Basic theoretical bases As a chronic wound is called a secondarily healing wound which despite adequate therapy does not tend to heal for a period of 6-9 weeks. The cause of the chronic wound occurrence and its transformation into an acute wound can be infection, influence of associated diseases, skin top layer microtraumatization or skin necrosis cavity. Among the most frequent types of chronic wounds there are aligned venous ulcerations, arterial rodent ulcers, decubitus ulcers and neuropathic rodent ulcers as a consequence of diabetes mellitus disease. Knowledge about wound healing has been deepened considerably in the last few years. The pharmaceutical industry introduces to the market continuously new means of phase wound healing and owing to new trends the classical treatment has nearly disappeared. Essay targets 1.To monitor nurse knowledge about new trends in chronic wound healing. 2.To determine what means of draping and bandaging materials are used in chronic wound treatment in practice and what means appear to be the most effective. 3.To find out if in practical terms there are conditions for nurses to use new trends in chronic wound healing and what constraints they meet in their endeavour to apply these trends. 4.To learn if patients with a non-healing wound are informed about new trends in chronic wound healing. 5.To learn if new trends in chronic wound healing are available for affected patients and in what extent they are used by them. 6.To determine if new trends in chronic wound healing improve life quality of patients with chronic wounds. Used methods The empirical part of the diploma work was processed with a tool of qualitative research inquiry. For data acquisition I chose the technique of semi-structured interview with respondents. For research inquiry I selected two groups of respondents. The first group of respondents was comprised of 10 nurses employed in Nemocnice České Budějovice, a.s. and in the other group there were 5 patients hospitalized in this facility. The interview findings were analysed and divided into categories. For clear arrangement there were created schemes to individual categories in XMind programme. The schemes are supplied with commentary and several quotations of the respondents. Findings From interview analyses it is clear that there is a certain influence of individuality. In the first part there is monitored nurse knowledge about modern trends in chronic wound healing. The conclusion of the research is that in all sections where interviewed nurses work chronic wounds are treated by the way of wet (phase) healing. I also found out that there are several therapeutic and draping materials suitable for all phases of chronic wound healing. There are also described a few practical problems which make effective care about chronic wounds difficult. In the second part there are mentioned particular defects in patient acquaintance with modern methods in wound healing and insufficient education by medical staff. There are also described all problems which deteriorate life quality of patients with chronic wounds. Conclusion The chronic wound healing methods have changed completely in the last few years. Pharmaceutical firms introduce to the market a lot of new materials facilitating very effective and comfortable care about wounds. However, this fact requires continuous education of medical staff participating in the chronic wound treatment. This brings positive results and finally decreases economic costs of care about patients with chronic wounds.

This thesis is about two different theoretical interpretations of objects and object-orientation in design of health care information systems – the interpretations of Activity Theory/Developmental Work Research and Computer Science respectively. One motive to my interest in objects of work and software, is to better understand the problems and possibilities in an inter¬dis¬ciplinary research project. With an origin in 2001, a Wound Care Project began as a joint R & D endeavour with the initial idea of utili¬zing digital photos. Soon, an information system (“Hedvig”) was developed for the purpose of managing digital photos and related treatment records on wounds. Later, this work expanded in creation of a distributed information system (“Helar”), a digital prototype for support of wound care treatment. Eventually, the thesis is summing up reflections related to the object concepts. AT/DWR has its strength in analysis and design of required change in a work practice but is still weak in method and techniques for support of making specific computa¬tional systems. In a way this shortcoming is thought of to be balanced by the technological CS discipline of which one of its main forces is to develop theory and practice for construction of computational information systems. This thesis suggest, in the inter¬dis¬ciplinary field of Health Care Information Systems Design, a further developed object con¬cept, and related scenarios and use cases, as a way of taking advantage of a combination of those two different strengths. / Avhandlingen handlar om två olika teoretiska tolkningar av objekt och objektorientering i design av informationssystem för hälso- och omvårdnadsarbete - tolkningar utifrån verksamhetsteori/utvecklande arbetsforskning (activity theory/developmental work research: AT/DWR) å ena