L'opinion générale est que les ulcères sont rares pendant l'enfance, les lésions provoquées par Helicobacter pylori (H. pylori) ne se produisant que des décennies après l'acquisition de l'infection. L’infection par cette bactérie est en outre moins fréquente chez les enfants dans les pays développés par rapport aux adultes. Par ailleurs, l’usage chronique de médicaments gastro-toxiques est peu fréquent dans cette tranche d’âge. Cependant, plusieurs études ont montré qu’environ 1/10 des enfants référés pour des symptômes de dyspepsie en Europe et infectés par H. pylori présentent un ulcère gastrique ou duodénal, mais aussi que la fréquence de ces lésions chez les enfants non infectés n’est pas nulle.<p>Afin de déterminer la fréquence des ulcères gastriques et duodénaux et des érosions, nous avons commencé par réaliser une étude prospective avec la participation de 19 centres répartis dans 14 pays d'Europe. Tous les enfants référés pour une endoscopie haute ont été recrutés durant une brève période de 1 mois. Parmi les 694 enfants inclus, 56 (8,1%) avaient soit des ulcères (ulcère gastrique 17/56, 30% - ulcère duodénal 7/56, 13%) soit des érosions (érosions gastriques 21/56, 37% - érosions duodénales 9/56, 16% - érosions gastriques et duodénales 2/56, 4%). Cette étude a permis de confirmer que la fréquence des lésions augmente avec l’âge, les enfants atteints de lésions étant significativement plus âgés que les témoins. En effet, les lésions ont surtout été observées chez les enfants dans la deuxième décade de vie. Une infection par H. pylori était présente seulement chez 15 des 56 enfants (27%), un médicament gastro-toxique avait été utilisé chez 13/56 (23%), une maladie inflammatoire chronique de l’intestin était présente chez 7/56 (13%) et une polyarthrite juvénile chez 2/56 (4%, plus d'un facteur de risque présent dans la plupart des cas). Aucun facteur de risque n’a pu être démontré chez 24/56 enfants (43%), une proportion beaucoup plus élevée que celle initialement attendue.<p>Nous avons ensuite réalisé une étude cas-témoins prospective et multicentrique (12 centres participants). Tous les patients avec une lésion érosive ou ulcérée de la muqueuse gastroduodénale ont été inclus avec deux témoins appariés pour l’âge, le centre et la période. Sept cent trente-deux patients (244 cas dont 153 avec seulement des érosions et 91 avec un ou des ulcères, 488 témoins) ont été inclus. Les enfants qui avaient reçu un antibiotique, un inhibiteur de la pompe à proton ou un anti-H2 durant les 4 semaines précédant l’endoscopie ont été exclus de l’analyse statistique parce que ces médicaments influencent la détermination<p>7<p>du statut H. pylori et la gravité des lésions (42 cas et 98 témoins). Nos résultats montrent que, chez les enfants, l'infection à H. pylori est un facteur de risque pour les ulcères duodénaux et les érosions duodénales, mais pas pour les lésions gastriques. Le sexe masculin, la consommation d'AINS, les maladies rénales chroniques et le tabagisme sont d'autres facteurs de risque indépendants de lésions érosives ou d’ulcères gastroduodénaux. Cependant, aucun facteur de risque identifiable n’a été retrouvé dans une grande proportion d'enfants (97/202, 48.0%) ce qui confirme les résultats de notre première étude.<p>Chez les adultes également la proportion d’ulcères sans infection à H. pylori et sans prise d’AINS est en augmentation ces dernières années tout en restant plus faible que chez l’enfant. La fréquence des ulcères gastriques et duodénaux avec un diamètre d’au moins 5 mm a été comparée, dans notre centre et dans un centre d’endoscopie adulte situé dans la même région de Bruxelles, sur une période de deux ans. Ces données montrent que les ulcères sont moins fréquents chez les enfants que chez les adultes (20/1279 enfants avec endoscopie haute - 1,6% vs adultes 58/1010 - 5,7%, OR 0,30, 95%CI 0,10-0.86, p = 0,02) et surtout moins fréquemment associés à une infection par H. pylori (8/20 vs 40/58, OR 0,26, 95%CI 0,16- 0.78, p <0,0001).<p>Comme l’activation de la réponse immunitaire locale est inefficace pour éliminer l’infection par H. pylori et serait plutôt impliquée dans la pathogenèse des lésions de la muqueuse, nous avons comparé la réponse immunitaire muqueuse des lymphocytes T et les réponses naïves chez les enfants et chez les adultes infectés par H. pylori ainsi que chez des témoins non infectés appariés pour l’âge.<p>Dans une première étude, nous avons obtenu des biopsies de la muqueuse antrale chez 43 patients dyspeptiques (12 enfants, 31 adultes). Les concentrations de cytokines libérées dans le milieu de culture et la densité de cellules CD3+, CD25+ et CD69+ ont été évaluées par cytométrie en flux. Le nombre de cellules sécrétant de l’interféron-γ (IFN-γ), de l’interleukine-4 (IL-4) et de l’IL-10 a été mesuré par ELISPOT. Les données obtenues montrent que l’augmentation de la sécrétion d'IFN-γ et l’élévation du nombre de cellules secrétant de l’IFN-γ au niveau de la muqueuse antrale lors d’une infection par H. pylori sont plus faibles chez les enfants que chez les adultes.