The purpose of this thesis is to design an innovative sickbed for the paralyzed patients. One goal of the sickbed is to avoid the occurrence of pressure ulcers. The other one is to tune the tensions of patient¡¦s muscles. To analyze the muscle tension, a simplified model for human body was proposed. This model divided the human body into 5 blocks when ignoring the arms and hands. It described the geometric relationships between the blocks and muscles under different body postures and external supports from the design sickbed. It was noted that the number of unknowns of the model was larger than the number of equations derived from the equilibrium conditions. An optimization method, which was to obtain a desired distribution of muscle tensions, was adopted to find the solutions for the unknowns. Among the possible supporting states, which included the body postures and supporting locations, the ones that met the desired tension distribution were searched. Then, the technique of Graph theory was used to obtain a set of supporting states that could avoid the occurrence of pressure ulcers. Finally, a preliminary design of the sickbed structure was discussed. If the relaxed condition of muscles was desired, the simulation study indicated that large number of supporting states could meet the purpose. That means there exist many body postures or supporting locations allowing the muscles of body in the relaxed condition. This feature allows one to choose a set of supporting states that two consecutive states own different supporting locations and prevents any spot of body from continuous loading. Such a supporting scheme should minimize the occurrence of pressure ulcers.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Ãlcera por pressÃo (UP) à uma lesÃo comum entre idosos e indivÃduos com mobilidade fÃsica prejudicada. Ela afeta a qualidade de vida dos indivÃduos e gera custos considerÃveis, uma vez que està se tornando um problema mundial crescente, devido ao envelhecimento da populaÃÃo. Ciclos de isquemia e reperfusÃo tÃm sido identificados como fatores causais primÃrios, mas existem outros fatores que influenciam a intensidade dos danos. Atualmente, nÃo existe um mÃtodo eficaz e de baixo custo para tratar esta condiÃÃo. O uso clÃnico da fumaÃa de Artemisia vulgaris (FAV) para o tratamento de lesÃes na pele de diversas origens està descrito na literatura. Entretanto à pouco documentado e atualmente nada foi descrito em modelos experimentais de ulcera por pressÃo a respeito da sua atividade cicatrizante, bem como o seu efeito tÃxico. Dessa forma objetivou-se investigar o perfil toxicolÃgico e o efeito cicatrizante da aplicaÃÃo tÃpica da fumaÃa de Artemisia vulgaris em modelo de Ãlcera por pressÃo em camundongos. Este trabalho foi aprovado pelo Comità de Ãtica (89/2011). Foi utilizado um modelo nÃo-invasivo de UP em camundongos Swiss machos, que consiste em 4 ciclos de isquemia e reperfusÃo atravÃs da colocaÃÃo de dois ÃmÃs na superfÃcie da pele dorsal. Cinco grupos experimentais foram testados: (1): com Ãlcera e sem tratamento, (2): com Ãlcera e FAV tÃpico, (3): com Ãlcera, FAV tÃpica e filme de poliuretano, (4): com Ãlcera e tratado com hidrogel e filme de poliuretano e (5) sem Ãlcera, e sem tratamento. A anÃlise foi realizada nos dias 5, 7, 14 e 21 apÃs a induÃÃo da Ãlcera. Foram avaliados parÃmetros macroscÃpicos de cicatrizaÃÃo atravÃs da escala EWAT (Experimental Wound Assessment Tool â Instrumento de avaliaÃÃo de ferida experimental), Ãrea da ferida e porcentagem de contraÃÃo. Nos parÃmetros microscÃpicos foram avaliados: a anÃlise histopatolÃgica, a espessura da camada de colÃgeno e densidade de colÃgeno na derme, a contagem de fibroblastos e fibrÃcitos e a mediÃÃo da espessura da epiderme. AvaliaÃÃo da imunomarcaÃÃo para NOSi e nitrotirosina e ensaio de malondialdeÃdo (MDA) foi realizado para investigar o stress oxidativo. Testes toxicolÃgicos com parÃmetros hematolÃgicos, bioquÃmicos, histopatolÃgicos e comportamentais foram realizados em animais tratados com FAV. Resultados: a FAV nÃo mostrou toxicidade nos parÃmetros avaliados. Em todos os resultados a FAV + filme transparente foi melhor do que a FAV. EWAT macroscÃpica e escores inflamatÃrios mostraram diferenÃas