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David J. Margolis - One of the best experts on this subject based on the ideXlab platform.
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clinical interventions for venous Leg Ulcers proposals to improve the quality of clinical Leg Ulcer research
Wound Repair and Regeneration, 2016Co-Authors: Gerald S Lazarus, David J. Margolis, Robert S Kirsner, Ellie Lindsay, Jonathan M Zenilman, Frances M Valle, Nicky Cullum, Vickie R Driver, Lisa J Gould, Sean TunisAbstract:The present status of clinical Leg Ulcer healing research was reviewed by 25 experts over 2 days on September 28 and 29, 2015. Multiple clinical effectiveness reviews were presented suggesting that published clinical wound healing research often does not meet present (2015) evidence based standards. Specific areas requiring remediation were highlighted and approaches to overcoming existing challenges were proposed. Participants using anonymous voting technology developed an action plan to resolve perceived deficiencies. Statements were accepted if 75% of participants agreed. Older patients with a high frequency of comorbid conditions posed particular difficulties in designing clinical research protocols and better diagnostic categorization is necessary A standardized model template for collecting information about diagnosis and evaluation of the effect of interventions on healing of all types of Leg Ulcers was considered a high priority. Such a model template could be modified depending on the specific etiology of the Leg Ulcers. Generally agreed on quantifiable standards to establish degree of morbidity was considered a high priority. There was universal agreement that sources of funding and conflicts of interest needed to be disclosed in presentations and all publications. All clinical research studies should be registered with appropriate authorities. There was substantial enthusiasm for a clinical research network with quality standards for membership and an advisory research core available to investigators. Such a network should be funded and actively managed to insure long-term viability. The governance of such an entity needs to be established by the wound care community. The present trend to integrate patients into the clinical research process was endorsed and there was enthusiasm to develop patient advocacy for wound healing research.
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phase i study of h5 020cmv pdgf β to treat venous Leg Ulcer disease
Molecular Therapy, 2009Co-Authors: David J. Margolis, Lee M Morris, Maryte Papadopoulos, Linda Weinberg, Jennifer C Filip, Stephanie A Lang, Sachin S Vaikunth, Timothy M CrombleholmeAbstract:Venous Leg Ulcers are a prevalent nonhealing wound of the lower extremity. Although topically applied growth factors successfully improve wound repair in animal studies, similar studies on humans with venous Leg Ulcers have not been successful. This study was designed to evaluate the acute safety and biologic feasibility of peri-Ulcer injection of a replication-incompetent adenoviral construct expressing platelet-derived growth factor-β (PDGF-β). In this phase I study, we demonstrate the initial safety, feasibility, and biologic plausibility of using H5.020CMV.PDGF-β to treat venous Leg Ulcer disease.
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the accuracy of venous Leg Ulcer prognostic models in a wound care system
Wound Repair and Regeneration, 2004Co-Authors: David J. Margolis, Lynne Allentaylor, Ole Hoffstad, Jesse A. BerlinAbstract:Venous Leg Ulcers are among the most common chronic wounds. Treatment is commonly with a limb compression bandage. Previous small, often single-center, studies have shown that it is possible to predict which wounds are likely to respond to compression therapy. We designed this cohort study using a dataset of over 20,000 individuals with a venous Leg Ulcer to investigate the accuracy of several prognostic models. Creating complex models using logistic regression, as well as simply counting prognostic factors, we show that initial measures of wound size and duration accurately predict, as measured by area under the receiver operator curve and Brier score, who will heal by the 24th week of care. For example, a wound that is less than 10 cm2 and less than 12 months old at the first visit has a 29 percent chance of not healing by the 24th week of care, while a wound greater than 10 cm2 and greater than 12 months old has a 78 percent chance of not healing. Ultimately, these models can be applied by a clinician to help determine whom to continue to treat with standard care and perhaps whom to treat with adjuvant therapies. They may also aid in the design of clinical trials.
