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2.
J Wound Ostomy Continence Nurs ; 47(2): 173-181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150141

RESUMO

PURPOSE: The purpose of this study was to investigate the use of an mHealth application (app), self-management physical activity intervention FOOTFIT with an added patient-provider connectivity feature (FOOTFIT+), that was designed to strengthen the lower extremities of minimally ambulatory individuals with venous leg ulcers (VLUs). DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: Twenty-four adults 18 years and older with VLUs being treated in 2 wound clinics in the Southeastern United States participated in this study. METHODS: Preliminary estimates and 95% confidence intervals for the medians of short-term functional impacts on foot function, strength, ankle range of motion, walking capacity, depression, and physical functioning were obtained pre- and postassessment after the 6-week intervention trial. RESULTS: There were negligible changes in either group for foot function. It is noted that both groups experienced substantial foot and ankle impairment at baseline. The greatest improvement in range of motion was noted in the FOOTFIT group for dorsiflexion of the right ankle (4.6 ± 5.22 lb/in over baseline) whereas strength decreased in both ankles for dorsiflexion and plantar flexion in the FOOTFIT+ group. No improvements were noted in walking distance or physical health for FOOTFIT (slight decrease -2.9 ± 5.6) and FOOTFIT+ (slight increase 3.0 ± 6.6) during the 6-week study period. CONCLUSIONS: In a minimally ambulatory population with VLUs, our mHealth FOOTFIT intervention composed of progressive exercise "boosts" demonstrated minimal short-term effects. We recommend engagement with the app for a longer period to determine longer-term outcomes of lower extremity function.


Assuntos
Exercício Físico/psicologia , Perna (Membro)/irrigação sanguínea , Telemedicina/instrumentação , Úlcera Varicosa/terapia , Idoso , Feminino , Humanos , Perna (Membro)/anormalidades , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sudeste dos Estados Unidos , Telemedicina/métodos , Úlcera Varicosa/fisiopatologia
3.
Am Fam Physician ; 101(3): 159-166, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003952

RESUMO

Chronic wounds are those that do not progress through a normal, orderly, and timely sequence of repair. They are common and are often incorrectly treated. The morbidity and associated costs of chronic wounds highlight the need to implement wound prevention and treatment guidelines. Common lower extremity wounds include arterial, diabetic, pressure, and venous ulcers. Physical examination alone can often guide the diagnosis. All patients with a nonhealing lower extremity ulcer should have a vascular assessment, including documentation of wound location, size, depth, drainage, and tissue type; palpation of pedal pulses; and measurement of the ankle-brachial index. Atypical nonhealing wounds should be biopsied. The mainstay of treatment is the TIME principle: tissue debridement, infection control, moisture balance, and edges of the wound. After these general measures have been addressed, treatment is specific to the ulcer type. Patients with arterial ulcers should be immediately referred to a vascular surgeon for appropriate intervention. Treatment of venous ulcers involves compression and elevation of the lower extremities, plus exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area.


Assuntos
Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Doença Crônica/terapia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Humanos , Lesão por Pressão/fisiopatologia , Lesão por Pressão/terapia , Úlcera Varicosa/fisiopatologia , Úlcera Varicosa/terapia , Ferimentos e Lesões/prevenção & controle
6.
Plast Reconstr Surg ; 144(6): 1463-1474, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764670

RESUMO

BACKGROUND: Several randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds have been published. Previous articles have revealed that the role of platelet-rich plasma in promoting chronic wound healing is uncertain. This quantitative meta-analysis was conducted to evaluate whether superior outcomes can be obtained by using platelet-rich plasma in nonhealing ulcers compared with traditional wound care. METHODS: The PubMed, EMBASE, EBSCO (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases were searched through November of 2018 for randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds. For binary outcome measures, we calculated the risk ratio. The continuous outcomes were expressed as the mean differences. Subgroup analyses were also performed according to the type of chronic ulcer. RESULTS: Overall, 630 adult patients in 15 randomized controlled trials from 2000 to 2018 were included. The number of ulcers healed in the platelet-rich plasma group was higher than in the control group, and the difference was statistically significant (risk ratio, 1.26; 95 percent CI, 1.11 to 1.42; p = 0.0003). During the fourth week of follow-up, the number of ulcers healed in the platelet-rich plasma group was significantly greater than in the control group (risk ratio, 3.50; 95 percent CI, 1.80 to 6.81; p = 0.0002). CONCLUSIONS: Platelet-rich plasma is a valuable and safe treatment dressing for chronic nonhealing ulcers; it is simple to prepare and has remarkable effects. Further high-quality prospective studies are necessary to validate these results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Pé Diabético/terapia , Plasma Rico em Plaquetas , Lesão por Pressão/terapia , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Idoso , Bandagens , Doença Crônica , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia
7.
J Vasc Surg Venous Lymphat Disord ; 7(5): 699-705, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31421838

