1
|
Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2024. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
Collapse
Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Şişman H, Alptekin D, İnce S, Akıl Y. Evaluation of earthquake-related wounds; example of a university. J Tissue Viability 2023; 32:607-612. [PMID: 37487917 DOI: 10.1016/j.jtv.2023.07.003] [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: 06/09/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND It is a holistic assessment of the forms of the first few piles of wound care. The right approach in this process directly affects the healing stages and treatment rates of the wound. OBJECTIVE To examine earthquake injuries retrospectively and to contribute to the literature. METHODS The data of patients who were treated in a university hospital between February 10 and February 21 after the earthquake were evaluated retrospectively using the wound evaluation formula. RESULTS A total of 116 patients' wounds were evaluated. The mean age of the participants was 31 ± 19.5 (min = 1, max = 72), the mean wound follow-up day was 6.5 ± 3 (min = 1, max = 15), and the most common type of injury was crushing (45.7%).), the injury site was found to be the lower extremity region (73,3) the most. There were signs of infection in the wound area in 62.9% of the patients. The most signs of pocketing, exudate, and infection in the wound were found in amputation (p < 0.05). The wound type with the highest moisture content of the wound and healthy skin around the wound was found to be fasciotomy (p < 0.05). The highest mean percentage of black necrosis was found in crushing (p < 0.05). CONCLUSION The study gives us information about the type and location of the injury and the condition of the wound bed. Earthquakes are among the disasters that cause the most loss of life and injury in developing countries such as our country. This study is one of the rare studies evaluating the wound and its features in the literature of our country, and more studies are needed in this area.
Collapse
Affiliation(s)
- Hamide Şişman
- Department of Abdi Sutcu Vocational School of Health Services, Cukurova University, Adana, Turkey.
| | - Dudu Alptekin
- Department of Abdi Sutcu Vocational School of Health Services, Cukurova University, Adana, Turkey.
| | - Sema İnce
- Department of Çukurova University Faculty of Medicine Balcalı Hospital Adana, Turkey.
| | - Yasemin Akıl
- Department of Çukurova University Faculty of Medicine Balcalı Hospital Adana, Turkey.
| |
Collapse
|
3
|
Healing Time of Skin Ulcers in Homecare Residents in the Province of Reggio Emilia, Northern Italy. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121989. [PMID: 36556354 PMCID: PMC9785422 DOI: 10.3390/life12121989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The growing phenomenon of skin ulcers represents an important health problem; therefore, we conducted a pilot study to evaluate the ulcer healing time among adult subjects followed by the Home Nursing Service of the AUSL-IRCCS of Reggio Emilia, Northern Italy, and diagnosed with at least one skin ulcer during the period of January-August 2020. We recruited 138 subjects (45.5% men) with a mean age of 86.1 years. The subjects presented with 232 ulcers, of which 76.7% were pressure ulcers (60.1% were stage II), 18.1% were vascular ulcers, and 4.7% were diabetic foot ulcers. Ulcer management required only one weekly access for the majority of subjects, with a recovery frequency of 53.6% at the end of the observation period. The median ulcer healing time was 3.6 months and was shorter in women (2.6 months) than men (5.1 months), with an increasing trend according to the number of ulcers and the severity of pressure ulcers for vascular and diabetic foot ulcers. In conclusion, this is the first study carried out in an Italian population describing the distribution and characteristics of homecare residents with skin ulcers and highlighting the factors influencing the healing time and as consequence the duration of nursing care.
