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Costantini E, Aielli L, Gualdi G, Baronio M, Monari P, Amerio P, Reale M. Pulsed Radiofrequency Electromagnetic Fields as Modulators of Inflammation and Wound Healing in Primary Dermal Fibroblasts of Ulcers. Bioengineering (Basel) 2024; 11:357. [PMID: 38671778 PMCID: PMC11047973 DOI: 10.3390/bioengineering11040357] [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: 02/19/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Venous leg ulcers are one of the most common nonhealing conditions and represent an important clinical problem. The application of pulsed radiofrequency electromagnetic fields (PRF-EMFs), already applied for pain, inflammation, and new tissue formation, can represent a promising approach for venous leg ulcer amelioration. This study aims to evaluate the effect of PRF-EMF exposure on the inflammatory, antioxidant, cell proliferation, and wound healing characteristics of human primary dermal fibroblasts collected from venous leg ulcer patients. The cells' proliferative and migratory abilities were evaluated by means of a BrdU assay and scratch assay, respectively. The inflammatory response was investigated through TNFα, TGFβ, COX2, IL6, and IL1β gene expression analysis and PGE2 and IL1β production, while the antioxidant activity was tested by measuring GSH, GSSG, tGSH, and GR levels. This study emphasizes the ability of PRF-EMFs to modulate the TGFβ, COX2, IL6, IL1β, and TNFα gene expression in exposed ulcers. Moreover, it confirms the improvement of the proliferative index and wound healing ability presented by PRF-EMFs. In conclusion, exposure to PRF-EMFs can represent a strategy to help tissue repair, regulating mediators involved in the wound healing process.
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Affiliation(s)
- Erica Costantini
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, 66100 Chieti, Italy; (G.G.); (P.A.)
| | - Lisa Aielli
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, 66100 Chieti, Italy; (L.A.); (M.R.)
| | - Giulio Gualdi
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, 66100 Chieti, Italy; (G.G.); (P.A.)
| | - Manuela Baronio
- Pediatrics Clinic and Institute for Molecular Medicine A. Novivelli, Department of Clinical and Expermental Sciences, University of Brescia and ASST-Spedali Civili of Brescia, 25123 Brescia, Italy;
| | - Paola Monari
- Department of Dermatology, Spedali Civili of Brescia, 25123 Brescia, Italy;
| | - Paolo Amerio
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, 66100 Chieti, Italy; (G.G.); (P.A.)
| | - Marcella Reale
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, 66100 Chieti, Italy; (L.A.); (M.R.)
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Júnior SADO, Oliveira ACDS, Dantas Araújo MP, Dantas BADS, Sánchez MDCG, Torres GDV. Influence of pain on the quality of life in patients with venous ulcers: Cross-sectional association and correlation study in a brazilian primary health care lesions treatment center. PLoS One 2023; 18:e0290180. [PMID: 37582120 PMCID: PMC10426926 DOI: 10.1371/journal.pone.0290180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
We aimed to verify the association and correlation between pain and QoL in people with VU treated in a Brazilian Primary Health Care (PHC) lesions treatment center. This is an observational, cross-sectional study with a quantitative approach, carried out in a service specialized in the treatment of chronic injuries, linked to 29 PHC units. Sociodemographic and health characterization instruments were used. The Short Form Health Survey-36 (SF-36) and Visual Analogue Pain Scale (VAPS) also were used. The Kruskal-Wallis test verified the association between the scalar variables of QoL and pain intensity. With Spearman's correlation test, we verified the level of correlation between the scales applied. A total of 103 patients participated in the study. Higher QoL scores associated with moderate pain were found, especially in the Physical role functioning, Physical functioning, and Vitality domains. Correlation analysis showed its greatest (moderate) strength in the interaction between the highest scores in the Physical role functioning and Emotional role functioning domains with the lowest pain levels.
