Professional competence in physical therapy.

Defining, assessing, and measuring ongoing or continuing professional competence in physical therapy has been receiving more attention, perhaps due in part to the increasing reality of direct access (e.g., examination and treatment of patients without referral), increased professional autonomy, and the transition to the doctor of physical therapy as the entry-level degree. The purpose of this paper is to review recent initiatives related to competence beyond initial licensure and give examples of the multidimensional nature of assessing continuing professional competency in physical therapy.

Decubitus ulcers: a review of the literature.

Decubitus ulcers are a worldwide health care concern affecting tens of thousands of patients and costing over a billion dollars a year. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture), and internal factors (e.g. fever, malnutrition, anaemia, and endothelial dysfunction). Often, enough damage is done to create the basis for a decubitus ulcer after as little as 2 h of immobility, a situation which may be difficult to avoid if the patient must undergo prolonged surgery or remain bedridden. Damage owing to pressure may also occur hours before the patient receives medical attention, especially if the patient falls or becomes immobilized owing to a vascular event. Several classification systems for decubitus ulcers have been described, based on where injury first occurs. The histologic progression of decubitus ulcers is a dynamic process involving several stages, each having characteristic histologic features. A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates. With accurate risk assessment and preventative care, we can hope to minimize complications and mortality owing to decubitus ulcers.