Therapie des Ulcus cruris venosum ist. Zudem ist deren korrekte Auswahl und Anwendung angesichts der langen Bestandsdauer der Ulzerationen zu hinterfragen. Weiterführende Fachkenntnisse bei Anwendern und Verordnern sowie Patientenschulungen sind erforderlich.
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Affiliation(s)
- Kerstin Protz
- Universitätsklinikum Hamburg Eppendorf, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Hamburg
| | - Kristina Heyer
- Universitätsklinikum Hamburg Eppendorf, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Hamburg
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum Essen
| | - Barbara Temme
- Wundpraxis Berlin, Chirurgie, Krankenhaus Neukölln, Berlin
| | - Karl-Christian Münter
- Gemeinschaftspraxis Bramfeld, Allgemeinmedizin, innere Medizin und Phlebologie, Hamburg
| | - Ida Verheyen-Cronau
- Kreiskrankenhaus Frankenberg gGmbH, Schulzentrum für Pflegeberufe, Frankenberg
| | - Katharina Klose
- Universitätsklinikum Hamburg Eppendorf, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Hamburg
| | | | - Matthias Augustin
- Universitätsklinikum Hamburg Eppendorf, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Hamburg
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Diener H, Debus E, Herberger SK, Heyer K, Augustin M, Tigges W, Karl T, Storck M. Versorgungssituation gefäßmedizinischer Wunden in Deutschland. GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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[German national consensus on wound documentation of leg ulcer : Part 2: Routine care - classification of variable characteristics]. Hautarzt 2017; 68:896-911. [PMID: 28681136 DOI: 10.1007/s00105-017-4012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Standards in the assessment and documentation of disease processes are the basis of guideline-based care. For the treatment of chronic wounds, especially leg ulcers, no approved parameters are available. OBJECTIVES Against this background, our aim was to develop standards for the documentation of leg ulcer in routine care. This article presents the recommendations for the classification and characteristics of the variables. MATERIALS AND METHODS The development of the documentation standard was based on a systematic literature research and was performed in a Delphi-based consensus process. The national consensus process included meetings as well as web-based questionnaires. The Consensus Group is coordinated by the German Center for Health Services Research in Dermatology (CVderm). RESULTS The documentation standards and their variables for leg ulcer routine care were developed in seven meetings of the consensus group. The consensus group consists of 38 delegates of wound care societies, health insurances, wound networks and associations. DISCUSSION For each variable, recommended in routine care, a distinct response scheme (defined set of variable characteristics) was defined. As a next step, a structured implementation process is required, which was part of the resolutions of the consensus group.
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Heyer K, Milde S, Schmitt J, May M, Helfrich J, Augustin M. [A standard data set for the evaluation of venous leg ulcers in selective contracts : National consensus]. Hautarzt 2017; 68:815-826. [PMID: 28567507 DOI: 10.1007/s00105-017-3990-8] [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: 11/26/2022]
Abstract
BACKGROUND Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available. OBJECTIVES Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference. MATERIALS AND METHODS Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks. RESULTS For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators. CONCLUSIONS The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.
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Affiliation(s)
- K Heyer
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - S Milde
- AOK-Bundesverband, Berlin, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), TU Dresden, Dresden, Deutschland
| | - M May
- AOK Rheinland/Hamburg, Hamburg, Deutschland
| | | | - M Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Heyer K, Protz K, Glaeske G, Augustin M. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J 2017; 14:338-343. [PMID: 27199102 PMCID: PMC7949887 DOI: 10.1111/iwj.12605] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.
