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Woo K. The Chronic Wound-Related Pain Model: Holistic Assessment and Person-Centered Treatment. Clin Geriatr Med 2024; 40:501-514. [PMID: 38960540 DOI: 10.1016/j.cger.2023.12.013] [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: 07/05/2024]
Abstract
Chronic wound-related pain is a complex biopsychosocial experience that is experienced spontaneously at rest and exacerbated during activities. Tissue debridement, trauma at dressing change, increased bioburden or infection, exposure of periwound skin to moisture, and related treatment can modulate chronic wound-related pain. Clinicians should consider multimodal and multidisciplinary management approach that take into account the biology, emotions, cognitive thinking, social environment, and other personal determinants of pain. Unresolved pain can have a significant impact on wound healing, patients' adherence to treatment, and individual's quality of life.
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Affiliation(s)
- Kevin Woo
- Faculty of Health Sciences, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6, Canada.
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2
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Chan SM, Tabari A, Rudié E, D'Amore B, Cox M, Mugahid A, Iqbal S, Daye D. Disparities in access to endovenous treatment options in chronic lower extremity superficial venous insufficiency: A national 7-year analysis. J Vasc Surg Venous Lymphat Disord 2024; 12:101867. [PMID: 38452897 DOI: 10.1016/j.jvsv.2024.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The goal of this study was to analyze trends in treatment access for chronic superficial venous disease and to identify disparities in care. METHODS This retrospective study was exempt from institutional review board approval. The American College of Surgeon National Surgical Quality Improvement Program database was used to identify patients who underwent vein stripping (VS) and endovenous procedures for treatment of chronic superficial venous disease. Endovenous options included radiofrequency ablation (RFA) and laser ablation. Data was available from 2011 to 2018 and demographic information was extracted for each patient identified by Current Procedural Terminology codes. For all racial and ethnic groups, trend lines were plotted, and the relative rate of change was determined within each specified demographic. RESULTS There were 21,025 patients included in the analysis. The overall mean age was 54.2 years, and the majority of patients were female (64.8%). In total, 27.9%, 55.2%, and 16.9% patients underwent VS, RFA, and laser ablation, respectively. Patients who received laser ablation were older (P < .001). Hispanic ethnicity was associated with significantly lower odds of receiving endovascular thermal ablation (EVTA) over VS (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.64-0.78; P < .001). American Indian/Alaska Native patients were more likely to receive EVTA over VS (OR, 4.02; 95% CI, 2.48-6.86); similarly, Native Hawaiian/Pacific Islander patients were more likely to receive EVTA over VS, although this difference was not statistically significant (OR, 1.44; 95% CI, 0.93-2.27). On multinomial regression, Hispanic patients were less likely to receive RFA over VS, whereas American Indian/Alaskan Native patients were more likely to receive RFA over VS. In all racial and ethnic groups, the percentage of endovenous procedures increased, whereas vein stripping decreased. CONCLUSIONS Based on a hospital-based dataset, demographic indicators, including age, sex, race, and ethnicity, are associated with differences in endovenous treatments for chronic superficial venous insufficiency suggesting disparities in obtaining minimally invasive treatment options among certain patient groups.
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Affiliation(s)
- Shin Mei Chan
- UCSF Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Emma Rudié
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brian D'Amore
- Drexel University College of Medicine, Philadelphia, PA
| | - Meredith Cox
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Duke University School of Medicine, Durham, NC
| | - Ayah Mugahid
- UCSF Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Shams Iqbal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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3
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Valesky EM, Hach-Wunderle V, Protz K, Zeiner KN, Erfurt-Berge C, Goedecke F, Jäger B, Kahle B, Kluess H, Knestele M, Kuntz A, Lüdemann C, Meissner M, Mühlberg K, Mühlberger D, Pannier F, Schmedt CG, Schmitz-Rixen T, Strölin A, Wilm S, Rabe E, Stücker M, Dissemond J. Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V. J Dtsch Dermatol Ges 2024; 22:1039-1051. [PMID: 38938151 DOI: 10.1111/ddg.15415] [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: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 06/29/2024]
Abstract
This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.