RESUMO

OBJECTIVE: We aimed to compare mechanochemical ablation (MOCA) and thermal ablation (radiofrequency ablation and endovenous laser therapy) for venous ulcer healing in patients with clinical class 6 chronic venous insufficiency. METHODS: Electronic medical records were reviewed of patients with venous ulcers who underwent truncal or perforator ablation between February 2012 and November 2015. These records contained history of venous disease and ulcer history, procedures, complications, follow-up, method of wound care, and current status of the ulcer. The patients were grouped according to the method of ablation for comparison. RESULTS: In 66 patients, 82 venous segments were treated, 29 with thermal methods and 53 with MOCA; 16% of patients had prior venous intervention. Before ablation, three patients in the thermal group had a history of deep venous thrombosis compared with seven in the MOCA group. On average, patients treated with MOCA were older (thermal ablation, 57.2 years; MOCA, 67.9 years; P = .0003). Ulcer duration before intervention ranged from 9.2 months for thermal ablation to 11.2 months for MOCA (P = NS). In total, 74% of patients treated with MOCA healed their ulcers compared with 35% of those treated with thermal ablation (P = .01). A healed ulcer was defined as elimination of ulcer depth and superficial skin coverage. The mean time to heal was 4.4 months in the thermal ablation group compared with 2.3 months with MOCA (P = .01). The mean length of follow-up was 12.8 months after thermal ablation and 7.9 months after MOCA (P = .02). Both age (P = .03) and treatment modality (P = .03) independently had an impact on ulcer healing on multiple logistic regression analysis. All but two patients were treated with an Unna boot after venous ablation. Complications included readmission of two patients with nonaccess-related infections, one nonocclusive deep venous thrombosis, and one late death unrelated to the procedure second to pneumonia in the setting of advanced colon cancer. There were three recurrent ulcers at 1 week, 2 months, and 7 months after MOCA that rehealed with Unna boot therapy and continued compression. CONCLUSIONS: MOCA is safe and effective in treating chronic venous ulcers and appears to provide comparable results to methods that rely on thermal ablation. Younger age and use of MOCA favored wound healing. MOCA was an independent predictor of ulcer healing. Randomized studies are necessary to further support our findings.


Assuntos
Ablação por Cateter , Terapia a Laser , Úlcera Varicosa/cirurgia , Insuficiência Venosa/cirurgia , Cicatrização , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
8.
Int Wound J ; 16(6): 1323-1329, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31418520

RESUMO

The factors preventing healing in venous leg ulcers are still not fully understood. Iron-mediated tissue damage has been hypothesised, yet anecdotally anaemia is also thought to have a negative effect on wound healing. This article summarises the current evidence for these theories and their likely effects in the context of venous ulceration. A comprehensive search of the literature was conducted. Studies suggest that a number of forms of iron including haemosiderin and ferritin are implicated in progression of venous disease, ulcer formation, and impaired healing, which is thought to be primarily free radical mediated. There is a paucity of evidence for the role of iron deficiency and anaemia on ulcer healing; however, there is likely to be a highly complex interplay between the damaging effects of iron on local tissues and the negative effects of anaemia-mediated tissue hypoxia. Studies looking at options to increase local oxygen delivery such as topical haemoglobin suggest that this may have an impact on some aspects of healing, but findings are generally inconclusive. There is growing evidence that locally elevated iron levels may have a detrimental effect on ulcer healing and formation; however, more robust research is needed.


