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Cacua Sánchez MT, Botero AM, Moreno-Mattar O. Cost-effectiveness analysis of intralesional and perilesional recombinant human epidermal growth factor vs hydrocolloid therapy in venous ulcer treatment in the Colombian context. J Vasc Surg Venous Lymphat Disord 2024; 12:101745. [PMID: 38145819 DOI: 10.1016/j.jvsv.2023.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To perform a comparative analysis of health care expenses and outcomes in response to the question: What is the cost-effectiveness of intralesional and perilesional recombinant human epidermal growth factor (rhEGF) compared with hydrocolloid therapy in patients diagnosed with chronic venous insufficiency without infection in Colombia? METHODS A Markov model was used to determine cost effectiveness over a 5-year period, considering the perspective of the health system in Colombia. The study included patients aged >18 years diagnosed with chronic venous insufficiency and used clinical studies to calculate the probabilities of epithelialization, infection, recurrence, and mortality. RESULTS RhEGF is more expensive per unit than hydrocolloids, but it is proven to be effective at healing ulcers in 8 to 12 weeks, even in complex cases. Hydrocolloids, in contrast, typically require 29.5 weeks on average, and ≤46 weeks for complex cases. Despite the cost, rhEGF is more cost effective because it achieves results comparable with hydrocolloid therapy at a lower cost per additional quality-adjusted life-year. CONCLUSIONS Based on cost-effectiveness analysis, rhEGF is a superior alternative to hydrocolloids for treating venous ulcers in Colombia. Not only is it more affordable, but it also enhances patients' quality of life and streamlines the health care system's resource use.
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Affiliation(s)
- María Teresa Cacua Sánchez
- Health Services, Ambulatory Surgery Center, Hospital Occidente de Kennedy, Vascular Laboratory SURA, Bogotá, Colombia
| | - Ana María Botero
- Vascular Surgeon, Colombian Association for Vascular Surgery, Bogotá, CO
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Patton D, Avsar P, Sayeh A, Budri A, O'Connor T, Walsh S, Nugent L, Harkin D, O'Brien N, Cayce J, Corcoran M, Gaztambide M, Derwin R, Sorensen J, Moore Z. Assessing the healthcare costs associated with venous leg ulcer compression bandages - A scoping review. J Tissue Viability 2023; 32:618-626. [PMID: 37423836 DOI: 10.1016/j.jtv.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
AIM To determine the monetary costs identified in economic evaluations of treatment with compression bandages among adults with venous leg ulcers (VLU). METHOD A scoping review of existing publications was conducted in February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Ten studies met the inclusion criteria. To place the costs of treatment into context, these are reported in conjunction with the healing rates. Three comparisons were made: 1.4 layer compression versus no compression (3 studies). One study reported that 4 layer compression was more expensive than usual care (£804.03 vs £681.04, respectively), while the 2 other studies reported the converse (£145 vs £162, respectively) and all costs (£116.87 vs £240.28 respectively). Within the three studies, the odds of healing were statistically significantly greater with 4 layer bandaging (OR: 2.20; 95% CI: 1.54-3.15; p = 0.001).; 2.4 layer compression versus other compression (6 studies). For the three studies reporting the mean costs per patient associated with treatment (bandages alone), over the treatment period, analysis identified a mean difference (MD) in costs for 4 layer vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) of -41.60 (95% CI: 91.40 to 8.20; p = 0.10). The OR of healing for 4 layer compression vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 0.70 (95% CI: 0.57-0.85; p = 0.004). For 4 layer vs comparator 2 (2 layer compression) the MD is: 14.00 (95% CI: 53.66 to -25.66; p < 0.49). The OR of healing for 4 layer compression vs comparator 2 (2 layer compression) is: 3.26 (95% CI: 2.54-4.18; p < 0.00001). For comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) vs comparator 2 (2 layer compression) the MD in costs is: 55.60 (95% CI: 95.26 to -15.94; p = 0.006). The OR of healing with Comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 5.03 (95% CI:4.10-6.17; p < 0.00001). Three studies presented the mean annual costs per patient associated with treatment (all costs). The MD is 172 (150-194; p = 0.401), indicating no statistically significant difference in costs between the groups. All studies showed faster healing rates in the 4 layer study groups. 3. Compression wrap versus inelastic bandage (one study). Compression wrap was less expensive than inelastic bandage (£201 vs £335, respectively) with more wounds healing in the compression wrap group (78.8%, n = 26/33; 69.7%, n = 23/33). CONCLUSION The results for the analysis of costs varied across the included studies. As with the primary outcome, the results indicated that the costs of compression therapy are inconsistent. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Aicha Sayeh
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Aglecia Budri
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Simone Walsh
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Linda Nugent
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.
| | - Denis Harkin
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Niall O'Brien
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | | | | | | | - Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Jan Sorensen
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
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Chan DYS, Surendra NK, Ng YZ, Lee SH, Yong E, Hong Q, Goh CC, Lai TP, Tan AHM, Law CCC, Liang S, Car J, Lo ZJ. Prospective study on the clinical and economic burden of venous leg ulcers in the tropics. J Vasc Surg Venous Lymphat Disord 2023; 11:954-963. [PMID: 37209840 DOI: 10.1016/j.jvsv.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/17/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Venous leg ulcers (VLUs) are both chronic and recurrent. The treatment of such ulcers often require multiple outpatient visits and dressing changes. Several reports on the costs of treating such VLUs have been reported in the west. We prospectively evaluated the clinical and economic burden of VLUs in a population of Asian patients in the tropics. METHODS Patients from a prospective two-center study conducted at two tertiary hospitals in Singapore, as a part of the Wound Care Innovation in the Tropics program, between August 2018 and September 2021 were recruited. The patients were followed up for 12 weeks (visit 1 to visit 12), until index ulcer healing, death, or lost to follow-up (whichever came first). These patients were then followed up 12 weeks later to determine the longer term outcome of the wound (healed, recurrence, remained unhealed). The itemized costs derived from the medical service were retrieved from the relevant departments of the study sites. The patients' health-related quality of life was assessed at baseline and the last visit of the 12-week follow-up period (or until index ulcer healing), using the official Singapore version of the EuroQol five-dimension-5L questionnaire, which also includes a visual analog scale (EQ-VAS). RESULTS A total of 116 patients were enrolled; 63% were men, and the mean patient age was 64.7 years. Of the 116 patients, 85 (73%) had a healed ulcer at 24 weeks (mean duration to ulcer healing, 49 days), and 11 (12.9%) had experienced ulcer recurrence within the study period. Within the 6-month follow-up period, the mean direct healthcare cost per patient was USD$1998. The patients with healed ulcers had significantly lower costs per patient compared with those with unhealed ulcers (USD$1713 vs USD$2780). Regarding health-related quality of life, 71% of the patients had a lower quality of life at baseline, which had improved at 12 weeks of follow-up, with only 58% of the patients reported to have a lower quality of life. Also, the patients with healed ulcers scored higher for both utilities (societal preference weights) and EQ-VAS at follow-up (P < .001). In contrast, patients with unhealed ulcers only scored higher EQ-VAS at follow-up (P = .003). CONCLUSIONS The findings from this exploratory study provide information on the clinical, quality of life, and economic burden of VLUs in an Asian population and suggest the importance of healing VLUs to reduce the effects on patients. The present study provides data as a basis for economic evaluation as a consideration for the treatment of VLUs.
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Affiliation(s)
| | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sze-Han Lee
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qiantai Hong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tina Peiting Lai
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | - Audrey Hui Min Tan
- Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Shanying Liang
- Department of Surgery, Woodlands Health, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Zhiwen Joseph Lo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Surgery, Woodlands Health, Singapore, Singapore
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Quirk K. Use of a prescribed exercise intervention as an adjunct to improve venous leg ulcer healing. Br J Nurs 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gray D, Stanton J, Rouncivell D, McRobert J. Venous and lymphovenous lower limb wound outcomes in specialist UK wound and lymphoedema clinics. Br J Nurs 2023; 32:S12-S18. [PMID: 37596073 DOI: 10.12968/bjon.2023.32.15.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
This article explores the impact of combining tissue viability and lymphoedema techniques on optimising time to healing. AIM To investigate the healing rates observed in patients who presented to wound and lymphoedema specialist clinics, located in the south eastern region of England, with venous/lymphovenous ulceration of the lower limb during the COVID-19 pandemic in 2020-2022 (30 months in all). METHODOLOGY A retrospective analysis of patient outcomes. RESULTS 1041 patients were referred to the service, with a healing rate of 88.5% over 78 days. DISCUSSION When comparing 2013-2019 healing rates/time to healing vs 2020-2022 there was a decrease of 1.5% in the rate of healing and a mean reduction in time to healing of 40 days. CONCLUSION Despite the pandemic the service was able to maintain previous levels of outcomes and observed a decrease in the mean time to healing.
