A survey of protective cushion usage in individuals with spinal cord injury while traveling in a motor vehicle and on a commercial airliner

Abstract

Objective

While there are specific recommendations for pressure relieving cushions when seated in a wheelchair, there is a paucity of information regarding prescribed wheelchair cushions for persons with spinal cord injury (SCI) when traveling and not in their wheelchair seat. A questionnaire was designed to ascertain if individuals with SCI who are primarily wheelchair users utilize a prescribed wheelchair cushion when traveling in a motor vehicle (MV) or on a commercial airliner, as not utilizing one may be a causative factor in developing pressure ulcers.

Design and setting

Survey design in an outpatient SCI rehabilitation setting.

Participants

Full-time wheelchair users, with chronic (>1 year) SCI.

Results

Forty-two participants completed the survey, with a mean age of 39 years old and time post-injury of 10.4 years. All subjects used a prescribed wheelchair cushion when seated in their wheelchair. Twenty-seven subjects reported transferring to a MV seat (59.5% of sample), with 25 (92.6%) reporting not using a prescribed wheelchair cushion when sitting directly on the MV seat. For subjects who traveled on an airplane (n = 23–54.8%), 19 (82.6%) reported that they do not sit on a prescribed specialty cushion.

Conclusion

Persons with chronic SCI, who are primary wheelchair users, utilize prescribed wheelchair cushions when sitting in their wheelchair, but most do not utilize a prescribed wheelchair cushion when seated in a MV (if they transfer out of their chair) or on a airplane seat. Studies to determine the pressures over the bony prominences on their travel surfaces may need to be undertaken to see whether the pressures are appropriate, as they may be a source of skin breakdown.     

Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia: a retrospective study

Symptomatic superficial femoral artery (SFA) disease presenting either with severe claudication or critical limb ischaemia is treated with bypass surgery and traditionally has been the ‘goldstandard’ procedure. Surgical bypass using autogenous vein or prosthetic grafts as a conduit is well accepted and there are comparable patencies and limb salvage rates with either conduit.1There have been considerable advances in the last two decades in percutaneous endovascular technology for the treatment of SFA disease. The techniques that have been developed include percutaneous balloon angioplasty and stenting, with variable results.2,3 Despite having three different options, namely surgical bypass, balloon angioplasty and stenting, none is superior to the other.Although the five-year primary patency rate of femoropopliteal above-the-knee bypass with autogenous saphenous vein is 70%, this method of treatment is invasive with long incisions in the lower extremities and a peri-operative complication rate of 12%.4 Vascular surgeons have become more experienced with catheter-based technology and due to the minimal invasiveness of the procedure, both patients and vascular surgeons are increasingly attracted to endovascular procedures. Mwipatayi et al.5 and Nguyen et al.6 found stenting resulted in equivalent outcomes when compared to balloon angioplasty alone, but Laird et al.7 found that self-expanding nitinol stents were associated with better angiographic results and improved patency compared with balloon angioplasty alone.Randomised, controlled trials comparing bypass surgery and balloon angioplasty alone generally showed similar outcomes in terms of amputation-free survival but in the short term, surgery was more expensive than angioplasty.8 Another study comparing surgical bypass with balloon angioplasty and stenting showed better primary patency for the stent group (67%) than the bypass group (49%) and there were higher re-intervention rates in the bypass group.9Since there are conflicting data in the literature regarding the success of different methods of treatment of SFA disease and there is a lack of consensus guidelines on the optimum management of SFA disease, the aim of this study was to compare the results of stenting and surgical bypass in the local environment with regard to limb salvage rates in patients with severe leg ischaemia.     

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insights into the diagnosis of infection in chronic leg ulcers (CLUs). A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations, and Google Scholar from January 1990 to July 2017. The inclusion criteria were original studies, systematic reviews, and consensus documents focused on “infection” in CLUs, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out‐of‐date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review showed seven clinical signs and symptoms that could be diagnostic for infection in CLUs, including: new, increased, or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non‐healing; and erythema and increased local temperature, whilst the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.     

Leg Amputation for an Extensive,Severe and Intractable Sickle Cell Anemia Ulcer in a Brazilian Patient

A 35-year-old African Brazilian patient had sickle cell anemia complicated with recurrent vasoocclusive (VOC) crises and refractory painful leg ulcers for 16 years. The ulcers started over both medial malleoli and expanded gradually. The ulcer on the left leg spread from the foot to the knee circumferentially and was refractory to all forms of therapy within the frame work of multi-disciplinary care. The patient agreed to a below the knee amputation of the left leg. He felt much better after the amputation but developed severe neuropathic phantom pain that was well controlled medically. He could differentiate the sickle cell anemia and ulcer pain from the neuropathic pain. About 6 months after the amputation he had dengue fever with fatal outcome. This is the first report of treatment of refractory sickle cell anemia leg ulcer with amputation and probably the first report of a Brazilian patient with sickle cell anemia and dengue fever.     

