Leg ulceration negatively affects quality of life (QOL). The relationship between important clinical attributes such as ulcer severity, pain and health related quality of life (HRQL) is poorly understood. The Wilson and Cleary model of Health Related Quality of Life (WC model) is a guiding framework that links clinical measures to QOL. Thesis Objectives: I describe the relationship between ulcer severity, comorbidity, etiology and pain and HRQL. Methods: An integrative mixed-methods approach was used: a systematic review of studies that examined the relationship between clinical variables and HRQL or QOL as outlined in the WC model (n=22); a review of studies (n=11) that compared the HRQL of persons with leg ulcers to population normative scores; and, an analysis of the relationship between clinical factors and HRQL in a cohort of 564 persons with venous leg ulcers drawn from two randomized control trials. Results: There is empirical support for the causal linkages between disease severity, symptoms, function, health perception and QOL that comprise the causal pathway as outlined in the WC model. Venous ulcers are associated with a poor quality of life, and numerous aspects of functioning are impaired, in particular physical function. In 564 individuals with venous ulcers, pain was present in 78.8%. Those younger than 65 years were 1.5 times more likely to be in the higher pain group compared to those 65 and older. Physical HRQL was significantly impaired. Predictors of poor physical HRQL included venous-arterial ulcers, a more severe ulcer, arthritis and a higher level of pain. Poor mental HRQL was associated with the younger age group, a comorbid condition and a higher level of pain. Increasing ulcer duration negatively affected mental state, but the findings were of borderline significance. Conclusion: The WC model is a clinically useful framework to select variables to represent HRQL and to base hypotheses about causal associations between clinical variables and QOL. Future research should focus on specifying the measurement models to represent disease severity, symptom status and functional status. Clinically the WC model is a useful bedside heuristic to explore the impact on leg ulceration on daily life and wellbeing. / Thesis (Master, Nursing) -- Queen's University, 2010-01-16 13:11:38.045

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

<p>Swedish studies have shown that more people than expected have problems with leg ulcers and that the yearly cost for treatment per patient is approximately 26 500kr. </p><p>Since the elderly population is on the rise, there is a need to highlight this growing problem, to make sure that proper assessment tools are used and to improve the standard of care given to patients with leg ulcers. The aim was to show what a difference the nurse can make to patients with leg ulcers. With all types of wounds it is imperative to establish if there is any underlying reasons since certain illnesses can cause more wounds or delay the healing process. The doctor is responsible for making the diagnosis and to prescribe the correct treatment whereas the nurse’s responsibility is for the nursing care and its documentation. The patient’s lifestyle, his next of kin and his environment all play an important part in this healing process. A holistic approach is therefore necessary to be able to give good standard of nursing care. The nurse can by being careful and precise when changing the dressing, using assessment tools and document, give encouragment for compliance, inform and educate patients, help a great deal in the patient’s healing process. Further research is needed to see how the nurses’ compliance can be improved, and how new knowledge can be implemented. </p><p>Nurse students need to learn more about wounds and wound treatments in their basic education, and evidencebased guidelines have to be used in the caring for leg ulcer patients.</p>

Swedish studies have shown that more people than expected have problems with leg ulcers and that the yearly cost for treatment per patient is approximately 26 500kr. Since the elderly population is on the rise, there is a need to highlight this growing problem, to make sure that proper assessment tools are used and to improve the standard of care given to patients with leg ulcers. The aim was to show what a difference the nurse can make to patients with leg ulcers. With all types of wounds it is imperative to establish if there is any underlying reasons since certain illnesses can cause more wounds or delay the healing process. The doctor is responsible for making the diagnosis and to prescribe the correct treatment whereas the nurse’s responsibility is for the nursing care and its documentation. The patient’s lifestyle, his next of kin and his environment all play an important part in this healing process. A holistic approach is therefore necessary to be able to give good standard of nursing care. The nurse can by being careful and precise when changing the dressing, using assessment tools and document, give encouragment for compliance, inform and educate patients, help a great deal in the patient’s healing process. Further research is needed to see how the nurses’ compliance can be improved, and how new knowledge can be implemented. Nurse students need to learn more about wounds and wound treatments in their basic education, and evidencebased guidelines have to be used in the caring for leg ulcer patients.

