Trycksår är ett förekommande problem inom den kirurgiska omvårdnaden som leder till ökade vård- och samhällskostnader samt ett ökat lidande för patienten. Det är av stor vikt att vårdpersonalen arbetar förebyggande för att motverka uppkomsten av trycksår samt att i god tid upptäcka om ett trycksår har uppstått. Syftet med denna studie var att undersöka trycksårsincidens efter långvarig neurokirurgisk kirurgi, identifiera vart trycksåren uppstår och om de kunde kopplas till riskfaktorer. Metoden som valdes var en kvantitativ prospektiv kohortstudiedesign för att resultatet skulle kunna användas i den peroperativa och postoperativa omvårdnaden. Hudkostymen inspekterades två gånger postoperativt på tjugoen patienter. Resultatet visade att 76 % av studiedeltagarna hade trycksår efter operation och det vanligaste förekommande området var hälarna. Ingen skillnad mellan dem som utvecklade trycksår och dem som inte utvecklade trycksår kunde hittas deskriptivt. Sammanfattningsvis, trots att det förekommer ett förebyggande arbete är trycksårsincidens hög på den här patientgruppen. Mer kunskap och kvalitetsutveckling inom området behövs. En ökad medvetenhet om vilka hudområden som är mest utsatta och hur vårdpersonalen kan arbeta för att avlasta dessa områden bör kunna bidra till att trycksårsincidensen sjunker. / Pressure ulcers are a common problem in the surgical care that leads to increased health and social costs and increased suffering for the patient. It is very important that caregivers take preventive measures to counter the occurrence of pressure ulcers and the timely detection of a pressure ulcer. The aim of this study is to investigate the incidence of pressure ulcers after prolonged neurosurgical surgery and identify where the pressure ulcers occur. The method chosen was a quantitative prospective kohortstudydesign to the result could be used in the perioperative and postoperative care. The skin was inspected twice postoperatively at twenty-one patients. The result of this study shows that 76 % of the participants had pressure ulcers after surgery and the most common area where the heels. No difference between those who developed pressure ulcers and those who did not develop pressure ulcers could be found descriptive. Although there is a prevention of pressure ulcer the incidence is still relatively high in this patient population. More knowledge and quality in the area is needed. An increased awareness of the skin areas that are most vulnerable and how caregivers can work to relieve these areas should be able to contribute to pressure ulcer incidence drops.

Bakgrund: Trycksår har alltid funnits inom vården och delas in i fyra grader. Trycksår utvecklas då ischemi uppstår över benutskott. Immobilitet och tryck orsakar ett minskat blodflöde. Det finns flera risker som bidrar till att trycksår uppstår. Det finns även flera bedömningsinstrument för att underlätta sjukvårdens bedömning av riskpatienter. Trycksårsförebyggande åtgärder inkluderar lägesändring, nutritionsåtgärder, tryckavlastande material så som madrasser och kuddar. Kunskaperna kring detta är bristande bland vårdpersonalen och det råder även blandade inställningar hos vårdpersonalen. Dock är det oklart hur dessa inställningar påverkar och relaterar till trycksår. Syfte: Syftet var att belysa vårdpersonalens inställningar och kunskaper till trycksår.Metod: Metoden bestod av en systematisk litteraturöversikt där kvalitativa och kvantitativa studier genomgicks. Urvalet bestod av sju kvantitativa och tre kvalitativa studier. Dessa analyserades och subteman och teman uppdagades.Resultat: Resultatet består av tre huvudteman med respektive subteman. Huvudtemat Kunskaper gällande trycksår beskriver samband mellan kunskaper och inställningar samt dess påverkan på arbetet med trycksår. Högre utbildning visade på en mer positiv inställning till trycksårarbete. Erfarenhet påverkade även inställningen positivt till trycksårarbete. Det uttrycks även vilja att erhålla vidareutbildning kring trycksår. Huvudtemat Trycksårsprevention beskriver hur den bristande kunskapen påverkar vårdpersonalens inställning till trycksårsprevention. De negativa inställningarna till prevention leder till en lägre prioritering av arbetet. Vårdpersonal ser ej samband mellan trycksår och patientlidande. Huvudtemat Vårdteamet beskriver vårdpersonalens okunskap kring kompetensbeskrivningar och uppdelning av ansvarsområden. Vårdpersonalens bristande samarbete uppdagas som en viktig komponent till bristfälligt arbete med trycksår.Diskussion: Metoddiskussionen tar upp möjliga felkällor och tolkningar som görs samt hur dessa påverkar resultatet. Resultatet diskuteras utifrån Virgina Hendersons modell om Grundprinciper för patientvårdande verksamhet.

