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Protz K, Dissemond J, Augustin M, Janke TM. [Acquisition, status and transfer of knowledge in compression therapy : Cross-sectional study in healthcare professions using phlebological compression therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:476-485. [PMID: 38413502 DOI: 10.1007/s00105-024-05314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Due to scientific progress, healthcare professionals should regularly undergo appropriate continuing education. For this, knowledge transfer is essential. Therefore, the aim of this cross-sectional study was to investigate the acquisition, status and transfer of knowledge of professional groups applying phlebological compression therapy in Germany. MATERIALS AND METHODS Healthcare professionals (physicians, nurses and medical assistants) received a questionnaire developed for this study, which queried different aspects of acquisition, status and transfer of knowledge. RESULTS Responses from 522 participants were analysed. The topic of compression therapy was not taught in the nursing or medical education of 43.3%. Specialist journals that address compression therapy were read regularly (at least 6 times/year) by 16.1% of the participants; 63.0% had no specialist books on this subject. Only 6.7% were aware of AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") guidelines on the topic and 16.3% of the corresponding DNQP ("Deutsches Netzwerk für Qualitätsentwicklung in der Pflege") expert standard. In all, 41.2% participated in at least one internal training on compression therapy per year, 72.0% in external training and 19.2% in online training. A total of 30.7% stated that they did not use any information sources to acquire knowledge. CONCLUSIONS Possible sources of knowledge about compression therapy in Germany are insufficiently known within the investigated healthcare professional groups studied or are not regularly used. The result is a considerable knowledge deficit with a discrepancy between the current state of science and practice.
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Affiliation(s)
- Kerstin Protz
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Deutschland
| | - Matthias Augustin
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Toni Maria Janke
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Guo X, Gao Y, Ye X, Zhang Z, Zhang Z. Experiences of patients living with venous leg ulcers: A qualitative meta-synthesis. J Tissue Viability 2024; 33:67-74. [PMID: 38065827 DOI: 10.1016/j.jtv.2023.11.012] [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: 04/05/2023] [Revised: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Venous Leg Ulcer is characterized by a prolonged course, delayed healing and high recurrence rate. Bringing challenges to patient treatment and care.Patients need to control the negative behavioral factors that affect wound healing and recurrence, which seriously affect their quality of life. OBJECTIVE To integrate qualitative research related to the disease experience and feelings of patients with Venous Leg Ulcer and provide references for optimizing patient intervention measures. METHODS We searched databases including Pubmed, CINAHL, EMBASE, Web of Science, PsycINFO, The Cochrane library, ProQuest, CNKI and Wan Fang Data from 2000 to February 2023 to collect qualitative studies on the experiences of patients living with venous leg ulcers. We used the Australian JBI evidence-based healthcare center qualitative research quality evaluation standard to evaluate the quality of literature. After quality assessment, meta-synthesis was used to summarize and explain the results. RESULTS Sixteen studies were eligible for inclusion, and the total number of included individuals was 146. The perceptions of individuals with Venous Leg Ulcer synthesized three overarching themes and their subthemes: disease cognition (Understanding the cause of VLU,Understanding of VLU treatment, Recognition of VLU recurrence); physical experience (Pain symptoms, Other symptoms); and psychological and social experience (psychological impact, health education, economic burden, social relations, response strategies, doctor-patient/nurse-patient relationship). CONCLUSION The lives of patients with venous leg ulcers are influenced by various complex and diverse factors. Healthcare professionals must recognize the patient's emotional needs, establish a multidimensional support system, and promote wound healing through patient self-adjustment.