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Affiliation(s)
- Eva Maria Valesky
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Viola Hach-Wunderle
- Vascular Center, Department of Angiology, Northwest Hospital, Frankfurt am Main, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Nikola Zeiner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Björn Jäger
- Initiative Chronische Wunden, Quedlinburg, Germany
| | - Birgit Kahle
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Holger Kluess
- Professional Association of Phlebologists and Lymphologists, Freiburg, Germany
| | - Michaela Knestele
- Hospital Marktoberdorf, Department of Surgery, Kreiskliniken Ostallgäu, Marktoberdorf, Germany
| | - Anja Kuntz
- Welfare Center Leonberg, Gerlingen, Germany
| | | | - Markus Meissner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
- Dermatology Office, Prof. Dr. Markus Meissner, Wiesbaden, Germany
| | - Katja Mühlberg
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominic Mühlberger
- St. Marien Hospital Herne, Department of Vascular Surgery, Ruhr University Bochum, Herne, Germany
| | | | | | - Thomas Schmitz-Rixen
- Goethe University Frankfurt, University Hospital, Department of Endovascular and Vascular Surgery, Frankfurt am Main, Germany
| | - Anke Strölin
- University Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Stefan Wilm
- Institute for General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eberhard Rabe
- Private Office Dermatology & Phlebology, Bonn, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Catholic Hospital Bochum, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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Shi Y, Liu R, Ye C. Personalized compression therapeutic textiles: digital design, development, and biomechanical evaluation. Front Bioeng Biotechnol 2024; 12:1405576. [PMID: 38988869 PMCID: PMC11233689 DOI: 10.3389/fbioe.2024.1405576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/23/2024] [Indexed: 07/12/2024] Open
Abstract
Physical-based external compression medical modalities could provide sustainable interfacial pressure dosages for daily healthcare prophylaxis and clinic treatment of chronic venous disease (CVD). However, conventional ready-made compression therapeutic textiles (CTs) with improper morphologies and ill-fitting of pressure exertions frequently limit patient compliance in practical application. Therefore, the present study fabricated the personalized CTs for various subjects through the proposed comprehensive manufacturing system. The individual geometric dimensions and morphologic profiles of lower extremities were characterized according to three-dimensional (3D) body scanning and reverse engineering technologies. Through body anthropometric analysis and pressure optimization, the knitting yarn and machinery variables were determined as the digital design strategies for 3D seamless fabrication of CTs. Next, to visually simulate the generated pressure mappings of developed CTs, the subject-specific 3D finite element (FE) CT-leg modelings with high accuracy and acceptability (pressure prediction error ratio: 11.00% ± 7.78%) were established based on the constructed lower limb models and determined tissue stiffness. Moreover, through the actual in vivo trials, the prepared customized CTs efficiently (Sig. <0.05; ρ = 0.97) distributed the expected pressure requirements referring to the prescribed compression magnitudes (pressure error ratio: 10.08% ± 7.75%). Furthermore, the movement abilities and comfortable perceptions were evaluated subjectively for the ergonomic wearing comfort (EWC) assessments. Thus, this study promotes the precise pressure management and clinical efficacy for targeted users and leads an operable development approach for related medical biomaterials in compression therapy.