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Affiliation(s)
- David Gray
- Managing Partner, Pioneer Sussex Wound Healing and Lymphoedema Centres / Professor of Wound Study, Wound Healing and Practice Development Unit, Birmingham City University
| | - Julie Stanton
- Director of Nursing (Community), Pioneer Sussex Wound Healing and Lymphoedema Centres
| | - David Rouncivell
- Data Manager, Pioneer Sussex Wound Healing and Lymphoedema Centres
| | - John McRobert
- Clinical Director of Research, Pioneer Sussex Wound Healing and Lymphoedema Centres
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Chen L, Gao Y, Liu M, Li Q, Han C, Zhao Y, Li B, Xu J, Dai Y, Li P, Li J, Li Y, Ran X. Efficacy and safety of pentoxifylline for chronic venous leg ulcers: study protocol for a multicenter randomized controlled trial in China (ESPECT study). Trials 2023; 24:491. [PMID: 37533132 PMCID: PMC10394857 DOI: 10.1186/s13063-023-07547-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Venous leg ulcers (VLUs) are the most severe manifestation of chronic venous disease, with long healing time and a high recurrence rate. It imposes a heavy burden on patients, their families, and the health care system. Chronic inflammation triggered by sustained venous hypertension is now recognized as the hallmark of chronic venous disease. The anti-inflammatory effect of pentoxifylline may offer a promising avenue to treat VLUs. However, current evidence of pentoxifylline for VLUs is relatively small and of low quality. The aim of this study is to evaluate the efficacy and safety of pentoxifylline for VLUs in the Chinese population. METHODS This is a randomized, double-blinded, double-dummy, multi-center, placebo-controlled clinical trial. A total of 240 patients will be randomized to receive pentoxifylline (400 mg, twice daily) or placebo for 24 weeks. All participants will receive diosmin treatment and standard care of VLUs and other comorbidities. The primary outcome is the difference in the wound healing rate within 12 weeks between pentoxifylline and placebo. Secondary outcomes include (1) percent wound size changes at 12 weeks, (2) the levels of TNF-α and IL-6, (3) venous clinical severity score and chronic venous insufficiency quality of life score, and (4) ulcer recurrence within 24 weeks. DISCUSSION This study would evaluate the efficacy and safety of pentoxifylline for VLUs in the Chinese population. If confirmed, it wound offer another effective and safe therapeutic option for treatment of VLUs. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (No. ChiCTR-2100053053). Registered on 10 November, 2021, https://www.chictr.org.cn/showproj.aspx?proj=137010.
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Affiliation(s)
- Lihong Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Yun Gao
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Ming Liu
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Qiu Li
- Department of Endocrinology, Shandong Provincial Hospital, Jinan, 250021, China
| | - Chunmao Han
- Department of Burn and Wound Repair, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yue Zhao
- Department of Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Binghui Li
- Department of Wound Repair, LiYuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430077, China
| | - Jun Xu
- Department of Diabetic Podiatry, Zhu Xianyi Memorial Hospital of Tianjin Medical University, Tianjin, 300070, China
| | - Yan Dai
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Pei Li
- CSPC Ouyi Pharmaceutical Co., Ltd., Shijiazhuang, 052160, China
| | - Jianli Li
- CSPC Ouyi Pharmaceutical Co., Ltd., Shijiazhuang, 052160, China
| | - Yuanyuan Li
- CSPC Ouyi Pharmaceutical Co., Ltd., Shijiazhuang, 052160, China
| | - Xingwu Ran
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China.
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Lian Y, Birt L, Wright D. Hospital clinicians' perspectives of using compression therapy on venous leg ulcers: a systematic qualitative review. Br J Nurs 2023; 32:S30-S42. [PMID: 36840520 DOI: 10.12968/bjon.2023.32.4.s30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Venous leg ulcer treatment is frequently discontinued in hospitals in contravention of national guidance, significantly affecting patient outcomes and increasing NHS costs. AIM To identify, from the published literature, reasons for variable implementation. METHOD Systematic review with narrative synthesis, including full papers in English with empirical qualitative data. Synonyms for venous leg ulcer, compression therapy and secondary care were searched across a range of health-related databases. The Critical Appraisal Skills Programme (CASP) checklist determined study quality, and meta-ethnography was used for data synthesis. RESULTS 7040 titles and abstracts and 41 full-text papers were screened with four papers selected. Three key themes were generated: educational needs surrounding implementation of compression therapy, patient factors regarding adherence and organisational resources including availability of appropriate equipment and trained staff. CONCLUSION Barriers at the ward level were identified. There is a need to better understand why hospitals are not addressing them.
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Affiliation(s)
- Yaping Lian
- Tissue Viability Nurse Specialist, Tissue Viability Team, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridge
| | - Linda Birt
- LOROS Associate Professor in Palliative Care and Frailty, School of Healthcare, College of Life Sciences, University of Leicester, Leicester
| | - David Wright
- Head of School of Healthcare and Professor of Health Services Research, School of Healthcare, College of Life Sciences, University of Leicester, Leicester
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Shankar S, Mk A, Palani T, Nagasubramanian VR. Factors associated with health-related quality of life of south indian population with chronic venous leg ulcers - A hospital based pilot study. J Vasc Nurs 2022; 40:162-166. [PMID: 36435598 DOI: 10.1016/j.jvn.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Venous leg ulcers (VLU) are chronic, recurrent and have a significant impact on the patients' health- related quality of life (HRQoL). This study assessed the association of patient-specific factors on the HRQoL of patients with chronic venous leg ulcers. MATERIALS AND METHODS The study included 21 males and 21 females aged 18 years and above, with chronic VLU. Data on demographics, education, occupation, per capita income, duration of ulcer were subjectively recorded. The socio-economic status was scored based on the Modified Kuppuswamy scale 2019, ulcer severity was assessed using M.A.I.D. Scale and the HRQoL of the patients were assessed using the 36-Item Short-Form Health Survey Version 1.0. The differences in the mean HRQoL scores between patients based on their gender and socio-economic class were assessed using an unpaired sample t-test. The association of age, severity, duration of the ulcer with the HRQoL were assessed using Pearson's correlation. A probability value of < 0.05 was considered statistically significant. RESULTS There were 21 (50%) males and 21 (50%) females with a mean age of 55.45 ± 7.73 years. The mean duration of ulcers was 7.26 ± 3.34 months and the mean ulcer severity score was 2.16 ± 0.96. Role limitations due to the physical health were found to be most impacted due to the disease condition with the least mean score of 26.78 ± 31.90 %. There were no significant differences in the mean scores of the physical and the mental components of HRQoL based on gender but there were significant differences based on socio-economic status. The lower the socio-economic status, the poorer the HRQoL. Age, severity of ulcers and ulcer duration had a significant negative correlation with HRQoL. CONCLUSION The study observed a low HRQoL of patients in physical aspects reflecting on the extensive limitation on the performance of daily physical activities. Patient-specific factors such as age, socio-economic status, severity, and chronicity of ulcers were found to influence HRQoL.
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Affiliation(s)
- Shruthi Shankar
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Chennai, India
| | - Ayyappan Mk
- Department of Vascular Surgery, Sri Ramachandra Medical Center and Hospital, Chennai, India
| | - Thennarasu Palani
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Chennai, India
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Johnston S, Finlayson K, Bui U, O'Donoghue E, Fletcher B, N Parker C. Risk factors for the recurrence of venous leg ulcers in adults: A systematic review protocol. J Tissue Viability 2022; 31:804-807. [PMID: 35810110 DOI: 10.1016/j.jtv.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Venous leg ulcers are slow to heal, and recurrence is frequent. Living with venous leg ulcers can affect physical and psychological health, and result in financial burden for individuals. Physiological and psychosocial factors are associated with venous leg ulcer recurrence. As over 50% of venous leg ulcers will recur within 12 months of healing, a comprehensive knowledge of holistic risk factors associated with recurrence is required by health professionals involved in the care of the person with venous leg ulcers. AIM To develop a systematic review protocol to determine the risk factors for recurrence of venous leg ulcers in adults. METHOD AND ANALYSIS This protocol was developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols (PRISMA-P). The inclusion criteria will be based on the PICOS mnemonic-adults with a history of venous leg ulcer/s (participants), risk factor/s under physiological (general/medical), clinical, demographics, psychosocial categories (I (intervention) or E (exposure), venous leg ulcer non-recurrence (comparison group), venous leg ulcer recurrence (outcomes to be measured) and will include study designs of original qualitative, quantitative and mixed method studies (study designs to be included). Methodological quality will be assessed using the Mixed Methods Appraisal Tool. This Systematic Review Protocol was registered in PROSPERO [CRD42021279792]. RESULTS If meta-analysis is not possible, a narrative review of results will be presented. CONCLUSIONS This systematic review on recurrence of venous leg ulcers can provide evidence-based information for preventive strategies for recurrence of a healed venous leg ulcer. The standardised approach outlined in this systematic review protocol offers a rigorous and transparent method to conduct the review.
