Staphylococcus aureus est l’un des principaux agents étiologiques des infections suppuratives superficielles et profondes ainsi que des syndromes liés à l’action de toxines. Paradoxalement, cette bactérie est un agent commensal qui est présent sur la peau ainsi que dans les cavités nasales notamment. Cela permet de considérer cette bactérie comme un organisme colonisant commensale. Les bases génétiques expliquant la différence entre une bactérie pathogène et une bactérie commensale reste inconnues. En utilisant la technique Optical Maps sur des souches de S. aureus isolées de plaies de pieds diabétiques avec différents niveau de virulence, nous avons pu montrer l’existence d’un prophage insérés dans le génome des souches colonisantes et absent des souches infectantes. Le phage, nommé ROSA, est localisé dans un hotspot d’insertion de phage NM2. Il est aussi localisé en amont du locus isd qui est requis pour l’assimilation du fer essentiel à la bactérie dans sa phase pathogène. Le phage ROSA inactive la voie isd en dérégulant l’activité du régulateur transcriptionnel majeur Fur en absence de fer. Il réduit aussi la virulence de ces souches sur les 2 modèles de virulence (Le ver C. elegans et le Zebrafish). L’expulsion du phage ROSA restaure la régulation du locus isd par Fur et la production de sidérophores en absence de Fer, la formation du biofilm et la virulence des souches. La mutation du gène Fur nous a permis de déduire que le phage ROSA affectait les bactéries de manière indépendante de Fur. Enfin, nous avons étudié la prévalence des souches colonisantes sur les plaies de pieds diabétiques. Nous avons observé que 20% des souches présentait l’insertion ROSA et 89% appartenait au complexe clonal CC8. Les souches colonisantes, avec leur niveau bas de virulence, devraient faire l’objet de détection dans le but de rationnaliser l’utilisation des antibiotiques et ainsi lutter contre l’apparition de bactéries multirésistantes aux antibiotiques. / Staphylococcus aureus is an opportunistic bacterium capable of causing a wide range of severe diseases when it gains access to underlying tissues. Paradoxically, this causative pathogen is a common inhabitant of the skin microflora and colonizes the nares and other human mucosa, and as such, may be considered as a commensal colonizing organism. The genetic basis for the differences in pathogenic/colonizing potential is unknown. By performing optical maps comparisons of a collection of S. aureus strains of defined virulence potential isolated from diabetic foot ulcers at different stages, we brought to light a prophage present in colonizing-causing bacteria. The phage, namely ROSA, was localized in a hotspot region NM2 near the locus isd, the main iron surface determinant that transport iron across the bacterial wall. It induces a deregulation of the activity of the transcriptional regulator Fur involving the biofilm formation of the bacteria in response to low iron environment. It reduced also significantly the virulence of the strain in two in vivo models (the nematode C. elegans and the zebrafish). The expulsion of the phage restored the regulation of the locus isd, the siderophore production, the biofilm formation and the virulence of the strain. The mutation of the fur gene within the colonizing strain enabled us to determine that the phage ROSA affect the the bacteria in a Fur-independent manner. Finally we determined the prevalence of these colonizing strains in skin and soft tissue infections (diabetic foot ulcers). We observed that 20% (39/195) of the strains harboured this insertion and 89% belonged to the clonal complex CC8. This colonizing strain by its low virulence potential must be detected in the aim to contribute to a sounder use of antibiotic treatment, an important point in front of the increase of multidrug resistant bacteria.