Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 223-247).

Wound care is an important part of the daily work of nurses in all facilities like hospitals, institutes for long-term patients, social care institutions, or ambulances. In recent years, the treatment of wounds puts more and more emphasis on modern methods, mainly in the Czech Republic (CR) and Ireland. As already mentioned, nursing is constantly evolving, and possibilities for wound treatment are wide. Our aim will be to compare the ways and methods of wound treatment in three different countries. We will focus on the General Nurse, as a nursing care provider. In the theoretical part, the work was focused on characteristic of wounds, their distribution, general healing as well as concrete treatment in the countries concerned, specifically according to the competence of nurses. A major part was devoted to the education of nurses The main purpose of the research was focused on the way nurses treat wounds in Namibia, Ireland and the Czech Republic. Based on the research subject the following research questions and goals were set: Identify and describe how nurses treat wounds in the selected countries. How are wounds healed in Namibia, Ireland and the Czech Republic? How is the wound care in Namibia, Ireland and the Czech Republic? What kind of education does a nurse have to have in the countries concerned, in connection with the wound care? For the empirical part of the thesis, a qualitative approach was selected. A semi-structured interview with nurses from the selected countries was used. Further records of the wound treatment were used. These were obtained during the internship in Namibia, a personal visit to Ireland and my experience during my studies in the Czech Republic. Respondents were recruited by purposive sampling, the condition of which was wound care requiring hospital treatment. The interviews were conducted using a range of questions addressing nurses in those countries during their working hours and if needed, supplementing the required information via Skype. The research sample consisted of nine respondents - nurses from Namibia, Ireland and the Czech Republic and then records of the wound treatment of 9 patients from Namibia, the Czech Republic and Ireland were drawn. The countries have their competencies relating to this issue. In Ireland, Czech Republic there is a re-bandaging nurse, who creates a nursing plan and, if needed, consults everything with the physician. In Namibia, due to lack of nurses and physicians, only competences of local nurses which they acquired during their university studies, are sufficient. These competences lead to decisions and choice of care and wound treatment. In the Czech Republic, nurses shall consult the healing process and the course of treatment with the physician. In the area of education of nurses from the surveyed countries in connection with wound care the research investigation showed that university education is required in Namibia, in the Czech Republic as well as in Ireland. The third mentioned research question related to methods of care with clients suffering from acute or chronic wounds. Wound care in Namibia, Ireland, and in the Czech Republic does not differ in some specific procedures; however, in most cases it is very different. In severe cases of wounds, for many patients it is an unforgettable memory, which requires a professional approach, consisting of knowledge and experience. The nurse provides a unique support to the patient, education is therefore very important and unconditional in order to enable the patient coping with the situation. The results of this thesis can serve as information and study material to other grades of the surgical block and for further research on a similar topic.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Medicinal plants and their constituents have been shown to be a major source of new biomolecules. The (-)-borneol is an alcohol monoterpene which shows a series of biological activities with potential to accelerate the wound healing process. The present study was to conduct a systematic review that provides an overview of the characteristics of monoterpenes and derivatives iridoids with wound healing effect and its mechanisms of action. Besides, evaluate the wound healing activity of (-)-borneol incorporated to chitosan film in excisional wound model in rats. Systematic Review: articles published in LILACS, EMBASE and PubMed were examined. Seven articles were found on the wound healing effect of 3 monoterpenes and 2 derivatives iridoids. Excisional wound model: A total of 90 Wistar male rats, weighing between 250-300 g. The animals underwent fullthickness wound were treated with placebo (inert chitosan film - QUIN), chitosan films containing (-)-borneol 0.5% (QUIBO05) or chitosan films containing (-)-borneol 1% (QUIBO1) by 3, 7, 14, and 21 days. The residual wounds were photographed and evaluated by wound area, presence of edema, crust, secretion and necrosis. The tissue was removed and properly treated with histochemistry. Additional groups were submitted to excision of the skin, treated for 3 days, and the wounds were taken for performing the measurement of myeloperoxidase. Mieloperoxidase (MPO) assays: Granulation tissue samples of the wounds were submitted to MPO activity. Both QUIBO concentrations decrease the myeloperoxidase activity at 3rd day after injury. The histological sections were analyzed by the presence of polymorphonuclear and mononuclear cells, fibroblast proliferation, collagen deposition and epithelialization rates. The QUIBO05 was able to significantly reduces the wound area, accelerates the inflammatory response and it was able to increase significantly the epithelization rates at 7th day. Finally, QUIBO provided collagen proliferation when compared to QUIN group. The results suggest that QUIBO showed wound healing effect. / Plantas medicinais e seus constituintes tem se mostrado como uma grande fonte de novas biomoléculas. O (-)-borneol é um monoterpeno alcoólico que tem apresentado diversas atividades biológicas com potencial para acelerar o processo de cicatrização. O presente estudo buscou realizar uma revisão sistemática de monoterpenos e derivados iridóides com efeito cicatrizante. Além de, avaliar a atividade cicatrizante do (-)-borneol incorporado ao filme bioativo de quitosana em modelo de ferida cutânea aberta em ratos. Revisão Sistemática: foram pesquisados artigos publicados na LILACS, PubMed e EMBASE. Sete artigos foram encontrados sobre o efeito cicatrizante de 3 monoterpenos e 2 derivados iridóides. Ferida cutânea aberta: Foram utilizados 90 ratos, Wistar, machos, pesando entre 250-300 g. Os animais foram submetidos a uma excisão cutânea e tratados com filme de quitosana inerte (QUIN), filmes de quitosana contendo (-)-borneol a 0,5% (QUIBO05) ou filmes de quitosana contendo (-)-borneol a 1% (QUIBO1), por 3, 7, 14 e 21 dias. As feridas residuais foram fotografadas e avaliadas quanto à área, presença de edema, crosta, secreção, necrose e cicatriz patológica. O tecido foi retirado e devidamente tratado com técnica histoquímica. Grupos adicionais foram submetidos à excisão cutânea, tratados por 3 dias e tiveram as feridas retiradas para a realização da medida da mieloperoxidase. Medida da mieloperoxidase (MPO): amostras do tecido de granulação das feridas foram submetidas à análise da atividade da MPO. Todas as concentrações do QUIBO reduziram a atividade da enzima de MPO ao 3º dia pós-lesão. As secções foram analisadas quanto à presença de células mononucleares e polimorfonucleares, proliferação de fibroblastos, deposição de colágeno e re-epitelização. O QUIBO foi capaz de reduzir significativamente a área da ferida, acelerar a resposta inflamatória e aumentar significativamente o índice de epitelização quando comparado ao QUIN ao 7º dia pós-lesão. Além disso, todas as concentrações do QUIBO estimularam a deposição de fibras colágenas durante todos os estágios do reparo quando comparado ao QUIN. Os resultados sugerem que o QUIBO possui efeito cicatrizante.