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Affiliation(s)
- Sandra Johnston
- Faculty of Health, School of Nursing Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia
| | - Kathleen Finlayson
- Faculty of Health, School of Nursing Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Australia
| | - Ut Bui
- Faculty of Health, School of Nursing Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Australia
| | - Erica O'Donoghue
- Faculty of Health, School of Nursing Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Australia
| | | | - Christina N Parker
- Faculty of Health, School of Nursing Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Australia.
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Saleem T, Luke C, Raju S. Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome. J Vasc Surg Venous Lymphat Disord 2022; 10:1343-1351.e3. [PMID: 35779829 DOI: 10.1016/j.jvsv.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Klippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. METHODS A single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. RESULTS Their mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. CONCLUSIONS Superficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS.
| | - Cooper Luke
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS
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11
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Liu S, Team V, Qiu Y, Weller CD. Investigating Quality of Life Instrument Measurement Properties for Adults with Active Venous Leg Ulcers: A Systematic Review. Wound Repair Regen 2022; 30:468-486. [PMID: 35639021 PMCID: PMC9545457 DOI: 10.1111/wrr.13034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/07/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
The primary objective of this systematic review was to identify which quality of life instruments have been applied in published studies of patients with active venous leg ulcers. Our secondary objective was to map the measurement properties of each identified quality of life instrument and to inform future recommendations for clinical practice and research. We searched CINAHL, Ovid Medline, Ovid Emcare and ProQuest to identify studies published from 1 January 2000 to 31 July 2021. Eleven studies that utilised quality of life instruments in adults with active venous leg ulcers met the inclusion criteria. Thirteen quality of life instruments were identified as some studies utilised both generic and condition‐specific quality of life instruments. Six out of nine (6/9) instruments were rated ‘very good’ of methodological quality on internal consistency; 1/7 studies rated ‘adequate’ on reliability; 2/4 rated ‘adequate’ on content validity; 3/6 studies rated ‘adequate’ on structural validity; 5/6 rated ‘adequate’ on hypotheses testing for construct and 2/6 studies rated ‘adequate’ on responsiveness. There is limited evidence of measurement properties of quality of life instruments for people with active venous leg ulcers. The Venous Leg Ulcer Quality of Life Questionnaire (VLU‐QoL) could be provisionally recommended for use although from our review it is clear further studies to assess VLU‐QoL measurement properties are needed to inform future recommendations for clinical practice and research.
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Affiliation(s)
- Shiwen Liu
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
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12
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Saucedo D, Evans N, Lim CS. Initiating compression therapy for those living with heart failure. Br J Community Nurs 2021; 26:S12-S17. [PMID: 34473543 DOI: 10.12968/bjcn.2021.26.sup9.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression therapy is used to treat leg symptoms arising from chronic venous disease and lymphoedema. Heart failure, which is traditionally regarded as a contraindication for compression therapy, is prevalent among patients with such leg symptoms. This article aims to assess the evidence on the safety and effectiveness of compression therapy, as well as recommending the assessment and measures required when initiating compression therapy in patients with heart failure. Recent evidence suggests that initiating compression therapy in patients with stable and compensated heart failure is safe if appropriate precautionary measures are undertaken. However, there is still insufficient evidence to support the safety of compression therapy in patients with severe and decompensated heart failure. A standardised, evidence-based guideline on compression therapy in patients with heart failure will help medical and nursing professionals and improve informed consent for the patients.
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Affiliation(s)
- Dumitriu Saucedo
- Senior Clinical Fellow in Vascular Surgery, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - Nicholas Evans
- Clinical Nurse Specialist in Vascular Surgery, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - Chung Sim Lim
- Consultant Vascular Surgeon, the Department of Vascular Surgery, Royal Free London NHS Foundation Trust
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13
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Muldoon J, Hampton S, Gray S, Cosham T. Compression hosiery for venous disorders and oedema: a question of balance. Br J Community Nurs 2021; 25:S26-S32. [PMID: 32886551 DOI: 10.12968/bjcn.2020.25.sup9.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.
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Affiliation(s)
| | | | - Sarah Gray
- Tissue Viability Nurse Consultant; Bowel and Bladder Nurse Specialist, East Sussex
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14
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Weller CD, Martin C, Bouguettaya A, Underwood M, Barker AL, Haines T, Pouniotis D, Wolfe R. Once daily 300 mg aspirin with compression versus compression alone in patients with chronic venous leg ulcers (ASPiVLU): A randomised, double-blinded, multicentre, placebo-controlled, clinical trial. J Tissue Viability 2021:S0965-206X(21)00090-5. [PMID: 34330595 DOI: 10.1016/j.jtv.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
AIM Venous leg ulcers are lower limb skin ulcers characterised by a cycle of healing and recurrence due to underlying chronic venous insufficiency. While compression improves healing outcomes, many ulcers do not heal. As a daily 300 mg oral dose of aspirin in conjunction with compression may improve healing outcomes, we investigated the effect of adjuvant aspirin on venous leg ulcer healing in participants already receiving compression. MATERIALS AND METHODS We conducted a prospective, randomised, double-blinded, placebo-controlled, clinical trial (known as ASPiVLU). Participants were recruited from six wound clinics in Australia. We screened 844 participants. Community-dwelling adult participants identified at six hospital outpatient clinics and clinically diagnosed with a venous leg ulcer present for 6+ weeks were eligible between April 13, 2015 to June 30, 2018. We randomised 40 participants (n = 19 aspirin, n = 21 placebo) and evaluated against the primary outcome. There were no dropouts. Ten serious adverse events in six participants were recorded. None were study related. The primary outcome measure was healing at 12 weeks based on blinded assessment. RESULTS We found no difference in the number of ulcers healed at 12 weeks between the intervention and control groups. CONCLUSION This study could not detect whether or not aspirin affected VLU healing speed. This is likely because we recruited fewer participants than expected due to the high number of people with venous leg ulcers in Australia who were already taking Aspirin; future research should investigate other adjuvant therapies or different study designs.
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15
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Greene E, Avsar P, Moore Z, Nugent L, O'Connor T, Patton D. What is the effect of larval therapy on the debridement of venous leg ulcers? A systematic review. J Tissue Viability 2021; 30:301-9. [PMID: 34172356 DOI: 10.1016/j.jtv.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
AIM To determine the impact of larval therapy on the debridement of venous leg ulcers, in comparison to other debridement methods or no debridement. METHOD Using systematic review methodology, published quantitative studies focusing on the effect of larval therapy on the debridement of venous leg ulcers were included. The search was conducted in January 2020 and updated in May 2021 using CINAHL, PubMed, Embase, and the Cochrane library, and returned 357 records, of which six studies met the inclusion criteria. Data were extracted using a predesigned extraction tool and all studies were quality appraised using the RevMan risk of bias assessment tool. RESULTS Larval therapy was found to debride at a faster rate than hydrogel (p = 0.011, p < 0.001, p = 0.0039), have a similar effect to sharp debridement (p = 0.12, p = 0.62), and was a resource-effective method of debridement (p < 0.05, p < 0.001, p < 0.001). When larval therapy in combination with compression therapy was compared to compression alone, larvae had a greater effect on debridement (p < 0.05), however, it did not improve overall wound healing rates (p = 0.54, p = 0.664, p = 0.02). Pain levels increased during larval therapy and reduced after treatment, when compared to other standard debridement techniques. CONCLUSION Larval therapy promotes rapid debridement of venous leg ulcers. However, further high quality randomised controlled trials, comparing larval therapy to other debridement methods for venous leg ulcers, incorporating the use of compression is required to determine the long term effects of larval therapy.
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16
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Abstract
The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.
