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Clemett VJ, Graham T, Woodward S, Grocott P. Effectiveness of interventions to enhance shared decision-making in wound care: A systematic review. J Clin Nurs 2024; 33:2813-2828. [PMID: 38685798 DOI: 10.1111/jocn.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
AIMS To explore the effectiveness of interventions to enhance patient participation in shared decision-making in wound care and tissue viability. BACKGROUND Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision-making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision-making in wound care. DESIGN Systematic review of interventional studies to enhance shared decision-making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. METHODS Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors. DATA SOURCES Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov). RESULTS 1063 abstracts were screened, and eight full-text studies included. Findings indicate, interventions to support shared decision-making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used. CONCLUSIONS Future research on shared decision-making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care. REGISTRATION The review protocol was prospectively registered (PROSPERO database: CRD42023389820). NO PATIENT OR PUBLIC CONTRIBUTION Not applicable as this is a systematic review.
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Affiliation(s)
- Victoria J Clemett
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tanya Graham
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Pasek J, Szajkowski S, Cieślar G. A Double-Blind Study on the Effectiveness of Polarized Light Therapy in the Treatment of Venous leg Ulcers-Pilot Study. INT J LOW EXTR WOUND 2024:15347346241264602. [PMID: 39033399 DOI: 10.1177/15347346241264602] [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: 07/23/2024]
Abstract
Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm2, in group 2; 2.8 (2.6-3.1) cm2 (p = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (p < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (p < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (p < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.
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Affiliation(s)
- Jarosław Pasek
- Collegium Medicum, Jan Długosz University in Częstochowa, Częstochowa, Poland
| | - Sebastian Szajkowski
- Faculty of Medical and Social Sciences, Warsaw Medical Academy of Applied Sciences, Warszawa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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Holloway S. Collaborative and sustainable woundcare: supporting this vision. Br J Community Nurs 2024; 29:S4-S5. [PMID: 38814850 DOI: 10.12968/bjcn.2024.29.sup6.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
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Probst S, Saini C. Microjet wound therapy versus sharp debridement on wound size reduction: a pilot randomised controlled trial. J Wound Care 2024; 33:357-364. [PMID: 38683777 DOI: 10.12968/jowc.2024.33.5.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes. METHOD A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023. RESULTS A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations. CONCLUSION This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.
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Affiliation(s)
- Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland
- Geneva School of Health Sciences, Geneva, Switzerland
- Care Directorate, Geneva University Hospitals, Geneva Switzerland
- College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Camille Saini
- HES-SO University of Applied Sciences and Arts Western Switzerland
- Geneva School of Health Sciences, Geneva, Switzerland
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Chen Y, Zhao X, Wang X, Li LJ, Wu L. The Management of Chronic Graft-Versus-Host Disease Skin Ulcers after Hematopoietic Stem Cell Transplantation: A Case Report. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38506587 DOI: 10.1097/asw.0000000000000122] [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: 03/21/2024]
Abstract
ABSTRACT The comprehensive management of a patient with chronic graft-versus-host disease skin ulcers after hematopoietic stem cell transplantation is challenging. This report describes the case of a 53-year-old woman who presented with ulcers on her right leg 140 weeks after a bone marrow transplant. The patient received wound assessment and management based on the Triangle of Wound Assessment and Wound Bed Preparation 2021, respectively. Hydrogel and antibacterial protease dressings were applied along with systemic oral administration of moxifloxacin hydrochloride (two capsules, two times daily) and JiXueGanPian tablets (classic Chinese herbal formula; two capsules, two times daily), hospital-community-home continuous care, and patient-centered education. Finally, after 133 days of nursing, the patient's wound was completely healed without complications or other skin issues. The use of hydrogel combined with the antibacterial protease dressing was a promising technique for handling this type of wound, enhanced by multidisciplinary collaboration. Of course, providing patients with education that focuses on prevention is necessary.
