Aims and Objectives: To compare three risk assessment scales with respect to predictive validity Background: In paediatrics there are several competing scales and at least ten published paediatric pressure ulcer risk assessment scales have been identified. However there are few studies exploring the validity of such scales, and none identified that compares paediatric risk assessment scales. Design: Cross sectional study Methods: Three risk assessment scales, Braden Q, Garvin and Glamorgan, were compared. The total scores and sub-scores were tested to determine if children with pressure ulcers were significantly different from those with no pressure ulcer. Logistic regression was conducted to determine if the probability of developing a pressure ulcer was a better predictor of development of pressure ulcer compared with the total score of each scale. Receiver operating characteristic curves were computed and the area under the curve used to compare the performance of the risk assessment scales. Results: Data from 236 children were collected. 71 were from children in eleven hospitals who were asked to provide data on children with pressure ulcers (although seventeen did not have a pressure ulcer) of whom five were deep (grade 4). A sample of 165 were from one hospital, of which seven had a pressure ulcer, none grade four. The Glamorgan risk assessment scale had a higher predictive ability than either the Braden Q or Garvin. The mobility sub-score of each of the risk assessment scales was the most predictive in each case. Conclusions: The Glamorgan scale is the most valid of the three paediatric risk assessment scales studied in this population. Mobility alone may be as effective as employing the more complex risk assessment scale. Relevance to clinical practice: If a paediatric risk assessment scale is employed to predict risk, then unless it is valid, it may identify children who are not at risk and waste resources, or fail to identify children at risk possibly resulting in adverse health outcomes.

An ulcer is an open wound that remains unhealed even after weeks of treatment. These types of wounds require a long process of treatment due to other underlying health problems. Having an unhealing, painful and often infected wound decreases patients’ life quality significantly. The treatment includes using wound dressing applied by nurses, to protect the wound from infections, collect exudate and provide a closed and sterile environment. During a treatment, which could last for months, patients experience a lot of emotional and physical challenges. Deva is a design concept proposing the use of smart sensors in wound care treatment in a way that it will improve the communication between patients and nurses, by providing information and guidance. The ecosystem consists of a smart wound patch that will turn any wound dressing today into a “smart” one, an electrostimulation therapy sock and digital platforms where the information will be available. This way information on the wound status will be available for the patient, their family members or caregivers and the nurses.This project has been developed by interviewing nurses and wound care professionals from Turkey, Sweden and Denmark. The insights reflect the situation and the healthcare system in these countries and a wound care treatment journey might differ in other settings.

Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines for Research & Evaluation II instrument. Findings of the assessment indicated a high overall quality of the CPG; its immediate use was recommended and systematic evaluation was suggested to promote usage in a wider array of health care contexts. The quality domains with the highest scores were scope, purpose, applicability, editorial independence (all 100%), rigor of development (99.7%), and clarity of presentation (99.3%). The stakeholder involvement domain demonstrated the lowest--yet still robust--score (94.4%). The CPG can be used to emphasize appropriate and specific nursing competencies for making informed decisions when identifying and describing patients at risk for developing PUs. Further research and evaluation of the use of this CPG will be useful to demonstrate how CPGs can help to decrease the incidence of avoidable PUs. The potential for positive social change relative to the prevention of PUs is high. Decreased incidence of preventable PUs will eliminate unnecessary health care costs and improve overall health outcomes of patients at all levels of socioeconomic status.

Tetracycline molecules including doxycycline (DOX), consist of a group of broad-spectrum antibiotics. In addition, tetracyclines inhibit matrix metalloproteinase (MMPs) that contribute to tissue remodeling, inflammation, angiogenesis and are over-expressed in certain pathologies - such as Alzheimer’s disease, metastasis and diabetic foot ulcers (DFUs). Tetracyclines are hypothesized to inhibit MMPs through the chelation and sequestration of catalytic divalent ions such zinc and calcium. This inhibitory duality may be beneficial in pathologies that are characterized by MMP over-expression and prone to infection, such as DFUs. Compared to oral administration, topical DOX is an attractive route of administration for chronic wound healing as it may minimize the risks: associated antibiotic resistance; is being targeted directly to the wound bed. However, DOX is notoriously unstable in aqueous solution and common topical formulations. Liquid chromatography and mass spectrometry (LCMS) were employed to monitor stability using an in vitro MMP assay and an applicable E. coli anti-bacterial assay was assessed to quantify drug activity. 2 % (w/w) topical DOX demonstrated an acceptable stability 30 day when stored at 4 ºC. DOX inhibited MMP9 activity with an IC50 value of 48.27 μM. With respect to anti-bacterial activity, using cultured BL21 E.Coli and quantification of drug activity as an expression of colony forming units (CFUs) successfully reproduced the antimicrobial IC50 of doxycycline as 4.3 µM. Transdermal DOX has the potential to improve standard of care for DFUs, quality of life for the patient and reduce costs to the healthcare system. / Thesis / Master of Science (MSc) / Tetracyclines comprise of a group of broad-spectrum antibiotics; whose primary mechanism of action is inhibition of protein synthesis through binding of the bacterial ribosome. In addition, tetracyclines inhibit matrix metalloprotease (MMPs), zinc-dependent proteases that contribute to tissue remodeling, angiogenesis and are over-expressed in certain pathophysiologies such as diabetic foot ulcers (DFUs). The antibacterial mechanism of DOX on MMPs is reported and understood, however the inhibition is hypothesized to involve cation chelation. Thus, investigating this interaction is warranted to assist in developing a therapeutic for DFUs. A more logical product would involve direct topical application, such as a stable transdermal formulation of DOX.