SAMMANFATTNING   Bakgrund: Trycksår är en lokal skada i huden och i underliggande vävnad som kan uppkomma i samband med sjukdom, vård och behandling. Trycksår betraktas idag som en vårdskada och ska anmälas som en avvikelse. För individen innebär det stort lidande och ger höga kostnader för samhället, större omvårdnadsbehov och förlängda vårdtider. Studier visar att kunskap om trycksårsprevention hos sjuksköterskor och undersköterskor i Sverige inte är tillräckligt hög. Ett trycksensorsystem (MAP-system) finns nu tillgängligt som ger omedelbar feedback av patientens tryckpunkter som ett hjälpmedel vid trycksårsprevention. Syfte: Att utvärdera effekten av MAP- systemet avseende förekomst av trycksår hos äldre patienter under vårdtiden på en geriatrisk avdelning på sjukhus. Metod: En randomiserad, kontrollerad studiedesign valdes. En geriatrisk vårdavdelning valdes ut med en MAP-grupp (n=91) och en kontrollgrupp (n=99). Ett studieprotokoll användes med uppgifter om: demografisk data, hudinspektion (trycksårsklassificering kategori 1-4), Modifierad Nortonbedömning, komfort, maxtryck samt preventiva åtgärder. Insamlad data behandlades i SPSS och signifikansberäkning, standardavvikelse och medeltal räknades ut. Resultat: Användande av MAP-systemet gav ingen signifikant skillnad i andelen patienter med trycksår mellan MAP- och kontrollgruppen. Andel patienter med trycksår i MAP-gruppen dag ett var 24,2 % och dag 14, 28,2 %. I kontrollgruppen var andelen dag ett 18,2 % och dag 14, 23,8 %. Vanligaste lokalisationen av trycksår var hälar därefter sakrum och glutealt. Patienter med trycksår fick signifikant fler trycksårsförebyggande åtgärder. Slutsats: Studien visar ingen signifikant skillnad mellan andelen patienter med trycksår i MAP- och kontrollgruppen. Preventiva åtgärder prioriterades främst till patienter med trycksår. Genomförandet av studien antas ha medfört ökat fokus på trycksårsprevention samt påverkat prevalensen av trycksår positivt på den aktuella avdelningen. / ABSTRACT   Background: Pressure ulcers consist of local damage to the skin and underlying tissue and can occur in relation to illness, care and treatment. Pressure ulcers are today considered as an adverse event and are to be reported as a deviation from care routines. For the individual it can be the source of great suffering. It also generates large costs for the community, increased needs of nursing as well as prolonged periods of hospitalization. Studies show that the level of knowledge among registered nurses and assistant nurses in Sweden is insufficient. A pressure mapping system (MAP system) is now available, and can provide immediate feedback about the patient´s pressure points as a tool for pressure ulcer prevention. Aim: To study the effect of the MAP system regarding the presence of pressure ulcers in elderly hospitalized patients on a geriatric ward. Method: A randomized, controlled study design was chosen. A geriatric ward was selected with a MAP group (n=91) and a control group (n=99). A study protocol containing demographic data, systematic skin inspection (with classification of pressure ulcers category 1-4), Modified Norton scale, comfort, maximum pressure and preventive measures was used. Data was processed in SPSS; generating mean, standard deviation and level of significance. Results: No significant difference in the prevalence of pressure ulcers was shown between the MAP- group and the control group. The prevalence of pressure ulcers in the MAP-group was 24,2 % on day one and 28,2 % on day 14. In the control group the corresponding numbers were 18,2 % and 23,8 %. The most common localization of pressure ulcers were heels, followed by the sacral and gluteal regions. Patients with pressure ulcers received significantly more preventive measure compared to patients without pressure ulcers. Conclusion: The study shows no significant differences between the groups regarding the prevalence of patients with pressure ulcers. Preventive measures were prioritized mostly for patients with existing pressure ulcers. The study is assumed to have increased the focus on pressure ulcer prevention thus affecting the prevalence of pressure ulcers in a positive way on the present ward.

DHEA has been determined to have medically significant activity and is the parent compound to the more active metabolites; 17α-AED, 17β-AED and 17β-AET, which exhibit strong biological activity that has been attributed to androgenic, estrogenic or anti-glucocorticoid activity in vivo and in vitro. This study compared DHEA, 17α-AED, 17β-AED and 17β-AET for their ability to activate the human AR, ER and GR receptors and determine the relative androgenicity, estrogenicity and glucocorticoid activity. The results show that, at the receptor level, these androstene hormones are weak AR and even weaker ER activators. Direct androstene hormone activation of the human AR, ERα, and ERβ may not be essential for their biological function. Similarly, these hormones indirectly activated the human GR receptor; only in the presence of high dexamethasone concentrations. These results underscore the major difference between androstene hormone interactions with these nuclear receptors. 17β-AED and 17α-AED, androstene epimers that produce either survival or death, were utilized to treat T98G Glioblastoma cells. We identified 26 genes oppositely regulated by 17β-AED and 17α-AED to directly affect the cellular life or death decision. Network analysis demonstrated that these 26 genes are essential to regulating three critical Glioblastoma pathways. This report, for the first time, demonstrates that naturally occurring, chemically identical adrenal hormones (17β-AED or 17α-AED) direct a cellular life or death decision through contrasting modulation of identical signaling pathways and core regulators. Chronic pressure ulcers represent a significant health problem and are characterized by hypoxia, bacterial infection, repetitive ischemia/reperfusion and altered cellular and systemic stress responses. Whole genome microarray analysis was utilized in conjunction with IPA® premiere networking software to analyze chronic wound edge tissue. IPA® network analysis identified Ubiquitin C (UBC) as the most significant network. Sixteen (16) ubiquitin C associated genes were identified to be different in the chronic pressure ulcer and normal skin control. Targeted network analysis associated core regulators to 8 UBC associated genes that are unique to chronic pressure ulcers. The identification of these genes will allow the establishment of more effective treatments for Spinal Cord Injury (SCI) patients with chronic pressure ulcers.

Introdução: As lesões de pele representam um grande desafio para os profissionais de saúde que prestam cuidados a pacientes críticos, especialmente os com alterações cardiopneumológicas, pois é frequente ocorrências de úlceras por pressão e de lesões por fricção nessa clientela com aumento de custos no tratamento e do tempo de internação além de desconforto e impacto negativo sobre a qualidade do serviço prestado e de vida dos pacientes. Objetivos: Este estudo objetivou identificar e analisar os coeficientes de incidência de úlceras por pressão e lesões por fricção e os fatores de risco para o seu desenvolvimento em pacientes de Unidade de Terapia Intensiva (UTI) Cardiopneumológica. Métodos: Trata-se de um estudo de coorte, prospectivo, cuja coleta de dados ocorreu durante os meses de novembro de 2013 a fevereiro de 2014, com censura de uma semana. O estudo foi realizado em uma UTI destinado a pacientes com doenças cardíacas e pulmonares de um hospital de grande porte na cidade de São Paulo, após aprovação dos Comitês de Ética em Pesquisa (CEP) da Escola de Enfermagem da Universidade de São Paulo e da instituição, de acordo com protocolo número 20780713.4.0000.5392, com parecer consubstanciado publicado na Plataforma Brasil em 24/10/2013. Participaram da amostra 370 pacientes maiores de 18 anos, que não apresentavam úlceras por pressão e lesões por fricção na admissão, que aceitaram participar do estudo (assinando o Termo de Consentimento Livre e Esclarecido) e que estavam na unidade há menos de 24 horas. Para análise dos dados foram utilizadas análises univariadas e a Classification And Regression Tree (CART). Resultados: Incidências globais de 10,80%, 7,02% e 2,16%, respectivamente para úlceras por pressão, lesões por fricção e ambas as lesões simultaneamente foram encontradas nos pacientes críticos. Diferentes fatores de risco foram encontrados, conforme o tipo de lesão, sendo o tempo de permanência na UTI igual ou superior a 9,5 dias e idade igual ou superior a 42,5 anos comuns para as úlceras por pressão e lesões simultâneas. Além desses, raça branca; uso de superfícies de suporte e número de artefatos invasivos na admissão; e uso de transfusão sanguínea