This is a Straussian grounded theory study about the impact of nurses’ values on pressure ulcer prevention. Semi-structured interviews were used to gather data from participants (n=16) who were recruited from the non-acute adult medical wards of 14 hospitals in one NHS Trust and a local university. The participants were asked to talk about their experiences of preventing and managing pressure ulcers and their values were elicited from their accounts. The data were analysed and interpreted with Straussian grounded theory. Nurses were found to work according to the value that they placed on pressure ulcer prevention, as this value influenced the manner in which they prioritised and delivered skin care to their patients. Similar links between nurses’ values and their delivery of care with regards to other aspects of nursing were also identified. The delivery of care to prevent pressure ulcers was found to be subject to clinical priorities and other factors. As a result, the majority of care to maintain skin integrity was delivered by nursing auxiliaries and students because nurses were busy doing other things. Despite this, nurses who place a high value on pressure ulcer prevention appear to be more proactive and determined to deliver care that protects the integrity of their patients’ skin than their peers. This is highlighted by the participants’ accounts of how their prioritisation and delivery of care to prevent pressure ulcers changed when the value that they placed on pressure ulcer prevention increased from low to high. This study also identified the manner in which the value that nurses place on pressure ulcer prevention is formed and evolves. The recommendations that arise from this study are: further testing of this grounded theory in other settings to increase its generalisability and a greater awareness of the impact that the value that nurses place on different aspects of patient care has on their delivery of care to patients, especially with regards to pressure ulcer prevention. Nurse education and training must also take into account some of the factors that help to form and change the value that nurses place on pressure ulcer prevention. Greater attention needs to be paid to the value that nurses place on different aspects of nursing in view of the relationship between nurses’ values and care delivery, if patients are to receive the best possible care.

Estudo descritivo cujo objetivo foi traçar o perfil dos pacientes com diabetes mellitus (DM) que possuem úlcera no pé, atendidos no Ambulatório de Especialidades Mario Covas de Marília-SP. A amostra foi constituída por 60 pacientes atendidos no período de agosto a setembro de 2003. Para coleta de dados utilizou-se entrevista, consulta ao prontuário e avaliação dos pés. Os resultados mostraram maior freqüência no sexo masculino (51,7%), destacando a faixa etária de 50 a 70 anos (64,4%). Em relação ao tipo de diabetes, 95% eram do tipo 2; o tempo médio referido do diagnóstico foi de 12,6 anos e do tratamento 12,1 anos; 63% referiram realizar dieta, 56,7% faziam uso de antidiabético oral e 61,7% de insulina. Considerando os parâmetros de controle do diabetes, 79,6% apresentavam mau controle glicêmico e 56,6% sobrepeso. As complicações crônicas mais freqüentes foram retinopatia (31,7%) e pé diabético associado à doença vascular periférica ( 31,7%). Todos apresentavam hipertensão arterial e em 26,6% estava associada à obstrução arterial crônica. O diagnóstico de obstrução arterial crônica estava presente em 51,7% dos pacientes. Na avaliação dos pés, 53,3% deambulavam; 55% possuíam alteração na marcha; 55% amputação prévia; 48% história de úlceras anteriores; 65% corte de unhas inadequado; 31,7% dedos em garra; 23,3% dedos sobrepostos; 18,3% proeminência do primeiro metatarso; 45% usavam sapatos e meias inadequados. Na avaliação circulatória identificou-se entre os pacientes, pulsos não palpáveis em 27% do tibial posterior direito e 23% do esquerdo; em 26% do pedioso direito e 21% do esquerdo; 35% possuíam edema; 45% rubor na pendência e empalidecimento à elevação; a sensibilidade tátil pressórica estava ausente