Photoplethysmography-based assessment of varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics

BACGROUND

Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography.

METHOD

The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography.

RESULT

This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise.

CONCLUSION

Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.

Knowledge and Awareness of Varicose Veins and Its Risk Factors in Al-Qunfudah, Saudi Arabia

Background Varicose veins are defined as visibly swollen and twisted veins, surrounded sometimes by patches of flooded capillaries. Varicose veins are a relatively common condition. For many people, they are a family trait. Women are at least twice as likely as men to develop them. Aim This study aims to assess the public knowledge and awareness of varicose veins in Al-Qunfudah, Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people in Al-Qunfudah, Saudi Arabia. An online questionnaire was used for data collection. The data collection sheet included socioeconomic-demographic information. Varicose vein knowledge was assessed in the second portion using three-point ratings. The final section had multiple-choice questions about risk factors and complications, including symptoms, diagnostic techniques, and risk factors for varicose veins. Results Participants were included in the study after excluding individuals aged less than 18 years old, with a majority being males (319; 79.9%). Regarding age distribution, participants aged 36-45 years constituted the largest group (132; 33.1%). Out of 399 participants, 369 (92.5%) had not been diagnosed with varicose veins. Most participants (271, 67.9%) had heard of varicose veins, with the primary sources of information being someone they knew with varicose veins (106, 39.11%). Family history was considered an important factor by 141 (35.3%) of respondents while 217 (54.4%) were unsure. Female gender and old age showed significantly higher knowledge levels (p< 0.05). Conclusion The current study concluded that while there was a fair level of public awareness of varicose veins in general, there was a noticeable lack of knowledge regarding clinical symptoms and diagnostic techniques. Younger females demonstrated noticeably greater awareness and comprehension of the illness.

Predicting factors of patient satisfaction after varicose vein surgery at a university hospital in Nepal

INTRODUCTION

Varicose veins are a common vascular problem with a high prevalence, yet they are often neglected. The main objective of this study was to explore the patient satisfaction after varicose vein surgery, along with its predicting factors. To our knowledge, no similar study has been conducted in Nepal to date.

METHODOLOGY

This retrospective cross-sectional study included patients who underwent varicose vein surgery at Dhulikhel Hospital from September 2019 to February 2020. The satisfaction level after the surgery was assessed using a 10-point Likert scale questionnaire during a telephone interview with their verbal consent. Descriptive statistics and linear regression were performed to identify the predicting factors of patient satisfaction.

RESULTS

Among a total of 84 patients interviewed, 53.6% were male. The mean age of the participants was 43.13 ± 13.62 years. The mean patient satisfaction score was 42 ± 5.5, with nursing service, discharge teaching and hospital service being the highest scoring items in terms of patient satisfaction. Linear regression revealed age ≤40 years as a predictor of higher patient satisfaction (β=0.258, p=0.015) while early stage of varicose veins (β=-0.233, p=0.026) and duration of post-operative follow-up (β=-0.25, p=0.021) were negative predictors of patient satisfaction. This means that patients with C2-C3 venous disease and longer duration of postoperative follow-up tended to have lower satisfaction scores.

CONCLUSION

The overall patient satisfaction following varicose vein surgery was very good, and the major predictors of better satisfaction were age ≤40 years, C4-C6 clinical classification of venous disease and the shorter duration of follow-up after surgery.

What is the prevalence of chronic venous disease among health care workers? A scoping review

Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain, swelling, varicose veins, and skin changes, with venous ulceration ultimately occurring in severe disease. To assess the prevalence of CVD among health care workers, a scoping review of existing publications exploring the prevalence of CVD among health care workers was conducted in July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. A total of 15 papers met the inclusion criteria and these formed the basis of the review. Among health care workers, the mean prevalence of CVD was 58.5% and the mean prevalence for varicose veins was 22.1%. There is an increased prevalence of CVD in health care workers when compared with the general population. Therefore, there is a need for early diagnosis and the use of preventative measures to protect health care workers from CVD and varicose vein development.

Risk Assessment of Varicose Veins Among Teachers in Al-Ahsa, Saudi Arabia

Background

Varicose veins (VV) are abnormally swollen, tortuous, and prominent veins caused by insufficient venous valves leading to venous congestion and elevated venous pressure. Prolonged standing at work has been proposed to be an important risk factor for varicose veins. Teachers are prone to have varicose veins due to prolonged standing. The aim of this study was to assess the risk of varicose veins among teachers in Al-Asha, Saudi Arabia.

Method

This was a cross-sectional study conducted among teachers of primary, secondary, and high schools in Al-Ahsa, of both genders, between April 2022 and June 2022. The participants were interviewed and examined for the presence of signs and symptoms of the disease. Finally, the collected data were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 26.0 for Windows) software.

