Tissue biopsy and swab culture are the gold standards for diagnosing tissue infection; these tests require significant time, diagnostic costs, and resources. Towards earlier and specific diagnosis of infection, a non-destructive, rapid, and mobile detection device is described to distinguish bacterial species via light scatter spectra from the surface of an infected tissue, reagent-free. Porcine skin and human cadaveric skin models of wound infection were used with a 650 nm LED and an angular photodiode array to detect bacterial infections on the tissue surface, which can easily be translated to a typical CMOS array or smartphone. Tissue samples were inoculated with Escherichia coli, Salmonella Typhimurium, or Staphylococcus aureus and backscatter was collected from 100 degrees to 170 degrees in 10 degrees increments; each bacterial species resulted in unique Mie scatter spectra. Distinct Mie scatter spectra were obtained from epidermis (intact skin model) and dermis (wound model) samples, as well as from porcine and human cadaveric skin samples. Interactions between bacterial colonies and lipid particles within dermis samples generated a characteristic Mie scatter spectrum, while the lipid itself did not contribute to such characteristic spectrum as corroborated with body lotion experiments. The designed angular photodiode array is able to immediately and non-destructively detect tissue bacterial infection and identify the species of infection within three seconds, which could greatly improve point of care diagnostics and antibiotic treatments.

Bakgrund: Förekomsten av diabetes typ 2 ökar både nationellt och internationellt. Många av dessa patienter utvecklar diabeteskomplikationer i form av diabetesneuropati som är en av de vanligaste bakomliggande orsakerna till diabetesfotsår. Samarbetet kring diabetesfotsår mellan olika professioner behöver öka för att få en bättre prognos för sårläkning och således bättre livskvalitet för dessa patienter. Diabetessjuksköterskor och distriktssköterskor är involverade i vården av patienter med diabetes och diabetesfotsår men hur samarbetet mellan dessa professioner ser ut är inte klarlagt. Syfte: Syftet med denna studie är att undersöka diabetessjuksköterskans och distriktssköterskans upplevelse av samarbete vid omvårdnad av diabetesfotsår hos patienter med typ 2 diabetes samt hur ett samarbete kan förbättra vården för patienter med diabetesfotsår.   Metod:  En kvalitativ intervjustudie med deduktiv ansats valdes för att bemöta studiens syfte. Sex semi-strukturerade intervjuer genomfördes och data analyserades enligt Granheim & Lundmans kvalitativa innehållsanalys. Resultat: Studien resulterade i fem olika kategorier; vikten av kommunikation, brist på rutiner, integrerat samarbete inom vården, utveckling och heterogen kompetens samt säkerhetskultur inom vården. Förbättring av samarbetet mellan diabetessjuksköterskor och distriktssköterskor kan leda till ökad kompetensen hos sjuksköterskorna samt till bättre livskvalitet för patienter med diabetesfotsår.  Slutsats: Samtliga deltagare har uttryckt vikten av ett bra samarbete och skapande av rutiner som kan leda till bättre förutsättningar för patienter med diabetesfotsår. Betydelsen av kompetensen och kunskapsutbyte var viktiga faktorer för ett välfungerande samarbete. / Background: The incidence of type 2 diabetes is increasing both nationally and internationally. Many of the patients develop diabetic complications in the form of diabetic neuropathy, which is one of the most common underlying causes of diabetic foot ulcers. Diabetes nurses and community health nurses are involved in the care of patients with diabetes and diabetic foot ulcers, but what the collaboration between these professions looks like is not clear. Objective: The purpose of this study is to investigate the diabetes nurse's and community health nurse's experience of collaboration in the care of diabetic foot ulcers in people with type 2 diabetes and how collaboration could improve care for patients with diabetic foot ulcers. Method: A qualitative interview study with an deductive approach was chosen to meet the purpose of the study. Six semi-structured interviews were conducted and the data were analyzed according to Granheim & Lundman's qualitative content analysis. Results: The study results in five different categories; the importance of communication, lack of routines, integrated collaboration in healthcare, development and heterogeneous competence and safety culture in healthcare. Improving of the collaboration between different professional groups can lead to an increase in the competence of the staff and to a better quality of life for the patients with diabetic foot ulcers. Conclusion: All participants emphasized on the importance of good collaboration and the creation of routines that can lead to better conditions for patients with diabetic foot ulcers. The importance of competence and knowledge exchange were important factors for a well-functioning collaboration.

