Objetivo: Determinar a influência do resultado imediato da angioplastia infrainguinal no sucesso clínico em 24 meses. Métodos: Foi realizado um estudo observacional prospectivo, que avaliou 40 angioplastias percutâneas infrainguinais, realizadas no período de abril de 2007 a fevereiro de 2011. Foram incluídos somente os casos com sucesso técnico e angiográfico intraoperatório. Todos os pacientes eram portadores de isquemia crítica de membro inferior decorrente unicamente de obstrução arterial crônica infrainguinal. Ultrassom com Doppler colorido (UDC) foi realizado um dia antes da cirurgia e no pós-operatório imediato. Foram registradas as velocidades de pico sistólico (VPS) nas artérias tibial anterior, tibial posterior e fibular na topografia do tornozelo. O gradiente de VPS pré e pós-operatório (GVPS) foi analisado e comparado prospectivamente quanto à melhora clínica em 2 anos, conforme os padrões recomendados pela SVS/ISCS. Foram utilizados os valores da artéria com a melhor variação perioperatória e da média das 3 artérias. Sucesso clínico foi definido como ausência de dor de repouso ou cicatrização de lesão. Resultados: Fizeram parte do estudo 19 mulheres e 20 homens, com média de idade de 68,5 ± 8,1 anos. Após 2 anos de seguimento, 26/40 lesões tiveram sucesso clínico sem novas intervenções cirúrgicas. Tempo de cicatrização variou de 4 a 111 semanas (mediana = 21,5 semanas). Lesões TASC II A/B tiveram sucesso clínico maior que TASC II C/D em 1 ano de seguimento (p<0,05), mas não em 2 anos (p=0,11). Entre os 14 casos de insucesso clínico, 6 foram submetidos a nova angioplastia e 4 a enxerto arterial. Três pacientes com angioplastia pérvia não tiveram cicatrização de lesão. Um paciente teve recorrência da úlcera no retorno de 24 meses. A perviedade primária foi de 62,5% ± 7,7% em 2 anos; e o salvamento de membro, de 92,5% ± 4,2% no mesmo período. Houve aumento de VPS, no leito distal, identificado pelo UDC. A variação de VPS foi de 44,4 cm/s, na melhor artéria, e de 21,9 cm/s, na média das artérias, para os casos de sucesso clínico. Para os casos de insucesso clínico, a variação foi de 45,3 cm/s, na melhor artéria, e de 24,7 na média das artérias. A comparação por UDC pré-operatória e pós-operatória imediata, através de VPS, não mostrou diferença estatística entre o grupos em 2 anos de seguimento. Conclusão: o aumento de fluxo pela avaliação por UDC, no pós-operatório imediato, não está relacionado com a resolução dos sintomas em 24 meses / Purpose: to evaluate the impact of the initial result of Percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, in the two-years clinical outcome. Methods: Between February 2007 and April 2011 thirty-nine patients with femoropopliteal atherosclerotic disease successfully treated by PA were included (40 limbs). One patient had both limbs treated in different occasions, and was considered as 2 cases for analysis. All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex-ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) was recorded in the anterior tibial, posterior tibial and fibular arteries at the level of distal third of the leg. All patients were followed for 2 years. Comparison between good and bad groups were based on VPS, including the perioperative gradient (GPSV) of the artery with highest variation and the mean of the VPS in the 3 arteries. After 2-years good result were defined as good when the patient had no pain and complete healing of a previous ulcer or minor amputations. It was considered as bad result when a second intervention was required or when unhealed lesions were present at the end of the 2-year period. Results: Mean age was 68,5 ± 8,1 years-old. In 26 cases the long-term result was good. Healing time ranged from 4 to 111 weeks (median 21.5). Bad long-term results were observed in 14 cases. Three lesions had persisted unhealed despite patent angioplasty. One case has ulcer recurrence at 24 months appointment. In 10 cases a second procedure was carried out (redo angioplasty in 6 and bypass in 4). TASCII A/B registered better clinical success then TASCII C/D (p<0,05) at 1-year follow-up but not at 2-years (p=0,11). Two-year limb salvage was 92,5% ± 4,2%. Primary patency was 62,5% ± 7,7% in 2-years. GVPS was 44,4 cm/s (highest artery) and 21,9 cm/s (mean PSV) in success group. GVPS was 45,3 cm/s (highest artery), and 24,7cm/s (mean VPS). The quality of the initial result, as measured by GPSV, was not associated with a good or bad long-term success (p>0,05). Conclusion: once the procedure was successfully performed, the degree of increase in flow is not related to the long-term durability and ulcer healing