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a multicentre study of percentage change in venous Leg Ulcer area as a prognostic index of healing at 24 weeks
British Journal of Dermatology, 2000Co-Authors: Jonathan Kantor, David J. MargolisAbstract:Venous Leg Ulcers, which may take months to heal, account for 40-70% of all lower extremity chronic wounds. New treatment options for venous Leg Ulcers have recently been proposed, and therefore deciding which patients are candidates for these novel-and often expensive-treatments is an important task. Moreover, researchers conducting clinical trials often wish to enrol patients who are unlikely to heal in order to minimize sample sizes needed and research costs. Our purpose was to assess the use of percentage change in venous Leg Ulcer area over the first few weeks of treatment as a prognostic indicator of healing or non-healing at 24 weeks. We conducted a cohort study based on an existing data set from a multicentre randomized clinical trial that enrolled 104 patients. Wounds were measured using digital planimetry for 4 consecutive weeks following the inception of good wound care. Utilizing the Wilcoxon rank sum (Mann-Whitney) test, we found that percentage change in area over time distinguished between those who healed and those who failed to heal after 24 weeks of good wound care (P < 0.05). The rate of healing, or area healed per week, did not differentiate between those who healed at 24 weeks and those who did not, as all patients had similar rates of healing over the first 4 weeks of treatment. Percentage change in area from baseline to week 4 provided the best combination of positive and negative predictive values (68.2%, 74.7%) and the largest area under the receiver operating characteristic curve (0.75). Thus, percentage change in area over the first 4 weeks of treatment represents a practical and predictive measure of complete wound healing by 24 weeks.
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risk factors associated with the failure of a venous Leg Ulcer to heal
Archives of Dermatology, 1999Co-Authors: David J. Margolis, Jesse A. Berlin, Brian L StromAbstract:Background Venous Leg Ulcers afflict a significant portion of the population. The most popular form of therapy for venous Leg Ulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful. Objective To describe risk factors associated with the failure of a wound to heal when treated with a limb-compression bandage for 24 weeks. Design A retrospective cohort study. Setting Single-center outpatient specialty clinic at an academic medical center. Participants Two hundred sixty consecutive patients with chronic venous Leg Ulcers. Main Outcome Measure The magnitude of the effect of a given risk factor on the probability that a wound will heal within 24 weeks of care. Results Based on an assessment of Leg wounds during initial office visits, we observed that the failure of a wound to heal within 24 weeks was significantly associated with larger wound area, measured in square centimeters (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.11-1.27), duration of the wound in months (OR, 1.09; 95% CI, 1.04-1.16), history of venous ligation or venous stripping (OR, 4.58; 95% CI, 1.84-11.36), history of hip or knee replacement surgery (OR, 3.52; 95% CI, 1.12-11.08), ankle brachial index of less than 0.80 (OR, 3.52; 95% CI, 1.12-11.08), and the presence of fibrin on more than 50% of the wound surface (OR, 3.42; 95% CI, 1.38-8.45). Conclusions Several risk factors are associated with the failure of a patient's venous Leg Ulcer to heal while using limb-compression therapy. It is prudent to consider these factors when referring a patient to a wound care subspecialists or for alternative therapies.
Peter Franks - One of the best experts on this subject based on the ideXlab platform.
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clinical predictors of Leg Ulcer healing
British Journal of Dermatology, 2010Co-Authors: Christine Moffatt, Rachael Smithdale, Debra C Doherty, Peter FranksAbstract:Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic Leg Ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic Leg Ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community Leg Ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the Ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the Ulcer duration (P = 0.002), complexity of the Ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that Ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic Leg Ulceration. There appears to be little scope for interventions to improve healing from the factors identified.
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the venous Leg Ulcer quality of life vlu qol questionnaire development and psychometric validation
Wound Repair and Regeneration, 2007Co-Authors: Asha Hareendran, Christine Moffatt, Helen Doll, Diane J Wild, Elaine Musgrove, Carolyn Wheatley, Peter FranksAbstract:To develop and validate a disease-specific quality of life (QoL) measure, based on the conceptual model of the SKINDEX-29 for patients with a chronic venous Leg Ulcer (VLU), in-depth interviews, and focus groups of patients (n=36) with VLU were used to generate VLU-specific items. These items were added to selected SKINDEX-29 items that were adapted for use in VLU. Further samples of VLU patients were used for item reduction (n=124) and to assess the psychometric properties of the new tool (n=120). The final VLU-QoL contained 34 items: 17 items adapted from the SKINDEX-29 and 17 VLU-specific items. Factor analysis of the items confirmed the existence of three hypothesized domains: Activities (12 items), Psychological (12 items), and Symptom Distress (10 items). Reliability in terms of internal consistency and test-retest reliability was found to be good. The measure was also found to be valid and responsive to clinical change. The VLU-QoL has good psychometric properties. The instrument's sensitivity to differences in clinical outcome and responsiveness to change in clinical parameters makes it a useful tool to assess the outcomes of treatment from the patients' perspective.
