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71.
Background: Foot health is an important issue in older people. Inappropriate shoes increase the risk of callous and ulcer formation, as well as increasing the risk of falls. There are no data defining the size of this problem. Objective: The aim of the study was to investigate the proportion of elderly people on a general rehabilitation ward wearing incorrectly sized shoes and to look for the presence of complications. Methods: Sixty five consecutive patients (mental state questionnaire score >6) admitted to a rehabilitation ward had their foot length and width measured, and the size of their current footwear recorded. Sensation was tested with a standard 10 g monofilament. The presence of ulceration was noted. Foot pain was recorded by the patient on a visual analogue scale. Any history of diabetes mellitus, peripheral vascular disease, or peripheral neuropathy was noted. Results: The median age of the subjects was 82 (range 64–93). Six (9%) had a history of diabetes, seven (11%) had symptomatic peripheral vascular disease, and 17 (26%) had sensory impairment. Ten patients (15%) had foot ulceration present, and 47 patients (72%) had ill fitting shoes (a discrepancy in length of more than half a British shoe size fitting or more than one British width fitting, 7 mm). Incorrect shoe length was significantly associated with the presence of ulceration (odds ratio (OR) = 10.04, p = 0.016). Presence of ulceration was significantly associated with a history of peripheral vascular disease (OR = 11.56, p = 0.008). Pain was significantly associated with incorrect shoe length (p = 0.0238) and with sensory impairment (p = 0.0314). Conclusion: Most older people on a rehabilitation ward wore ill fitting shoes. An association was found between ill fitting shoes and self reported pain, and between ill fitting shoes and ulcer formation. A straightforward assessment of footwear in older people could improve comfort and avoid preventable foot disorders. 相似文献
72.
M Size ES Borgstein HJ Haisma 《Malawi medical journal : the journal of Medical Association of Malawi》2005,17(1):12-14
The intensive care unit at Queen Elizabeth Central Hospital (QECH) has 4 beds and offers level 2 care. A retrospective audit of all admissions to the unit during 2002 was carried out. There were a total of 339 admissions giving a bed occupancy rate of 82 %. Surgical patients made up 81 % of admissions. 45% of all admissions were ventilated. Overall mortality was 38%. Ventilated patients had a mortality of 71% compared with 10% for non-ventilated. Data are also presented for mortality within the surgical and paediatric surgical admissions. 相似文献
73.
Leese GP 《Diabetes/metabolism research and reviews》2000,16(2):133-137
Management decisions for patients with diabetic eye disease can remain difficult despite the presence of guidelines. The cases below illustrate the dilemmas about the timing of instituting insulin in patients needing laser photocoagulation for improvement of glycaemic control. The use of angiotensin-converting enzyme inhibitors for diabetic eye disease is also discussed. 相似文献
74.
Kroese ED; Dortant PM; van Steeg H; van Oostrom CT; van der Houven van Oordt CW; van Kranen HJ; de Vries A; Wester PW; van Kreijl CF 《Carcinogenesis》1997,18(5):975-980
E mu-pim-1 transgenic mice are predisposed to develop lymphomas. Due to
their low spontaneous tumour incidence and their increased sensitivity
towards the lymphomagen ethylnitrosourea these mice may present an
interesting model for short-term carcinogenicity testing. Here, we report
on the further exploration of this transgenic mouse model with two
additional carcinogens known to have, among others, the
lymphohaematopoietic system as target, i.e. benzo[a]pyrene (B[a]P) and
12-O-tetradecanoylphorbol-13-acetate (TPA). B[a]P, given three times a week
(by gavage) for 13 weeks at 4.3, 13 or 39 mg/kg body weight, resulted in a
dose-related increase in lymphomas up to a 90% incidence in E(mu)-pim-1
mice during the observation period of 40 weeks. B[a]P also induced tumours
of the forestomach within this observation period, though at a lower
incidence and apparently equally effective in wildtype and transgenic mice.
TPA, on the other hand, was unable to induce lymphomas (or tumours in any
other organ) in either transgenic or wildtype animals within the
observation period of 44 weeks, when applied dermally at the maximum
tolerated dose of 3 microg/mouse, twice a week for 35 weeks. Molecular
analysis showed that B[a]P-induced lymphomas in transgenic mice were of
T-cell origin, 80% of which had elevated levels of c-myc expression. None
of the lymphomas had increased N-myc expression and mutation analysis of
the ras-gene family revealed a K-ras mutation in only one out of eight
tumours investigated. Also, none of the lymphomas showed aberrant
expression of p53 as determined by immunohistochemistry. It is concluded
that the E mu-pim-1 mouse model will not be very suitable for short-term
carcinogenicity testing in general: only genotoxic chemicals that have the
lymphohaematopoietic system as target for carcinogenesis in wild- type
mice, appear to be efficiently identified.
