1
|
Las Heras K, Garcia-Orue I, Rancan F, Igartua M, Santos-Vizcaino E, Hernandez RM. Modulating the immune system towards a functional chronic wound healing: A biomaterials and Nanomedicine perspective. Adv Drug Deliv Rev 2024; 210:115342. [PMID: 38797316 DOI: 10.1016/j.addr.2024.115342] [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: 01/26/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
Chronic non-healing wounds persist as a substantial burden for healthcare systems, influenced by factors such as aging, diabetes, and obesity. In contrast to the traditionally pro-regenerative emphasis of therapies, the recognition of the immune system integral role in wound healing has significantly grown, instigating an approach shift towards immunological processes. Thus, this review explores the wound healing process, highlighting the engagement of the immune system, and delving into the behaviors of innate and adaptive immune cells in chronic wound scenarios. Moreover, the article investigates biomaterial-based strategies for the modulation of the immune system, elucidating how the adjustment of their physicochemical properties or their synergistic combination with other agents such as drugs, proteins or mesenchymal stromal cells can effectively modulate the behaviors of different immune cells. Finally this review explores various strategies based on synthetic and biological nanostructures, including extracellular vesicles, to finely tune the immune system as natural immunomodulators or therapeutic nanocarriers with promising biophysical properties.
Collapse
Affiliation(s)
- Kevin Las Heras
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Itxaso Garcia-Orue
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Institute of Health Carlos III, Madrid, Spain
| | - Fiorenza Rancan
- Department of Dermatology, Venereology und Allergology,Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Manoli Igartua
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Institute of Health Carlos III, Madrid, Spain
| | - Edorta Santos-Vizcaino
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Institute of Health Carlos III, Madrid, Spain.
| | - Rosa Maria Hernandez
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Institute of Health Carlos III, Madrid, Spain.
| |
Collapse
|
2
|
Pinkova J, Monaro S. Integrating new approaches to care in a vascular wound clinic. JOURNAL OF VASCULAR NURSING 2024; 42:83-88. [PMID: 38823976 DOI: 10.1016/j.jvn.2024.01.002] [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: 07/30/2023] [Revised: 11/12/2023] [Accepted: 01/08/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION An evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AIM This case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DESIGN Descriptive Observational Case Study. CLINICAL CARE An evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application 'Tissue Analytics', a "purposedesigned digital wound management platform that records, tracks, and analyses wounds". RESULTS Week 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view. Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size. Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size. Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. CONCLUSION The patient's treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.
Collapse
Affiliation(s)
- Jana Pinkova
- Vascular Clinical Nurse Consultant, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| | - Susan Monaro
- Vascular Clinical Nurse Consultant, Concord Repatriation General Hospital Concord, Clinical Senior Lecturer, Susan Wakil School of Nursing and Midwifery, University of Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Stevenson EM, Coda A, Bourke MDJ. Investigating low rates of compliance to graduated compression therapy for chronic venous insufficiency: A systematic review. Int Wound J 2024; 21:e14833. [PMID: 38522455 PMCID: PMC10961173 DOI: 10.1111/iwj.14833] [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: 12/14/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.
Collapse
Affiliation(s)
- Elise M. Stevenson
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
| | - Michael D. J. Bourke
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| |
Collapse
|
4
|
Tettelbach WH, Driver V, Oropallo A, Kelso MR, Niezgoda JA, Wahab N, Jong JLD, Hubbs B, Forsyth RA, Magee GA, Steel P, Cohen BG, Padula WV. Dehydrated human amnion/chorion membrane to treat venous leg ulcers: a cost-effectiveness analysis. J Wound Care 2024; 33:S24-S38. [PMID: 38457290 DOI: 10.12968/jowc.2024.33.sup3.s24] [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] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of dehydrated human amnion/chorion membrane (DHACM) in Medicare enrolees who developed a venous leg ulcer (VLU). METHOD This economic evaluation used a four-state Markov model to simulate the disease progression of VLUs for patients receiving advanced treatment (AT) with DHACM or no advanced treatment (NAT) over a three-year time horizon from a US Medicare perspective. DHACM treatments were assessed when following parameters for use (FPFU), whereby applications were initiated 30-45 days after the initial VLU diagnosis claim, and reapplications occurred on a weekly to biweekly basis until completion of the treatment episode. The cohort was modelled on the claims of 530,220 Medicare enrolees who developed a VLU between 2015-2019. Direct medical costs, quality-adjusted life years (QALYs), and the net monetary benefit (NMB) at a willingness-to-pay threshold of $100,000/QALY were applied. Univariate and probabilistic sensitivity analyses (PSA) were performed to test the uncertainty of model results. RESULTS DHACM applied FPFU dominated NAT, yielding a lower per-patient cost of $170 and an increase of 0.010 QALYs over three years. The resulting NMB was $1178 per patient in favour of DHACM FPFU over the same time horizon. The rate of VLU recurrence had a notable impact on model uncertainty. In the PSA, DHACM FPFU was cost-effective in 63.01% of simulations at the $100,000/QALY threshold. CONCLUSION In this analysis, DHACM FPFU was the dominant strategy compared to NAT, as it was cost-saving and generated a greater number of QALYs over three years from the US Medicare perspective. A companion VLU Medicare outcomes analysis revealed that patients who received AT with a cellular, acellular and matrix-like product (CAMP) compared to patients who received NAT had the best outcomes. Given the added clinical benefits to patients at lower cost, providers should recommend DHACM FPFU to patients with VLU who qualify. Decision-makers for public insurers (e.g., Medicare and Medicaid) and commercial payers should establish preferential formulary placement for reimbursement of DHACM to reduce budget impact and improve the long-term health of their patient populations dealing with these chronic wounds. DECLARATION OF INTEREST Support for this analysis was provided by MiMedx Group, Inc., US. JLD, and RAF are employees of MiMedx Group, Inc. WHT, BH, PS, BGC and WVP were consultants to MiMedx Group, Inc. VD, AO, MRK, JAN, NW and GAM served on the MiMedx Group, Inc. Advisory Board. MRK and JAN served on a speaker's bureau. WVP declares personal fees and equity holdings from Stage Analytics, US.
Collapse
Affiliation(s)
- William H Tettelbach
- RestorixHealth, Los Angeles, CA, US
- College of Podiatric Medicine, Western University of Health Sciences, US
- Duke University School of Medicine, Department of Anesthesiology, US
- American Professional Wound Care Association, 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, CA, US
| | | | | | | | - William V Padula
- Stage Analytics, Suwanee, GA, US
- Department of Pharmaceutical & Health Economics, Mann School of Pharmacy & Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, US
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, US
| |
Collapse
|
5
|
Furtado L, Coelho F, Mendonça N, Soares H, Gomes L, Sousa JP, Duarte H, Costeira C, Santos C, Araújo B. Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses' Adoption of Evidence-Based Practice: A Scoping Review. Healthcare (Basel) 2024; 12:245. [PMID: 38255132 PMCID: PMC10815808 DOI: 10.3390/healthcare12020245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
This scoping review, conducted within the Joanna Briggs Institute (JBI) framework, analysed the recent literature (January 2018 to March 2023) addressing factors inherent to professional practice environments and organisational contexts influencing nurses' adoption of evidence-based practice (EBP). This review included studies involving nurses regardless of sector, practice setting, and scope of practice. A systematic search was undertaken across the PubMed, Web of Science, CINAHL, and MEDLINE databases, as well as the EThOS, OATD, and RCAAP platforms. The extracted textual elements underwent a content analysis, resulting in a coding structure established through an inductive approach that categorised information into main categories and subcategories linked by similarity and thematic affinity. Forty-one studies were included, revealing four main categories of factors impacting EBP adoption by nurses: (1) organisational dynamics, (2) management and leadership, (3) teamwork and communication, and (4) resources and infrastructure. The study's limitations acknowledge the subjective nature of categorisation, recognising potential variations based on individual perspectives despite adopting procedures to minimise the risk of bias. The results provide a substantial foundation for developing interventions to cultivate environments conducive to EBP adoption by nurses, thereby enhancing the integration of evidence into nurses' professional practice contexts. This review was prospectively registered on the Open Science Framework (registration no. osf.io/e86qz).
