Wound healing studies and interfacial phenomena:use and relevance of the corneal model

The interaction of the wound dressing as a biomaterial with the wound bed is the central issue of this chapter. The interfacial phenomenon that encompasses the biological and biochemical consequences that arise when a biomaterial is introduced to a host biological environment is discussed. A great deal can be learned from observations arising from the behaviour of biomaterials at other body sites; one particularly relevant body site in the context of wound healing is the anterior eye. The cornea, tear film and posterior surface of the contact lens provide an informative model of the parallel interface that exists between the chronic wound bed, wound fluid and the dressing biomaterial. © 2011 Woodhead Publishing Limited All rights reserved.

A kapitalizmus néhány rendszerspecifikus vonása (Some system-specific features of capitalism)

A szerző korábban a szocialista rendszer és a posztszocialista átmenet elemzésére használta azt a szemléletet és módszertant, amelyet rendszerparadigmának nevezett el. A jelen tanulmány a kapitalizmus néhány általános vonásának vizsgálatára alkalmazza ezt a megközelítést. A cikk - fogalmi tisztázás után - példákat sorol fel a kapitalizmus néhány rendszerspecifikus vonására, majd kettővel részletesebben foglalkozik. Az egyik: a rendszer dinamizmusa. Az elmúlt évszázad nagy újításai, amelyek mélyrehatóan átalakították nemcsak a termelés technológiáját, hanem az emberek mindennapi életét is, a kapitalista rendszer és annak főszereplője, a vállalkozó vezette be és terjesztette el. Csak a kapitalizmusban tud kialakulni a vállalkozás és újítás mechanizmusa, az ehhez szükséges erőteljes ösztönzés és rugalmas tőkepiac. A másik példa: a kapitalista rendszer immanens tulajdonsága a munkaerőpiacon jelentkező tartós többlet, szemben a szocialista rendszerrel, amelynek kifejlett formájában tartós munkaerőhiány mutatkozik. Elméletileg és tapasztalatilag is igazolható, hogy minél dinamikusabb a kapitalista gazdaság állandó átalakulása, annál inkább keletkezik strukturális munkanélküliség. A hatékony bér elmélete megmagyarázza, miért érdeke a munkaadónak, hogy a piactisztító bérnél magasabb bért fizessen, és ezzel munkanélküliséget idézzen elő. A kapitalizmus reformálható rendszer. Ám ügyelni kell arra, hogy a részreformok között milyen a kapcsolat. Szerencsés esetben kiegészítik egymást. Ám ennél sokkal gyakoribb, hogy miközben szembeszállunk a rendszer egyik kedvezőtlen hajlamával, utat engedünk egy másik kedvezőtlen hajlam megerősödésének. ___________________ The author previously applied the outlook and methodology he named the system paradigm to analysing the socialist system and post-socialist transition. This study takes the same approach to some general attributes of capitalism. After clarifying some concepts, the author presents examples of some system-specific features of capitalism, before ad-dressing two of them in detail. One is the dynamism of the system. The great innovations of the last century that radically altered both the technology of production and people s daily lives were all introduced and disseminated by the capitalist system and its protago-nist, the entrepreneur. Only under capitalism can the mechanism of entrepreneurship and innovation emerge, with the strong incentives and flexible capital market they require. The other immanent feature is a chronic surplus on the labour market that contrasts sharply with the chronic labour shortage prevalent under the mature socialist system. Theory and experience confirm that the faster the ongoing transformation of a capitalist economy proceeds, the greater the propensity for structural unemployment to appear. It is explained by the efficiency pay hypothesis how an employer has an incentive to pay more than a market-clearing wage, thereby introducing unemployment. Capitalism is a system that can be reformed, but attention needs paying to relations between reforms of different parts of the system. In fortunate cases they complement each other, but it is commoner to find that tackling one unfavourable tendency only allows another such tendency to increase.