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Affiliation(s)
- Xiaoyu Guo
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yanqiu Gao
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Xiaoshan Ye
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zexiang Zhang
- Nurse-Led Clinics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhenmei Zhang
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Senft JD, Fleischhauer T, Poß-Doering R, Frasch J, Feißt M, Awounvo S, Müller-Bühl U, Altiner A, Szecsenyi J, Laux G. Primary Care Disease Management for Venous Leg Ulceration in German Healthcare: Results of the Ulcus Cruris Care Pilot Study. Healthcare (Basel) 2023; 11:2521. [PMID: 37761717 PMCID: PMC10531034 DOI: 10.3390/healthcare11182521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Despite proven effectiveness, compression therapy is applied in only 20-40% of patients with venous leg ulceration, leading to avoidable chronification and morbidity. The Ulcus Cruris Care project was established to develop a new disease-management concept comparable to existing programs for chronic diseases to support evidence-based treatment of venous leg ulceration. This prospective controlled study assessed its first implementation. Interventional elements comprised online training for general practitioner practices, software support for case management, and educational materials for patients. A total of 20 practices and 40 patients were enrolled in a 1:1 ratio to the intervention and control group. Guideline-conform compression therapy was applied more frequently in the intervention group (19/20 [95%] vs. 11/19 [58%]; p = 0.006). For patients with ulcers existing ≤ 6 months, the healing rate at 12 weeks was 8/11 [73%] (intervention) compared to 4/11 [36%] (control; p = 0.087). Patients after intervention had higher scores for self-help and education in the PACIC-5A questionnaire (42.9 ± 41.6 vs. 11.4 ± 28.8; p = 0.044). Treatment costs were EUR 1.380 ± 1.347 (intervention) and EUR 2.049 ± 2.748 (control; p = 0.342). The results of this study indicate that the Ulcus Cruris Care intervention may lead to a significant improvement in care. Consequently, a broader rollout in German healthcare seems warranted.
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Affiliation(s)
- Jonas D. Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Thomas Fleischhauer
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Regina Poß-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jona Frasch
- aQua Institute for Applied Quality Promotion and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sinclair Awounvo
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Uwe Müller-Bühl
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Dissemond J, Protz K, Stücker M. Compression therapy in dermatology. J Dtsch Dermatol Ges 2023; 21:1003-1019. [PMID: 37565365 DOI: 10.1111/ddg.15161] [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: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 08/12/2023]
Abstract
Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Stücker
- Department for Dermatology, Venerology and Allergology, Ruhr-University Bochum, Vein Center of Dermatology and Vascular Surgery, Bochum, Germany
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Dissemond J, Protz K, Stücker M. Kompressionstherapie in der Dermatologie. J Dtsch Dermatol Ges 2023; 21:1003-1020. [PMID: 37700410 DOI: 10.1111/ddg.15161_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Kerstin Protz
- CompetenzzentrumVersorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Bochum
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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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[Classification and nomenclature of current materials for compression therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:270-281. [PMID: 36754895 PMCID: PMC10050045 DOI: 10.1007/s00105-023-05108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
Compression therapy has been an essential part of conservative therapy for people with chronic wounds and edema of the lower extremities for hundreds of years. The initiated therapy can be divided into the decongestion phase, maintenance phase, and prevention. The choice of the respective compression materials is based, among other factors, on these phases, the clinical stage and symptoms, the needs of the affected person and their physical abilities. Today, a wide range of different materials and methods are available for compression therapy. Thus, it is increasingly difficult to keep an overview of these treatment options, especially since the nomenclature used by the manufacturers is often inconsistent. Thus, the materials and methods for compression therapy currently available in German-speaking countries and their clinical indications are described in this review article. In addition, a uniform nomenclature is proposed, on the basis of which an appropriate exchange between all those involved in the care of people with compression therapy is guaranteed.
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Protz K, Dissemond J, Augustin M, Maria Janke T. Phlebological compression bandaging competence: comparing performance of nurses before and after one-off training. J Wound Care 2022; 31:1039-1045. [PMID: 36475855 DOI: 10.12968/jowc.2022.31.12.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the differences in applying phlebological compression bandaging (PCB) in nurses before and after one-off training, and to compare the performance of subgroups. METHODS Participants received training teaching the correct application of PCB. Participants' competence was measured using the newly developed control score of compression bandaging (CCB score) before and after training, one and three months later. Subgroup analyses compared participants (work setting, wound certification, PCBs applied per week). RESULTS In total, 47 participants took part (mean age 40.7 years, 85.1% female, 59.6% outpatient nurses, 59.6% >10 years' working experience, 55.3% with a wound certificate). The CCB score improved after training. In all subgroups, the score differed significantly over time (p≤0.002 in all cases) except for participants applying the highest number of PCBs (p=0.241). In hospital-based participants, the CCB score three months after training was considerably, but non-significantly, higher than before training (2.84 versus 4.21, respectively; p=0.068). In participants working in outpatient settings, with and without a wound certificate, and applying a low (<5) and medium (5-10) number of PCBs per week, the CCB score remained significantly higher than before training (p≤0.011 in all cases). CONCLUSION All subgroups benefited from training, mostly significantly, and maintained gains in competence for three months. Frequently applying these skills may improve performance. Previously published results showed that ideal pressure-related parameters are rarely achieved. Regular training should be offered, including the use of pressure-measuring devices, allowing nurses to gain experience and develop deeper understanding of correct PCB application.
