Made available in DSpace on 2016-04-27T18:47:31Z (GMT). No. of bitstreams: 1 Maria Vilma dos Santos.pdf: 756420 bytes, checksum: 0d36376c620e3d71348e5d07b90dacf1 (MD5) Previous issue date: 2008-10-14 / To analyze the factors that interfere in the process of cicatrisation of the bearers of chronic wounds with age above 60 years was the general objective of this research with qualitative approach. He/she tells himself the implementation of the nursing intervention in the treatment of chronic wound accomplished in a senior person, typical participant in the municipal district of Diadema-SP, and it analyzes other five people's bearers of chronic wounds deposition. He/she identified a gap in the social relationships the they be nurtured by the knowledge to take care of itself and of the other as same subjects, learning and teaching to face with wisdom the physiologic and practical challenges concerning the attention the health. It was verified, also the impact that the wounds generate in the senior person, considering the aspects physical, psychological, social and economical relationships; pointing the importance of the orientation and attendance of the nursing in the treatment of wounds, detaching the Program Health of the Family as a service that provides the opportunity of an integration of the cares the these people / Analisar os fatores que interferem no processo de cicatrização dos portadores de feridas crônicas com idade acima de 60 anos foi o objetivo geral desta pesquisa com abordagem qualitativa. Relata-se a implementação da intervenção de enfermagem no tratamento de ferida crônica realizado em uma pessoa idosa, participante típica no município de Diadema-SP, e analisa o depoimento de outras cinco pessoas portadoras de feridas crônicas. Identificou-se uma lacuna nas relações sociais a serem nutridas pelo saber cuidar de si e do outro como sujeitos iguais, aprendendo e ensinando a enfrentar com sabedoria os desafios fisiológicos e práticos acerca da atenção a saúde. Verificou-se, também o impacto que as feridas geram na pessoa idosa, considerando os aspectos físicos, psicológicos, relações sociais e econômicas; apontando a importância da orientação e assistência da enfermagem no tratamento de feridas, destacando o Programa Saúde da Família como um serviço que proporciona a oportunidade de uma integralidade dos cuidados a estas pessoas

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective To determine the scope of knowledge possessed by fifth year medical students, general practitioners (GP’s) and surgical registrars, concerning chronic wound management. Design Cross sectional study Methods Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at three universities and general practitioners attending refresher courses. Result. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GP’s and 47 surgical registrars completed questionnaires. The overall median (25th–75th percentiles) knowledge scores for registrars, GP’s and students were 65%;(55%–70%), 55%;(45%–65%) and 45%;(35%–50%) respectively. Whereas the scores of registrars and GP’s did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GP’s attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound-care was only mild to moderate, with more GP’s than registrars requesting literature. Conclusions Very little, if any training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country; however it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.

Basic theoretical bases As a chronic wound is called a secondarily healing wound which despite adequate therapy does not tend to heal for a period of 6-9 weeks. The cause of the chronic wound occurrence and its transformation into an acute wound can be infection, influence of associated diseases, skin top layer microtraumatization or skin necrosis cavity. Among the most frequent types of chronic wounds there are aligned venous ulcerations, arterial rodent ulcers, decubitus ulcers and neuropathic rodent ulcers as a consequence of diabetes mellitus disease. Knowledge about wound healing has been deepened considerably in the last few years. The pharmaceutical industry introduces to the market continuously new means of phase wound healing and owing to new trends the classical treatment has nearly disappeared. Essay targets 1.To monitor nurse knowledge about new trends in chronic wound healing. 2.To determine what means of draping and bandaging materials are used in chronic wound treatment in practice and what means appear to be the most effective. 3.To find out if in practical terms there are conditions for nurses to use new trends in chronic wound healing and what constraints they meet in their endeavour to apply these trends. 4.To learn if patients with a non-healing wound are informed about new trends in chronic wound healing. 