Preventing Venous Ulcer Recurrence: The Impact of the Well Leg Clinic

2002 ◽  
Vol 17 (3-4) ◽  
pp. 134-136
Author(s):  
N. Fassiadis ◽  
C. Godby ◽  
L. Agland ◽  
N. Law
Keyword(s):  
District Hospital ◽  
Hospital Setting ◽  
Venous Ulcer ◽  
Clinic Visit ◽  
Ulcer Recurrence ◽  
Venous Ulcers ◽  
Clinic Appointment ◽  
Age Range ◽  
The Impact

Background: The aim of this prospective study was to evaluate the effectiveness of a nursing-led clinic within a District Hospital setting in detecting early skin break-down in healed venous ulcers. Patients and Methods: A total of 76 patients (45 women, 31 men; age range 24-91 years, mean 74 years) with healed venous ulcers were included in the study between July 1999 and April 2001. Patients were counselled about managemant of ulcers at their initial visit and followed up at 3 and 6 months. Results: We received 79 referrals and of those 76 (96%) accepted our invitation. Fifty-six patients did attend the first clinic appointment, 39 (67%) attended their second clinic visit at 3 months and 38 (68%) were followed up by a telephone call at 6 months. During this period 9 recurrent leg ulcers were noted which were referred for further intervention. Conclusion: It is important to provide follow-up for patients with healed ulcers in order to minimise the recurrence rate and to re-institute treatment soon, as recurrence can occur early following healing.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

2022 ◽  
pp. 153473462110659
Author(s):  
Michele Neves Brajão Rocha ◽  
Carol Viviana Serna Gonzalez ◽  
Eline Lima Borges ◽  
Vera Lúcia Conceição de Gouveia Santos ◽  
Soraia Assad Nasbine Rabeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outpatient Clinic ◽  
Onset Time ◽  
Venous Ulcer ◽  
High Recurrence Rate ◽  
Ulcer Recurrence ◽  
Clinical Approach ◽  
Historical Cohort ◽  
Venous Ulcers

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

An evaluation of opioid use during acute hospital admissions

2022 ◽  
Vol 4 (1) ◽  
pp. 24-31
Author(s):  
Alison Blackburn
Keyword(s):  
Acute Pain ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Opioid Use ◽  
Opioid Medication ◽  
Age Range ◽  
The Impact ◽  
Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

Feasibility of collaborative precision medicine oncology between academic- and community-based hospitals.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18015-e18015
Author(s):  
Lorna Rodriguez-Rodriguez ◽  
Mark Krasna ◽  
Kim M. Hirshfield ◽  
Veronica Rojas ◽  
Gregory Riedlinger ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Community Hospital ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Hospital Setting ◽  
Tumor Board ◽  
Health Staff ◽  
Study Enrollment ◽  
The Impact

e18015 Background: The Rutgers Cancer Institute of New Jersey (CINJ) is conducting an ongoing, prospective, observational clinical trial that is evaluating use of comprehensive genomic profiling (CGP) and molecular tumor board (MTB) review to assist in caring for patients with rare or refractory cancers. As part of this precision medicine approach to cancer care, CINJ has formed a partnership with community hospitals (Meridian Health) to enroll patients in this study, and to actively participate in MTB meetings. The purpose of this cohort analysis is to evaluate the feasibility of using CGP to identify clinically-relevant genomic alterations as an aid to guiding point-of-care management in a community hospital setting. Methods: Meridian Health staff was trained in patient selection, enrollment, and follow-up. CGP was performed by Foundation Medicine, Inc. The patient case’s clinical history, pathology, and CGP results were presented at an MTB meeting. The enrolling physicians (n = 11) were invited to attend the MTB in person or through web-accessible video conferencing. A letter listing MTB consensus recommendations on potential treatment options was sent to the referring physician, and patient follow-up was scheduled at regular intervals. Results: 35 patients were enrolled by Meridian Health. Gyn and GI cancers were the most common types at enrollment (each 26%, 9 out of 35), followed by breast cancer (20%, 7 out of 35). At study enrollment, the mean KPS was 91%, and 23 patients (66%) had stage IV disease. The median duration between study enrollment and MTB presentation was 44 days. 3 patients were excluded because of deteriorated clinical status at the time of the MTB. MTB-based treatment options were implemented in 9 of 32 patients (28%). This result is similar to those reported in published analyses of patients enrolled at CINJ. Conclusions: Collaborations between an academic cancer center and a community hospital is a feasible approach to facilitating access to precision medicine for cancer patients treated in the community. A larger cohort is needed to determine the impact on patient’s outcomes.