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-04T17:53:19Z No. of bitstreams: 1 leonardocoelhopertence.pdf: 1941969 bytes, checksum: f7f3753c2825d1dfd1c727018b9807ec (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-13T16:21:57Z (GMT) No. of bitstreams: 1 leonardocoelhopertence.pdf: 1941969 bytes, checksum: f7f3753c2825d1dfd1c727018b9807ec (MD5) / Made available in DSpace on 2016-07-13T16:21:58Z (GMT). No. of bitstreams: 1 leonardocoelhopertence.pdf: 1941969 bytes, checksum: f7f3753c2825d1dfd1c727018b9807ec (MD5) Previous issue date: 2012-06-15 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo do presente estudo foi investigar os efeitos da aplicação contrapesos no VO2, FC e PE durante a pedalada unilateral. Participaram do estudo 11 ciclistas (31 ± 8 anos, 176 ± 8 cm, 70,6 ± 10,8 Kg, 22,7 ± 2,1 Kg.m2, e 64 ± 9 ml.kg-1.min-1). Os ciclistas compareceram ao laboratório em 7 dias diferentes. No primeiro dia, foram submetidos à avaliação antropométrica, a um teste de pedalada bilateral (PB) em carga constante nas potências de 60 e 100 W e cadências de 60, 75 e 90 rpm, seguido por um teste de PB incremental. Do segundo ao sétimo dia, foram realizados os testes de pedalada unilateral (PU) com o membro inferior dominante utilizando os contrapesos de 2,5 kg ou 5,0 kg ou sem contrapeso nas potências de 60 e 100 W. O VO2, FC e PE foram medidos em todos os testes de PB e PU. Os dados foram apresentados por média ± desvio padrão. Foi utilizada ANOVA para medidas repetidas e posteriormente a plotagem de Bland-Altman para verificar a concordância entre a PU e a PB. Na potência de 60 W, a PU pode ser executada sem a necessidade de aplicação de contrapesos. Na potência de 100 W, durante a PU, tanto o contrapeso de 2,5 quanto o de 5,0 Kg equipararam o VO2 com o da PB, independentemente da cadência utilizada. Para a frequência cardíaca e percepção do esforço, o uso de contrapesos na potência de 60 W mostrou-se efetivo em reproduzir a PB. Entretanto, na potência de 100 W, a aplicação de contrapesos tanto para a frequência cardíaca quanto para a percepção do esforço, não foi um método eficaz para tornar a PU similar a PB. / The aim of this study was to investigate the effects of applying counterweight on VO2, HR and RPE during single-leg cycling. The study included 11 cyclists (31 ± 8 years, 176 ± 8 cm, 70.6 ± 10.8 kg, BMI 22.7 ± 2.1 and 64 ± 9ml.kg-1.min-1). The experimental design was divided into 7 different days. On the first day, the volunteers were submitted to anthropometric evaluation, a double-leg test of cadences in powers of 60 and 100 W and cadences of 60, 75 and 90 rpm followed by a double-leg incremental test. From the second to the seventh day, were performed single-leg tests with dominant leg using the counterweight 2.5 kg or 5kg or noncounterweight and in the 60 W and 100 W powers. The VO2, HR and RPE values were measured in all tests. The data were presented by mean ± standard deviation. We used, ANOVA for repeated measures and subsequently the Bland-Altman plot to assess the agreement between single-leg and double-leg cycling. The PU60 was not different from PB60 from the point of view of oxygen uptake. At 100 W workload, both the counterweights 2.5 Kg and 5,0 Kg matched the oxygen uptake, enabling single-leg cycling to be performed with the same metabolic cost of double-leg cycling. However, at 100 W workload, the counterweight apparatus was not effective to make similar single-leg and double-leg cycling based on HR and RPE comparisons.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-14T17:58:21Z No. of bitstreams: 1 Ana Luiza Soares Rodrigues.pdf: 1097029 bytes, checksum: 6d854fd13dfbf1dda2898d6f73d3ba62 (MD5) / Made available in DSpace on 2016-10-14T17:58:21Z (GMT). No. of bitstreams: 1 Ana Luiza Soares Rodrigues.pdf: 1097029 bytes, checksum: 6d854fd13dfbf1dda2898d6f73d3ba62 (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O estudo teve como objetivos avaliar a efetividade do gel de papaína a 2% comparado ao gel de carboximetilcelulose a 2% no tratamento de pacientes com úlceras venosas crônicas e analisar as características sociodemográficas, econômicas e clínicas destes pacientes, atendidos no Ambulatório de Reparo de Feridas do Hospital Universitário Antonio