Collapse
|
4
|
Alvarez-Irusta L, Van Durme T, Lambert AS, Macq J. People with chronic wounds cared for at home in Belgium: Prevalence and exploration of care integration needs using health care trajectory analysis. Int J Nurs Stud 2022; 135:104349. [DOI: 10.1016/j.ijnurstu.2022.104349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
|
5
|
DAĞCI M, ÖZTEKİN D. Yara Bakımında Kullanılan Yara Örtüsü Teknolojileri: Randomize Kontrollü Çalışmaların İncelenmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.996192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
6
|
Gazi U, Taylan-Ozkan A, Mumcuoglu KY. The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing. MEDICAL AND VETERINARY ENTOMOLOGY 2021; 35:257-266. [PMID: 33314340 DOI: 10.1111/mve.12497] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Chronic wounds are still regarded as a serious public health concern, which are on the increase mainly due to the changes in life styles and aging of the human population. There are different types of chronic wounds, each of which requires slightly different treatment strategies. Nevertheless, wound bed preparation is included in treatment of all types of chronic wounds and involves tissue debridement, inflammation, and infection control, as well as moisture balance and epithelial edge advancement. Maggot therapy (MT) is a form of biological debridement which involves the application of live medical grade Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) larvae. Whereas it was initially thought to act mainly through debridement, today MT is known to influence all four overlapping physiological phases of wound repair: homeostasis, inflammation, proliferation, and remodelling/maturing. During MT, medical-grade larvae are applied either freely or enclosed in tea-bag like devices (biobag) inside the wounds, which suggests that larva excretion/secretion (ES) products can facilitate the healing processes directly without the need of direct contact with the larvae. This review summarizes the relevant literature on ES-mediated effects on the cellular responses involved in wound healing.
Collapse
Affiliation(s)
- U Gazi
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - A Taylan-Ozkan
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
- Department of Medical Microbiology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - K Y Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
7
|
|
8
|
Holloway S, Pokorná A, Janssen A, Ousey K, Probst S. Wound Curriculum for Nurses: Post-registration qualification wound management-European qualification framework level 7. J Wound Care 2020; 29:S1-S39. [PMID: 32857627 DOI: 10.12968/jowc.2020.29.sup7a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Holloway
- Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales, UK
| | - A Pokorná
- Professor, Masaryk University,Faculty of Medicine, Dept. of Nursing and Midwifery, Brno, Czech Republic Institute of Health Information and Statistics of the Czech Republic, Department of quality of care assessment, Head of Department, Prague, Czech Republic
| | - A Janssen
- Health & Social Care, Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - K Ousey
- Professor and Director, Institute of Skin Integrity and Infection Prevention Huddersfield, UK, Visiting Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Brisbane, Australia; Visiting Professor, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland; Director, Institute of Skin Integrity and Infection Prevention Huddersfield, UK
| | - S Probst
- Professor of tissue viability and wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
| |
Collapse
|
9
|
Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
10
|
Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
Collapse
Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
| |
Collapse
|
11
|
Münter KC, Meaume S, Augustin M, Senet P, Kérihuel JC. The reality of routine practice: a pooled data analysis on chronic wounds treated with TLC-NOSF wound dressings. J Wound Care 2019; 26:S4-S15. [PMID: 28182533 DOI: 10.12968/jowc.2017.26.sup2.s4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE A number of randomised controlled trials (RCT) have compared control groups with TLC-NOSF dressings (UrgoStart) on chronic wounds. Our aim was to determine whether the clinical trials' results translate into routine management of such wounds, by pooling the data from real-life observational studies. METHOD Observational studies, conducted in France and Germany, evaluating current practices in patients suffering from non-selected chronic wounds treated with a TLC-NOSF dressing were identified. Demographic data, baseline description of wounds and description of their evolution during treatment were extracted and combined. We used two main indicators of clinical outcomes to measure the impact of the TLC-NOSF dressing on this population: time to wound closure and time to 50% reduction of the Pressure Ulcer Scale for Healing (PUSH) score. RESULTS In total, data from 10,220 patients were included, with 7903 leg ulcers (LUs), 1306 diabetic foot ulcers (DFUs) and 1011 pressure ulcers (PUs). The overall closure rate was 30.8 % [95 % confidence interval (CI): 29.9-31.7 %]. While the country, patient age, and number of wounds were identified as independent prognosis factors of healing, the most significant were wound duration and baseline area. The delay in initiating TLC-NOSF dressings treatment was also found to be significant. Overall the average time to complete closure was 112.5 days [95%CI: 105.8-119.3] for LUs, 98.1 days [95 %CI: 88.8-107.5] for DFUs and 119.5 days [95%CI: 94.6-144.3] for PUs. Based on a subgroup analysis of the French cohort, time to closure is substantially shorter for wounds treated with the TLC-NOSF dressing as a first-line intervention compared with those where it has been prescribed as a second-line intervention. CONCLUSION Compared with available data on time to complete closure of chronic wounds managed by 'standard' care, the data from this pooled data analysis showed healing time is reduced, which is consistent with the results of RCTs on TLC-NOSF. That these data are in agreement with those from the RCTs is testimony to their generalisability and important for routine practice. This indicates that using TLC-NOSF dressings in routine wound management can reduce the healing time of LUs, DFUs and PUs. These data also suggest that the earlier the decision to use this dressing, the shorter the time to closure, whatever the severity and the nature of these chronic wounds.
