Abstrakt Utifrån en hermeneutisk ansats har en enkät följd av djupgående intervjuer utförts i syfte att ge kunskap och förståelse för det omlärande en amputerad genomgår. Studien har även riktats mot upplevelse av omlärande i samband med spegelterapi och digital terapi för att ytterligare belysa de amputerades upplevelser av dessa terapier. Då digital terapi än så länge är en ny terapiform som endast testats på en patient har uppfattningarna om denna metod varit begränsade. De djupgående intervjuerna har i urvalet begränsats till amputerade till följd av ett trauma. Det omlärande de amputerade upplevt har tolkats utifrån en helhetsfokuserad lärandeteori för att belysa vidden av lärande för den traumatiskt amputerade personen. Omlärandet har berört både samspelsprocessen och tillägnelseprocessen och lärandeteorins samtliga tre dimensioner. Dessutom har de amputerade upplevt att deras identitet har påverkats till följd av den traumatiska amputationen. De intervjuade upplever dessutom att deras traumatiska amputation har medfört psykologiska påfrestningar som liknar dem vid psykiskt utmattningssymptom. Det är därför av betydelse att mer forskning görs inom detta fenomen för att på så sätt ge amputerade det stöd de behöver för en bra återhämtning. Abstract Based on a hermeneutical approach a questionnaire followed by in-depth interviews was conducted in order to provide knowledge and understanding of the relearning an amputee undergoes. This study was also directed to experienced relearning in connection with mirror therapy and digital therapy to further illustrate the amputee's experiences of these therapies. When digital therapy so far is a new form of therapy that has only been tested on one patient, perceptions of this method have been limited. For the in-depth interviews the selection was limited to amputees as a result of a trauma. The relearning the amputees experienced was interpreted on the basis of a whole-focused learning theory to illustrate the breadth of learning for the traumatic amputee. The relearning has involved both the interaction process and the appropriation process and all three dimensions of the learning theory. In addition, the interviewed felt that their identity has been affected as a result of the traumatic amputation. The interviewed also experienced that their traumatic amputation has led to psychological stresses similar to those of mental fatigue symptoms. It is therefore important that more research is done in this phenomenon so as to give amputees the support they need for a good recovery. / therese_liden@hotmail.com

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 5 uppsatser.

Tierärztl. Hochsch., Diss., 2004--Hannover.

Bakgrund: Årligen amputeras cirka 3000 personer i Sverige på nedre extremiteter. Orsaken till amputation är till största delen (90 %) dålig blodcirkulation men kan även bero på sepsis eller olycksfall. Sedan 1950 talet har antalet amputationer femdubblats då fler personer drabbats av diabetes, befolkningen har ökat och fler personer röker. Efter en amputation kan en persons existens förändras. Genom att utgå från personens egna tankar kan få sjuksköterskan veta hur personen upplever livet efter en amputation. Syfte: Syftet med studien var att beskriva personers upplevelser av livet efter en amputation Metod: Metoden var en innehållsanalys av narrativa texter i form av bloggar. Texterna analyserades utifrån Lundman och Graneheims beskrivning av innehållsanalys med manifest ansats. Resultat: Utifrån analysen framkom tre kategorier. Ur kategorin Förändrad hälsa framkom det att personerna upplevde smärtproblematik och drabbades av psykiskt lidande i efterförloppet. Förändringar i vardagen beskriver hur personerna kan uppleva ett beroende av stöd och hjälp från andra. Personer kan uppleva rädsla för hur andra ska reagera på deras utseende. Ur kategorin Förändrad syn på livet saknade personerna sitt tidigare liv och kropp men de kunde också uppleva förbättrat välbefinnande efter amputationen. Slutsats: Upplevelsen av livet efter en amputation skiljde sig åt beroende på om denna var planerad eller utfördes akut. Varje person har en unik upplevelse utifrån hans/hennes erfarenheter. För att sjuksköterskan ska kunna ge en god vård behövs mer kunskap om hur personer upplever livet efter en amputation.