em 38,3% dos pacientes. Quanto as características das úlceras, 36,6% relataram como causa de maior freqüência bolha infectada e 26,6% trauma mecânico; a localização mais freqüente foi na região plantar (23,3%) e nos dedos (21,7%); o tempo médio das úlceras foi de 0,9 anos; dimensões de 1 a 10 cm2 (65%); 41,7% das úlceras possuíam leito de cor vermelha; 53,3% exsudato4 seroso; 38,3% dor moderada; 58,3% odor discreto e 46,7% grau 2 segundo a classificação de Wagner. O tratamento mais referido para as úlceras foi soro fisiológico e óleo de girassol (81,7% ).Os resultados deste estudo mostraram a gravidade das complicações relacionadas aos pés dos pacientes com diabetes, destacando a história de úlcera e amputação anterior, complicações vasculares e neuropatia como importante fatores de risco para as lesões em pés e trauma extrínseco como principal desencadeante destas lesões, reiterando que intervenções básicas podem contribuir para a sua redução. Apontaram também para a necessidade de elaboração de um protocolo de atendimento; com ênfase no processo educativo junto a pessoa, familiares e profissionais, visando uma maior adesão ao tratamento e controle do DM bem como intensificando medidas preventivas no cuidado aos pés. / This descriptive study aimed to establish the profile of diabetes mellitus (DM) patients with foot ulcers, attended at the Ambulatório de Especialidades Mario Covas in Marília-SP, Brazil. The sample consisted of 60 patients, attended in August and September 2003. Data were collected by means of interviews, patient files and foot evaluation. Research results disclosed higher frequency among men (51.7%), especially in the age range from 50 to 70 years (64.4%). 95% of the patients suffered from type 2 diabetes; average reported diagnosis time was 12.6 years and average reported treatment time 12.1 years. 63.3% mentioned a diet, 56.7% took oral antidiabetic drugs and 61.7% took insuline. In view of diabetes control parameters, 79.6% of the patients demonstrated bad glycemic control and 56.6% were overweight. The most frequent chronic complications were retinopathy (31.7%) and diabetic foot associated with peripheric vascular disease (31.7%). All patients demonstrated arterial hypertension, associated with chronic arterial obstruction in 26.6% of the cases. The chronic arterial obstruction diagnosis applied to 51.7% of the patients. With respect to foot evaluation, 53.3% of all patients displayed instability; 55% claudication; 55% previous amputation; 48% ulcer antecedents; 65% inappropriate nail cutting; 31.7% claw toes; 23.3% hammer toes; 18.3% prominence of the metatarsus and 45% used inadequate shoes and socks. During circulatory evaluation, pulse could not be palpated in 27% of the right posterior tibial and 23% of the left one; in 26.6% of the right pedal and 21% of the left one; 35% of the patients had edema; 45% dependent redness and blanching on elevation; tactile sensitivity to pressure was absent in 38.3% of the patients. With respect to ulcer characteristics, 36.6% mentioned an infected blister as the most frequent cause and 26.6% a mechanical trauma; the most frequent locations were the plantar (23.3%) and toe (21.7%) region; average ulceration time was 0.9 years, dimensions ranged from 1 to 10 cm2; 41.7% of the ulcers involved redness, 53.3% serous discharge 38.3% moderate pain; 58.3% discrete smell and 46.7% Wagner classification level 2. The most frequently mentioned treatment for ulcers was physiological serum and sunflower oil (81.7%). Study results displayed the seriousness of complications related to diabetic foot, highlighting ulcer antecedents and previous amputation, vascular complications and neuropathy as important risk factors for foot injuries and extrinsic trauma as the main factor leading to this kind of injury, reiterating that basic interventions can contribute to its reduction. Results also indicated the need to elaborate a care protocol, emphasizing the education of patients, family members and professionals with a view to greater treatment adhesion and control of DM, as well as intensifying preventive measures in foot care.

