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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, Moore Z. A systematic review of the impact of compression therapy on quality of life and pain among people with a venous leg ulcer. Int Wound J 2024; 21:e14816. [PMID: 38445749 PMCID: PMC10915825 DOI: 10.1111/iwj.14816] [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: 05/24/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
AIM To gain a greater understanding of how compression therapy affects quality of life, this systematic review appraised existing published studies measuring the impact of compression therapy on health quality of life (HRQoL), and pain, among people with venous leg ulcers (VLU). METHOD Five databases were searched, and two authors extracted data and appraised the quality of selected papers using the RevMan risk of bias tool. Due to heterogeneity in the types of compression and instruments used to evaluate HRQoL, meta-analysis was not appropriate; thus, a narrative synthesis of findings was undertaken. RESULTS Ten studies were included, 9 RCTs and one before-after study. The studies employed nine different HRQoL tools to measure the impact of a variety of compression therapy systems, with or without an additional exercise programme, versus other compression systems or usual care, and the results are mixed. With the use of the Cardiff Cardiff Wound Impact Schedule, the SF-8 and the SF-12, study authors found no differences in QoL scores between the study groups. This is similar to one study using QUALYs (Iglesias et al., 2004). Conversely, for studies using EuroQol-5D, VEINES-QOL, SF-36 and CIVIQ-20 differences in QoL scores between the study groups were noted, in favour of the study intervention groups. Two further studies using QUALYs found results that favoured a two-layer cohesive compression bandage and the TLCCB group, respectively. Results for the five studies that assessed pain are also mixed, with one study finding no difference between study groups, one finding that pain increased over the study period and three studies finding that pain reduced in the intervention groups. All studies were assessed as being at risk of bias in one or more domains. CONCLUSION Results were varied, reflecting uncertainty in determining the impact of compression therapy on quality of life and pain among people with a venous leg ulcer. The heterogeneity of the compression systems and the measures used to evaluate HRQoL make it a challenge to interpret the overall evidence. Further studies should strive for homogeneity in design, interventions and comparators to enhance both internal and external validity.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Aicha Sayeh
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Lida InstituteShanghaiChina
| | - Simone Walsh
- Study Feasibility and Activation Manager, RCSI Clinical Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Linda Nugent
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
| | - Denis Harkin
- RCSI University of Medicine and Health SciencesDublinIreland
| | - Niall O'Brien
- The Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
| | | | | | | | - Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandSouthportQueenslandAustralia
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Guo X, Gao Y, Ye X, Zhang Z, Zhang Z. Experiences of patients living with venous leg ulcers: A qualitative meta-synthesis. J Tissue Viability 2024; 33:67-74. [PMID: 38065827 DOI: 10.1016/j.jtv.2023.11.012] [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: 04/05/2023] [Revised: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Venous Leg Ulcer is characterized by a prolonged course, delayed healing and high recurrence rate. Bringing challenges to patient treatment and care.Patients need to control the negative behavioral factors that affect wound healing and recurrence, which seriously affect their quality of life. OBJECTIVE To integrate qualitative research related to the disease experience and feelings of patients with Venous Leg Ulcer and provide references for optimizing patient intervention measures. METHODS We searched databases including Pubmed, CINAHL, EMBASE, Web of Science, PsycINFO, The Cochrane library, ProQuest, CNKI and Wan Fang Data from 2000 to February 2023 to collect qualitative studies on the experiences of patients living with venous leg ulcers. We used the Australian JBI evidence-based healthcare center qualitative research quality evaluation standard to evaluate the quality of literature. After quality assessment, meta-synthesis was used to summarize and explain the results. RESULTS Sixteen studies were eligible for inclusion, and the total number of included individuals was 146. The perceptions of individuals with Venous Leg Ulcer synthesized three overarching themes and their subthemes: disease cognition (Understanding the cause of VLU,Understanding of VLU treatment, Recognition of VLU recurrence); physical experience (Pain symptoms, Other symptoms); and psychological and social experience (psychological impact, health education, economic burden, social relations, response strategies, doctor-patient/nurse-patient relationship). CONCLUSION The lives of patients with venous leg ulcers are influenced by various complex and diverse factors. Healthcare professionals must recognize the patient's emotional needs, establish a multidimensional support system, and promote wound healing through patient self-adjustment.
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Affiliation(s)
- Xiaoyu Guo
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yanqiu Gao
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Xiaoshan Ye
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zexiang Zhang
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhenmei Zhang
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Perry C, Atkinson RA, Griffiths J, Wilson PM, Lavallée JF, Mullings J, Cullum N, Dumville JC. What promotes or prevents greater use of appropriate compression in people with venous leg ulcers? A qualitative interview study with nurses in the north of England using the Theoretical Domains Framework. BMJ Open 2022; 12:e061834. [PMID: 35914912 PMCID: PMC9345063 DOI: 10.1136/bmjopen-2022-061834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers. DESIGN Qualitative interview study with nurses using the Theoretical Domains Framework (TDF). SETTING Three National Health Service Trusts in England. PARTICIPANTS Purposive sample of 15 nurses delivering wound care. RESULTS Nurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as 'shadowing' in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients 'on board' with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use. CONCLUSIONS Rising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it.