sidan och datavetenskap (computer science: CS) å den andra. Ett motiv för mitt intresse för objekt i arbete och i programvara, är att bättre förstå problem och möjligheter i ett tvärvetenskapligt forskningsprojekt. Med en början i 2001, startade ett sårvårdsprojekt som ett forsknings- och utvecklingsarbete med den initiala idén att nyttja digitala foton, och snart utvecklades ett informationssystem ("Hedvig") för syftet att hantera digitala foton och annan relaterad behandlingsdokumentation för sårvård. Senare expanderade detta arbetet i skapandet av ett distribuerat informationssystem ("Helar"), en digital prototyp för stöd av sårbehandlingsarbete. Denna avhandling summerar reflektioner relaterade till objektbegreppen. AT/DWR har sin styrka i analys och design av efterfrågad förändring av en arbetspraktik, men är fortfarande svag i metod och tekniker för att stödja skapandet av specifika datorsystem. På ett sätt är det här tillkortakommandet tänkt att balanseras av den teknologiskt datavetenskapliga disciplinen, där en av dess främsta drivkrafter är att utveckla teori och praktik för konstruktion av datoriserade informationssystem. I det tvärvetenskapliga fältet av design av informationssystem för hälso- och omvårdnadsarbete, föreslår denna avhandling fortsatt utveckling av objektkoncepten, och utveckling av de relaterade "scenarios" och "use cases", som ett sätt att dra fördel av en kombination av dessa två olika förtjänster, som de olika disciplinerna står för. objekt, objektorientering, sårvård, digitala foton, verksamhetsteori, datavetenskap, informationssystem

Bakgrund: Äldres behov av vård kommer att öka med en åldrande befolkning och fler kommer att drabbas av svårläkta sår. För att möta det stigande vårdbehovet behövs digitala verktyg vid sårbehandling, som kan bidra till trygghet, tillgänglighet och att vårdens resurser används effektivt. Specialistsjuksköterskor har ett utökat ansvar vid utveckling och implementering av digitala verktyg. Genom digitala verktyg ska vård ges utifrån individens behov men det är en utmaning att utveckla verktyg som är personcentrerade. Idag finns det verksamheter i Sverige som arbetar med sårbehandling via appen OneWound. Syfte: Att undersöka sjuksköterskors erfarenheter av appen OneWound vid sårbehandling. Metod: Kvalitativ intervjustudie med induktiv ansats som analyserades med kvalitativ innehållsanalys, vilket mynnade ut i tre kategorier och åtta subkategorier. Resultat: Sjuksköterskorna utvecklades i sin profession genom teoretisk kunskap och användning av OneWound. Sjuksköterskorna kunde möta hinder vid implementering, vilket påverkade användningen. Påverkningsfaktorer beskrevs som personliga egenskaper, tekniska problem och brist på rutiner i verksamheten. Genom användning av OneWound med möjlighet till konsultation av sårexperter upplevde sjuksköterskorna trygghet, arbetsglädje och stöd viaappens funktioner samt vinster på individ- och samhällsnivå som bidrog till hållbar vård och en känsla av att erbjuda en vård av hög kvalité. Slutsats: OneWound tillfredsställde sjuksköterskornas behov av ny kunskap, struktur, och stöd vid sårbehandling. Utifrån ett omvårdnadsperspektiv ger studiens resultat en inblick i de utmaningar som finns vid sårbehandling och de positiva effekter som OneWound bidrar till. Forskning behövs för att utforska patientperspektivet samt hur OneWound erfars i förhållande till traditionell specialistkontakt vid svårläkta sår. / Background: The elderly’s need for care will increase with an aging population and more will suffer from wounds that are hard-to-heal. To meet the rising need for care, digital tools are needed in wound care, which can contribute to safety, accessibility and efficient use of care resources. Specialist nurses have an increased responsibility for the development and implementation of digital tools. Through digital tools, care must be provided based on the individual’s needs. However, it is a challenge to develop tools that are person-centered. Today, there are healthcare providers in Sweden that work with wound care via the OneWound app. Aim: To investigate nurses’ experiences of the OneWound app in wound care. Method: Qualitative interview study with an inductive approach that was analyzed with qualitative content analysis, which resulted in three categories and eight subcategories. Results: The nurses developed in their profession through theoretical knowledge and use of the OneWound app. The nurses faced obstacles during implementation. Impact factors were described as personal characteristics, technical problems and lack of routines. Through the use of OneWound with the possibility to consult wound experts, nurses felt safe, experienced job satisfaction and support through the app's functions as well as gains at the individual and community level that contributed to sustainable care and a sense of offering high quality care.  Conclusion: OneWound satisfied the nurses' need for new knowledge, structure, and support in wound treatment. From a nursing perspective, the results of the study provide an insight into the challenges that exist in wound treatment and the positive effects that the OneWound app contributes to. Further research is needed to explore the patient perspective and how OneWound is experienced in relation to traditional specialist contact when facing hard-to-heal wounds.