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Affiliation(s)
- Amy Cox
- Respiratory Registered Nurse, Royal Derby Hospital-University Hospitals of Derby and Burton
| | - Chrissie Bousfield
- Associate Professor, School of Health Sciences, University of Nottingham
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17
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Conde-Montero E, Bohbot S, Grado Sanz R, Peral Vázquez A, Recarte-Marín L, Pérez-Jerónimo L, Galán Sánchez JL, de la Cueva Dobao P. Association of autologous punch grafting, TLC-NOSF dressing and multitype compression therapy to rapidly achieve wound closure in hard-to-heal venous leg ulcers. J Med Vasc 2020; 45:316-325. [PMID: 33248534 DOI: 10.1016/j.jdmv.2020.10.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To document the efficacy of a combined therapeutic strategy in achieving rapid wound healing in patients with long-standing ulcers. MATERIALS AND METHODS Outpatients with hard-to-heal venous leg ulcers were included in an interventional, prospective, single-arm, mono-centre study and treated with autologous punch grafting, TLC-NOSF dressing and multi-type compression therapy. The primary outcome was the percentage of healed wounds by week 12. Secondary outcomes included time-to-reach wound closure, wound area reduction, treatment acceptability and safety. RESULTS From November 2018 to October 2019, 42 patients with 51 ulcers were included (23 males, 70.6±40.8 years old, with multiple comorbidities). Despite poor wound healing prognosis at baseline (47% of recurrent ulcers, with a mean duration of 15 months and a mean area of 12.6cm2), wound healing was achieved in 47 ulcers (92%) after a mean period of treatment of 25±13 days. A relative wound area reduction>75% was also reached in three additional ulcers by the last evaluation visit. No adverse event related to the procedure was reported throughout the study period. The associated treatment were very well tolerated and accepted by the patients. CONCLUSIONS The evaluated procedure induced fast re-epithelisation of the treated ulcers. Based on our experience, this simple and successful reparative strategy may be considered as an interesting option in the treatment of venous leg ulcers of poor prognosis.
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Affiliation(s)
- E Conde-Montero
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain.
| | - S Bohbot
- Medical affairs department, Laboratoires URGO Medical, 15, avenue de Iena, 75116 Paris, France
| | - R Grado Sanz
- Centro de salud cervantes, Hospital Universitario de Guadalajara, calle Miguel-Cervantes, 16, 19001 Guadalajara, Spain
| | - A Peral Vázquez
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - L Recarte-Marín
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - L Pérez-Jerónimo
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - J-L Galán Sánchez
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain
| | - P de la Cueva Dobao
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain
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18
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Abstract
Despite guidelines, best-practice statements and CQUIN targets, venous leg ulcers have been highlighted as an area that continues to demonstrate lack of evidence-based practice and variation in practice, which contribute to poor patient outcomes and escalating costs. Leg ulcer services that use a systematic and standardised approach to leg ulcer management are highly successful in improving healing rates, preventing recurrence and contributing to patients' wellbeing. This article seeks to explore the use of the plan-do-study-act (PDSA) cycle in clinical practice to improve and standardise leg ulcer management.
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Affiliation(s)
- Kirsten Mahoney
- Senior Tissue Viability Nurse, Welsh Wounds Innovation Centre
| | - Wendy Simmonds
- Clinical Nurse Specialist in Wound Healing, Cardiff and Vale Health Board
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19
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Gethin G, Vellinga A, Tawfick W, O'Loughlin A, McIntosh C, Mac Gilchrist C, Murphy L, Ejiugwo M, O'Regan M, Cameron A, Ivory JD. The profile of patients with venous leg ulcers: A systematic review and global perspective. J Tissue Viability 2020; 30:78-88. [PMID: 32839066 DOI: 10.1016/j.jtv.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND A holistic profile that includes demographic, medical history and wound characteristics of individuals with venous leg ulceration is lacking. Lack of such a profile negatively impacts the ability to develop interventions to improve patient outcomes. OBJECTIVES To describe the profile of the patient population with venous leg ulceration from published observational (non-interventional) studies and to identify gaps in the knowledge base for future research in this area. METHODS A systematic review of observational studies that included more than 50 patients, from any world region, of any age and in any care setting. RESULTS twenty studies, involving 3395 patients, from all world regions met our criteria. Demographic characteristics were well reported and showed a female to male ratio of 1.2:1, average age of 47-65 years, high levels of co-morbidities including hypertension (53-71%) and diabetes (16-20%), and only one study reporting ethnicity. When reported, approximately 4-30% had high levels of depression. The average wound size was 18.6-43.39 cm2; mean wound duration was 13.8-65.5 months, mean number of recurrences was four. No study reported on demographic factors plus medical history plus wound characteristics together. CONCLUSION a comprehensive, holistic profile of the population with VLU is lacking. There is a critical need for more comprehensive profiling to enable the development of targeted interventions to improve outcomes.
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Affiliation(s)
- G Gethin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland.
| | - A Vellinga
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - W Tawfick
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A O'Loughlin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C McIntosh
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C Mac Gilchrist
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - L Murphy
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M Ejiugwo
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M O'Regan
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A Cameron
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - J D Ivory
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
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20
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Fulcher E, Gopee N. Effect of different compression bandaging techniques on the healing rate of venous leg ulcers: a literature review. Br J Community Nurs 2020; 25:S20-S26. [PMID: 32501762 DOI: 10.12968/bjcn.2020.25.sup6.s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Venous leg ulcers (VLUs) are a common health problem in older adults, for which the widely used method of treatment includes compression therapy. There are various compression bandages and hosiery systems available for use, but it remains unclear as to which types of compression systems are most effective in enabling healing of VLUs. This study aimed to determine which type of the two most commonly used compression bandaging (four-layer and two-layer) is more effective in providing complete ulcer healing of VLUs. Key search terms were identified using the PICO (population, intervention, comparison, outcome) model, with distinct inclusion and exclusion criteria, in a strategic search of electronic databases (e.g. CINAHL and MEDLINE) along with wider sources, including Google Scholar. More studies favoured the four-layer compression system than two-layer for providing better healing rates in the treatment of VLUs, but two-layer bandaging tends to provide a better quality of life and may be more cost-effective, although comorbidities and other factors also need to be considered. In choosing the type of compression bandage for the management of leg ulcers, the healing rate achieved by the chosen bandage needs to be carefully monitored, while also taking into consideration other factors such as the quality of life for the patient.
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Affiliation(s)
- Emily Fulcher
- Staff Nurse, University Hospitals Coventry and Warwickshire NHS Trust
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21
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Abstract
The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.
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Affiliation(s)
- Alison Schofield
- Tissue Viability Team Clinical Nurse Specialist, North Lincolnshire and Goole NHS Foundation Trust
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22
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Mullings J. Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway. Br J Community Nurs 2020; 24:S6-S11. [PMID: 31479331 DOI: 10.12968/bjcn.2019.24.sup9.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research has shown that leg ulcers represent the largest category of wound type treated within the UK. Venous leg ulcers are often classified as chronic wounds with increased protease levels causing the wound to become suspended in the inflammatory stage, which leads to delayed healing. If treatment choices are not evidence-based and appropriate regimens are not instigated early on in the wound care journey, the cost to both the patient and the healthcare service is substantial. Recent guidance from the National Institute of Health and Care Excellence (NICE) recommends UrgoStart (Urgo Medical) for treating venous leg ulcers as an adjunct therapy to the gold standard of compression therapy. Correct treatment choices must be made by clinicians using up-to-date relevant wound care knowledge. Evidence-based treatment algorithms and pathways can assist with correct product and therapy placement, assisting decision-making to improve patient outcomes. The present article describes a patient-centred leg ulcer pathway that embeds NICE guidance.
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Affiliation(s)
- Julie Mullings
- Community Matron, Tissue Viability and Infection Prevention Manchester University NHS Foundation Trust
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23
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Abstract
At the 2019 European Venous Forum in Zurich Switzerland, a symposium entitled "State of the art: benefits of MPFF throughout CVD progression" was held to discuss the developing treatment strategies for patients at all stages of chronic venous disease (CVD). At the early stages of CVD, management should be focused on preventing disease progression through lifestyle changes and conservative treatment; treatment can also include venoactive drugs (VAD) such as micronized purified flavonoid fraction (MPFF; Daflon®), which is the most well-known and most widely prescribed VAD in Europe. As the disease progresses, patients who require interventional procedures (e.g., endovenous procedure or sclerotherapy) can also benefit from MPFF treatment in the recovery period after the procedure, as MPFF has been shown to reduce periprocedural pain and bleeding (hematoma), and to improve CVD symptoms during this period. Management of CVD in patients with venous leg ulcers (VLU) is the most challenging; in these patients, recommended adjunct therapies to be combined with standard compression therapy include VAD (MPFF) and non-VAD drugs (pentoxifylline and sulodexide) which have been shown to speed VLU healing in comparison with compression therapy alone.
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Affiliation(s)
- Andrew N Nicolaides
- Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus.