Assuntos
Anemia/metabolismo , Ferro/metabolismo , Úlcera Varicosa/metabolismo , Hemossiderina/metabolismo , Humanos , Pele/metabolismo , Úlcera Varicosa/fisiopatologia , Cicatrização/fisiologia
10.
Int J Low Extrem Wounds ; 18(3): 309-316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31237193

RESUMO

Chronic wounds unresponsive to existing treatments constitute a serious disease burden. Factors that contribute to the pathogenesis of chronic ulcers include oxidative stress, comorbid microbial infections, and the type of immune system response. Preclinically, and in a case study, a formulation containing a Ceratothoa oestroides olive oil extract promoted wound healing. Patients with chronic venous and pressure ulcers, clinically assessed as being unresponsive to healing agents, were treated for 3 months with an ointment containing the C oestroides extract combined with antibiotic and/or antiseptic agents chosen according to the type of bacterial infection. Treatment evaluation was performed using the Bates-Jensen criteria with +WoundDesk and MOWA cell phone applications. After 3 months of treatment, C oestroides resulted in an average decrease of 36% in the Bates-Jensen score of ulcers (P < .000), with the decrease being significant from the first month (P < .007). The combined use of topically applied antibiotics and antiseptics efficiently controlled microbial ulcer infection and facilitated wound healing. In relation to other factors such as initial wound size, chronicity appeared to be an important prognostic factor regarding the extent of wound healing. Future clinical investigations assessing the wound healing efficacy of the C oestroides olive oil extract are warranted.


Assuntos
Isópodes/química , Azeite de Oliva/administração & dosagem , Lesão por Pressão , Extratos de Tecidos/administração & dosagem , Úlcera Varicosa , Infecção dos Ferimentos , Idoso , Animais , Antibacterianos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Bactérias/citologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Curativos Biológicos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Lesão por Pressão/diagnóstico , Lesão por Pressão/fisiopatologia , Lesão por Pressão/terapia , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/fisiopatologia , Úlcera Varicosa/terapia , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapia
11.
Angiol. (Barcelona) ; 71(3): 102-109, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190288

RESUMO

INTRODUCCIÓN: las úlceras crónicas vasculares de miembros inferiores constituyen un problema de salud pública frecuente que originan morbilidad y cambios en la calidad de vida de quienes padecen esta situación; además, requieren un tratamiento a menudo largo y difícil. Estudios europeos reportan prevalencia de úlceras venosas activas de 1,48 por cada 1000 habitantes. OBJETIVO: estimar el tiempo de epitelización y factores pronósticos en úlceras de etiología venosa en pacientes que asisten al servicio de clínica de heridas de tres hospitales. MATERIAL Y MÉTODOS: se trata de un estudio de cohorte prospectivo observacional en el que se realizó seguimiento a 79 pacientes durante 6 meses. Se incluyeron a pacientes ambulatorios y diagnóstico de úlcera crónica vascular venosa y se excluyeron pacientes que presentaron antecedentes de consumo corticoides y expuestos a quimioterapia. La estimación de la epitelización se realizó a través del método de Kaplan Meier, Log Rank test, se estimaron los hazard ratio y se construyó el modelo de regresión de Cox. RESULTADOS: la epitelización global de las úlceras de etiología venosa en este estudio fue de un 35%. Se discriminó la epitelización por hospital. Los hallazgos fueron los siguientes: Hospital 1: 22%; hospital 2: 28%, y hospital 3: 55%. Se construyó un modelo con dos variables: persona que realiza la curación y puntuación Resvech ≤ 13. CONCLUSIÓN: los pacientes con úlceras de etiología venosa que son atendidos exclusivamente por profesionales de enfermería con experiencia en el área y tienen una puntuación ≤ 13 puntos en el índice de Resvech 2.0 se curan 5 veces más. La puntuación Resvech ≤ 13 puntos es un factor protector


INTRODUCTION: the chronic vascular ulcers of the members of the lower part of a frequent public health problema that originate morbidity and changes in the quality of life of those who suffer from this situation; In addition, they require a treatment that is often long and difficult. European studies report a prevalence of active venous ulcers of 1.48 per-1,000 inhabitants. OBJECTIVE: to estimate the epithelization time and prognostic factors in ulcers of venous etiology in patients attending the hospital wound clinic service. MATERIAL AND METHODS: this is a prospective observational cohort study, in which 79 patients are followed up for 6 months. It was included: outpatients, diagnosis of chronic venous vascular ulcer; Patients who were published: were excluded. The epithelization estimation was performed through the Kaplan Meier method, the Log Rank test, the risk indexes were estimated and the Cox regression model was constructed. RESULTS: the global epithelization of ulcers of venous etiology in this study was 35%; Epithelization was discriminated by hospital. The findings were the following: Hospital 1, 22%; hospital 2, 28% and hospital 3, 55%. 13. CONCLUSION: patients with ulcers of venous etiology are treated by nurses with experience in the area and have a score lower than and equal to 13 points in the Resvech 2.0 index, 5 times more being, the lower score and equal to 13 points, a protective factor