5.To learn if new trends in chronic wound healing are available for affected patients and in what extent they are used by them. 6.To determine if new trends in chronic wound healing improve life quality of patients with chronic wounds. Used methods The empirical part of the diploma work was processed with a tool of qualitative research inquiry. For data acquisition I chose the technique of semi-structured interview with respondents. For research inquiry I selected two groups of respondents. The first group of respondents was comprised of 10 nurses employed in Nemocnice České Budějovice, a.s. and in the other group there were 5 patients hospitalized in this facility. The interview findings were analysed and divided into categories. For clear arrangement there were created schemes to individual categories in XMind programme. The schemes are supplied with commentary and several quotations of the respondents. Findings From interview analyses it is clear that there is a certain influence of individuality. In the first part there is monitored nurse knowledge about modern trends in chronic wound healing. The conclusion of the research is that in all sections where interviewed nurses work chronic wounds are treated by the way of wet (phase) healing. I also found out that there are several therapeutic and draping materials suitable for all phases of chronic wound healing. There are also described a few practical problems which make effective care about chronic wounds difficult. In the second part there are mentioned particular defects in patient acquaintance with modern methods in wound healing and insufficient education by medical staff. There are also described all problems which deteriorate life quality of patients with chronic wounds. Conclusion The chronic wound healing methods have changed completely in the last few years. Pharmaceutical firms introduce to the market a lot of new materials facilitating very effective and comfortable care about wounds. However, this fact requires continuous education of medical staff participating in the chronic wound treatment. This brings positive results and finally decreases economic costs of care about patients with chronic wounds.

Current state: The treatment of chronic wounds is a complex process which is applied in the form of different interventions by nurses in the general practitioner's office for adults and nurses from the surgical outpatient clinic. The treatment is influenced by different equipment used in particular offices, by the presence or absence of the interest in implementing modern methods and, of course, by poor participation of health insurance companies as regards the problem in question. The treatment of chronic wounds should be accomplished by completing all the phases of the nursing process. It is necessary to seek for motivation towards further education in this field. Pursuing moist wound healing is mostly cheaper as it makes the treatment shorter, which leads to patient's satisfaction. Objectives: The objective of the thesis was to evaluate the nursing process applied during the treatment of chronic wounds in the general practitioner's office for adults and the surgical outpatient clinic, as well as observe the influence of education on the nurse's professional performance regarding this treatment. The research included the analysis of the competencies of nurses in the treatment of chronic wounds and the treatment methods chosen by the nurses to benefit the patient. Last but not least, we observed the circumstances of the admission of a nurse specialist as a GP's partner for chronic wounds treatment, and the obstacles to moist wound healing implementation in the GP's office for adults and the surgical outpatient clinic. Methods: To compare the treatment of chronic wounds in the general practitioner's office for adults and the surgical outpatient department we carried out qualitative research investigation. Data collection was based on in-depth interview with prepared open questions. The interviews were recorded by voice recorder, transcribed literally and subsequently analysed. When analysing the transcripts, we used the method of open coding, by the technique "pencil and paper". The text of the dialogues was reduced and segmented into individual codes. On the basis of similarity, the codes were classified in analytical units. The categories were classified into schemes by means of SmartArt programme in Microsoft Office Word. The results were interpreted with the use of the open cards technique. The first group of respondents consisted of nurses from a practitioner's office for adults and a private surgical outpatient department. The other group comprised practitioners for adults and surgeons treating outpatients. Research sample: The research sample consisted of 12 respondents from three medical facilities in České Budějovice. In the first set there were three nurses working in the practitioner's office for adults and three nurses working in the surgical outpatient department. The second set comprised three women MDs for adults, two surgeons treating outpatiens and a woman surgeon. The intentional selection was dependent on respondents' willingness to participate in the research and it ceased when the state of theoretical saturation was reached. Results: The research investigation showed that modern moist healing of chronic wounds is mostly implemented in the offices of practitioners rather than in surgical outpatient clinics. The surgical department is aseptic and they want to minimize the risk of possible infection. Apart from moist healing the surgeons use other modern healing methods such as laser biostimulation, biostimulatory polarized light and instrument-aided lymphatic drainage. The education of the nurses involved in chronic wounds treatment is not provided within academic courses. Just two nurses completed university education whereas the other nurses get acquainted with current information at commercial presentations provided by pharmaceutical representatives. These nurses lack the capability of objective assessment of basic and specific parameters of the wounds and of subsequent treatment.