O conhecimento embasado nas melhores evidências científicas para a assistência de enfermagem às pessoas com feridas crônicas (FC) deve alicerçar o ensino da temática na formação do enfermeiro. Diante da relevância epidemiológica do problema, o docente de enfermagem se depara com o desafio de ensinar aos estudantes, o cuidado às pessoas com essa complicação, nos diversos contextos de atenção à saúde. A etapa da avaliação da FC é fundamental para identificar e descrever o processo de cicatrização e a seleção da terapia tópica, que o favoreça. A educação à distância (EAD) tem demonstrado ser uma estratégia efetiva para atualização do conhecimento. Diante disto, o objetivo deste estudo foi identificar o impacto da EAD, no conhecimento de docentes de enfermagem e enfermeiros vinculados ao ensino superior, acerca da avaliação de FC. Tratou-se de um estudo prospectivo, quase-experimental, com coleta de dados antes e após a intervenção. Após aprovação pelo Comitê de Ética em Pesquisa, foram convidados a participar da pesquisa, docentes e enfermeiros vinculados ao ensino, de instituições de ensino superior (IES) públicas e privadas, que ministrassem disciplinas teóricas e/ ou práticas, nos cursos de graduação em Enfermagem, de um município do interior do Estado de São Paulo. A amostra foi composta por 26 docentes e enfermeiros vinculados ao ensino, que participaram do curso de atualização \"Avaliação de Feridas Crônicas na Assistência de Enfermagem\" oferecido através do Ambiente Virtual de Aprendizagem (AVA) Moodle. Entre os participantes, a média de idade de 42,3 anos (DP 9,56), e todos eram do sexo feminino. O tempo médio de experiência no ensino foi de 11,16 anos (DP 8,02), 24 (92,3%) docentes afirmaram lecionar disciplinas teóricas e/ ou práticas, dos quais, 91,7% referiram atuar no cuidado de pessoas com FC, nos cenários de prática. A ferramenta mais utilizada para a busca de informações sobre \"feridas crônicas\" pela maioria dos participantes foi a internet. O aumento na porcentagem de acertos após a intervenção foi estatisticamente significante e o domínio que obteve maior número de acertos no pré e pós-teste foi \"Dimensionamento da ferida\", com melhor desempenho ao final do curso. A correlação entre o tempo de experiência na docência e o desempenho no teste de conhecimento foi negativa, e a associação entre a utilização de outras estratégias para busca de informações, tais como troca de experiência entre os pares, participação em eventos científicos acerca do tema, melhorou o desempenho dos participantes. A utilização da EAD, como ferramenta para a intervenção educativa, visando a divulgação de recomendações para a avaliação de feridas crônicas, impactou positivamente na aquisição de conhecimentos dos participantes. A adoção de tecnologias para o aprimoramento dos docentes de enfermagem trouxe implicações que podem favorecer o ensino e gerar mudanças na prática clínica de enfermagem / The knowledge based on the best scientific evidence of care to people with chronic wounds (CW) should be the basis of this theme teaching in nursing education. Considering the epidemiological relevance of this problem, nursing faculty are faced with the challenge of teaching students how to look after people with this complication in different contexts of health care. The assessment of CW is critical to identify and describe the healing process and the selection of the best topical therapy. The effectiveness of E-learning (EL) strategy to update knowledge has been demonstrated in other studies. Therefore, the aim of this study was to identify the impact of e-learning on CW assessment knowledge of teachers and nurses involved with higher education. A prospective and quasi-experimental study was conducted with data collection before and after the intervention. After the board of ethics approval, teachers and nurses were invited to participate in the research. These teachers and nurses involved in higher education institutions, both public and private, teach theoretical subjects and or practices in nursing undergraduate courses in the municipality in the state of Sao Paulo. The sample consisted of 26 teachers and nurses who attended the update course \"Assessment of Chronic Wounds in Nursing Care\" offered through the Virtual Learning Environment (VLE) Moodle. Among participants, we identified an average age of 42.3 years (SD=9.56), and regarding gender, all subjects were female. The average teaching experience was 11.16 years (SD=8.02), 24 (92.3%) teachers reported teaching theoretical subjects and/or practices, of which 91.7% reported working with CW care in practice scenarios. The most widely used tool to search for information