A Cross-sectional, Comparative Study of Pain and Activity in Persons With and Without Injection-Related Venous Ulcers
Index: Ostomy Wound Manage. 2013;59(5):14–24.
Persons with leg ulcers, including venous ulcers, often report pain. A cross-sectional, comparative study was conducted among 61 patients receiving care in an urban clinic (31 with and 30 without a venous ulcer, mean age 54 years [range 40 to 65 years], 93% African American) to examine pain and its relation to activity and walking in persons with injection-related venous ulcers. The questionnaire included items about pain and its treatment, as well as activity and walking (ie, Brief Pain Inventory [BPI] Short Form, Self-Treatment of Pain, Pain and Narcotic Use, Difficulty with Activities, and Walking Scale questionnaires). Among those with a venous ulcer (VU+), worst pain significantly related to total interference (r = 0.65, P <0.0001) and total difficulty (r = 0.42, P = 0.02) BPI scores. The common pain sites for those VU+ involved the legs (24, 36.4%), wound sites (13, 19.7%), back (eight, 12.1%), general body (five, 7.6%), shoulder and knee (four, 6.1% each), and other (eight, 12.1%). Persons VU+ were more likely than those without a venous ulcer (VU-) to have received a prescription for narcotics in the past year (96% versus 41%, X2 = 21.3, P <0.0001). Persons VU+ versus VU- were significantly (X2 = 8.89, P = 0.003) more likely to resort to street drug use and relapse to addiction if pain was not adequately treated. They were also twice as likely to have decreased walking over the past 5 years (67% versus 33%, X2 = 5.93, P <0.02). Among those VU+, venous ulcers added to chronic pain and decreased walking. These findings highlight the negative effects of injection-related venous ulcers on pain, activity, and walking, as well as the propensity of this group to resort to illicit drug use for pain control. Persons VU+ should have pain assessed and treated.
Keywords: venous ulcers, intravenous substance abuse, complication, pain, activity
Ramadan Fasting in Patients with a Stoma: A Prospective Study of Quality of Life and Nutritional Status
Index: Ostomy Wound Manage. 2013;59(5):26–32.
Ramadan fasting is an Islamic obligation for healthy Muslims after the age of puberty. Persons with an acute or chronic disease may be excused from this obligation; the degree of the disease is an important parameter for not fasting. Little is known about the effect of fasting on persons with a stoma. A prospective study was conducted among 56 patients with a cancer-related fecal stoma (33 [58.9%] male, mean age 55.9 ± 13.1 years) over two periods of Ramadan to analyze the effect of fasting 15 to 16 hours on nutritional and metabolic status and quality of life. Eligible patients were divided into two groups: fasting (n = 14) and nonfasting (n = 42). Demographic and stoma information, as well as disease and treatment-related variables, were evaluated. Participants completed cancer patient and colorectal cancer patient quality-of-life instruments and rated their religious orientation. Laboratory tests (blood urea nitrogen, creatinin, cholesterol, prealbumin, albumin, and transferrin) were performed 1 to 3 weeks before Ramadan, and questionnaires and tests were repeated 1 to 3 weeks after Ramadan in people who fasted. Demographic parameters, including religious orientation scale scores, were similar between fasting and nonfasting groups. Patients in the fasting group had significantly higher albumin levels (4.6 ± 0.2 versus 4.1 ± 0.4, P = 0.001), prealbumin levels (27.6 ± 7.4 versus 21.3 ± 8.5, P = 0.018), and global health status scores (81.5 ± 16.7 versus 68.3 ± 20.1, P = 0.030) than patients in the nonfasting group. Patients who fasted also had their stoma for a longer period of time than patients in the nonfasting group (average 9 months [range 3–87 months] in the fasting versus 4.5 months [range 3–36 months] in the nonfasting group, P = 0.084), and the proportion of patients with a permanent stoma was higher in the fasting group than in the nonfasting group (P = 0.051). Ramadan fasting had almost no influence on quality of life. Fasting lowered prealbumin levels (27.6 ± 7.4 versus 21.2 ± 4.4; P = 0.046), but did not adversely affect other nutritional or global health status variables. Most patients in the fasting group (13, 92.9%) stated they would feel sad if they were not fasting. The results of this study suggest that although fasting may decrease prealbumin levels, persons with a stoma and good nutritional status may decide for themselves whether to fast.
Keywords: prospective study, surgical stoma, fasting, Islam, nutritional status
The Effect of a Cellulose Dressing and Topical Vancomycin on Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive Organisms in Chronic Wounds: A Case Series
Index: Ostomy Wound Manage. 2013;59(5):34–43.
High levels of persistent bacteria may contribute to wound chronicity and delayed healing. A prospective study was conducted to: 1) evaluate the effect of applying vancomycin topically on appropriately cultured chronic lower leg wounds, specifically methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive bacteria, and 2) evaluate its effect in combination with a cellulose dressing on healing. Twenty-three (23) outpatients (11 men, 12 women, average age 65 years [range 39–89 years]) with lower extremity wounds (15 venous ulcers, six chronic open wounds with a history of diabetes, and two chronic open trauma wounds) averaging 43.58 weeks’ (range 5–121 weeks) duration and swab-cultured positive for MRSA or Gram-positive bacteria were provided 1 g vancomycin delivered by a cellulose dressing and changed every 72 hours. Patients served as their own control, and all wounds were debrided once a week. Wound surface area and bacterial and exudate levels were recorded weekly during the 3-week pretreatment period and compared to 3-week treatment period levels. Patients were followed until healed. Mean change in wound surface area was +14.5% (SD 71.91) per week before and -24.6% (SD 13.59) during the vancomycin treatment period (P = 0.014), average exudate levels decreased from 2.75 (range 1–4) to 1.81 (range 0–3) (P = 0.016), and the number of patients with positive wound cultures for MRSA or Gram-positive bacteria decreased from 23 to four after the 3-week study period. All wounds healed after an average of 8.18 weeks (SD 4.76, range 2–17 weeks). The results of this study suggest topical vancomycin applied using a dressing that retains moisture reduces wound bacterial load and may facilitate healing. Randomized, controlled clinical studies to evaluate the effectiveness and efficacy of this treatment modality and explore the relationship between wound culture results and healing are warranted.
Keywords: leg ulcers, case study, methicillin-resistant Staphylococcus aureus, vancomycin, wound healing
OWM: Please describe the education, training, and work experiences that prepared you for your current position as the executive director of the US Wound Registry (USWR).
During my residency in Family Medicine, I had some exposure to public health research. Back then, we were using paper medical records, and few people were discussing patient registries as a mechanism for research. I became interested in electronic health records in 1995 when the AMA published its 53-page physician documentation guidelines. By then, I was a faculty member of the medical school and we were threatened with pay cuts if we over-coded our services. It was clear to me that only a computer could consistently calculate the level of service correctly, given the complexity of the system. So, in 1995, I began working with a computer programmer to automate the calculation of the physician charges generated in the wound center. By 2000, Intellicure, Inc (College Station, TX) was a company, and David Walker, our CEO, had developed a similar internal calculation system for the hospital facility charges.
SAWC Poster Compendium: AQUACEL® EXTRA™ Hydrofiber® Dressing, a Novel CMC Dressing
Expert Recommendations for Optimizing Outcomes Utilizing Apligraf® for Diabetic Foot Ulcers
Innovations for Wound Bed Preparation: The Role of Drawtex Hydroconductive Dressings