Biomedical subjects
Publications and source records attributed to J J Dale.
Clients are more likely to wear compression hosiery and look after it properly if they understand how it works. Community nurses can enhance their clients' compliance by educating them about the role compression hosiery plays in treating and preventing venous disease.
Graduated compression hosiery is used with a range of conditions caused by insufficient venous return. It is vital for patients to have the correct hosiery for their condition, and to understand its importance.
Six hundred patients with chronic leg ulcers were assessed and classified with regard to social class, mobility and employment. It has been shown that there is no increased incidence of chronic leg ulceration in the more disadvantaged socio-economic groups, but when leg ulceration occurs it is more likely to be recurrent and take longer to heal. Although in only 11% of patients was mobility affected by leg ulceration alone, the condition interfered with work and or leisure activities to a moderate or severe degree in 42%.
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In a controlled trial to ascertain whether ultrasound given weekly in conjunction with a standard treatment for chronic leg ulcers improves the rate of healing 56 patients were randomised to standard treatment (paste impregnated bandage and a self-adhesive elastic bandage) and 52 to standard treatment plus pulsed ultrasound given weekly. After 12 weeks the proportion of ulcers healed was 20% greater in the ultrasound than in the control group.
Six hundred patients with chronic leg ulcers were studied by detailed history and examination as part of a population survey. In 22% ulceration began before the age of 40, and in this group the sex incidence was equal. Over age 40 there was an increasing preponderance of women. Ulcers were significantly more common in the left leg in women but not in men. The site of 26% of ulcers did not include the classical medial goiter area. The median duration of the ulceration at the time of the survey was nine months and 20% had not healed in over two years. The great majority of patients had had recurrence, 66% having had episodes of ulceration for more than five years. Healing of ulcers is a serious problem, but preventing recurrence is the greater challenge.
Six hundred patients with chronic leg ulcers were interviewed and examined for evidence of arterial impairment. There were 827 ulcerated legs. Pedal pulses could not be felt in 94 (11%). A Doppler resting pressure index of 0.9 or less was found in 176 legs (21%). Risk factors for arterial impairment included age, ulceration affecting the foot, and a history of claudication, ischaemic heart disease, or cerebrovascular disease. Roughly half the patients with arterial impairment also showed the clinical features of chronic venous insufficiency. Careful assessment for arterial disease is mandatory before patients with chronic leg ulcers are treated with elastic compression.
A postal survey in two health board areas in Scotland, encompassing a population of about one million, identified 1477 patients with chronic ulcers of the leg. Women outnumbered men by a ratio of 2.8:1. The median age of the women was 74 and of the men 67. Seventy two (5%) were hospital inpatients, 174 (12%) were managed jointly by the primary care team and outpatient departments, and 1201 (83%) were managed entirely in the community. Efforts to improve the management of chronic ulcers of the leg should focus on primary health care.