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1.
Int J Low Extrem Wounds ; 18(3): 301-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31140336

RESUMO

Introduction. Chronic illness and risk factors for chronic illness are rising public health concerns for individuals and health care systems. Individuals with venous leg ulceration (VLU) have at least one chronic illness. As there is a projected increase in VLU prevalence there is a need to determine concurrent prevalence of risk factors for chronic illness among this population. Methods. A cross-sectional design conducted in 8 community, nurse-led, leg ulcer clinics. Results. Fifty patients (58%, n = 29 females) were enrolled. Seventy percent were >65 years old; 90% had at least one chronic illness; 60% had hypertension; 30% had atrial fibrillation; 18% had diabetes; 18% heart failure; and 28.6% musculoskeletal conditions. All had at least one risk factors for chronic illness (mean = 2.26), the most frequent being overweight (30%), obesity (30%), high cholesterol (22.2%), and restricted physical activity (22%). Participants took a mean 5.2 medications daily and 26% were on current oral antibiotics. Conclusions. Comprehensive, holistic assessment and regular reassessment with a preventative focus needs to consider chronic illness and risk factors for chronic illness. Patients with VLU are in frequent contact with their multidisciplinary team. This is an opportunity to improve care and make every encounter count.


Assuntos
Doença Crônica/epidemiologia , Hipercolesterolemia , Sobrepeso , Úlcera Varicosa , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Saúde Holística , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Irlanda/epidemiologia , Úlcera da Perna , Masculino , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/fisiopatologia
2.
Medicine (Baltimore) ; 98(5): e14389, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702633

RESUMO

Venous leg ulcers (VLUs) are an important health problem, and the size of ulcers often affects patient care, healing time, and quality of life. However, the risk factors associated with ulcer size have been rarely reported. The aim of this study was to establish the risk factors for the size of venous ulceration by analyzing the patient demographics and the results of duplex ultrasonography.This study was an in-patient population-based cross-sectional study conducted at a single center during the period from 2013 to 2017. Men and women aged >18 years, who consecutively presented to our hospital with VLU, were included. According to the size of the ulcer, patients were divided into two groups, those with ulcers≤2 cm and those with ulcers >2 cm. Demographic, anthropometric, and clinical data were collected. For the analysis, univariate and multivariate logistic regressions were used.A total of 232 patients with VLUs were admitted to our hospital from 2013 to 2017, including 117 patients (50.4%) with ulcer diameters ≤2 cm and 115 patients (49.6%) with ulcer diameters >2 cm. According to the results of the multivariate analysis, the ulcer duration (P = .001), the diameter of perforating veins (PVs) around the ulcers (P = .025), the reflux time of common femoral veins (CFVs) (P = .013), the reflux time of great saphenous veins (GSVs) (P = .021), and the reflux time of PVs around the ulcers (P = .001) were independent risk factors for VLUs.These findings provide evidence that the size of VLU was significantly related to the ulcer duration, the diameter of PV around the ulcers, the CFV reflux time, the GSV reflux time, and the PV reflux time.


Assuntos
Úlcera Varicosa/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Veia Femoral/fisiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Veia Safena/fisiologia , Fatores Sexuais , Ultrassonografia , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/epidemiologia
4.
Int Wound J ; 16(1): 256-265, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30393963

RESUMO

The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010-2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010-2014), with VLUs based on the ICD-10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one-factor analysis of variance (anova) or Kruskal-Wallis non-parametric test, as appropriate. A survival analysis by Kaplan-Meier curves and log-rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal-Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.