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Affiliation(s)
- Yu Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Laboratory for Artificial Intelligence in Design, Hong Kong, Hong Kong SAR, China
| | - Rong Liu
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Laboratory for Artificial Intelligence in Design, Hong Kong, Hong Kong SAR, China
| | - Chongyang Ye
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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5
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Tan M, Urbanek T, Rabe E, Gianesini S, Parsi K, Davies AH. Compression therapy in the management of varicose veins. Phlebology 2024; 39:276-279. [PMID: 38101949 PMCID: PMC10993631 DOI: 10.1177/02683555231222679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Kurosh Parsi
- Department of Dermatology, St Vincent’s Hospital, Sydney, Australia
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - on behalf of UIP
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Medical University of Silesia, Katowice, Poland
- Department of Dermatology, University of Bonn, Bonn, Germany
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Dermatology, St Vincent’s Hospital, Sydney, Australia
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6
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Hirsch T, Arns H, Schleinitz J, Fiedler HW. An innovative flat-knit compression garment for lymphoedema patients led to better outcomes: a multicentre study. J Wound Care 2024; 33:220-228. [PMID: 38573905 DOI: 10.12968/jowc.2024.33.4.220] [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: 04/06/2024]
Abstract
OBJECTIVE To evaluate the clinical performance, quality of life (QoL) and patient satisfaction with an innovative flat-knit compression garment for the daytime treatment of lymphoedema patients in daily routine. METHOD In a prospective multicentre observational study, patients with leg or arm lymphoedema (stage I-II, International Society of Lymphology (ISL) standards, 2016) received a made-to-measure flat-knit compression class 2 JOBST Confidence (BSN-JOBST GmbH, Germany) thigh-high stocking or arm sleeve. Primary endpoint was the oedema status as determined by the mean sum of the circumferences at the beginning and the end of the wearing period. Secondary endpoints included QoL-related parameters and patient satisfaction with product features assessed through questionnaires. The observation period lasted three weeks. RESULTS A total of 97 patients (87 females, 10 males), of which 65 had leg lymphoedema and 32 had arm lymphoedema, received the study device. The oedema status was effectively maintained (slight reduction in mean sum of circumferences by -3.1±7.3cm; p=0.0001). For QoL-related parameters, the patients reported fewer limitations in work, leisure and psychological wellbeing after wearing the stocking or arm sleeve (all p-values <0.0001). They also experienced less limitations in function and movement, feeling of tension and heaviness, and fewer difficulties wearing clothes, shoes, jewellery or watches at study end (all p-values <0.0001). In terms of pleasant feeling on the skin, moisture management, softness of material, range of motion, overall wearing comfort and heat build-up under the garment, patients were more satisfied with the tested compression garment than with previously worn compression garments (all p-values <0.001). CONCLUSION In this study, the tested innovative compression product increased patient satisfaction with the improved product features while the lymphoedema status was successfully maintained.
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Affiliation(s)
- Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Halle, Germany
| | - Helene Arns
- Practice for Vascular Diseases, Essen, Germany
| | - Jörg Schleinitz
- Practice for General Medicine, Phlebology and Lymphology, Lützen, Germany
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Crébassa V, Grenier EM, Batot GM, Matieu-Dupas E, Chaigneau CM. Valitrack study: Objective evaluation of medical compression wearing time and patient activity with the Accutrack ® by Sigvaris Group sensor. Phlebology 2024; 39:194-201. [PMID: 38014485 DOI: 10.1177/02683555231219177] [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: 11/29/2023]
Abstract
INTRODUCTION Objective measurement of compliance is mandatory to evaluate therapeutic effects and clinical benefits of medical compression stockings. This Valitrack study evaluates the Accutrack sensor equipped with an accelerometer. The evaluation is done under controlled and free conditions and during washing. RESULTS Global accordance results are excellent: Sensitivity (98.6%) and specificity (95.2%) and 92% of patients are not disturbed by the sensors when putting on the stockings. DISCUSSION Thanks to its specificities one sensor per patient is sufficient. Its sensitivity distinguishes still and active positions. Only hand washing remains a false positive. The Accutrack sensor objectively measures compliance and will not be a bias because 96% of patients forget it. CONCLUSIONS Objective compliance measurement with Accutrack allows us to evaluate the efficacity of compression, the reasons of non-compliance, and the patient's actual physical activity according to its accelerometer time-stamped.
