Proefschrift--Utrecht. / Bibliography: p. 101-104.

Ulcers of the human skin are difficult to cure and a massive burden to patients. Their treatment costs in the UK are in excess of £ 100 million annually (1989). Both suffering and costs can be reduced significantly by establishing if an ulcer is responding to treatment. Any measurement device must not make any contact with the patient in order to avoid pain, damage or infection of the wound. This work describes a novel non invasive measurement method for superficial skin ulcers. Measurement is carried out using a new version of colour coded structured light method to obtain three dimensional surface data. A set of parallel stripes of light is projected onto the ulcerated skin and observed by a camera. The stripes are displaced by an amount which is related to the shape of the skin. It is shown how stripe parameters such as colour, distance, width and coding may be optimised with respect to the object of interest to maximise the performance of the method. Two newly developed stripe extraction algorithms ensure that the centre positions of the projected stripes are found with a precision better than 0.1 mm. From the position of the stripes on the skin a computer then calculates a representation of its shape by triangulation. This is stored in a three dimensional surface map. The volume of a skin ulcer is the difference between the measured base of the lesion and the original healthy skin. The work demonstrates that the original shape may be simulated by a specialised spline interpolation method which is based on the surroundings of the ulcer. The technique is implemented in a portable instrument which is capable of measuring the area and volume of a wide range of different ulcers and pressure sores with a standard deviation of less than 5% of the total figure. With the current equipment the measurement is made in half a second and its result is available after less than 5 minutes. The technique works well in subdued ambient lighting and on most ulcers. In cases where the ulcer is wet, specular reflection may cause problems but the system is usually able to correct for them. The instrument is suitable for a large variety of ulcers but is not able to measure wounds which undermine the skin, extend outside the normal field of view or are highly flexible.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Com o aumento da expectativa de vida populacional, tem-se a Ãlcera por pressÃo (UP) como um dos agravos com elevada incidÃncia. Assim, esforÃos para o desenvolvimento de pesquisas que resultem em contribuiÃÃes reais para a prÃtica clÃnica dos enfermeiros assistenciais sÃo necessÃrios. Por isso, optou-se em realizar esta revisÃo integrativa, um dos mÃtodos da PrÃtica Baseada em EvidÃncias que tem por objetivo incorporar as evidÃncias encontradas na literatura à prÃtica assistencial e/ou gerencial. Para isso, a presente investigaÃÃo objetivou analisar as evidÃncias disponÃveis na literatura sobre as intervenÃÃes de enfermagem aplicadas para o tratamento das UP em pacientes acamados. Para seleÃÃo dos artigos, foram utilizadas cinco bases de dados (CINAHAL, SCOPUS, COCHRANE, LILACS e PUBMED) alÃm da revista ESTIMA. A amostra dessa revisÃo foi composta por 27 artigos, referentes a intervenÃÃes, de Ãmbito geral, utilizadas para tratar UP. ApÃs anÃlise dos artigos incluÃdos, os resultados apontaram que a eletromagnÃtico-terapia possui evidÃncias do seu beneficio para cicatrizaÃÃo das UP, porÃm nÃo existem diretrizes sobre sua aplicabilidade. Isto tambÃm foi descrito para o Ultrassom terapÃutico e a V. A. C. terapia. Quanto ao processo de limpeza de ferida, foram descritas utilizaÃÃo de vÃrias substÃncias, dentre essas, nÃo foi encontrada evidÃncia de que uma se sobressaia em relaÃÃo à outra. Na questÃo alimentar, ficou evidente que os pacientes que recebem suplementaÃÃo de proteÃnas, zinco e vitamina C em suas dietas, tendem a cicatrizar a UP em um menor perÃodo. Ao abordar a etiliologia das UP, enfocou-se o reposiciosamento e as superfÃcies de suporte (SS). Ficou patente que os pacientes devem ser reposicionados a cada duas horas, quando deitados, e a cada 15 minutos, quando sentados, como forma de minimizar as forÃas de pressÃo e cisalhamento. No entanto, a evidÃncia referente a esse cuidado possui limitaÃÃes que impedem concluir quanto ao real alÃvio de pressÃo que causa. Com relaÃÃo à forma de mensurar a UP, um Ãnico estudo fez parte da amostra desta dissertaÃÃo, de modo que este apenas descreveu a aplicaÃÃo da Escala de PUSH como forma de documentar a UP. Outro ponto crucial foi a abordagem quanto ao conhecimento dos enfermeiros e as tÃcnicas de cuidados