Pedro/UFF. Método: Ensaio clínico controlado e randomizado (ECCR) com tempo de seguimento de 12 semanas. A amostra consecutiva foi composta por 18 voluntários e um total de 28 úlceras venosas. A coleta de dados ocorreu de abril de 2013 a janeiro de 2014. O desfecho primário do estudo foi a redução da área da lesão e os desfechos secundários foram a redução de tecidos desvitalizados no leito da úlcera e a redução da quantidade de exsudato. A pesquisa foi submetida ao Comitê de Ética em Pesquisa da Faculdade de Medicina, do Hospital Universitário Antonio Pedro/UFF e aprovada com o número 196/98, CAAE nº 0154.0.258.000-08. Resultados: Os grupos foram homogêneos quanto às características sociodemográficas, econômicas e clínicas. A idade dos voluntários variou de 45 a 85 anos, com média de 61,94 anos. A maioria dos participantes se declarou casado (55,6%), com escolaridade até o ensino fundamental (66,7%), residente de São Gonçalo (44,4%) e aposentado (66,7%). Todos os voluntários possuíam insuficiência venosa crônica, 61,1% apresentava hipertensão arterial sistêmica e 11,1% diabetes mellitus. A maioria das úlceras venosas lesões teve início há mais de dez anos (53,6%) e a localização mais acometida foi a região maleolar (53,6%). Quanto à evolução das úlceras ao longo de 12 semanas de tratamento, o grupo papaína apresentou redução significativa da área das lesões, especialmente no período entre a 5ª e a 12ª semanas de tratamento, com duas úlceras cicatrizadas e aumento expressivo da quantidade de tecido de epitelização no leito das lesões. Nos dois grupos de tratamento houve redução significativa da quantidade de tecido desvitalizado e aumento de tecido de granulação da 1ª semana para a 12ª semana (p-valor <0,05). Conclusão: o gel de papaína a 2% apresentou maior efetividade quanto à redução da área das lesões, entretanto se mostrou similar ao gel de carboximetilcelulose a 2% quanto à redução da quantidade de exsudato e de tecido desvitalizado. A partir dos resultados da pesquisa foram destacados os principais cuidados de enfermagem que podem auxiliar a assistência e o tratamento de pacientes com úlceras venosas crônicas. / The study aimed to evaluate the effectiveness of papain gel at 2% compared to the carboxymethylcellulose gel at 2% in the treatment of patients with chronic venous ulcers and analyze sociodemographic, economic and clinical characteristics of these patients, treated at the Outpatient Wound Repair at Antonio Pedro University Hospital/UFF. Method: Randomized Controlled Trial (RCT) with 12 weeks of follow-up. The consecutive sample consisted of 18 volunteers and a total of 28 venous ulcers. The data collection occurred from April 2013 to January 2014. The primary end point was the decrease of the lesion area and the secondary endpoints were devitalized tissue decrease in the ulcer bed and the reduction of the amount of exudate. The study was submitted to the Ethics Committee of the Faculty of Medicine, University Hospital Antonio Pedro/UFF and approved with the number 196/98, CAAE n. 0154.0.258.000-08. Results: The groups were homogenous regarding sociodemographic, economic and clinical characteristics. The volunteers ages ranged from 45 to 85 years old, with a mean of 61.94 years old. Most participants declared married (55.6%), with schooling up to elementary school (66.7%), resident of São Gonçalo (44.4%) and retired (66.7%). All volunteers had chronic venous insufficiency, 61.1% had hypertension and 11.1% diabetes mellitus. Most venous ulcers injuries began more than ten years ago (53.6%) and the most affected location was the malleolar area (53.6%). Regarding the ulcers evolution over the 12 weeks of treatment, the papain group showed a significant decrease in the lesions area, especially in the period between the 5th and the 12th weeks of treatment, with two healed ulcers and significant increase in the amount of epithelialization tissue. In both treatment groups, there was a significant decrease in the amount of devitalized tissue and an increase of the granulation tissue from 1st week to the 12th week (p <0.05). Conclusion: The papain gel at 2% was more effective in reducing of the lesions area, however it showed similar to the carboxymethylcellulose gel at 2% in reducing the amount of exudate and devitalized tissue. From the results of the research were highlighted the main nursing care that can help the assistance and treatment of patients with chronic venous ulcers.

