Recherche de publication

BACKGROUND

Graduated compression is routinely employed as standard therapy for chronic venous insufficiency.

AIM

The study aims to compare the haemodynamic efficiency of a multi-component graduated compression bandage (GCB) versus a negative graduated compression bandage (NGCB) applied with higher pressure over the calf.

METHODS

In 20 patients, all affected by greater saphenous vein (GSV) incompetence and candidates for surgery (Clinical, etiologic, anatomic and pathophysiologic data, CEAP C2-C5), the ejection fraction of the venous calf pump was measured using a plethysmographic method during a standardised walking test without compression, with GCB and NGCB, all composed of the same short-stretch material. Sub-bandage pressures were measured simultaneously over the distal leg and over the calf.

RESULTS

NGCBs with median pressures higher at the calf (62 mmHg) than at the distal leg (50 mmHg) achieved a significantly higher increase of ejection fraction (median +157%) compared with GCB, (+115%) with a distal pressure of 54 mmHg and a calf pressure of 28 mmHg (P < 0.001).

CONCLUSIONS

Patients with severe venous incompetence have a greater haemodynamic benefit from NGCB, especially during standing and walking, than from GCB.

Following an audit of practice in North East London Foundation Trust (NELFT), obstacles in the management of lower limb conditions were identified. An appraisal of needs in terms of skills and theory updates for staff led to a fixed-term 'honorary contract' between the trust and a wound-care company to facilitate a rolling programme of education, to upskill staff in terms of assessment and treatment, and develop standardised care pathways. After 3 months, a repeated practice audit revealed a reduction in nurse contact hours of 1156 hours. The partnership with industry proved to be beneficial and did not compromise care, and trust staff were not obligated to use their product.

OBJECTIVE

To discuss the role of the clinical nurse specialist in managing patients with ulceration caused by mixed venous arterial disease.

METHOD

A small scale retrospective audit study of eight mixed aetiology patients drawn from the caseload of leg ulcer patients within a specialist leg ulcer service in Ayrshire, Scotland was conducted by two specialist nurses with over 8 years' experience in specialist leg ulcer management. Patients were individually assessed using Doppler ultrasound and a rigorous set of validated risk factor criteria. Where Doppler ultrasound was considered to be unreliable, due to an inability to detect sounds, or where further diagnostic information was required in order to safely plan care, arterial duplex scanning was carried out by the cardiac department at Ayr Hospital. All patients were treated with a cohesive inelastic compression bandage system and closely observed by the specialist nurse.

RESULTS

All eight patients with mixed aetiology leg ulcers were reported to experience complete ulcer healing within 6-30 weeks after first application of the inelastic bandage system. The regimen was well tolerated by all patients and no adverse events were recorded.

CONCLUSION

With accurate assessment and treatment by a specialist team, patients with mixed venous arterial disease were safely and successfully managed where they may have remained unhealed.

DECLARATION OF INTEREST

This was an independent retrospective audit study conducted by two clinical nurse specialists, with educational support by Activa Healthcare to assist in bringing it to print.

The objective of this study was to determine the efficacy of a new active debridement system. The project is underpinned by evidence relating to wound assessment and differential diagnosis, pressure ulceration and categorisation, debridement and several current key government agendas in relation to essential skin care, pressure ulcer prevention and management.

The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.

and a. This pair of parameters allows us to determine the maximum value of the observed events for tfi¥, as well as the period within which 50% of these events occur. This mathematic procedure is easy, clinically based and more precisely as Kaplan–Meier estimation, so we think that it has the potential to replace Kaplan–Meier curve.

BACKGROUND

Acne vulgaris is a common skin disease with a large quality of life impact, characterized by comedones, inflammatory lesions, secondary dyspigmentation, and scarring. Although traditionally considered a disease of adolescence, reports suggest it is also a disease of adults, especially adult women. Our objectives were to determine acne prevalence in a large, diverse group of women and to examine acne by subtype and in relation to other skin findings, measurements, and lifestyle factors.

METHODS

We recruited 2895 women aged 10-70 from the general population. Photographs were graded for acne lesions, scars, and dyspigmentation. Measurements were taken of sebum excretion and pore size, and survey data were collected.

RESULTS

Of the women studied, 55% had some form of acne: 28% had mild acne, and 27% had clinical acne, 14% of which was primarily inflammatory and 13% of which was primarily comedonal. Acne peaked in the teenage years, but 45% of women aged 21-30, 26% aged 31-40, and 12% aged 41-50 had clinical acne. Women with inflammatory acne were younger than those with comedonal acne (p≤0.001), and postmenopausal women had less acne than age-matched peers (p<0.0001). Acne was associated with facial hirsutism (p=0.001), large pores (p=0.001), and sebum excretion (p=0.002). Smokers had more, primarily comedonal, acne than nonsmokers.

CONCLUSIONS

The cross-sectional design precludes conclusions about progression of acne with age. Participation was restricted to women. The photographic nature of the study imposes general limitations. Techniques used in this study were not sufficiently sensitive to identify cases of subclinical acne. More than a quarter of women studied had acne, which peaked in the teens but continued to be prevalent through the fifth decade.

Einleitung:

Das Débridement stellt eine wesentliche Säule in der Behandlung von Patienten mit chronischen Wunden dar und ist essentiell um weiterführende therapeutische Maßnahmen einleiten zu können. Die Durchführung eines mechanischen Débridements ist für die Patienten jedoch oft mit starken Schmerzen verbunden, so dass entweder kein radikales Débridement durchgeführt werden kann oder eine Analgesie bis hin zu operativen Eingriffen in Intubationsnarkose notwendig ist. Für Patienten bei denen insbesondere festhaftende Fibrinbeläge aus Wunden entfernt werden müssen, stellt das aus Polyester-Monofilament-fasern bestehende Debrisoft® eine neue schmerzarme therapeutische Option dar.

Material und Methoden:

In unserer Fallberichtserie stellen wir fünf Patienten einer dermatologischen Klinik mit sehr schmerzhaften chronischen Wunden der unteren Extremität vor. Bei den Patienten war ein Pyoderma gangraenosum, eine Epidermolysis bullosa dystrophica, ein Ulcus cruris hypertonicum Martorell, ein Ulcus cruris metabolicum sowie ein gramnegativer Fußinfekt diagnostiziert worden. Bei allen Patienten war ein chirurgisches Débridement aufgrund der ausgeprägten Schmerzhaftigkeit in lokaler Anästhesie nicht möglich. Um einen operativen Eingriff in Intubationsnarkose zu vermeiden, wurde bei diesen Patienten ein Débridement mit Debrisoft durchgeführt.

Ergebnisse:

Bei allen Patienten war eine schmerzarme, nahezu vollständige Abtragung der Fibrinbeläge mittels einmaliger Anwendung von Debrisoft® ohne weitere analgesierende Maßnahmen möglich.

Schlussfolgerung:

Das Débridement mittels Debrisoft® stellt insbesondere bei Patienten mit sehr schmerzhaften chronischen Wunden mit ausgeprägten Fibrinbelägen eine nicht-invasive und daher sichere, schmerzarme Alternative dar. Diese neue Therapieoption kann auch ohne größeren materiellen oder zeitlichen Aufwand ambulant durchgeführt werden.