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Hresko DJ, Ngo QC, Ogrin R, Drotar P, Ekinci E, Tint AN, Kumar DK. Application of StyleGAN Architecture for Generating Venous Leg Ulcer Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083027 DOI: 10.1109/embc40787.2023.10340126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Leg ulcers caused by impaired venous blood return are the most typical chronic wound form and have a significant negative impact on the lives of people living with these wounds. Thus, it is important to provide early assessment and appropriate treatment of the wounds to promote their healing in the normal trajectory. Gathering quality wound data is an important component of good clinical care, enabling monitoring of healing progress. This data can also be useful to train machine learning algorithms with a view to predicting healing. Unfortunately, a high volume of good-quality data is needed to create datasets of suitable volume from people with wounds. In order to improve the process of gathering venous leg ulcer (VLU) data we propose the generative adversarial network based on StyleGAN architecture to synthesize new images from original samples. We utilized a dataset that was manually collected as part of a longitudinal observational study of VLUs and successfully synthesized new samples. These synthesized samples were validated by two clinicians. In future work, we plan to further process these new samples to train a fully automated neural network for ulcer segmentation.
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Atkin L, Clothier A. The role of venous intervention for the treatment of patients with venous leg ulceration. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S6-S12. [PMID: 37344146 DOI: 10.12968/bjon.2023.32.12.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
More than 1 million people are estimated to have lower limb venous ulceration in the UK. Such wounds are predominantly caused by sustained venous hypertension, as a result of chronic venous insufficiency, often due to venous valve incompetence or an impaired calf muscle pump. Compression therapy is key to venous leg ulcer management and the majority of nurses are aware of the importance of starting patients on compression therapy as early as possible. However, there appears to be a lack of awareness of the importance of venous assessment and that more patients could benefit from endovenous correction of superficial venous incompetence.
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Affiliation(s)
- Leanne Atkin
- Lecturer Practitioner/Vascular Nurse Consultant, School of Human and Health Sciences, University of Huddersfield and Mid Yorkshire NHS Trust
| | - Annie Clothier
- Lecturer Practitioner/Vascular Nurse Consultant, School of Human and Health Sciences, University of Huddersfield and Mid Yorkshire NHS Trust
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de Oliveira Viana Pereira DM, de Souza Oliveira AC, de Oliveira Júnior SA, Jacinto MAG, Dionísio AJ, Lima AEO, da Silva Dantas BA, de Oliveira Sousa SL, Martínez CSG, de Vasconcelos Torres G. Correlation between Generic and Disease-Specific Quality of Life Questionnaires in Patients with Venous Ulcerations: A Cross-Sectional Study Carried out in a Primary Health Care Setting in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3583. [PMID: 36834277 PMCID: PMC9961915 DOI: 10.3390/ijerph20043583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Venous Ulcers (VU) are a serious health problem that affect the Quality of Life (QoL). They are evaluated by many different scales in the literature. We aimed to analyze the correlation between the Medical Outcomes Short-Form Health QoL (SF-36) and Charing Cross Venous Ulcer Questionnaire (CCVUQ) scales. This is a cross-sectional study conducted in a Brazilian center specializing in chronic VU of the Primary Health Care (PHC) provided to patients with active VU. The general QoL instrument SF-36 and the CCVUQ, specific for people with VU, were used. Spearman's Rho Test determined the correlation between the variables analyzed. Our sample had a total of 150 patients. We found a direct correlation between the domestic activities division (CCVUQ) aspect and the SF-36 Physical role functioning (strong), and Physical functioning (moderate) domains. The Social interaction division (CCVUQ) aspect presented moderate correlation with the domains of the SF-36 Physical role functioning and Physical functioning. The Vitality domain (SF-36) showed moderate correlation with the aspects of CCVUQ Cosmesis division and Emotional status division. The greatest forces of direct correlation were observed between the physical, functional and vitality aspects of SF-36 with those represented by domestic activities and social interaction in the CCVUQ.