Collapse
Affiliation(s)
- K C Münter
- Joint Practice For Internal Medicine, General Medicine, Phlebology & Pain Therapy, Hamburg, Germany
| | - S Meaume
- Geriatric Department, Rotschild University Hospital, APHP, Paris, France
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg, Germany
| | - P Senet
- Department of Dermatology, University Hospital Paris Est, APHP, Paris, France
| | | |
Collapse
|
12
|
Gillespie P, Carter L, McIntosh C, Gethin G. Estimating the health-care costs of wound care in Ireland. J Wound Care 2019; 28:324-330. [DOI: 10.12968/jowc.2019.28.6.324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To estimate the cost of wound care to the Irish health-care system. Methods: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. Results: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. Conclusion: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere.
Collapse
Affiliation(s)
- Paddy Gillespie
- School of Business and Economics, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Laura Carter
- School of Business and Economics, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Caroline McIntosh
- Alliance for Research and Innovation in Wounds, NUI Galway, Galway, Ireland
- Discipline of Podiatric Medicine, NUI Galway, Galway, Ireland
| | - Georgina Gethin
- Alliance for Research and Innovation in Wounds, NUI Galway, Galway, Ireland
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
- School of Nursing and Midwifery, Monash University, Australia
| |
Collapse
|
13
|
Aune E, Struksnes S. Home care nurses' experience of providing health-care to patients with hard-to-heal wounds. J Wound Care 2019; 28:178-187. [DOI: 10.12968/jowc.2019.28.3.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Solveig Struksnes
- Institute of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Norway
| |
Collapse
|
14
|
Žulec M, Rotar-Pavlič D, Puharić Z, Žulec A. "Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E559. [PMID: 30769943 PMCID: PMC6406886 DOI: 10.3390/ijerph16040559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.
Collapse
Affiliation(s)
- Mirna Žulec
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Danica Rotar-Pavlič
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
| | - Zrinka Puharić
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Ana Žulec
- Polyclinic Marija, Kneza Mislava 2, Zagreb 10000, Croatia.
| |
Collapse
|
15
|
Pasek J, Cieślar G, Sieroń A. Combined therapy in the treatment of mixed etiology leg ulcer - case report. Ther Clin Risk Manag 2018; 14:1915-1921. [PMID: 30349270 PMCID: PMC6183550 DOI: 10.2147/tcrm.s176321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The most frequent causes of leg ulcers are chronic venous disease (CVD) related mainly to venous hypertension and peripheral arterial disease (PAD) related to disseminated atheromatous lesions in lower limb arteries. In 15%-21% of patients, ulcers of mixed venous-arterial etiology occur, which are usually more resistant for conservative therapy (compression therapy, pharmacotherapy, wearing elastic stockings, leg elevation and massage, change of lifestyle, and regular physical exercises). The contemporary model of complex therapy of leg ulcers in the course of chronic venous and arterial insufficiency more often also comprises numerous physical therapy procedures as associated therapy. This paper presents beneficial results of treatment applied to a 58-year-old patient with 1-month lasting painful chronic ulcers of both shins of mixed venous-arterial etiology, resistant to conservative therapy, which was performed by using the device Laserobaria-S for local combined physical therapy including simultaneous action of hyperbaric oxygen, extremely low-frequency (ELF) variable magnetic field, and low-energy light radiation. As a result of a 9-week therapeutic cycle consisting of 30 daily procedures, a complete healing of ulcers in both shins with accompanying subsidence of pain and substantial reduction in the intensity of local inflammation around the ulcer was obtained. The patient reported no side effects, and no complications were observed during the therapy.
