Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Eighty-four patients who were endoscopically confirmed to have healed duodenal ulcers were entered into this 1 year, double-blind, placebo-controlled trial of sucralfate, lg twice daily, in the prevention of duodenal ulcer recurrence. Patients remained in the study until recurrence of ulceration was endoscopically confirmed. Sixty-one patients could be evaluated for efficacy of treatment. Within 6 months, 23 of 31 placebo patients (74%) and 6 of 30 sucralfate patients (20%) had ulcer recurrence. At 12 months, 25 of 31 placebo patients (80%) and 8 of 30 receiving sucralfate (27%) had ulcer recurrence. The lower rate of ulcer recurrence in patients receiving sucralfate was significant (p = 0.0001). Survival curves also showed that sucralfate was significantly more effective in preventing relapse (p = 0.0001). Three patients were judged as experiencing drug-related side effects, two of which were in the placebo group. The results indicate that sucralfate is significantly more effective than placebo in the prevention of recurrence of duodenal ulcer disease.

In the vast majority of cases, appropriate identification and mitigation of risk factors can prevent or minimize pressure ulcer (PU) formation. However, some PUs are unavoidable. Based on the importance of this topic and the lack of literature focused on PU unavoidability, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference in 2014 to explore the issue of PU unavoidability within an organ system framework, which considered the complexities of nonmodifiable intrinsic and extrinsic risk factors. Prior to the conference, an extensive literature review was conducted to analyze and summarize the state of the science in the area of unavoidable PU development and items were developed. An interactive process was used to gain consensus based on these items among stakeholders of various organizations and audience members. Consensus was reached when 80% agreement was obtained. The group reached consensus that unavoidable PUs do occur. Consensus was also obtained in areas related to cardiopulmonary status, hemodynamic stability, impact of head-of-bed elevation, septic shock, body edema, burns, immobility, medical devices, spinal cord injury, terminal illness, and nutrition.

Yes / BACKGROUND: Venous leg ulcers (VLUs) are the commonest cause of leg ulceration, affecting 1 in 100 adults. There is a significant health burden associated with VLUs - it is estimated that the cost of treatment for 1 ulcer is up to pound1300 per year in the NHS. The mainstay of treatment is with graduated compression bandaging; however, treatment is often prolonged and up to one quarter of venous leg ulcers do not heal despite standard care. Two previous trials have suggested that low-dose aspirin, as an adjunct to standard care, may hasten healing, but these trials were small and of poor quality. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established. METHODS/DESIGN: AVURT is a phase II randomised double blind, parallel-group, placebo-controlled efficacy trial. The primary objective is to examine whether aspirin, in addition to standard care, is effective in patients with chronic VLUs (i.e. over 6 weeks in duration or a history of VLU). Secondary objectives include feasibility and safety of aspirin in this population. A target of 100 participants, identified from community leg ulcer clinics and hospital clinics, will be randomised to receive either 300 mg of aspirin once daily or placebo. All participants will receive standard care with compression therapy. The primary outcome will be time to healing of the reference ulcer. Follow-up will occur for a maximum of 27 weeks. The primary analysis will use a Cox proportional hazards model to compare time to healing using the principles of intention-to-treat. Secondary outcomes will include ulcer size, pain evaluation, compliance and adverse events. DISCUSSION: The AVURT trial will investigate the efficacy and safety of aspirin as a treatment for VLU and will inform on the feasibility of proceeding to a larger phase III study. This study will address the paucity of information currently available regarding aspirin therapy to treat VLU. TRIAL REGISTRATION: The study is registered on a public database with clinicaltrials.gov ( NCT02333123 ; registered on 5 November 2014).