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Affiliation(s)
| | | | - Severino Azevedo de Oliveira Júnior
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Av. Olavo Lacerda Montenegro n. 2685, Parnamirim 59158-400, Brazil
| | - Maria Angélica Gomes Jacinto
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Av. dos Caiapós n. 121, Bairro Pitimbú, Natal 59067-400, Brazil
| | - Alessandra Justino Dionísio
- Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte (UFRN), Rua dos Palmares, 30, Parque das Árvores, Parnamirim 59154-145, Brazil
| | - Alana Ellen Oliveira Lima
- Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte (UFRN), Av. Maria Lacerda Montenegro nº 339, Parnamirim 59152-900, Brazil
| | - Bruno Araújo da Silva Dantas
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Rua Alice Azevedo, 30, Natal 59080-015, Brazil
| | | | - Carmelo Sergio Gómez Martínez
- Facultad de Enfermería, Universidad Católica de Murcia (UCAM), Calle Orden de Santiago, num 5, Abarán-Murcia, 30550 Murcia, Spain
| | - Gilson de Vasconcelos Torres
- Centro de Ciências da Saúde, Research Productivity Scholarship (CNPQ/PQ1D), Universidade Federal do Rio Grande do Norte (UFRN), Rua das Massarandubas, 292, Nova Parnamirim, Parnamirim 59150-630, Brazil
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A shear-wave sonoelastography investigation of calf muscle pump biomechanics in patients with chronic venous disease and healthy controls. J Bodyw Mov Ther 2023; 33:53-59. [PMID: 36775526 DOI: 10.1016/j.jbmt.2022.09.026] [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: 04/07/2020] [Revised: 05/23/2022] [Accepted: 09/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND chronic venous disease (CVD) is a common progressive disorder with incompetence of calf muscle pump due to weakness and ankle mobility abnormality is an important etiological factor in CVD, but the biomechanical properties of calf muscle pump are remain unknown. OBJECTIVES The purpose of the present study was to evaluate group differences between the biomechanical properties changes of the medial gastrocnemius muscle (GM) and its fascias in participants with CVD and healthy controls. METHODS In this case-control study, thirty patients with CVD in three equal groups (mild: C1 - C2, moderate: C3 - C4, severe: C5 - C6) and 20 healthy subjects in a control group participated. The medial GM and its fascias shear modulus (stiffness) were measured using a shear-wave sonoelastography in rest and active dorsiflexion positions of ankle joint. RESULTS The results of variance (ANOVA) analysis showed a significant difference in shear wave elastography (SWE) value between the groups for medial GM and its fascias at rest and active dorsiflexion of the ankle joint (P < 0.05). There was a statistically significant increase in SWE value of the medial GM and its fascias in moderate (c3-c4) and severe CVD groups (C5-C6) compared to the control and mild (C1-C2) CVD groups. A positive correlation was discovered between disease grades and the medial GM and its fascias SWE in patients with CVD ranging between r = 0.846 to 0.891; P < 0.001. CONCLUSION An alteration stiffness in calf myofascial pump as compared to control group indicated an impaired myofascial biomechanics. Calf myofascial SWE may be valuable information in the diagnosis and follow-up processes of patients with CVD.
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Abstract
Early prediction of delayed healing for venous leg ulcers could improve management outcomes by enabling earlier initiation of adjuvant therapies. In this paper, we propose a framework for computerised prediction of healing for venous leg ulcers assessed in home settings using thermal images of the 0 week. Wound data of 56 older participants over 12 weeks were used for the study. Thermal images of the wounds were collected in their homes and labelled as healed or unhealed at the 12th week follow up. Textural information of the thermal images at week 0 was extracted. Thermal images of unhealed wounds had a higher variation of grey tones distribution. We demonstrated that the first three principal components of the textural features from one timepoint can be used as an input to a Bayesian neural network to discriminate between healed and unhealed wounds. Using the optimal Bayesian neural network, the classification results showed 78.57% sensitivity and 60.00% specificity. This non-contact method, incorporating machine learning, can provide a computerised prediction of this delay in the first assessment (week 0) in participants' homes compared to the current method that is able to do this in 3rd week and requires contact digital planimetry.