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implementation of a Leg Ulcer strategy
British Journal of Dermatology, 2004Co-Authors: Christine Moffatt, Peter FranksAbstract:SUMMARY: Background The care of patients with Leg Ulceration has developed over the past 15 years, although there is little information available to determine how these changes have affected clinical and patient defined outcomes. OBJECTIVES: To describe and evaluate the implementation of a Leg Ulcer strategy. PATIENTS/METHODS: This study used a pre- and postimplementation evaluation within population-based services within the boundaries of community services providing Leg Ulcer care. Evidence-based Leg Ulcer services were developed, including standardized assessment using Doppler ultrasound, rationalization of treatment using multilayer elastic high compression, development of referral criteria and acute service support. Complete Ulcer healing rates, health-related quality of life and use of health resources were evaluated after 12 weeks in both pre- and postimplementation cycles. RESULTS: A total of 955 patients were evaluated (518 preimplementation, 437 postimplementation). The levels of assessment and treatment were poor prior to the change in practice with just one patient having evidence of correct assessment and 49 (11%) receiving high compression therapy. Postimplementation, this improved to 412 of 437 (94%) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week healing rates preimplementation ranged between 9% and 24%, and postimplementation rose from 19% to 39%. Combined overall healing rates improved from 71 of 518 (14%) to 160 of 437 (37%), odds ratio =3·53, P < 0·001. Frequency of treatment visits reduced from a mean (SD) of 24·0 (16·1) over 12 weeks to 13·5 (8·6), P < 0·001. Intervention led to major improvements in health-related quality of life (measured using the Nottingham Health Profile), with significant improvements for energy, pain, sleep and mobility (P < 0·01). CONCLUSIONS: Rationalization of Leg Ulcer services through a total service change results in improvements in professional practice, better patient outcomes, and efficient use of current resources. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.
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risk factors for Leg Ulcer recurrence a randomized trial of two types of compression stocking
Age and Ageing, 1995Co-Authors: Peter Franks, M Oldroyd, Deborah Dickson, Elizabeth J Sharp, Christine MoffattAbstract:Patients with recently healed Leg Ulceration were entered into a study of Leg Ulcer recurrence. In all, 188 patients [69% women, mean age = 72 (SD = 12) years] were entered into the study, of whom 166 were considered suitable for ready-made stockings and were randomized to one of two class II below-knee compression stockings and followed for at least 18 months. The remaining patients required either made-to-measure stockings (5) or could not tolerate stockings owing to friable skin and were treated by other methods (17). Overall cumulative recurrence rate was 26% after 1 year and 31% at 18 months. Independent risk factors for (RR = 2.34, p = 0.021) and unsuitability for stockings (RR = 2.52, p = 0.013). The randomized groups had similar stockings, 25 (15%) could not put their stockings on at all and 43 (26%) were only able to put them on with great difficulty. The two stocking types differed significantly in this regard when analysed for trend.
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community Leg Ulcer clinics effect on quality of life
Phlebology, 1994Co-Authors: Peter Franks, Christine Moffatt, M Connolly, N Bosanquet, M Oldroyd, R M Greenhalgh, C N MccollumAbstract:Objective:To investigate changes in the quality of life of patients with Leg Ulcers being treated in community Leg Ulcer clinics.Design:Patients were interviewed using a standard questionnaire, and...
Carolina D Weller - One of the best experts on this subject based on the ideXlab platform.