Collapse
Affiliation(s)
- Luís Furtado
- Department of Nursing, Mental Health and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Fábio Coelho
- Department of Nursing, Mental Health and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal
| | | | - Hélia Soares
- Department of Nursing, Mental Health and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal
| | - Luís Gomes
- Department of Nursing, Mental Health and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal
| | - Joana Pereira Sousa
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal
| | - Hugo Duarte
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal
| | - Cristina Costeira
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal
| | - Cátia Santos
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| |
Collapse
|
6
|
Veličković VM, Macmillan T, Kottner J, Crompton A, Munro I, Paine A, Savović J, Spelman T, Clark M, Smit HJ, Smola H, Webb N, Steyerberg E. Prognostic models for clinical outcomes in patients with venous leg ulcers: A systematic review. J Vasc Surg Venous Lymphat Disord 2024; 12:101673. [PMID: 37689364 DOI: 10.1016/j.jvsv.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE The purpose of this review was to identify prognostic models for clinical application in patients with venous leg ulcers (VLUs). METHODS Literature searches were conducted in Embase, Medline, Cochrane, and CINAHL databases from inception to December 22, 2021. Eligible studies reported prognostic models aimed at developing, validating, and adjusting multivariable prognostic models that include multiple prognostic factors combined, and that predicted clinical outcomes. Methodological quality was assessed using the CHARMS checklist and PROBAST short form questionnaire. RESULTS Thirteen studies were identified, of which three were validation studies of previously published models, four reported derivation and validation of models, and the remainder reported derivation models only. There was substantial heterogeneity in the model characteristics, including 11 studies focused on wound healing outcomes reporting 91 different predictors. Three studies shared similar predicted outcomes, follow-up timepoint and used a Cox proportional hazards model. However, these models reported different predictor selection methods and different predictors and it was therefore not feasible to summarize performance, such as discriminative ability. CONCLUSIONS There are no standout risk prediction models in the literature with promising clinical application for patients with VLUs. Future research should focus on developing and validating high-performing models in wider VLU populations.
Collapse
Affiliation(s)
- Vladica M Veličković
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Tirol, Austria.
| | | | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Abby Paine
- Source Health Economics, London, United Kingdom
| | - Jelena Savović
- Bristol Population Health Science Institute, Bristol, United Kingdom
| | - Tim Spelman
- Burnet Institute, Melbourne, Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Clark
- Welsh Wound Innovation Centre, Ynysmaerdy, Pontyclun, United Kingdom
| | | | - Hans Smola
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Department of Dermatology, University of Cologne, Cologne, Germany
| | - Neil Webb
- Source Health Economics, London, United Kingdom
| | | |
Collapse
|
7
|
Patton D, Avsar P, Sayeh A, Budri A, O'Connor T, Walsh S, Nugent L, Harkin D, O'Brien N, Cayce J, Corcoran M, Gaztambide M, Derwin R, Sorensen J, Moore Z. Assessing the healthcare costs associated with venous leg ulcer compression bandages - A scoping review. J Tissue Viability 2023; 32:618-626. [PMID: 37423836 DOI: 10.1016/j.jtv.2023.06.009] [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: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
AIM To determine the monetary costs identified in economic evaluations of treatment with compression bandages among adults with venous leg ulcers (VLU). METHOD A scoping review of existing publications was conducted in February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Ten studies met the inclusion criteria. To place the costs of treatment into context, these are reported in conjunction with the healing rates. Three comparisons were made: 1.4 layer compression versus no compression (3 studies). One study reported that 4 layer compression was more expensive than usual care (£804.03 vs £681.04, respectively), while the 2 other studies reported the converse (£145 vs £162, respectively) and all costs (£116.87 vs £240.28 respectively). Within the three studies, the odds of healing were statistically significantly greater with 4 layer bandaging (OR: 2.20; 95% CI: 1.54-3.15; p = 0.001).; 2.4 layer compression versus other compression (6 studies). For the three studies reporting the mean costs per patient associated with treatment (bandages alone), over the treatment period, analysis identified a mean difference (MD) in costs for 4 layer vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) of -41.60 (95% CI: 91.40 to 8.20; p = 0.10). The OR of healing for 4 layer compression vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 0.70 (95% CI: 0.57-0.85; p = 0.004). For 4 layer vs comparator 2 (2 layer compression) the MD is: 14.00 (95% CI: 53.66 to -25.66; p < 0.49). The OR of healing for 4 layer compression vs comparator 2 (2 layer compression) is: 3.26 (95% CI: 2.54-4.18; p < 0.00001). For comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) vs comparator 2 (2 layer compression) the MD in costs is: 55.60 (95% CI: 95.26 to -15.94; p = 0.006). The OR of healing with Comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 5.03 (95% CI:4.10-6.17; p < 0.00001). Three studies presented the mean annual costs per patient associated with treatment (all costs). The MD is 172 (150-194; p = 0.401), indicating no statistically significant difference in costs between the groups. All studies showed faster healing rates in the 4 layer study groups. 3. Compression wrap versus inelastic bandage (one study). Compression wrap was less expensive than inelastic bandage (£201 vs £335, respectively) with more wounds healing in the compression wrap group (78.8%, n = 26/33; 69.7%, n = 23/33). CONCLUSION The results for the analysis of costs varied across the included studies. As with the primary outcome, the results indicated that the costs of compression therapy are inconsistent. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.
Collapse
Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Aicha Sayeh
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Aglecia Budri
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Simone Walsh
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Linda Nugent
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.
| | - Denis Harkin
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Niall O'Brien
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | | | | | | | - Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Jan Sorensen
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| |
Collapse
|
8
|
Sussman G. An update on wound management. Aust Prescr 2023; 46:29-35. [PMID: 38053564 PMCID: PMC10664094 DOI: 10.18773/austprescr.2023.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Wound management involves an understanding of the aetiology and pathophysiology of a wound, the healing process and how best to manage both. Acute wounds can occur suddenly, such as burns and skin tears. Chronic wounds fail to progress through the normal stages of healing and can include ulcers, pressure injuries and infected wounds. Dressings and bandages provide the optimal environment for the healing of all wound types. It is important for healthcare practitioners to understand the key differences in their properties, uses and precautions. Selecting the ideal dressing or bandage can minimise the healing duration, reduce the bioburden, and improve a patient's quality of life.
Collapse
Affiliation(s)
- Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University
| |
Collapse
|
9
|
Mahajan NM, Wanaskar K, Ali N, Mahapatra DK, Iqbal M, Bhat AR, Kaleem M. Innovative Wound Healing Hydrogel Containing Chicken Feather Keratin and Soy Isoflavone Genistein: In Vivo Studies. Gels 2023; 9:462. [PMID: 37367133 DOI: 10.3390/gels9060462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
The current study was performed to isolate keratin from chicken feathers with an intention to develop a keratin-genistein wound-healing hydrogel, along with its in vivo analysis. Pre-formulation aspects were analysed by using FTIR; SEM; HPTLC, while gel was characterized for gel strength, viscosity, spreadability, drug content, etc. Additionally, an in vivo study along with biochemical factors against pro-inflammatory factors and histopathological studies were conducted to determine possible wound-healing and anti-inflammatory effects. Pre-formulation studies revealed the presence of amide bonds with region of dense fibrous keratin and an internal porous network in extracted keratin, which corresponds with standard keratin. Evaluation of optimised keratin-genistein hydrogel indicated the development of neutral, non-sticky hydrogel which spread evenly on the skin. In vivo studies in rats indicate higher degrees of wound-healing in combined hydrogel (94.65%) for a duration of 14 days as compared to an individual hydrogel formulation with the development of the epidermis and excessive proliferation of fibrous connective tissue indicating wound repair. Furthermore, the hydrogel inhibited the overexpression of IL-6 gene along with other pro-inflammatory factors, indicating its anti-inflammatory effects. In order to find out the possibility of closure of wounds and anti-inflammatory properties of the novel product, an in vivo investigation into the healing of wounds in laboratory animals was carried out through biochemical (ELISA and qRT-PCR) analyses against inflammatory markers (IL-2, IL-6, IL-1, IL-10, and COX-2) and histopathological (liver, skin, and the kidneys) investigations. Based on the results, we conclude that keratin-genistein hydrogel is a promising therapeutic molecule for the management of wound repair.
Collapse
Affiliation(s)
- Nilesh M Mahajan
- Department of Pharmaceutics, Dadasaheb Balpande College of Pharmacy, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440037, Maharashtra, India
| | - Kalyani Wanaskar
- Department of Pharmaceutics, Dadasaheb Balpande College of Pharmacy, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440037, Maharashtra, India
| | - Nemat Ali
- Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, P.O. Box 55760, Riyadh 11451, Saudi Arabia
| | - Debarshi Kar Mahapatra
- Department of Pharmaceutical Chemistry, Dadasaheb Balpande College of Pharmacy, Nagpur 440037, Maharashtra, India
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abid R Bhat
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mohammed Kaleem
- Department of Pharmacology, Dadasaheb Balpande College of Pharmacy, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440037, Maharashtra, India
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Bar L, Marks D, Brandis S. Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory. Patient Prefer Adherence 2023; 17:51-66. [PMID: 36636284 PMCID: PMC9831124 DOI: 10.2147/ppa.s390123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. METHODS Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. RESULTS Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie's Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. CONCLUSION Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. PRACTICE IMPLICATIONS These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.
