A placebo controlled trial of ultrasound therapy in chronic leg ulceration.

A controlled study of the effects of ultrasound on healing chronic leg ulcers was carried out in conjunction with standard treatment on 38 patients divided randomly into two groups. All patients received standard treatment (paste impregnated bandage and a self-adhesive elastic bandage plus placebo ultrasound or ultrasound (1.0 watt/cm2 at 1 MHz, for 10 min) twice weekly for 8 weeks. Percentage healed ulcer area and number of healed ulcers were compared after 2, 4, 6 and 8 weeks. There were no significant differences in the proportion of healed ulcers or ulcer area in the ultrasound group as compared with the placebo group.     

Pulsed ultrasound does not improve healing of venous ulcers

A controlled study of the effects of pulsed ultrasound was carried out in conjunction with a standard treatment for healing chronic leg ulcers on 44 patients divided randomly into two groups. All patients received standard treatment (paste impregnated bandage and a self-adhesive elastic bandage) plus placebo-ultrasound or pulsed ultrasound (1:9, 0.5 watt/cm2 at 1 MHz, for 10 min) 3 days a week for 4 weeks, thereafter twice weekly for 4 weeks and once weekly for the following 4 weeks. Percentage healed ulcer area and comparison of percentage healed ulcers were examined after 4, 8 and 12 weeks. There were no significant differences in the proportion of healed ulcers or ulcer area in the pulsed ultrasound group as compared with the placebo group.     

门诊老年压疮病人创面感染原因分析及治疗护理对策

[目的]探讨门诊压疮感染发生的相关原因、病原菌分布以及护理干预对策。[方法]回顾性分析了门诊25例压疮感染病人的临床资料及创面病原菌培养结果并对其护理干预重点进行总结。[结果]压疮病人主要照顾者的知识缺乏是感染发生的主要原因;创面感染的病原菌以铜绿假单胞菌为主;经过一系列的护理干预,16例病人创面在3个月~4个月完全愈合,7例病人创面在6个月内完全愈合,2例病人由于基础疾病恶化而死亡。[结论]压疮感染的原因是多方面的;合理使用抗生素,积极清创,选择合适的敷料,营养支持;对照顾者的健康教育是护理干预的关键。     

The management of the client with a leg ulcer: precarious nursing practice

The management of clients who present at the doctor's surgery with leg ulcers follows an accepted but often perilous course It is generally accepted custom and practice that the overall care of this client group is delegated to nurses without the medical practitioner first determining the nature of the underlying pathology The usual arrangement of care for patients with leg ulcers is such that the development of chronic wounds is almost inevitable The author, drawing on the medical and nursing literature and on the findings of her ongoing doctoral research, suggests that nurses in primary care should re-examine this area of practice and consider alternative approaches that would emphasize the unique contribution professional nursing practice could bring to this patient group     

Managing leg and foot ulcers: the role of Kerraboot

Foot and leg ulcers are chronic wounds characterized by slow or non-healing breakdown of epidermal and dermal tissue on the foot or below the knee. The prevalence is high and ulcers are a significant drain on the NHS in terms of nursing time and cost of dressings, and are incredibly burdensome to the individual patient. This article reviews the evidence for a new wound management system, Kerraboot, designed for the management of leg and foot ulcers. It is a boot-shaped dressing that completely surrounds the ulcer, creating an optimum healing environment. In clinical investigations, Keraboot offered patients relief from pain, was comfortable, easy to use and effectively controlled embarrassing odour, while also saving nursing time. Currently Kerraboot is recommended for the management of diabetic foot ulcers and venous ulcers where the patient is unable to tolerate compression therapy.     

高龄Ⅲ期压疮患者一例的循证护理

目的 为1例高龄Ⅲ期压疮患者确定基于循证的压疮护理方案.方法 按照PICO原则,针对患者的临床表现提出护理问题,计算机检索Cochrane图书馆（2012）、PubMed（1980-2012）、EMBASE（1974-2012）、JBI循证数据库（2012）及中国生物医学文献数据库（1978-2012）,共纳入2篇临床指南、7篇系统评价及证据总结,结合患者情况,从压疮伤口消毒、床具、营养支持、换药敷料等方面实施针对性护理.结果 3 d后,患者左足跟外侧结痂脱落;15 d后,尾骶部压疮痊愈,长出新生皮肤,色泽鲜红,无渗液,无异味.结论 采用循证的方法可以为患者提供更加科学和个性化的护理方案,有效治疗和预防压疮,减轻患者的痛苦,提高护理质量.     

Venous leg ulcers: the role of the GP and district nurse

AIM: To identify the healing rates for patients with venous leg ulcers (VLUs) who are nursed by district nurses. METHOD: The researchers performed a retrospective chart review of patients treated for VLU disease by district nurses to determine the healing rate, time to heal and variables associated with diagnosis. Forty random charts were abstracted from seven surgeries in Oxfordshire. RESULTS: Forty per cent of patients healed in less than 12 weeks and a further 42.5 per cent healed in 6.5 months. Some trusts and GPs lack understanding of what the district nursing service can offer patients with VLUs. CONCLUSION: If district nurses work collaboratively with GPs, either in the home or in a weekly clinic, they can provide good care to patients with VLUs.     

