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Cacua Sanchez MT, Buenahora G, Carrillo Bravo CA. Effectiveness of the Use of the Human Recombinant Epidermal Growth Factor in the Subsidized Regime vs The Contributive Regime in Patients with Venous Ulcers in Bogotá. Drug Des Devel Ther 2024; 18:1933-1945. [PMID: 38831868 PMCID: PMC11146618 DOI: 10.2147/dddt.s437105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Vascular ulcers constitute a serious global public health problem, responsible for causing a significant social and economic impact due to their recurrent, disabling nature and the need for prolonged therapies to cure them. Objective To evaluate the use and efficacy of the rhEGF in the epithelialization of patients with a diagnosis of CEAP stage 6 venous insufficiency, in the two regimes of the health system in Colombia, the contributive (equivalent to a health system where citizens with payment capacity contribute a percentage of their salary) and the subsidized (equivalent to a health system where the state covers the vulnerable population and low socioeconomic level) versus the other treatments used. Methodology Observational, descriptive, retrospective, multicenter study, in which 105 medical records with 139 ulcers were reviewed, in 2 centers, one belonging to the subsidized system and the other to the contributive system in Colombia. Results The association with the epithelialization variable of the different treatment groups for ulcers according to the application of the mixed effect model test, for both regimes was for the Biologicals (EC 34.401/p = 0.000), Bioactive Agents (Hydrogels) (EC 24.735/p = 0.005) groups; for the rest of the treatment groups, the results were neither associated nor statistically significant. Conclusion Intra- and perilesional therapy with rhEGF expands the therapeutic spectrum in patients with venous ulcers, regardless of the type of health system in which it will be applied, shortening the healing time and reaching a possible therapeutic goal, which according to this study there is an association with epithelialization regardless of the regime applied.
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Healy CR, Gethin G, Pandit A, Finn DP. Chronic wound-related pain, wound healing and the therapeutic potential of cannabinoids and endocannabinoid system modulation. Biomed Pharmacother 2023; 168:115714. [PMID: 37865988 DOI: 10.1016/j.biopha.2023.115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Chronic wounds represent a significant burden on the individual, and the healthcare system. Individuals with chronic wounds report pain to be the most challenging aspect of living with a chronic wound, with current therapeutic options deemed insufficient. The cutaneous endocannabinoid system is an important regulator of skin homeostasis, with evidence of system dysregulation in several cutaneous disorders. Herein, we describe the cutaneous endocannabinoid system, chronic wound-related pain, and comorbidities, and review preclinical and clinical evidence investigating endocannabinoid system modulation for wound-related pain and wound healing. Based on the current literature, there is some evidence to suggest efficacy of endocannabinoid system modulation for promotion of wound healing, attenuation of cutaneous disorder-related inflammation, and for the management of chronic wound-related pain. However, there is 1) a paucity of preclinical studies using validated models, specific for the study of chronic wound-related pain and 2) a lack of randomised control trials and strong clinical evidence relating to endocannabinoid system modulation for wound-related pain. In conclusion, while there is some limited evidence of benefit of endocannabinoid system modulation in wound healing and wound-related pain management, further research is required to better realise the potential of targeting the endocannabinoid system for these therapeutic applications.
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Affiliation(s)
- Catherine R Healy
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - Georgina Gethin
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland; School of Nursing and Midwifery, University of Galway, Galway City, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway City, Ireland
| | - Abhay Pandit
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland.
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Chan KS, Lo ZJ, Wang Z, Bishnoi P, Ng YZ, Chew S, Chong TT, Carmody D, Ang SY, Yong E, Chan YM, Ho J, Graves N, Harding K. A prospective study on the wound healing and quality of life outcomes of patients with venous leg ulcers in Singapore-Interim analysis at 6 month follow up. Int Wound J 2023; 20:2608-2617. [PMID: 36915237 PMCID: PMC10410353 DOI: 10.1111/iwj.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
Venous leg ulceration results in significant morbidity. However, the majority of studies conducted are on Western populations. This study aims to evaluate the wound healing and quality of life for patients with venous leg ulcers (VLUs) in a Southeast Asian population. This is a multi-centre prospective cohort study from Nov 2019 to Nov 2021. All patients were started on 2- or 4-layer compression bandage and were reviewed weekly or fortnightly. Our outcomes were wound healing, factors predictive of wound healing and the EuroQol 5-dimensional 5-level (EQ-5D-5L) health states. Within our cohort, there were 255 patients with VLU. Mean age was 65.2 ± 11.6 years. Incidence of diabetes mellitus was 42.0%. Median duration of ulcer at baseline was 0.30 years (interquartile range 0.136-0.834). Overall, the median time to wound healing was 4.5 months (95% confidence interval [CI]: 3.77-5.43). The incidence of complete wound healing at 3- and 6-month was 47.0% and 60.9%, respectively. The duration of the wound at baseline was independently associated with worse wound healing (Hazard ratio 0.94, 95% CI: 0.89-0.99, P = .014). Patients with healed VLU had a significantly higher incidence of perfect EQ-5D-5L health states at 6 months (57.8% vs 13.8%, P < .001). We intend to present longer term results in subsequent publications.