scholarly journals Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology

2009 ◽  
Vol 33 (4) ◽  
pp. 549 ◽  
Author(s):  
Kate P Taylor ◽  
Sandra C Thompson ◽  
Marianne M Wood ◽  
Mohammed Ali ◽  
Lyn Dimer
Keyword(s):  
Health Worker ◽  
Hospital Setting ◽  
Aboriginal Health ◽  
Hospital Staff ◽  
Tertiary Hospital ◽  
Culturally Appropriate Care ◽  
Job Role ◽  
The Impact ◽  
Aboriginal Health Worker

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting.

Subcutaneous fasciotomy and eradication of superficial venous reflux for chronic and recurrent venous ulcers: mid-term results

2011 ◽  
Vol 26 (5) ◽  
pp. 197-202 ◽  
Author(s):  
J T Christenson ◽  
C Prins ◽  
G Gemayel
Keyword(s):  
Ulcer Healing ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Subcutaneous Tissue ◽  
Skin Grafting ◽  
Venous Ulcer ◽  
Venous Disease ◽  
Ulcer Recurrence ◽  
Venous Ulcers ◽  
Mid Term Results

Objective Increased intramuscular and subcutaneous tissue pressures are often found in patients with severe chronic venous insufficiency venous ulcer disease. Additional subcutaneous para-tibial fasciotomy promotes early ulcer healing. This study evaluates the mid-term effect of eradication of superficial reflux with additional fasciotomy in patients with increased tissue pressures. Method Between January 2006 and June 2009, 58 patients underwent fasciotomy. Tissue pressures (intramuscular and subcutaneous) were measured. Sixty-nine limbs with 91 venous ulcers were treated. Mean duration of the venous ulcer was 3.4 years. Underlying disease was post-thrombotic syndrome (PT) in 19 patients (33%, 24 limbs, 27 ulcers) and non-post-thrombotic (non-PT) severe chronic venous insufficiency in 39 (67%, 45 limbs, 64 ulcers). All patients were C6 at the time of surgery. Preoperative tissue pressures were 23.5 ± 6.1 mmHg (intramuscularly) and 9.8 ± 3.2 mmHg (subcutaneously). Results Ninety ulcers (99%) healed postoperatively (42 with and 48 without skin grafting). Tissue pressures significantly decreased following surgery and remained low at three months postoperatively. Ten ulcers in six patients recurred six to 20 months postoperatively (11%), resulting in 86.4 actuarial freedom from venous ulcer recurrence at three years following surgery. Four patients (1 non-PT and 3 PT) had re-fasciotomy; all healed initially but two ulcers (2 patients, PT) recurred at 11 and 12 months. Those patients underwent re-fasciotomy, one healed and one recurred six months later. Conclusion Eradication of superficial reflux with additional subcutaneous fasciotomy for chronic and recurrent venous ulcer improves ulcer healing or success of skin grafting. Mid-term results are excellent particularly in patients with non-PT disease. Recurrence is more frequently seen in patients with PT syndrome. In patients with ulcer recurrence and high tissue pressures, re-fasciotomy can be helpful to promote healing, particularly in patients with primary venous disease.

scholarly journals Varicose veins: our experience in KVG Medical College and Hospital, Karnataka

2021 ◽  
Vol 8 (11) ◽  
pp. 3392
Author(s):  
Abhirup H. Ramu ◽  
Priyanka Kenchetty ◽  
Aishwarya K. Chidananda
Keyword(s):  
Clinical Presentation ◽  
Varicose Veins ◽  
Adult Population ◽  
Venous Ulcer ◽  
Vascular Disorder ◽  
Medical College ◽  
Venous Ulcers ◽  
Saphenofemoral Junction ◽  
Determine Effect

