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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

Which type of compression is the most effective for healing venous leg ulcers?
There is good evidence that compression therapy is an effective intervention for patients with venous leg ulceration uncomplicated by significant arterial disease. However, there are many forms of compression therapy available
on prescription.

This updated Cochrane systematic review has re-evaluated the evidence base to seek more detailed information on the most effective forms of compression intervention.

The systematic review sought high-quality randomised, controlled trials, which compared the effectiveness of compression bandages or stockings in terms of healing venous leg ulcers. A total of 39 trials were included in the review.
The findings confirmed that patients with venous leg ulcers treated with compression healed more quickly than those who did not receive compression. Multi-component systems that consist of several layers of compression are more effective than single component systems.

Furthermore, multi-component systems that include an elastic layer appear to be more effective than those without an elastic layer. The review also showed that different versions of the four-layer system achieved similar healing rates.

A commentary notes that the improved quality of the randomised trials that are being carried out means that the results of this updated review can be more confidently stated. It also notes that, since the evidence to support the use of compression for healing venous leg ulceration is now robust, research should now shift to discovering the most effective methods for implementing these findings into practice. This may be through researching educational interventions or implementation strategies.

O'Meara S, Cullum N, Nelson EA. Compression for venous leg ulcers. Cochrane Database Syst Rev 2009;1:CD000265.

Gethin G. Evid Base Nurs 2009;12(4):116.

Is there a link between anger and hostility and coronary heart disease?
It is difficult to explore links between psychological issues and physical disease due to a number of complex methodological issues. For example, the definition of anger and hostility will vary according to sociocultural norms. To date, studies that have examined links between psychological issues and coronary heart disease (CHD) have focused on stress and anxiety.

This systematic review included 38 prospective cohort studies, which evaluated the association between hostility and anger and future CHD events in healthy people and people with CHD. CHD events were defined as CHD mortality, non-fatal myocardial infarction, angina, cardiac arrest and coronary artery stenosis. The review found that anger and hostility were associated with increased risks of CHD events for both healthy people and those with known CHD. There was a stronger association between anger and hostility and CHD for men than
for women.

A commentary notes that the results of reviews such as this must be viewed with caution because of the methodological challenges associated with such studies.  However, it suggests that it is reasonable to conclude that this review supports the link between psychological issues and physical disease and the need to provide clinical interventions that address such psychological issues.

Chida Y, Steptoe A. The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J Am Coll Cardiol 2009;5(3):936-46.

Ford K. Evid Base Nurs 2009;12(4):121.