foram fatores constatados respectivamente para as úlceras por pressão, lesões por fricção e lesões simultâneas Conclusão: Os coeficientes de incidência e os fatores de risco constatados assemelham-se a alguns estudos da literatura, somente para as úlceras por pressão. Para as lesões por fricção e lesões simultâneas, não foram encontrados estudos desenvolvidos junto a pacientes críticos, sendo, no entanto, corroborados alguns dos fatores de risco descritos em grupos e cenários distintos como idosos residentes em instituições de longa permanência e pacientes crônicos hospitalizados. O estudo contribui, portanto, para os conhecimentos relacionados à epidemiologia dessas lesões, recomendando-se a replicação de seus métodos, principalmente para as lesões por fricção em pacientes hospitalizados, isoladamente ou em associação com as úlceras por pressão. Por outro lado, ao favorecerem a maior compreensão do panorama dessas lesões em pacientes cardiopneumológicos críticos, os resultados obtidos poderão favorecer o planejamento de cuidados preventivos específicos para essa clientela / Introduction: Skin lesions represent a major challenge for health professionals who care for critical patients cardiopneumologics. In clinical practice, have been frequent occurrences of pressure ulcers and skin tears, by rubbing with increased costs in treatment, prolonged hospitalization, in addition to discomfort and negative impact on the quality of service and the quality of life of patients.Goal: This study aimed to identify and analyze the rate of incidence of pressure ulcers and skin tears and the risk factors for its development in patients in the Intensive Care Unit(ICU) Cardiopneumologic. Methods: This study is a prospective cohort which data collection occurred during the months of November 2013 to February 2014, with censorship of a week. The study was conducted in a Surgical Intensive Care Unit Cardiopneumologic of a large hospital in the city of São Paulo, after approval of the Ethics Committee (EC) of the School of Nursing, University of São Paulo and the institution in accordance with protocol number 20780713.4.0000.5392 with sound embodied the EC Platform published in Brazil on 10/24/2013. A sample of 370 patients older than 18 years who did not have any injuries mentioned (pressure ulcers and skin tears) on admission, and who agreed to participate (by signing the Instrument of Consent) and who were in the unit for less than 24 hours. For data analysis were used univariate analyzes and the Classification And Regression Tree (CART). Results: overall incidences of 10.80%, 7,02% and 2.16% respectively for pressure ulcers, skin tears and both lesions simultaneously were found in critically ill patients. Different risk factors were found, depending on the type of injury, and length of stay in ICU less than 9,5 days old and less than 42,5 years common for pressure ulcers and concurrent injuries. Besides these, the white race; Use of support surfaces and the number of invasive devices in entry; and use of blood transfusion were observed factors respectively for pressure ulcers, skin tears and simultaneous injuries Conclusion: The incidence and risk factors observed are similar to some studies in the literature, only for pressure ulcers. For skin tears and simultaneous lesions, no studies have not found together developed the critical patients, however, corroborated some of the risk factors described in groups and different scenarios as seniors residents in long-term hospitalized chronic patients and institutions. The study therefore contributes to the knowledge regarding the epidemiology of these types of injuries, recommending that replication of their methods, especially for lesions friction in acute inpatients and critics, alone or in combination with pressure ulcers. On the other hand, by favoring a greater understanding of these lesions panorama critical cardiopneumologics patients, the results will may facilitate the planning of specific preventive care for these clients