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Barriers and enablers to physical activity in people with venous leg ulcers: A systematic review of qualitative studies. Int J Nurs Stud 2022; 135:104329. [DOI: 10.1016/j.ijnurstu.2022.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
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Gomes NN, Rosa LMMDS, Ferreira MDA, Silva RCD. Social representations of patients with vasculogenic ulcers about quality of life: an analysis of the social context. Rev Bras Enferm 2021; 75:e20210136. [PMID: 34705995 DOI: 10.1590/0034-7167-2021-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the social representations of patients with vasculogenic ulcers about quality of life and analyze such representations from the social context of patients' insertion in relation to the healthcare service. METHOD a qualitative research, based on social representations, developed in a Family Clinic in Rio de Janeiro with 30 patients with vasculogenic ulcers for over 90 days. Data were produced through interviews and submitted to lexicographical analysis using the Alceste software. RESULTS the weaknesses of care in the healthcare service to which patients were linked contributed to exacerbate the reconfiguration of daily life that the occurrence of ulcers implies, due to the presence of pain and physical restrictions, influencing the representation of quality of life. FINAL CONSIDERATIONS the representation was objectified as a counterpoint to the image of "being happy", and actions expressed proactivity in the search for a cure or passivity due to lack of clinical results.
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Mahlapuu M, Sidorowicz A, Mikosinski J, Krzyżanowski M, Orleanski J, Twardowska-Saucha K, Nykaza A, Dyaczynski M, Belz-Lagoda B, Dziwiszek G, Kujawiak M, Karczewski M, Sjöberg F, Grzela T, Wegrzynowski A, Thunarf F, Björk J, Ekblom J, Jawien A, Apelqvist J. Evaluation of LL-37 in healing of hard-to-heal venous leg ulcers: A multicentric prospective randomized placebo-controlled clinical trial. Wound Repair Regen 2021; 29:938-950. [PMID: 34687253 PMCID: PMC9298190 DOI: 10.1111/wrr.12977] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 12/01/2022]
Abstract
Many patients with venous leg ulcers do not reach complete healing with compression treatment alone, which is current standard care. This clinical trial HEAL LL‐37 was a phase IIb double‐blind, randomized, placebo‐controlled study, with the aim to evaluate the efficacy and safety of a new drug LL‐37 for topical administration, in combination with compression therapy, in 148 patients suffering from hard‐to‐heal venous leg ulcers. The study had three arms, consisting of two groups treated with LL‐37 at concentrations of 0.5 or 1.6 mg/mL, and a placebo cohort. Patients had a mean age of 67.6 years, a median ulcer duration of 20.3 months, and a mean wound size at the time of randomization of 11.6 cm2. Efficacy analysis performed on the full study population did not identify any significant improvement in healing in patients treated with LL‐37 as compared with the placebo. In contrast, a post hoc analysis revealed statistically significant improvement with LL‐37 treatment in several interrelated healing parameters in the subgroup of patients with large target wounds (a wound area of at least 10 cm2 at randomization), which is a known negative prognostic factor for healing. The study drug was well tolerated and safe in both dose strengths. In summary, this clinical trial did not detect any significant differences in healing of venous lower leg ulcers in the entire study cohort comparing patients treated with LL‐37 versus placebo. A subgroup analysis provided an interesting observation that LL‐37 could offer a treatment benefit in patients with large ulcers, exigently warranting a further study adequately powered to statistically assess the treatment outcome in this patient group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Folke Sjöberg
- Burn Center, Linköping University Hospital, Linköping, Sweden
| | - Tomasz Grzela
- Clinic of Phlebology and the Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
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Oliveira BGRBD, Castro JBDA, Lisboa EFNS, Kang HC, Ferreira MDA. The presence of anemia in patients with leg ulcer: laboratory test. Rev Bras Enferm 2021; 75:e20210064. [PMID: 34614085 DOI: 10.1590/0034-7167-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. METHOD This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. RESULTS 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. CONCLUSION The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.