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Affiliation(s)
- Kerstin Protz
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Matthias Augustin
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toni Maria Janke
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Poß-Doering R, Anders C, Fleischhauer T, Szecsenyi J, Senft J. Exploring healthcare provider and patient perspectives on current outpatient care of venous leg ulcers and potential interventions to improve their treatment: a mixed methods study in the ulcus cruris care project. BMC PRIMARY CARE 2022; 23:229. [PMID: 36076159 PMCID: PMC9453712 DOI: 10.1186/s12875-022-01841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The project "Ulcus Cruris Care" aims to improve primary care for patients with venous leg ulcer (VLU) in General Practitioner (GP) practices using a complex intervention comprised of educational components, standardized treatment recommendations, computer-assisted documentation, and case management by non-physician medical assistants (MAs). Prior to implementing and testing the intervention components in general practices, in-depth exploration of current outpatient treatment of VLU patients and relevant implementation determinants was pursued.
Methods
A mixed-methods study explored views of GPs, MAs, and patients regarding current VLU outpatient care and the planned intervention components to identify potential implementation determinants. Data were collected through semi-structured guide-based telephone interviews (n = 29) and a survey questionnaire (n = 28). Interviews were transcribed verbatim. Analysis was inductive initially and finalized in a deductive-inductive approach based on domains of the Theoretical Domains Framework to support structuring of relevant implementation determinants. Survey data were analyzed descriptively.
Results
Current VLU outpatient care was described as frequently tailored to individual wounds and gradient. In general, workload was shared by GPs (diagnostics, counselling) and MAs (wound care). All care providers were aware of compression therapy, yet not all of them considered it essential for VLU care. Standardized operating procedures and educational components including e-learning were considered supportive. Stronger involvement of non-physician assistants was seen as opportunity to optimize VLU care. Concerns were identified regarding integration of software-supported case management into daily practice routines and regarding potential limitations in decision-making autonomy when using standard operating procedures.
Conclusions
Findings in this study emphasize a need for educational interventions addressing VLU care providers as well as patients, particularly with regards to compression therapy. The conception of the planned intervention appears to be adequate and a structured guideline-based case management might be a promising approach for optimization of VLU treatment.
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Durán-Sáenz I, Verdú-Soriano J, López-Casanova P, Berenguer-Pérez M. Knowledge and teaching-learning methods regarding venous leg ulcers in nursing professionals and students: A scoping review. Nurse Educ Pract 2022; 63:103414. [PMID: 35872515 DOI: 10.1016/j.nepr.2022.103414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022]
Abstract
AIM According to our scoping review questions, three aims were formulated to synthesize the evidence published on: (1) the content (2) the best or most appropriate teaching-learning methods for training nurses and undergraduate nursing students in venous leg ulcer care, and (3) to identify the level of knowledge in nurses and undergraduate nursing students about venous leg ulcer care. BACKGROUND A venous leg ulcer can be defined as a skin lesion on the leg or foot that occurs in an area affected by ambulatory venous hypertension. Hence, nurse visits are the main driver of Venous Leg Ulcer-related healthcare costs. Optimal levels of knowledge obtained with appropriate methodologies tend to improve care. Nonetheless, the time devoted to chronic wound education in undergraduate nursing curricula has been considered insufficient and inadequate. METHODS For this scoping review, a search was performed in January 2021. To identify sources of evidence, a systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cuiden, ERIC and ScienceDirect. All types of evidence associated with knowledge, teaching and/or learning methods regarding venous leg ulcers in nursing were included. RESULTS Finally, 19 documents were included. In these articles, the content mostly widely included in teaching-learning methods was compression therapy (14/19), anatomy, physiology, aetiology and/or pathophysiology (10/19) and topical treatment and care (8/19); various other topics were mentioned but less frequently. Teaching/learning methods and interventions were heterogeneous in modality, content, and duration but the majority showed better results after implementation. When looking at knowledge level, studies mainly focused on nursing staff. In general, it seems that there is a lack of knowledge and skills. CONCLUSIONS Regarding our three pivotal questions: (1) There is no uniform type of content over the studies analysed and the most referred was compression therapy. (2) The educational interventions studied have demonstrated effectiveness, but there is insufficient data to determine which is the most effective. (3) This scoping review has highlighted the lack of knowledge among nurses and nursing students about venous leg ulcer care. Additionally, we felt that there is no ideal assessment tool to quantify knowledge, skills, attitude, confidence, and commitment in this context. TWEETABLE ABSTRACT A scoping review that synthesise the evidence on the level of knowledge and teaching-learning methods in nursing regarding of people with venous leg ulcers shows lack of knowledge and variability in programs.