<p>8<p>Dans une seconde étude, nous avons comparé l’infiltrat inflammatoire de la muqueuse antrale dans différents groupes d’âge (moins de 8 ans, 8 à 17 ans, 18 à 55 ans) de patients successifs infectés par H. pylori et des témoins appariés pour l’âge. Nous avons montré une corrélation entre l'âge et la densité de neutrophiles, de cellules CD3+ et de CD8+, mais pas de cellules CD20+. Le recrutement des neutrophiles dans la muqueuse antrale est plus faible chez les enfants et apparaît corrélé avec une plus faible activation du facteur de transcription NF-kB (déterminé par immunohistochimie et par EMSA) dans cette même muqueuse. L’infiltrat inflammatoire et l’activation du NF-kB sont légèrement (mais non significativement) plus intenses en cas d’infection par une souche plus virulente (facteur de virulence cagA). Ces souches cagA+ sont retrouvées en proportion équivalente dans les différents groupes d’âge. Par contre, la charge bactérienne, mesurée par un score semi-quantitatif en histologie, n’influence pas l’intensité de l’infiltrat inflammatoire.<p>En conclusion :H. pylori reste un facteur étiologique majeur pour les ulcères et les érosions duodénales chez l’enfant, mais pas pour les lésions gastriques dans les pays à faible prévalence de l'infection et la proportion de lésions associées à une infection est plus faible que chez les adultes. Aucun facteur d’exposition connu ne peut être associé aux lésions endoscopiques dans la moitié des cas, ce qui justifiera des études ultérieures pour identifier d’autres causes exogènes ou endogènes à ces lésions.<p>La réponse immunitaire de l’hôte est impliquée dans la pathogenèse des lésions gastroduodénales associées à une infection par H. pylori. Or il a été démontré dans les travaux faisant l’objet de cette thèse que cette réponse immunitaire est plus faible chez l’enfant que chez l’adulte pour certains facteurs (cytokines Th1, immunité humorale, recrutement des polynucléaires et des lymphocytes au niveau muqueux, activation du facteur de transcription NF-κB). D’autres études confirment la plus faible réponse humorale et Th1, mais également Th17 ainsi qu’une activation plus intense des Treg. Les cytokines ou les voies de signalisation responsables de cette réponse immunitaire plus faible restent inconnues, ce qui ouvre la voie à d’autres investigations. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

[ES] La Fotogrametría es una ciencia y tecnología que tiene utilidad médica creciente. Una aplicación médica destacable de la Fotogrametría es la medición de las úlceras de la piel. Las úlceras de la piel constituyen un problema médico y social importante: por su elevado coste económico, afectación de la salud y calidad de vida, frecuente cronicidad y complicaciones. La medición de la úlcera es necesaria y útil para el seguimiento clínico. La disminución de variables de tamaño de la úlcera indica su progresión hacia la cicatrización. Los procedimientos tradicionales de medición unidimensional y bidimensional, como la regla graduada y la planimetría con acetato, se siguen utilizando por su sencillez y comodidad de uso. Sin embargo, son invasivos y tienen inconvenientes técnicos, como inexactitud e imprecisión. Otros procedimientos de medición tridimensional (3D), como la inyección de líquido y los moldes de pasta, pueden tener, además, efectos adversos, como dolor, irritación o reacción alérgica. Algunos procedimientos sin contacto que utilizan técnicas de escaneo con luz estructurada o láser: 1/ necesitan dispositivos de escaneo específicos; 2/ no se ha demostrado su utilidad en la práctica clínica; 3/ tienen un coste elevado. Por otra parte, no hay un procedimiento de referencia (patrón oro) para la medición del volumen de las úlceras cutáneas. Una optimización de las técnicas utilizadas para la valoración objetiva de la evolución de las úlceras de la piel ayudaría a comparar la eficacia de los distintos tratamientos y seleccionar los más adecuados, así como predecir el tiempo de curación. Por todo lo anterior, se justifica el desarrollo de un procedimiento de medición de úlceras basado en una técnica fotogramétrica sin contacto, como la estereofotogrametría. El objetivo general de esta tesis es desarrollar un procedimiento fotogramétrico para el escaneo, medición, clasificación tisular y seguimiento clínico de úlceras cutáneas; y validar dicho procedimiento en un estudio clínico con pacientes, evaluando su fiabilidad y exactitud. El procedimiento SfM-3DULC está basado en las técnicas estereofotogramétricas SfM (Structure from Motion) y MVS (Multi View Stereo) y utiliza como software de escaneo Agisoft PhotoScan y