Title from first page of PDF document. Includes bibliographical references (p. 31-34).

Bakgrund: Venösa bensår är ingen sjukdom utan ett symtom som orsakas av bakomliggande faktorer. Det är framförallt äldre personer som har en ökad risk för sårbildning. Sjuksköterskan är ansvarig för att utföra en bedömning av såret inför val av behandling. Syfte: Att beskriva sjuksköterskors bedömning av venösa bensår hos patienter inom hemsjukvården. Metod: Studien är en kvalitativ intervjustudie med induktiv ansats. Data samlades in genom sex semistrukturerade intervjuer. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: Sjuksköterskans tillvägagångssätt vid bedömning, sjuksköterskan och patienten tillsammans i en bedömning, sjuksköterskans behov av erfarenhet, stöd och utveckling i bedömning. Sårets egenskaper och fastställande av bakomliggande orsak var av stor betydelse. Likaså poängterades vikten av att göra en helhetsbedömning av patienten, vilket visade sig både ha positiva och negativa sidor relaterat till patientens hemmiljö. Kontinuerlig utbildning och stöd från kollegor ansågs vara till stor hjälp vid bedömning av patienter med venösa bensår. Slutsats: Det konstaterades att bedömningen av venösa bensår upplevs svår, innehåller flera moment samt att praktiken inte alltid stämmer överens med teorin. För att försäkra att patienten får de bästa förutsättningarna till en god sårläkning bör sjuksköterskan se till hela människan och varje patients enskilda behov. / Titel: Nurse's assessment of venous leg ulcers in home based care Background: Venous leg ulcers is not an illness, but a symptom caused by underlying factors. It is mostly elderly people which have an increased risk for ulceration. The nurse is responsible for making the assessment of the ulcer, before choice of treatment. Aim: To describe nurse's assessment of venous leg ulcers in patients within home based care. Method: The study is qualitative interview study with an inductive approach. Data was collected through six semi- structured interviews. The material was analysed with qualitative content analysis. Results: The analysis resulted in three categories: Nurses approach to assessment, the nurse and the patient together in an assessment, nurses needs for experience, support and development in assessment. The ulcer's characteristics and determination of underlying cause were of great importance. Similarly, the importance of making a comprehensive assessment of the patient was emphasized, which proved to have both positive and negative sides related to the patient's home environment. Continuous education and support from colleagues were of great help in assessing patients with venous ulcers. Conclusion: It was confirmed that the assessment of venous leg ulcers is experienced complex, containing several moments, and that practice and theory are not always consistent. To ensure that the patient gets the best prerequisites for good wound healing, the nurse should look after the entire person and patient's individual needs.

Bakgrund: Venösa bensår uppkommer till följd av venös insufficiens. Tillståndet förväntas öka i takt med en åldrande befolkning. Behandlingen kan vara tidskrävande och följsamheten är låg. Sjuksköterskan spelar en viktig roll vid behandlingen av dessa personer. Genom att belysa personers upplevelser av att leva med venösa bensår kan kunskap genereras som är nödvändig för att sjuksköterskan ska kunna ge god vård. Syfte: Att belysa personers upplevelser av att leva med venösa bensår. Metod: Litteraturöversikt med riktad innehållsanalys. Analysen utgick från de tre centrala komponenterna begriplighet, hanterbarhet och meningsfullhet i Antonovskys teori om känsla av sammanhang (KASAM). Sökningar genomfördes i tre databaser. Sökord för att leva med kombinerades med sökord för venösa bensår. Träffar begränsades till artiklar publicerade mellan 1 januari 2008 och 31 augusti 2018. Elva vetenskapliga artiklar valdes ut för analys. Resultat: Under tre huvudkategorier formulerades åtta underkategorier. Huvudkategorierna var begriplighet, hanterbarhet och meningsfullhet. I kategorin begriplighet beskrevs upplevelser av att drabbas av venösa bensår, betydelsen av kontroll samt betydelsen av information. Under hanterbarhet beskrevs användandet av resurser och strategier för att hantera livet. Under meningsfullhet beskrevs tillståndets inverkan på människors identitet och självbild, sårens plats i livet samt hur livet med bensår upplevdes på ett emotionellt plan. Diskussion: I resultatdiskussionen lyftes aspekter av tid relaterat till omvårdnad och behandling. Sjuksköterskans betydelse för följsamhet till behandling samt vikten av information och kunskap belystes. Resultatet diskuterades i relation till Antonovskys centrala komponenter samt tidigare forskning. / Background: Venous leg ulcers occur as a result of venous insufficiency. The condition is expected to increase in line with an aging