Collapse
Affiliation(s)
- Laila Bar
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
- Department of Occupational Therapy, Gold Coast University Hospital, Southport, Queensland, Australia
- Correspondence: Laila Bar, Department of Occupational Therapy, Level 4, Bond Institute of Health and Sport, 2 Promethean Way, Robina, Queensland, 4226, Australia, Tel +61 413 855 090, Email
| | - Darryn Marks
- Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
| | - Susan Brandis
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
| |
Collapse
|
12
|
Ciecholewska-Juśko D, Junka A, Fijałkowski K. The cross-linked bacterial cellulose impregnated with octenidine dihydrochloride-based antiseptic as an antibacterial dressing material for highly-exuding, infected wounds. Microbiol Res 2022; 263:127125. [PMID: 35878492 DOI: 10.1016/j.micres.2022.127125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
The highly absorbent, antibacterial dressings with a sustained release of the antimicrobial are considered necessary measures to counteract chronic wound biofilm-based infections. This study aimed to analyze wet and dry bacterial cellulose (BC) materials, modified by chemical cross-linking, and impregnated with an antiseptic based on octenidine dihydrochloride (OCT) in the context of its antibiofilm/antibacterial activity, exudate absorption, and cytotoxicity. The native BC was obtained from cost-effective, ecological-friendly potato juice (leftover from the starch industry). The ability to absorb and retain OCT, exudate absorption capacity, the kinetics of OCT release as well as antibiofilm/antibacterial activity of modified BC materials against biofilm-forming and planktonic bacteria (Staphylococcus aureus and Pseudomonas aeruginosa) were investigated. The performed analyses revealed that modified BC materials, thanks to their layered structure with numerous air spaces, were characterized by sustained exudate absorption and OCT release profile, which allowed them to exhibit high antimicrobial activity for up to 7 days, with a reduction of planktonic and biofilm cells of 84-100% and 69-93%, respectively. The modified BC materials showed also no cytotoxicity against fibroblast cell line L929 in vitro and were characterized by firm adhesion to the curved surfaces. These results indicate that cross-linked BC impregnated with OCT may be a particularly promising dressing material (obtained using sustainable processes), especially in the treatment of biofilm-infected, highly-exuding wounds.
Collapse
Affiliation(s)
- Daria Ciecholewska-Juśko
- Department of Microbiology and Biotechnology, Faculty of Biotechnology and Animal Husbandry, West Pomeranian University of Technology, Szczecin, Piastów 45, 70-311 Szczecin, Poland.
| | - Adam Junka
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Medical University of Wroclaw, Borowska 211a, 50534 Wrocław, Poland.
| | - Karol Fijałkowski
- Department of Microbiology and Biotechnology, Faculty of Biotechnology and Animal Husbandry, West Pomeranian University of Technology, Szczecin, Piastów 45, 70-311 Szczecin, Poland.
| |
Collapse
|
13
|
Liu S, Team V, Qiu Y, Weller CD. Investigating Quality of Life Instrument Measurement Properties for Adults with Active Venous Leg Ulcers: A Systematic Review. Wound Repair Regen 2022; 30:468-486. [PMID: 35639021 PMCID: PMC9545457 DOI: 10.1111/wrr.13034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/07/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
The primary objective of this systematic review was to identify which quality of life instruments have been applied in published studies of patients with active venous leg ulcers. Our secondary objective was to map the measurement properties of each identified quality of life instrument and to inform future recommendations for clinical practice and research. We searched CINAHL, Ovid Medline, Ovid Emcare and ProQuest to identify studies published from 1 January 2000 to 31 July 2021. Eleven studies that utilised quality of life instruments in adults with active venous leg ulcers met the inclusion criteria. Thirteen quality of life instruments were identified as some studies utilised both generic and condition‐specific quality of life instruments. Six out of nine (6/9) instruments were rated ‘very good’ of methodological quality on internal consistency; 1/7 studies rated ‘adequate’ on reliability; 2/4 rated ‘adequate’ on content validity; 3/6 studies rated ‘adequate’ on structural validity; 5/6 rated ‘adequate’ on hypotheses testing for construct and 2/6 studies rated ‘adequate’ on responsiveness. There is limited evidence of measurement properties of quality of life instruments for people with active venous leg ulcers. The Venous Leg Ulcer Quality of Life Questionnaire (VLU‐QoL) could be provisionally recommended for use although from our review it is clear further studies to assess VLU‐QoL measurement properties are needed to inform future recommendations for clinical practice and research.
Collapse
Affiliation(s)
- Shiwen Liu
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Fibre Bragg Grating Based Interface Pressure Sensor for Compression Therapy. SENSORS 2022; 22:s22051798. [PMID: 35270942 PMCID: PMC8915074 DOI: 10.3390/s22051798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
Compression therapy is widely used as the gold standard for management of chronic venous insufficiency and venous leg ulcers, and the amount of pressure applied during the compression therapy is crucial in supporting healing. A fibre optic pressure sensor using Fibre Bragg Gratings (FBGs) is developed in this paper to measure sub-bandage pressure whilst removing cross-sensitivity due to strain in the fibre and temperature. The interface pressure is measured by an FBG encapsulated in a polymer and housed in a textile to minimise discomfort for the patient. The repeatability of a manual fabrication process is investigated by fabricating and calibrating ten sensors. A customized calibration setup consisting of a programmable translation stage and a weighing scale gives sensitivities in the range 0.4–1.5 pm/mmHg (2.6–11.3 pm/kPa). An alternative calibration method using a rigid plastic cylinder and a blood pressure cuff is also demonstrated. Investigations are performed with the sensor under a compression bandage on a phantom leg to test the response of the sensor to changing pressures in static situations. Measurements are taken on a human subject to demonstrate changes in interface pressure under a compression bandage during motion to mimic a clinical application. These results are compared to the current gold standard medical sensor using a Bland–Altman analysis, with a median bias ranging from −4.6 to −20.4 mmHg, upper limit of agreement (LOA) from −13.5 to 2.7 mmHg and lower LOA from −32.4 to −7.7 mmHg. The sensor has the potential to be used as a training tool for nurses and can be left in situ to monitor bandage pressure during compression therapy.
Collapse
|
15
|
EHO-85: A Multifunctional Amorphous Hydrogel for Wound Healing Containing Olea europaea Leaf Extract: Effects on Wound Microenvironment and Preclinical Evaluation. J Clin Med 2022; 11:jcm11051229. [PMID: 35268320 PMCID: PMC8911171 DOI: 10.3390/jcm11051229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
The prevalence of chronic wounds is increasing due to the population aging and associated pathologies, such as diabetes. These ulcers have an important socio-economic impact. Thus, it is necessary to design new products for their treatment with an adequate cost/effectiveness ratio. Among these products are amorphous hydrogels. Their composition can be manipulated to provide a favorable environment for ulcer healing. The aim of this study was to evaluate a novel multifunctional amorphous hydrogel (EHO-85), containing Olea europaea leaf extract, designed to enhance the wound healing process. For this purpose, its moistening ability, antioxidant capacity, effect on pH in the wound bed of experimental rats, and the effect on wound healing in a murine model of impaired wound healing were assessed. EHO-85 proved to be a remarkable moisturizer and its application in a rat skin wound model showed a significant antioxidant effect, decreasing lipid peroxidation in the wound bed. EHO-85 also decreased the pH of the ulcer bed from day 1. In addition, in mice (BKS. Cg-m +/+ Leprdb) EHO-85 treatment showed superior wound healing rates compared to hydrocolloid dressing. In conclusion, EHO-85 can speed up the closure of hard-to-heal wounds due to its multifunctional properties that are able to modulate the wound microenvironment, mainly through its remarkable effect on reactive oxygen species, pH, and moistening regulation.
Collapse
|
16
|
Rocha MNB, Serna Gonzalez CV, Borges EL, Santos VLCDG, Rabeh SAN, Nogueira PC. Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort. INT J LOW EXTR WOUND 2022:15347346211065929. [PMID: 34981995 DOI: 10.1177/15347346211065929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.
