Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment.

BACKGROUND: Despite regular treatment of venous leg ulcers (VLUs), some fail to heal. Although several risk factors have previously been identified to be associated with the failure of VLUs to heal, the majority of studies are limited to <24-week follow-up. METHODS: A retrospective cohort study was performed at an academic vascular and wound center. A total of 65 patients with VLUs who were observed for a year or more were identified. These patients underwent a variety of treatments following the Society for Vascular Surgery and American Venous Forum VLU guidelines. Risk factors, which were based on previously defined elements for failure of VLUs to heal after a period of treatment, were examined. Both univariate (unadjusted) and multivariate (adjusted) logistic regression analyses were used to assess the magnitude of effect that a given risk factor had on healing. RESULTS: Of 65 patients treated for a minimum of 52 weeks, 19 (29%) remained unhealed. By univariate analysis, deep venous disease (P = .01; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.49-22.72), history of deep venous thrombosis (P < .001; OR, 14.06; 95% CI, 3.77-52.39), and depression (P = .04; OR, 3.89; 95% CI, 1.10-13.80) were all shown to be significant risk factors for nonhealing. The patient's race (ie, being nonwhite; P = .02; OR, 103.45; 95% CI, 1.94-5.53 × 103), deep venous disease (P = .05; OR, 37.0; 95% CI, 1.05-1.31 × 103), and history of deep venous thrombosis (P = .01; OR, 122.4; 95% CI, 3.09-4.84 × 103), however, were all shown to be significant for nonhealing under multivariate analysis. In addition, identification of an incompetent perforator (P = .02; OR, 0.006; 95% CI, 9.27 × 10-5-0.44) was conversely shown to be a good prognostic factor for healing. CONCLUSIONS: This study confirmed that risk factors known to be associated with the failure of a VLU to heal-deep venous disease and post-thrombotic etiology-were significant at 52 weeks, whereas depression and race (nonwhite) are novel risk factors. An analysis of markers of access to care showed no difference between white and nonwhite, suggesting other factors as a cause. The predominance of deep venous disease in the unhealed vs healed cohort (84% vs 48%) highlights the need for a viable treatment option for deep venous disease due to reflux. Overall, this study emphasizes the need to consider all risk factors when evaluating a patient for VLU to coordinate an effective treatment plan and to identify gaps in our treatment.

Recruitment strategy effectiveness for a cryotherapy intervention for a venous leg ulcer prevention study.

PURPOSE: To describe the strategies and costs associated with recruiting African American and white adults into a randomized controlled pilot trial. DESIGN: "Cryotherapy for Venous Disorders: A Pilot Study" is a randomized controlled trial designed to determine the effects of a cool gel wrap and leg elevation intervention versus a leg elevation alone intervention on skin temperature, skin microcirculation, quality of life, and pain in adults with stages 4 and 5 chronic venous disorders. We sought to recruit 60 participants (21 African Americans, 37 whites, and 2 Hispanic or Latino) to complete the study. These enrollment targets reflect the demographic distribution of the community in which the study was conducted (33% African American, 66% white, and 2% Latino). Proactive and reactive recruitment strategies were implemented to recruit subjects. RESULTS: Seventy-three individuals (9 African American men, 29 African American women, 11 white men, 22 white women, 1 Asian woman, and 1 Hispanic woman) were screened, and of those, 67 were randomized (9 African American men, 25 African American women, 9 white men, 22 white women, 1 Asian woman, and 1 Hispanic women). Fifty-eight completed the study, yielding an overall 11% attrition rate. An additional 8 subjects canceled or did not show up for a first appointment. Reactive recruitment strategies were most successful for recruiting men, women, African American, and white participants. The 3 most successful reactive strategies were referrals from providers/clinics (34%), flyers posted in the hospital elevators (22%), and targeted mailings from a business (16%). Of the healthcare provider referrals (19), wound care nurses referred 12 completed participants. The amount budgeted for advertisement was $5,000 (2% of the total grant award). The amount spent on recruitment including labor was $5,978, which averaged $103 per participant who completed the study (N = 58). Reactive strategies per participant completer proved more cost-efficient than proactive strategies ($83 vs $215). However, the time spent by the principal investigator (approximately 100 hours or 2.5 hours per week x 40 weeks) on recruitment, particularly maintaining frequent face-to-face contact with providers, increased success in the area of healthcare provider referrals. CONCLUSION: A variety of recruitment strategies are needed to ensure a diverse participant response to clinical research studies. As nurses become more involved in research activities, and particularly in recruitment, it is important to understand the most effective types of strategies and costs associated with these activities.

