Safety and performance evaluation of a next-generation antimicrobial dressing in patients with chronic venous leg ulcers.

The objective of this study was to investigate the safety and performance of AQUACEL™ Ag+ dressing, a wound dressing containing a combination of anti-biofilm and antimicrobial agents, in the management of chronic wounds. Patients (n = 42) with venous leg ulcers exhibiting signs of clinical infection were treated for 4 weeks with AQUACEL™ Ag+ dressing, followed by management with AQUACEL™ wound dressings for 4 weeks. Wound progression, wound size, ulcer pain and clinical evolution of the wound were assessed for up to 8 weeks. Adverse events were recorded throughout the study. AQUACEL™ Ag+ dressing had an acceptable safety profile, with only one patient discontinuing from the study, because of a non-treatment-related adverse event. After 8 weeks, substantial wound improvements were observed: 5 patients (11·9%) had healed ulcers and 32 patients (76·2%) showed improvement in ulcer condition. The mean ulcer size had reduced by 54·5%. Patients reported less pain as the study progressed. Notable improvements were observed in patients with ulcers that were considered to require treatment with systemic antibiotics or topical antimicrobials at baseline (n = 10), with a mean 70·2% reduction in wound area. These data indicate that AQUACEL™ Ag+ dressing has an acceptable safety profile in the management of venous leg ulcers that may be impeded by biofilm.

Use of a three-curved rocker sole shoe modification to improve intermittent claudication calf pain--a pilot study.

This was a pilot study utilizing hospital-based walking trials to compare two footwear conditions. Two pairs of identical therapeutic shoes were ordered for volunteer claudicant subjects. One pair was adapted with a specifically designed three-curve rocker sole. Volunteer claudicant subjects (n = 8, mean age 66 +/- 9.9 years) with stable pain-free distances of 10-400 meters to calf claudication pain were recruited into the study. Walking trials were used to compare differences in both the pain-free distance to claudication and the intensity of the calf pain once claudicating exhibited by each subject while walking separately with the two footwear conditions during the same clinical session. The results demonstrated that claudicant pain-free walking distance was increased, and the intensity of claudication calf pain reduced when walking with the rocker-soled in comparison with baseline. A specifically designed rocker sole has the potential to offer a reduction in the intensity of calf pain experienced by claudicants. A more extensive study is planned to determine the efficacy of this new footwear adaptation when the footwear is worn for extended periods.

Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index?

OBJECTIVE: Conventional sphygmomanometers are being replaced by automated devices; can they be used to accurately calculate ABPI? METHOD: Thirty-six volunteers (72 legs) attending a vascular clinic had their ankle, brachial blood pressure and ABPIs calculated using each of these 3 methods. (1) Conventional aneuroid BP cuff with hand held doppler. (2) OMRON HEM 705CP portable automated BP monitor. (3) The hand held doppler to determine systolic BP measured by the OMRON. RESULTS: Conventional doppler readings for brachial and ankle pressures were generally higher than those obtained digitally by less than 3 mmHg but this was not statistically significant. This did not translate into a significant difference in ABPIs obtained using all 3 techniques; the correlation coefficient of conventional ABPI with automated ABPI (method 2) was 0.746, this was improved to 0.899 using method 3. The OMRON failed to detect a signal in 16 of the 72 legs, 11 of these legs had ABPIs <0.66. CONCLUSION: Conventional doppler measurements give higher readings for systolic blood pressure but there is no significant difference when calculating ABPI. A normal digital ABPI excludes significant vascular disease and a low digital ABPI indicates disease. If no blood pressure is recordable a doppler should be used to confirm the true result. Automated oscillometric BP monitors may be used to accurately measure ABPI in non-diabetics in the community without teaching clinicians to use a doppler, thus removing observer error. This may be of particular use in the community to exclude significant arterial disease in venous ulcer patients and assess general cardiovascular risk.

Use of accelerometers in a large field-based study of children: protocols, design issues, and effects on precision.

BACKGROUND: Objective methods can improve accuracy of physical activity measurement in field studies but uncertainties remain about their use. METHODS: Children age 11 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), were asked to wear a uni-axial accelerometer (MTI Actigraph) for 7 days. RESULTS: Of 7159 children who attended for assessment, 5595 (78%) provided valid measures. The reliability coefficient for 3 days of recording was .7 and the power to detect a difference of 0.07 SDs (P 90%. Measures tended to be higher on the first day of recording (17 counts/min; 95% CI, 10-24) and if children wore the monitor for fewer days, but these differences were small. The children who provided valid measures of activity were different from those who did not, but the differences were modest. CONCLUSION: Objective measures of physical activity can be incorporated into large longitudinal studies of children.

Estimating tibial nail length using forearm referencing.

Tibial nail length can be estimated pre-operatively by several methods, but this usually requires an intact contralateral tibia. The purpose of this study is to describe an alternative method using the forearm as a reference. A simple clinical method using a forearm measurement is described. This method gives an accurate estimation of the likely range of nail length's that may be required using a simple formula.

An open-label study to assess changes in efficacy and satisfaction with migraine care when patients have access to multiple sumatriptan succinate formulations.

BACKGROUND: Because a patient's migraines often differ in duration, intensity, and accompanying symptoms, as well as the conditions and circumstances at the time of the headache, the mode for treatment also may change. OBJECTIVE: The goal of this study was to determine whether migraine management is improved by providing 3 formulations of sumatriptan succinate to patients, together with education to assist them in selecting the most appropriate formulation for specific attacks. METHODS: This was an open-label study conducted in 3 family practice settings. Patients were recruited who had at least a 1-year history of migraine meeting International Headache Society criteria and experienced 2 to 6 attacks per month within the previous 3 months. Patients received instructions on oral, intranasal, and subcutaneous (SC) sumatriptan and were provided with all 3 formulations to treat 6 headaches. Migraine features, formulation used, reason for selecting specific formulation, migraine symptom relief, and use of follow-up doses were recorded in diaries. At follow-up, patients completed a questionnaire assessing satisfaction with access to multiple formulations. RESULTS: Of the 33 enrolled patients (26 women, 7 men; mean age, 38.5 years [range, 23-54 years]), 25 (75.8%) completed all visits. Of 149 headaches treated, 39 (26.2%) were mild at onset, 70 (47.0%) were moderate, and 40 (26.8%) were severe. Eighty (53.7%) headaches were treated with tablets, 35 (23.5%) with nasal spray, and 34 (22.8%) with SC injection. Primary reasons for selecting specific formulations included "fewer side effects" for tablets, "convenience" for nasal spray, and "quick onset of action" for SC injection. Twenty-one (84.0%) patients reported being either very satisfied or satisfied with their ability to manage their headaches. Physicians reported that 18 of 24 (75.0%) patients had an improved attitude toward managing their headaches. All formulations were well tolerated. Eight (32.0%) patients reported adverse events, the 2 most common being chest pressure and fatigue. CONCLUSION: The patients in this study reported greater satisfaction with migraine management when given access to multiple sumatriptan formulations and education regarding their appropriate use.

Doctor, can I drive with this plaster? An evidence based response.

The purpose of this study is to assess the effect of the commonly used below elbow plaster casts on driving ability. The position of the Driver and Vehicle Licensing Agency and five motor insurance companies is established. The study aims to help doctors decide whether or not a patient is fit to drive with a plaster cast. Three types of cast were tested using one driver. A score was given for several driving abilities. The right Colles cast was found to have no effect on ability to drive. Scaphoid and Bennett's casts were found to have significant affects on driving ability. The DVLA has no specific guidelines regarding driving with a plaster cast and the position of insurance companies is variable, but will usually depend upon medical advice.