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Sawad, Aseel Bin, und Fatema Turkistani. „Treatment of venous leg ulcers using bilayered living cellular construct“. Journal of Comparative Effectiveness Research 9, Nr. 13 (September 2020): 907–18. http://dx.doi.org/10.2217/cer-2020-0076.
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Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients’ physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers’ coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.
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Žulec, Mirna, Danica Rotar-Pavlič, Zrinka Puharić und Ana Žulec. „“Wounds Home Alone”—Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study“. International Journal of Environmental Research and Public Health 16, Nr. 4 (15.02.2019): 559. http://dx.doi.org/10.3390/ijerph16040559.
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Background: Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. Methods: Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. Results: More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. Conclusion: Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.
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Aziz, Faisal, Joseph D. Raffetto, Jose A. Diaz, Daniel D. Myers, Kathleen J. Ozsvath, Teresa L. Carman und Brajesh K. Lal. „Practice patterns of adjunctive therapy for venous leg ulcers“. Phlebology: The Journal of Venous Disease 32, Nr. 1 (09.07.2016): 19–26. http://dx.doi.org/10.1177/0268355515625526.
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Objectives Venous leg ulcers (VLU) are the most severe clinical sequelae of venous reflux and post thrombotic syndrome. There is a consensus that ablation of refluxing vein segments and treatment of significant venous obstruction can heal VLUs. However, there is wide disparity in the use and choice of adjunctive therapies for VLUs. The purpose of this study was to assess these practice patterns among members of the American Venous Forum. Methods The AVF Research Committee conducted an online survey of its own members, which consisted of 16 questions designed to determine the specialty of physicians, location of treatment, treatment practices and reimbursement for treatment of VLUs Results The survey was distributed to 667 practitioners and a response rate of 18.6% was achieved. A majority of respondents (49.5%) were vascular specialists and the remaining were podiatrists, dermatologists, primary care doctors and others. It was found that 85.5% were from within the USA, while physicians from 14 other countries also responded. Most of the physicians (45%) provided adjunctive therapy at a private office setting and 58% treated less than 5 VLU patients per week. All respondents used some form of compression therapy as the primary mode of treatment for VLU. Multilayer compression therapy was the most common form of adjunctive therapy used (58.8%) and over 90% of physicians started additional modalities (biologics, negative pressure, hyperbaric oxygen and others) when VLUs failed compression therapy, with a majority (65%) waiting less than three months to start them. Medicare was the most common source of reimbursement (52.4%). Conclusions Physicians from multiple specialties treat VLU. While most physicians use compression therapy, there is wide variation in the selection and point of initiation for additional therapies once compression fails. There is a need for high-quality data to help establish guidelines for adjunctive treatment of VLUs and to disseminate them to physicians across multiple specialties to ensure standardized high-quality treatment of patients with VLUs.
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Atias, Ziva, John M. Pederson, Hemant K. Mishra und Shoshana Greenberger. „The effect of natural matrix biopolymer membrane on hard-to-heal venous leg ulcers: a pilot randomised clinical trial“. Journal of Wound Care 29, Nr. 5 (02.05.2020): 295–302. http://dx.doi.org/10.12968/jowc.2020.29.5.295.
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Objective: The aim of this study was to evaluate the therapeutic effects of natural matrix biopolymer membrane (NMBM) in the treatment of venous leg ulcers (VLUs). Method: Patients exhibiting one or more VLU were assigned to a test group receiving NMBM or to a control group receiving conventional treatment. Patients exhibiting venous insufficiency-related ulcers within 0.1–170cm 2 were included. Efficacy was assessed based on ulcer size and visual analogue scale (VAS) pain scores at baseline and at weeks one, two and four. Ulcer size and pain were compared between groups using a two-way ANOVA. Results: In this study, 25 patients with 32 VLUs (NMBM group: 14 patients with 17 ulcers; control group: 11 patients with 15 ulcers) were included in the final analysis. At four weeks after baseline measurements, the mean percentage change in VLU area of patients in the NMBM group was 61.6% (95% CI: 40.3–82.9) compared with 84.1% (95% CI: 56.5–111.7) for control group patients. Additionally, the mean percentage change in VLU volume of NMBM group patients was 51.2% (95% CI: 31.8–70.6) compared with 84.0% (95% CI: 57.0–121.0) for control group patients. The NMBM group patients exhibited a mean decrease of 0.38 (95% CI: –0.85–1.61) in VAS pain score over four weeks, compared with a mean decrease of 0.13 (95% CI: –1.32–1.58) for control group patients. No significant differences in VLU area (p=0.210), volume (p=0.122) or VAS pain score (p=0.460) were shown between groups. Conclusion: NMBM was found to be as effective and safe as the control group treatments. This pilot study suggests NMBM can be used safely to promote ulcer healing.
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Team, Victoria, Georgina Gethin, John D. Ivory, Kimberley Crawford, Ayoub Bouguettaya und Carolina D. Weller. „Ankle Brachial Pressure Index and compression application: Review summary“. Wound Practice and Research 27, Nr. 2 (25.06.2019): 74–77. http://dx.doi.org/10.33235/wpr.27.2.74-77.
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Venous leg ulcers (VLUs) are a significant complication amongst persons with chronic venous insufficiency (CVI) that frequently follow a cycle of healing and recurrence. Current clinical practice guidelines (CPGs) recommend applying below knee compression to improve VLU healing. Compression could be applied if the Ankle Brachial Pressure Index (ABPI) rules out significant arterial disease, as sufficient peripheral arterial circulation is necessary to ensure safe compression use. We conducted a content analysis of 13 global CPGs on the accuracy of recommendations related to ABPI and compression application. Eight CPGs indicated that compression is recommended when the ABPI is between 0.8 and 1.2 mmHg. However, this review found there is disagreement between 13 global VLU CPGs, with a lack of clarity on whether or not compression is indicated for patients with ABPIs between 0.6 and 0.8 mmHg. Some CPGs recommend reduced compression for treatment of VLUs, while others do not recommend any type of compression at all. This has implications for when it is safe to apply compression, and the inconsistency in evidence indicates that specialist advice may be required at levels beyond the ABPI “safe” range listed above.
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Randall, Sue, Panagiota Avramidis, Naomi James, Alanda Vincent und Michelle Barakat-Johnson. „Getting lower leg ulcer evidence into primary health care nursing practice: a case study“. Wound Practice and Research 27, Nr. 2 (25.06.2019): 78–85. http://dx.doi.org/10.33235/wpr.27.2.78-85.
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Venous leg ulcers (VLUs) are open lesions on the lower leg caused by venous disease, which are associated with high morbidity and pose a challenge to manage effectively (Scottish Intercollegiate Guidelines Network, 2010). Gold standard treatment for VLUs is graduated compression therapy to aid venous return. This paper presents an approach to the challenging management of VLUs that is based on a problem, and subsequent local audit. We use a case study that illustrates a collaborative approach to determine gaps in evidence-based practice (EBP), and a nurse-led initiative in consultation with executive managers and doctors. In our sample, 40% of patients had not consulted a vascular specialist. They did not have a formal diagnosis of leg ulcer aetiology and therefore had not received optimum treatment. Access and cost were main factors impacting on leg ulcer care. Nurses providing evidence-based management of VLUs should ensure collaboration with key stakeholders. This assists in implementing diagnosis of ulcer aetiology for best practice measures. At this local health district, a change in policy to reflect EBP for VLU management in primary health care has been achieved.
