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      The humanistic and economic burden of chronic wounds: a protocol for a systematic review

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          Abstract

          Background

          Chronic non-healing wounds present a substantial economic burden to healthcare system; significant reductions in quality of life for those affected, and precede often serious events such as limp amputations or even premature deaths. This burden is also likely to increase with a larger proportion of elderly and increasing prevalence of life-style diseases such as obesity and diabetes. Reviews of the evidence on the burden of illness associated with chronic wounds have not been comprehensive in scope and have not provided an assessment of the distribution of the health care costs across categories of resource use.

          Methods/design

          This study is a systematic review of multiple databases for studies on adult patients with chronic wounds and with the primary objective to assess the impact on health-related quality of life by category of ulcers, and associated direct and indirect costs. Eligible studies will primary be empirical studies evaluating, describing or comparing measurement of quality of life and economic impact. Two reviewers will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form. Differences in applied methodologies and uncertainties will clearly be accounted for. Conservative valuations of costs and impact on health-related quality of life will be prioritised. Variations that may depend on age distribution, the categorisation of ulcer, healthcare system etc. will be described clearly.

          Discussion

          The proposed systematic review will yield a comprehensive assessment of the humanistic and economic burden of chronic wounds in an adult population. A better understanding of the humanistic and economic burden of chronic wounds is essential for policy and planning purposes, to monitor trends in disease burden and not at least in order to estimate the real-world cost-effectiveness of new treatments and therapies.

          Systematic review registration

          PROSPERO CRD42016037496

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13643-016-0400-8) contains supplementary material, which is available to authorized users.

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          Most cited references19

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          Aging and wound healing.

          Impaired wound healing in the elderly presents a major clinical and economic problem. With the aging population growing in both number and percentage, the importance of understanding the mechanisms underlying age-related impairments in healing is increased. Normal skin exhibits characteristic changes with age that have implications for wound healing. Additionally, the process of wound healing is altered in aged individuals. Although historically healing in the aged was considered defective, there is now consensus that healing in the elderly is delayed but the final result is qualitatively similar to that in young subjects.
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            Definitions and guidelines for assessment of wounds and evaluation of healing.

            Chronic wounds represent a worldwide problem. For laboratory and clinical research to adequately address this problem, a common language needs to exist. This language should include a system of wound classification, a lexicon of wound descriptors, and a description of the processes that are likely to affect wound healing and would healing end points. The report that follows defines wound, acute wound, chronic wound, healing and forms of healing, wound assessment, wound extent, wound burden, and wound severity. The utility of these definitions is demonstrated as they relate to the healing of a skin wound, but these definitions are broadly applicable to all wounds.
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              Chronic wound repair and healing in older adults: current status and future research.

              Older adults are more likely to have chronic wounds than younger people, and the effect of chronic wounds on quality of life is particularly profound in this population. Wound healing slows with age, but the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The effect of age and accompanying multimorbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables; lack of standardization in data collection; and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this article, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify research questions to guide future study of age-associated changes in chronic wound healing.
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                Author and article information

                Contributors
                kjarbrink@ntu.edu.sg
                gaoni@ntu.edu.sg
                henrik.sonnergren@med.lu.se
                artur.schmidtchen@ntu.edu.sg
                carolinepang@ntu.edu.sg
                rambajpai@ntu.edu.sg
                josip.car@imperial.ac.uk , josip.car@ntu.edu.sg
                Journal
                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                2046-4053
                24 January 2017
                24 January 2017
                2017
                : 6
                : 15
                Affiliations
                [1 ]ISNI 0000 0001 2224 0361, GRID grid.59025.3b, Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, , Nanyang Technological University, ; 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921 Singapore
                [2 ]GRID grid.411843.b, Department of Dermatology, , Skåne University Hospital, ; Lasarettsgatan 15, 221 85 Lund, Sweden
                [3 ]ISNI 0000 0001 2224 0361, GRID grid.59025.3b, Dermatology and Innate Immunity Laboratory, Lee Kong Chian School of Medicine, , Nanyang Technological University, ; 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921 Singapore
                [4 ]ISNI 0000 0001 2224 0361, GRID grid.59025.3b, Medical Library, , Lee Kong Chian School of Medicine, ; 11 Mandalay Road, Singapore, 308232 Singapore
                [5 ]ISNI 0000 0001 2113 8111, GRID grid.7445.2, Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, , Imperial College London, ; 3rd Floor Reynolds Building, St Dunstan’s Road, London, W6 8RP UK
                Author information
                http://orcid.org/0000-0001-8969-371X
                Article
                400
                10.1186/s13643-016-0400-8
                5259833
                28118847
                60cc8656-8828-458d-bc6a-0573f90990ba
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 29 April 2016
                : 19 December 2016
                Funding
                Funded by: Lee Kong Chian School of Medicine, Nanyang Technological University
                Funded by: FundRef http://dx.doi.org/10.13039/501100001348, Agency for Science, Technology and Research;
                Categories
                Protocol
                Custom metadata
                © The Author(s) 2017

                Public health
                chronic wounds,hard-to-heal ulcers,quality of life,health-related quality of life,quality-adjusted life years,cost of illness,costs and cost analysis,economics

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