[Acquisition, status and transfer of knowledge in compression therapy : Cross-sectional study in healthcare professions using phlebological compression therapy]. / Wissenserwerb, Wissensstand und Wissenstransfer in der Kompressionstherapie : Querschnittsstudie in Gesundheitsberufen, die phlebologische Kompressionsversorgungen anwenden.

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.

[Compression therapy for inflammatory dermatoses of the legs]. / Kompressionstherapie bei entzündlichen Dermatosen der Beine.

In addition to venous and lymphatic diseases, there is increasing scientific evidence that inflammatory dermatoses of the legs are also indications for compression therapy. Specifically, diseases such as pyoderma gangrenosum, livedoid vasculopathy, cutaneous vasculitides, necrobiosis lipoidica, psoriasis, or erysipelas are conditions for which adjunctive compression therapy may be used when manifestations occur on the lower extremities. When inflammatory dermatoses are accompanied by edema, compression therapy is not an off-label use. Especially because of the often problematic pain symptoms, compression therapy can be performed with low resting pressures around 20 mmHg, especially in inflammatory dermatoses.In this review article, the current scientific aspects of compression therapy in inflammatory dermatoses of the legs and the corresponding limitations are presented in a differentiated manner.

Compression therapy in dermatology.

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.

[Diagnosis of leg edema]. / Diagnostik von Beinödemen.

Edema of the lower extremities is always associated with a pathological condition that should be treated, especially in patients with chronic wounds. Because the underlying causes of edema can vary greatly and sometimes be complex, clinical and, if necessary, various diagnostic tests should also be performed. Often, a suspected clinical diagnosis can already be made after clinical inspection with testing of Stemmer's and Godet's signs. Sonographic examination should then be performed as the next diagnostic test. Although measurement techniques such as water plethysmography are currently considered gold standard for volume measurements, they are very complex and prone to error, so that they are rarely used in clinical routine today. In summary, it is recommended to perform a clinical examination, if possible in combination with sonography, for edema diagnosis. Especially at the beginning of the decongestion phase, regular circumferential measurements should be performed and documented. This documentation is of high relevance for evaluation of therapeutic success.

Phlebological compression bandaging competence: comparing performance of nurses before and after one-off training.

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.

[Wound treatment without curative intention: position paper of the Initiative Chronische Wunden (ICW) e. V.] / Wundbehandlung ohne kurative Zielsetzung: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V.

Today, patients with chronic wounds are treated in many different fields of medicine. Despite this great interdisciplinary and interprofessional importance, there is still a lack of uniformly accepted definitions and classifications. Therefore, a group of experts from the professional society Initiative Chronische Wunden (ICW) e. V. translated and adapted the classification of chronic wounds into healable, maintenance and nonhealable wounds on the basis of the internationally published literature into German. This classification results in the aim of curative, limited respectively non-curative or palliative wound care, which are very important for everyday clinical practice. It thus becomes clear that complete wound closure is not always the central intention of wound treatment. For many patients with chronic wounds, other aspects such as the best possible quality of life and the promotion of health-related self-management as well as the avoidance of complications are important for treatment concepts. These therapy intentions should be differentiated and individually discussed with patients in order to facilitate shared decision making.

Development of a model to predict closure of chronic wounds in Germany: Claims data analysis.

Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time-to-event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c-statistics. This requires future data linkage between SHI and primary studies (eg, registers).

[Diagnosis and therapy of erysipelas: A position paper of the Society Initiative Chronische Wunde (ICW) e. V.] / Diagnostik und Therapie des Erysipels: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V.

Erysipelas is a bacterial soft tissue infection caused by ß-haemolytic streptococci that spreads proximally along the lymphatic system of the skin. The entry sites of the pathogens can be minor injuries or chronic wounds. The diagnosis of erysipelas is made clinically by the spreading eythema and overheating of the skin, the reduced general condition with fever and chills as well as by means of serological inflammation parameters and must be distinguished from numerous differential diagnoses.Systemic therapy is carried out with penicillin usually. In local therapy, the value of measures such as compression therapy or cooling is currently still controversial. Long-term therapy of the lymphoedema and the consistent avoidance and treatment of entry sites are essential, especially for the prevention of recurrence.

Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH.

Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.

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.

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.

Social participation of people with chronic wounds: A systematic review.

Living with chronic ulcers can be burdensome and restrictive, with regard to not only physical and psychological but also social well-being. This review aims to analyse social participation in patients with chronic wounds and to compare results across different wound types. A search string was applied in several electronic databases. Results were screened according to predefined inclusion and exclusion criteria. Data of eligible articles were extracted and synthesised narratively. The search revealed 42 eligible publications. Only minor differences across different ulcer types could be detected. Overall, family members were the main social contacts for patients; they often provided wound care and emotional support. Patients had few non-family relations, but those existing were often very close. Patients felt guilty as their condition imposed burden on family and friends, as well. A close relationship with nurses was described. Restrictions were caused by direct and indirect consequences of the wound. Overall, social support and social connections were reduced in wound patients. Inconsistent results were found regarding social isolation. In summary, people with chronic wounds experience impairments in all aspects of social participation. Therefore, social participation deserves increased attention in routine care both as a trigger of burden and as an outcome of therapy.

Nutritional status and quality of nutrition in chronic wound patients.