como software de medición del modelo 3D el programa 3DULC, creado por los autores. Este procedimiento escanea y reconstruye un modelo digital 3D de la úlcera utilizando una cámara digital, con la que se adquieren una serie de fotografías desde varias localizaciones y orientaciones. Para la validación del procedimiento SfM-3DULC, se realizó un estudio piloto en el que se evaluó su fiabilidad y exactitud. También se propuso una nueva variante del procedimiento ImageJ, en la que se utiliza una ortofotografía (Ortho-ImageJ), para medir el área proyectada. Por último, se compararon las mediciones realizadas por un grupo de dermatólogos y otro grupo de no expertos. Todas las variables medidas por dermatólogos usando SfM-3DULC mostraron excelentes puntuaciones de fiabilidad intra-evaluador (ICC > 0.99) e inter-evaluador (ICC > 0.98). En conclusión, el software 3DULC desarrollado, en su versión 1.0: 1/ Interviene en la fase de medición de la úlcera cutánea, tras su escaneo. 2/ Es autónomo respecto al procedimiento de escaneo, y podría utilizarse junto a cualquier otra técnica que obtenga una nube de puntos de la úlcera cutánea. 3/ Detecta el contorno de la úlcera de forma asistida basándose en su respuesta espectral. 4/ Clasifica las zonas de la úlcera cutánea según su tipo de tejido utilizando un árbol de decisión. 5/ Mide las siguientes variables morfométricas de la úlcera cutánea: coeficiente de circularidad, coeficiente de lisura, longitud máxima, perímetro, profundidad máxima, área proyectada, área de la superficie excavada, área de la superficie de referencia y volumen. 6/ Presenta los resultados con un informe HTML que facilita la interpretación por personal sanitario. / [CA] La Fotogrametria és una ciència i tecnologia que té utilitat mèdica creixent. Una aplicació mèdica destacable de la Fotogrametria és el mesurament de les úlceres de la pell. Les úlceres de la pell constitueixen un problema mèdic i social important: pel seu elevat cost econòmic, afectació de la salut i qualitat de vida, freqüent cronicitat i complicacions. El mesurament de l'úlcera és necessària i útil per al seguiment clínic. La disminució de variables de mida de l'úlcera indica la seva progressió cap a la cicatrització. Els procediments tradicionals de mesurament unidimensional i bidimensional, com el regle graduat i la planimetria amb acetat, es continuen utilitzant per la seva senzillesa i comoditat d'ús. No obstant això, són invasius i tenen inconvenients tècnics, com inexactitud i imprecisió. Altres procediments de mesurament tridimensional (3D), com la injecció de líquid i els motles de pasta, poden tenir, a més, efectes adversos, com dolor, irritació o reaccions al·lèrgiques. Alguns procediments sense contacte que utilitzen tècniques d'escaneig amb llum estructurada o làser: 1 / necessiten dispositius d'escaneig específics; 2 / no s'ha demostrat la seva utilitat en la pràctica clínica; 3 / tenen un cost elevat. D'altra banda, no hi ha un procediment de referència (patró or) per al mesurament del volum de les úlceres cutànies. Una optimització de les tècniques utilitzades per a la valoració objectiva de l'evolució de les úlceres de la pell ajudaria a comparar l'eficàcia dels diferents tractaments i seleccionar els més adequats, així com predir el temps de curació. Per tot l'anterior, es justifica el desenvolupament d'un procediment de mesurament de úlceres basat en una tècnica fotogramètrica sense contacte, com la estereofotogrametría. L'objectiu general d'aquesta tesi és desenvolupar un procediment fotogramètric per a l'escaneig, mesurament, classificació tissular i seguiment clínic d'úlceres cutànies; i validar aquest procediment en un estudi clínic amb pacients, avaluant la seva fiabilitat i exactitud. El procediment SFM-3DULC està basat en les tècniques estereofotogramétricas SFM (Structure from Motion) i MVS (Multi View Stereo) i utilitza com a programari d'escaneig Agisoft PhotoScan i com a programari de mesurament de el model 3D el programa 3DULC, creat pels autors. Aquest procediment escaneja i reconstrueix un model digital 3D de l'úlcera utilitzant una càmera digital, amb la qual s'adquireixen una sèrie de fotografies des de diverses localitzacions i orientacions. Per a la validació de l'procediment SFM-3DULC, es va realitzar un estudi pilot en el qual es va avaluar la seva fiabilitat i exactitud. També es va proposar una nova variant del procediment ImageJ, en què s'utilitza una ortofotografia (Ortho-ImageJ), per mesurar l'àrea projectada. Finalment, es van comparar les mesures realitzades per un grup de dermatòlegs i un altre grup de no experts. Totes les variables mesures per dermatòlegs usant SFM-3DULC van mostrar excel·lents puntuacions de fiabilitat intra-avaluador (ICC> 0.99) i inter-avaluador (ICC> 0.98). En conclusió, el programari 3DULC desenvolupat, en la seva versió 1.0: 1 / Intervé en la fase de mesurament de l'úlcera cutània, després de la seva exploració. 