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Affiliation(s)
- Vincent Crébassa
- Vascular Doctor & Phlebologist Clinique du Millénaire, Montpellier, France
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8
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Yang WT, Xiong Y, Wang SX, Ren HL, Gong C, Jin ZY, Wen JH, Zhang WD, Tao XM, Li CM. A randomized controlled trial of standard vs customized graduated elastic compression stockings in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2024; 12:101678. [PMID: 37708938 DOI: 10.1016/j.jvsv.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy of customized graduated elastic compression stockings (c-GECSs) based on lower leg parameter models with standard GECSs (s-GECSs) in patients with chronic venous disease (CVD). METHODS In this randomized, single-blind, controlled trial, 79 patients with stage C2 or C3 CVD were assigned to one of two groups: c-GECSs or s-GECSs. The primary outcome was change to Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) scores at months 1, 3, and 6 as compared with baseline. Secondary outcomes included compliance with wearing ECSs, interface pressure at the smallest circumference of the ankle (point B) and the largest circumference of the calf (point C), and calf volume (CV). RESULTS There were 13 pairs of s-GECS and 2 pairs of c-GECS that showed pressure values higher than the standard at either point B or C. The c-GECSs were significantly superior to s-GECSs in terms of score improvement at all three time points (month 1, 8.47 [95% confidence interval (CI), 7.47-9.45] vs 5.89 [95% CI, 5.00-6.78]; month 3, 9.60 [95% CI, 8.47-10.72] vs 6.72 [95% CI, 5.62-7.83]; month 6, 7.09 [95% CI, 5.93-8.24] vs 3.92 [95% CI, 2.67-5.18]; P < .0001). Besides, at month 1, the mean daily use time of the c-GECS and s-GECS groups was 10.7 and 9.5 hours, respectively (P < .05). Correlation analysis indicated a negative relationship between local high pressure and daily duration in the s-GECS group (rpb = -0.388; n = 38; P < .05). Variances in pressure were greater in the s-GECSs group. The c-GECSs showed advantage in maintaining pressure. Both c-GECSs and s-GECSs effectively reduced CV (mL), with no significant differences between groups (month 1, 90.0 [95% CI, 71.4-108.5] vs 85.0 [95% CI, 65.6-104.2]; month 3, 93.8 [95% CI, 69.7-117.8] vs 85.9 [95% CI, 65.5-106.2]; month 6, 70.8 [95% CI, 46.5-95.2]) vs 60.8 [95% CI, 44.1-77.5]). CONCLUSIONS The c-GECSs based on individual leg parameter models significantly improved VEINES-QOL scores and provided stable and enduring pressure as compared with s-GECSs for patients with stage C2 or C3 CVD. Although both c-GECSs and s-GECSs effectively reduced CV, the superior fit and comfort of c-GECSs improved patient compliance. Hence, c-GECSs are a viable alternative for patients who have difficulty tolerating s-GECSs.
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Affiliation(s)
- Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ying Xiong
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chi Gong
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhen-Yi Jin
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia-Hao Wen
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Ming Tao
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Ferguson G, Baguley F. Decision-making on the use of compression hosiery and compression bandaging: a systematic review. Br J Community Nurs 2024; 29:S20-S25. [PMID: 38478419 DOI: 10.12968/bjcn.2024.29.sup3.s20] [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: 07/23/2024]
Abstract
This systematic literature review was carried out by a final-year nursing student in response to clinical experience, and to understand the rationale and evidence around managing venous ulcers. In the student's clinical experience, the two most commonly used treatment methods were forms of compression hosiery and compression bandaging. The CINAHL, Science Direct, Cochrane Library, Internurse and MEDLINE databases were searched for literature published over the period 2003-2023. From the resulting five papers, five key themes were identified: types of compression systems used and the rationale for decision-making; clinical effectiveness; the impact on patient experience and quality of life; pain levels following application of compression systems; and cost effectiveness. Conclusion: Management and prevention of venous ulceration is complex. The decisions should be made in partnership with the patient and will be influenced by context. Overall, compression hosiery was identified as the more favourable system.