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Affiliation(s)
- Catherine Perry
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ross A Atkinson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Paul M Wilson
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jacqueline F Lavallée
- Division of Medical Education, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Julie Mullings
- Northenden Health Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
- MAHSC, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Barriers and enablers to physical activity in people with venous leg ulcers: A systematic review of qualitative studies. Int J Nurs Stud 2022; 135:104329. [DOI: 10.1016/j.ijnurstu.2022.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
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Majeed GM, Lodhia K, Carter J, Kingdon J, Morris RI, Gwozdz A, Saratzis A, Saha P. A Systematic Review and Meta-Analysis of 12-Month Patency After Intervention for Iliofemoral Obstruction Using Dedicated or Non-Dedicated Venous Stents. J Endovasc Ther 2021; 29:478-492. [PMID: 34758673 PMCID: PMC9096580 DOI: 10.1177/15266028211057085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular stenting of the deep venous system has been proposed as a method to treat patients with symptomatic iliofemoral outflow obstruction. The purpose of this systematic review and meta-analysis was to compare the effectiveness of this treatment at 1-year following the development of dedicated venous stents. METHOD AND RESULTS We searched MEDLINE and EMBASE for studies evaluating the effectiveness of venous stent placement. Data were extracted by disease pathogenesis: non-thrombotic iliac vein lesions (NIVL), acute thrombotic (DVT), or post-thrombotic syndrome (PTS). Main outcomes included technical success, stent patency at 1 year and symptom relief. A total of 49 studies reporting outcomes in 5154 patients (NIVL, 1431; DVT, 950; PTS, 2773) were included in the meta-analysis. Technical success rates were comparable among groups (97%-100%). There were no periprocedural deaths. Minor bleeding was reported in up to 5% of patients and major bleeding in 0.5% upon intervention. Transient back pain was noted in 55% of PTS patients following intervention. There was significant heterogeneity between studies reporting outcomes in PTS patients. Primary and cumulative patency at 1 year was: NIVL-96% and 100%; DVT-91% and 97%; PTS (stents above the ligament)-77% and 94%, and; PTS (stents across the ligament)-78% and 94%. There were insufficient data to compare patency outcomes of dedicated and nondedicated venous stents in patients with acute DVT. In NIVL and PTS patients, stent patency was comparable at 1 year. There was inconsistency in the use of validated tools for the measurement of symptoms before and after intervention. When reported, venous claudication, improved in 83% of PTS patients and 90% of NIVL patients, and ulcer healing occurred in 80% of PTS patients and 32% of NIVL patients. CONCLUSIONS The first generation of dedicated venous stents perform comparably in terms of patency and clinical outcomes to non-dedicated technologies at 1 year for the treatment of patients with NIVL and PTS. However, significant heterogeneity exists between studies and standardized criteria are urgently needed to report outcomes in patients undergoing deep venous stenting.
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Affiliation(s)
- Ghulam M Majeed
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Krishan Lodhia
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jemima Carter
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jack Kingdon
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Rachael I Morris
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Adam Gwozdz
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | | | - Prakash Saha
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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Lin HC, Fang CL, Hung CC, Fan JY. Potential predictors of quality of life in patients with venous leg ulcers: A cross-sectional study in Taiwan. Int Wound J 2021; 19:1039-1050. [PMID: 34611998 PMCID: PMC9284624 DOI: 10.1111/iwj.13700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross‐sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing.
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Affiliation(s)
- Hsiao-Ching Lin
- Department of Surgery, Division of Plastic Surgery, Wound Care Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chien-Liang Fang
- Department of Surgery, Division of Plastic Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Tai-Chung City, Taiwan
| | - Chang-Chiao Hung
- Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chia-Yi, Taiwan
| | - Jun-Yu Fan
- Division of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan, Taiwan
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Badesha AS, Singh Bains PR, Singh Bains BR, Khan T. A systematic review and meta-analysis of the treatment of obstructive chronic deep venous disease using dedicated venous stents. J Vasc Surg Venous Lymphat Disord 2021; 10:267-282.e4. [PMID: 33965610 DOI: 10.1016/j.jvsv.2021.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This review aims to summarise the efficacy and safety of dedicated venous stenting for the treatment of obstructive chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also highlighted. METHODS MEDLINE and Embase were searched to identify relevant literature on dedicated venous stents published from January, 2010 to May, 2020. The patient population and study characteristics; procedural characteristics; and outcomes related to post-stenting symptoms, health-related quality of life, patency and complications were analysed. RESULTS Sixteen single-arm observational studies were included from 2,366 studies identified from key-word searches. In total, 1,688 patients were included, of which 70.5% had post-thrombotic syndrome and the remainder had non-thrombotic iliac vein lesions. Nine studies (n = 848), stated whether lesions were stenotic (36.6%) or occlusive (63.4%). Seven studies did not report the lesion characteristics (n = 840). Eight different dedicated venous stent brands were employed. 73.4% of ulcers healed at last follow-up. The remaining symptomatic changes were described narratively; sustained improvements in pain, venous claudication and oedema following stenting were observed. Significant post-stenting improvements in health-related quality of life were noted, as measured by the Chronic Venous Insufficiency Questionnaire-20 instrument. Overall, the most frequently reported complications were in-stent occlusion (n = 204), in-stent stenosis (n = 149) and minor bleeding (n = 77). At 12 months, the primary patency ranged from 59% to 94%, whilst the secondary patency ranged 87% to 100%. The pooled-primary and secondary stent patency rates at 12 months were 74.0% and 90.4%, respectively. The incidence of major and minor bleeding was 1.9% and 4.7%, respectively; bleeding complications were more common in patients undergoing hybrid intervention. CONCLUSION Deep venous stenting using dedicated venous stents is a safe technique to treat obstructive chronic deep venous disease and within the limitations of this study, is associated with good patency outcomes and symptomatic improvement.
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Affiliation(s)
- Arshpreet Singh Badesha
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Prab Rajan Singh Bains
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Bal Rajan Singh Bains
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Taha Khan
- Manchester Vascular Service, Manchester, United Kingdom
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Michaels J, Wilson E, Maheswaran R, Radley S, Jones G, Tong TS, Kaltenthaler E, Aber A, Booth A, Buckley Woods H, Chilcott J, Duncan R, Essat M, Goka E, Howard A, Keetharuth A, Lumley E, Nawaz S, Paisley S, Palfreyman S, Poku E, Phillips P, Rooney G, Thokala P, Thomas S, Tod A, Wickramasekera N, Shackley P. Configuration of vascular services: a multiple methods research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Vascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.
Objectives
To identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.
Design
This was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.
Setting
Specialist vascular inpatient services in England.
Data sources
Modelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.
Interventions
The data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.
Main outcome measures
Systematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.
Results
Systematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.
Limitations
The major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.
Conclusions
There is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.
Future work
Further evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.