empregadas por eles ao tratar UP. Percebeu-se que prevalece a desinformaÃÃo destes em decorrÃnca do desconhecimento que inicia na graduaÃÃo. Diante desse quadro, pensa-se em como as UP estÃo sendo tratadas e para isso analisaram-se as evidÃncias empregadas diante da dor, do odor e do exsudato. Quanto à dor, ficou clara a recomendaÃÃo do gel de benzidamina e a pomada EMLA, principalmente antes da realizaÃÃo procedimentos, como desbridamento. Quanto ao odor, nÃo foram encontrados estudos que descrevessem a melhor forma de minimizÃ-lo. Para a quantidade de exsudato, este està intimamente relacionado ao perÃodo de cicatrizaÃÃo que a UP encontra-se. Em se tratando das coberturas propriamente ditas, os estudos selecionados abordaram o hidrocoloide, a aloe vera, terapia normotermica e o colÃgeno. Estas coberturas foram abordadas em UP com diferentes estÃgios de cicatrizaÃÃo e ambos os estudos apresentaram taxa de cura adequada com ao descrever o uso de cada uma delas. Entretanto, nÃo foram identificadas evidÃncias que comprovem a superioridade de uma destas terapias. Logo, reforÃa-se a necessidade da busca de conhecimento contÃnuo por parte dos enfermeiros, bem como a importÃncia da avaliaÃÃo global dos pacientes que sÃo submetidos a seus cuidados, haja vista que as contribuiÃÃes reais para prÃtica de tratamento de UP ainda sÃo limitadas. Com isso, urgem que sejam desenvolvidos ensaios clÃnicos para elucidar muitas das respostas que ainda nÃo estÃo explÃcitas. / With the increase in life expectancy, pressure ulcer (PU) has become one of the high incidence injuries. Thus, it is necessary to develop research efforts that result in actual contributions to the clinical practice of nurse assistants. So, we chose to perform this integrative review, one of the methods of Evidence-Based Practice that aims to incorporate the evidence found in the literature to assistance and/or management practice. Therefore, this research aimed to analyze the evidence available in the literature on the nursing interventions applied to the PU treatment in bedridden patients. For articles selection we used five databases (CINAHAL, Scopus, Cochrane, LILACS and PubMed) and Estima Journal. The sample of this review was composed of 27 articles related to interventions of general purpose used in PU treatment. After analyzing the articles included, the results showed that electromagnetic therapy has evidence of its benefit for healing of PU; however there are no guidelines for its applicability. This has also been described for Therapeutic ultrasound and VAC therapy. Regarding the wound cleaning process, they described the use of many substances, such as aloe vera, tap water and saline solution. They also approached the use of hydro massage. We did not find any evidence that among these substances one stood out more than others. Regarding the food issue, we verified that patients who receive supplemental protein, zinc and vitamin C in their diets tend to heal the PU in a shorter period. By dealing with the etiology of PU, we focused on repositioning and support surfaces (SS). It became evident that the patients should be repositioned every two hours when lying down and every 15 minutes when sitting, as a way of minimizing the pressure and shear forces. However, the evidence for this care has limitations that don not allow us to conclude on the real pressure relief it causes. Regarding the method of PU measurement, a single study composed the sample of this dissertation, so it only described the application of the Pressure Ulcer Scale for Healing (PUSH) as a way of documenting PU. Another crucial point was the approach to knowledge of nurses and care techniques employed by them when treating PU. We noticed the prevalence of lack of information among them that starts at graduation. Given this situation, we reflect on how PU is being treated, and thus we analyzed the evidence used against pain, odor and exudate. As for the pain, we verified the recommendation of benzydamine gel and EMLA cream, especially before performing procedures such as debridement. As for the odor, we did not find any study describing the best way to minimize it. As for the amount of exudate, it is closely related to the healing period of PU. Regarding the coverage itself, the studies selected approached the hydrocolloid, aloe vera, normothermic wound therapy and collagen. The coverage were approached in PU with different healing stages, and both studies presented appropriate cure rate when describing the use of each one of them. However, there were no evidences to prove the superiority of any of these therapies. Thus, we reinforce the need for the continuous pursuit of knowledge made by nurses, as well as the importance of the overall assessment of patients who are submitted to their care, given that the actual contributions to the PU treatment practice are still limited. Therefore, there is urgent need to develop clinical trials to elucidate many of the answers that are not yet explicit.