Community nurses', home carers' and patients' perceptions of factors affecting venous leg ulcer recurrence and management of services

AIM: This study examines the feasibility of utilizing social service home carers (SSHC) to provide a collaborative approach with community nurses for the provision of leg ulcer aftercare in four National Health Service (NHS) Trusts. The purpose of this study was to gain insight into what community nurses and people with healed venous leg ulcers felt influenced leg ulcer recurrence. BACKGROUND: Studies have demonstrated that provision of community-based leg ulcer clinics has improved healing rates of venous leg ulcers, yet recurrence remains a problem. The reasons for this are far from clear, and further research is required before unequivocal support can be given to one approach to the provision of care for this client group. Collaborative approaches to the provision of leg ulcer aftercare are beginning to receive more attention. It has been recognized that social service health carers could be co-opted to provide essential aftercare once healing has occurred, although the logistics of this approach have not been fully explored. METHODS: This study was conducted in four NHS Trusts. Stage one used focus groups to explore the perceptions of district nurses (n = 15) and social service health carers (n = 15) of a leg ulcer shared care project and to gain insight into factors that they felt influenced recurrence. The second stage used semistructured interviews (n = 12) to explore the perceptions that people with healed leg ulcers have about factors influencing ulcer recurrence. FINDINGS: Key themes emerging from this study were: health promotion is perceived by community nurses and patients to be ineffective and leg ulcer aftercare services are fragmented. Organizational factors such as time constraints and limited resources were cited by community nurses and home carers as being responsible for high leg ulcer recurrence rates. Community nurses expressed a desire to delegate preventative aspects of leg ulcer care to home carers rather than participate in health promotion strategies to support healing behaviours. CONCLUSIONS: A strategy aimed at supporting healing behaviour in elderly people has the potential to reduce the recurrence of leg ulceration and improve quality of life. The findings suggest that such a strategy needs to rationalize delivery of leg ulcer aftercare to provide seamless care. It needs to improve carers' and patients' understanding of factors influencing leg ulcer recurrence and facilitate development of a more balanced professional--patient relationship.     

Care of patients with leg ulcers: A nursing perspective

Care of patients with leg ulcers is challenging as well as rewarding. Recent advances in scientific knowledge about healing should be incorporated in the nursing care of leg ulcer patients. This article provides an update on the state of the science in the care of leg ulcers in geriatric patients, and focuses on assessment and local care of such ulcers. Ulcer assessment provides the basis for selecting therapies to maximize healing. Wound cleansing and appropriate dressings are essential to good patient outcomes. Furthermore, healing is enhanced when these interventions are combined with strategies that maximize oxygen to the ulcer, promote appropriate levels of activity, optimize perfusion through physiological positioning, and reduce mechanical shear through selection of proper footwear. Care of patients with leg ulcers provides the nurse an opportunity to apply pathophysiology, utilize scientific data, and function as an integral player on the wound care team.     

Nursing documentation of leg ulcers: adherence to clinical guidelines in a Swedish primary health care district

The aim of this study was to investigate the adherence of nursing documentation to clinical guidelines in leg ulcer patients. Using two audit instruments, 100 patient records from primary health care were reviewed. The nursing content in the records was assessed according to instructions for documentation in local clinical guidelines for leg ulcers and the comprehensiveness of the nursing process in recording was reviewed. The results indicated deficiencies in the documentation of aspects of relevance in the care of leg ulcer patients. In addition, the findings indicated flaws in the adoption of the nursing process in recording. Only one problem in one patient record was recorded that consistently used the nursing process. The conclusion is that, despite specific and locally developed guidelines for care of leg ulcer patients, nursing records did not provide a precise audit of the care process. Because patient record information without a clear structure following the nursing process tends to impede communication and evaluation of care, such defective information is likely to have a significant impact on the continuity and quality in patient care.     

Effects of venous leg ulceration on patients' quality of life

This article reviews the literature on quality of life of people with venous leg ulcers. Research indicates that, in most people, chronic ulceration is a continuous cycle of skin breakdown over a period of decades and is associated with impaired quality of life. Management of leg ulceration represents a major component of the community nursing workload, with community nurses spending approximately half of their time treating patients with leg ulcers. However, the complex psychological and social effects of ulceration on the patient are often overlooked as the nurse's main focus is on clinical aspects of wound care. This article identifies the importance of adopting a holistic approach to the care of patients with venous leg ulcers to improve outcomes and quality of life.     