population. Treatment may be time consuming and the adherence to treatment is low. The nurse plays an important role in the treatment of these persons. By highlighting people’s experiences of living with venous leg ulcers, knowledge necessary for the nurse to provide good care can be gained. Aim: To highlight people’s experiences of living with venous leg ulcers. Method: A literature review with directed content analysis. The analysis was based on the three key components in Antonovsky's theory of sense of coherence (SOC): comprehensiveness, manageability and meaningfulness. Searches were carried out in three databases. Keywords for to live with were combined with keywords for venous leg ulcers. Searches were limited to articles published between the 1st of January 2008 and the 31st of August 2018. Eleven scientific articles were selected for analysis. Results: Eight subcategories were presented under three main categories. The main categories were comprehensiveness, manageability and meaningfulness. The comprehensiveness category described experiences of suffering from venous leg ulcers, the significance of control and the importance of information. In the manageability category, the use of resources and strategies to handle life were described. In the meaningfulness category, the impact of leg ulcers on identity and self-image were described. The place of the ulcers in patients’ lives and descriptions of how life with leg ulcers was emotionally experienced were also presented. Discussion: Aspects in relation to nursing and treatment were discussed. Time, adherence to treatment, information and knowledge were highlighted. This was discussed in the light of Antonovsky's core components as well as previous research.

This study attempted to investigate the impact of new technology, specifically tele-advice on community nurses' care of leg ulcers. Firstly, a stratified randomised controlled study was designed to measure the impact of using this technology on their levels of wound knowledge and confidence. An individual self-test questionnaire and an attitudinal scale measured nurses' knowledge and confidence respectively both pre and post-intervention. Secondly, a new visual wound assessment tool was designed to represent the state of the wound by a single numerical value; the State of the Wound Index (SWI). Thirdly, the impact of nurses' knowledge, confidence and patient variables was explored to assess their impact on the state of the wound as represented by SWI. The sample consisted of thirty-eight registered primary care nurses from two local NHS trusts in South Wales and their corresponding 38 patients with venous leg ulcers. Nurses were stratified according to their qualifications into experimental or control groups. Both groups were shown to have comparable levels of knowledge and confidence pre-intervention. Nurses in the experimental group received expert tele-advice by a Clinical Nurse Specialist (CNS) over a 12 week period regarding the care of their patient's leg ulcer, whilst those in the control group continued to care for their leg ulcer patients in the traditional way. hi the experimental group, nurses' level of knowledge increased significantly (p=0.02) whilst no improvement was observed for the control group. In terms of confidence, the experimental group reached near significance when extremely positive statements were excluded with no improvement observed for the control group. Results show that the intervention had a positively significant impact on nurses' wound care knowledge and level of confidence. A set of 18 tele-transmittable wound factors was identified by a panel of wound experts. These factors were ranked by another independent panel of leg ulcer experts and no significance could be established in their order of importance. These factors were then examined for their highest and lowest possible estimates for every wound in the sample both pre and post intervention using a Visual Analogue Scale (VAS). These estimated values formed the basis for 95% confidence interval estimates from which 100 virtual nurse assessed values were generated. These values were then used to generate SWI. This new index ranged from 0 (best possible state) to 100 (worse possible) and was seen to reliably increase when the wound deteriorated and decrease as the wound improved. Linear regression models were built to establish the relationship between SWI, patient variables and nurses' knowledge and confidence levels pre and post-intervention. These indicated that knowledge and confidence can have a positive impact on the healing process. This study has shown that there is great potential for the use of tele-advice in community nurses' care of leg ulcers. For this to succeed, it is recommended that further pre and post registration nurse training is provided to enhance their knowledge in wound care, especially in the areas of physiology and wound assessment.