This project sought to develop a system that facilitated the visual inspection of venous leg ulcers by establishing a selection of reliable parameters. The project had three principal aims: to develop a reliable method for capturing the colours exhibited by a venous leg ulcer; to establish a colour range that experienced clinicians believed represented wet necrotic tissue and erythema; and to develop software that highlighted the two manifestations in digital photographs. The project method was divided into three phases. The first phase examined images taken from twenty-two patients over forty-seven episodes of care. During each episode three sequential images were captured using a frame to control for orientation, magnification and lighting resulting in a bank of 141 images. The reliability of the system to accurately capture colour was then determined by examining the amount of colour variation recorded across the set of three images taken at each episode. The second phase asked eight experienced clinicians to examine a set of twenty photographs taken from the bank established in phase one. On each photograph the clinicians were asked to identify areas of wet necrotic tissue or erythema and outline the areas with a colour pen supplied for each manifestation. A colour range was then constructed to represent each manifestation by measuring the range, mean and standard deviation of pixels that were located within the outlined areas. The third phase developed a computerised system that used the colour range established in phase two to highlight areas of a digital image that represented either erythema or wet necrotic tissue. The validity of the highlighted areas was then tested by asking experienced clinicians to identify their level of agreement with the areas selected by the computer system. Analysis of the results from phase one indicated that the system used to record images at each episode of care provided a reliable method for maintaining consistent orientation, magnification and replication of colour. Results from phase two yielded a two distinct colour representation of erythema and wet necrotic tissue. Erythema ranged from 3600 to 3780 of hue with a mean of 369.210, and wet necrotic tissue ranged from 3670 to 3900 of hue with a mean of 387.730. Results from phase three indicated that whilst clearly delineated areas of erythema and wet necrotic tissue were visible, the validity of the representations was varied. 50 per cent of experienced clinicians agreed with the areas selected as erythema and 60 per cent agreed with the areas selected by the computer system as wet necrotic tissue. The system developed during this study for recording images of venous leg ulcers provides a reliable method for further research into the visual progression of this disease. However, the colour range identified as being representative of erythema or wet necrotic tissue and the computer system developed to highlight such areas in a digital image, requires further investigation before it is applicable to the clinical setting. The findings do however provide further insights into the varied nature of expert opinion when judging the colour of venous leg ulceration.

No description available.

I Sverige lider cirka 50 000, främst äldre personer av svårläkta bensår. Venös insufficiens är vanligaste sjukdom som orsakar svårläkta bensår. Behandlingen kan vara besvärlig och oftast påverkar patientens vardag. Syftet med studien var att beskriva patienters upplevelser av att leva med svårläkta bensår. En litteraturöversikt med kvalitativ ansats baserad på vetenskapliga artiklar genomfördes. Artiklarna söktes i databaser, analyserades och sammanställdes för att finna meningsbärande innehåll med utgångspunkten i patienters upplevelser. Resultatet visade att svårläkta bensår påverkade patienternas dagliga liv och välbefinnande på olika sätt och presenterades under fyra teman: Styrd av smärta, lukt och läckage i vardagen, Besvärlig behandling, Begränsningar som påverkar människans kroppsuppfattning, Betydelsen av vårdmötet. Patienterna hade negativa upplevelser av att leva med svårläkta bensår vilket orsakade mycket lidande och begränsade deras rörlighet och sociala liv. De upplevde dåligt självförtroende och en förlorad kontroll över sin egen kropp. Sjuksköterskor bör ha bättre förståelse för och ha kunskaper om hur det är att leva med svårläkta bensår för att ge en god patientcentrerad omvårdnad.

SYFTESyftet med studien var att beskriva sjuksköterskors erfarenheter av att behandla venösa bensår samt att beskriva undersökningsgruppen i de ingående artiklarna.BAKGRUNDBefolkningen ökar och människor lever längre vilket leder till att även bensår blir allt vanligare. Sjuksköterskor är omvårdnadsansvariga när det kommer till att behandla bensår och sjuksköterskors inställning och attityd till dessa patienter lägger grunden för hur behandlingen formas och utövas. En god omvårdnad ska skapas där sjuksköterskorska begränsa påfrestningarna och lidande för patienterna som uppstått på grund av deras bensår.METODFöreliggande studie är en beskrivande litteraturstudie som baseras på nio vetenskapliga artiklar med både kvantitativ och kvalitativ ansats. Databaserna Cinahl, Scopus och PubMed har systematiskt använts med sökningar mellan 2000 -2015.RESULTATSjuksköterskors erfarenheter av att behandla venösa bensår kunde delas in i tre övergripande teman. Dessa resulterade i de övergripande rubrikerna sjuksköterskorserfarenheter av patienters följsamhet, sjuksköterskors erfarenhet av upplevd kunskap och samarbete samt sjuksköterskors erfarenhet av känslor relaterat till behandling. Sjuksköterskor beskrev att behandla bensår kunde leda till en rad olika känslor och det fanns mycket som påverkade behandlingen, som patienters motvillighet och följsamhet, sjuksköterskors egen kunskap samt samarbetet med andra professioner.SLUTSATSSjuksköterskor visade brister i sitt ansvar vid behandling av bensår då de inte följer professionens etiska kod. Många sjuksköterskor erfor en otillräcklig kunskap inom bensårsbehandling och en motvillighet att ta sig an patienter med bensår, då de inte såg det som givande.

