Background: Pressure ulcer are one of the most common healthcare injuries and is a challenge for healthcare professionals. A pressure ulcer occurs from pressure or shear or a combination of both and it is mainly the elderly who are at risk. Pressure-relieving aids are used to prevent the pressure ulcer. The patient's experience is important in the care in order to prevent the pressure ulcer. Not understanding the patient's experience can lead to missed care and actions which in turn can lead to serious consequences. Aim: To describe patient's experiences of living with pressure ulcers. Method: A literature study was performed. An analysis of eleven qualitative articles that focused on the patient's experiences of pressure ulcers were conducted. Results: Two main themes and six subthemes emerged. The result presents the two main theme: Physical impact and Mental impact. Physical impact describes that pressure ulcers are painful and limit patient's mobility, which leads to becoming dependent on nursing care. Mental impact describes that the pressure ulcer causes the patients to isolate themselves, become dependent of others and lead to feelings of hopelessness. Conclusion: Patients experienced that being dependent on others are difficult and they experienced feelings of worthless and incapable. The smell and pain of the pressure ulcer and its wound fluids impairs patient's self-esteem and wellbeing, resulting in social isolation and hopelessness. / Trycksår är en av de vanligaste vårdskadorna inom hälso- och sjukvården som leder till ett lidande hos patienterna. Lidande är något som patienten blir utsatt för och är tvungen att leva med. Syftet med studien är att beskriva patienters upplevelser av att leva med trycksår. Att ta hänsyn till patienters upplevelser och deras kunskap kan resultera till en minskad sjukhusvistelse. Sjuksköterskan har som ansvar att främja hälsa, förebygga sjukdom, återställa hälsa och lindra patienters lidande. En viktig del av sjuksköterskans ansvar i omvårdnaden är att förhindra tryckskador. För att förhindra tryckskador ska sjuksköterskan känna till faktorer som ökar risken för trycksår, vilka är inkontinens, nedsatt rörlighet, anemi, rökning, malnutrition, nedsatt känsel, ödem, övervikt, hypotoni, diabetes och ateroskleros. För att kunna ge en adekvat behandling krävs det först att genomföra en bedömning för att kunna avgöra vilken behandling som blir aktuell. Stödytor som till exempel madrasser och sittdynor är det mest effektiva tillvägagångsätt för att förebygga trycksår hos patienter som befinner sig i samma ställning under en längre tid. Stödytans funktion är att jämnt fördela kroppens tyngdpunkt över hela ytan. I litteraturstudiens resultat inkluderades elva artiklar med kvalitativansats för att beskriva patienters upplevelser av att leva med trycksår. Patienterna upplever att trycksår är smärtsamma och begränsar dem i deras dagliga liv. Att leva med trycksår innebär att leva ett liv i smärta. Smärtan förvärrades av rörelser och bidrog till en nedsatt rörelseförmåga. Patienter uttryckte en förlust av rörlighet i samband med sitt trycksår, vilket bidrog till minskad förmåga att fortsätta med sitt dagliga liv. Den begränsade rörligheten gjorde att de blev beroende av andra personer och hjälpmedel. Många upplevde att tryckavlastande stödytor var obekväma och smärtsamma. Att ha trycksår bidrog även till sociala begränsningari livet. Patienterna uppgav att på grund av lukten från trycksåret så valde de att isolera sig från sociala aktiviteter. Att vara beroende av andra upplevdes som påfrestande vilket försämrade deras självkänsla och självförtroende, vilket bidrog till att de kände sig värdelösa och otillräckliga som inte kunde klara sig själva. Att få hjälp med intimvård och hygien upplevdes av patienterna som hotande för deras värdighet och integritet. Läketiden och behandlingen av trycksår var lång och fick patienterna att uppleva nedstämdhet och hopplöshet. Slutligen påverkar trycksår patienterna båda fysisk och psykisk och inverkar på deras välbefinnande och hälsa.

Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. Median duration of NPWT was 31 days (range 3 to 169) for pressure ulcers and 27 days (range 5 to 119) for the surgical wound group. Median lengths of stay in the early treatment groups were 85 days (range 11 to 239) for pressure ulcers and 57 days (range 7 to 119) for the surgical group versus 166 days (range 60 to 657) and 87 days (range 31 to 328), respectively, for the late treatment pressure ulcer and surgical groups (P <0.0001). After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (β = 0.96, P <0.0001 [pressure ulcers]; β = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.

No / Wounds arising from various conditions are painful, embarrassing and often requires treatment plans which are costly. A crucial task, during the treatment of wounds is the measurement of the size, area and volume of the wounds. This enables to provide appropriate objective means of measuring changes in the size or shape of wounds, in order to evaluate the efficiency of the available therapies in an appropriate fashion. Conventional techniques for measuring physical properties of a wound require making some form of physical contact with it. We present a method to model a wide variety of geometries of wound shapes. The shape modelling is based on formulating mathematical boundary-value problems relating to solutions of Partial Differential Equations (PDEs). In order to model a given geometric shape of the wound a series of boundary functions which correspond to the main features of the wound are selected. These boundary functions are then utilised to solve an elliptic PDE whose solution results in the geometry of the wound shape. Thus, here we show how low order elliptic PDEs, such as the Biharmonic equation subject to suitable boundary conditions can be used to model complex wound geometry. We also utilise the solution of the chosen PDE to automatically compute various physical properties of the wound such as the surface area, volume and mass. To demonstrate the methodology a series of examples are discussed demonstrating the capability of the method to produce good representative shapes of wounds.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

Trycksår är en vårdskada och uppkommer av långvarigt tryck utav utrustning eller benutskott. På barnintensivvårdsavdelning vårdas barn med observerbar svikt i minst ett organ, dessa barn har stor risk att utveckla trycksår. Patricia Benners omvårdnadsteori är teoretisk referensram för studien. Syftet med studien var att beskriva sjuksköterskans trycksårsförebyggande åtgärder för barn som vårdas på barnintensivvårdsavdelning. En systematisk litteratursökning genomfördes i tre databaser. Sökningen genererade elva resultatartiklar. Resultatet presenteras i tre kategorier: följa rutiner och riktlinjer, identifierade trycksårsrisker för patienter på avdelningar som bedriver barnintensivvård samt omvårdnadshandlingar och hjälpmedel. Resultatet påvisade att många trycksårs fall går att förebygga med rutiner, utbildning samt hjälpmedel. Barn med massiv svikt kunde vara så ostabila att trycksårsförebyggande åtgärder var omöjliga. Personal samt verksamhet kan med fördel implementera de evidensbaserade trycksårsförebyggande åtgärderna men fortsatt forskning utav utbredningen av trycksår på barnintensivvårdsavdelning i Sverige kan behöva genomföras. / Pressure ulcer is an injury caused by hospitalizations when sustained pressure over bony prominence or devices for a prolonged period of time pressure ulcer may appear. Critically ill infants and children admitted to the pediatric intensive care unit (PICU) are at risk of developing pressure ulcer. Patricia Benner’s nursing theory is used as theoretical guideline for this study. The aim of this study was to describe preventing measures against pressure ulcers performed by nurses for infants and children admitted at PICU.  A systematic literature review was conducted and three databases resulting in eleven articles. The result was presented in three categories: follow routines and guidelines, identify associated risk factors for pressure ulcer on patients in the PICU and also practical nursing and tools. The result of this study showed that pressure ulcer can be prevented with guidelines, education and tools. For some patients in the PICU pressure ulcer could not be prevented due to their clinical instability. Hospital staff and board should implement evidence basted pressure ulcer prevention measures. Further research concerning Swedish practice could be needed.

