Background Pressure ulcers are localized injuries to the skin and underlying tissue caused by pressure, shear or a combination of these. The consequences of pressure ulcers are contributing to higher risk of morbidity and mortality. It also increases costs to society and causing suffering affecting the quality of life for individuals. Research shows that patients often do not get access to those interventions with the highest evidence-based utility. Many times, there can be great differences within countries regarding interventions that reaches the patients. Aim The aim of the study was to describe pressure ulcers prevention by registered nurses in San José, Costa Rica. Method A qualitative design with semi-structured interviews was used. The study consisted of interviews with six registered nurses whereof one was an included pilot interview. The data process consisted of recording the interviews, transcription and a qualitative content analysis. Findings The main findings show that there is insufficient knowledge regarding pressure ulcer prevention and that there is a lacking ability to implement the existing knowledge into daily practice. Conclusion Strategies are needed to implement routines regarding pressure ulcer prevention and broader knowledge is needed to enable the registered nurses to follow these routines and to perform accurate and evidence based care. The lack of resources and time influence the ability to fulfil professional responsibilities regarding pressure ulcer prevention. The management have the important task to make sure that the needed knowledge and resources exists so that the staff can fulfil their work duties.

Bakgrund: Trycksår är en typ av skada som är vanligt förekommande inom sjukvården. Den är ofta smärtsam för den drabbade, både fysiskt som psykiskt, och är dessutom icke sällan svårläkt. Upplevelsen av att leva med trycksår kommer ofta i skymundan i arbetet kring trycksår. Det behövs en större förståelse för den drabbades upplevelse för att se till att de interventioner på området som vården kan använda också implementeras. Detta för att ge patienten en så god chans som möjligt till ett bra liv. Syfte: Syftet var att beskriva patienters upplevelse av att leva med trycksår. Metod: En litteraturöversikt på kvalitativa och kvantitativa artiklar hämtade från databaserna Cinahl Complete, PubMed och PsycInfo. En kvalitativ innehållsanalys har gjorts på det inhämtade materialet. Resultat: Med utgångspunkt från artikelanalysen identifierades fyra teman: ”smärta och obehag”, ”begränsningar i vardagen”, ”upplevelse av vården” och ”att blicka framåt”. Sammanfattning: Trycksår är en vårdskada som uppstår till följd av ett långvarigt tryck mot huden. Delar av kroppen som är extra utsatta är där huden ligger nära benet. Att ha trycksår är mycket smärtsamt såväl fysiskt som psykiskt tillsammans med känslor av av obehag och skam. De som drabbats av trycksår känner sig ofta missförstådda av vården och känner att deras upplevelse inte tas på allvar. / Background: A pressure ulcer is a common type of health care-inflicted injury. It is often painful for the patient stricken, both physically and psychologically, and is furthermore not seldom hard to heal. The patients experience of living with a pressure ulcer is often overlooked when it comes to dealing with pressure ulcers. There is a need for a greater understanding for the experience of the patient involved to make sure that the interventions that can be used also are implemented. This is to give the patient the chance of a life as good as possible. Aim: The aim was to describe patients experiences of living with pressure ulcers Method: A systematic review of qualitative and quantitative articles collected from the databases Cinahl Complete, PubMed and PsycInfo. A qualitative analysis has been performed on the material. Results: With the analysis of the articles as a starting point, four themes emerged: ”pain and discomfort”, ”restrictions in everyday life”, ”experience of health care” and ”looking forwards”. Summary: Pressure ulcer is a type of wound originating from long time pressure against the skin. Especially exposed areas of the body are located to where the skin is close to the bone. Having a pressure ulcer is very painful both physically and psychologically along with feelings of discomfort and shame. Those affected by pressure ulcer often feel misunderstood by health care and that their experience is not listen to.

Bakgrund: Trycksår uppstår i samband med vård och anses vara en vårdskada. För att bedöma svårighetsgraden av ett trycksår används internationellt standardiserat mätinstrument. Preventiva åtgärder och behandlingsåtgärder vid uppkomna trycksår är viktiga verktyg. Patienters upplevelser ger också vården en bättre förståelse för vad som hjälper, eller inte. Upplevelserna kan användas för att förbättra och effektivisera vården, samt främja ett personcentrerat förhållningssätt. Syfte: Syftet var att beskriva patienters upplevelser av att leva med trycksår. Metod: Metoden som användes var en litteraturöversikt. Vetenskapliga, kvalitativa artiklar valdes ut ur databaserna PubMed och CINAHL complete. Artiklarnas resultat sammanställdes sedan och presenterades i fyra olika teman. Resultat: Resultatet visade att patienterna blev mycket påverkade av sina trycksår, framförallt av smärta. Att ha blivit drabbad bidrog till en förtroendekris för vården. Konsekvenser var bland annat isolering, sömnpåverkan och förändrade sociala relationer. En del patienter blev negativt inställda till vården och andra fick ett annat perspektiv. Sammanfattning: Trycksåren påverkade patienternas hälsa. Patienterna påverkades av att vara beroende av andra, inte få rätt hjälp som behövdes samt kommunikationsmisstag och stressrelaterade faktorer. Genom denna uppsats förstärks värdet av sjuksköterskans hälsofrämjande arbete och vikten av patienternas upplevelser. Uppsatsen visar på betydelsen av att arbeta personcentrerat och inkluderande vid patientnära arbete. / Background: Pressure ulcer that occur during institutional care is considered a healthcare injury. To assess the level of injury, an international standardized assessment tool is used. The preventative arrangements and treatment care are important tools when treating, and preventing, ulcers. The patients’ experience may influence which care that works, care quality, care efficiency and encourage patient-centered approach.  Aim: The aim was to describe patients’ experiences of living with pressure ulcers.  Method: The method used was a literary survey. Scientific articles of qualitative nature that followed preset inclusion-criteria were chosen from the databases PubMed and CINAHL complete. The results of each article were then complied and presented in the survey under four themes.  Results: The result showed that the patients were heavily affected by their pressure ulcer, they were especially affected by pain. Some consequences were; isolation, negative effects on sleep as well as changed social relations. Some patients were negative toward health care as a result, and others developed a new perspective on health care.  Conclusion: Pressure ulcers affected patients’ health. Patients’ health was affected by dependency on others, not receiving the help needed, as well as communication difficulties and stress factors. Through this survey the importance of person-centered, inclusive care is highlighted as well as the health-strengthening work of the nurse.

