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Bayer A, Höntsch G, Kaschwich M, Dell A, Siggelkow M, Berndt R, Rusch R, Harder J, Gläser R, Cremer J. Vivostat Platelet-Rich Fibrin ® for Complicated or Chronic Wounds-A Pilot Study. Biomedicines 2020; 8:biomedicines8080276. [PMID: 32781647 PMCID: PMC7459803 DOI: 10.3390/biomedicines8080276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022] Open
Abstract
Vivostat Platelet-Rich Fibrin® (PRF) is an autologous platelet concentrate used for the local treatment of chronic or complicated wounds. Still, its application for this indication is not evidence-based. Therefore, we performed this monocentric retrospective pilot study investigating the clinical outcome of a local treatment of chronic or complicated wounds in 35 patients (23 male, 12 female, mean age 68.7 years) treated with Vivostat PRF®. This study population is the largest among published studies analyzing the clinical efficacy of Vivostat PRF® on chronic wounds so far. Using the perpendicular method we divided the wounds into three sizes (<10, 10–30, and >30 cm2). The clinical efficacy of the Vivostat PRF treatment was the primary endpoint and was divided into three groups of increasing degrees of wound improvement: (1) no improvement of the wound (wound area was not reduced > 10% under Vivostat PRF® treatment), (2) improvement of the wound (reduced area > 10% under Vivostat PRF® treatment) and (3) complete epithelialization (wounds that were completely re-epithelialized after Vivostat PRF® treatment). We included patients’ diagnosis and concomitant diseases (peripheral arterial occlusive disease (PAOD)), chronic venous insufficiency (CVI)), diabetic foot syndrome (DFS)) in our data analysis in order to investigate their potential impact on the wound healing capacity of Vivostat PRF®. Our results show that in the entire study population, 13 out of 35 (37.1%) patients experienced wound improvement and 14 out of 35 (40%) patients showed complete epithelialization of their wound under Vivostat PRF® treatment. In summary, 77.1% of the treated patients benefited from the Vivostat PRF® therapy. These positive wound healing effects were all observed within the first three to six Vivostat PRF® applications. Subgroup analyses showed that Vivostat PRF® appeared to be more efficient in patients without CVI in comparison to patients with CVI (p = 0.02). Moreover, Vivostat PRF® treatment seems to be particularly efficient in PAOD-related wounds with a reduced crural arterial blood supply (p = 0.01). Additionally, we performed an experimental human in vivo study on ten male students where we artificially generated bilateral gluteal wounds and analyzed the influence of the Vivostat PRF® treatment on the expression of two genes (human beta Defensin-2, ((hBD-2) and human beta-Defensin-3 (hBD-3)) in keratinocytes of resected wound specimens that are induced during wound healing. Interestingly, this analysis revealed that only seven of out ten individuals showed a relevant hBD-2 and hBD-3 gene induction after Vivostat PRF® treatment. This led to the novel “key-lock-hypothesis”. With the goal of an individualized precision medicine approach with optimized wound treatment strategies in the future, this is an important observation that demands further experimental and clinical studies.
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Affiliation(s)
- Andreas Bayer
- Institute of Anatomy, Kiel University, Olshausenstr. 40, 24098 Kiel, Germany
- Correspondence:
| | - Gesa Höntsch
- Department of Heart and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105 Kiel, Germany; (G.H.); (R.B.); (R.R.); (J.C.)
| | - Mark Kaschwich
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (M.K.); (A.D.)
| | - Annika Dell
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (M.K.); (A.D.)
| | - Markus Siggelkow
- Department of Vascular and Thoracic Surgery, Imland Clinic Rendsburg, Lilienstraße 20–28, 24768 Rendsburg, Germany;
| | - Rouven Berndt
- Department of Heart and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105 Kiel, Germany; (G.H.); (R.B.); (R.R.); (J.C.)
| | - Rene Rusch
- Department of Heart and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105 Kiel, Germany; (G.H.); (R.B.); (R.R.); (J.C.)
| | - Jürgen Harder
- Department of Dermatology, Kiel University, Rosalind-Franklin-Str. 9, 24105 Kiel, Germany; (J.H.); (R.G.)
| | - Regine Gläser
- Department of Dermatology, Kiel University, Rosalind-Franklin-Str. 9, 24105 Kiel, Germany; (J.H.); (R.G.)
| | - Jochen Cremer
- Department of Heart and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105 Kiel, Germany; (G.H.); (R.B.); (R.R.); (J.C.)