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

The Commodification of Queer Virgins in Shakespeare, Spenser, and Keats

The purpose of this thesis was to explore selected works from William Shakespeare, Edmund Spenser, and John Keats, in order to expose textual instances of feminist thought. This analysis was aided with feminist theorists falling under the main strains of queer theory, materialism, and gender performance. Specifically, this thesis focused on the ways in which women, particularly virgin daughters, were viewed as property by their male kin. It also looked at how these women engaged in various symbolic masquerades and/or actual cross-dressing as a response to the aforementioned phenomenon. Finally, the thesis exposed how these masquerades can be construed as a queering of identity—manifested through reversals of power and rejection of patriarchal institutions like marriage.

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Spic'ing into Existence: Epitaph, Epithet, and the Ethnopoetic Imagination

Quién Es, Quién Somos? Spic’ing into Existence claims a four-fold close-reading: first, analysis of texts: from theoretical meditations to (prison) memoir and film. Second, a half dozen central figures appear, largely Latinx and black American. They cut across a score of registers, socio-economics, ideological reservations, but all are, as Carl Carlton sang, poetry in motion. Writers, poets, theologians, pathologists, artists, comedians, actors, students whose vocation is invocation, the inner surge of their calling. Third, the manuscript draws from a series of historical moments—from radical liberation of the late 60s, to contemporary student activism. Finally, this body of work is movement, in all its social, gestural, and kinesthetic viscera. From this last heading, we peel away layers of what I call the ethnopoet, the fascia undoing that reveals its bio-political anatomy, dressing its bare life with kinship speech. First, the social revolutions of the Civil Rights, Black Power, abolitionism, the Black Panthers and Young Lords, boycotts and jarring artistic performances. These events are superficial not in vain sense, but key epicenters of underground murmurings, the workings of a cunning assailant. She robs not lavish estates, but another day to breathe. Gesturally, as perhaps the interlocutor, lies this author, interspersing his own diatribes to conjure her presence. The final branch is admittedly the most intangible. Kinesthetically, we map the nimbleness, footwork lígera of what I call the ethnopoet. Ethnopoet is no mere aggregate of ethnicity and poetry, but like chemical reaction, the descriptor for its behavior under certain pressures, temperatures, and elements. Elusive and resisting confinement, and therefore definition, the ethnopoet is a shapeshifting figure of how racialized bodies [people of color] respond to hegemonic powers. She is, at bottom, however, a native translator, the plural-lensed subject whose loyalty is only to the imagination of a different world, one whose survival is not contingent upon her exploitation. The native translator’s constant re-calibrations of oppressive power apparatuses seem taxing at best, and near-impossible, at worst. To effectively navigate through these polarized loci, she must identify ideologies that in turn seek “affective liberatory sances” in relation to the dominant social order (43). In a kind of performative contradiction, she must marshall the knowledge necessary to “break with ideology” while speaking within it. Chicana Studies scholar, Chela Sandoval, describes this dual movement as “meta-ideologizing”: the appropriation of hegemonic ideological forms in order to transform them (82). Nuestros padres se subieron encima de La Bestia, y por eso somos pasageros a ese tren. Y ya, dentro su pansa, tenemos que ser vigilantes cuando plantamos las bombas. In Methodology of the Oppressed, Sandoval schematizes this oppositional consciousness around five principle categories: “equal rights,” “revolutionary,” “supremacist,” “separatist,” and “differential.” Taken by themselves, the first four modes appear mutually exclusive, incapable of occupying the same plane, until a fifth pillar emerges. Cinematographic in nature, differential consciousness, as Sandoval defines it, is “a kinetic motion that maneuvers, poetically transfigures, and orchestrates while demanding alienation, perversion, and reformation in both spectators and practitioners” (44). For Sandoval, then, differential consciousness is a methodology that privileges an incredible sense mobility, one reaching artistic sensibilities. Our fourth and final analytic of movement serves an apt example of this dual meaning. Lexically speaking, ‘movement’ may be regarded as a political mobilization of aggrieved populations (through sustained efforts), or the process of moving objects (people or otherwise) from one location to another. Praxis-wise, it is both action and ideal, content and form. Thus, an ethnic poetics must be regarded less as a series of stanzas, shortened lyric, or even arrangement of language, but as a lens through which peripheralized peoples kaleidecope ideological positions in an “original, eccentric, and queer sight” (43). Taking note of the advantages of postponing identifications, the thesis stands its ground on the term ethnopoet. Its abstraction is not dewey-eyed philosophy, but an anticipation of poetic justice, of what’s to come from callused hands. This thesis is divided into 7.5 chapters. The first maps out the ethnopoet’s cartographies of struggle. By revisiting that alleged Tío Tomas, Richard Rodriguez, we unearth the tensions that negatively, deny citizenship to one silo, but on the flipside, engender manifold ways of seeing, hearing, and moving . The second, through George Jackson’s prison memoirs, pans out from this ethnography of power, groping for an apparatus that feigns an impervious prestige: ‘the aesthetic regime of coercion.’ In half-way cut, the thesis sidesteps to spic into existence, formally announcing, through Aime Cesaire, myself, and Pedro Pietri, the poeticization of trauma. Such uplift denies New Age transcendence of self, but a rehearsal of our entrapment in these mortal envelopes. Thirdly, conscious of the bleeding ethnic body, we cut open the incipient corpse to observe her pathologist. Her native autopsies offer the ethnic body’s posthumous recognition, the ethnopoetics ability to speak for and through the dead. Chapter five examines prolific black artists—Beyonce and Kendrick Lamar—to elide the circumvention of their consumption via invoking radical black hi/her-stories, ones fragmenting the black body. Sixth, the paper compares the Black Power Salute of the 1968 Mexico City Olympics to Duke’s Mi Gente Boycott of their Latino Student Recruitment Weekend. Both wielded “silent gestures,” that shrewdly interfered with white noise of numbed negligence. Finally, ‘taking the mask off’ that are her functionalities, the CODA expounds on ethnopoet’s interiority, particularly after the rapid re-calibration of her politics. Through a rerun of El Chavo del Ocho, one of Mexican television’s most cherished shows, we tune into the heart-breaking indigence of barrio residents, only to marvel at the power of humor to, as Friday’s John Witherspoon put it, “fight another day.” This thesis is the tip of my tongue. Y por una vez, déjala que cante.