Made available in DSpace on 2014-08-20T14:38:01Z (GMT). No. of bitstreams: 1 dissertacao_pedro_quevedo.pdf: 852940 bytes, checksum: 646d10b8df90285825807c9a0da507ab (MD5) Previous issue date: 2010-12-20 / A retrospective study of clostridial diagnosed in ruminants from 1978-2008 in southern Rio Grande do Sul, was conducted in the influence area of the Regional Diagnostic Laboratory of the Federal University of Pelotas. Out of 5.446 bovine specimens sent by practitioners or from necropsies performed 91 (1,67%) were diagnosed as clostridiosis. Of those, 30 (0.55%) were diagnosed as by black leg, 15 (0.27%) as bacillary hemoglobinuria, 9 (0.16%) as botulism, 9 (0.16%) as malignant edema, and 28 (0.51%) as tetanus. Out of 860 sheep specimens 49 (5.69%) were bacterial diseases and 14 (28,57%) of those were diagnosed as clostridiosis, being 10 (1.16%) cases of tetanus, 3 (0.34%) of malignant edema, and 1 (0.11%) %) of enterotoxemia. It was concluded that some clostridiosis cause important losses in livestock in Rio Grande do Sul, mainly black leg. The vaccination of young stock against black leg is recommended in the whole state. Vaccination against botulism is recommended in areas of native pastures where phosphorus deficieny occurs, and vaccination against bacillary hemoglobinuria is recommended in low lands where fasciolosis is enzootic. In cattle, tetanus may occur as outbreaks with significant economic losses, recommending also the vaccination of animals. In sheep clostridioses are less important being tetanus the more frequent. Good hygienic practices, mainly during castration or tail are recommended to prevent the disease. Enterotoxemia is a rare disease in the region, because most sheep are raised in native pastures with limited grass production; vaccination is only recommended in sheep grazing in cultivate pastures or supplemented with concentrates. / Foi realizado um estudo retrospectivo dos diagnósticos de clostridioses ocorridos na região sul do Rio Grande do Sul correspondente a área de influência do Laboratório Regional de Diagnóstico da Faculdade de Veterinária da Universidade Federal de Pelotas entre janeiro 1978 e janeiro de 2008 e acompanhados os casos de clostridioses diagnosticados nos anos 2009 e 2010. De um total de 5.446 materiais de bovinos provenientes de necropsias ou órgãos enviados 91 (1,67%) correspondiam a enfermidades causadas por bactérias do gênero Clostridium sendo 30 (0,55%) de carbúnculo sintomático, 15 (0,27%) de hemoglobinúria bacilar, 9 (0,16%) de botulismo, 9 (0,16%) de edema maligno e 28 (0,51%) de tétano. De 860 materiais de ovinos 49 (5,69%) diagnósticos corresponderam a doenças bacterianas e desses 14 (28,57%) foram de surtos de clostridioses. Dos 14 surtos de clostridioses observados em ovinos 10 (1,16%) foram de tétano, três (0,34%) de edema maligno e um (0,11%) de enterotoxemia. Concluiu-se que algumas clostridioses causam prejuízos econômicos à bovinocultura da região, principalmente o carbúnculo sintomático, recomendando-se a vacinação sistemática dos bovinos jovens contra esta clostridiose. Recomenda-se, também, a vacinação contra botulismo, em áreas de campo nativo onde ocorre carência de fósforo e contra hemoglobinúria bacilar em áreas de campos baixos onde ocorre infecção por Fasciola hepatica. Em bovinos o tétano pode ocorrer como surtos com prejuízos econômicos importantes, recomendando-se, também, a vacinação dos animais. Em ovinos as clostridioses têm pouca importância, sendo o tétano a mais frequente. Para a profilaxia desta doença em ovinos recomenda-se utilizar práticas de manejo, como descola e castração, em condições adequadas de higiene. Enterotoxemia é uma enfermidade rara na região por que a maioria dos ovinos permanece em campos nativos com limitada produção de foragem; recomenda-se a vacinação somente em animais em pastagens cultivadas ou suplementados com concentrados.

