{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:41:10Z","timestamp":1777916470673,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2017,1,16]],"date-time":"2017-01-16T00:00:00Z","timestamp":1484524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Phlebology"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Determine the impact of CG168 on referrals to a leg ulcer service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012\u2013June 2013) and an 18-month period commencing six months after (January 2014\u2013June 2015) publication of CG168 were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p\u2009=\u20090.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p\u2009=\u20090.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p\u2009=\u20090.271) with an increase in endothermal (2 vs. 32 legs, p\u2009=\u20090.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p\u2009=\u20090.0006).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0268355516688357","type":"journal-article","created":{"date-parts":[[2017,1,18]],"date-time":"2017-01-18T04:22:42Z","timestamp":1484713362000},"page":"84-88","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service"],"prefix":"10.1177","volume":"33","author":[{"given":"Huw OB","family":"Davies","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, University of Birmingham, Netherwood House, Solihull Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Popplewell","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Birmingham, Netherwood House, Solihull Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gareth","family":"Bate","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Birmingham, Netherwood House, Solihull Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Birmingham, Netherwood House, Solihull Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy","family":"Darvall","sequence":"additional","affiliation":[{"name":"Musgrove Park Hospital, Taunton, Somerset, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W","family":"Bradbury","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Birmingham, Netherwood House, Solihull Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,1,16]]},"reference":[{"key":"bibr1-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.2003.05222.x"},{"key":"bibr2-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-5-44"},{"key":"bibr3-0268355516688357","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2014.23.12.601"},{"key":"bibr4-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12326"},{"key":"bibr5-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1007\/BF03166911"},{"key":"bibr6-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(00)00379-X"},{"key":"bibr7-0268355516688357","doi-asserted-by":"crossref","unstructured":"Nationa Institute for Health and Care Excellence Clinical Guideline 168: Varicose veins in the legs. 2013.","DOI":"10.5005\/jp\/books\/11886_17"},{"key":"bibr8-0268355516688357","first-page":"289","volume":"45","author":"Allegra C","year":"2004","journal-title":"Phlebolymphology"},{"key":"bibr9-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2004.10.002"},{"key":"bibr10-0268355516688357","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/24.5.407"},{"key":"bibr11-0268355516688357","unstructured":"National Insititute for Health and Care Excellence Clinical Knowledge Summary: Leg ulcer-venous. 2015."},{"key":"bibr12-0268355516688357","unstructured":"Scottish Intercollegiate Guidelines Network: management of chronic venous leg ulcers. 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