The objective of the study reported here was to document the distribution of epidermal growth factor receptor (EGFr) and quantitate receptor density in normal as well as ulcerated equine gastric squamous mucosa. Fifteen horses with endoscopically normal stomachs were divided into three equal groups. Group 1 was a normal control. A protocol that alternated 24 hour periods of free-choice hay with 24 hours of feed deprivation was utilized to induce squamous mucosal gastric ulceration in Group 2 (48 hours total off-feed) and Group 3 (96 hours total off-feed). Gastric tissue was collected from 3 stomach locations at post-mortem examination and an avidin-biotin immunoperoxidase technique was developed to stain the formalin-fixed tissue for EGFr. A computerized image analysis system was used to measure EGFr area and mean intensity values at four sites within the epithelium from the basal cell layers to the lumen in the ulcer/erosion margin, erosion bed, and 10-14 mm distant from the lesion. / Master of Science

SAMMANFATTNING Introduktion Trycksår utgör en global utmaning med påverkan på individ, vård och samhället. Trycksårkan orsaka både psykiskt och fysisk lidande, vilket i sin tur kan leda till en minskning avlivskvaliteten. Det är viktigt att sjuksköterskor förstår hur patienter upplever att det är att levamed trycksår. Detta för att vården ska kunna anpassa sig till den unika patientens behov avomvårdnad.SyfteSyftet var att undersöka patienters erfarenhet av att ha och leva med trycksår, samt upplevtlidande. Metod Studien genomfördes som en beskrivande litteraturöversikt. Artikelsökningar gjordes viadatabaserna Pubmed och Cinahl. Efter granskning utfördes ett urval av 10 vetenskapligakvalitativa artiklar som fokuserade på att undersöka patienters upplevelse av att leva medtrycksår, och uppfyllde kvalitetskraven. Artiklarnas resultat sammanställdes genom Fribergsfyra stegs processen. Resultat Tre huvudkategorier och sex underkategorier identifierades i artiklarna, inspirerade av KatieErikssons teori. Huvudkategorierna var sjukdomslidande, livslidande och vårdlidande.Subkategorierna omfattade upplevelser av smärta från trycksår och dess negativa påverkan påpatientens dagliga och sociala liv, och därmed på livskvaliteten. Positiva upplevelser kanuppstå mitt i lidandet, vilket stärker patienternas syn på livet och ger dem kraft att hanterasvårigheter och lidande. Slutsats Denna litteraturöversikt visar hur trycksår påverkar patienters livskvalitet negativt, men lyfterockså fram positiva upplevelse. Dessa positiva erfarenheter kan stärka patienternas syn påsituationen och hjälpa dem att hantera livet med trycksår. Det finns fortfarande ett påtagligtbehov av att vården intensifierar sitt arbete med att hantera smärta hos patienter med trycksår. / ABSTRACT Introduction Pressure ulcers constitute a global challenge with an impact on individuals, healthcare, andsociety. Pressure ulcers can cause both mental and physical suffering, which, in turn, maylead to a reduction in quality of life. It is essential for nurses to understand how patientsexperience living with pressure ulcers. This is crucial for healthcare to adapt to the uniqueneeds of each patient. Objectives The aim was to investigate patients' experiences of having and living with pressure ulcers, aswell as their perceived suffering.MethodThe study was conducted as a descriptive literature review. Article searches were conductedvia the databases PubMed and CINAHL. After reviewing, 10 qualitative scientific articleswere selected, which focused on exploring patients' experiences with pressure ulcers and metthe quality standards. The findings of the articles were compiled and categorized into themesthrough Friberg's four-step process. Results Three main categories and six subcategories were identified in the articles, inspired by KatieEriksson's theory. The main categories were suffering from illness, suffering from life, andsuffering from care. The subcategories included experiences of pain from pressure ulcers andits negative impact on the patient's daily life, social life and consequently on their quality oflife. Positive experiences can emerge during suffering, strengthening patients' outlook on lifeand empowering them to cope with difficulties and hardship. Conclusion This literature review demonstrates how pressure ulcers negatively impact patients' quality oflife, while also highlighting positive experiences among those suffering. These positiveexperiences strengthen patients' perspectives on their situation and aid them in coping withsuffering. There is still a clear need for healthcare to intensify its efforts in managing painamong patients with pressure ulcers.