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Affiliation(s)
- Kai Siang Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | | | - Zifei Wang
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Priya Bishnoi
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Stacy Chew
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Tze Tec Chong
- Department of Vascular SurgerySingapore General HospitalSingaporeSingapore
| | - David Carmody
- Department of EndocrinologySingapore General HospitalSingaporeSingapore
| | - Shin Yuh Ang
- Nursing DivisionSingapore General HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Yam Meng Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Jackie Ho
- Department of Cardiac, Thoracic & Vascular SurgeryNational University HospitalSingaporeSingapore
| | - Nicholas Graves
- Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
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Ffrench C, Finn D, Velligna A, Ivory J, Healy C, Butler K, Sezgin D, Carr P, Probst S, McLoughlin A, Arshad S, McIntosh C, Gethin G. Systematic review of topical interventions for the management of pain in chronic wounds. Pain Rep 2023; 8:e1073. [PMID: 37711431 PMCID: PMC10499071 DOI: 10.1097/pr9.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/09/2022] [Accepted: 12/24/2022] [Indexed: 09/16/2023] Open
Abstract
Chronic wounds adversely affect quality of life. Pain is associated with chronic wounds, and its impact can vary according to wound aetiology, condition, and patient factors. This systematic review examined the effectiveness of topical interventions in the management chronic wound-related pain guided by PRISMA recommendations of randomised controlled trials (RCTs) where pain reduction is the primary outcome. Inclusion criteria were adults (older than 18 years) with chronic venous, arterial, diabetic, or pressure ulcers where pain has been managed through topical administration of pharmacological/nonpharmacological agents. Searches were conducted in Ovid Embase, Ovid MEDLINE, EBSCOhost, CINAHL, CENTRAL, PubMed, Web of Science, and Scopus. Studies were screened for eligibility; risk of bias and data were extracted by 2 independent assessors. Searches retrieved 10,327 titles and abstracts (7760 after deduplication). Nine full texts (1323 participants) examining ibuprofen (n = 4), morphine (n = 2), BWD + PHMB [polihexanide-containing biocellulose wound dressing] (n = 1), and EMLA (n = 2) were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was not possible, but initial exploration suggests improved outcomes (reduced pain) for ibuprofen when compared with controls. Two studies involving morphine showed conflicting findings. Included studies often had small samples, and considering confounding factors (eg, comorbidities), the results should be interpreted with caution. Review of included studies suggests that topical interventions may provide pain relief in individuals with chronic wounds. Further adequately powered RCTs are recommended to assess the efficacy of topical interventions for the management of chronic wound-related pain.
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Affiliation(s)
- Cathal Ffrench
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
| | - David Finn
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Akke Velligna
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
| | - John Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Irish Research Council (IRC), Dublin, Ireland
| | - Catherine Healy
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Karen Butler
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
| | - Peter Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Sebastian Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
- Care Directorate, University Hospital Geneva, Geneva, Switzerland
| | - Aonghus McLoughlin
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Department of Medicine, University of Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | - Sundus Arshad
- Department of Medicine, University of Galway, Galway, Ireland
| | - Caroline McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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Bobbink P, Gschwind G, Probst S. Nursing students' skills in applying short-stretch compression bandages using the control of compression bandaging score. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S28-S35. [PMID: 37344137 DOI: 10.12968/bjon.2023.32.12.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
AIM To assess the feasibility using the Control of Compression Bandaging (CCB) score to measure skills development on short-stretch compression therapy during a second-year nursing students' workshop. DESIGN A quasi-experimental pilot study with one group. METHOD All students followed a blended learning unit comprising an e-learning unit on leg ulcers and compression therapy including videos, followed by hands-on workshops where they could exercise how to apply short-stretch compression bandages. Clinical nurse specialists in wound care collected pre- and post-workshop measures. Data collection included feasibility, absolute pressure under compression bandages and the CCB score. RESULTS Six clinical nurse specialists (CNSs) collected data and 16 students participated in this pilot study. The mean application time was 8.02 minutes (min=2, max=20) pre and 9.25 minutes (min=5, max=17) post workshop. Pressure under compression bandages increased at the forefoot (P=0.01) and the calf muscle base (P=0.03) post workshop. One extreme outlier was observed. In addition, the CCB score increased from 3.57 to 4.47 (P=0.16). Using pressure measuring devices was described as essential by all the CNSs and the CCB score was easy to use. CONCLUSION Using the CCB score and pressure measuring devices were feasible during an undergraduate education session. Recruitment procedure and modality of data collection were satisfactory. This score may be a valuable way to assess students' skills in short-stretch compression therapy. If used for formal assessment, a passing score should be defined.
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Affiliation(s)
- Paul Bobbink
- Lecturer, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland; University Institute of Higher Education and Research in Healthcare, University of Lausanne, Switzerland
| | - Géraldine Gschwind
- Assistant Lecturer, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland
| | - Sebastian Probst
- Professor, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland; Care Directorate, University Hospital Geneva, Switzerland; College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
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Lim SLX, Chung RE, Holloway S, Harding KG. Modified compression therapy in mixed arterial-venous leg ulcers: An integrative review. Int Wound J 2021; 18:822-842. [PMID: 33738975 PMCID: PMC8613381 DOI: 10.1111/iwj.13585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/21/2023] Open
Abstract
Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.