Assuntos
Úlcera da Perna/epidemiologia , Úlcera da Perna/terapia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Epidemiológicos , Feminino , Previsões , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Estudos de Tempo e Movimento
5.
J Eur Acad Dermatol Venereol ; 33(7): 1241-1248, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30422345

RESUMO

Venous Leg Ulcers (VLU) occur in about 1% of the Western population. A VLU takes 3-12 months to heal, it recurs often, and it has a negative impact on the quality of life. The risk factors for the development of a first VLU are not well-understood and prevention of a first VLU therefore remains underappreciated. The aim of this study was to identify risk factors for developing a first VLU in adults (aged > 18 years) by searching the literature. We searched the Cochrane Library, Pubmed, Cinalh and Narcisto identify studies that investigated risk factors in developing a VLU. The last search was performed in January 2018. Two reviewers independently reviewed the abstracts and full-text articles, and assessed the methodological quality of the included studies. Results of studies using duplex scanning, and comparing participants with and without VLUs were included in the qualitative analysis. Where possible a quantitative meta-analysis was conducted. We found five studies that investigated the relation of several risk factors with VLU development. The methodological differences of the studies made it impossible to perform a quantitative analysis. The risk factors higher age (four studies), higher body mass index (four studies), low physical activity (four studies), arterial hypertension (four studies), deep vein reflux (three studies), deep venous thrombosis (three studies) and family history of VLU (three studies) were significantly associated with a VLU in the majority of the studies. To what extent they influence the development of a VLU remains unclear because of the limited number of studies that investigated the association of these risk factors with VLU development, and the heterogeneity of these studies. Further studies are needed to confirm the association of these risk factors with the development of a VLU and to explore overweight and low physical activity in more detail.


Assuntos
Úlcera da Perna/epidemiologia , Úlcera Varicosa/epidemiologia , Fatores Etários , Índice de Massa Corporal , Exercício Físico , Humanos , Hipertensão/epidemiologia , Úlcera da Perna/genética , Fatores de Risco , Fatores Sexuais , Úlcera Varicosa/genética , Trombose Venosa/epidemiologia
6.
Phlebology ; 34(5): 311-316, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30336756

RESUMO

BACKGROUND: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. AIM: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. METHODS: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. RESULTS: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p = 0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. CONCLUSIONS: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.


Assuntos
Bases de Dados Factuais , Assistência à Saúde , Fidelidade a Diretrizes , Atenção Primária à Saúde , Encaminhamento e Consulta , Úlcera Varicosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Reino Unido/epidemiologia , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia
7.
Int J Clin Pract ; 72(12): e13263, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30239088

RESUMO

AIM: This study aimed to validate the relationships between possible predictive factors and clinically diagnosed infection in adult patients with chronic leg ulcers. METHODS: This study used a sample of 636 adult participants whose ulcers were diagnosed as either venous, arterial or mixed aetiology leg ulcers and had no clinical signs of infection at recruitment. Data were extracted from recruitment to 12 weeks from six longitudinal prospective studies from 2004 to 2015. Survival analysis was used to investigate mean time-to-infection, including the Kaplan-Meier method and the Cox proportional-hazards regression model. RESULTS: The sample included 74.7% venous, 19.6% mixed and 5.7% arterial leg ulcers. There were 101 (15.9%) participants diagnosed with infection at least once within 12 weeks of follow-up. Mean time-to-infection was 10.89 weeks (95% CI = 10.66-11.12). After adjustment for potential confounders, a Cox proportional hazards regression model found that depression, using walking aids, calf ankle ratio <1.3, wound area ≥10 cm2 and ulcers with slough tissue at recruitment were significant risk factors for wound infection. CONCLUSION: This study has validated the predictive ability of factors which have been found in a cross-sectional study to be significantly associated with infection in patients with leg ulcers, including venous leg ulcers, arterial leg ulcers and mixed aetiology leg ulcers. Results showed that patients with chronic leg ulcers, who either presented with depression, used walking aids, had a calf ankle ratio <1.3, a wound area ≥10 cm2 or an ulcer with slough tissue, had greater likelihood of developing infection compared to those without these factors.


