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International Wound Journal Apr 2021The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management. The Lindsay Leg Club model is an alternative...
The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management. The Lindsay Leg Club model is an alternative approach to the management of leg health that can improve patient outcomes. This article reports on an audit of a relational database located within the Leg Club Network, containing records of more than 17 000 patients (known as members) who attended a Leg Club in a 5-year period (2014-2019). Overall, over 266 000 member leg assessments and treatments were entered into the database. The average nurse-member attendance time was 28 min, with a skill mix of 23% senior nurses, 70% qualified and associate nurses, and 7% nurses in supervisory roles. Healing rates averaged 62% after 12 weeks. Recurrence rates were 20% after 12 weeks. Annual clinical and volunteer hours averaged 821 and 800 h, respectively. Staffing costs were £28 per wound treatment or leg assessment with a typical duration of 27 min; 71% of members were aged 70 to 94 years old, which indicates the need for a service that caters to the specific requirements of this age group. However, no data on psychosocial and well-being outcomes were recorded. Their inclusion in further developments of this database is recommended.
Topics: Aged; Aged, 80 and over; Databases, Factual; Humans; Leg; Leg Ulcer; Medical Audit; Recurrence; Varicose Ulcer; Wound Healing
PubMed: 33236851
DOI: 10.1111/iwj.13522 -
Actas Dermo-sifiliograficas Dec 2011Ulcers are a frequent cause of dermatologic consultation, and most correspond to leg ulcers. Major advances in the treatment of ulcers have occurred in recent years as a... (Review)
Review
Ulcers are a frequent cause of dermatologic consultation, and most correspond to leg ulcers. Major advances in the treatment of ulcers have occurred in recent years as a result of research that has led to new concepts such as the consideration of the chronic ulcer as an inflammatory process involving proinflammatory cytokines and deficits of growth factors. Furthermore, studies into the use of the wet dressing have led to the appearance of a wide variety of new dressings. The aim of this review is to update the reader's knowledge of the treatment of ulcers in general and of leg ulcers in particular, with a detailed description of the new dressings available and of the new therapies for use in refractory cases.
Topics: Algorithms; Ankle Brachial Index; Anti-Infective Agents, Local; Bandages; Biopsy; Combined Modality Therapy; Cytokines; Debridement; Diagnosis, Differential; Extracellular Matrix Proteins; Humans; Hydrogels; Inflammation; Intercellular Signaling Peptides and Proteins; Leg Ulcer; Peripheral Arterial Disease; Skin Neoplasms; Ultrasonography; Varicose Ulcer; Wound Healing; Wound Infection
PubMed: 21890074
DOI: 10.1016/j.ad.2011.05.005 -
International Wound Journal Apr 2019Clinical practice guidelines (CPGs) for venous leg ulcer (VLU) management recommend below-knee compression to improve healing outcomes after calculating the... (Review)
Review
Clinical practice guidelines (CPGs) for venous leg ulcer (VLU) management recommend below-knee compression to improve healing outcomes after calculating the ankle-brachial pressure index (ABPI) to rule out significant arterial disease. This systematic scoping review aimed to complete a qualitative and quantitative content analysis of international CPGs for VLU management to determine if consensus existed in relation to recommendations for compression application based on an ABPI reading and clinical assessment. Our review shows that there is a lack of consensus across 13 VLU CPGs and a lack of clear guidance in relation to the specific ABPI range of compression therapy that can be safely applied. An area of uncertainty and disagreement exists in relation to an ABPI between 0.6 and 0.8, with some guidelines advocating that compression is contraindicated and others that there should be reduced compression. This has implications in clinical practice, including when it is safe to apply compression. In addition, the inconsistency in the levels of evidence and the grades of recommendation makes it difficult to compare across various guidelines.
