Ulm, Univ., Diss., 2009.

Frakturen des Beckens und des Azetabulums stellen eine an Bedeutung zunehmende Entität bei älteren Patienten dar. Die Frakturen haben eine direkte Auswirkung auf die Mobilität häufig bereits in ihrer Gehfähigkeit eingeschränkter Patienten. Dekubitus sind eine bekannte und gefürchtete Komplikation eingeschränkter Mobilität. Bisher fehlen in der Literatur Daten zu möglichen Risikofaktoren für die Entstehung von Dekubitus, insbesondere zu solchen, die sich von chirurgischer Seiter beeinflussen ließen. Aus einer prospektiv geführten Datenbank konsekutiver Patienten mit Becken- und Azetabulumfrakturen, die zwischen 01/2008 und 07/2018 iam Universitätsklinikum Leipzig stationär behandelt wurden, wurden Patienten im Alter ≥ 55 Jahre identifiziert. Ausgeschlossen wurden Patienten mit Mehrfachverletzungen und mit bei Aufnahme vorbestehendem Dekubitus. Retrospektiv wurden aus der Krankenakte Daten zu Epidemiologie, Komorbiditäten, Hospitalisations-/Behandlungsdauer und erfolgter Behandlung wurden aus der Krankenakte erhoben. Insgesamt wurden im Beobachtungszeitraum 407 Patienten (Alter 78±10 Jahre, 69.3 % weiblich) behandelt. Bei 46/407 (11.3 %) Patienten trat während der Hospitalisation ein neuer Dekubitus auf (Grad 1: 39%, Grad 2: 52 %, Grad 3: 9 %, Grad 4: 0 %). Die mittlere Hospitalisationsdauer war bei Patienten mit Dekubitus (25±17 d) signifikant länger als bei Patienten, die keinen Dekubitus entwickelten (12±9 d, p<0.001). Patienten mit einem Dekubitus warteten zudem signifikant länger auf die definitive Behandlung (5±5 d vs. 3±4 d, p=0.001). Zudem waren ein höheres Alter (p=0.006), männliches Geschlecht (p=0.020), Diabetes (p=0.001) und maligne systemische Erkrankungen (p=0.001) mit dem Auftreten eines Dekubitus assoziiert. In der logistischen Regressionsanalyse zeigte sich, dass die „Zeit bis zur definitiven Behandlung“ ein unabhängiger Risikofaktor für die Entstehung eines Dekubitus ist. Die für oben genannte Confounder adjustierte Odds Ratio betrug dabei 1.10 (95%-CI 1.03, 1.19; c-value = .774, p = .008) für jeden Tag der Verzögerung. Schlussfolgerung: Bei älteren Patienten mit isolierten Becken- und Azetabulumfrakturen ist die Zeit bis zur Behandlung ein unabhängiger Risikofaktor für die Entstehung eines Dekubitus während der Hospitalisation. Dabei erhöht jeder Tag der Verzögerung das Risiko um rund 10 %.:Abkürzungsverzeichnis II 1 Einleitung 1.1 Dekubitus als Krankheitsbild des älteren Patienten 1.1.1 Definition und Klassifikation des Dekubitus 1.1.2 Epidemiologie und Pathophysiologie 1.1.3 Risikobewertung und Assessment 1.1.4 Risikofaktoren 1.1.5 Aktuelle präventive und therapeutische Methoden 1.1.6 Komplikationen 1.2 Becken- und Acetabulumfrakturen bei älteren Patienten 1.2.1 Epidemiologie und Ätiologie 1.2.2 Therapieoptionen 8 1.3 Fragestellung/Rationale der Studie 2 Publikation 3 Zusammenfassung der Arbeit 4 Literaturverzeichnis 5 Abbildungs- und Tabellenverzeichnis 6 Anlagen 7 Darstellung des eigenen Beitrags 8 Erklärung über die eigenständige Abfassung der Arbeit 9 Danksagung

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.

Abstract The diploma thesis is focused on the application of a national methodics for prevalence monitoring and comparison of pressure sores (decubitus ulcers) incidence in health care facilities in the Czech Republic. Pressure sores are a global problem and their incidence should be prevented by preventive measures and high-quality nursing care. However, despite all the provisions, we are not successful in the prevention of their incidence. It is necessary to define standardized quality indicators of the nursing care, to compare the results, and to share the information with specialists, which would result in continuous quality improvement (benchmarking), and to support good practice. In the world the quality indicators monitoring of health care is quite common, in the Czech Republic the process has been only developing. In the area of Czech nursing care only the falls in health care facilities are monitored on the national level. The methodics for the monitoring of pressure sore incidence has not been established yet on the national level. In 2003 the first comparison of four teaching hospitals was carried out in the incidence of pressure sores by means of the method of prevalence investigation. In 2005 the data collection methodics was elaborated during the solution of the grant project IGA MZ Č NO 77723-3. Six teaching hospitals were compared for the prevalence of pressure sores, with division into four specialty groups: internal medicine, surgical, intensive and follow-up care. In 2008 a project of quality and safety of the Ministry of Health was implemented, with a view to elaborate uniform methodics for prevalence investigation and comparison of a standard indicator in the area of pressure sores at the national level, regardless of the type of a health care facility. At the meeting of the Work Group for Health Care Quality of the Ministry of Health of the Czech Republic I recommended to include the indicator in the National Set of Health Care Indicators. The work aims at the verification of the applicability of the new methodics and software in practice, and at the facilitation of their implementation into practice. It is focused on the opinions of the project participants on the developed software, on its application into practice and on the challenges that should be tackled during the implementation into practice. In order to get the necessary information, we have chosen a method of qualitative investigation using a semi-structured interview. Eight respondents, direct participants in the project, were interviewed. According to the results of the interviews, health facilities pay much attention to the pressure sores monitoring. The investigations are carried out by means of an incidence and prevalence method. The monitoring of pressure sores incidence has not been included in clinical information systems yet, and it is carried out in several different ways. The interest in comparison between hospitals (benchmarking) is considerable. The results of the investigation are used above all for the purpose of improvement of measures preventing the incidence of pressure sores, of the improvement of quality of nursing care, and of reducing the workload of nurses. The extent of the economic impact of the pressure sores incidence on health facilities is not clear. If we want to facilitate the application of national methodics of monitoring the pressures sores prevalence to practice and the use of application software, we should ensure adequate awareness of health care managers, training of teams of health professionals, coordinators and editors, who will go on to work with the national methodics. The monitoring of the national quality indicator in the area of pressure sores is another shift in the implementation of goals of the Ministry of Health concerning the quality of care and safety of the patients.