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24
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Nicolaides AN. The Most Severe Stage of Chronic Venous Disease: An Update on the Management of Patients with Venous Leg Ulcers. Adv Ther 2020; 37:19-24. [PMID: 31970660 DOI: 10.1007/s12325-020-01219-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 12/14/2022]
Abstract
Venous leg ulcers (VLUs) are the most severe manifestation of chronic venous disease (CVD). Due to their chronic nature, high recurrence rate and slow healing time, VLUs account for 80% of all leg ulcers seen in patients with CVD. VLUs impose a heavy burden on patients that reduces their quality of life; VLUs also represent a major socioeconomic impact due to the cost and duration of care. The primary medical approach to treating VLUs is local compression therapy in combination with venoactive drug (VAD) pharmacotherapy to promote the reduction of the inflammatory reaction initiated by venous hypertension. Micronized purified flavonoid fraction (MPFF; Daflon®) is the most widely prescribed VAD. MPFF counteracts the pathophysiologic mechanisms of CVD and ulceration and has proven to be an effective adjunct to compression therapy in patients with large and chronic VLUs. Two other non-VAD drugs, pentoxifylline and sulodexide, have also been shown to improve VLU healing and are also recommended in addition to compression therapy. However, MPFF is the only VAD with the highest strength of recommendations in the 2018 guidelines for the healing of VLUs.
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25
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McDaniel JC, Rausch J, Tan A. Impact of omega-3 fatty acid oral therapy on healing of chronic venous leg ulcers in older adults: Study protocol for a randomized controlled single-center trial. Trials 2020; 21:93. [PMID: 31948466 PMCID: PMC6966808 DOI: 10.1186/s13063-019-3970-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background This trial addresses the global problem of chronic venous leg ulcers (CVLUs), wounds that cause significant infirmity for an estimated 9.7 million people annually, mainly older adults with comorbidities. Advanced therapies are needed because standard topical therapies are often ineffective or yield only short-term wound healing. Thus, we are testing a new oral therapy containing the bioactive elements of fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for targeting and reducing the high numbers of activated polymorphonuclear leukocytes (PMN) in wound microenvironments that keep CVLUs “trapped” in a chronic inflammatory state. Methods This double-blind RCT will include 248 eligible adults ≥ 55 years of age with CVLUs receiving standard care at a large Midwest outpatient wound clinic. Participants are randomized to two groups: 12 weeks of daily oral therapy with EPA + DHA (1.87 g/day of EPA + 1.0 g/day of DHA) or daily oral therapy with placebo. At 0, 4, 8, and 12 weeks, across the two groups, we are pursuing three specific aims: Aim 1. Compare levels of EPA + DHA-derived lipid mediators, and inflammatory cytokines in blood and wound fluid; Subaim 1a. Compare inflammatory cytokine gene expression by PMNs in blood; Aim 2. Compare PMN activation in blood and wound fluid, and PMN-derived protease levels in wound fluid; Aim 3. Compare reduction in wound area, controlling for factors known to impact healing, and determine relationships with lipid mediators, cytokines, and PMN activation. Subaim 3a. Compare frequency of CVLU recurrence and levels of study variables in blood between the randomly assigned two subgroups (continuing EPA + DHA therapy versus placebo therapy beyond week 12) within the EPA + DHA group with healed CVLUs after 3 months of therapy. Subaim 3b. Compare symptoms of pain at all time points and quality of life at first and last time points across the two groups and two subgroups. Discussion This trial will provide new evidence about the effectiveness of EPA + DHA oral therapy to target and reduce excessive PMN activation systemically and locally in patients with CVLUs. If effective, this therapy may facilitate healing and thus be a new adjunct treatment for CVLUs in the aging population. Trial registration ClinicalTrials.gov, NCT03576989; Registered on 13 June 2018.
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Affiliation(s)
- Jodi C McDaniel
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA.
| | - Jamie Rausch
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA
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Martinengo L, Yeo NJY, Markandran KD, Olsson M, Kyaw BM, Car LT. Digital health professions education on chronic wound management: A systematic review. Int J Nurs Stud 2019; 104:103512. [PMID: 32086027 DOI: 10.1016/j.ijnurstu.2019.103512] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Continuing education is crucial for healthcare professionals to keep up with research but attending classroom lectures is a major barrier. Chronic wound management is increasingly relevant for continuous professional training. Digital education offers learning tailored to individual needs and could be an effective alternative to healthcare professionals' training. However, the effectiveness of digital education for chronic wound management training has not been explored. OBJECTIVES To assess the effectiveness of digital education in improving healthcare professionals' knowledge, attitudes, practical skills and behaviour change on chronic wound management, and their satisfaction with the intervention. DESIGN This systematic review follows Cochrane methodology and is one of a series of reviews on the use of digital education for health professions education. Protocol registration: PROSPERO CRD42018109971 DATA SOURCES: Searches were conducted in MEDLINE, Embase, Web of Science, ERIC, PsycINFO, CINAHL, CENTRAL, and ProQuest Dissertation and Theses Database. REVIEW METHODS We included randomised control trials, cluster randomised control trials and quasi-randomised control trials comparing digital or blended education with traditional learning, no intervention or other forms of digital or blended education for pre- or post-registration healthcare professionals in chronic wound management. A narrative summary of findings is presented. RESULTS Seven studies (1,404 participants) were included. All studies investigated interventions for nursing students or professionals working in hospitals or community settings, and all but one study focused on pressure ulcers. Five studies (935 participants) assessed post-intervention knowledge, and indicated that digital education was more effective than no intervention, while blended learning was superior to exclusive digital education. Three studies (543 participants) assessed post-intervention skills and reported mixed results. One study (140 participants) compared post-intervention behaviour change and satisfaction with blended and online digital education, and reported no difference in behaviour between the groups, and higher satisfaction with blended education. For knowledge retention up to six months, digital education was more effective than no intervention, while blended learning was superior to digital education. The risk of bias in included studies was mostly high or unclear. CONCLUSIONS Digital education on chronic wound management appears to be less effective than blended education and more effective than no intervention in improving knowledge among nurses and nursing students. Data for other outcomes is scarce and inconclusive. Future studies should assess participants' skills, attitudes, satisfaction and behaviour change; cost-effectiveness and potential untoward effects of digital education, compare digital education to other learning modalities and include other healthcare professionals in diverse clinical settings.
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Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road Level 18, Singapore 308232, Singapore.
| | - Natalie Jia Ying Yeo
- Laboratory of Molecular and Vascular Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Level 3, Singapore 636921, Singapore.
| | - Kasturi D/O Markandran
- Laboratory of Muscle and Cardiac Biophysics, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Level 3, Singapore 636921, Singapore.
| | - Maja Olsson
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road Level 18, Singapore 308232, Singapore; Institute of Health and Biomedical Innovation, Queensland University of Technology, 149 Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road Level 18, Singapore 308232, Singapore; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road Level 18, Singapore 308232, Singapore.
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road Level 18, Singapore 308232, Singapore; Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan's Road, London W6 8RP, UK.
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Stacey MC. Biomarker directed chronic wound therapy - A new treatment paradigm. J Tissue Viability 2020; 29:180-3. [PMID: 32007337 DOI: 10.1016/j.jtv.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/29/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022]
Abstract
AIM To develop a treatment paradigm for chronic leg ulcers that incorporates new biomarkers of wound healing with currently available therapies. METHODS Recently published data on GM-CSF and MMP-13 as biomarkers of venous leg ulcer (VLU) healing status with accuracies of 92% and 78% respectively, was reviewed along with the wound bed preparation (WBP) theoretical framework for treatment of chronic wounds. The broad categories of wound treatments that align with the WBP concepts were identified. These were then considered in a hierarchical order that initially improves the wound bed and subsequently incorporates more complex advanced wound therapies. Identification of the non-healing status of the wound is the driver to advance through the different treatments. RESULTS A point of care test of wound healing status is the key to the systematic use of currently available therapies for chronic leg ulcers in a timely fashion. The different therapies address - debridement, moisture control, bacterial contamination, protease inhibition, formation of granulation tissue, application of growth factors, application of matrix constructs, and application of cellular components. Progression through this hierarchical order of therapies is directed by the leg ulcer remaining in a non-healing state with the previous therapies having been implemented. CONCLUSION Combining a validated point of care test of wound healing with a systematic approach to wound therapies, has the potential to create a new paradigm of chronic leg ulcer treatment - biomarker directed wound therapy.
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Abstract
Leg ulcers are some of the most common wounds treated by the NHS. Ulceration is usually classified as being of venous or arterial origin. Arterial ulcers develop because of reduced arterial flow to the leg caused by peripheral arterial disease. Venous leg ulcers, the most common form, develop because of vein incompetence, with valve failure leading to pressure in the veins. Nurses working with patients with oedema find that chronic oedema can cause the limb affected to swell, causing skin to stretch and break and lead to ulceration. This is known as superficial ulceration. This article discusses the causes, assessment and management of these different types of leg ulcer.
