Welcome to the new year and new opportunities to promote patient-centered care. In this issue, you can find useful clinical pearls for almost every patient population, with articles reporting on a variety of skin conditions and associated chronic wounds.
In this month's CME article, Lazar et al examined patient-centered outcomes for patients with a venous leg ulcer by reviewing a large number of randomized controlled trials. Although many studies reported results regarding wound healing and pain control, few examined mobility and the positive benefits of walking. Walking stimulates the calf muscle pump and promotes local muscle contraction, propelling the venous blood toward the heart. A recent study identified impaired calf muscle pump as a surrogate measure of frailty and reported that it has a negative impact on circulatory function. Halkar et al1 linked abnormal calf muscle pump function as a predictor of all-cause mortality, including heart failure.
The CME authors also identified the need for research on risk factors associated with delayed healing. One step would be to accurately characterize venous disease and co-existing arterial disease. The recently updated CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification of venous disease is an ideal framework to delineate potential delayed healing risk factors associated with venous disease.2 Future studies should use this classification system to investigate the importance of key venous disease parameters. In addition, research should also use traditional ankle-brachial pressure index measurements or audible signals along with segmental lower limb duplex arterial Dopplers to accurately characterize co-existing arterial disease.
We hope that by now you have read the report by the Agency for Healthcare Research and Quality (AHRQ) on how digital tools promote patient-centered care.3 This project highlighted the AHRQ's 2021 annual report from its Digital Healthcare Research Program, describing 21 completed and 25 ongoing projects.4 Although not specifically focused on skin and wound care, the new data on managing BP is vitally important in the total care management of persons with diabetes mellitus.
Dr Laitereerapong's report highlighted patients' self-report on an app at home prior to a clinical visit.5 Patients who self-reported had higher rates of depression than those assessed at their provider appointments, underscoring the importance of treating the wounded person holistically. Health encompasses the body-mind connection. It is not just the tissue that is injured; the person's mind also needs attention. As we have written previously, "the hole (the wound) is more than the sum of its parts."
This finding reminded us of an important article by Dr Kodange where he stated, "Patient well-being can be overlooked in wound assessment protocols focused on the local wound bed only."6 In the newly revised Wound Bed Preparation model, depression and mental health are part of the patient-centered concerns: Just as pain is assessed, so too should be the patient's mental health. Revisit Dr Kodange's article for information on screening for depression and subtle signs of depression and anxiety in patients with wounds.6
We have a whole new year ahead of us-let's advance the science of skin and wound care by listening to the patient to develop a care plan that addresses their concerns.
Elizabeth A. Ayello, PhD, MS, RN, CWON, FAAN
R. Gary Sibbald, MD, MEd, FAAD, JM
REFERENCES