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Úlcera Varicosa/terapia , Úlcera Varicosa/fisiopatologia , Reepitelização/fisiologia , Estudos Prospectivos , Seguimentos , Doença Crônica , Fatores Socioeconômicos , Estimativa de Kaplan-Meier , Fatores de Tempo , Prognóstico
12.
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
13.
J Wound Ostomy Continence Nurs ; 46(3): 187-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083059

RESUMO

BACKGROUND: The purpose of this article is to examine the evidence related to a unique phenomenon of purple-maroon discoloration of the buttocks found in homecare patients and to recommend a label for this phenomenon. CASES: Initially, we searched the literature to identify and retrieve any evidence related to this unique form of purple-maroon discoloration of the buttocks. No evidence was found. To illustrate the condition, we compared 4 cases of what we have labeled chronic tissue injury to 6 patients with purple-maroon discoloration of the buttocks from different causes. CONCLUSION: Chronic tissue injury is characterized by a persistent purple-maroon discoloration located on the fleshy portion of the buttocks that does not improve or deteriorate. Unlike other causes of purple discoloration such as deep tissue pressure injury, there is minimal change in the discoloration over time. Additional research is needed to further our understanding of the histopathology of this phenomenon.


Assuntos
Nádegas/anormalidades , Lesão por Pressão/classificação , Úlcera Varicosa/classificação , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Nádegas/irrigação sanguínea , Feminino , Humanos , Masculino , Lesão por Pressão/complicações , Lesão por Pressão/fisiopatologia , Úlcera Varicosa/complicações , Úlcera Varicosa/fisiopatologia
14.
Wound Repair Regen ; 27(5): 562-590, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31025794

RESUMO

Compression therapy is the current evidence-based approach to manage venous leg ulcers (VLU); however, adherence is a major barrier to successful treatment. Combination approaches may relieve the burden of treatment by shortening the time to ulcer healing. This scoping review conducted by Australian researchers aimed to establish the evidence of effectiveness of various adjuvant methods on wound healing and recurrence. Randomized Controlled Trials (RCTs), and Systematic Reviews (SR) and Meta-Analyses (MA) on VLU management approaches published from January 2015 to December 2018 were included in this review. The articles included in the scoping review were grouped according to the management approaches, including (1) pharmaceutical interventions, (2) surgical interventions, (3) topical agents, (4) the use of devices, and (5) other, such as physiotherapy and psychological interventions. Results of this scoping review indicate that there is a limited high-quality evidence of effectiveness in most adjuvant therapies on wound healing and recurrence. Given the low-quality evidence observed in this scoping review for adjuvant treatments, the implication for practice is that current management guidelines be followed. Further rigorous studies have the potential to produce better quality evidence. Quality of evidence can be improved by ensuring large sample sizes of a single etiology wounds, standardizing reporting outcomes, and maintaining detailed and evidence-based protocols in physiological or psychological interventions.


Assuntos
Terapia Combinada/métodos , Cooperação do Paciente/estatística & dados numéricos , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Anti-Infecciosos , Bandagens Compressivas , Campos Eletromagnéticos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia por Ultrassom , Úlcera Varicosa/fisiopatologia
16.
Wounds ; 31(4): 91-96, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30802208