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Djalalov, Sandjar, Shayan Sehatzadeh, David H. Keast und William WL Wong. „Economic evaluation of compression stockings for the prevention of venous leg ulcer recurrence in Ontario“. Journal of Wound Care 29, Nr. 3 (02.03.2020): 141–51. http://dx.doi.org/10.12968/jowc.2020.29.3.141.
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Objective: Approximately between 1.5 and 3.0 per 1000 people are affected by venous leg ulcers (VLUs). The treatment and management of VLUs is costly and recurrence is a major concern. There is evidence that compression stockings can reduce the rate of re-ulceration compared with no compression. We present the first cost-effective analysis of compression stockings in preventing recurrence of VLUs from the perspective of the Ontario healthcare system. Method: A cost-utility analysis with a five-year time horizon was conducted. Use of compression stockings was compared with usual care (no compression stockings). We simulated a hypothetical cohort of 65-year-old patients with healed VLUs, using a state-transition model. Model input parameters were obtained mainly from the published literature. We estimated quality-adjusted life years (QALYs) gained and direct medical costs. We conducted various sensitivity analyses. Results: Compared with usual care, compression stockings were associated with higher costs and increased QALYs. Cost-utility analysis showed that the incremental cost-effectiveness ratio of compression stockings was $23,864 per QALY gained compared with no compression stockings. The most influential drivers of cost-effectiveness were the utility value of healed VLUs, cost of stockings, number of stocking replacements, monthly prevention cost and the risk of VLU recurrence. Conclusion: Compared with usual care, compression stockings were cost-effective in preventing VLUs, using a willingness-to-pay threshold of $50,000. These observations were consistent even when uncertainty in model inputs and parameters were considered.
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Hallas-Hoyes, Laura, Stephanie Williamson, Andrew Kerr, Trevor Andrews und Leanne Calladine. „An advanced self-care delivery model for leg ulcer management: a service evaluation“. Journal of Wound Care 30, Nr. 9 (02.09.2021): 751–62. http://dx.doi.org/10.12968/jowc.2021.30.9.751.
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Background: Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs, with a cost burden of over £3 billion each year. Objective: The aim of this service evaluation was to assess the effects of implementing a self-care delivery model on clinical outcomes with the intention of limiting face-to-face health professional contact to one appointment every 6 weeks. Method: A suitability assessment was conducted and a cohort of patients were moved to a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous report. Results: This highlighted that, in 84 of the 95 patients selected, the VLUs had healed by week 24 on the pathway, a further 10 patients' VLUs had healed by week 42 and only one remaining patient reached 42 weeks without healing. Conclusion: These results support the hypothesis that patients with VLUs can self-care and deliver clinical effectiveness. It is recommended that all services explore the possibility of introducing a self-care model for VLU care.
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Dini, Valentina, Agata Janowska, Giulia Davini, Jean-Charles Kerihuel, Stéphane Fauverghe und Marco Romanelli. „Biomodulation induced by fluorescent light energy versus standard of care in venous leg ulcers: a retrospective study“. Journal of Wound Care 28, Nr. 11 (02.11.2019): 730–36. http://dx.doi.org/10.12968/jowc.2019.28.11.730.
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Objective: The recently completed EUREKA study confirmed the efficacy and safety profile of fluorescent light energy (FLE) in treating hard-to-heal wounds. To supplement the EUREKA prospective, observational, uncontrolled trial results, researchers selected one of the EUREKA clinical centres to conduct a retrospective analysis of matching wound care data for 46 venous leg ulcers (VLU) patients who had received standard wound care over a five-year period, compared with 10 EUREKA VLU subjects. Method: The study centre selected 46 patients with VLUs based on the matching criteria (wound age and size, patient's age and gender). They compared the healing rates of these matching VLUs with 10 VLU patients treated at the same centre during the EUREKA study. Results: The EUREKA patients had larger and significantly older wounds (p<0.05) and significantly more risk factors (p<0.05) than the matching wounds. However, they had better outcomes (EUREKA: 40% versus matching group: 7% for full wound closure by 16 weeks). No wound breakdown was observed at 16 weeks in the EUREKA group, compared with 25% in the matching group. No EUREKA patient developed infections requiring antibiotics, compared with 37% in the matching group. EUREKA wounds had a mean relative wound area regression (RWAR) of 32% at week six and 50% at week 16, compared with −3% at week six and −6% at week 16 for the matching group. Conclusion: These findings show that the system based on FLE was well-tolerated and efficacious, with better clinical outcome results compared with the wounds analysed in this retrospective matching study and treated with standard of care alone.
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Miles, Sandra J., Roger Lord, Damian Williams und Paul Fulbrook. „Study protocol: a pilot clinical trial of topical glyceryl trinitrate for chronic venous leg ulcer healing“. Wound Practice and Research 27, Nr. 3 (September 2019): 131–34. http://dx.doi.org/10.33235/wpr.27.3.131-134.
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Background: Chronic venous leg ulcers (VLUs) are costly to the healthcare system and a burden to patients, significantly reducing quality of life. Nitric oxide (NO) is important to wound healing, with a small study demonstrating a NO donor, topical glyceryl trinitrate (GTN), was effective for VLU healing. The aim of this study is to examine the application of topical GTN in relation to VLU healing. Methods: A pilot double-blinded randomised controlled clinical trial will be undertaken. Participants in the control group (n=20) will receive a placebo ointment (ointment base) and participants in the treatment group (n=20) will receive a NO donor (base ointment with 2% GTN) weekly for 4 weeks. The inclusion criteria will be adults >18 years of age with a chronic VLU. Rate of healing will be determined by planimetry (ulcer tracing) using the Gillman equation. Significance: This clinical trial aims to provide proof of concept of a novel treatment, topical GTN, which may accelerate wound healing through improvements to vasodilation and antimicrobial properties at the wound bed.
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Ivins, Nicola, und Nia Jones. „Two-layer reduced compression system for lower limb wounds: a non-comparative evaluation“. British Journal of Community Nursing 25, Sup4 (01.04.2020): S10—S16. http://dx.doi.org/10.12968/bjcn.2020.25.sup4.s10.
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Leg ulceration is a debilitating condition in which various factors play a role in determining patients' quality of life (QoL), and compression therapy has been shown to improve QoL. The 3M Coban 2 Lite Compression System provides reduced compression (25–30 mmHg) ideal for patients with painful venous leg ulcers (VLU) who are unable to tolerate high-strength compression or those with mixed-aetiology leg ulcers (MLU) who have an ankle-brachial pressure index (ABPI)≥0.5. This non-comparative evaluation aims to report the initial clinical experiences with 3M Coban 2 Lite and evaluate the performance of this two-layer reduced compression bandage system in treating chronic VLUs and MLUs. In total, 30 patients (12 men (40%); mean age=68.5 years) were enroled for evaluation. The duration of the chronic wounds was 28 months (range=1.5–144 months); 16 patients had VLUs, while 14 had MLUs. Complete healing was achieved in 6 (20%) patients, and an overall mean reduction in wound surface area (4.11 cm2) was observed between the baseline and study endpoint (16 weeks). Thus, 3M Coban 2 Lite seems safe and effective for treating painful VLUs and MLUs in patients unable to tolerate high-strength compression.