The Kepler-454 system: a small, not-rocky inner planet, a Jovian world, and a distant companion

Kepler-454 (KOI-273) is a relatively bright (V = 11.69 mag), Sun-like star that hosts a transiting planet candidate in a 10.6 day orbit. From spectroscopy, we estimate the stellar temperature to be 5687 ± 50 K, its metallicity to be [m/H] = 0.32 ± 0.08, and the projected rotational velocity to be v sin i <2.4 km s^-1. We combine these values with a study of the asteroseismic frequencies from short cadence Kepler data to estimate the stellar mass to be , the radius to be 1.066 ± 0.012 R_o, and the age to be Gyr. We estimate the radius of the 10.6 day planet as 2.37 ± 0.13 R_⊕. Using 63 radial velocity observations obtained with the HARPS-N spectrograph on the Telescopio Nazionale Galileo and 36 observations made with the HIRES spectrograph at the Keck Observatory, we measure the mass of this planet to be 6.8 ± 1.4 M_⊕. We also detect two additional non-transiting companions, a planet with a minimum mass of 4.46 ± 0.12 M_J in a nearly circular 524 day orbit and a massive companion with a period >10 years and mass >12.1 M_J. The 12 exoplanets with radii ⊕ and precise mass measurements appear to fall into two populations, with those ⊕ following an Earth-like composition curve and larger planets requiring a significant fraction of volatiles. With a density of 2.76 ± 0.73 g cm^-3, Kepler-454b lies near the mass transition between these two populations and requires the presence of volatiles and/or H/He gas.