2 / És autònom respecte a l'procediment d'escaneig, i podria utilitzar-costat de qualsevol altra tècnica que obtingui un núvol de punts de l'úlcera cutània. 3 / Detecta el contorn de l'úlcera de forma assistida basant-se en la seva resposta espectral. 4 / Classifica les zones de l'úlcera cutània segons el seu tipus de teixit utilitzant un arbre de decisió. 5 / Mesura les variables morfomètriques de l'úlcera cutània: coeficient de circularitat, coeficient de llisor, longitud màxima, perímetre, profunditat màxima, àrea projectada, àrea de la superfície excavada, àrea de la superfície de referència i volum. 6 / Presenta els resultats amb un informe HTML que facilita la interpretació per personal sanitari. / [EN] Photogrammetry is a science and technology of increasing medical utility. A notable medical application of photogrammetry is the measurement of skin ulcers. Skin ulcers are a major medical and social problem: due to their high economic cost, impact on health and quality of life, frequent chronicity and complications. Ulcer measurement is necessary and useful for the clinical follow-up. Decreasing ulcer size variables indicate progression towards healing. Traditional one- and two-dimensional measurement procedures, such as the graduated ruler and acetate planimetry, are still used because of their simplicity and ease of use. However, they are invasive and have technical drawbacks, such as inaccuracy and imprecision. Other three-dimensional (3D) measurement procedures, such as liquid injection and paste moulds, may also have adverse effects, such as pain, irritation or allergic reaction. Some non-contact procedures that use structured light or laser scanning techniques: 1/ require specific scanning devices; 2/ have not been demonstrated to be useful in clinical practice; 3/ are expensive. Moreover, there is no reference procedure (gold standard) for the measurement of skin ulcer volume. Optimisation of the techniques used for the objective assessment of the evolution of skin ulcers would help to compare the efficacy of different treatments and to select the most appropriate ones, as well as to predict healing time. Therefore, the development of an ulcer measurement procedure based on a non-contact photogrammetric technique, such as stereophotogrammetry, is justified. The main objective of this thesis is to develop a photogrammetric procedure for the scanning, measurement, tissue classification and clinical follow-up of skin ulcers; and to validate this procedure in a clinical study with patients, evaluating its reliability and accuracy. The SfM-3DULC procedure is based on the stereophotogrammetric techniques SfM (Structure from Motion) and MVS (Multi View Stereo) and uses Agisoft PhotoScan as scanning software and 3DULC as 3D model measurement software. This procedure scans and reconstructs a 3D digital model of the ulcer using a digital camera, which acquires photographs from various locations and orientations. In order to validate the SfM-3DULC procedure, a pilot study was conducted to assess its reliability and accuracy. A new variant of the ImageJ procedure was also proposed, in which an orthophotography (Ortho-ImageJ) is used to measure the projected area. Finally, measurements made by a group of dermatologists and a group of non-experts were compared. All the variables measured by dermatologists using SfM-3DULC showed excellent scores of intra-rater reliability (ICC > 0.99) and inter-rater reliability (ICC > 0.98). In conclusion, the 3DULC software developed, in its version 1.0: 1/ Is used to measure the skin ulcer, after its scan. 2/ Is autonomous with respect to the scanning procedure, and could be used with any other technique that obtains a point cloud of the skin ulcer. 3/ Outlines the edge of the ulcer semi-automatically, based on its spectral response. 4/ Classifies skin ulcer areas according to their tissue type, using a decision tree. 5/ Measures the following morphometric variables of the skin ulcer: circularity coefficient, evenness coefficient, maximum length, perimeter, maximum depth, projected area, surface area, reference surface area and volume. 6/ Presents the results with an HTML report that facilitates its interpretation by healthcare personnel. / Esta tesis doctoral fue financiada con una beca predoctoral de la Generalitat Valenciana – Consellería de Educación, Investigación, Cultura y Deporte, y el Fondo Social Europeo (ACIF/2018/160). / Sánchez Jiménez, D. (2022). SfM-3DULC: Desarrollo y validación de un procedimiento fotogramétrico para el escaneo, medición, clasificación tisular y seguimiento clínico de úlceras cutáneas [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/181691