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Affiliation(s)
- Kristina Heyer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Gerd Glaeske
- Centre for Social Policy ResearchUniversity of BremenBremenGermany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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Abstract
BACKGROUND One of the most significant, and growing, challenges in modern medicine, i.e. the treatment of chronic wounds, is marked by nonuniform data. This concerns both prevalence and incidence of chronic dermatosis, in particular venous ulcers (ulcus cruris), as well as the impact on the health-related quality of life, and practical and economic parameters of the success of different therapies. PURPOSE The aim of this work is to examine the epidemiology of chronic wounds, in particular age-associated venous ulcers, their impact on health-related quality of life, the treatment regimen, and practical and economic parameters of the success of different therapies. MATERIALS AND METHODS Performed were analysis of data on the care of venous ulcers in Germany, based on secondary data of Barmer GEK from 2009 and 2012, comparison with data of a NHS Kent Community Health Trust study, and analysis of studies concerning structures, processes and critical success factors for the treatment of chronic wounds, including economic effects. CONCLUSION Early causal therapy with treatment based on the stage of the wound, consequent goal-oriented interdisciplinary care, and relapse prophylaxis is critical for successful healing of venous ulcers. The costs of treatment significantly correlate with the duration of treatment which can be reduced by up to 60% using guideline-based concepts for the treatment of chronic wounds. Treatment success, in particular with regard to cost-benefit considerations, can be optimized by telemedicine networks of key players who treat chronic wounds.
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Jockenhöfer F, Gollnick H, Herberger K, Isbary G, Renner R, Stücker M, Valesky E, Wollina U, Weichenthal M, Karrer S, Kuepper B, Roesch A, Dissemond J. Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1 000 patients from 10 specialised dermatological wound care centers in Germany. Int Wound J 2016; 13:821-8. [PMID: 25483380 PMCID: PMC7949738 DOI: 10.1111/iwj.12387] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022] Open
Abstract
Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1 000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9 years. The wounds persisted on average for 40·8 months and had a mean size of 43·7 cm(2) . Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed-type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post-surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non-insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome. Cofactors and comorbidities of patients with chronic leg ulcers have previously been studied but not in detail. Here, we were able to demonstrate the existence of several potentially relevant cofactors, comorbidities of their associations and geographical distributions, which should be routinely examined in patients with chronic leg ulcers and - if possible - treated.
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Affiliation(s)
- Finja Jockenhöfer
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany
| | - Harald Gollnick
- Department of Dermatology and Venereology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Katharina Herberger
- Institute for Healthcare Research of Dermatology and Health Care Professions, University Hospital of Hamburg, Hamburg, Germany
| | - Georg Isbary
- Department of Dermatology, Allergology and Environment Medicine, Clinical Centre Schwabing Munich, Munich, Germany
| | - Regina Renner
- Department of Dermatology and Venereology, University Hospital of Erlangen, Erlangen, Germany
| | - Markus Stücker
- Department of Dermatology, Centre for venous disease of the dermatological and vascular surgery, University Hospital of Bochum, Bochum, Germany
| | - Eva Valesky
- Department of Dermatology and Venereology, University Hospital of Frankfurt a. M., Frankfurt, Germany
| | - Uwe Wollina
- Department of Dermatology, Venereology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Michael Weichenthal
- Department of Dermatology, Venereology, University Hospital of Kiel, Keil, Germany
| | - Sigrid Karrer
- Department of Dermatology, Venereology, University Hospital of Regensburg, Regensburg, Germany
| | - Bernhard Kuepper
- General Medical Department, Timaru Public Hospital, SCDHB, Timaru, New Zealand
| | - Alexander Roesch
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany.
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Heyer K, Herberger K, Protz K, Glaeske G, Augustin M. Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data. Wound Repair Regen 2016; 24:434-42. [DOI: 10.1111/wrr.12387] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kristina Heyer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Katharina Herberger
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Gerd Glaeske
- Center for Social Policy Research; University of Bremen; Bremen Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Abstract
SummaryChronic wounds are of great socioeconomic importance. Usually they are associated with a long, complicated and burdensome course of disease and require high nursing and medical expenses. The quality of life of patients with chronic wounds is substantially impaired. This article provides a systematic overview of current studies on the morbidity and the health care situation of patients with chronic wounds, especially in patients with leg ulcers in Germany.Analyses based on routine data of statutory health insurances show higher incidence and prevalence rates, for example of patients with leg ulcers, compared with previously regional surveys. The quality of care is inadequate, particularly in diagnostics and therapy of patients with leg ulcers. To date, there is undersupply and a lack of execution and deficient knowledge about the compression treatment in patients with venous leg ulcers.Thus, there is need for further action in order to establish better implementation of guidelines in the management of patients with chronic wounds.
