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Previous literature showed weak and sometimes contradictory evidence regarding the best interventions to prevent pressure ulcers and the best factors that can serve as predictors for ulceration. The aim of this study was to explore effective interventions and associated risk factors in the area of pressure ulcer. A retrospective approach was used to explore such interventions and risk factors in a more natural clinical environment than found in a prospective study. While retrospective studies have their limitations, one problem of prospective studies, the Hawthorn effect, is not present. In order to meet the aims of the study, a matched case-controlled design was employed. A convenience sampling technique was used to select all patients who matched the study criteria. Two groups of patients were selected. The first group developed pressure ulcer during hospitalization, the other did not. In order to have a sound and robust comparison, each patient from the pressure ulcer groups was matched or at least nearly matched with another patient from the non-pressure ulcer group for a number Waterlow sub-scores. Further criteria for selection included a minimum of three days total length of stay in hospital and being initially free of any pressure ulcer on admission for both of the study groups. Electronic medical records for all patients were revised, and multidimensional data were extracted using a data extraction sheet. Data analyses were carried out using univariate analysis (t-test, Mann-Whitney, Chi-square and Fisher’s exact test) and multivariate analysis (binary logistic regression). In univariate analysis for preventive interventions, the following interventions were significantly associated with pressure ulcer prevention (P≤ 0.05): standard hospital bed, seating cushion, static pressure redistributing mattress, re-positioning every four hours and helping the patient to sit regularly in a chair. When the effect of all interventions was adjusted through the multivariate model, the following interventions were independently associated with prevention: draw sheet, re-positioning every four hours and helping patient to sit regularly in chair (odds ratio = 0.24, 0.06 and 0.13 respectively; P≤ 0.05). In univariate analysis for risk factors related to physical activity and mobility, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): moving in bed with help, the ability to take a bath only in bed, needing two helpers in performing activities of daily living and moving outside bed only by a hoist. When adjusting the effect of all variables related to physical activity and mobility through the multivariate model, only two factors were independently associated with developing pressure ulcer: moving in bed with help and the ability to take a bath only in bed (odds ratio = 7.69 and 3.67 respectively; P≤ 0.05). In univariate analysis for risk factors related to pressure ulcer intrinsic risk factors, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): presence of three underlying medical conditions, dehydration, depression, having a blood transfusion, serum albumin <32mg/dl, haemoglobin <130 g/l in males or <115 for females and systolic blood pressure <113 mmHg. When adjusting the effect of all variables related to intrinsic risk factors through the multivariate model, the following risk factors were independently associated with pressure ulcer: presence of two underlying medical conditions, presence of three underlying medical conditions, cognitive impairment, serum albumin <32mg/dl and haemoglobin <130 g/l in males or <115 for females (odds ratio = 13.3, 143, 4.3, 0.10 and 0.14 respectively; P≤ 0.05). Findings from this study suggest a number of interventions to be effective in PUs prevention, and a number of risk factors that can predict risk of PUs. Findings were based on statistical association between acquiring PUs and the independent variables (preventive interventions and risk factors). This cannot constitute a cause and effect relationship due to the retrospective nature of data analyzed; it only supports the association between a number of interventions and risk factors in preventing or predicting PUs. This can guide further research to investigate these interventions and risk factors by employing the same approach used, but in a prospective manner.