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-03-18T11:35:43Z No. of bitstreams: 1 PDF - Cynthia Layse Ferreira de Almeida.pdf: 3612014 bytes, checksum: ff23a88527b4e07c470c1b649ddb0716 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-22T15:01:26Z (GMT) No. of bitstreams: 1 PDF - Cynthia Layse Ferreira de Almeida.pdf: 3612014 bytes, checksum: ff23a88527b4e07c470c1b649ddb0716 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-22T15:01:35Z (GMT) No. of bitstreams: 1 PDF - Cynthia Layse Ferreira de Almeida.pdf: 3612014 bytes, checksum: ff23a88527b4e07c470c1b649ddb0716 (MD5) / Made available in DSpace on 2016-07-22T15:01:35Z (GMT). No. of bitstreams: 1 PDF - Cynthia Layse Ferreira de Almeida.pdf: 3612014 bytes, checksum: ff23a88527b4e07c470c1b649ddb0716 (MD5) Previous issue date: 2013-09-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Spondias purpurea L. (Anacardiaceae), popularly known as “siriguela”, is used in folk medicine for the relief of fever and pain, as diarrhea medication, antispasmodic, diuretic, anti-anemic and analgesic. Pharmacognostic studies with the species indicate the strong presence of tannins, flavonoids and triterpenes in their leaves, and roots, which are generally related to the antiulcer activity. The aim of this study was to evaluate the gastroprotective activity of the extract phase of S. purpurea in animal models. For this, the ethanolic extract (Sp-EtOHE) and the dichloromethane fraction (Sp-DCMF) of leaves of S. purpurea were obtained. Regarding the gastroprotective activity, doses of 125, 250 and 500 mg/kg (p.o.) were tested against different models of acute induction of ulcer by acidified ethanol, ethanol, stress immobilization and cold, and nonsteroidal anti-inflammatory drug (NSAID). In the model of acidified ethanol, there was a reduction in the ulcerative lesion index (ULI) for 61, 71 and 65% Sp-EtOHE and 29, 77 and 68% to Sp-DCMF. In ulceration caused by ethanol, Sp-EtOHE and Sp-DCMF in the same doses protect the gastric mucosa and were not altered parameters of the stomach contents of rats. The evaluation by the stress model, Sp-EtOHE and Sp-DCMF decreased the ULI in 23, 59 and 70% and 24, 61 and 72%, respectively. Previous models were made for the determination of C-Reactive Protein (CRP) in blood samples and were observed significant reductions of this parameter. Similarly, in the model of NSAID-induced gastric ulcers, there was inhibition of injuries to Sp-EtOHE and Sp-DCMF. In order to investigate the mechanisms of action related to gastroprotection promoted by SpEtOHE (250 mg/kg) and Sp-DCMF (250 mg/kg) was evaluated the involvement of nitric oxide and sulfhydryl compounds. Thus, it was verified that the gastroprotective effect of S. purpurea not involve the participation of nitric oxide. However, this effect is related to the participation of sulfhydryl compounds. Thus, these data suggest that S. purpurea presents gastroprotective activity, possibly related to mechanisms cytoprotectives. / Spondias purpurea L. (Anacardiaceae), popularmente conhecida como “siriguela”, é utilizada na medicina popular para o alívio de febre e dores, como antidiarréico, antiespasmódico, diurético, analgésico e antianêmico. Estudos farmacognósticos realizados com a espécie indicam a presença marcante de taninos, flavonoides e triterpenos em suas folhas, e raízes, os quais geralmente estão relacionados com a atividade antiulcerogênica. Assim, o objetivo deste trabalho foi avaliar a atividade gastroprotetora do extrato e fase de S. purpurea em modelos animais. Para isso foram obtidos o extrato etanólico (EEtOH-Sp) e a fase diclorometano (FaDCM-Sp) das folhas de S. purpurea. Com relação à atividade gastroprotetora, as doses de 125, 250 e 500 mg/kg (v.o.) do EEtOH e FaDCM foram testados frente a modelos de indução aguda de úlcera por etanol acidificado, etanol, estresse por imobilização e frio e anti-inflamatório não-esteroidal (AINE). No modelo de etanol acidificado, houve a redução do índice de lesão ulcerativo (ILU) em 61, 71 e 65% para EEtOH e 29, 77 e 68% para FaDCM. Nas ulcerações causadas por etanol, EEtOH-Sp e FaDCM-Sp nas mesmas doses protegeram a mucosa gástrica, bem como não foram alterados parâmetros do conteúdo estomacal dos ratos. Na avaliação pelo modelo do estresse, EEtOH-Sp e FaDCM-Sp diminuíram o ILU em 23, 59, 70 e 24, 61, 72%, respectivamente. Foram realizados para os modelos anteriores a dosagem da Proteína C reativa ultrassensível (PCR) nas amostras de sangue e foram observadas reduções significativas deste parâmetro. Da mesma maneira, no modelo de úlceras gástricas induzidas por AINE, houve inibição das lesões para EEtOH-Sp e FaDCM-Sp. No intuito de investigar os mecanismos de ação relacionados à gastroproteção promovida pelo EEtOH-Sp (250 mg/kg) e FaDCM-Sp (250 mg/kg), foi avaliado o envolvimento do óxido nítrico e dos grupamentos sulfidrílicos. Assim, foi observado que o efeito gastroprotetor de S. purpurea não envolve a participação do óxido nítrico. Entretanto, este efeito está relacionado à participação dos grupamentos sulfidrílicos, sugerindo que S. purpurea apresenta atividade gastroprotetora, possivelmente relacionada a mecanismos citoprotetores.