L'angiodermite nécrotique ou "Hypertensive Leg Ulcer" (HLU) est un ulcère de jambe inflammatoire de traitement difficile, associé à une hypertension artérielle chronique. La douleur est très importante et nécessite l'utilisation de la morphine pour soulager les patients. Notre objectif était d'analyser les caractéristiques de l'inflammation et d'étudier son implication dans la physiopathologie de la nécrose cutanée. La peau inflammatoire est le siège d'un infiltrat composé de macrophages et de lymphocytes. L'épiderme et les cellules vasculaires lisses des microvaisseaux présentent des troubles de la différenciation et une importante prolifération. Nous observé une forte augmentation des transcrits de l'interleukine 1β (IL-1β), de l'IL-6 et de l'Oncostatin M (OSM), qui sont exprimées par les macrophages.Les kératinocytes humains in vitro et in vivo chez la souris montrent un phénotype semblable lorsqu'ils sont exposés à ces cytokines.Comparée à la peau inflammatoire et à la peau saine, la peau en périphérie de l'inflammation est douloureuse et présente des altérations histologiques intermédiaires. On observe une légère augmentation de l'expression des cytokines inflammatoires IL-1β et OSM. D'autre part, la consommation de morphine est associée au niveau d'expression de l'OSM et l'inflammation systémique reflète la douleur ressentie par le patient. Ces éléments sont en faveur d'une implication des cytokines inflammatoires IL-1β et OSM dans la physiopathologie de la douleur et de la nécrose dans l'HLU. Le cercle vicieux pourrait être bloqué par l'utilisation des biothérapies anticytokines, ce qui met en avant de nouvelles cibles thérapeutiques. / Hypertensive Leg Ulcer (HLU) is an inflammatory skin lesion associated to chronic high blood pressure. The ulcer is painful requiring morphine to relieve patients. Our objective was to analyze the characteristics of the inflammation and to study it’s implication in pathogenesis of skin necrosis. Inflammatory skin is infiltrated by macrophages and lymphocytes. Keratinocytes and vascular smooth muscle cells of microvessels display an alteration of differentiation and an important proliferation. We studied the expression of cytokines associated to skin inflammation and we observed a strong augmentation of the transcripts for the interleukin 1β (IL-1β), the IL-6 and the Oncostatin M (OSM); which are expressed by the macrophages. The reconstructed human epidermis in vitro exposed to these cytokines showed a similar phenotype of the histological studies in human. At least, injection of these cytokines to the mouse produces an inflammation and an alteration of the epidermis comparable to HLU.Compared to the inflammatory skin and to the healthy skin, the skin in periphery of the inflammation is painful and presents intermediate histological alterations. We observed a slight augmentation of the inflammatory cytokines IL-1β and OSM. On the other hand, the consumption of morphine is associated with the level of expression of the OSM and systemic inflammation reflects the pain felt by the patient.The present evidence indicates an involvement of inflammatory cytokines IL-1β and OSM in the pathogenesis of pain and skin necrosis in the HLU. The vicious circle may be blocked by the use of biotherapies against inflammatory cytokines, which highlights new therapeutic targets.

