Sentinel health events surveillance in diabetes. Deaths among persons under age 45 with diabetes

The pilot study for a sentinel health events surveillance system for deaths among persons under age 45 with diabetes was conducted in six states in 1984 and 1985. Two hundred and thirty-three events were identified. Information from death certificates, physicians, and families revealed that 22% died from acute complications of diabetes and 53% from chronic complications. Blood pressure measurement and urinalysis testing had been performed in the last year for almost all of the decedents, but other preventive practices were reported less frequently. Hypertension was present in 57% and of those, was not controlled in 73%. Forty-four percent were cigarette smokers at the time of death. Agreement between physicians and families was generally higher for clinical conditions than for care practices. This surveillance system appears to yield information about the health care of persons with diabetes not readily available from other sources, although modifications may be necessary before implementation.     

Facilitating Perinatal Grieving Between the Mother and the Father

Society often expects mothers and fathers to share equally in the perinatal grief process because the child was a common bond between them. Unfortunately, in perinatal grief, this is not always the case. The mother and the father can experience incongruent grieving and use discordant coping mechanisms. It is important to evaluate these differences to facilitate communication between the distraught parents. Improved communication can in turn facilitate the grieving process.     

Effects of leg and body position on transcutaneous oxygen measurements in healthy subjects and subjects with peripheral artery disease after lower-extremity arterial revascularization: A pilot study

Transcutaneous oxygen (TcPO(2)) measurements provide a noninvasive, objective determination of the oxygen level at the skin surface. This offers a means of estimating the underlying circulation and tissue oxygenation. The purpose of the pilot study was to measure the TcPO(2) value of the lower extremity of healthy men and women and of patients with peripheral arterial disease (PAD) in 4 different body and leg positions 24 hours after peripheral vascular surgery reconstruction. The specific aim was to determine if lower-extremity TcPO(2) measurements were affected by changes in extremity position in these subject populations. A convenience sample of 4 healthy health care professionals and 4 patients who had peripheral vascular reconstruction surgery 24 hours before the measurements were studied. Subjects were studied in 4 different leg and body positions: supine with legs extended, sitting with legs dependent, a 5 degrees head-up reverse Trendelenburg, and supine with legs elevated 10 in. The Radiometer TCM30 TcPO(2) monitor was used to carry out these measures. Findings revealed a statistically significant difference in TcPO(2) measurements between the 2 groups, with the healthy subjects having a significantly higher TcPO(2) measurement in all extremity positions compared with the revascularized subjects with PAD (P =.02-.05). Significant changes were noted in both the foot temperature (P =.03) and TcPO(2) measurements with extremity positions within the healthy subject group (P =.001). The foot and leg TcPO(2) measurements affect from leg and body position did not reach significance (P =.09) in the subjects with PAD. No change in foot temperature with extremity positioning (P =.42) was noted in the subjects with PAD. This pilot study provides a base in which additional research will be performed with TcPO(2) measurements in both the healthy and revascularized person.     

An experimental collagen-impregnated dacron graft: Potential for endothelial seeding

This study evaluates the potential for endothelial seeding of a collagen-impregnated Dacron graft with or without surface modifiers (fibronectin, heparin) to attach and retain these cells during flow. Human umbilical endothelial cells were harvested, cultured, labeled with Indium111-oxine and seeded onto 30 mm X 4 mm diameter grafts. Six graft surfaces were studied: 1) a collagen-impregnated Dacron graft, HemashieldR (C); 2) C + fibronectin (C + F); 3) C + heparin (C + H); 4) C + F + H; 5) HytrelR + F (Hyt + F); and 6) Hyt + F + H. Radioactive loss determined the percentage attachment and then percentage retention of labeled inoculum after a one-hour in vitro perfusion. Scanning electron and light microscopy demonstrated the endothelium on the graft surface following perfusion. Fibronectin-coated grafts had a significantly higher percentage attachment than those without fibronectin (ANOVA, P less than 0.05). However, the percentage retention following perfusion was similar for all Dacron grafts and statistically inferior to the HytrelR grafts studied (ANOVA, P less than 0.05). SEM evaluation of the C + F + H graft surface was qualitatively the most impressive Dacron surface for seeding, yet was inferior to the HytrelR graft. We conclude that fibronectin benefits the initial attachment of endothelium to collagen-coated Dacron rivaling the HytrelR surface. Fibronectin does not improve percentage retention of the HemashieldR surface during perfusion, therefore, some of its initial benefit is lost.