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Öien RF, Roxenius J, Boström M, Wickström HL. Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics. BMJ Open 2024; 14:e087894. [PMID: 39174055 PMCID: PMC11440203 DOI: 10.1136/bmjopen-2024-087894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVE To investigate whether patients with hard-to-heal ulcers in Sweden were treated according to an aetiological diagnosis and to explore ulcer healing, treatment time, ulcer-related pain and the prescription of analgesics and antibiotics. DESIGN A national mapping of data from the patients' medical records, between April 2021 and March 2023. SETTING Data from medical records for patients with hard-to-heal ulcers from a randomised clustered sample of two units per level of care and region. PARTICIPANTS Patients with hard-to-heal ulcers treated in primary, community and specialist care, public or private, within units covering all 21 regions in Sweden. OUTCOME MEASURES Descriptive analysis of data from the patients' medical records. RESULTS A total of 2470 patients from 168 units were included, of which 39% were treated in primary care, 24% in community care and 37% in specialist care. A total of 49% of patients were treated without an aetiological diagnosis. Healing occurred in 37% of patients and ulcer-related pain was experienced by 1224 patients (50%). Antibiotics were given to 56% of the patients. Amputation occurred in 5% and 11% were deceased. CONCLUSION Only 51% of patients with hard-to-heal ulcers had a documented aetiological ulcer diagnosis, which means that approximately 20 000 patients in Sweden might receive suboptimal treatment. Future research needs to explore why so many patients are undiagnosed and how to improve diagnosis, which could lead to faster healing and shorter treatment times.
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Affiliation(s)
- Rut Frank Öien
- Blekinge County Council Blekinge Centre of Competence, Karlskrona, Sweden
| | - Jenny Roxenius
- Blekinge County Council Blekinge Centre of Competence, Karlskrona, Sweden
| | - Maria Boström
- Blekinge County Council Blekinge Centre of Competence, Karlskrona, Sweden
- Regional Department of Competence in Family Medicine and Primary Health Care, Växjö, Sweden
| | - Hanna Linnea Wickström
- Blekinge County Council Blekinge Centre of Competence, Karlskrona, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Center for Primary Health Care Research, Malmö, Sweden
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Valesky EM, Hach-Wunderle V, Protz K, Zeiner KN, Erfurt-Berge C, Goedecke F, Jäger B, Kahle B, Kluess H, Knestele M, Kuntz A, Lüdemann C, Meissner M, Mühlberg K, Mühlberger D, Pannier F, Schmedt CG, Schmitz-Rixen T, Strölin A, Wilm S, Rabe E, Stücker M, Dissemond J. Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V. J Dtsch Dermatol Ges 2024; 22:1039-1051. [PMID: 38938151 DOI: 10.1111/ddg.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 06/29/2024]
Abstract
This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.
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Affiliation(s)
- Eva Maria Valesky
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Viola Hach-Wunderle
- Vascular Center, Department of Angiology, Northwest Hospital, Frankfurt am Main, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Nikola Zeiner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Björn Jäger
- Initiative Chronische Wunden, Quedlinburg, Germany
| | - Birgit Kahle
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Holger Kluess
- Professional Association of Phlebologists and Lymphologists, Freiburg, Germany
| | - Michaela Knestele
- Hospital Marktoberdorf, Department of Surgery, Kreiskliniken Ostallgäu, Marktoberdorf, Germany
| | - Anja Kuntz
- Welfare Center Leonberg, Gerlingen, Germany
| | | | - Markus Meissner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
- Dermatology Office, Prof. Dr. Markus Meissner, Wiesbaden, Germany
| | - Katja Mühlberg
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominic Mühlberger
- St. Marien Hospital Herne, Department of Vascular Surgery, Ruhr University Bochum, Herne, Germany
| | | | | | - Thomas Schmitz-Rixen
- Goethe University Frankfurt, University Hospital, Department of Endovascular and Vascular Surgery, Frankfurt am Main, Germany
| | - Anke Strölin
- University Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Stefan Wilm
- Institute for General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eberhard Rabe
- Private Office Dermatology & Phlebology, Bonn, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Catholic Hospital Bochum, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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Liu J, Guo Q. Early versus deferred endovenous sclerotherapy of superficial venous reflux in patients with venous ulceration. Int Wound J 2024; 21:e14445. [PMID: 37845810 PMCID: PMC10895194 DOI: 10.1111/iwj.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