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Affiliation(s)
- Sheryl Li Xin Lim
- Blackpool Victoria Hospital, Blackpool Teaching Hospitals, Blackpool, UK
| | - Rui En Chung
- Royal Stoke University Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
| | | | - Keith G Harding
- FRCS Wound Healing Research Unit, Cardiff University, Cardiff, UK
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Bobbink P, Larkin PJ, Probst S. Experiences of Venous Leg Ulcer persons following an individualised nurse-led education: protocol for a qualitative study using a constructivist grounded theory approach. BMJ Open 2020; 10:e042605. [PMID: 33243816 PMCID: PMC7692966 DOI: 10.1136/bmjopen-2020-042605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Venous leg ulcers are slow-healing wounds with a high risk of recurrences. To prevent recurrences and promote healing, different nurse-led educational interventions have been developed. The impact of these interventions on self-management is ambiguous. Also, how persons with a venous leg ulcer experiences these educational sessions are poorly described. AIM This study protocol presents the methodology to provide a comprehensive explanation of participants' journeys-of how they experience their individualised education sessions concerning self-management. METHODS AND ANALYSIS A constructivist grounded theory approach according to Charmaz involving 30 participants will be used. Data will be collected through semistructured face-to-face interviews. Interviews will be transcribed verbatim and analysed with initial and focus coding using MAXQDA. Data collection and data analysis will occur iteratively, focusing on constant comparison to obtain well-developed categories. Categories will be reinforced using existent literature. ETHICS AND DISSEMINATION This pre-results study is embedded in a clinical trial (NCT04019340) and approved by ethical committee of the canton of Geneva (CCER: 2019-01964). A theory will emerge from participants' journeys informing future education sessions for patients with venous leg ulcers. The findings will be disseminated through peer-reviewed publications and communications.
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Affiliation(s)
- Paul Bobbink
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Philip J Larkin
- University of Lausanne and University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
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Sawad AB, Turkistani F. Treatment of venous leg ulcers using bilayered living cellular construct. J Comp Eff Res 2020; 9:907-918. [PMID: 32969709 DOI: 10.2217/cer-2020-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients' physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers' coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.
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Affiliation(s)
- Aseel Bin Sawad
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fatema Turkistani
- Clinical & Hospital Pharmacy Department, College of Pharmacy, Taibah University, Medina, Saudi Arabia
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Bobbink P, Pugliese MT, Larkin P, Probst S. Nurse-led patient education for persons suffering from a venous leg ulcer in outpatient's clinics and homecare settings: A scoping review. J Tissue Viability 2020; 29:297-309. [PMID: 32907753 DOI: 10.1016/j.jtv.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/10/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THIS STUDY To provide an overview of the available nurse-led individualized educational interventions, for persons with Venous Leg Ulcer (VLUs) in an outpatient or homecare settings. MATERIALS AND METHODS For this scoping review, a search was performed between December 2019 and January 2020. To identify sources of evidence a systematic search was conducted in PubMed, CINAHL, Embase, PsychINFO, Web of Science and LiSSa as well as in clinical trial registers to identify sources of evidence. All types of evidence associated with a nurse led-intervention were included. RESULTS Fifteen sources of evidence met the inclusion criteria. Educational sessions varied in modality, content and duration. Education sessions were face to face and supported by written materiel. The content focused on compression therapy and exercises. The duration and numbers of sessions varied. The most reported health related outcomes was wound healing. CONCLUSION This scoping review provides a broad overview of the available evidence and ongoing research for individualized nurse-led education persons with VLUs. Variability in the literature was found, which suggests that more intervention studies are needed to test and evaluate efficacy of nurse-led patient education.
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Affiliation(s)
- Paul Bobbink
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland; University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Marie-Therese Pugliese
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | - Philip Larkin
- Department of Palliative and Supportive Care and Academic Director, Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Switzerland
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
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Pernot CCEG, Zwiers I, Ten Cate-Hoek AJ, Wittens CHA. The need for a timely diagnostic workup for patients with venous leg ulcers. J Wound Care 2019; 27:758-763. [PMID: 30398937 DOI: 10.12968/jowc.2018.27.11.758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the need for an extended diagnostic workup in patients with venous leg ulcers (VLUs) and to establish the prevalence of the underlying causes of VLU. METHOD This retrospective cohort study analysed data from patients with VLU. The visual analogue scale (VAS) was used for pain assessment. The ankle-brachial index (ABI) was measured to exclude patients with arterial pathology. A duplex was performed. All patients received a wound treatment plan and ambulatory compression therapy. Continuous variables were presented as mean±standard deviation (SD) or median and interquartile range (IQR). Mann-Whitney U test and Kruskal-Wallis were used. When normally distributed, an independent sample t-test was used. RESULTS A total of 70 patients were recruited. Of these, 18 (25.7%) experienced a VLU once and 52 (74.3%) had a recurrent VLU. Treatment of the underlying lesions was performed in almost 30% of patients. Patients who were treated showed almost two times slower healing rates compared with those who were not treated for an underlying pathology. The mean time in patient referral exceeded two years, and patients who did not see their GP were treated by nurses who did not provide regular feedback the GP; as a result, compression therapy was not always adequate. CONCLUSION Patients with a VLU showing no signs of healing after 2 months should be referred to a dedicated wound care centre to avoid delays.