Topics: Adult; Aged; Aged, 80 and over; Ankle Brachial Index; Compression Bandages; Female; Humans; Leg Ulcer; Male; Middle Aged; Practice Guidelines as Topic; Varicose Ulcer; Wound Healing
PubMed: 30485668
DOI: 10.1111/iwj.13048 -
Tidsskrift For Den Norske Laegeforening... Apr 2005Arterial ischaemic ulcers develop because of inadequate perfusion leading to local ischaemia in the skin and underlying tissue. The most common cause is peripheral... (Review)
Review
Arterial ischaemic ulcers develop because of inadequate perfusion leading to local ischaemia in the skin and underlying tissue. The most common cause is peripheral arterial disease, giving rise to symptoms like intermittent claudication, rest pain and gangrene, in addition to local ulceration. Diabetes mellitus increases the risk of ulcer formation; admittedly mainly neuropathic ulcers with a low component of peripheral arterial disease. Yet a combination of neuropathy and ischaemia is common ("neuro-ischaemic ulcer"). A thorough patient history and clinical examination can help discriminate arterial ulcers from venous, pressure, traumatic and vasculitis ulcers. Reduction of ankle systolic pressure and calculated ankle/brachial index, sometimes additional other non-invasive laboratory tests, confirm peripheral arterial disease. The primary treatment of arterial ischaemic ulcer is to increase blood supply to the affected area, primarily by endovascular treatment or open arterial reconstruction. Endovascular treatment (balloon angioplasty) is the method of choice because of graft infection risk in patients with open ulcers. Most arterial ischaemic ulcers will progress to healing if the blood supply is reestablished.
Topics: Angioplasty, Balloon; Antihypertensive Agents; Arteries; Atmosphere Exposure Chambers; Blood Pressure Determination; Humans; Ischemia; Leg Ulcer; Vascular Surgical Procedures; Venous Insufficiency
PubMed: 15815738
DOI: No ID Found -
Journal of Advanced Nursing Mar 2018To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the... (Review)
Review
AIM
To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the perspective of patients with venous leg ulceration.
BACKGROUND
Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health-related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration.
DESIGN
Qualitative evidence synthesis (using framework synthesis).
DATA SOURCES
Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015.
REVIEW METHODS
Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations.
RESULTS
Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment-related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood.
CONCLUSION
The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient-reported outcome measures for use with this population.
Topics: Humans; Leg Ulcer; Nurse-Patient Relations; Patient Reported Outcome Measures; Qualitative Research; Quality of Life; Reproducibility of Results; Social Behavior; Varicose Ulcer
PubMed: 28960514
DOI: 10.1111/jan.13465 -
International Wound Journal Dec 2015A chronic wound fails to complete an orderly and timely reparative process and places patients at increased risk for wound complications that negatively impact quality... (Review)
Review
A chronic wound fails to complete an orderly and timely reparative process and places patients at increased risk for wound complications that negatively impact quality of life and require greater health care expenditure. The role of extracellular matrix (ECM) is critical in normal and chronic wound repair. Not only is ECM the largest component of the dermal skin layer, but also ECM proteins provide structure and cell signalling that are necessary for successful tissue repair. Chronic wounds are characterised by their inflammatory and proteolytic environment, which degrades the ECM. Human acellular dermal matrices, which provide an ECM scaffold, therefore, are being used to treat chronic wounds. The ideal human acellular dermal wound matrix (HADWM) would support regenerative healing, providing a structure that could be repopulated by the body's cells. Experienced wound care investigators and clinicians discussed the function of ECM, the evidence related to a specific HADWM (Graftjacket(®) regenerative tissue matrix, Wright Medical Technology, Inc., licensed by KCI USA, Inc., San Antonio, TX), and their clinical experience with this scaffold. This article distills these discussions into an evidence-based and practical overview for treating chronic lower extremity wounds with this HADWM.
Topics: Acellular Dermis; Extracellular Matrix; Humans; Leg Ulcer; Tissue Scaffolds; Wound Healing
PubMed: 24283346
DOI: 10.1111/iwj.12185 -
BMJ (Clinical Research Ed.) Aug 2007To review the evidence of effectiveness of dressings applied to venous leg ulcers. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To review the evidence of effectiveness of dressings applied to venous leg ulcers.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Hand searches of journals and searches of electronic databases, conference proceedings, and bibliographies up to April 2006; contacts with dressing manufacturers for unpublished studies.
