Chronic Leg Ulceration - Essay Example

Chronic Leg Ulceration Collins (2004) defined ulcers as failure of breaks in the skin layers to heal. When this ulcer fails to heal, they develop into chronic type of ulcer. Chronic ulcers on the foot and leg affect mostly the elderly patients (Collins 2004). Poor circulation of the blood in the legs is the most common cause of chronic leg ulcers (arterial and venous leg ulcers). Other causes are inclusive of: (1) Injuries – traumatic ulcers; (2) Diabetes – due to poor circulation of blood or sensation loss that results in pressure ulcers; (3) Certain conditions in the skin; (4) Vascular diseases such as stroke, angina, and heart attack; (5) Tumors; and (6) Infections. 1. Examine briefly the use of the Nottingham Health Profile (NHP) tool to measure the concept of health related quality of life in patients with chronic leg ulceration in the MAIN ARTICLE According to Franks, Moffatt, Doherty, et al (2006), leg ulceration is an important morbidity that is recognized to give a negative impact on the health related quality of life (HRQoL) of the patient. Nottingham Health Profile (NBP) and SF – 36 are generic tools used to evaluate HRQoL through qualitative methodologies. The NHP consists of 38 statements grouped into six domains and are inclusive of the following: (1) physical mobility, (2) bodily pain, (3) sleep, (4) social isolation, (5) emotional reaction, and (6) energy. In all three clinical assessments, patients were administered NHP. Although patients were encouraged to complete the tool unassisted, those patients who were having eyesight or reading difficulties were provided assistance by research nurses. Like any other generic tools, NHP is highly dependent on respondents’ age and gender and a score ranging from 0 (indicating that patient does not perceive the problem) to 100 (indicating very worst problem perception). Franks, Moffatt, Doherty, et al (2006) noted that NHP is an effective tool to distinguish various chronic conditions and its impact on the lives of the patients. Franks, Moffatt, Doherty, et al (2006) added that a number of studies noted that under a variety of conditions, NHP is capable of detecting clinical changes. Furthermore, NHP validity has been evaluated in patients having chronic ulceration of the leg and its results revealed that in patients’ clinical status, this tool was sensitive to the changes. Lastly, Franks, Moffatt, Doherty, et al (2006) noted that NHP has been an effective tool in distinguishing patients with leg ulcers healed after 12 weeks compared to the leg ulcers that remained unhealed. 2. Compare and contrast the literature and identify an alternative method that the authors of the main article could have used to measure health and quality of life in their study Franks, Moffatt, Doherty, et al (2006) stated that studies for short follow ups that examined health – related quality of life of the patient have shown consistent improvements. On the other hand, studies for longer – term effect of patients’ treatment is known in a little amount. In southwest London, United Kingdom, all patients suffering from leg ulcers were examined for leg ulcer as well as those who completed the Nottingham Health Profile and were followed up at 24 to 48 weeks. Franks, Moffatt, Doherty, et al (2006) stated that 76 years was the mean age (SD 13) for the patients and 50 (63.2%) being women. The ulcers were present for “a median of 8 months” before the study with a median ulceration area of 4.0 cm. Twenty four weeks after, a significant pain improvement was noted in 41 patients with ulcers and 43 patients with healed ulcers. After 48 weeks, in both groups, improvements had been reduced and the energy that previously improved after 24 weeks also deteriorated in both patients. Franks, Moffatt, Doherty, et al (2006) found out that over time, the treatment positive effects on the quality of life that is health – related may not be sustained and it was reported that this may be a consequence of health status general deterioration as the elderly patients age. In this study, Franks, Moffatt, Doherty, et al used the NHP validity to detect clinical changes and noted NHP as effective in distinguishing healing of the leg ulcer of the patient. In line with the study of Franks, Moffatt, Doherty, et al (2006), Hedner, Carlsson, Kulich, et al (2004) noted that only few studies were done to evaluate patient – reported outcomes that are in connection with the primary event of thrombosis in the deep veins. This is partly due to lack of measures that are specific for diseases. Hence, this study is aimed to develop a disease specific health related quality of life (HRQL) measure and deep venous thrombosis quality of life questionnaire (DVTQOL) for patients being exposed recently and being treated with proximal deep venous thrombosis. Hedner, Carlsson, Kulich, et al (2004) added that DVTQOL is an instrument that is valid and reliable for measuring HRQL in patient who had DVT recently and are currently being treated with oral anticoagulation. Hence, Hedner, Carlsson, Kulich, et al (2004) concluded that DVTQOL is an instrument that is short and friendly to the users with good reliability and validity. However, Hedner, Carlsson, Kulich, et al suggested that reliability on test – retest and responsiveness to change clinical trials must be explored. In contrast with the study of Franks, Moffatt, Doherty, et al (2006) who uses Nottingham Health Profile measurement, the study of Hedner, Carlsson, Kulich, et al (2004) dealt further on the study of deep venous thrombosis quality of life questionnaire in measuring disease specific health quality of life of the patient. However, just like the study of Franks, Moffatt, Doherty, et al (2006) health – related quality of life of the patient among patients with leg ulcers were examined. On the other hand, Jull, Walker, Hackett et al (2004) made a population based control study to quantify the effect of ulceration of the leg on health – related quality of life to estimate the value of a health state for ulceration of the leg. In this study, 241 people with leg ulcer of different etiology and 224 controls were randomly selected from electoral roll by using stratified sampling. From this study, Jull, Walker, Hackett et al (2004) concluded that the quality of life is reduced by