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Platelet-Released Growth Factors and Platelet-Rich Fibrin Induce Expression of Factors Involved in Extracellular Matrix Organization in Human Keratinocytes. Int J Mol Sci 2020; 21:ijms21124404. [PMID: 32575800 PMCID: PMC7378768 DOI: 10.3390/ijms21124404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Platelet-released growth factor (PRGF) is a thrombocyte concentrate lysate which, like its clinically equivalent variations (e.g., Vivostat PRF® (platelet-rich fibrin)), is known to support the healing of chronic and hard-to-heal wounds. However, studies on the effect of PRGF on keratinocytes remain scarce. This study aims to identify genes in keratinocytes that are significantly influenced by PRGF. Therefore, we performed a whole transcriptome and gene ontology (GO) enrichment analysis of PRGF-stimulated human primary keratinocytes. This revealed an increased expression of genes involved in extracellular matrix (ECM) organization. Real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) analysis confirmed the PRGF-mediated induction of selected ECM-related factors such as transforming growth factor beta-induced protein, fibronectin 1, matrix metalloproteinase-9, transglutaminase 2, fermitin family member 1, collagen type I alpha 1 and collagen type XXII alpha 1. PRGF-induced expression of the above factors was influenced by blockade of the epidermal growth factor receptor (EGFR), a receptor playing a crucial role in wound healing. A differential induction of the investigated factors was also detected in skin explants exposed to PRGF and in experimentally generated in vivo wounds treated with Vivostat PRF®. Together, our study indicates that the induction of ECM-related factors may contribute to the beneficial wound-healing effects of PRGF-based formulations.
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Lozano-Platonoff A, Contreras-Ruiz J, Dominguez-Cherit J, Cardenas-Sanchez A, Alvarez-Rivero V, Martínez-Regalado JA. Translation, cross-cultural adaptation and validation of the "Cardiff wound impact schedule," a wound-specific quality of life instrument, to the native Spanish of Mexican patients. Int Wound J 2019; 17:167-173. [PMID: 31713315 DOI: 10.1111/iwj.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to translate into Mexican Spanish, cross-culturally adapt and validate the wound-specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross-cultural adaptation of self-report measures, Spine Phila Pa, 1976, 2000, 318-391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub-scales of CWIS and SF-36 (P = .010 to P < .001). The instrument was able to discriminate between healed and unhealed ulcers. The instrument obtained an overall Cronbach's alpha of .952, corresponding to an excellent internal consistency (.903-.771 alpha range for domains). The CWIS can be appropriately used to assess the health-related QoL of Mexican patients with chronic leg ulcers.
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Affiliation(s)
- Adriana Lozano-Platonoff
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Jose Contreras-Ruiz
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Judith Dominguez-Cherit
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico.,Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Cardenas-Sanchez
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Valeria Alvarez-Rivero
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
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Lemes JS, Amaral KVA, Nunes CAB, Campos ACA, Batista AN, Malaquias SG. Instruments to Assess the Subjective Repercussions of People with Chronic Wounds: Integrative Review. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To analyze the instruments described in the literature for extended assessment in people with chronic wound. Materials and methods: Study of integrative review of the literature. The search was conducted on databases including PUBMED, Web of Science, SciELO, CINAHL, Science Direct (Elsevier), Scopus, and Biblioteca Virtual da Saúde (BVS). Results: The search found 19 060 articles; after relevance tests, 41 were left. The instrument most used in the studies of this review was the Short Form 36 Health Survery (SF-36), which is a tool to assess quality of life (QOL). Conclusion: A diversity of instruments was identified for extended assessment of people with wounds, with those investigating QOL being the most frequent. The repercussions are, mostly, contained in the QOL assessment instruments, but superficially and/or not explicitly, as in the SF-36, the means most-frequently identified in the studies of this review. These findings suggest the likelihood of differentiated implications of these instruments according to the etiology of the lesions, psychosocial and psychospiritual needs of the individual, as well as the context to which they are destined, like teaching, clinical practice, or research.