Masters of Science - Msc (Physiotherapy) / Vocational rehabilitation relates to rehabilitating a person with an amputation back into actively participating in society. Although vocational rehabilitation is important, before it can be implemented, the participation restrictions should be identified. Even though lower limb amputation surgery is commonly performed in South Africa, and given the high unemployment rate in the country, no research has been done into the participation restrictions and vocational needs of a person with a unilateral lower limb amputation in the Western Cape. The aim of this study was to determine and explore the participation restrictions and vocational rehabilitation needs in terms of hobbies, sport activities, employment and employment needs of persons with a unilateral lower limb amputation (LLA) in the Western Cape. The objectives were to: 1) Determine the participation restrictions of persons with a unilateral LLA in the Western Cape. 2) To explore the vocational rehabilitation needs of persons with a lower limb amputation. A mixed methods approach, and an explanatory sequential design was used in this study. The study was conducted in two phases. The first phase utilised a quantitative approach and the WHODAS 2.0 was used as the instrument to collect data. The second phase aimed to explain the data collected in the first phase in more depth, and semi-structured telephonic interviews were utilized to collect the qualitative data. The study was set in the Cape Metropole region of the Western Cape. Participants were recruited from Tygerberg Tertiary Hospital and a private sub-acute rehabilitation centre. In the quantitative (first) phase of the study, 50 participants were conveniently recruited to participate. In the second phase eight participants were purposefully selected from the pool of 50 participants from the first phase of the study who consented to participate in the second phase. Quantitative data was analysed using SPSS vs. 22 and analysed for descriptive and inferential statistics. Qualitative data has been analysed using Creswell's seven step process of thematic analysis. Ethical clearance has been obtained from the University of the Western Cape, permission to access patients' details has been obtained from Tygerberg Tertiary Hospital and private sub-acute rehabilitation centre. Written informed consent as well as permission for audio recording during the telephonic interview was obtained.

O presente estudo aborda a amputação desde o momento em que passa a fazer parte das inquietações da autora, integrando seu mundo-vida, por meio de interrogações relativas à questão da amputação, suas implicações e sentimentos experimentados pela pessoa que a vivencia. Constitui-se numa investigação de caráter qualitativo, desenvolvida à luz do referencial teórico-metodológico da fenomenologia e que busca compreender, então, a vivência de uma amputação, a partir da visão da pessoa que a experiencia. Inicialmente, a fim de compreender o fenômeno que se mostra diante de meus olhos, pedindo um aclaramento, realizei um levantamento bibliográfico, o que me possibilitou conhecer a amputação sob vários enfoques, além de permitir a apropriação de algumas idéias do pensamento filosófico de Merleau-Ponty, abordando a percepção, o corpo que percebe e é percebido, na sua relação com o mundo, e o enraizamento do espírito neste corpo. Após conhecer a amputação, sob o ponto de vista literário, busquei o seu compartilhar com a pessoa a ela submetida, habitando seu mundo. Compartilhando desse momento, pude compreender seu sentido e seus significados, expressando-os sob a forma de categorias temáticas. Desta forma, foi possível desvelar algumas facetas do fenômeno amputação, além de compreender a pessoa amputada e a amputação tal como ela se mostra em si mesma. / This study addresses amputation as from the moment when it became part of the author’s concerns, integrating her world and her life, through inquiries concerning the issue of amputation, its implications and the feelings of those who experience it. It is a qualitative investigation, conducted in the light of the theoretical and methodological framework of phenomenology. Thus, its aim is to understand the experience of amputation from the viewpoint of the amputee. Initially, in order to understand the phenomenon that stands before my eyes and calls for clarification, I conducted bibliographic research, which enabled me to understand amputation better and from several points of view, as well as allowing me to appropriate some of the ideas contained in Merleau-Ponty’s philosophic thoughts, in which perception, the perceiving and perceived body, is addressed in regard to its relation with the world and the deep-rooted position of the spirit in this body. After becoming acquainted with amputation from the literary point of view, I sought to share it with an amputee, inhabiting this person’s world. By sharing this moment, I was able to understand its significance and meanings, expressing them in the form of thematic categories. Thus, it was possible to reveal some of the facets of the amputation phenomenon, besides understanding the amputee and amputation such as it reveals itself.