BACKGROUND: Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors' knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists' diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. METHODS: A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. RESULTS: Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11-15 years median experience. Participants reported treating a median of 21-30 diabetes patients each week, including 1-5 with foot ulcers. Overall, participants registered median scores of at least "very often" (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: "never" (1 (1 - 3)) using total contact casting, "sometimes" (4 (2 - 5)) performing an ankle brachial index, "sometimes" (4 (1 - 6)) using University of Texas Wound Classification System, and "sometimes" (4 (3 - 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). CONCLUSIONS: This study provides the first baseline information on Australian podiatrists' adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

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Pressure ulcers (PUs) are a very common health problem. Nurses in clinical practice collect large volumes of PU data every day, which must be recorded and used appropriately. With this in mind, this research explored how PU data is recorded and used in clinical settings. In addition, the magnitude of PU problem in Jordan was assessed. A mixed methods approach was utilised to address the research objectives. As a first stage, Tissue Viability Nurses (TVNs) in the UK from the Tissue Viability Society (TVS) and the National Health Service (NHS) were asked to complete an online questionnaire. Subsequently, a number of them (n=16) participated in semi-structured interviews in order to complement and explain the questionnaire responses. In Jordan, a cross sectional point prevalence survey employing the European Pressure Ulcer Advisory Panel (EPUAP) methodology was conducted to measure the prevalence rate of pressure ulcers. Integration between the questionnaire and interview results occurred on a number of different occasions. The questionnaire findings (n=167) showed there to be a difference in the prevalence rate between the primary and secondary settings (X2=20.59, df=3, p&lt;0.001), with an overall mean of 7%, and a range of 0.5-25%. It was also found that the prevalence survey and clinical audits (71.8%, n=120), conducted annually (40.9%, n=67) or monthly (22.6%, n=37) by TVNs (63.6%, n=105), were the most common methods of calculating the reported prevalence rate. The field notes taken during the interviews, which were analysed thematically using the template analysis approach, highlighted that PU audits can be conducted via additional methods to those reported in the questionnaires. These include: actual audits where patients are inspected by TVNs or link nurses; relying on the nurses to complete audit forms; and, finally, reviewing the recording systems to generate reports. Moreover, the questionnaire findings showed that PU data is mainly recorded on a combination system (48.2%, n=79), or in some cases recorded on a computerised system (9.8%, n=16). The interviews again complement these findings by expanding that PU data can be recorded, reported and referred using paper, electronic or combination records. The advantages and disadvantages of each recording system were explored and defined into separate themes. Additionally, conducting a PU audit requires certain tools. It was clear from the questionnaire that the Waterlow risk assessment scale (RAS) (88.8%, n=142), and the EPUAP classification tool (83%, n=132) were the most commonly used in the UK. Regarding the uses of PU data, the interview findings showed that there are several. For example, it can be used to generate reports about PU in a given organisation, and these reports can be used to provide feedback to the nurses, TVNs, and management, and could also prompt decisions about purchasing equipment, employing nurses or offering training in areas where there are high levels of PU cases. Prevalence and incidence data, in particular, can be used to evaluate intervention, to monitor quality, to ensure best practice is provided, as educational tools for conducting audits, and for initiating safeguarding and investigating procedures. Despite all these potential uses, however, some interviewees think that some PU data, especially the prevalence data, is useless and difficult to capture, and that incidence data is more reliable and powerful. In Jordan, the researcher examined the skin of all inpatients aged eighteen or above, except patients in the emergency, day care and maternity wards, in both university and general hospitals. This yielded a sample of 302 patients. Any PU identified was graded according to the EPUAP grading scale (GS). The risk of PU development was assessed using the Braden scale. Data was also collected on preventive measures used in the clinical setting. Of the patients examined, 11.9% (n=36) had PU grade 1-4 (excluding grade 1: 6.6%, n=20). Interestingly, this PU prevalence rate is lower than that published in most studies which have employed the same methodology but it is thought that the differences in age and frailty in the Jordanian sample, compared with most others, could explain the low prevalence. The sacrum and heel were the most commonly affected sites (55.6%, n=20). Grade one was the most common grade (44.4%, n=16) and 85 (28.1%) patients were considered at risk of developing pressure damages. Despite the relatively low prevalence, very few patients at risk received adequate prevention measures (16.5%, n=14), and there is therefore a need to raise awareness of the need for PU prevention in Jordan.