Bakgrund: Trycksår är sår som utvecklas på huden och de underliggande vävnaderna när en del av kroppen utsätts för långvarigt tryck eller skjuv. Trycksår anses vara en vårdskada som vanligtvis uppkommer i samband med vård. De är vanliga bland personer som tillbringar långa perioder i sängen eller på en stol, särskilt de som har nedsatt rörlighet eller känslighet. Trycksår kan vara smärtsamma, en orsak till lidande både fysiskt och psykiskt, och kan leda till allvarliga komplikationer såsom minskning av livskvalitet om de inte behandlas ordentligt. Det är viktigt att sjuksköterskor förstår patienternas upplevelse av att leva med trycksår för att kunna sätta in fungerande omvårdnadsåtgärder som minskar smärtupplevelsen och lidandet och tillfredsställer patienternas individuella behov. Syfte: Syftet var att belysa patienters upplevelser av att leva med trycksår. Metod: En litteraturöversikt genomfördes i enlighet med Fribergs metodbeskrivning. Tio vetenskapliga kvalitativa artiklar hämtades från CINAHL Complete och PubMed som inkluderades i resultatet. Resultat: Litteraturöversikten delades in i tre huvudkategorier för att belysa patienternas erfarenheter av att ha trycksår: fysiska upplevelser, psykosociala upplevelser och upplevelser av vårdpersonal/otillräcklig vård. Inom varje huvudkategori identifierades underteman: upplevelser av smärta och obehag, upplevelser av sömnpåverkan, emotionella faktorer, upplevelser av dagliga aktiviteter och deras påverkan på relationer, samt upplevelser av att möta vårdpersonal och upplevelser av otillräcklig vård. Slutsats: I denna litteraturöversikt framkommer det hur trycksår påverkar patienternas livskvalitet negativt och betonar vikten av kunskap i vården av dessa patienter. Trots tillgängliga förebyggande åtgärder uppstår trycksår som en vårdskada och upplevs som ett svek vilket ökar patientens lidande. En ökad förståelse för detta lidande kan driva vården att aktivt arbeta med att öka patienternas förtroende och välbefinnande genom avgörande kommunikation med sjuksköterskan och att involvera patienterna i sin egen behandling. / Background: Pressure ulcers are sores that develop on the skin and underlying tissues when a part of the body is subjected to prolonged pressure or shear. Pressure ulcers are considered a care injury that usually occurs in connection with care. They are common among people who spend long periods in bed or in a chair, especially those who have reduced mobility or sensitivity. Pressure ulcers can be painful and be a cause of suffering both physically and psychologically and can lead to serious complications such as reduced quality of life, if not treated properly. It is important that nurses understand patients' experience of living with pressure ulcers in order to implement effective nursing measures that reduce the pain and suffering experience and to satisfy the patients' individual needs. Aim: The aim was to shed light on patients' experiences of living with pressure ulcers. Method A literature review was implemented in accordance with Friberg's method description. Ten qualitative scientific articles were retrieved from CINAHL Complete and PubMed and included in the results. Results: The literature review was divided into three main categories to highlight patients' experiences of having pressure ulcers: physical experiences, psychosocial experiences, and experiences of healthcare professionals/care. Within each main category sub-themes were identified: experiences of pain and discomfort, experiences of impact on sleep, emotional factors, experiences of daily activities and their impact on relationships, as well as experiences of encountering care and experiences of inadequate care. Conclusions: This literature review revealed how pressure ulcers negatively affect patients' quality of life and emphasizes the importance of knowledge in the care of these patients. Despite available preventive measures, pressure ulcers occur as a health care injury and are perceived as a betrayal, which increases the patient's suffering. An increased understanding of this suffering can drive care to actively work to increase patients' trust and well-being through crucial communication with the nurse and to involve patients in their own treatment.

No / To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK. Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant. Results: Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53–66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p < 0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37–38 nurse visits over the study period. Patients' dressings were changed, on average, every 4–5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ∼£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for < 10% of the cost. Conclusion: Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy. / 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC

Yes / To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji. Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis. Rotuma hospital, Fiji. HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included. There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients. HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.