A dissertation submitted to the Faculty of Science University of the Witwatersrand, Johannesburg for the Degree of Master of Science. Johannesburg 1992 / 1. Beder, J.B. Thornley, A.L. and Veale.R, Human keratinocyte culture techniques using foetal, neonatal and adult keratinocytes with particular reference to extensive bum wounds. This paper was presented at the South African Burn Society Biannual Congress held at Berg en Dal, Kruger National Park, from 31 August to 1 September 1989. 2. Beder, J.B., Thornley, A.L. and Veale, R. Human keratinocyte culture techniques in extensive burn wounds. The Journal of Trauma and Emergency Medicine. 1990 Jan/Feb; 7 (1); 29-32. 3. Beder J.B. Cultured allografts. A letter appearing in the Continuing Medical Education Journal (CEM). 1990 Jan; 8(1): 48. 4. Beder, J.B. Problems and attempted solutions associated with the application of cultured epidermal grafts to full thickness burns in extensively burnt patients. This paper was presented in the form of a poster at the Association of Surgeons of South Africa Biannual Congress held in Bloemfontein from May 1-4 1990. 5. Beder, J.B., Thornley, A.L., Veale R., Kadwa, A.M., Scott, E. Healing chronic leg ulcers cultured keratinocyte allografts. This paper was presented at the annual Congress of The Surgical Research Society of Southern Africa held in Bloemfontein from 29 April to 1 May 1990. This paper was the runner-up for the best paper presented at the above congress. 6. The abstract of the paper mentioned in 5. above was published in the South African Journal of Surgery 1990 Sep; 28 (3): 123. 7. Beder, J.B., Healing full thickness burns with various types of cultured epidermal grafts - a comparative study. This paper was presented at the Z4th annual meeting of the British Burn Association held at the post-graduate centre, Stock Mandeville, Aylesbury, Bucks. England, United Kingdom, on the 10th May 1991. 8. Beder, J.B, J.B. A comparative study of various keratinocyte cell lines used in the synthesis of confluent stratified keratinocyte sheets. This paper was presented at the skin culture meeting, a satellite meeting of the 24th annual meeting of the British Burn Association, held at the post-graduate centre, Stoke-Mandeville, Aylesbury, Bucks, England, United Kingdom, on the 8th May 1991. 9. Beder, J.B. Healing chronic leg ulcers using cultured keratinocyte allografts. This paper was presented at the skin culture meeting of the British Burn Association held at the post-graduate centre, Stoke- Mandeville, Aylesbury, Bucks, England, United Kingdom on the 8th May 1991. 10. Beder, J.B., Thornley, A.L. and Veale, R. Healing chronic ulcers and other skin defects, using cultured keratinocyte allografts - including an assessment of their survival. Submitted for publication to the British Medical Journal. 11. Beder, J.B. The preparation and grafting of cultured epidermal sheets. Submitted for publication to the South African Journal of Surgery. 13. Beder, J.B., Thoenley, A.L. and Veale. R. Healing full thickness burns with cultured epidermal grafts - a comparative study. Submitted for publication to Transplantation.

Orientador: Elenice Deffune / Banca: Sonia Regina Pérez Evangelista Dantas / Banca: Hélio Amante Miot / Resumo: As úlceras venosas são impactantes e representam um grande desafio médico devido ao entrelaçamento de comorbidades e causas multifatoriais, sendo de suma importância o surgimento de inovações tecnológicas na abordagem terapêutica que sejam acessíveis aos seus portadores. Diante dessa realidade, este trabalho se propôs a abordar as úlceras venosas comparando um produto existente no mercado, Hidrocolóide (HC), com uma proposta in house, o Gel de Plaquetas (GP), através da diminuição da área, avaliação descritiva da vascularização e queixas referidas. Participaram do estudo 17 pacientes, perfazendo um total de 22 úlceras venosas que foram acompanhados durante 90 dias, utilizando um dos produtos citados, de acordo com o randomização, em associação com o uso de faixas elásticas. A distribuição do grupo, segundo a randomização foi de 13 lesões no grupo de hidrocolóide e 9 no grupo de gel de plaquetas. A média percentual de redução das áreas das feridas foi de 57,78% para hidrocolóide e de 53,45% para gel de plaquetas, não apresentando diferenças estatisticamente significativas. O desempenho dos produtos estudados apresentaram grande similaridade no percentual de redução de área, o que indica que é preciso um estudo amostral maior para evidenciar superioridade de um produto sobre o outro. Porém quando comparados, quanto ao menor tempo de acompanhamento (D15), o gel de plaquetas apresentou melhor desempenho, com redução maior do que o hidrocolóide em tempo reduzido semelhante. A análise histológica no momento pré e pós tratamento sugere que o GP atua de forma a estimular a regeneração dos tecidos (estroma coeso) e de forma mais definitiva (distribuição dos vasos difusa na derme reticular). O aspecto do fechamento da lesão é mais consistente quando comparado com os pacientes que usaram HC onde se observou a formação de uma fina epiderme frágil... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Venous ulcers are striking and represent a major challenge due to the commingling of medical comorbidities and multifactorial causes, with the emergence of great importance to technological innovations in therapeutic approaches that are accessible to their patients. Given this reality, this study proposes to address venous ulcers comparing a product on the market, hydrocolloid (HC) with a proposed in-house, the Platelet Gel (GP), by decreasing the area and descriptive evaluation of vascularization complaints referred. The study included 17 patients, a total of 22 venous ulcers who were followed for 90 days, using one of the products listed, according to the randomization, in association with the use of compression elastic. The distribution of the group, according to randomization was 13 injuries in the hydrocolloid group and 9 in the group of platelet gel. The average percentage reduction of wound areas was 57.78% for hydrocolloid and 53.45% for platelet gel, showing no statistically significant differences. The performance of the products studied showed great similarity in the percentage of area reduction, which indicates that it is necessary to study a larger sample to demonstrate the superiority of one product over another. But when compared, for the shortest time of follow-up (D15), the platelet gel performed better, with greater reductions than the hydrocolloid in a short time like that. Histological analysis in the D0 and D90 of the treatment suggests that the GP acts to stimulate the regeneration of tissues (stroma together) and more definite form (diffuse distribution of vessels in the reticular dermis). The appearance of the closure of the injury is more consistent when compared with patients who used HC we observed the formation of a thin skin, fragile, observed in histological sections showed that a distribution of vessels in the papillary dermis. Histological sections confirmed... (Complete abstract click electronic access below) / Mestre

Equine gastric ulcer syndrome (EGUS) has been reported to occur in 40% to over 90% of horses across multiple equestrian disciplines. The objective of this study was to evaluate the effect of trace mineral supplementation on gastric ulcers in exercising yearling horses. Twenty-one Quarter Horse yearlings, 15 to 18 mo of age, were randomly assigned to 1 of 3 treatment groups. The control group received no supplemental trace minerals, the inorganic group received supplemental sulfated trace minerals, and the organic treatment received supplemental amino acid complexed trace minerals. The trial consisted of 3 consecutive 28-d periods, separated by 5 d of diet acclimation. The basal ration included a 14% CP textured concentrate, with coastal Bermudagrass hay fed in Periods 1 and 3 and alfalfa consumed in Period 2. In Periods 1 and 2, horses were exercised on a mechanical horse-exerciser, but were lunged or underwent training in an undergraduate course in Period 3. At the end of each period, horses were transported for 6 h, 5 d before being endoscopically examined to assign ulcer scores. Data were analyzed as repeated measures using the mixed procedure of SAS, with the model including fixed effects of treatment, period, and their interaction (SAS 9.2). All P-values < 0.05 were considered significantly different. Baseline EGUS scores were not different among treatment groups, with a mean of 2.1. There was no effect of treatment in any period, or a period by treatment interaction. There was a significant period effect (P < 0.01). Mean ulcer scores in Periods 1, 2, and 3 were significantly lower than baseline, with mean scores of 1.5, 1.0, and 1.5, respectively. There was a tendency (P=0.06) for mean ulcer scores to be lower in Period 2 than in Periods 1 and 3, which were not different. Average daily intakes of Zn, Mn, Cu, and Co were significantly higher in the organic and inorganic than control horses (P < 0.0001). Under the conditions of this study, trace mineral supplementation did not affect gastric ulcer appearance and severity. However, it is possible that dietary and management alternatives, such as hay and concentrate types, could be anti-ulcerogenic.

Equine gastric ulcer syndrome (EGUS) is common amongst equine athletes of various disciplines and linked to decreased performance. Prevalence among racehorses has been reported to be over 90%, performance horses at 60%, and endurances horses at about 70%. In swine, concentrate form and smaller particle size increase gastric ulceration; thus, the objective of this study was to investigate the effect of concentrate type on EGUS. Quarter Horse yearlings (n=19; 12-18 mo) were blocked by initial EGUS score on a scale of 0 to 4 (0= no ulceration or hyperkeratosis, 4= extensive, deep ulceration) and sex, and utilized in a 77-d cross-over design with two 28-d periods separated by a 21-d washout period. During the first 28-d period, horses were separated into 1 of 2 treatment groups that were all fed Bermuda grass hay and either a commercially available pelleted or textured concentrate. After the initial 28-d period, horses were all fed pelleted feed and Bermuda grass hay for a 21-d washout period then treatment groups were switched for the final 28-d period. Baseline EGUS scores were not different between horses assigned to either treatment (mean 1.1); however, upon treatment, horses fed textured feed acquired a reduced incidence of ulceration as compared to those fed pelleted (mean score of 1.6 vs 1.1, respectively; P =0.02). Degree and incidence of ulceration was influenced by concentrate form; yearlings fed pelleted feed had higher ulcer scores then those fed textured feed. Therefore, the findings of this study suggests that textured feed may be a effective management tool to aid in the reduction of severity in horses afflicted with EGUS.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences