Behandling och omvårdnad vid svårläkta bensår är komplext då en bidragande orsak till uppkomst är arteriell och/eller venös insufficiens, där initial diagnos är grundläggande. Adekvat behandling kräver kännedom om bakomliggande faktorer, förbandsmaterial samt omläggningsprinciper. Svårläkta bensår förekommer främst hos personer över 65 års ålder. I takt med att medelåldern ökar, ökar även prevalensen av dessa sår vilket ställer krav på sjukvården, inte minst på sjuksköterskan för att tillgodose patientens behov samt främja hälso- och sjukvårdens budget.Studien innefattar åtta semistrukturerade intervjuer utförda på fem äldreboenden. Materialet analyserades med kvalitativ innehållsanalys. Det konstaterades att sjuksköterskan besitter ett stort ansvar gällande sårbehandling i den kliniska verksamheten. Sjuksköterskorna uttryckte bristande kännedom likväl erfarenhet inom det berörda området och upplevde ett behov av kompetensutveckling i avseende till sårbehandling. Erfarenhet av bensår samt kollegors rekommendationer ansågs ligga till grund för hur sårvården bedrevs på besökta verksamheter. Att inneha ett helhetsperspektiv betonades av betydelse för resultatet av vård och behandling. Omhändertagandet av svårläkta bensår beskrevs som komplext, kunskapskrävande och kostsamt. Mer utbildning behövs för att optimera sårvården. / Treatment and nursing of slow healing leg ulcers is complex as a contributing factor to the occurence is arterial and/or venous insufficiency, where the diagnosis is fundamental. Adequate treatment requires knowledge of the underlying factors, dressings and rescheduling principles. Slow-healing leg ulcers occurs mainly in people over age 65. As the average age increases, so does the prevalence of these wounds, which places demands on health care, not least the nurse to meet the patient's needs and promote the health care budget.In this study eight semi-structured interviews was conducted in five elderly homes. The material was analyzed using qualitative content analysis. It was found that nurses possess a big responsibility concerning wound treatment in the clinical practice. The nurses expressed lack of knowledge as well experience in the relevant field and felt a need for professional development in relation to wound care. Experience of leg ulcers and colleagues' recommendations were considered to be the basis for the wound care conducted in visited units. An holistic approach was emphasized relevant to the outcome of care and treatment. The disposal of slow healing leg ulcers were described as complex, knowledge-intensive and costly. More education is needed to optimize wound care.

Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

No description available.

Syftet med denna litteraturstudie var att lyfta fram hur vardagen upplevs, och vad som påverkar den, av patienter med svårläkande venöst bensår. Elva vetenskapliga artiklar granskades och kvalitetsbedömdes enligt givna kriterier. Därefter inleddes den strukturella analysen där tre huvudteman framträdde. Carnevalis balansmodell användes som teoretisk referensram. De tre teman som återfanns var: relationen mellan patient och profession; fysiska, psykiska och sociala konsekvenser av att leva med svårläkande venöst bensår, samt föreställningar och kunskap. Det första temat berörde vikten av god kommunikation mellan patient och profession. Det andra temat behandlade patientens egna känslor och upplevelser relaterade till bensåret. Det tredje temat hanterade kunskap och föreställningar bland såväl patient som sjuksköterska och läkare. Sjuksköterskan har makt och kunskap att påverka alla de faktorer som präglar patientens tillvaro. Genom god kommunikation, kontinuitet och ett hänsynstagande till patientens upplevelser förknippade med bensåret, i synnerhet smärta, kan dennes balans i vardagen återskapas. / The aim of this literature review was to highlight the daily life experiences, and what affects them, when living with a venous leg ulcer. Eleven research articles were examined and measured by quality according to a given set of criteria. Thereafter the structural analysis was commenced whereby three major themes emerged. Carnevali’s theory of daily life balance was used as a theoretical framework. The three themes that crystallised were: the relation between patient and profession; physical, psychological and social consequences of living with a slow healing venous leg ulcer, and knowledge and perceptions related to the ulcer. The first theme regarded the importance of good communication between the patient and the profession. The second theme considered the patient’s own experiences and feelings in relation to the leg ulcer. The third theme handled the knowledge and perceptions that influenced the patient’s lived experience. The registered nurse has the power and the knowledge to influence the ingredients that shape the patient’s life trajectory. Through good communication, continuity and consideration towards the patient’s feelings related to the leg ulcer, especially regarding pain, the daily life balance could be regained.