Úlceras crônicas são algumas das principais causas de morbi-mortalidade, devido a sua alta probabilidade de infecção e sepse; por esse motivo, elas tem um impacto significativo na saúde pública e no dispêndio de recursos com assistência médica. Úlceras (ou feridas) são caracterizadas por uma perda de substância tecidual, provocando a descontinuidade do tecido cutâneo e adjacentes, alterando a estrutura anatômica e fisiológica das regiões afetadas. As mais comuns são: cirúrgicas, venosas (de estase, varicosa), arteriais, neurotróficas (hanseníase, diabetes, alcoolismo), por pressão ou mistas. A membrana de celulose bacteriana (CB) é utilizada como curativo temporário para tratamento dessas úlceras de pele de diversas origens, devido à excelente conformação no corpo, manutenção da umidade local, redução da dor e aceleração da regeneração do epitélio. A própolis tem mostrado possuir efeitos antibacteriano, antifúngico, antiviral, anti-inflamatório, hepatoprotetor, antioxidante, antitumoral e imunomodulatórios. Outro tratamento para úlceras muito utilizado é a laserterapia de baixa intensidade (LBI), cujos efeitos regenerativos são comprovados; além de promover a cicatrização de úlceras, promove o alívio da dor, melhora da circulação local e diminuição da inflamação. O objetivo deste trabalho foi avaliar a eficácia da aplicação de curativos temporários de CB pura ou com própolis associados ou não a aplicação de LBI em indivíduos que apresentavam úlceras crônicas. A amostra conteve 8 pacientes, num total de 12 úlceras, divididos aleatoriamente em 05 grupos: Grupo Membrana de CB Pura (G1), Grupo Membrana de CB com Própolis (G2), Grupo Laser (G3), Grupo Membrana de CB Pura + Laser (G4), Grupo de Membrana de CB com própolis + Laser (G5). Sessenta e sete por cento das úlceras tratadas evoluíram para cicatrização total, apresentando aumento da velocidade de cicatrização em comparação com o tempo de existência da úlcera. Do restante das úlceras tratadas, somente uma teve sua área final aumentada devido a fatores como diabetes descompensada e infecção bacteriana; as outras tiveram uma grande evolução e chegaram próximas da reepitelização total. Todos os tratamentos se mostraram efetivos no tratamento de úlceras crônicas, porém o diferencial na cura foi a utilização de membranas de CB pura e com própolis. / Chronic skin ulcers are a major source of morbidity-mortality due to their high probability of infection and sepsis; for this reason, they have a significant impact on public health and the expenditure of healthcare resources. Skin ulcers (or wounds) are characterized by a loss of tecidual substance, interrupting cutaneous tissue and changing their anatomic and physiologic structures. The most commom ulcers are: cirurgical, venous, arterials, neurotrophics, pressure ulcers or mixed factors. Bacterial cellulose (BC) membrane is used as a temporary curative for the treatment of several types of skin ulcers due to its amazing body conformation, keeping the humidity, reducing the pain and accelerating the ephitelium healing process. Propolis have shown antimicrobial, antifungal, antiviral, anti-inflammatory, hepatoprotective, antioxidant, antitumor and immunity modulation effects. Another treatment for skin ulcers is low-level laser therapy (LLLT), who have regenerative effects, and it also promoves the ulcer cicatrization, pain relief, better local circulation and reduces the inflammation. The aim of this study was to evaluate the effectiveness of pure BC and propolis BC membrane curative application, associated or not to LLLT in individuals who had chronic ulcers. The sample contained 8 patients and 12 ulcers, randomly divided in 5 groups: Pure BC Membrane Group (G1), Propolis BC Membrane Group (G2), Laser Group (G3), Pure BC Membrane + Laser Group (G4) and Propolis BC Membrane + Laser (G5). Sixty seven per cent of the treated ulcers progressed to full cicatrization, increasing the speed of cicatrization when compared to the existent period of the ulcer. The resto of treated ulcers had a great evolution and got close to the total reepithelization, except for one that had increased its final area because of decompensated diabetes and bacterial infection. All treatments had shown effectiveness for the treatment of chronic skin ulcers, however the differential on healing process was the use of pure BC membranes and propolis BC membranes.