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Goepel L, Herberger K, Debus S, Diener H, Tigges W, Dissemond J, Gerber V, Augustin M. [Wound networks in Germany: structure, functions and objectives 2014]. Hautarzt 2015; 65:960-6. [PMID: 25339384 DOI: 10.1007/s00105-014-3527-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wound networks are structured collaborations between various professions and medical disciplines in the field of treatment of patients with chronic wounds. In view of the complex chronic courses of such wounds with many relevant underlying diseases, comorbidities and a multitude of possible therapy options, the evidence-based structured treatment of patients with wound problems is of particular importance. However, this treatment is very heterogeneous and often uncoordinated. OBJECTIVE This article describes a stocktaking of the active regional wound networks in Germany with characterization of their structures, activities and objectives. METHODS A nationwide survey was carried out targeting wound specialists and wound societies as well as already established wound networks for which an updating was carried out. All identified networks were issued with a standardized questionnaire about the size of the network, extent of regional coverage, participating medical disciplines and professional groups and activities. In addition to the preformulated questions, free text information was also encouraged. RESULTS A total of 35 wound networks could be identified. The majority of networks consisted of representatives of hospitals as well as physicians in private practice and nursing personnel. The most frequently represented medical disciplines were vascular surgeons (74%), general physicians (63%), diabetologists (60%), general surgeons (60%) and dermatologists (57%). The most frequent activities were informal meetings on further education (77%), exchange of experiences and second opinions (both 71%) and consultation on patient treatment (69%). Selective contracts were only implemented in very few cases. CONCLUSION The wound networks established in Germany on self-initiatives represent strong interdisciplinary and interprofessional-oriented specialist platforms with a high potential for structured and efficient treatment. Incentives for systematic utilization of these structures in the course of improvements in quality and remuneration of treatment of patients with chronic wounds would be desirable.
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Affiliation(s)
- L Goepel
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol 2014; 89:73-81. [PMID: 24626651 PMCID: PMC3938357 DOI: 10.1590/abd1806-4841.20142156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/23/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chronic leg ulcer may have an impact on patients' quality of life. OBJECTIVES This study aimed to identify the impact of leg ulcers on patient's quality of life
using the Dermatology Life Quality Index and to define the main factors correlated
with this perception. METHOD Cross-sectional, non-probabilistic sampling study. We included patients with
chronic leg ulcers being treated for at least 3 months. A sociodemographic and
clinical survey was conducted to assess the profile of the ulcers. We administered
a screening for depressive symptoms and the Dermatology Life Quality Index. We
performed a descriptive statistical analysis, chi-square test and Mann-Whitney
test for categorical data, Pearson for numeric variables, and multiple regression
for categorical data. RESULTS Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers
(48.8%) were the most prevalent. Seventy-three percent of the sample perceived no
impact/low impact on quality of life in the past week, and 26.8% perceived
moderate/high impact. A multiple regression analysis identified the causes of
lesion, pain related to the ulcers, time of onset, and severity of the depressive
symptoms as the variables that had an influence on quality of life. CONCLUSIONS The majority of the sample perceived low or no impact of the condition on the
quality of the life. The variables etiology of the lesion (p<0.001), pain
related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the
depressive symptoms (p<0.001) had an influence on the quality of life,
suggesting the need for further studies with more robust designs to confirm the
causal relationship between these characteristics and quality of life.