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Affiliation(s)
- Marie Todd
- Lymphoedema Clinical Nurse Specialist, Glasgow Lymphoedema Service, NHS Greater Glasgow and Clyde
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Abstract
The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.
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Affiliation(s)
- Marie Todd
- Lymphoedema Clinical Nurse Specialist, Glasgow Lymphoedema Service
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Mosti G, Mancini S, Bruni S, Serantoni S, Gazzabin L, Bucalossi M, Polignano R, Mariani F, Luca B, Partsch H. Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A Multicentric Italian Randomized Clinical Experience. Phlebology 2019; 35:124-133. [PMID: 31234752 DOI: 10.1177/0268355519858439] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Compression therapy by inelastic bandages is highly effective in achieving venous leg ulcer healing. Inelastic bandages may be expensive as they need to be changed and discarded at every dressing change. In addition, correct application is difficult in the clinical practice, even by expert healthcare personnel. The aim of our work was to assess whether adjustable compression wraps are more cost effective and more effective than inelastic bandage to achieve venous leg ulcer healing. Methods Sixty-six venous leg ulcer patients were randomized to be treated by adjustable compression wrap (CircAid® JuxtaCure®) ( n = 33) and inelastic bandage (Coban 2 Layer®) ( n = 33). Study duration was 12 weeks. During weekly visits, the ulcers were cleansed and dressed with the same products, and the only variable was the compression device. Ulcer size, ulcer pain, patient’s perception of compression systems, and compression pressure were assessed during the visits, and the material cost was evaluated at the 12th week. Results Adjustable compression wraps were significantly cheaper than bandages (p < 0.0001) and were also more effective (not significantly) in achieving ulcer healing. To heal one ulcer patient, €228 had to be spent when applying an adjustable compression wrap and €381 if inelastic bandages were used. About 26/33 (78.8%) patients in the adjustable compression wrap group were healed after 12 weeks versus 23/33 (69.7%) in the inelastic bandage group (n.s.). Ulcer pain was reduced by both compression devices. Patient perception of compression pressure was similar with both compression devices. Compression pressure was similar at application but better maintained by adjustable compression wrap over time. Conclusions Adjustable compression wraps are significantly cheaper and more effective (not significantly) in achieving venous leg ulcer healing. Self-applicable, adjustable compression wraps are therefore a powerful, cost-effective alternative to inelastic bandages in treating venous leg ulcer.
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Affiliation(s)
- Giovanni Mosti
- Angiology Department, MD Barbantini Clinic, Lucca, Italy
| | - Stefano Mancini
- Heart and Vascular Surgery Department, University of Siena, Siena, Italy
| | - Sergio Bruni
- Outpatient Department for Hard-to-Heal skin ulcers, San Giuseppe Hospital, Empoli, Italy
| | - Simone Serantoni
- Vascular Ulcers and Diabetic Foot Surgery Unit, Villa Fiorita Clinic, Prato, Italy
| | - Luca Gazzabin
- Vascular Ulcers and Diabetic Foot Surgery Unit, Villa Fiorita Clinic, Prato, Italy
| | | | | | | | - Bastiani Luca
- Institute of Clinical Physiology, Italian National Research Council e CNR, Pisa, Italy
| | - Hugo Partsch
- Emeritus, Medical University of Vienna, Vienna, Austria
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Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J 2017; 15:29-37. [PMID: 29243398 DOI: 10.1111/iwj.12814] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/27/2017] [Accepted: 08/04/2017] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing venous leg ulcers (VLUs) in clinical practice by the UK's National Health Service (NHS) and the associated costs of patient management. This was a retrospective cohort analysis of the records of 505 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015/2016 prices. Overall, 53% of all VLUs healed within 12 months, and the mean time to healing was 3·0 months. 13% of patients were never prescribed any recognised compression system, and 78% of their wounds healed. Of the 87% who were prescribed a recognised compression system, 52% of wounds healed. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 30% of all the VLUs may have been clinically infected at the time of presentation, and only 22% of patients had an ankle brachial pressure index documented in their records. The mean NHS cost of wound care over 12 months was an estimated £7600 per VLU. However, the cost of managing an unhealed VLU was 4·5 times more than that of managing a healed VLU (£3000 per healed VLU and £13 500 per unhealed VLU). This study provides important insights into a number of aspects of VLU management in clinical practice that have been difficult to ascertain from other studies and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, Rickmansworth, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
| | | | - Peter Vowden
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK and University of Bradford, Bradford, UK
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Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix ® ) allograft for the treatment of venous leg ulcers. Int Wound J 2017; 15:114-122. [PMID: 29024419 PMCID: PMC7949978 DOI: 10.1111/iwj.12843] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
A randomised, controlled, multicentre clinical trial was conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane (EpiFix) allograft as an adjunct to multilayer compression therapy for the treatment of non-healing full-thickness venous leg ulcers. We randomly assigned 109 subjects to receive EpiFix and multilayer compression (n = 52) or dressings and multilayer compression therapy alone (n = 57). Patients were recruited from 15 centres around the USA and were followed up for 16 weeks. The primary end point of the study was defined as time to complete ulcer healing. Participants receiving weekly application of EpiFix and compression were significantly more likely to experience complete wound healing than those receiving standard wound care and compression (60% versus 35% at 12 weeks, P = 0·0128, and 71% versus 44% at 16 weeks, P = 0·0065). A Kaplan-Meier analysis was performed to compare the time-to-healing performance with or without EpiFix, showing a significantly improved time to healing using the allograft (log-rank P = 0·0110). Cox regression analysis showed that subjects treated with EpiFix had a significantly higher probability of complete healing within 12 weeks (HR: 2·26, 95% confidence interval 1·25-4·10, P = 0·01) versus without EpiFix. These results confirm the advantage of EpiFix allograft as an adjunct to multilayer compression therapy for the treatment of non-healing, full-thickness venous leg ulcers.
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Affiliation(s)
- Christian Bianchi
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | | | | | - Gregory Tovmassian
- Center for Clinical Research, Inc. Sacramento Foot and Ankle Center, Sacramento, CA, USA
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Martínez Martínez M, Escario Travesedo E, Jiménez Acosta F. Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto. Actas Dermo-Sifiliográficas 2017; 108:524-31. [DOI: 10.1016/j.ad.2017.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/29/2017] [Accepted: 02/26/2017] [Indexed: 01/24/2023] Open
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Finlayson K, Miaskowski C, Alexander K, Liu WH, Aouizerat B, Parker C, Maresco-Pennisi D, Edwards H. Distinct Wound Healing and Quality-of-Life Outcomes in Subgroups of Patients With Venous Leg Ulcers With Different Symptom Cluster Experiences. J Pain Symptom Manage 2017; 53:871-879. [PMID: 28063868 DOI: 10.1016/j.jpainsymman.2016.12.336] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/04/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Adults with venous leg ulcers frequently experience multiple symptoms that may influence quality of life (QOL). OBJECTIVES The objective of this study was to identify patient subgroups based on their experience with a pain-depression-fatigue-sleep disturbance symptom cluster and to identify differences in patient characteristics and wound-healing and QOL outcomes between the subgroups. METHODS Secondary data analysis from previous longitudinal studies of 247 patients with venous leg ulcers. Latent class analysis identified subgroups of patients with distinct experiences with the symptom cluster of pain, depression, fatigue, and sleep disturbance. Hierarchical regression analysis identified relationships between the subgroups and QOL outcomes. Survival analysis identified differences between the subgroups and ulcer healing. RESULTS Latent class analysis found 67% of patients were in a mild symptom subgroup (i.e., experiencing no or mild pain, depressive symptoms, fatigue, or sleep disturbance). One-third of the samples were in a severe symptom subgroup, who reported moderate-to-severe levels of these symptoms. Compared with the mild subgroup, patients in the severe subgroup had poorer QOL scores (t = 8.06, P < 0.001). Symptom subgroup membership accounted for 19% of the variance (P < 0.001) within a hierarchical regression model that explained 42% of the variance in QOL (F(7,170) = 16.89, P < 0.001, R2 = 0.42). Cox proportional hazards regression found that at enrollment into the study, patients in the severe symptom subgroup were 1.5 times (95% confidence interval 1.02-2.08) less likely to heal in the following 24 weeks (P = 0.037). CONCLUSION Significant relationships were found between delayed ulcer healing, decreased QOL, and membership in the severe symptom subgroup. These findings suggest that comprehensive symptom assessment is needed to identify patients at higher risk for poor outcomes and enable early intervention.