The increased incidence of diabetes mellitus has underscored the importance of effective management strategies, particularly in preventing complications such as diabetic foot ulcers (DFU). Chronic infections associated with DFU pose significant health risks, including lower limb amputations, highlighting the urgent need for non-invasive methods to assess skin microbiota changes. This study aimed to evaluate simple methods of sampling and quantifying skin bacteria, comparing techniques such as Gram staining, DAPI staining, fluorescence in situ hybridization (FISH), and polymerase chain reaction (PCR). Furthermore, the study investigated bacterial abundance variations across different sampling sites on the foot. Skin bacteria were sampled from healthy human volunteers using tape stripping (TPS) and swabbing. Gram-staining of the samples showed that most bacteria were found on the heel of the foot, and only Gram-positive bacteria were found on the skin of healthy study participants. However, Gram-staining showed artifacts in the form of bubbles under the microscope, which interfered with bacteria counting. PCR provided results indicating the presence of Staphylococcal species on the skin of healthy feet. DAPI staining showed images of bacteria like the ones stained with Gram staining. After using FISH-probe it was found that only a few bacteria hybridized with the probe and further optimization of the protocol is required. The study evaluated various techniques for sampling and quantifying skin bacteria and compared the number of bacteria present on the foot of healthy individuals, which may be used to identify infections before they develop into more serious conditions.

Úlceras de pele são causadas devido à deficiência na circulação sanguínea. O diagnóstico é feito pela análise visual das regiões afetadas. A quantificação da distribuição de cores da lesão, por meio de técnicas de processamento de imagens pode auxiliar na caracterização e análise da dinâmica do processo patológico e resposta ao tratamento. O processamento de imagens de úlceras dermatológicas envolve etapas relacionadas a segmentação, caracterização e indexação. Esta análise é importante para classificação, recuperação de imagens similares e acompanhamento da evolução de uma lesão. Este trabalho apresenta um estudo sobre técnicas de segmentação e caracterização de imagens coloridas de úlceras de pele, baseadas nos modelos de cores RGB, HSV, L*a*b* e L*u*v*, utilizando suas componentes na extração de informações de textura e cor. Foram utilizadas técnicas de Aprendizado de Máquina e algoritmos matemáticos para a segmentação e extração de atributos, utilizando uma base de dados com 172 imagens. Nos testes de recuperação, foram utilizadas diferentes métricas de distância para avaliação do desempenho e técnicas de seleção de atributos. Os resultados obtidos evidenciam bom potencial para apoio ao diagnóstico e acompanhamento da evolução do tratamento com valores de até 75% de precisão para as técnicas de recuperação, 0,9 de área embaixo da curva receiver-operating-characteristic na classificação e 0,04 de erro médio quadrático entre a composição de cores da imagem segmentada automaticamente e a segmentada manualmente. Nos testes utilizando seleção de atributos, foi observado uma redução nos valores de precisão de recuperação (60%) e valores similares nos tetes de classificação (0,85). / Skin ulcers are caused due to deficiency in the bloodstream. The diagnosis is made by a visual analysis of the affected area. Quantification of color distribution of the lesion by image processing techniques can aid in the characterization and response to treatment. The image processing steps involves skin ulcers related to segmentation, characterization and indexing. This analysis is important for classification, image retrieval and similar tracking the evolution of an injury. This project presents a study of segmentation techniques and characterization of color images of dermatological skin ulcers, based on the color models RGB, HSV, L*a*b* and L*u*v*, using their components in the extraction of texture and color information. Were used Machine Learning techniques, mathematical algorithms for segmentation and extraction of attributes, using a database containing 172 images in two versions. In recovery tests were used different distance metrics for performance evaluation and techniques of features selection. The results show good potential to support the diagnosis and monitoring of treatment progress with values up to 75% precision in recovery techniques, 0.9 area under the curve receiver-operating-characteristic) in classification, and 0.04 mean square error between the color composition of the automatically segmented image and the manually segmented image. In tests utilizing feature selection was observed a decrease in precision values of image retrieval (60%) and similar values in the classification\'s tests (0.85).