Collapse
Affiliation(s)
- Jarosław Pasek
- Institute of Physical Education Tourism and Physiotherapy, University of Jan Długosz in Częstochowa, Częstochowa, Poland,
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| |
Collapse
|
16
|
Samaniego-Ruiz MJ, Llatas FP, Jiménez OS. Assessment of chronic wounds in adults: an integrative review. Rev Esc Enferm USP 2018; 52:e03315. [PMID: 29947700 DOI: 10.1590/s1980-220x2016050903315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/27/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the main aspects that should be assessed in adults with chronic wounds. METHOD This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases. RESULTS Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution). CONCLUSION The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.
Collapse
Affiliation(s)
| | - Federico Palomar Llatas
- Universidad Católica de Valencia San Vicente Mártir, Valencia, España.,Consorcio Hospital General Universitario de Valencia, Área de Gestión Clínica de la Piel, Valencia, España
| | - Onofre Sanmartín Jiménez
- Universidad Católica de Valencia San Vicente Mártir, Valencia, España.,Instituto Valenciano de Oncología, Servicio de Dermatología Médico Quirúrgica, Valencia, España
| |
Collapse
|
17
|
Welsh L. Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. Int Wound J 2018; 15:53-61. [PMID: 29045004 PMCID: PMC7949797 DOI: 10.1111/iwj.12822] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 01/01/2023] Open
Abstract
The aims of this study were to determine the knowledge and skills of nurses involved in wound care, to provide a critical overview of the current evidence base underpinning wound care and to determine the extent of utilisation of existing evidence by nurses involved in the management of wounds in practice. A semi-systematic review of the literature was undertaken on Cinahl, Medline Science Direct and Cochrane using the search terms: wound, tissue viability, education, nurse, with limitations set for dates between 2009 and 2017 and English language. Shortfalls were found in the evidence base underpinning wound care and in links between evidence and practice, prevalence of ritualistic practice and in structured education at pre- and post-registration levels. The evidence underpinning wound care practice should be further developed, including the conduction of independent studies and research of qualitative design to obtain rich data on both patient and clinician experiences of all aspects of wound management. More structured wound care education programmes, both at pre-registration/undergraduate and professional development levels, should be established.
Collapse
Affiliation(s)
- Lynn Welsh
- School of Health, Nursing and MidwiferyUniversity of the West of ScotlandPaisleyScotland
| |
Collapse
|
18
|
Coster AD. Keeping up with wound care in the community setting. Br J Community Nurs 2017; 22:S5. [PMID: 28862896 DOI: 10.12968/bjcn.2017.22.sup9.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Harris C, Duong R, Vanderheyden G, Byrnes B, Cattryse R, Orr A, Keast D. Evaluation of a muscle pump-activating device for non-healing venous leg ulcers. Int Wound J 2017; 14:1189-1198. [PMID: 28770561 PMCID: PMC7949827 DOI: 10.1111/iwj.12784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022] Open
Abstract
This evaluation involves an innovative muscle pump‐activating device (geko™) as an adjunctive therapy with best practices for non‐healing venous leg ulcers (VLUs). Stimulating the common peroneal nerve (at the fibular head), the geko™ device creates a response that acts as foot and calf muscle pumps, increasing venous, arterial and microcirculatory flow. The aim was to evaluate and determine if the geko™ is effective in this population and if it should be added to the medical supply formulary. In all, 12 patients with 18 recalcitrant VLUs (defined as less than 30% reduction in wound size in 30 days with best practices) in two community settings in Ontario consented to the evaluation and were treated with the geko™ for up to 20 weeks. A total of 44% of wounds healed, and 39% decreased in size. One patient non‐adherent with the geko™ and best practices had deterioration in his or her wounds. With the patients as their own control, the mean weekly healing rate with the geko™ was 9·35% (±SD 0·10) compared to 0·06% (±SD 0·10) prior to baseline, which was statistically significant (P < 0·01). Three patients not in optimal therapy increased compression due to decreased pain, further enabling healing. This study was not a randomised investigation, although the patients acted as their own controls. A pragmatic evaluation reflects the reality of the community sector; in spite of best practices or evidence‐based care, therapy is not uniformly applied, with some participants unable to tolerate or indeed comply with optimal compression therapy. Rash occurred under the devices in 7 of 12 (58%) patients. One patient stopped the device due to rash, while another had to take breaks from using the device. Subsequently, the manufacturer (FirstKind Ltd) has developed a new device and protocol specific to the requirements of wound therapy to minimise this response. This small case series demonstrated the highly significant effectiveness of the geko™ device in these hard‐to‐heal VLUs. Further evaluations to determine dose and patient selection criteria are underway.
