Ankle and exercise blood pressures as predictors of coronary morbidity and mortality in a prospective follow-up study.

Elevated ankle blood pressure (ABP) may be one of the earliest signs of subclinical atherosclerosis. However, its behavior in different degrees of atherosclerotic vascular damage has not been well characterized. We examined the association of ABP and brachial exercise blood pressure with the incidence of future coronary events. A cohort of 3808 consecutive ambulatory persons (mean age 50 years, 34% women), referred to a symptom-limited exercise test and free of cardiovascular events at baseline, was prospectively followed up for 15 years. Altogether, 383 (80 fatal and 303 non-fatal) incident coronary events occurred. Cox proportional hazards models, adjusting for several conventional risk factors, were used to analyse the independent association of ABP with the risk of an incident coronary heart disease (CHD) event. Persons with normal ankle, brachial resting and brachial exercise blood pressures were taken as the reference group. Other groups were formed on the basis of ankle and exercise blood pressures and compared with the reference group. Even in persons among whom the elevated ABP was the only abnormal finding, the multivariate adjusted hazard ratio (HR) of a future CHD event was significantly elevated (HR=1.60, 95% confidence interval 1.20-2.14, P<0.0001). In general, the HRs were higher for fatal events than for non-fatal events. The measurement of ABP could be an inexpensive and non-invasive tool to detect elevated risk of a CHD event.

Decreased oxygen saturation as a result of haemoglobin Titusville.

INTRODUCTION: Our patient was admitted to the hospital due to shortness of breath. Although partial pressure of oxygen in arterial blood was normal, oxygen saturation measured with pulse oximetry (SpO(2)) was markedly decreased. SpO(2) and oxygen saturation of arterial blood (SaO(2)) stayed low during monitoring even with an increased fraction of oxygen in inspired air. METHODS: Report of a case. RESULTS: After extensive investigations, a rare haemoglobin variant, haemoglobin Titusville, with decreased oxygen binding capacity was discovered. This is the first haemoglobin Titusville case reported in Scandinavian countries.

24-hour Holter-monitoring in the perianaesthetic period in dogs premedicated with dexmedetomidine.

Baseline and perianaesthetic 24-hour Holter recordings were carried out in six healthy beagles. After dexmedetomidine premedication anaesthesia was induced with propofol and maintained with propofol infusion or isoflurane for one hour. Dexmedetomidine alone was used as control. The recordings were analysed for ventricular premature complexes (VPC), atrioventricular (AV) blocks and mean heart rate/hour (HR). In most recordings, no ventricular arrhythmias were detected, the maximum frequency being two VPCs/24 h. VPCs were not seen during anaesthesia or during the recovery period. The development of second-degree AV-blocks varied from dog to dog. Most of the heart blocks were seen during the premedication period when bradycardia was most prominent. During the subsequent night, HR was similar between treatments and did not differ from that seen on the baseline recordings. In beagles treated with dexmedetomidine alone or combined with propofol or propofol/isoflurane, ventricular arrhythmias were not detected more frequently than those reported in healthy non-anaesthetised dogs.

MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity.

PURPOSE: To compare MR imaging, radiography and bone scintigraphy in the diagnosis of stress injuries to bones of the pelvis and lower extremity. MATERIAL AND METHODS: Fifty consecutive conscripts with clinical signs of a stress injury to bone underwent MR imaging and bone scintigraphy. Forty-three patients also had radiographs available. Bone scintigraphy served as a gold standard. RESULTS: Compared to the bone scintigraphy, the sensitivity of radiography was 56%, specificity 94%, accuracy 67%, positive predictive value (PPV) 95%, and negative predictive value (NPV) 48%. The kappa value for radiography and bone scintigraphy was fair (0.39). Correspondingly, the sensitivity of MR imaging was 100%, specificity 86%, accuracy 95%, PPV 93% and NPV 100%. The kappa value for MR imaging and bone scintigraphy was very good (0.89). MR imaging depicted 3 bone stress injuries that were not visible on bone scintigraphy. Positive findings obtained from radiography correlated with MR signs of fracture line or callus (p<0.001). CONCLUSION: MR imaging is more sensitive than two-phase bone scintigraphy, and MR imaging should be used as the gold standard in the assessment of stress injuries of bone. Radiography reveals mainly the late phases of bone stress injuries, such as stress fracture and callus.

Patients with pressure ulcers in Finnish hospitals.