As úlceras por pressão são definidas como lesões causadas pela constante pressão exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangüíneo com diminuição ou interrupção da irrigação tissular, ocasionando oclusão de vasos e capilares, isquemia e morte celular. O objetivo principal deste trabalho foi verificar a resposta da cicatrização em úlceras por pressão, em clientes no atendimento domiciliar com a estimulação do ultra-som pulsado de baixa intensidade. A metodologia proposta foi a investigação de voluntários humanos não diabéticos, portadores de úlceras por pressão de qualquer grau, região, tamanho e profundidade em qualquer fase de cicatrização, sem processo infeccioso evidente, sem uso de medicação antiinflamatória. Todas as lesões receberam assistência de enfermagem obedecendo ao mesmo protocolo de curativos, para os portadores de 2 lesões apenas uma delas recebeu estimulação de ultra-som pulsado de baixa intensidade 30 mW/\'CM POT.2\', freqüência 1.5 Mhz em sessões de 20 minutos, três vezes por semana, durante seis meses, perfazendo um ciclo de aproximadamente 72 aplicações, ou menos sessões quando a alta aconteceu antes do prazo. Os resultados foram acompanhados através de quatro instrumentos: análise comparativa descritiva, análise histológica, análise morfométrica e análise fotográfica . A pesquisa foi observacional descritiva, sendo realizada uma análise estatística, através de dados extraídos dos prontuários e mensurações das áreas das lesões. O estudo histológico revelou melhora na vascularização, demonstrou angiogênese e processo inflamatório local. / The pressure ulcers are areas of injured skin and tissue caused by constant pressure on certain areas of the body, compromising the irrigation of tissue and also, causing the occlusion of vases and capillaries, ischemia and cellular death. The main objective of this work was the evaluation the wound healing process in pressure ulcers, during homecare service, with stimulation of low intensity ultrasound combined with papain. The methodology evaluation was applied in human volunteers without diabetic, with wounds in any ranges, region, size and depth. These wounds were in any phase and without any evident infectious process, without use of any antiinflammatory drugs. During all the execution of the work the injuries were treated according to the same protocol . Patients with only one wound received ultrasound stimulation in sessions of twenty minutes, three times per week, during six months, constituting a healing cycle of approximately 72 applications. Early treatment closing caused a reduction of sessions number. Considering patients with two injuries only one of the received the ultrasonic stimulation. The results had been followed through four studies: descriptive comparative analysis, histological analysis, morphometric analysis and photographic analysis. The results obtained were submitted to statistical analysis, by analyzing data extracted from clinical records and measurements of injury areas. The histological study disclosed improvement in the vascularization, it demonstrated angiogenesis and local inflammatory process.