Study registration
This study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jonathan Michaels
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Wilson
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ravi Maheswaran
- Department of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Radley
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Thai-Son Tong
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ahmed Aber
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Chilcott
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rosie Duncan
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munira Essat
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Goka
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aoife Howard
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Anju Keetharuth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shah Nawaz
- Department of Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzy Paisley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Edith Poku
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Patrick Phillips
- Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gill Rooney
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven Thomas
- Department of Vascular Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Nyantara Wickramasekera
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Shackley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Morris RI, Pouncey AL, Quintana B, Khan T, Smith A, Saha P, Black SA. Quality of life outcomes for patients undergoing venous stenting for chronic deep venous disease. J Vasc Surg Venous Lymphat Disord 2021; 9:1185-1192.e2. [PMID: 33540137 DOI: 10.1016/j.jvsv.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate change in venous disease-specific quality of life (QoL) after iliac vein stenting for chronic venous outflow obstruction. METHODS We performed a retrospective analysis of all Venous Insufficiency Epidemiological and Economic Study - Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaires completed at a single-center between 2016 and 2019 by patients treated with iliac vein stenting for chronic venous outflow obstruction. Patients were asked to complete the questionnaire at baseline (before stenting) and at subsequent follow-up appointments (after stenting), at 6, 12, 24, and 36 months. The Villalta score was recorded by a venous nurse specialist. The initial unpaired analysis compared all completed VEINES-QoL/Sym and Villalta scores at baseline to all follow-up time-points, and then compared them individually between baseline and each follow-up point. A secondary paired analysis included data only from patients who had completed the questionnaire at baseline and at least one follow-up. RESULTS A total of 385 questionnaires from 187 patients who completed the VEINES-QoL/Sym between 2016 and 2019 were included. The median follow-up was 12 months, 127 patients (68%) were female, and 148 (79%) were treated for post-thrombotic syndrome. The median VEINES-QoL score at baseline was 35.69 (interquartile range [IQR], 20.85-46.67). Significant improvement was observed postoperatively and sustained throughout the study period (6 months, 64.81 [IQR, 38.12-83.88]; 12 months, 60.52 [IQR, 33.6-82.3]; 24 months, 60.37 [IQR, 34.31-80.65]; 36 months, 55.98 [IQR, 39.18-81.47]). The VEINES-Sym scores demonstrated similar improvement. A secondary analysis of paired baseline/follow-up data from 61 patients confirmed significant improvement from baseline for VEINES-QoL (6 months +26.45; 12 months, +25.81; 24 months, +30.09; P ≤ .0001), VEINES-Sym (6 months, +23.86; 12 months, +20.43; 24 months, +27.55; P > .001), and Villalta scores (6 months, -3.7; 12 months, -4.2; 24 months, -6.4; P < .0001). The median Villalta score was 14 (IQR, 10-16). This score improved to 9 (IQR, 5-13) at 6 months of follow-up; to 8 (IQR, 5-11) at 12 months; to 7 (IQR, 4-12) at 24 months; and to 6 (IQR, 3.75-10.25) at 36 months (P ≤ .0001). Good correlation between the Villalta and both VEINES-QoL and SYM scores was observed at follow-up (r = 0.69 and r = 0.71, respectively; P < .0001). CONCLUSIONS Venous disease-specific QoL improves and severity of post-thrombotic syndrome is decreased after iliac vein stenting for chronic venous outflow obstruction. These improvements are sustained at 36-month follow-up.
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Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Anna L Pouncey
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Belen Quintana
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Taha Khan
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Alberto Smith
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Prakash Saha
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
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Bobbink P, Larkin PJ, Probst S. Experiences of Venous Leg Ulcer persons following an individualised nurse-led education: protocol for a qualitative study using a constructivist grounded theory approach. BMJ Open 2020; 10:e042605. [PMID: 33243816 PMCID: PMC7692966 DOI: 10.1136/bmjopen-2020-042605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Venous leg ulcers are slow-healing wounds with a high risk of recurrences. To prevent recurrences and promote healing, different nurse-led educational interventions have been developed. The impact of these interventions on self-management is ambiguous. Also, how persons with a venous leg ulcer experiences these educational sessions are poorly described. AIM This study protocol presents the methodology to provide a comprehensive explanation of participants' journeys-of how they experience their individualised education sessions concerning self-management. METHODS AND ANALYSIS A constructivist grounded theory approach according to Charmaz involving 30 participants will be used. Data will be collected through semistructured face-to-face interviews. Interviews will be transcribed verbatim and analysed with initial and focus coding using MAXQDA. Data collection and data analysis will occur iteratively, focusing on constant comparison to obtain well-developed categories. Categories will be reinforced using existent literature. ETHICS AND DISSEMINATION This pre-results study is embedded in a clinical trial (NCT04019340) and approved by ethical committee of the canton of Geneva (CCER: 2019-01964). A theory will emerge from participants' journeys informing future education sessions for patients with venous leg ulcers. The findings will be disseminated through peer-reviewed publications and communications.
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Affiliation(s)
- Paul Bobbink
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Philip J Larkin
- University of Lausanne and University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
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11
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Occurrence and Severity of Pain in Patients with Venous Leg Ulcers: A 12-Week Longitudinal Study. J Clin Med 2020; 9:jcm9113399. [PMID: 33114118 PMCID: PMC7690800 DOI: 10.3390/jcm9113399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study was to analyze the dynamics of pain severity and its predictors in a group of patients with chronic venous leg ulcers. Methods: A 12-week longitudinal study included 754 patients with chronic venous leg ulcers. Subjective severity of pain was measured at weekly intervals with an 11-point visual analogue scale (VAS). Results: A significant decrease in VAS scores has been observed throughout the entire analyzed period. Higher severity of pain during follow-up was independently predicted by the presence of pus and/or unpleasant smell from the ulceration during the first visit, as well as by the occurrence of posterior and/or circumferential ulcers. The presence of ulcer redness during the first visit was associated with lesser pain severity; also, a significant interaction effect between the ulceration redness and warmth was observed. Conclusions: Implementation of complex holistic care may contribute to a substantial decrease in the occurrence and severity of pain in a patient with venous leg ulcers. Pain control seems to depend primarily on clinical parameters and topography of venous ulcers. The predictors of pain severity identified in this study might be considered during the planning of tailored care for patients with venous leg ulcers.
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12
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Jull A, Slark J, Parsons J. Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 154:1304-1311. [PMID: 30285080 DOI: 10.1001/jamadermatol.2018.3281] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized. Objective To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression. Data Sources The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017. Study Selection Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis. Data Extraction and Synthesis Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model. Main Outcomes and Measures The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported. Results Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004). Conclusions and Relevance The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced.