Orientador: Denise Engelbrecht Zantut Wittmann / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T21:40:22Z (GMT). No. of bitstreams: 1 Parisi_MariaCandidaRibeiro_D.pdf: 1004803 bytes, checksum: f7591fe1c6053bef6e0b229778f255ce (MD5) Previous issue date: 2009 / Resumo: O objetivo deste estudo foi comparar três sistemas de classificação de úlceras em pé diabético avaliando a capacidade de predição de cicatrização em 6 meses de tratamento e seguimento: o sistema de Wagner, o da Universidade do Texas (UT) e o sistema S(AD)SAD (área-profundidade, sepsis, arteriopatia e denervação). Estudamos e classificamos de acordo com cada sistema 94 portadores de Diabetes Mellitus tipo 2 e úlcera em pés. Analisamos a área da úlcera, profundidade, aspecto, presença de infecção, associação com neuropatia e isquemia nos membros inferiores. Desenvolvemos e avaliamos um novo escore obtido através da soma dos itens do sistema S(AD)SAD. O desfecho primário foi a ocorrência de cicatrização. A média de idade dos pacientes foi 57,6 anos, 48 úlceras (51,1%) cicatrizaram; 11 (12,2%) pacientes evoluíram com amputação menor. Diferenças significativas entre as úlceras que cicatrizaram e que não cicatrizaram foram encontradas em relação à profundidade (p=0,002), presença de infecção (p=0,006) e denervação (p=0,002) quando classificadas através do sistema S(AD)SAD, assim como com o sistema da UT, grau (p=0,002) e estágio (p=0,032), e com os graus do sistema de Wagner (p=0,002). Concluímos que os três sistemas foram bons preditores de cicatrização. Úlceras com S(AD)SAD escore =9 (total possível de 15) apresentaram 7,6 vezes mais chances de cicatrização que escores =10 (65,6% versus 20,0%, p<0,001). O S(AD)SAD escore pode representar uma boa ferramenta na rotina prática. Ao contrário de dados publicados em centros da Europa e Estados Unidos, demonstramos forte associação de ausência de infecção com maiores chances de cicatrização em pé diabético. / Abstract: Objective: The aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the S(AD)SAD system in a specialist clinic in Brazil. Methods: Ulcer area, depth, appearance, infection, and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated. Follow-up was for at least 6 months. The primary outcome measure was the incidence of healing. Results: Mean age was 57.6 years; 57 (60.6%) were male. 48 ulcers (51.1%) healed without surgery; 11 (12.2%) subjects underwent minor amputation. Significant differences in terms of healing were observed for depth (p=0.002), infection (p=0.006) and denervation (p=0.002) using the S(AD)SAD system, for UT Grade (p=0.002) and Stage (p=0.032), and for Wagner grades (p=0.002). Ulcers with a S(AD)SAD score of =9 (total possible 15) were 7.6 times more likely to heal than scores =10 (p<0.001). Conclusions: All three systems predicted ulcer outcome. The S(AD)SAD score of ulcer severity could represent a useful addition to routine clinical practice routine. The association between outcome and ulcer depth confirms earlier reports. The association with infection was stronger than reported from centres in Europe or N America. / Doutorado / Clinica Medica / Doutor em Ciências Médicas

Diabetes Mellitus (DM) à um dos mais importantes problemas mundiais de saÃde na atualidade, tanto em termos de nÃmero de pessoas afetadas, incapacitaÃÃes, mortalidade prematura, como dos custos envolvidos no seu controle e no tratamento de suas complicaÃÃes (CONSENSO.1997 ). A ulceraÃÃo em pà diabÃtico à a causa mais comum de amputaÃÃes nÃo traumÃticas de membros inferiores em paÃses industrializados (ARMSTRONG et al., 1998a). Ocorre em 15% dos diabÃticos e à responsÃvel por 6% a 20% das hospitalizaÃÃes (ARMSTRONG et al., 1998c). Este estudo teve como objetivo avaliar a influÃncia da pressÃo arterial, hemoglobina glicada, tempo de diabetes, IMC, altura, escolaridade e renda na incidÃncia de Ãlcera nos pÃs de portadores de diabetes mellitus, atendidos entre junho de 1999 a janeiro de 2002, no ambulatÃrio do Pà diabÃtico do Centro Integrado de Diabetes e HipertensÃo do Cearà (CIDH). Foram realizados dois estudos entre dezembro de 2000 e janeiro 2002 . No estudo transversal de 83 diabÃticos tipo 2 portadores de Ãlceras nos pÃs (37 homens e 46 mulheres), na faixa etÃria de 37 a 86 anos, os participantes foram avaliados quanto à histÃria clÃnica, exame fÃsico dos pÃs, avaliaÃÃo