about \"chronic wounds\" was the internet. The increase in the percentage of correct answers after the intervention was statistically significant and the item with highest number of correct answers in both pre and posttests was \"Dimensioning the wound\", with better performance at the end of the course. The correlation between times of teaching experience and performance on the knowledge test was negative, and the association between the use of other strategies to knowledge update (such as exchange of experience among peers, participation in scientific events on the theme) was found to improved performance of the participants. The use of EL as a tool for educational intervention focused on disseminating recommendations for CW assessment positively impacted the acquisition of knowledge among participants. Adopting technologies for the improvement of nursing faculty\'s abilities had outcomes that may support education and generate changes in the clinical nursing practice

O conhecimento embasado nas melhores evidências científicas para a assistência de enfermagem às pessoas com feridas crônicas (FC) deve alicerçar o ensino da temática na formação do enfermeiro. Diante da relevância epidemiológica do problema, o docente de enfermagem se depara com o desafio de ensinar aos estudantes, o cuidado às pessoas com essa complicação, nos diversos contextos de atenção à saúde. A etapa da avaliação da FC é fundamental para identificar e descrever o processo de cicatrização e a seleção da terapia tópica, que o favoreça. A educação à distância (EAD) tem demonstrado ser uma estratégia efetiva para atualização do conhecimento. Diante disto, o objetivo deste estudo foi identificar o impacto da EAD, no conhecimento de docentes de enfermagem e enfermeiros vinculados ao ensino superior, acerca da avaliação de FC. Tratou-se de um estudo prospectivo, quase-experimental, com coleta de dados antes e após a intervenção. Após aprovação pelo Comitê de Ética em Pesquisa, foram convidados a participar da pesquisa, docentes e enfermeiros vinculados ao ensino, de instituições de ensino superior (IES) públicas e privadas, que ministrassem disciplinas teóricas e/ ou práticas, nos cursos de graduação em Enfermagem, de um município do interior do Estado de São Paulo. A amostra foi composta por 26 docentes e enfermeiros vinculados ao ensino, que participaram do curso de atualização \"Avaliação de Feridas Crônicas na Assistência de Enfermagem\" oferecido através do Ambiente Virtual de Aprendizagem (AVA) Moodle. Entre os participantes, a média de idade de 42,3 anos (DP 9,56), e todos eram do sexo feminino. O tempo médio de experiência no ensino foi de 11,16 anos (DP 8,02), 24 (92,3%) docentes afirmaram lecionar disciplinas teóricas e/ ou práticas, dos quais, 91,7% referiram atuar no cuidado de pessoas com FC, nos cenários de prática. A ferramenta mais utilizada para a busca de informações sobre \"feridas crônicas\" pela maioria dos participantes foi a internet. O aumento na porcentagem de acertos após a intervenção foi estatisticamente significante e o domínio que obteve maior número de acertos no pré e pós-teste foi \"Dimensionamento da ferida\", com melhor desempenho ao final do curso. A correlação entre o tempo de experiência na docência e o desempenho no teste de conhecimento foi negativa, e a associação entre a utilização de outras estratégias para busca de informações, tais como troca de experiência entre os pares, participação em eventos científicos acerca do tema, melhorou o desempenho dos participantes. A utilização da EAD, como ferramenta para a intervenção educativa, visando a divulgação de recomendações para a avaliação de feridas crônicas, impactou positivamente na aquisição de conhecimentos dos participantes. A adoção de tecnologias para o aprimoramento dos docentes de enfermagem trouxe implicações que podem favorecer o ensino e gerar mudanças na prática clínica de enfermagem / The knowledge based on the best scientific evidence of care to people with chronic wounds (CW) should be the basis of this theme teaching in nursing education. Considering the epidemiological relevance of this problem, nursing faculty are faced with the challenge of teaching students how to look after people with this complication in different contexts of health care. The assessment of CW is critical to identify and describe the healing process and the selection of the best topical therapy. The effectiveness of E-learning (EL) strategy to update knowledge has been demonstrated in other studies. Therefore, the aim of this study was to identify the impact of e-learning on CW assessment knowledge of teachers and nurses involved with higher education. A prospective