The aim of this diploma thesis is to design and implement a multiplatform application for detection, localization and determination of the extent of chronic wounds. The application is intended to assist nurses, doctors and healthcare assistants to monitor and evaluate chronic wounds in the course of treatment. The application is based on the Typescript programming language, on the Ionic hybrid application framework and on the Electron desktop application framework. Chronic wound assessment runs on the server-side where the Python programming language is used. The Flask application framework is used for the RESTful application interface and the OpenCV library is used for image processing.

Digitalization of health care is one of the most prioritized areas within the healthcare community. Within chronic wound care, considered the silent epidemic and one of the most expensive and unsolved burdens to the medical system, the next generation of wound dressings with abilities of real-time monitoring has attracted considerable attention. The most frequent complication in a chronic wound is infection. Infection in chronic wounds not detected in time can lead to amputation of limbs or even death. Real-time monitoring of chronic wounds gives possibilities to detect infection in early stages and avoids unnecessary wound dressing changes since the change disturbs healing. Here, a prototype of an infection detection dressing has been designed. Flexible and biocompatible sensors for wound temperature and wound pH level has been used. Measured values are transmitted via Bluetooth to an Android smartphone Application where measured values are displayed together with a Wound Status Bar. Based on the Arduino Nano electronics platform, the system connects to the smartphone application, measures and displays measured values, and the wound status bar responds correctly to changes in the measured values. The prototype developed highlights questions that need to be solved when moving into the next generation of real-time monitoring wound dressings. / Digitalisering av sjukvården är ett av de mest prioriterade området inom den medicinska utvecklingen. Inom området behandling av kroniska sår, som anses vara en dold sjukdom och är en av den mest kostsamma och olösta bördan inom sjukvården, har utvecklingen av nästa generations sårförband som ska övervaka ett kroniskt sår i realtid uppmärksammats och skapat ett stort intresse. Den mest vanliga komplikationen i ett kroniskt sår är att såret blir infekterat. Om en infektion i ett sår inte blir upptäckt och behandlat i tid kan det leda till amputering av lemmar och till och med död. Med ett real-tids övervakande förband kan en infektion upptäckas i tid men kan även förhindra onödiga byten av förband då även förbandsbyten påverkar det kroniska sårets läkning. Genom att integrera flexibla och biokompatibla sensorer i ett förband som mäter temperatur och pH-värde i såret, och sedan skicka sensor data via Bluetooth till en Android applikation där data visuellt visas, har en prototyp av en infektions detekterande enhet utvecklats. Projektet resulterade i ett system där sensorerna och en Bluetooth modul kopplades till en Arduino Nano. Sensor data skickas via Bluetooth till en Android applikation där mätvärdena visas och även en indikator som uppdateras beroende på ändringar i sårets status. Framtagningen av protypen har genererat viktiga frågeställningar att överväga när nästa generations real-tids övervakande förband ska utvecklas.