Bakgrund: Svårläkta sår är ett växande problem då vi lever allt längre och de är vanligare hos äldre personer. Ett svårläkt sår är ett sår som inte läkt inom en sex veckors period. Det finns flera bakomliggande orsaker till uppkomsten av denna typ av sår, malignitet och venös insufficiens är två exempel. Sjuksköterskan bör ha evidensbaserad kunskap för att kunna ge en god omvårdnad till de patienter som lider av ett svårläkt sår. Syfte: Syftet med litteraturöversikten är att beskriva patienters upplevelser av att leva med maligna tumörsår eller venösa bensår. Metod: En litteraturöversikt har genomförts med hjälp av Fribergs metod. Samtliga tio vetenskapliga artiklar som använts i litteraturöversikten har använt sig av kvalitativ metod. Databaserna som använts vid datainsamlingen är Academic Search Complete, Cinahl Complete och PubMed. Resultat: Resultatet sammanfattas i fyra huvudteman: Upplevelsen av symtom, En förändrad identitet, Social isolering och Att leva med ett svårläkt sår. Det var vanligt bland deltagarna att såren hade en negativ inverkan på deras liv och orsakade dem en förändrad kroppsuppfattning. Symtomen upplevdes besvärande och orsakade dem oro, ångest och skam över den egna kroppen, som ledde till att de isolerade sig från omgivningen. Deltagarna använde sig av olika coping-strategier för att hantera sin situation och klara av det dagliga livet. Diskussion: Resultatet diskuterades utifrån Jocalyn Lawlers somologiska teori som beskriver hur en patient kan uppleva en omvårdnadssituation och hur sjuksköterskan kan främja ett vårdande möte genom att se hela patienten. / Background: Chronic wounds are an increasing problem in society because we live longer, and the problem is more common when we get older. The criteria of a chronic wound are that it has not healed within six weeks. There are several underlying reasons for this type of wounds; malignancy and venous insufficiency are two examples. A nurse should have evidence based knowledge to be able to provide good care for patients suffering from this type of wounds. Aim: The aim of the study was to describe the patients’ experience of living with malignant wounds or venous leg ulcers. Method: A literature study has been carried out using Friberg’s method. Ten scientific articles used in the literature study were qualitative. The databases that were used in data collection were Academic Search Complete, Cinahl Complete and PubMed. Results: The results are summarized into four main themes: Perception of symptoms, A changed identity, Social isolation and Live with a chronic wound. The study showed that the wounds had a negative impact on the patients’ lives and caused them an altered body image. The symptoms were experienced as bothersome and caused anxiety, fear and shame. That led to social isolation. Participants used a variety of coping strategies to manage their situation to manage with their daily life. Discussion: The results were analyzed on the basis of Jocalyn Lawler’s somology theory that describes how a patient may experience a nursing situation and how the nurse can promote a caring encounter when seeing the whole patient.

Diante de pesquisas realizadas com o 5Ultra-som pulsado de baixa intensidade na regeneração de pele de ratos submetidos a queimaduras provocadas por calor (ALVES, 1988) e em pacientes portadores de úlceras tróficas de perna (HILÁRIO, 1993) se propôs estudar os efeitos do ultra-Som pulsado de baixa intensidade em pacientes com Mal de Hansen (MH) cujas manifestações cutâneas eram caracterizadas como o Mal Perfurante Plantar (MPP) e úlceras do tegumento, sendo que o emprego do ultra-som pulsado e de baixa intensidade mostrou-se eficaz na reparação das referidas lesões. O presente trabalho foi realizado em pacientes assistidos pelo Sistema Único de Saúde (SUS) na cidade de Bebedouro-SP lotados no setor de Vigilância Epidemiológica. A casuística constitui-se de seis pacientes apresentando MPP nos quais aplicou-se o ultra-som pulsado (U.S.P.) em uma freqüência de três vezes por semana no mesmo período circadiano. Os tratamentos tiveram duração variando entre vinte e quarenta minutos consoante a extensão das lesões cutânea. Independente do tempo das lesões não foi estabelecido previamente o número de aplicações a serem executadas, mas as aplicações foram realizadas até a obtenção da cicatrização total das lesões. A evolução das lesões até a cicatrização foi feita mediante o emprego de um software especialmente desenvolvido para tal finalidade e documentados fotograficamente. Não houve correlação entre o número de aplicações com o tamanho da lesão ou com o tempo decorrido do aparecimento das mesmas, embora a extensão e a forma das diferentes ulcerações não sejam equivalentes, quer