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Affiliation(s)
| | | | | | - Hye Chung Kang
- Universidade Federal Fluminense. Niterói, Rio de Janeiro, Brazil
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Gomes NN, Rosa LMMDS, Ferreira MDA, Silva RCD. Representations and practices of patients with vasculogenic ulcers on quality of life. Rev Gaucha Enferm 2021. [DOI: 10.1590/1983-1447.2021.20200098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To identify the social representations and practices of patients with vasculogenic ulcer about their quality of life. Method: Qualitative research that applied the Social Representations theory. Participants were 30 patients with vasculogenic ulcers registered at a health unit in Rio de Janeiro. Data was collected through semi-structured interviews, and lexical analysis was applied. Results: The social representations about the quality of life of the patients were built from the affections arising from the changes in their lives. Thus, losses arising from the reconfiguration of daily life led to a negative symbolic construction about themselves and their lives, which resulted, on the one hand, in proactive self-care behaviors and, on the other, in less self-care. Conclusion: Care for health promotion and social support is required to re-signification of life with ulcer and the adoption of new coping practices.
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McNamara SA, Cahn BA, Sanders M, Lopez AJ. Venous Procedures to Treat Venous Leg Ulcers. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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de Oliveira AS, Correia DL, Vasconcelos KVP, da Silva FAA, Alexandre SG, Ferreira SL. Venous ulcer: characterization of outpatient care at a university hospital. ESTIMA 2020. [DOI: 10.30886/estima.v18.928_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To characterize the clinical and sociodemographic profile of people with venous ulcers followed up in a specialize outpatient clinic of a university hospital. Method: documentary study carried out in a general surgery outpatient clinic of a university hospital. 104 instruments applied in the first nursing consultation were reviewed. Results: there was a predominance of females, with a mean age of 54 years. The majority did not perform paid work, the wound being the reason for leaving work activities. Systemic arterial hypertension and obesity were the most prevalent comorbidities. The person with venous ulcer was the main person involved in direct care of the wound. Conclusion: the profile of the study population is compatible with other studies in different contexts in Brazil. The results allow a reflection on the assistance provided and the effectiveness of the implemented interventions.
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de Oliveira AS, Correia DL, Vasconcelos KVP, da Silva FAA, Alexandre SG, Ferreira SL. Úlcera venosa: caracterização dos atendimentos em ambulatório de hospital universitário. ESTIMA 2020. [DOI: 10.30886/estima.v18.928_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: caracterizar o perfil clínico e sociodemográfico de pessoas com úlceras venosas acompanhadas em ambulatório especializado de um hospital universitário. Método: estudo documental realizado em ambulatório de cirurgia geral de um hospital universitário. Realizou-se a revisão de 104 instrumentos aplicados na primeira consulta de enfermagem. Resultados: houve predominância do sexo feminino, com média de idade de 54 anos. A maioria não exercia atividade remunerada, sendo a ferida o motivo do afastamento das atividades laborais. A hipertensão arterial sistêmica e a obesidade foram as comorbidades mais prevalentes. A pessoa com úlcera venosa foi a principal envolvida no cuidado direto com a ferida. Conclusão: o perfil da população do estudo se mostra compatível com outros estudos em diferentes contextos do Brasil. Os resultados permitem uma reflexão acerca da assistência prestada e efetividade das intervenções implementadas.
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Kaba E, Triantafyllou A, Fasoi G, Kelesi M, Stavropoulou A. Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207610. [PMID: 33086753 PMCID: PMC7589511 DOI: 10.3390/ijerph17207610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/24/2022]
Abstract
Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.
