Outcomes of venous ulcer care: results of a longitudinal study

A longitudinal study involving 81 patients with venous ulcers was conducted to explore the outcomes and cost of wound care in a home healthcare (HHC) setting and an outpatient care setting. Ulcers were managed with a saline gauze or hydrocolloid dressing and compression hosiery, or covered with an Unna's boot. Outcomes did not vary between physician's office and home care. Patients preferred home care, but costs and charges were much higher for HHC than for patients managed in the physician's office. Recurrence rates and costs varied greatly. Eighty-eight percent of ulcers in the saline dressing group did not heal or recurred compared to 21% of ulcers in the Unna's boot and 13% of ulcers in the hydrocolloid dressing group. The data also suggest hydrocolloid dressings are more cost-effective than Unna's boot or saline-gauze dressings. Controlled clinical studies to ascertain the cost-effectiveness of venous ulcer care in different patient care settings and the use of different treatment modalities, as well as care system oriented toward outcome for the patient rather than service, design, and distribution, are needed.     

Daflon 500 mg and venous leg ulcer: new results from a meta-analysis

The objective of this study was to assess the effect of oral treatment with Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) on leg ulcer healing. This study was conducted as a meta-analysis of randomized prospective studies using Daflon 500 mg as an adjunct to conventional treatment. Medical literature databases and the manufacturer's records were searched for relevant clinical trials. Five prospective, randomized, controlled studies in which 723 patients with venous ulcers were treated between 1996 and 2001 were identified. Conventional treatment (compression and local care) in addition to Daflon 500 mg 2 tablets daily was compared with conventional treatment plus placebo in two studies (n = 309), or with conventional treatment alone in three studies (n = 414). The primary end point was complete ulcer healing at 6 months. The results are expressed as a reduction in the relative risk (RRR) of healing with 95% confidence intervals (CI). Since, in the present case, the desired treatment effect is increased ulcer healing, RRR should be positive to indicate a benefit of adjunctive Daflon 500 mg over conventional therapy alone. Type 1 error was set at 5%. At 6 months, the chance of ulcer healing was 32% better in patients treated with adjunctive Daflon 500 mg than in those managed by conventional therapy alone (RRR, 32%; 95% CI, 3% to 70%). This difference was present from month 2 (RRR, 44%; 95% CI, 7% to 94%), and was associated with a shorter time to healing (16 weeks vs 21 weeks; p = 0.0034). The benefit of Daflon 500 mg was found in the subgroup of ulcers between 5 and 10 cm2 in area (RRR, 40%; 95% CI, 6% to 87%), as well as in patients with ulcers of 6 to 12 months' duration (RRR, 44%; 95% CI, 6% to 97%). These results confirm that venous ulcer healing is accelerated by Daflon 500 mg treatment. Daflon 500 mg might be a useful adjunct to conventional therapy in large and longstanding ulcers that might be expected to heal slowly.     

Venous leg ulcer patient priorities and quality of care: results of a survey

A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of >5 years. Seventy-three patients (91%) were satisfied with the overall quality of care. A linear relationship was observed between average assessment score and the relative importance of the quality aspects studied. The quality of medical technical care and empathy aspects of interpersonal care received the most positive assessments and were given highest priority. Next in importance were the quality and coherence of information provided and cooperation between different healthcare sectors. Organizational aspects of care were less positively assessed and received lower priority ratings. Venous leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.     

Variation in fatigue may be poorly explained by pain: results from a longitudinal,exploratory study

It is frequently claimed that fatigue reflects pain and that strategies for alleviating fatigue in patients with ankylosing spondylitis (AS) should focus on pain management. The aim of this study was twofold: to investigate the correlation between fatigue and pain over time and to investigate the temporal relationship between fatigue and pain in patients with AS. Fatigue and pain were assessed twice a week for 35 weeks in 23 patients with AS. Data were reported with text messages on mobile phones, constituting around 70 repeated measurements per patient. To estimate correlation over time, the correlation coefficient within individuals was estimated. When estimating the temporal relationship, we lagged the independent variable and performed individual linear regression. In 16 (70 %) of the patients, ≤36 % of the variance in fatigue was explained by pain. The association between fatigue and pain was synchronous in time in 13 (57 %) patients, while 5 (22 %) patients reported that fatigue precedes pain by 1 week and 5 (22 %) that pain precedes fatigue by 1 week. Fatigue and pain may be two separate and independent symptoms in some patients with AS. The clinical implication is that the two symptoms should be targeted separately because it cannot always be expected that an improvement in one is followed by an improvement in the other.     