Collapse
Affiliation(s)
| | - Carol Viviana Serna Gonzalez
- Graduate Program in Adult Health Nursing, University of São Paulo School of Nursing (28133Universidade de Sao Paulo, Escola de Enfermagem-EEUSP), Sao Paulo, Sao Paulo, Brazil
| | - Eline Lima Borges
- Department of Basic Nursing, 28114Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vera Lúcia Conceição de Gouveia Santos
- Medical-Surgical Nursing Department, 67816University of Sao Paulo School of Nursing (Universidade de Sao Paulo, Escola de Enfermagem-EEUSP), Sao Paulo, São Paulo, Brazil
| | - Soraia Assad Nasbine Rabeh
- General and Specialized Nursing Department, University of Sao Paulo School of Nursing in Riberão Preto (Universidade de Sao Paulo, Escola de Enfermagem de Ribeirão Preto-EERP/USP), Ribeirão Preto, São Paulo, Brazil
| | - Paula Cristina Nogueira
- Medical-Surgical Nursing Department, 67816University of Sao Paulo School of Nursing (Universidade de Sao Paulo, Escola de Enfermagem-EEUSP), Sao Paulo, São Paulo, Brazil
| |
Collapse
|
17
|
Cleary-Holdforth J, O'Mathúna D, Fineout-Overholt E. Evidence-Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland. Worldviews Evid Based Nurs 2021; 18:379-388. [PMID: 34750977 DOI: 10.1111/wvn.12543] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system. AIM To establish clinician, educator, and student's EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland. METHODS Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data. RESULTS Clinicians, educators, and students reported positive beliefs about EBP (M = 59.98, SD 8.68; M = 87.72, SD = 10.91; M = 55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M = 12.85, SD = 14; educators: M = 31.09, SD = 16.54; students: M = 16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M = 74.07, SD = 19.65; M = 86.43, SD = 15.01; M = 93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP. LINKING EVIDENCE TO ACTION Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.
Collapse
Affiliation(s)
- Joanne Cleary-Holdforth
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Dónal O'Mathúna
- College of Nursing, Ohio State University, Columbus, Ohio, USA
| | - Ellen Fineout-Overholt
- Gallup Certified Strengths Coach, College of Nursing & Health Sciences, University of Texas at Tyler, Tyler, Texas, USA
| |
Collapse
|
18
|
Qiu Y, Team V, Osadnik CR, Weller CD. Barriers and enablers to physical activity participation in patients with venous leg ulcers: a systematic review protocol of qualitative evidence. JBI Evid Synth 2021; 19:3155-3162. [PMID: 34100830 DOI: 10.11124/jbies-20-00549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize available qualitative evidence to provide an overview of the barriers and enablers that influence physical activity participation in patients with venous leg ulcers. INTRODUCTION Management of venous leg ulcers is a costly and time-consuming process in clinical settings due to the protracted healing process. Physical activity may be a useful adjuvant treatment to improve healing outcomes. However, a low level of physical activity is still observed in patients with venous leg ulcers and the reasons are multifactorial. A comprehensive understanding of the barriers and enablers to physical activity participation from different perspectives is crucial to develop workable interventions and achieve desired healing outcomes. INCLUSION CRITERIA The review will consider qualitative studies that focus on evidence concerning the barriers and enablers influencing physical activity level in adults diagnosed with venous leg ulcers in all settings. METHODS Relevant studies will be searched in MEDLINE, CINAHL Plus, PsycINFO, and Emcare databases. Only studies published in English will be considered, with no date limits. Two independent reviewers will perform title and abstract screening and the full text of potential eligible studies will be retrieved and assessed against the inclusion criteria. All eligible studies will be appraised for methodological quality. Qualitative data will be extracted manually by two independent reviewers. A meta-aggregation approach will be used to pool and categorize findings from the included studies. The ConQual approach will be used to grade the final synthesized findings to determine confidence in the analysis findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021238579.
Collapse
Affiliation(s)
- Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | | | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
19
|
A pre-experimental pilot study exploring EBP Beliefs and EBP Implementation among post-graduate student nurses in Saudi Arabia. Nurse Educ Pract 2021; 57:103215. [PMID: 34700260 DOI: 10.1016/j.nepr.2021.103215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022]
Abstract
AIM This study aimed to measure the impact of a dedicated EBP module on the knowledge, skills and capability for EBP of students undertaking the inaugural MSc in Nursing: Advanced Practice programme in the KSA. BACKGROUND Evidence-based practice (EBP) yields multiple benefits for all key stakeholders of healthcare. Key to this are healthcare professionals armed with necessary EBP knowledge and skills. Nurses, the largest professional group in healthcare, can be instrumental in effecting sustained EBP implementation. In the Kingdom of Saudi Arabia (KSA) achieving this is hindered by a chronic shortage of nurses and a heavy reliance on expatriate nurses who are often a transient workforce, resulting in a high turnover. The Government of Saudi Arabia 2030 Vision aspires to address the indigenous nurse shortage and the quality of healthcare. In 2017 the inaugural MSc in Nursing: Advanced Practice programme was established in the KSA to prepare Saudi nurses for emerging advanced practice roles. A dedicated EBP module was a core component of the programme. METHODS A pre-experimental pilot study conducted over 18-months collected data from the same participants at three different points. Two validated EBP questionnaires measuring EBP Beliefs and EBP Implementation were administered to post-graduate students undertaking the MSc in Nursing: Advanced Practice programme in one Higher Education Institution in the KSA. Descriptive, inferential and correlational statistics were employed to analyse the demographic data, group mean scores and distribution on the EBP scales, as well the correlation between EBP Beliefs and EBP Implementation. FINDINGS Findings demonstrated that the educational intervention did improve participants' EBP beliefs and implementation. Participants reported positive beliefs about EBP at all 3 data collection points (M = 57.4 SD = 7.0; M = 62.54 SD = 7.21; M = 55.31 SD = 15.81, respectively). EBP implementation was low prior to undertaking the module but improved thereafter as illustrated across the 3 data collection points (M = 15.14 SD = 11.9; M = 27.64 SD = 14.35; M = 25.9 SD = 20.43). On both measures, higher scores indicate higher EBP beliefs and implementation. CONCLUSION This study established the EBP Beliefs and EBP Implementation of a sample of postgraduate nursing students in the KSA. Findings revealed a substantial improvement in both EBP Beliefs and EBP Implementation following the EBP module. Findings support the use of a dedicated module to prepare nurses to use EBP and to practice at an advanced level while simultaneously preparing them for leadership roles in healthcare in KSA. In so doing, this will help to advance the healthcare goals of the KSA 2030 vision.
Collapse
|
20
|
Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. Br J Dermatol 2021; 187:141-148. [PMID: 34549421 DOI: 10.1111/bjd.20692] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/11/2022]
Abstract
Chronic wounds have a debilitating effect on the quality of life of many individuals, and the large economic impact on health system budgets warrants greater attention in policy making and condition management than is currently evident. The aim of this narrative review is to summarize the nature and extent of the chronic wound problem that confronts health systems across the world. The first section is used to highlight the underlying epidemiology relating to chronic wounds, while the second explores the economic costs associated with them and the relative efficiency of measures designed to manage them.
Collapse
Affiliation(s)
- N Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - C J Phillips
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - K Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
| |
Collapse
|
21
|
Kolluri R, Lugli M, Villalba L, Varcoe R, Maleti O, Gallardo F, Black S, Forgues F, Lichtenberg M, Hinahara J, Ramakrishnan S, Beckman JA. An estimate of the economic burden of venous leg ulcers associated with deep venous obstruction. Vasc Med 2021; 27:63-72. [PMID: 34392750 PMCID: PMC8808361 DOI: 10.1177/1358863x211028298] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Venous leg ulcers (VLU) embody the most severe stage of the broad spectrum of
chronic venous disease. Approximately 40% of patients with VLU present with
the underlying deep venous disease (DVD). Although the data are scarce,
these deep venous disease-related VLU (DRV) are thought to have higher
recurrence rates and a substantial economic burden. The objective of this
study was to assess the economic burden of DRV across Australia, France,
Germany, Italy, Spain, the UK, and the USA. Methods: A comprehensive literature review was undertaken to identify publications
documenting the incidence and prevalence of VLU and DRV, medical resource
utilization, and associated costs of DRV. Findings from this literature
review were used to estimate the economic burden of illness, including
direct medical costs over a 12-month interval following initial presentation
of a newly formed DRV. Results: Total annual incidence of new or recurrent DRV in Australia, France, Germany,
Italy, Spain, UK, and the US are estimated at 122,000, 263,000, 345,000,
253,000, 85,000, 230,000, and 643,000 events, respectively, in 2019.
Incidence ranges from 0.73 to 3.12 per 1000 persons per year. The estimated
annual direct medical costs for patients managed conservatively in these
geographies total ~ $10.73 billion (USD) or $5527 per person per year. Conclusion: The availability of published data on the costs of VLU care varies widely
across countries considered in this analysis. Although country-specific VLU
practice patterns vary, there is a uniform pattern of high-cost care.