Background: The varicose veins is the most common vascular disorder of the lower extremities. It affects more than 5% of adult population but in India incidence of varicose veins seems to be far less common because patients come for complications such as pain, oedema, pigmentation and ulceration leading to tip of Iceberg phenomenon. This study will help in finding epidemiology, mode of presentation and effect of surgery on venous ulcers and recurrence. The aims and objectives of the study was to study the incidence of varicose veins according to age, sex and occupation with spectrum of clinical presentation in varicose veins. To determine effect of surgery in healing of varicose ulcers if present and study of recurrence upto 6 months.Methods: This prospective study involved 50 patients admitted in KVG Medical College and Hospital, Sullia with clinical diagnosis of varicose veins. The study period was 18 months inclusive of a 6 month follow up period.Results: Most patients was between 41 to 50 years (26 %.), males (74%), left side involvement in (70%) and farmer by occupation (40%) with pain as most common presenting symptom in (76%). Long saphenous system involvement in (94%). 6 patients out of 50 showed recurrence of varicose veins. 4 patient showed recurrence out of 21 venous ulcer patients.Conclusions: For varicose veins saphenofemoral junction ligation with stripping of vein with perforator ligation showed good outcome. Venous ulcers heal well after surgery with few recurrences.

scholarly journals Child and Adolescent Multiple Victimization and/or Polyvictimization: A Portuguese Comparative Study

Societies ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 120
Author(s):  
Ana Isabel Sani ◽  
Daniela Bastos ◽  
Maria Alzira Pimenta Dinis
Keyword(s):  
Comparative Study ◽  
Youth Development ◽  
Psychological Counselling ◽  
Multiple Victimization ◽  
Raising Awareness ◽  
Effective Assessment ◽  
The University ◽  
Age Range ◽  
The Impact

Worldwide, children and adolescents are exposed to violence every day and in countless contexts, whether in the family, at school, or in the community. Child multiple victimization has been the subject of extensive international research because of the impact on child and youth development. A quantitative and comparative study aiming to understand child multiple victimization and/or polyvictimization from the perspective of children is presented. Two groups were studied, with and without psychological counselling, with 20 children each, aged 12–18 years old. All the participants answered to juvenile victimization questionnaire (JVQ). The study was approved by the University Ethics Committee responsible for the study in Portugal, and it was initiated after the obtained consent of the children’s legal guardians. The results indicated that young people frequently experience violent situations, with particular emphasis on conventional crimes, e.g., theft, robbery, vandalism, and assault with or without a weapon, with sexual victimization being less common. The results also show that there is a cumulative experience of violence, which evidences multiple victimization and polyvictimization of the child/adolescent throughout their life. These phenomena are not necessarily more common between populations with clinical follow-up. When the types of violence were compared, multiple victimization and polyvictimization, this study found no differences between the samples with and without psychological counselling. It can be concluded that the multiple victimization or polyvictimization problem is not unusual among the population in the studied age range. It is important to alert to the phenomenon of child/adolescent multiple victimization, aiming at a more effective assessment and intervention among these populations. Raising awareness of the phenomenon of multiple child and youth victimization or polyvictimization is of particular importance for preventing violence at all stages of development.

scholarly journals Nursing Interventions Aimed at Persons with Venous Ulcers: an Integrative Review

Aquichan ◽  
2020 ◽  
Vol 20 (1) ◽  
pp. 1-14
Author(s):  
Johana Enyd Cifuentes Rodriguez ◽  
Sandra Guerrero Gamboa
Keyword(s):  
Venous Ulcer ◽  
Integrative Review ◽  
Delivery Mode ◽  
Nursing Interventions ◽  
Wound Area ◽  
Face To Face ◽  
Venous Ulcers ◽  
Theoretical Foundations ◽  
Nursing Professional

Objectives: This work sought to identify and describe the theoretical foundations, components, duration, delivery mode, and results of the nursing interventions aimed at persons with venous ulcers as available in the literature. Materials and method: Integrative review between 2000 and 2018 in the Pubmed, Ovidnursing, and EBSCOhost electronic databases. Results: This review includes 16 articles. Most of the interventions were of educational nature; three were developed in the community (through the Leg Club model) and the other ones were delivered by a nursing professional, face to face. The minimum time of duration for these was eight weeks, with telephone follow up. The most-common result variables were venous ulcer healing and reduction of the wound area. Conclusions: Diversity existed in relation with the components of the interventions and the results expected. Report of the interventions must be reinforced, along with the use of nursing theories that support their design.

scholarly journals Hypothalamic obesity: prevalence, associations and longitudinal trends in weight in a specialist adult neuroendocrine clinic