The HARPS-N Rocky Planet Search. I. HD 219134 b: A transiting rocky planet in a multi-planet system at 6.5 pc from the Sun

We know now from radial velocity surveys and transit space missions thatplanets only a few times more massive than our Earth are frequent aroundsolar-type stars. Fundamental questions about their formation history,physical properties, internal structure, and atmosphere composition are,however, still to be solved. We present here the detection of a systemof four low-mass planets around the bright (V = 5.5) and close-by (6.5pc) star HD 219134. This is the first result of the Rocky Planet Searchprogramme with HARPS-N on the Telescopio Nazionale Galileo in La Palma.The inner planet orbits the star in 3.0935 ± 0.0003 days, on aquasi-circular orbit with a semi-major axis of 0.0382 ± 0.0003AU. Spitzer observations allowed us to detect the transit of the planetin front of the star making HD 219134 b the nearest known transitingplanet to date. From the amplitude of the radial velocity variation(2.25 ± 0.22 ms-1) and observed depth of the transit(359 ± 38 ppm), the planet mass and radius are estimated to be4.36 ± 0.44 M⊕ and 1.606 ± 0.086R⊕, leading to a mean density of 5.76 ± 1.09 gcm-3, suggesting a rocky composition. One additional planetwith minimum-mass of 2.78 ± 0.65 M⊕ moves on aclose-in, quasi-circular orbit with a period of 6.767 ± 0.004days. The third planet in the system has a period of 46.66 ± 0.08days and a minimum-mass of 8.94 ± 1.13 M⊕, at0.233 ± 0.002 AU from the star. Its eccentricity is 0.46 ±0.11. The period of this planet is close to the rotational period of thestar estimated from variations of activity indicators (42.3 ± 0.1days). The planetary origin of the signal is, however, thepreferredsolution as no indication of variation at the corresponding frequency isobserved for activity-sensitive parameters. Finally, a fourth additionallonger-period planet of mass of 71 M⊕ orbits the starin 1842 days, on an eccentric orbit (e = 0.34 ± 0.17) at adistance of 2.56 AU.The photometric time series and radial velocities used in this work areavailable in electronic form at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr(ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/584/A72

The Mass of Kepler-93b and The Composition of Terrestrial Planets

Kepler-93b is a 1.478 ± 0.019 R ⊕ planet with a4.7 day period around a bright (V = 10.2), astroseismicallycharacterized host star with a mass of 0.911 ± 0.033 M⊙ and a radius of 0.919 ± 0.011 R⊙. Based on 86 radial velocity observations obtainedwith the HARPS-N spectrograph on the Telescopio Nazionale Galileo and 32archival Keck/HIRES observations, we present a precise mass estimate of4.02 ± 0.68 M ⊕. The corresponding high densityof 6.88 ± 1.18 g cm-3 is consistent with a rockycomposition of primarily iron and magnesium silicate. We compareKepler-93b to other dense planets with well-constrained parameters andfind that between 1 and 6 M ⊕, all dense planetsincluding the Earth and Venus are well-described by the same fixed ratioof iron to magnesium silicate. There are as of yet no examples of suchplanets with masses >6 M ⊕. All known planets inthis mass regime have lower densities requiring significant fractions ofvolatiles or H/He gas. We also constrain the mass and period of theouter companion in the Kepler-93 system from the long-term radialvelocity trend and archival adaptive optics images. As the sample ofdense planets with well-constrained masses and radii continues to grow,we will be able to test whether the fixed compositional model found forthe seven dense planets considered in this paper extends to the fullpopulation of 1-6 M ⊕ planets.Based on observations made with the Italian Telescopio Nazionale Galileo(TNG) operated on the island of La Palma by the Fundación GalileoGalilei of the INAF (Istituto Nazionale di Astrofisica) at the SpanishObservatorio del Roque de los Muchachos of the Instituto de Astrofisicade Canarias.