STUDIES REVIEWED
All randomised controlled trials that evaluated dressings applied to venous leg ulcers were eligible for inclusion. Data from eligible studies were extracted and summarised independently by two reviewers using a data extraction sheet. Methodological quality was assessed independently by two reviewers.
RESULTS
The search strategy identified 254 studies; 42 of these fulfilled the inclusion criteria. Hydrocolloids were no more effective than simple low adherent dressings used beneath compression (eight trials; relative risk for healing with hydrocolloid 1.02, 95% confidence interval 0.83 to 1.28). For other comparisons, insufficient evidence was available to allow firm conclusions to be drawn. None of the dressing comparisons showed evidence that a particular class of dressing healed more ulcers. Some differences existed between dressings in terms of subjective outcome measures and ulcer healing rates. The results were not affected by the size or quality of trials or the unit of randomisation. Insufficient data were available to allow conclusions to be drawn about the relative cost effectiveness of different dressings.
CONCLUSIONS
The type of dressing applied beneath compression was not shown to affect ulcer healing. The results of the meta-analysis showed that applying hydrocolloid dressings beneath compression produced no benefit in terms of ulcer healing compared with applying simple low adherent dressings. No conclusive recommendations can be made as to which type of dressing is most cost effective. Decisions on which dressing to apply should be based on the local costs of dressings and the preferences of the practitioner or patient.
Topics: Bandages; Costs and Cost Analysis; Humans; Leg Ulcer; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome; Wound Healing
PubMed: 17631512
DOI: 10.1136/bmj.39248.634977.AE -
Journal of Tissue Viability Feb 2024Venous Leg Ulcer is characterized by a prolonged course, delayed healing and high recurrence rate. Bringing challenges to patient treatment and care.Patients need to... (Review)
Review
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.
Topics: Humans; Quality of Life; Australia; Varicose Ulcer; Wound Healing; Leg Ulcer
PubMed: 38065827
DOI: 10.1016/j.jtv.2023.11.012 -
Deutsches Arzteblatt International Apr 2011Chronic leg ulcers are defined as those that show no tendency to heal after 3 months of appropriate treatment or are still not fully healed at 12 months. In this... (Review)
Review
BACKGROUND
Chronic leg ulcers are defined as those that show no tendency to heal after 3 months of appropriate treatment or are still not fully healed at 12 months. In this article, we present an approach to the challenging problem of chronic leg ulcers that is based on the principles of evidence-based medicine, i.e., the explicit use of the best available scientific evidence as a guide to treatment.
METHODS
Selective review of the relevant literature, including current guidelines and meta-analyses, concerning diagnostic and therapeutic strategies for chronic leg ulcers.
RESULTS
The main types of causally directed treatment are: vein surgery to eliminate pathological reflux, interventions to improve the circulation in arterial occlusive disease, and treatment of underlying diseases, such as diabetes mellitus.
CONCLUSION
Physicians providing modern evidence-based management of chronic leg ulcers should make use of their own clinical experience in combination with the best current scientific evidence. It seems clear that the many available treatment options should be evaluated critically in an interdisciplinary setting. In particular, causally directed treatment must be provided in addition to symptomatic, stage-based local wound treatment.
Topics: Chronic Disease; Clinical Trials as Topic; Evidence-Based Medicine; Humans; Leg Ulcer; Treatment Outcome
PubMed: 21547162
DOI: 10.3238/arztebl.2011.0231 -
Journal of Wound Care Nov 2023To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs).
OBJECTIVE
To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs).
METHOD
Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups.
RESULTS
In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use).
CONCLUSION
Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.
Topics: Humans; Aged; United States; Quality of Life; Retrospective Studies; Wound Healing; Medicare; Varicose Ulcer; Venous Insufficiency; Leg Ulcer
PubMed: 37907359
DOI: 10.12968/jowc.2023.32.11.704