Bakgrund: De nationella riktlinjerna i Vårdhandboken anger att sårbehandling är sjuksköterskans ansvarsområde, trots att undersköterskor oftast sköter uppgiften. Det finns inget hinder i lagstiftningen att sårbehandlingen överlåts på undersköterskan, förutsatt att vården är patientsäker. Forskning visar att sjuksköterskor ofta känner sig osäkra gällande sårbehandlingar, men forskning om undersköterskors erfarenheter saknas. Syftet: Att beskriva sjuksköterskors och undersköterskors erfarenheter av att vårda patienter med svårläkta sår på vårdavdelningar. Metod: Semistrukturerade intervjuer med sju sjuksköterskor och åtta undersköterskor analyserades med manifest kvalitativ innehållsanalys med induktiv ansats. Resultat: Deltagarna beskrev att undersköterskor vanligen utför såromläggningar och att sjuksköterskor i varierande utsträckning försöker följa behandlingen, men att tidspress utgjorde ett hinder för sjuksköterskornas önskan om att vara mer delaktiga. Det framkom att sårbehandling är en komplex uppgift, för vilken de flesta ansåg att de inte hade tillräcklig kompetens. Stöd hämtades från erfarna kollegor och teamet runt patienten som bland annat bestod av sårexperter från Sårcentrum. Slutsats: Vårdgivaren behöver inse att komplexiteten i vården av patienter med svårläkta sår utmanar målet om god och säker vård. Därför krävs personal väl förberedd för uppgiften, både genom en god teoretisk grund och omfattande klinisk erfarenhet av sårbehandlingar – som ges den tid som faktiskt behövs. / Background: The National guidelines stipulate that wound care is the registered nurse's area of ​​responsibility, but usually assistant nurses perform the task. There is no hinder in legislation to entrust the task to assistant nurses, provided the care remains safe. Research shows that nurses often feel uncertain about wound care, but research on assistant nurses' experiences is lacking. The purpose: To describe registered nurses 'and assistant nurses' experiences of caring for patients with difficult-to-heal wounds in care units. Method: Semi-structured interviews with seven registered nurses and eight assistant nurses were analyzed with manifest qualitative content analysis with inductive approach. Results: Participants described that assistant nurses usually perform the wound care and that registered nurses try to follow the treatment to varying degrees, but that the time pressure constituted an obstacle to nurses' desire to be more involved. The result showed that wound care is a complex task, for which many felt they lacked sufficient competence. Support was obtained from experienced colleagues and the team around the patient, which consisted of wound specialists from the Wound Center. Conclusion: The caregiver needs to realize that the complexity of caring for patients with hard-to-heal-wounds is a challenge to patient safety and hence requires competent staff who are well prepared for the task, both through a theoretical basis and frequent practice of wound care that is granted the time actually required.

The increasing spread of antibiotic resistance among bacteria poses a major threat to the public health. There is an urge for the development of innovative formulations of existing and new antibiotics. One area of interest is in wound care, where two interesting antimicrobials are the conventional antibiotic amoxicillin and the antimicrobial peptide AP114. The objective of this work was to systemically evaluate topical gel formulations of these APIs by following a Quality by Design approach. A short excipient compatibility study was performed and the thickening agents poloxamer 407 and HPMC were chosen to be included in the following Design of Experiment (DoE) study of formulation composition and storage climate. The DoE set up was generated by the software MODDE Pro® and a short stability study of four weeks was performed, including analysis of the apparent pH, rheology stability, appearance, BCA assay, UV-Vis and FTIR spectroscopy and Franz cell diffusion. The results showed that AP114 formulations stored at 2-8˚C with poloxamer 407 should be with buffer pH 5-6 and 5-15 wt% organic phase to maximize stability, while HPMC based AP114 gels should be with buffer pH 6-8 and 10-40 wt% organic phase. Poloxamer 407 was not preferrable for amoxicillin formulations. The optimal HPMC based amoxicillin formulations included the storage temperature 25˚C, a buffer pH 7-8 and 40-60 wt% organic phase. HPMC based amoxicillin gels stored at 2-8˚C should be composed with buffer pH 6-8 and 10-40 wt% organic phase.