2013 ◽  
Vol 168 (4) ◽  
pp. 501-507 ◽  
Author(s):  
Caroline A Steele ◽  
Daniel J Cuthbertson ◽  
Ian A MacFarlane ◽  
Mohsen Javadpour ◽  
Kumar S V Das ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Clinic Visit ◽  
Morbidly Obese ◽  
Obesity Prevalence ◽  
Hypothalamic Obesity ◽  
Physical Activity Advice ◽  
The Impact ◽  
Hypothalamic Damage

ObjectiveObesity is highly prevalent among adults with acquired, structural hypothalamic damage. We aimed to determine hormonal and neuroanatomical variables associated with weight gain and obesity in patients following hypothalamic damage and to evaluate the impact of early instigation of weight loss measures to prevent or limit the severity of obesity in these patients.DesignRetrospective study of 110 adults with hypothalamic tumours attending a specialist neuroendocrine clinic. BMI was calculated at diagnosis and at last follow-up clinic visit. Endocrine data, procedures, treatments and weight loss measures were recorded and all available brain imaging reviewed.ResultsAt last follow-up, 82.7% of patients were overweight or heavier (BMI≥25 kg/m2), 57.2% were obese (BMI≥30 kg/m2) and 14.5% were morbidly obese (BMI≥40 kg/m2). Multivariate analysis revealed that use of desmopressin (odds ratio (OR)=3.5;P=0.026), GH (OR=2.7;P=0.031) and thyroxine (OR=3.0;P=0.03) was associated with development of new or worsened obesity. Neuroimaging features were not associated with weight gain. Despite proactive treatments offered in clinic in recent years (counselling, dietetic and physical activity advice, and anti-obesity medications), patients have continued to gain weight.ConclusionsDespite increased awareness, hypothalamic obesity is difficult to prevent and to treat. Improved understanding of the underlying pathophysiologies and multicentre collaboration to examine efficacy of novel obesity interventions are warranted.

0640 Initial Sleep Center Evaluation and Follow Up Improves Positive Airway Pressure (PAP) Therapy Adherence When Compared to Direct Referrals Without Sleep Physician Follow Up: A Retrospective Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A244-A245
Author(s):  
T Aljarod ◽  
L Tran ◽  
M Al Ikhwan ◽  
B Prasad
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Educational Interventions ◽  
Time Frame ◽  
Clinic Visit ◽  
Missed Opportunities ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction Obstructive sleep apnea (OSA) affects 26% of adults and positive airway pressure (PAP) is the gold-standard of therapy. Factors affecting PAP adherence—use >4 hours in a 24-hour period—have been studied extensively. We compared of the three months (or other time frame) PAP adherence between patients seen by a sleep specialist prior to OSA diagnosis versus patients referred directly for OSA testing by non-sleep specialist providers. The goal of the study was to understand the impact of sleep consultation on PAP adherence. Methods Direct referral (DR) patients underwent polysomnography (PSG) and received PAP devices prior to the sleep clinic visit. In contrast, sleep center patients (SC) had a sleep clinic visit with a sleep physician or APRN prior to PSG. Eighty-four patients were included in this study, 42 DR and 42 SC patients. Exclusion criteria were age <18 years old, absence of baseline PSG, and lack of 90-day compliance data. Covariates included demographics, body mass index (BMI), AHI, nadir oxygen saturation, demographics, and Epworth Sleepiness Scale (ESS) score. Objective PAP adherence for first 90 days was the primary outcome. Results Age (p=0.1), ESS (p=0.3), BMI (p=0.6), and AHI (p=0.9) were not significantly different between the groups. SC patients had greater PAP adherence (4.77 hours, 95%CI: 4.1 to 5.4) compared to DR patients (3.61 hours, 95%CI: 2.88 to 4.33, p=0.02). SC patients were also 8 times more likely to follow up in clinic within 1 year of starting PAP treatment (Likelihood Ratio 8.25, p=0.004). Conclusion While possibly more time-efficient for patients, direct referrals may ultimately result in lower PAP adherence due to missed opportunities for receiving education about OSA and PAP therapy. This is consistent with findings from a previous meta-analysis demonstrating that educational interventions improve PAP adherence. Moving forward, we will continue encouraging directly referred patients to follow up in the sleep center after PSG. Support None

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