O desenvolvimento de competências profissionais em processos de ensino-aprendizagem insere a simulação na perspectiva tecnológica realística de situações clínicas para atingir objetivos educacionais, visando segurança e qualidade. A ação competente operacionaliza saberes pela combinação de conhecimentos, habilidades e atitudes. A competência avaliação de risco para úlcera por pressão é privativa do enfermeiro, o agravo é indicador de qualidade e segurança do paciente. O objetivo do estudo foi avaliar o processo de ensino-aprendizagem ante a estratégia de simulação clínica, visando o desenvolvimento da competência profissional avaliação de risco para úlceras por pressão e seus respectivos conhecimentos, habilidades e atitudes. Fundamentou-se, teoricamente, o estudo, nos preceitos da andragogia, no modelo de Simulação da National League for Nursing/Jeffries, nas concepções de competências de Le Boterf e recomendações para prevenção de úlcera por pressão do NPUAP/ EPUAP. Trata-se de estudo descritivo com análise quanti e qualitativa, desenvolvido no Laboratório de Simulação da Universidade Federal do Piauí, em Teresina, com estudantes de enfermagem do último ano do curso. Constou de três etapas: construção e validação de conteúdo do instrumento para conhecimentos, habilidades e atitudes da competência, elaboração do plano de aula e sequência didática do cenário de simulação, aplicação de pré/pós-teste sobre o componente \"conhecimento\", aula expositiva, execução do cenário de simulação pelos estudantes, avaliação dos cenários pelo comitê de juízes e debriefing por grupo focal, após o cenário. Verificou-se confiabilidade do construto e do instrumento de medida da competência com concordância predominando de 80 a 100% de pertinência. O instrumento constou de 32 itens: conhecimento (14), habilidades (8) e atitudes (10), com escala de resposta de cinco pontos, de nada (1) a extremamente (5). Inicialmente o estudo contou com 35 estudantes. Desses, 29 (82,8%) participaram da simulação. Predominou o sexo feminino 22 (76%), faixa etária de 21 a 24 anos, 24 (82,7%) e procedentes de Universidades Públicas do Estado do Piauí (83%). Os resultados mostraram melhores níveis de combinação de saberes para o componente conhecimentos, após a aplicação das estratégias de ensino autorreferidos pelos estudantes. Na avaliação dos conhecimentos, habilidade e atitudes, durante o cenário, houve discordância entre os juízes: para o juiz 1 predominaram parâmetros negativos da escala (nada e muito pouco) e para o juiz 2 e 3 os positivos (bastante e extremamente). As comparações pelo teste de variância ANOVA mostraram diferenças significativas entre juiz 1 e 2 (p-valor = < 0,01) e juiz 1 e 3 (p-valor=<0,01) para todos os componentes. A análise dos dados obtidos, durante o debriefing, originou cinco categorias com suas respectivas unidades de registro temáticas pela análise de conteúdo de Bardin. Os resultados sugerem que a estratégia é capaz de resgatar o raciocínio operativo dos estudantes durante a ação, desenvolver pensamento crítico-reflexivo sobre a competência, identificar lacunas de aprendizagem, promover satisfação aos estudantes e melhorar a autoimagem profissional. Conclui-se que a estratégia possibilita o desenvolvimento da competência avaliação de risco para úlcera por pressão nas dimensões de saberes (conhecimento), fazeres (habilidades) e querer-agir, saber-agir e poder-agir (atitudes), explorados neste estudo. / The development of professional compentece in teaching-learning insert the simulation into a technological viewpoint of realistic clinical situations to achieve educational objective, seeking safety and quality. A competent action guides abilities by combining knowledge, skills and attitudes. A competence assessment of risk for pressure ulcer is private of nursing, the injury is an indicator of quality and patient safety. The aim of this study was to evaluate the teaching-learning strategy in the presence of clinical simulation, aiming at the development of professional competence assessment of risk for pressure ulcers and their knowledge, skills and attitudes. The study was theoretically based on precepts of andragogy, the simulation model of the National League for Nursing / Jeffries, conceptions of competence Le Boterf and recommendations for prevention of pressure ulcers of NPUAP / EPUAP. This is a descriptive study with qualitative and quantitative analysis, developed in the Simulation Laboratory of Federal University of Piauí, Teresina, with final-year nursing students. Consisted of three steps: construction and content validation instrument for knowledge, skills and attitudes of competence, preparation of lesson plan and instructional sequence of the simulation scenario, application of pre / post-test on a component \"knowledge\", lecture , execution of the simulation scenario by students, evaluation of scenarios by the committee of judges and \"debriefing\" by focus group after the scenario. Reliability of construct and instrument for measuring of competence agreement was verified, with predominating 80-100% of relevance. The instrument consisted of 32 items: knowledge (14) skills (8) and attitudes (10), with response scale of five points, nothing (1) to extremely (5). Initially, this study included 35 students. Of these, 29 (82.8%) participated in simulation. Participants were predominantly female 22 (76%), aged 21-24 years 24 (82.7%) and students of public universities of the State of Piauí (83%). The results showed higher levels of combination of abilities for knowledge component, after application of teaching strategies self-reported by students. In evaluation of knowledge, skill and attitudes during the scene, there was disagreement among judges, to judge 1, negative parameters of the scale were predominant (nothing and very little) and for judges 2 and 3 predominated positives parameters (quite and extremely). Comparisons by ANOVA test showed significant differences between judges 1 and 2 (p-value = <0.01) and judges 1 and 3 (p-value = <0.01) for all components. The data analysis obtained during the debriefing, originated five categories with their respective units registration by thematic content analysis of Bardin. The results suggest that this strategy is able to rescue of students, reasoning operating during the action, develop critical thinking and reflective about the competence, identify learning gaps, promote satisfaction to students and improve professional self-image. We conclude that the strategy enables the development of competency assessment for pressure ulcer risk in dimensions of knowledge (knowledge), activities (skills), act-want, act-learn and act-power (attitudes), explored in this study.

As úlceras por pressão são definidas como lesões causadas pela constante pressão exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangüíneo com diminuição ou interrupção da irrigação tissular, ocasionando oclusão de vasos e capilares, isquemia e morte celular. O objetivo principal deste trabalho foi verificar a resposta da cicatrização em úlceras por pressão, em clientes no atendimento domiciliar com a estimulação do ultra-som pulsado de baixa intensidade. A metodologia proposta foi a investigação de voluntários humanos não diabéticos, portadores de úlceras por pressão de qualquer grau, região, tamanho e profundidade em qualquer fase de cicatrização, sem processo infeccioso evidente, sem uso de medicação antiinflamatória. Todas as lesões receberam assistência de enfermagem obedecendo ao mesmo protocolo de curativos, para os portadores de 2 lesões apenas uma delas recebeu estimulação de ultra-som pulsado de baixa intensidade 30 mW/\'CM POT.2\', freqüência 1.5 Mhz em sessões de 20 minutos, três vezes por semana, durante seis meses, perfazendo um ciclo de aproximadamente 72 aplicações, ou menos sessões quando a alta aconteceu antes do prazo. Os resultados foram acompanhados através de quatro instrumentos: análise comparativa descritiva, análise histológica, análise morfométrica e análise fotográfica . A pesquisa foi observacional descritiva, sendo realizada uma análise estatística, através de dados extraídos dos prontuários e mensurações das áreas das lesões. O estudo histológico revelou melhora na vascularização, demonstrou angiogênese e processo inflamatório local. / The pressure ulcers are areas of injured skin and tissue caused by constant pressure on certain areas of the body, compromising the irrigation of tissue and also, causing the occlusion of vases and capillaries, ischemia and cellular death. The main objective of this work was the evaluation the wound healing process in pressure ulcers, during homecare service, with stimulation of low intensity ultrasound combined with papain. The methodology evaluation was applied in human volunteers without diabetic, with wounds in any ranges, region, size and depth. These wounds were in any phase and without any evident infectious process, without use of any antiinflammatory drugs. During all the execution of the work the injuries were treated according to the same protocol . Patients with only one wound received ultrasound stimulation in sessions of twenty minutes, three times per week, during six months, constituting a healing cycle of approximately 72 applications. Early treatment closing caused a reduction of sessions number. Considering patients with two injuries only one of the received the ultrasonic stimulation. The results had been followed through four studies: descriptive comparative analysis, histological analysis, morphometric analysis and photographic analysis. The results obtained were submitted to statistical analysis, by analyzing data extracted from clinical records and measurements of injury areas. The histological study disclosed improvement in the vascularization, it demonstrated angiogenesis and local inflammatory process.