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Affiliation(s)
- Carina C E G Pernot
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Ineke Zwiers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Arina J Ten Cate-Hoek
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands. Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cees H A Wittens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. School for Public Health and Prim Care, Fac, Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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11
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Jansen MM, van de Ven AA, van der Valk PG, Wilder-Smith OH. Measuring sensory and pain thresholds by Semmes-Weinstein monofilaments in patients with leg ulcers: a pilot study. J Wound Care 2019; 28:647-655. [PMID: 31600108 DOI: 10.12968/jowc.2019.28.10.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pain is a common and disabling symptom in patients with leg ulcers. Clinical quantification of pain mostly depends on subjective pain reports, which do not reveal underlying mechanisms. The aim of this pilot study is to identify mechanisms underlying the pain in patients with leg ulcers by documenting alterations in pain processing using quantitative sensory testing. METHODS In nine ulcer patients the mechanical sensory thresholds and the mechanical pain thresholds were determined by Semmes-Weinstein monofilaments (SWM) at three different sites: on the contralateral (unaffected) leg, on the skin of the affected leg 10cm from the ulcer margin, and on the affected leg, close (1-2cm) to the ulcer margin. Besides the mechanical sensory thresholds and mechanical pain thresholds, pain at the site of the ulcer, using an 11-point numeric rating scale (NRS), was documented. RESULTS Mechanical sensory thresholds were increased in all subjects. Almost half (44%) of patients consistently showed allodynia at the unaffected site. The lowering of mechanical pain thresholds correlated with higher scores on the NRS. CONCLUSION All patients showed diminished touch and/or protective sensation, which might have contributed to ulcer development via (partial) loss of protective function. The allodynia at the unaffected site suggests the presence of central sensitisation of pain processing.
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Affiliation(s)
- Mark Mpm Jansen
- Midden-Brabant Hospital Pharmacy, Elisabeth TweeSteden Hospital Tilburg, The Netherlands
| | | | | | - Oliver Hg Wilder-Smith
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands.,Center for Sensory-Motor Interaction, Department of Health Sciences, Aalborg University, Denmark
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Probst S, Allet L, Depeyre J, Colin S, Buehrer Skinner M. A targeted interprofessional educational intervention to address therapeutic adherence of venous leg ulcer persons (TIEIVLU): study protocol for a randomized controlled trial. Trials 2019; 20:243. [PMID: 31036037 PMCID: PMC6489295 DOI: 10.1186/s13063-019-3333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous leg ulcers are slow-healing wounds with a high recurrence rate of 70% and a 60% risk of becoming chronic. Signs and symptoms such as pain or exudate are not only a burden on those affected but also on the healthcare system and society in general. The estimated leg ulcer prevalence in the general population is 1%. Treatment costs for leg ulcers are estimated to be 3% of overall health expenditure. Current therapeutic approaches are multifaceted and include compression therapy, leg elevation, specific ankle-exercises and a protein diet. They require an interdisciplinary team of health care professionals. Approximately 70% of patients have a knowledge deficit with regards to therapeutic measures and have difficulties with adherence to treatment protocols. Therefore, it is of utmost importance that the treatment team provides effective patient education and support during the learning phase. However, there is little evidence and no published studies that describe and evaluate effective interdisciplinary educational interventions that target compliance/adherence to the treatment plan in patients with leg ulcers. We therefore propose to develop an evidence-based interprofessional educational intervention and evaluate its feasibility first in a pilot study and subsequently in a randomized controlled trial. METHOD/DESIGN First, the development of an evidence-based educational intervention in collaboration with an expert panel is proposed and second, a randomized controlled feasibility study in a wound-care outpatient clinic. Eligible patients (n = 20) with leg ulcers will be randomized to receive either interdisciplinary education and usual care or only usual care, for 12 weeks. Data will be analyzed using SPSS version 25. Univariate and bivariate analysis will be conducted according to the data level and distribution of the data. DISCUSSION We will first develop an evidenced-based educational intervention and second, we will examine the feasibility of implementing this educational intervention in a realistic care context in patients with leg ulcers. The results will inform the final design of a subsequent randomized controlled trial, which will examine the effectiveness of the educational intervention. An intervention that enhances patient adherence to therapy would be beneficial to individual patients and to society as a whole. TRIAL REGISTRATION ClinicalTrials.gov, NCT03454698 . Registered on 6 March 2018.
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Affiliation(s)
- Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
| | - Lara Allet
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
- University Hospital, Geneva, Switzerland
| | - Jocelyne Depeyre
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
| | - Sophie Colin
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
| | - Monika Buehrer Skinner
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Naik G, Ivins NM, Harding KG. A prospective pilot study of thigh-administered intermittent pneumatic compression in the management of hard-to-heal lower limb venous and mixed aetiology ulcers. Int Wound J 2019; 16:940-945. [PMID: 31016851 DOI: 10.1111/iwj.13125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 01/16/2023] Open
Abstract
This was a prospective observational pilot study of a unique intermittent pneumatic compression (IPC) device designed to be applied in the thigh region of the affected limb in patients with lower limb ulceration of both venous and mixed (venous and arterial) aetiologies. This compression system consists of a circumferential three-chamber thigh garment and an electronic pneumatic compression pump operating over a repeated 4-minute cycle. Patients were recruited from outpatient wound clinics. Those recruited were treated with standard therapy in addition to IPC, which was applied for 2 hours per day, and followed up for a total of 8 weeks. The primary objective of the study was to examine the effects of IPC on wound healing over an 8-week period. The other objectives were to assess patients' experiences of pain and the acceptability of IPC device. Twenty-one patients were recruited, and wounds progressed towards healing in 95.24% (20/21) of the patients. Pain scores decreased in 83.33% (15/18) of the patients. Most patients felt that the thigh-applied IPC device was comfortable and easy to apply and remove. The thigh-administered IPC device can be recommended for use in routine clinical practice, especially when other treatment options are limited.