RESUMO

OBJECTIVE: This study evaluates the effects of topical and systemic N-acetyl cysteine (NAC) treatment on wound healing in a diabetic rat model. MATERIALS AND METHODS: A total of 48 male Wistar Albino rats were randomly divided into 4 groups of 12. Diabetes was induced with an intraperitoneal injection of 60 mg/kg streptozotocin. A 2-cm x 1-cm full-thickness wound was created on the back of each animal. In group 1 (control) and group 3 (systemic NAC), the wounds were closed with 0.9% sodium chloride-treated sterile gauze. In group 2 (topical NAC) and group 4 (topical + systemic NAC), the wounds were closed with sterile gauze treated with 3 mL (300 mg) of NAC. The animals in groups 3 and 4 were administered 200 mg/kg of NAC once daily through an orogastric tube. On days 1 and 14, the wounded areas were measured. Tissue and blood samples were taken on day 14 for histopathological and biochemical examination. RESULTS: On day 14, the wounded area in groups 2, 3, and 4 was found to be smaller than in group 1 (control). Histopathologically, epithelialization and fibrosis scores were significantly lower, whereas the inflammation score was higher in group 1 than in the other groups. Tissue oxidative stress parameters (malondialdehyde, fluorescent oxidation products, total oxidative stress) were higher in the control group than in the other groups. In groups 3 and 4 (which received systemic NAC), the oxidative stress parameters in serum samples were lower than those of the control group and group 2. Serum sulphydryl levels were the lowest in group 1. CONCLUSIONS: The results of this study show that both topical and systemic administration of NAC improved wound healing in a diabetic rat model. This effect of NAC may be related to its antioxidant properties since a reduction in oxidative stress parameters in both tissue and serum were shown in the present study.


Assuntos
Derme Acelular , Transplante de Pele/métodos , Úlcera Varicosa/patologia , Úlcera Varicosa/terapia , Tratamento Conservador , Desbridamento , Sobrevivência de Enxerto , Humanos , Projetos Piloto , Transplante Autólogo , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia , Cicatrização
17.
J Vasc Surg Venous Lymphat Disord ; 7(4): 570-576, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30777673

RESUMO

BACKGROUND: Venous ulcers are painful, recurrent, and difficult to heal. Electronic medical records (EMRs) are often not optimized to track wounds. Specialized wound care programs may not interface with office-based records, creating a need to standardize the process of venous ulcer measurement and dressing documentation within existing systems. This work describes the creation of an EMR protocol to track venous ulcer size, to standardize dressings, to address related health issues, and to improve education of the patient. We hypothesized that the institution of an EMR protocol to track clinical features of venous ulcer patients, including wound size and health status, would facilitate wound healing. METHODS: We performed a retrospective review of a prospective database from September 2014 to May 2017. Modifications to the EMR included the formation of a venous ulcer patient list, a dressing tracker, calculation of total ulcer area, graphing of ulcer size over time, and images of the wound area. Patient education materials were created through the EMR and loaded into an automatic end-visit printout that emphasized smoking cessation, weight loss, and consultation with specialty services as necessary. Quarterly meetings with the supervising physician were established to review each patient's wound progress and to target areas of improvement. RESULTS: During the study period, 204 patients with chronic C5 and C6 disease were observed. Before the start of the project, the healing rate was 53.3%. Wound healing rates improved from 59.5% (quarter 1) to 77.94% (quarter 8). In the quarter before the project started, there were no patients who had quit or cut down on smoking or smokeless tobacco, no patients who were referred for weight loss consultation, and nine who were already patients of bariatric surgery. During the study period, 29% of patients quit smoking, 19% decreased smoking, and 20% cut down smokeless tobacco use. There were 54 patients who underwent advanced arterial evaluation; 175 patients underwent sclerotherapy and 137 patients had endovenous thermal ablation to treat axial reflux in the affected limb. The EMR modification project took 13 months to craft and to implement, with approximately 8 hours of meeting time from the surgical team. CONCLUSIONS: A comprehensive care model for venous ulcer patients through EMR modification improved overall patient care, increased communication between providers, and facilitated ulcer healing. EMR modification can be introduced with an acceptable time investment on the part of both the provider and the institutional information technology team.