Die akute Extremitätenischämie ist ein klinischer Notfall, der in Abhängigkeit der Dauer und der Ausprägung klinischer Symptome interventionell und chirurgisch behandelt werden kann. Ziel dieser Studie war es, den klinischen und technischen Erfolg der primären interventionellen Therapie der akuten Extremitätenischämie zu untersuchen und die Bedeutung der Anwendung und Kombination primär nicht-thrombolytischer Verfahren zu eruieren. Als zusätzliche Zielparameter wurden die Mortalitätsrate, die Komplikationsrate, das amputationsfreie Überleben sowie das reischämiefreie Intervall evaluiert. Im Rahmen unserer Studie wurden 165 Patienten (89 männlich: 53,9%, 76 weiblich: 46,1%, Altersmittelwert: 77,5 Jahre, STABW ± 13,1 Jahre) und 167 Extremitäten (links n = 84, rechts n = 83) retrospektiv untersucht. Während der stationären Aufnahme wurden das Verschlussalter ermittelt (perakut bis chronisch), die Art des Verschlusses (komplett vs. inkomplett), die Lokalisation und Genese des Verschlusses sowie die Risikofaktoren der Patienten. Der technische Erfolg wurde radiologisch mithilfe des TIMI-Scores erhoben, der klinische Erfolg wurde während des stationären Aufenthalts und im Rahmen des Follow-ups beurteilt. Die Mehrheit der Verschlüsse (60,5 %, n = 101) war weniger als 7 Tage alt und präsentierte sich klinisch als eine inkomplette Ischämie (n = 147, 88%). Die Okklusion reichte in 63,5 % nicht über das POP II Segment hinaus. Ursächlich war bei n = 107 der 167 Extremitäten (64,1 %) ein „akut auf chronischer“ Verschluss bei vorbestehender pAVK, in n = 41 Fällen eine Thrombembolie (24,6 %) und in n = 19 Extremitäten eine arterielle Thrombose (11,4 %). Bei allen behandelten Extremitäten handelte es sich um einen primären Eingriff, der mittels perkutaner mechanischer Rotationsthrombektomie durchgeführt wurde. Dieser wurde bei n = 152 Verschlüssen (91 %) mit anderen (nicht thrombolytischen) interventionellen Verfahren kombiniert. Dabei wurden n = 66 Verschlüsse (39,5 %) mit einer mehrfachen Kombination aus PTA, Stent und/oder konventioneller PAT behandelt. Bei weiteren n = 43 Interventionen (25,7 %) reichte eine alleinige zusätzliche Stentimplantation aus, bzw. bei n = 33 Okklusionen (19,8 %) eine alleinige zusätzliche PTA. Lediglich in n = 15 Fällen (9 %) wurde die PMT ohne additive endovaskuläre Verfahren durchgeführt. Wir konnten in 92,2 % der Fälle (n = 154 Eingriffen) einen primären technischen und auch klinischen Erfolg beobachten. Insgesamt lag die reischämie-/reinterventionsfreie Rate nach 30 Tagen bei 86,2 %. Die reischämie-/reinterventionsfreie Rate betrug nach 6, 12, 24 und 36 Monaten jeweils 75,6%, 69,7%, 67,1% und respektive 64,4%. Die Amputationsrate betrug nach 30 Tagen 6,3 %, nach 6 Monaten 9 % und nach einem Jahr 11,2 %. Insgesamt verstarben n = 76 von den initial 165 Patienten (46,1 %) innerhalb des Nachbeobachtungs-zeitraums von 31,8 Monaten (STABW ± 24 Monate). Nach 30 Tagen lag das Gesamtüberleben bei 91 %, nach 6 Monaten bei 83,8 % und nach einem Jahr bei 77,2 %. Drei Patienten verstarben innerhalb der ersten 24 Stunden nach dem Eingriff, was entweder auf die Intervention oder die Kontrastmittel- und Volumenbelastung zurückzuführen war und als F-Komplikation zu werten ist. In 4,2 % der Fälle (n = 7) konnte die akute Extremitätenischämie nicht suffizient endovaskulär behandelt werden. Bei n = 6 Eingriffen (3,6 %) kam es zu Minorkomplikationen und in n = 8 weiteren Fällen zu Majorkomplikationen. Darunter waren die häufigsten Komplikationen das Kompartmentsyndrom (n = 4, 2,4 %) und die distale Embolisation (n = 4, 2,4 %) ohne anschließende Möglichkeit der erfolgreichen Thrombusbergung. Alle anderen n = 146 Eingriffe (87,4 %) verliefen komplikationslos. / Purpose: To evaluate the role of adjunctive, solely non-thrombolytic endovascular therapy in treatment of acute lower-extremity ischemia by rotational percutaneous mechanical thrombectomy. Methods: Retrospective, single center evaluation of 165 patients (167 limbs) that underwent rotational percutaneous mechanical thrombectomy between 2009 and 2016. Results: Rotational percutaneous mechanical thrombectomy was used as a single therapy in 9.0% (15 limbs), followed by percutaneous aspiration thrombectomy in 6.0% (10 limbs), percutaneous transluminal angioplasty in 19.8% (33 limbs) and stenting in 25.7% (43 limbs). Rotational percutaneous mechanical thrombectomy was followed by any combination of these 3 interventions in 39.5%. Clinical and technical success was documented in 92.2%, complications in 10.3% (n=17). No significant difference in clinical and technical success was observed using rotational percutaneous mechanical thrombectomy alone or with additional endovascular therapy. On a long term basis, the re-ischemia free survival was nearly twice as high as in previous studies that reported more cases treated by rotational percutaneous mechanical thrombectomy alone. Conclusion: To assure a long-lasting primary patency after percutaneous mechanical thrombectomy concomitant treatment of underlying lesions with adjunctive, non-thrombolytic endovascular methods should be considered.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: The aims of this study are to estimate the cumulative incidence of lower extremity amputation (LEA) revision and reamputation adjusting for a competing risk of death, estimate the one-year event-free mortality rates for patients with peripheral vascular disease undergoing LEA, and develop predictive models for LEA revision and reamputation adjusting for a competing risk of death. Methods: This was a retrospective review of the prospectively collected Vascular Quality Initiative (VQI) registry between 2013 and 2018. Adults undergoing unilateral LEA were included. Demographics, comorbidities, medications, smoking status, history of vascular procedures and revascularization attempts, and procedure urgency were considered. Models to predict LEA revision and reamputation were developed using multivariable regression on the interval-censored competing risks data using semiparametric regression on the cumulative incidence function. Results: The cumulative incidences of LEA revision and revision-free mortality within one year of index amputation are 14.9% and 15.5% respectively. Patient BMI, smoking status, aspirin use, history of revascularization, and level of planned LEA are significantly associated with the odds of LEA revision. Age, amputation urgency, dialysis, and level of planned LEA are associated with the one-year odds of revision-free mortality. A patient receiving an index above knee amputation (AKA) has 61% lower odds of LEA revision (p < 0.0001) but 51% higher odds of revision-free mortality following LEA (p < 0.0001). Previous revascularization procedures increase the odds of revision by 23% (p < 0.0001). The cumulative incidences of reamputation and one-year reamputation-free mortality following LEA are 11.5% and 16.9% respectively. Urgency of the procedure, history of revascularization procedures, and level of planned LEA are statistically associated with the odds of reamputation when adjusting for the competing risk of death. Patients receiving index AKA have 62% lower odds of reamputation (p < 0.0001) compared to BKA. Dialysis is the strongest predictor of one-year mortality (OR 2.576, p < 0.0001). Conclusions: Patients with appropriately managed PVD, which still progresses to amputation have higher odds of LEA revision and reamputation. Revision risk can be predicted and compared on the basis of patient factors and the planned index amputation.