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Affiliation(s)
| | - Fiona Baguley
- Course Lead, MSc Healthcare Leadership, Robert Gordon University, Aberdeen
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10
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Salcedo Mercado AM, Rodríguez Cabrero RA, Lozano Corona R, Anaya-Ayala JE. Durometry for the Assessment of Severity of Post-thrombotic Syndrome and Possible Clinical Applications. Vasc Endovascular Surg 2024; 58:54-59. [PMID: 37429286 DOI: 10.1177/15385744231189023] [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: 07/12/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) impacts the patient's quality of life. Available scales to determine its severity remain controversial, therefore, it is of importance to identify new auxiliary methods for the assessment of this sequelae. Measurement of skin hardness (MSH) might be decisive in tracking PTS. The purpose of this study is to assess if the use of durometry is an objective measure to evaluate prognosis of affected limbs in patients with PTS. We compared MSH of extremities with PTS vs healthy limbs, as well as their variation after 3 months of medical treatment to evaluate if durometry can be used to find differences. We strongly believe that measuring and keeping track of skin changes specifically skin hardness can be a useful factor in the prognosis and treatment of PTS. METHODS Prospective cohort study from January 2021 to February 2022 in patients with unilateral PTS. The MSH of the affected limb was compared to the healthy limb. A calibrated durometer was used, 4 measurements were completed at the time of diagnosis and subsequent follow-up were carried out after 3 months of treatment. The percentage of healing (in case of ulcers) and adherence to treatment was carefully monitored. The statistical program R was used. RESULTS A total of 1088 durometric measurements were performed on 17 patients, and 34 limbs. The MSH in limbs with PTS was 39.09 and in the control limbs (19.8) (P = <.00001). After 3 months of treatment, the MSH in PTS varied in PTS limbs (39.09 to 30.4) (P = <.000012). Adherence to treatment was 70.5%. CONCLUSIONS MSH varied between healthy limbs and the ones with PTS, before and after treatment. Durometry might represent a method for assessing skin changes in patients with PTS.
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Affiliation(s)
| | | | | | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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11
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Yang WT, Ren HL, Zheng K, Jin ZY, Wen JH, Wang SX, Zhang WD, Li CM. Development and validation of a graduated compression stockings adherence scale. Phlebology 2023; 38:605-612. [PMID: 37651292 DOI: 10.1177/02683555231200109] [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: 09/02/2023]
Abstract
OBJECTIVE Compression therapy with the use of graduated compression stockings (GCSs) is a common treatment strategy for chronic venous disease (CVD). However, there is no uniform and objective standard to assess adherence to the use of GCSs. The aim of this study is to develop and validate a GCS Compliance Scale (GCSAS) to fill gaps in internationally recognized comprehensive scales and provide a useful tool for future research. METHODS The items included in the GCSAS were based on a review of the literature and open-ended interviews with experts, who screened the initial items using an item-level content validity index. Then, pilot tests were conducted three times with 50 participants. After exclusion of redundant and cross-loading items by exploratory factor analysis, 290 subjects were recruited to evaluate the reliability and validity of the proposed GCSAS. Analyses included internal consistency, test-retest reliability, split-half reliability, construct validity, criterion validity, convergent validity, and discriminant validity. RESULTS The final GCSAS consisted of 17 items and 5 dimensions. The results of the exploratory factor analysis indicated that the variances of each factor explained were 22.03%, 14.85%, 14.74%, 14.16%, and 13.35%, and all 5 factors explained 79.13% of the variance among the 17 items. The factor loadings of all items were >0.7. Confirmatory factor analysis indicated that the indices were adequate. A significant positive correlation was found between the GCSAS and the Venous Insufficiency Epidemiological and Economic Study - Quality of Life questionnaire scores (r = 0.76, p < 0.001). The Cronbach's alpha coefficient was 0.90, test-retest reliability was 0.81, and split-half reliability was 0.92. CONCLUSIONS The GCSAS showed good validity and reliability to assess compliance with the use of GCSs among patients with CVD.
