A randomised study of NPWT closure versus alginate dressings in peri-vascular groin infections: quality of life, pain and cost.

OBJECTIVE: The aim of this study was to compare the vacuum assisted wound closure (VAC) system (negative pressure wound therapy; NPWT) and alginate wound dressings in terms of quality of life (QoL), pain resource use and cost in patients with deep peri-vascular groin infection after vascular surgery. METHOD: Patients with deep peri-vascular groin infection (Szilagyi grade III) were included and randomised to NPWT or alginate therapy. EuroQol 5D (EQ-5D) and brief pain inventory (BPI) were used to evaluate QoL and pain, respectively. RESULTS: Wound healing time until complete skin epithelialisation was shorter in the NPWT (n=9) compared to the alginate group (n=7), median 57 and 104 days, respectively (p=0.026). No difference was recorded in QoL and pain between the groups at study start and the second assessment. QoL analysis within groups between time points, showed that patients in NPWT groups improved in EQ-5D domains, 'self-care' (p= 0.034), 'usual activities' (p=0.046); EQ-5D index value (p=0.046) and EQ-VAS (p=0.028). Patients in the NPWT group reported significantly less pain 'affecting their relations with other people' and 'sleep' between time points. The NPWT group had significantly fewer dressing changes compared to the alginate group (p<0.001). The median frequency of wound dressing changes outside hospital was 20 (IQR 6-29) in the NPWT group (n=9), compared to 48 (IQR 42-77) in the alginate group (n=8; p=0.004). The saved personnel time for wound care in the first week for the NPWT group, compared with the alginate group, was 4.5 hours per week per nurse. The total hospitalised care cost was 83-87% of the total cost in both groups. CONCLUSION: NPWT therapy in patients with deep peri-vascular groin infection can be regarded as the dominant strategy due to improved clinical outcome with equal cost and quality of life measures.

Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital.

AIMS AND OBJECTIVES: This study aimed to describe and identify risk factors associated with hospital-acquired pressure ulcers among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. BACKGROUND: Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital-acquired pressure ulcers compared with patients with pre-existing pressure ulcers. DESIGN: A point prevalence study with a cross-sectional survey design was conducted at a Swedish university hospital. METHOD: Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. RESULTS: The prevalence of pressure ulcers was 27% (95% confidence interval, 23-31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. CONCLUSION: The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development. RELEVANCE TO CLINICAL PRACTICE: Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.

Patients' experiences of living with peripheral arterial disease awaiting intervention: a qualitative study.

The aim of this study was to investigate patients' experiences of living with peripheral arterial disease (PAD) and the influence on activities of daily living. Twenty-four patients with various degrees of PAD were interviewed. The transcribed texts were analysed using manifest and latent content analysis. Living with PAD meant carrying a hard-to-bear physical, social and emotional burden, and struggling for relief. The experience of burden was interpreted in the following themes representing consequences and strategies for gaining control in daily life: (I) "being limited by the burden" (II) "striving to relieve the burden" (III) "accepting and adapting to the feeling of burden". The use of different coping strategies was crucial to achieve some relief. Pain and sleep disturbance emerged as a major feature of living with PAD, and by combining both analgesics and non-pharmacological methods some pain relief was received. To provide optimal alleviation of pain for these patients, education about pain and pain management is of great importance followed by regular evaluations of the pain and pain management. Furthermore, the study underlines the importance of preventing the progression of the vascular disease and from the individual power and knowledge support and preserve as independent life as possible.