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Meaume S, Dompmartin A, Lok C, Lazareth I, Sigal M, Truchetet F, Sauvadet A, Bohbot S. Quality of life in patients with leg ulcers: results from CHALLENGE, a double-blind randomised controlled trial. J Wound Care 2017; 26:368-379. [PMID: 28704156 DOI: 10.12968/jowc.2017.26.7.368] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We recently showed the superiority of a matrix metalloproteinase (MMP) modulating dressing (foam impregnated with NOSF, nano-oligosaccharide factor) compared with a lipidocolloid matrix (TLC) control dressing in median wound area reduction (WAR). Here we report the results from the same study assessing the performance and safety of TLC-NOSF in the local management of venous leg ulcers (VLUs) or mixed leg ulcers and determining its impact on the patient's health-related quality of life (HRQoL). METHOD A superiority randomised double-blind controlled trial was conducted on patients presenting with a non-infected leg ulcer (VLUs or mixed leg ulcers) of predominantly venous origin (ABPI >0.8), with a surface area ranging from 5 to 50cm2 and a duration of 6 to 36 months. Patients were randomly allocated to either the TLC-NOSF matrix foam (UrgoStart) dressing group or to the neutral TLC foam dressing group (UrgoTul Absorb). All received appropriate compression therapy and the wounds were assessed blindly (clinical examination, wound area tracing and photographic record) every 2 weeks for a period of 8 weeks, or until complete closure. A secondary endpoint, described here, was the patient's HRQoL, documented by the patient, through the EuroQol 5D tool (EQ-5D) questionnaire and visual analogue scale (VAS). RESULTS In total, 187 patients were randomised to either the TLC-NOSF group (n=94) or the control dressing group (n=93). The two groups were well balanced at baseline with regard to wound and patient characteristics. In the HRQoL questionnaire (EQ-5D), the pain/discomfort and anxiety/depression dimensions were significantly improved in the TLC-NOSF group versus the control one (pain/discomfort: 1.53±0.53 versus 1.74±0.65; p=0.022, and anxiety/depression: 1.35±0.53 versus 1.54±0.60, p=0.037). The VAS score was better in the test group compared with the control group (72.1±17.5 versus 67.3±18.7, respectively), without reaching significance (p=0.072). Acceptability and tolerance of the two products were similar in both groups. CONCLUSION The double-blind clinical trial has demonstrated that the TLC-NOSF matrix dressing promotes faster healing of VLUs and mixed leg ulcers and significantly reduces the pain/discomfort and anxiety/depression experienced by the patients. These results suggest that acceleration of VLU healing could improve the HRQoL of the patients and reduced the emotional and social burden of these chronic wounds.
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Affiliation(s)
- S Meaume
- Dermatologist and Geriatrician, Head of Geriatric Department and Wound Care Unit, Rothschild University Hospital, Paris, France
| | - A Dompmartin
- Dermatologist, Dermatology Department, Clemenceau University Hospital, Caen, France
| | - C Lok
- Head of Dermatology Department, South University Hospital, Amiens, France
| | - I Lazareth
- Department of Vascular Medicine, Saint-Joseph Hospital, Paris, France
| | - M Sigal
- Dermatologist, Head of Dermatology Department, Victor Dupouy Hospital, Argenteuil, France
| | - F Truchetet
- Head of Dermatology Department, Beauregard Hospital, Thionville, France
| | - A Sauvadet
- Clinical Research Department, Laboratoires URGO, Chenôve, France
| | - S Bohbot
- Clinical Research Department, Laboratoires URGO, Chenôve, France
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Sriyani KA, Gunawardena N, Wasalathanthri S, Hettiarachchi P. Validation of Sinhala Version of Cardiff Wound Impact Schedule in Patients with Diabetic Leg and Foot Ulcers. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:240-245. [PMID: 27692255 DOI: 10.1016/j.anr.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 01/16/2023] Open
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González de la Torre H, Quintana-Lorenzo ML, Perdomo-Pérez E, Verdú J. Correlation between health-related quality of life and venous leg ulcer's severity and characteristics: a cross-sectional study. Int Wound J 2016; 14:360-368. [PMID: 27112627 DOI: 10.1111/iwj.12610] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
Abstract
This study aims to determine health-related quality of life (HRQoL) in patients suffering with venous ulceration and to correlate wound's severity status with HRQoL loss as well as identify the aspects of HRQoL most negatively affected by the presence of venous ulcers. In this observational, cross-sectional, descriptive, analytical multi-centre study, data was compiled over a period of 3·5 months. Thrity-four patients with venous ulceration were recruited. The RESVECH 2·0 scale was used to monitor wounds. The MAID scale was used to measure wound's severity. The Charing Cross Venous Ulcer Questionnaire (CCVUQe) (Spanish version) was used to evaluate quality of life. The mean CCVUQe score was 60·58 ± 16·04. The HRQoL dimension most affected was 'Emotional state' (mean score = 77. 67 ± 17·34). The average RESVECH 2.0 score for the wounds was 13·15 ± 5·07. A statistically significant association between total CCVUQ-e score and total RESVECH 2.0 score was detected [Pearson correlation coefficient r = 0·546 (P ≤ 0·001)]. Venous ulcers affect patients' HRQoL, particularly their emotional status. There is a relationship between the severity of the wound and loss of HRQoL. The presence of non-viable tissue, poor exudate control and infection all determine loss of HRQoL. New studies are needed to confirm these findings.