Collapse
Affiliation(s)
- Raghu Kolluri
- Department of Internal Medicine, Riverside Methodist Hospital/OhioHealth, Columbus, OH, USA
| | - Marzia Lugli
- Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Emilia-Romagna, Italy
| | - Laurencia Villalba
- Department of Vascular Surgery, Vascular Care Centre, Wollongong, NSW, Australia
| | - Ramon Varcoe
- Department of Surgery, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Maleti
- Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Emilia-Romagna, Italy
| | - Fernando Gallardo
- Department of Vascular Surgery, Hospital Quironsalud, Marbella, Spain
| | - Stephen Black
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fannie Forgues
- Centre de Phlébologie Interventionnelle, Région de Toulouse, Clinique Pasteur, Toulouse, France
| | | | | | | | - Joshua A Beckman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
22
|
Zhang M, Qiao X, Han W, Jiang T, Liu F, Zhao X. Alginate-chitosan oligosaccharide-ZnO composite hydrogel for accelerating wound healing. Carbohydr Polym 2021; 266:118100. [PMID: 34044919 DOI: 10.1016/j.carbpol.2021.118100] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Moist, breathable and antibacterial microenvironment can promote cell proliferation and migration, which is beneficial to wound healing. Here, we fabricated a novel sodium alginate-chitosan oligosaccharide‑zinc oxide (SA-COS-ZnO) composite hydrogel by spontaneous Schiff base reaction, using aldehydated sodium alginate (SA), chitosan oligosaccharide (COS), and zinc oxide (ZnO) nanoparticles, which can provide a moist and antibacterial environment for wound healing. The porosity and swelling degree of SA-COS-ZnO hydrogel are 80% and 150%, respectively, and its water vapor permeability is 682 g/m2/24h. The composite hydrogel showed good biocompatibility to blood cells, 3T3 cells, and 293T cells, and significant antibacterial activity against Escherichia coli, Staphylococcus aureus, Candida albicans, and Bacillus subtilis. Moreover, the hydrogel showed a promoting effect on wound healing in a rat scald model. The present study suggests that marine carbohydrates composite hydrogels are promising in wound care management.
Collapse
Affiliation(s)
- Miao Zhang
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China
| | - Xiaoni Qiao
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Wenwei Han
- Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China; Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Tianze Jiang
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China
| | - Fei Liu
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Xia Zhao
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266237, China.
| |
Collapse
|
23
|
|
24
|
Once daily 300 mg aspirin with compression versus compression alone in patients with chronic venous leg ulcers (ASPiVLU): A randomised, double-blinded, multicentre, placebo-controlled, clinical trial. J Tissue Viability 2021; 30:509-516. [PMID: 34330595 DOI: 10.1016/j.jtv.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
AIM Venous leg ulcers are lower limb skin ulcers characterised by a cycle of healing and recurrence due to underlying chronic venous insufficiency. While compression improves healing outcomes, many ulcers do not heal. As a daily 300 mg oral dose of aspirin in conjunction with compression may improve healing outcomes, we investigated the effect of adjuvant aspirin on venous leg ulcer healing in participants already receiving compression. MATERIALS AND METHODS We conducted a prospective, randomised, double-blinded, placebo-controlled, clinical trial (known as ASPiVLU). Participants were recruited from six wound clinics in Australia. We screened 844 participants. Community-dwelling adult participants identified at six hospital outpatient clinics and clinically diagnosed with a venous leg ulcer present for 6+ weeks were eligible between April 13, 2015 to June 30, 2018. We randomised 40 participants (n = 19 aspirin, n = 21 placebo) and evaluated against the primary outcome. There were no dropouts. Ten serious adverse events in six participants were recorded. None were study related. The primary outcome measure was healing at 12 weeks based on blinded assessment. RESULTS We found no difference in the number of ulcers healed at 12 weeks between the intervention and control groups. CONCLUSION This study could not detect whether or not aspirin affected VLU healing speed. This is likely because we recruited fewer participants than expected due to the high number of people with venous leg ulcers in Australia who were already taking Aspirin; future research should investigate other adjuvant therapies or different study designs.
Collapse
|
25
|
Weller CD, Team V, Probst S, Gethin G, Richards C, Sixsmith J, Turnour L, Bouguettaya A. Health literacy in people with venous leg ulcers: a protocol for scoping review. BMJ Open 2021; 11:e044604. [PMID: 33980525 PMCID: PMC8117997 DOI: 10.1136/bmjopen-2020-044604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/08/2021] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Chronic venous leg ulcer (VLU) healing is a complex clinical problem. It requires intervention from skilled, costly, multidisciplinary wound-care teams, working with patients to manage their care. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence, with some evidence suggesting the value of exercise as well. These activities require health education and health literacy (HL) as patients must process, understand and consistently apply health information for successful self-management. Research suggests that those most vulnerable to VLUs also tend to have limited HL, but there have been no reviews examining the state of HL in patients with previous or active VLUs. This scoping review aims to examine the level of HL in VLU patients and how HL may link to self-management behaviours (particularly exercise and compression adherence), and their VLU healing generally. METHODS AND ANALYSIS We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines and the Levac methodology framework to explore eligible papers that examine the effect of HL on their exercise and compression adherence. Electronic databases will be searched (MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, OpenGray), examining for all papers on these subjects published between 2000 and 2020. All studies describing compression and or exercise during VLU management will be included. Study characteristics will be recorded; qualitative data will be extracted and evaluated. Quantitative data will be extracted and summarised. ETHICS AND DISSEMINATION We will disseminate results through peer-reviewed publications. We will use data (ie, journal articles) from publicly available platforms; so, this study does not require ethical review. The consultation step will be carried out with patients, carers and health professionals as part of an established wound consumer group.
Collapse
Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | | | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Catelyn Richards
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Jane Sixsmith
- Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Louise Turnour
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ayoub Bouguettaya
- School of Psychology, University of Birmingham Edgbaston Campus, Birmingham, UK
| |
Collapse
|
26
|
Homs-Romero E, Romero-Collado A, Verdú J, Blanch J, Rascón-Hernán C, Martí-Lluch R. Validity of Chronic Venous Disease Diagnoses and Epidemiology Using Validated Electronic Health Records From Primary Care: A Real-World Data Analysis. J Nurs Scholarsh 2021; 53:296-305. [PMID: 33638608 DOI: 10.1111/jnu.12639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the validity of lower limb chronic venous disease (CVD) diagnoses entered in a large electronic health record database in primary care in Catalonia, Spain; to investigate the reliability of these data for research purposes; and to estimate the prevalence and incidence of CVD, chronic venous insufficiency (CVI), and venous leg ulcer (VLU). DESIGN Real-world data analysis based on a large electronic health record database in primary care in Catalonia, Spain. METHODS We used a primary care research database (Information System for the Development of Research in Primary Care [SIDIAP]), which contains anonymous data on some 5.8 million people from 279 primary care centers, accounting for more than 80% of the Catalonian population and 15% of the Spanish population. We evaluated the validity of the ICD-10 codes for CVD in SIDIAP for 200 adult patients through the responses of 20 primary care physicians to a questionnaire. FINDINGS The positive predictive value of CVD in SIDIAP was 89.95% (95% confidence interval [CI] 84.99-93.40). The prevalence rates for CVD, CVI, and VLU were 9.54% (95% CI 9.51-9.56), 3.87%, and 0.33%, respectively. The incidence rates for CVD, CVI, and VLU were 7.91/1,000 person-years (95% CI 7.82-8.00), 3.37/1,000 person-years (95% CI 3.31-3.43), and 0.23/1,000 person-years (95% CI 0.21-0.24), respectively. CONCLUSIONS The Catalonian SIDIAP database contains valid CVD diagnoses. The prevalence and incidence rates found using real-world data are low compared with those in the literature, possibly because CVD is an underdiagnosed entity. CLINICAL RELEVANCE Real-world data can inform clinicians on lower limb venous health in a population, show changes as individuals age, and reveal aspects where healthcare can be improved.