This study aimed to compare early endovenous sclerotherapy with superficial venous reflux combined with compression therapy and deferred intervention in patients with venous leg ulcers (VLUs). A total of 80 patients with 80 VLUs treated at the Department of General Surgery, Shangjin Nanfu Hospital, Chengdu, China, between February 2022 and January 2023 were included in the study. The primary outcome was the time to ulcer healing from the date of compression therapy or endovenous sclerotherapy. Secondary outcome measures were the rate of ulcer healing at 6 months, the rate of ulcer recurrence at 6 months, and patient-reported health-related quality of life. A total of 54 patients received early intervention and 26 received deferred intervention. The patient and clinical characteristics at baseline were similar between the two treatment groups. The median time to ulcer healing was 1.5 months (95% confidence interval [CI], 1.3-1.7 months) in the early-intervention group and 3.5 months (95% CI, 2.9-4.1 months) in the deferred-intervention group. The time to ulcer healing was shorter in the early-intervention group than in the deferred-intervention group (p < 0.001). The rate of ulcer healing at 6 months was 94% in the early-intervention group and 92% in the deferred-intervention group. The rate of ulcer recurrence before the end of the 6-month follow-up period was 2% in the early-intervention group and 4% in the deferred-intervention group. In conclusion, early endovenous sclerotherapy for superficial venous reflux resulted in faster healing of VLUs than deferred endovenous sclerotherapy.
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Affiliation(s)
- Jiabin Liu
- Department of General SurgeryShangjin Nanfu HospitalChengduSichuanChina
- Division of Thyroid Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Qiang Guo
- Department of General SurgeryShangjin Nanfu HospitalChengduSichuanChina
- Division of Vascular Surgery, Department of General SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
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Pasek J, Szajkowski S, Cieślar G. Quality of Life in Patients with Venous Leg Ulcers Treated by Means of Local Hyperbaric Oxygen Therapy or Local Ozone Therapy-A Single Center Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2071. [PMID: 38138174 PMCID: PMC10744587 DOI: 10.3390/medicina59122071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Venous leg ulcers pose a significant medical problem worldwide. The complexity of the problem determines the need for further interdisciplinary activities that will improve the quality of life for treated patients. This study compared the quality of life of patients with venous leg ulcers who received local hyperbaric oxygen therapy or local ozone therapy procedures as part of comprehensive treatment. Materials and Methods: The study included 129 patients (62 men and 57 women) with venous leg ulcers. Group I underwent local hyperbaric oxygen therapy (HBOT), and Group II underwent local ozone therapy (OZONE). In both groups, the patients' quality of life was assessed before the start of the treatment cycle, as well as 10 weeks and 6 months after the completion of the treatment, by means of the EQ-5D-5L questionnaire and the Polish shortened version of the SF-36 scale. Results: After completing the respective therapeutic cycle, both groups showed statistically significant (p < 0.001) improvement in quality of life, according to the EQ-5D-5L questionnaire and the SF-36 scale. Differences were noted between the 1st examination (before treatment) and the 2nd examination (10 weeks after treatment), as well as the 3rd examination (6 months after treatment). In the EQ-5D-5L assessment of anxiety and depression, self-care, and activities of daily living 6 months after the end of treatment, better results were found in the group of patients treated with local hyperbaric oxygen therapy (p < 0.001). In this group, 6 months after the end of the treatment, a statistically significantly higher result on the EQ-VAS scale was also obtained (73.09 ± 19.8 points vs. 68.03 ± 17.37 points, p = 0.043). However, in the SF-36 assessment performed 6 months after the end of treatment, better results-a statistically significantly lower value of the quality of life index-were recorded in the group of patients treated with local ozone therapy (103.13 ± 15.76 points vs. 109.89 ± 15.42 points, p < 0.015). Conclusions: Hyperbaric oxygen therapy and local ozone therapy procedures have a beneficial effect on improving the quality of life of patients with venous leg ulcers.