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abpi reporting and compression recommendations in global clinical practice guidelines on venous Leg Ulcer management a scoping review
International Wound Journal, 2019Co-Authors: Carolina D Weller, Victoria Team, John D Ivory, Kimberley Crawford, Georgina GethinAbstract:Clinical practice guidelines (CPGs) for venous Leg Ulcer (VLU) management recommend below-knee compression to improve healing outcomes after calculating the ankle-brachial pressure index (ABPI) to rule out significant arterial disease. This systematic scoping review aimed to complete a qualitative and quantitative content analysis of international CPGs for VLU management to determine if consensus existed in relation to recommendations for compression application based on an ABPI reading and clinical assessment. Our review shows that there is a lack of consensus across 13 VLU CPGs and a lack of clear guidance in relation to the specific ABPI range of compression therapy that can be safely applied. An area of uncertainty and disagreement exists in relation to an ABPI between 0.6 and 0.8, with some guidelines advocating that compression is contraindicated and others that there should be reduced compression. This has implications in clinical practice, including when it is safe to apply compression. In addition, the inconsistency in the levels of evidence and the grades of recommendation makes it difficult to compare across various guidelines.
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aspirin in venous Leg Ulcer study aspivlu study protocol for a randomised controlled trial
Trials, 2016Co-Authors: Carolina D Weller, Anna Barker, Ian A Darby, Terrence Peter Haines, Martin Underwood, Stephanie A Ward, Pat Aldons, Elizabeth Dapiran, Jason Madan, Paula LovelandAbstract:Background Venous Leg Ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of Ulcers remain unhealed after 2 years, and Ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous Ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid Ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing.
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aspirin in venous Leg Ulcer study aspivlu study protocol for a randomised controlled trial
Trials, 2016Co-Authors: Carolina D Weller, Anna Barker, Ian A Darby, Terrence Peter Haines, Martin Underwood, Stephanie A Ward, Pat Aldons, Elizabeth Dapiran, Jason Madan, Paula LovelandAbstract:Venous Leg Ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of Ulcers remain unhealed after 2 years, and Ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous Ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid Ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing. This randomised, double-blinded, multicentre, placebo-controlled, clinical trial will recruit participants with venous Leg Ulcers from community settings and hospital outpatient wound clinics across Australia. Two hundred sixty-eight participants with venous Leg Ulcers will be randomised to receive either aspirin or placebo, in addition to compression therapy, for 24 weeks. The primary outcome is time to healing within 12 weeks. Secondary outcomes are Ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks. The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous Leg Ulcers. Study completion is anticipated to occur in December 2018. Australian New Zealand Clinical Trials Registry, ACTRN12614000293662
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venous Leg Ulcer management in general practice practice nurses and evidence based guidelines
Australian Family Physician, 2012Co-Authors: Carolina D Weller, Sue M EvansAbstract:Background: Venous Leg Ulcers represent the most common chronic wound problem seen in general practice and are commonly managed by practice nurses. Compression therapy has been shown to improve healing. Methods: We explored current practice nurse management of venous Leg Ulcers to determine if evidence based guidelines were used to aid management. A cross-sectional survey in a metropolitan general practice network was used. Results: The majority of practice nurses reported that they do not routinely use, or have confidence in using, a Doppler to measure ankle brachial pressure index before compression application and are not responsible for application of compression therapy. Most common referrals are to wound clinics or vascular surgeons. Barriers to referral include access to services and cost of compression bandages. Conclusion: Our study highlights that practice nurse knowledge of venous Leg Ulcer management is suboptimal and that current practice does not comply with evidence based management guidelines.
Christine Moffatt - One of the best experts on this subject based on the ideXlab platform.
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clinical predictors of Leg Ulcer healing
British Journal of Dermatology, 2010Co-Authors: Christine Moffatt, Rachael Smithdale, Debra C Doherty, Peter FranksAbstract:Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic Leg Ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic Leg Ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community Leg Ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the Ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the Ulcer duration (P = 0.002), complexity of the Ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that Ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic Leg Ulceration. There appears to be little scope for interventions to improve healing from the factors identified.