Collapse
Affiliation(s)
- Connie Harris
- CarePartners (formerly), Perfuse Medtec Inc., London, ON Canada.,Hamilton Niagara Haldimand Brant (HNHB) Community Care Access Centre, Hamilton, ON Canada
| | - Rochelle Duong
- Mississauga Halton Community Care Access Centre, Mississauga, ON Canada
| | | | - Beth Byrnes
- CarePartners, South West Division, Tillsonburg, ON Canada
| | - Renee Cattryse
- CarePartners, South West Division, Tillsonburg, ON Canada
| | - Ava Orr
- CarePartners, Mississauga Halton Division, Mississauga, ON Canada
| | - David Keast
- Parkwood Institute, Western University, London, ON Canada
| |
Collapse
|
20
|
Micheli C, Palese A, Canzan F, Ambrosi E. No Sting Barrier Film to Protect Skin in Adult Patients: Findings From a Scoping Review With Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:403-411. [PMID: 28759158 DOI: 10.1111/wvn.12232] [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] [Accepted: 12/31/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the industrialized world, approximately 1-1.5% of the population has received treatments for skin lesions. In the 1990s, a polymeric barrier film called the No Sting Barrier Film (NSBF) was developed as an alternative to petrolatum-based ointments and zinc oxide formulas. To date, few studies have explored the effectiveness of NSBF in protecting skin integrity. AIMS To map the methods, fields and outcomes used to produce evidence on NSBF effectiveness. METHODS A scoping review was performed in 2015. A search strategy for identifying relevant studies was designed and performed. Systematic reviews, meta-analyses, randomized controlled trials, controlled clinical trials, and comparative studies for all types of interventions were included; research conducted in any clinical context was eligible for inclusion. Studies were selected by two reviewers; data extraction and analysis also was performed by two reviewers and disagreements were discussed. RESULTS Six studies were included. NSBF's potential as a skin protector was investigated with respect to (a) chronic wounds (pressure ulcers or vascular leg ulcers); (b) urinary or fecal incontinence; and (c) post-mastectomy irradiation. The principal clinical outcomes investigated were, respectively: (a) wound healing, wound exudates and erythema control; (b) incidence of incontinence-associated dermatitis and skin reactions; and (c) intensity of pruritus and skin reactions. Pain and comfort were measured in all clinical applications. The main process outcomes investigated were: (a) ease of application, (b) application and removal time, and (c) costs. Zinc oxide and petroleum formulations were the most common comparison interventions in research on chronic ulcers and incontinence; sorbolene cream and topical corticosteroids were the most frequent comparisons in the context of post-mastectomy irradiation. LINKING EVIDENCE TO ACTION NBSF may be used for peri-wound skin protection in patients with chronic wounds, with urinary or fecal incontinence and for women undergoing post-mastectomy irradiation. However, more robust experimental studies are needed in all clinical fields where NBSF is applied.