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Affiliation(s)
- Jarosław Pasek
- Collegium Medicum im dr Władysława Biegańskiego, Jan Długosz University in Częstochowa, 13/15 Armii Krajowej St., 42-200 Częstochowa, Poland
| | - Sebastian Szajkowski
- Faculty of Medical and Social Sciences, Warsaw Medical Academy of Applied Sciences, 8 Rydygiera St., 01-793 Warszawa, Poland;
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Stefana Batorego St., 41-902 Bytom, Poland;
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Tettelbach WH, Driver V, Oropallo A, Kelso MR, Niezgoda JA, Wahab N, De Jong JL, Hubbs B, Forsyth RA, Magee GA. Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers. J Wound Care 2023; 32:704-718. [PMID: 37907359 DOI: 10.12968/jowc.2023.32.11.704] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs). METHOD Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups. RESULTS In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use). CONCLUSION Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.
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Affiliation(s)
- William H Tettelbach
- HCA Healthcare, Mountain Division, US
- College of Podiatric Medicine, Western University of Health Sciences, US
- Duke University School of Medicine, Department of Anesthesiology, US
- Association for the Advancement of Wound Care, US
- American Professional Wound Care Association, US
- MiMedx Group Inc., GA, US
| | - Vickie Driver
- Wound Care and Hyperbaric Centers at INOVA Healthcare, US
- Wound Care Collaborative Community, US
| | - Alisha Oropallo
- Comprehensive Wound Healing Center, US
- Hyperbarics at Northwell Health, US
| | | | | | - Naz Wahab
- Wound Care Experts, NV, US
- HCA Mountain View Hospital, US
- Roseman University College of Medicine, US
- Common Spirit Dignity Hospitals, US
| | | | | | - R Allyn Forsyth
- MiMedx Group Inc., GA, US
- Department of Biology, San Diego State University, US
| | - Gregory A Magee
- Keck School of Medicine, University of Southern California, US
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Lin HC, Fang CL, Hsu CH, Fan JY. Psychometric Properties of the Traditional Chinese Version of the Venous Leg Ulcer Quality of Life Questionnaire. Adv Skin Wound Care 2023; 36:213-218. [PMID: 36940378 PMCID: PMC10026955 DOI: 10.1097/01.asw.0000919472.71267.a8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE Symptoms and treatment of venous leg ulcers (VLUs) adversely impact patients' quality of life (QoL). There is no QoL tool that considers the linguistic and cultural specificities of patients with VLU in Taiwan. This study aimed to evaluate the psychometric properties of the traditional Chinese version of the Venous Leg Ulcer Quality of Life Questionnaire (VLU-QoL). METHODS The processes of translation and cultural adaptation of the VLU-QoL from English to traditional Chinese included forward translation, back translation, linguistic modification, and expert review. Using a sample of 167 patients with VLU from a hospital in southern Taiwan, the psychometric properties analyzed were internal consistency, test-retest reliability, content validity, convergent validity, and criterion-related. RESULTS The traditional Chinese version of the VLU-QoL demonstrated good overall internal consistency (Cronbach α = .95) and overall test-retest reliability coefficient (r = 0.98). Confirmatory factor analysis was used to assess the convergent validity of the scale; results showed that the Activity, Psychology, and Symptom Distress constructs had acceptable fit and a structure similar to that of the original scale. The scale had its criterion-related validity verified using the Taiwanese version of the 36-item Short-Form Health Survey, demonstrating a good correlation coefficient r that ranged from -0.7 to -0.2 (P < .001). CONCLUSIONS The Chinese version of the VLU-QoL is valid and reliable for assessing the QoL in patients with VLU, delivering a tool that nurses can use to deliver timely and appropriate care to improve patients' QoL.