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Sánchez, Ferrán Plá, Rodrigo Rial, Iñaki Cernuda Artero, Pilar Ruíz Álvarez, Guillermo Moñux Ducajú, Isaac Martínez López, Maday Cabrero Fernández, Oscar Uclés Cabeza und Francisco Javier Serrano Hernando. „Free skin micrografts with cyanoacrylate as outpatient treatment for venous leg ulcers“. Journal of Wound Care 28, Nr. 10 (02.10.2019): 670–75. http://dx.doi.org/10.12968/jowc.2019.28.10.670.
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Objective: The present study describes an ambulatory, free skin micrograft technique with cyanoacrylate as a coadjuvant venous leg ulcer (VLU) healing strategy and its outcomes after one month. Methods: This prospective study involved Comprehensive Classification System for Chronic Venous Disorders (CEAP) stage C6 patients with good granulation tissue and negative culture results, consecutively recruited in January 2017 in the Hospital Clinico San Carlos. A skin micrograft was harvested from the anterior surface of the patient's thigh with a 0.4cm punch (0.12cm2). The graft was adhered to the ulcer bed with cyanoacrylate. Anti-adherent dressing and double-layer bandaging was applied, with weekly replacements. Measurements were obtained of the surface of the VLU and graft progression (in cm2) using a photographic grid. Results: A total of 12 VLUs in 12 patients were included, with a mean treated surface of 20.32±13.9cm2. A total of 18 grafts were placed and all were found to be viable after one week. Average graft growth was not noticeable after one week but was found to be 0.25±0.08cm2 after week two, 0.41±0.98cm2 after week three, and 0.70±0.15cm2 after week four (p<0.001). There were no complications in the donor zone. Conclusion: The findings of this study show that free skin micrografting with cyanoacrylate as outpatient treatment for VLUs was simple, rapid and without complication in this study, and may contribute to its wider application in clinical use.
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Tilbrook, Helen, Laura Clark, Liz Cook, Martin Bland, Hannah Buckley, Ian Chetter, Jo Dumville et al. „AVURT: aspirin versus placebo for the treatment of venous leg ulcers – a Phase II pilot randomised controlled trial“. Health Technology Assessment 22, Nr. 55 (Oktober 2018): 1–138. http://dx.doi.org/10.3310/hta22550.
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Background Venous leg ulcers (VLUs) are the most common cause of leg ulceration, affecting 1 in 100 adults. VLUs may take many months to heal (25% fail to heal). Estimated prevalence is between 1% and 3% of the elderly population. Compression is the mainstay of treatment and few additional therapies exist to improve healing. Two previous trials have indicated that low-dose aspirin, as an adjunct to standard care, may improve healing time, but these trials were insufficiently robust. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established. Objectives Primary objective – to assess the effects of 300 mg of aspirin (daily) versus placebo on the time to healing of the reference VLU. Secondary objectives – to assess the feasibility of leading into a larger pragmatic Phase III trial and the safety of aspirin in this population. Design A multicentred, pilot, Phase II randomised double-blind, parallel-group, placebo-controlled efficacy trial. Setting Community leg ulcer clinics or services, hospital outpatient clinics, leg ulcer clinics, tissue viability clinics and wound clinics in England, Wales and Scotland. Participants Patients aged ≥ 18 years with a chronic VLU (i.e. the VLU is > 6 weeks in duration or the patient has a history of VLU) and who are not regularly taking aspirin. Interventions 300 mg of daily oral aspirin versus placebo. All patients were offered care in accordance with Scottish Intercollegiate Guidelines Network (SIGN) guidance with multicomponent compression therapy aiming to deliver 40 mmHg at the ankle when possible. Randomisation Participants were allocated in a 1 : 1 (aspirin : placebo) ratio by the Research Pharmacy, St George’s University Hospitals NHS Foundation Trust, using a randomisation schedule generated in advance by the investigational medicinal product manufacturer. Randomisation was stratified according to ulcer size (≤ 5cm2 or > 5cm2). Main outcome measure The primary outcome was time to healing of the largest eligible ulcer (reference ulcer). Feasibility results – recruitment 27 patients were recruited from eight sites over a period of 8 months. The target of 100 patients was not achieved and two sites did not recruit. Barriers to recruitment included a short recruitment window and a large proportion of participants failing to meet the eligibility criteria. Results The average age of the 27 randomised participants (placebo, n = 13; aspirin, n = 14) was 62 years (standard deviation 13 years), and two-thirds were male (n = 18). Participants had their reference ulcer for a median of 15 months, and the median size of ulcer was 17.1 cm2. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis for log-ulcer area and duration (hazard ratio 0.58, 95% confidence interval 0.18 to 1.85; p = 0.357). One expected, related serious adverse event was recorded for a participant in the aspirin group. Limitations The trial under-recruited because many patients did not meet the eligibility criteria. Conclusions There was no evidence that aspirin was efficacious in hastening the healing of chronic VLUs. It can be concluded that a larger Phase III (effectiveness) trial would not be feasible. Trial registration Clinical Trials.gov NCT02333123; European Clinical Trials Database (EudraCT) 2014-003979-39. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 55. See the NIHR Journals Library website for further project information.
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Bongiovanni, Cheryl M. „Effects of Hypochlorous Acid Solutions on Venous Leg Ulcers (VLU): Experience With 1249 VLUs in 897 Patients“. Journal of the American College of Clinical Wound Specialists 6, Nr. 3 (Dezember 2014): 32–37. http://dx.doi.org/10.1016/j.jccw.2016.01.001.
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Raffetto, Joseph D., Daniela Ligi, Rosanna Maniscalco, Raouf A. Khalil und Ferdinando Mannello. „Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment“. Journal of Clinical Medicine 10, Nr. 1 (24.12.2020): 29. http://dx.doi.org/10.3390/jcm10010029.
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Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50–70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.
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Vitse, Julian, Farid Bekara, Stephanie Byun, Christian Herlin und Luc Teot. „A Double-Blind, Placebo-Controlled Randomized Evaluation of the Effect of Low-Level Laser Therapy on Venous Leg Ulcers“. International Journal of Lower Extremity Wounds 16, Nr. 1 (17.02.2017): 29–35. http://dx.doi.org/10.1177/1534734617690948.
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This study aimed to determine the effect of low-level laser therapy (LLLT) on chronic venous leg ulcers (VLUs). A double-blinded prospective randomized controlled trial was conducted to compare incidence of complete wound closure, ulcer size and pain reduction in patients randomized to 24 treatments of placebo or LLLT (635 nm) over 12 weeks. Patients presented with a 6-week history of VLUs ranging in size from 5 to 20 cm2. Venous origin was confirmed by Doppler ultrasound and an ankle brachial index of 0.8 or greater. Of 24 patients, 23% of the test group (n = 13) and 18% of placebo group (n = 11) achieved complete wound closure. At 12 weeks, patients in test and placebo groups had a mean surface area reduction of 6.26 cm2 ( P < .0001) and 6.72 cm2 ( P < .005), respectively, and a mean pain score decrease of 43.54 points ( P < .0001) and 25.73 points ( P = .002) respectively. Differences between groups was not statistically significant for wound closure ( P = 1.0) or ulcer size ( P = .80). Mean ulcer pain was significantly reduced from initiation of treatment compared with 4 weeks’ follow-up after 12 weeks with LLLT ( P < .01). Within the limitations of the study, LLLT may not have early effects as an adjunctive therapy to wound healing of VLUs, but LLLT may have delayed effects on VLU healing and associated pain, which requires further study.