INTRODUÇÃO: A avaliação da articulação do quadril continua sendo considerada complexa e desafiadora. Avanços recentes nas técnicas cirúrgicas e de imagem têm contribuído para a identificação das estruturas que contribuem para a dor no quadril. Medidas válidas, confiáveis, reprodutíveis e repetíveis são necessárias para que se possa identificar mudanças que ocorreram na articulação do quadril ao longo do tempo, e para avaliar os desfechos do tratamento realizado. Tanto no ambiente clínico como no de pesquisa, um processo sistemático de avaliação é fundamental para constituir uma prática baseada em evidência. Entretanto, são poucos os estudos encontrados na literatura que avaliaram a reprodutibilidade da avaliação da força muscular, da amplitude de movimento (ADM) e da funcionalidade do quadril em sujeitos saudáveis, medidas fundamentais para que se possa avaliar os efeitos de intervenções clínicas no tratamento de pacientes com problemas na articulação do quadril e comparar com dados normativos. OBJETIVO: Avaliar a reprodutibilidade de um protocolo de avaliação da força muscular, ADM e funcionalidade de quadril em sujeitos saudáveis. MATERIAIS E MÉTODOS: 15 voluntários saudáveis (30 quadris), de ambos os sexos, entre 22 e 37 anos, foram submetidos ao teste e reteste, com um único avaliador, da força muscular, da amplitude de movimento e da funcionalidade do quadril. Quatro sessões de avaliação foram realizadas no Setor de Plasticidade Neuromuscular do Laboratório de Pesquisa do Exercício da Universidade Federal do Rio Grande do Sul. As avaliações foram compostas por: (1) medidas antropométricas, (2) aplicação de questionários funcionais, (3) teste de agachamento unipodal, (4) avaliação fotogramétrica e goniométrica da ADM do quadril, (5) teste de força máxima com dinamômetro manual e dinamômetro isocinético, (6) avaliação da dor. RESULTADOS: a dinamometria manual apresentou excelente reprodutibilidade, com coeficiente de correlação intraclasse (CCI) > 0,9 (com intervalos de confiança (ICs) entre 0,85 e 0,99) e valores de erro padrão de medida relativo (EPM%) inferiores a 10%. Os testes dos rotadores externos em 0°, 10° e 20° de rotação interna; dos rotadores internos em 15° de rotação externa e dos abdutores do quadril da dinamometria isocinética e os da rotação externa ativa e passiva e da rotação interna bilateral passiva da fotogrametria da ADM do quadril também apresentaram reprodutibilidade considerada excelente, com CCIs > 0,75, e valores aceitáveis do EPM e EPM%. Porém, tanto na dinamometria isocinética quanto na avaliação da ADM, em muitas das situações testadas, os testes permaneceram com a reprodutibilidade entre razoável e boa (CCIs entre 0,48 a 0,75, no geral), com ICs muito amplos, principalmente para a avaliação da ADM. No dinamômetro isocinético, os testes dos rotadores externos foram mais reprodutíveis que o dos rotadores internos; e os testes em extremos articulares de ambos rotadores foram menos reprodutíveis. A classificação do Kappa do teste de agachamento unipodal foi satisfatória (k=0,59). Os testes menos reprodutíveis foram: a fotogrametria da abdução ativa do quadril (CCI=0,39), da abdução passiva do quadril (CCI=0,48) e a ADM ativa de flexores do quadril realizada com um goniômetro (CCI=0,51). CONCLUSÃO: Uma boa parte dos testes apresentou reprodutibilidade excelente e justifica a aplicação no ambiente clínico, quando realizados por um único avaliador. Entretanto, aprimoramentos nas técnicas utilizadas são necessários a fim de melhorar a reprodutibilidade e reduzir os erros de medida na avaliação do quadril. / INTRODUCTION: The assessment of the hip is still considered complex and challenging. Recent advances in surgical and imaging techniques have contributed to the identification of structures that contribute to hip pain. Measures that are valid, reliable, reproducible and repeatable are necessary to identify changes that have occurred at the hip joint over time, and to evaluate the treatment outcomes. Both at the clinical and research settings, a systematic evaluation process is crucial to provide an evidence-based practice. However, there are few studies in the literature that evaluated the reliability of muscle strength, range of motion (ROM) and hip function measurements in healthy subjects, fundamental steps to assess the effects of clinical interventions in the treatment of patients with problems in the hip joint and compare with normative values. PURPOSE: To evaluate the reliability of an assessment protocol of muscle strength, ROM and hip functionality in healthy subjects. MATERIALS AND METHODS: 15 healthy volunteers (30 hips), of both sexes, between 22 and 37 years