Result

Out of 399 participating teachers with a mean age of 43.2 ± 12.9 years, 216 (54.1%) were males and the remainder were female. The commonest symptom was pain in the legs, which was exacerbated by work (43.1%). Most of the participants were working for more than 16 years (43.6%) and standing for less than six hours per day (72.7%). The most pointed sign was spider legs-shaped veins (23.8%). However, the least collective sign was paleness in the ulcer area after healing (1.8%). A total of 140 teachers had a family history of varicose veins, 74 of them (18.5%) were diagnosed with varicose veins previously. We summarize our result as female teachers who have a family history of VV have more risk to develop the disease.

Conclusion

The prevalence of varicose veins was high among teachers in Al-Ahsa, Saudi Arabia. According to our study, teachers have a significant chance of developing the condition since their working style contributes to its progression. Further actions need to be made in order to increase awareness and prevent its complications.

Configuration of vascular services: a multiple methods research programme

Background

Vascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.

Objectives

To identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.

Design

This was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.

Setting

Specialist vascular inpatient services in England.

Data sources

Modelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.

Interventions

The data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.

Main outcome measures

Systematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.

Results

Systematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.

Limitations

The major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.

Conclusions

There is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.

Future work

Further evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.

Study registration

This study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

Prevalence of Varicose Veins Among Nurses at Different Departments in a Single Tertiary Care Center in Riyadh

Background

Varicose veins (VV) is a chronic venous disease that affects the lower extremities. It is the dilation of subcutaneous veins, three to four millimeters in diameter. VV can be attributed to several risk factors such as age, obesity, multiple parities, heavy lifting, and long-standing hours. Direct and indirect complications can occur due to VV. Several studies were conducted to estimate the prevalence of VV.

Methods

A self-administered questionnaire was used to estimate the prevalence of VV among nurses from different departments in the National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. The questionnaire included questions on weight, height, work history, lifestyle, and multiple diseases. The chi-square test and Fisher’s exact test were used for testing the association between the various predictors and the diagnosis of VV.

Results

A total of 366 nurses participated in the study. There were 40 (39 females and one male) cases of VV accounting for 11.0%. Variables that have a statistically significant association with VV were social status and lifting heavy objects (p=0.02), a family history of VV (p-value=<0.001), and the number of childbirths (p=0.04). The observation of each department was not statistically significant with VV (p=0.35).

Conclusion

Among nurses, positive family history, age, marital status, long-standing hours, and heavy object lifting were significant risk factors for the development of VV. However, the prevalence of VV in the four departments was low.

The impact of lack of disease awareness on the experience of primary varicose veins

Symptoms are often one of the main reasons for patients with chronic diseases to seek medical care. However, the symptoms experienced by patients with primary varicose veins are not serious until late in the course, hence rarely drawing enough attention. A deep understanding of disease awareness and experiences of patients is particularly important in disease management. The aim of this study was to describe the awareness and experience of patients with primary varicose veins. This study used a descriptive design with a qualitative approach. Semistructured interviews were conducted with 12 patients with primary varicose veins at a general central county hospital in China. Colaizzi's 7-step analysis was used to analyze the interview text. Participants reported their lack knowledge of the disease, including etiology, symptoms, and complications. Three themes emerged concerning the experiences: "preoperative emotional responses," "lack of confidence in disease management," and "the need for family and social support." The findings suggested that the health care system in China needed to increase the awareness about the disease and pay more attention to the needs of patients, give better health education, and provide effective social support, so as to improve self-management among patients.

Predictors of exercise capacity in chronic venous disease patients

Objectives

The aim of this study was to determine predictors of exercise capacity and explore the relationship between exercise capacity, lower extremity performance level, pain, fatigue, physical activity, sleep quality, and quality of life in patients with chronic venous disease.

Methods

A total of 170 chronic venous disease patients who were referred to the Cardiovascular Surgery department were included. Assessment tools included the six-minute walk test for exercise capacity, repeated sit-to-stand test for lower limb performance level, Visual Analog Scale for pain, Fatigue Severity Scale for fatigue, Pittsburgh Sleep Quality Index for sleep quality, International Physical Activity Questionnaire for physical activity, and Venous Insufficiency Epidemiological and Economic Study’s Quality of Life questionnaire for quality of life.

Results

Exercise capacity was weakly and negatively correlated with body mass index (r = –0.391, p < 0.001), pain level (r = –0.268, p < 0.001), age (r = –0.355, p < 0.001), and fatigue severity (r = –0.141, p < 0.05). There was a weak positive correlation in walking distance with quality of life (r = –0.129, p < 0.05) and education level (r = 0.166, p < 0.05), whereas moderate positive correlation was observed between walking distance and lower limb performance level (r = 0.518, p < 0.001). Lower limb performance level was a significant predictor of exercise capacity, accounting for 50% of the variance.

Conclusions

Exercise capacity is an important determinant of morbidity. Therefore, there is a need to improve lower extremity performance and functional mobility in patients suffering from chronic venous disease.