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Affiliation(s)
- Andrew Jull
- School of Nursing, University of Auckland, New Zealand.,National Institute for Health Innovation, University of Auckland, New Zealand
| | - Julia Slark
- School of Nursing, University of Auckland, New Zealand
| | - John Parsons
- School of Nursing, University of Auckland, New Zealand
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Docking R, Boateng J, Catanzano O, Schofield P. A Preliminary Study of Pain Relieving Dressings for Older Adults With Chronic Leg Ulcers From the Provider’s Perspective: A Qualitative Study. J Pain Palliat Care Pharmacother 2018; 32:71-81. [DOI: 10.1080/15360288.2018.1527801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Aim Appraise the evidence on the outcomes of Leg Clubs on ulcer healing, psychosocial outcomes, patient safety, cost and experiences of Leg Club members. Background The Leg Club is a community-based social model of care in 30 UK locations and nine overseas for treating patients with chronic leg wounds. However, its cumulative effectiveness has not been reviewed to-date. Methods Systematic review of primary research relating to the impact and quality of care of Leg Clubs treating patients with leg ulcers. Six electronic databases were systematically searched using the MeSH term ‘leg ulcer’, including other representative terms, in combination with ‘Leg Club’. The quality of individual studies was assessed using appraisal tools. The confidence in the quantitative evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE); and the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) assessed the quality of qualitative findings. Findings A total of 17 relevant publications were identified. Out of the 17 articles, four publications represent findings from randomised controlled trial (RCT). Thus, evidence from 14 independent studies involving at least 532 participants were included in the synthesis of this review. The quality of the evidence varied across the different outcomes and were mostly low or of very low quality. Findings from one underpowered RCT from Australia reporting on clinical, patient-reported outcomes and economic outcomes were evaluated as moderate quality. Studies indicate that the Leg Club model has a positive impact on ulcer healing and recurrence, mood, sleep, quality of life and pain. Moreover, only three studies assessed wound infections and reported no infections had occurred during treatment at the Leg Clubs. Economic evaluations find Leg Clubs to be probably more cost-effective than usual care. Both patients and nurses projected positive views about the Leg Clubs, with particular emphasis on improved social interactions and delivery of patient-centred care.
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15
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Jull A, Muchoney S, Parag V, Wadham A, Bullen C, Waters J. Impact of venous leg ulceration on health-related quality of life: A synthesis of data from randomized controlled trials compared to population norms. Wound Repair Regen 2018; 26:206-212. [DOI: 10.1111/wrr.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew Jull
- School of Nursing; University of Auckland; Auckland New Zealand
- National Institute for Health Innovation; University of Auckland; Auckland New Zealand
| | - Sara Muchoney
- National Institute for Health Innovation; University of Auckland; Auckland New Zealand
| | - Varsha Parag
- National Institute for Health Innovation; University of Auckland; Auckland New Zealand
| | - Angela Wadham
- National Institute for Health Innovation; University of Auckland; Auckland New Zealand
| | - Chris Bullen
- National Institute for Health Innovation; University of Auckland; Auckland New Zealand
| | - Jill Waters
- Auckland District Health Board; Auckland New Zealand
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Salomé GM, Ferreira LM. Impact of non-adherent Ibuprofen foam dressing in the lives of patients with venous ulcers. ACTA ACUST UNITED AC 2018; 44:116-124. [PMID: 28658329 DOI: 10.1590/0100-69912017002002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/15/2016] [Indexed: 01/10/2023]
Abstract
Objective to evaluate pain in patients with lower limb venous ulcer who used non-adherent Ibuprofen foam dressing (IFD). Methods we conducted a prospective study of patients with lower limb venous ulcers treated from April 2013 to August 2014. We used the Numerical Scale and McGill Pain Questionnaire, performing the assessments at the moment of inclusion of the patient in the study and every eight days thereafter, totaling five consultations. We divided the patients into two groups: 40 in the Study Group (SG), who were treated with IFD, and 40 in the Control Group (CG), treated with primary dressing, according to tissue type and exudate. Results at the first consultation, patients from both groups reported intense pain. On the fifth day, SG patients reported no pain and the majority of CG reported moderate pain. Regarding the McGill Pain Questionnaire, most patients of both groups reported sensations related to sensory, affective, evaluative and miscellaneous descriptors at the beginning of data collection; after the second assessment, there was slight improvement among the patients in the SG. After the third consultation, they no longer reported the mentioned descriptors. CG patients displayed all the sensations of these descriptors until the fifth visit. Conclusion non-adherent Ibuprofen foam dressing is effective in reducing the pain of patients with venous ulcers.
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Affiliation(s)
- Geraldo Magela Salomé
- - Sapucaí Valley University, Professional Master's Degree in Applied Health Sciences, Pouso Alegre, MG, Brazil
| | - Lydia Masako Ferreira
- - Sapucaí Valley University, Professional Master's Degree in Applied Health Sciences, Pouso Alegre, MG, Brazil
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17
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Moffatt C, Murray S, Keeley V, Aubeeluck A. Non-adherence to treatment of chronic wounds: patient versus professional perspectives. Int Wound J 2017; 14:1305-1312. [PMID: 28857457 PMCID: PMC7950059 DOI: 10.1111/iwj.12804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022] Open
Abstract
The reasons for the non-adherence to treatment for wound healing are complex and fall into unintentional and intentional categories. This study explored intentional and unintentional non-adherence to treatment from patient/carer and health care professional perspectives. Patients with wounds receiving ALLEVYN Life dressings (n = 20) and patients not receiving ALLEVYN Life dressings who were deemed to be non-adherent to treatment regimes (n = 6) took part in semi-structured interviews to explore their experiences of living with a wound, treatment and intentional and unintentional non-adherence. Three focus groups of health care professionals explored issues surrounding non-adherence to treatment regimes. Groups included nurses and doctors (n = 25). We found that relationships between participants and health care professionals varied in character across the groups. All participants expressed reasons for both intentional and unintentional adherence. Many reasons for intentional non-adherence are related to comfort and working the regime around patients' lives. Health care professionals considered the most common form of non-adherence to be unintentional. However, patients describe the most common form of non-adherence as being intentional. The relationship between patients and health care professionals varied in character between the groups. Discrepancies between professional and patient perspectives need to be reconciled and addressed to improve adherence to treatment regimes.
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Affiliation(s)
- Christine Moffatt
- Royal Derby HospitalSchool of Health Sciences, University of NottinghamDerbyUK
| | | | | | - Aimee Aubeeluck
- Royal Derby HospitalSchool of Health Sciences, University of NottinghamDerbyUK
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18
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Fearns N, Heller-Murphy S, Kelly J, Harbour J. Placing the patient at the centre of chronic wound care: A qualitative evidence synthesis. J Tissue Viability 2017; 26:254-259. [DOI: 10.1016/j.jtv.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/08/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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Phillips P, Lumley E, Duncan R, Aber A, Woods HB, Jones GL, Michaels J. A systematic review of qualitative research into people's experiences of living with venous leg ulcers. J Adv Nurs 2017; 74:550-563. [PMID: 28960514 DOI: 10.1111/jan.13465] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
AIM To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the perspective of patients with venous leg ulceration. BACKGROUND Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health-related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration. DESIGN Qualitative evidence synthesis (using framework synthesis). DATA SOURCES Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015. REVIEW METHODS Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations. RESULTS Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment-related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood. CONCLUSION The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient-reported outcome measures for use with this population.
