Jobst UlcerCARE compression hosiery for venous leg ulcers

Central Venous Pathologies: Treatments and Economic Impact

Chronic venous insufficiency (CVI) is responsible for significant costs to society in the form of medical and surgical treatment and, importantly, unmeasurable lost work productivity due to pain and disability. Symptomatic chronic central vein obstruction, a cause of CVI, is potentially treatable using open surgical and endovascular techniques to restore vessel patency. Although upper extremity central vein obstruction often requires an open surgical procedure for durable relief, endovascular stents have proven remarkably useful for iliofemoral disease. Containment of healthcare resources requires accurate diagnosis, durable treatment modalities, and appropriate patient selection so that therapy is targeted to those individuals most likely to benefit. In this regard, identification of appropriate lesions should be based on intravascular ultrasound and 3-dimensional imaging studies. Treatment with dedicated venous stents offers the potential for long-term symptomatic improvement and increased work productivity when used in a well-defined, anatomically appropriate population with significant, symptomatic CVI.

Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol

AIM

To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care.

BACKGROUND

The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care.

DESIGN

Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups.

METHODS

During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014.

DISCUSSION

Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300.

Health service pathways for patients with chronic leg ulcers: identifying effective pathways for facilitation of evidence based wound care

BACKGROUND

Chronic leg ulcers cause long term ill-health for older adults and the condition places a significant burden on health service resources. Although evidence on effective management of the condition is available, a significant evidence-practice gap is known to exist, with many suggested reasons e.g. multiple care providers, costs of care and treatments. This study aimed to identify effective health service pathways of care which facilitated evidence-based management of chronic leg ulcers.

METHODS

A sample of 70 patients presenting with a lower limb leg or foot ulcer at specialist wound clinics in Queensland, Australia were recruited for an observational study and survey. Retrospective data were collected on demographics, health, medical history, treatments, costs and health service pathways in the previous 12 months. Prospective data were collected on health service pathways, pain, functional ability, quality of life, treatments, wound healing and recurrence outcomes for 24 weeks from admission.

RESULTS

Retrospective data indicated that evidence based guidelines were poorly implemented prior to admission to the study, e.g. only 31% of participants with a lower limb ulcer had an ABPI or duplex assessment in the previous 12 months. On average, participants accessed care 2-3 times/week for 17 weeks from multiple health service providers in the twelve months before admission to the study clinics. Following admission to specialist wound clinics, participants accessed care on average once per week for 12 weeks from a smaller range of providers. The median ulcer duration on admission to the study was 22 weeks (range 2-728 weeks). Following admission to wound clinics, implementation of key indicators of evidence based care increased (p < 0.001) and Kaplan-Meier survival analysis found the median time to healing was 12 weeks (95% CI 9.3-14.7). Implementation of evidence based care was significantly related to improved healing outcomes (p < 0.001).

CONCLUSIONS

This study highlights the complexities involved in accessing expertise and evidence based wound care for adults with chronic leg or foot ulcers. Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health.

Diffuse large B-cell lymphoma presenting as a chronic leg ulcer: the importance of repeat tissue biopsy

Ulceration of the leg is often associated with significant consequences for both the individual and society. The diagnosis of chronic leg ulcer is not appropriate. Primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, is a distinct clinicopathological entity. Chemotherapy in the form of R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) is considered to be the first line of treatment for these lymphomas. We report a 69-year-old man who presented with chronic leg ulcer with a first negative biopsy and a diagnosis of PCLBCL, leg type, verified on the subsequent biopsy. This case report emphasises the importance of differential diagnosis of lymphoma in non-healing ulcers and also the value of repeat tissue biopsy in cases with a negative initial result but strong clinical suspicion.

Assessing bacterial burden in wounds: comparing clinical observation and wound swabs

A randomised controlled trial (RCT) was conducted to compare the efficacy of nanocrystalline silver and cadexomer iodine dressings in healing chronic lower leg ulcers. The relationships between wound swab culture results and nurses' clinical assessments of critical colonisation, and between bacterial burden and healing rate, were also examined. There were 281 individuals with leg ulcers recruited. The bacterial burden of wounds was assessed using semi-quantitative wound swabs collected at baseline and intervals during the study. The study found no relationship between the nurses' clinical assessments and bacterial burden as identified from wound swabs in the wounds. A significant difference in wound healing was found with the use of nanocrystalline silver as compared to cadexomer iodine in the first 2 weeks of treatment when nil or low levels of leukocytes, gram positive bacilli, gram positive cocci or gram negative cocci were reported. This study has raised a number of questions regarding the need for further investigation into methods of assessing wound bacterial burden as well as the impact of wound biofilms on wound assessment and treatment.

Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

Moffatt Christine, Kommala Dheerendra, Dourdin Nathalie, Choe Yoonhee. Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. ABSTRACT This study aimed to review available data on the reasons attributed to patient non concordance with compression therapy for the treatment of venous leg ulcers (VLUs), the frequency of non concordance and its effects on clinical outcomes. The biomedical literature was searched for publications on VLUs, compression therapy and concordance over the past 20 years. Physical, aesthetic and cosmetic factors, patient lack of education about VLUs, cost of therapy and issues with treatment by clinicians were all reported to influence concordance with compression therapy. The search identified 10 studies reporting patient concordance with compression stockings or bandages; while non concordance ranged from 2% to 42% of patients in three randomised controlled trials, it was generally higher in real-world studies, ranging from 9.7% to 80%. Another set of six studies indicated that the healing rate was half and the median time to complete healing was twice as long when patients were not concordant. Further, recurrence rates were 2-20 times greater when patients did not comply with the use of stockings following VLU healing. In conclusion, published biomedical literature has documented that non concordance with compression therapy negatively impacts the outcome of VLUs, highlighting the need to improve patient concordance to maximise therapeutic benefits.

Giving information on compression to patients with venous leg ulcers

Venous leg ulceration is a common condition that is more likely to affect the elderly (Alexander House Group, 1992; Coupe and Walukiewicz, 2000) and often has a psychological, as well as physical, impact on the individual (Charles, 1995). Many of those affected are cared for within the community (Maylor, 2002) and may become isolated because of the difficulties caused by their condition (Charles, 1995). Compression bandaging therapy has been shown as an effective treatment for venous leg ulcers (Loftus and Wheatley, 2000) but the bandages must be worn continually during treatment and therefore need to be socially and psychologically acceptable if the patient is to be happy with the treatment regimen (Pudner, 1998). Nurses need to be competent in the care of leg ulcers so that pain and discomfort are minimized and patients need to be willing to accept the treatment given.

Acti-Glide: a simple method of applying compression hosiery

Compression hosiery is often worn to help prevent aching legs and swollen ankles, to prevent ulceration, to treat venous ulceration or to treat varicose veins. However, patients and nurses may experience problems applying hosiery and this can lead to non-concordance in patients and possibly reluctance from nurses to use compression hosiery. A simple solution to applying firm hosiery is Acti-Glide from Activa Healthcare.

JOBST® Opaque compression hosiery in the management of venous disease

Prevention of leg ulceration is a simple process involving assessment, accurate measurement of the leg and application of appropriate compression hosiery along with appropriate care of the skin. Persuasion of at-risk individuals to be aware of and follow prevention options needs to be incorporated in the ongoing health promotion activities of the practitioner (Price and Harding, 1996). This product focus examines the potential contributions of the new JOBST Opaque gradient compression hosiery (with the innovative JOBST soft care yarn) in prevention and management of venous disease and deep vein thrombosis, without sacrificing comfort and style in order to promote patient concordance.