Ulcerative colitis (UC) is a chronic disease of the colon or large intestine that causes inflammation and ulceration of the inner lining of the colon and rectum. In patients with ulcerative colitis, the body’s immune system overreacts and the body mistakes food, bacteria or other internal materials in the colon for an invading substance. The immune system attacks the material, thus irritating the colon. Limited knowledge of inflammatory conditions coupled with a narrow range of therapeutic options necessitates investigating the role of natural products. This study describes the effect of natural coconut oil on chemically-induced acute and chronic disease in mice. Ulcerative colitis was induced in four groups (5 mice per group) of 10-week-old female C57BL/6 mice by exposing them to 2.5-3% dextran sulfate sodium (DSS) for 5 and 29 days in the acute and chronic models, respectively. Coconut oil treatment was given via food containing 5% coconut oil to three diseased groups in three different regimens: one, preventive group receiving treatment prior to disease induction (14 d in acute; 28 d in chronic); two, simultaneous group receiving treatment simultaneous to disease induction; and three, regular treatment group receiving treatment after the disease induction –until termination of the experiment (14 d in acute; 60 d in chronic). Coconut food was replaced by the regular chow in the disease and water control groups. Clinical symptoms (diarrhea, occult blood, anal bleeding and body weight change) and the size of the isolated colon were recorded for comparison between experimental and control groups. Groups receiving coconut food displayed remissions in clinical markers of the disease. Improvements in clinical symptoms, histopathology, as well as cytokine activities were observed in both models, but the effects were more significant on the basis of standard error in the chronic model.

PURPOSE: Substantial research demonstrates that many nursing homes are not providing adequate quality of care for residents because of inadequate processes of care and insufficient numbers and training of nursing staff. Some residents experience poor-quality outcomes, such as pressure ulcers and unintended weight loss. To address these issues, the long-term care industry has focused on improving quality of care by improving staff education about care processes and reducing nurse turnover rate. The aim of this study was to compare the association between - licensed nurse hours of care and turnover rate to five quality measures—incidence of ADL decline, physical restraints, prevalence of pressure ulcers among residents with risk factors for skin breakdown, and prevalence of unintended weight loss. DESIGN: The study population included 618 freestanding Texas nursing facilities. A cross-sectional multiple regression analysis was conducted using 2007 data to examine the relationship between nurse staffing levels and turnover and resident outcomes with control variables for facility and resident characteristics. RESULTS: The high-risk pressure ulcer variable accounted for 10% of the variation in the regression model. LVN (hprd) was positively associated with an increase in high-risk pressure ulcers. The ADL decline variable accounted for 7.5% of the variation in the regression model, and RN hprd was positively associated with ADL decline. The prevalence of weight loss variable accounted for 3% of the variation in the regression model. RN turnover rate was approaching significance. The physical restraint variable accounted for 2% of the variation in the regression model. LVN contract hprd was significant and positively associated with an increase in physical restraint use although a minimal contribution to the model given the low percentage of LVN contract hprd. The prevalence of low-risk pressure ulcers was not significant. The control variable case mix index was positively associated with ADL decline, high-risk pressure ulcers, and weight loss. CONCLUSIONS: This research will contribute to understanding the relationship of licensed nursing staff to resident outcomes. Additionally, it will contribute to nursing education, research, and policy. While controlling for acuity using case mix index, some negative findings were still noted that requires further research. / text

The quality of nursing care is becoming an increasingly important concept in contemporary nursing. The most effective means of achieving quality of nursing care and the means of proof is the accreditation of medical facilities. It is a significant appreciation of professionalism, the work of health professionals and an important signal for the patients. Quality of care, security of supply and preventing potential risks for health care priority. The main aim of the thesis "The influence of accreditation on quality of care in selected health facilities" was to map the set of quality management and impact monitoring and evaluation of quality indicators in hospitals accredited by the Czech Republic. To determine whether accreditation has become an instrument to ensure comparable quality, and time has changed from an unpopular instrument into an instrument for continuous quality improvement. The survey took place from November 2010 to March 2011 in the form of quantitative data collection using an anonymous questionnaire survey in selected hospitals accredited by the Czech Republic. In the research study were asked managers of nursing care, main, upper station and sisters. The thesis has been established 6 goals. The first objective was to determine what indicators of quality nursing care in accredited hospitals