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Affiliation(s)
- Patrick Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elizabeth Lumley
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rosie Duncan
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Ahmed Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Georgina L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Jonathan Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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The Use of PRISM (Pictorial Representation of Illness and Self Measure) in Patients Affected by Chronic Cutaneous Ulcers. Adv Skin Wound Care 2017; 28:489-94. [PMID: 26479691 DOI: 10.1097/01.asw.0000471977.92623.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE PRISM (Pictorial Representation of Illness and Self Measure) is a nonverbal visualization instrument. The authors chose to use this tool to avoid the limitation of the other tests for the assessment of quality of life by using interview methods that depend on the cognitive and cultural level of the patient. The aim of the study was to assess the impact on the quality of life of different types of chronic wounds using the PRISM test. SETTING The PRISM test was administered by the same medical student to each patient visiting the dermatology department for a routine visit and medication. PARTICIPANTS The PRISM test was administered to 77 patients with chronic cutaneous ulcers referred to the Dermatology Department of the Spedali Civili of Brescia, Italy. MATERIALS AND METHODS The authors analyzed the "Self-llness-Separation"' (SIS) value, which resulted from the PRISM test, and related it to sex, age, and ulcer etiology. RESULTS Considering all categories, the mean SIS was 9.58 cm; a different perception of the disease between the sexes was noted and also in the subgroups based on the ulcer's different etiology. In addition, the age of the affected patients influenced the SIS value. CONCLUSIONS PRISM is an easy and sensitive instrument to record information about the patient's expectations and suffering in order to improve the overall physician-patient relationship.
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21
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Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery. Int J Behav Med 2016; 23:714-721. [DOI: 10.1007/s12529-016-9567-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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22
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Pedras S, Carvalho R, Pereira MG. Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality. J Health Psychol 2016; 23:1488-1498. [DOI: 10.1177/1359105316656769] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The goal of this study was to analyze the relationships between anxiety, depression symptoms, and functionality as predictors of quality of life, in patients with diabetic foot ulcer taking in consideration clinical variables. A sample of 202 participants indicated for a lower limb amputation surgery, were assessed before the surgery, on physical and mental quality of life, functionality, a anxiety and depression symptoms. Anxiety and depression symptoms, as well as functionality level were predictors of mental quality of life. Pain, having a first amputation, depression symptoms, and functionality were predictors of physical quality of life. In order to promote quality of life, psychological variables should be targeted, in clinical practice.
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Affiliation(s)
- Susana Pedras
- University of Minho, School of Psychology, Braga, Portugal
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González de la Torre H, Quintana-Lorenzo ML, Perdomo-Pérez E, Verdú J. Correlation between health-related quality of life and venous leg ulcer's severity and characteristics: a cross-sectional study. Int Wound J 2016; 14:360-368. [PMID: 27112627 DOI: 10.1111/iwj.12610] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
Abstract
This study aims to determine health-related quality of life (HRQoL) in patients suffering with venous ulceration and to correlate wound's severity status with HRQoL loss as well as identify the aspects of HRQoL most negatively affected by the presence of venous ulcers. In this observational, cross-sectional, descriptive, analytical multi-centre study, data was compiled over a period of 3·5 months. Thrity-four patients with venous ulceration were recruited. The RESVECH 2·0 scale was used to monitor wounds. The MAID scale was used to measure wound's severity. The Charing Cross Venous Ulcer Questionnaire (CCVUQe) (Spanish version) was used to evaluate quality of life. The mean CCVUQe score was 60·58 ± 16·04. The HRQoL dimension most affected was 'Emotional state' (mean score = 77. 67 ± 17·34). The average RESVECH 2.0 score for the wounds was 13·15 ± 5·07. A statistically significant association between total CCVUQ-e score and total RESVECH 2.0 score was detected [Pearson correlation coefficient r = 0·546 (P ≤ 0·001)]. Venous ulcers affect patients' HRQoL, particularly their emotional status. There is a relationship between the severity of the wound and loss of HRQoL. The presence of non-viable tissue, poor exudate control and infection all determine loss of HRQoL. New studies are needed to confirm these findings.
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Affiliation(s)
- Héctor González de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - María L Quintana-Lorenzo
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Estrella Perdomo-Pérez
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract 2015; 29:96-102. [PMID: 25658932 DOI: 10.1097/hnp.0000000000000072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.
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Stephen-Haynes J, Callaghan R. Zinc-impregnated and odour-control two-layer compression. ACTA ACUST UNITED AC 2015; 24:S52, S54-7. [DOI: 10.12968/bjon.2015.24.sup15.s52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jackie Stephen-Haynes
- Professor of Tissue Viability, Birmingham City University and Consultant Nurse in Tissue Viability, Worcester Health & Care Trust
| | - Rosie Callaghan
- Tissue Viability Specialist Nurse, Worcester Health & Care Trust
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Carr C, Shadwell J, Regan P, Hammett S. An evaluation of short-stretch compression systems for chronic lower-limb leg ulcers. Br J Community Nurs 2015; Suppl Wound Care:S38, S40-7. [PMID: 25757382 DOI: 10.12968/bjcn.2015.20.sup3.s38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria included patients with untreated peripheral disease, ankle-brachial pressure index (ABPI)<0.5 or those unable to consent. Staff were asked to rate performance, wear time, fluid handling and conformability. Wound tissue types improved significantly for n=16 (84%) patients. Pain scores reduced significantly by week 2, n=11 (58%) patient leg ulcers had improved, n=2 (11%) patients in standard compression noted a marked reduction in malodour and sloughy tissue. n=16 (84%) rated the overall performance as 'very good' or 'good'. A detailed cost analysis was undertaken on one patient, suggesting a potential cost saving of £186.92 per month and a cost efficiency saving of 43.4%.
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Affiliation(s)
- Caryn Carr
- Lead Tissue Viability Nurse Specialist, Southern Health NHS Foundation Trust
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Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care 2014; 23:601-12. [DOI: 10.12968/jowc.2014.23.12.601] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Green
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
| | - R. Jester
- Professor; Faculty of Health and Social Care, London South Bank University, London, SEI 0AA
| | - R. McKinley
- Professor of Education in General Practice; Keele University Medical School, Staffordshire, ST5 5BG
| | - A. Pooler
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
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Ousey K, Edward KL. Exploring Resilience When Living with a Wound - An Integrative Literature Review. Healthcare (Basel) 2014; 2:346-55. [PMID: 27429282 PMCID: PMC4934596 DOI: 10.3390/healthcare2030346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/10/2014] [Accepted: 08/26/2014] [Indexed: 01/13/2023] Open
Abstract
The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound.
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Affiliation(s)
- Karen Ousey
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
| | - Karen-Leigh Edward
- Faculty of Health Sciences, Australian Catholic University, Locked Bag 4115 Fitzroy MDC, Victoria 3065, Australia.
- Nursing Research Unit, St Vincent's Private Hospital Melbourne, 59-61 Victoria Pde Fitzroy, Victoria 3065, Australia.
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Sustaining Behavior Changes Following a Venous Leg Ulcer Client Education Program. Healthcare (Basel) 2014; 2:324-37. [PMID: 27429280 PMCID: PMC4934594 DOI: 10.3390/healthcare2030324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/18/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022] Open
Abstract
Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the “Leg Ulcer Prevention Program” (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n = 49) examination of behavior maintenance across an average 8 to 9 months period. Physical activity levels increased over time. Leg elevation, calf muscle exercises, and soap substitute use were seen to fluctuate over the follow up time points. The use of a moisturizer showed gradual decline over time. The provision of a client-focused venous leg ulcer program was associated with behavior changes that had varied sustainability across the evaluation period.
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Smith G, Simon D, McDermott E, Gibson E. Incorporating novel solutions to lower-limb problems into compression formularies. Br J Community Nurs 2014; Suppl:S37-44. [PMID: 24912834 DOI: 10.12968/bjcn.2014.19.sup6.s37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigates the effect of a new short-stretch two-layer compression system in eight patients with common chronic lower-limb conditions in three locations in the UK. Chronic leg ulcers are the most common type of lower-limb ulceration with 70% caused by chronic venous hypertension. An appropriate level of compression is proven to heal chronic venous leg ulcers. The study was only a small sample of patients; however, the underlying conditions included chronic venous eczema, diabetes, sarcoma, cellulitis and mixed-aetiology ulcers. During the study, the UK experienced some of the hottest temperatures in the last 30 years. This had an impact on five patients, who noted an increase in malodour associated with their leg ulcers. CoFlex TLC (Aspen Medical Europe Ltd) foam comfort layer is impregnated with cyclodextrin-a naturally based oligosaccharide known to reduce malodour. The zinc-impregnated foam bandages in this study were viewed very favourably by both patients and staff, particularly those who had chronic venous eczema.
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Affiliation(s)
- Glenn Smith
- Clinical Nurse Specialist for Nutrition and Tissue Viability, Isle of Wight NHS Trust
| | - Deborah Simon
- Tissue Viability Lead, 5 Boroughs Partnership NHS Foundation Trust
| | - Emma McDermott
- District Nurse Team Leader, 5 Boroughs Partnership NHS Foundation Trust
| | - Elaine Gibson
- East Kent University Hospital NHS Foundation Trust and Clinical Manager, Aspen Medical Europe
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Varga MA, Holloway SL. The lived experience of the wound care nurse in caring for patients with pressure ulcers. Int Wound J 2014; 13:243-51. [PMID: 24779529 DOI: 10.1111/iwj.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/10/2014] [Accepted: 03/21/2014] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to report the lived experience of the wound care nurse (WCN) in caring for patients with pressure ulcers (PU). WCN play an important role in caring for patients with PU, but the effect on caring for individuals with such wounds is poorly understood. A descriptive and interpretative study on the life worlds of spatiality, temporality, relationality and corporeality was carried out. Utilising the hermeneutic Heideggerian phenomenology, data were collected over a 3-month period in 2012 using in-depth interviews with five WCN. The interviews revealed eight themes: 'challenge', 'making sense of it all', 'coping and self-care', 'advocate of mine/making a difference', 'knowledge and technology', 'we have seen what can happen', 'holistic caring' and 'frustration'. Twenty-five sub-themes were also identified. WCN experienced a demanding and rewarding role of caring, influenced by the environment and the challenges with individuals living with PU. This study demonstrated an enriching yet challenging role. Recommendations for WCN, health care authorities and education providers include raising awareness of the importance of self-care, greater recognition of the effect of this role on patients with PU and changing education to include reflective practice and resilience strategies.
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Affiliation(s)
| | - Samantha L Holloway
- Wound Healing Research Unit, Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
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Franks PJ, Morgan PA. Health-related quality of life with chronic leg ulceration. Expert Rev Pharmacoecon Outcomes Res 2014; 3:611-22. [DOI: 10.1586/14737167.3.5.611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- D. Upton
- Institute of Health and Society, University of Worcester, UK
| | - A. Andrews
- Institute of Health and Society, University of Worcester, UK
| | - P. Upton
- Institute of Health and Society, University of Worcester, UK
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Brown A. Evaluating the reasons underlying treatment nonadherence in VLU patients: introducing the VeLUSET Part 1 of 2. J Wound Care 2014; 23:37, 40, 42-4, passim. [DOI: 10.12968/jowc.2014.23.1.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Brown
- East of England Strategic Health Authority, UK
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Upton D, Andrews A. Negative pressure wound therapy: improving the patient experience Part 2 of 3. J Wound Care 2013; 22:582, 584-91. [PMID: 24225598 DOI: 10.12968/jowc.2013.22.11.582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the clear benefits of negative pressure wound therapy (NPWT) as a treatment for wounds, it is essential that greater focus is given to the patient experience of this treatment. In particular, it is important that any unpleasant consequences, such as pain, stress, and skin trauma are minimised, so as to promote quality of life and healing. This article presents part two of three studies which aim to explore ways in which the patient experience of NPWT can be improved. In this study, the views of wound care clinicians (n=12) were investigated in greater depth through semi-structured interviews. Findings indicate a pressing need to minimise pain, particularly through ongoing assessment and collaboration with patients, and also through the use of appropriate dressings, films and other products that promote patient comfort. Additionally, it is evident that greater education is needed for both nurses and patients about NPWT, in order to promote high-quality care and patient wellbeing.