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Batas, Renata. „Community nursing care for chronic wounds: a case study of optimal home treatment of a venous leg ulcer“. Gastrointestinal Nursing 17, Sup5 (Juni 2019): S32—S39. http://dx.doi.org/10.12968/gasn.2019.17.sup5.s32.
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Europe's aging population presents an increasing number of chronic diseases, including vascular diseases that can lead to chronic wounds. These chronic wounds carry a significant health burden for individuals and economic burden for healthcare systems. Of chronic ulcers in the lower limbs, 80–85% are venous leg ulcers (VLUs). VLUs can be treated using a combination of compression therapy, modern wound dressings and wound-bed preparation based on tissue management, inflammation and infection control, moisture balance and epithelial advancement. This approach should improve the patient's quality of life in a way that is fast, cost-effective and minimises pain. Optimal treatment should involve holistic, comprehensive care for the individual patient, supported by multidisciplinary teamwork and patient education for self-care. An aging population also increases the need for community nursing care in patients' homes. Access to home wound care differs between European countries, particularly whether it is provided by registered nurses, as part of the healthcare system, or by homecare assistants, as part of the social care system. In countries like Slovenia, community nurses play an important role in the multidisciplinary treatment of VLUs, as they care for patients in the home environment and can best assess their condition. The GP first makes the initial wound assessment and diagnosis before authorising the community nurse to provide wound care in the patient's home. A case study is presented of a 91-year-old male patient with a VLU, alongside reduced mobility and multiple comorbidities. The treatment method provided optimal healing and is described and illustrated in detail.
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Das, Saroj K., Luxmi Dhoonmoon, Duncan Bain und Swati Chhabra. „Microcirculatory changes in venous leg ulcers using intermittent electrostimulation of common peroneal nerve“. Journal of Wound Care 30, Nr. 2 (02.02.2021): 151–55. http://dx.doi.org/10.12968/jowc.2021.30.2.151.
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Objective: Activation of the venous muscle pumps of the leg by intermittent transdermal neuromuscular stimulation of the common peroneal nerve has been previously shown to augment venous and arterial flow in patients with leg ulcers. This study aims to establish if microcirculation in the wound bed and periwound area are augmented by the activation of a neuromuscular electrostimulation device (NMES) (Geko, Firstkind Ltd., UK). Method: In this self-controlled, observational study, laser speckle contrast imaging was used to map and quantify microcirculatory flow in the wound bed and periwound area of patients with venous leg ulcers (VLU). Values of flow and pulsatility in these locations were compared with the NMES device, both active and inactive. Results: A total of 16 patients took part in the study. Microvascular flux increased by 27% (p=0.014) in the wound bed, and by 34% (p=0.004) in the periwound area, when the NMES device was activated. Pulsatility increased by 170% (p<0.001) in the wound bed and 173% (p<0.001) in the periwound area when the device was activated. Conclusion: Intermittent electrostimulation of the common peroneal nerve substantially increased both microcirculatory flux and pulsatility in the wound bed and in the periwound area of the VLUs of patients in this study. This provides a plausible mechanistic explanation for its reported efficacy in healing VLUs.
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Paranhos, Thalita, Caroline S. B. Paiva, Fernanda C. I. Cardoso, Priscila P. Apolinário, Flavia Figueiredo Azevedo, Maria G. B. Saidel, Henrique C. Oliveira, Ariane P. Dini, Ana R. S. O. Kumakura und Maria H. Melo Lima. „Assessment of the use of Unna boot in the treatment of chronic venous leg ulcers in adults: systematic review protocol“. BMJ Open 9, Nr. 12 (Dezember 2019): e032091. http://dx.doi.org/10.1136/bmjopen-2019-032091.
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IntroductionChronic venous insufficiency (CVI) is an anomaly of the normal functioning of the venous system caused by valvular incompetence with or without the obstruction of venous flow. This condition can affect either or both of the superficial and the deep venous systems. Venous dysfunction can even result in congenital or acquired disorders, and its complications include venous leg ulcers (VLUs). The objective of this systematic review is to determine the effectiveness of Unna boot in the treatment of wound healing of VLU by assessing the quality of the available evidence.Methods and analysisA literature search in PubMed, CINAHL, Scopus, Web of Science, Cochrane Library, BVS/BIREME, Embase, ProQuest, BDTD, Thesis and Dissertation Catalog, Sao Paulo Research Foundation/Thesis and dissertation, OPEN THESIS, A service of the US National Institute of Health, Center for Reviews and Dissemination-University of New York and SciElo published in the last 10 years, the period from January 1999 to March 2019. The review will include primary studies (original), and Controlled Trials or Observational studies (cross-sectional, case–control or longitudinal studies) with VLU. The exclusion will include leg ulceration due to different causes, such as pressure, arterial, diabetic or mixed-aetiology leg ulcers. Data synthesis will be performed using a narrative summary and quantitative analysis.Ethics and disseminationThis systematic review does not require approval by the ethics committee, as individual patient data will not be collected. Dissemination of findings will be through publications in peer-reviewed journals and/or via conference presentations.PROSPERO registration numberCRD42019127947
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Jull, Andrew, Angela Wadham, Chris Bullen, Varsha Parag, John G. M. Parsons, George Laking, Jill Waters, Markos Klonizakis und Jane O'Brien. „Prescribed exercise regimen versus usual care and hypochlorous acid wound solution versus placebo for treating venous leg ulcers: study protocol for a randomised controlled trial (Factorial4VLU)“. BMJ Open 11, Nr. 2 (Februar 2021): e043420. http://dx.doi.org/10.1136/bmjopen-2020-043420.
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IntroductionCompression is the mainstay of treatment for venous leg ulcers (VLUs) and there are few effective adjuvant treatments. There is only observational evidence supporting the use of hypochlorous acid (HOCl) as a topical wound solution on VLU and some limited randomised evidence for the effect of a prescribed regimen of exercise.Methods and analysisThe Factorial4VLU trial is a pragmatic, blinded, factorial randomised controlled trial, with 380 participants receiving either a prescribed exercise regimen compared with usual care and either active HOCl wound solution or placebo wound solution at each dressing change for up to 24 weeks. All participants will receive compression therapy. The primary outcome is the proportion of participants with healed VLU at 12 weeks after randomisation as adjudicated by blinded review of ulcer photographs. Secondary outcomes are proportion healed at 24 weeks, time to healing, estimated change in ulcer area, change in 2-Minute Walk Test, change in health-related quality of life, incidence of infection and incidence of all-cause adverse events. If either of the interventions shows a statistically significant positive difference on healing outcomes, cost-effectiveness will be modelled using a health service perspective.Ethics and disseminationThe Factorial4VLU trial received ethical approval from the Northern B Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.Trial registration numbersAustralia and New Zealand Clinical Trials Register (http://www.anzctr.org.au) (ACTRN12620000116921); Universal Trial Number (WHO) (U1111-1236-2997).