Bakgrund: Förekomsten av venösa bensår hos den vuxna befolkningen i EU-länderna uppskattas vara mellan 490 000 upp till 1,3 miljoner personer. Den viktigaste behandlingen för att förebygga recidiverande bensår är kompressionsstrumpor. Hos de patienter som inte använder kompressionsstrumpor har risken att få recidiv beräknats vara 100% och hos de som använder strumporna 16%. Patientens livskvalitet påverkas av att det oftast krävs lång vårdtid och behandling av bensåret och att det vanligtvis är ett återkommande problem. Syfte: Att beskriva faktorer som påverkar patientens följsamhet till kompressionsbehandling för att förebygga och behandla venösa bensår. Metod: Studien har genomförts som en litteraturöversikt. Datainsamling har skett genom sökningar i databaserna CINAHL och PubMed. Resultat: Sammanfattningsvis så visar resultatet att det finns flera faktorer som påverkade patientens följsamhet. Patienternas följsamhet minskade till följd av smärtan som orsakades av kompressionsbandaget eller vid såromläggningen. Hos nya oerfarna sjuksköterskor fanns bristande kunskap i hur kompressionsbandaget ska appliceras, hos ett flertal patienter fanns bristande kunskap och förståelse varför kompressionsbehandling var viktigt för att förhindra nya venösa bensår. Appliceringssvårigheter med att ta av och på kompressionsstrumporna, tillit till sjuksköterskan och utseendet på kompressionsstrumporna/bandaget var andra faktorer som påverkade följsamheten. Slutsats: Patientens följsamhet till kompressionsbehandling påverkas av både hämmande och främjande faktorer. Det som sjuksköterskan bland annat kan göra för att påverka patientens följsamhet till kompressionsbehandling är att informera om hur kompressionsbehandling hjälper till med läkningen och egenvårdsråd för att förhindra recidiv. / Background: The incidence of venous leg ulcers in the adult population in the EU countries are estimated to be between 490,000 and 1.3 million. The main treatment for the prevention of recurrent leg ulcers is compression stockings. For those patients who don´t use compression stockings, the recurrence has been calculated to be 100% and for those who used the socks 16%. Patient's quality of life is affected by the fact that it is usually required long care and treatment of the leg and that it is usually a recurring problem. Aim : To describe factors that affect patient compliance with compression therapy to prevent and treat venous leg ulcers. Methods: The study has been carried out as a litterature review. Data collection has been done through searches in the CINAHL and PubMed databases. Results: In summary, the result shows that there are several factors that affected the patient's compliance. Patient compliance decreased as a result of the pain caused by the compression bandage or by the wound dressing. At new inexperienced nurses were lacking in knowledge of how the compression bandage should be applied, in several patients there was a lack of knowledge and understanding why compression treatment was important to prevent new venous leg ulcers. Difficulty in applying and removing the compression socks, trust in the nurse and the appearance of the compression socks / bandage were other factors that affected compliance. Conclusion: The patient's adherence to compression treatment is affected by both inhibitory and promotional factors. What the nurse can do, among other things to influence the patient's adherence to compression therapy is to inform about how compression treatment helps with the healing and self-care advice to prevent recurrence.

The aim of this study is to develop new insights which pressure relief (PR) cushion designers can use to guide the design of new cushions with greater efficacy at preventing pressure ulcers than contemporary cushions. A methodological framework was formulated which incorporated a number of research techniques from the user-centred methodology USERfit, and included methodological triangulation. Exploratory interviews and observational work were conducted in a specialist unit for spinal cord injury (SCI). This involved ten patients, four physiotherapists, two nurses and an outpatient technician. Additionally, two questionnaires were designed and circulated amongst SCI patients and staff with completed responses from 41 patients and 31 staff. From the analyses of the data gathered from the literature, observational work, interviews and questionnaire responses, 28 recommendations for cushion design were formulated. These recommendations covered the principles which underpin cushion design, cushion usability and the future direction of cushion design.

As úlceras por pressão são definidas como lesões causadas pela constante pressão exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangüíneo com diminuição ou interrupção da irrigação tissular, ocasionando oclusão de vasos e capilares, isquemia e morte celular. O objetivo principal deste trabalho foi verificar a resposta da cicatrização em úlceras por pressão, em clientes no atendimento domiciliar com a estimulação do ultra-som pulsado de baixa intensidade. A metodologia proposta foi a investigação de voluntários humanos não diabéticos, portadores de úlceras por pressão de qualquer grau, região, tamanho e profundidade em qualquer fase de cicatrização, sem processo infeccioso evidente, sem uso de medicação antiinflamatória. Todas as lesões receberam assistência de enfermagem obedecendo ao mesmo protocolo de curativos, para os portadores de 2 lesões apenas uma delas recebeu estimulação de ultra-som pulsado de baixa intensidade 30 mW/\'CM POT.2\', freqüência 1.5 Mhz em sessões de 20 minutos, três vezes por semana, durante seis meses, perfazendo um ciclo de aproximadamente 72 aplicações, ou menos sessões quando a alta aconteceu antes do prazo. Os resultados foram acompanhados através de quatro instrumentos: análise comparativa descritiva, análise histológica, análise morfométrica e análise fotográfica . A pesquisa foi observacional descritiva, sendo realizada uma análise estatística, através de dados extraídos dos prontuários e mensurações das áreas das lesões. O estudo histológico revelou melhora na vascularização, demonstrou angiogênese e processo inflamatório local. / The pressure ulcers are areas of injured skin and tissue caused by constant pressure on certain areas of the body, compromising the irrigation of tissue and also, causing the occlusion of vases and capillaries, ischemia and cellular death. The main objective of this work was the evaluation the wound healing process in pressure ulcers, during homecare service, with stimulation of low intensity ultrasound combined with papain. The methodology evaluation was applied in human volunteers without diabetic, with wounds in any ranges, region, size and depth. These wounds were in any phase and without any evident infectious process, without use of any antiinflammatory drugs. During all the execution of the work the injuries were treated according to the same protocol . Patients with only one wound received ultrasound stimulation in sessions of twenty minutes, three times per week, during six months, constituting a healing cycle of approximately 72 applications. Early treatment closing caused a reduction of sessions number. Considering patients with two injuries only one of the received the ultrasonic stimulation. The results had been followed through four studies: descriptive comparative analysis, histological analysis, morphometric analysis and photographic analysis. The results obtained were submitted to statistical analysis, by analyzing data extracted from clinical records and measurements of injury areas. The histological study disclosed improvement in the vascularization, it demonstrated angiogenesis and local inflammatory process.