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the venous Leg Ulcer quality of life vlu qol questionnaire development and psychometric validation
Wound Repair and Regeneration, 2007Co-Authors: Asha Hareendran, Christine Moffatt, Helen Doll, Diane J Wild, Elaine Musgrove, Carolyn Wheatley, Peter FranksAbstract:To develop and validate a disease-specific quality of life (QoL) measure, based on the conceptual model of the SKINDEX-29 for patients with a chronic venous Leg Ulcer (VLU), in-depth interviews, and focus groups of patients (n=36) with VLU were used to generate VLU-specific items. These items were added to selected SKINDEX-29 items that were adapted for use in VLU. Further samples of VLU patients were used for item reduction (n=124) and to assess the psychometric properties of the new tool (n=120). The final VLU-QoL contained 34 items: 17 items adapted from the SKINDEX-29 and 17 VLU-specific items. Factor analysis of the items confirmed the existence of three hypothesized domains: Activities (12 items), Psychological (12 items), and Symptom Distress (10 items). Reliability in terms of internal consistency and test-retest reliability was found to be good. The measure was also found to be valid and responsive to clinical change. The VLU-QoL has good psychometric properties. The instrument's sensitivity to differences in clinical outcome and responsiveness to change in clinical parameters makes it a useful tool to assess the outcomes of treatment from the patients' perspective.
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Leg Ulcer management
2007Co-Authors: Christine Moffatt, Ruth Martin, Rachael SmithdaleAbstract:Ch 1 Introduction. Ch 2 Causes of Leg Ulceration. Ch 3 An assessment framework. Ch 4 Understanding non-invasive vascular assessment. Ch 5 Assessment and management of pain. Ch 6 The psychological impact of Leg Ulceration. Ch 7 Improving concordance in Leg Ulcer management. Ch 8 Wound bed preparation. Ch 9 Wound infection. Ch 10 Compression therapy. Ch 11 Venous Ulceration. Ch 12 Ischaemic Ulceration. Ch 13 Diabetic foot Ulceration. Ch 14 Mixed aetiology Ulceration. Ch 15 Adjunctive and novel therapies
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implementation of a Leg Ulcer strategy
British Journal of Dermatology, 2004Co-Authors: Christine Moffatt, Peter FranksAbstract:SUMMARY: Background The care of patients with Leg Ulceration has developed over the past 15 years, although there is little information available to determine how these changes have affected clinical and patient defined outcomes. OBJECTIVES: To describe and evaluate the implementation of a Leg Ulcer strategy. PATIENTS/METHODS: This study used a pre- and postimplementation evaluation within population-based services within the boundaries of community services providing Leg Ulcer care. Evidence-based Leg Ulcer services were developed, including standardized assessment using Doppler ultrasound, rationalization of treatment using multilayer elastic high compression, development of referral criteria and acute service support. Complete Ulcer healing rates, health-related quality of life and use of health resources were evaluated after 12 weeks in both pre- and postimplementation cycles. RESULTS: A total of 955 patients were evaluated (518 preimplementation, 437 postimplementation). The levels of assessment and treatment were poor prior to the change in practice with just one patient having evidence of correct assessment and 49 (11%) receiving high compression therapy. Postimplementation, this improved to 412 of 437 (94%) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week healing rates preimplementation ranged between 9% and 24%, and postimplementation rose from 19% to 39%. Combined overall healing rates improved from 71 of 518 (14%) to 160 of 437 (37%), odds ratio =3·53, P < 0·001. Frequency of treatment visits reduced from a mean (SD) of 24·0 (16·1) over 12 weeks to 13·5 (8·6), P < 0·001. Intervention led to major improvements in health-related quality of life (measured using the Nottingham Health Profile), with significant improvements for energy, pain, sleep and mobility (P < 0·01). CONCLUSIONS: Rationalization of Leg Ulcer services through a total service change results in improvements in professional practice, better patient outcomes, and efficient use of current resources. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.
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risk factors for Leg Ulcer recurrence a randomized trial of two types of compression stocking
Age and Ageing, 1995Co-Authors: Peter Franks, M Oldroyd, Deborah Dickson, Elizabeth J Sharp, Christine MoffattAbstract:Patients with recently healed Leg Ulceration were entered into a study of Leg Ulcer recurrence. In all, 188 patients [69% women, mean age = 72 (SD = 12) years] were entered into the study, of whom 166 were considered suitable for ready-made stockings and were randomized to one of two class II below-knee compression stockings and followed for at least 18 months. The remaining patients required either made-to-measure stockings (5) or could not tolerate stockings owing to friable skin and were treated by other methods (17). Overall cumulative recurrence rate was 26% after 1 year and 31% at 18 months. Independent risk factors for (RR = 2.34, p = 0.021) and unsuitability for stockings (RR = 2.52, p = 0.013). The randomized groups had similar stockings, 25 (15%) could not put their stockings on at all and 43 (26%) were only able to put them on with great difficulty. The two stocking types differed significantly in this regard when analysed for trend.