Collapse
Affiliation(s)
- Chiara Micheli
- Staff Nurse, APSP Dott., Antonio Bontempelli, Trento, Italy
| | | | - Federica Canzan
- Clinical Teacher, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elisa Ambrosi
- Clinical Teacher, Azienda Provinciale per i Servizi Sanitari, Polo Universitario Professioni Sanitarie, Trento, Italy
| |
Collapse
|
21
|
Ylönen M, Viljamaa J, Isoaho H, Junttila K, Leino-Kilpi H, Suhonen R. Internet-based learning programme to increase nurses' knowledge level about venous leg ulcer care in home health care. J Clin Nurs 2017; 26:3646-3657. [PMID: 28102916 DOI: 10.1111/jocn.13736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To test the effectiveness of an Internet-based education programme about venous leg ulcer nursing care on perceived and theoretical knowledge levels and attitudes among nurses working in home health care. BACKGROUND Nurses have been shown to have knowledge gaps in venous leg ulcer nursing care. Internet-based learning could offer a means for flexible continuing education for home healthcare environment. DESIGN Quasi-experimental study with pre- and postmeasurements and nonequivalent intervention and comparison groups. METHOD Nurses (n = 946) in home health care in two Finnish municipalities were invited to participate in the study and divided into intervention and comparison groups. The intervention group received education programme about venous leg ulcer nursing care, while the comparison group did not. Data were collected at baseline, at six weeks and at 10 weeks to test the hypotheses: nurses using education programme about venous leg ulcer nursing care will have higher level of knowledge and more positive attitudes than those not using education programme about venous leg ulcer nursing care. An analysis of variance and mixed models with repeated measures were used to test differences in knowledge and attitudes between and within the groups. RESULTS There were statistically significant increases in knowledge levels in the intervention group from baseline to the first and second follow-up measurements. In the comparison group, the knowledge levels remained unchanged during the study. Attitude levels remained unchanged in both groups. CONCLUSION Nurses' perceived and theoretical knowledge levels of venous leg ulcer nursing care can be increased with Internet-based education. However, this increase in knowledge levels is short-lived, which emphasises the need for continuous education. RELEVANCE TO CLINICAL PRACTICE Internet-based education about venous leg ulcer nursing care is recommended for home healthcare nurses. Education programme about venous leg ulcer nursing care provides flexible method for nurses' learning with feasible and cost-effective access to evidence-based education. Education programme about venous leg ulcer nursing care material can be used in all nursing environments where Internet is available.
Collapse
Affiliation(s)
- Minna Ylönen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Viljamaa
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | | | - Kristiina Junttila
- Group Administration, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Hospital District of South-West Finland, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
22
|
Harding K. Challenging passivity in venous leg ulcer care - the ABC model of management. Int Wound J 2016; 13:1378-1384. [PMID: 27146452 PMCID: PMC7949496 DOI: 10.1111/iwj.12608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems.
Collapse
Affiliation(s)
- Keith Harding
- Dean of Clinical InnovationCardiff UniversityCardiffUK
- Medical DirectorWelsh Wound Innovation CentreCardiffUK
| |
Collapse
|
23
|
Abstract
Practice nurses working in GP surgeries are responsible for caring for patients with both acute and chronic wounds. The management of wounds is challenging and it is important to achieve and maintain an optimum healing environment. As practice nurses play an integral part in managing both acute and chronic wounds within a community setting, it is essential that they can make informed decisions as to which products to use. A clinical in-market evaluation of 23 patients was carried out to assess the performance of ActivHeal Aquafiber® in clinical practice. Overall, the dressing performed well in respect of fluid handling and durability. The dressing addressed patient needs in terms of easy application and removal, prevention of leakage and wound progression.
Collapse
Affiliation(s)
- Jolene Parkes
- Practice Nurse, Mansfield and Ashfield NHS Clinical Commissioning Group
| |
Collapse
|
24
|
Geraghty J. International wound care: setting the bar high. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S3. [PMID: 25075383 DOI: 10.12968/bjon.2014.23.sup12.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|