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Affiliation(s)
- Yi Chen
- Yi Chen, MD, RN, is Enterostomal Therapist and Instructor, School of Nursing, Suzhou Medical College, Soochow University, Jiangsu, China. At the First Affiliated Hospital of Soochow University, XueHua Zhao, BS, RN, is Associate Professor of Nursing, Outpatient Department of Wound and Ostomy; and Xun Wang, BS, RN, is Associate Professor of Nursing and Chief Nurse, Outpatient Department of Wound and Ostomy. Lai Juan Li, BS, RN, is Associate Professor of Nursing, Wound and Ostomy Care Clinic, the First People's Hospital of Lianyungang, Jiangsu, China. Lin Zhu Wu, BS, RN, is Associate Professor of Nursing, Outpatient Department of Wound and Ostomy, the First Affiliated Hospital of Soochow University
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Fernández-Araque A, Martinez-Delgado M, Jiménez JM, López M, Castro MJ, Gila EC. Assessment of nurses' level of knowledge of the management of chronic wounds. NURSE EDUCATION TODAY 2024; 134:106084. [PMID: 38171141 DOI: 10.1016/j.nedt.2023.106084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Chronic wounds are a challenge and a major cause of morbidity. A wound is considered chronic if healing does not occur within the expected time frame depending on the etiology and location of the wound. OBJECTIVE To assess the level of knowledge about chronic wound management of postgraduate nurses in different areas of the health system and their previous satisfaction with the training received during their undergraduate studies. DESIGN Cross-sectional study of a health system of 95,000 inhabitants and 557 nursing professionals working in it. PARTICIPANTS Nurses working in the study health system and in areas with care for patients with chronic wounds in social, primary and hospital care. RESULTS Survey results described a low knowledge of chronic wound management in general. Data on knowledge according to area of work showed that nurses in primary care had the highest knowledge of wound etiology. Nurses working in health and social care were most knowledgeable in diagnostic knowledge. Hospital nurses showed the lowest knowledge overall. A relationship was observed when nurses had a master's degree followed by an expert with better knowledge in the test. In addition, nurses reported little training in chronic wounds during their university studies (69.73 %, n = 106). CONCLUSIONS Therefore, a review of this point should be considered to improve the management of chronic wounds and their correct approach among nursing students. A review of continuing and even specialised training needs in the clinical care setting should also be considered.
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Affiliation(s)
- Ana Fernández-Araque
- Research Group "Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology", Faculty of Health Science, University of Valladolid, Soria, Spain.
| | | | - Jose-Maria Jiménez
- Research Group "Multidisciplinary Assessment and Intervention in Health Care and Sustainable Lifestyles VIMAS+", Nursing Faculty, University of Valladolid, Spain.
| | - María López
- Research Group "Multidisciplinary Assessment and Intervention in Health Care and Sustainable Lifestyles VIMAS+", Nursing Faculty, University of Valladolid, Spain.
| | - Maria Jose Castro
- Department of Nutrition and Dietetics, Faculty of Nursing, University of Valladolid. Valladolid, Spain.
| | - Estela Carnicero Gila
- Department of Anatomy and Radiology, Faculty of Medicine, University of Valladolid, Soria, Spain.
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Smet S, Verhaeghe S, Beeckman D, Fourie A, Beele H. The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study. J Tissue Viability 2024:S0965-206X(24)00027-5. [PMID: 38461069 DOI: 10.1016/j.jtv.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
AIMS To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds. DESIGN Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in [placeholder]. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations. METHODS Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study. RESULTS Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3. CONCLUSIONS Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours.
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Affiliation(s)
- Steven Smet
- Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro University, Örebro, Sweden. https://twitter.com/DimitriBeeckman
| | - Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. https://twitter.com/anika_fourie
| | - Hilde Beele
- Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
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Lee A, Woodmansey E, Klopfenstein B, O'Leary JL, Cole W. Remote assessment and monitoring with advanced wound therapy to optimise clinical outcomes, access and resources. J Wound Care 2024; 33:90-101. [PMID: 38329827 DOI: 10.12968/jowc.2024.33.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Patients in rural communities may have limited access to wound care; however, this may be mitigated by using a shared care approach. This study assessed the impact of a remote assessment and monitoring tool in combination with adjunctive continuous topical oxygen therapy (cTOT) in patients with diabetes and hard-to-heal wounds. METHOD Patients with hard-to-heal wounds (defined as no visible improvement in the previous four weeks) were enrolled to this 12-week pilot study to validate a shared care approach using an Advanced Digital Wound Care Platform-telehealth (ADWCPt) system (eKare Inc., US) coupled with cTOT. Patient and wound assessments were reviewed by the clinician either remotely, via telehealth calls, or at the clinic, and the number of face-to-face clinic visits was recorded. Patient health status scores were captured before and after the study, along with feedback on usability of the remote platform and cTOT device. RESULTS The wounds in all eight patients studied reduced in size over 12 weeks (mean percentage area reduction 92.0%), and two wounds were completely re-epithelialised. Another wound almost healed (99.2% wound area reduction). Clinical interactions consisted of self-assessments (n=80, 50.0%), video assessments with the clinician (n=27, 16.9%), and face-to-face interactions in clinic (n=53, 33.1%). Operational efficiencies encompassed a 54.0% increase in the number of clinical interactions, whereas clinical time was reduced by 25.8%. Health status scores improved across all eight patients and feedback on the shared approach and cTOT device was favourable. CONCLUSION A shared care model with ADWCPt coupled with an innovative cTOT device saved time and resources, improving patient access and engagement, along with a marked improvement in the wound healing trajectory.