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Affiliation(s)
- Iván Durán-Sáenz
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz School of Nursing, Vitoria-Gasteiz, Spain; Bioaraba, Basque Nurse Education Research Group, Vitoria-Gasteiz, Spain, Araba University Hospital, Vitoria-Gasteiz School of Nursing, Vitoria-Gasteiz, Spain.
| | - José Verdú-Soriano
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Sciences, University of Alicante, Carretera San Vicente Del Raspeig s/n, San Vicente Del Raspeig, Alicante 03690, Spain
| | - Pablo López-Casanova
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Sciences, University of Alicante, Carretera San Vicente Del Raspeig s/n, San Vicente Del Raspeig, Alicante 03690, Spain
| | - Miriam Berenguer-Pérez
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Sciences, University of Alicante, Carretera San Vicente Del Raspeig s/n, San Vicente Del Raspeig, Alicante 03690, Spain
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Stürmer EK, Dissemond J. Evidenz in der lokalen Therapie chronischer Wunden: Was ist gesichert? PHLEBOLOGIE 2022. [DOI: 10.1055/a-1755-4959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZUSAMMENFASSUNGChronische Wunden sind ein komplexes Symptom verschiedener Grunderkrankungen. Sie können bspw. vaskulärer, metabolischer oder immunologischer Genese sein. Auch wenn die Therapie dieser Grunderkrankungen im Vordergrund steht und zielführend ist, so beeinflussen diese Wunden die Lebensqualität der einzelnen Patienten oder Patientinnen stark. Zur Lokaltherapie chronischer Wunden steht ein breites Portfolio an Möglichkeiten zur Verfügung. Anders als in anderen Bereichen der Medizin ist die Evidenz für die verschiedenen Lokaltherapeutika meist gering. Deshalb rücken Experten-Empfehlungen und Leitlinien an ihre Stelle, die sinnvolle Behandlungspfade aufzeigen. Die wichtigsten Fragestellungen in der täglichen Praxis betreffen die Wahl und Effektivität der Wundspülung und des Wunddebridements, das Exsudatmanagement, den Einsatz von antimikrobiellen Wirkstoffen in Lösungen und Wundauflagen, die Unterdruck-Wundtherapie (NPWT) und die Indikationsstellung zur Kompressionstherapie. Trotz des Mangels an Evidenz folgt die Behandlung chronischer Wunde einigen grundlegenden Prinzipien, die im folgenden Artikel inklusive der dazugehörigen Behandlungsempfehlungen dargestellt werden.
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Affiliation(s)
- Ewa Klara Stürmer
- Universitäres Herz- und Gefäßzentrum, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Joachim Dissemond
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
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Senft JD, Fleischhauer T, Frasch J, van Rees W, Feißt M, Schwill S, Fink C, Poß-Doering R, Wensing M, Müller-Bühl U, Szecsenyi J. Primary care disease management for venous leg ulceration—study protocol for the Ulcus Cruris Care [UCC] randomized controlled trial (DRKS00026126). Trials 2022; 23:60. [PMID: 35057840 PMCID: PMC8771170 DOI: 10.1186/s13063-021-05944-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Venous leg ulcers (VLU) have a prevalence of 1–2% in developed countries, and affected patients are severely and long-term impaired in daily activities, work, and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case management. The main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants, and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention.
Methods
The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the visual analog scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query, and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation.
Discussion
The UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life, and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered.
Trial registration
The trial protocol (version 1 as of July 19, 2021) has been registered in the German Clinical Trials Register on August 30, 2021 (DRKS00026126).