Assuntos
Protocolos Clínicos/normas , Registros Eletrônicos de Saúde/normas , Úlcera Varicosa/terapia , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Bases de Dados Factuais , Feminino , Comunicação em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Pennsylvania , Projetos Piloto , Estudos Retrospectivos , Comportamento de Redução do Risco , Abandono do Hábito de Fumar , Fatores de Tempo , Resultado do Tratamento , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/fisiopatologia , Perda de Peso
18.
Wounds ; 31(3): 68-74, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30720443

RESUMO

INTRODUCTION: Venous leg ulcers (VLUs) are often chronic and difficult to treat, which makes alternative options to conventional care necessary to improve ulcer healing rates. While human acellular dermal matrices (ADMs) have shown promise in treating diabetic foot ulcers, no comparative studies have been published regarding VLU treatment. Decellularized ADMs (D-ADMs) have been used successfully in the treatment of a wide variety of wound repairs and may be effective in treating VLUs. OBJECTIVE: This study is a multicenter, randomized, controlled, open-label trial designed to evaluate the safety and efficacy of D-ADM compared with conventional wound care management in patients with chronic ulcers of the lower extremity. MATERIALS AND METHODS: Patients were randomly assigned to receive either D-ADM or standard of care (control) in a 2:1 ratio. Treatment began at week 0 and wounds were evaluated on a weekly basis until wound closure was observed or the patient completed 24 weekly follow-up visits. RESULTS: Eighteen patients were included in the D-ADM arm and 10 patients in the control arm. There was a strong trend of reduction in percent wound area for D-ADM patients with an average reduction of 59.6% at 24 weeks versus 8.1% at 24 weeks for control patients. In addition, healed ulcers in the D-ADM arm remained closed at a substantially higher rate after termination than healed ulcers in the control. CONCLUSIONS: In this report, the authors note the successful increase in healing rates and rate of percent wound closure as compared with conventional care options.


Assuntos
Derme Acelular , Pé Diabético/terapia , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Idoso , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia
19.
Br J Surg ; 106(5): 555-562, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30741425

RESUMO

BACKGROUND: Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost-effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers. METHODS: This was a within-trial cost-utility analysis with a 1-year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality-adjusted life-year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health-related quality of life, and per protocol. RESULTS: After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost-effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost-effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost-effective. CONCLUSION: Early treatment of superficial reflux is highly likely to be cost-effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com).


Assuntos
Ablação por Cateter/economia , Análise Custo-Benefício , Procedimentos Endovasculares/economia , Tempo para o Tratamento , Úlcera Varicosa/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia , Cicatrização
20.
J Vasc Surg Venous Lymphat Disord ; 7(2): 217-221, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30612969

RESUMO

BACKGROUND: Guidelines as well as multiple RTCs support the use of intermittent pneumatic compression (IPC) for the treatment of venous leg ulcers when conservative measures fail. Unfortunately, the clinical usefulness of IPC is significantly limited by the physical limitations of pneumatic motors, which leads to bulky devices with slow inflation cycles, uncomfortable sleeves, lack of patient mobility, and ultimately poor patient compliance with therapy. A novel mechanical device for lower leg graded intermittent sequential compression was designed to address these limitations of IPC therapy for venous leg ulcer treatment by providing rapid compression cycles in a truly wearable device that offers the additional benefit of monitoring compression dose and patient compliance. The wearable intermittent compression (WIC) device was hypothesized to provide improved augmentation of venous flow compared with both baseline and standard IPC therapy. METHODS: Ten patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency were recruited under institutional review board approval. The primary end point for the study was augmentation of venous blood flow as measured by peak venous velocity. Patients underwent measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins for the following conditions: (1) baseline, (2) WIC device on a low setting, and (3) WIC device on a high setting. In five patients, an additional measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins was completed while wearing a commercially available IPC device. RESULTS: Both low and high settings of the WIC device resulted in higher average peak venous velocities when compared with both baseline and the IPC device (P < .05). No patients reported discomfort with either the WIC device or the IPC device during therapy. CONCLUSIONS: The WIC device significantly increases the augmentation of venous flow as measured by peak venous velocity in both the popliteal and femoral veins in patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency. In addition, the WIC device was found to be easy to use and comfortable during therapy. Future studies are planned to determine if the WIC improvements in venous flow augmentation and patient compliance will lead to higher rates of venous ulcer healing.


Assuntos
Veia Femoral , Dispositivos de Compressão Pneumática Intermitente , Veia Poplítea , Úlcera Varicosa/terapia , Insuficiência Venosa/terapia , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Desenho de Equipamento , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Veia Poplítea/diagnóstico por imagem , Veia Poplítea/fisiopatologia , Estudos Prospectivos , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
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