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Affiliation(s)
- Aliza Lee
- Salem VA Health Care System, Virginia, US
| | | | | | - Jessica L O'Leary
- University of Florida, College of Medicine, Jacksonville, Florida, US
| | - Windy Cole
- Natrox Wound Care Cambridge, UK
- College of Podiatric Medicine, Kent University, Ohio, US
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Qiu Y, Fan S, Fu Q, Yang M, Zhu L. Fatalism as a Mediator of the Association Between Family Resilience and Self-Management Among Patients with Chronic Wounds in China. Patient Prefer Adherence 2024; 18:53-67. [PMID: 38223440 PMCID: PMC10787554 DOI: 10.2147/ppa.s446219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose The purpose of this study was to examine how fatalism acts as a mediator in the correlation between family resilience and self-management among patients with chronic wounds in China. Participants and Methods This study used a cross-sectional research design. A total of 269 adult patients (18-94 years old) with chronic wounds residing in Wuxi, China participated in this study. Participants completed the Chinese version of the Walsh Family Resilience Questionnaire, 16-item Chinese version of the Fatalism Scale, and Self-Management Scale of Chronic Wound Patients. We conducted correlation and mediation analyses using SPSS 27.0 and PROCESS 4.0. Results The results indicated family resilience was a significant positive predictor of self-management (β = 0.7101, p < 0.0001), and the pathway between family resilience and self-management was partially mediated by fatalism (Effect = 0.1432, 95% confidence interval [0.0625, 0.2341]). Conclusion The results indicated that incorporating spiritual interventions into future person-centered self-management programs could align with the motivation of patients with chronic wounds and their families, and reduce the negative impact of fatalism on health outcomes.
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Affiliation(s)
- Yuhuan Qiu
- Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
| | - Shujun Fan
- Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Qiuyan Fu
- Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Minlie Yang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
| | - Lihong Zhu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
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Alawi SA, Taqatqeh F, Matschke J, Bota O, Dragu A. Use of a collagen-elastin matrix with split-thickness skin graft for defect coverage in complex wounds. J Wound Care 2024; 33:14-21. [PMID: 38197274 DOI: 10.12968/jowc.2024.33.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation). METHOD A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery. RESULTS Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder. CONCLUSION Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds.
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Affiliation(s)
- Seyed Arash Alawi
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Feras Taqatqeh
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Jan Matschke
- Department of Maxillofacial Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Olimpiu Bota
- Department of Plastic Surgery, First Surgical Clinic, Emergency County Hospital Cluj-Napoca, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
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Babaei N, Lotfi M, Avazeh M. The necessity of developing a virtual care model for patients with chronic wounds: letter to the editor. Ir J Med Sci 2023; 192:2821-2822. [PMID: 37032396 PMCID: PMC10088747 DOI: 10.1007/s11845-023-03368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad‐Soltani T, Avazeh M. Barriers to the implementation of virtual care programmes for patients with chronic wounds: Qualitative empirical research. Nurs Open 2023; 10:7301-7313. [PMID: 37612895 PMCID: PMC10563415 DOI: 10.1002/nop2.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/17/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
AIM To assess the barriers to the implementation of virtual care for patients with chronic wounds from wound therapists' perspective. DESIGN A qualitative study. METHODS The study was conducted in two consecutive phases: (1) literature review, (2) descriptive qualitative study. In the first phase, texts published in English until 2023 were identified using international databases. The entire text of the selected studies was evaluated independently by two reviewers. Data analysis was carried out using textual content analysis. In the second phase of the study, twelve participants from Iranian wound care clinics participated. Data were collected through focus group discussion and analysed using conventional content analysis. Integration of both phases was conducted in the data analysis stage. RESULTS The most important barriers in providing virtual care to patients with chronic wounds were identified into five categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, IT users' insufficient knowledge and limitation of virtual care scope of practice. CONCLUSION The findings of the present study identified different barriers in the implementation of virtual care for patients with chronic wounds. In order to successfully develop a virtual care programme, it is necessary to adopt suitable policies regarding information and communication technology, provide the necessary legal frameworks, assign an adequate budget and consider the ethical, cultural, social and social issues. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Identifying barriers to developing a virtual care programme will help manage patients with chronic wounds at home. IMPACT This study accurately identifies barriers to providing virtual care for patients with chronic wounds and helps plan to address these barriers and facilitate the development of a virtual care programme for these patients at home. REPORTING METHOD This research has adhered to the SRQR reporting guideline. NO PATIENT OR PUBLIC CONTRIBUTION The involvement of patients or the public in the design, or conduct, or reporting, or dissemination plans of this research was not suitable.
