The effect of body weight and age on frequency of repairs in lower-limb prostheses.

INTRODUCTION: Overweight patients sometimes present a practical problem for provision of lower-limb prostheses. Most information about the effect of body weight on the endurance of prostheses is based on laboratory tests. This is a retrospective study based on an audit to study the effect of body weight and age on the frequency of repairs. SUBJECTS: One hundred and sixteen patients were involved (98 male), age 16-96 years, mean=58.7 years; weight 47-140 kg, mean=88 kg; 68 were transtibial amputees and 48 were transfemoral amputees. Causes of amputation were trauma (49), peripheral vascular disease (29), and others (38). Amputation was done 1-66 years prior to assessment, mean=13.66 years. Period of use of current prostheses was 0.5-28 years, mean=3.5 years. RESULTS: One hundred and one repairs were done in a period of 6 months. The number of repairs was found to correlate significantly with weight (P value<0.001) and inversely with age (P value=0.003). No significant correlation was found between repairs and gender, cause of amputation, or level of amputation. CONCLUSION: Body weight and age of amputee are determining factors in the frequency of repairs of lower-limb prostheses. However, a larger study for a longer period will be needed to confirm our finding.

Views of health professionals on discussing sexual issues with patients.

PURPOSE: This survey was carried out to study the views of multidisciplinary health professionals about discussing sexual issues with patients. METHODS: A questionnaire was sent to professionals (nurses, doctors, physiotherapists and occupational therapists) to return by post. A duplicate questionnaire was sent 4 weeks later to a random sample of respondents. RESULTS: A total of 813 replies were analysed (61% response rate). Mean age+(SD) of respondents was 37+10. Most were female (85%). Test-retest reliability of the questions showed moderate to very good agreement. Most respondents (90%) agreed that addressing sexual issues ought to be part of the holistic care of patients. However, most staff (86%) were found to be poorly trained and most (94%) were unlikely to discuss sexual issues with their patients. The gender and age of respondents was not significantly related to their participation in such discussion. Therapists had less training, lower comfort level, and less willingness to discuss sexual issues than doctors and nurses while doctors discussed sexual issues significantly often more than others (p< or =0.001). Respondents from rehabilitation wards were equivalent to those from medical or surgical wards in their training and comfort. However, they participated in discussing sexuality with patients less often than those from medical wards. CONCLUSION: Health professionals agreed that patients' sexual issues needed to be addressed and discussed in health services. However, they were poorly trained, ill prepared and rarely participated in such discussion. This suggests that training in sexuality and sexual issues should be implemented as part of the training of health care professionals.

Short-term sequelae of minor head injury (6 years experience of minor head injury clinic).

PURPOSE: It is known that post-concussive symptoms may persist after mild head injury. However, the majority of those patients are denied follow-up or support. A minor head injury clinic was thus established in North Staffordshire Hospital in 1993 to address these problems. METHODS: Patients 16-65 years old attending hospital with minor head injury were invited to attend the clinic two weeks after presentation. A specialized brain injury nurse and/or assistant clinical psychologist assessed them. Patients with persistent symptoms were invited to a second assessment four weeks later. RESULTS: One thousand two hundred and fifty-five patients were invited for first assessment, the most common cause of head injury was assault (454) followed by road traffic accident (334). Six hundred and sixteen patients did not attend the first assessment; most of non-attendees were those who had been assaulted (281). Six hundred and thirty-nine patients attended, (472) were male, their mean age was 33. Forty-three per cent of them had history of recent alcohol intake. One third had had a previous head injury. Although 391 attendees were in regular employment, 219 patients were unable to return to work 2 weeks after discharge (56%), and 49 people were still off sick 6 weeks after the injury. The most common complaints at both assessments were fatigue, headache, dizziness, irritability, sleep disturbances, poor concentration and poor memory in that order. CONCLUSION: This study shows a significant number of patients with minor head injury still complaining of post concussive symptoms, which may contribute to a delay in return to work. The high incidence of non-attendance among the assaulted victims may indicate that this group needs to be more effectively targeted. Further study to look at the longer-term consequences of minor head injury is required in view of these findings.