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- Olsson, Maja, et al.
(författare)
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The humanistic and economic burden of chronic wounds : A systematic review
- 2019
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Ingår i: Wound Repair and Regeneration. - : Wiley. - 1067-1927. ; 27:1, s. 114-125
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Forskningsöversikt (refereegranskat)abstract
- Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard-to-heal, or having led to an amputation. The review excluded studies that did not present data on generic health-related quality of life and/or cost data, case studies, randomized controlled trials, economic modeling studies, abstracts, and editorials. Extracted data were summarized into a narrative synthesis, and for a few articles using the same health-related quality of life instrument, average estimates with 95% confidence intervals were calculated. Thirty articles met the inclusion criteria. Findings revealed that health-related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound-related amputations. The cost burden was mainly attributed to amputations for patients also comorbid with diabetes, where the cost for hospitalization ranged from US$12,851 to US$16,267 (median) for this patient group. Patients with chronic wounds have poor health-related quality of life in general and wound-related costs are substantial. Development and implementation of wound management strategies that focus on increasing health-related quality of life and effectively reduce costs for this patient group are urgently needed.
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- Sloniecka, Marta, et al.
(författare)
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Substance P Promotes Fibrosis in Human Corneal Stroma
- 2018
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Ingår i: Wound Repair and Regeneration. - : Wound Healing Society. - 1067-1927 .- 1524-475X. ; 26:1, s. A22-A22
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Substance P (SP) is a neuropeptide which has been shown to be present in human corneal cells, keratocytes. Many studies suggest its role in various cellular processes important in wound healing such as proliferation or migration. We hypothesize that SP regulates expression of keratocyte markers, extracellular matrix (ECM) components and fibrotic markers that are overexpressed during fibrosis, in both primary keratocytes and myofibroblasts. Primary keratocytes, which were isolated from healthy human corneas obtained from the local cornea bank, and an in vitro corneal fibrosis model (myofibroblasts) were used throughout this study. The effect of SP on keratocyte and myofibroblast contractile abilities was assessed by cell contraction assay. Gene expression of keratocyte markers (keratocan and aldehyde dehydrogenase 3 family, member A1 [ALDH3A1]), ECM components (collagen I, collagen III, collagen V and lumican), and markers of fibrosis (a-smooth muscle actin [a-SMA] and fibronectin), was determined by qRT-PCR. Treatment of keratocytes with SP resulted in decreased expression of keratocan gene but increased ALDH3A expression. SP increased expression of fibrotic markers, a-SMA and fibronectin. Moreover, collagen I, collagen III and collagen V genes were also up-regulated by SP. Expression of lumican was unaffected by SP. Furthermore, keratocytes treated with SP showed increased contractile abilities. Similar effects of SP were observed in the corneal fibrosis model. SP decreased keratocan, but increased ALDH3A1 gene expression. a-SMA, fibronectin, collagen I, collagen III and collagen V genes were up-regulated. Expression of lumican was unaffected. Contractile abilities of myofibroblasts increased upon SP treatment. In conclusion, SP is able to regulate keratocyte marker genes and to increase expression of various ECM genes and fibrotic markers in both keratocytes and myofibroblasts. This suggests that SP might promote fibrosis in human cornea.
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- Örneholm, Hedvig, et al.
(författare)
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High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.
- 2015
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Ingår i: Wound Repair and Regeneration. - : Wiley. - 1524-475X .- 1067-1927. ; 23:6, s. 922-931
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Tidskriftsartikel (refereegranskat)abstract
- Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n=770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1(st) 1983 to December 31(st) 2012 were considered for the study. 701 patients (median age 67 (22-95) fulfilled the inclusion criteria and were followed according to a pre-set protocol until final outcome (healing or death). Severe peripheral vascular disease (SPVD) was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five per cent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, nine per cent (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine per cent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing. This article is protected by copyright. All rights reserved.
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- Örneholm, Hedvig, et al.
(författare)
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Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer
- 2017
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Ingår i: Wound Repair and Regeneration. - : Wiley. - 1067-1927. ; 25:2, s. 309-315
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Tidskriftsartikel (refereegranskat)abstract
- Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n = 617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a 2-year follow-up, according to a preset protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at 2 years following healing of a plantar forefoot ulcer. Thirty-four percent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within 2 years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only 8% within 2 years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research.
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