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Toerien, Barend J., und Berta Smit. „Juffrou Sophia vlug vorentoe“. World Literature Today 68, Nr. 4 (1994): 870. http://dx.doi.org/10.2307/40150793.
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Faria, Elaine Cristina, Tatiana Loiola, Geraldo Magela Salomé und Lydia Masako Ferreira. „Unna boot therapy impact on wellbeing, hope and spirituality in venous leg ulcer patients: a prospective clinical trial“. Journal of Wound Care 29, Nr. 4 (02.04.2020): 214–20. http://dx.doi.org/10.12968/jowc.2020.29.4.214.
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Objective: To assess the impact of Unna boot therapy on subjective wellbeing, hope and spirituality in patients with venous leg ulcers (VLU). Method: This was a prospective, descriptive, analytical, multicentre clinical trial conducted in a nursing care and education centre, an outpatient wound care clinic and a primary health care unit in Brazil. Adult patients with VLUs took part in the study. Patients with diabetic foot ulcers and mixed ulcers were excluded. A questionnaire assessing sociodemographic and religious characteristics of patients, the Subjective Wellbeing Scale, the Spirituality Self-Rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. Results: A total of 60 patients (63.3% female; 86.7% aged ≥60 years) participated. Before Unna boot therapy, 65%, 66.7% and 65% of patients reported a score of one on positive affect, negative affect and life satisfaction, respectively, indicating poor subjective wellbeing. After one month of compression therapy, 66.7%, 50.0%, and 80.0% of patients reported a score of three for each element positive affect, negative affect and life satisfaction, respectively, showing a significant improvement in subjective wellbeing (p=0.029). A significant increase in total SSRS scores (p=0.017) was found between baseline (mean: 9.77) and one month of treatment (mean: 25.47), indicating a significant increase in a sense of spirituality. There was also a significant increase in total HHI values (p=0.009) between baseline (mean: 15.68) and one month of compression therapy (mean: 39.38), suggesting a significant increase in hope among patients. Conclusion: Patients with VLUs treated with Unna boot therapy in this study showed significant improvement in subjective wellbeing, spirituality and hope for cure.
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Grant, Anthony P., und Ian F. Hancock. „A Handbook of Vlax Romani“. Language 72, Nr. 4 (Dezember 1996): 885. http://dx.doi.org/10.2307/416149.
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Kelechi, Teresa J., Margaret A. Prentice, Martina Mueller, Mohan Madisetti und Alexey Vertegel. „A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial“. JMIR mHealth and uHealth 8, Nr. 5 (15.05.2020): e15015. http://dx.doi.org/10.2196/15015.
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Background Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity. Objective The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function. Methods In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance. Results A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85% of the time for duration, whereas 33% (8/24) of patients adhered more than 85% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from −0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app. Conclusions The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features. Trial Registration ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695
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Gerami, Masoud, und Aidan Hawes. „vLex Justis: the Alternative Just Got Better“. Legal Information Management 20, Nr. 2 (Juni 2020): 93–97. http://dx.doi.org/10.1017/s1472669620000201.
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AbstractMasoud Gerami, Managing Director of vLex Justis, and Aidan Hawes, Head of Commercial Development, discuss the development and launch of the new vLex Justis platform. They describe the process of making decisions behind the content and features available on the platform, and how these will be continually enhanced in the future. They also discuss the global circumstances the platform was launched within and share their goal of meeting customer needs in a future which will bring new ways of working.
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Zalán, Andrea, Judit Béres und Horolma Pamjav. „Paternal genetic history of the Vlax Roma“. Forensic Science International: Genetics 5, Nr. 2 (März 2011): 109–13. http://dx.doi.org/10.1016/j.fsigen.2010.08.017.
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Hugo, Daniel. „Die man wat vlug vir die Nobel Prys“. South African Theatre Journal 11, Nr. 1 (Januar 1997): 286–88. http://dx.doi.org/10.1080/10137548.1997.9688211.
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Raffetto, Joseph D. „Pathophysiology of wound healing and alterations in venous leg ulcers-review“. Phlebology: The Journal of Venous Disease 31, Nr. 1_suppl (25.02.2016): 56–62. http://dx.doi.org/10.1177/0268355516632998.
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Venous leg ulcer (VLU) is one of the most common lower extremity ulcerated wound, and is a significant healthcare problem with implications that affect social, economic, and the well-being of a patient. VLU can have debilitating related problems which require weekly medical care and may take months to years to heal. The pathophysiology of VLU is complex, and healing is delayed in many patients due to a persistent inflammatory condition. Patient genetic and environmental factors predispose individuals to chronic venous diseases including VLU. Changes in shear stress affecting the glycocalyx are likely initiating events, leading to activation of adhesion molecules on endothelial cells, and leukocyte activation with attachment and migration into vein wall, microcirculation, and in the interstitial space. Multiple chemokines, cytokines, growth factors, proteases and matrix metalloproteinases are produced. The pathology of VLU involves an imbalance of inflammation, inflammatory modulators, oxidative stress, and proteinase activity. Understanding the cellular and biochemical events that lead to the progression of VLU is critical. With further understanding of inflammatory pathways and potential mechanisms, certain biomarkers could be revealed and studied as both involvement in the pathophysiology of VLU but also as therapeutic targets for VLU healing.
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Li, Daxian, Ji Lee, Chang Choi, Jaihwan Kim, Sun Kim und Woojin Kim. „The Analgesic Effect of Venlafaxine and Its Mechanism on Oxaliplatin-Induced Neuropathic Pain in Mice“. International Journal of Molecular Sciences 20, Nr. 7 (03.04.2019): 1652. http://dx.doi.org/10.3390/ijms20071652.
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The analgesic effect of venlafaxine (VLX), which is a selective serotonin and noradrenaline reuptake inhibitor (SNRI), has been observed on oxaliplatin-induced neuropathic pain in mice. Significant allodynia was shown after oxaliplatin treatment (6 mg/kg, i.p.); acetone and von Frey hair tests were used to assess cold and mechanical allodynia, respectively. Intraperitoneal administration of VLX at 40 and 60 mg/kg, but not 10 mg/kg, significantly alleviated these allodynia. Noradrenaline depletion by pretreatment of N-(2-Chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4, 50 mg/kg, i.p.) blocked the relieving effect of VLX (40 mg/kg, i.p.) on cold and mechanical allodynia. However, serotonin depletion by three consecutive pretreatments of para-chlorophenylalanine (PCPA, 150 mg/kg/day, i.p.) only blocked the effect of VLX on mechanical allodynia. In cold allodynia, the α2-adrenergic antagonist idazoxan (10 μg, i.t.), but not the α1-adrenergic antagonist prazosin (10 μg, i.t.), abolished VLX-induced analgesia. Furthermore, idazoxan and 5-HT3 receptor antagonist bemesetron (MDL-72222, 15 μg, i.t.), but not prazosin or mixed 5-HT1, 2 receptor antagonist methysergide (10 μg, i.t.), abolished VLX-induced analgesia in mechanical allodynia. In conclusion, 40 mg/kg of VLX treatment has a potent relieving effect against oxaliplatin-induced neuropathic pain, and α2-adrenergic receptor, and both α2-adrenergic and 5-HT3 receptors are involved in this effect of VLX on cold and mechanical allodynia, respectively.
