Comparative study of quality of life and psychosocial characteristics in patients with psoriasis and leg ulcers

The client and family experience of attending a nurse-led clinic for chronic wounds

BACKGROUND

The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds.

METHODS

Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken.

RESULTS

Twelve clients and two family members participated, and the average length of interviews was 20min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic.

CONCLUSIONS

The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic.

Coptisine Alleviates Imiquimod-Induced Psoriasis-like Skin Lesions and Anxiety-like Behavior in Mice

Psoriasis is a common inflammatory skin disorder, which can be associated with psychological disorders, such as anxiety and depression. This study investigated the efficacy and the mechanism of action of a natural compound coptisine using imiquimod (IMQ)-induced psoriasis mice. Coptisine reduced the severity of psoriasis-like skin lesions, decreased epidermal hyperplasia and the levels of inflammatory cytokines TNF-α, IL-17, and IL-22. Furthermore, coptisine improved IMQ-induced anxiety in mice by increasing the number of entries and time in open arms in the elevated plus maze (EPM) test. Coptisine also lowered the levels of inflammatory cytokines TNF-α and IL-1β in the prefrontal cortex of psoriasis mice. HaCaT keratinocytes and BV2 microglial cells were used to investigate the effects of coptisine in vitro. In M5-treated HaCaT cells, coptisine decreased the production of IL-6, MIP-3α/CCL20, IP-10/CXCL10, and ICAM-1 and suppressed the NF-κB signaling pathway. In LPS-stimulated BV2 cells, coptisine reduced the secretion of TNF-α and IL-1β. These findings suggest that coptisine might be a potential candidate for psoriasis treatment by improving both disease severity and psychological comorbidities.

Social participation of people with chronic wounds: A systematic review

Living with chronic ulcers can be burdensome and restrictive, with regard to not only physical and psychological but also social well-being. This review aims to analyse social participation in patients with chronic wounds and to compare results across different wound types. A search string was applied in several electronic databases. Results were screened according to predefined inclusion and exclusion criteria. Data of eligible articles were extracted and synthesised narratively. The search revealed 42 eligible publications. Only minor differences across different ulcer types could be detected. Overall, family members were the main social contacts for patients; they often provided wound care and emotional support. Patients had few non-family relations, but those existing were often very close. Patients felt guilty as their condition imposed burden on family and friends, as well. A close relationship with nurses was described. Restrictions were caused by direct and indirect consequences of the wound. Overall, social support and social connections were reduced in wound patients. Inconsistent results were found regarding social isolation. In summary, people with chronic wounds experience impairments in all aspects of social participation. Therefore, social participation deserves increased attention in routine care both as a trigger of burden and as an outcome of therapy.

Factors associated with loneliness in patients with diabetes mellitus

Aim

To (a) explore the prevalence of loneliness in patients with diabetes mellitus and (b) identify loneliness-related factors in the group of hospitalized patients with diabetes mellitus.

Design

A cross-sectional study.

Methods

The study included 248 patients with diabetes mellitus who were staying in six Polish hospitals. A questionnaire including sociodemographic and clinical data, and the Revised UCLA Loneliness Scale (R-UCLA), was used for research data collection. Data were collected from March 2019 to June 2019.

Results

Patients with diabetes generally experience moderate loneliness, with almost one-fifth (16%) of patients experiencing intense loneliness. The patients scored a mean 9.94 out of a possible 20 in belongings and affiliation category and 20.14 out of a possible 40 in the intimate others category. Lower education, being single and the presence of chronic complications of diabetes mellitus were risk factors for increased loneliness.

Instruments to Assess the Subjective Repercussions of People with Chronic Wounds: Integrative Review

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.