Assuntos
Úlcera Varicosa/epidemiologia , Infecção dos Ferimentos/epidemiologia , Idoso , Doença Crônica , Depressão/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Úlcera da Perna/epidemiologia , Úlcera da Perna/etiologia , Úlcera da Perna/patologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Úlcera Varicosa/patologia , Andadores
8.
BMC Health Serv Res ; 18(1): 421, 2018 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-29880046

RESUMO

BACKGROUND: Venous leg ulcers (VLUs) are expensive to treat and impair quality of life of affected individuals. Although improved healing and reduced recurrence rates have been observed following the introduction of evidence-based guidelines, a significant evidence-practice gap exists. Compression is the recommended first-line therapy for treatment of VLUs but unlike many other developed countries, the Australian health system does not subsidise compression therapy. The objective of this study is to estimate the cost-effectiveness of guideline-based care for VLUs that includes public sector reimbursement for compression therapy for affected individuals in Australia. METHODS: A Markov model was designed to simulate the progression of VLU for patients receiving guideline-based optimal prevention and treatment, with reimbursement for compression therapy, and then compared to usual care in each State and Territory in Australia. Model inputs were derived from published literature, expert opinion, and government documents. The primary outcomes were changes to costs and health outcomes from a decision to implement guideline-based optimal care compared with the continuation of usual care. Sensitivity analyses were performed to test the robustness of model results. RESULTS: Guideline-based optimal care incurred lower total costs and improved quality of life of patients in all States and Territories in Australia regardless of the health service provider. We estimated that providing compression therapy products to affected individuals would cost the health system an additional AUD 270 million over 5 years but would result in cost savings of about AUD 1.4 billion to the health system over the same period. An evaluation of unfavourable values for key model parameters revealed a wide margin of confidence to support the findings. CONCLUSIONS: This study shows that guideline-based optimal care would be a cost-effective and cost-saving strategy to manage VLUs in Australia. Results from this study support wider adoption of guideline-based care for VLUs and the reimbursement of compression therapy. Other countries that face similar issues may benefit from investing in guideline-based wound care.


Assuntos
Bandagens Compressivas/economia , Úlcera da Perna/economia , Úlcera Varicosa/economia , Cicatrização/fisiologia , Idoso , Austrália , Análise Custo-Benefício , Tomada de Decisões , Feminino , Humanos , Úlcera da Perna/epidemiologia , Úlcera da Perna/terapia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia
9.
BMJ Open ; 8(3): e019440, 2018 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-29572395

RESUMO

BACKGROUND: Complex wounds impose a substantial health economic burden worldwide. As wound care is managed across multiple settings by a range of healthcare professionals with varying levels of expertise, the actual care delivered can vary considerably and result in the underuse of evidence-based interventions, the overuse of interventions supported by limited evidence and low value healthcare. OBJECTIVES: To quantify the number, type and management of complex wounds being treated over a two-week period and to explore variations in care by comparing current practices in wound assessment, prevention and treatment. DESIGN: A multiservice cross-sectional survey. SETTING: This survey spanned eight community services within five Northern England NHS Trusts. RESULTS: The point prevalence of complex wounds in this community-based population was 16.4 per 10 000 (95% CI 15.9 to 17.0). Based on data from 3179 patients, antimicrobial dressings were being used as the primary dressing for 36% of patients with complex wounds. Forty per cent of people with leg ulcers either had not received the recommended Doppler-aided Ankle Brachial Pressure Index assessment or it was unclear whether a recording had been taken. Thirty-one per cent of patients whose most severe wound was a venous leg ulcer were not receiving compression therapy, and there was limited use of two-layer compression hosiery. Of patients with a pressure ulcer, 39% were not using a pressure-relieving cushion or mattress. CONCLUSIONS: Marked variations were found in care, underuse of evidence-based practices and overuse of practices that are not supported by robust research evidence. Significant opportunities for delivering better value wound care therefore exist. Efforts should now focus on developing strategies to identify, assess and disinvest from products and practices supported by little or no evidence and enhance the uptake of those that are.