significativas entre o grupo tratado, FAV + filme de poliuretano e grupo controle (p <0,01). Ãrea contraÃÃo da ferida foi aumentada em no grupo FAV grupo + filme de poliuretano, por 99,62% (84,65% vs, controle), bem como a contagem de fibroblastos (112,7  7,9 vs 80,0  6,4; controle, p < 0,01) e densidade de colÃgeno (33,9%  6,6 vs 20,9  8,6%, controle, p <0,01). FAV + filme de poliuretano aumentou a espessura da epiderme (113,2  18,1 vs 52,1  8,9, controle p <0,01) e tambÃm a contagem do nÃmero de vasos sanguÃneo no tecido conjuntivo (142,3  15,1 vs 68, 5  8,6; controle, p <0,01). O nÃmero de cÃlulas marcadas para NOSi e nitrotirosina, foi reduzido no grupo FAV + filme de poliuretano (601,5  94,0 vs 95,7  2005,0, controle, NOSi e 666,0  142,4 vs 1877,2  133, 8; controle, nitrotirosina, p <0,01). O MDA tambÃm foi reduzido pelo tratamento com FAV + filme de poliuretano (0,08  0,03 vs 0,3  0,05; controle, p <0,05). ConcluÃmos que a aplicaÃÃo tÃpica da FAV nÃo produziu efeito tÃxico e acelerou a cicatrizaÃÃo de feridas possivelmente por propriedades antioxidantes. O uso do filme de poliuretano intensificou a aÃÃo da FAV. / Pressure ulcer (PU) is a common injury among elderly and subjects with impaired physical mobility. It affects the quality of life of individuals and generates considerable costs, since it is becoming a worldwide growing problem due to the aging of the population. Cycles of ischemia and reperfusion from pressure have been identified as primary causal factor but other factors influence the intensity of damage. Currently, there is no effective and inexpensive method to treat this condition. For this reason, we aimed to check whether the traditional indication of smoke from Artemisia vulgaris (SAV) really contributes to the wound healing process of the PU. This work was approved by Ethics Committee (89/2011). It was used a non-invasive model of PU in mice which consists of 4 cycles of ischemia and reperfusion by the placement of two magnets on the dorsal skin surface of mice. Five experimental groups were tested: negative control, with ulcer and without treatment; positive control, with ulcer and treated with hydrogel and transparent film; treated group 1, with ulcer and topical SAV, treated group 2, with ulcer and topical SAV and transparent film, and a group without ulcer and without treatment. The analysis was conducted on days 5, 7, 14 and 21 after ulcer induction. Macroscopic parameters of healing were assessed through the EWAT (Experimental Wound Assessment Tool). Wound area, percentage of contraction, histopathological analysis, collagen layer thickness and collagen density in the dermis, counting of fibroblasts and fibrocytes, measurement of epidermis thickness were also assessed. Evaluation of the immunostaining for iNOS and nitrotyrosine and malondialdehyde assay (MDA) was performed to investigate oxidative stress. Toxicological tests were conducted in treated animals and SAV showed no toxic effect. In all the results SAV+film treatment was better than SAV. Results: Macroscopic EWAT and inflammatory scores showed significant differences between SAV+film treated group and control group (p<0,01). Wound contraction area was enhanced in SAV+film group by 99,62% (vs 84,65%, control) as well as fibroblast count (112,7  7,9 vs 80,0  6,4; control, p<0,01) and collagen density (33,9%  6,6 vs 20,9%  8,6; control, p<0,01). Epidermal width was increased by SAV+film (113,2  18,1 vs 52,1  8,9; control p<0.01) and also the blood vessel counting in the conjunctive tissue (142,3  15,1 vs 68,5  8,6; control, p<0.01). The counting of iNOS and nitrotyrosine immunostained cells showed a reduction by SAV+film (601,5  94,0 vs 2005,0  95,7; control, iNOS and 666,0  142,4 vs 1877,2  133,8; control, nitrotyrosine, p<0.01). MDA assay showed also a reduction by SAV+film treatment (0,08  0,03 vs 0,3  0,05; control, p<0.05). In conclusion, SAV topical application promoted wound healing by anti-oxidant properties and by modulating the inflammatory process. The effect of SAV was enhanced when the wound area was covered by the transparent film after smoke application. In addition, this method showed no toxic effect and may be an effective and low cost alternative for PU healing treatment.