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Background Oedema, commonly known as tissue swelling, occurs mainly on the leg and the arm. The condition may be associated with a range of causes such as venous diseases, trauma, infection, joint disease and orthopaedic surgery. Oedema is caused by both lymphatic and chronic venous insufficiency, which leads to pooling of blood and fluid in the extremities. This results in swelling, mild redness and scaling of the skin, all of which can culminate in ulceration. Methods We present a method to model a wide variety of geometries of limbs affected by oedema and venous ulcers. The shape modelling is based on the PDE method where a set of boundary curves are extracted from 3D scan data and are utilised as boundary conditions to solve a PDE, which provides the geometry of an affected limb. For this work we utilise a mixture of fourth order and sixth order PDEs, the solutions of which enable us to obtain a good representative shape of the limb and associated ulcers in question. Results A series of examples are discussed demonstrating the capability of the method to produce good representative shapes of limbs by utilising a series of curves extracted from the scan data. In particular we show how the method could be used to model the shape of an arm and a leg with an associated ulcer. Conclusion We show how PDE based shape modelling techniques can be utilised to generate a variety of limb shapes and associated ulcers by means of a series of curves extracted from scan data. We also discuss how the method could be used to manipulate a generic shape of a limb and an associated wound so that the model could be fine-tuned for a particular patient.

No / 482 people with leg ulcers were identified among those receiving health care in Bradford, UK. Of these wounds 195 (40.4%) were venous leg ulcers. Typically the people who experienced these wounds were elderly Caucasian females however a sub-group of younger males of Asian descent were seen to experience ulcers involving neuropathy. The leg ulcers were typically small in size although 33 people had wounds over 25 cm2 in surface area. The leg ulcers tended to persist with many present for at least 1 year with 4 wounds active for over 5 years. 205 people had experienced previous episodes of leg ulcer occurrence. Of the leg ulcers encountered 18.0% (n = 87) were infected and where wounds were swabbed for their microbial burden MRSA was identified in 8.5% of cases. Use of Doppler ultrasound to assess the aetiology of the wound had been performed in 66.4% of cases and where wounds remained undiagnosed (n = 69) only 8 had been Doppler assessed. While 75% of all venous leg ulcers received compression 48 people with venous leg ulcers did not have compression applied to their wound.

No / While most motorcyclists focus on the maintenance of their motorcycle and personal safety equipment, recent research has highlighted the impact of motorcycling on lowerlimb health. This article underlines the importance of regular health checks to recognise early warning signs of venous disease and how health promotion initiatives linked to preventative strategies may help to minimise the risk of developing venous leg ulcers in this difficult-to-reach population.

No / This paper aims to estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/ health board and corresponding National Health Service (NHS) costs in the UK. This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients’ characteristics, wound-related health outcomes and health-care resource use were quanti ed for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any speci c diagnosis. The prevalence of acute, chronic and unspeci ed wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates. Declaration of interest: The study’s sponsors had no involvement in the study design, the collection, analysis and interpretation of the data, the writing of this manuscript and the decision to submit this article for publication. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research (NIHR), the Department of Health, or any of the other sponsors. / NIHR Wound Prevention and Treatment Healthcare Technology Co-operative (National Institute for Health Research WoundTec HTC), Bradford Institute For Health Research, Bradford, West Yorkshire, UK, following an open tendering process. Additional funding was provided by: 3M Health Care Limited, Loughborough, Leicestershire, UK; Activa Healthcare Limited, Burton On Trent, Staffordshire, UK; Brightwake Limited, Kirkby In Ashfield, Nottinghamshire, UK; KCI Medical Limited, Crawley, West Sussex, UK; Longhand Data, Welburn, North Yorkshire, UK; Medira Limited, Cambridge, Cambridgeshire, UK; Mölnlycke Health Care Limited, Dunstable, Bedfordshire, UK; Park House Healthcare Limited, Elland, West Yorkshire, UK; Perfectus Biomed Limited, Daresbury, Warrington, UK; Pulsecare Medical LLC, North Andover, Massachusets, US; Smith & Nephew Medical Limited, Hull, East Riding Of Yorkshire, UK; Sozo Woundcare Limited, Harrogate, North Yorkshire, UK; Systagenix Wound Management Limited, Gatwick Airport, West Sussex, UK; Trio Healthcare, Great Missenden, Buckinghamshire, UK; Urgo Limited, Loughborough, Leicestershire, UK; Willingsford Limited, Southampton, Hampshire, UK.