pursue. Interested in us as quality indicators that were studied before accreditation, and quality indicators to setting up medical facilities in preparation for accreditation. The second objective was determine how frequently watched indicator of quality is monitored in hospital. The third objective was to determine whether there was in accredited hospitals to reduce adverse events - falls. The fourth objective was to determine whether there was in accredited hospitals to reduce the incidence of nosocomial infections in complying with barrier nursing regime. The fifth objective was to identify the biggest problems arose during the implementation of audits, completeness and comprehensiveness of nursing documentation management into practice. " The sixth objective was to determine whether there was during the preparation of an increase in hospital nursing staff. The thesis then was examined six hypotheses. First hypothesis Accredited hospitals monitor the quality of care provided by at least ten quality indicators - were confirmed. Hypothesis 2 The most frequently monitored indicator of the quality of nursing care, the prevalence of pressure ulcers - was confirmed. All respondents said they monitor the prevalence of pressure ulcers as an indicator of quality nursing care. Hypothesis 3 gaining accreditation to reduce the incidence of falls - was confirmed. Hypothesis 4 obtaining accreditation decreased nosocomial infections - was confirmed. Hypothesis 5 The biggest problem in implementing the audit, management complexity and completeness of nursing documentation in practice "has been an increase in paperwork for nursing staff - were confirmed. Hypothesis 6 During the preparation for accreditation has been an increase in nursing staff - has not been confirmed. Accreditation is perceived by respondents as beneficial for the hospital. Due to accreditation standards and developing quality indicators were identified risk areas in the provision of hospital care and detail can be paid to the prevention of adverse events, nosocomial infections and other risks. The results of work will be to provide medical facilities where the research was conducted investigation, the presentation of the research will be presented at a conference, the South Bohemian nursing days "and also gives the United Accreditation Commission of the Czech Republic as a presentation at the conference to be held early next year (spring ) 2012th Nursing standards were created.

L’obésité et le diabète sont associés à des complications, notamment une fragilité cutanée. Celle-ci pourrait être associée à une altération du métabolisme du glucose et à une augmentation du tissu adipeux sous-cutané. Il a été montré que l’hypoderme pourrait avoir une fonction spécifique pour la peau. Notre travail a consisté d’une part à caractériser l’adiposité hypodermique et à étudier son influence dans la réactivité du tissu cutané en réponse à des pressions faibles ou fortes chez des souris obèses et d’autre part à étudier le processus de cicatrisation. Les fortes pressions augmentent la fragilité cutanée ce qui peut aboutir à des lésions, notamment des ulcères de pression. Les études ont été réalisées chez des souris C57BL/6J développant une obésité induite par une alimentation riche en lipides et en sucres pendant 4 et 12 semaines. La taille des adipocytes de l’hypoderme a été mesurée ainsi que leur réponse lipolytique en présence ou non d’insuline. La réactivité tissulaire a été évaluée en mesurant les variations du flux sanguin en réponse : 1) à l’application d’une pression locale faible afin de déterminer la vasodilatation induite par la pression (PIV), 2) par iontophorèse d’acétylcholine ou de nitroprussiate de sodium. Afin d’explorer le processus spécifique d’ulcère de pression chez les souris obèses diabétiques, une compression par cycles d’ischémie-reperfusion a été réalisée. Ces études ont été complétées par des explorations métaboliques, histologiques et biochimiques. Par ailleurs nous avons déterminé l’impact de l’augmentation de l’adiposité sur des fibroblastes dermiques in vitro afin de mieux comprendre le processus de cicatrisation.Dans ce travail de thèse, nous avons mis en évidence une augmentation de l’adiposité hypodermique associée à une insulinorésistance tissulaire et systémique. Nous avons également montré un retard de cicatrisation en fonction de l’évolution de l’obésité et des réponses micro vasculaires diminuées post cicatrisation par rapport à une peau non lésée / Obesity and diabetes led to complications, including skin fragility. Skin fragility could be associated to a glucose metabolism alteration and a subcutaneous adipose tissue increase. It has been shown that hypodermis could have a specific function for the skin. Our work consisted on the one hand in characterizing the dermal adiposity and studying its involvement in the skin tissue reactivity in response to low or high pressures in obese mice and, on the other hand, in studying the healing process. High pressures increase cutaneous fragility which can lead to skin wounds, in particular pressure ulcers. This study was realized using C57BL/6J male mice with a diet-induced obesity. C57BL/6J mice were fed a high fat and high sugar diet during 4 or 12 weeks. Hypodermis adipocytes size was measured as well as their lipolytic response in presence or absence of insulin. The skin tissue reactivity was assessed measuring the skin blood flow variations in response to 1) a local pressure application in order to determine the pressure-induced vasodilation (PIV), 2) an acetylcholine or sodium nitroprusside iontophoresis. To examine the specific mechanism of the pressure ulcer in obese diabetic mice, a compression with ischemia-reperfusion cycles was realized. Metabolic assessment, histological and molecular biological studies were carried out to characterize each stage of healing through obesity. Furthermore, we determined the adiposity increase on dermal fibroblasts in vitro to better understand the healing process. In this thesis work, we have highlighted a hypodermis adiposity linked to a tissue and a systemic insulin resistance. We have also showed a delayed healing depending on the evolution of the obesity. The microvascular responses were decreased post healing compared to a non-wounded skin