Although pressure ulcer (PrU) development is now generally considered an indicator for quality of care, questions and concerns about situations in which they are unavoidable remain. Considering the importance of this issue and the lack of available research data, in 2010 the National Pressure Ulcer Advisory Panel (NPUAP) hosted a multidisciplinary conference to establish consensus on whether there are individuals in whom pressure ulcer development may be unavoidable and whether a difference exists between end-of-life skin changes and pressure ulcers. Thirty-four stakeholder organizations from various disciplines were identified and invited to send a voting representative. Of those, 24 accepted the invitation. Before the conference, existing literature was identified and shared via a webinar. A NPUAP task force developed standardized consensus questions for items with none or limited evidence and an interactive protocol was used to develop consensus among conference delegates and attendees. Consensus was established to be 80% agreement among conference delegates. Unanimous consensus was achieved for the following statements: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive. Consensus was not obtained on the practicality or standard of turning patients every 2 hours nor on concerns surrounding the use of medical devices vis-à-vis their potential to cause skin damage. Research is needed to examine these issues, refine preventive practices in challenging situations, and identify the limits of prevention.

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

No description available.

No / The establishment of a correct diagnosis links care to established guidelines and underpins all subsequent therapeutic activity. Problems can arise when definitions of disease overlap, as is the case with diabetic foot ulceration and pressure ulcers on the foot occurring in people with diabetes. In such cases, clinicians must ensure that patients receive a care bundle that recognises both the wound causation (pressure and shear) and the underlying pathology (diabetic neuropathy, potential foot architecture disruption and ischaemia). All patients with diabetes that have foot ulceration, irrespective of wound aetiology should, therefore, be seen by the multidisciplinary diabetic foot team. Care can then be optimised to include appropriate assessments, including assessment of peripheral perfusion, correct offloading, appropriate diabetic management, and general foot and skin care.

Bakgrund: En kombination av olika riskfaktorer och ett yttre tryck bidrar till att patienter drabbas av trycksår. Sjuksköterskor i samarbete med undersköterskor ansvarar för att förhindra risken för trycksår hos patienter. Tidigare studie påvisar att femton procent av inneliggande patienter på sjukhus drabbas av trycksår. Syfte: Syftet med studien är att belysa varför patienter får trycksår trots att sjuksköterskan i samarbete med undersköterskan bör ha kunskaper för att förebygga vårdrelaterade trycksår. Metod: Författarna använder sig av metoden allmän litteraturöversikt. Tolv artiklar med både kvalitativ och kvantitativ ansats ligger till grund för resultatet. Resultat: Resultatet påvisar tre huvudteman som påverkar det förebyggande arbetet av vårdrelaterade trycksår. Dessa teman är kunskaper angående trycksårsprevention, hinder i trycksårspreventionen och personalrelaterade faktorer. Diskussion: De huvudteman och subteman som framkommer i resultatet är bidragande faktorer till att patienter i dag utvecklar vårdrelaterade trycksår. Faktorerna bidrar även till ett ökat vårdlidande för patienten. Ett lidande som kan undvikas om ett gott förebyggande arbete utförs. / Background: A combination of risk factors and external pressure might cause a patient suffering from pressure ulcer. Health-care professionals who work close to patients are responsible for preventing the risk of pressure ulcer. A study found that fifteen percent of hospitalized patients suffer from pressure ulcer. Aim: The aim of this study is to highlight why patients have pressure ulcers even though the nurse in collaboration with the assistant nurse should have the knowledge to prevent health care associated pressure ulcer. Method: This study is a literature review. Twelve articles, of both quantitative and qualitative approach, was found and included in the results. Results: The result shows three main themes that seems to influence the pressure ulcer prevention. These themes are knowledge in pressure ulcer prevention, barriers in pressure ulcer prevention and personnel-related factors. Discussion: The main themes and subthemes that emerged from the results are contributing factors to patients today are developing healthcare associated pressure ulcers. These factors also contribute to an increased care associated suffering for the patient. A suffering that can be avoided if a good preventive work are performed.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 195-207). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Bakgrund: Trycksår är en skada på hud eller vävnad som uppstår genom tryck och/eller skjuv. Det finns många faktorer som ökar risken för trycksår. Såren kan skapa lidande för patienter både fysiskt och psykiskt vilket förlänger återhämtning och vårdtid. Sjuksköterskan ansvarar för att bjuda in patienter och anhöriga till delaktighet för att utföra en god och säker omvårdnad. Syfte: Att undersöka patienters upplevelse av delaktighet i sin egen trycksårsbehandling och/eller trycksårsprevention. Metod: Allmän litteraturöversikt användes som design där 10 kvalitativa originalstudier hittades i databaserna PubMed, Psycinfo och CINAHL. Kvalitetsgranskningen genomfördes med hjälp av SBU:s granskningsmall och analyserades enligt Fribergs fyra-stegs analysmetod. Teoretisk referensram som valdes till arbetet är Katie Erikssons omsorgsteori.  Resultat: Fyra huvudkategorier samt fem underkategorier identifierades. Både positiva och negativa upplevelser om delaktighet framkom. Positiva upplevelser av delaktighet förekom vid personcentrerad vård där utbytet av information och kunskap var ömsesidigt. Det som påverkade patienternas delaktighet negativt var smärta och bristande kunskap hos både patienter och vårdpersonal. Faktorer som ansågs lindra lidandet och hade positiv inverkan på delaktighet var ett gott bemötande från personalen, med fokus på personcentrering och tillgång till adekvat information.  Slutsats: Patienter har olika upplevelser av delaktighet i sin egen trycksårsbehandling. Delaktigheten är beroende av att patienten förses med efterfrågad information och kunskap samt att vården personcentrerad. Personalen måste besitta specifik kunskap för att möjliggöra patientens delaktighet i vården. I framtiden bör fler studier genomföras för att få en bredare kunskap om området. / Background: A pressure ulcer is an injury to skin or tissue that occurs through pressure and/or shear. There are many factors that increase the risk of pressure ulcers. The wounds can create suffering for patients both physically and psychologically, which prolongs recovery and treatment time. The nurse is responsible for inviting patients and relatives to participate in order to perform good and safe nursing care. Aim: To examine patients' experience of participation in their own pressure ulcer treatment and/or pressure ulcer prevention.  Method: General literature review was used as design where ten qualitative original studies were found in the databases PubMed, Psycinfo and CINAHL. The quality review was carried out using SBU's review template and then analyzed according to Friberg's four-step analysis method. The theoretical frame of reference chosen for the work is Katie Eriksson's theory of care. Result: Four main categories and five subcategories were identified. Both positive and negative experiences of participation emerged. Positive experiences of participation occurred in person-centred care where the exchange of information and knowledge was mutual. What negatively affected patients' participation was pain and a lack of knowledge on the part of both patients and healthcare staff. Factors considered to alleviate suffering and have a positive impact on participation were good treatment from staff, focusing on person-centredness and access to adequate information. Conclusion: Patients have different experiences of participation in their own pressure ulcer treatment. Participation is dependent on the patient being provided with the requested information and knowledge and the care being person-centred. The staff must possess specific knowledge to enable the patient's participation in care. In the future, more studies should be carried out to gain a broader knowledge of the area.

Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain the etiology and progression of PI while Lewin's Change Theory was used to promote behavioral change in the nursing team. The practice-focused questions for closing the gap between nursing knowledge and practice were what percentage of nurses complied with standard PI prevention guidelines and what was the level of nursing staff teamwork in the agency per the Nursing Teamwork Survey [NTS]. This PI prevention initiative used a cross-sectional design. Data collection involved review of nursing documentation and electronic surveying of all nursing staff using the MISSCARE survey, the NTS, and the AHRQ assessment checklists, which were completed via SurveyMonkey, an online survey software. The impact of the PI prevention initiative was assessed by comparing the results of the documentation review and surveys pretest to the posttest results. There was significant improvement in nursing compliance with PI prevention and treatment. Pressure injury incidence rate fell from 13.6% to 5.1%. The positive social impact includes improving patient care and safety, minimizing PI incidence and producing an efficient team.