da condiÃÃo vascular: palpaÃÃo dos pulsos pediosos dorsais e tibiais posteriores, exame neurolÃgico: sensibilidade protetora plantar ao monofilamento de Semmes-Weinstein 5.07, sensibilidade vibratÃria ao diapasÃo 128 Hz e sensibilidade ao frio verificada com objeto metÃlico frio. No estudo caso-controle aninhado (ROTHMAN, 1986; CLAYTON: HILLS 1993), com 83 casos e 188 controles, na faixa etÃria de 37 a 86 anos, casos foram portadores de diabetes tipo 2 com Ãlcera nos pÃs, Ãlcera de pà foi definida como lesÃo aberta no malÃolo ou abaixo dele (BOULTON et al., 1986), controles foram portadores de diabetes tipo 2 atendidos no CIDH, sem histÃria de Ãlcera e/ou amputaÃÃo. Para cada caso Ãndex foi selecionado um ou mais controles pareados por sexo, idade e data de admissÃo no CIDH. Para estimar a relaÃÃo entre os potenciais fatores de risco e a incidÃncia de Ãlcera de pà foi utilizado um modelo de regressÃo logÃstica condicional. A descriÃÃo clÃnica de 83 portadores de diabetes com Ãlcera demonstrou que Ãlcera de pà à mais freqÃente no sexo feminino, idade acima de 59,74 anos, duraÃÃo do diabetes acima de 11 anos, baixa renda, baixa escolaridade, dependentes ou sem ocupaÃÃo, IMC acima de 25 kg/mÂ, diabetes mal controlado, portadores de neuropatia perifÃrica, doenÃa vascular perifÃrica e retinopatia diabÃtica. Analisando-se os fatores associados ao risco na incidÃncia de Ãlcera de pÃ, em portadores de diabetes mellitus, observa-se que, na anÃlise sem pareamento, a mÃdia da hemoglobina glicada e a duraÃÃo do diabetes foram significantemente maior nos casos que nos controles, enquanto que a mÃdia da pressÃo arterial sistÃlica e diastÃlica foram significantemente menor nos casos que nos controles. Na anÃlise nÃo ajustada atravÃs da regressÃo logÃstica condicional, a hemoglobina glicada e a maior duraÃÃo do diabetes mellitus estavam significantemente associadas à maior chance de ocorrÃncia de Ãlcera. Para cada acrÃscimo de 1% na hemoglobina glicada correspondeu um aumento de 20% na chance de ocorrer Ãlcera. Na anÃlise ajustada entre cada fator de risco e a ocorrÃncia de Ãlcera de pÃ, apenas a hemoglobina glicada permaneceu associada a risco de ulceraÃÃo, aumentando inclusive a forÃa da associaÃÃo. Para cada acrÃscimo de 1% na hemoglobina glicada, aumentou em 38% a chance de ocorrÃncia de Ãlcera de pÃ. / Diabetes Mellitus (DM) is at the present time one of the most important world problems of health, so much in terms of number of affected people, disability, premature mortality, as of the costs involved in your control and in the treatment of your complications (CONSENT..., 1997). Diabetic foot ulceration is the cause more common of amputations non traumatic of lower extremity in industrialized countries (ARMSTRONG et al., 1998a). Occur in 15% of the diabetic and it is responsible for 6 to 20% of the hospitalizations (ARMSTRONG et al., 1998c). This study had as objective assess the influence of the blood pressure, hemoglobin glicada, time of diabetes, BMI, height, education level and income in the ulcer incidence in the feet of diabetic mellitus, assisted among June from 1999 to January of 2002, in the clinic of the diabetic Foot in the Integrated Center of Diabetes and Hypertension of Cearà (ICDH). Two studies were accomplished between December of 2000 and January 2002. Sectional study of the 83 diabetic type 2 with ulcers in the feet (37 men and 46 women), age from 37 to 86 years, the participants were assessed with relationship to the clinical history, feet physical exam , evaluation of the vascular condition: palpation of posterior tibialis and dorsalis pedis pulses, neurologycal exam: sensory testing on each foot using Semmes Westein monofilament 5.07, vibration sensation using a 128-Hz tuning fork and sensibility to the cold verified with cold metallic object In the case-control nested study (ROTHMAN, 1986; CLAYTON; HILLS, 1993), with 83 cases and 188 controls, in the age group from 37 to 86 years, cases were individuals bearers of diabetes type 2 with ulcer in the feet. Foot ulcer was defined as an open lesion which was present below the level of the melleolus (BOULTON et al., 1986). Controls were diabetic type 2 assisted in ICDH, without history of ulcer e/ou amputation. For each index caso it was selected an or more controls matched by sex, age and admission date in ICDH. To esteem