Bakgrund: Trycksår är idag en vanligt förekommande vårdskada. Få studier har gjorts gällande trycksår i samband med buklägeskirurgi. Syfte: Syftet var att undersöka trycksårsprevalensen bland patienter som genomgått kirurgi i bukläge och identifiera möjliga riskfaktorer för trycksår. Metod: En prospektiv deskriptiv studie med kvantitativ design. Datainsamlingen utfördes på neurokirurgiska och ortopediska kliniken under nio veckor, vid ett stort sjukhus i mellansverige. Hudobservationer och journalgranskning skedde på totalt 29 patienter. Frågeställningarna besvarades med deskriptiv statistik och analyserades med Mann Whitney U test och Chi2. Resultat: Var tredje patient som genomgått buklägeskirurgi utvecklade trycksår. Den totala trycksårsprevalensen var 34 procent, antalet trycksår per patient varierade mellan ett till sex stycken. Trycksåren varierade mellan kategori ett och två enligt EPUAPs klassiferingssystem. Det mest utsatta området var ansiktet (51 %). Identifierade riskfaktorer var högt BMI, den postoperativa kroppstemperaturen, ålder och operationens längd. Slutsats: Patienter som genomgår kirurgi i bukläge har en ökad risk att utveckla trycksår. Fortsatt kvalitetsarbete behövs för att motverka vårdskador, patientlidande, ökade vårdtider och kostnader för denna grupp patienter. För vidare utveckling inom området behövs fler och större studier. / Background: Pressure ulcer is today a frequent occuring problem in health care.  There are few studies done regarding the incidence of pressure ulcers after surgery in prone position. Aim: The aim was to investigate the prevalense of pressure ulcer among patients who have been operated upon in prone position, and to identify possible risk factors for pressure ulcer among these patients. Method: A prospective study with quantitative design was chosen. The data was collected during nine weeks at a Neurosurgical and Orthopedic ward. Skin observations and reviewing medical records were conducted for a total of 29 patients. The research questions were answered by descriptive statistics and the data was analyzed using a Mann Whitney U test and Chi2. Results: One out of three patients developed pressure ulcers after surgery in prone position. The prevalence of identified pressure ulcers in the study was 34 percent, the number of pressure ulcers per patient varied between one and six. The ulcers were classified according to EPUAPs classification and the identified ulcers were assigned class one and two. The most vulnerable part was the face (51%). Identified risk-factors are high BMI, body temperature post operatively, patients’ age and duration of surgical procedure. Conclusion: Patients undergoing surgery in prone position are more likely to develop postoperative pressure ulcers. Further preventive measures to avoid health care associated adverse events are necessary in order to reduce unnecessary patient suffering, increasing hospitalization and costs for this group of patients. For further progress in this field more extensive studies are needed

<p>Human motion monitoring is an important function in numerous applications. In this dissertation, two systems for monitoring motions of multiple human targets in wide-area indoor environments are discussed, both of which use radio frequency (RF) signals to detect, localize, and classify different types of human motion. In the first system, a coherent monostatic multiple-input multiple-output (MIMO) array is used, and a joint spatial-temporal adaptive processing method is developed to resolve micro-Doppler signatures at each location in a wide-area for motion mapping. The downranges are obtained by estimating time-delays from the targets, and the crossranges are obtained by coherently filtering array spatial signals. Motion classification is then applied to each target based on micro-Doppler analysis. In the second system, multiple noncoherent multistatic transmitters (Tx's) and receivers (Rx's) are distributed in a wide-area, and motion mapping is achieved by noncoherently combining bistatic range profiles from multiple Tx-Rx pairs. Also, motion classification is applied to each target by noncoherently combining bistatic micro-Doppler signatures from multiple Tx-Rx pairs. For both systems, simulation and real data results are shown to demonstrate the ability of the proposed methods for monitoring patient repositioning activities for pressure ulcer prevention.</p> / Dissertation

One of the major obstacles to pressure ulcer research is the difficulty in accurately measuring mechanical loading of specific anatomical sites. A human motion analysis system capable of automatically segmenting a patient's body into high-risk areas can greatly improve the ability of researchers and clinicians to understand how pressure ulcers develop in a hospital environment. This project has developed automated computational methods and algorithms to analyze pressure images acquired in a hospital setting. The algorithm achieved 99% overall accuracy for the classification of pressure images into three pose classes (left lateral, supine, and right lateral). An applied kinematic model estimated the overall pose of the patient. The algorithm accuracy depended on the body site, with the sacrum, left trochanter, and right trochanter achieving an accuracy of 87-93%. This project reliably segments pressure images into high-risk regions of interest.