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Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of HealthTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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Quirk K. Use of a prescribed exercise intervention as an adjunct to improve venous leg ulcer healing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S34-S38. [PMID: 37596074 DOI: 10.12968/bjon.2023.32.15.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND The complex healing process of venous leg ulcers (VLUs) is widely documented, yet wound healing outcomes continue to challenge community nurses. Compression therapy remains the 'gold standard' to improve healing outcomes. However, the complexities surrounding VLUs demand a holistic and unified approach. Advising patients with VLUs to perform exercises is a widely accepted practice based on the known benefits of lower leg mobility reducing venous hypertension. A lack of standardisation surrounding this subject has generated a rise in academic interest over the past decade, particularly in the benefit of a prescribed exercise intervention (PEI) as an adjunct to compression for VLU patients. AIM This review explored the use of an unsupervised PEI as an adjunct to improve VLU healing in housebound patients wearing compression therapy. The aim was to determine if a PEI is beneficial to VLU healing alongside compression therapy. RESULTS The review identified five randomised controlled trials (RCT) between 2009 and 2022. Although the evidence showed some limitations, statistically and clinically significant results were identified for VLU healing outcomes. CONCLUSION A PEI designed to engage the calf muscle pump is beneficial to improve VLU healing outcomes, alongside compression therapy, for housebound patients and should be included in the community nursing holistic model of care for VLU management.
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Affiliation(s)
- Kirstie Quirk
- Registered Nurse, Manx Care, Community Nursing, Douglas, Isle of Man
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Pasek J, Szajkowski S, Cieślar G. Application of Topical Hyperbaric Oxygen Therapy and Medical Active Dressings in the Treatment of Arterial Leg Ulcers-A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:5582. [PMID: 37420748 DOI: 10.3390/s23125582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
Leg ulcers are a very serious worldwide medical problem. When the ulcer is extensive and deep the prognosis is usually unfavorable. The treatment requires comprehensive solutions that take into account modern specialized medical dressings, and more and more often, selected methods in the field of physical medicine. The study included 30 patients (13 women-43.4% and 17 men-56.6%) with chronic arterial ulcers of the lower limbs. The mean age of the treated patients was 65.63 ± 8.77 years. Patients were randomly assigned to two study groups. In group 1 (16 patients), specialist ATRAUMAN Ag medical dressings and local hyperbaric oxygen therapy treatments were used. In group 2 (14 patients), only specialized ATRAUMAN Ag dressings were used. The treatment was carried out for 4 weeks. The progress of healing ulcers was assessed by using the planimetric method, while the intensity of pain ailments was assessed by the visual analog VAS scale. In both study groups, a statistically significant reduction in the mean surface area of the treated ulcers was obtained, respectively, from 8.53 ± 1.71 cm2 to 5.55 ± 1.11 cm2 in group 1 (p < 0.001) and 8.43 ± 1.51 cm2 to 6.28 ± 1.13 cm2 in group 2 (p < 0.001). There was also a statistically significant reduction in the intensity of pain ailments, respectively: 7.93 ± 0.68 points to 5.00 ± 0.63 points in group 1 (p < 0.001) and 8.00 ± 0.67 points to 5.64 ± 0.49 points in group 2 (p < 0.001). The percentage change in ulcer area from baseline in group 1 was 34.6 ± 8.47% and was statistically significantly greater than in group 2 (25.23 ± 6.01%) (p = 0.003). In turn, the percentage assessment of the pain intensity assessed in the VAS scale in group 1 was 36.97 ± 6.36% and was statistically significantly higher compared to group 2 (29.34 ± 4.77%) (p = 0.002). The addition of local hyperbaric oxygen therapy treatments as a supplement to the therapy with the use of specialized medical dressings improves the effectiveness the arterial ulcers treatment of the lower limbs in terms of reducing the ulceration area and reducing pain ailments.