the relationship between the potentials risk factors and the incidence of foot ulcer it was used a model of conditional logistics regression. The clinical description of 83 diabetic with ulcer demonstrated that foot ulcer is more frequent in the female sex, age above 59,74 years, duration of diabetes above 11 years, low income, low education, dependent or without occupation, BMI above 25 kg/mÂ, diabetes badly controlled, outlying peripheral neuropathy, peripheral vascular disease and diabetic retinopathy. Being analyzed the factors associated to the risk in the incidence of foot ulcer in diabetic , it is observed that: in the analysis without matched, the average of the hemoglobin glicada and the duration of the diabetes were larger significantly in the cases that in the controls, while the average of the systolic and diatolic blood pressure were smaller significantly in the cases that in the controls. In the analysis non adjusted through the conditional logistics regression the hemoglobin glicada and the largest duration of the diabetes mellitus, they were associated significant the largest chance of ulcer occurrence. For each increment of 1% in the hemoglobin glicada corresponded an increase of 20% in the chance of occurrence ulcer. In the adjusted analysis between each risk factor and the occurrence of foot ulcer the hemoglobin glicada stayed just associated to risk of ulceration, increasing the force of the association. For each increment of 1% in the hemoglobin glicada, it increased in 38% the chance of occurrence a foot ulcer.

Bakgrund: Larvterapi är en alternativ behandlingsmetod i bensårsläkning. Sårläkning med larver har förekommit i mer än 70 år men vid antibiotikans introduktion minskades användandet av larvterapi. Då det idag finns problem med antibiotikaresistens introducerades larvterapi åter. Syftet med denna studie var att belysa hur larvterapi påverkar bensårsbehandlingen för patienter med kroniska bensår. Metod: En integrativ litteraturstudie genomfördes utifrån två kvalitativa och sju kvantitativa vetenskapliga artiklar.  Resultat: Det som belystes var fysiologisk påverkan av bensåret såsom debridering och läkning samt upplevelsen av larvterapi såsom smärta, obehagskänslor och lukt. Studien visade att debridering vid bensår med larvterapi gav bättre resultat än med hydrogelbehandling. Larverna debriderade såren från nekrotisk vävnad så att bensårens omfång minskade drastiskt. Anmärkningsvärt var att sex av nio studier nämnde att smärta upplevdes under behandlingsprocessen men att acceptansen av larvterapi som behandlingsform var över förväntan trots smärtan. En del patienter hade initialt en negativ inställning inför larvterapi men var villiga att prova behandlingsmetoden. Larvterapi kunde förbättra patienters välbefinnande och vid smärtförekomst gick behandlingsmetoden att genomföra med hjälp av information och smärtstillande läkemedel varvid den totala läkningstiden förkortades. / Background: Larval therapy is an alternative treatment method in wound healing. Wound healing with larvae has occurred for more than 70 years. The introduction of antibiotics decreased larval therapy, but though there are problems with the resistance of antibiotics, larval therapy returned. The objective of this study was to highlight the impact of larval therapy for chronic leg ulcers.  Method: An integrative literature study was performed based on two qualitative and seven quantitative scientific articles.  Results: The impacts of the leg ulcers that were highlighted were physiological such as debridement and healing, also the experience of larval therapy such as pain, feelings of discomfort and wound odor. The study showed that the debridement in leg ulcers with larval therapy gave better results than hydrogel treatment. The larvae debrided necrotic tissue from the wounds and decreased the wound dramatically. Remarkably, six out of nine studies mentioned pain as a big factor during treatment but the acceptance of larval therapy was beyond expectation. Although some patients were reluctant to try larval therapy, most patients were willing to go through with the treatment. Larval therapy improved the wellbeing of patients and if pain occurred during larval therapy patients were motivated with information and were relieved with painkillers so the total time of healing was shortened.