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Affiliation(s)
- D Upton
- Professor of Health Psychology, Institute of Health and Society, University of Worcester, UK
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Upton D, Andrews A. Negative pressure wound therapy: improving the patient experience Part 1 of 3. J Wound Care 2013; 22:552-7. [DOI: 10.12968/jowc.2013.22.10.552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D. Upton
- Institute of Health and Society, University of Worcester, UK
| | - A. Andrews
- Institute of Health and Society, University of Worcester, UK
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Kapp S, Miller C, Donohue L. The clinical effectiveness of two compression stocking treatments on venous leg ulcer recurrence: a randomized controlled trial. INT J LOW EXTR WOUND 2013; 12:189-98. [PMID: 24043677 DOI: 10.1177/1534734613502034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous leg ulcers affect up to 3% of people aged 65 years and older, present significant pain and suffering, and are associated with long episodes of health care. These chronic wounds recur at rates of up to 69%. A double blind randomized controlled trial was conducted in a home nursing setting in Victoria, Australia to compare the effectiveness of a 23 to 32 mm Hg (moderate) and a 34 to 46 mm Hg (high) compression stocking treatment on venous ulcer recurrence. Participants (n = 100) were monitored for 26 weeks. Study wound recurrence was low (11.8%), and the average time to recurrence was 77.91 days. Adherence to treatment was low (44%) with nonadherence significantly higher in the high-compression stocking group, χ(2)(1) = 8.827, P = .003. Regression modeling found that adherence to treatment significantly predicted study wound recurrence, Wald(1) = 7.917, P = .005. Estimated hazard ratios showed that participants who did not adhere were 9 times more likely to have their wound recur. Risk of recurrence was 3 times greater for those randomized to moderate compression when compared with the high-compression stocking. Implementing strategies that optimize adherence to compression will reduce ulcer recurrence. Once this has been realized, the potential to adhere to high-compression treatment would further reduce the risk of recurrence.
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Knowledge Deficits and Information-Seeking Behavior in Leg Ulcer Patients. J Wound Ostomy Continence Nurs 2013; 40:381-7. [DOI: 10.1097/won.0b013e31829a2f4d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adni T, Martin K, Mudge E. The psychosocial impact of chronic wounds on patients with severe epidermolysis bullosa. J Wound Care 2013; 21:528, 530-6, 538. [PMID: 23413491 DOI: 10.12968/jowc.2012.21.11.528] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the lived experience of individuals with chronic wounds associated with dystrophic and junctional epidermolysis bullosa (EB),to improve understanding and, therefore, enhance the care provided to this group of patients by acquiring in depth data on the psychosocial issues that affect them. METHOD A phenomenological study using interpretive phenomenological analysis was employed. A purposive sampling method was used with six individuals replying to postal invitation to participate. RESULTS Following one-to-one interviews, six superordinate themes were identified. These were: coping, pain, perceptions, emotional impact, social impact and support network, each with subordinate themes. All of the superordinate themes have been identified by previous research into chronic wounds, burns and disfiguring conditions; however, new subordinate themes arose. CONCLUSION This study highlighted the need for individuals with EB to have a multidisciplinary approach to their care with a particular need for pain management, psychological intervention and nursing support from those whom clients perceive as understanding the requirements of patients with EB. Further research into identity issues in individuals with EB is advocated. DECLARATION OF INTEREST There were no external sources of funding for this study.The authors have no conflicts of interest to declare.
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Affiliation(s)
- T Adni
- EB Service, Dermatology Department, Heart of England NHS Foundation Trust, UK.
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Taverner T, Closs SJ, Briggs M. The journey to chronic pain: a grounded theory of older adults' experiences of pain associated with leg ulceration. Pain Manag Nurs 2013; 15:186-98. [PMID: 23402894 DOI: 10.1016/j.pmn.2012.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
This study aimed to develop a grounded theory to describe and explain the experience of pain and its impact, as reported by the individuals who had pain associated with chronic leg ulceration. The Strauss and Corbin grounded theory approach was used. In-depth interviews were undertaken with 11 people aged ≥ 65 years from Leeds in the north of England. All participants were cared for by home care nurses and had painful leg ulceration. The emergent grounded theory centered on a core category of "The journey to chronic pain." The theory suggested a trajectory consisting of three phases that the patient experiences, where the end result is a chronic pain syndrome. In phase 1, leg ulcer pain has predominantly acute nociceptive properties, and if this is not managed effectively, or ulcers do not heal, persistent pain may develop with both nociceptive and neuropathic properties (i.e., phase 2). If phase 2 pain is not managed effectively, patients may then develop refractory long-term pain (phase 3). Those who progress to phase 3 tend to experience negative consequences such as insomnia, depression, and suicidal ideation. Only when health care professionals understand and acknowledge the persistent and long-term nature of the pain in this patient group can the pain be managed effectively.
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Affiliation(s)
- Tarnia Taverner
- University of British Columbia, Vancouver, British Columbia, Canada.
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Green J, Jester R, McKinley R, Pooler A. Patient perspectives of their leg ulcer journey. J Wound Care 2013; 22:58, 60-2, 64-6. [DOI: 10.12968/jowc.2013.22.2.58] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Green
- Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - R. Jester
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Education, HEFT, Birmingham
| | - R. McKinley
- Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - A. Pooler
- Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
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Abstract
The World Health Organization (WHO) (2012) estimates that half a billion adults in the world are classified as obese. This article outlines initiatives that could be undertaken by district nurses to reduce the prevalence of obesity and improve the statistics relating to morbidity and mortality from obesity-related conditions. As district nurses already have a complex caseload, the initiatives discussed by the author are simple enough to be incorporated into the assessments and health screening already being undertaken.
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Affiliation(s)
- Lynn Sellwood
- Staffordshire ans Stoke on Trent Partnership Trust, UK.
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Abstract
BACKGROUND Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used. OBJECTIVES To determine the effects of topical agents or dressings for pain in venous leg ulcers. SEARCH METHODS For this third update the following databases were searched: Cochrane Wounds Group Specialised Register (searched 9 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4); Ovid MEDLINE (2009 to April Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 08, 2012); Ovid EMBASE (2009 to 2012 Week 18); and EBSCO CINAHL (2009 to May 2 2012). No date or language restrictions were applied. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of topical agents or dressing for the treatment of pain in venous ulcers were included. DATA COLLECTION AND ANALYSIS Two review authors independently performed trial selection, data extraction and risk of bias assessment. MAIN RESULTS Six trials (343 participants) evaluated Eutectic Mixture of Local Anaesthetics (EMLA): lidocaine-prilocaine cream for the pain associated with ulcer debridement. The between-group difference in pain measured on a 100 mm scale was statistically significant in favour of EMLA (MD -20.65, 95% CI -12.19 to -29.11). No significant between-group differences in burning or itching were observed.Two trials (470 participants with venous leg ulcers) evaluated ibuprofen slow-release foam dressings for persistent venous leg ulcer pain. Compared with local best practice, significantly more participants in the ibuprofen dressing group achieved the outcome of >50% of the total maximum pain relief score between day 1 and day 5 than participants in the local best practice group (RR 1.63, 95% CI 1.24 to 2.15). The number needed to treat was 6 (95% CI 4 to 12). In the second trial, compared with an identical non-ibuprofen foam dressing, there was no statistically significant difference in the proportion of participants experiencing slight to complete pain relief on the first evening of treatment.Limited data were available to assess healing rates or adverse events. AUTHORS' CONCLUSIONS There is some evidence to suggest that ibuprofen dressings may offer pain relief to people with painful venous leg ulcers. EMLA (5%) appears to provide effective pain relief during the debridement of venous leg ulcers. Further research should consider standardised pain assessment methods and assess both the effect on ulcer healing and the impact of long term use of these treatments.
