Clinimetrics of the Lanarkshire Oximetry Index for patients with leg ulcers: A systematic review and meta-analysis.

Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.

A fresh way to treat venous leg ulcers with measured compression.

The majority of lower leg ulceration has a venous component. Compression therapy is the "Gold Standard" to reverse venous hypertension and heal venous ulceration. Over recent years, new compression systems have evolved which means greater choice for patients. This describes venous disease and assessment and treatment choices. Case studies are also presented.

Preventing, assessing and managing skin tears.

The ageing population means nurses in all care settings are increasingly likely to care for patients with skin tears. This article reviews the evidence on preventing, assessing and managing these.

Causes and strategies for moisture lesions.

Moisture lesions or incontinence-associated dermatitis are painful and distressing consequences of prolonged exposure to urine and faeces. They may adversely affect patients' physical and psychological wellbeing, so minimising damage is a vital part of the nurse's role. This article outlines their causes and strategies to prevent and treat them, as well as the causes of urinary and faecal incontinence and containment options.

Management of skin conditions in the older population 2.

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.

Assessment of skin integrity in the elderly 1.

Intrinsic changes to the skin are a normal part of the ageing process. Careful assessment of the skin for any abnormalities should be included in any patients' holistic assessment. It is essential that all health care professionals have a fundamental knowledge of the structure and function of the skin in order to be able to assess any changes to normal skin; identify existing skin problems and potential risk factors. Only by carrying out a detailed and systematic examination, we can implement effective strategies of management. This is the first of two papers. This paper will describe the structure and functions of the skin and explore skin assessment. The second paper will describe some of the more common skin conditions seen in ageing skin and their management.

Pulse oximetry vascular assessment in patients with leg ulcers.

Arterial screening of the lower limbs is recommended before compression therapy is initiated in patients with ulceration or dermatitis. Hand-held Doppler ABPI is the accepted assessment tool but has limitations. Pulse oximeters have potential as alternative screening instruments with some advantages over Doppler. This article reviews the mode of action, application and limitations of pulse oximeters. A pulse oximetry toe/finger arterial screening index, which may be used as an alternative to Doppler ABPI, is described. Case studies are reported in which arterial blood flow which was easily detected by pulse oximetry could not be detected by Doppler.