Hilde Beele

Processes underlying adherence to leg ulcer treatment: A qualitative field study

BACKGROUNDnNon-adherence to leg ulcer regimen is a major problem. Reasons for non-adherent behaviour are not fully understood. Literature about processes underlying adherence in leg ulcer patients is scarce.nnnOBJECTIVESnTo explore the processes underlying adherent behaviour in patients with leg ulcers who received an intervention to enhance adherence to leg ulcer lifestyle advice.nnnDESIGNnA qualitative field study was conducted among patients receiving an adherence-promoting intervention.nnnSETTINGSnThe study was carried out in a home care setting in Belgium.nnnPARTICIPANTSnTwenty-six patients with venous leg ulcers were included and received the intervention from five tissue viability nurses in a community healthcare organisation.nnnMETHODSnSemi-structured interviews with open-ended questions were held with patients and nurses after the end of the intervention. Data were also collected by means of participant observation. Data collection and data analysis took place iteratively and analysis was validated by means of researcher triangulation.nnnRESULTSnTrust in the nurse was central to leg ulcer treatment adherence. Patients who had a trusting relationship with their nurse showed better adherence to the recommended lifestyle modifications. Trust was facilitated by nurses spending meaningful time with the patient, which means they took time to talk with the patient. Trust was also established because nurses provided care beyond patients expectations, taking time for wound care and being attentive to pain and other problems. A trusting relationship promoted compliance even if patients were not convinced of the benefits of the leg ulcer lifestyle advice. Perceived physical improvement and diminished discomfort after following the lifestyle advice convinced patients of the importance and positive effect of the regimen, which they doubted at first. Self-efficacy for performing leg exercises was often much higher than self-efficacy for being physically active and elevating the legs. Physical impediments, co-morbidities and socio-structural impediments influenced the patients ability to adhere to leg ulcer advice.nnnCONCLUSIONSnA conceptual framework to understand adherence to leg ulcer treatment was developed. Nurses should be aware of how nurse-related factors can affect adherence. Aspects that foster trust could be incorporated into leg ulcer care.

Morphological effects of serotonin and ketanserin on embryonic chick skin in vitro

Cell and organotypical cultures are used to study the direct effect of serotonin and of ketanserin, a serotonin antagonist, on dermal and epidermal cells of embryonic chick skin. Ketanserin stimulates the increase in cell number and inhibits the differentiation, whereas serotonin stimulates differentiation and inhibits the increase in cell number.

Direct effects of serotonin and ketanserin on the functional morphology of embryonic chick skin in vitro.

SummaryDifferent organotypical culture methods are used to test the direct effects of serotonin and ketanserin, a S2, α1, and H1 receptor antagonist in vascular tissue, on fibroblasts and epidermal cells of embryonic chick skin in vitro. From light microscopic and electron microscopic analyses, we learn that serotonin enhances keratinization and differentiation, whereas ketanserin reduces differentiation in comparison to the control cultures. Incorporation data of fragments cultured with [3H]thymidine show that ketanserin, within a dose range from 0.05 to 5 μg/ml, stimulates proliferation. Serotonin at a concentration of 10 μg/ml slightly slows down proliferation, whereas lower doses of 0.1 and 1 μg/ml result in tritium activities that do not differ from control cultures.

Skin organ culture model to test the toxicity of polyoxyethylene networks

Films of polyoxyethylene network were prepared from two types of triethoxysilane-terminated prepolymers. In this way, films of polyoxyethylene network with possible applications in the biomedical field could be made easier. To test their biocompatibility, these networks were added to organ cultures of adult human skin and embryonic chicken skin. A rapid toxic effect was observed, especially with the urethane-linked network. Enzymatical degradation of the network by enzymes in the culture medium might be responsible for the formation of toxic metabolites. Testing of related chemical compounds in our in vitro assay suggested that the formation of a silane group with an amino terminal is most likely to be responsible for the toxic effects observed.

Effects of Serotonin and Ketanserin on the Functional Morphology of Skin: Organotypical Cultures of Adult Human Skin and Embryonic Chick Skin as Experimental Models

The direct effects of serotonin and ketanserin -an 5HT2 receptor antagonist with wound-healing properties- have been tested, on organotypical cultures of both adult human skin and embryonic chick skin. A biopsy punch method, to obtain reproducable fragments of chick skin has been worked out.

Direct effects of serotonin, and 5-HT2, α1 and H1 receptor-antagonists on embryonic chick skin in vitro: A morphological and functional study

Ketanserin (K), a 5-HT2, alpha 1 and H1 receptor antagonist, at a concentration of 5 micrograms/ml inhibits keratinisation, but increases DNA-, collagen and glycosaminoglycan (GAG) synthesis in embryonic chick skin in vitro. On the other hand, serotonin (S) at a concentration of 10 micrograms/ml stimulates keratinisation and does not enhance DNA, collagen and GAG synthesis. 5 nM doses of ketanserin and serotonin give analogous results. The effects of other 5-HT2-receptor antagonists (e.g. BW 501 and cinanserin) are comparable to those of K, whereas prazosin (an alpha 1 receptor antagonist) and pyrilamin (an H1 receptor antagonist) do not show any effect on embryonic chick skin in vitro.

The effects of ionizing radiation on the glycosaminoglycan synthesis in embryonic cartilage in vitro.

The effects of ionizing radiation on the glycosaminoglycan synthesis of cartilaginous tibiae of 6.5 day old chick embryos have been studied in vitro over a 3 day period. As a parameter for the glycosaminoglycan synthesis, the incorporation of 3H-glucosamine is evaluated by liquid scintillation counting. A radiation induced inhibition ranging from 6% at 20 Gy to 68% at 200 Gy is observed. Light microscopical autoradiographs reveal that the secretion of the newly synthesized glycosaminoglycans is not affected significantly by ionizing radiation up to 150 Gy. Electron microscopical pictures confirm this observation and show that the chondrocytes in the irradiated tibiae remain viable. At 200 Gy most cells are necrotic. The results indicate that the radiation effects on the synthesis of the extracellular matrix components are determined by the damage of the RNA transcription.

Dose-Response Curve of the Effects of Serotonin and Ketanserin on the Functional Morphology of Skin in vitro

A cumulative dose-response curve of the effects of serotonin and its 5-HT2 receptor antagonist ketanserin in embryonic chick skin has been set up using morphological analysis and incorporation of 3H-thymidine as parameters. The resemblance between the results of the morphological analysis and those of the functional analysis was striking. From the results of these experiments, we could deduce new arguments in favor of the hypothesis that a 5-HT2 receptor is involved in the effects of serotonin and ketanserin in embryonic chick skin observed in vitro.

Effects of serotonin and ketanserin on the functional morphology of chick down feather bulbi in vitro

Chick feather bulbi cultured in vitro showed an increased DNA synthesis and a delayed keratinization after treatment with ketanserin, a serotonin2 antagonist with wound-healing properties. In contrast, serotonin stimulates keratinization of the keratinocytes in the bulbus.

In vitro culture of chick down feather bulbi: A tool to obtain proliferating and differentiating keratinocytes in an organotypic structure

Chick down feather bulbi can be cultured in different culture systems. Morphological analysis and3H-thymidine incorporation measurements prove that the majority of cells are viable epithelial cells.