Tom Defloor - One of the best experts on this subject based on the ideXlab platform.
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development and psychometric evaluation of an instrument to assess venous Leg Ulcer lifestyle knowledge among nurses
Journal of Advanced Nursing, 2011Co-Authors: Ann Van Hecke, Caroline Goeman, Dimitri Beeckman, Maud Heinen, Tom DefloorAbstract:van hecke a., goeman c., beeckman d., heinen m. & defloor t. (2011) Development and psychometric evaluation of an instrument to assess venous Leg Ulcer lifestyle knowledge among nurses. Journal of Advanced Nursing67(12), 2574–2585. Abstract Aim. Development and psychometric testing of an instrument to assess venous Leg Ulcer lifestyle knowledge. Background. Nurses often lack knowledge to provide adequate Leg Ulcer advice. No valid and reliable instruments are available to assess knowledge on venous Leg Ulcer advice among nurses. Methods. The instrument was developed based on a literature review and patient cases. Content validity was evaluated in a Delphi procedure by nine Leg Ulcer experts. Item-analysis, construct validity and stability were assessed. A sample of 350 nurses and student nurses participated. Data collection took place between February and April 2009. Results. The instrument included four topics: (1) Compression therapy, (2) Physical activity/Leg exercises, (3) Leg elevation and (4) Pain management. Multiple-choice questions were developed to assess factual knowledge. Patient cases were developed to assess more complex cognitive skills. Content validity was established. The quality of the response alternatives varied between 0·01 and 0·68. The difficulty index for questions evaluating factual knowledge ranged from 0·12 to 0·78. Patient cases’ questions had a difficulty index between 0·07 and 0·60. The score of participants with (theoretically expected) more expertise was significantly higher than the score of participants with (theoretically expected) less expertise. The intraclass correlation coefficients ranged between 0·71 and 0·77. Eleven questions had moderate kappa-values (0·41–0·60), and in eight questions, there was fair agreement (0·30–0·40). Conclusion. An instrument with an acceptable content validity and construct validity was developed. The instrument can be applied in nursing education, nursing practice and nursing research to evaluate venous Leg Ulcer advice knowledge.
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processes underlying adherence to Leg Ulcer treatment a qualitative field study
International Journal of Nursing Studies, 2011Co-Authors: Ann Van Hecke, Sofie Verhaeghe, Maria Grypdonck, Hilde Beele, Tom DefloorAbstract:Abstract Background Non-adherence to Leg Ulcer regimen is a major problem. Reasons for non-adherent behaviour are not fully understood. Literature about processes underlying adherence in Leg Ulcer patients is scarce. Objectives To explore the processes underlying adherent behaviour in patients with Leg Ulcers who received an intervention to enhance adherence to Leg Ulcer lifestyle advice. Design A qualitative field study was conducted among patients receiving an adherence-promoting intervention. Settings The study was carried out in a home care setting in Belgium. Participants Twenty-six patients with venous Leg Ulcers were included and received the intervention from five tissue viability nurses in a community healthcare organisation. Methods Semi-structured interviews with open-ended questions were held with patients and nurses after the end of the intervention. Data were also collected by means of participant observation. Data collection and data analysis took place iteratively and analysis was validated by means of researcher triangulation. Results Trust in the nurse was central to Leg Ulcer treatment adherence. Patients who had a trusting relationship with their nurse showed better adherence to the recommended lifestyle modifications. Trust was facilitated by nurses spending meaningful time with the patient, which means they took time to talk with the patient. Trust was also established because nurses provided care beyond patients' expectations, taking time for wound care and being attentive to pain and other problems. A trusting relationship promoted ‘compliance' even if patients were not convinced of the benefits of the Leg Ulcer lifestyle advice. Perceived physical improvement and diminished discomfort after following the lifestyle advice convinced patients of the importance and positive effect of the regimen, which they doubted at first. Self-efficacy for performing Leg exercises was often much higher than self-efficacy for being physically active and elevating the Legs. Physical impediments, co-morbidities and socio-structural impediments influenced the patient's ability to adhere to Leg Ulcer advice. Conclusions A conceptual framework to understand adherence to Leg Ulcer treatment was developed. Nurses should be aware of how nurse-related factors can affect adherence. Aspects that foster trust could be incorporated into Leg Ulcer care.
