I Sverige lider ca 50 000 människor av svårläkta bensår och av dessa är ca 50 procent or-sakade av venös insufficiens. Patienter med bensår upplever ofta att de påverkas negativt fysiskt, psykiskt och socialt. Syftet med studien var att beskriva distriktssköterskors upple-velser av att kunna främja hälsa hos patienter med venösa bensår. Metoden som valdes var kvalitativ innehållsanalys med induktiv ansats. Data samlades in genom intervjuer med nio distriktssköterskor. Ur analysen framkom fyra teman; Samtala och informera för att skapa ökad förståelse, Arbeta med livsstilsrådgivning, Kunna underlätta vardagen samt Kunna se hela människan i omvårdnaden. Slutsatsen är att distriktssköterskorna blir ett stöd för pati-enterna, både under den tid de har sina sår och även genom att ge patienterna kunskap för att förebygga uppkomst av nya sår. Distriktssköterskorna upplever att de kan främja hälsa genom att flytta fokus från bensåret och istället se till hela människan. Fortsatt forskning inom området behövs ur ett patientperspektiv; hur patienter med venösa bensår upplever att distriktssköterskor kan ge stöd och främja hälsa. / Approximately 50 000 people in Sweden are suffering from slow healing leg ulcers, and about 50 per cent of these ulcers are caused by venous insufficiency. Patients with leg ul-cers often experience being adversely affected physically, psychologically and socially. The purpose of the study was to describe district nurses experiences of being able to pro-mote health in patients with venous leg ulcers. The chosen method was qualitative content analysis with inductive approach. Data was collected through interviews with nine district nurses. The analysis resulted in four themes; Communicate and inform to increase com-prehension, Work with lifestyle counselling, Being able to facilitate everyday life and Be-ing able to have an holistic approach in nursing care. The conclusion is that district nurses become a support to the patients during the time they are affected by ulcers, and also by providing the patients with knowledge of how to prevent the emergence of new ulcers. District nurses experience they are able to promote health by not only focus on the ulcer but also see the person behind the ulcer. Further research is needed from a patient perspec-tive; how patients with venous leg ulcers experience that district nurses can provide sup-port and promote health.

This critical synopsis of prior work by Clive Beggs is submitted in support of a PhD by published work. The work focuses on venous and cerebrospinal fluid (CSF) anomalies associated with multiple sclerosis (MS) and other neurological diseases. MS is characterized by focal inflammatory lesions, which are often venocentric. Recently a vascular syndrome, chronic cerebrospinal venous insufficiency (CCSVI) has been linked with MS. This syndrome, which is characterized by constricted cerebral venous outflow, has become mired in controversy, with various studies producing conflicting findings, with the result that the science associated with CCSVI has become obscured. Clive Beggs work seeks to bring clarity to the debate surrounding CCSVI by characterizing physiological changes associated with constricted cerebral venous outflow. The work submitted here involves collaborative studies with Robert Zivadinov (University of Buffalo), Paolo Zamboni (University of Ferrara), and Chih- Ping Chung (National Yang Ming University of Medicine). The key findings of these studies are: (i) MS patients, diagnosed with CCSVI, exhibit greatly increased hydraulic resistance of the cerebral venous drainage system; (ii) MS patients experience loss of the small cerebral veins; (iii) MS patients exhibit reduced CSF bulk flow, consistent with mild venous hypertension; (iv) MS patients exhibit increased CSF pulsatility in the Aqueduct of Sylvius, which appears to be linked with mild venous hypertension associated with CCSVI; and (v) jugular venous reflux is associated with white matter and parenchymal volumetric changes in Alzheimer’s patients. Collectively, these findings suggest that extracranial venous anomalies are associated with changes in the intracranial physiology.