of age, were submitted to the test and retest, with a single investigator, of muscle strength, ROM and hip functionality. Four test sessions were held at the Neuromuscular Plasticity Department of the Exercise Research Laboratory at the Federal University of Rio Grande do Sul. The hip assessment included: (1) anthropometric measurements, (2) patient-reported outcome measures, (3) single leg squat test, (4) photogrammetric and goniometric hip ROM examination, (5) maximum strength test with handheld and isokinetic dynamometers, (6) pain evaluation by intensity rating scale. RESULTS: the handheld dynamometer showed excellent reliability with intraclass correlation coefficient (ICC) > 0.9 (with confidence intervals (CIs) between 0.85 and 0.99) and relative standard error values (% SEM) of less than 10%. The external rotators tests at 0°, 10° and 20° of internal rotation; internal rotators at 15° of external rotation, and hip abductors on an isokinetic dynamometer, and active and passive external rotation and bilateral passive internal rotation taken by photogrammetric analysis of the hip also showed excellent reliability, with ICCs> 0.75, and acceptable SEM and SEM% values. However, in many tests performed on the isokinetic dynamometer and in ROM assessment, the reliability remained between fair and good (ICCs between 0.48 to 0.75 overall), with very large CIs, especially for the assessment of ROM. At the isokinetic dynamometer, testing of the external rotators was more reliable than the internal rotators; and the strength rotators tests at the extremes ROMs the reliability was lower. The kappa interpretation for the single leg squat test was satisfactory (k = 0.59). The worst reliability tests were photogrammetry of active hip abduction (ICC = 0.39), passive hip abduction (ICC = 0.48) and active ROM of the hip flexors performed with a goniometer (ICC = 0.51). CONCLUSION: A good part of the tests showed excellent reliability and justifies the application at the clinical setting, when performed by a single investigator. However, improvements are needed in some of the used techniques to improve the reliability and reduce measurement errors in the assessment of the hip.

A avaliação da articulação do quadril é considerada desafiadora e medidas reprodutíveis são fundamentais para construir uma prática baseada em evidências. O objetivo da presente dissertação de Mestrado foi avaliar a reprodutibilidade intra e interavaliador do teste de força máxima isométrica com dinamômetro manual, da avaliação fotogramétrica e goniométrica da amplitude de movimento (ADM) e da medida do deslocamento angular do quadril 2-D em vídeo por meio do teste de agachamento unipodal em sujeitos saudáveis. No Capítulo I, por meio de uma ampla revisão de literatura, percebemos a existência de divergências no que diz respeito à avaliação do quadril, uma vez que não foi observada uma avaliação sistematizada envolvendo as medidas mais comumente indicadas na prática clínica. O capítulo II avaliou a reprodutibilidade intra e interavaliador por três avaliadores para os desfechos força muscular por dinamometria manual (rotadores internos (RI) e externos (RE), adutores (ADU) e abdutores (ABD) e flexores (FLX) e extensores (EXT)), ADM do quadril por goniometria (FLX ativa (ATI) e passiva (PAS); RE ATI e PAS e os movimentos de rotação interna bilateral (RI BIL) e EXT ativas e fotogrametria (RE e RI BIL de forma ativa ATI e PAS e deslocamento angular durante o agachamento unipodal para as variáveis flexão de joelho no plano sagital (FLX JOE PS), báscula pélvica (BASC), adução do quadril (ADU QUA) e adução do joelho (ADU JOE) Todas as variáveis foram avaliadas nos lados direito (DIR) e esquerdo (ESQ). Vinte sujeitos do sexo masculino (27,0 ± 4,9 anos; massa corporal: 80,07 ± 13,13 kg; estatura: 1,78 ± 0,06 cm; dominância direita [n=18, 90%]), foram submetidos a dois dias de avaliação da funcionalidade do quadril por três avaliadores: (1) dia 1 pelo avaliador 1; (2) dia 2 por três avaliadores (avaliador 1, 2 e 3, com 30 minutos de intervalo entre as avaliações). A análise dos dados foi realizada no software SPSS v. 20.0, por meio de estatística descritiva (média, DP - desvio padrão) e inferencial (ICC – intraclass correlation coefficient; SEM – Standard error measurement; MDC – minimal detectable change = 1,96*SEM) (α<0,05). O teste t pareado foi utilizado para examinar se houve diferença sistemática entre o teste e re-teste e a ANOVA One-Way para medidas repetidas foi utilizada para comparar as médias entre os avaliadores. Havendo efeito principal significativo, foi utilizado um teste post-hoc de Bonferroni para comparações múltiplas (p≤0,05). Para