Includes bibliographical references. / 59 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Various articles published by John Robin Warren on the discovery and pathology of Helicobacter pylori. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 2000

There are many terms used to describe pressure ulcers: pressure sores, decubitus ulcers, bedsores, and pressure necrosis or ischaemic ulcers. Essentially they all describe damage to the patient's skin and underlying tissue. The nursing literature abounds with information about the risk, grading, prevention and treatment of pressure ulcers. These ulcers are a problem in hospital and long term care facilities, and are a major cause of morbidity. In the hospital setting they contribute to an extended length of stay and by doing so 'block' the bed for use by another patient. The ulcers are difficult to treat, are an ongoing cause for pain and discomfort for the patient and can be a strain on hospital finances. Pressure ulcers are not unique to modern times, as they have been discovered on the remains of an Egyptian mummified body (Armstrong & Bortz 2001). This would suggest that the problem dates back to the Pharoahs, and has continued to be a challenging problem throughout the centuries (Bridel 1992). The escalating costs of treating these ulcers today, has brought about an emphasis on the risk factors, prevention and the appropriate interventions, rather than an acceptance of these ulcers as a tolerable ondition (Bridel 1992). In the operating room, nurses are faced with unique challenges when caring for their patients. This is due to difficulty in caring for patients under the influence of the anaesthesia required for surgery, long periods of forced immobility and the inability of the patient to perceive pain and discomfort from the pressure of the hard surface of the operating room table. These problems are increased by nurses' inability to gain access to the patient because of the sterile drapes required to cover the patient for surgery. Armstrong and Bortz (2001) present information from one study in which it is stated that surgical patients have 90% greater chance of developing pressure ulcers than medical patients. One reason for this may be due to the limited information available in regard to the most effective support surface to place on top of the operating room table. This gap in information is problematic for operating room nurses as it limits their ability to select the most effective item of equipment, and determine if the chosen equipment reduces pressure on tissue intra- operatively. The most effective operating room table mattress used and the skills and knowledge of the operating room nurse about the aetiology and prevention of pressure ulcer prevention, are important aspects of nursing care and can influence patient outcomes. The potential for complications to occur may be dependent on single or combined factors such as the patient's age, disease processes, nutritional status and mobility. Preparatory and supportive nursing interventions for surgical procedures based on best available evidence, nursing experience and patient preference, can reduce the incidence of pressure ulcer development in the perioperative environment. This doctoral portfolio contains four separate sections related and linked together by a common theme - pressure ulcer prevention in the perioperative environment. This first section of the portfolio situates the topic and provides a brief overview of the portfolio. The second section is a critical review of the literature pertaining to the most commonly used operating room table mattresses, and the effectiveness of these mattresses in the prevention of pressure ulcer development. This review highlighted a lack of quality research in this area, and while many evaluations have been undertaken to determine the effectiveness of perating room table mattresses, the results are contradictory concerning the patients, exposures and interventions. Because of issues related to the methodological quality of published research in this area a systematic review using meta- analysis was not possible rather a critical review of the research literature is used. The third section of the portfolio reports on a hermeneutic ethnography of the perceived skills and knowledge of nurses in the prevention of pressure ulcer development in the perioperative environment. This study was designed to determine if pressure ulcer prevention forms an aspect of the everyday practice of perioperative nurses. This review has highlighted the need for operating room nurses to review practices when caring for patients in the perioperative environment particularly in respect of pressure ulcer prevention. The fourth and final section of the portfolio summarises the research and provides recommendations for nursing practice and further research in the area of pressure ulcer prevention in the perioperative environment. / Thesis (D.Nurs.)--Department of Clinical Nursing, 2004.