Acid perfusion of duodenal ulcer craters and ulcer pain: a controlled double blind study

Although early studies attributed an important role to acid in the pathogenesis of duodenal ulcer pain, recent reports are conflicting. The aim of the present study is to determine whether direct acidification of the duodenal ulcer crater in symptomatic patients reproduces ucler pain. Patients with endoscopically diagnosed duodenal ulcers were studied. No premedication or sedation was given. A washing tube was passed via the endoscope and 0.1 N hydrochloric acid as well as normal saline were sequentially administered on to the ulcer crater, the sequence of infusion being randomised and double blind. Forty patients were studied. Sixteen developed typical ulcer pain during acid infusion compared with four with saline (p less than 0.005). Ten patients who developed pain on acid were rechallenged with acid after their pains disappeared. Typical pain recurred in all. Twenty patients without duodenal ulcer did not develop pain when 200 ml of 0.1 N hydrochloric acid was infused into the duodenum. Acid therefore appears to have a definite role in the pathogenesis of duodenal ulcer pain although other factors may also be important.     

Hypertensive ischemic leg ulcer (Martorell's ulcer): a specific disease entity?

Histology of seven clinically diagnosed cases of Martorell's ulcer was compared with that of twenty-seven crural ulcers of venous origin. Although the majority of Martorell's ulcers are accompanied by a longstanding hypertension with markedly elevated diastolic pressure values, the conception of a specific disease entity with a common etiology should be abandoned. Some of the cases may be due to hypertension alone, but others may be caused or at least enhanced by other microvascular disorders.     

Coping, pain, and disability in osteoarthritis: a longitudinal study

OBJECTIVE: To establish the role of coping styles as prospective determinants of pain and disability in patients with osteoarthritis (OA) of the knee or hip. METHODS: Data from 71 patients with OA of the hip and 119 patients with OA of the knee were used. Using regression analysis, relationships were established between the use of active and passive coping styles and the level of pain and disability 36 weeks later. RESULTS: In patients with knee OA, the passive coping style of resting was found to predict a higher level of disability 36 weeks later after controlling for the baseline level of disability. In the same manner in patients with knee OA, the active coping style of transforming pain was found to predict higher levels of pain 36 weeks later. In patients with hip OA, no significant relationship between coping styles and pain and disability was found. CONCLUSION: The role of resting as a prospective determinant of disability, as reported in patients with other chronic disorders, could also be established for knee OA, but not hip OA. Transforming pain was found to be a risk factor for pain in knee OA.     

Long-term results of small-diameter proximal splenorenal venous shunt: a retrospective study

AIM:To investigate recurrent variceal hemorrhage and long-term survival rates of patients treated with partial proximal splenorenal venous shunt.METHODS:Patients with variceal hemorrhage who were treated with small-diameter proximal splenorenal venous shunt in Ruijin Hospital between 1996 and 2009 were included in this study.Shunt diameter was determined before operation using Duplex Doppler ultrasonography.Peri-operative and long-term results in term of rehemorrhage,encephalopathy and mortality were follow...     

Autologous stem cell‐based therapy for sickle cell leg ulcer: a pilot study

Recurrent chronic leg ulcers are among the most severe vasculopathic complications of sickle cell disease (SCD). Their treatment remains a challenge. Stem cell therapy with bone marrow mononuclear cells (BMMC) is a promising new therapeutic option for other forms of chronic ulcers. This prospective pilot study was performed to evaluate safety and feasibility of BMMC implantation in patients with SCD and chronic leg ulcers (SCLU). Ulcer closure, recurrence and local pain were evaluated. BMMC were successfully administered to 23 SCLU patients and no serious adverse events occurred. During the 6‐month follow‐up period, 91·3% of patients had improved ulcer pain compared with baseline and 29·2% of the treated ulcers achieved total healing. The frequency of progenitor stem cells (CD34CD45^low and fibroblast colony‐forming units) in BMMC was found to be significantly reduced in SCLU patients and compared to SCD patients without ulcers (P < 0·004 and P < 0·01, respectively). No relationship was observed between treatment outcome and the number of implanted BM progenitor stem cells. In conclusion, BMMC implantation is a feasible and safe procedure, showing favourable outcomes for the treatment of SCLU, and encouraging further controlled clinical trials.     

Rheumatology patients' use of complementary therapies: results from a one-year longitudinal study

OBJECTIVE: To examine the natural history of complementary and alternative medicine (CAM) use and its impact on outcomes within a cohort of rheumatology patients. METHODS: Consecutive patients were recruited from 3 university and 3 private rheumatology practices. Baseline chart reviews provided demographic information and rheumatic diagnoses. Patients answered questions on CAM use and health status during 1 year. We identified correlates of 4 CAM usage patterns (started, maintained, stopped, nonuse) and compared outcomes among these groups. RESULTS: Of 232 baseline participants, 203 (87%) and 177 (76%) responded to the 6- and 12-month surveys. In each survey, approximately 34% reported currently using CAM. During the year, 44% of patients remained nonusers whereas 12% started, 22% maintained, and 22% stopped use. The most frequent reasons for stopping CAM were lack of effectiveness and expense. CAM users and nonusers had no difference in outcomes. CONCLUSIONS: Arthritis patients' usage behavior varied substantially, but CAM use was not associated with a difference in outcomes.