Kristina Heyer

Effectiveness of Advanced versus Conventional Wound Dressings on Healing of Chronic Wounds: Systematic Review and Meta-Analysis

Background: Wound dressings are essential in the treatment of chronic wounds and should be selected on valid and recent evidence. Objective: Effectiveness of advanced compared to conventional dressings for chronic wound healing. Methods: Comprehensive literature search, systematic review and meta-analyses of the results of advanced dressing studies on chronic wound treatment. Comprehensiveness and coverage of all relevant studies is the most striking difference in relation to other meta-analyses and systematic reviews. Results: The mean odds ratio of complete healing was 1.52 favouring advanced over conventional dressings in 65 controlled trials. In 287 study conditions including uncontrolled studies, mean odds were 0.97 (advanced dressings/controlled studies), 0.77 (conventional/controlled) and 0.47 (advanced/uncontrolled). The overall healing rate was 33%. When causal treatment was applied, a reduced effect was observed. The consideration of all types of chronic wounds, advanced wound dressings and studies resulted in more study effects, more reliable estimates of mean effects and more statistical power. These differences in the design are likely to explain the differences in the meta-analytic results. Conclusion: A general superiority of advanced dressings on complete healing was shown. The generalizability of the results is limited by the methodological and report quality within studies identified, unexplained heterogeneity in study effects and possibly by publication bias.

Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data.

Epidemiologic analyses in routine care of chronic wounds are scarce, and published studies show wide variations. This study analyzes the population‐based prevalence and incidence of chronic wounds in Germany. Secondary analyses of data from a German statutory health insurance with about 9 million insured persons were examined (2010 to 2012). Internal diagnostic validations were used to control for different inclusion criteria. In 2012, 1.04% (95% CI 1.03–1.05) of insured patients had a wound diagnosis, including 0.70% with leg ulcers and 0.27% with diabetic ulcers. Wound treatment was received by 0.43% (0.43–0.44) of patients. Prevalence and incidence increased over 3 years. Extrapolated to the German population, there were 786,407 prevalent and 196,602 incident chronic wounds, including 326,334/172,026 patients who underwent wound‐relevant treatment in 2012. There is an annually increasing frequency of chronic wounds in Germany. Chronic wound epidemiology is sensitive to wound treatment as a filter criterion.

Compression therapy: scientific background and practical applications

Compression bandaging is the most prevalent form of treatment for venous leg ulcers. Successful treatment requires knowledge of the appropriate materials and the ability to employ them following current guidelines. This study investigates German health‐care providers for their knowledge of bandage materials and their practical ability in applying short‐stretch compression bandages.

Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany.

Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large‐scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD‐10 diagnoses. The status of active disease was defined by wound‐specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010–2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi‐component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under‐provision of care, with CT in incident VLUs in Germany requiring active measures.

Compression therapy - current practice of care: level of knowledge in patients with venous leg ulcers.

Compression therapy is a mainstay in the causal treatment of patients with venous leg ulcers. It facilitates healing, reduces pain and recurrences, and increases quality of life. Up until now, there is a scarcity of scientific data with respect to the level of care and the specific knowledge of patients with venous leg ulcers.

Quality of Care of Patients with Chronic Lymphoedema in Germany

Background: The management of lymphoedema is complex and should be based on guidelines. To date, no data assessing quality of care in lymphoedema in Germany are available. Objective: We aimed at evaluating the quality of care of lymphoedema in the metropolitan area of Hamburg using guideline-based indicators. Methods: Cross-sectional, community-based study including patients with lymphoedema. Assessment included a structured interview, clinical examination and patient-reported outcomes. Quality indicators derived from guidelines by a Delphi consensus were applied. Results: 348 patients (median age 60.5 years) with lymphoedema (66.4%), lipoedema (9.5%) or combined oedema (24.1%) were included. 86.4% performed compression therapy, 85.6% received lymphatic drainage. On average 55.0% of the quality of care criteria were met; 64.8% were satisfied with care. The distribution curve of the health care index was almost normal. Treatment by specialists led to a higher quality of care index. Conclusion: Although overall quality of care in lymphoedema is fair, many patients are not treated properly according to guidelines.

Registerforschung in der Dermatologie

Patient registries are prospective, systematic data collections, which are non-interventional (observational) in nature and reflect care practices under routine conditions. As a result, they include the most common disease characteristics (e.g. in cancer registries) and/or medical interventions (e.g. in therapy registries). The importance of registries in health services research and in clinical medicine is rapidly increasing. This is due to increasingly scarce resources in the health system and the growing need for data on benefits and efficiency. Registries permit evaluation long-term outcomes on e.g. quality of life, effectiveness as well as treatment quality. An overview of registry methodology from definitions to data analysis is given, existing registries in dermatology in Germany are summarized.

Prevalence and Regional Distribution of Lower Limb Amputations from 2006 to 2012 in Germany: A Population based Study

OBJECTIVE/BACKGROUND International studies show conflicting results regarding the frequency of lower limb amputations over time. However, published data are often based on event related amputation frequencies per year, on hospital statistics or on regional surveys. Thus, they do not allow population based statements. The present study assesses the population based epidemiology of amputations in Germany. METHODS Secondary analyses of 80 German statutory health insurance companies with 4 million insurants nationwide in 2012 were performed. From 2006 to 2012, lower limb amputations were identified in the entire population and in persons with diabetes mellitus (DM) and arterial occlusive disease (AOD). Lower limb amputations and persons with DM and arterial occlusive diseases were extracted by specific operation procedure codes and International Classification of Diseases-10 codes. Descriptive standardized analyses by age, sex, and regional distribution were conducted. RESULTS The proportion of patients with at least one lower limb amputation in the entire population stayed constant over time at 0.04% (95% confidence interval [CI] 0.04-0.04). Extrapolated to the German population in 2012 there were 49,150 cases and 32,767 persons with amputations. In 2012, about 70% of amputations were minor (0.03% [95% CI 0.03-0.03]) versus major amputations (0.01% [95% CI 0.01-0.01]). Related to DM and AOD, there was a small decrease in the amputation rate per patient, even though the DM prevalence increased by 10.4%. CONCLUSION The amputation rates per patient in Germany have remained stable in the overall population and show slight decline in patients with diabetes mellitus and with arterial occlusive disease between 2006 and 2012. In the future, intensified preventive measures are crucial to reduce the number of amputations of the lower extremities permanently.

Kompressionstherapie – Versorgungspraxis: Informationsstand von Patienten mit Ulcus cruris venosum

Eine Säule der kausalen Therapie bei Patienten mit Ulcus cruris venosum ist die Kompressionstherapie. Sie unterstützt die Abheilung, reduziert Schmerzen und Rezidive und steigert die Lebensqualität. Bislang existieren kaum wissenschaftliche Daten zu dem Versorgungsstand und fachspezifischem Wissen von Patienten mit Ulcus cruris venosum.

Registry research in dermatology

Patient registries are prospective, systematic data collections, which are non-interventional (observational) in nature and reflect care practices under routine conditions. As a result, they include the most common disease characteristics (e.g. in cancer registries) and/or medical interventions (e.g. in therapy registries). The importance of registries in health services research and in clinical medicine is rapidly increasing. This is due to increasingly scarce resources in the health system and the growing need for data on benefits and efficiency. Registries permit evaluation long-term outcomes on e.g. quality of life, effectiveness as well as treatment quality. An overview of registry methodology from definitions to data analysis is given, existing registries in dermatology in Germany are summarized.