Assuntos
Lesão por Pressão/epidemiologia , Lesão por Pressão/terapia , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bandagens/estatística & dados numéricos , Leitos/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Cicatrização , Ferimentos e Lesões/complicações , Adulto Jovem
10.
Phlebology ; 33(6): 425-429, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28639875

RESUMO

Objective The goal of this American College of Phlebology Patient Reported Outcome Venous Registry analysis was to examine the clinical efficacy of compression stockings using short-form 6D questionnaire (SF-6D). Method SF-6D scores were modeled over time using linear mixed effects model. Changes of SF-6D score from baseline to the last encounter were examined using a paired t-test. Analysis of variance was used to compare changes from baseline in SF-6D scores between C classifications. All analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary NC). Results Baseline mean SF-6D score was 0.83 and at follow-up, 0.85. Mean SF-6D change was +0.02 points (P = .001) over an average time period of 5.5 months. Patients' SF-6D scores were estimated to increase by +0.03 points (P = .005) per year of usage of compression stockings. SF-6D score changes across C classifications did not demonstrate significant differences (P = .265). Conclusion There was an improvement of SF-6D score in the registry participants who used circular knit compression stockings.


Assuntos
Modelos Cardiovasculares , Sistema de Registros , Meias de Compressão , Inquéritos e Questionários , Úlcera Varicosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sociedades Médicas , Estados Unidos , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/fisiopatologia
11.
Phlebology ; 33(1): 60-67, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28077026

RESUMO

Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013-2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95-56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08-1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23-10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18-8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08-0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while regular physical exercise mitigated that risk. Future studies should investigate the relationships between the duration and type of regular exercise and the risk of venous ulceration to make more specific recommendations on preventing ulcer development.


Assuntos
Úlcera Varicosa/epidemiologia , Varizes/epidemiologia , Adulto , Idoso , Armênia/epidemiologia , Distribuição de Qui-Quadrado , Doença Crônica , Exercício Físico , Feminino , Humanos , Traumatismos da Perna/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Fatores de Proteção , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Comportamento Sedentário , Fatores de Tempo , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/cirurgia , Varizes/diagnóstico , Varizes/cirurgia
12.
BMJ ; 359: j5157, 2017 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-29175902

RESUMO

Objective To determine the effect of low dose aspirin on ulcer healing in patients with venous leg ulcers.Design Pragmatic, community based, parallel group, double blind, randomised controlled trial.Setting Five community nursing centres in New Zealand.Participants 251 adults with venous leg ulcers who could safely be treated with aspirin or placebo: 125 were randomised to aspirin and 126 to placebo.Interventions 150 mg oral aspirin daily or matching placebo for up to 24 weeks treatment, with compression therapy as standard background treatment.Main outcome measures The primary outcome was time to complete healing of the reference ulcer (largest ulcer if more than one ulcer was present). Secondary outcomes included proportion of participants healed, change in ulcer area, change in health related quality of life, and adverse events. Analysis was by intention to treat.Results The median number of days to healing of the reference ulcer was 77 in the aspirin group and 69 in the placebo group (hazard ratio 0.85, 95% confidence interval 0.64 to 1.13, P=0.25). The number of participants healed at the endpoint was 88 (70%) in the aspirin group and 101 (80%) in the placebo group (risk difference -9.8%, 95% confidence interval -20.4% to 0.9%, P=0.07). Estimated change in ulcer area was 4.1 cm2 in the aspirin group and 4.8 cm2 in the placebo group (mean difference -0.7 cm2, 95% confidence interval -1.9 to 0.5 cm2, P=0.25). 40 adverse events occurred among 29 participants in the aspirin group and 37 adverse events among 27 participants in the placebo group (incidence rate ratio 1.1, 95% confidence interval 0.7 to 1.7, P=0.71).Conclusion Our findings do not support the use of low dose aspirin as adjuvant treatment for venous leg ulcers.Trial registration ClinicalTrials.gov NCT02158806.