Introduction: The procedure of longitudinal median sternotomy is the most commonly used approach in cardiac surgery with the necessary complex postoperative treatment. A multifactorial approach is particularly important to prevent later complications, which can be very serious or fatal. The theoretical part of the thesis is not just about the risk factors that may interfere with the healing process but also about nutritional measures that could reduce the risk or completely prevent the profound dehiscence of the sternotomic wound. Methodology: The research method consisted of a retrospective analysis of the risk factors of deep sternal dehiscence in 22 patients who underwent cardiac surgery using the technique of longitudinal median sternotomy over a ten-year interval. 11 patients with sternal healing disorder were selected and included in group 1. Subsequently, an additional 11 patients were selected without sternal dehiscence. These patients were selected in such a way that their characteristics corresponded to the characteristics of patients of the first group in terms of statistical evaluation and comparison of both groups (type of exercise, length of operation, use of extracorporeal circulation, LIMA / BIMA, etc.). In the selection of patients in the control group 2, the laboratory nutrition...

Chronic wounds are a major financial and clinical burden causing the deaths of millions per year. Over expression of elastase is well documented as the main culprit that delays the normal wound repair process within chronic wounds. The aim of this thesis is to design a responsive chronic wound dressing based on the hydrogel polymer, PEGA (polyethylene glycol acrylamide) in the form of particles to mop-up excess elastase by exploiting polymer collapse in response to elastase hydrolytic activity within sample fluids mimicking the environment of chronic wounds. PEGA particles were functionalised with enzyme cleavable peptides (ECPs) containing charged residues. Upon cleavage the charge balance changes, causing polymer swelling and consequent elastase entrapment. The pH range of chronic wounds is reported in the range of 5.45 - 8.65. Due to its pI which is around 8.3, within this range elastase exist both in its cationic and anionic forms. To accommodate a hydrogel dressing that could selectively entrap excess elastase both in its cationic and anionic, oppositely charged ECPs were designed. In its cationic form, elastase was found to have a high preference of cleaving ECPs and penetrating into PEGA particles bearing negative charges. In contrast, in its anionic form the opposite effect was observed, wherein elastase preferred to cleave ECPs and penetrate PEGA particles bearing positive charges. The diffusion, accessibility and entrapment of elastase into functionalised PEGA particles was explored using various fluorescence microscopy techniques. Removal of the charged residue by elastase showed a reduction in particle swelling causing the pores of PEGA particles to become restricted. In this manner, cleaved PEGA particles prevented the accessibility of molecules with a molecular weight as low as 20 kDa into the cleaved PEGA particles. Since elastase has a molecular weight of 25.9 kDa the collapsing of the pores within PEGA particles entrapped elastase inside the interior of cleaved PEGA particles. In its cationic form (at pH 7.4) elastase was found to penetrate and become trapped more into both negative and positive PEGA particles compared to neutral particles. The negative particles were shown to trapped cationic elastase within 2 minutes compared to the positive particles. In contrast, the neutral particles failed to retain and encapsulate elastase as the fluorescence inside the neutral particles was found to decrease. Coinciding with these observations, after sample fluids containing elastase were treated with functionalised PEGA particles, the residual elastase activity in sample fluids was reduced more by the charged PEGA particles compared to neutral particles. The cell culture studies demonstrated that the elastase activity observed in human dermal fibroblasts (HDF) was also reduced more by the charged particles compared to the neutral particles. However, the positive particles were found to significantly reduced HDF-elastase activity compared to both the negative and neutral PEGA particles. Overall, this thesis exemplifies that on the basis of charge selective cleaving of ECPs coupled to PEGA particles can be exploited to selectively remove excess proteases such as elastase from sample fluids mimicking the environment of chronic wounds.

