CNPq / O tratamento e cuidados com úlceras de pé diabético é uma questão de saúde pública. As técnicas atuais utilizadas para o acompanhamento do processo de cicatrização de úlceras abertas são baseadas principalmente em medidas aproximadas da área da ferida e envolvem contato direto, o que representa riscos de contaminação para o paciente. Neste trabalho é proposto o uso de técnicas de visão computacional para medir não apenas a área, mas o volume de úlceras abertas, fornecendo informação objetiva sobre o processo de cicatrização para os médicos, evitando contato direto com a ferida durante o procedimento de medição. A técnica proposta envolve a aquisição de uma sequência de imagens da ferida com iluminação estruturada usando um laser de baixa potência em linha, seguida de reconstrução da profundidade a partir da geometria do dispositivo de aquisição. É identificada a região da ferida de forma semiautomática e construída uma superfície fictícia do que seria a pele natural para servir de base para o cálculo do volume, que corresponde à quantidade de tecido faltante. Experimentos controlados ex-vivo utilizando um modelo de borracha de um Pé Diabético e um joelho de porco com uma ferida artificial representando a pele humana demonstram a viabilidade da técnica proposta. / Treatment and follow-up of Diabetic Foot ulcers is a major public health issue. Current techniques used for following up the healing process of open ulcers are mostly based on approximate area measurements of the wound and involve direct contact, which poses risks of contamination for the patient. This work proposes the use of computer vision techniques to measure not just the area, but the volume of open ulcers, providing additional objective information about the healing process to physicians while avoiding direct contact with the wound during the measurement procedure. The proposed technique involves acquiring a sequence of images of the wound with structured illumination using a low-power laser beam line, followed by depth reconstruction from the geometry of the acquisition device. The wound region is identified in a semi-automatic way and a fictitious surface of what would be the normal skin surface is then used to compute the volume, which corresponds to the missing amount of tissue. Controlled ex-vivo experiments using a rubber model of a Diabetic Foot and a knuckle of pork with an artificial wound representing the human skin demonstrate the viability of the proposed technique. / 5000

CNPq / O tratamento e cuidados com úlceras de pé diabético é uma questão de saúde pública. As técnicas atuais utilizadas para o acompanhamento do processo de cicatrização de úlceras abertas são baseadas principalmente em medidas aproximadas da área da ferida e envolvem contato direto, o que representa riscos de contaminação para o paciente. Neste trabalho é proposto o uso de técnicas de visão computacional para medir não apenas a área, mas o volume de úlceras abertas, fornecendo informação objetiva sobre o processo de cicatrização para os médicos, evitando contato direto com a ferida durante o procedimento de medição. A técnica proposta envolve a aquisição de uma sequência de imagens da ferida com iluminação estruturada usando um laser de baixa potência em linha, seguida de reconstrução da profundidade a partir da geometria do dispositivo de aquisição. É identificada a região da ferida de forma semiautomática e construída uma superfície fictícia do que seria a pele natural para servir de base para o cálculo do volume, que corresponde à quantidade de tecido faltante. Experimentos controlados ex-vivo utilizando um modelo de borracha de um Pé Diabético e um joelho de porco com uma ferida artificial representando a pele humana demonstram a viabilidade da técnica proposta. / Treatment and follow-up of Diabetic Foot ulcers is a major public health issue. Current techniques used for following up the healing process of open ulcers are mostly based on approximate area measurements of the wound and involve direct contact, which poses risks of contamination for the patient. This work proposes the use of computer vision techniques to measure not just the area, but the volume of open ulcers, providing additional objective information about the healing process to physicians while avoiding direct contact with the wound during the measurement procedure. The proposed technique involves acquiring a sequence of images of the wound with structured illumination using a low-power laser beam line, followed by depth reconstruction from the geometry of the acquisition device. The wound region is identified in a semi-automatic way and a fictitious surface of what would be the normal skin surface is then used to compute the volume, which corresponds to the missing amount of tissue. Controlled ex-vivo experiments using a rubber model of a Diabetic Foot and a knuckle of pork with an artificial wound representing the human skin demonstrate the viability of the proposed technique. / 5000