Orientador: Marli Terezinha Cassamassimo Duarte / Resumo: As úlceras cutâneas crônicas de origem neuropática secundárias à hanseníase são de difícil resolução e onerosas ao sistema público de saúde e aos pacientes acometidos. Há coberturas de alta tecnologia para o tratamento das úlceras, entretanto, são de custo elevado. Desta forma, faz-se necessário identificar tratamento que possa ser usado nessa população, buscando minimizar ou regredir completamente a úlcera e que seja de baixo custo. Objetivo: Avaliar a viabilidade de um protocolo para uso da pomada de óxido de zinco nas concentrações a 20% e 25% comparada ao hidrogel, no tratamento de úlcera crônica de perna de pessoas com sequelas de hanseníase e propor instrumento de acompanhamento de pacientes em tratamento de úlceras crônicas. Método: Estudo clínico pragmático, do tipo piloto, randomizado com três braços paralelos, aberto em relação ao controle (hidrogel) e cego entre os dois grupos de intervenção, a saber: óxido de zinco a 20% e 25%. A população do estudo foi constituída por pacientes atendidos nos ambulatórios do Instituto Lauro de Souza Lima, portadores de úlceras de perna, que já concluíram o tratamento para a hanseníase e a amostra constituída por 12 pacientes com 36 úlceras. Como desfechos primários foram avaliadas as taxas de adesão, recrutamento e de eventos adversos. O desfecho secundário foi a avaliação da eficácia das intervenções por meio da avaliação inicial e evolução da úlcera, empregando-se a Pressure Ulcer Scale for Healing (PUSH) e a mediana da área em ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The chronic skin ulcers of neuropathic origin, secondary to leprosy, are difficult to heal and costly to the public health system and patients. There are high technology dressings for wound treatment, however, they are expensive. In this way, it is necessary to identify the treatment which can be applied to this population, seeking to minimize or completely reduce the ulcer at lower costs. Objective: To evaluate the viability of a protocol for the use of zinc oxide ointment at 20% and 25% concentrations compared to hydrogel, in the treatment of chronic leg ulcers of people with leprosy sequelae, and to suggest a follow-up instrument for patients under treatment of chronic ulcers. Method: This is a pragmatic, pilottype, randomized trial with three parallel segments, open to the control (hydrogel) and blind between the two intervention groups, namely: zinc oxide at 20 and 25%. The study population consisted of patients with leg ulcers, attended at the outpatient clinics of Lauro de Souza Lima Institute, who had already completed the treatment for leprosy, and the sample comprised 12 patients with 36 ulcers. Adherence, recruitment, and adverse event rates were assessed as primary outcomes. Evaluation of the efficacy of the interventions through the initial evaluation and evolution of the ulcer, using Pressure Ulcer Scale for Healing (PUSH), and median of the area in cm2, were assessed as secondary outcomes. Results: Four participants with 11 ulcers were included in the hydrogel ... (Complete abstract click electronic access below) / Mestre

I Sverige lider ca 50 000 personer av bensår vilket definieras som ”sår på ben och/eller fot nedom knät som ej läkt på 6 veckor”, ungefär hälften av dessa är venösa bensår. De flesta som drabbas av bensår är 65 år eller äldre. Syftet med denna studie var att beskriva patienters upplevelse av att leva med venösa bensår. Studien är baserad på en kvalitativ metod med en induktiv ansats. Data samlades in genom intervjuer från sex patienter och analyserades sedan med hjälp av innehållsanalys. Resultatet baseras på två kategorier; begränsat och bundet liv samt önskan att bli sedd. Dessa kategorier bildade temat; att vara hel men ändå inte. Utifrån denna studie kan personal som vårdar och behandlar bensårspatienter få ökad kunskap om hur patienter upplever att det är att leva med venösa bensår. Med hänsyn till detta vore det önskvärt att effektiva och välstrukturerade vårdrutiner utarbetas för att uppnå helhetssyn inom vården och behandlingen av bensårspatienter. / Approximately 50 000 people in Sweden are suffering from leg ulcers which is defined as "wounds on the legs and/or foot below the knee, which is not healed in 6 weeks", about half of them are venous leg ulcers. Most people who suffer from leg ulcers are 65 years or older. The purpose of this study was to describe patients' experiences of living with venous leg ulcers. The study is based on a qualitative method with an inductive approach. Data were collected through interviews from six patients and analyzed with help of content analyzing. The results are based on two different categories: limited and restricted life, and desire to be seen. These categories formed the theme; to be whole but still not. Based on this study, staff who care for and treat leg ulcer patients can increase knowledge about how patients feel it is to live with venous leg ulcers. Given this, it would be desirable that there are effective and well-structured care practices designed to achieve holistic healthcare and treatment of patients with leg ulcers.