Assuntos
Aspirina/uso terapêutico , Úlcera da Perna/tratamento farmacológico , Úlcera Varicosa/tratamento farmacológico , Adjuvantes Farmacêuticos , Adulto , Idoso , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Úlcera da Perna/epidemiologia , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Resultado do Tratamento , Úlcera Varicosa/epidemiologia , Cicatrização
13.
Surg Technol Int ; 30: 77-79, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28693044

RESUMO

INTRODUCTION: The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. MATERIALS AND METHODS: Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. RESULTS: Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduction in wound size and, more commonly, complete wound closure. CONCLUSION: Adding venous evaluation referral to wound center protocol in patients with suspected venous disease improved healing outcomes, thus improving quality of life.


Assuntos
Úlcera Varicosa , Procedimentos Cirúrgicos Vasculares , Humanos , Qualidade de Vida , Resultado do Tratamento , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Cicatrização
14.
Int J Low Extrem Wounds ; 16(1): 36-44, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28682680

RESUMO

The aim of the study was to update the clinical database of chronic wounds in order to derive an evidence based understanding of the condition and hence to guide future clinical management in China. A total of 241 patients from January 1, 2011 to April 30, 2016 with chronic wounds of more than 2 weeks' duration were studied in wound healing department in Shanghai. Results revealed that among all the patients the mean age was 52.5 ± 20.2 years (range 2-92 years). The mean initial area of wounds was 30.3 ± 63.0 cm2 (range 0.25-468 cm2). The mean duration of wounds was 68.5 ± 175.2 months (range 0.5-840 months). The previously reported causes of chronic wounds were traumatic or surgical wounds (n = 82, 34.0%), followed by pressure ulcers (n = 59, 24.5%). To study the effects of age, patients were divided into 2 groups: less than 60 years (<60), and 60 years or older (≥60). The proportion of wounds etiology between the 2 age groups was analyzed, and there was significant statistical difference ( P < .05, 95% confidence interval [CI] = 0.076-0.987). To study the associations between outcome and clinical characteristics in chronic wounds, chi-square test was used. There were significant differences in the factor of wound infection. ( P = .035, 95% CI = 0.031-0.038) Regarding therapies, 72.6% (n = 175) of the patients were treated with negative pressure wound therapy. Among all the patients, 29.9% (n = 72) of them were completely healed when discharged while 62.7% (n = 150) of them improved. The mean treatment cost was 12055.4 ± 9206.3 Chinese Yuan (range 891-63626 Chinese Yuan). In conclusion, traumatic or surgical wounds have recently become the leading cause of chronic wounds in Shanghai, China. Etiology of the 2 age groups was different. Infection could significantly influence the wound outcome.


Assuntos
Tratamento de Ferimentos com Pressão Negativa/estatística & dados numéricos , Cicatrização , Infecção dos Ferimentos , Ferimentos e Lesões , Adulto , Idoso , China/epidemiologia , Doença Crônica , Pé Diabético/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Ferida Cirúrgica/epidemiologia , Úlcera Varicosa/epidemiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia , Ferimentos e Lesões/classificação , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
15.
J Vasc Surg Venous Lymphat Disord ; 5(4): 525-532, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28623990

RESUMO

BACKGROUND: The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial previously reported that patients with venous leg ulcers treated with saphenous stripping experienced a significantly reduced incidence of ulcer recurrence compared with patients treated with compression therapy. Most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class 5 (C5) and class 6 (C6) patients. METHODS: We retrospectively reviewed all CEAP C5 or C6 patients treated with EVTA to define the incidence of ulcer healing and recurrence. Patients with active ulcers were managed weekly in a comprehensive wound center until healed. After healing, patients were treated with compression stockings and returned at 6-month intervals for follow-up. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with ulcer recurrence. RESULTS: EVTA of the great saphenous vein (n = 146), small saphenous vein (n = 20), or both (n = 7) was performed on 173 limbs with active (n = 72) or healed (n = 101) ulcers. Deep venous insufficiency was present in 54 cases (31.2%). Concomitant phlebectomy was performed in 59 limbs (34%). Median follow-up time was 25.2 months after EVTA. Venous ulcers healed after EVTA in 57% of cases at 3 months, 74% at 6 months, and 78% at 12 months. Ulcers recurred in 9% of patients at 1 year after EVTA, 20% at 2 years, and 29% at 3 years of follow-up. Ulcers recurred significantly more often in patients with deep venous insufficiency and in patients who did not undergo phlebectomy of associated varicose veins at the time of EVTA. CONCLUSIONS: Ulcers recurred in a minority of CEAP clinical C5 and C6 patients after EVTA of the saphenous veins. Ulcer recurrence was less frequent in patients without concomitant deep venous reflux and in those treated with phlebectomy of varicose veins at the time of EVTA. We suggest consideration of phlebectomy at the time of EVTA for patients with C5 and C6 venous insufficiency, particularly in those with isolated superficial venous insufficiency.