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Affiliation(s)
- Jarosław Pasek
- Collegium Medicum im. dr Władysława Biegańskiego, Jan Długosz University in Częstochowa, 13/15 Armii Krajowej St., 42-200 Częstochowa, Poland
| | - Sebastian Szajkowski
- Faculty of Medical and Social Sciences, Warsaw Medical Academy of Applied Sciences, 8 Rydygiera St., 01-793 Warszawa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Stefana Batorego St., 41-902 Bytom, Poland
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Rodríguez-Abad C, Rodríguez-González R, Martínez-Santos AE, Fernández-de-la-Iglesia JDC. Effectiveness of augmented reality in learning about leg ulcer care: A quasi-experimental study in nursing students. NURSE EDUCATION TODAY 2022; 119:105565. [PMID: 36155210 DOI: 10.1016/j.nedt.2022.105565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Chronic wounds are a serious public health problem worldwide. Providing optimal treatment to patients suffering from leg ulcers is a priority for nursing. Therefore, nursing students need to acquire the necessary competencies to provide evidence-based care. Augmented Reality (AR) is an emerging technology in health science education which can help nursing students achieve these skills if it is promoted by both institutions and educationalists. OBJECTIVES To test the effectiveness of an AR-based methodology for teaching-learning aspects of the nursing curriculum (leg ulcer care), as well as to describe how AR influences different learning determinants of nursing students. DESIGN A quasi-experimental study was carried out. PARTICIPANTS/SETTINGS The participants of the study were 137 s-year nursing students from the School of Nursing of the University of Santiago de Compostela (Spain) (average age = 21.59 years, 80.29 % females). Of them, 65 comprised the control group (Non-AR-based teaching) and 72 comprised the experimental group (AR-based teaching). METHODS Pre-post tests were used to measure knowledge and skills about leg ulcer care in both groups. Additionally, two validated questionnaires were selected to identify the influence of AR on learning determinants in the experimental group. The study took place during the 2018/2019 academic year. RESULTS Significantly higher scores (7.68 vs. 6.14) were found in the knowledge post-test in the experimental group (p ≤ 0.001), while the pre-test did not show differences between groups (4.43 vs. 4.32). Also, nursing students indicated high scores in attention, autonomous learning, understanding and motivation to carry out learning objectives using AR. CONCLUSIONS AR is a tool that improves performance related to the specific aspects of the nursing academic curriculum (leg ulcer care), while encouraging positive attitudes towards the teaching-learning process. These findings reinforce the need to include innovative methodologies in nursing classrooms.
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Affiliation(s)
- Carlos Rodríguez-Abad
- University of Santiago de Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain
| | - Raquel Rodríguez-González
- University of Santiago de Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain
| | - Alba-Elena Martínez-Santos
- University of Santiago de Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain; DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain; Dermatology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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He ZH, Yang HM, Dela Rosa RD, De Ala MB. The effects of virtual reality technology on reducing pain in wound care: A meta-analysis and systematic review. Int Wound J 2022; 19:1810-1820. [PMID: 35318806 PMCID: PMC9615291 DOI: 10.1111/iwj.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 12/11/2022] Open
Abstract
Virtual reality (VR) technology has been widely used in clinical nursing care in recent years. We aimed to systematically evaluate the effect and safety of VR technology on pain control in wound care, to provide evidence and support for clinical wound care. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal databases for randomised controlled trials (RCTs) on the application of VR technology in wound care up to December 20, 2021. Two researchers independently assessed the quality of the included RCTs and extracted associated data. RevMan5.3 statistical software was used for data analysis. 13 RCTs involving 1258 adult patients were included, of whom 588 patients underwent VR intervention. VR technology intervention could reduce the VAS score(MD = -1.13, 95%CI:-2.01~-0.26, P < .001), pain cognition score(MD = -3.94, 95%CI:-4.59 ~ -3.30, P < .001), pain emotion score(MD = -5.21, 95%CI: -10.46 ~ -0.04, P < .001), pain sensation score (MD = -4.94, 95%CI: -9.46 ~ -0.42, P = .03) and blood pressure(MD = -4.66, 95%CI: -8.63 ~ -0.69, P = .02) during would care. There were no significant differences on the heart rate (MD = -1.85, 95%CI: -5.71 ~ -2.01, P = .45) and VR interestingness (MD = 28.96, 95%CI: -22.10 ~ 80.02, P = .27) of the VR group and control group. No publication biases among the synthesised outcomes were found (all P > .001). VR technology can effectively reduce the pain degree and sensation of patients during wound care, which may be an effective auxiliary non-drug method used for pain relief during wound care.
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Affiliation(s)
- Zhen-Hua He
- Faculty of Medicine and Health, Shaoxing University Yuanpei College, Shaoxing, China.,School of Nursing, Philippine Women's University, Manila, Philippines
| | - Hong-Mei Yang
- Department of One Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Ronnell D Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines.,College of Nursing and Midwifery, Bataan Peninsula State University, Bataan, Philippines
| | - Minerva B De Ala
- School of Nursing, Philippine Women's University, Manila, Philippines
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Ali M, Kwak SH, Lee BT, Choi HJ. Controlled release of vascular endothelial growth factor (VEGF) in alginate and hyaluronic acid (ALG–HA) bead system to promote wound healing in punch-induced wound rat model. JOURNAL OF BIOMATERIALS SCIENCE, POLYMER EDITION 2022; 34:612-631. [PMID: 36218190 DOI: 10.1080/09205063.2022.2135264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For wound healing, angiogenesis is one of the main therapeutic factors for recovering the injured tissue. To address this issue, a combination of two different polymers, alginate (ALG) and hyaluronic acid (HA) in an 80:20 ratio composition is used to optimize the bead system along with the 5 IU heparin (Hep) by crosslinking into calcium chloride (CaCl2). Encapsulation of Vascular endothelial growth factor (VEGF) in the bead system shows delayed cumulative release in phosphate buffer saline (PBS). For in vitro studies, calf pulmonary artery endothelial (CPAE) cells showed biocompatibility. ALG-HA/VEGF150 improves endothelial Vascular cell adhesion protein 1 (VCAM1) and endothelial nitric oxide synthase (eNOS) expression markers in CPAE cells. In vivo evaluation of the bead system shows around 68% of wound closure 2 weeks post-implantation in 8 mm punch wound models. The treatment group shows decreased epithelial gap between the ends of the wound and neo-epidermal regeneration. ALG-HA/VEGF150 induced significant vascularization, collagen type-1 (Col-1) and fibronectin (FN) development in the in vivo models after 2 weeks of the implantation. Hence, ALG-HA/VEGF150 beads can be used to promote wound healing.