The purpose of this thesis was two-fold: first, to develop a Patient Satisfaction Questionnaire which reflects patient satisfaction with dressings used in the care of ulcerating metastatic skin lesions; and second, to evaluate patient satisfaction and patient preference with two types of dressings: Mesalt dressings and continuous wet saline dressings. The Patient Satisfaction Questionnaire was developed to measure patient satisfaction with dressing performance. Patients with ulcerating metastatic skin lesions were asked to identify important characteristics for evaluating patient satisfaction with dressings. These questions were validated and reviewed for clarity by the patients. A visual analogue scale was used as the response scale. Testing for reliability was limited. Mesalt dressings were compared to continuous wet saline dressings by evaluating patient satisfaction with pre-defined criteria. The criteria for evaluation included ease of application and removal, discomfort during and between dressing changes, control of odor, and patient preference. The study used a cross-over design in which each patient used one dressing for a month and the other dressing for the next month. Although 14 patients were involved in the study, only 10 were statistically analyzed. The remaining four patients were excluded because they were unable to complete a portion of each treatment. Two major findings were identified. First, regarding the Patient Satisfaction Questionnaire, patients with ulcerating metastatic skin lesions had numerous ideas about what should be asked to evaluate patient satisfaction with dressings. They considered the questionnaire to be an appropriate format and the questions generated by the investigator to be both important and understandable. Second, the findings of the study indicated that the Mesalt dressings received significantly more positive ratings when compared with continuous wet saline dressings for ease of application and odor control. Mesalt dressings were also significantly preferred to continuous wet saline dressings. The knowledge gained through this study is useful when helping patients decide which dressings to use in the care of ulcerating metastatic skin lesions. The Mesalt dressing appears to be a favorable choice, particularly when ease of application and odor control is important. / Applied Science, Faculty of / Nursing, School of / Graduate

Excerpt: Genital and oral lesions consistent with herpes simplex lesions are relatively common in my practice.

Context: Inferior vena cava (IVC) anomalies have a 0.5% incidence rate and could be associated with other congenital abnormalities. In later stage of the disease, trophic ulcers with or without deep vein thrombosis (DVT) is consistent finding.Case Report: A 29-year-old male patient presented with recurrent lower extremity ulcers. Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.Conclusion: IVC anomaly should be suspected in a young patient presenting with unexplained venous thrombosis and recurrent ulcers of a lower extremity. IVC anomaly would inherently lead to blood flow stasis and endothelial injury. Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

Rats given L-Ascorbic Acid in their drinking water prior to and during starvation did not develop severe ulceration in the glandular portion of their stomachs. Control rats which were either nontreated or given deactivated L-Ascorbic Acid developed severe stomach pathology on the starvation regimen. The present study was based on the finding that food deprivation results in severe rumenal ulceration in rats. Given that L-AA is essential in maintaining tissue integrity and that ulcers are examples of tissue degeneration, the L-AA in large amounts could retard, or prevent, the formation of starvation induced stomach ulcers in rats. The results show that large amounts of active L-AA were beneficial in maintaining the integrity of rat gastrointestinal tissue exposed to starvation conditions which, in the vitaimin's absence, induces deterioration.