The patient behind the wound assessment and plan.

OBJECTIVE: Hard-to-heal wounds are a common problem, worsened by ageing, and the increased prevalence of diabetes and morbid obesity. The provider-patient relationship has undergone a transformation, from a paternalistic to a mutual participation model, in which 'the physician tries to enter the patient's world to see the illness through the patient's eyes'. The indepth assessment of the impact of psychosocial, physical issues and provider-patient dynamics is crucial to wound healing and patient wellbeing. It can customise future treatment including physical therapy, psychological and social interventions to improve outcomes. METHOD: A new health-related quality of life instrument (HRQOL) proposal based on a survey consisting of 20 questions was completed by patients as a pilot project. The psychosocial, physical and provider-patient dynamics were evaluated. A total wound impact score (WIs) was tabulated, ranging from 20-80 points. A wound assessment and plan (PBW-AP) was created. RESULTS: In our sample of 25 patients, 75% experienced a moderate WIs (50-69) and 5% experienced a severe WIs (31-49). Feeling angry about having a wound was reported by 40% of patients. A majority of patients (60%) thought about their wounds >1 hour per day. Importantly, 24% answered that their primary care physicians never mentioned their wounds. CONCLUSION: It is important for all physicians taking care of patients with hard-to-heal wounds to see 'the patient behind the wound'. The PBW-AP algorithm is an individualised, multidisciplinary assessment and intervention based on a WIs. It is designed not only to identify but also to tackle psychosocial, physical, and provider-patient issues, to improve overall quality of life, patient satisfaction and clinical outcomes. Based on the results, the PBW-AP algorithm was designed to be used at initial and subsequent visits as a roadmap for problem identification and intervention.

Amplification of radiation damping in a 600-MHz NMR spectrometer: Application to the study of water-protein interactions.

A new application of a recently developed electronic radiation-damping (RD) control system is presented. It is possible to amplify radiation damping so as to make the water magnetization return back to its equilibrium direction in a time shorter than the characteristic RD time. Certain types of experiments involving radiation damping as a selective inversion pulse can be significantly improved by this new method. Moreover, amplification of RD is shown to improve water suppression and consequently the dynamics of 2D NOESY experiments on proteins.

Neutralization of radiation damping by selective feedback on a 400 MHz NMR spectrometer.

Radiation damping is a phenomenon well known among NMR spectroscopists of proteins as a source of undesirable features, especially in high-field and high-Q probe NMR. In this paper, we present an electronic neutralization network which dramatically reduces radiation damping. It detects the radiation field profile and feeds back into the probe an rf field with identical amplitude and opposite phase. Experimental results of a practical implementation carried out on a 400 MHz Bruker spectrometer are shown.

Bayesian signal extraction from noisy FT NMR spectra.

The statistical interpretation of the histogram representation of NMR spectra is described, leading to an estimation of the probability density function of the noise. The white-noise and Gaussian hypotheses are discussed, and a new estimator of the noise standard deviation is derived from the histogram strategy. The Bayesian approach to NMR signal detection is presented. This approach homogeneously combines prior knowledge, obtained from the histogram strategy, together with the posterior information resulting from the test of presence of a set of reference shapes in the neighbourhood of each data point. This scheme leads to a new strategy in the local detection of NMR signals in 2D and 3D spectra, which is illustrated by a complete peak-picking algorithm.