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Affiliation(s)
- Maqsood Ali
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Si Hyun Kwak
- Department of Plastic and Reconstructive surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Byong-Taek Lee
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- Institute of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- Institute of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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Gethin G. When the dressing doesn't fit. J Wound Care 2022; 31:807. [DOI: 10.12968/jowc.2022.31.10.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Georgina Gethin
- Professor of Nursing, School of Nursing and Midwifery, University of Galway, Galway, Ireland; Director, Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Research Associate, School of Health Sciences HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Soares Dantas J, Silva CCM, Nogueira WP, de Oliveira e Silva AC, de Araújo EMNF, da Silva Araújo P, Freire MEM. Health-related quality of life predictors in people with chronic wounds. J Tissue Viability 2022; 31:741-745. [DOI: 10.1016/j.jtv.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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Abstract
Chronic wounds are characterized by their inability to heal within an expected time frame and have emerged as an increasingly important clinical problem over the past several decades, owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. Even up to a few years ago, the management of chronic wounds relied on standards of care that were outdated. However, the approach to these chronic conditions has improved, with better prevention, diagnosis and treatment. Such improvements are due to major advances in understanding of cellular and molecular aspects of basic science, in innovative and technological breakthroughs in treatment modalities from biomedical engineering, and in our ability to conduct well-controlled and reliable clinical research. The evidence-based approaches resulting from these advances have become the new standard of care. At the same time, these improvements are tempered by the recognition that persistent gaps exist in scientific knowledge of impaired healing and the ability of clinicians to reduce morbidity, loss of limb and mortality. Therefore, taking stock of what is known and what is needed to improve understanding of chronic wounds and their associated failure to heal is crucial to ensuring better treatments and outcomes.
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Dowsett C, Thorne D. Improving lower limb care using the 3D Framework. Br J Community Nurs 2022; 27:S20-S26. [PMID: 35671197 DOI: 10.12968/bjcn.2022.27.sup6.s20] [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)
- Caroline Dowsett
- Clinical Nurse Specialist, Tissue Viability East London NHS Foundation Trust and Independent Nurse Consultant
| | - David Thorne
- Business Development Director, Well Up North PCN and the Northumberland Medical Alliance
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Behairy AS, Masry SE. Impact of Educational Nursing Intervention on Compression Therapy Adherence and Recurrence of Venous Leg Ulcers: A Quasi-Experimental Study. Ocul Oncol Pathol 2022; 8:120-132. [PMID: 35959154 PMCID: PMC9218629 DOI: 10.1159/000521054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 06/15/2024] Open
Abstract
Following the healing of venous leg ulcers, the primary problems for nursing and patients are adhering to compression therapy and preventing ulcer recurrence. As a result, it is important that patients comprehend their situation. The purpose of this study is to see how an educational nursing intervention affected compression therapy adherence and recurrence of venous leg ulcers in patients with chronic venous leg ulcers. A quasi-experimental design was used, including an intervention, a control group, and before and after assessments. This study was conducted in one of Egypt's largest teaching hospitals associated with Menoufia University. The 20-month study included 80 adult patients with healed venous leg ulcers. Each participant was randomized to either a control (got regular leg ulcer information) or study (received educational interventions) group. The following tools were used in the study: bio-sociodemographic variables, knowledge evaluation, compression therapy adherence scale, and recurrence follow-up, after 3, 6, and 12 months of implementation. Furthermore, there is a statistically significant difference between the study groups during the pretest (r = 0.885, 0.774, and 0.477, p = 0.002). The use of nursing education increased patients' understanding and adherence to compression treatment substantially. As a consequence, those with chronic venous leg ulcers may be able to avoid recurrent venous leg ulcers.