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / 1,4-Cineol à um monoterpeno Ãter amplamente distribuido, o qual à um dos constituintes responsÃveis pelo odor do limÃo. O objetivo deste trabalho foi avaliar o efeito gastroprotetor de 1,4-Cineol (CIN 100 e 200 mg/Kg) nos modelos de lesÃo induzidas por etanol ou piroxicam em camundongos e, posteriormente, investigar os possÃveis mecanismos de aÃÃo farmacolÃgica envolvidos nesta aÃÃo. A administraÃÃo oral de 1,4-cineol 200 mg/Kg foi capaz de proteger a mucosa gÃstrica dos danos causados pelo etanol (0,2 ml/amimal, v.o). Esta gastroproteÃÃo foi tambÃm avaliada microscopicamente mostrando que CIN (200 mg/Kg, p.o.) diminuiu o edema na submucosa, o infiltrado inflamatÃrio e a hemorragia. 1,4-Cineol (100 e 200 mg/Kg, v.o.) tambÃm reduziu significantemente as lesÃes gÃstricas causadas pelo piroxicam (30 mg/Kg, s.c.). O mecanismo de gastroproteÃÃo de CIN foi examinado na dose de 200 mg/Kg no modelo de lesÃo gÃstrica induzida por etanol em camundongos. Nos animais prÃ-tratados com L-NAME (10 mg/Kg, i.p.), um inibidor da oxido nÃtrico sintetase, com glibenclamida (10 mg/Kg i.p.), uma substÃncia que bloqueia os canais de potÃssio ATP-dependente, ou com capsazepina (5 mg/Kg i.p.) um antagonista dos receptores vanilÃides TRPV-1, o efeito gastroprotetor de CIN nÃo foi significantemente inibido por estes mecanismos. Por outro lado, o efeito gastroprotetor de CIN foi revertido em animais prÃ-tratados com indometacina (10 mg/Kg v.o.), um inibidor nÃo seletivo da ciclooxigenase, demostrando que hà uma ativaÃÃo desta enzima no mecanismo de aÃÃo de CIN. Este trabalho avaliou tambÃm o mecanismo antioxidante de CIN como um agente gastroprotetor contra as lesÃes induzidas pelo etanol. Sob as nossas condiÃÃes experimentais, o modelo de induÃÃo pelo etanol causou mudanÃas nos sistema antioxidante da mucosa gÃstrica dos camundongos, como a diminuiÃÃo dos nÃveis de grupamentos sulfidrila (GSH) e da atividade da superÃxido dismutase (SOD), tambÃm mostrou um aumento da atividade da mieloperoxidade (MPO) e uma concentraÃÃo aumentada das espÃcies que reagem com o Ãcido tiobarbitÃrico (TBARS) como Ãndice de peroxidaÃÃo lipÃdica (LPO). 1.4-Cineol (200 mg/Kg, v.o.) no modelo de Ãlcera por etanol, nÃo interferiu na concentraÃÃo do GSH, mas permitiu a restauraÃÃo da atividade normal de SOD, nÃveis normais de LPO e de atividade da MPO. Estes dados sugerem que CIN 100 e 200 mg/Kg promovem gastroproteÃÃo contra lesÃes induzidas pelo etanol e/ou piroxicam em camundongos nos quais o mecanismo de aÃÃo incluem o envolvimento de prostaglandinas endÃgenas e uma potente atividade antioxidante. / 1,4-Cineole is a widely distributed monoterpene ether, which is one of the flavor constituents of lime juice. The aim of this work was to evaluate the gastroprotective effect of 1,4-Cineole (CIN 100 and 200 mg/Kg) on ethanol or piroxicam-induced lesions in mice and further investigate the possible pharmacological mechanisms involved in this action. The oral administration of 1,4-cineole 200 mg/kg was able to protect the gastric mucosa from ethanol injury (0.2 ml/animal, p.o.). This gastroprotection was also evaluated microscopically showing that CIN (200 mg/kg, p.o.) decreased the cell loss in the mucosa, submucosal edema, inflammatory infiltration and hemorrhage. 1,4-Cineole (100 and 200 mg/kg, p.o.) also reduced significantly the gastric lesions induced by piroxicam (30 mg/kg, s.c.). Gastroprotective mechanism of CIN was examined in the dose of 200 mg/kg, in the model of gastric lesions induced by ethanol in mice. In animals pretreated with L-NAME (10 mg/kg, i.p.), an inhibitor of nitric oxide synthase, or with glibenclamide (10 mg/kg, i.p.), a drug that blocks ATP-dependent potassium channels, or with capsazepine (5 mg/kg, i.p.), an antagonist of vanilloid receptor TRPV-1, the gastroprotective effect of CIN was not inhibited significantly, suggesting that the effect of CIN is not involved with this mechanisms. Otherwise, the gastroprotective effect of CIN (200 mg/kg, p.o.) was reverted in animals pretreated with indomethacin (10 mg/kg, p.o.), a nonselective inhibitor of cyclooxygenase, demonstrating that there is activation of these enzymes in the mechanism of action of CIN. This work also evaluated the antioxidant mechanism of CIN as gastroprotective agent against ethanol-induced lesions. Under our experimental conditions, the model of induction of ethanol injury caused changes in the antioxidant system of the gastric mucosa of mice as the decrease in the levels of sulfhydryl groups (GSH) and activity of superoxide dismutase (SOD), also showed increased activity of myeloperoxidase (MPO) and high concentration of species that react with thiobarbituric acid (TBARS) as index of lipid peroxidation (LPO). 