Tetracycline molecules including doxycycline (DOX), consist of a group of broad-spectrum antibiotics. In addition, tetracyclines inhibit matrix metalloproteinase (MMPs) that contribute to tissue remodeling, inflammation, angiogenesis and are over-expressed in certain pathologies - such as Alzheimer’s disease, metastasis and diabetic foot ulcers (DFUs). Tetracyclines are hypothesized to inhibit MMPs through the chelation and sequestration of catalytic divalent ions such zinc and calcium. This inhibitory duality may be beneficial in pathologies that are characterized by MMP over-expression and prone to infection, such as DFUs. Compared to oral administration, topical DOX is an attractive route of administration for chronic wound healing as it may minimize the risks: associated antibiotic resistance; is being targeted directly to the wound bed. However, DOX is notoriously unstable in aqueous solution and common topical formulations. Liquid chromatography and mass spectrometry (LCMS) were employed to monitor stability using an in vitro MMP assay and an applicable E. coli anti-bacterial assay was assessed to quantify drug activity. 2 % (w/w) topical DOX demonstrated an acceptable stability 30 day when stored at 4 ºC. DOX inhibited MMP9 activity with an IC50 value of 48.27 μM. With respect to anti-bacterial activity, using cultured BL21 E.Coli and quantification of drug activity as an expression of colony forming units (CFUs) successfully reproduced the antimicrobial IC50 of doxycycline as 4.3 µM. Transdermal DOX has the potential to improve standard of care for DFUs, quality of life for the patient and reduce costs to the healthcare system. / Thesis / Master of Science (MSc) / Tetracyclines comprise of a group of broad-spectrum antibiotics; whose primary mechanism of action is inhibition of protein synthesis through binding of the bacterial ribosome. In addition, tetracyclines inhibit matrix metalloprotease (MMPs), zinc-dependent proteases that contribute to tissue remodeling, angiogenesis and are over-expressed in certain pathophysiologies such as diabetic foot ulcers (DFUs). The antibacterial mechanism of DOX on MMPs is reported and understood, however the inhibition is hypothesized to involve cation chelation. Thus, investigating this interaction is warranted to assist in developing a therapeutic for DFUs. A more logical product would involve direct topical application, such as a stable transdermal formulation of DOX.

Bakgrund: Diabetiska fotsår är en vanlig komplikation bland personer med diabetes. Sårläkningsprocessen och sårbehandlingen är en komplicerad och lång process vilka spelar en central roll i patientens liv. Patientens behov av hälso- och sjukvården är stort och kan leda till en ökad belastning på samhällets funktioner och ekonomi. Sjuksköterskan behöver ha kunskaper om patientens upplevelser av att leva med diabetiska fotsår för att kunna bemöta dem på bästa sätt och ge en personcentrerad vård. Syfte: Syftet var att beskriva patienters upplevelser av att leva med diabetiska fotsår.   Metod: Denna litteraturöversikt inkluderar åtta kvalitativa artiklar och två kvantitativa artiklar som besvarar syftet. Databaserna som användes för resultatartiklarna var CINAHL Complete och Medline with Full Text.    Resultat: Resultatet identifierades av tio artiklar och delades in i tre kategorier: fysisk påverkan, påverkan på det sociala livet och psykologiska aspekter. Första kategorin visar på att patienter känner sig begränsade i rörelser, hur inaktivitet kan påverka vardagslivet samt besvärande symtom som kan upplevas. Inom den andra kategorin beskrivs känslor kring hur diabetiska fotsåren har påverkat patienternas sociala liv. Den tredje kategorin omfattar de psykologiska aspekterna av att leva med diabetiska fotsår, känsla av förlorad identitet och tankar inför framtiden.   Slutsats: Resultatet som framkommer visar på att patienter upplever olika former av fysiska och sociala begränsningar. Det gäller för sjuksköterskan att kunna vara lyhörd, öppen samt ha en helhetssyn för patientens upplevelser. Sjuksköterskan bör med andra professioner samarbeta för på bästa sätt ge patienten stöd som den kan behöva. Genom att utbilda patienten och deras närstående kan öka kunskapen om egenvården samt förebygga eventuella diabetesrelaterade komplikationer. / Background: Diabetic foot ulcers are a common complication amongst people with diabetes. Wound healing process and wound treatment are complicated and long process, and these will play a central role in the patient’s life. The patient’s need for health care is great and can lead to a great burden on society’s functions and finances. The nurse needs to have knowledge of experiences in patients living with diabetic foot ulcers in order to be able to treat them in the best way and provide person-centered care.  Aim: The purpose was to describe patients’ experiences of living with diabetic foot ulcers.  Method: This literature review included eight qualitative articles and two quantitative articles to answer the purpose. The databases used for the results articles were CINAHL Complete and Medline with Full Text. Results: The results were identified by ten articles and divided into three categories: physical impact, impact on social life and psychological aspects. The first category shows that patients feel limited in movement, how inactivity can affect everyday life and troublesome symptoms that can be experienced. The second category describes feelings about how diabetic foot ulcers have affected patients' social lives. The third category includes the psychological aspects of living with diabetic foot ulcers, feelings of lost identity and thoughts for the future.  Conclusion: The results that emerge show that patients’ experience various forms of physical and social limitations. It is important for the nurse to be able to be responsive, open and have a holistic view of the patient's experiences. The nurse should work with other professionals to best provide the patient with the support they may need. By educating the patient and their relatives can increase knowledge about self-care and prevent any diabetes-related complications.

