BACKGROUND: Chronic venous insufficiency (CVI) may lead to sustained elevated pressure (aka venous hypertension) in the dermal venous microcirculation. Risk factors include advanced age, obesity, female gender, pregnancy, and prolonged standing. CVI in the lower extremities may lead to cutaneous changes such as xerosis and venous leg dermatitis (VLD). This review explores skin barrier restoration using skincare for xerosis and VLD.    Methods: Prior to the meeting, a structured literature search yielded information on fourteen draft statements. During the meeting, a multi-disciplinary group of experts adopted five statements on xerosis and VLD supported by the literature and the authors’ clinical expertise.   Results: VLD and associated xerosis is a common condition requiring more attention from healthcare providers. Compression therapy is the standard CVI and should be combined with good-quality skincare to enhance adherence to treatment. Maintaining an intact skin barrier by preventing and treating xerosis using gentle cleansers and ceramide-containing moisturizers may improve the skin sequelae of CVI. Skincare is frequently lacking or overlooked as part of the treatment of patients with CVI and VLD. This skin treatment is an unmet need that can be addressed with ceramides-containing pH balanced cleansers and moisturizers.
CONCLUSIONS: Compression therapy is the mainstay of treatment for CVI and VLD. Quality skincare can improve treatment adherence and the efficacy of compression therapy. Using a skincare agent may reduce friction and help patients avoid skin trauma while putting on compression garments. A ceramide-containing moisturizer sustained significant improvements in skin moisturization for 24 hours and may offer synergistic benefits together with compression treatment.  J Drugs Dermatol. 2024;23(2):61-66.     doi:10.36849/JDD.7588.

OBJECTIVE: Evaluate the discriminative and convergent validity of visual scales for the assessment of movement quality in the single-leg squat.
METHODS: Searches performed in CINAHL, Cochrane, Embase, PubMed, SPORTDiscus and Web of Science databases. Studies evaluating discriminative and convergent validity of movement quality visual assessments in single-leg squats were included. The COSMIN risk of bias checklist was used to assess the risk of bias, and certainty of evidence was assessed by the GRADE modified version.
RESULTS: Ten studies evaluating three different methods of visual assessment of the single-leg squat (Crossley scale; Whatman score and Medial knee displacement) were included. Very low certainty evidence suggests that the Crossley scale had sufficient discriminative validity for patient-centred outcomes. Very low to moderate certainty evidence suggests that the three visual methods of assessment of the single-leg squat had insufficient discriminative validity for surrogate outcomes and groups. None of the three methods had the convergent validity assessed.
CONCLUSIONS: The Crossley scale exhibited sufficient discriminative validity for patient-centred outcomes, although the evidence supporting this conclusion is of very low certainty. Visual scales for the assessment of the single-leg squat movement quality should be used with caution in clinical practice as most methods had insufficient discriminative validity and no reports of convergent validity.

BACKGROUND: Although there have been a number of studies exploring the impact and efficacy of transfemoral prosthetic components such as knee and foot mechanisms, the empirical evidence surrounding transfemoral prosthetic interface considerations is limited. This constitutes a substantial void for practicing clinicians seeking to apply best practices for patients who use transfemoral prostheses. Recent years have seen increased production and availability of clinical practice guidelines germane to prosthetic rehabilitation. In those areas where empirical evidence is lacking, consensus clinical opinions may constitute the highest level of evidence.
OBJECTIVE: A consensus exercise was performed to generate clinical practice recommendations in the areas of transfemoral interface considerations including socket variations and critical design features, suspension and interface considerations, alignment, heat retention and dermatologic considerations, female considerations, surgical considerations, and both regulatory and ethical considerations related to osseointegration.
METHODS: This began with the generation of postulate items through systematic and narrative literature reviews. A Delphi consensus exercise was performed among clinical experts in government hospital and private clinical practice settings, culminating in a series of clinical practice recommendations associated with the prosthesis-limb interface for individuals with transfemoral amputation.
RESULTS: The completed recommendations include guidance statements relative to socket variations and critical design features, female considerations, suspension and interface considerations, surgical variations and prescription considerations, rehabilitation team considerations and both regulatory and ethical considerations related to osseointegration.
CONCLUSIONS: The Delphi process facilitated the development of practice guidelines for transfemoral prosthetic interface considerations based on aggregated subject matter expertise.