no tempo de evolução, quer na profundidade das lesões, os resultados dos tratamentos com U.S.P. e de baixa intensidade mostraram-se segundo a metodologia de avaliação ser altamente satisfatório para o tratamento de lesões cutâneas decorrente da Hanseníase / Based on researches carried out with the low intensity pulsed ultrasound on the regeneration of burned rat skin previously exposed to heat and on legs trophic ulcers we proposed to study the effects of the low intensity pulsed ultrasound on Hansen’s disease patients whose cutaneous manifestations were characterized as the MPP. The study was carried out on six patients supported by the Public Health Care System (SUS/PHCS) in the city of Bebedouro- SP, crowded on the Epidemiological Observation ward. The low intensity pulsed ultrasonic radiation administrations were carried out three times a week on the same circadian. Irradiation time varied from twenty to forty minutes according to the extension of the lesion. The number of the administrations, which were carried out until the complete lesion cicatrisation in all patients, was not previously stipulated. Evaluation of cicatrisation was carried out making use of software and photographs taken at the beginning of the treatment and after every ten administrations of the pulsed ultrasound until the complete ulcers cicatrisation. It was not observed any correlation between number of ultrasound applications and area of the lesion or age of them. Although extension and shape were not equivalent, according to these results, pulsed low intensity ultrasound can be considered as an adjunctive treatment for cutaneous manifestations of Hansen’s disease

O processo acelerado de modernização científica e tecnológica tem gerado novas formas de conhecimento, o que tem levado instituições a rever o modo de formação dos profissionais. Dentre as várias características necessárias para este novo profissional, destacam-se a capacidade de buscar e utilizar novas informações, saber comunicar-se (nacional e internacionalmente), usar os recursos tecnológicos para a melhoria de vida, desenvolver a crítica e desempenhar a profissão de forma contextualizada e em equipe. Podemos afirmar então que o cuidado de enfermagem precisa ter uma abrangência maior. E assim, ao considerar a formação do enfermeiro, é que buscamos conhecer a situação atual do ensino, no que se refere à prevenção e tratamento de úlceras por pressão, nos cursos de graduação em enfermagem de oito Instituições Públicas de Ensino Superior do estado de São Paulo. Foi realizada uma pesquisa descritiva do tipo inquérito, da qual participaram 36 docentes, a maior parte do sexo feminino (97,2%), casados (75%), com idade entre 41 a 45 anos, com um tempo de formado variando de 16 a 25 anos, com aperfeiçoamento, 22,2% , especialização, 86,1% , mestrado 83,3% e doutorado 52,7%. Tinham experiência anterior à docência 94,4%, sendo a área mais freqüente a assistencial (47,2%). Foram citadas 2 disciplinas obrigatórias e 3 eletivas sobre o tema. Dentre os docentes, 28% ministram conteúdo teórico em sala de aula, 75,6% em estágio curricular e33,3% teórico-prático em laboratório. O modo de preparação para o ensino ocorreu por meio de publicações científicas 88,9%, pela prática profissional anterior a docência 80,6 % e em cursos de extensão 61,1%. As publicações incluíram 13 títulos de livros, 8 revistas nacionais e 8 revistas internacionais. O método mais utilizado em sala de aula foi aula expositiva (44,4%), em laboratório de ensino foi a demonstração pelo professor (58,3%), e no ensino clínico foi um aluno faz o procedimento e os demais observam (83,3%).Com relação aos recursos computacionais, 87,5% das instituições possuem laboratórios de informática e 100% possuem servidor. A relação aluno/computador nos cursos variou de 5,3 a 26,6. O tema mais abordado sobre prevenção foi: Fatores de risco (91,7%), e sobre tratamento Métodos de limpeza, desbridamento, coberturas, alívio da pressão e controle da dor (91,7%). Quanto ao preparo do docente para o ensino do tema, 58,3% se sentem preparados e 41,7%, não. Os comentários e sugestões dos docentes evidenciaram a necessidade de um enfoque maior na prevenção de UP e maior divulgação de inovações entre docentes. / The accelerated process of scientific and technological modernization has created new forms of knowledge. As a result, institutions have reconsidered the way they educate professionals. Among the different characteristics this \"new\" professional needs, special attention must be given to the ability to search for and use new information, to communicate (in the national and international spheres), to use technological resources for a better life, to develop criticism and perform the profession in a contextualized form through teamwork. Thus, it can be affirmed that nursing care needs to expand its range. That is why, in view of nursing education, we aim to get to know the current situation of teaching on the prevention and treatment of pressure ulcers in undergraduate nursing courses at eight Public Higher Education Institutions in the state of São Paulo. A descriptive inquiry was carried out. The participants were 36 lecturers, most of whom were women (97.2%), married (75%), between 41 and 45 years old; graduation times ranged from 16 to 25 years; 22.2% had taken refresher courses, 86.1% specialization courses, 83.3% Masters and 52.7% doctoral programs. 