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Affiliation(s)
- Gurudutt Naik
- Welsh Wound Innovation Centre, Pontyclun, UK.,Vauxhall Practice, Chepstow, UK
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14
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Bobbink P, Morin D, Probst S. Evaluation of needs and treatment benefits in outpatient care for leg ulcer patients: a pilot study. J Wound Care 2018; 27:527-533. [DOI: 10.12968/jowc.2018.27.8.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul Bobbink
- Lecturer, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva
| | - Diane Morin
- Professor Emeritus, Faculty of Nursing, Laval University, Quebec, Canada, Faculty of Biology and Medicine, Lausanne University, Switzerland
| | - Sebastian Probst
- Professor of Tissue Viability and Wound Care, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva
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Meaume S, Dompmartin A, Lok C, Lazareth I, Sigal M, Truchetet F, Sauvadet A, Bohbot S. Quality of life in patients with leg ulcers: results from CHALLENGE, a double-blind randomised controlled trial. J Wound Care 2017; 26:368-379. [PMID: 28704156 DOI: 10.12968/jowc.2017.26.7.368] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We recently showed the superiority of a matrix metalloproteinase (MMP) modulating dressing (foam impregnated with NOSF, nano-oligosaccharide factor) compared with a lipidocolloid matrix (TLC) control dressing in median wound area reduction (WAR). Here we report the results from the same study assessing the performance and safety of TLC-NOSF in the local management of venous leg ulcers (VLUs) or mixed leg ulcers and determining its impact on the patient's health-related quality of life (HRQoL). METHOD A superiority randomised double-blind controlled trial was conducted on patients presenting with a non-infected leg ulcer (VLUs or mixed leg ulcers) of predominantly venous origin (ABPI >0.8), with a surface area ranging from 5 to 50cm2 and a duration of 6 to 36 months. Patients were randomly allocated to either the TLC-NOSF matrix foam (UrgoStart) dressing group or to the neutral TLC foam dressing group (UrgoTul Absorb). All received appropriate compression therapy and the wounds were assessed blindly (clinical examination, wound area tracing and photographic record) every 2 weeks for a period of 8 weeks, or until complete closure. A secondary endpoint, described here, was the patient's HRQoL, documented by the patient, through the EuroQol 5D tool (EQ-5D) questionnaire and visual analogue scale (VAS). RESULTS In total, 187 patients were randomised to either the TLC-NOSF group (n=94) or the control dressing group (n=93). The two groups were well balanced at baseline with regard to wound and patient characteristics. In the HRQoL questionnaire (EQ-5D), the pain/discomfort and anxiety/depression dimensions were significantly improved in the TLC-NOSF group versus the control one (pain/discomfort: 1.53±0.53 versus 1.74±0.65; p=0.022, and anxiety/depression: 1.35±0.53 versus 1.54±0.60, p=0.037). The VAS score was better in the test group compared with the control group (72.1±17.5 versus 67.3±18.7, respectively), without reaching significance (p=0.072). Acceptability and tolerance of the two products were similar in both groups. CONCLUSION The double-blind clinical trial has demonstrated that the TLC-NOSF matrix dressing promotes faster healing of VLUs and mixed leg ulcers and significantly reduces the pain/discomfort and anxiety/depression experienced by the patients. These results suggest that acceleration of VLU healing could improve the HRQoL of the patients and reduced the emotional and social burden of these chronic wounds.
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Affiliation(s)
- S Meaume
- Dermatologist and Geriatrician, Head of Geriatric Department and Wound Care Unit, Rothschild University Hospital, Paris, France
| | - A Dompmartin
- Dermatologist, Dermatology Department, Clemenceau University Hospital, Caen, France
| | - C Lok
- Head of Dermatology Department, South University Hospital, Amiens, France
| | - I Lazareth
- Department of Vascular Medicine, Saint-Joseph Hospital, Paris, France
| | - M Sigal
- Dermatologist, Head of Dermatology Department, Victor Dupouy Hospital, Argenteuil, France
| | - F Truchetet
- Head of Dermatology Department, Beauregard Hospital, Thionville, France
| | - A Sauvadet
- Clinical Research Department, Laboratoires URGO, Chenôve, France
| | - S Bohbot
- Clinical Research Department, Laboratoires URGO, Chenôve, France
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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] [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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17
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Malaquias SG, Bachion MM, Sant'ana SMSC, Dallarmi CCB, Lino Junior RDS, Ferreira PS. [People with vascular ulcers in outpatient nursing care: a study of sociodemographic and clinical variables]. Rev Esc Enferm USP 2016; 46:302-10. [PMID: 22576532 DOI: 10.1590/s0080-62342012000200006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 05/30/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the sociodemographic and clinical characteristics of people with vascular ulcers and to investigate the association between these variables. This cross-sectional, observational clinical study was conducted in outpatient clinics from February to August 2009. Interview, clinical exam, Pressure Ulcer Scale Healing and photographic registry of the wounds were performed. Forty-two individuals participated who were, on average, 60 (± 12) years old, 73.8% males, with single wounds (66.7%) resulting from alterations in venous circulation (90.5%). Their wounds had lasted for up to one year (55.5%). There was an association between the PUSH score (p=0.019) and depth of wound (p=0.027) with currently performing occupational activity, as well as between history of tobacco use and gender (p=0.049). The sociodemographic characteristics that were observed were similar to the others, except for being male, which indicates the need for more studies in the population in Goiânia, Brazil.