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Affiliation(s)
- Kathleen Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia.
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Kimberly Alexander
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Wei-Hong Liu
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Bradley Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, New York, USA; Department of Oral and Maxillofacial Surgery, New York University, New York, New York, USA
| | - Christina Parker
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Diane Maresco-Pennisi
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
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Alkhater M, Jockenhöfer F, Stoffels I, Dissemond J. May-Thurner syndrome: an often overlooked cause for refractory venous leg ulcers. Int Wound J 2017; 14:578-582. [PMID: 28251803 DOI: 10.1111/iwj.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022] Open
Abstract
We report a 53-year-old female patient presenting with a refractory venous leg ulcer and unremarkable findings in the doppler Ultrasound venous mapping of the leg veins. Further comprehensive diagnostics demonstrated an underlying May-Thurner syndrome. After resolution of the primary mechanical obstruction, rapid wound healing in the following 3 weeks was documented. Iliac vein compression syndrome, commonly known as May-Thurner syndrome, is a distinguishable anatomical variant that results from an external compression over the left iliac vein exerted by the overriding adjacent right common iliac artery. It is mostly seen among young, healthy female patients and can easily be under-diagnosed. Lower extremities duplex ultrasonography remains the gold standard in diagnosing venous insufficiency, but it should not solely depend on it. Instead, clinicians should consider other possibilities, assessing the patency within the truncal veins, which in turn might contribute to the venous insufficiency along the lower limbs. An active early diagnostic approach can prevent significant overall morbidity and help patients to ease back into their daily-life activities. Therefore, it is recommended that all patients with suspected venous insufficiency and normal lower limbs duplex findings should undergo further evaluation of the truncal venous system pattern. May-Thurner syndrome, along with other causes of iliac veins compression, should be considered in the differential diagnosis in unclear persistent cases of unilateral venous symptoms.
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Affiliation(s)
- Maryam Alkhater
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
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Caimi G, Ferrara F, Montana M, Muratori I, Amato C, Canino B, Lo Presti R, Hopps E. Behaviour of the plasma concentration of gelatinases and their tissue inhibitors in subjects with venous leg ulcers. Clin Hemorheol Microcirc 2016; 60:309-16. [PMID: 25159491 DOI: 10.3233/ch-141863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Venous leg ulcers are common in subjects with chronic venous insufficiency. The increased intraluminal pressure causes alteration of the skin microcirculation, leukocyte activation and release of proteolytic enzymes leading to ulceration. An impaired expression and activity of matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs) might influence extracellular matrix degradation and deposition in chronic venous ulcers with the failure of the healing process. Our aim was to evaluate plasma concentration of gelatinases (MMP-2 and MMP-9) and their inhibitors (TIMP-1 and TIMP-2) in subjects with venous leg ulcers before and after the compression therapy. We enrolled 36 subjects (12 men and 24 women, mean age 67.38 ± 12.7 yrs) with non-infected venous leg ulcers (CEAP C6), which underwent a color Duplex scan examination of the veins and arteries of the inferior limbs and were treated with a multi-layer bandaging system. The ulcer healing was obtained in 23 subjects only (9 men and 14 women). We evaluated, on fasting venous blood, the plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 using ELISA kit, before and after the treatment. We observed a significant increase in plasma concentration of gelatinases and their inhibitors and in MMP-2/TIMP-2 ratio in subjects with leg ulcers in comparison with normal controls. In subjects with healed ulcers we found a decrease in MMP-9 and TIMP-1 levels and in MMP-2/TIMP-2 ratio compared to the baseline values, although higher levels of all the examined parameters in comparison with normal controls. In conclusion, plasma MMPs profile is impaired in subjects with venous leg ulcers and it improves after the healing, persisting anyway altered in respect to healthy controls.
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Abstract
The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems.
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Affiliation(s)
- Keith Harding
- Dean of Clinical InnovationCardiff UniversityCardiffUK
- Medical DirectorWelsh Wound Innovation CentreCardiffUK
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Kelechi TJ, Mueller M, Madisetti M, Prentice MA, Dooley MJ. Does cryotherapy improve skin circulation compared with compression and elevation in preventing venous leg ulcers? Int Wound J 2016; 14:641-648. [PMID: 27511115 DOI: 10.1111/iwj.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022] Open
Abstract
This trial compared skin blood flow, temperature and incidence of venous leg ulcers in patients with chronic venous disease using compression wraps and elevation pillows. Patients with CEAP C4 skin damage and C5 history of ulcers were randomly assigned to a cryotherapy intervention (n = 138) or placebo cuff control (n = 138) applied to the lower legs over 9 months. The time the ulcers healed prior to enrollment in the study for the cryotherapy group ranged from 1 to 2218 days (n = 8, median = 32 days); for the control group, the range was 24 to 489 days (n = 6, median = 390 days). There were no statistically significant blood flow changes measured in perfusion units with a laser Doppler flowmetre within or between the groups; mean difference between the groups was 0·62, P = 0·619. No differences were noted in skin temperature measured with an infrared thermometer within and between the groups; mean difference between the groups was -0·17°C, P = 0·540. Cryotherapy did not improve skin blood flow or temperature and did not show efficacy in preventing ulcers. However, at least 30% of intervention and 50% of control participants were anticipated to develop an ulcer during the study; only ∼7% occurred. These findings suggest that strict adherence to standard of care decreases the incidence of leg ulcers and remains a best practice for leg ulcer prevention.
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Affiliation(s)
- Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Mohan Madisetti
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Margie A Prentice
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Mary J Dooley
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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González de la Torre H, Quintana-Lorenzo ML, Perdomo-Pérez E, Verdú J. Correlation between health-related quality of life and venous leg ulcer's severity and characteristics: a cross-sectional study. Int Wound J 2016; 14:360-368. [PMID: 27112627 DOI: 10.1111/iwj.12610] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
Abstract
This study aims to determine health-related quality of life (HRQoL) in patients suffering with venous ulceration and to correlate wound's severity status with HRQoL loss as well as identify the aspects of HRQoL most negatively affected by the presence of venous ulcers. In this observational, cross-sectional, descriptive, analytical multi-centre study, data was compiled over a period of 3·5 months. Thrity-four patients with venous ulceration were recruited. The RESVECH 2·0 scale was used to monitor wounds. The MAID scale was used to measure wound's severity. The Charing Cross Venous Ulcer Questionnaire (CCVUQe) (Spanish version) was used to evaluate quality of life. The mean CCVUQe score was 60·58 ± 16·04. The HRQoL dimension most affected was 'Emotional state' (mean score = 77. 67 ± 17·34). The average RESVECH 2.0 score for the wounds was 13·15 ± 5·07. A statistically significant association between total CCVUQ-e score and total RESVECH 2.0 score was detected [Pearson correlation coefficient r = 0·546 (P ≤ 0·001)]. Venous ulcers affect patients' HRQoL, particularly their emotional status. There is a relationship between the severity of the wound and loss of HRQoL. The presence of non-viable tissue, poor exudate control and infection all determine loss of HRQoL. New studies are needed to confirm these findings.
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Affiliation(s)
- Héctor González de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - María L Quintana-Lorenzo
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Estrella Perdomo-Pérez
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Weller CD, Barker A, Darby I, Haines T, Underwood M, Ward S, Aldons P, Dapiran E, Madan JJ, Loveland P, Sinha S, Vicaretti M, Wolfe R, Woodward M, McNeil J. Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial. Trials 2016; 17:192. [PMID: 27068695 DOI: 10.1186/s13063-016-1314-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous leg ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of ulcers remain unhealed after 2 years, and ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing. METHODS/DESIGN This randomised, double-blinded, multicentre, placebo-controlled, clinical trial will recruit participants with venous leg ulcers from community settings and hospital outpatient wound clinics across Australia. Two hundred sixty-eight participants with venous leg ulcers will be randomised to receive either aspirin or placebo, in addition to compression therapy, for 24 weeks. The primary outcome is time to healing within 12 weeks. Secondary outcomes are ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks. DISCUSSION The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous leg ulcers. Study completion is anticipated to occur in December 2018. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12614000293662.
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O'Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J 2016; 14:130-137. [PMID: 26817648 DOI: 10.1111/iwj.12571] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/12/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022] Open
Abstract
Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.