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and  analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to     generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary   collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

In this paper, a new algorithm for utilizing energy storage is proposed and applied on floating wind turbine economics. The proposed algorithm’s decision making on storing energy or selling electricity onto the grid is based on the electricity price, which makes it unique and different from similar algorithms. From the literature review, it was concluded Ocean Renewable Energy Storage to be most suitable with the Spar-Type and Semi-Submersible floating wind turbine to which the paper is based upon. The objective of this paper is to find the suitable ratio of energy storage versus wind farm, find the product of increase in wholesale, and evaluate whether the proposed method makes the hybrid economically sound. The algorithm was applied on spot-price data from Denmark due to its large share of wind energy with wind data from off the coast of Morro Bay in California, USA. Additionally, a sensitivity analysis is applied to evaluate to energy storage cost impact as well as evaluate the algorithm by lowering the required energy storage size.   Using the algorithm, the wind farm must account for nine days’ worth of energy production with a product of energy storage versus wind farm ratio of 1.42. The wholesale price increased with 11.9-21.5% for the four years studied, however, all financial results favored not utilizing energy storage. By the results derived from the sensitivity analysis, it was concluded that with future cost reductions, the algorithm will still favor no energy storage. However, by fine tuning the algorithm to reduce the need for storage, positive financial result might be achievable. The key to achieve a profitable result seems to rely on minimizing the need for energy storage, to which the proposed algorithm fail to achieve. Conclusively, spot-price decision-based energy storing is not economically sound.

Syfte: Syftet  med  studien var  att undersöka  om  det  finns  en skillnad  i  livskvalité mellan  individer  med  transfemoral  amputation  som använder  mikroprocesstyrd knäkomponent (MPK) respektive mekanisk knäkomponent (Mek.). Design: Tvärsnittsstudie Försökspersoner: 14 protesbrukare  med unilateral transfemoral amputation (10 män, 4 kvinnor; 4 Mek., 10 MPK), amputerade på grund av trauma, kongenital orsak, infektion eller tumör och som använt sig av samma typ av knäled i minst ett år. Metod: För  att  studera  livskvalité  i  målpopulationen  genomfördes  en enkätundersökning bestående av RAND-36 samt kompletterande frågor. Deltagarna fördelades i två grupper med avseende på knäkomponent för att möjliggöra analys av resultaten. Resultat: Ingen signifikant  skillnad  i livskvalité uppmättes mellan  grupperna. De största  skillnaderna observerades  dock  i  den fysiska-  (Mek.:  0 MPK:  50) och emotionella (Mek.: 41,75 MPK: 100) rollfunktionen. Slutsats: Resultatet  i  studien  visade  ingen  signifikant  skillnad i  livskvalité mellan grupperna. Vidare  bör  mer  specifika  mätinstrument,  inriktade  mot  individer  med amputation, användas för att undersöka livskvalité i målpopulationen. / Purpose: The purpose of the study was to investigate if there is a difference in qualityof  life  (QoL)  between  individuals  with  a  transfemoral  amputation  usingmicroprocessor-controlled  knee  components  (MPK)  versus  mechanical  kneecomponents (Mech.). Design: Cross-sectional study Subjects: 14 prosthesis users with a unilateral transfemoral amputation  (10 men, 4women; 4 Mech., 10 MPK), amputated due to trauma, congenital reasons, infection ortumor and used the same prosthetic knee for at least one year. Method: To study QoL in the  population concerned a questionnaire was carriedout, including the RAND-36 and supplementary questions. The  participants  were divided into two groups with regard to the knee component to enable the results to be analyzed. Results: No significant difference in QoL were found between the groups. The largest differences were observed in physical (Mech.: 0 MPK: 50) and emotional (Mech.: 41.75MPK: 100) role function. Conclusion: The result of the study showed no significant difference in QoL between the groups. Furthermore, specific measuring instruments targeting individuals with amputation should be used to investigate quality of life in the population concerned.