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Fulcher, Emily, und Neil Gopee. „Effect of different compression bandaging techniques on the healing rate of venous leg ulcers: a literature review“. British Journal of Community Nursing 25, Sup6 (02.06.2020): S20—S26. http://dx.doi.org/10.12968/bjcn.2020.25.sup6.s20.
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Venous leg ulcers (VLUs) are a common health problem in older adults, for which the widely used method of treatment includes compression therapy. There are various compression bandages and hosiery systems available for use, but it remains unclear as to which types of compression systems are most effective in enabling healing of VLUs. This study aimed to determine which type of the two most commonly used compression bandaging (four-layer and two-layer) is more effective in providing complete ulcer healing of VLUs. Key search terms were identified using the PICO (population, intervention, comparison, outcome) model, with distinct inclusion and exclusion criteria, in a strategic search of electronic databases (e.g. CINAHL and MEDLINE) along with wider sources, including Google Scholar. More studies favoured the four-layer compression system than two-layer for providing better healing rates in the treatment of VLUs, but two-layer bandaging tends to provide a better quality of life and may be more cost-effective, although comorbidities and other factors also need to be considered. In choosing the type of compression bandage for the management of leg ulcers, the healing rate achieved by the chosen bandage needs to be carefully monitored, while also taking into consideration other factors such as the quality of life for the patient.
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Saghdaoui, Layla Bolton, Sarah Onida, Alun Huw Davies und Mary Wells. „Why nurses in primary care need to be research active: the case of venous leg ulceration“. British Journal of Community Nursing 25, Nr. 9 (02.09.2020): 422–28. http://dx.doi.org/10.12968/bjcn.2020.25.9.422.
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Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.
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Nagy, Nikoletta, Gábor Szabad, Győző Szolnoky, Zsuzsanna Kiss-László, Éva Dósa-Rácz, Zsuzsanna Bata-Csörgő, Lajos Kemény und Márta Széll. „Chronic Nonhealing Wounds: Could Leg Ulcers Be Hereditary?“ Ulcers 2013 (10.03.2013): 1–4. http://dx.doi.org/10.1155/2013/219257.
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Background. A number of well-known acquired and putative inherited etiological factors contribute to the development of venous leg ulcer (VLU). Aim. In this study we set out to perform a meta-analysis of putative genetic and acquired factors predisposing to VLU development. Methods. VLU patients (n=157) were divided into three subgroups in accordance with their acquired etiological factors. The frequencies of four genetic factors were determined: the R506Q (Leiden) mutation of the F5 gene, the G20210A mutation of the F2 (prothrombin) gene, the 2451 A/G SNP of the fibroblast growth factor receptor 2 (FGFR2) 3′ UTR, and the −308 G/A SNP of the tumor necrosis factor α (TNFA) promoter. Results. The −308 TNFA SNP exhibited a higher frequency among VLU patients without known acquired predisposing factor in their history, than among patients with thrombosis or soft tissue infection in their history (Fisher P=0.0173). Conclusions. This study has demonstrated that the group of VLU patients is heterogeneous in their genetic predisposing factors. Further large-scale studies are needed to delineate the associations among genetic and acquired etiological factors with regard to VLU development and to integrate the consequences of the already known genetic factors to the management of VLU.
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Raffetto, Joseph D. „Which dressings reduce inflammation and improve venous leg ulcer healing“. Phlebology: The Journal of Venous Disease 29, Nr. 1_suppl (Mai 2014): 157–64. http://dx.doi.org/10.1177/0268355514529225.
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Chronic venous leg ulcers (VLU) affect around 1% of the adult population in the Western world. The impact of VLU is both social and economic, with significant expenditures on active venous ulcers to provide medical treatment and eventual healing. At the core of VLU is venous hypertension which affects the venous macrocirculation. The changes incurred in venous hemodynamics leads to microcirculatory changes affecting the postcapillary venule and surrounding tissues. Inflammation by leukocytes affecting the venous endothelium, promotes a complex cascade and activation of adhesion molecules expression, chemokines and cytokines released, altered growth factor responses, and activation of protease (e.g. tPA) and proteinase (e.g. MMPs) activity that causes dysregulation and compromise of tissue integrity with eventual dermal damage and ulcer development. A critical component to treating VLU is correcting the abnormal venous hemodynamics and compression therapy. Unfortunately, VLU recurrence ranges between 30–70%, and other modalities in therapy along with compression are required. The goal for adjuvant products is to restore the balance from an inflammatory chronic wound to that of a reparative wound that will promote provisional matrix and epithelialization. There are many products on the market that can be used as adjuvant to compression therapy, but it must be recognized that there is a paucity of clinical trials that have evaluated the clinical effectiveness of specific products with clearly defined end points, and most importantly a healed VLU with a low recurrence rate. This review will discuss the fundamentals of VLU inflammation, and evaluate the available literature that may have benefit in reducing inflammation and lead to effective VLU healing.
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. „658 ZN: Schaf No-Claim Zo Vlug Mogelijk Af“. Zorg en Financiering 5, Nr. 5 (Mai 2006): 64–65. http://dx.doi.org/10.1007/bf03092482.
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Baló, Márton A. „Variation in the nominal morphology of Northern Vlax Romani“. Word Structure 14, Nr. 1 (März 2021): 25–58. http://dx.doi.org/10.3366/word.2021.0179.
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The present paper discusses two particular instances of variation in the nominal morphology of Northern Vlax Romani varieties as spoken in Hungary: the masculine oblique base and the feminine plural oblique base. The discussion is conducted in an analogical framework, relying only on surface forms and their relationships, using the notion of schemas ( Booij 2010 ), and taking it one step further. When there is a ‘weak point’ in the grammar of a language, variation may emerge and pattern-seeking may begin; the pattern-seeking processes can be interpreted and explained with reference to possible analogical connections among surface forms.
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Cox, Amy, und Chrissie Bousfield. „Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review“. British Journal of Community Nursing 26, Sup6 (01.06.2021): S10—S20. http://dx.doi.org/10.12968/bjcn.2021.26.sup6.s10.
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The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.
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Alok, U., P. Bhardwaj, A. Singh und J. J. Cherian. „Current understanding on venous leg ulcer“. Indian Journal of Pharmaceutical and Biological Research 2, Nr. 03 (30.09.2014): 30–36. http://dx.doi.org/10.30750/ijpbr.2.3.6.
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Venous leg ulcer (VLU) or stasis ulcer is a relatively common, chronic and recurring problem. Besides being costly to the health-care system, it significantly impairs the quality of life of the patients. Nearly 1% of adults and 3.6% of older patients are reported to suffer from this chronic condition. Chronic venous insufficiency is considered to be the predominant cause of VLU. The most recent theories associate the pathogenesis of venous ulcer with microcirculatory abnormalities and generation of an inflammatory response. The pharmacological treatment for VLU is based on the pathogenesis and often includes diosmin, pentoxifylline, diuretics as well as antibiotics and the non-pharmacological treatment like compression and skin grafting. VLU has a high rate of recurrence and requires self-care to avoid relapse. Treatment of VLU should always focus for complete treatment, and improve quality of life for patients along with minimum relapse. In recent years novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder.