leg ulcers and to a similar extent with common chronic conditions such as arthritis and diabetes. This study confirms the impression from the investigations that were done qualitatively that ulceration of the leg imposes significant burden on the sufferers. The result of this study provides HRQOL baseline that facilitates international comparison in people who are suffering from ulcers of the leg and second, this study allows comparison among disease conditions. Lastly, this study proved strategic group values providing health policy and planning inputs and enriching prevalence and traditional options. Just like the study of Jull, Walker, Hackett et al (2004), the study of Franks, Moffatt, Doherty, et al (2006) and Hedner, Carlsson, Kulich, et al (2004) were able to establish that specific health related quality of life (HRQL) of the patient were much affected with chronic leg ulcers. Persoon, Heinen, Van der Vleuten et al, (2004) made a systematic review of literature on the impact of the leg ulcers on the daily life of the patients. Studies for venous leg ulcers up to year 2002 were searched from Medline and Cinahl databases and this was followed by “snowball method.” From the studies, it was reported that ulcers in the leg posed a threat to physical and to psychological function and to some extent, social functioning. Its major limitations were pain and immobility, disturbance of sleep, lack of energy, work limitations, worries, frustrations, and lack of self esteem. When compared to healthy individuals, it was reported that these patients have significant poor quality of life when compare to individuals who are healthy. Persoon, Heinen, Van der Vleuten et al, (2004) concluded that ulcer of the leg had brought impact to the lives of the patient. This study further confirmed the studies of Franks, Moffatt, Doherty, et al (2006); Hedner, Carlsson, Kulich, et al (2004); and Jull, Walker, Hackett et al (2004) noting that the health – related quality of life is markedly reduced by the effects of ulceration of the leg of patient. Briggs and Flemming (2007) made another study on the patients living with ulceration of the leg. The aim of this study was to identify and synthesize all published research studies that are qualitative in nature exploring the experience of the patients living with ulcer of the leg. Briggs and Flemming revealed from this review of studies that ulceration of the leg can have significant effect in the life of a person and leaves detrimental effects on the life of a person. In this study, it was noted that ulceration of the leg must be viewed as a condition that is chronic and debilitating. Briggs and Fleming (2007) however noted some limitations of the study. These include the following: (1) Only quantified the finding and the weight was given to the majority view, (2) this study is viewed from different philosophical perspective, and (3) includes studies irrespective to the type of ulcer. In contrast with the aforementioned studies, the study of Briggs and Flemming were concerned on published research studies on patients with leg ulcers. In line with Briggs and Flemming, Persoon, Heinen, Van der Vleuten et al, (2004) made a systematic review of literature on the impact of the leg ulcers. Although different methods were made to come to a conclusion, all researchers were able to prove that leg ulcers posed physical, psychological and social functioning, thereby decreasing the quality of life of these patients. Another way to validate the quality of life of the patient was done by Hareendran, Doll, Wild, Mofatt, et al, (2007) who made a study aiming to develop as well as validate a disease specific quality of life (QoL) measure that is based on SKINDEX – 29, a conceptual model, for patients suffering from chronic venous leg ulcer (VLU). Hareendran, Doll, Wild, Mofatt, et al found out that VLU – QoL has a “good psychometric properties.” The sensitivity of this instrument to clinical outcome differences and change response in clinical parameters made it as a tool that is useful to assess treatment outcome from the perspective of the patients. The strengths that were noted in this study include the following: (1) clearly defined recruitment and samples that are large among VLU patients, (2) the simultaneous collection of the factors that are clinical and reported by the patients, and (3) reassessment of the same patients after 2 -3 days and 8 weeks thereafter for psychometric instrument validation. In relation to other studies, another research was made to identify the specific quality of life of the patient suffering from chronic leg ulcer was measured using the SKINDEX - 29 done by Hareendran, Doll, Wild, Mofatt, et al, (2007). Although different method was applied by other researchers in the aforementioned studies, Hareendran, Doll, Wild, Mofatt, et al, made the same conclusion that a significant relationship between treatment status and wound healing exists in all studies. References Briggs, M. and Flemming, K. 2007, Living with leg ulceration: a synthesis of qualitative research. Journal of Advanced Nursing, 59(4), pp. 319-328. Collins, S. 2004. Foot and Leg Ulcers. Retrieved, June 24, 2008, from http://www.tiscali.co.uk/lifestyle/healthfitness/health_advice/netdoctor/archive/000135.html Franks, P. Moffatt, C. Doherty, D. Smithdale, R. and Martin, R. 2006. Longer-term changes in quality of life in chronic leg ulceration. Wound Repair and Regeneration 14(2006), pp. 536 – 541. Hareendran, A. Doll, H. Wild, D. Mofatt, C. Musgrove, E. Wheatley, C. and Franks, P. 2007. The venous leg ulcer quality of life (VLU-QoL) questionnaire: development and psychometric validation. Wound Repair and Regeneration, 15(2007), pp. 265 – 273. Hedner, W. Carlsson, J. Kulich, K. Stigendal, L. Ingelgard, A. and Wiklund, I. 2004. An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire. Health and Quality Life Outcomes, 2(30), pp. 2-8. Jull, A. Walker, N. Hackett, M. Jones, M. Rodgers, A. Birchall, N. Norton, R. and MacMahon, S. 2004. Leg ulceration and perceived health: a population based case-control study. Age and Ageing 33(3), pp. 236-241. Persoon, A. Heinen, M. Van der Vleuten, C. De Rooij, M. Van de Kerkhof, P. and Van Archterberg, T. 2004. Leg Ulcers: A review if their impact in daily life. Journal of Clinical Nursing, 13, pp. 341-354. Read More