Introdução: A Insuficiência Venosa Crônica (IVC) é responsável pela grande maioria dos sintomas vasculares que acometem os membros inferiores, podendo levar a graves sintomas. A Síndrome de compressão Venosa Cavo-ilíaca (SCVCI) é cada vez mais reconhecida como importante causa da IVC e os métodos de imagem utilizados para o seu diagnóstico fornecem informações anatômicas, mas não trazem informações fisiológicas claras. A importância diagnóstica dos Gradientes pressóricos venosos Cavo-ilíacos precisa ser mais bem estudada e esses ainda não foram comparados ao método padrão-ouro atualmente disponível, o Ultrassom Intravascular (UI). Esse estudo tem como objetivo avaliar a correlação entre as medidas de Pressão intravenosa (PI) e Gradientes pressóricos (GP) e a presença de obstrução venosa significativa no Sistema Cavo-Ilíaco (SCI) estabelecida pelo UI, para o diagnóstico da SCVCI em pacientes portadores de IVC avançada dos membros inferiores. Método: Foram incluídos 50 pacientes com IVC avançada (Classificação CEAP 3 ou superior) de, ao menos, um dos membros inferiores, sem melhora após um ano de tratamento clínico, totalizando 100 membros inferiores. Todos os pacientes foram submetidos, prospectivamente, aos exames de Ultrassom Vascular com Doppler Colorido (UVDC), Angiotomografia Computadorizada Helicoidal (ACTH), Flebografia Multiplanar Ascendente (FMA), Medidas de pressão intravenosa e Ultrassom Intravascular (UI). Os membros inferiores estudados foram divididos em dois grupos: Grupo 1 com obstrução <50% ao UI e Grupo 2 com obstrução >= 50% ao UI. A correlação entre os gradientes e demais variáveis quantitativas foi realizada utilizando o Coeficiente de Spearman. As Curvas ROC foram utilizadas para avaliar qual o melhor desempenho entre os gradientes, na discriminação do grau de obstrução. O desempenho diagnóstico isolado dos GP em comparação com o UI foi avaliado por meio das medidas de Sensibilidade, Especificidade, Valor Preditivo Positivo, Valor Preditivo Negativo e Acurácia. A concordância dos exames com o UI foi realizada por meio do Kappa e do teste de McNemar. A Análise de Regressão Logística foi utilizada para avaliar a contribuição dos GP com a Flebografia, na identificação de pacientes com obstrução significativa. Foram utilizados os programas R (Versão 3.1.0) e SPSS (Versão 2.0). Valores de p<0,05 foram considerados significativos. Resultados: O Grupo 2 apresentou maior predomínio de acometimento do membro inferior esquerdo e maior pontuação nas escalas Visual Analógica para Dor (EVAD), no Escore de Severidade Clínica Venosa (ESCV) e no Questionário de Qualidade de Vida SF-36 (QQV SF-36). As pressões Femorais em repouso (PVF-r) e após hiperemia (PVF-h), bem como os Gradientes Fêmoro-Cava após hiperemia (GFC-h) e o Gradiente Femoral hiperemia-repouso (GFh-r) mostraram-se significativamente mais elevados no Grupo 2 (p=0,001; <0,001; 0,002 e 0,006, respectivamente). As mesmas pressões e gradientes apresentaram correlação significativa com o grau de estenose ao UI, pela análise do Coeficiente de Sperman (PVF-r 0,350, p<0,001; PVF-h 0,379, p<0,001; GFC-h 0,302, p=0,002; GFh-r 0,218, p=0,029), sendo que o melhor desempenho para diagnóstico entre esses parâmetros, pela análise de Curva ROC, foi alcançado pelos gradientes GFC-h e GFh-r. Entretanto, o desempenho diagnóstico isolado dos GP, quando comparados ao UI, apresenta baixos valores de Sensibilidade (<40%), Valor preditivo Negativo (<60%) e Acurácia (<30%), bem como, valores de concordância baixos ao Kappa (<0,3) e discordância desproporcional com o UI pelo teste de McNemar (p<0,05). Os melhores resultados foram encontrados com o UVDC, com ACTH e com a FMA. Ao combinar os resultados da FMA com os GP, ocorre melhora significativa no desempenho diagnóstico, especialmente com a associação da FMA com o GFC-h. Conclusão: Existe correlação significativa entre as Pressões e GP venosos e o grau de estenose aferido ao UI. Entretanto, essa correlação não se traduz em bom desempenho