Bakgrund: Exakt siffra på hur många personer som lider av svårläkta sår i Sverige saknas fortfarande. Äldre och multisjuka personer med komplexa vårdbehov drabbas i större utsträckning. Svårläkta sår inverkar negativt på personens livskvalité och leder till ett ökat lidande. Genom att studera specialistsjuksköterskors erfarenhet av att vårda äldre personer med svårläkta sår inom hemsjukvården kan sårbehandlingen optimeras. Syfte: Syfte var att beskriva specialistsjuksköterskors erfarenheter av att vårda äldre personer med svårläkta sår inom hemsjukvården. Metod: En kvalitativ, semistrukturerad intervjustudie med elva specialistsjuksköterskor inom hemsjukvården i södra Sverige. Resultat: Efter analysen framkom kategorien - Organisations betydelse för sårbehandling med underkategorier: Samarbete med primär- och slutenvården; Kontinuitetens betydelse; Att samverka i teamet; kategorien - Bristande kompetens och kunskap hos hälso- och sjukvårdspersonal med underkategorier: Behov av utbildning till omvårdnadspersonal; Specialistsjuksköterskans strävan efter mer kunskap; kategorien - Personcentrerat förhållningssätt i hemsjukvården med underkategorier med underkategorier: Sårvård på patientens villkor; Sårvård i personens hem. Slutsats: Sårbehandling i hemsjukvården framställs som utmanade och komplex. Trots alla utmaningar visade specialistsjuksköterskor respekt för patienterna och fann lösningar i hemmet för att kunna utföra sårvården på ett patientsäkert sätt och tillgodose patientens behov. En personcentrerad vård tillämpades i möte med patienterna. Specialistsjuksköterskor upplevde bristfällig organisation, saknad av kompetens, kunskap och kontinuitet hos hälso-sjukvårdspersonal. En ny strategi behövs för att personer med svårläkta sår ska få jämlik sårvård, särskilt när antalet multisjuka äldre personer ökar. Implementering av det nya nationella vårdprogrammet för svårläkta sår kan vara en ny lösning och metod för att hantera de utmaningar och brister som identifierats i denna studie. Ytterligare forskning behövs för att undersöka hur utmaningarna inom hemsjukvården kan hanteras på ett effektivt sätt. / Background: The exact number of people suffering from chronic wounds in Sweden is still unknown. Older and multi-ill individuals with complex care needs are more affected. Chronic wounds negatively affect the person's quality of life and lead to increased suffering. Studying specialized nurses' experiences of caring for elderly persons with chronic wounds in home healthcare can optimize wound treatment. Aim: The aim was to describe specialized nurses' experiences of caring for elderly persons with chronic wounds in home healthcare. Methods: A qualitative, semi-structured interview study was conducted with eleven specialized nurses in home care service in South of Sweden. Results: After the analysis, the category were identified - The importance of organizational structure for wound treatment with subcategories: Collaboration with primary and hospital care; The importance of continuity; Working in a team; the category - Lack of competence and knowledge among healthcare personnel with subcategories: The need for education of nursing personnel; Specialized nurses' pursuit of more knowledge; the category - Person-centered approach in home healthcare, with subcategories: Wound care according to the patient's wishes; Wound care in the person’s home. Conclusion: Treatment of wounds in home healthcare is portrayed as challenging and complex. Despite all the challenges, specialized nurses showed respect for patients and found solutions in the home setting to perform wound care in a patient safety care and meet patient needs. Person-centered care was applied in interactions with patients. Specialist nurses experienced inadequate organization, lack of competence, knowledge, and continuity among healthcare personnel. A new strategy is needed to ensure equal wound care for people with hard-to-heal wounds, especially as the number of elderly people with multiple illnesses increases. Implementation of the new national care program for hard-to-heal wounds may be a new solution and method for addressing the challenges and shortcomings identified in this study. Further research is needed to investigate how the challenges within home healthcare can be effectively addressed.