Defining universally accepted guidelines for the diagnosis and treatment of chronic exertional compartment syndrome (CECS) is hampered by the absence of high-quality scientific research. The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS of the leg in civilian and military patient populations.
An international expert group was queried using the Delphi technique with a traditional three-round electronic consultation. Results of previous rounds were anonymously disclosed in the questionnaire of rounds 2 and 3, if relevant. Consensus was defined as > 70% positive or negative agreement for a question or statement.
The panel consisted of 27 civilian and military healthcare providers. Consensus was reached on five essential key characteristics of lower leg CECS. The panel achieved partial agreement regarding standardization of the diagnostic protocol, including muscle tissue pressure measurements. Consensus was reached on conservative and surgical treatment regimens. However, the experts did not attain consensus on their approach of postoperative rehabilitation and preferred treatment approach of recurrent or residual disease. A summary of best clinical practice for the diagnosis and management of CECS was formulated by experts working in civilian and military healthcare facilities.
The Delphi panel reached consensus on key criteria for signs and symptoms of CECS and several aspects for conservative and surgical treatment. The panel did not agree on the role of ICP values in the diagnostic process, postoperative rehabilitation guidelines protocol, or the preferred treatment approach for recurrent or residual disease. These aspects serve as a first attempt to initiate simple guidelines for clinical practice.

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Acute or chronic redness of the lower leg is a frequent reason for visits to clinics and practices. The differential diagnosis is often challenging. The aim of this guideline is to define criteria and procedures for the differential diagnosis of acute or chronic, unilateral or bilateral redness of the lower leg. Finding the correct diagnosis is essential for selecting an appropriate treatment and can help to reduce the inappropriate use of antibiotics. The guideline committee identified the most relevant differential diagnoses: 1. erysipelas, 2. stasis dermatitis, 3. hyperergic ictus reaction, 4. superficial and deep vein thrombosis, 5. gout, 6. chronic allergic contact dermatitis, and 7. acute toxic or allergic contact dermatitis. Algorithms/diagnostic pathways, each of which can be broken down into anamnesis, clinical examination, and diagnostics, have been developed for these seven diagnoses. In addition, the guideline group identified over 40 other relevant diagnoses and summarized their characteristics in a table to facilitate further differential diagnoses.

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BACKGROUND: Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers.
OBJECTIVE: We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice.
METHODS: We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers.
METHODS: We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia.
METHODS: We recruited general practitioners (15) and practice nurses (20).
METHODS: We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners\' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains.
RESULTS: Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes.
CONCLUSIONS: We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.