diagnóstico dos GP. O GFC-h acrescenta informação significativa à Flebografia, na identificação dos casos com obstrução >-50% ao UI. / Introduction: Chronic venous insufficiency (CVI) is responsible for most of the vascular symptoms affecting the lower limbs, and can lead to severe complications. Iliac vein compression syndrome (IVCS) is increasingly recognized as an important cause of CVI. The imaging methods used for its diagnosis provide anatomical information but not clear physiological information. The diagnostic importance of the cavo-iliac vein pressure gradients (VPG) requires further study, and they have not yet been compared with the currently available gold standard, the Intravascular ultrasound (IVUS). The aim of this study was to evaluate the correlations between intravenous pressure (IP) and VPG, and the presence of significant IVUS-diagnosed venous obstruction in the cavo-iliac system, for assessment of IVCS in patients with advanced CVI of the lower limbs. Method: The study included 100 lower limbs of 50 patients with advanced CVI (Clinical-Etiology-Anatomy-Pathophysiology - CEAP classification 3 or higher), without symptoms improvement after one year of clinical treatment. All patients prospectively underwent Color Doppler vascular Ultrasound (CDVU), Helical Computed Tomography Angiography (HCTA), Multiplane Ascending Phlebography (MAP), IP measurements, and IVUS. The studied limbs were divided into Group 1 with obstruction <50% by IVUS and Group 2 with obstruction >=50% by IVUS. Spearman\'s correlation coefficient was used to compare gradients and other quantitative variables. Receiver operating characteristic (ROC) curves were used to evaluate the best performance among the gradients for determination of the degree of obstruction. Isolated diagnostic performance of PGs was compared with the IVUS for Sensitivity, Specificity, Positive predictive value, Negative predictive value, and Accuracy. The agreement between the evaluation methods and IVUS was determined using the Kappa statistic and McNemar\'s test. Logistic regression analysis was used to evaluate the contribution of PG to the MAP in identifying patients with significant obstruction. R (Version 3.1.0) and SPSS (Version 2.0) were used for statistical analysis. Values of p<0.05 were considered significant. Results: Group 2 showed a higher prevalence of left lower limb impairment and higher scores on the Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS), and the Short Form (SF)-36 Quality of Life questionnaire (QOL SF-36). Femoral pressures at rest (FP-r) and after hyperemia (FP-h), Femorocaval gradient after hyperemia (FCG-h), and Femoral gradient after hyperemia (FG-h) were significantly higher in Group 2 (p=0.001, <0.001, 0.002, and 0.006, respectively). Using Spearman\'s correlation coefficient, the same pressures and gradients showed a significant association with the degree of stenosis by IVUS, (FP-r 0.350, p<0.001; FP-h 0.379, p<0.001; FCG-h 0.302, p = 0.002; FG-h 0.218, p=0.029), and the best diagnostic performance among these parameters, using ROC curve analysis, was obtained with the FCG-h and FG-h gradients. However, the isolated diagnostic performance of the PG, when compared with the IVUS, showed low values for sensitivity (<40%), negative predictive value (<60%), and accuracy (<30%), as well as low kappa concordance values (<0.3) and inconsistent disagreement with IVUS, using McNemar\'s test (p <0.05). The best results were found with CDVU, HCTA, and MAP. Combining MAP results with PG led to a significant improvement in diagnostic performance, especially for the association between MAP and FCG-h. Conclusion: There was a significant correlation between VP and PG and the degree of stenosis measured by IVUS. However, this correlation did not result in good diagnostic performance by the PG. The FCG-h adds significant information to MAP in the identification of cases with obstruction >-50% by IVUS.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.