Orientador: Maria Aparecida Neves Jardini / Resumo: A estimulação elétrica (EE) tem sido usada no tratamento de lesões crônicas apresentando resultados favoráveis no fechamento da lesão cutânea entre outras aplicações clínicas. No entanto, a literatura carece de estudos avaliando se os efeitos da EE no fechamento da lesão oral. Diante disso, torna-se relevante investigar os efeitos da EE durante o processo de reparo da lesão oral em camundongos (Swiss). Métodos: Noventa animais foram divididos em grupos: Controle (C; n=45) que receberam a aplicação da EE com o aparelho desligado e Teste (EE; n=45) que receberam a EE (100 µA; 9 kHz; 660 mVpp; 1x/dia por 3 dias). Uma lesão de espessura total foi realizada com punch de biópsia de 1,5 mm de diâmetro. Os animais foram eutanasiados no 1o, 3o e 5o dia após a confecção da lesão. As amostras foram fixadas em paraformaldeído 4%, descalcificadas em ácido fórmico 20% e emblocadas em parafina. Os parâmetros avaliados foram: fechamento clínico da lesão; distância de reparação epitelial (DRE) e conjuntiva (DRC), concentração de citocinas IL-1β, IL-6, IL-8, IL-10, TNF-α e VEGF; porcentagem de fibras colágenas e quantificação das proteínas de sinalização Smad2. Resultados: A área de fechamento clínico foi reduzida no grupo EE no 5º dia de avaliação (p=0,01). As DRE e DRC do grupo EE apresentaram menor distância em todos os tempos avaliados (p<0,05) com reduzida concentração de IL-6, TNF-α, IL-10 e VEGF (p<0,05). Não houve diferença na porcentagem de fibras colágenas e na phospho-Smad2. Conclus... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Since Electrical Stimulation (ES) has used for chronic wounds treatment and other clinical applications showing favorable results in wound closure, it was hypothesized whether it could bring good results in oral wound closure. The aim was to investigate the ES effects during the oral wound healing process in mice (Swiss). Methods: Ninety animals were divided in groups: Control (C; n=45) which received a fictitious ES application, i.e. the ES applicance was shutted off and ES (ES; n=45) which received ES (100 µA; 9 kHz; 660 mVpp) once time a day for 3 days consecutively. A full thickness wound was done using a 1.5 mm diameter biopsy punch in the hard palate. The animals were euthanized on 1st, 3rd and 5th day post-wounding. The samples were fixed, decalcified and embedded in paraffin. The parameters evaluated were: clinical wound closure; distance of epithelial and connective wound edges (EWD and CWD); cytokines (IL-1β, IL-6, IL-8, IL-10), TNF-α and VEGF by multiplex, percentage of collagen fibers and Smad proteins. Results: Clinical wound closure area was reduced on day 5 in ES group (p = 0.01). Both EWD and CWD distance were shorter in all times (p < 0.05) with a reduction of inflammatory cytokines production (p < 0.05). There were no difference in collagen percentage and phospho-Smad2. Conclusion: ES had a positive effect on clinical and histomorphometric wound closure outcomes showing a modulation of inflammatory response in the beginning of wound healing. / Doutor

Baharestani M, Amjad I, Bookout K, Fleck T, Gabriel A, Kaufman D, McCord SS, Moores DC, Olutoye OO, Salazar JD, Song DH, Teich S, Gupta S. V.A.C. ® Therapy in the management of paediatric wounds: clinical review and experience. ABSTRACT Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure® (V.A.C.® Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.® Therapy System.