A comprehensive background is herein presented for lumbar skin strain and its effect on skin adhered wearable (SAW) products. A background of the development of computational models of the interaction of skin and novel SAWs being researched is also presented. These include products involving the use of high deflection strain gauges to measure skin strain during functional movements (FMs) as a method to address the complicated phenotyping of the etiological causes of low back pain (LBP). The background concludes with the mathematical calculation of the principal skin strain magnitudes and orientations using retroreflective marker coordinate data in a motion capture lab setting and the potential role of principal skin strain on the post-operative management of wounds to accelerate healing and minimize infection and scarring. The mechanics response of lumbar skin among 30 participants was measured during various FMs, for which high strain movements (Flexion, Flexion right/left, Sit To Stand) exhibited principal strain magnitudes repeatedly above 50% while others (Rotation right/left, Lateral Bending right/left, Extension, and Extension right/left) exhibited magnitudes repeatedly below 50%. Principal strain orientation was presented in easily visualizable mappings that demonstrated minimal variability both within and between participants for a given FM. Principal strain rates were measured, ranging between 25% and 151% per second among movements. The mechanics response of lumbar skin was again measured for a single participant, albeit this time between bare skin and skin with a SAW; which in this example was kinesiology tape with a high deflection nanocomposite strain gauge. Results indicated very significant skin restriction during Flexion, for which a macroscopic skin strain of 65% was reduced to 22% because of the KT tape and additionally down to 13% because of the addition of the sensor (on top of the KT tape). A FEM was created based off this scenario, for which it was shown that the mechanical properties of skin in vitro are insufficient in representing the mechanical response of skin due to its stiffness. This was hypothesized to be due to the increased hydration (lower stiffness) of in vivo skin, for which high deformation stiffness in the literature is not available. The thesis is concluded with future research directions that would benefit the design of SAWs where high deformation is considered. Future research directions are also discussed regarding post-operative wound healing and the potential role of repeated skin strains, such as concerning scarring and infection.

No / Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.

Une meilleure utilisation des ressources infirmières représente une avenue prometteuse dans l’amélioration de la performance des services de première ligne. La mesure de la performance des services infirmiers constitue une composante centrale à l’amélioration de leur organisation et à la qualité des soins dispensés dans ce secteur d’activités. Le but de cette recherche était de mesurer et de valider des indicateurs de performance des services infirmiers en première ligne à partir d’un cas traceur en soins de plaies ainsi que d’évaluer la fiabilité des données clinico-administratives utilisées pour mesurer les indicateurs à partir des dossiers cliniques. Cette étude a adopté un devis longitudinal corrélationnel. Les données ont été collectées sur une période d’une année dans un service de soins courants d’un Centre local de services communautaires (CLSC) à partir de données clinico-administratives contenues dans le système informatique I-CLSC. L’épisode de soins constituait l’unité d’analyse. Huit indicateurs ont été mesurés, dont cinq indicateurs de processus : 1) le suivi infirmier; 2) la continuité relationnelle; 3) l’enseignement; 4) l’évaluation initiale; et 5) la rencontre avec une infirmière spécialisée en soins de plaies, et trois indicateurs de résultats : 1) la fréquence; 2) la durée; et 3) l’intensité du suivi. Les objectifs de mesure et de validation ont été réalisés à partir d’un échantillon de 482 épisodes de soins de plaies d’une durée supérieure à sept jours. L’étude de fiabilité a été réalisée à partir d’un sous-échantillon de 107 épisodes. Des analyses descriptives et corrélationnelles ont été réalisées. Les résultats de validation ont démontré des associations fortes statistiquement significatives entre les indicateurs de suivi infirmier et de continuité et les trois indicateurs de résultats. Les résultats de fiabilité ont démontré un haut taux de concordance entre les données contenues dans les dossiers cliniques et les données clinico-administratives pour six des huit indicateurs à l’étude. En conclusion, des indicateurs de processus valides et pertinents dans la pratique infirmière de première ligne peuvent être mesurés de façon régulière par les gestionnaires à partir de données clinico-administratives fiables et facilement accessibles. / Better use of nursing resources is a promising avenue for improving the performance of primary care services. Measuring the performance of nursing services is a central component in improving their organization and the quality of care delivered in this sector. The aim of this study was to measure and validate primary care nursing performance indicators from a tracer case in wound care and to assess the reliability of clinical-administrative data used to measure indicators from clinical records. This study adopted a correlational longitudinal design. Data were collected over a one-year period in a Local community services centre (CLSC) using clinical-administrative data contained in the I-CLSC electronic database. The episode of care was the unit of analysis. Eight indicators were measured, including five process indicators: 1) nursing follow-up; 2) relational continuity; 3) teaching; 4) initial assessment; and 5) consultation with a specialized nurse, and three outcome indicators: 1) frequency; 2) duration; and 3) intensity. Measurement and validation objectives were performed using a sample of 482 episodes of wound care lasting more than seven days. The reliability study was based on a sub-sample of 107 episodes. Descriptive and correlational analyzes were performed. Validation results demonstrated very strong associations between nursing follow-up and continuity indicators and the three outcome indicators. Reliability results demonstrated a high concordance between clinical records and clinical-administrative data for six of the eight indicators. In conclusion, valid and relevant process indicators in primary care nursing can be measured on a regular basis by managers using reliable and easily accessible clinical-administrative data.