Collapse
Affiliation(s)
- Erica Homs-Romero
- Primary Health Care Nurse, Figueres Basic Healthcare Area (Àrea Bàsica de Salut de Figueres)
| | | | - Jose Verdú
- Professor of Nursing, Department of Nursing, University of Alicante, Spain
| | - Jordi Blanch
- Unitat de suport a la recerca de Girona., Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | | | - Ruth Martí-Lluch
- Unitat de suport a la recerca de Girona., Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain.,Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Girona, Spain
| |
Collapse
|
27
|
Nunes SB, Hodel KVS, Sacramento GDC, Melo PDS, Pessoa FLP, Barbosa JDV, Badaró R, Machado BAS. Development of Bacterial Cellulose Biocomposites Combined with Starch and Collagen and Evaluation of Their Properties. MATERIALS 2021; 14:ma14020458. [PMID: 33477891 PMCID: PMC7833372 DOI: 10.3390/ma14020458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
One of the major benefits of biomedicine is the use of biocomposites as wound dressings to help improve the treatment of injuries. Therefore, the main objective of this study was to develop and characterize biocomposites based on bacterial cellulose (BC) with different concentrations of collagen and starch and characterize their thermal, morphological, mechanical, physical, and barrier properties. In total, nine samples were produced with fixed amounts of glycerol and BC and variations in the amount of collagen and starch. The water activity (0.400–0.480), water solubility (12.94–69.7%), moisture (10.75–20.60%), thickness (0.04–0.11 mm), water vapor permeability (5.59–14.06 × 10−8 g·mm/m2·h·Pa), grammage (8.91–39.58 g·cm−2), opacity (8.37–36.67 Abs 600 nm·mm−1), elongation (4.81–169.54%), and tensile strength (0.99–16.32 MPa) were evaluated and defined. In addition, scanning electron microscopy showed that adding biopolymers in the cellulose matrix made the surface compact, which also influenced the visual appearance. Thus, the performance of the biocomposites was directly influenced by their composition. The performance of the different samples obtained resulted in them having different potentials for application considering the injury type. This provides a solution for the ineffectiveness of traditional dressings, which is one of the great problems of the biomedical sector.
Collapse
Affiliation(s)
- Silmar Baptista Nunes
- PPG GETEC, University Center SENAI CIMATEC, National Service of Industrial Learning, SENAI CIMATEC, Salvador 41650-010, Brazil; (S.B.N.); (F.L.P.P.); (J.D.V.B.); (R.B.)
| | - Katharine Valéria Saraiva Hodel
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, SENAI CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (G.d.C.S.)
| | - Giulia da Costa Sacramento
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, SENAI CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (G.d.C.S.)
| | - Pollyana da Silva Melo
- Department of Materials, University Center SENAI CIMATEC, National Service of Industrial Learning, Salvador 41650-010, Brazil;
| | - Fernando Luiz Pellegrini Pessoa
- PPG GETEC, University Center SENAI CIMATEC, National Service of Industrial Learning, SENAI CIMATEC, Salvador 41650-010, Brazil; (S.B.N.); (F.L.P.P.); (J.D.V.B.); (R.B.)
| | - Josiane Dantas Viana Barbosa
- PPG GETEC, University Center SENAI CIMATEC, National Service of Industrial Learning, SENAI CIMATEC, Salvador 41650-010, Brazil; (S.B.N.); (F.L.P.P.); (J.D.V.B.); (R.B.)
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, SENAI CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (G.d.C.S.)
| | - Roberto Badaró
- PPG GETEC, University Center SENAI CIMATEC, National Service of Industrial Learning, SENAI CIMATEC, Salvador 41650-010, Brazil; (S.B.N.); (F.L.P.P.); (J.D.V.B.); (R.B.)
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, SENAI CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (G.d.C.S.)
| | - Bruna Aparecida Souza Machado
- PPG GETEC, University Center SENAI CIMATEC, National Service of Industrial Learning, SENAI CIMATEC, Salvador 41650-010, Brazil; (S.B.N.); (F.L.P.P.); (J.D.V.B.); (R.B.)
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, SENAI CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (G.d.C.S.)
- Correspondence: ; Tel.: +55-(71)-3879-5624
| |
Collapse
|
28
|
Nosrati H, Aramideh Khouy R, Nosrati A, Khodaei M, Banitalebi-Dehkordi M, Ashrafi-Dehkordi K, Sanami S, Alizadeh Z. Nanocomposite scaffolds for accelerating chronic wound healing by enhancing angiogenesis. J Nanobiotechnology 2021; 19:1. [PMID: 33397416 PMCID: PMC7784275 DOI: 10.1186/s12951-020-00755-7] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/12/2020] [Indexed: 12/23/2022] Open
Abstract
Skin is the body's first barrier against external pathogens that maintains the homeostasis of the body. Any serious damage to the skin could have an impact on human health and quality of life. Tissue engineering aims to improve the quality of damaged tissue regeneration. One of the most effective treatments for skin tissue regeneration is to improve angiogenesis during the healing period. Over the last decade, there has been an impressive growth of new potential applications for nanobiomaterials in tissue engineering. Various approaches have been developed to improve the rate and quality of the healing process using angiogenic nanomaterials. In this review, we focused on molecular mechanisms and key factors in angiogenesis, the role of nanobiomaterials in angiogenesis, and scaffold-based tissue engineering approaches for accelerated wound healing based on improved angiogenesis.
Collapse
Affiliation(s)
- Hamed Nosrati
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | | | - Ali Nosrati
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Khodaei
- Department of Materials Science and Engineering, Golpayegan University of Technology, Golpayegan, Iran
| | - Mehdi Banitalebi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Korosh Ashrafi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sanami
- Department of Medical Biotechnology, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zohreh Alizadeh
- Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Anatomical Sciences, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
29
|
Bar L, Brandis S, Marks D. Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review. Patient Prefer Adherence 2021; 15:2085-2102. [PMID: 34556978 PMCID: PMC8455298 DOI: 10.2147/ppa.s323766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Patient adherence to wearing compression stockings in the management of chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is low. Poor adherence with compression stockings contributes to recurrence and impaired healing of VLUs. As such, the purpose of this review was to report on the scientific evidence related to adherence and explore modifiable factors which impact adherence with compression stockings. METHODS A systematic search was conducted from inception to 31 October 2019. Following the PRISMA-ScR Checklist, PubMed, Medline, CINAHL, Cochrane, Embase, OT Seeker and Web of Science were explored using search terms: compression/compression stocking/compression garment/compression sock/stockings/garments and adherence/compliance/concordance. RESULTS We identified 2613 papers of which 125 full text papers were assessed for eligibility and 69 met inclusion criteria. Papers were grouped and charted by concepts relevant to the research questions and narratively synthesized. Several dominant themes emerged, and a conceptual framework was developed incorporating modifiable variables, adherence itself, and outcomes related to adherence. Specifically considering interventions to improve adherence, only five of 14 randomized controlled trials were able to demonstrate improvements in adherence through unidimensional approaches. All nine of the case studies/series demonstrated a positive impact on adherence, eight of which described a personalized multidimensional approach. A lack of consensus around defining, measuring, and quantifying adherence with compression stockings was identified, resulting in wide variation in reported adherence rates. CONCLUSION Inconsistency in the definition and measurement of adherence limits meaningful interpretation of the literature. No individual intervention has consistently demonstrated improved adherence. Multidimensional interventions show promise but require further investigation with high-quality trials. Improving adherence appears to improve health outcomes in VLU /CVI populations but there is a lack of information directly linking improved adherence with cost outcomes. TRIAL REGISTRATION Open Science Framework: ACTRN12620000544976p.
Collapse
Affiliation(s)
- Laila Bar
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Queensland, Australia
- Correspondence: Laila Bar Email
| | - Susan Brandis
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Queensland, Australia
| | - Darryn Marks
- Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Queensland, Australia
| |
Collapse
|
30
|
Cavezzi A. Medicine and Phlebolymphology: Time to Change? J Clin Med 2020; 9:E4091. [PMID: 33353052 PMCID: PMC7766771 DOI: 10.3390/jcm9124091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients' management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients' lack of education, industry-influenced science, and physician's improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
Collapse
|
31
|
Olsson M, Friman A. Quality of life of patients with hard-to-heal leg ulcers: a review of nursing documentation. Br J Community Nurs 2020; 25:S13-S19. [PMID: 33300847 DOI: 10.12968/bjcn.2020.25.sup12.s12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
People with hard-to-heal leg ulcers experience reduced quality of life (QoL), including physical, mental and social aspects; this, in turn, negatively affects the wound healing process. QoL is often overlooked by health professionals treating those with hard-to-heal wounds, for whom the focus is instead on the wound itself and the healing process. This study aimed to investigate how the QoL of patients with hard-to-heal wounds is documented and followed up by nurses. The healthcare records of patients with hard-to-heal wounds were reviewed using an audit instrument. Data were collected retrospectively from 12 patient healthcare records. The nursing documentation included few notes related to patients' QoL. The nurses focused on issues such as nutrition, mobilisation and smoking, while the patients expressed concerns about anxiety/depressed mood, pain and sleeping difficulties. Only nine of the documented problems were approved according to the instrument. Most importantly, documentation of planned interventions and outcomes was missing. Documentation by nurses around the QoL of patients with hard-to-heal wounds is lacking, because of which QoL might be neglected and wound healing might not progress well.