Introdução: A Insuficiência Venosa Crônica (IVC) é responsável pela grande maioria dos sintomas vasculares que acometem os membros inferiores, podendo levar a graves sintomas. A Síndrome de compressão Venosa Cavo-ilíaca (SCVCI) é cada vez mais reconhecida como importante causa da IVC e os métodos de imagem utilizados para o seu diagnóstico fornecem informações anatômicas, mas não trazem informações fisiológicas claras. A importância diagnóstica dos Gradientes pressóricos venosos Cavo-ilíacos precisa ser mais bem estudada e esses ainda não foram comparados ao método padrão-ouro atualmente disponível, o Ultrassom Intravascular (UI). Esse estudo tem como objetivo avaliar a correlação entre as medidas de Pressão intravenosa (PI) e Gradientes pressóricos (GP) e a presença de obstrução venosa significativa no Sistema Cavo-Ilíaco (SCI) estabelecida pelo UI, para o diagnóstico da SCVCI em pacientes portadores de IVC avançada dos membros inferiores. Método: Foram incluídos 50 pacientes com IVC avançada (Classificação CEAP 3 ou superior) de, ao menos, um dos membros inferiores, sem melhora após um ano de tratamento clínico, totalizando 100 membros inferiores. Todos os pacientes foram submetidos, prospectivamente, aos exames de Ultrassom Vascular com Doppler Colorido (UVDC), Angiotomografia Computadorizada Helicoidal (ACTH), Flebografia Multiplanar Ascendente (FMA), Medidas de pressão intravenosa e Ultrassom Intravascular (UI). Os membros inferiores estudados foram divididos em dois grupos: Grupo 1 com obstrução <50% ao UI e Grupo 2 com obstrução >= 50% ao UI. A correlação entre os gradientes e demais variáveis quantitativas foi realizada utilizando o Coeficiente de Spearman. As Curvas ROC foram utilizadas para avaliar qual o melhor desempenho entre os gradientes, na discriminação do grau de obstrução. O desempenho diagnóstico isolado dos GP em comparação com o UI foi avaliado por meio das medidas de Sensibilidade, Especificidade, Valor Preditivo Positivo, Valor Preditivo Negativo e Acurácia. A concordância dos exames com o UI foi realizada por meio do Kappa e do teste de McNemar. A Análise de Regressão Logística foi utilizada para avaliar a contribuição dos GP com a Flebografia, na identificação de pacientes com obstrução significativa. Foram utilizados os programas R (Versão 3.1.0) e SPSS (Versão 2.0). Valores de p<0,05 foram considerados significativos. Resultados: O Grupo 2 apresentou maior predomínio de acometimento do membro inferior esquerdo e maior pontuação nas escalas Visual Analógica para Dor (EVAD), no Escore de Severidade Clínica Venosa (ESCV) e no Questionário de Qualidade de Vida SF-36 (QQV SF-36). As pressões Femorais em repouso (PVF-r) e após hiperemia (PVF-h), bem como os Gradientes Fêmoro-Cava após hiperemia (GFC-h) e o Gradiente Femoral hiperemia-repouso (GFh-r) mostraram-se significativamente mais elevados no Grupo 2 (p=0,001; <0,001; 0,002 e 0,006, respectivamente). As mesmas pressões e gradientes apresentaram correlação significativa com o grau de estenose ao UI, pela análise do Coeficiente de Sperman (PVF-r 0,350, p<0,001; PVF-h 0,379, p<0,001; GFC-h 0,302, p=0,002; GFh-r 0,218, p=0,029), sendo que o melhor desempenho para diagnóstico entre esses parâmetros, pela análise de Curva ROC, foi alcançado pelos gradientes GFC-h e GFh-r. Entretanto, o desempenho diagnóstico isolado dos GP, quando comparados ao UI, apresenta baixos valores de Sensibilidade (<40%), Valor preditivo Negativo (<60%) e Acurácia (<30%), bem como, valores de concordância baixos ao Kappa (<0,3) e discordância desproporcional com o UI pelo teste de McNemar (p<0,05). Os melhores resultados foram encontrados com o UVDC, com ACTH e com a FMA. Ao combinar os resultados da FMA com os GP, ocorre melhora significativa no desempenho diagnóstico, especialmente com a associação da FMA com o GFC-h. Conclusão: Existe correlação significativa entre as Pressões e GP venosos e o grau de estenose aferido ao UI. Entretanto, essa correlação não se traduz em bom desempenho diagnóstico dos GP. O GFC-h acrescenta informação significativa à Flebografia, na identificação dos casos com obstrução >-50% ao UI. / Introduction: Chronic venous insufficiency (CVI) is responsible for most of the vascular symptoms affecting the lower limbs, and can lead to severe complications. Iliac vein compression syndrome (IVCS) is increasingly recognized as an important cause of CVI. The imaging methods used for its diagnosis provide anatomical information but not clear