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Behairy AS, Masry SE. Impact of Educational Nursing Intervention on Compression Therapy Adherence and Recurrence of Venous Leg Ulcers: A Quasi-Experimental Study. Ocul Oncol Pathol 2021; 8:120-132. [DOI: 10.1159/000521054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Abstract
Following the healing of venous leg ulcers, the primary problems for nursing and patients are adhering to compression therapy and preventing ulcer recurrence. As a result, it is important that patients comprehend their situation. The purpose of this study is to see how an educational nursing intervention affected compression therapy adherence and recurrence of venous leg ulcers in patients with chronic venous leg ulcers. A quasi-experimental design was used, including an intervention, a control group, and before and after assessments. This study was conducted in one of Egypt’s largest teaching hospitals associated with Menoufia University. The 20-month study included 80 adult patients with healed venous leg ulcers. Each participant was randomized to either a control (got regular leg ulcer information) or study (received educational interventions) group. The following tools were used in the study: bio-sociodemographic variables, knowledge evaluation, compression therapy adherence scale, and recurrence follow-up, after 3, 6, and 12 months of implementation. Furthermore, there is a statistically significant difference between the study groups during the pretest (r = 0.885, 0.774, and 0.477, p = 0.002). The use of nursing education increased patients’ understanding and adherence to compression treatment substantially. As a consequence, those with chronic venous leg ulcers may be able to avoid recurrent venous leg ulcers.
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Stürmer EK, Dissemond J. Evidenz in der lokalen Therapie chronischer Wunden: Was ist gesichert? AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1469-7828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungChronische Wunden sind ein komplexes Symptom verschiedener Grunderkrankungen. Sie können bspw. vaskulärer, metabolischer oder immunologischer Genese sein. Auch wenn die Therapie dieser Grunderkrankungen im Vordergrund steht und zielführend ist, so beeinflussen diese Wunden die Lebensqualität der einzelnen Patienten oder Patientinnen stark. Zur Lokaltherapie chronischer Wunden steht ein breites Portfolio an Möglichkeiten zur Verfügung. Anders als in anderen Bereichen der Medizin ist die Evidenz für die verschiedenen Lokaltherapeutika meist gering. Deshalb rücken Experten-Empfehlungen und Leitlinien an ihre Stelle, die sinnvolle Behandlungspfade aufzeigen. Die wichtigsten Fragestellungen in der täglichen Praxis betreffen die Wahl und Effektivität der Wundspülung und des Wunddebridements, das Exsudatmanagement, den Einsatz von antimikrobiellen Wirkstoffen in Lösungen und Wundauflagen, die Unterdruck-Wundtherapie (NPWT) und die Indikationsstellung zur Kompressionstherapie. Trotz des Mangels an Evidenz folgt die Behandlung chronischer Wunde einigen grundlegenden Prinzipien, die im folgenden Artikel inklusive der dazugehörigen Behandlungsempfehlungen dargestellt werden.
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Affiliation(s)
- E. K. Stürmer
- Universitätsklinikum Hamburg-Eppendorf, Universitäres Herz- und Gefäßzentrum, Klinik und Poliklinik für Gefäßmedizin, Hamburg
| | - J. Dissemond
- Universitätsklinikum Hamburg-Eppendorf, Universitäres Herz- und Gefäßzentrum, Klinik und Poliklinik für Gefäßmedizin, Hamburg
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Cox A, Bousfield C. Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review. Br J Community Nurs 2021; 26:S10-S20. [PMID: 34106008 DOI: 10.12968/bjcn.2021.26.sup6.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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Protz K, Dissemond J, Karbe D, Augustin M, Klein TM. Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study. Wound Repair Regen 2021; 29:261-269. [PMID: 33598997 DOI: 10.1111/wrr.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.
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Affiliation(s)
- Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toni Maria Klein
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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[Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. German version]. Hautarzt 2021; 72:137-152. [PMID: 33301064 DOI: 10.1007/s00105-020-04734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Erfurt-Berge C, Michler M, Renner R. [Standard of patient-centred care before admission to a university wound centre]. Hautarzt 2021; 72:517-524. [PMID: 33507330 PMCID: PMC8169500 DOI: 10.1007/s00105-021-04759-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
Hintergrund und Fragestellung Die Versorgungswege von Patienten mit chronischen Wunden sind häufig sehr langwierig. Dies kann zu einer verminderten Versorgungsqualität und zu einer verspäteten Diagnose der eigentlichen Ursache führen. Gleichzeitig existieren zertifizierte Einrichtungen für diese Patientengruppe. Die vorliegende Arbeit untersucht mögliche Gründe für eine verzögerte Zuweisung an diese Zentren und ob eine spezifische Patientenauswahl an universitäre Zentren gelangt. Patienten und Methoden Durch eine retrospektive Auswertung der Patientendatensätze zum Zeitpunkt der Erstvorstellung im zertifizierten Wundzentrum wurden Variablen zum Versorgungszustand vor der universitären Vorstellung analysiert. Ergebnisse Es konnten Datensätze von 177 Patienten ausgewertet werden (53 % weiblich, 47 % männlich). Die Altersspanne lag zwischen 27 und 95 Jahren. Die mittlere Bestandsdauer der Wunde betrug 22 Monate. Eine Gefäßdiagnostik war im Vorfeld in 32 % (arterielle Diagnostik) bzw. 36 % (phlebologische Diagnostik) durchgeführt worden. Eine Gewebeprobe war in 9 % der Fälle entnommen worden, v. a. bei Patienten mit > 24 Monaten bestehender Wunde. In nur 45 % der Fälle stimmte die externe Diagnose mit der im Wundzentrum abschließend gestellten Diagnose überein. Diskussion Die Versorgungssituation von Patienten mit chronischen Wunden außerhalb spezialisierter Versorgungsstrukturen ist als unzureichend anzusehen. Eine frühzeitige Versorgung nach etablierten Standards in Diagnostik und Therapie sowie zeitnahe Überweisung bei stagnierendem Verlauf an eine Spezialsprechstunde sind anzustreben.