Background: Diabetes – one of the leading non-communicable diseases of our time is steadily increasing in prevalence with each year. The disease is linked to several complications that can have major consequences for both the individual and society at large. Diabetic foot ulcers are one of these complications. Aim: The aim of this study was to investigate preventive nursing measures that can be provided to patients at risk of diabetic foot ulcers. Method: This study was conducted as a literature review. The databases CINAHL and Medline were used to identify relevant articles. The database searches resulted in 11 articles that were included in the study and analyzed with the use of a thematic analysis approach. Results: Three overarching categories that nurses can work within to prevent diabetic foot ulcers were derived from the thematic analysis, namely: Care based on needs, Education and Importance of collaborations. Conclusion: Care based on needs, Education and Collaboration are areas in which the nurse can provide preventive care to patients with diabetes at risk of developing diabetic foot ulcers or to patients with already existing foot ulcers. Based on the studies key concepts, implications on the preventive areas relevance for nursing were drawn. Further studies are recommended to investigate how these nursing measures for preventing diabetic foot ulcers can be disseminated within the nursing profession. By spreading these nursing measures within the profession good conditions for minimizing the disease burden of diabetic foot ulcers can be established. / Bakgrund: Diabetes – en av vår tids främsta icke-smittsamma sjukdomar ökar stadigt i prevalens för varje år som går. Sjukdomen är kopplad till en rad komplikationer, bland annat diabetesfotsår, som kan innebära konsekvenser för individen och samhället i stort. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans preventiva omvårdnadsåtgärder kring fotsår hos patienter med diabetes. Metod: Studien genomfördes som en litteraturstudie. Databaserna CINAHL och Medline användes för att identifiera relevanta artiklar. Sökningarna i databaserna resulterade i 11 artiklar som inkluderades och analyserades med en tematisk analysmetod. Resultat: Den tematiska analysen resulterade i tre övergripande kategorier inom vilka sjuksköterskor kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som har eller riskerar att utveckla diabetesfotsår. Slutsats: Vård utifrån behov, Utbildning och Vikten av samarbeten är områden inom vilka sjuksköterskan kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som riskerar eller har utvecklat diabetesfotsår. Sett ur de centrala begreppens perspektiv kan slutsatsen att de identifierade omvårdnadsåtgärderna är relevanta för omvårdnad dras. Studiens resultat är således relevanta för sjuksköterskeprofessionen och vidare studier rekommenderas undersöka hur omvårdnadsåtgärderna kan spridas inom professionen. Om omvårdnadsåtgärderna kan spridas inom professionen och tillhandahållas patientgruppen finns goda förutsättningar att förebygga samt lindra den sjukdomsbörda som diabetesfotsår kan leda till.

Bakgrund: Diabetes Mellitus är en folksjukdom och ett samlingsnamn för flera olika typer av diabetes. En vanlig komplikation vid långvarig diabetes är fotsår, men vid god egenvård kan dessa fotsår till stor del förebyggas. Syfte: Undersöka personer med diabetes erfarenheter av egenvård relaterat till fotsår. Metod: Litteraturöversikten baserades på åtta vetenskapliga artiklar med kvalitativ design. Sökningen genomfördes i databaserna PubMed och Cinahl. Artiklarna kvalitetsgranskades, analyserades och sammanställdes. Resultat: Personer med diagnosen diabetes har i vissa fall bristande egenvård i relation till fotvård och fotsår. Analysen ledde fram till två huvudkategorier och sex subkategorier. Huvudkategorierna var; Hinder till att utföra egenvård samt Vikten av god kommunikation med vårdpersonal för att främja egenvård.  Konklusion: Personer med diabetes har i många fall bristande kunskap om fotsår. Detta leder till att de i många fall har svårt att utföra en god egenvård. Personanpassad och återkommande information från sjukvården har i många fall stärkt egenvården. / Background: Diabetes Mellitus is a public disease and a collective name for several different types of diabetes. A common complication of long-term diabetes is foot ulcers, but with good self-care, these foot ulcers can largely be prevented.  Aim: Investigate people with diabetes experiences of self-care related to foot ulcers. Methods: The literature review was based on eight scientific articles with a qualitative design. The search was performed through the databases PubMed and Cinahl. The articles were quality reviewed, analyzed and compiled. Results: People diagnosed with diabetes in some cases lack self-care in relation to foot care and foot ulcers. The analysis led to two main categories and six subcategories. The main categories were Obstacles to performing self-care and The importance of good communication with healthcare professionals to promote self-care. Conclusion: People with diabetes often lack knowledge about foot ulcers. In many cases this leads to them having difficulty in performing good self-care. Personalized and recurring information from healthcare has in many cases strengthened self-care.

Yes / To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji. Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis. Rotuma hospital, Fiji. HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included. There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients. HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.