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Impaired wound healing and the resulting chronic wounds may cause significant morbidity and mortality. In these pathogenic wound environments, the ratio of inflammatory and anti-inflammatory cytokines is highly biased to the pro-inflammatory side. While the inflammatory process is an essential step in healthy wound healing, chronic wounds remain in a constant self-sustaining state of inflammation. Thus, decreased cell proliferation, reduced matrix deposition and delayed wound closure are the results. Although various cytokine-based therapies have shown promising results on skin regeneration in preliminary studies, their overall clinical use has been considerably limited by the short half-life time of the signaling molecules due to rapid dilution and degradation in the protease-rich chronic wound environment. In this work, we explored the ability of starPoly(ethylene glycol)-GAG hydrogels to modulate the hallmarks of chronic wound development, such as the prolonged inflammation, increased cell influx and delayed proliferative phase. Therefore, different strategies were developed to shape the cytokine levels in the wound towards a more pro-regenerative direction, finally promoting the natural repair process in chronic skin wounds. By biomimetically utilizing the interactions between cytokines and the tissue ECM in a GAG-based biohybrid hydrogel, we could engineer the concentrations of various signaling factors involved in the regulation of the repair process. More in detail, we utilized customized functionalized starPEG-GAG hydrogels to (1) reduce the extensive levels of inflammatory chemokines by scavenging them via GAG component of the hydrogel and thus diminish immune cell influx in a mouse wound model; (2) locally deliver the immunomodulatory IL-4 and IL-10 to shift the signaling balance into the pro-regenerative direction and thus resolve inflammation and (3) administer pre-conjugated TGF-β to enhance myofibroblast differentiation and extracellular matrix deposition. We believe that the presented hydrogel platform may become a promising tool in the management of cytokines in regenerative applications, which can be translated towards the clinical use for the treatment of chronic wounds and other diseases characterized by uncontrolled inflammation.:1 introduction 1.1 Motivation 1.2 Current state of biomaterial-based concepts in dermal wound healing 1.3 Objective 2 fundamentals 2.1 The physiological process of wound healing 2.1.1 The role of macrophages in wound healing 2.1.2 The role of fibroblasts in wound healing 2.1.3 The role of cytokines and their interaction with the ECM 2.2 The pathophysiology of chronic wounds 2.3 Strategies for treatment of chronic wounds 2.4 Biomaterials in medicine 2.4.1 Polymers in medicine 2.4.2 Mechanical properties 2.4.3 Cellular adhesion 2.4.4 Interaction with cytokines 2.4.5 Scaffold degradability 2.4.6 StarPEG-GAG hydrogels as potential material in wound healing 3 materials & methods 3.1 Preparation of hydrogels 3.1.1 Functionalization of glass surfaces 3.1.2 Hydrogel formation with EDC - NHS chemistry 3.1.3 Hydrogel formation with thiol - maleimide chemistry 3.1.4 Rheometric measurement of hydrogel discs 3.1.5 Characterization of cytokine uptake and release 3.2 Culture of human & murine cells 3.2.1 Isolation and differentiation of murine dermal fibroblasts 3.2.2 Isolation & differentiation of murine macrophages 3.2.3 Culture of human & murine cell lines 3.3 In vitro methods 3.3.1 Enzyme-linked immunosorbent assay (ELISA) 3.3.2 Bead-based multiplex immunoassay 3.3.3 Live/Dead Staining 3.3.4 Crystal violet staining 3.3.5 Cell proliferation assay 3.3.6 RNA extraction & analysis 3.3.7 cDNA synthesis 3.3.8 Quantitative real time rt-PCR 3.4 Statistical analysis 3.5 Software use 4 scavenging inflammatory chemokines to control immune cell influx in the wound 4.1 Results 4.1.1 Engineering heparin-based hydrogels to scavenge chemokines 4.1.2 Heparin-based hydrogels reduce migration of immune cells 4.1.3 Heparin-based hydrogels decrease wound immune cell influx and inflammatory signaling 4.2 Discussion 5 promotion of regenerative macrophage polarizationin inflammatory environments 5.1 Results 5.1.1 Reversible complexation of IL-4 & IL-10 to starPEG-heparin gels 5.1.2 Stabilizing effects of starPEG-heparin gels on IL-4 5.1.3 IL-4 & IL-10-laden starPEG-heparin hydrogels modulate macrophage polarization 5.1.4 IL-4-laden starPEG-heparin induce collagen deposition in dermal fibroblasts 5.2 Discussion 6 modulation of human dermal fibroblast proliferation and differentiation 6.1 Results 6.1.1 Reversible complexation of TGF-b to starPEG heparin gels 6.1.2 Cell attachment, spreading and proliferation 6.1.3 Matrix deposition by fibroblasts grown on starPEG-heparin hydrogels 6.1.4 Degradation of starPEG-heparin hydrogels 6.1.5 TGF-b-laden starPEG-heparin that efficiently induces myofibroblast differentiation 6.2 Discussion 7 general discussion 7.1 Summary and conclusion 7.2 Future perspective Appendix 8 supplementary materials & methods 9 declaration of authorship 10 publications and conference contributions bibliography list of figures list of tables nomenclature selbstständigkeitserklärung

The diploma thesis entitled Specific needs of patients during negative pressure wound therapy, consists of two main parts, a theoretical and a practical part. The theoretical part includes findings from research and publications dealing with the issues of wound healing through local application of vacuum therapy, treatment with other methods of wet healing, the impact of long-term non-healing wounds on human needs and the role of the nurse in this scenario. The practical part of the diploma thesis refers to the quantitative research carried out by 46 respondents who were treated with a negative vacuum method, another method of wet healing or a combined form.