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Affiliation(s)
- Cornelia Erfurt-Berge
- Wundzentrum DDG/ICW, Hautklinik Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - Melanie Michler
- Zentralbereich Medizin: Struktur‑, Prozess- und Qualitätsmanagement, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 6, 72076, Tübingen, Deutschland
| | - Regina Renner
- Wundzentrum DDG/ICW, Hautklinik Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
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Rabe E, Földi E, Gerlach H, Jünger M, Lulay G, Miller A, Protz K, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Pannier F. Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. Hautarzt 2021; 72:37-50. [PMID: 33386416 PMCID: PMC8692288 DOI: 10.1007/s00105-020-04706-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | - E Földi
- Földiklinik, Rösslehofweg 2-6, 79856, Hinterzarten, Germany
| | - H Gerlach
- , Zehntstr. 25, 68519, Viernheim, Germany
| | - M Jünger
- Klinik und Poliklinik f. Hautkrankheiten, Universitätsmedizin, Ferdinand Sauerbruchstraße, 17475, Greifswald, Germany
| | - G Lulay
- Klinik für Gefäß- u. Endovaskularchirurgie, Phlebologie-Lymphologie, Frankenburgstr. 31, 48431, Rheine, Germany
| | - A Miller
- Dermatologische Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Germany
| | - K Protz
- Wundforschung, Universitätsklinikum Hamburg-Eppendorf, Bachstr. 75, 22083, Hamburg, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Hertener Str. 27, 45657, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Konrad Goldmann Str. 5b, 79100, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - F Pannier
- Praxis für Dermatologie & Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany
- Dermatologische Universitätsklinik Köln, Cologne, Germany
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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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Schlupeck M, Stubner B, Erfurt-Berge C. Development and evaluation of a digital education tool for medical students in wound care. Int Wound J 2020; 18:8-16. [PMID: 32924289 PMCID: PMC7949190 DOI: 10.1111/iwj.13498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to develop and evaluate an interactive, video‐enhanced, and case‐based online course for medical students. We chose a case about wound care since this topic is still underrepresented in the medical curriculum. First, instructional videos were created to teach practical skills in wound care. These were implemented into a case‐based online course, using the online learning platform ILIAS. In a comparative initial and final survey, numbers of users were assessed, content and structure of the course, as well as the thematic interest of the students and self‐assessed gain of competence, were evaluated. Since the summer of 2019, 310 students have successfully completed the course. The survey data showed a high participation rate and a positive response regarding the content as well as the structural concept. Most of the students rated the content within the course as useful for their future medical work (86.1%) and the gain of knowledge superior to a traditional lecture (69.4%). Self‐assessments of video‐mediated skills showed a significant increase in subjectively perceived competence. The online course is an efficient way to reach many students by the small use of resources. It resembles an option to arouse growing interest in wound care in medical students.
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Affiliation(s)
- Mischa Schlupeck
- Department of Dermatology, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Birgit Stubner
- Department of Media Didactics and E-Learning, Office of Student Affairs of the Medical Faculty, Friedrich-Alexander University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Gong JM, Du JS, Han DM, Wang XY, Qi SL. Reasons for patient non-compliance with compression stockings as a treatment for varicose veins in the lower limbs: A qualitative study. PLoS One 2020; 15:e0231218. [PMID: 32343695 PMCID: PMC7188228 DOI: 10.1371/journal.pone.0231218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
The study aims to explore the comprehensive reasons for patients’ non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients’ non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients’ compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients’ compliance with GECS therapy.