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Affiliation(s)
- Patrick Alexander Wachholz
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu Medical School, Public Health Program, BauruSP, Brazil, MD, Geriatrician and Internal Medicine - Master's Degree Student, Public Health Program, Botucatu Medical School - Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP) - Bauru (SP), Brazil
| | - Paula Yoshiko Masuda
- Instituto Lauro de Souza Lima, Medical Residency Program in Dermatology, BauruSP, Brazil, MD, Preceptor, Medical Residency Program in Dermatology, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
| | - Dejair Caitano Nascimento
- Universidade de São Paulo, Instituto Lauro de Souza Lima, BauruSP, Brazil, Pharmacist, PhD in Pharmacology, Universidade de São Paulo (USP) - Scientific Researcher, Instituto Lauro de Souza Lima, Bauru - SP - Bauru (SP), Brazil
| | - Cecilia Midori Higashi Taira
- Instituto Lauro de Souza Lima, BauruSP, Brazil, Nurse - Technical Coordinator, Outpatient Clinic of Wounds, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
| | - Norma Gondim Cleto
- Universidade Estadual Paulista Julio de Mesquita Filho, Instituto Lauro de Souza Lima, Medical Residency Program in Dermatology, BauruSP, Brazil, MD, Master's Degree in Medical Biotechnology, Universidade Estadual Paulista Julio de Mesquita Filho (Unesp) - Preceptor, Medical Residency Program in Dermatology, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
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Chaby G, Senet P, Ganry O, Caudron A, Thuillier D, Debure C, Meaume S, Truchetet F, Combemale P, Skowron F, Joly P, Lok C. Prognostic factors associated with healing of venous leg ulcers: a multicentre, prospective, cohort study. Br J Dermatol 2014; 169:1106-13. [PMID: 23909381 DOI: 10.1111/bjd.12570] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some prognostic markers of venous leg ulcer (VLU) healing have been evaluated, mostly in retrospective studies. OBJECTIVES To identify which clinical characteristics, among those known as possible prognostic factors of VLU healing, and which VLU-associated sociodemographic and psychological factors, are associated with complete healing at week 24 (W24). METHODS A prospective, multicentre, cohort study was conducted in 22 French dermatology departments between September 2003 and December 2007. The end point was comparison between healed and nonhealed VLUs at W24, for patient clinical and biological characteristics; psychological, cognitive and social assessments; affected leg inclusion characteristics; venous insufficiency treatment and percentage of initial wound area reduction during follow-up. RESULTS In total, 104 VLUs in 104 patients were included; 94 were analysed. The mean VLU area and duration were 36.8 ± 55.5 cm2 and 24.8 ± 45.7 months, respectively. At W24, 41/94 VLUs were healed. Univariate analysis significantly associated complete healing with superficial venous surgery (P = 0.001), adherence to compression therapy at W4 (P = 0.03) and W24 (P = 0.01), ankle-joint ankylosis (P = 0.01) and mean percentage of VLU area reduction at W4 (P = 0.04). Multivariate analysis retained superficial venous surgery during follow-up [odds ratio (OR) 8.4, 95% confidence interval (CI) 1.9-48.2] and percentage reduction of the VLU area at W4 (OR 1.6, 95% CI 1.0-2.14) as being independently associated with healing. CONCLUSIONS These results indicate that complete healing of long-standing, large VLUs is independently associated with ablation of the incompetent superficial vein and percentage of wound area reduction after the first 4 weeks of treatment.
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Affiliation(s)
- G Chaby
- Department of Dermatology, Hôpital Sud, University of Amiens, 80054, Amiens, France
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Jockenhöfer F, Gollnick H, Herberger K, Isbary G, Renner R, Stücker M, Valesky E, Wollina U, Weichenthal M, Karrer S, Klode J, Dissemond J. Bacteriological pathogen spectrum of chronic leg ulcers: Results of a multicenter trial in dermatologic wound care centers differentiated by regions. J Dtsch Dermatol Ges 2013; 11:1057-63. [PMID: 23945189 DOI: 10.1111/ddg.12170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND In almost every chronic wound different bacteria species can be detected. PATIENTS AND METHODS Retrospective, multicenter evaluation of bacterial swab results from 2010 and 2011 in patients with chronic leg ulcer treated in 10 dermatologic wound care centers from 5 regions in Germany. RESULTS Data of 970 patients were analyzed. Staphylococcus aureus was detected in 47.6 % of the patients, 8.6% of these were methicillin-resistant (MRSA). Pseudomonas aeruginosa was found in 31.1 %, enterobacteria in 28.6 % and Proteus mirabilis in 13.7 % of the patients. The regional comparison showed a significant south-north gradient for S. aureus, P. aeruginosa, and enterobacteria. Moreover, a highly significant west-east gradient for MRSA was found with detection rates of 13.5 % in the west to 4.0 % in the east. Furthermore, nationally there was a significant negative correlation between S. aureus and P. aeruginosa or P. mirabilis, respectively, as well as a positive correlation of P. aeruginosa with respect to wound size and duration. In addition to climatic and therapeutic conditions, different regional health care structures are discussed as potentially relevant reasons for these significantly different regional detection rates. CONCLUSIONS Our data show the regional variability of the spectrum of currently detected bacteria in patients with chronic leg ulcers in Germany.