Carcass and meat quality characteristics of Arsi-Bale goats supplemented with different levels of air-dried Moringa stenopetala leaf

This study was conducted to assess the effect of air-dried Moringa stenopetala leaf (MSL) supplementation on carcass components and meat quality in Arsi-Bale goats. A total of 24 yearling goats with initial body weight of 13.6+/-0.25 kg were randomly divided into four treatments with six goats each. All goats received a basal diet of natural grass hay ad libitum and 340 g head^(−1) d^(−1) concentrate. The treatment diets contain a control diet without supplementation (T1) and diets supplemented with MSL at a rate of 120 g head^(−1) d^(−1) (T2), 170 g head^(−1) d^(−1) (T3) and 220 g head^(−1) d^(−1) (T4). The results indicated that the average slaughter weight of goats reared on T3 and T4 was 18.2 and 18.3 kg, respectively, being (P<0.05) higher than those of T1 (15.8 kg) and T2 (16.5 kg). Goats fed on T3 and T4 diets had higher (P<0.05) daily weight gain compared with those of T1 and T2. The hot carcass weight in goats reared on T3 and T4 diets was 6.40 and 7.30 kg, respectively, being (P<0.05) higher than those of T1 (4.81 kg) and T2 (5.06 kg). Goats reared on T4 had higher (P<0.05) dressing percentage than those reared in other treatment diets. The rib-eye area in goats reared on T2, T3 and T4 diets was higher (P<0.05) than those of T1. The protein content of the meat in goats reared on T3 and T4 was 24.0 and 26.4%, respectively being significantly higher than those of T1 (19.1%) and T2 (20.1%). In conclusion, the supplementation of MSL to natural grass hay improved the weight gain and carcass parts of Arsi-Bale goats indicating Moringa leaves as alternative protein supplements to poor quality forages.

Técnica de curativo: estudo comparativo entre profissionais e estudantes de enfermagem

Comparar o desenvolvimento de profissionais e estudantes de enfermagem quanto à realização da técnica de curativo. Metodologia: estudo descritivo com abordagem quantitativa. A amostra foi escolhida através de amostragem por conveniência, tendo participado da pesquisa 14 profissionais de enfermagem, que foram observados no período de março a junho de 2009, e 24 estudantes de enfermagem, regularmente matriculados no último período do Curso de Graduação em Enfermagem da Universidade Federal da Paraíba, os quais foram observados no período de março e maio de 2010. O procedimento de coleta de dados foi efetuado através da observação não participante e preenchimento de um roteiro semi-estruturado, após a aprovação do Comitê de Ética em Pesquisa do Hospital Universitário Lauro Wanderley, sob Protocolo n. 011/09. Resultados: na maioria dos aspectos analisados, os estudantes se sobressaíram aos profissionais, principalmente com relação à lavagem das mãos, orientação do paciente e utilização de movimentos únicos para limpeza da ferida. Conclusão: os profissionais devem melhorar seu conhecimento, buscando atualização nessa área, e os estudantes devem ser supervisionados durante a realização do procedimento

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty‑four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty‑one percent were male. Motorized vehicles caused 51% of injuries in males. Forty‑one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty‑seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long‑term follow‑up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure. Our experience

Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940’s and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.