and quasi-experimental study was conducted with data collection before and after the intervention. After the board of ethics approval, teachers and nurses were invited to participate in the research. These teachers and nurses involved in higher education institutions, both public and private, teach theoretical subjects and or practices in nursing undergraduate courses in the municipality in the state of Sao Paulo. The sample consisted of 26 teachers and nurses who attended the update course \"Assessment of Chronic Wounds in Nursing Care\" offered through the Virtual Learning Environment (VLE) Moodle. Among participants, we identified an average age of 42.3 years (SD=9.56), and regarding gender, all subjects were female. The average teaching experience was 11.16 years (SD=8.02), 24 (92.3%) teachers reported teaching theoretical subjects and/or practices, of which 91.7% reported working with CW care in practice scenarios. The most widely used tool to search for information about \"chronic wounds\" was the internet. The increase in the percentage of correct answers after the intervention was statistically significant and the item with highest number of correct answers in both pre and posttests was \"Dimensioning the wound\", with better performance at the end of the course. The correlation between times of teaching experience and performance on the knowledge test was negative, and the association between the use of other strategies to knowledge update (such as exchange of experience among peers, participation in scientific events on the theme) was found to improved performance of the participants. The use of EL as a tool for educational intervention focused on disseminating recommendations for CW assessment positively impacted the acquisition of knowledge among participants. Adopting technologies for the improvement of nursing faculty\'s abilities had outcomes that may support education and generate changes in the clinical nursing practice

Bakgrund diabetes är en allvarlig och vanligt förekommande sjukdom. Av personer som drabbas av diabetes beräknas 15 procent någon gång i livet drabbas av komplikationen diabetesfotsår som ökar risken för infektioner och amputation. Hälsorelaterad livskvalitet är ett begrepp som i kvantitativ forskning mäts med olika mätinstrument uppbyggda av domäner som belyser psykisk, fysisk, och social hälsa. För att ha god hälsa behöver personer känna en känsla av sammanhang. Syftet: Att beskriva vilka domäner av hälsorelaterad livskvalitet som är betydelsefulla för personer med diabetesfotsår. Metod: en litteraturöversikt utfördes baserad på 13 kvantitativa artiklar som mätte hälsorelaterad livskvalitet med generiska mätinstrument hos personer med diabetesfotsår. Litteratursökningar utfördes i CINAHL, PubMed och Web of Science. Resultatet: visade att domänen av hälsorelaterad livskvalitet där personer med diabetesfotsår hade lägst resultat var fysisk rollfunktion. Högst hälsorelaterad livskvalitet återfanns i domänen mental hälsa. Konklusionen är att diabetesfotsår inverkar negativt främst på den domän av hälsorelaterad livskvalitet som belyser fysisk rollfunktion i vardagligt liv för personer med diabetesfotsår. Studien visar i vilka domäner omvårdnaden behöver utvecklas och var resursdiagnoser kan återfinnas hos personer med diabetesfotsår. / Background diabetes is a global and serious disease which is likely to become eaven more common in the future. Out of all people suffering from diabetes about 15 percent is at risk of developing diabetic foot ulcer in their lifetime. In quantitavie research health related quality of life is measured with tools containing domains of psychological, physical and social health. People need a sense of coherence to be able to percieve good health. Aim: was to describe which domains of health related quality of life have the greatest role for people with diabetic foot ulcer. Method a litterature review was conducted based on 13 quantitative research articles were health related quality of life was measured with generic tools in people with diabetic foot ulcer. Reserach was found on CINAHL, PubMed and Web of Science. Results people with diabetic foot ulcer have the least health related quality of life in the domain physical role. Mental health was shown to be the domain where most health related quality of life was found in people with diabetic foot ulcer. Conclusion was that diabetic foot ulcer have a great impact in the domain physical role. Devolepment in nursing needs to focus on this aspect of life. In the same way resource diagnoses can be found in regard of the mental health more often than in any other domain of health related quality of life.