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Morilla‐Herrera JC, Morales‐Asencio JM, Gómez‐González AJ, Díez‐De Los Ríos A, Lupiáñez‐Pérez I, Acosta‐Andrade C, Aranda‐Gallardo M, Moya‐Suárez AB, Kaknani‐Uttumchandani S, García‐Mayor S. Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study). J Adv Nurs 2020; 76:2191-2197. [PMID: 32395842 PMCID: PMC7496185 DOI: 10.1111/jan.14412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/09/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
AIM To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact® ) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health-related quality of life, level of pain, and time to complete healing. DESIGN Open randomized controlled trial, with blinded endpoint. METHODS Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound-related variables (area, exudate, and time to healing), level of pain, adverse effects, and health-related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA-typing technique through polymerase chain reaction to obtain the level of colony-forming units. Measures will be collected at baseline, 4, 8, and 12 weeks. DISCUSSION Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced. IMPACT Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.
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Affiliation(s)
- Juan C. Morilla‐Herrera
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Distrito Sanitario Málaga – Valle del GuadalhorceMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | - José M. Morales‐Asencio
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | | | | | - Inmaculada Lupiáñez‐Pérez
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Distrito Sanitario Málaga – Valle del GuadalhorceMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | | | - Marta Aranda‐Gallardo
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
- Agencia Sanitaria Costa del SolMarbellaSpain
| | - Ana B. Moya‐Suárez
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
- Agencia Sanitaria Costa del SolMarbellaSpain
| | - Shakira Kaknani‐Uttumchandani
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | - Silvia García‐Mayor
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
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Lin BS, Chen CW, Zhou SK, Tseng YH, Wang SC, Huang YK. Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging. Phlebology 2020; 35:814-823. [PMID: 32700650 DOI: 10.1177/0268355520935739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Venous leg ulcers, or static leg ulcers, are chronic wounds associated with ambulatory venous hypertension of the lower extremities as a consequence of venous valve reflux, reduce venous capacitance, poor calf venous pump, heart failure, or in conjunction with venous obstruction. A static ulcer with venous thrombosis in a pelvic or thigh vein responds favorably to anticoagulation agents. However, anticoagulation is less effective and even harmful when ambulatory venous hypertension has another cause such as venous reflux, poorly heart function, and poor calf venous pump. METHOD TRiggered Angiography Non-Contrast-Enhanced (TRANCE) magnetic resonance imaging (MRI) exploits differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing detailed radiation-free venograms without the use of contrast agents. The method is a new tool for evaluating the presence of thrombosis in the venous systems. TRANCE-MRI was employed to document the existence of venous thrombosis within the eight patients in this study. Subsequently, we used a wireless wearable near-infrared spectroscopy device to compare deep vein thrombosis-associated and non-deep vein thrombosis-associated static ulcers. The sampling depths were 5 and 10 mm, representing the dermis and subcutaneous tissue, respectively. RESULT There are four patients with venous leg ulcers proven with venous thrombosis by TRANCE-MRI and are classified as deep vein thrombosis group. Compared with the non-deep vein thrombosis group, the deep vein thrombosis group had less deoxyhemoglobin, less total hemoglobin, and a significantly lower H2O signal in the 5-mm sampling depth (dermis level). And eight health participants were included as control group. Wounded patients (including deep vein thrombosis and non-deep vein thrombosis patients) have higher H2O concentration on the 5-mm depth sampling than control group. In the 10-mm sampling depth (subcutaneous level), the deoxyhemoglobin and tissue oxygen saturation of the deep vein thrombosis group were lower than those of the non-deep vein thrombosis group, and the H2O concentration was higher than non-deep vein thrombosis group. Patients with static foot ulcers and deep vein thrombosis had similar oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue oxygen saturation than did those without deep vein thrombosis in 5-mm depth sampling (dermis level). Notably, the H2O signal of patients with non-deep vein thrombosis-associated static ulcers was higher for the 5-mm sampling depth. CONCLUSION In patients with static ulcers and deep vein thrombosis, the H2O level may be higher in the 10-mm sampling depth, indicating that those patients had more subcutaneous water. In patients with non-deep vein thrombosis static foot ulcer, the near-infrared spectroscopy (NIRS) indicated worse fluid retention in the dermis level. The H2O value in the NIRS may be different owing to underline the cause of the venous leg ulcers.
