Morbid obesity and the prone position: a case report.

An improperly positioned prone patient can experience serious impairment of cardiopulmonary function. However, with appropriate preparation, even an extremely obese patient can safely tolerate the prone position.

Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking.

Patients with recently healed leg ulceration were entered into a study of leg ulcer recurrence. In all, 188 patients [69% women, mean age = 72 (SD = 12) years] were entered into the study, of whom 166 were considered suitable for ready-made stockings and were randomized to one of two class II below-knee compression stockings and followed for at least 18 months. The remaining patients required either made-to-measure stockings (5) or could not tolerate stockings owing to friable skin and were treated by other methods (17). Overall cumulative recurrence rate was 26% after 1 year and 31% at 18 months. Independent risk factors for (RR = 2.34, p = 0.021) and unsuitability for stockings (RR = 2.52, p = 0.013). The randomized groups had similar stockings, 25 (15%) could not put their stockings on at all and 43 (26%) were only able to put them on with great difficulty. The two stocking types differed significantly in this regard when analysed for trend.

Factors associated with healing leg ulceration with high compression.

To investigate factors relevant to the healing of leg ulceration by high compression, patients were interviewed using a standard questionnaire prior to treatment with a four-layer bandage high-compression system in six community ulcer clinics. We explored the relation of size, ulcer duration and medical history to healing. Cumulative healing rates were high using this method, being 69% after 12 weeks and 83% after 24 weeks. Twelve-week healing rates varied slightly between clinics, ranging from 62% to 83%. Univariate analysis of the total group showed that male sex (RR = 0.77, p = 0.023), poor limb joint mobility (RR = 0.39, p < 0.001), poor general mobility (RR = 0.49, p = 0.015), treatment at home (RR = 0.52, p < 0.001), ulcer size > 10 cm2 (RR = 0.37, p < 0.001), history of deep vein thrombosis (RR = 0.67, p = 0.016) and ulcer duration >6 months (RR = 0.35, p < 0.001) were significantly inversely associated with healing, Ulcer size, duration, limb joint mobility and general mobility were significant independent factors in multivariate analysis.

Venous ulcer healing: effect of socioeconomic factors in London.

OBJECTIVE: To determine which social and clinical factors are associated with healing in patients with venous ulceration. DESIGN: Patients were questioned about social factors at their first visit to a community ulcer clinic. They were treated by high compression bandage system and were interviewed again after 12 weeks. SETTING: Community leg ulcer clinics held in health centres throughout Riverside Health Authority in London. PATIENTS: All patients referred to five community leg ulcer clinics with venous ulceration over a six month period. MAIN OUTCOME MEASURES: These were factors significantly associated with healing within 12 weeks of beginning treatment, measured by odds ratio (OR) given by logistic regression analysis. MAIN RESULTS: Of 168 patients with venous ulceration, 87 (52%) healed after 12 weeks of treatment. Univariate analysis showed that low social class (OR = 3.44, 95% CI 1.17, 10.14), lack of central heating (OR = 2.22, 95% CI 1.18, 4.18), and being single (OR = 2.77, 95% CI 1.15, 6.69) were all significantly associated with delayed healing. After adjustment for the known risk factors of ulcer size, ulcer duration, and general mobility only lack of central heating was still significant (OR = 2.27, 95% CI 1.11, 4.55). The remaining factors failing to achieve statistical significance because of their inter-relationship with the known risk factors. CONCLUSIONS: Clinical features of the ulcer seem to determine the progress of healing in patients with leg ulceration. Although there were associations between socio-economic factors and poor healing, adjustment for clinical risk factors generally led to lower non-significant associations. Only lack of central heating retained its association and may play a part in prolonging healing of venous ulceration.

A pioneering service to the community. The Riverside Community Leg Ulcer Project.

1. Leg ulceration is an extensive problem that is often poorly managed. 2. Research-based treatment of leg ulceration results in rapid improvements in healing rates. 3. A systematic, multidisciplinary approach optimises the effectiveness of services. 4. Effective services must be underpinned by comprehensive training programmes.

Community leg ulcer clinics: cost-effectiveness.

This study investigates the cost-effectiveness and efficacy of a new service provided by community leg ulcer clinics, and compares it with treatment in existing hospital-based venous ulcer care clinics. Data were provided prospectively from district nurses and retrospectively from patients. Success in treatment was assessed as a percentage of ulcers completely healed after 12 weeks of treatment, analysed by the up-table method. Treatment success of 22% at 12 weeks using existing methods compared with 80% in community clinics. Costs were estimated to be 433,600 pounds and 169,000 pounds respectively. These findings indicate that community leg ulcer clinics were more effective and less expensive than the previous system of care.

Community clinics for leg ulcers and impact on healing.

OBJECTIVE: To evaluate the effectiveness of community clinics for leg ulcers. DESIGN: All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle/brachial index > 0.8) were treated with a high compression bandage of four layers. SETTING: Six community clinics held in health centres in Riverside District Health Authority supported by the Charing Cross vascular surgical service. PATIENTS: All patients referred to the community services with leg ulceration, irrespective of cause and duration of ulceration. MAIN OUTCOME MEASURES: Time to complete healing by the life table method. RESULTS: 550 ulcerated legs were seen in 475 patients of mean (SD) age 73.8 (11.9) years. There were 477 venous ulcers of median size 4.2 cm2 (range 0.1-117 cm2), 128 being larger than 10 cm2. These ulcers had been present for a median of three months (range one week to 63 years) with 150 present for over one year. Four layer bandaging in the community clinics achieved complete healing in 318 (69%) venous ulcers by 12 weeks and 375 (83%) by 24 weeks. There were 56 patients with an ankle/brachial arterial pressure index < 0.8, indicating arterial disease. The 50 patients with pressure index < 0.8 > 0.5 were treated with reduced compression, and 24 (56%) healed by 12 weeks and 31 (75%) by 24 weeks. The figures for overall healing for all leg ulcers were 351/550 (67%) at 12 weeks and 417/550 (81%) at 24 weeks, compared with only 11/51 (22%) at 12 weeks before the community clinics were set up. CONCLUSIONS: Community clinics for venous ulcers offer an effective means of achieving healing in most patients with leg ulcers.

A trial of a hydrocolloid dressing in the management of indolent ulceration.

A report of a randomised, controlled trial of a hydrocolloid dressing used in the treatment of leg ulcers that were failing to heal.

Assessing a calcium alginate dressing for venous ulcers of the leg.

A small study of Tegagel calcium alginate dressings is described, with a discussion of the methodology employed.

Clock mutations alter developmental timing in Drosophila.

The developmental time of period mutants in Drosophila melanogaster was monitored under different environmental conditions. We observed that the pers mutants, which have short 19 h circadian cycles, develop faster from eggs to adult than the wild-type: perL mutants, which have long 28 h circadian rhythms, complete development more slowly than the wild-type. These results suggest that endogenous timers may be involved in regulating the development time of D. melanogaster.