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Affiliation(s)
- Jane O'Brien
- School of Nursing Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Kathleen Finlayson
- School of Nursing Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Graham Kerr
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- Faculty of Health, Wound Management Innovation Cooperative Research Centre, Queensland University of Technology, Brisbane, Australia
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White J, Ivins N, Wilkes A, Carolan-Rees G, Harding KG. Non-contact low-frequency ultrasound therapy compared with UK standard of care for venous leg ulcers: a single-centre, assessor-blinded, randomised controlled trial. Int Wound J 2015; 13:833-42. [PMID: 25619411 PMCID: PMC7949520 DOI: 10.1111/iwj.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022] Open
Abstract
‘Hard‐to‐heal’ wounds are those which fail to heal with standard therapy in an orderly and timely manner and may warrant the use of advanced treatments such as non‐contact low‐frequency ultrasound (NLFU) therapy. This evaluator‐blinded, single‐site, randomised controlled trial, compared NLFU in addition to UK standard of care [SOC: (NLFU + SOC)] three times a week, with SOC alone at least once a week. Patients with chronic venous leg ulcers were eligible to participate. All 36 randomised patients completed treatment (17 NLFU + SOC, 19 SOC), and baseline demographics were comparable between groups. NLFU + SOC patients showed a −47% (SD: 38%) change in wound area; SOC, −39% (38%) change; and difference, −7·4% [95% confidence intervals (CIs) −33·4–18·6; P = 0·565]. The median number of infections per patient was two in both arms of the study and change in quality of life (QoL) scores was not significant (P = 0·490). NLFU + SOC patients reported a substantial mean (SD) reduction in pain score of −14·4 (14·9) points, SOC patients' pain scores reduced by −5·3 (14·8); the difference was −9·1 (P = 0·078). Results demonstrated the importance of high‐quality wound care. Outcome measures favoured NLFU + SOC over SOC, but the differences were not statistically significant. A larger sample size and longer follow‐up may reveal NLFU‐related improvements not identified in this study.
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Affiliation(s)
- Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK.
| | - Nicola Ivins
- Wound Healing Research Unit, Cardiff University, School of Medicine, Cardiff, UK
| | - Antony Wilkes
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - Grace Carolan-Rees
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - Keith G Harding
- Wound Healing Research Unit, Cardiff University, School of Medicine, Cardiff, UK
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Edwards H, Finlayson K, Skerman H, Alexander K, Miaskowski C, Aouizerat B, Gibb M. Identification of symptom clusters in patients with chronic venous leg ulcers. J Pain Symptom Manage 2014; 47:867-75. [PMID: 23998779 DOI: 10.1016/j.jpainsymman.2013.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL. OBJECTIVES To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers. METHODS For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters. RESULTS Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue. CONCLUSION Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.
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Affiliation(s)
- Helen Edwards
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kathleen Finlayson
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
| | - Helen Skerman
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kimberly Alexander
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bradley Aouizerat
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Michelle Gibb
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Brown A, Kendall S, Flanagan M, Cottee M. Encouraging patients to self-care - the preliminary development and validation of the VeLUSET©, a self-efficacy tool for venous leg ulcer patients, aged 60 years and over. Int Wound J 2013; 11:326-34. [PMID: 24373556 DOI: 10.1111/iwj.12199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 11/28/2022] Open
Abstract
Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but evidence suggests that many find these difficult to perform. Bandura's self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self-care, interventions can be developed to strengthen their self-efficacy beliefs in performing these activities successfully. There are currently a variety of self-efficacy scales available to measure self-efficacy in a variety of conditions; but not a disease-specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop and validate a disease-specific, patient-focused self-efficacy scale for patients with healed venous leg ulceration. This scale will need further validation studies; however, it is ready for use in clinical practice and will enable practitioners to identify those patients who may need additional support in performing self-care activities to prevent recurrence.
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Affiliation(s)
- Annemarie Brown
- Independent Tissue Viability Consultant Doctoral Fellow, East of England SHA
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Senet P, Bause R, Jørgensen B, Fogh K. Clinical efficacy of a silver-releasing foam dressing in venous leg ulcer healing: a randomised controlled trial. Int Wound J 2013; 11:649-55. [PMID: 23374589 DOI: 10.1111/iwj.12022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/21/2012] [Accepted: 12/03/2012] [Indexed: 11/30/2022] Open
Abstract
Biatain and Biatain-Ag are two identical wound dressings except the fact that Biatain-Ag releases silver. In the present multinational double-blinded randomised controlled trial the effect of the two dressings were compared for treatment of venous leg ulcers. A total of 181 patients were treated for 6 weeks with either Biatain or Biatain-Ag followed by 4 weeks treatment with Biatain. Biatain-Ag showed superior performance in relative wound area reduction after 6 weeks treatment and the estimated treatment difference increased after 10 weeks indicating that the effect of silver continues at least for 4 weeks after treatment. A subgroup of the patients differed significantly from the others with respect to parameters associated with a poor healing prognosis; patients were older, had significant history of venous thrombosis, larger ulcers with longer duration and more often recurrent. For this subgroup of patients Biatain-Ag showed significant (P < 0·05) better performance in terms of relative ulcer area reduction and healing rate. In conclusion, this study suggests the superior performance of Biatain-Ag compared with the non silver-releasing dressing Biatain in particular for patients having ulcers associated with a poor healing prognosis.
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Affiliation(s)
- Patricia Senet
- Département de Dermatologie, UF de Dermatologie Vasculaire, Assistance-Publique Hôpitaux de Paris, Hôspital Tenon, Paris, France
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Clarke-Moloney M, Keane N, O'Connor V, Ryan MA, Meagher H, Grace PA, Kavanagh E, Walsh SR, Burke PE. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance. Int Wound J 2012; 11:404-8. [PMID: 23078587 DOI: 10.1111/j.1742-481x.2012.01108.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings. A total of 100 patients with healed venous leg ulcers were recruited, and were randomised to either class 1 (n = 50) or class 2 (n = 50) compression stockings. Follow-up was at 1 week, 3, 6, 9 and 12 months to monitor ulcer recurrence and compliance. Patients had a duplex scan to identify the source of venous incompetence. The rate of ulcer recurrence after 12 months was 16·1%, and the difference in recurrence rate between classes was not statistically significant (P = 0·287) although greater numbers in class 1 developed a recurrence. Participants (88·9%) were compliant; non-compliant patients were at a significantly greater risk of recurrence (P≤ 0·0001). Thirteen patients had both superficial and deep incompetence; those randomised to class 1 stockings (n = 4) developed ulcer recurrence. Patients with a history of multiple episodes of ulceration were more likely to develop a recurrence (P = 0·001). The lowest venous ulcer recurrence rates were seen in patients who were compliant with hosiery regardless of the compression level. Patients with both superficial and deep incompetence had a lower rate of recurrence with class 2 compression.
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Affiliation(s)
- Mary Clarke-Moloney
- Vascular Research Unit, Department of Vascular Surgery, University Hospital Limerick, Limerick, IrelandDepartment of Public Health Nursing, HSE West Ennis, Co Clare, IrelandSt. John's Hospital Limerick, Limerick, Ireland
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O'Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J 2012; 10:389-96. [PMID: 22697811 DOI: 10.1111/j.1742-481x.2012.00995.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study.
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Affiliation(s)
- Jane O'Brien
- School of Nursing & Midwifery, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Wollina U, Heinig B, Naumann G, Scheibe A, Schmidt WD, Neugebauer R. Effects of low-frequency ultrasound on microcirculation in venous leg ulcers. Indian J Dermatol 2011; 56:174-9. [PMID: 21716543 PMCID: PMC3108517 DOI: 10.4103/0019-5154.80412] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm). Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin. Conclusions: The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Ghatnekar AV, Elstrom T, Ghatnekar GS, Kelechi T. Novel wound healing powder formulation for the treatment of venous leg ulcers. J Am Col Certif Wound Spec 2011; 3:33-41. [PMID: 24527167 DOI: 10.1016/j.jcws.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers.
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Affiliation(s)
- Angela V Ghatnekar
- Regranion, LLC, Charleston, SC 29412, USA ; Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | - Gautam S Ghatnekar
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Teresa Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA
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50
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Koupidis SA, Paraskevas KI, Stathopoulos V, Mikhailidis DP. Impact of lower extremity venous ulcers due to chronic venous insufficiency on quality of life. Open Cardiovasc Med J 2008; 2:105-9. [PMID: 19430523 PMCID: PMC2627528 DOI: 10.2174/1874192400802010105] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 11/18/2008] [Accepted: 11/19/2008] [Indexed: 11/22/2022] Open
Abstract
Lower extremity venous ulcers comprise a complex medical and social issue. The conservative and/or surgical management of venous ulcers is often inadequate. In addition, the psychosocial aspect of the disease is often overlooked and most often undertreated. Common symptoms such as pain, low self-esteem and patient isolation are usually not recognized and therefore not adequately managed.This mini-review summarizes the current data on the management of lower extremity venous ulcers and their impact on the quality of life of these patients.
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