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Heatley, Francine, Layla Bolton Saghdaoui, Safa Salim, Sarah Onida und Alun Huw Davies. „Primary care survey of venous leg ulceration management and referral pre-EVRA trial“. British Journal of Community Nursing 25, Sup12 (01.12.2020): S6—S10. http://dx.doi.org/10.12968/bjcn.2020.25.sup12.s6.
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Venous leg ulceration (VLU) is a public health concern that is largely managed in community settings. The present study aimed to survey current VLU management in the community. A 14-question survey was distributed to primary care professionals, and 90 responses were received. Some 54% of respondents stated that they would assess ankle brachial pressure indices (ABPI) for those with VLU, while 25% reported that they would not. Additionally, 62% reported not organising duplex ultrasound scanning. Compression therapy was offered by 82% of respondents. When asked whether VLU patients were referred to specialist services in secondary or tertiary care, some 32% reported that they would. However, 57% reported that, if a study suggested that referral to specialist services was beneficial, they would change their practice. On the basis of the findings, the authors concluded that there is diversity in VLU diagnostic and treatment pathways. New, high-quality evidence may improve practice, but care delivery is influenced by local factors including time and resource distribution.
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Mujahidah, Fatimah Fitriani. „Faktor-faktor yang Mempengaruhi Keteraturan Pemeriksaan Antenatal Care di Puskesmas Biru-Biru Kabupaten Bone“. Jurnal Ilmiah Kesehatan 2, Nr. 1 (30.04.2020): 30–35. http://dx.doi.org/10.36590/jika.v2i1.37.
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Pemeriksaan antenatal merupakan cara efektif untuk menurunkan angka kesakitan dan kematian ibu. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi keteraturan pemeriksaan antenatal care di puskemsas unit Pelayanan tenaga dinas kesehatan Kabupaten Bone. Desain penelitian yang digunakan pada penelitian ini adalah cross sectional. Populasi penelitian adalah 322 wanita yang melakukan pemeriksaan antenatal. Besar pengambilan 32 orang yang dipilih secara accidental sampling. Hasil penelitian menunjukkan hubungan bermakna antara pengetahuan (ρ vlue = 0,000) dan keteraturan kunjungan antenatal dengan sikap subjek dengan (ρ vlue=0,01) sedangkan hubungan dukungan suami dengan keteraturan kunjungan antenatal didapatkan (ρ vlue=0,912). Dengan demikian dapat disimpulkan bahwa ada hubungan antara pengetahuan dan sikap dengan keteraturan kunjungan antenatal K1-K4, dan tidak ada hubungan dengan dukungan suami dengan keteraturan kunjungan antenatal K1-K4. Penelitian ini menyarankan petugas kesehatan agar meningkatkan program penyuluhan kepada ibu hamil, perlunya penambahan alat kesehatan untuk melengkapi kebutuhan pemeriksaan antenatal di puskemsas Biru-Biru Kabupaten Bone, serta perlunya meningkatkan kesadaran anggota keluarga khususnya suami untuk mendukung ibu hamil untuk memeriksakan kehamilannya sedini mungkin.
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Massand, Sameer, Joseph A. Lewcun und Charles A. LaRosa. „Clinical and cost efficacy of advanced wound care matrices in the treatment of venous leg ulcers: a systematic review“. Journal of Wound Care 30, Nr. 7 (02.07.2021): 553–61. http://dx.doi.org/10.12968/jowc.2021.30.7.553.
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Background: Venous leg ulcers (VLUs) are hard-to-heal, recurrent and challenging to treat. Advanced wound care matrices (AWCMs) have been developed to supplement conventional therapies. These costly AWCMs warrant careful comparison as healthcare expenditures are subjected to increasing scrutiny. Aim: This study was designed to compare AWCMs in their ability to heal VLUs and their cost efficacy through a systematic review of randomised controlled trials (RCTs). Method: An organised search of Medline, Cochrane Library, Central and CINAHL databases identified RCTs that compared AWCMs to standard compression therapy in the healing of VLUs. Bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Eight studies analysing bilayered skin substitute (BSS) (Apligraf), dehydrated human amnion/chorion membrane (dHACM) (Epifix), human fibroblast-derived dermal substitute (HFDDS) (Dermagraft), extracellular wound matrix (ECM) (Oasis), advanced matrix (AM) (Talymed) and matrix wound dressing (MWD) (Promogran) met the inclusion criteria. Results: Four studies reported significant improvement over standard therapy: BSS, dHACM, ECM and AM. Incremental cost per additional successful treatment was determined for each trial, ranging from $2593 (MWD) to $210,800 (HFDDS). Conclusion: Our consolidated analysis of eight major RCTs of AWCMs in the treatment of VLUs revealed a great variation in clinical and cost efficacy among these products. The included trials were inconsistent in methodology, and these limitations should be noted, but, in the absence of RCTs to compare these products, our systematic review may serve as a guide for practitioners who seek to optimise wound healing while considering cost efficacy.
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Guest, Julian F., Karen Staines und Nina Murphy. „Cost-effectiveness of using intermittent pneumatic compression to manage hard-to-heal venous leg ulcers in the UK“. Journal of Wound Care 30, Nr. 7 (02.07.2021): 544–52. http://dx.doi.org/10.12968/jowc.2021.30.7.544.
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Objective: To estimate whether thigh-administered intermittent pneumatic compression (IPC) could potentially afford the UK's National Health Service (NHS) a cost-effective intervention for the management of hard-to-heal venous leg ulcers (VLUs). Method: A Markov model was constructed depicting the management of hard-to-heal VLUs with IPC plus standard care or standard care alone over a period of 24 weeks. The model estimated the cost-effectiveness of the two interventions in terms of the incremental cost per quality-adjusted life year (QALY) gained at 2019/20 prices. Results: Treatment of hard-to-heal VLUs with IPC plus standard care instead of standard care alone is expected to increase the probability of healing by 58% (from 0.24 to 0.38) at 24 weeks and increase health-related quality of life over 24 weeks from 0.32 to 0.34 QALYs per patient. Additionally, the cost of treating with IPC plus standard care (£3,020 per patient) instead of standard care alone (£3,037 per patient) has the potential to be cost-neutral if use of this device is stopped after 6 weeks in non-improving wounds. Sensitivity analysis showed that the relative cost-effectiveness of IPC plus standard care remains <£20,000 per QALY with plausible variations in costs and effectiveness. Conclusion: Within the limitations of this study, the addition of IPC to standard care potentially affords a cost-effective treatment to the NHS for managing hard-to-heal VLUs. However, a controlled study is required to validate the outcomes of this analysis.
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Mervis, Joshua S., Robert S. Kirsner und Hadar Lev-Tov. „Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort“. BMJ Open 9, Nr. 1 (Januar 2019): e023313. http://dx.doi.org/10.1136/bmjopen-2018-023313.