Thesis objectives: The diploma thesis deals with the issue of prevention of skin lesions in perioperative care. In the theoretical part, the current state of knowledge is presented concerning the pressure ulcers identification due to the persisting real problems in differential diagnostics in clinical practice. Further, the thesis deals with the issue of wet and thermal lesions, which occur also during the perioperative care. In the empirical part of the diploma thesis, the first objective was to find the frequency of documented occurrence of decubital lesions in connection with the surgery in Jihlava Hospital for a period of one year. The second objective of the thesis was to find out whether, and what barriers exist when using specific preventive measures. The last aim of the diploma thesis was to compare the efficiency of preventive measures from the point of view of perioperative nurses and nurses from service units. Three hypotheses were formulated to meet the objectives of the thesis. Method for achieving the objectives: The set objectives were achieved through a retrospective analysis of the hospital information system data and a quantitative questionnaire survey. The study included nurses working in surgery, orthopaedics, traumatology, intensive care units and perioperative nurses in Jihlava Hospital. The total number of respondents was 140. Scientific benefits of the thesis: The research implies that the use of prophylactic aids in pre-operative preparation contributes significantly to reducing the risk of skin lesions. The addressed set of nurses did not indicate any serious barriers to their application and, on the contrary, considered it to be very effective. The results of the thesis can be used in practice, especially in a specific health facility for further care improvement. The findings and conclusions: On the research group we have verified that the declared use of preventive strategies in the area of prevention of lesions in perioperative care differs according to the type and focus of the workplace; (p = 0.000) the least frequent use was declared by the general nurse from orthopaedics, however, the methods used did not differ (p = 0,220). In addition, we found out that there was a statistically significant difference in the opinion on efficiency of prophylactic covering in lesion prevention (p = 0.001, the worst evaluation was by the respondents from orthopaedics) but only 2 respondents stated negative experience with their use.

Bakgrund. I omvårdnaden ska distriktssköterskan se till människans hela situation och omvårdnaden ska utföras på ett personcentrerat och säkert sätt. I hemsjukvården utförs vården i patientens hem, antingen i ordinärt eller särskilt boende. Trycksår är en vanlig vårdskada och nutritionen är viktig för att förebygga och behandla trycksår. Syftet var att beskriva i vilken utsträckning som distriktssköterskor i hemsjukvården använder nutritionsåtgärder som trycksårsbehandling. Metod. För att besvara syftet användes en kvantitativ design där redan insamlad data från en trycksårsmätning togs del av. Resultatet visade att nutritionsåtgärder användes som trycksårsbehandling till 65% av patienterna. Bland varannan distriktssköterska som inte använde nutritionsåtgärder framkom olika orsaker. Det var vanligare att nutritionsåtgärder användes vid risk enligt riskbedömningarna MNS och SF-MNA. De vanligast använda nutritionsåtgärderna var näringsdryck och extra mellanmål. Resultatet visade att det fanns skillnader i trycksårens svårighetsgrad i förhållande till boendeform. Slutsats. Det fanns utrymme för förbättringar i att använda nutritionsåtgärder vid trycksår. Nutritionen spelar en betydelsefull roll i behandlingen av trycksår och det är viktigt att riskbedömningar utförs. Genom att tidigt använda nutritionsåtgärder som trycksårsbehandling kan distriktssköterskan främja hälsa, förebygga sjukdom och skada samt minska patientens lidande. / Background. In Nursing Care, it's important to see to the whole perspective of the patient, and the care should be performed in a person-centred and safe way. The purpose was to describe district nurses [DN] using of nutrition therapy as treatment for patients with pressure ulcers in home healthcare. Method. A quantitative design, where material from an already collected pressure ulcer study, was used. The result showed that nutritional therapy was used as pressure ulcer treatment in 65% of the patients. Among every other DN who did not use nutritional therapy as treatment of pressure ulcer, various causes were identified. It was more common to use nutritional therapy when risks according to MNS and SF-MNA assessments were found. The most common nutrition therapies were nutritional drinks and extra snacks. The result showed that there were differences in the severity of pressure ulcers in relation to patients' housing type. Conclusion. There was room for improvements in using nutrition therapy as pressure ulcer treatment. Nutrition plays an important role in the prevention and treatment of pressure ulcer, and it's important that risk assessments are performed. By initiating nutritional treatment early, the DN can promote health, prevent disease and injury, and reduce the patient's suffering.