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Humphreys C, Moffatt C, Hood V. Risk of falling for people with venous leg ulcers: a literature review. Br J Community Nurs 2016; 21 Suppl 3:S34-8. [PMID: 26940732 DOI: 10.12968/bjcn.2016.21.sup3.s34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Little is known about the risk of falling for people with venous leg ulcers (VLUs), and this subject has not been considered in UK populations. Many problems associated with living with VLUs are also known risk factors for sustaining a fall. This literature review considered the question: 'Do community-dwelling older adults with VLUs have different outcomes in physical function measures used to assess the risk of falling compared with those without VLUs?' METHOD A review of quantitative literature relating to measures of physical function in people with and without VLUs was undertaken, the development of which was guided by the PRISMA guidelines. FINDINGS People with VLUs have poorer scores in measures of physical function than in people without. Reliability of studies included in the review was hampered by small sample sizes and threats to internal validity and generalisability. CONCLUSIONS People with VLUs may be at a greater risk of falling owing to limitations in balance and mobility. Improving physical function may result in ulcer healing and better quality of life. Reducing falls risk may also lead to improved patient safety and enhanced care outcomes. Further research is needed to better understand the problem.
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Affiliation(s)
- Catriona Humphreys
- Senior Physiotherapist, Nottingham University Hospitals NHS Trust, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, Faculty of Medicine and Health Sciences, University of Nottingham, England
| | - Victoria Hood
- Lecturer, Faculty of Medicine and Health Sciences, University of Nottingham, England
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19
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Mooij MC, Huisman LC. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment? Phlebology 2016; 31:68-73. [DOI: 10.1177/0268355516632436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose.
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Affiliation(s)
- Michael C Mooij
- Department of Phlebology, Centrum Oosterwal Alkmaar, The Netherlands
| | - Laurens C Huisman
- Department of Vascular Surgery, Flevoziekenhuis, Almere and Department of Vascular Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
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20
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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] [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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21
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Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care 2014; 23:601-12. [DOI: 10.12968/jowc.2014.23.12.601] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Green
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
| | - R. Jester
- Professor; Faculty of Health and Social Care, London South Bank University, London, SEI 0AA
| | - R. McKinley
- Professor of Education in General Practice; Keele University Medical School, Staffordshire, ST5 5BG
| | - A. Pooler
- Lecturer; School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
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O’Brien JA, Finlayson KJ, Kerr G, Edwards HE. Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial. BMC DERMATOLOGY 2014; 14:16. [PMID: 25277416 PMCID: PMC4188410 DOI: 10.1186/1471-5945-14-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. METHOD/DESIGN This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. DISCUSSION This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual's exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12612000475842.
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Affiliation(s)
- Jane A O’Brien
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Kathleen J Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Graham Kerr
- School of Exercise and Nutrition, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen E Edwards
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Malaquias SG, Bachion MM, Martins MA, Nunes CADB, Torres GDV, Pereira LV. Impaired tissue integrity, related factors and defining characteristics in persons with vascular ulcers. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014001090013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This transversal study aimed to analyze factors related to, and defining characteristics of, Impaired Tissue Integrity in persons with vascular ulcers, and compare the mean of these factors between the groups presenting different degrees in the severity of tissue compromise. The study was undertaken in February-August 2009, in the municipal health network of Goiânia in the state of Goiás, using interviews, clinical examinations and photographic records of the wounds. For analysis, simple and percentage frequencies and the Student t-test (p<0.05) were used. Five related factors were identified in more than half of the 42 participants: impaired circulation, knowledge deficit, chemical irritants, fluid excess and nutritional factors. Three defining characteristics were identified in all of the participants. There was no difference in the mean of related factors between groups. Impaired Tissue Integrity in persons with vascular ulcers was a phenomenon which demands professional attention extending beyond circulatory impairment. The mean of factors did not indicate greater or lesser severity of the compromising of the tissue integrity.
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Abstract
PURPOSE To enhance the learner's competence with knowledge of the clinical variants and management of psoriasis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of the types, symptoms, and diagnostic testing of psoriasis.2. Apply knowledge of psoriasis treatment to patient care scenarios. ABSTRACT Psoriasis is an inflammatory skin condition that is associated with various comorbidities. To the wound care physician, the Koebner phenomenon is of importance, as any superficial trauma can induce psoriasis. Particularly, periwound and joints are particularly susceptible to flare-ups of this condition. This review highlights the epidemiology and treatment of psoriasis.