No

No / Many service commissioners are demanding a reduction in pressure ulcer prevalence and regard pressure ulceration as a key indicator of care quality. Within our area of practice, local commissioners have indicated that all health care providers in the district should work together to reduce pressure ulceration across the local health care economy. Health care professionals clearly have a critical role to play in patient assessment, risk categorisation, care planning and equipment provision. However, this alone will not be sufficient to achieve the reduction targets which will involve effective patient engagement. National and International guidelines all recognise the importance of patient education in care and recognise the significance of patient involvement in personalised care planning and service provision. Hartigan et al have demonstrated the value of education leaflets in supporting pressure ulcer prevention in an elderly population. Patient support applications running on mobile phones and tablets are also available to assist in pressure ulcer prevention and patient education but are not widely used in a hospital setting. This study examines how effective standard verbal and written information is at delivering patient education for pressure ulcer prevention. Local hospital policy is that all patients identied as being at risk of developing pressure ulceration are provided with information on what a pressure ulcer is, what constitutes risk and how to assist staff in pressure ulcer prevention. The policy includes patient and carer involvement in care planning, and encouragement to report skin changes and pain to staff.

No / Activa Healthcare

Sammanfattning Syftet med studien var att beskriva distriktssköterskors reflektioner kring att arbeta med kroniska bensår. Studien genomfördes som en semistrukturerad intervjustudie och hade deskriptiv design. Totalt sexton distriktssköterskor intervjuades, åtta distriktssköterskor med landstinget som arbetsgivare och åtta distriktssköterskor med kommunal arbetsgivare. Materialet analyserades med kvalitativ innehållsanalys. Resultatet visade att distriktssköterskorna ansåg att arbetet med kroniska bensår var ett vanligt förekommande arbetsmoment samt att bristande samarbete från patienten var en bidragande orsak till långa behandlingstider och utebliven sårläkning. Distriktssköterskorna beskrev vikten av att medvetandegöra patienterna om sitt egenansvar för att främja sårläkningsprocessen. Kunskapen till att behandla kroniska bensår ansåg distriktssköterskorna att de hade, men det spelade ingen roll hur mycket distriktssköterskorna gjorde så länge patienterna inte var följsam i behandlingen. Kompressionsbehandling beskrevs av distriktssköterskorna som den främsta behandlingsmetoden för att uppnå läkning av kroniska bensår, men de upplevdes ibland problematiskt att motivera patienterna till kompressionsbehandling. Det påtalades av distriktssköterskorna att god dokumentation och individuella vårdplaner underlättade deras arbete samt möjliggjorde utvärdering av sårläkningsprocessen. Slutsatsen är att distriktssköterskorna upplever att patienter med kroniska bensår som är väl informerade och motiverade till följsamhet kunde ges optimal bensårsbehandling. Profylaktiskt arbete är viktigt för att undvika recidiv vid behandling av kroniska bensår.

Bensår är ett ökande problem i samhället, detta som följd av att vi blir allt äldre. Bensår är svåra att läka och det är vanligt att de återkommer. Kroniska bensår definieras som sår som inte läker inom sex veckor. De vanligaste orsakerna till bensår är venös insufficiens, arteriell insufficiens eller en bladning av dessa. Syftet med litteraturstudien var att beskriva personers upplevelser av att leva med kroniska bensår. Det här arbetet har utförts som en litteraturstudie, där sökning av artiklar har gjorts i två databaser CINAHL och PubMed. Efter sökning i databaserna har 16 artiklar valts ut och granskats. Analysen av artiklar har gjorts genom att plocka ut förekommande fenomen i texten och kategorisera dessa i huvudteman med underteman. Analysen resulterade i tre huvudteman: smärta, aktivitetsbegränsningar och lukt och vätskande sår. Det finns många olika faktorer som påverkar personernas upplevelser av att leva med bensår, där smärta, rörelseförmågan och lukt och vätska från såret har en central roll. Studien visar på att många personer upplever att deras problem inte tas på allvar. Det holistiska synsättet inom vården måste förbättras och mer hänsyn bör tas till personernas existentiella, psykiska, sociala och kroppsliga upplevelser.

Tropical ulcer is a very specific form of cutaneous ulceration. It occurs worldwide in most tropical and a number of subtropical areas. The disease occurs mainly in older children and young adults with children under the age of 5 and adults over 45 years rarely being affected. Ulcers occur most commonly on the lower leg but may occur on the upper limb. Although most ulcers normally heal slowly over many weeks or months, some ulcers may recur. Recognised complications include squamous cell carcinoma, gangrene and osteitis, although these are rare. A number of authors have reported on the disease and suggested diet, trauma and infection as aetiological factors for this condition. This survey was thus conducted to assess as many of these factors as possible. The study took place in 5 tropical areas, namely Zambia, Gambia, southern India, Fiji and Papua New Guinea. Consultations took place at hospitals, rural clinics, health centres and villages. Although many authors have suggested that the disease is related to malnutrition, few have objectively assessed the nutritional status of the patients and compared it with controls. Those studies which included objective assessments were limited to small areas and only investigated specific parameters. In order to investigate the immune response of the host to an anaerobic infection, the antibody levels to the organisms isolated from the ulcers were measured by an ELISA test. The local host response to an infection with a Fusobacterium species was assessed by the number of antibody secreting B-lymphocytes at the site of the ulcers. These parameters may play a role in the localisation of the ulcers and account for recurrent infections.