Prevalence and characteristics of lymphoedema at a wound-care clinic.

OBJECTIVE: Lymphoedema is estimated to affect up to 300,000 Canadians but remains underrecognised and undertreated. A retrospective chart review was conducted to determine the clinical characteristics and treatment practices of lymphoedema in a Canadian wound care clinic. METHOD: Data were collected retrospectively from dictated clinic notes of 326 lymphoedema patients at a wound clinic in a regional rehabilitation hospital. RESULTS: The mean age (±SD) of diagnosis was 66.8 (±15.5). Patients had 7.3 (±3.3) comorbidities and took 8.4 (±4.6) concomitant medications. The most common comorbidities were venous disease (73%), hypertension (60%), and obesity (46%). Clinic patients were less likely to be women, have arm lymphoedema, or have cancer-related aetiology compared with previous studies, reflecting a two-tiered model of care delivery in the area. Treatments prescribed by the clinic were consistent best practice recommendations for conservative treatment. CONCLUSION: A significant proportion of the wound clinic's patients had lymphoedema. Lack of resources, lack of awareness among primary care providers, and patient adherence are barriers to lymphoedema care.

Lymphedema in Canada: a qualitative study to help develop a clinical, research, and education strategy.

OBJECTIVE: The aim of this study was to gather data from Canadian stakeholders to help construct a national strategy and agenda for lymphedema management. METHODS: The Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema therapists, patient advocates, and others, used participatory action research and Open Space Technology to identify issues and build consensus at a national meeting of lymphedema stakeholders. Proceedings were videotaped and underwent content analysis. Existing Canadian documentation on lymphedema services was analyzed. Using those data sources, the Canadian Lymphedema Framework drafted a development strategy. RESULTS: Of 320 invited stakeholders (patients, therapists, physicians, industry representatives, and health policymakers), 108 participated in a day-long videotaped meeting discussing strategies to improve the management of lymphedema and related disorders in Canada. Participants identified barriers, challenges, and issues related to the need to raise awareness about lymphedema with patients, physicians, and the public. Five priority areas for development were articulated: education, standards, research, reimbursement and access to treatment, and advocacy. The main barrier to development was identified as the lack of clear responsibility within the health care system for lymphedema care. CONCLUSIONS: Data from stakeholders was obtained to solidly define priority areas for lymphedema development at a national level. The Canadian Lymphedema Framework has created a working plan, an advisory board, and working groups to implement the strategy.

Chronic wound caring ... a long journey toward healing.

Healthcare professionals use words like "frustrating," "expensive," and "time-consuming" to describe chronic wound care. Healing a wound that has been present for an extended period of time is difficult. Often the problem is not just the wound but also the "woundedness" of the individual with the wound. The patient's needs in chronic wound care often continue over months, years, or even a lifetime. This article addresses more than the wound--it offers healthcare professionals' accounts of patient stories and their active involvement in the long journey toward chronic wound healing.

Photographic assessment of the appearance of chronic pressure and leg ulcers.

The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT) used in this comparison represents a modified version of the PSST and includes the six domains that can be determined from wound photographs. The PWAT was used on photographs of both chronic pressure ulcers (n = 56) and leg ulcers due to vascular insufficiency (n = 81). The photographic tool has excellent intrarater (ICC = 0.96) and interrater (ICC = 0.73) reliability and good concurrent validity (r = 0.70) compared with a full bedside assessment PSST. The PWAT has also shown to be sensitive to change in wound appearance of healing ulcers, but not nonhealing ulcers. These results would suggest that in the event that a full bedside assessment is not possible, wound photographs may be used to accurately assess wound appearance of both chronic pressure ulcers located on the trunk and vascular ulcers of the lower extremity. Establishing a valid and reliable assessment of wound healing using photographic images is of great relevance to the advancing fields of computer image analysis and telemedicine.

Why do patients seek family physicians' services for cold symptoms?

OBJECTIVE: To examine the frequency of presentation to family physicians' offices for cold symptoms, the reasons for presentation, and the duration of symptoms before presentation. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: One hundred consecutive patient encounters in each of 15 family practices from January 27 to February 3, 1994, involving both academic and non-academic family physicians in the London region. Data were collected prospectively using a checklist attached to each chart. MAIN OUTCOME MEASURES: Proportion of patients presenting with cold symptoms, reasons for presentation, number of days patients had had symptoms, billing code. RESULTS: A total of 1421 checklists were analyzed, 822 from academic practices and 599 from community practices. Proportion of presentations for cold symptoms was 14.8%, but visits coded as common cold represented 5.7%. Median number of days patients waited before presentation was 7.0; older patients tended to wait longer. Many patients were worried about developing complications (51.0%) or were fed up with their symptoms (31.9%). Most patients were between the ages of 20 and 64 (44.6%), and 57.6% of all patients had developed complications requiring treatment. CONCLUSIONS: The proportion of visits coded as common cold was lower than Ontario averages. Most patients had complications rather than simple colds and had managed their symptoms on their own for a fairly long time.

Pressure ulcer assessment instruments: a critical appraisal.

Numerous evaluation tools have been developed to document various aspects of wound status or appearance of pressure ulcers. These include the Pressure Sore Status Tool (PSST), Pressure Ulcer Scale for Healing (PUSH Tool), Sussman Wound Healing Tool (SWHT), Sessing scale, and the Wound Healing Scale (WHS). A critical appraisal of the literature was undertaken to examine the purpose and methods for the development of each instrument, the extent to which the instruments have been validated to date, the practicality of their use, and the work that remains to be done to establish their suitability for clinical and/or research purposes. All of these instruments have been developed to describe and evaluate change in pressure ulcer status over time with the exception of the WHS, which was developed as an alternative to reverse staging. More of the validation parameters have been addressed for the PSST and the Sessing scale than for the PUSH Tool, the SWHT, and the WHS. All of the instruments can be completed within approximately 5 minutes except the PSST, which requires 10 to 15 minutes to complete. For all instruments, experience with wounds and training in the use of the instrument are required to improve reliability. For each of the measurement instruments, suggestions are made that would complete necessary validation procedures and thus prepare the instruments for clinical and/or research purposes.

The basic principles of wound care.

A chronic wound should prompt a search for the underlying causes. Knowledge of the physiology of the normal wound healing trajectory through the stages of hemostasis, inflammation, granulation, and maturation provides a framework for understanding the advantages of moist interactive wound healing. Good chronic wound care is patient-centered, holistic, interdisciplinary, and evidence-based.