Syfte: Syftet med studien var att beskriva distriktssköterskors erfarenheter av vad som underlättade och hindrade evidensbaserad vård av ben- och fotsår inom primärvården. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes med åtta distriktssköterskor. Samtliga arbetade på hälsocentraler i södra Hälsingland. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys. Som teoretisk referensram användes PARIHS modellen. Huvudresultat: I studien framkom olika faktorer som underlättar respektive hindrar distriktssköterskor inom primärvården att arbeta efter en rutin för ben- och fotsår. Det som underlättade var ett välfungerande teamarbete på arbetsplatsen, att rutinen var anpassad så att den var lätt att arbeta efter och att den fanns lättillgänglig i datasystemet, specifik kunskap om sårvård och ett engagemang för patienten och för ämnet sårvård samt att patienten behöver stöd och utbildning för att kunna medverka i vården. Det som hindrade var bristande förståelse och engagemang från chef och kollegor, svårigheter att motivera patienterna till att medverka till behandling samt att journalsystemet inte var anpassat efter ben- och fotsårsrutinen. Slutsats: I studien framkom olika faktorer som underlättade och hindrade distriktssköterskor att använda sig av evidensbaserad vård av ben- och fotsår i det dagliga arbetet. Det som påverkade distriktssköterskornas användning av rutinen var i störst utsträckning faktorer i omgivningen. För att underlätta för distriktssköterskor att kunna arbeta enligt evidensbaserad sårvård måste ansträngningar göras för att undanröja hinder. PARIHS modellen kan användas som stödjande verktyg före, under och efter implementeringsprocessen. / Purpose: The purpose of the study was to describe district nurses' experiences of the facilitating and preventative factors that influence the use of evidence-based wound care in primary healthcare. Method : A qualitative interview study with semi-structured interviews was conducted with eight district nurses. All worked at health centers in southern Hälsingland. The interviews were transcribed and analyzed by qualitative content analysis. As a theoretical reference frame, the PARIHS model was used. Main outcome : The study revealed different factors that facilitate or prevent district nurses in primary healthcare to work for a routine for leg and foot ulcers. What facilitated was a well-functioning team work at the workplace, that the routine was adapted so that it was easy to work after and was easily accessible in the computer system, specific knowledge about wound care and commitment to the patient and on the subject of wound care and that the patient needs support and education to be able to participate in healthcare. What was prevented was insufficient understanding and commitment from the boss and colleagues, difficulty in motivating patients to participate in treatment and that the journal system was not adapted to the leg and foot routine. Conclusion : The study identified various factors which facilitated and prevented district nurses from using evidence-based care of leg and foot ulcers in their daily work. What influenced the use of the routine by district nurses was to the greatest extent factors in the environment. In order to facilitate district nurses to work according to evidence-based wound care, efforts must be made to eliminate obstacles. The PARIHS model can be used as a supporting tool before, during and after the implementation process.

DIABETESFOTEN HOS INNELIGGANDE STROKEPATIENTER: RISK, OMFATTNING, OCH OMVÅRDNADSÅTGÄRDERBAKGRUND: Fotkomplikationer är de allvarligaste komplikationerna till diabetes som ofta leder till kostnadskrävande behandlingar och amputation. Stroke resulterar i förlust eller begränsning av tidigare fysiska, psykiska och sociala aktiviteter, inklusive nedsatt förmåga att skydda sina fötter och utföra egenvård. Strokepatienter med diabetes har stor risk att skada sig i den förlamade sidan av kroppen. Nedsatt mobilitet är en riskfaktor som kan orsaka patienten skada. På vårdavdelning för strokedrabbade patienter kan sjuksköterskan genom god omvårdnad och preventiva åtgärder bidra till att risken för utveckling av skada på fötterna hos strokepatienter minskar.SYFTE: Syftet med studien är att kartlägga omfattningen av diabetesfot på en neurologisk klinik samt granska omvårdnadsdokumentationen om preventionsåtgärder hos strokepatienter med diabetes avseende risken att utveckla fotsår.METOD: En retrospektiv