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25
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The Lived Experiences of Persons With Chronic Venous Insufficiency and Lower Extremity Ulcers. J Wound Ostomy Continence Nurs 2014; 41:122-6. [DOI: 10.1097/won.0000000000000010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dias TYDAF, Costa IKF, Salvetti MDG, Mendes CKTT, Torres GDV. Influência da assistência e características clínica na qualidade de vida de portadores de úlcera venosa. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000600004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar a influência da assistência e das características clínicas na qualidade de vida de pacientes com úlcera venosa. MÉTODOS: Estudo transversal com amostragem por conveniência que incluiu 100 portadores de úlcera venosa. Utilizou-se um formulário estruturado contendo variáveis sociodemográficas e de saúde, características da assistência e da úlcera venosa e um instrumento de qualidade de vida relacionada à saúde. RESULTADOS: A média dos domínios do SF-36 foi baixa. Observou-se associação entre as características da assistência e os domínios capacidade funcional e dor. As características clínicas da lesão mostraram associação com os domínios: capacidade funcional, dor, estado geral de saúde, vitalidade e aspectos sociais. CONCLUSÃO: Os pacientes com úlcera venosa apresentam prejuízos em todos os domínios da qualidade de vida. As características da assistência e da lesão influenciaram a qualidade de vida desse grupo de pacientes, sugerindo que uma assistência integral e de qualidade pode colaborar na melhoria da qualidade de vida desses pacientes.
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Taverner T, Closs SJ, Briggs M. The journey to chronic pain: a grounded theory of older adults' experiences of pain associated with leg ulceration. Pain Manag Nurs 2013; 15:186-98. [PMID: 23402894 DOI: 10.1016/j.pmn.2012.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
This study aimed to develop a grounded theory to describe and explain the experience of pain and its impact, as reported by the individuals who had pain associated with chronic leg ulceration. The Strauss and Corbin grounded theory approach was used. In-depth interviews were undertaken with 11 people aged ≥ 65 years from Leeds in the north of England. All participants were cared for by home care nurses and had painful leg ulceration. The emergent grounded theory centered on a core category of "The journey to chronic pain." The theory suggested a trajectory consisting of three phases that the patient experiences, where the end result is a chronic pain syndrome. In phase 1, leg ulcer pain has predominantly acute nociceptive properties, and if this is not managed effectively, or ulcers do not heal, persistent pain may develop with both nociceptive and neuropathic properties (i.e., phase 2). If phase 2 pain is not managed effectively, patients may then develop refractory long-term pain (phase 3). Those who progress to phase 3 tend to experience negative consequences such as insomnia, depression, and suicidal ideation. Only when health care professionals understand and acknowledge the persistent and long-term nature of the pain in this patient group can the pain be managed effectively.
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Affiliation(s)
- Tarnia Taverner
- University of British Columbia, Vancouver, British Columbia, Canada.
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Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study. Implement Sci 2012; 7:104. [PMID: 23101504 PMCID: PMC3520793 DOI: 10.1186/1748-5908-7-104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 10/17/2012] [Indexed: 11/29/2022] Open
Abstract
Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer care is often fragmented, indicating that quality improvement is needed.
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Purcell A, Marshall A, King J, Buckley T. Eutectic mixture of local anaesthetics (EMLA) 5% cream as a primary dressing on a painful lower leg ulcer. J Wound Care 2012; 21:309-10, 312, 314. [PMID: 22886329 DOI: 10.12968/jowc.2012.21.7.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer.
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Affiliation(s)
- A Purcell
- Central Coast Community Nursing Service, Central Coast Local Health District, Australia.
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Williams AF. Working in partnership with patients to promote concordance with compression bandaging. Br J Community Nurs 2012; 17 Suppl:S1-S16. [PMID: 25211595 DOI: 10.12968/bjcn.2012.17.sup10a.s1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients may be tempted to remove their compression bandages if they find them uncomfortable, particularly at night. Working in partnership with patients to select bandages that they find tolerable and then applying them in a way that promotes comfort will encourage concordance with this therapy.
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Affiliation(s)
- Anne F Williams
- Nurse Consultant/Researcher, Esk Lymphology, Dalkeith, Midlothian, Scotland and NHS Highland Lymphoedema Project Consultant
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Heinen M, Borm G, van der Vleuten C, Evers A, Oostendorp R, van Achterberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomized controlled trial. Int J Nurs Stud 2012; 49:151-61. [DOI: 10.1016/j.ijnurstu.2011.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/31/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
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Taverner T, Closs J, Briggs M. A meta-synthesis of research on leg ulceration and neuropathic pain component and sequelae. ACTA ACUST UNITED AC 2012; 20:S18, S20, S22-27. [PMID: 22067932 DOI: 10.12968/bjon.2011.20.sup12.s18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leg ulceration represents a substantial health problem, and pain is likely to be an associated symptom. The aim of this meta-synthesis was to undertake a systematic review of qualitative studies investigating the experience of chronic painful leg ulceration. This study undertook the meta-synthesis approach described by Sandelowski and Barroso (2003), which is a synthesis and re-interpretation of the findings from several qualitative studies. Findings were extracted and synthesized. The overarching theme was that patients with chronic leg ulceration suffer from persistent pain with associated sequelae. Word descriptors used by participants also suggested that patients have neuropathic pain. In addition, findings from the meta-synthesis suggested that pain associated with chronic leg ulcer may have a neuropathic pain component. Pain associated with leg ulceration is likely to have nociceptive properties as well as neuropathic properties. If neuropathic pain is not identified and managed effectively, patients are at risk of developing a chronic pain condition with associated sequelae, such as poor sleep, depression and suicidal ideation. It is proposed that early identification and management may enable appropriate pain management which may prevent or reduce the associated risks.