CNPq / O tratamento e cuidados com úlceras de pé diabético é uma questão de saúde pública. As técnicas atuais utilizadas para o acompanhamento do processo de cicatrização de úlceras abertas são baseadas principalmente em medidas aproximadas da área da ferida e envolvem contato direto, o que representa riscos de contaminação para o paciente. Neste trabalho é proposto o uso de técnicas de visão computacional para medir não apenas a área, mas o volume de úlceras abertas, fornecendo informação objetiva sobre o processo de cicatrização para os médicos, evitando contato direto com a ferida durante o procedimento de medição. A técnica proposta envolve a aquisição de uma sequência de imagens da ferida com iluminação estruturada usando um laser de baixa potência em linha, seguida de reconstrução da profundidade a partir da geometria do dispositivo de aquisição. É identificada a região da ferida de forma semiautomática e construída uma superfície fictícia do que seria a pele natural para servir de base para o cálculo do volume, que corresponde à quantidade de tecido faltante. Experimentos controlados ex-vivo utilizando um modelo de borracha de um Pé Diabético e um joelho de porco com uma ferida artificial representando a pele humana demonstram a viabilidade da técnica proposta. / Treatment and follow-up of Diabetic Foot ulcers is a major public health issue. Current techniques used for following up the healing process of open ulcers are mostly based on approximate area measurements of the wound and involve direct contact, which poses risks of contamination for the patient. This work proposes the use of computer vision techniques to measure not just the area, but the volume of open ulcers, providing additional objective information about the healing process to physicians while avoiding direct contact with the wound during the measurement procedure. The proposed technique involves acquiring a sequence of images of the wound with structured illumination using a low-power laser beam line, followed by depth reconstruction from the geometry of the acquisition device. The wound region is identified in a semi-automatic way and a fictitious surface of what would be the normal skin surface is then used to compute the volume, which corresponds to the missing amount of tissue. Controlled ex-vivo experiments using a rubber model of a Diabetic Foot and a knuckle of pork with an artificial wound representing the human skin demonstrate the viability of the proposed technique. / 5000

CNPq / O tratamento e cuidados com úlceras de pé diabético é uma questão de saúde pública. As técnicas atuais utilizadas para o acompanhamento do processo de cicatrização de úlceras abertas são baseadas principalmente em medidas aproximadas da área da ferida e envolvem contato direto, o que representa riscos de contaminação para o paciente. Neste trabalho é proposto o uso de técnicas de visão computacional para medir não apenas a área, mas o volume de úlceras abertas, fornecendo informação objetiva sobre o processo de cicatrização para os médicos, evitando contato direto com a ferida durante o procedimento de medição. A técnica proposta envolve a aquisição de uma sequência de imagens da ferida com iluminação estruturada usando um laser de baixa potência em linha, seguida de reconstrução da profundidade a partir da geometria do dispositivo de aquisição. É identificada a região da ferida de forma semiautomática e construída uma superfície fictícia do que seria a pele natural para servir de base para o cálculo do volume, que corresponde à quantidade de tecido faltante. Experimentos controlados ex-vivo utilizando um modelo de borracha de um Pé Diabético e um joelho de porco com uma ferida artificial representando a pele humana demonstram a viabilidade da técnica proposta. / Treatment and follow-up of Diabetic Foot ulcers is a major public health issue. Current techniques used for following up the healing process of open ulcers are mostly based on approximate area measurements of the wound and involve direct contact, which poses risks of contamination for the patient. This work proposes the use of computer vision techniques to measure not just the area, but the volume of open ulcers, providing additional objective information about the healing process to physicians while avoiding direct contact with the wound during the measurement procedure. The proposed technique involves acquiring a sequence of images of the wound with structured illumination using a low-power laser beam line, followed by depth reconstruction from the geometry of the acquisition device. The wound region is identified in a semi-automatic way and a fictitious surface of what would be the normal skin surface is then used to compute the volume, which corresponds to the missing amount of tissue. Controlled ex-vivo experiments using a rubber model of a Diabetic Foot and a knuckle of pork with an artificial wound representing the human skin demonstrate the viability of the proposed technique. / 5000