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Affiliation(s)
- Hsiao-Ching Lin
- Hsiao-Ching Lin, MSN, RN, WOCN, is Wound, Ostomy, and Continence Nurse, Division of Plastic and Reconstruction Surgery, Department of Surgery, Wound Care Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital and Doctoral Student, College of Nursing, Kaohsiung Medical University, Taiwan. Chien-Liang Fang, MD, MBA, is Director, Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital and Assistant Professor, Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Tai-Chung City. Chin-Hao Hsu, MD, is Attending Physician, Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital. Jun-Yu Fan, PhD, RN, FAAN, is Professor, Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology; and Research Fellow, Division of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan
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Qiu Y, Osadnik CR, Team V. Planning exercise interventions as an adjunct treatment in managing venous leg ulcers: A qualitative study of nurses’ perspectives. J Tissue Viability 2023; 32:279-285. [PMID: 37032305 DOI: 10.1016/j.jtv.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/16/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives regarding strategies to support exercise interventions for people with venous leg ulcers. DESIGN 1:1 interview was guided by the Behaviour Change Wheel (BCW) to collect thoughts from clinicians with experiences in managing venous leg ulcers. SETTINGS Clinical nurses in metropolitan/regional Victoria, Australia. PARTICIPANTS A convenience sample of 21 nurses (mean clinical experience 14 years) was recruited. METHODS We conducted semi-structured remote interviews. Transcripts were coded and analysed using a theory-driven thematic analysis, and interventions to support the implementation of exercise interventions were mapped across the BCW. RESULTS Strategies related to capability, opportunity and motivation components from the BCW were identified. The strategies reported to be important included: i) education of patients and family members; ii) the provision of consistent and clear exercise advice; iii) setting realistic and meaningful goals in light of challenges encountered by patients; iv) flexibility in how exercise programmes were organised/structured, particularly to facilitate rapid adoption; and v) clinician education. CONCLUSIONS In-depth qualitative interviews of nurses working with people with venous leg ulcers in Australia revealed multifactorial issues that potentially affect prescription of care regarding physical exercise. In order to improve and standardise future clinical practice, a clear focus of future research should address such issues.
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Affiliation(s)
- Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia.
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Building B, Peninsula Campus, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia
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Matei SC, Dumitru CȘ, Radu D. Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment-A Comparison between Different Open Surgical Procedures. J Clin Med 2022; 11:7171. [PMID: 36498744 PMCID: PMC9738055 DOI: 10.3390/jcm11237171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic venous disease (CVD) is a common pathology that significantly affects the quality of life (QoL) of patients. Methods: QoL was assessed in 317 patients diagnosed with CVD who underwent surgeries, including cryostripping (n = 113), high ligation and stripping (HL&S, n = 96), and phlebectomies (n = 108). CVD symptoms and QoL were assessed before surgery and 2 weeks after surgery using the following questionnaires: CIVIQ-20, VAS, Eq-5D, PHQ-9 and GAD-9. Results. The results reveal a significant correlation (p < 0.05) between CEAP score and QoL questionnaires performed preoperatively and postoperatively in all three surgical technique groups, with a statistical improvement postoperatively. Phlebectomy had the best postoperative QoL score (r = 0.495) compared to the other two types of procedures. Conclusions: Analyzing patients’ subjective perception following conventional surgery for CVD treatment, an improved QoL is observed both in functional and psychosocial aspects, even early postoperatively. Classical surgical procedures remain an effective and feasible option in CVD treatment.
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Affiliation(s)
- Sergiu-Ciprian Matei
- Department of Surgery, “Victor Babeș” University of Medicine and Pharmacy Timișoara, EftimieMurgu Sq. no. 2, 300041 Timișoara, Romania
- 1st Surgical Clinic, “Pius Brînzeu” Emergency County Hospital, LiviuRebreanu Boulevard no. 156, 300723 Timișoara, Romania
| | - Cristina Ștefania Dumitru
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center, “Victor Babes” University of Medicine and Pharmacy, Sq. EftimieMurgu no. 2, 300041 Timișoara, Romania
| | - Daniela Radu
- Department of Surgery, “Victor Babeș” University of Medicine and Pharmacy Timișoara, EftimieMurgu Sq. no. 2, 300041 Timișoara, Romania
- 1st Surgical Clinic, “Pius Brînzeu” Emergency County Hospital, LiviuRebreanu Boulevard no. 156, 300723 Timișoara, Romania
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