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Affiliation(s)
- Tarnia Taverner
- University of British Columbia, School of Nursing, Vancouver
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Painful leg ulcers: community nurses’ knowledge and beliefs, a feasibility study. Prim Health Care Res Dev 2011; 12:379-92. [DOI: 10.1017/s1463423611000302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Farley P. Should topical opioid analgesics be regarded as effective and safe when applied to chronic cutaneous lesions? J Pharm Pharmacol 2011; 63:747-56. [DOI: 10.1111/j.2042-7158.2011.01252.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Objectives
The induction of analgesia for many chronic cutaneous lesions requires treatment with an opioid analgesic. In many patients suffering with these wounds such drugs are either contraindicated or shunned because of their association with death. There are now case reports involving over 100 patients with many different types of chronic superficial wounds, which suggest that the topical application of an opioid in a suitable gel leads to a significant reduction in the level of perceived pain.
Key findings
Some work has been undertaken to elucidate the mechanisms by which such a reduction is achieved. To date there have been no proven deleterious effects of such an analgesic system upon wound healing. Although morphine is not absorbed through the intact epidermis, an open wound provides no such barrier and for large wounds drug absorption can be problematic. However, for most chronic cutaneous lesions, where data has been gathered, the blood levels of the drug applied ranges from undetectable to below that required for a systemic effect.
Summary
If proven, the use of opioids in this way would provide adequate analgesia for a collection of wounds, which are difficult to treat in patients who are often vulnerable. Proof of this concept is now urgently required.
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Affiliation(s)
- Peter Farley
- Formerly Life and Health Sciences, Aston University, Birmingham, UK
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Comparison of bodily pain: persons with and without venous ulcers in an indigent care clinic. J Wound Ostomy Continence Nurs 2009; 36:493-502. [PMID: 19752658 DOI: 10.1097/won.0b013e3181b35ed1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to examine bodily pain and its relationship with functional status, perception of control, coping, and depression for patients with and without venous ulcers who were receiving care in an urban, primary care clinic for low-income adults. METHODS We used an exploratory, cross-sectional design. Participants (N = 301) completed demographic, pain severity and pain interference with function, depression, control, and coping questionnaires. Seventy patients (23.3%) had venous ulcers and 231 (76.7%) did not. RESULTS Participants were generally male (53%, n = 159), mostly African American (92%, n = 277), and ranged in age from 22 to 74 years (M = 49.5, SD = 8.5). Persons with and without venous ulcers did not differ significantly based on gender, race, number of pain sites (n = 3.3), or self-rated health. Those with leg ulcers were significantly older, had more health problems, and were more likely to have pain-related disability. The pain descriptors used by patients with venous ulcers were sharp (89%), nagging (87%), tiring (87%), and throbbing (87%). Patients with leg ulcers reported significantly lower average pain (M = 6.0) than those without leg ulcers (M = 6.6) and greater 24-hour pain relief from treatments or medications (55% vs 44%). Patients with venous ulcers reported greater control over their pain and greater coping with pain. The 2 groups did not differ significantly on depression, life control, or purpose in life scores. CONCLUSIONS Compared to patients without venous ulcers, those patients with venous ulcers rated their pain lower and reported higher coping and control over pain, which may be reflected in better subjective pain management despite having more pain sites and disability related to pain. Pain management for indigent patients with and without venous ulcers remains a concern and needs further study.
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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] [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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Abstract
BACKGROUND AND AIM Since 1998, many leg ulcer practice guidelines were developed. The aim of this paper is to describe the methodological and clinical content quality of those guidelines. Methods PubMed, CINAHL, Cochrane Library and websites known for publishing or collecting clinical practice guidelines were explored from 1998 up to June 2006. Reference lists of all identified guidelines were reviewed for other guidelines to be included. Guidelines were eligible if they were written in English, Dutch, French or German, if the scope was the treatment of venous leg ulcers, if the guideline was systematically developed and if the steps in guideline development were reported clearly. Seven guidelines were critically appraised. RESULTS The venous leg ulcer guidelines were clearly based on evidence. The stakeholder involvement varied during the development process. Especially patients' perspectives were often not considered. There was no uniform method used to weigh the evidence. Limited attention was given to pain and lifestyle advice recommendations. A paucity of information on compliance, quality of life, organizational aspects of care and economic evaluation data was given. Most of the guidelines failed to consider the issues of dissemination and implementation. Revisions of the guidelines for leg ulcer treatment were often not available. CONCLUSION AND IMPLICATIONS FOR FUTURE GUIDELINE DEVELOPERS It is recommended that leg ulcer guidelines should incorporate a multidisciplinary approach and patient involvement is necessary. Extensive background information and the formulation of the rationale are needed. The development of an implementation guide that addresses the barriers particular to the adoption of guidelines for leg ulcer treatment could support the process of implementation. Recommendations on pain, lifestyle advice, compliance and other quality-of-life issues should be incorporated in guidelines for leg ulcer treatment.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health - Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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