Syfte: Syftet med studien var att studera den äldre patientens upplevelse av att leva med svårläkta bensår och vad denne anser bidrar till eller förhindrar en positiv syn på sin tillvaro. Metod: Studien innehåller intervjuer med äldre personer drabbade av svårläkta bensår. En kvalitativ innehållsanalys genomfördes. Resultat: Resultatet visar att informanterna upplever smärta, oro för försämring, ångest och att den långsamma sårläkningen är påfrestande. Enligt informanterna krävs det deltagande vid sociala sammankomster och aktiviteter samt att hålla kontakt med vänner och anhöriga för att bibehålla en positiv syn på sin tillvaro. Livskvaliteten upplevs som relativt god. Liksom synen på tillvaron påverkas också den upplevda livskvaliteten av den egna situationen och då positivt genom att känna sig delaktig i ett socialt sammanhang och negativ genom förlust av självständighet. Samtliga informanter har en positiv upplevelse av den erhållna sjukvården, de tror på kontinuitet för ett bra behandlingsresultat och känsla av trygghet. Slutsats: Svårläkta bensår påverkar den äldre människan på olika områden i livet, fysiskt, psykisk och existentiellt. De äldre patienterna behöver hälso- och sjukvården samt ett socialt nätverk för att bibehålla en positiv livssyn. / Aim: The aim of this study was to study the older patient's experience of living with chronic leg ulcers and what he or she considers to contribute to or impede a positive outlook on their lives. Method: The study includes interviews with elderly people suffering from chronic leg ulcers. A content analysis was performed. Results: The result shows that the informants are experiencing pain, concerns about worsening, anxiety, and that the slow wound healing are stressful. According to informants, it requires attendance at social gatherings and activities and to keep in touch with friends and loved ones to maintain a positive outlook on their lives. The quality of life is perceived as relatively good. The perception of life and the perceived quality of life effects positively by feeling involved in a social context and negatively through the loss of independence. All respondents have a positive experience of the obtained medical care, they believe in the continuity for good treatment results and sense of security. Conlusion: Slow-healing leg ulcers affects older people in different areas of life, physical, psychological and existential. The older patients need health care and a social network to maintain a positive outlook on life.

Bakgrund Svårläkta bensår ställer stora krav på distriktssköterskan som måste ha kunskaper inom många områden. Distriktssköterskan lägger ungefär 25–50 % av sin arbetstid på att handlägga patienter med svårläkta bensår. Svårläkta bensår orsakar stort lidande för patienten, fysiskt, psykiskt och socialt. Det är även en stor kostnad för samhället, samt tidskrävande både för patienten och vården. Syfte Syftet med studien var att utforska distriktsköterskors erfarenheter av att handlägga patienter med svårläkta bensår. Metod Kvalitativ studie med individuella intervjuer genomfördes med åtta distriktssköterskor och analyserades med hjälp av kvalitativ innehållsanalys. Resultat Resultatet bygger på fyra kategorier. Den första visade att distriktssköterskor önskar mer kunskap och tid för att lära sig om olika förband och även arbeta mer kostnadseffektivt. Den andra visade att det är viktigt för distriktssköterskan med samverkan med olika vårdinstanser, samt att så få som möjligt handlägger och bedömer såret. Den tredje visade att distriktssköterskan uppmärksammar att patienterna upplever problem med rörligheten. En del distriktssköterskor ser att många av patienterna är oroliga för sårläkning, läckage och lukt och kan då isolera sig. Den fjärde visade att några patienter får störd nattsömn ofta på grund av smärta från såret. Konklusion.För att patienter med svårläkta bensår ska känna sig trygga och leva ett så normalt liv som möjligt trots sina sår behöver distriktssköterskan ha kunskap, erfarenhet, och tid. / Background Chronic leg ulcers place great demands on the district nurse who must have knowledge in many areas. The district nurse spends about 25-50% of her working hours on treating patients with chronic leg ulcers. Chronic leg ulcers cause great suffering to the patient, physically, mentally and socially. It is also a great cost to society, and time-consuming for both the patient and the care. Aim The purpose of the study was to explore the district nurses' experience of treating patients with chronic leg ulcers. Method A qualitative study with individual interviews was conducted with eight district nurses and analyzed with the help of qualitative content analysis. Results The result is based on four categories. The first showed that district nurses want more knowledge and time to learn about different associations and also work more cost-effectively. The other showed that it is important for the district nurse to cooperate with various health care institutions, and that as few as possible handle and assess the wound. The third showed that the district nurse notes that patients experience mobility problems. Some district nurses see that many of the patients are worried about wound healing, leakage and odor and can then isolate themselves. The fourth showed that some patients get disturbed sleep often because of pain from the wound. Conclusion For patients suffering from chronic leg ulcers to feel safe and live as normal a life as possible despite their wounds, the district nurse needs to have the knowledge, experience, and time.