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Affiliation(s)
- Amoura Soliman Behairy
- Medical-Surgical Nursing Department, Faculty of Nursing, Menoufia University, Shibin Al Kawm, Egypt
- Nursing Department, Faculty of Medical Applied Sciences, Buraydah Private Colleges, Buraydah, Saudi Arabia
| | - Samah E. Masry
- Medical-Surgical Nursing Department, Faculty of Nursing, Menoufia University, Shibin Al Kawm, Egypt
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Pasek J, Szajkowski S, Cieślar G. Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone therapy for venous leg ulcers. INT J LOW EXTR WOUND 2022:15347346221104611. [PMID: 35637162 DOI: 10.1177/15347346221104611] [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: 11/15/2022]
Abstract
A significant health problem in many countries of the world is the occurrence of hard to heal leg ulcers. In recent years modern methods of physical medicine in comprehensive treatment have been used often including ozone therapy. The study included 54 patients, 25 male and 29 female in age between 39 and 87 years (mean age: 66.7 ± 11.9 years) with venous leg ulcers who underwent a cycle of local ozone therapy. The progress in wound healing was evaluated by computerized planimetry and pain intensity was assessed with use a visual analog scale (VAS) . As a result of the applied local ozone therapy a statistically significant reduction of the ulcer area was achieved from median 7.1 (5.6-9.4) cm2 to 4.4 (3-7) cm2 (P = .000001), which was on median 38.74 (27.27-51.42)% compared to the baseline values before the start of the therapy. In 2 patients (3.7%) the ulcers were completely healed. 18 patients (33.3%) achieved a reduction in ulcer area of more than 50% of the baseline value and the remaining 34 patients (63%) also achieved a reduction in ulcer area. A statistically significant in the percentage of surface area was observed in the group of 19 patients suffering from > 5 years of age compared to the group of 35 patients suffering from ≤5 years (median 50 (32.03-67.16)% versus 33.96 (23.71-45); P = .033178), while percentage changes in ulcer surface area did not differ significantly between all other subgroups of patients. There was also a statistically significant reduction in the intensity of pain in VAS scale in all patients, median 6 (5-7) points before treatment versus 4.4 (3-7) points after treatment, P = .000001). Local ozone therapy of venous leg ulcers accelerate the healing process of ulcers in objective planimetric assessment and reduce the intensity of pain ailments.
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Affiliation(s)
- Jarosław Pasek
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Częstochowa, Poland
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| | - Sebastian Szajkowski
- Department of Osteopathic Medicine, Department of Physiotherapy, Medical University of Mazovia in Warsaw, Warszawa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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Cowdell F. Evidence should inform more than prescribing decisions. Br J Dermatol 2022; 187:4. [PMID: 35490370 PMCID: PMC9541342 DOI: 10.1111/bjd.21603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Linked Article:Hewitt et al. Br J Dermatol 2022; 187:82–88.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences Birmingham City University Birmingham UK
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Evaluation of a Virtual Team-Based Project Designed to Improve Chronic Wound Patient Care in Ontario, Canada. Adv Skin Wound Care 2022; 35:442-446. [PMID: 35426839 DOI: 10.1097/01.asw.0000823984.14448.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the Extension for Community Healthcare Outcomes Ontario Skin and Wound Care project, a virtual team-based endeavor designed to improve the care of patients with chronic wounds. METHODS The study team conducted phone interviews with healthcare professionals (n = 8) regarding their patients (n = 10). The management recommendations were grouped, and the study participants questioned concerning the implementation of the recommendations. Interviews were recorded and transcribed, and the transcripts were analyzed for common themes. The Queen's University Research Ethics Board approved this study. RESULTS Interviews documented improvement in 50% of patients; the other half of the patients did not improve because of patient- and healthcare-system barriers. Three of five nonhealing patients were nonadherent regarding compression, and only one of six suggested biopsies were carried out. The investigators noted three primary reasons for the lack of recommendation implementation: (1) could not obtain a diagnostic procedure, (2) lack of a diagnosis, and (3) patient was reluctant to make a lifestyle change. Major themes included problems in care coordination and suboptimal patient and provider education, along with other obstacles to management. CONCLUSIONS Participants stated that the project provided a beneficial learning experience. The findings highlighted a lack of integrated and coordinated interprofessional chronic wound care.
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Team V, Jones A, Teede H, Weller CD. Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework. Front Public Health 2021; 9:634669. [PMID: 34778157 PMCID: PMC8581233 DOI: 10.3389/fpubh.2021.634669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.
