Tropical ulcer is a very specific form of cutaneous ulceration. It occurs worldwide in most tropical and a number of subtropical areas. The disease occurs mainly in older children and young adults with children under the age of 5 and adults over 45 years rarely being affected. Ulcers occur most commonly on the lower leg but may occur on the upper limb. Although most ulcers normally heal slowly over many weeks or months, some ulcers may recur. Recognised complications include squamous cell carcinoma, gangrene and osteitis, although these are rare. A number of authors have reported on the disease and suggested diet, trauma and infection as aetiological factors for this condition. This survey was thus conducted to assess as many of these factors as possible. The study took place in 5 tropical areas, namely Zambia, Gambia, southern India, Fiji and Papua New Guinea. Consultations took place at hospitals, rural clinics, health centres and villages. Although many authors have suggested that the disease is related to malnutrition, few have objectively assessed the nutritional status of the patients and compared it with controls. Those studies which included objective assessments were limited to small areas and only investigated specific parameters. In order to investigate the immune response of the host to an anaerobic infection, the antibody levels to the organisms isolated from the ulcers were measured by an ELISA test. The local host response to an infection with a Fusobacterium species was assessed by the number of antibody secreting B-lymphocytes at the site of the ulcers. These parameters may play a role in the localisation of the ulcers and account for recurrent infections.

Bakgrund: Trycksår är en skada på hud eller vävnad som uppstår genom tryck och/eller skjuv. Det finns många faktorer som ökar risken för trycksår. Såren kan skapa lidande för patienter både fysiskt och psykiskt vilket förlänger återhämtning och vårdtid. Sjuksköterskan ansvarar för att bjuda in patienter och anhöriga till delaktighet för att utföra en god och säker omvårdnad. Syfte: Att undersöka patienters upplevelse av delaktighet i sin egen trycksårsbehandling och/eller trycksårsprevention. Metod: Allmän litteraturöversikt användes som design där 10 kvalitativa originalstudier hittades i databaserna PubMed, Psycinfo och CINAHL. Kvalitetsgranskningen genomfördes med hjälp av SBU:s granskningsmall och analyserades enligt Fribergs fyra-stegs analysmetod. Teoretisk referensram som valdes till arbetet är Katie Erikssons omsorgsteori.  Resultat: Fyra huvudkategorier samt fem underkategorier identifierades. Både positiva och negativa upplevelser om delaktighet framkom. Positiva upplevelser av delaktighet förekom vid personcentrerad vård där utbytet av information och kunskap var ömsesidigt. Det som påverkade patienternas delaktighet negativt var smärta och bristande kunskap hos både patienter och vårdpersonal. Faktorer som ansågs lindra lidandet och hade positiv inverkan på delaktighet var ett gott bemötande från personalen, med fokus på personcentrering och tillgång till adekvat information.  Slutsats: Patienter har olika upplevelser av delaktighet i sin egen trycksårsbehandling. Delaktigheten är beroende av att patienten förses med efterfrågad information och kunskap samt att vården personcentrerad. Personalen måste besitta specifik kunskap för att möjliggöra patientens delaktighet i vården. I framtiden bör fler studier genomföras för att få en bredare kunskap om området. / Background: A pressure ulcer is an injury to skin or tissue that occurs through pressure and/or shear. There are many factors that increase the risk of pressure ulcers. The wounds can create suffering for patients both physically and psychologically, which prolongs recovery and treatment time. The nurse is responsible for inviting patients and relatives to participate in order to perform good and safe nursing care. Aim: To examine patients' experience of participation in their own pressure ulcer treatment and/or pressure ulcer prevention.  Method: General literature review was used as design where ten qualitative original studies were found in the databases PubMed, Psycinfo and CINAHL. The quality review was carried out using SBU's review template and then analyzed according to Friberg's four-step analysis method. The theoretical frame of reference chosen for the work is Katie Eriksson's theory of care. Result: Four main categories and five subcategories were identified. Both positive and negative experiences of participation emerged. Positive experiences of participation occurred in person-centred care where the exchange of information and knowledge was mutual. What negatively affected patients' participation was pain and a lack of knowledge on the part of both patients and healthcare staff. Factors considered to alleviate suffering and have a positive impact on participation were good treatment from staff, focusing on person-centredness and access to adequate information. Conclusion: Patients have different experiences of participation in their own pressure ulcer treatment. Participation is dependent on the patient being provided with the requested information and knowledge and the care being person-centred. The staff must possess specific knowledge to enable the patient's participation in care. In the future, more studies should be carried out to gain a broader knowledge of the area.