as medidas de força de todos os grupos musculares, a reprodutibilidade intra-avaliador revelou valores de ICC classificados como excelentes para todos os grupos musculares avaliados (ICC≥0,89; p<0,001) com valores médios de SEM = 11,83 ± 2,94 N e MDC = 23,21 ± 5,80 N A reprodutibilidade interavaliador revelou valores de ICC excelentes para todos os grupos musculares (ICC≥0,90; p<0,001) com valores médios de SEM = 10,69 ± 1,96 N e MDC = 20,93 ± 3,86 N. Em relação às medidas de ADM obtidas por goniometria, a reprodutibilidade intravaliador foi classificada como excelente (ICC≥0,77; p<0,05) com valores médios de SEM = 2,67 ± 0,54°e MDC = 5,21 ± 1,04°, com exceção da ADM de FLX PASS DIR (ICC≥0,68; p=0,100), EXT ATI DIR (ICC=0,73; p=0,030) e ESQ (ICC=0,66; p=0,011), consideradas satisfatórias. A reprodutibilidade interavaliador dos valores de ADM por goniometria foram classificadas como excelentes na comparação interavaliadores (ICC≥0,77; p<0,001) com valores médios de SEM = 5,22 ± 1,04° e MDC = 6,95 ± 6,34°, com exceção dos valores de ICC da variável EXT ESQ ATI considerada satisfatória (ICC=0,62), Quanto à ADM obtidas através da fotogrametria, as medidas apresentaram valores de ICC para reprodutibilidade intra e interavaliador classificados como excelentes (ICC≥0,93 e ≥0,96, respectivamente; p<0,001) e valores médios de SEM = 1,94 ± 0,39°e MDC = 3,8 ± 0,76° (intra-avaliador) e de 1,43 ± 0,18° e 2,80 ± 0,34° (interavaliador), respectivamente Para os valores de deslocamento angular durante o agachamento unipodal, com exceção dos valores de ICC da variável de ADU QUA ESQ (ICC=0,62; p=0,021), classificada como satisfatória, todos os valores de ICC foram considerados excelentes para todas as medidas de reprodutibilidade intra-avaliador (ICC≥0,82; p<0,001), com valores médios de SEM = 2,55 ± 1,01° e MDC = 4,98 ± 1,99°. Para reprodutibilidade interavaliador, todos os valores de ICC foram classificados como excelentes (ICC≥0,87; p<0,001), com valores médios de SEM = 1,78 ± 0,65° e MDC = 3,48 ± 1,26°. Os resultados demonstram que os testes avaliados podem ser usados tanto na prática clínica quanto em pesquisas, pois apresentam medidas confiáveis, uma vez que sua reprodutibilidade intra e interavaliador são satisfatórias/excelentes. Entretanto, aprimoramentos nas técnicas utilizadas são necessários a fim de melhorar a reprodutibilidade e reduzir os erros de medida na avaliação do quadril. / The evaluation of the hip joint continues to be considered challenging and reproducible measures are key to building an evidence-based practice. The objective of this Master's thesis was to evaluate the intra and inter-rater reproducibility of the isometric maximum strength test with manual dynamometer, the photogrammetric and goniometric evaluation of range of motion (ROM) and the 2-D video analysis of single leg squat test in healthy subjects. In Chapter I, through a large literature review, we noticed the existence of disagreements regarding hip assessment, since a systematized evaluation involving the measures most commonly indicated in clinical practice was not observed. Chapter II evaluated the intra and inter-rater reproducibility by three evaluators for manual dynamometry: internal and external rotators (IR and ER), adductors (ADD) and abductors (ABD), flexors (FLX) and extensors (EXT ), hip ROM by goniometry (active extension and bilateral internal rotation; active and passive flexion and external rotation); and by photogrammetry (active and passive IR and ER) and angular displacement during single leg squat (knee flexion in the sagittal plane (KFLX SP), pelvic drop (PD), hip adduction (HADD) and knee adduction (KADD). All variables were evaluated on the right (R) and left (L) sides Twenty male subjects (27.0 ± 4.9 years, body mass: 80.07 ± 13.13 kg, height: 1.78 ± 0.06 cm, right dominance [n = 18, 90%]) were submitted to two days of evaluation of hip functionality by three evaluators: (1) day 1 by the evaluator 1; (2) day 2 by three evaluators (evaluator 1, 2 and 3, with a 30-minute interval between evaluations). Data analysis was performed in SPSS v. 20.0, by means of descriptive statistics (mean, SD - standard deviation) and inferential (ICC - intraclass correlation coefficient; SEM) (α<0.05). The paired t-test was used to examine whether there was a systematic difference between the test and re-test and the One-Way ANOVA for repeated measures was used to compare the means among the evaluators. For the strength measurements of all muscle groups, the intra-rater reproducibility revealed values classified as excellent for all muscle groups evaluated (ICC≥0.89; p<0.001) with SEM values = 11.83 ± 2.94 N and MDC = 23.21 ± 5.80 N. The inter-rater reproducibility revealed excellent ICC values for all muscle groups (ICC≥0.90, p<0.001) with SEM values = 10.69 ± 1.96 N and MDC = 20.93 ± 3.86 N Regarding the measurements of ROM obtained by goniometry, the intra-rater reproducibility was classified as excellent (ICC≥0.77, p<0.05) with mean values of SEM = 2.67 ± 0.54° and MDC = 5.21 ± 1.04°, with the exception of passive right flexion (ICC=0.68; p=0.100), active right extension (ICC=0.73; p=0.030) and active left extension (ICC=0.66; p=0.011), considered satisfactory. The inter-rater reproducibility of ROM values by goniometry were classified as excellent in the inter-rater comparison (ICC≥0.77; p<0.001) with SEM values = 5.22 ± 1.04° and MDC = 6.95 ± 6.34, with the exception of ICC values of the active left extension considered satisfactory (ICC=0.62). Regarding the ROM obtained through photogrammetry, the measurements presented ICC values for intra and inter-rater reproducibility classified as excellent (ICC≥0.93 and ≥0.96, respectively; p<0.001) and mean values of SEM = 1.94 ± 0.39° and MDC = 3.8 ± 0.76° (intra-rater) and 1.43 ± 0.18° and 2.80 ± 0.34° (inter-rater), respectively. For the values of angular displacement during unipodal single leg squat, except for the ICC values of the left hip adduction variable (ICC=0.62; p=0.021), classified as satisfactory, all were considered excellent for all measures (ICC≥0.82, p<0.001), with SEM values = 2.55 ± 1.01° and MDC = 4.98 ± 1.99°. For inter-rater reproducibility, all ICC values were classified as excellent (ICC≥0.87; p<0.001), with SEM values = 1.78 ± 0.65° and MDC = 3.48 ± 1.26°. The results demonstrate that the tests evaluated can be used both in clinical practice and in research, since they present reliable measures, since their intra and inter-rater reproducibility are satisfactory/excellent. However, improvements in the techniques used are necessary to improve reproducibility and reduce measurement errors in hip assessment.

Submitted by THAYS CRISTINA OLIVEIRA DE QUADROS null (thays_quadros@hotmail.com) on 2016-03-02T18:32:42Z No. of bitstreams: 1 Tese completa thays 02.03.16.pdf: 1989348 bytes, checksum: 75edcaa9e80015e2965931de58d7c03e (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-03-04T13:38:45Z (GMT) No. of bitstreams: 1 quadros_tco_dr_jabo.pdf: 1989348 bytes, checksum: 75edcaa9e80015e2965931de58d7c03e (MD5) / Made available in DSpace on 2016-03-04T13:38:45Z (GMT). No. of bitstreams: 1 quadros_tco_dr_jabo.pdf: 1989348 bytes, checksum: 75edcaa9e80015e2965931de58d7c03e (MD5) Previous issue date: 2016-02-05 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Foram avaliados os efeitos da nutrição in ovo com vitamina D3 e da dieta hídrica contendo alendronato de sódio sobre o desenvolvimento ósseo e parâmetros zootécnicos. O experimento foi constituído de duas fases (incubação e criação). No período de incubação, o delineamento experimental foi inteiramente casualizado com cinco tratamentos (ovos não injetados, injetados somente com óleo de oliva, 1,2μg, 2,4 µg e 3,6 µg de vitamina D3 / 100 µL de óleo de oliva) de injeção de vitamina D3 em 600 ovos férteis de matrizes de frango de corte, favorecendo desafio para fase seguinte, ou seja, promovendo menor desenvolvimento embrionário ósseo, gerando o desafio para a fase de criação para testar os níveis de alendronato de sódio. Na fase de criação o delineamento foi inteiramente casualizado, em esquema fatorial 2 x 5 (vitamina D3 durante o período de incubação e diferentes concentrações de AS no período de criação). A nutrição in ovo de vitamina D3 não afeta a eclodibilidade (P>0,05), no entanto, afeta de maneira negativa a densidade óssea de pintos pós-eclosão. O alendronato de sódio não apresentou dados significativos (P>0,05) para parâmetros de desenvolvimento ósseo. Portanto, conclui-se que se tornam necessárias novas pesquisas a fim de determinar níveis ideais deste fármaco com o intuito de melhorar a condição óssea de frangos de corte. / The effects of nutrition in ovo with vitamin D3 and hydro diet containing sodium alendronate on bone development and performance parameters were evaluated on this study. The experiment consisted in two stages (hatching and growing). The incubation period and the experimental design was completely randomized with five treatments (not injected eggs; injected only with olive oil; 1.2μg; 2.4 μg and 3.6 μg of vitamin D3 / 100 μL of olive oil) injection of vitamin D3 in 600 fertile eggs of matrices broilers, favoring a challenge to the next stage, ie, a lower bone promoting embryonic development, generating a challenge for the growing phase to test the levels of AS. The stage of growing design was completely randomized in a factorial 2 x 5 (vitamin D3 during the incubation period and different concentrations of AS in the growing period). The vitamin D3 nutrition in egg hatchability did not affect (P> 0.05), however, negatively affected the bone densitometry post-hatch chicks, as the sodium alendronate showed no significant data (P> 0.05) for bone development parameters. However, it is concluded that further studies are necessary to determine the levels of this drug in order to improve the bone condition of broilers. / FAPESP: 2012/15365-1