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adherence to Leg Ulcer lifestyle advice qualitative and quantitative outcomes associated with a nurse led intervention
Journal of Clinical Nursing, 2011Co-Authors: Ann Van Hecke, Maria Grypdonck, Hilde Beele, Katrien Vanderwee, Tom DefloorAbstract:Aim and objectives. Examining the (experienced) changes associated with a nursing intervention to enhance adherence to Leg Ulcer lifestyle advice. Background. Few interventions to enhance adherence to Leg Ulcer treatment are developed and tested. Design. Qualitative evaluation approach and pre–post-test design were used. Method. Twenty-six patients with venous Ulcers in a community care setting participated. Data were collected by means of interviews and participant observation. Frequency and duration of wearing compression, Leg exercising and Leg elevation, activity level, pain and Ulcer size were registered at baseline, after the end of the intervention and three months later. Inductive content analysis and Wilcoxon signed-rank test were used. Results. Knowledge about Leg Ulcer advice increased. The education contributed to more consciously following of the advice. The rationale of the advice and its association with healing or recurrence remained often unclear. More patients performed exercises after the intervention and at follow-up. Patients often looked out onto a ‘new’ perspective where enhancement of quality of life and even healing might be attainable. Some patients regained independence after learning how to apply and remove compression garments themselves. The frequency of exercising and the duration of exercises increased significantly. Step counts had not altered significantly. Patients not elevating the Legs at baseline elevated the Legs more and for a longer period of time after the intervention. This effect on Leg elevation decreased after three months. No significant changes were reported on hours wearing compression. Conclusions. The perceived changes suggest that the intervention holds a promise for current home care. Combining qualitative and quantitative research assisted to determine the possible effects of the intervention, increasing the potential for a meaningful randomised trial in the future. Relevance to clinical practice. Education about Leg Ulcer advice should be incorporated in nursing practice. Further testing of the intervention is recommended.
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how evidence based is venous Leg Ulcer care a survey in community settings
Journal of Advanced Nursing, 2009Co-Authors: Ann Van Hecke, Maria Grypdonck, Hilde Beele, Dirk De Bacquer, Tom DefloorAbstract:AIM This paper is a report of a study to describe venous Leg Ulcer care regarding compression, pain management and lifestyle advice in community settings and to identify factors that predict the provision of lifestyle advice by nurses. BACKGROUND Incongruence between evidence and practice in Leg Ulcer care has been reported. Little is known about predictive factors related to the provision of lifestyle advice. METHOD Two focus interviews and a Delphi procedure were used to develop a self-administered questionnaire based on the Graham questionnaire. Nurses employed by community healthcare organizations and independent nurses in private practices participated (n = 789). The data were collected in 2006. FINDINGS Compression was applied in 58.7% of patients with venous Ulcers. Pain was present in 82.9%. A third of patients with pain received analgesics, but half of these patients (52.1%) took analgesics as prescribed. Half of the nurses (50.8%) gave lifestyle advice related to the Leg Ulcer. It was mainly instructions about Leg elevation (68.3%), promoting physical activity (39.8%) and optimizing nutrition (16.7%) that were provided. Nurses who perceived themselves to have adequate Leg Ulcer knowledge and skills were 3.75 times more likely to provide lifestyle advice compared with those lacking such knowledge and skills. Nurses who found Leg Ulcer care not rewarding, rarely successful or difficult gave statistically significantly less lifestyle advice than those who found it rather rewarding, successful and not difficult. CONCLUSION Patients with Leg Ulcers receive less than optimum care and patient education. A particular challenge lies in Leg Ulcer education programmes and pain management.