Bakgrund: Sår på nedre extremiteter är vanligt förekommande, särskilt hos äldre. De sår som inte läkt inom sex veckor räknas som svårläkta och brukar medföra stora lidanden för de drabbade samt stora samhällsekonomiska kostnader. Sårens komplexitet påverkas av bakomliggande sjukdomsfaktorer och diabetespatienter är särskilt utsatta. Kosten är grundläggande för att upprätthålla kroppens livsviktiga funktioner men trots detta används sällan nutritionsbehandling för denna typ av sår. Syfte: Att sammanställa nutritionens betydelse för sår på nedre extremiteter. Metod: En litteraturstudie baserad på 15 kvantitativa empiriska studier om nutritionens betydelse för bensår och/eller diabetiska fotsår. Huvudresultat: Samband identifierades mellan nutritionsstatus och såromfattning där sämre nutritionsstatus ledde till mer allvarliga sår och ökad amputationsrisk. Näringsbrister, framför allt av mikronäringsämnena vitamin C, D, magnesium och zink, uppdagades hos deltagarna. Deltagarnas kost bestod av hög andel kolhydrater och fett medan proteinintaget i många fall var under rekommenderade nivåer. Trots påtaglig undernäring led majoriteten av deltagarna av övervikt eller fetma. Näringstillskott, särskilt av mikronäringsämnen, påskyndade sårläkningsprocessen och gav även förbättrade värden för CRP och glykemisk kontroll. Vikten av vitamin D är speciellt framträdande. Slutsats: Nutritionen har bevisligen stor betydelse för sårutvecklingen. Därför bör patienter med svårläkta sår utredas för eventuella näringsbrister oavsett kroppsvikt. Med individanpassade kostråd och nutritionsinsatser kan patienten bättre stödjas i strävan efter sårläkning genom egenvårdsinsatser. / Background: Ulcers on lower extremities are common, especially among the elderly. Ulcers not healing in six weeks are considered chronic and lead to significant suffering for those affected and substantial socioeconomic costs. Underlying medical factors contribute to ulcer complexity and patients with diabetes are particularly exposed. Nutrition is essential for maintaining and strengthening the body's vital functions. However, nutritional therapy is not as commonly used for lower extremity ulcers as for other wounds. Objective: To compile the significance of nutrition for lower extremity ulcers. Method: A literature review based on 15 quantitative primary studies on the significance of nutrition for leg ulcers and/or diabetic foot ulcers. Main Results: Relationship between nutritional status and ulcer size was identified where poorer nutritional status led to more severe ulcers and increased risk of amputation. Nutritional deficiencies, especially micronutrients vitamin C, D, magnesium, and zinc, were found among the participants. Diets consisted of a high proportion of carbohydrates and fats, while protein intake often was below recommended levels. Most participants were overweight or obese despite apparent malnutrition. Nutritional supplements, especially of micronutrients, accelerated the ulcer healing process and improved values for C-reactive protein (CRP) and glycemic control in controlled studies. The importance of vitamin D was emphasized in this literature review. Conclusion: Nutrition plays a significant role on ulcer development. Patients with chronic ulcers should be screened for potential nutritional deficiencies, regardless of body weight. With individualized dietary advice and nutritional interventions can patients receive better support in efforts for self-care and ulcer healing.

Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain the etiology and progression of PI while Lewin's Change Theory was used to promote behavioral change in the nursing team. The practice-focused questions for closing the gap between nursing knowledge and practice were what percentage of nurses complied with standard PI prevention guidelines and what was the level of nursing staff teamwork in the agency per the Nursing Teamwork Survey [NTS]. This PI prevention initiative used a cross-sectional design. Data collection involved review of nursing documentation and electronic surveying of all nursing staff using the MISSCARE survey, the NTS, and the AHRQ assessment checklists, which were completed via SurveyMonkey, an online survey software. The impact of the PI prevention initiative was assessed by comparing the results of the documentation review and surveys pretest to the posttest results. There was significant improvement in nursing compliance with PI prevention and treatment. Pressure injury incidence rate fell from 13.6% to 5.1%. The positive social impact includes improving patient care and safety, minimizing PI incidence and producing an efficient team.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 4 uppsatser.

Diabetes är en sjukdom som i många fall kan leda till olika senkomplikationer, en av dem är fotsår. Att leva med diabetiska fotsår kan inverka på livskvaliteten, därför är det viktigt att få kunskap om vad som påverkar livskvaliteten för att kunna ge bättre omvårdnad och öka välbefinnandet. Syftet var att belysa vad som påverkar livskvaliteten hos personer med diabetiska fotsår. Datainsamlingen resulterade i 12 artiklar som besvarade studiens syfte. Granskning av artiklarna genomfördes och data kategoriserades. Fem kategorier framkom som visade att rädsla, smärta, immobilitet, kunskap och stöd påverkade livskvaliteten hos personer med diabetiska fotsår. Det fanns en rädsla för fördröjd sårläkning, utveckling av nya sår och att i framtiden eventuellt behöva amputera. Smärta från diabetiska fotsår upplevdes som frustrerande och var en av orsakerna till immobilitet vilket i sin tur skapade social isolering. Kunskap var betydelsefullt för att kunna förebygga uppkomsten av nya fotsår och för att de drabbade skulle kunna söka vård tidigare. För att kunna hantera vardagen var det därför viktigt att få stöd från olika personer i omgivningen. Sjuksköterskan kan förbättra omvårdnaden och skapa förutsättningar för bättre livskvalitet genom att se människan bakom fotsåret. / Diabetes is a disease which in many cases leads to various complications, one of them is foot ulcers. Living with diabetic foot ulcers can affect the quality of life, therefore it is important to gain knowledge about what affects the quality of life in order to provide better care and improve well-being. The aim was to highlight aspects that affects the quality of life in people with diabetic foot ulcers. The data collection resulted in 12 articles who responded to the purpose of the study. The examination of the articles was conducted and data was categorized. Five categories emerged which showed that fear, pain, immobility, knowledge and support affected the quality of life among people with diabetic foot ulcers. There was a fear of delayed wound healing, development of new wounds, and for the risk of amputation in the future. Pain from diabetic foot ulcers was perceived as frustrating and was one of the causes of immobility, which in turn created the social isolation. This knowledge was important in order to prevent the occurrence of new foot ulcers so that those affected could seek treatment earlier. In order to manage everyday life, it was therefore important to receive support from different people in the surrounding. The nurse can improve the care and create better quality of life by seeing the person behind the foot ulcer.

Background: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. Methods/design: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. Interventions: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat (TM)). TempStat (TM) is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. Outcomes: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. Discussion: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability.

Diabetes is a growing public health problem that can lead to serious complications for the pa-tient such as foot ulcers and amputations. For affected patients the foot ulcers causes suffer-ing, pain and impaired health. The foot ulcers also contribute to major costs to the society and affects healthcare resources hard. A large part of the district nurse's work consists of wound care. Therefore it is important that the district nurse possess adequate knowledge of wound dressings to promote wound healing and thereby shorten the wound healing time. The aim of the study was to examine the wound healing time due to treatment with antiseptic or non-antiseptic dressings in elderly patients with diabetes and foot ulcers. The method used was a quantitative register study with a retrospective and descriptive design. Patients included in the study were 241 men and women aged ≥ 65 years with diabetes and healed foot ulcers. Men were represented by 68 % (n=164) and women by 32 % (n=77). The results showed no signif-icant difference in wound healing time due to treatment with antiseptic or non-antiseptic dressings. The most common non-antiseptic dressing used was polyurethane foam and the most common antiseptic dressing used was silver dressing. More research to compare wound healing time between non-antiseptic and antiseptic dressings in elderly patients with diabetes and foot ulcers are needed. District nurses need to increase their knowledge within different dressings and its positive and negative effects.