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Affiliation(s)
- Finja Jockenhöfer
- Department of Dermatology, Venereology and Allergology, University Clinic of Essen, Germany
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Heyer K, Augustin M, Protz K, Herberger K, Spehr C, Rustenbach S. Effectiveness of Advanced versus Conventional Wound Dressings on Healing of Chronic Wounds: Systematic Review and Meta-Analysis. Dermatology 2013; 226:172-84. [DOI: 10.1159/000348331] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022] Open
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Sánchez FSL, Roura JMI, Carrasco EC, González-Porras JR, Rodríguez JRE, Nevarez IS, Sánchez SD. Venous leg ulcer in the context of chronic venous disease. Phlebology 2013; 29:220-6. [DOI: 10.1177/0268355513480489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5–C6 and C1 (control) group. Methods Data from a national, multicentre, observational and cross-sectional study ( n = 1598) were used to compare three groups of CVD: C1 ( n = 243), C5 ( n = 136) and C6 ( n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Results Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers ( P < 0.05). Both SF-12 and CIVIQ-20 QoL questionnaires indicated a poorer QoL in patients with ulcers than in those with C1 ( P < 0.05). Compared with the C5 group, patients with active ulcers (C6) had lower QoL scores, but the differences were not statistically significant. Conclusions Patients with venous leg ulcers (C5–C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.
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Affiliation(s)
- F S Lozano Sánchez
- Department of Angiology and Vascular Surgery, IBSAL-Hospital Universitario de Salamanca, Spain
| | - J Marinel Io Roura
- Department of Angiology and Vascular Surgery, Hospital de Mataro, Barcelona, Spain
| | | | | | - J R Escudero Rodríguez
- Department of Angiology and Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Sánchez Nevarez
- Department of Angiology and Vascular Surgery, Hospital Universitario La Fe, Valencia, Spain
| | - S Díaz Sánchez
- Primary Care Physician of Centro de Salud Pintores, Parla, Madrid, Spain
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Augustin M, Brocatti LK, Rustenbach SJ, Schäfer I, Herberger K. Cost-of-illness of leg ulcers in the community. Int Wound J 2012; 11:283-92. [PMID: 23020710 DOI: 10.1111/j.1742-481x.2012.01089.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Leg ulcer management is complex, time-consuming and of high socio-economic importance. Data on cost-of-illness in leg ulcer care are sparse. The objective of this study was to evaluate the cost-of-illness in leg ulcer treatment in the metropolitan area of Hamburg. About 147 institutions involved in wound care participated in a cross-sectional study. Patients consecutively recruited underwent a standardised interview and clinical examination. Main economic outcomes were direct, indirect and intangible costs from a societal perspective. Five hundred and two patients with a mean age of 71 years and mean wound duration of 9 years were enrolled. Annual total costs summed up to a mean of 9060€ /patient/year (8288€ direct, 772€ indirect costs). Direct costs carried by statutory health insurances amounted to 7680€ , patients themselves paid on average 607€. Leg ulcer is associated with high costs for health insurances, patients and the society. Exploratory predictor analyses suggest that early, interprofessional disease-management could lower treatment costs.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing and Comprehensive Wound Center, University Medical Center Hamburg, D-20246 Hamburg, Germany.
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