Collapse
Affiliation(s)
- Malin Olsson
- Malin Olsson, Head Nurse, Rinkeby Healthcare Center, Sweden
| | - Anne Friman
- Anne Friman, Lecturer in Nursing, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute
| |
Collapse
|
32
|
Las Heras K, Igartua M, Santos-Vizcaino E, Hernandez RM. Chronic wounds: Current status, available strategies and emerging therapeutic solutions. J Control Release 2020; 328:532-550. [DOI: 10.1016/j.jconrel.2020.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
|
33
|
Weller CD, Richards C, Turnour L, Team V. Venous leg ulcer management in Australian primary care: Patient and clinician perspectives. Int J Nurs Stud 2020; 113:103774. [PMID: 33080480 DOI: 10.1016/j.ijnurstu.2020.103774] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/20/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Venous leg ulcers are the most common chronic wound seen in Australian primary care. Healing outcomes are protracted due to suboptimal use of clinical practice guideline recommendations. A better understanding of the differences between patients and clinicians may optimise management in primary care and improve healing and health outcomes for patients and healthcare spend in society. OBJECTIVE We explored venous leg ulcer management from patients' and primary care clinicians' perspective, including assessment, diagnosis, treatment, referral, and health education as outlined in the clinical practice guidelines. DESIGN We conducted a qualitative secondary analysis of data obtained from the qualitative face-to-face and telephone interviews with the primary care clinicians and telephone interviews with patients with venous leg ulcers. SETTING Clinicians were recruited from urban and rural primary health practices across Victoria, Australia. Patients were recruited from two specialist care wound clinics in Victoria. PARTICIPANTS We analysed data from interviews with 66 participants, including 31 patients with venous leg ulcers, 15 general practitioners and 20 practice nurses. METHODS Secondary analysis of qualitative data was carried out using thematic analysis. Interview transcripts were coded and analysed for common themes. RESULTS We found patients and clinicians reported differing perspectives related to venous leg ulcer management. Patients reported the need for earlier referral to specialist wound care clinics from primary care, emphasizing the need for vascular assessment and compression therapy. Clinicians discussed clinical judgements about when to refer rather than follow guideline recommendations. Clinicians frequently discussed managing venous leg ulcers using only topical dressing treatments, without compression therapy. Patients reported inadequate pain management for wound pain. Meanwhile, clinicians reported that they generally did not discuss wound pain management as part of overall venous leg ulcer management. Clinicians reported patients lacked an understanding about the role of compression in management of and subsequent healing outcomes. Patients stated they wanted more information about how to care for venous leg ulcers and how best to prevent recurrence, and needed more information than was already provided by clinicians. Conversely, clinicians reported less information is given to ensure patients were not overwhelmed with health information. CONCLUSION There are discrepancies between what patients want and what clinicians do. These data suggest that patients' preferences are aligned with venous leg ulcer clinical practice guideline recommendations. Greater awareness of the guidelines by health professional may not only reduce discrepancies they may improve health and healing outcomes. Tweetable abstract: Patients and primary care clinicians have different perspectives about venous leg ulcer management.
Collapse
Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC 3004, Australia.
| | - C Richards
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC 3004, Australia.
| | - L Turnour
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC 3004, Australia.
| | - V Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC 3004, Australia.
| |
Collapse
|
34
|
Rognoni C, Lugli M, Maleti O, Tarricone R. Venous stenting for patients with outflow obstruction and leg ulcers: cost–effectiveness and budget impact analyses. J Comp Eff Res 2020; 9:705-720. [DOI: 10.2217/cer-2020-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: To perform cost–effectiveness analysis (CEA) and budget impact analysis (BIA) comparing stenting to standard medical treatment (SMT) for the management of deep venous outflow obstruction and leg ulcers from the Italian Healthcare Service perspective. Materials & methods: A Markov model was developed to project costs and quality-adjusted life-years (QALYs) over 3 years, based on data from literature combined with real-world data. Moreover, a BIA was performed comparing the current scenario (100% SMT) with increasing utilization rates of stenting over SMT from 0.5 to 5%, in the next 5 years. Results: Stenting is a cost-effective (incremental cost-utility ratio €12,388/QALY) or dominant option versus SMT, according to in-patient or day-hospital settings, respectively. Increasing use of stenting over SMT, in the next 5 years, is expected to yield additional costs of 39.5 million Euros (in-patient) or savings of 5.1 million Euros (day-hospital). Conclusion: Stenting is a cost-effective option compared with SMT for patients with deep vein occlusion and ulceration in Italy.
Collapse
Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan 20136, Italy
| | - Marzia Lugli
- National Reference Training Center in Phlebology (NRTCP), Vascular Surgery – Cardiovascular Deptartment, Hesperia Hospital, Modena 41125, Italy
| | - Oscar Maleti
- National Reference Training Center in Phlebology (NRTCP), Vascular Surgery – Cardiovascular Deptartment, Hesperia Hospital, Modena 41125, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan 20136, Italy
- Department of Social and Political Sciences, Bocconi University, Milan 20136, Italy
| |
Collapse
|
35
|
Seaton PCJ, Cant RP, Trip HT. Quality indicators for a community-based wound care centre: An integrative review. Int Wound J 2020; 17:587-600. [PMID: 32030879 DOI: 10.1111/iwj.13308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
The purpose of this review was to identify the role and contribution of community-based nurse-led wound care as a service delivery model. Centres increasingly respond proactively to assess and manage wounds at all stages - not only chronic wound care. We conducted an integrative review of literature, searching five databases, 2007-2018. Based on inclusion and exclusion criteria, we systematically approached article selection and all three authors collaborated to chart the study variables, evaluate data, and synthesise results. Eighteen studies were included, representing a range of care models internationally. The findings showed a need for nurse-led clinics to provide evidence-based care using best practice guidelines for all wound types. Wound care practices should be standardised across the particular service and be integrated with higher levels of resources such as investigative services and surgical units. A multi-disciplinary approach was likely to achieve better patient outcomes, while patient-centred care with strong patient engagement was likely to assist patients' compliance with treatment. High-quality community-based wound services should include nursing leadership based on a hub-and-spoke model. This is ideally patient-centred, evidence-based, and underpinned by a commitment to developing innovations in terms of treatment modalities, accessibility, and patient engagement.
Collapse
Affiliation(s)
- Philippa C J Seaton
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Robyn P Cant
- Monash University, Melbourne, Victoria, Australia.,Federation University, Churchill, Victoria, Australia
| | - Henrietta T Trip
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| |
Collapse
|
36
|
Weller CD, Bouguettaya A, Britt H, Harrison C. Management of people with venous leg ulcers by Australian general practitioners: An analysis of the national patient-encounter data. Wound Repair Regen 2020; 28:553-560. [PMID: 32306490 DOI: 10.1111/wrr.12820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/29/2020] [Accepted: 04/14/2020] [Indexed: 12/01/2022]
Abstract
Venous Leg Ulcers cost Australia's healthcare system millions yearly, as they are underdiagnosed, and possibly undertreated. Most Venous Leg Ulcers are seen in general practice. However, it is currently unknown as to what treatment actions are most common in these contexts. Understanding how they are managed in these settings can improve healthcare delivery and patient outcomes. Using cross-sectional general practitioner patient encounter data collected April 2006 to March 2016 from the Bettering the Evaluation and Care of Health program, a continuous national study of general practice clinical activity in Australia, we aimed to describe the characteristics of venous leg ulcer management by general practitioners in Australia. Among the 972 100 general practitioner-patient encounters recorded, 3604 (0.34%) involved management of VLU. Male general practitioners managed Venous Leg Ulcers significantly more often than female general practitioners. Most Venous Leg Ulcers were treated via dressings (76%) and/or pharmacological treatments (25.7%), with few patients receiving the best practice treatment of medical compression (2.1%) or referral (4.9%). Patients with new (first visit) Venous Leg Ulcers were more likely to receive pharmacological treatments and to be referred elsewhere, and less likely to receive dressings than patients receiving follow-up care. There appears to be a large gap between best practice guidelines and actual Venous Leg Ulcers treatments, as referrals and appropriate treatment was low. Further longitudinal studies are needed to determine the effectiveness of care for people with Venous Leg Ulcers who are managed by general practitioners.
Collapse
Affiliation(s)
| | | | - Helena Britt
- Faculty of Medicine & Health, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales
| | - Christopher Harrison
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales
| |
Collapse
|
37
|
Effectiveness of implementation strategies for venous leg ulcer guidelines: A systematic review. J Tissue Viability 2020; 29:161-168. [PMID: 32340716 DOI: 10.1016/j.jtv.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/23/2020] [Accepted: 03/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of clinical practice guidelines (CPGs) is to improve patient care; however inconsistencies between recommended practice and what actually happens in clinical practice continues. Venous Leg Ulcers (VLUs) have a significant negative impact on patients' quality of life and it is acknowledged that managing people with venous leg ulcers is protracted and costly. The aim of this review is to identify the most effective strategies to implement clinical practice guidelines for the management of VLUs by health care professionals in the hospital, outpatient, home and community setting. METHODS A systematic review guided by methods from the Cochrane Effective Practice and Organisation of Care (EPOC) group was undertaken to identify implementation strategies for VLU clinical practice guidelines. Eligible studies were identified via systematic electronic searches of Medline, Embase, CINHAL and the Cochrane Library. RESULTS We identified 142 potential studies of which one randomised controlled trial met the inclusion criteria. Following an analysis of the included study, it is not possible to recommend one implementation strategy over another when implementing practice guidelines for people with VLUs. CONCLUSION We identified a limited evidence base for the effectiveness of implementation strategies for VLU CPGs. No one implementation strategy is better than another to facilitate VLU CPG implementation by health care professionals in hospital, outpatient, home or community settings.