La enfermedad de Crohn es una enfermedad inflamatoria intestinal muy rara en nuestro medio y con una distribución muy variable en diferentes partes del mundo, la incidencia media es de 6,7 (rango de 1,6 a 14,6) casos por 100 000 habitantes anualmente y la prevalencia de 140 (rango de 10 a 199) casos por 100 000 habitantes en occidente. Presentamos el caso de un varon de 52 años natural y procedente del Callao con una imagen por colonoscopia compatible con una Ulcera Cecal y sin otras alteraciones en el tracto gastrointestinal, el cual presento un diagnostico anatomopatológico compatible con una Enfermedad de Crohn que es confirmada por serología. / Crohn s Disease, is a rare inflammatory bowel disease in Perú. Incidence rates vary from 1,6 – 14,6 / 100 000 and prevalence rate is 140 / 100000 in the western hemisphere. We report a case of 52 y.o male patient from Callao Peru, with a colonoscopy image of a solitary cecal ulcer and without other gastrointestinal findings and a histology suggestive of Crohn s Disease with a ASCA positive and p –ANCA negative.

Sårvård är central omvårdnadsuppgift i sjuksköterskans profession som kräverspecifika kunskaper, förberedelser och tidsplanering vilket innebär behov av en radolika resurser men även kostnader för hälso- och sjukvården. Sjuksköterskanskunskap gällande prevention och sårvårdsbehandling utgör grunden förevidensbaserad sårvård med patientens personliga behov i fokus. Syftet var att belysasjuksköterskors erfarenheter av sårvård, och genomfördes som en systematisklitteraturstudie där resultatet utgjordes av åtta kvalitativa och två kvantitativavetenskapliga artiklar. I resultatet framkom fyra teman som belyser sjuksköterskorserfarenheter av sårvård; utmaningar; helhetssyn i sårvård; behov av kunskap ochbetydelsen av stöd. Konklusionen påvisar vikten av att se på patienten som har behovav sårvård ur ett helhetsperspektiv. Det handlar inte enbart om att behandla självasåret utan bemötandet utifrån helhetssyn, att se personen i den aktuellaomvårdnadssituationen. Studien belyser även vikten av teamarbete och ett gottsamarbete mellan olika professioner i sjukvården, vilket leder till att kontinuitetuppnås. Slutligen behövs det kontinuerlig sårvårdsutbildning till sjuksköterskor inomklinisk verksamhet men även fortsatt forskning som lyfter tillämplig avevidensbaserad prevention av sår samt effektstudier av sårbehandling. / Wound care is a central task of the nursing profession that requires specificknowledge, preparation and planning which means the needs of a variety of resources,but also the costs of health care. The nurse's knowledge regarding wound treatment,care, and prevention is the basis for evidence-based wound care with the patient'spersonal needs in mind. The aim was to highlight nurses' experiences of wound care,and carried out a systematic literature where the result had eight qualitative and twoquantitative scientific articles. The results revealed four themes that highlight nurses'experiences of wound care; challenges; holistic approach to wound care; need forknowledge and the importance of support. The conclusion demonstrates theimportance of ensuring the patient is in need of wound care from a holisticperspective. It is not just about treating the wound without seeing the human being inits entirety, and to respond to the patient in the current nursing situation. The studyalso highlights the importance of team work and good cooperation between differentprofessionals in health care, which leads to continuity, is achieved. Finally, we needcontinuous wound care training for nurses in clinical practice but also continuedresearch that highlights relevant evidence-based prevention of ulcers and efficacystudies of wound healing.