94.4% possessed earlier experience before teaching, most of whom (47.2%) in the field of care delivery. 2 compulsory and 3 optional subjects about the theme were mentioned. 28% of the lecturers presented theoretical contents in the classroom and 75.6% in curricular training, while 33,3 % offered theoretical-practical contents in laboratories. Teaching preparation was realized by means of scientific publications (88.9%), by professional practice previous to teaching (80.6%) and by extension courses (61.1%). The publications included 13 book titles, 8 national and 8 international journals. Seminars were the most used method (44.4%) in the classroom, demonstrations by the lecturer (58.3%) at the teaching lab, and a student demonstrating the procedure while the others are observing (83.3%) in clinical teaching. With respect to computer resources, 87.5% of the institutions have computer labs and 100% have a server. The student /computer index ranged from 5,3 to 26,6.The most frequently discussed theme related to prevention was: \'Risk factors\' (91.7%) and, in terms of treatment, \'Cleaning, debridement, dressing, pressure relief and pain control methods\' (91.7%). As to the lecturer\'s preparation for teaching about the theme, 58.3% feel prepared, whereas 41.7% do not. The lecturers\' comments and suggestions revealed the need for a greater focus on pressure ulcer prevention and for greater dissemination of novelties among lecturers.

Objetivo: determinar e analisar a incidência de úlcera por pressão e os fatores de risco para o seu desenvolvimento, assim como sua relação com a carga de trabalho de enfermagem, em pacientes internados em unidade de terapia intensiva. Métodos: como parte do projeto de pesquisa intitulado Segurança do paciente em unidades de terapia intensiva: influência dos recursos humanos de enfermagem na ocorrência de eventos adversos, o presente estudo constituiu uma coorte retrospectiva, realizado em nove unidades de terapia intensiva e uma semi-intensiva, de dois hospitais-escola da cidade de São Paulo. A amostra foi composta por 766 pacientes, sem úlcera por pressão 24 horas após a admissão nas unidades do estudo. As variáveis de interesse foram extraídas do banco de dados do estudo original e dos prontuários digitalizados dos pacientes que participaram do estudo. Para as análises estatísticas foram utilizados incidência cumulativa, Qui-quadrado de Pearson, Mann-Whitney e Regressão logística (Stepwise Forward). Resultados: a incidência de úlcera por pressão foi de 18,7%. Pacientes em ventilação mecânica apresentaram 3,5 vezes maior chance de úlcera por pressão (OR 3,479; IC 95% 2,190-5,528; p < 0,001); estar em cuidados paliativos aumentou a chance de úlcera por pressão em 7,8 vezes (OR 7,829; IC 95% 1,927-31,817; p = 0,004); cada dia a mais de internação aumentou em 10,1% a chance de úlcera por pressão (OR 1,101; IC 95% 1,071-1,132; p < 0,001); cada ponto do Nursing Activities Score aumentou a chance de úlcera por pressão em 1,5% (OR 1,015; IC 95% 1,003-1,027; p = 0,016); entre 60 e 84 anos a chance foi 2,3 vezes maior de úlcera por pressão do que aqueles com menos de 45 anos (OR 2,331; IC 95% 1,283-4,236; p = 0,005) e a partir dos 85 anos, a chance foi 2,7 vezes maior de úlcera por pressão do que aqueles com menos de 45 anos (OR 2,695; IC 95% 0,945-7,683; p < 0,064). Conclusão: admitindo-se que a UP é um evento adverso e que sua ocorrência está relacionada a baixa qualidade da assistência, a incidência de 18,7% aqui encontrada pode ser considerada alta. Muito ainda precisa ser feito no âmbito da prevenção, no intuito de alcançar índices mais aceitáveis. / Objective: To determine and to analyze pressure ulcers incidence and risk factors, and their relationships with nursing work-load in critical care patients. Methods: As a part of the research project named \"Patient safety in intensive care units: the influence of nursing personnel in adverse events occurrence\", a retrospective cohort study was taken in nine intensive care units and one semi-intensive care unit in two university