相似文献
75.
Mucormycosis is a rare fungal infection of childhood, occurring mainly in
patients with chronic illnesses such as diabetes and malignancies. The
fungus seldom grows in culture and confirmation of the diagnosis depends on
histologic examination of infected tissues. To date, the reported natural
history of the disease has been rapid progression and a fatal outcome.
Therefore, the importance of early diagnosis by tissue biopsy and early
treatment with surgical debridement and systemic antifungal therapy cannot
be overemphasized. The pulmonary system is the most common site for
mucormycosis in patients with leukemia. We report what we believe to be the
first successfully treated case of isolated muscular mucormycosis occurring
in a child with biphenotypic acute leukemia. The diagnosis was made
promptly by tissue examination at the time of surgical debridement. The
patient was also given systemic amphotericin-B therapy.
相似文献
76.
Selection criteria for human embryo transfer: A comparison of pyruvate uptake and morphology 总被引:5,自引:0,他引:5
Joe Conaghan Kate Hardy Alan H. Handyside Robert M. L. Winston Henry J. Leese 《Journal of assisted reproduction and genetics》1993,10(1):21-30
Purpose Pyruvate uptake is higher in human embryos developing to the blastocyst stage than those arresting at cleavage stages. To investigate whether pyruvate uptake provides an improved criterion for selecting embryos for transfer, we have measured uptakes by individual embryos noninvasively over 24-hr periods between the first day (day 1) postinsemination and embryo transfer on day 2 or 3 and correlated the levels with implantation and pregnancy outcome.Results The mean uptake was significantly lower for embryos that implanted than for those which failed to implant: 22.9 ± 1.0 and 27.1 ± 0.6 pmol/embryo/hr, respectively on day 2, and 22.4 ± 1.5 and 26.9 ± 0.8 pmol/embryo/hr, respectively, on day 3, but the wide range of uptakes by individual embryos was overlapping.Conclusion We conclude that pyruvate uptake as the sole criterion for embryo selection cannot predict which embryos will implant after transfer. Assessment of embryos using morphological and developmental criteria, therefore, remains the most consistent, though inefficient, indicator of pregnancy potential. 相似文献
77.
NC de Bruin KA van Velthoven M de Ridder T Stijnen RE Juttmann HJ Degenhart HK Visser 《Archives of disease in childhood》1996,74(5):386-399
Data on body composition in conjunction with reference centiles are helpful in identifying the severity of growth and nutritional disorders in infancy and for evaluating the adequacy of treatment given during this important period of rapid growth. Total body fat (TBF) and fat-free mass (FFM) were estimated from total body electrical conductivity (TBEC) measurements in 423 healthy term Caucasian infants, aged 14-379 days. Cross sectional age, weight, and length related centile standards are presented for TBF and FFM. Centiles were calculated using Altman's method, based on polynomial regression and modelling of the residual variation. The TBF percentage steeply increased during the first half year of life, and slowly declined beyond this age. Various simple TBEC derived anthropometric prediction equations for TBF and FFM are available to be used in conjunction with these standards. Regression equations for the P50 and the residual SD, depending on age, weight, or length, are provided for constructing centile charts and calculating standard deviation scores. 相似文献
78.
79.
Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals. 相似文献
80.
Primary Care Trusts (PCTs), charged with improving the health of their population, need to measure the extent to which patients actually benefit from the health care that is provided for them. One way of achieving this is to measure health status of patients over time. The study described here reports on the feasibility of administering the EQ-5D in general practitioner (GP) surgeries and identifies how the results might be used by practices and PCTs to improve the health of their populations. The study took place in an opportunistic sample of 1942 patients attending GP surgeries. One year later, patients who had provided contact details were sent another EQ-5D together with a request for additional information about their use of health care services in the intervening time period. A total of 770 patients completed this follow-up questionnaire. There were significant age effects associated with variation in self-reported health status and also associated with top-level Read diagnostic codes in some groups of patients. The results showed that EQ-5D could be used by individual GP practices to identify patients with specific health problems. This knowledge can also be used by PCTs and other primary care organisations, to better target scarce health resources. 相似文献