Le biofilm bactérien constitue un obstacle majeur à la cicatrisation des plaies. Par ailleurs, il est responsable de l’émergence d’une résistance et d’une tolérance accrues aux antibiotiques. Par conséquent, le développement de systèmes de délivrance contrôlée d’un agent ciblant la structure du biofilm apparaît comme une approche thérapeutique alternative indispensable et urgente pour la prise en charge des plaies chroniques. A travers cette étude, nous avons développé des systèmes membranaires pour pansements libérant une protéine, la dispersine B (DB),capable de cibler de manière sélective la matrice du biofilm, en créant un microenvironnement délétère pour le biofilm bactérien. Pour ce faire, nous nous sommes intéressés aux membranes asymétriques (MAs) à base de polyesters biodégradables tels que le poly(3-hydroxybutyrate-co-4-hydroxybutyrate), le poly (butylène succinate-co-butylène adipate) (PBSA), et l’acide polylactique. En incorporant dans la solution de polymère des agents porogènes hydrophiles (APs), nous avons pu obtenir des MAs à porosité élevée, un réseau poreux interconnecté, perméables au dioxygène et à l’eau vapeur. En utilisant l’albumine de sérum bovin, nous avons pu montrer que la capacité de piégeage de la protéine et sa libération contrôlée à partir des MAs de PBSA était influencée par la structure de celles-ci et la présence d’APs résiduels. Les études in vitro ont montré une très grande efficacité anti-biofilm à la fois en inhibition et en dispersion (jusqu’à 80%). Les tests standards normalisés de cytotoxicité in vitro ont montré que les MAs de PBSA non chargées et chargées en DB répondaient aux critères de cytocompatibilité exigées pour une application de type pansement. / Bacterial biofilms are a major obstacle to the wound healing process. In addition, they are responsible for the emergence of resistance and tolerance to antibiotics. Hence, the development of controlled drug delivery systems targeting the bacterial biofilm appears as an urgent and essential alternative therapeutic approach for the effective management of chronic wound. In this work, we developed wound dressings in which a protein, dispersin B (DB), is released capable of selectively targeting the biofilm matrix, creating a deleterious microenvironment for the bacterial biofilm. To this end, we were interested in asymmetric membranes (AMs) from biodegradable polyesters such as the poly(3-hydroxybutyrate-co-4-hydroxybutyrate), the poly (butylene succinate-co-butylene adipate) (PBSA) and the polylactic acid. By the incorporation of hydrophilic porogen agents (PA), we were able to obtain AMs with a high level of porosity, exhibiting a porous interconnected network and oxygen and water vapor permeability. Using bovine serum albumin as a model protein, we demonstrated that protein loading and release from the PBSA AMs were affected by the membrane structure and the presence of residual PA. In vitro studies showed highest antibiofilm efficiency both in inhibition and dispersion (up to 80%). Normalized in vitro cytotoxicity standard assays revealed that unloaded and DB-loaded PBSA membranes met cytocompatibility criteria required for wound dressing applications.