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Affiliation(s)
- Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Shao-Kui Zhou
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
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20
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Dissemond J, Lützkendorf S, Dietlein M, Neßeler I, Becker E, Möller U, Thomassin L, Bohbot S, Münter KC. Clinical evaluation of polyabsorbent TLC-NOSF dressings on chronic wounds: a prospective, observational, multicentre study of 1140 patients. J Wound Care 2020; 29:350-361. [DOI: 10.12968/jowc.2020.29.6.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The superior wound healing properties and cost-effectiveness of TLC-NOSF dressings in the local treatment of chronic wounds have already been demonstrated by several randomised controlled trials (RCTs) at a high quality level. Therefore, this study aimed to evaluate the efficacy and safety of new TLC-NOSF dressings with polyabsorbent fibres in an unselected population of patients under real-life conditions. Method: A large, prospective, multicentre, observational study with two polyabsorbent TLC-NOSF dressings (UrgoStart Plus Pad and UrgoStart Plus Border, Laboratoires Urgo, France) was conducted in Germany between July 2017 and December 2018. Main outcomes included wound healing rate, clinical assessment of wound healing progression, local tolerability and acceptance of dressings. Results: A total of 1140 patients with chronic wounds of various aetiologies (leg ulcers, diabetic foot ulcers, pressure ulcers, etc.) were treated with the investigated dressings in 130 centres, for a mean duration of 56±34 days. By the final visit, 48.5% of wounds had healed and 44.8% had improved. Similar results were reported regardless of wound aetiology or regardless of proportions of sloughy and granulation tissue at the start of treatment. According to the subgroup analysis by wound duration, the sooner the TLC-NOSF treatment was initiated, the better the clinical outcomes for all types of wounds. The dressings were very well tolerated and accepted by the patients. Conclusion: These results are consistent with those from RCTs conducted on TLC-NOSF dressings. They complete the evidence on the good healing properties and safety profile of these dressings, especially in non-selected patients treated in current practice, and regardless of the characteristics of wounds and patients. They support the use of the dressings as a first-line intervention and until wound healing in the management of chronic wounds, in association with appropriate standard of care.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
| | | | | | - Ingo Neßeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
- Medical Office Specialized on Vascular Medicine, Köln, Germany
| | | | | | | | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO Medical, Paris, France
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21
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Sigal ML, Addala A, Maillard H, Chahim M, Sala F, Blaise S, Dalac S, Meaume S, Bohbot S, Tumba C, Tacca O. Evaluation of TLC-NOSF dressing with poly-absorbent fibres in exuding leg ulcers: two multicentric, single-arm, prospective, open-label clinical trials. J Wound Care 2019; 28:164-175. [DOI: 10.12968/jowc.2019.28.3.164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Azeddine Addala
- Vascular Medicine Department, Edouard Herriot Hospital, Lyon, France
| | - Hervé Maillard
- Dermatology Department, Le Mans Hospital, Le Mans, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Florent Sala
- Vascular Surgery Department, Montréal Polyclinic, Carcassonne, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Sophie Dalac
- Dermatology Department, Dijon University Hospital, Dijon, France
| | - Sylvie Meaume
- Geriatric Department, Rotschild University Hospital, Paris, France
| | - Serge Bohbot
- Medical Affair Department, Laboratoires Urgo, Paris, France
| | - Clémence Tumba
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
| | - Olivier Tacca
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
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