Quality of life related to clinical aspects in people with chronic wound

ABSTRACT Objective: To evaluate the quality of life of people with chronic wounds and to compare this index with clinical parameters. Method: A cross-sectional study conducted between July 2014 and February 2015, evaluating people with chronic wounds in outpatient care during a nursing consultation, in the city of Guarapuava, Paraná. Quality of life was assessed by the Quality of Life Index - wounds version. Data were analyzed using the Mann Whitney test and T-test. Results: 53 people participated. The mean quality of life score was 22.65±3.08. The most significant scores in the analyzes were the family domain (27.71±2.94) with the highest mean score, and the health domain (18.91±4.58) had the lowest. Pain in walking (p=0.031) and using pain medication (p=0.002) presented a significant relation with overall score. There was a significant difference between the groups for the items pain at rest (p=0.022), pain in moving (p=0.006), using pain medication (p<0.001) and presence of infection (p=0.004), in the rest item (p=0.015) in the socioeconomic domain, and type of wound (p=0.05) and rest (p=0.041) in the psychological domain. Conclusion: The overall Quality of Life Index and by domains was classified as good and very good, where the family domain was better evaluated to the deriment of the health domain due to the clinical parameter of pain.

Differences between patient- and proxy-reported HRQoL using the Wound-QoL

The purpose of this study was to examine the patient- and proxy-report agreement on the Wound-quality of life (QoL) questionnaire to assess health-related QoL in patients with chronic wounds. Patients and their proxies (in this case, relatives) were recruited via different nursing services in Germany and asked to complete the Wound-QoL. Intraclass correlation coefficients were calculated for each Wound-QoL scale and the total score, and weighted Cohen's Kappa coefficients for individual items. Proxies tended to report lower health-related QoL in the Wound-QoL than their relatives with chronic wounds. Agreement between the two perspectives was moderate on single-item level and excellent on scale level. Proxy-reports can be helpful, if patients are unable to provide information, although caution remains when interpreting the results. However, the patient's own perspective remains preferable.

Netherton syndrome; neuropsychological and psychosocial functioning of child and adult patients and their parents

Background:

Netherton syndrome is a rare severe skin disease. Clinical experience showed considerable psychosocial burdens among Netherton syndrome patients/families. Their (neuro)psychological functioning has never been investigated.

Objective:

To investigate neuropsychological/psychosocial functioning of Netherton syndrome patients and parents.

Methods:

A total of 12 Netherton syndrome patients and/or parents completed neuropsychological tests, semi-structured-interviews, and psychological-questionnaires.

Results:

Intelligence results showed disharmonic profiles, with below-average scores on processing speed. Neuropsychological problems and unfavorable outcomes on health-related quality of life, illness-appearance-related problems, and negative social consequences among patients/parents were found. Psychopathological (emotional) problems were reported; stigmatization, bullying was common among Netherton syndrome patients.

Conclusion:

Compared with normative data, Netherton syndrome patients showed neuropsychological and psychosocial problems. Standard follow-up is necessary to identify problems at early stage.

Determinants of quality of life and psychological status in adults with psoriasis

We investigated whether disease severity and clinical manifestations were associated with depression, anxiety, stress and quality of life in adults with psoriasis. Participants were recruited from a dermatology outpatient clinic at a teaching hospital. Information on sociodemographic characteristics, disease severity, presence of arthropathy and head involvement was specifically recorded. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Quality of life and psychological symptoms were measured using the Dermatology Life Quality Index (DLQI) and the Depression Anxiety Stress Scale (DASS), respectively. One hundred individuals were recruited. Unadjusted analysis revealed that head involvement was associated with depression [odds ratio (OR) 8.509; 95% confidence interval (CI) 1.077-67.231] and anxiety (OR 6.46; 95% CI 1.401-29.858). Severe disease was associated with a poorer quality of life compared to mild disease (OR 3.750; 95% CI 1.330-10.577). Younger age was associated with an increased risk of depression [mean difference (MD) - 8.640; 95% CI - 16.390 to - 0.890], anxiety (MD - 11.553; 95% CI - 18.478 to- 4.628), stress (MD - 11.440; 95% CI - 19.252 to - 3.628) and severely impaired quality of life (MD - 12.338; 95% CI - 19.548 to - 5.127). Following adjustments for age and disease severity, anxiety, stress and depression remained associated with severely impaired quality of life.

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation

This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.