Bakgrund: Majoriteten av amputationer av nedre extremiteter är resultatet av diabetes eller perifer kärlsjukdom. Amputation kan vara en livsförändrande händelse åtföljd av utmaningar för den drabbade patienten med tidsberoende depression som ofta används för att kvantifiera dess inverkan på deras psykologiska välbefinnande. Erikson beskriver lidande olika former. Syftet: Syftet med studien var att belysa patienters upplevelser efter amputation av en nedre extremitet. Metod: Till denna litteraturöversikt har 14 kvalitativa originalartiklar valts. Artiklarna har hämtats från Pubmed och Cinahl. Analysen har genomförts med hjälp av Graneheim och Lundmans kvalitativa innehållsanalys med manifest ansats. Sökord som har använts var amputation, Lower extremity, Experience och Patient. Resultatet består av tre huvudkategorier och åtta subkategorier. Under huvudkategorier: Inre faktorer presenteras; psykisk belastning; anpassning efter amputation. Under rubriken: Faktorer som påverkar rörligheten; fysiska begränsningar; Protesens betydelse; att känna sig isolerad; att uppleva smärta. Under yttre faktorer presenteras: Sociala interaktioner och betydelsen av stöd. Diskussion: Negativa upplevelser skapade oro och kunde bidra till isolering, liksom smärta och all form av lidande beskrivs som hinder. Familjemedlemmarna hade stödjande roll samtidigt som patienterna eftersträvade självständighet. Slutsats: Efter amputation av nedre extremitet bemötte patienterna många utmaningar i vardagen. Förändring i det sociala livet var vanligt förekommande vilket gjorde att dessa patienter led av psykisk ohälsa relaterat till bland annat stigmatisering. Förslag på vidare forskning är att undersöka hur omgivningens bristande kunskap om amputerade personer kan ökas för att patienterna ska kunna uppnå bättre livskvalitet. / <p>2023-03-23</p>

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