Malnutrition is a negative confounding factor influencing wound healing. The prevalence of malnutrition increases with age, as do chronic wounds. The aim of this prospective study was to analyse the nutritional status of patients with chronic wounds. Data collection of sociodemographic and nutritional parameters was based on an inter-professionally developed questionnaire as well as the Mini Nutritional Assessment (MNA). A total of 90 patients with chronic wounds of different aetiologies were included. Pain and dental health were found to be significant factors: Patients with malnutrition or the risk of malnutrition had significantly lower tooth and oral health scores (rs = -0.218, P = .039), and higher pain levels at rest (rs = 0.339, P < .001), while dressing (rs = 0.268, P = .014), and upon exercising (rs = 0.303, P = .005). Our data address the impact of nutrition on chronic wounds and confirm the relationship between pain, dental health, and nutritional status. Clinicians should be aware of adequate pain management and dental health care in chronic wound patients. Further studies, particularly on characterisation of preventive and therapeutic measures in the nutrition of chronic wound patients, are of great importance.

[Compression Therapy in Patients with Leg Ulcers - which Costs do Really Occur?] / Kompressionstherapie bei Patienten mit Ulcus cruris ­ welche Kosten entstehen wirklich?

INTRODUCTION: Patients with leg ulcers often have severe edema of the lower extremities, which should be treated as part of a successful wound treatment. Today in Germany the necessary compression therapies are often performed with very error-prone and time-consuming short-stretch bandages only. Multicomponent systems, adaptive compression bandages and leg ulcer stocking systems are newer, much less error-prone treatment options. In addition to the often lacking knowledge, the fears of high costs are also mentioned as reasons for the lack of prescription of these systems. It was therefore our aim to investigate the costs of different treatment options, differentiated in the outpatient and inpatient sector. METHODS: For the economic calculations, both material and personnel costs were taken into account for different scenarios. RESULTS: Both material and personnel costs were included in the calculation. We were able to demonstrate that the cost for a continuous compression therapy for inpatients accrues between 5.29 Euros to 18.50 Euros per day. For the outpatient setting costs of 2.29 Euros to 34.29 Euros per day were calculated. The different constellations of compression therapy can make sense thus not only for medically but also for economically aspects. CONCLUSION: As a consequence of this data, both the different systems and the economic factors of compression therapy in patients with leg ulcers should be known to the therapists. These treatment options should then be prescribed and performed according to individual factors, taking into account the needs and abilities of the patients.

Education in people with venous leg ulcers based on a brochure about compression therapy: A quasi-randomised controlled trial.

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.

[Importance of adequate pressure in compression therapy : Basis for successful treatment]. / Bedeutung des adäquaten Drucks in der Kompressionstherapie : Basis der erfolgreichen Behandlung.

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.

[Internal diagnostic validation of patients with a chronic wound: possibilities of identification on the basis of routine data]. / Interne Diagnosevalidierung von Patienten mit einer floriden chronischen Wunde - Möglichkeiten der Identifizierung auf der Basis von Routinedaten.

OBJECTIVE: There are still few epidemiological data on patients with chronic wounds (leg ulcers, diabetic foot ulcers and pressure ulcers). Statutory health insurance (SHI) data is increasingly being used for questions relating to healthcare science. When using this data, which is primarily collected for billing purposes, the methodological procedure for defining cases must be presented transparently. Here, it must be checked whether the target group can be validly defined using the coded diagnoses and, if necessary, further information from routine data. Therefore, the aim of this contribution is, on the one hand, to develop criteria with the help of which patients with a florid (active) chronic wound can be identified safely or as doubtful cases in routine data and, on the other hand, to determine the corresponding frequency estimates. METHODS: Initially, a literature research was carried out to identify parameters relevant to care in patients with chronic wounds. In the next step, these were divided into specific, less specific and non-specific criteria (visual validity) in a multi-stage consensus procedure with regard to the specificity for wound care. On this basis, three different case definitions are used to identify florid chronic wounds. Based on an SHI sample of insured persons, frequency estimates were made for various case definitions (safe and questionable cases). RESULTS: Of the 21 parameters identified in the literature, eight were classified as specific, six as less specific and eight as non-specific criteria for the identification of patients with chronic florid wounds. Using diagnostic coding alone for the target diseases, an administrative prevalence of chronic wounds of 1.13% was observed for the year 2010. If a case is defined using the less specific and/or the specific criteria, prevalence drops to 0.79%; if only the specific criteria are used, prevalence drops only marginally to 0.78%. These changes were observed in patients with leg ulcers and diabetic foot ulcers, but not in patients with pressure ulcers. Here, the lowest administrative prevalence (0.18%) can be seen when only looking at the diagnoses, but this increases slightly when taking wound-relevant treatments into account (specific and less specific criteria: 0.25%). CONCLUSION: It is possible to define patients with a chronic florid wound on the basis of wound-relevant treatments using SHI data and to make estimates of administrative prevalence. Depending on the question, the criteria for defining cases can be narrowed down or broadened. The comparison provides information on the internal validity of diagnostic coding. However, further studies are needed to verify external validity.

Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists.

Knowledge about methods and materials and their correct usage is the basis for compression therapy. This study compares knowledge and practical skills of participants with further training with those who had no training. This comparison provides information on whether further qualifications have an impact on knowledge and practical skills. In seminars for compression therapy, data on specific and non-specific expertise were acquired. A practical test determined the participants' skills for creating a compression bandage in a pressure value range of 50-60 mmHg. In total, 1338 participants with specific expertise and 138 participants with non-specific expertise took part. Knowledge evaluation showed that 7·9% of the specific expertise group had knowledge regarding padding, 10% regarding multi-component systems and 13·6% regarding ulcer stocking systems. In the practical test, 12·3% of all participants achieved the target range. The majority of users in both groups is not familiar with the different compression materials or their appropriate usage. In the non-specific expertise group, knowledge concerning up-to-date materials and methods is one-third lower. The practical test showed major deficits on both sides. Appropriate exercises, for example, with pressure-measuring devices, should be mandatory for all professional groups who perform compression bandaging.