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Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D. Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Oliveira BC, de Oliveira BGRB, Deutsch G, Pessanha FS, de Castilho SR. Effectiveness of a synthetic human recombinant epidermal growth factor in diabetic patients wound healing: Pilot, double-blind, randomized clinical controlled trial. Wound Repair Regen 2021; 29:920-926. [PMID: 34563097 DOI: 10.1111/wrr.12969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
To investigate whether the addition of human recombinant epidermal growth factor (h-EGF) to 2% carboxymethyl cellulose gel is more effective in diabetic wound healing than standard treatment, a pilot, double-blind, randomized and controlled clinical trial with therapeutic intervention was performed at a university hospital. The sample consisted of 25 patients (14 in the intervention group that used rh-EGF and 11 in the control group that used 2% carboxymethyl cellulose gel). Data were tabulated in SPSS and analysed by intention to treat, without loss or exclusion of participants. Twenty-five subjects participated with a mean age of 60.6 years, a predominance of males in both groups and 100% prevalence of type-2 diabetes. Within 12 weeks, complete wound healing occurred in three ulcers in the intervention group versus one ulcer in the control group. The percent reduction in the wound area was significantly higher in the intervention group than in the control group (p = 0.049). Concerning the types of tissue, an increase in granulation and epithelial tissue and a reduction in exudate levels were observed in both groups. Decreased slough occurred only in the intervention group. No participant experienced serious or local adverse events during the study period. This study shows that h-EGF is effective, with a statistically significant reduction in wound area, improvement of tissue quality, and safe treatment of chronic wounds. In addition, this study demonstrated that blinding of participants during research using h-EGF is feasible.
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Affiliation(s)
- Bianca Campos Oliveira
- Doctoral student in Health Care Sciences, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Beatriz Guitton Renaud Baptista de Oliveira
- Full Professor at Universidade Federal Fluminense, Coordinator of the Graduate Program in Health Care Sciences, Federal Fluminense University, Health Area Coordinator - FAPERJ, Niterói, Rio de Janeiro, Brazil
| | - Gabriela Deutsch
- PhD in Sciences Applied to Health Products, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | | | - Selma Rodrigues de Castilho
- Full Professor at Federal Fluminense University, Director of the College of Pharmacy, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
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Weller CD, Richards C, Turnour L, Team V. Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study. Front Pharmacol 2021; 12:663570. [PMID: 34149416 PMCID: PMC8209379 DOI: 10.3389/fphar.2021.663570] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Catelyn Richards
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Louise Turnour
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
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Weller CD, Team V, Probst S, Gethin G, Richards C, Sixsmith J, Turnour L, Bouguettaya A. Health literacy in people with venous leg ulcers: a protocol for scoping review. BMJ Open 2021; 11:e044604. [PMID: 33980525 PMCID: PMC8117997 DOI: 10.1136/bmjopen-2020-044604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/08/2021] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Chronic venous leg ulcer (VLU) healing is a complex clinical problem. It requires intervention from skilled, costly, multidisciplinary wound-care teams, working with patients to manage their care. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence, with some evidence suggesting the value of exercise as well. These activities require health education and health literacy (HL) as patients must process, understand and consistently apply health information for successful self-management. Research suggests that those most vulnerable to VLUs also tend to have limited HL, but there have been no reviews examining the state of HL in patients with previous or active VLUs. This scoping review aims to examine the level of HL in VLU patients and how HL may link to self-management behaviours (particularly exercise and compression adherence), and their VLU healing generally. METHODS AND ANALYSIS We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines and the Levac methodology framework to explore eligible papers that examine the effect of HL on their exercise and compression adherence. Electronic databases will be searched (MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, OpenGray), examining for all papers on these subjects published between 2000 and 2020. All studies describing compression and or exercise during VLU management will be included. Study characteristics will be recorded; qualitative data will be extracted and evaluated. Quantitative data will be extracted and summarised. ETHICS AND DISSEMINATION We will disseminate results through peer-reviewed publications. We will use data (ie, journal articles) from publicly available platforms; so, this study does not require ethical review. The consultation step will be carried out with patients, carers and health professionals as part of an established wound consumer group.
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Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | | | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Catelyn Richards
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Jane Sixsmith
- Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Louise Turnour
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ayoub Bouguettaya
- School of Psychology, University of Birmingham Edgbaston Campus, Birmingham, UK
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Scientific and Clinical Abstracts From WOCNext® 2021: An Online Event ♦ June 24-26, 2021. J Wound Ostomy Continence Nurs 2021; 48:S1-S49. [PMID: 37632236 DOI: 10.1097/won.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kathirvel S, Kaur S, Dhillon MS, Singh A. Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India: A pragmatic randomized controlled trial. J Family Med Prim Care 2021; 10:1267-1274. [PMID: 34041164 PMCID: PMC8140256 DOI: 10.4103/jfmpc.jfmpc_1436_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients. METHODOLOGY Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted. RESULTS The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001). CONCLUSION Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.
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Affiliation(s)
- Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Probst S, Gethin G. Virtually EWMA - telemedicine and the future. J Wound Care 2020; 29:S3. [PMID: 33179544 DOI: 10.12968/jowc.2020.29.sup11.s3] [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]
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