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Affiliation(s)
- Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhen-Yi Jin
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia-Hao Wen
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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12
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Stanek A, Mosti G, Nematillaevich TS, Valesky EM, Planinšek Ručigaj T, Boucelma M, Marakomichelakis G, Liew A, Fazeli B, Catalano M, Patel M. No More Venous Ulcers-What More Can We Do? J Clin Med 2023; 12:6153. [PMID: 37834797 PMCID: PMC10573394 DOI: 10.3390/jcm12196153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most severe complication caused by the progression of chronic venous insufficiency. They account for approximately 70-90% of all chronic leg ulcers (CLUs). A total of 1% of the Western population will suffer at some time in their lives from a VLU. Furthermore, most CLUs are VLUs, defined as chronic leg wounds that show no tendency to heal after three months of appropriate treatment or are still not fully healed at 12 months. The essential feature of VLUs is their recurrence. VLUs also significantly impact quality of life and could cause social isolation and depression. They also have a significant avoidable economic burden. It is estimated that the treatment of venous ulceration accounts for around 3% of the total expenditure on healthcare. A VLU-free world is a highly desirable aim but could be challenging to achieve with the current knowledge of the pathophysiology and diagnostic and therapeutical protocols. To decrease the incidence of VLUs, the long-term goal must be to identify high-risk patients at an early stage of chronic venous disease and initiate appropriate preventive measures. This review discusses the epidemiology, socioeconomic burden, pathophysiology, diagnosis, modes of conservative and invasive treatment, and prevention of VLUs.
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Affiliation(s)
- Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
| | - Giovanni Mosti
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Angiology Department, MD Barbantini Clinic, Via del Calcio 2, 55100 Lucca, Italy
| | - Temirov Surat Nematillaevich
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Specialized Surgery, Central Hospital of Ministry of Internal Affairs, Chimboy St. 2 A, Almazar District, Tashkent 100095, Uzbekistan
| | - Eva Maria Valesky
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Tanja Planinšek Ručigaj
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Dermatovenereological Clinic, University Medical Centre Ljubljana, Gradiskova 10 Street, 1000 Ljubljana, Slovenia
| | - Malika Boucelma
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Internal Medicine, University of Algiers, Bachir Mentouri Hospital, Algiers 16208, Algeria
| | - George Marakomichelakis
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- 4th Department of Internal Medicine, General Hospital of Evangelismos, 16676 Athens, Greece
| | - Aaron Liew
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Medicine, Portiuncula University Hospital, University of Galway, H91 TK33 Galway, Ireland
| | - Bahar Fazeli
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Mariella Catalano
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Biomedical, Clinical Sciences L Sacco Hospital, Inter-University Research Center on Vascular Disease, University of Milan, 20157 Milan, Italy
| | - Malay Patel
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Vascular Surgery, Apollo CVHF, Heart Institute, Ahmedabad 380059, India
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Barnes H. To explore the factors that impact on patient concordance with venous leg ulcer management using compression therapy. Br J Community Nurs 2023; 28:S8-S18. [PMID: 36809900 DOI: 10.12968/bjcn.2023.28.sup3.s8] [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: 02/24/2023]
Abstract
It is understood that intervention for venous leg ulcer (VLU) management is more successful the sooner compression is applied, yet healing rates of VLUs are falling and recurrence rates increasing. This literature review seeks to explore the factors affecting patient concordance with compression therapy to manage VLU. Of the literature searched, 14 articles were identified and four themes of reasons for non-concordance emerged: education; pain/discomfort; physical limitations; and psychosocial issues. The reasons for non-concordance are vast and complex; district nurses must explore these reasons to help improve the alarming rates of non-concordance. A personalised approach is necessary to meet individual needs. High risks of ulcer recurrence are noted and a greater understanding of the chronic nature of ulceration should be conveyed. Follow-up care and building trust is linked with higher rates of concordance. Further research is needed within district nursing as the majority of venous ulceration is managed within the community.
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Affiliation(s)
- Helen Barnes
- District Nurse, Bolton NHS Foundation Trust, Greater Manchester, UK
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Bar L, Marks D, Brandis S. Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory. Patient Prefer Adherence 2023; 17:51-66. [PMID: 36636284 PMCID: PMC9831124 DOI: 10.2147/ppa.s390123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. METHODS Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. RESULTS Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie's Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. CONCLUSION Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. PRACTICE IMPLICATIONS These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.