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Greenwood M, Grothier L. Effective patient outcomes using a gelling fibre dressing. Br J Community Nurs 2012; Suppl:S42-S47. [PMID: 22584184 DOI: 10.12968/bjcn.2012.17.sup3.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Exudate has an important function within the process of wound healing; however, maintaining the wound bed at the optimum moisture level is a key factor in the wound's progression (Moore, 2005). A patient's experience of living with a wound is often tarnished when leakage caused by the fluid discharged is unmanageable, which can subsequently have a negative effect on daily living and quality of life (Edwards, 2003). Such wounds can cause substantial pain, suffering, loss of self-esteem, family distress, and a considerable financial cost to the NHS (Dowsett, 2011). It is estimated that 2-3% of the local healthcare budget will be spent on chronic wound management (Posnett et al, 2009). This article will present three case studies demonstrating the effective use of a gelling fibre dressing (Durafiber, Smith & Nephew) used on different wound aetiologies, including the clinical benefits and patient outcomes.
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Abstract
AIM to explore patients' lived experience of using negative pressure wound therapy (NPWT). METHOD A phenomenological approach based on Heideggerian philosophy was undertaken. The study population consisted of 6 participants who had used NPWT for a minimum of 4 weeks. Semi-structured interviews were transcribed verbatim and investigated for themes using interpretative phenomenological analysis. RESULTS Three superordinate themes were identified: altered sense of self, new culture of technology and leading a restricted life. Themes associated with an altered sense of self and leading a restricted life were in keeping with other wound care studies. Identification of barriers such as managing technical difficulties, practicalities of daily living, and improved understanding of NPWT for both patient and practitioner, can foster hope and reduce anxiety. CONCLUSIONS Recommendations include holistic assessment of patient suitability for NPWT, education for patients and health professionals on NPWT, use of lighter, quieter devices, and the inclusion of a technology domain in future health-related quality of life studies on NPWT.
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Abstract
Venous leg ulcers are a major health issue in terms of financial burden to the NHS, nurses' input, and physical, psychological and social impact to the patient. The best practice management of leg ulcers is the application of high compression, which is a complex task and requires substantial skill and knowledge. Healing and recurrence rates are poor in some cases and this adds to the physical and psychosocial impact, as well as the financial burden. Many of the sequelae of ulceration hinder patients' ability to tolerate treatment. Nurses must acknowledge the difficulties patients face and become skilled in holistic assessment, care planning and the delivery of patient-focused best practice.
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Affiliation(s)
- Marie Todd
- Specialist Lymphoedema Service, NHS Greater Glasgow and Clyde
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47
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Taverner T, Closs J, Briggs M. A meta-synthesis of research on leg ulceration and neuropathic pain component and sequelae. ACTA ACUST UNITED AC 2012; 20:S18, S20, S22-27. [PMID: 22067932 DOI: 10.12968/bjon.2011.20.sup12.s18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leg ulceration represents a substantial health problem, and pain is likely to be an associated symptom. The aim of this meta-synthesis was to undertake a systematic review of qualitative studies investigating the experience of chronic painful leg ulceration. This study undertook the meta-synthesis approach described by Sandelowski and Barroso (2003), which is a synthesis and re-interpretation of the findings from several qualitative studies. Findings were extracted and synthesized. The overarching theme was that patients with chronic leg ulceration suffer from persistent pain with associated sequelae. Word descriptors used by participants also suggested that patients have neuropathic pain. In addition, findings from the meta-synthesis suggested that pain associated with chronic leg ulcer may have a neuropathic pain component. Pain associated with leg ulceration is likely to have nociceptive properties as well as neuropathic properties. If neuropathic pain is not identified and managed effectively, patients are at risk of developing a chronic pain condition with associated sequelae, such as poor sleep, depression and suicidal ideation. It is proposed that early identification and management may enable appropriate pain management which may prevent or reduce the associated risks.
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Affiliation(s)
- Tarnia Taverner
- University of British Columbia, School of Nursing, Vancouver
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48
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49
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Painful leg ulcers: community nurses’ knowledge and beliefs, a feasibility study. Prim Health Care Res Dev 2011; 12:379-92. [DOI: 10.1017/s1463423611000302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Groah SL, Libin A, Spungen M, Nguyen KL, Woods E, Nabili M, Ramella-Roman J, Barritault D. Regenerating matrix-based therapy for chronic wound healing: a prospective within-subject pilot study. Int Wound J 2011; 8:85-95. [PMID: 21078132 PMCID: PMC7950993 DOI: 10.1111/j.1742-481x.2010.00748.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to determine whether a skin-specific bioengineered regenerating agent (RGTA) heparan sulphate mimetic (CACIPLIQ20) improves chronic wound healing. The design of this article is a prospective within-subject study. The setting was an urban hospital. Patients were 16 African-American individuals (mean age 42 years) with 22 wounds (mean duration 2.5 years) because of either pressure, diabetic, vascular or burn wounds. Two participants each were lost to follow-up or removed because of poor compliance, resulting in 18 wounds analysed. Sterile gauze was soaked with CACIPLIQ20 saline solution, placed on the wound for 5 min, then removed twice weekly for 4 weeks. Wounds were otherwise treated according to the standard of care. Twenty-two percent of wounds fully healed during the treatment period. Wounds showed a 15.2-18.1% decrease in wound size as measured by the vision engineering research group (VERG) digital wound measurement system and total PUSH scores, respectively, at 4 weeks (P = 0.014 and P = 0.003). At 8 weeks there was an 18-26% reduction in wound size (P = 0.04) in the remaining patients. Wound-related pain measured by the visual analogue pain scale and the wound pain scale declined 60% (P = 0.024) and 70% (P = 0.001), respectively. Patient and clinician satisfaction remained positive throughout the treatment period. It is concluded that treatment with CACIPLIQ20 significantly improved wound-related pain and may facilitate wound healing. Patient and clinician satisfaction remained high throughout the trial.
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Affiliation(s)
- Suzanne L Groah
- SCI Research Center, National Rehabilitation Hospital, Washington, DC 20010, USA.
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