journalgranskningsstudie med kvantitativ och kvalitativ ansats. Studien genomfördes på en neurologisk klinik på ett universitetssjukhus i södra Sverige. Samtliga journaler N=101 från strokepatienter med diabetes som vårdades på kliniken från 1 januari 2015 till den 20 december 2015 granskades med hjälp av Global Trigger Tool (GTT). Dataanalysen delades i två delar: deskriptiv statistisk analys och manifest kvalitativ innehållsanalys.RESULTAT: Medianåldern är 78 år (41-93 år). Kvinnor n=40, män n=61. Journalgranskningen visade generellt på bristande dokumentation. Riskbedömning för fotsår var inte dokumenterad i någon av journalerna. För patienter som hade dokumenterade fotsår (n= 3) var lokalisationen av fotsår på samma sida som patienten var förlamad. Dokumenterade preventions- och omvårdnadsåtgärder i sängen: (n=12) och i stolen: (n=0). Enligt IWGDF riskklassifikation identifierades (n =12) som har riskfaktorer för fotproblem och fotsår. Dokumentation av omvårdnadsprocessen följdes inte i journalerna.SLUTSATS: Patienterna har hög ålder, är multisjuka och förlamade helt eller på ena sidan av kroppen. Lokalisationen av fotsår på samma sida som patienten var förlamad. Brister i omvårdnadsdokumentation och preventionsarbete medför risk för patientens säkerhet. Studien ger mer kunskap när det gäller risk för utvecklandet av fotsår hos patienter med stroke och diabetes som vårdas på neurologisk klinik. Studien ger ett underlag för att utveckla klinikens kvalitetsarbete och försäkra patientsäkerhet genom att öka kunskap om diabeteskomplikationer och riktlinjer, omvårdnadsdokumentation enligt omvårdnadsprocessen, samt kritiskt tänkande av omvårdnad. Fler studier om fotsår hos strokepatienter rekommenderas. / THE DIABETIC FOOT IN HOSPITALIZED STROKE PATIENTS: RISK, PREVELANCE AND NURSING ACTIONS.BACKGROUND: Complications in the foot is the most serious one of the diabetes. Often, this leads to expensive treatments and amputation. Stroke results in loss or limitation of previous physiological, psychological and social activities and including a reduced ability to protect their feet and perform self-care. Stroke patients with diabetes have a high risk of injury in the paralyzed side of the body. Impaired mobility is a risk factor that can cause patient harm. On the nursing ward for stroke patients the nurse can through good nursing intervention and preventive actions contribute to the risk of developing damage to their feet in stroke patients decreases.AIM: The aim of the study is to explore the prevalence of diabetic foot at a neurological clinic and review the nursing documentation of preventions actions in stroke patients with diabetes with regard to the risk of developing foot ulcers.METHOD: A retrospective medical record review study with quantitative and qualitative approach. The study was conducted at a neurological clinic at a university hospital in southern Sweden. All the records (n = 101) of stroke patients with diabetes who were treated at the clinic from 1 January 2015 to 20 December 2015. The examination was conducted using Global Trigger Tool (GTT). Data analysis was divided into two parts: the descriptive statistical analysis and manifest content analysis.RESULTS: Median age is 78 years (41-93). Women (n = 40), men (n = 61). Journal review showed insufficient documentation. Risk assessment for foot ulcers was not documented in any of the journals. Patients with documented foot ulcer (n= 3), the localization of ulcers is on the same side as the patient is paralyzed. Prevention and nursing actions, (n = 12) documented action in bed, (n = 0) documented actions in the chair. According IWGDF risk classification (n =12) identified as having risk factors for foot problem and foot ulcer. Documentation of nursing process was not followed in the journals.SUMMARY: The patients had high age with multiple comorbidities and paralyzed in the whole or on one side of the body. The localization of foot ulcers is on the same side as the patient is paralyzed. Insufficiency in nursing documentation and prevention work result in risk to patient safety and impaired quality of care. The study provides more knowledge about the risk of the developing foot ulcer for patients with stroke and diabetes who treated in the neurological clinic. The study provide foundation to develop the clinic quality work and ensure patient safety through increasing knowledge to the clinic about diabetic complications and guidelines, nursing documentation in accordance with the nursing process and critical thinking of nursing. More studies of foot ulcers in stroke patients are recommended. Keywords: diabetes mellitus, diabetes foot ulcers, documentation, Global Trigger Tool, journal examination, nursing, prevention,