Bakgrund Honung har använts inom sårvård i tusentals år. Dock har den fallit i glömska i modern tid då sjukvården fick tillgång till antibiotika. Överutskrivning av antibiotika bidrar till att antibiotikaresistenta bakterier utvecklas. Nyare forskning visar att sårbehandling med honung uppfattas som lovande. Sjuksköterskor ansvarar för val av lämpliga förband vilket gör att sjuksköterskor behöver kontinuerlig utbildning för att kunna utföra en evidensbaserad praktik. Syfte Syftet med denna litteraturöversikt är att sammanställa forskningsbaserad kunskap om effekterna på sårläkning av medicinsk honung hos patienter med sår. Metod Litteraturöversikt bygd på tio vetenskapliga studier har genomförts som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Resultat Ett tema: God sårläkningsförmåga samt fyra huvudkategorier av effekter av medicinsk honung i sårläkningsprocessen: antimikrobiell effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet samt säkerhet har identifierats i denna studie. Slutsats Medicinsk honung har god sårläkningsförmåga tack vare sin antimikrobiella effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet för patienterna samt säker användning. Medicinsk honung kan användas på alla typer av sår i olika faser av sårläkningsprocessen. Medicinsk honung är säker att använda både för vuxna och barn. Sjuksköterskornas evidensbaserade praktik ger en möjlighet att bidra till minskningen av användandet av antibiotika genom att välja medicinsk honung i sårbehandlingen. / Background Honey has been used in wound care for thousands of years. However, in modern times it has been forgotten ever since antibiotics was introduced. Overprescription of antibiotics can lead to antibiotic resistant bacteria. New research shows promising results with medical honey in wound care. Registered nurses are responsible to choose an appropriate wound dressing, this stipulates the need for a nurse to continuously update their knowledge in wound care to be able to perform evidence-based practice. Aim The aim with this literature review is to compile research-based knowledge about the effect on wound healing medical honey can provide on patents with wound. Method This literature review based on ten studies has been conducted as a structured literature review with elements of a systematic review. Results One theme: good wound healing ability and four head categories of effects of medical honey in wound healing process: antimicrobial effect, support of wound healing process, improved quality of life and security has been identified in this study. Conclusions Medical honey has good wound healing ability because of its antimicrobial effect, support of wound healing process, improved quality of life and safe for patients to use. Medical honey can be used on all types of wounds in different phases of the wound healing process. Medical honey is safe to use both for adults and for children. Nurses evidenced based practice give an opportunity to contribute to reduce the utilization of antibiotics by choosing medical grade honey in wound care.

Background: The economic, social and clinical negative effects of hard- to- heal wounds continue to increase. Antimicrobial resistance is also increasing and is today a public health problem in the world. Wound infection should primarily be treated with local treatment based on a structured approach. Aim: The purpose of the study was to describe the district nurse's experiences and knowledge of wound treatment for preventive measures and treatment to counteract and eliminate wound infection. Method: A qualitative interview study with an inductive approach and strategic selection. Twelve district nurses from different parts of Sweden participated. Results: By using antimicrobial dressings, antibiotics could be avoided in many cases for treatment of local wound infection. The wound treatment was based on a holistic approach with continuity and a pursuit of cross-professional collaboration. It was expressed that continuous training in wound treatment is required for optimal wound treatment to be carried out. Conclusion: The district nurse has the ultimate responsibility for wound treatment and has extensive knowledge of how to use preventive care against wound infection. This led to a reduction in the use of antibiotics, which is an important step in preventing further development of antimicrobial resistance. However, continued education and research in this area is required. / Bakgrund: De ekonomiska, sociala samt kliniska negativa effekterna av ett svårläkt sår fortsätter att öka och så även antimikrobiell resistens, som idag klassas som ett folkhälsoproblem i världen. Sårinfektion bör i första hand behandlas med lokal behandling utifrån ett strukturerat förhållningssätt. Syfte: Studiens syfte var att beskriva distriktssköterskans erfarenheter och kunskaper kring sårbehandling och preventiva åtgärder för att motverka och häva sårinfektion. Metod: En kvalitativ intervjustudie med induktiv ansats och strategiskt urval. Tolv distriktssköterskor från olika delar av Sverige deltog.  Resultat: Genom användning av antimikrobiella förband kunde antibiotika i många fall undvikas som behandling vid lokal sårinfektion. Sårbehandlingen utgick från ett holistiskt synsätt med kontinuitet och en strävan efter ett tvärprofessionellt samarbete. Det uttrycktes att det krävs fortlöpande utbildning inom området för att optimal sårbehandling ska kunna bedrivas. Konklusion: Distriktssköterskan har det yttersta ansvaret för sårbehandling och har stor kunskap kring hur preventivt arbete mot sårinfektion kunde genomföras. Det medförde att användning av antibiotika minskade vilket är ett viktigt steg i att förhindra fortsatt utveckling av antimikrobiell resistens. Det krävs dock fortsatt utbildning och forskning inom det här området.

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