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Affiliation(s)
- Héctor González de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - María L Quintana-Lorenzo
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Estrella Perdomo-Pérez
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care 2014; 23:601-12. [DOI: 10.12968/jowc.2014.23.12.601] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Green
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
| | - R. Jester
- Professor; Faculty of Health and Social Care, London South Bank University, London, SEI 0AA
| | - R. McKinley
- Professor of Education in General Practice; Keele University Medical School, Staffordshire, ST5 5BG
| | - A. Pooler
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
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Meaume S, Truchetet F, Cambazard F, Lok C, Debure C, Dalac S, Lazareth I, Sigal ML, Sauvadet A, Bohbot S, Dompmartin A. A randomized, controlled, double-blind prospective trial with a Lipido-Colloid Technology-Nano-OligoSaccharide Factor wound dressing in the local management of venous leg ulcers. Wound Repair Regen 2012; 20:500-11. [DOI: 10.1111/j.1524-475x.2012.00797.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 03/30/2012] [Indexed: 01/13/2023]
Affiliation(s)
- Sylvie Meaume
- Dermatology & Geriatric Department; Rothschild University Hospital; Paris France
| | | | | | - Catherine Lok
- Dermatology Department; South University Hospital; Amiens France
| | - Clélia Debure
- Department of Vascular Medicine; Corentin Celton Hospital; Issy-les-Moulineaux France
| | - Sophie Dalac
- Dermatology Department; Bocage University Hospital; Dijon France
| | - Isabelle Lazareth
- Department of Vascular Medicine; Saint-Joseph Hospital; Paris France
| | | | - Anne Sauvadet
- Clinical Research Department; Laboratoires URGO; Chenôve France
| | - Serge Bohbot
- Clinical Research Department; Laboratoires URGO; Chenôve France
| | - Anne Dompmartin
- Dermatology Department; Clemenceau University Hospital; Caen France
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Renner R, Gebhardt C, Simon JC, Seikowski K. Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers. J Dtsch Dermatol Ges 2011; 7:953-61. [PMID: 19386020 DOI: 10.1111/j.1610-0387.2009.07082.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with chronic leg ulcers are handicapped in daily life, both by physical complaints and social problems. The aim of our study was not only to assess a possible impairment of quality of life (QOL) of leg ulcer patients but also to evaluate if there is a real improvement of QOL after healing of the ulcer. Patients with chronic venous insufficiency served as the control group. We further analyzed if there were significant differences in the response between patients who were and were not performing compression therapy. PATIENTS AND METHOD We interviewed three groups of patients (active venous leg ulcer, healed venous leg ulcer and patients with chronic venous insufficiency using the "Freiburger Life Quality Assessment für Venenerkrankungen" (FLQAv). RESULTS Physical problems, daily handicaps and social problems all increased with age. Contrary to our expectations, healing of a leg ulcer did not lead to a significant increase in QOL. Instead, patients with active ulcers did not regard their QOL as lower than those in the other groups. Compression therapy also did not impair QOL in the three groups. CONCLUSION Even though ulcer healing is an admirable goal, it does not necessarily lead to an improved QOL, probably because of the numerous comorbidities in this patient group. Nonetheless, it is important to control problems associated directly with the wound to allow ulcer patients to participate actively in everyday life and minimize social problems.