Comparison of bodily pain: persons with and without venous ulcers in an indigent care clinic.

PURPOSE: The purpose of this study was to examine bodily pain and its relationship with functional status, perception of control, coping, and depression for patients with and without venous ulcers who were receiving care in an urban, primary care clinic for low-income adults. METHODS: We used an exploratory, cross-sectional design. Participants (N = 301) completed demographic, pain severity and pain interference with function, depression, control, and coping questionnaires. Seventy patients (23.3%) had venous ulcers and 231 (76.7%) did not. RESULTS: Participants were generally male (53%, n = 159), mostly African American (92%, n = 277), and ranged in age from 22 to 74 years (M = 49.5, SD = 8.5). Persons with and without venous ulcers did not differ significantly based on gender, race, number of pain sites (n = 3.3), or self-rated health. Those with leg ulcers were significantly older, had more health problems, and were more likely to have pain-related disability. The pain descriptors used by patients with venous ulcers were sharp (89%), nagging (87%), tiring (87%), and throbbing (87%). Patients with leg ulcers reported significantly lower average pain (M = 6.0) than those without leg ulcers (M = 6.6) and greater 24-hour pain relief from treatments or medications (55% vs 44%). Patients with venous ulcers reported greater control over their pain and greater coping with pain. The 2 groups did not differ significantly on depression, life control, or purpose in life scores. CONCLUSIONS: Compared to patients without venous ulcers, those patients with venous ulcers rated their pain lower and reported higher coping and control over pain, which may be reflected in better subjective pain management despite having more pain sites and disability related to pain. Pain management for indigent patients with and without venous ulcers remains a concern and needs further study.

Etiologia da microbiota presente em úlceras venosas de usuários de bota de unna / Aetiology of the microbiota in venous ulcers of Unna’s boot users

A cicatrização das lesões crônicas é um grande desafio para o enfermeiro, que precisa contribuir para que o processo de cicatrização seja acelerado. Os microrganismos estão presentes em todas as feridas crônicas, porém a cicatrização ocorre mesmo na presença destes no leito da ferida; sendo assim, um dos fatores determinantes para que ocorra a infecção é o desequilíbrio na interação com o hospedeiro em favor do microrganismo e não a mera presença deste. Objetivou-se com este estudo identificar os microrganismos prevalentes nas Úlceras Venosas de pacientes usuários de Bota de Unna buscando minimizar os prejuízos causados na cicatrização, assim, o enfermeiro tem subsídios para orientar o paciente e contribuir para uma melhor assistência na realização dos curativos. Para isso, foi realizada uma pesquisa retrospectiva através do levantamento do resultado das culturas realizadas em Úlceras Venosas de pacientes usuários de Bota de Unna do ano de 2008 no Ambulatório para Tratamento de Úlceras da Clínica de Educação para Saúde (CEPS)...

The healing of chronic lesions is a major challenge for the nurse, who need help the healing process is accelerated. Microorganisms are present in all chronic wounds, but healing occurs even in the presence of the wound bed, so in one of the determining factors for the occurrence of infection is the imbalance in the interaction with the host in favor of micro-organism and not mere presence.This project aimed to identify microorganisms prevalent in venousulcers in patients using Unna boot to minimize damage caused to heal, so the nurse has support to guide the patient and contribute to better assist in making dressings. To this end, we conducted aretrospective study by surveying the results of cultures performed on venous ulcers in patients using Unna boot in the year 2008 at the Clinic for treatment of ulcers, Clinical Education for Health(CEPS)...