physiological information. The diagnostic importance of the cavo-iliac vein pressure gradients (VPG) requires further study, and they have not yet been compared with the currently available gold standard, the Intravascular ultrasound (IVUS). The aim of this study was to evaluate the correlations between intravenous pressure (IP) and VPG, and the presence of significant IVUS-diagnosed venous obstruction in the cavo-iliac system, for assessment of IVCS in patients with advanced CVI of the lower limbs. Method: The study included 100 lower limbs of 50 patients with advanced CVI (Clinical-Etiology-Anatomy-Pathophysiology - CEAP classification 3 or higher), without symptoms improvement after one year of clinical treatment. All patients prospectively underwent Color Doppler vascular Ultrasound (CDVU), Helical Computed Tomography Angiography (HCTA), Multiplane Ascending Phlebography (MAP), IP measurements, and IVUS. The studied limbs were divided into Group 1 with obstruction <50% by IVUS and Group 2 with obstruction >=50% by IVUS. Spearman\'s correlation coefficient was used to compare gradients and other quantitative variables. Receiver operating characteristic (ROC) curves were used to evaluate the best performance among the gradients for determination of the degree of obstruction. Isolated diagnostic performance of PGs was compared with the IVUS for Sensitivity, Specificity, Positive predictive value, Negative predictive value, and Accuracy. The agreement between the evaluation methods and IVUS was determined using the Kappa statistic and McNemar\'s test. Logistic regression analysis was used to evaluate the contribution of PG to the MAP in identifying patients with significant obstruction. R (Version 3.1.0) and SPSS (Version 2.0) were used for statistical analysis. Values of p<0.05 were considered significant. Results: Group 2 showed a higher prevalence of left lower limb impairment and higher scores on the Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS), and the Short Form (SF)-36 Quality of Life questionnaire (QOL SF-36). Femoral pressures at rest (FP-r) and after hyperemia (FP-h), Femorocaval gradient after hyperemia (FCG-h), and Femoral gradient after hyperemia (FG-h) were significantly higher in Group 2 (p=0.001, <0.001, 0.002, and 0.006, respectively). Using Spearman\'s correlation coefficient, the same pressures and gradients showed a significant association with the degree of stenosis by IVUS, (FP-r 0.350, p<0.001; FP-h 0.379, p<0.001; FCG-h 0.302, p = 0.002; FG-h 0.218, p=0.029), and the best diagnostic performance among these parameters, using ROC curve analysis, was obtained with the FCG-h and FG-h gradients. However, the isolated diagnostic performance of the PG, when compared with the IVUS, showed low values for sensitivity (<40%), negative predictive value (<60%), and accuracy (<30%), as well as low kappa concordance values (<0.3) and inconsistent disagreement with IVUS, using McNemar\'s test (p <0.05). The best results were found with CDVU, HCTA, and MAP. Combining MAP results with PG led to a significant improvement in diagnostic performance, especially for the association between MAP and FCG-h. Conclusion: There was a significant correlation between VP and PG and the degree of stenosis measured by IVUS. However, this correlation did not result in good diagnostic performance by the PG. The FCG-h adds significant information to MAP in the identification of cases with obstruction >-50% by IVUS.

This work is focused on methods of real-time vein imaging using a camera in the near infrared region. The theoretical section describes the dependence of reflectance and absorbance of blood and tissue on the wavelength and suggests appropriate ways of illumination and viewing the bloodstream. The paper describes methods for real-time venous processing and projection. Based on theoretical knowledge a device sensing and projecting an image of real time examination of the venous system and a user-friendly programme for operating this device were created. The created device has been tested on a number of people to confirm proper operation.