The purpose of the study was to determine the long-term effects of muscle weakness secondary to strokes on the bone mineral content of the hemiparetic limb. Patients who had experienced single recent strokes were studied. The bone mineral content of each limb was measured by Dual Energy X-ray Absorptiometry using the region of interest analysis program. Muscle strength of each muscle group was ranked using the Oxford scale, and the mean was calculated for each limb. Bone and muscle parameters were measured within seven days after the stroke and repeated thereafter at monthly intervals for up to 6 mo. A repeated measures analysis of variance, Newman-Keuls pair-wise comparisons, and orthogonal contrasts were done for each parameter. Significance levels were set at P < 0.05. Sixteen patients were included in this study. Demineralization was more pronounced in the upper than lower limbs. Demineralization of bones on the paralyzed side started during the first month after the stroke and gradually progressed. By the fourth month, the bone mineral content decreased by a mean of 9.3% (P = 0.01) and 3.7% (P = 0.01) in the upper and lower limbs, respectively, for the 11 patients followed for 4 mo. In the patients we followed for more than 4 mo, there was no further significant mineral loss. No change in bone mineral content was observed in the healthy nonparetic limbs. In conclusion, after a stroke, bone demineralization occurs in the paralyzed side and reaches its maximum within 3 to 4 mo. Arms are affected more than legs.

Yes / Passive prosthetic devices are set up to provide optimal function at customary walking speed and thus may function less effectively at other speeds. This partly explains why joint kinetic adaptations become more apparent in lower-limb amputees when walking at speeds other than customary. The present study determined whether a trans-tibial prosthesis incorporating a dynamic-response foot that was attached to the shank via an articulating hydraulic device (hyA-F) lessened speed-related adaptations in joint kinetics compared to when the foot was attached via a rigid, non-articulating attachment (rigF). Eight active unilateral trans-tibial amputees completed walking trials at their customary walking speed, and at speeds they deemed to be slow-comfortable and fast-comfortable whilst using each type of foot attachment. Moments and powers at the distal end of the prosthetic shank and at the intact joints of both limbs were compared between attachment conditions. There was no change in the amount of intact-limb ankle work across speed or attachment conditions. As speed level increased there was an increase on both limbs in the amount of hip and knee joint work done, and increases on the prosthetic side were greater when using the hyA-F. However, because all walking speed levels were higher when using the hyA-F, the intact-limb ankle and combined joints work per meter travelled were significantly lower; particularly so at the customary speed level. This was the case despite the hyA-F dissipating more energy during stance. In addition, the amount of eccentric work done per meter travelled became increased at the residual knee when using the hyA-F, with increases again greatest at customary speed. Findings indicate that a trans-tibial prosthesis incorporating a dynamic-response foot reduced speed-related changes in compensatory intact-limb joint kinetics when the foot was attached via an articulating hydraulic device compared to rigid attachment. As differences between attachment conditions were greatest at customary speed, findings indicate a hydraulic ankle-foot device is most effectual at the speed it is set-up for.

Purpose The vascular endothelium is an influential contributor to vasodilation at rest, yet its role during peak exercise is relatively unknown. The purpose of this study is to determine if exercise leg blood flow during dynamic submaximal and maximal exercise is related to resting vascular endothelial function. Methods Nineteen subjects (aged 23 ± 0.57 yr) completed multiple assessments of vascular endothelial function including passive leg movement (PLM), rapid onset vasodilation, (ROV) and flow-mediated dilation (FMD). Peak muscle blood flow was assessed during single leg knee extension (KE) exercise. Doppler ultrasound of the femoral artery was utilized to assess muscle blood flow. Results Peak exercise blood flow was linearly related with microvascular endothelial function determined by PLM (P < 0.001) and ROV (P < 0.001). Normalizing muscle blood flow for quadriceps mass did not change this significant association. Individuals with high vascular endothelial function had greater muscle blood flow during KE compared to those with low endothelial function (P = 0.05). Post hoc analysis indicated a significant difference in blood flow between high and low endothelial function groups at 20 W, 30 W, and peak flow (P = 0.042, 0.048, 0.001, respectively). Conclusion Peak muscle blood flow during dynamic exercise is correlated with vascular endothelial function, as measured by PLM and ROV, accounting for between 30 to 50% of the variance in this relationship. These data support the hypothesis that endothelial function significantly contributes to the peak blood flow response during dynamic exercise.