1,4-Cineole (200 mg/kg, p.o.) in the model of ethanol did not interfere with the concentration of GSH, but allowed the restoration of normal SOD activity, normal levels of LPO and MPO activity. The data suggest that CIN 100 and 200 mg/kg promote gastroprotection against lesions induced by ethanol or piroxicam in mice whose mechanisms include the involvement of endogenous prostaglandins and potent antioxidant activity.

Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. Health utility estimates are an integral part of determining the cost-effectiveness of treatments for DFUs. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review of studies reporting health utility estimates for non-healing DFUs was conducted and included nine studies. The quality of the studies, as it related to the health utility estimates for non-healing DFUs, was difficult to determine due to a lack of reporting of study and patient characteristics. The health utility estimates ranged from 0.44 to 0.89. None of the studies investigated for factors associated with the health utility of patients with non-healing DFUs. In addition, an exploratory regression analysis of data from a randomized controlled trial (RCT) of hyperbaric oxygen therapy (HBOT) in patients with chronic, non-healing DFUs was conducted. No factors were identified that were associated with health utility; however, the sample size was small and the analysis exploratory. Further research is required to identify such factors. Finally, a descriptive regression model, including several baseline factors, was created which provided a heath utility estimate of 0.647 for Canadian patients with non-healing DFUs; however, the results should be interpreted with caution, especially as some subgroups had very small numbers of patients (e.g., Wagner Grade of 4; patients with 4 or more wounds). In summary, guidance is lacking on the best methodology to conduct and analyze studies that provide estimates of the health utility of patients with non-healing DFUs, or any other health state, that are to be used to inform economic evaluations. Additionally, a tool is needed to aid analysts in critically appraising studies so that they can select the best estimate of health utility value to include in economic evaluations. / Thesis / Master of Health Sciences (MSc) / Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review was conducted and included nine studies, for which health utility estimates ranged from 0.44 to 0.89. An exploratory regression analysis of data from an Ontario-based study in patients with non-healing DFUs was conducted. No factors associated with health utility were identified but further research is required. A descriptive regression model, adjusting for several baseline factors, provides a health utility of 0.647 for Canadian patients, but should be interpreted with caution. Guidance is needed on the best methodology to conduct studies to estimate the health utilities for use in economic evaluations and for a tool to critically appraise studies to help select the best estimate of health utility for inclusion in economic evaluations.

Chronic diabetic foot ulcers, venous leg ulcers and pressure ulcers affect a large subset of the United State population yet they remain a challenge for physicians to treat. There are many different types of products on the market for the treatment of chronic wounds. Some use living cells but only two are FDA approved to heal chronic wounds. A new type of product recently garnered attention in the wound care market because it also contains living cells: hypothermically stored amniotic tissue products. Hypothermically stored amniotic tissue is unique because it maintains living cells and offers the benefits of containing signaling molecules and maintaining an intact extra cellular matrix. While there are other types of amniotic or placental tissue products in the wound care market, they are processed by dehydration or cryopreservation which limits their capacities for maintaining living cells. This thesis will explore the potential for hypothermically processed amniotic tissue products to treat chronic wounds.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

No description available.

No description available.