Patients affected by Diabetes Mellitus have reduced tactile sensitivity and atrophy of the small muscles in the foot, resulting in high-pressure points that may remain unnoticed. The increased pressure can cause micro-trauma leading to wounds. Because of the Diabetes Mellitus, DFUs do not heal easily. Up to 25% of them will develop diabetic foot ulcers (DFU), and 25% of DFUs that do not heal ultimately result in amputation. This Master Thesis will describe and gather results of a newly acquired large international collaborative EU project (EIT Health 2020-2022) between three universities and three companies across Europe. This collaborative group will be the first to tackle the Diabetic Foot Ulcers problem preventatively with an innovative shoe concept, with seven different apex settings, which can be easily modified to avoid ulcerations in different areas of the foot. As an initial pilot, this master thesis project focuses on the analysis of the plantar pressure distribution by using the innovative shoes DR Comfort based on the adjustable rocker profiles, used as a prototype for the prevention of the Diabetic Foot Ulcer (DFU) formation in patients affected by Diabetes. This project captures the motion data of healthy people with different shoe soles while walking at different levels of speed and assess the values of the peak plantar pressure, with the use of the Pedar-X, a measuring system device for the in-shoe plantar pressure. The evaluation of the adjustable rocker profiles is made through the calculation and analysis of the significant differences and p-values in peak plantar pressure, as well as the analysis of the Mean Plantar Pressure (MMP). The results of this study show a reduction (although not pronounced) of the areas that are more affected by DFU. This study cannot be generalized to diabetic patients since ethical approval has not yet been received. / Patienter med DM har minskad taktil känslighet och atrofi i de små musklerna i foten, vilket resulterar i högatryckpunkter som kan för bli obemärkta. Det ökade trycket kan orsaka mikrotrauma som leder till sår. På grund av Diabetes Mellitus, läker inte DFU lätt. Upp till 25% av dem kommer att utveckla diabetiska fotsår (DFU), och 25% av DFU: er som inte läker leder slutligen till amputation. Detta examensarbete kommer att beskriva och samla resultat från ett nyförvärvat stort internationellt EU-projekt (EIT Health 2020-2022) mellan tre universitet och tre företag i hela Europa. Denna samarbetsgrupp kommer att vara den första att förebygga problemet med diabetiska fotsår med ett innovativt skokoncept diabetiska fotsår med ett innovativt skokoncept. De kommer utföras med sju olika inställningar som lätt kan modifieras för att undvika sår på olika områden i foten. Som en första pilot fokuserar detta examensarbete på analys av plantartryckfördelning genom att använda de innovativa DR Comfort-skorna baserade på de justerbara ”rocker”-profilerna, som används som en prototyp för att förebygga bildningen av Diabetic Foot Ulcer (DFU) hos patienter som drabbats av Diabetes. Den här avhandlingen fångar rörelsen hos friska personer med olika skosulor medan de går i olika hastighet och analyserar värdena för det maximala plantartrycket med användning av pedar-x. Pedar-x är en mätanordning för plantorns tryck i skon. Utvärderingen av de justerbara ”rocker”-profilerna gjordes genom beräkning och analys av de signifikanta skillnaderna i top plantartrycket samt analysen av plantartryckets maximala medelvärde (MMP). Resultaten av denna studie visar en minskning (även om den inte betydlig) av de områden som mest drabbats av DFU. Denna studie kan inte generaliseras till diabetespatienter eftersom etiskt godkännande ännu saknas.

For this project, we use a modified version of a previously developed mathematical model, which describes the relationships among matrix metalloproteinases (MMPs), their tissue inhibitors (TIMPs), and extracellular matrix (ECM). Our ultimate goal is to quantify and understand differences in parameter estimates between patients in order to predict future responses and individualize treatment for each patient. By analyzing parameter confidence intervals and confidence and prediction intervals for the state variables, we develop a parameter space reduction algorithm that results in better future response predictions for each individual patient. Moreover, use of another subset selection method, namely Structured Covariance Analysis, that considers identifiability of parameters, has been included in this work. Furthermore, to estimate parameters more efficiently and accurately, the standard error (SE- )optimal design method is employed, which calculates optimal observation times for clinical data to be collected. Finally, by combining different parameter subset selection methods and an optimal design problem, different cases for both finding optimal time points and intervals have been investigated.