Evaluation of divided attention psychophysical task performance and effects on pupil sizes following smoked,vaporized and oral cannabis administration

Establishing science‐based driving per se blood Δ⁹‐tetrahydrocannabinol (THC) limits is challenging, in part because of prolonged THC detection in chronic, frequent users. Therefore, documenting observable signs of impairment is important for driving under the influence of drugs. We evaluated frequent and occasional cannabis smokers' performance on the modified Romberg balance, one leg stand (OLS), and walk and turn (WAT) tasks, and pupil size effects following controlled placebo (0.001% THC), smoked, vaporized and oral (6.9% [~50.4 mg] THC) cannabis administration. Significant effects following inhaled doses were not observed due to delayed tasks administration 1.5 and 3.5 h post‐dose, but significant impairment was observed after oral dosing (blood THC concentrations peaked 1.5–3.5 h post‐dose). Occasional smokers' odds of exhibiting ≥2 clues on the OLS or WAT following oral dosing were 6.4 (95% CI 2.3–18.4) times higher than after placebo, with THC and 11‐hydroxy‐THC blood concentrations individually producing odds ratios of 1.3 (1.1–1.5) and 1.5 (1.3–1.8) for impairment in these tasks, respectively. Pupil sizes after oral dosing under the direct lighting condition were significantly larger than after placebo by mean (SE, 95% CI) 0.4 (0.1, 0.2–0.6) mm at 1.5 h and 0.5 (0.2, 0.2–0.8) mm at 3.5 h among all participants. Oral cannabis administration impaired occasional cannabis users' performance on the OLS and WAT tasks compared to placebo, supporting other reports showing these tasks are sensitive to cannabis‐related impairment. Occasional smokers' impairment was related to blood THC and 11‐hydroxy‐THC concentrations. These are important public health policy findings as consumption of edible cannabis products increases. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.     

Improvisations in classic and modified techniques of flap surgery to improve the success rate for pressure ulcer healing in patients with spinal cord injury

The recurrence of pressure ulcers (PrUs) and dehiscence of reconstructive flap have always been a problem. The present study aimed to evaluate the results of reconstructive flap surgeries in patients with spinal cord injury (SCI) having PrUs, using classic and modified flaps with improvisations to decrease wound dehiscence, flap necrosis and tension in flap. This is a prospective clinical study. The setting was a tertiary care centre in northern India. Thirty‐five patients with SCI having 37 stage III and IV PrUs. PrUs were treated using classic and modified flaps with improvisations. The outcome was evaluated using criteria of wound dehiscence, flap necrosis and recurrence. The results of flap surgery were excellent in 32 (86·48%) patients, good in 4 (10·81%) patients and poor in 1 (2·7%) patient. Partial flap necrosis (2·7%), low incidence of PrU recurrence rate at flap site (5·4%) and overall PrU recurrence (11·4%) were the complications observed. Improvisation of classic and modified techniques of flap surgeries along with reinforcement of general care principles of paraplegia can be effective in minimising complications often associated with PrU reconstructive surgery thus improving the ultimate outcome.     

‘What ever I do it’s a lost cause.’ The emotional and behavioural experiences of individuals who are ulcer free living with the threat of developing further diabetic foot ulcers: a qualitative interview study

Objective Individuals who have had one diabetic foot ulcer (DFU) are at high risk for developing further DFUs. This study was designed to examine the emotional and behavioural consequences of living with this heightened risk of re‐ulceration. Participants and setting Fifteen women and men living in south‐west England were interviewed at home or at the university by an academic psychologist. Design Interviews were audiotaped and transcribed verbatim. Thematic analysis using the constant comparative method was employed for data analysis. Results Participants reported having little perceived control in preventing further DFUs. This lack of control was associated with a range of negative emotions including fears and worries about developing further foot ulcers, amputation and guilt for the past neglect. Tensions were present between participants’ beliefs and reported behaviours, that is, what they felt they ought to be doing and what they were actually doing to care for their feet; most engaged in ‘strategic adherence’, that is, conducting a trade‐off between living a normal life and following foot‐care advice. Conclusion A lack of perceived control appears central to the emotional and behavioural responses of individuals living with the threat of re‐ulceration. We propose that these responses may serve to increase individuals’ risk of re‐ulceration and that these ‘risk factors’ should be considered part of the management of this patient group.     

Treatment of lepromatous ulcers using citric acid as a sole antimicrobial agent

A prospective study was carried out to assess the role of citric acid as a sole antimicrobial agent in the management of lepromatous ulcers. Thirty-four known cases of lepromatous ulcers not responding to conventional antibiotic therapies for long duration were investigated for culture and susceptibility studies. Staphylococcus aureus (25·00%) and Klebsiella spp. (23·43%) were found to be the most common isolates. Amikacin (68·75%) and ciprofloxacin (67·18%) were found to be the most effective antimicrobial agents. Topical application of citric acid ointment resulted in complete healing in 25 (73·52%) cases. In eight cases (26·48%), there was elimination of infective agent from ulcer site and formation of healthy granulation, but no complete healing of ulcer was seen. Results indicate that citric acid is the best alternative for the effective management of lepromatous ulcers when other therapies are exhausted.     

Protective Action of Deglycyrrhizinized Liquorice on the Occurrence of Stomach Ulcers in Pylorus-Ligated Rats

The effect of graded doses of a deglycyrrhizinized liquorice extract (d.Li.) was studied on the frequency of stomach ulcers and the secretion of gastric juice in pylorus-ligated rats. 25-50 mg of d.Li. given intraperitoneally reduced considerably the number of ulcers in comparison with the control group of rats without any significant changes in gastric secretion. Higher doses —100-200 mg — gave complete protection against the development of gastric ulcers and also reduced the output of gastric juice. The results give strong support for the existence of an ulcer-protecting principle in the d.Li.