Background: Most patients with leg-ulcers are managed within primary- and community care and a main part of district nurses' duties is to provide leg-ulcer care. Leg-ulcers have an impact on patients' quality of life, health services and society. Previous studies have shown that district nurses have a poor knowledge and fail to work evidence-based within this field. It is therefore of great interest to explore the district nurses' experiences of this matter, as an evidence-based approach is essential to optimize wound-healing and prevent re-occurrence. Aim/ objective: The aim of this study was to explore district nurses' experiences of working evidence-based whilst caring for patients with venous leg-ulcers. Method: The study has a qualitative design with an inductive approach. Data has been collected from members in a closed web-site group on social media, containing nurses countrywide, with experience of leg-ulcer care. A questionnaire with open and closed questions was used. Data from the 55 responses received were analysed using qualitative content analysis, which resulted in two main areas related to Competence and Working environment. Results: The main findings concerned the lack of co-operation with other professional groups, shortage of continuous training, unavailability of time, continuity and other resources, inability of patients to comply, and a need for improved management support. Discussions with more experienced nursing colleagues for advice was regarded as highly important and useful. Conclusions: The result shows that organizational structures hindered the district nurses to work evidence-based. This study can contribute to inspiration and increase the awareness in the different levels within the working organization regarding the importance of working evidence-based on this topic.

Bakgrund: Sår på fötterna eller underbenen som inte läker inom sex veckor kallas för svårläkta bensår och tar ofta månader eller upp till flera år att läka. Bensår är ofta återkommande och är ett vanligt förekommande problem som ökar med stigande ålder. Syfte: Syftet med denna uppsats var att beskriva personers upplevelser av att leva med bensår. Metod: Litteraturöversikt med sökning och sammanställning av tidigare forskning. Resultat: Resultatet i denna litteraturöversikt visade att personer med bensår upplevde mer lidande och sämre livskvalitet fysiskt, psykiskt och socialt sett. Diskussion: Personer med bensår är en utsatt patientgrupp som har försämrad livskvalitet och därför ställs det stora krav på sjuksköterskans etiska medvetenhet och ett personcentrerat förhållningssätt. Slutsats: Resultatet visade tydligt att det deltagarna tyckte var jobbigast med bensår var smärtan och de sociala, fysiska och psykiska förändringarn som de tvingades genomgå på grund av bensåret. En bra relation mellan sjuksköterska och patient var viktig för att skapa bra förutsättningar för personens vård och välmående. / Background: Wounds on the feets or lower legs that doesn’t heal within six weeks is called leg ulcers. Leg ulcers often takes months or several years to heal and they often recur. It is a big problem that increases with increasing age. Aim: The aim of this literature review was to describe patients experience of living with a leg ulcer. Methods: Literature review with search and compilation of previous results. Results: The results of this literature review showed that people with leg ulcers experienced more suffering and a impaired quality of life than people without leg ulcers. Discussion: Persons with leg ulcers was a exposed patient group that experienced impaired quality of life and that made big demands on the ethical awareness from nurses and a person-centered approach on the nursing. Conclusion: The results clearly viewed that the participants thought that the pain and the social, physical, psychic changes that they were forced to experience because of the leg ulcer was the worst thing. A good relationship between nurse and patient was important to create the best possible conditions for the patient’s health and well-being.

