Thesis (doctoral)--Universität Hamburg, 1979.

Thesis (doctoral)--Karolinska Institutet, Stockholm, 1995. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (Ph.D.)--Aberdeen University, 2008. / Title from web page (viewed on Apr. 20, 2009). Includes bibliographical references.

Thesis (Ph.D.)--Aberdeen University, 2009. / Title from web page (viewed on Sep. 2, 2009). Includes bibliographical references.

Thesis (doctoral)--University of Göteborg, 1986. / Extra t.p. with thesis statement inserted. Includes bibliographical references.

A leg ulcer is a chronic wound of the skin that, at best, takes many months to fully heal and causes great distress to the patient. Treating leg ulcers places a large financial burden upon the National Health Service in the United Kingdom, estimated to be in excess of £300M annually. Measurement of the size of leg ulcers is a guide to assessing the progress of wound healing, and the use of non-invasive measurement techniques avoids damaging or infecting the wound. The area of a leg ulcer is currently measured by presenting a human observer with a captured video image of a wound, who then uses a mouse or pointing device to delineate the wounded region. Typically, the standard deviation of area measurements taken this way is approximately 5% of the wound area. In addition, different observers can show a bias difference in their area measurements from 3% to 25% of the wound area. It is proposed to reduce the incidence of such errors by using an active contour model to improve the delineation. Four different models are developed by adapting and applying several contributions made to the active contour model paradigm. Novel features include an external force that acts normally, but not tangentially, to the boundary, a new external energy term that promotes homogeneity of the gray level at the edge of the wound and the application of the minimax principle for setting the parameters of an active contour model with piecewise b-spline curves. The algorithms provide the physician with a new and practical tool for producing area measurements with improved precision and are semi-automatic, requiring only a manual delineation to start the algorithm. In most cases, measurement precision is improved by application of the algorithms. Many wounds give rise to measurable bias differences between average manual area measurements and the corresponding algorithmic area measurements, typically averaging 3% to 4% of wound area. With some wounds the bias magnitude can exceed 10% as a result of the contour partly deviating from the true edge of the wound and following a false edge.

This thesis demonstrates my original contribution to the specialty of -wound healing as it has evolved over the past twenty years. It comprises three projects through which I present and illustrate a selection of the work I have carried out as a researcher, clinician and educator in wound healing, and the relationship between these areas. This thesis begins with Project One, which discusses my contribution to wound healing research. Project Two explores the ways I have used die outputs of research in developing -wound care practice within the context of a specialist wound healing unit. Project Three illustrates how I have utilised die outputs of research as the basis for educational materials. It is through engaging in a diverse range of activities in these three areas that I have been able to make a unique contribution to -wound healing nursing. In each of the projects die portfolio materials are discussed with reference to a number of theoretical frame-works. In Project One I use a hierarchical approach (Sackett et al, 1991, 2000) to explore my contribution to research. In Project Two I adopt die role definition approach developed by Hamric, Spross and colleagues (1983, 1989, 1996, 2000) in exploring my contribution to developing -wound care practice. Finally, in Project Three I utilise Benner's research on professional development (Benner, 1984) as a frame-work on -which to display my materials. While I have been writing this diesis I have reflected on twenty years experience in wound care nursing. This opportunity has facilitated me in planning for my future career in the specialty of -wound healing, and in making decisions about where I expect to focus my attention in the future.

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