Bakgrund: Åldrandet orsakar hudförändringar vilket resulterar i att huden blir tunnare och skörare. Det blir en ökad risk för hudskador hos äldre, däribland svårläkta bensår. Såren är komplexa att behandla och kräver omfattande resurser och de kan dessutom orsaka lidande och påverka patientens upplevelse av hälsa negativt. Cirka 1 procent av befolkningen drabbas av svårläkta bensår, där över 90 procent är förknippade till venösa, arteriella, trycksår och diabetessår. Syfte: Att beskriva patienters upplevelse av att leva med svårläkta bensår. Metod: Studien är skriven som en litteraturöversikt där både kvantitativa och kvalitativa artiklar har inkluderats Resultat: I resultaten framkom fyra teman som belyser hur svårläkta bensår påverkar patienternas liv. De inkluderar smärta, social isolering, minskad livskvalitet, kommunikationsproblem med sjuksköterskor, begränsningar i vardagen och vårdrelationers betydelse. Svårläkta bensår medför en negativ påverkan på både fysisk och psykisk hälsa vilket begränsar patienterna från att utföra dagliga aktiviteter. Studien pointerar betydelsen av en bättre kommunikation med sjuksköterskor och en tryggare vårdrelation. Konklusion: Studien klargör vilka utmaningar patienter med svårläkta bensår möter, samt psykologiska, fysiska och sociala hinder. Smärta och sömnproblem är vanligt förekommande samt en oro för negativ social respons, vilket resulterar i social isolering. För att öka patienternas förtroende och välbefinnande är kommunikation med sjuksköterska avgörande. / Background: Aging leads to changes in the skin, resulting in it becoming thinner and more fragile. This increases the risk of skin damage among the elderly, including the development of non-healing leg ulcers. Treating these ulcers is complex and requires substantial resources. Approximately 1 percent of the population suffers from non-healingleg ulcers, with over 90 percent being associated with diabetes, pressure sores, or arterialor venous leg ulcers. Aim: To describe patients' experiences of living with non-healing leg ulcers. Method: This study is conducted as a literature review, including both quantitative and qualitative articles. Findings: Four central themes were defined in the study, illuminating how non-healing leg ulcers impact patients' lives. These include pain, social isolation, reduced quality of life, communication issues with nurses, daily life limitations, and the significance of healthcare relationships. Non-healing leg ulcers have a negative impact on both physical and mental health, limiting patients in performing daily activities. The study underscores the importance of improved communication with nurses and a secure healthcare relationship. Conclusion: The study clarifies the challenges faced by patients with non-healing legulcers, as well as psychological, physical, and social barriers. Pain and sleep problems are common, as well as concerns about negative social responses, leading to social isolation.To enhance patients' trust and well-being, communication with nurses is crucial.

Bakgrund: Bensår är ett globalt hälsoproblem och befolkningen blir allt äldre. Därmed ökar kroniska sjukdomar och risken att utveckla bensår. De flesta bensåren behandlas inom primärvården där distriktsköterskans roll är central. Det krävs att distriktssköterskan har en helhetsyn i vårdandet och därmed ett personcentrerat arbetsätt. Personcenterad vård är en av distriksköterkans kärnkompetenser varför erfarenheter av personcentrerad vård i mötet med personer med bensår utforskas. Syfte: Att beskriva distriktssköterskors erfarenhet av personcentrerad vård i mötet med personer som har bensår. Metod: Kvalitativ intervjustudie. Nio distriktsköterskor intervjuades genom individuella semistrukturerade intervjuer. Texten bearbetades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Resultatet visade att personcentrerad vård ansågs vara ett naturligt arbetssätt för distriktssköterskorna och innefattade helhetsyn, delaktighet och kontinuitet. Resultatet belyste distriktsköterskans roll att anpassa sitt förhållningsätt, vikten av teamarbete samt att distriksktssköterskorna besitter djupare kunskap i det personcentrerade vårdandet av personer med bensår. Det framkom varierande förutsättningar för personcenterad vård i organsiationer, arbetsplatsen och patientmöten. Slutsats: Distriktssköterskorna har en central roll i den personcentrerade vården genom fördjupade kunskaper. Därför är det viktigt att det finns goda förutsättningar för personcentrerad vård för personer med bensår eftersom det kan öka livskvalitén och minska tiden för sårläkning. Det kan även bidra till större arbetstillfredsställelse för distriktsköterskor och kostnadseffektivitet. / Background: Leg ulcers are a global health problem and the population is getting older. This increases chronic diseases and the risk of developing leg ulcers. Most leg ulcers are treated in primary care where the district nurse's role is central. It is required that the district nurse has a holistic view of care and thus a person-centered way of working. Person-centered care is one of the district nurse's core competencies, which is why experiences of person-centered care when dealing with people with leg ulcers are explored. Aim: To describe district nurses' experience of person-centred care in the meeting with people having leg ulcer. Method: Qualitative interview study. Nine district nurses were interviewed through individual semi-structured interviews. The text was processed with qualitative content analysis using an inductive approach. Results: The result showed that person-centred care was considered a natural way of working for the district nurses and included a holistic view, participation and continuity. The result highlighted the role of the district nurse in adapting their approach, the importance of teamwork and that the district nurses have deeper knowledge in the person-centred care of people with leg ulcers. Various conditions emerged for person-centred care in organisations, the workplace and patient meetings. Conclusions: The district nurses have a central role in person-centred care through in-depth knowledge. Therefore, it is important that there are good conditions for person-centered care for people with leg ulcers because it can increase the quality of life and reduce the time for wound healing. It can also contribute to greater job satisfaction for district nurses and cost efficiency.

No description available.