Made available in DSpace on 2016-12-08T16:24:07Z (GMT). No. of bitstreams: 1 PGCA09MA054.pdf: 260243 bytes, checksum: 0f7b307401cecae66d2650af13dce4dd (MD5) Previous issue date: 2009-06-20 / The main objective of the slaughtering of animals for human consumption is to obtain meat in quantity and with quality. Thus, the meat needs to be within the standards required by current legislation. However, the agroindustry still faces serious problems due to microbiological contamination of carcasses during slaughter and/or processing. Alternatives proposed aiming to decontaminate carcasses during slaughter include treatment with the use of organic acids and/or steam. Such treatments aim to ensure the biological safety of foods and complement the autocontrol programs of industry on a prevention basis, such as hygiene care during the handling of foods and the sanitization of equipment to avoid any type of cross contamination. However, little research has provided conclusive information regarding whether these treatments lead to organoleptic and physico-chemical changes in the pork, which would be completely undesirable in terms of the quality parameters. Thus, this study aims to evaluate the possible physico-chemical changes in pork legs submitted to treatments with organics acids, steam and a combination of the two treatments. Visual and sensory analysis was carried out on the aspect, color, consistency and odor, before and after each treatment, together with physico-chemical analysis in order to determine the pH and the percentage of lipids, proteins, moisture and volatile compounds, also before and after each treatment. The results obtained revealed that the treatments used did not interfere in the attributes of aspect, color, odor and consistency and also did not lead to changes in the physico-chemical properties, with the exception that the treatment using organic acid combined with steam led to a decrease in the pH and increase in the moisture content and volatile compounds in the meat. However, this treatment did not denature the physicochemical quality of the pork, which remained within the standards, and therefore appropriate for human consumption / O abate de animais para o consumo humano tem por objetivo principal a obtenção de carne em quantidade e em qualidade. Para isso, é necessário que a carne esteja dentro dos padrões exigidos pela legislação vigente, porém, as agroindústrias ainda enfrentam sérios problemas com relação à contaminação microbiológica de carcaças durante o abate e/ou processamento. Entre as alternativas propostas visando descontaminar carcaças no abate, tem sido proposto o tratamento com uso de ácidos orgânicos e/ou vapor. Tais tratamentos têm o objetivo de garantir a segurança biológica dos alimentos e complementar os programas de autocontrole das indústrias de caráter preventivo, como os cuidados higiênicos na manipulação dos alimentos e na higienização dos equipamentos evitando todo e qualquer tipo de contaminação cruzada. Porém, poucas pesquisas trazem informações conclusivas sobre o fato desses tratamentos promoverem ou não alterações físico-químicas da carne suína, o que seria totalmente indesejável frente a seus parâmetros de qualidade. Assim sendo, o presente projeto se propôs a avaliar as possíveis alterações físico-químicas de pernis suínos submetidos a tratamentos com ácidos orgânicos, vapor e associação dos dois tratamentos. Sendo realizadas análises visuais e sensoriais de aspecto, coloração, consistência e odor, antes e após cada tratamento, bem como, análises físico-químicas visando determinação do percentual de lipídeos, proteínas, pH, umidade e voláteis, também, antes e após cada tratamento. Os resultados obtidos revelaram que os tratamentos utilizados não interferiram nos atributos aspecto, cor, odor e consistência e, também, não alteraram suas propriedades físico-químicas, sendo que, somente o tratamento de vapor associado aos ácidos orgânicos diminuiu o pH e aumentou o teor de umidade e voláteis da carne, porém, não descaracterizou a qualidade físico-química da carne suína, que permaneceu dentro de seus padrões ideais, apta ao consumo humano