腧穴热敏化艾灸治疗Ⅱ、Ⅲ期压疮的效果观察

目的探讨腧穴热敏化艾灸应用于压疮患者效果。方法将80例II、III期脑卒中后出现压疮的患者分为观察组40例和对照组40例。对照组给予常规治疗和护理,观察组在对照组的基础上实施腧穴热敏化艾灸。结果观察组压疮愈合评分低于对照组(P0.05);压疮治疗有效率高于对照组(P0.05)。结论腧穴热敏化艾灸能有效改善局部血液循环,促进机体新陈代谢,利于脑卒中后压疮愈合。     

静脉溃疡病人愈合后皮肤结构变化的超声随访观察

目的观察静脉溃疡愈合后皮肤的超声结构,以探讨创面的愈合质量。方法应用皮肤超声仪检测静脉溃疡病人愈合后形成的瘢痕表皮及真皮的厚度,并分析真皮中的低回声区像素(LEPs)。结果与正常皮肤比较,静脉溃疡愈合后的瘢痕的平均表皮厚度显著增加(P<0.01),平均真皮厚度则显著降低(P<0.01),而真皮中LEPs的数量及分布均无明显变化。皮肤的回声参数与创面愈合时间、创面大小、创面存在时间及病人年龄均无显著的相关性。结论静脉溃疡创面愈合后,真皮中液体的数量及分布无显著改变,表明愈合后水肿得到了控制。     

Prevalence of non-healed and healed chronic leg ulcers in an elderly rural population

OBJECTIVE: To estimate the prevalence of non-healed and healed chronic leg ulcers in an elderly rural population. DESIGN: All persons 70 years or older were asked about present and previous leg ulcers. SETTING: A rural village in mid-west Sweden with 4000 inhabitants. PARTICIPANTS: 541 persons aged 70 years and above. OUTCOME MEASURES: The prevalence of healed or non-healed chronic leg ulcers in the population aged > or = 70. RESULTS: Healed or non-healed leg ulcers were reported by 53 persons (9.8%). Examination of these patients and also 100 individuals who had negated present or previous leg ulceration, giving the total prevalence of 12.6%. CONCLUSION: The result indicates a certain risk for overestimation of prevalence, as well as underestimation and decreased reliability when basing the figures only on telephone interviews or posted questionnaires.     

Setting up a community nurse-led healed leg ulcer clinic

The success of compression therapy and emphasis on healing rates of venous ulcers in studies has shifted the emphasis from prevention to cure. Venous insufficiency is, in the majority of cases, a chronic condition. From a patient's perspective, unless they are suitable for corrective surgery, he/she will never be rewarded with a cure. Patients often need to make permanent life-style changes to reduce the risk of ulceration or re-ulceration and may require differing levels of support to achieve this. The implementation of a designated clinic for patients with healed leg ulcers in a primary care trust in the east end of London is the first step in promoting a collaborative approach to prevention of leg ulcer recurrence.     

The Prevalence of Leg Ulcers in Older People: Implications for Community Nursing

Abstract The prevalence of chronic leg ulcers has been investigated in older people living in the community. This condition has a low prevalence, but major health costs are associated with frequent home nursing visits, community nursing services being the main providers of care. An estimate was made of the prevalence of chronic leg ulcers in a cross-sectional random sample of noninstitutionalized older people living in a major Australian city ( N = 1,050). The prevalence estimate is compatible with estimates of 1 % in the over-60 age group found in Swedish and Northern American studies. Age-adjusted gender ratios demonstrate slightly higher prevalence in females than males (1.25:1). Implications for community nursing services for primary, secondary, and tertiary prevention are outlined and include education programs for seniors dispelling myths that leg ulcers are a natural part of aging, screening for venous and arterial peripheral vascular disease in the older community, collaborative nurse and podiatrist foot care clinics, and the location of leg ulcer clinics in geriatric day care centers.     

下肢静脉溃疡应用湿性愈合护理加高压氧治疗的效果观察

目的探讨下肢静脉溃疡应用湿性愈合护理加高压氧治疗的效果。方法便利抽样法选择2007年3月至2011年12月在解放军海军总医院门诊伤口护理中心换药的下肢静脉溃疡患者60例为研究对象。按随机数字表法将其分为对照组和观察组,每组30例;对照组患者采用常规湿性愈合敷料护理下肢静脉溃疡,观察组患者采用湿性愈合护理加高压氧治疗下肢静脉溃疡。比较两组患者治疗护理后总疗效、显效及治愈时间和所需医疗费用等。结果观察组患者疗效明显优于对照组,差异有统计学意义（x2=5．455,P〈0．05）。观察组患者显效和愈合时间明显短于对照组,差异均有统计学意义（均P〈0．05）。观察组患者所需医疗费用明显少于对照组,差异有统计学意义（P〈0．05）。结论湿性愈合敷料换药加高压氧治疗是一种良好的治疗下肢静脉溃疡的方法,其疗效优于单纯湿性愈合敷料换药,值得推广应用。     

Managing and promoting change: implementing the Leg Club model

Patient knowledge of their disease may increase concordance to compression therapy. The Lindsay Leg Club model (Lindsay, 2004) empowers the community nursing team to truly get to know their communities and deliver local, high-quality, evidence-based care for patients with leg ulcers and leg related problems. The author's experience of opening a Leg Club has lead to changes in clinical practice: re-evaluation of the use of long stretch bandages in favour of short stretch; replacing conventional compression bandage systems with two piece graduated compression hosiery; increased patient concordance post healing with increased use of compression hosiery; the introduction of toe bandaging and appropriate long-term management for those patients with lymphoedema; and developing the role of the nursing auxiliary in leg ulcer care.