Alveolite

A etiologia da alveolite é desconhecida. Considera-se não haver uma causa específica, mas sim uma associação de factores inerentes ao seu aparecimento. O diagnóstico é realizado, geralmente, entre o 2º e 5º dia após exodontia, sendo bastante claro. Manifesta-se por uma dor aguda e pulsátil, mal controlada com analgésicos, e de apresentação clínica uma inflamação da mucosa em torno do alvéolo, com parcial ou total perda do coágulo, apresentando-se este vazio ou com tecido necrótico e/ou restos alimentares. Pode ainda haver uma exposição óssea. Diversas são as taxas de incidência, variando consoante os factores de risco predisponentes da doença. São estes a idade, género, ciclo menstrual e toma de contraceptivos orais (nas mulheres), trauma cirúrgico e experiência do médico, a indicação da extração, bem como características do dente a ser extraído, ainda as técnicas e anestesia usadas, bem como remanescentes ósseos e/ou radiculares, uso de retalhos e suturas, patologias sistémicas, medicação e cuidados pós-operatórios do doente. Todos estes podem ter impacto no desenvolvimento desta condição, devendo o médico dentista eliminá-los e reduzi-los ao máximo. A prevenção aplica-se a medidas não farmacológicas, como redução de factores de risco, em combinação a terapia farmacológica, de modo a favorecer uma correta cicatrização. Recurso a soluções antissépticas, medicação tópica (intra-alveolar) e prescrição sistémica de antibióticos e anti-inflamatórios não esteroides são algumas dessas medidas. Ao nível do tratamento, vários métodos e materiais estão disponíveis no mercado. Por ser uma condição que o próprio organismo “combate”, o objectivo terapêutico passa basicamente pela redução dos sintomas debilitantes do paciente e controlo bacteriano. A opção é individual, uma vez que não existe nenhum tratamento com características ideais, sendo os resultados na literatura bastante discrepantes. Limpeza do alvéolo, medicação intra-alveolar (tópica) e/ou sistémica, bem como terapia com laser de baixa intensidade, são algumas opções. A administração antibiótica deve ser reservada para casos especiais, não devendo ser abordada como método de rotina. Analgésicos são uma opção, podendo ser aconselhada consoante o quadro clínico doloroso. Também o reforço para uma higiene oral rigorosa, com irrigação do alvéolo para evitar detritos e impactação alimentar (no caso de não existirem obtundantes intra-alveolares) devem ser preocupação do médico dentista. Deve haver um seguimento regular do paciente, especialmente se aplicados medicamentos tópicos, para avaliação e renovação (se necessário) do curativo até recuperação. O médico dentista deve saber identificar um caso de alveolite, encontrando-se informado e consciente das várias opções preventivas e terapêuticas. Estudos mais claros e objectivos são necessários na procura de critérios de diagnóstico genéricos da doença, bem como terapêuticas preventivas e de tratamentos com taxas de sucesso altas e suportadas por evidência científica. Para que, desta forma, seja elaborado um protocolo universal a seguir na prática clínica.

Perspective of nurses involved in an action-research study on the changes observed in care provision: results from a focus group

Background According to the Nursing Role Effectiveness Model, the structural components (nurses, patients, organizational variables) may directly BMC Health Services Research 2016, Volume 16 Suppl 3 Page 41 of 132 or indirectly influence the care outcomes through the process (actions developed by the nurses). Objectives: To identify the changes that, from the nurses' perspective, occurred during the provision of care to patients with peripheral venous catheters (PVCs) between the first and the second phase of the Action-Research (AR) study, and the components that influenced these changes. Methods During the second phase of the AR study (December, 2011), a focus group composed of six nurses was held at a medicine unit of a central hospital. A script was used with six open-ended questions. All ethical procedures were followed. Results Positive changes in nursing care provision to patients with PVCs were identified related to the type of dressing used, patient monitoring, aseptic care, and infusion rate. The nurses believed that some variables of the organizational component influenced those changes, such as the centralization of the material used for catheterization or the availability of materials, such as transparent dressings. The nurses also valued the following aspects: knowledge of the research findings of the first phase; training sessions on the topic; and, above all, the nurses' engagement throughout the process of change in care provision. Conclusions Considering the model of analysis used, we found that the changes identified in nursing care resulted from several factors, with the engagement of the professionals themselves in the change process being considered a key aspect.