Assuntos
Terapia a Laser , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/cirurgia , Idoso , Feminino , Veia Femoral/cirurgia , Seguimentos , Humanos , Incidência , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Recidiva , Estudos Retrospectivos , Veia Safena/cirurgia , Meias de Compressão , Fatores de Tempo , Resultado do Tratamento , Varizes/cirurgia , Cicatrização
16.
Phlebology ; 32(1_suppl): 3-19, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28211296

RESUMO

Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema. An initial search of Medline, Cochrane Database for Systematic Reviews and Google Scholar databases was conducted. The references of articles obtained in the primary search, including a Cochrane review of phlebotonics for venous insufficiency, were reviewed for additional studies. Studies were included if patients had a diagnosis of chronic venous disease documented with Doppler and Impedance Plethysmography. Studies excluded were those that had patients with arterial insufficiency (Ankle Brachial Index < .6), comorbidity of diabetes, obesity, rheumatological diseases, or if other causes of edema were present (congestive heart failure, renal, hepatic or lymphatic cause), or if the patient population had recent surgery or deep vein thrombosis, or had been using diuretics (in studies of edema). Other elements of the study design were to note specifically the type of compression therapy used in conjunction with Micronized Purified Flavonoid Fraction. Results The literature review yielded 250 abstracts, 65 of which met criteria for further review and 10 papers were selected for consideration in the systematic review. Conclusion In summary, the general level of evidence supports the recommendation that the use of medical therapy with Micronized Purified Flavonoid Fraction has beneficial outcomes without serious adverse events. In the United States, diosmiplex is the only available prescription formulation of Micronized Purified Flavonoid Fraction. It is derived from the rinds of oranges and is categorized as a medical food and not as a drug; and may be a particularly attractive therapy for many chronic venous disease patients because of its favorable safety profile. The Working Group for chronic venous disease concurs with previous guidance by the International European Society for Vascular Surgery in 2015 which recommended the use of Micronized Purified Flavonoid Fraction for the healing of venous ulcers, alone and adjunctive to compression therapy, and for the reduction in symptoms of chronic venous disease such as edema.


Assuntos
Flavonoides/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/epidemiologia , Animais , Capilares/citologia , Cardiologia/métodos , Doença Crônica , Edema/terapia , Hemodinâmica , Humanos , Hipertensão , Leucócitos/citologia , Permeabilidade , Qualidade de Vida , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/fisiopatologia , Doenças Vasculares/fisiopatologia , Veias/fisiopatologia , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/fisiopatologia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia
17.
J Wound Ostomy Continence Nurs ; 44(1): 41-47, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28060003