SAMMANFATTNING    Bakgrund: Venösa bensår är ett globalt vanligt förekommande fenomen, 1–2 % av jordens befolkning anses vara drabbade. Bensår skapar stort lidande för patientens fysiska och psykiska hälsa. Två vanliga förekommande problem är smärta och isolering. Det finns flera metoder för att läka venösa bensår där flerlagers-kompressionslinda anses vara en av det bästa metoderna. Att läka bensår skulle kunna minska patientlidandet.    Syfte: Att sammanställa och jämföra läkningseffekten av två- och fyra-lagerskompressionslindning hos patienter med venösa bensår.   Metod: En deskriptiv design med litteraturöversikt användes som metod där tio vetenskapliga kvantitativa originalartiklar inkluderades. Artikelsökning gjordes i databaserna PubMed och CINAHL.   Resultat: Litteraturöversikten kunde inte påvisa en skillnad mellan 2LB- och 4LB-kompressiongrupperna för förbättrad och fullständig läkningsförmåga. Båda lindorna bekräftades ha en sårläkande effekt. Effekten av kompressionslindorna gav en mer påskyndad sårläkning, än hos patienter utan kompressionsbehandling. Majoriteten av de inkluderade studierna visade på ett liknande resultat i fullständig procentuell läkning mellan två-lagerkompressionslindning (2LB) och fyra-lagerkompressionslindning (4LB).   Slutsats: Litteraturöversikten visar att kompressionsbehandling med 2LB och 4LB har en likvärdig och god sårläkande effekt för patienter. Både 2LB och 4LB är mer gynnsam för sårläkning och välmående än utan kompressionsbehandling för patienter som lever med venösa bensår. / ABSTRACT Background: Venous leg ulcers is a globally common phenomenon, 1-2 % of the world’s population is believed to be affected. Leg ulcers causes great suffering for the patient's physical and mental health. Two common complications are pain and isolation. There are several methods to heal venous leg ulcers, multilayer-compression-therapy is considered one of the best methods. Healing leg ulcers could reduce patient suffering. Purpose: To compile and compare the healing effects of two- and four-layer compression therapy in patients with venous leg ulcers.   Method: A descriptive design with a literature review as method, with ten scientific quantitative original articles were included. Article searches was done in databases PubMed and CINAHL.   Results: The results did not show a difference between the 2LB and 4LB-groups regarding complete and improved healing. However, both methods had a healing effect. The bandages were more effective in accelerating healing in patients, than in patients without compression therapy. Most of the included studies showed a similar result in the percentage of complete healing effect between the two-layer compression therapy (2LB) and four-layer compression therapy (4LB).   Conclusion: This literature review demonstrated that compression therapy with 2LB and 4LB has an equally as well as good healing effect for patients. Both 2LB and 4LB are significantly more beneficial for wound healing and well-being than without compression therapy for patients living with venous leg ulcers.

This critical synopsis of prior work by Clive Beggs is submitted in support of a PhD by published work. The work focuses on venous and cerebrospinal fluid (CSF) anomalies associated with multiple sclerosis (MS) and other neurological diseases. MS is characterized by focal inflammatory lesions, which are often venocentric. Recently a vascular syndrome, chronic cerebrospinal venous insufficiency (CCSVI) has been linked with MS. This syndrome, which is characterized by constricted cerebral venous outflow, has become mired in controversy, with various studies producing conflicting findings, with the result that the science associated with CCSVI has become obscured. Clive Beggs work seeks to bring clarity to the debate surrounding CCSVI by characterizing physiological changes associated with constricted cerebral venous outflow. The work submitted here involves collaborative studies with Robert Zivadinov (University of Buffalo), Paolo Zamboni (University of Ferrara), and Chih- Ping Chung (National Yang Ming University of Medicine). The key findings of these studies are: (i) MS patients, diagnosed with CCSVI, exhibit greatly increased hydraulic resistance of the cerebral venous drainage system; (ii) MS patients experience loss of the small cerebral veins; (iii) MS patients exhibit reduced CSF bulk flow, consistent with mild venous hypertension; (iv) MS patients exhibit increased CSF pulsatility in the Aqueduct of Sylvius, which appears to be linked with mild venous hypertension associated with CCSVI; and (v) jugular venous reflux is associated with white matter and parenchymal volumetric changes in Alzheimer’s patients. Collectively, these findings suggest that extracranial venous anomalies are associated with changes in the intracranial physiology.