hospitals in Sao Paulo. A total of 766 pacients without pressure ulcer 24 hours after their admission in the units were studied. The variables of interest for this study were collected in digitalized records. The statistical analysis were done using cumulative incidence, Pearson´s Chi-Square, Mann- Whitney´s and Logisitic regression (Stepwise Forward) tests. Results: the incidence of pressure ulcers was 18.7%. Patients under mechanical ventilation had a chance 3.5 times higher for developing of pressure ulcer (OR 3.479; IC 95% 2.190-5.528; p < 0.001); being under paliative care augmented 7.8 times the chance for developing pressure ulcer (OR 7.829; IC 95% 1.927-31.817; p = 0.004); for each day more of stay in ICU, the chance of developing pressure ulcers were 10.1% higher (OR 1.101; IC 95% 1.071-1.132; p < 0.001); each point of Nursing Activities Score rose the chance of developing pressure ulcer in 1.5% (OR 1.015; IC 95% 1.003-1.027; p = 0.016); patients between 60 and 84 years-old had a 2.3 higher chance of developing pressure ulcers than patients younger than 45 years-old (OR 2.331; IC 95% 1.283- 4.236; p = 0.005) and, after the age of 85, the chance for developing pressure ulcers were 2.7 times higher than in patients younger than 45 years-old (OR 2.695; IC 95% 0.945-7.683; p < 0.064). Conclusion: admitting that pressure ulcers are an adverse effect and that their occurrence is related with poor assistance quality, we can consider the incidence of 18,7% found in this cohort as high. Prevention actions must be enforced to guarantee a decrease in these figures.

Orientador: João Pessoa Araujo Junior / Resumo: A suinocultura é uma das principais atividades do agronegócio brasileiro. Por isso, perdas devem ser evitadas a fim de satisfazer a indústria e o bem-estar dos animais. O aparecimento de úlceras gastroesofágicas em suínos causa prejuízos para o produtor e pode levar os animais à morte. O objetivo do trabalho foi verificar a participação de Fusobacterium necrophorum e Helicobacter suis como agentes etiológicos das úlceras nos suínos. Para isso foi realizada avaliação macroscópica e microscópica das lesões, padronização e aplicação de qPCR para diagnóstico bacteriano e visualização de micro-organismos em lâminas de histopatologia coradas por prata, a partir de estômagos de suínos com e sem úlceras. Foram avaliados 126 estômagos, 63 sadios e 63 com úlcera. O DNA extraído de fragmento de tecido da região do pars oesophagea foi utilizado para a análise por qPCR. Foi detectado DNA de F. necrophorum em seis (4,8%) estômagos e H. suis em 16 (12,7%). Os resultados demonstraram que houve diferença quanto a classificação macroscópica e microscópica das lesões. A classificação macroscópica das lesões dos estômagos serve como uma forma de triagem a fim de demonstrar as condições de saúde do animal abatido. A histopatologia pode demonstrar o processo inflamatório desde o seu início, quando a lesão ainda não é visível macroscopicamente favorecendo o rastreamento das possíveis causas das lesões. Os resultados demonstraram associação entre a detecção de H. suis e a presença de úlceras. Para a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Swine production is one of the main activities of the Brazilian agribusiness and because of that losses must be avoided in order to satisfy the industry and animal welfare. The appearance of gastroesophageal ulcers in swine causes loss to the producer and can lead to animal’s death. The aim of the present study was to verify the participation of Fusobacterium necrophorum and Helicobacter suis as etiological agents of ulcers in swine. Macroscopic and microscopic evaluation of the lesions was performed, qPCR for bacterial diagnose and microorganism visualization in histology slides stained with silver from swine with and without ulcers was also performed. In total, 126 stomachs were evaluated, 63 healthy and 63 with ulcer. The DNA extracted from the tissue fragment of the region pars oesophagea was used for qPCR. DNA of F. necrophorum was detected in six (4.8%) stomachs and H. suis in 16 (12.7%). Results demonstrated that there was statistical difference as to the macroscopic and microscopic lesions classification. Data pointed to an association between H. suis detection and ulcer presence. An association between gravity of the lesions and the presence of bacteria was observed to both microorganisms. The macroscopic classification of the stomachs lesions serves as a form of screening in order to demonstrate the health conditions of the slaughtered animals. Histopathology can demonstrate the inflammatory process from its onset, when the lesion is not yet visible macroscopically ... (Complete abstract click electronic access below) / Doutor