The aim of this study is to develop new insights which pressure relief (PR) cushion designers can use to guide the design of new cushions with greater efficacy at preventing pressure ulcers than contemporary cushions. A methodological framework was formulated which incorporated a number of research techniques from the user-centred methodology USERfit, and included methodological triangulation. Exploratory interviews and observational work were conducted in a specialist unit for spinal cord injury (SCI). This involved ten patients, four physiotherapists, two nurses and an outpatient technician. Additionally, two questionnaires were designed and circulated amongst SCI patients and staff with completed responses from 41 patients and 31 staff. From the analyses of the data gathered from the literature, observational work, interviews and questionnaire responses, 28 recommendations for cushion design were formulated. These recommendations covered the principles which underpin cushion design, cushion usability and the future direction of cushion design.

As úlceras por pressão são definidas como lesões causadas pela constante pressão exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangüíneo com diminuição ou interrupção da irrigação tissular, ocasionando oclusão de vasos e capilares, isquemia e morte celular. O objetivo principal deste trabalho foi verificar a resposta da cicatrização em úlceras por pressão, em clientes no atendimento domiciliar com a estimulação do ultra-som pulsado de baixa intensidade. A metodologia proposta foi a investigação de voluntários humanos não diabéticos, portadores de úlceras por pressão de qualquer grau, região, tamanho e profundidade em qualquer fase de cicatrização, sem processo infeccioso evidente, sem uso de medicação antiinflamatória. Todas as lesões receberam assistência de enfermagem obedecendo ao mesmo protocolo de curativos, para os portadores de 2 lesões apenas uma delas recebeu estimulação de ultra-som pulsado de baixa intensidade 30 mW/\'CM POT.2\', freqüência 1.5 Mhz em sessões de 20 minutos, três vezes por semana, durante seis meses, perfazendo um ciclo de aproximadamente 72 aplicações, ou menos sessões quando a alta aconteceu antes do prazo. Os resultados foram acompanhados através de quatro instrumentos: análise comparativa descritiva, análise histológica, análise morfométrica e análise fotográfica . A pesquisa foi observacional descritiva, sendo realizada uma análise estatística, através de dados extraídos dos prontuários e mensurações das áreas das lesões. O estudo histológico revelou melhora na vascularização, demonstrou angiogênese e processo inflamatório local. / The pressure ulcers are areas of injured skin and tissue caused by constant pressure on certain areas of the body, compromising the irrigation of tissue and also, causing the occlusion of vases and capillaries, ischemia and cellular death. The main objective of this work was the evaluation the wound healing process in pressure ulcers, during homecare service, with stimulation of low intensity ultrasound combined with papain. The methodology evaluation was applied in human volunteers without diabetic, with wounds in any ranges, region, size and depth. These wounds were in any phase and without any evident infectious process, without use of any antiinflammatory drugs. During all the execution of the work the injuries were treated according to the same protocol . Patients with only one wound received ultrasound stimulation in sessions of twenty minutes, three times per week, during six months, constituting a healing cycle of approximately 72 applications. Early treatment closing caused a reduction of sessions number. Considering patients with two injuries only one of the received the ultrasonic stimulation. The results had been followed through four studies: descriptive comparative analysis, histological analysis, morphometric analysis and photographic analysis. The results obtained were submitted to statistical analysis, by analyzing data extracted from clinical records and measurements of injury areas. The histological study disclosed improvement in the vascularization, it demonstrated angiogenesis and local inflammatory process.