BACKGROUND:  Because of the demographic change, lower extremity peripheral artery disease (PAD) is becoming increasingly relevant with respect to health economics. PAD patients often suffer from multiple diseases. Consequently, therapy is commonly complex and requires an interdisciplinary approach. Because of rapid technical developments, interventional endovascular therapy regimens play an increasingly important role.
METHODS:  Review and literature search on the basis of the current German S3 guidelines on the therapy of PAD as well as international guidelines. In terms of state-of-the-art therapies, relevant current studies were considered.
RESULTS:  Knowledge of existing guidelines and recommendations as well as new therapeutic approaches is essential for the adequate therapy of PAD patients. A close cooperation between the interventional radiologist and the vascular surgeon is the key to success. In addition to established conservative approaches and invasive bypass surgery, the endovascular approach has been a mainstay in the TASC A and B environment for years. It has recently shown promising results in advanced PAD conditions, such as TASC C and D. An endovascular-first strategy is defined in most guidelines.
CONCLUSIONS:  A primarily endovascular-first strategy has become the standard in the majority of even complex lesions of the lower extremity arterial system. Regarding the crural segment, a decrease in mortality compared to bypass surgery has been demonstrated. Further evidence can be expected from ongoing randomized multicenter trials.
CONCLUSIONS:   · Adequate diagnostic examination is essential for the classification and strategy of therapy in PAD. · Therapeutic decisions are ideally made in an interdisciplinary conference. · Interventional therapy of intermittent claudication after exhaustion of conservative and medicamentous therapy. · Endovascular-first approach in supra- and infrainguinal lesions. · Additional evidence expected from future randomized trials.
UNASSIGNED: · Kersting J, Kamper L, Das M et al. Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD) - Current Data and Perspectives. Fortschr Röntgenstr 2019; 191: 311 - 322.
UNASSIGNED:  Die periphere arterielle Verschlusskrankheit (PAVK) hat aufgrund des demografischen Wandels eine zunehmende gesundheitsökonomische Relevanz. PAVK-Patienten sind häufig mehrfach vorerkrankt und dementsprechend komplex und interdisziplinär zu behandeln. Der endovaskulär-interventionellen Therapie fällt dank rascher technischer Entwicklungen eine immer zentralere Rolle zu.
METHODS:  Allgemeines Review mit Literaturrecherche, ausgehend von der aktuellen deutschen S3-Leitlinie zur Therapie der PAVK sowie aktuellen internationalen Leitlinien. Im Hinblick auf moderne Therapieverfahren fand die aktuelle Studienlage Berücksichtigung.
UNASSIGNED:  Die Kenntnis aktueller Leitlinien und Handlungsempfehlungen sowie neuer therapeutischer Tendenzen und Ansätze ist essenziell zur suffizienten Behandlung von PAVK-Patienten. Zudem ist eine enge Zusammenarbeit zwischen interventioneller Radiologie und Gefäßchirurgie der Schlüssel zum Erfolg. Neben konservativen Ansätzen und den Bypass-OP-Verfahren haben die endovaskulären Ansätze stark an Bedeutung gewonnen. Diese sind in den PAVK-Stadien TASC A und B seit vielen Jahren Methode der Wahl und zeigen nunmehr vielversprechende Ergebnisse in der Behandlung von diffizilen TASC-C- und -D-Konstellationen. Eine primär endovaskuläre Strategie ist in einer Vielzahl der Fälle leitliniengerecht.
UNASSIGNED:  Die primär endovaskuläre Vorgehensweise ist mittlerweile bei der Mehrzahl auch komplexer Läsionen der Becken-Bein-Achse zum Standard geworden. Der endovaskuläre Ansatz zeigt läsionsbezogen gut belegte Vorteile gegenüber der Bypass-Chirurgie, so zum Beispiel im Unterschenkelsegment eine Senkung der Mortalität. Weitere Evidenz wird zukünftig durch mehrere großangelegte randomisierte Multicenterstudien erwartet.
UNASSIGNED:   · Suffiziente Diagnostik essenziell zur Einordnung und Therapiefindung bei PAVK. · Therapieentscheidung idealerweise in interdisziplinärer Fallkonferenz. · Ausschöpfung konservativer sowie medikamentöser Therapie vor Intervention im Stadium der intermittierenden Claudicatio. · Primär endovaskulärer Ansatz bei supra- und infrainguinalen Läsionen. · Zusätzliche Evidenz von kommenden randomisierten Studien zu erwarten.
UNASSIGNED: · Kersting J, Kamper L, Das M et al. Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD) – Current Data and Perspectives. Fortschr Röntgenstr 2019; 191: 311 – 322.

The aim was to evaluate the quality of current venous leg ulcer (VLU) clinical practice guidelines (CPGs) to assist healthcare professionals in choosing an accessible high quality CPG to advise their practice, and to identify areas for improvement in future versions of current CPGs.
A systematic review of PubMed, Embase, online CPG databases, and reference lists of included CPGs was carried out. Full text CPGs published no earlier than 1998 reporting evidence based recommendations on VLU diagnosis and management in English were included. CPGs that were only available if purchased were excluded. Two reviewers identified eligible CPGs, extracted data, and assessed the quality independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Significant scoring discrepancies were discussed with a third reviewer.
Fourteen eligible CPGs were identified (1999-2016). The majority of CPGs originated from Europe or North America. Overall, there was good inter-reviewer reliability of scores with an intraclass correlation coefficient of 0.986 (95% confidence interval 0.979-0.991). No single CPG achieved the highest score in all six domains. Significant methodological heterogeneity was observed across VLU CPGs; however, consistently, poor performance was noted in domain 5, concerning CPG applicability.
Four CPGs were considered of adequate quality for clinical use. Consolidation of efforts to drive high quality, comprehensive VLU CPGs is necessary to reduce the number of and heterogeneity seen in currently published guidelines. Elements of methodological quality are lacking and a structured approach with use of checklists and CPG creation tools, such as AGREE II or others, may bolster rigour in future VLU CPGs.