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Affiliation(s)
- Laila Bar
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
- Department of Occupational Therapy, Gold Coast University Hospital, Southport, Queensland, Australia
- Correspondence: Laila Bar, Department of Occupational Therapy, Level 4, Bond Institute of Health and Sport, 2 Promethean Way, Robina, Queensland, 4226, Australia, Tel +61 413 855 090, Email
| | - Darryn Marks
- Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
| | - Susan Brandis
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
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A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients. PLoS One 2022; 17:e0272566. [PMID: 35939451 PMCID: PMC9359574 DOI: 10.1371/journal.pone.0272566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Although compression therapy is well established for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD), considerable variation exists in its organization in clinical practice which may impact patient outcomes. The current study aims to deepen our understanding of the main drivers of the complex care organization for compression therapy and to identify targets for improvement.
Methods
This realist evaluation includes a mixed-method design consisting of semi-structured interviews with patients and health care professionals involved in compression therapy (n = 30), stakeholder meetings (n = 2) and surveys (n = 114). Data were collected to create the content of context-mechanism-outcome-configurations (CMOcs) important in compression therapy. Based on these CMOcs, targets for improvement to optimize the organization of compression care were identified.
Results
We identified overarching context factors and mechanisms targeting four optimal outcomes for the organization of compression therapy: selecting initial compression therapy types that support patient’s self-reliance (1), evidence based selection of elastic compression stocking type and class (2), patient-based selection of assistive devices (3), individualizing treatment duration for DVT patients (4a) and providing follow-up for CVD patients (4b). We found that increasing health care professionals’ knowledge of compression therapy, the availability of unambiguous protocols and guidelines, increasing patient involvement (and if applicable their informal care giver) in the decision making process, the accessible availability of resources, and increasing interdisciplinary consultation enhanced desirable outcomes. These targets triggered mechanisms such as increased health care professionals’ willingness, confidence and motivation to provide patient-based care and increased patients’ self-confidence and self-efficacy.
Conclusions
This study provides a detailed insight into what needs to be in place to optimize compression care and identified five main targets for improvement.
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[Medical compression stockings for chronic venous diseases and lymphedema : Scientific evidence and results of a patient survey on quality of care]. Hautarzt 2022; 73:708-717. [PMID: 35648140 PMCID: PMC9427895 DOI: 10.1007/s00105-022-05007-3] [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] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Hintergrund und Ziele Medizinische Kompressionsstrümpfe (MKS) sind bei chronischer venöser Insuffizienz (CVI) aller Stadien indiziert und beim Lymphödem eine unverzichtbare Therapiekomponente; 8 % der deutschen Bevölkerung tragen vom Arzt verordnete MKS, Frauen häufiger als Männer (12 % vs. 5 %) und insbesondere Personen ab 60 Jahren (17 %). Die Adhärenz der Patienten ist relevant für eine erfolgreiche Behandlung mit MKS. Untersucht wurde die Versorgung mit MKS aus Patientensicht. Patienten und Methodik Die vorliegende Studie untersuchte 2019 die Versorgungsqualität durch strukturierte Interviews mit 414 repräsentativ ausgewählten Nutzern. Die Erkenntnisse werden vor dem Hintergrund wissenschaftlicher Evidenz zur Wirkung der MKS diskutiert. Ergebnisse Venenprobleme sind der häufigste Verordnungsgrund (44 %), gefolgt von Lymphödemen (22 %) bzw. Mehrfachindikationen (27 %). Patienten tragen MKS zumeist täglich und durchschnittlich 11 h/Tag; 89 % der Patienten waren zufrieden bzw. sehr zufrieden mit den MKS und berichteten je nach Indikation ein differenziertes Wirkprofil. Dieses reflektiert die umfangreiche wissenschaftliche Evidenz zur klinischen Wirksamkeit der MKS. Ein wichtiger Faktor für die Patientenadhärenz ist die ärztliche Schulung und Aufklärung. Schlussfolgerungen MKS werden von Patienten sehr gut akzeptiert. Bei der Verordnung sollen praktischen Aspekte wie An- und Ausziehen, empfohlene Tragedauer und -häufigkeit sowie der Wirkmechanismus der MKS vermittelt werden. Graphic abstract ![]()
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