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Affiliation(s)
- Jian-Mei Gong
- Nursing School of Jilin University, Changchun, China
| | - Jian-Shi Du
- Nursing School of Jilin University, Changchun, China
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- * E-mail:
| | - Dong-Mei Han
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xin-Yu Wang
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shao-Long Qi
- Department of the Lymphatic and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Gradalski T, Ochalek K. Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case-Control Pilot Study. Lymphat Res Biol 2020; 18:428-432. [PMID: 32150495 DOI: 10.1089/lrb.2019.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A report on the usefulness of the instruction of lay carers in multilayer short-stretch compression bandaging within the initial intensive phase physical treatment of mixed-etiology chronic lower limb edema. Methods and Results: In a group of adult obese patients (including 24 females) with venous insufficiency and chronic bilateral lower limb edema, and without a history of physical therapy, 20 (ambulatory managed) were bandaged once daily (four layers, short stretch with cotton tube, and foam padding underneath) for 3 weeks (Monday-Friday) by skilled physiotherapists, and in 20 cases (education group, EG), the patients' lay carers were educated by these physiotherapists according to the same regime during one session. The outcome measures included limb volume (the method of circumference measurement with a tape at 4 cm intervals) after 1, 3, and 6 months, the time to reach the maintenance phase, the frequency of complementary bandaging during this phase, and the sense of self-efficacy (General Self-Efficacy scale, GSEs). No significant differences were noted between the two groups in the baseline measurements of age, body mass, and limb volume. The carers were able to apply compression bandages in all cases during the observation period. The time to reach the maintenance phase was longer in EG (6 vs. 1 weeks; p < 0.001). A similar median reduction in edema volume was observed at the end of the bandaging period, which continued for 3 and 6 months. It was only in EG that further improvement between 1 and 3 months was observed (p = 0.008). All participants represented an equally high optimistic sense of personal competence (GSEs). Conclusions: The instruction of lay carers in bandaging may provide a simple clinically effective solution for lower limb edema management, thus lowering its costs.
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Affiliation(s)
| | - Katarzyna Ochalek
- St Lazarus Hospice, Krakow, Poland.,Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland
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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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Protz K, Dissemond J, Seifert M, Hintner M, Temme B, Verheyen-Cronau I, Augustin M, Otten M. Education in people with venous leg ulcers based on a brochure about compression therapy: A quasi-randomised controlled trial. Int Wound J 2019; 16:1252-1262. [PMID: 31418532 PMCID: PMC7948578 DOI: 10.1111/iwj.13172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022] Open
Abstract
Brochures are a useful supplement to patient education. There is increasing evidence that they are an effective medium to support patient satisfaction, adherence, and empowerment. This study aims to produce reliable data on how much patients with venous leg ulcer (VLU) may profit from a brochure that focuses on VLU and on measures and aims of the related compression therapy. The evaluation took part from October 2018 until March 2019 and included 136 patients with VLU and related compression therapy. They were randomly sorted into a case group and a control group of 68 patients each. The case group received a brochure about venous disease and compression therapy and filled in a questionnaire after reading. The questions ranged from basic knowledge about VLU and compression therapy to aspects of self-care. The control group answered the same questions without previous reading of the brochure. The results show that in almost every aspect, the patients in the case group were better informed about their diseases, the compression therapy, and how they may support the measures adequately. This study suggests that patients with VLU may profit from a brochure that explains their disease and the related compression therapy. Better knowledge and understanding may strengthen their empowerment and adherence.