RESUMO

PURPOSE: The purpose of this study was to identify the clinical characteristics of mixed arteriovenous leg ulcers (MLU) that differentiated them from venous leg ulcers (VLU). DESIGN: Secondary analysis of data from larger electronic database. SUBJECTS AND SETTING: The sample comprised 1007 persons with lower extremity ulcers. Two hundred sixty three individuals with MLU were compared to 744 individuals with VLU; their ankle brachial indices were 0.51-0.90 and 0.91-.30 respectively. Subjects were drawn from community care settings from across Canada. METHODS: Data concerning baseline demographic and pertinent clinical characteristics including ulcer history were collected using multiple validated instruments. The Leg Ulcer Assessment Tool was used to collect demographic and pertinent medical history, The Short Form Health Survey 12 and the Euro Wuol 5D (EQ-5D) were used to measure health related quality of life, the numeric pain scales was used to measure character and intensity of pain. Groups were compared using χ or Mann-Whitney U. RESULTS: Individuals with MLU were significantly older, has lower body mass index, a history of smoking, and more comorbid conditions than subjects with VLU. In many cases, clinical presentation was indicative of significant arterial insufficiency including cool extremities, shiny, cracked and inelastic skin, impaired capillary refill, and weak pedal pulses. Ulcer pain was highly prevalent, but overall pain rating was similar between groups. Mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities. CONCLUSION: Greater knowledge and understanding of the distinct characteristics of MLU is critical for appropriate screening, prevention, assessment and management of persons with this form of leg ulcer. Pain and health related quality of life factors are important considerations when evaluating and managing these patients.


Assuntos
Úlcera da Perna/classificação , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Úlcera Varicosa/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Canadá , Dermatite/fisiopatologia , Edema/fisiopatologia , Feminino , Humanos , Úlcera da Perna/epidemiologia , Masculino , Pessoa de Meia-Idade , Pulso Arterial/enfermagem , Esclerodermia Localizada/fisiopatologia , Inquéritos e Questionários , Úlcera Varicosa/epidemiologia
18.
J Pain Symptom Manage ; 53(5): 871-879, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28063868

RESUMO

CONTEXT: Adults with venous leg ulcers frequently experience multiple symptoms that may influence quality of life (QOL). OBJECTIVES: The objective of this study was to identify patient subgroups based on their experience with a pain-depression-fatigue-sleep disturbance symptom cluster and to identify differences in patient characteristics and wound-healing and QOL outcomes between the subgroups. METHODS: Secondary data analysis from previous longitudinal studies of 247 patients with venous leg ulcers. Latent class analysis identified subgroups of patients with distinct experiences with the symptom cluster of pain, depression, fatigue, and sleep disturbance. Hierarchical regression analysis identified relationships between the subgroups and QOL outcomes. Survival analysis identified differences between the subgroups and ulcer healing. RESULTS: Latent class analysis found 67% of patients were in a mild symptom subgroup (i.e., experiencing no or mild pain, depressive symptoms, fatigue, or sleep disturbance). One-third of the samples were in a severe symptom subgroup, who reported moderate-to-severe levels of these symptoms. Compared with the mild subgroup, patients in the severe subgroup had poorer QOL scores (t = 8.06, P < 0.001). Symptom subgroup membership accounted for 19% of the variance (P < 0.001) within a hierarchical regression model that explained 42% of the variance in QOL (F(7,170) = 16.89, P < 0.001, R2 = 0.42). Cox proportional hazards regression found that at enrollment into the study, patients in the severe symptom subgroup were 1.5 times (95% confidence interval 1.02-2.08) less likely to heal in the following 24 weeks (P = 0.037). CONCLUSION: Significant relationships were found between delayed ulcer healing, decreased QOL, and membership in the severe symptom subgroup. These findings suggest that comprehensive symptom assessment is needed to identify patients at higher risk for poor outcomes and enable early intervention.


Assuntos
Depressão/epidemiologia , Fadiga/epidemiologia , Dor/epidemiologia , Qualidade de Vida/psicologia , Transtornos do Sono-Vigília/epidemiologia , Úlcera Varicosa/epidemiologia , Cicatrização , Idoso , Comorbidade , Depressão/diagnóstico , Depressão/psicologia , Fadiga/diagnóstico , Fadiga/psicologia , Feminino , Humanos , Perna (Membro) , Masculino , Dor/diagnóstico , Dor/psicologia , Prevalência , Fatores de Risco , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Síndrome , Resultado do Tratamento , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/psicologia
20.
Int Wound J ; 14(2): 338-343, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27199102

RESUMO

Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.


Assuntos
Doença Crônica/terapia , Meias de Compressão , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Úlcera Varicosa/epidemiologia
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