Gostovic, M &amp; Grube, R. Livet med venösa bensår. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Universitet: Fakulteten för Hälsa och Samhälle, Institutionen för Vårdvetenskap, 2022.   Bakgrund: Venösa bensår beror på venös insufficiens som är en kronisk sjukdom som orsakar cirkulatorisk svikt i de nedre extremiteterna och drabbar främst den äldre befolkningen. De venösa bensåren uppkommer ofta på grund av trombos, yttre trauma, fysisk inaktivitet eller hereditet. Det är vanligt med samsjuklighet vid venös insufficiens. Behandlingen består främst av omläggning och livslång kompressionsbehandling. Syfte: Syftet med litteraturstudien var att undersöka patienters upplevelser av att leva med venösa bensår. Metod: En litteraturstudie som är baserad på resultat från 13 empiriska studier med kvalitativ ansats från Cinahl, PubMed och PsycInfo. Studierna har granskats med hjälp av Kvalitetsgranskningsmall för studier med kvalitativ forskningsmetodik och de inkluderade studierna har bedömts vara av hög samt medelhög kvalitet. De inkluderade studiernas resultat analyserades med hjälp av integrerad sammanställning av kvalitativ forskning inspirerad av metasyntes. Resultat: Sex teman identifierades: Egenvårdens betydelse för välbefinnandet, Svårigheter i egenvården, Vården som en del av vardagen, Upplevelsen av smärta, Upplevd självbild och skam samt Social och psykisk påverkan. Konklusion: Litteraturstudien gav en ökad förståelse för vad det innebär att leva med venösa bensår och gav en insikt i vilka kunskapsluckor som vården behöver fylla för att kunna förse patienterna med en adekvat omvårdnad. / Gostovic, M &amp; Grube, R. Life with venous leg ulcers. A Literature Review. Degree project in nursing 15 credit points. Malmö University: Faculty of Health and Society, Department of Care Science, 2022.   Background: Venous leg ulcers is caused by venous insufficiency which is a chronic disease caused by circulatory deficiency in the lower extremities and affects primarily the elderly population. The venous leg ulcers most commonly originates from thrombosis, external trauma, physical inactivity or heredity. Comorbidity is common among the patients with venous leg ulcers.  The treatment plan primarily consists of wound dressing and lifelong compression treatment. Aim: The aim of the study was to investigate the patients’ experiences of living with venous leg ulcers. Method: A literature review based on results from 13 empirical studies with qualitative design from Cinahl, PubMed and PsycInfo. The studies have been reviewed by using a review template intended for qualitative studies and the included studies were valued as high and medium high quality. The included studies results were analyzed with the help of an integrated compilation of qualitative research inspired by meta synthesis. Results: Six themes were identified: Self-care had an impact of the well-being, Health care as a part of the daily life, The experience of pain, Perceived self-image and shame and Social and psychological influence. Conclusion: The literature review increased the understanding of what it’s like to live with venous leg ulcers and gave an insight into which knowledge-gaps the health care needs to fill to provide the patients with adequate care.

Determining the prognosis or risk of an individual experiencing a specific health outcome within a certain time period is essential to improve health. An important aspect of prognostic research is the development of risk assessment models (RAMs). In support of the movement towards personalized medicine, health care professionals have employed RAMs to stratify an individual patient’s absolute risk of developing a health condition and select the optimal management strategy for that patient. The development of RAMs is generally conducted using data driven methods or through expert consensus. However, these methods present limitations. Accordingly, we recognized the need to select factors for RAM development or update that are evidence-based and clinically relevant using a structured and transparent approach. In this sandwich thesis, I highlight the methods used to select prognostic factors for VTE and bleeding RAMs for hospitalized medical patients. However, the same methods can be applied to any clinical outcome of interest. This work presents a conceptualized and tested novel mixed methods approach to select prognostic factors for VTE and bleeding in hospitalized medical patients that are evidence-based, clinically meaningful and relevant. Our findings may inform the development of new RAMs, the update of widely used RAMs, and external validation and prospective impact assessment studies. Also, these findings may assist decision makers in evaluating the risk of an individual having an outcome to optimize patient care. / Thesis / Doctor of Philosophy (PhD) / Measuring the probability of an individual experiencing a specific health outcome in a certain period of time based on that individual’s risk factors is important to improve health. Prediction tools are often used to calculate the probability of an outcome. Health care practitioners use prediction tools to assess an individual’s risk of a certain health outcome and in turn provide individualized management. Prediction tools include a number of agreed upon risk factors that should be assessed in order to best estimate the risk of an outcome. These risk factors are usually selected through exploring sets of data or by consulting a group of experts in the field. However, these methods have limitations. Therefore, we recognized that it is important, when developing prediction tools, to select risk factors that are evidence-based and clinically relevant by adopting a systematic, comprehensive, structured and transparent approach. These sets of risk factors can then aid health researchers when developing new prediction tools or updating existing ones and help clinicians predicting risk. In this thesis, I highlight the methods used to select factors for prediction tools that evaluate the risk of having a venous clot or a bleeding event in patients that are hospitalized for a medical condition. However, the same methods can be applied to any clinical condition and outcome of interest. This work presents a new approach that we conceptualized and tested to select risk factors for venous clots and bleeding events in hospitalized medical patients that are evidence-based, clinically meaningful and relevant. Our findings may inform the development of new prediction tools, the update of widely used tools, and the design of studies to validate these tools. Also, these findings may assist decision makers in evaluating the risk of an individual having an outcome to optimize patient care.