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IntroductionChronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%–2% of adults in the USA. Why some develop VLU and others do not is unclear. VLU have a significant impact on quality of life and are extremely costly and difficult to treat. Moreover, VLU prevalence is increasing, doubling in the last 20 years. In order to characterise the differences between people with CVI and those who ultimately develop VLU, we aim to set up the unique venous insufficiency in South Florida cohort.Methods and analysisSubjects will be recruited from the University of Miami Hospital and Clinic’s vascular laboratory database, which began in July 2011. Any adult age 18–95 who has had venous reflux detected on duplex ultrasound of the lower extremities is included. Approximately 2500 patients are already in the database that meet these criteria, with an estimated 2500 additional potential subjects to be recruited from the vascular laboratory database over the next 5 years. Subjects with a history of VLU prior to the duplex study date will be excluded. Data will be collected via review of the Doppler study report, patient phone interview and review of the electronic medical record. Subjects will be contacted for follow-up every 3 months for at least 5 years until the study endpoint, development of first VLU (fVLU), is reached. In order to estimate the time from reflux documentation to fVLU, Kaplan-Meier survival curves will be constructed. Cox proportional hazard regression models will be constructed to investigate possible risk factors.Ethics and disseminationThis study is approved by the University of Miami’s Institutional Review Board. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.
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Chaix, R., F. Austerlitz, B. Morar, L. Kalaydjieva und E. Heyer. „Vlax Roma history: what do coalescent-based methods tell us?“ European Journal of Human Genetics 12, Nr. 4 (04.02.2004): 285–92. http://dx.doi.org/10.1038/sj.ejhg.5201126.
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Kavala, Ali Aycan. „Autogenously Derived Regenerative Cell Therapy for Venous Leg Ulcers (vlus)“. American Journal of Cardiology 121, Nr. 8 (April 2018): e108. http://dx.doi.org/10.1016/j.amjcard.2018.03.252.
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Fucik, John E., und Dariusz Swietlik. „EXTRACTS FROM ASH ROOTS AND VELVETLEAF AFFECT WATER STATUS OF SOUR ORANGE SEEDLINGS“. HortScience 27, Nr. 6 (Juni 1992): 579b—579. http://dx.doi.org/10.21273/hortsci.27.6.579b.
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Water extracts of cocklebur,CBX (Xanthium spinosa L.) and velvetleaf,VLX (Abutilon theophrasti Medic.) shoots and Mexican ash,AshX (Fraxinus Berlandieriana A.DC.) roots were added to 9 month-old sour orange Citrus aurantium L.) seedlings(SOs) in water culture. Final extract concentrations represented either 50 or 12.5 g. of plant material liter-1 of culture solution, i.e. 1/20 or 1/80 dilutions. Leaf water potential(ψ); stomatal conductance(gs);transpiration(T) and growth responses were measured for 13 days. After 1 day, SOs in AshX and CBX had lower ψ than controls. After 11 days SOs in CBX had higher ψ than the others. ψ responded similarly to both extract concs.. Thru day 5, AshX decreased gs vs. the controls and VLX. By day 11, gs of SOs in AshX was less than for VLX but not the others. On days 1 and 5, gs for VLX at 1/20 was lower than controls but at 1/80, gs's were the highest of all treatments. These results supported by the T rates, growth responses and others findings suggest AshX and VLX induce water stress by reducing water absorption and/or transport in addition to possibly disrupting normal root/shoot communications
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Kreft, Daniel, Jonas Keiler, Eberhard Grambow, Sabine Kischkel, Andreas Wree und Gabriele Doblhammer. „Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data“. Angiology 71, Nr. 5 (13.03.2020): 452–64. http://dx.doi.org/10.1177/0003319720905751.
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This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk ( p < .001) in patients with any DVT, an 88% higher mortality ( p < .001) for femoral DVT, a 23% higher risk ( p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.
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Turner, Glenn W., Howard D. Grimes und B. Markus Lange. „Soybean vegetative lipoxygenases are not vacuolar storage proteins“. Functional Plant Biology 38, Nr. 10 (2011): 778. http://dx.doi.org/10.1071/fp11047.
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The paraveinal mesophyll (PVM) of soybean is a distinctive uniseriate layer of branched cells situated between the spongy and palisade chlorenchyma of leaves that contains an abundance of putative vegetative storage proteins, Vspα and Vspβ, in its vacuoles. Soybean vegetative lipoxygenases (five isozymes designated as Vlx(A–E)) have been reported to co-localise with Vsp in PVM vacuoles; however, conflicting results regarding the tissue-level and subcellular localisations of specific Vlx isozymes have been reported. We employed immuno-cytochemistry with affinity-purified, isozyme-specific antibodies to reinvestigate the subcellular locations of soybean Vlx isozymes during a sink limitation experiment. VlxB and VlxC were localised to the cytoplasm and nucleoplasm of PVM cells, whereas VlxD was present in the cytoplasm and nucleoplasm of mesophyll chlorenchyma (MC) cells. Label was not associated with storage vacuoles or any evident protein bodies, so our results cast doubt on the hypothesis that Vlx isozymes function as vegetative storage proteins.
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Mosti, Giovanni, Attilio Cavezzi, Luca Bastiani und Hugo Partsch. „Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer“. Journal of Clinical Medicine 9, Nr. 11 (19.11.2020): 3709. http://dx.doi.org/10.3390/jcm9113709.
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The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5–0.8) occurs as in mixed leg ulcers (MLU). Materials and methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU. Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP (p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP (p = −0.19). Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.
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Schroeppel DeBacker, Sarah E., Julie C. Bulman und Jeffrey L. Weinstein. „Wound Care for Venous Ulceration“. Seminars in Interventional Radiology 38, Nr. 02 (Juni 2021): 194–201. http://dx.doi.org/10.1055/s-0041-1727161.
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AbstractVenous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.
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Jull, Andrew, Angela Wadham, Chris Bullen, Varsha Parag und Jill Waters. „Wool-derived keratin dressings versus usual care dressings for treatment of slow-healing venous leg ulceration: study protocol for a randomised controlled trial (Keratin4VLU)“. BMJ Open 8, Nr. 2 (Februar 2018): e020319. http://dx.doi.org/10.1136/bmjopen-2017-020319.
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IntroductionKeratins, filament-forming proteins found in vertebrate epithelium, are downregulated in slow-healing venous leg ulcers (VLU) compared with normal-healing VLU. Laboratory and animal model research has suggested exogenous keratins increase expression of endogenous keratins. A non-randomised controlled trial of an exogenous keratin dressing reported increased healing in slow-healing VLU. To date, no randomised controlled trial has been done to verify these promising findings.Methods and analysisThe Keratin4VLU trial is a single-blind, pragmatic, parallel group, randomised controlled trial of keratin dressings compared with usual care non-medicated dressings in patients with VLU where either (1) the ulcer area is greater than 5 cm2, (2) the ulcer has been present for more than 26 weeks or (3) both. All patients will receive compression therapy. The primary outcome is the proportion of patients with healed VLU at 24 weeks after randomisation as adjudicated by blinded review of an ulcer photograph. Secondary outcomes are time to healing, estimated change in ulcer area, change in health-related quality of life, agreement between blinded and unblinded assessors and adverse events. The analysis will be intention-to-treat on the primary and secondary outcomes (excepting health-related quality of life).Ethics and disseminationThe Keratin4VLU trial received ethical approval from the Northern A Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.Trial registration numberNCT02896725; Pre-results.