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Affiliation(s)
- Regina Renner
- Department of Dermatology, Venereology and Allergy, University of Leipzig, Leipzig, Germany.
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Palfreyman SJ, Tod AM, Brazier JE, Michaels JA. A systematic review of health-related quality of life instruments used for people with venous ulcers: an assessment of their suitability and psychometric properties. J Clin Nurs 2010; 19:2673-703. [PMID: 20846219 DOI: 10.1111/j.1365-2702.2010.03269.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. BACKGROUND Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. DESIGN Systematic review. METHOD Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. RESULTS The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. CONCLUSIONS The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice. There appears to be an opportunity for nurses to develop a health-related quality of life health-related quality of life instruments to evaluate their impact on patient outcomes. Such instruments could potentially allow nursing interventions to be assessed more effectively than the recently proposed nursing metrics.
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Affiliation(s)
- Simon J Palfreyman
- Smith and Nephew Foundation, Sheffield Vascular Institute, University of Sheffield, Sheffield, UK.
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Langer A, Rogowski W. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers. BMC Health Serv Res 2009; 9:115. [PMID: 19591680 PMCID: PMC2716319 DOI: 10.1186/1472-6963-9-115] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/10/2009] [Indexed: 11/18/2022] Open
Abstract
Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC) list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1) Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies); (2) Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study); (3) REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies). The studies considered in this review were of varying and partly low methodological quality. They calculated that due to shorter treatment periods, fewer complications and fewer inpatient episodes the initial cost of the novel biotechnology products may be offset, making the treatment cost-effective or even cost-saving. The results of most studies were sensitive to initial costs of the products and the evidence of effectiveness. Conclusion The study results suggest that some growth factors and tissue-engineered artificial skin products feature favourable cost-effectiveness ratios in selected patient groups with chronic wounds. Despite the limitations of the studies considered, it is evident that health care providers and coverage decision makers should take not only the high cost of the biotechnology product but the total cost of care into account when deciding about the appropriate allocation of their financial resources. However, not only the cost-effectiveness but first of all the effectiveness of these novel biotechnology products deserve further research.
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Affiliation(s)
- Astrid Langer
- Institute of Health Economics and Health Care Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany.
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Bogaardt HCA, Speyer R, Baijens LWJ, Fokkens WJ. Cross-cultural adaptation and validation of the Dutch version of SWAL-QoL. Dysphagia 2008; 24:66-70. [PMID: 18626697 DOI: 10.1007/s00455-008-9174-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 05/22/2008] [Indexed: 11/29/2022]
Abstract
The aim of this work was to translate the 44-item SWAL-QoL into Dutch (SWAL-QoL-NL) and compare the validity of this questionnaire against Euroqol in a Dutch population with dysphagia. SWAL-QoL was translated according to international guidelines. SWAL-QoL-NL and Euroqol were completed by 152 patients in seven diagnosis groups. Internal consistency and correlations were calculated. Scores for nine subscales (General burden, Food selection, Eating duration, Fear of eating, Sleep, Fatigue, Mental health, Social functioning and a symptom score) ranged between 0.80 and 0.92 (Cronbach's alpha). Two subscales (Eating desire and Communication scored 0.67 and 0.60, respectively, and were removed from the questionnaire. The 14-item battery on clinical symptoms showed an internal consistency of 0.80, allowing the use of a sum score on group level in clinical research. Correlation of SWAL-QoL-NL subscales with the Euroqol was negligible to low (Pearson's correlations range = 0.09-0.36). The 39-item SWAL-QoL-NL proved to be a reliable tool to examine the impact of dysphagia on quality of life in a Dutch population. Internal consistency allows the use of nine subscales of SWAL-QoL-NL for comparisons on a group level (0.80 < alpha < 0.92) only. Also a Symptom score can be derived from the raw data.
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Affiliation(s)
- H C A Bogaardt
- Department of Otorhinolaryngology/D2-313, Academic Medical Center, Amsterdam, The Netherlands.
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