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Affiliation(s)
- Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC-Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
| | - Myriam Seifert
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC-Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Barbara Temme
- Wound Practice Berlin, Hospital Neukölln, Berlin, Germany
| | - Ida Verheyen-Cronau
- District Hospital Frankenberg gGmbH, Training Center for Nursing Professions, Frankenberg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC-Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC-Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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[Compression bandages with and without padding : Observational controlled survey of pressure and comfort]. Hautarzt 2019; 69:653-661. [PMID: 29696354 DOI: 10.1007/s00105-018-4167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the context of compression therapy, padded bandages are designed to prevent skin damage, increase adherence and support the success of therapy. Routine use is discussed, because comparative studies are lacking. OBJECTIVES This study examines effectiveness, comfort, and impact of short-stretch bandages without padding compared to underpadded bandages. PARTICIPANTS AND METHODS In all, 61 healthy participants wore padded bandages foam or synthetic cotton wool on one leg and nonpadded bandages on the other. On both sides, a resting pressure of 50 mm Hg was generated. After 60 min resting pressure, skin condition, comfort, pain, and fitting of the bandages were assessed. RESULTS All bandages showed pressure losses after 1 h; 82.0% of nonpadded bandages had a pressure drop of 9 mm Hg or more. The following were observed in unpadded bandages: constrictions (100.0%), severe redness (77.0%) and bruises (42.6%). Comfort was rated as pleasant by 3.3% without padding, by 83.9% with foam padding, and by 73.3% with synthetic cotton wool padding. Nonpadded compression bandages caused in 62.3% pain from 1-3 (numerical rating scale 0-10). CONCLUSIONS Padded compression bandages maintain the therapy-relevant pressure better, provide more comfort, and cause less pain and skin problems than nonpadded compression bandages. These aspects are crucial for adherence, and therapeutic success. After 1 h of use on the healthy leg, there were obvious differences. Significantly more side effects may appear after several hours of use on previously damaged skin. Therefore, compression bandages should always be padded.
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Abstract
BACKGROUND The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations. MATERIAL AND METHODS Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers. RESULTS The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients. CONCLUSION Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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Partsch H. Reliable self-application of short stretch leg compression: Pressure measurements under self-applied, adjustable compression wraps. Phlebology 2018; 34:208-213. [PMID: 30099955 DOI: 10.1177/0268355518793467] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adjustable compression wrap compression systems (Juxta fit™) and to compare the results with the pressure achieved by bandaging other legs using the same material. METHODS In the two training courses for nurses, specifically interested in leg ulcer treatment, the new bandage type of adjustable compression wrap was explained and workshops were organized, in which the interface pressure achieved by Juxta fit™ was measured. In the first course, the nurses applied the compression system to each other, and in the second course, another group did it on their own legs. Bandagers were instructed to apply the system strongly, with a target range of more than 50-60 mmHg. RESULTS In the first course with mutual application ( n = 34), the median pressure at the medial lower leg was 58.5 mmHg (minimal 31, maximal value 137 mmHg), in the second course in which self-application was tested ( n = 36), the corresponding values were 61.5 mmHg (minimum 35, maximum 102 mmHg). No pressures less than 30 mmHg were seen on the distal calf in either group. CONCLUSIONS In contrast to short stretch bandages that are frequently applied by bandagers with too low pressure, the adjustable compression wrap devices handled by the patients themselves produce more appropriate and more consistent pressure.
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Affiliation(s)
- Hugo Partsch
- Department of Dermatology, Vienna Medical University, Vienna, Austria
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Zasadzka E, Trzmiel T, Kleczewska M, Pawlaczyk M. Comparison of the effectiveness of complex decongestive therapy and compression bandaging as a method of treatment of lymphedema in the elderly. Clin Interv Aging 2018; 13:929-934. [PMID: 29785099 PMCID: PMC5957054 DOI: 10.2147/cia.s159380] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Lymphedema is a chronic condition which significantly lowers the quality of patient life, particularly among elderly populations, whose mobility and physical function are often reduced. Objectives The aim of the study was to compare the effectiveness of multi-layer compression bandaging (MCB) and complex decongestive therapy (CDT), and to show that MCB is a cheaper, more accessible and less labor intensive method of treating lymphedema in elderly patients. Patients and methods The study included 103 patients (85 women and 18 men) aged ≥60 years, with unilateral lower limb lymphedema. The subjects were divided into two groups: 50 treated with CDT and 53 with MCB. Pre- and post-treatment BMI, and average and maximum circumference of the edematous extremities were analyzed. Results Reduction in swelling in both groups was achieved after 15 interventions. Both therapies demonstrated similar efficacy in reducing limb volume and circumference, but MCB showed greater efficacy in reducing the maximum circumference. Conclusion Compression bandaging is a vital component of CDT. Maximum lymphedema reduction during therapy and maintaining its effect cannot be achieved without it. It also demonstrates its effectiveness as an independent method, which can reduce therapy cost and accessibility.
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Affiliation(s)
- Ewa Zasadzka
- Department of Geriatric Medicine and Gerontology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Tomasz Trzmiel
- Department of Geriatric Medicine and Gerontology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | | | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
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