Deep tissue injury (DTI) is a severe form of pressure ulcers resulting from ischemia and mechanical damage due to unrelieved pressure. Despite many preventative methods, none so far has significantly reduced the incidence of DTI. The use of a novel method of pressure ulcer prevention, intermittent electrical stimulation (IES), was investigated. The current study investigated the effects of IES on surface pressure and tissue oxygenation in individuals with SCI. The results demonstrated that IES induced contractions caused significant reductions in pressure around the ischial tuberosities, as well as significant and sustained increases in oxygenation. Direct measurements of oxygen in an invasive rodent model indicated that IES induced contractions resulted in a 20-100% increase in tissue oxygenation. The results indicate that IES directly targets the pathogenic factors contributing to the development of pressure ulcers and thereby may be an effective method for the prevention of DTI.

Bakgrund: I Sverige har cirka 50 000 människor venösa bensår och kostnaden för att behandla dessa beräknas uppgå till omkring en miljard kronor. Svårläkta venösa bensår kan påverka individen på ett fysiskt, psykiskt och socialt plan. Syftet: Att beskriva patienters erfarenheter av att hantera symptom relaterat till svårläkta venösa bensår. Metod: Kvalitativ forskningsintervju med semistrukturerade frågor tillämpades som datainsamlingsmetod och utfördes på fyra vårdcentraler i Mellansverige med totalt 11 deltagare. Materialet bearbetades sedan med en innehållsanalysmetod. Resultat: Deltagarna har till stor del lärt sig att anpassa sig till de besvär bensåret orsakade. Smärtan hanterades bland annat genom att ta smärtstillande läkemedel vilket även kunde förbättra sömnen. Vid dusch användes plastpåsar, gladpack eller plaststrumpor för att inte blöta ner bandaget och vid nedsatt mobilisering användes hjälpmedel såsom rollatorer, kryckor eller rullstol. Genom att informera omgivningen om bensårets existens kunde det sociala umgänget förbättras samt genom att tänka positivt och avleda negativa tankemönster på bensåret genom sysselsättning samt jämföra med dem som har det värre kunde deltagarna lättare acceptera bensåret. Slutsats: Patienter med svårläkta venösa bensår kan anpassa sig till de symptom bensåret ger upphov till genom att tillämpa copingstrategier för att hantera det dagliga livet. Anhöriga är en viktig del i denna anpassning. Genom att tänka positivt, avleda negativa tankemönster på bensåret genom att aktivera sig samt jämföra med dem som har det värre kan personen lättare acceptera sitt bensår. / Background: In Sweden, approximately 50 000 people have venous leg ulcers and the cost of treating these is estimated to around one billion SEK. Slow-healing venous leg ulcers can affect individuals on a physical, mental and social level. The aim: To describe patients' experiences of managing symptoms related to slow-healing venous leg ulcers. Method: A qualitative research interview with semi-structured questions was applied as the method of data collection and conducted in four health centres in central Sweden with a total of 11 participants. The material was then evaluated by content analysis. The result: The participants largely learned to adapt the difficulties caused by leg ulcer. The pain was managed for example by taking painkillers, which also could improve the sleep. When showering plastic bags, cling film or plastic socks were used to avoid soaking the bandage and in the case of reduced mobility walking aids such as walkers, crutches or wheelchairs were used. By informing friends and family about the existence of the leg ulcer, social interaction was improved and by thinking positively, diverting negative thought patterns through free-time activities and comparing with those who had it worse the participants could more easily accept the leg ulcer. Conclusion: Patients with difficult-to-heal venous leg ulcers can adapt to the symptoms caused by the leg ulcer by using coping strategies to deal with everyday life. Family members are an important part of this adaptation. By thinking positively, divert negative thought patterns of the leg ulcer by activating and compare with those who had it worse, the person can more easily accept their leg ulcers.