Collapse
|
38
|
Weller CD, Richards C, Turnour L, Team V. Understanding factors influencing venous leg ulcer guideline implementation in Australian primary care. Int Wound J 2020; 17:804-818. [PMID: 32150790 DOI: 10.1111/iwj.13334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to gain a better understanding of the venous leg ulcer (VLU) management in primary health care settings located in Melbourne metropolitan and rural Victoria, Australia. We explored health professionals' perspective on the use of the Australian and New Zealand Venous Leg Ulcer Clinical Practice Guideline (VLU CPG) to identify the main challenges of VLU CPG uptake in clinical practice. We conducted semi-structured interviews with 15 general practitioners (GPs) and 20 practice nurses (PNs), including two Aboriginal health nurses. The Theoretical Domains Framework guided data collection and analysis. Data were analysed using a theory-driven analysis. We found a lack of awareness of the VLU CPGs, which resulted in suboptimal knowledge and limited adherence to evidence-based recommendations. Environmental factors, such as busy nature of clinical environment and absence of handheld Doppler ultrasound, as well as social and professional identity factors, such as reliance on previous experience and colleague's advice, influenced the uptake of the VLU CPGs in primary care. Findings of this study will inform development of interventions to increase the uptake of the VLU CPG in primary care settings and to reduce the evidence-practice gap in VLU management by health professionals.
Collapse
Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Catelyn Richards
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Louise Turnour
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
39
|
Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 2020; 11:155. [PMID: 32180720 PMCID: PMC7059819 DOI: 10.3389/fphar.2020.00155] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023] Open
Abstract
Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.
Collapse
Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
40
|
Weller C, Richards C, Turnour L, Green S, Team V. Vascular assessment in venous leg ulcer diagnostics and management in Australian primary care: Clinician experiences. J Tissue Viability 2019; 29:184-189. [PMID: 31879057 DOI: 10.1016/j.jtv.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/02/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
AIM In this article, we focus on primary health clinicians' experiences of vascular assessment in venous leg ulcer (VLU) diagnostics and management, including ankle brachial pressure index (ABPI) measurements using Doppler ultrasonography. METHODS We conducted semi-structured face-to-face and telephone interviews with general practitioners [15] and practice nurses [20] from primary health care settings in Australia. Twenty-one participants were recruited from practices located in Melbourne metropolitan settings and 14 from rural Victoria. We used the theory driven thematic analysis as a method of data analysis. The Theoretical Domains Framework informed this analysis. RESULTS Five domains were identified as relevant, including Environmental Context and Resources, Motivation and Goals, Skills, Knowledge, and Beliefs about Capabilities. Although the Australian and New Zealand clinical practice guideline for prevention and management of venous leg ulcers recommend that vascular assessment is conducted for all patients with suspected VLUs, findings from our study indicate vascular assessments are not routinely performed in many primary care settings. Our study also found that a lack of awareness of clinical practice guidelines among clinicians might be one of the main issues for not following the latest clinical recommendations for vascular assessment in venous leg ulcer diagnostics and wound management practice. CONCLUSION We recommend development of theory-informed interventions for clinicians in primary health care settings to optimise VLU management and healing outcomes for patients with VLUs. Implementation and evaluation of these interventions have the potential to reduce the evidence-practice gap in VLU management and optimise healing outcomes.
Collapse
Affiliation(s)
- Carolina Weller
- Monash Nursing and Midwifery, Monash University, Victoria, Australia.
| | - Catelyn Richards
- Monash Nursing and Midwifery, Monash University, Victoria, Australia
| | - Louise Turnour
- Monash Nursing and Midwifery, Monash University, Victoria, Australia
| | - Sally Green
- Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Victoria, Australia
| |
Collapse
|
41
|
Weller CD, Bouguettaya A, Team V, Flegg J, Kasza J, Jayathilake C. Associations between patient, treatment, or wound‐level factors and venous leg ulcer healing: Wound characteristics are the key factors in determining healing outcomes. Wound Repair Regen 2019; 28:211-218. [DOI: 10.1111/wrr.12773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/10/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Carolina D. Weller
- Monash Nursing and Midwifery Level 5 Alfred Centre, 99 Commercial Road, Melbourne Victoria 3004 Australia
| | - Ayoub Bouguettaya
- Monash Nursing and Midwifery Level 5 Alfred Centre, 99 Commercial Road, Melbourne Victoria 3004 Australia
| | - Victoria Team
- Monash Nursing and Midwifery Level 5 Alfred Centre, 99 Commercial Road, Melbourne Victoria 3004 Australia
| | - Jennifer Flegg
- School of Mathematics and StatisticsUniversity of Melbourne Level 3, Old Geology South, Parkville Victoria 3010 Australia
| | - Jessica Kasza
- Monash School of Public Health and Preventative MedicineMonash University 553 St Kilda Road, Melbourne Victoria 3004 Australia
| | - Chathranee Jayathilake
- School of Mathematics and StatisticsUniversity of Melbourne Level 3, Old Geology South, Parkville Victoria 3010 Australia
| |
Collapse
|
42
|
Placke JM, Jockenhöfer F, Benson S, Dissemond J. Venous ulcerations occur more frequently in women on the left lower leg. Can pelvic congestion syndrome be an often undetected cause? Int Wound J 2019; 17:230-231. [PMID: 31701627 PMCID: PMC7948770 DOI: 10.1111/iwj.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jan-Malte Placke
- Department of Dermatology, University of Duisburg-Essen, Germany
| | | | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Germany
| | | |
Collapse
|
43
|
Pacella RE, Tulleners R, McCosker L, Cheng Q, Harding K, Edwards H, Yelland S, Dyer A, McGuiness W, Graves N. Reimbursement for the cost of compression therapy for the management of venous leg ulcers in Australia. Int Wound J 2019; 16:1069-1072. [PMID: 31140713 DOI: 10.1111/iwj.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rosana E Pacella
- University of Chichester, Chichester, UK.,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ruth Tulleners
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura McCosker
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Qinglu Cheng
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Anthony Dyer
- Wound Innovations, Brisbane, Queensland, Australia
| | - William McGuiness
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas Graves
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
44
|
Brain D, Tulleners R, Lee X, Cheng Q, Graves N, Pacella R. Cost-effectiveness analysis of an innovative model of care for chronic wounds patients. PLoS One 2019; 14:e0212366. [PMID: 30840658 PMCID: PMC6402622 DOI: 10.1371/journal.pone.0212366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/31/2019] [Indexed: 11/27/2022] Open
Abstract
Current provision of services for the care of chronic wounds in Australia is disjointed and costly. There is large variability in the way that services are provided, and little evidence regarding the cost-effectiveness of a specialist model of care for treatment and management. A decision-analytic model to evaluate the cost-effectiveness of a specialist wound care clinic as compared to usual care for chronic wounds is presented. We use retrospective and prospective data from a cohort of patients as well as information from administrative databases and published literature. Our results show specialist wound clinics are cost-effective for the management of chronic wounds. On average, specialist clinics were $3,947 cheaper than usual clinics and resulted in a quality adjusted life year gain of 0.04 per patient, per year. Specialist clinics were the best option under multiple scenarios including a different cost perspective and when the cost of a hospital admission was reduced. Current models of care are inefficient and represent low value care, and specialist wound clinics represent a good investment compared to current approaches for the management of chronic wounds in Australia.
Collapse
Affiliation(s)
- David Brain
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Wound Management Innovations Cooperative Research Centre, Brisbane, Australia
- * E-mail:
| | - Ruth Tulleners
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Wound Management Innovations Cooperative Research Centre, Brisbane, Australia
| | - Xing Lee
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Qinglu Cheng
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Wound Management Innovations Cooperative Research Centre, Brisbane, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Wound Management Innovations Cooperative Research Centre, Brisbane, Australia
| | - Rosana Pacella
- Australian Centre for Health Services Innovation (AusHSI), Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Wound Management Innovations Cooperative Research Centre, Brisbane, Australia
- The University of Chichester, West Sussex, United Kingdom
| |
Collapse
|