Prevalence Of Venous Leg Ulcers Research Articles

Venous Leg Ulcers: Advanced Therapies and New Technologies.

The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. Medical devices, such as a muscle pump activator, or intermittent pneumatic compression device, may be especially useful for specific subgroups of patients suffering from VLUs. Some of the above-mentioned technologies require broader evidence of clinical efficacy and are still considered experimental therapies in dermatology.

An estimate of the economic burden of venous leg ulcers associated with deep venous disease.

Introduction:Venous leg ulcers (VLU) embody the most severe stage of the broad spectrum of chronic venous disease. Approximately 40% of patients with VLU present with the underlying deep venous disease (DVD). Although the data are scarce, these deep venous disease-related VLU (DRV) are thought to have higher recurrence rates and a substantial economic burden. The objective of this study was to assess the economic burden of DRV across Australia, France, Germany, Italy, Spain, the UK, and the USA.Methods:A comprehensive literature review was undertaken to identify publications documenting the incidence and prevalence of VLU and DRV, medical resource utilization, and associated costs of DRV. Findings from this literature review were used to estimate the economic burden of illness, including direct medical costs over a 12-month interval following initial presentation of a newly formed DRV.Results:Total annual incidence of new or recurrent DRV in Australia, France, Germany, Italy, Spain, UK, and the US are estimated at 122,000, 263,000, 345,000, 253,000, 85,000, 230,000, and 643,000 events, respectively, in 2019. Incidence ranges from 0.73 to 3.12 per 1000 persons per year. The estimated annual direct medical costs for patients managed conservatively in these geographies total ~ $10.73 billion (USD) or $5527 per person per year.Conclusion:The availability of published data on the costs of VLU care varies widely across countries considered in this analysis. Although country-specific VLU practice patterns vary, there is a uniform pattern of high-cost care.

A relational database within the Leg Club Network: an audit.

The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management. The Lindsay Leg Club model is an alternative approach to the management of leg health that can improve patient outcomes. This article reports on an audit of a relational database located within the Leg Club Network, containing records of more than 17 000 patients (known as members) who attended a Leg Club in a 5‐year period (2014‐2019). Overall, over 266 000 member leg assessments and treatments were entered into the database. The average nurse‐member attendance time was 28 min, with a skill mix of 23% senior nurses, 70% qualified and associate nurses, and 7% nurses in supervisory roles. Healing rates averaged 62% after 12 weeks. Recurrence rates were 20% after 12 weeks. Annual clinical and volunteer hours averaged 821 and 800 h, respectively. Staffing costs were £28 per wound treatment or leg assessment with a typical duration of 27 min; 71% of members were aged 70 to 94 years old, which indicates the need for a service that caters to the specific requirements of this age group. However, no data on psychosocial and well‐being outcomes were recorded. Their inclusion in further developments of this database is recommended.

Compression therapy for chronic oedema and venous leg ulcers: CoFlex TLC Calamine.

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.

Venous leg ulcers: essentials of wound management

The prevalence of venous leg ulcers is expected to increase, due to an ageing population and sedentary lifestyles. Marie Todd emphasises the importance of well-trained staff, effective wound management and adequate compression.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice.

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).

Nurses' knowledge about venous leg ulcer care: a literature review.

There is an increasing prevalence of venous leg ulcers coinciding with increasing older people populations. They are therefore important health problems, which restrict daily activities and incur high costs. Efficient and comprehensive nursing care for people with venous leg ulcers requires knowledge of causes, presentations and characteristics, the effects that venous leg ulcers have on individuals and nursing care with evidence-based treatment. To identify the gaps between nurses' demonstrated knowledge of venous leg ulcers and the related nursing care treatment with evidence-based nursing care. A computerized search using MEDLINE, CINAHL the COCHRANE LIBRARY was conducted. The initial search yielded 174 citations from which 16 relevant articles were included in this review. Four themes in venous leg ulcer nursing care emerged demonstrating nurses' knowledge gaps: assessment, physiology and the healing process, nursing care and dressings, and compression treatment. This review suggests that there is a lack of knowledge related to venous leg ulcer physiology, the healing process and how this influences care and treatment. Nurses may not be using the evidence base sufficiently well to support ulcer healing and patient well-being. There is a need for a positive work culture development and ongoing educational programmes aimed at improving nurses' knowledge of venous leg ulcer treatment and care, which address the themes within the results of this review.

A budget impact analysis comparing a Hydrofiber®; dressing to an alginate dressing in managing exuding venous leg ulcers in France

An Excel model was developed to compare total costs (including primary and secondary dressings only) of Hydrofiber(®) ; dressing (2010 branded price) versus an alginate dressing (generic or branded price) in managing exuding venous leg ulcers considering mean wear time and mean duration of exudate management phase, from the French Social Security perspective over 5 years (2011-2015). Budget impact (based on prevalence of venous leg ulcers in France) was estimated as the difference between scenario 1 (Hydrofiber(®) ; versus alginate dressing usage proportion increasing slightly per year) and Scenario2 (proportion remaining at 2010 levels). Annual costs and net savings per patient for the dressings were calculated in analyses 1 and 2. Analysis 1 (28-day mean exudate management phase for both Hydrofiber(®) ; and alginate dressing groups): total costs 66·82€ Hydrofiber(®) ;, 70·08€ generic alginate, 77·0€ branded alginate; net savings 3·26€ and 10·18€ for Hydrofiber(®) ; versus generic and branded alginate. Analysis 2 (mean exudate management phase of 22·2 versus 28 days for Hydrofiber(®) ; versus alginate): total costs 52·92€, 70·08€ and 77·0€, and net savings 17·10€ and 24·02€, accordingly. Total cost savings (budget impact scenario 1 minus scenario 2): Analysis 1 - 223 107€ and 696 304€ for Hydrofiber(®) ; versus generic and branded alginate dressings, respectively; Analysis 2 - 1 169 845€ and 1 643 042€ accordingly. Sensitivity analyses indicated that results are reliable. This conservative analysis shows that effective exudate management using Hydrofiber(®) ; dressing can produce sizeable cost savings.

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Prevention and treatment of venous ulcers in primary chronic venous insufficiency

Hydrogel sheet dressings and short-stretch cohesive bandaging: case study

Hard-to-heal wounds such as leg ulcers are associated with long duration and a high incidence of complications such as pain, often resulting in considerable financial burden (European Wound Management Association (EWMA), 2008). The financial burden is not just one for the NHS but for the patients as well in lost days from work, taxi fares, prescription charges and even having to take early retirement. The prevalence of venous leg ulcers is approximately 1% in the whole population and this increases with age. Where appropriate research-based treatment protocols and guidelines are in place, about 50% of leg ulcers heal within 4months (EWMA, 2008). The following case study demonstrates that using protocols, national and local guidelines can have a positive effect on the patients wound care journey and promote optimal wound care (Wounds UK, 2008).

Conservative versus surgical treatment of venous leg ulcers: A prospective, randomized, multicenter trial

The prevalence of venous leg ulcers is as high as 1% to 1.5%, and the total costs of this disease are 1% of the total annual health care budget in Western European countries. Treatment modalities are conservative or surgical. Subfascial endoscopic perforating vein surgery (SEPS) combined with superficial vein ligation is performed in many centers to address vein incompetence in patients with chronic venous leg ulcers. Several reports describe good healing and low recurrence rates, although a randomized trial to compare surgical treatment including SEPS and treatment of the superficial venous system to conservative modalities has never been performed. Therefore, a prospective, randomized, multicenter trial was conducted to study whether ambulatory compression therapy with venous surgery is a better treatment than just ambulatory compression therapy in venous leg ulcer patients. Patients with an active (open) venous leg ulcer (CEAP C6) qualified for the study. The study consisted of two treatment groups. All patients were treated by standardized ambulatory compression therapy, and half of the patients received SEPS. Concomitant superficial venous incompetence was also treated in the second group. For allocation to both treatment groups, each patient was assigned by a computer program at the randomization center. The primary goal of the study was to compare the ulcer-free period during follow-up in both study groups. Secondary end points were ulcer healing and recurrence rates. From April 1997 until January 2001, 200 ulcerated legs (170 patients) were included in the study in 12 centers in The Netherlands. A total of 97 ulcers were allocated to the surgical group and 103 to the conservative group. Patient characteristics were similar in the two treatment groups at baseline, with the exception of a higher proportion in the conservative group of diabetes mellitus. Healing rates were 83% in the surgical group and 73% in the conservative group (not significant; median time to healing, 27 months). Recurrence rates were the same in both treatment groups (22% surgical vs 23% conservative). During follow-up of a mean of 29 months (median, 27 months) in the surgical group and 26 months (median, 24 months) in the conservative group, we found that in the surgical group, the ulcer-free rate was 72%, whereas in the conservative group this rate was 53% (P = .11; Mann-Whitney test). Patients with recurrent ulceration or medially located ulcers in the surgical group had a longer ulcer-free period than those treated in the conservative group (P = .02 for both). A first-time ulcer and one of the centers also had a positive effect on the ulcer-free period during follow-up (P < .001 and P = .02), independent of the treatment group. Deep vein incompetence did not affect the ulcer-free period. In conclusion, we suggest that patients with medial and/or recurrent ulceration should receive surgery combined with ambulatory compression therapy. A dedicated center should provide care for those patients.

Venous leg ulcer: Incidence and prevalence in the elderly

Background: Venous leg ulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. Objective: Our purpose was to estimate the prevalence and incidence of venous leg ulcers in the elderly. Methods: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual prevalence and incidence of venous leg ulcer. Results: The positive predictive value of our ascertainment strategy was 98.3% (95% confidence interval [CI], 90.0, 100.0). The annual prevalence of venous leg ulcer among the elderly was 1.69 (95% CI, 1.65, 1.74). The overall incidence rate was 0.76 (95% CI, 0.71, 0.83) for men and 1.42 (1.35, 1.48) per 100 person-years for women. Conclusion: Venous leg ulcer is a significant problem in those aged 65 years and older. As compared with previous studies, because we used medical records from a population of known size, our results are precise and less biased. (J Am Acad Dermatol 2002;46:381-6.)