There are many terms used to describe pressure ulcers: pressure sores, decubitus ulcers, bedsores, and pressure necrosis or ischaemic ulcers. Essentially they all describe damage to the patient's skin and underlying tissue. The nursing literature abounds with information about the risk, grading, prevention and treatment of pressure ulcers. These ulcers are a problem in hospital and long term care facilities, and are a major cause of morbidity. In the hospital setting they contribute to an extended length of stay and by doing so 'block' the bed for use by another patient. The ulcers are difficult to treat, are an ongoing cause for pain and discomfort for the patient and can be a strain on hospital finances. Pressure ulcers are not unique to modern times, as they have been discovered on the remains of an Egyptian mummified body (Armstrong & Bortz 2001). This would suggest that the problem dates back to the Pharoahs, and has continued to be a challenging problem throughout the centuries (Bridel 1992). The escalating costs of treating these ulcers today, has brought about an emphasis on the risk factors, prevention and the appropriate interventions, rather than an acceptance of these ulcers as a tolerable ondition (Bridel 1992). In the operating room, nurses are faced with unique challenges when caring for their patients. This is due to difficulty in caring for patients under the influence of the anaesthesia required for surgery, long periods of forced immobility and the inability of the patient to perceive pain and discomfort from the pressure of the hard surface of the operating room table. These problems are increased by nurses' inability to gain access to the patient because of the sterile drapes required to cover the patient for surgery. Armstrong and Bortz (2001) present information from one study in which it is stated that surgical patients have 90% greater chance of developing pressure ulcers than medical patients. One reason for this may be due to the limited information available in regard to the most effective support surface to place on top of the operating room table. This gap in information is problematic for operating room nurses as it limits their ability to select the most effective item of equipment, and determine if the chosen equipment reduces pressure on tissue intra- operatively. The most effective operating room table mattress used and the skills and knowledge of the operating room nurse about the aetiology and prevention of pressure ulcer prevention, are important aspects of nursing care and can influence patient outcomes. The potential for complications to occur may be dependent on single or combined factors such as the patient's age, disease processes, nutritional status and mobility. Preparatory and supportive nursing interventions for surgical procedures based on best available evidence, nursing experience and patient preference, can reduce the incidence of pressure ulcer development in the perioperative environment. This doctoral portfolio contains four separate sections related and linked together by a common theme - pressure ulcer prevention in the perioperative environment. This first section of the portfolio situates the topic and provides a brief overview of the portfolio. The second section is a critical review of the literature pertaining to the most commonly used operating room table mattresses, and the effectiveness of these mattresses in the prevention of pressure ulcer development. This review highlighted a lack of quality research in this area, and while many evaluations have been undertaken to determine the effectiveness of perating room table mattresses, the results are contradictory concerning the patients, exposures and interventions. Because of issues related to the methodological quality of published research in this area a systematic review using meta- analysis was not possible rather a critical review of the research literature is used. The third section of the portfolio reports on a hermeneutic ethnography of the perceived skills and knowledge of nurses in the prevention of pressure ulcer development in the perioperative environment. This study was designed to determine if pressure ulcer prevention forms an aspect of the everyday practice of perioperative nurses. This review has highlighted the need for operating room nurses to review practices when caring for patients in the perioperative environment particularly in respect of pressure ulcer prevention. The fourth and final section of the portfolio summarises the research and provides recommendations for nursing practice and further research in the area of pressure ulcer prevention in the perioperative environment. / Thesis (D.Nurs.)--Department of Clinical Nursing, 2004.