Refractory Venous Leg Ulcers: A Study of Risk Factors

BACKGROUND: Although certain risk factors for poor healing of leg ulcers have been identified, data concerning the characteristics of refractory ulcers have not been specifically studied in the literature. OBJECTIVE: To study the characteristics of refractory venous leg ulcers. METHODS: We retrospectively studied prognostic factors for healing in patients with refractory venous leg ulcers followed and treated in our dermatology department between January 1993 and January 2000. Each patient included in this study was compared with two patients matched for age and gender and presenting leg ulcers with normal healing, followed during the same period. RESULTS: Thirty-two of 571 patients with leg ulcers were included. The study population consisted of 20 females and 12 males with a mean age 73.5 years. The control population comprised 64 patients, 40 females and 24 males, with a mean age of 73 years. Univariate analysis demonstrated the negative prognostic impact of several previously identified factors (including surface area and history of the ulcer). In particular, multivariate analysis identified four main risk factors for refractory ulcer that are often associated in these patients: associated arterial disease, presence of post-thrombotic popliteal sequelae, recurrence of the ulcer, and disability. CONCLUSION: Four main risk factors that are often associated were identified, indicating the multifactorial nature of these refractory ulcers.     

新年Party我的眼妆最抢镜!

经过在各大PARTY上的多方打探。阅无数惹人注目的PARTYQUEEN之后，小编我终于掌握了超给力眼妆的终极成功秘诀，如果你也想在接下来的PARTY中赢得大家的掌声。尽情绽放自己的美丽，你可一定要接着看下去哦!     

Placental transfer of bupivacaine, pethidine and lignocaine in the rabbit. Effect of umbilical flow rate and protein content

Summary. The factors determining the placental transfer of drugs used in labour were studied in the rabbit placenta perfused in situ with Krebs bicarbonate buffer. During concurrent maternal intravenous infusion of bupivacaine, lignocaine, pethidine and antipyrine, drug concentrations were measured in maternal arterial plasma and placental effluent perfusate, the flow rate and protein content of which were varied. Protein binding and content were also measured. Placental clearance of antipyrine, which is unbound, was unaltered by perfusate protein content, and increased with umbilical perfusate flow up to 2 ml/min. Clearance of lignocaine and pethidine, which were 20–30% protein bound, increased to a small extent with perfusate protein, and were flow-dependent up to the maximum perfusate flow of 4 ml/min. Clearances of bupivacaine, which was > 80% bound, increased markedly with perfusate protein but, though flow-dependent, was one-tenth to one-fifth that of the other drugs. Fetal binding and glycoprotein content were less than maternal, hence the equilibrium fetal: maternal ratio is predictably lower for the highly bound bupivacaine than for lignocaine or pethidine. Measured fetal: maternal ratios of bupivacaine were, however, only one-half to one-third of the predicted equilibrium values, suggesting that bupivacaine does not unbind readily in a single transit through the rabbit placenta. Thus, though bupivacaine crosses the placenta more slowly than thc other drugs, the fetal dose of all these drugs will be greatest in healthy babies with good placental blood flows and high plasma proteins.     

Practices and Policies in the Initiation of Breastfeeding

Despite increasing knowledge about factors affecting the initiation of breastfeeding, many mothers still encounter problems and discontinue breastfeeding earlier than desired. Many hospitals still have not implemented the practices that are known to be helpful in the establishment of breastfeeding. As a result, a study was conducted to examine the policies and practices affecting breastfeeding in hospitals in Alberta, Canada. A questionnaire-based survey of all Alberta hospitals (including directors of nursing and staff nurses) found that many practices were still relatively inflexible; did not always reflect accurate, research-based information; and were not geared to the needs of mothers and infants. The implications of these findings are discussed.     

Learned Helplessness as a Framework for Practice in Long-Term Care Environments

This paper presents an overview of learned helplessness theory and uses the iatrogenic diseases of institutional life as a framework for describing long-term care environments. On the basis of the theory and the nature of the environments that offer residents little opportunity for choice and control over events in their daily lives, the author proposes some possible remedies to increase the quality of life among older people in long-term care.     

The Involvement of General Practitioners in the Care of Patients with Human Immunodeficiency Virus Infection: Current practice and Future Implications

The objective was to determine the current use of their generalpractitioner (GP) by patients with human immunodeficiency virus(HIV) infection and whether such patients would be interestedin having ‘shared care’ between a specialist HIVclinic and their GP. A questionnaire was administered to 203HIV-positive men attending the HIV outpatient clinic of a centralLondon teaching hospital. The main outcome measures were patientcharacteristics, numbers of patients registered with a GP, numbersof patients with a GP aware of their diagnosis, contacts withthe GP in the last year and level of interest and shared care.Eighty-five per cent of patients were registered with a GP ofwhom 67% knew of the diagnosis. Those diagnosed for more than2 years were significantly more likely to have an informed GP.A total of 73% of those registered had visited their GP in theprevious year although only 27% had visited for an HIV-relatedproblem. Only 19% had a GP actively involved in their HIV care.In all 51% of the patients indicated an interest in having sharedcare between the clinic and their GP. A high proportion of HIVpatients are registered with and attend a GP although they rarelyconsult for HIV-related problems. A significant proportion ofpatients expressed interest in having shared care suggestingthat there is the potential for increased GP involvement inthe care of patients with HIV infection.     

AN INVESTIGATION INTO THE PROBLEMS OF EASY CHAIRS USED BY THE ARTHRITIC AND THE ELDERLY

Groups such as the arthritic and the elderly are particularlysusceptible to seating problems. An extensive questionnaireto determine the nature and extent of seating difficulties wasgiven to patients at rheumatology clinics and members of daycentres for the elderly in Leeds. Forty-two per cent of subjectshad some degree of difficulty in rising from their easy chairat home and of these 18% either experienced great difficultyor could not rise unaided. Only 13% had chairs designed to aidrising (e.g. high chair) and 40% of subjects thought their chaircould be improved. Thirty-four per cent said that their easychair caused them pain or discomfort. Information about subjects'body dimensions and their easy chair dimensions was also collected.Further research based on the survey results is planned in orderto develop criteria for the design of easy chairs for the arthriticand the elderly. ^*Based on a paper presented at the Annual Provincial Meetingof the Royal Society of Medicine, Section of Rheumatology andRehabilitation, the British Association of Rheumatology andRehabilitation, Nottingham, 25 and 26 september 1980     

Estimation of the variance components for dermal ridge count

Refinements of the scoring algorithm to estimate variance components from pedigree data are developed. Subsequent to these modifications, heritability estimates were readily obtained from data for over 50 traits, including total finger ridge count reported here. A significant contribution to the total variance of ridge count could be attributed to the effects of dominance, a finding not previously reported for this dermatoglyphic trait.     

How does work work for people with bipolar affective disorder?

Despite modern treatments, bipolar disorder remains a chronic, relapsing disorder that leads to long-term psychosocial disability. A review of the literature suggests that while employment rates amongst individuals with bipolar disorder may improve over time, and are relatively better compared to some other chronic mental disorders, employment prospects do not match the high scholastic achievements seen amongst this group of people before the onset of their illness. For those with bipolar disorder, clinical recovery does not necessarily mean functional recovery, and the usual early age of onset may further reduce an individual's preparedness for employment. Two brief vignettes are used to discuss how occupational therapists can help their clients maintain their sense of hope in vocational recovery, gain better self-awareness and work with clients at various stages of recovery rather than waiting for full functional recovery. Further research is required to help identify specific factors that contribute to the success of employment integration amongst people with bipolar disorder.