The purpose of this descriptive study was to produce knowledge of the degree of pressure ulcers, pressure ulcer patients' physical and psychological well-being and the association of these factors with pressure ulcers' severity. These patients were treated in Finland's capital area hospitals. The pressure ulcer patients' sampling was gathered during 1 day with two questionnaires, which was completed by nurses. The response rate was 94%, and data analysis was based on percentage distributions. Statistical association was tested with the chi2 test. The measurement identified 164 patients with a total of 257 pressure ulcers. Prevalence was 6.4%. Most of the ulcers (40%) were grade II ulcers. Fifty-six per cent of patients suffered poor general health, 63% of the patients were immobile, but psychological well-being was better with 29% of pressure ulcer patients being adequately motivated to follow treatment for their pressure ulcers. It is essential to identify high-risk patients in order to provide optimal care.

Patients' satisfaction with breast reconstruction and reduction mammaplasty.

Patients' satisfaction is widely recognised as an important measure of the quality of care. This study measured patients' satisfaction with the outcome of breast reconstruction surgery and reduction mammaplasty and with the treatment received in hospital. A questionnaire about patients' reasons for having the operation and postoperative satisfaction was therefore sent to 137 patients after breast reconstruction and 142 who had had reduction mammaplasty. The response rate in the former group was 84% and in the latter 65%. In both groups of patients the main reasons for having the operation were difficulties with physical activities and in finding clothes to fit. Other factors were poor self-esteem and problems with body image. A total of 69% of the patients who had had reconstructions referred to problems with wearing an external prosthesis. In the reduction mammaplasty group one of the most important reasons for having the operation was pain, in particular neck, shoulder, and back pain. In the reconstruction group 94%, and in the reduction group 88%, thought the outcome of the operation was good or very good. They had no regrets about their decision to seek surgical treatment, even when the aesthetic outcome fell short of their expectations. The patients were generally satisfied with the treatment they had received. In the reconstruction group 97%, and in the reduction group 96%, of patients felt satisfied with their overall decision to have the operation. Our results confirm that these surgical procedures help to improve patients' quality of life. Among the patients who had had reconstructions, the resolved problems with body image were considered to be the main benefit of the operation. In the reduction group the main benefits were reduced neck, shoulder, and back pain. In both groups 91% of patients would have recommended the operation to a friend under similar circumstances. In the light of this evidence doctors should more readily recommend reconstruction to patients after mastectomy and reduction to women with heavy breasts.

Prevention of pressure ulcers in acute and long-term care facilities in Finland: results of a survey.

The purpose of this study was to identify those healthcare organizations that have a high incidence of pressure ulcers, and to determine what their staffs do to prevent pressure ulcer formation. The sample was formed from 11 hospitals in one large city on a certain day in Finland in 1998. The researchers sent questionnaires to 154 hospital units and achieved a 94% response rate. Psychiatric; gynecologic; obstetric; and eye, ear, nose, and throat units were not included. The data were collected using two questionnaires: The first gathered data about the organization and the second about the patients. Fifty-seven percent of the units surveyed reported having patients with pressure ulcers. Of these units, 45% were acute and 55% were long-term care. Thirty-nine percent of all units had a pressure ulcer team. Units with pressure ulcer patients had a staffing level of 0.6 registered nurses and practical nurses per bed, compared with 0.7 registered nurses and practical nurses per bed for those units without pressure ulcer patients. The average length of stay on the unit was less for those without pressure ulcers compared to those with ulcers (P < 0.001) and only 18% of the units without pressure ulcers had a pressure ulcer team. According to the results, those units with pressure ulcer patients identified the need for more preventive measures more frequently than the units without ulcer patients. In conclusion, pressure ulcers seem to predominate in long-term care settings, and the educational level of healthcare staffing seems to impact the occurrence of pressure ulcers. Common preventive measures are used by the staff in both acute and long-term care settings.

Prevalence and characteristics of pressure ulcers. A one-day patient population in a Finnish city.

This article discusses the prevalence and characteristics of pressure ulcers in a one-day patient population in a Finnish city. The data was collected using two questionnaires. Data analysis was based on percentage distributions; statistical significances were tested with the Chi-square test. The measurement identified 186 patients with a total of 300 pressure ulcers. The majority (90%) of these patients were hospitalized and 10% were in outpatient care. The main causes for the development of pressure ulcers were inadequate turning and positioning and the patient's primary illness. Most of the ulcers were grade II. Only a few patients had ulcers that exposed bone. The preventive effort should extend from the nursing unit level, through the organizational level, to the level of society as a whole. It should consist of the identification of people at high risk for pressure ulcers and the provisions of quality care for these people.

Predicting of postoperative cardiac events using ambulatory ECG monitoring prior to abdominal aortic surgery.

OBJECTIVES: The purpose of this study was to estimate the value of preoperative electrocardiographic (ECG) monitoring in predicting postoperative cardiac events in patients undergoing abdominal aortic surgery. DESIGN: A prospective open study. SETTING: University Hospital. MATERIALS: One hundred consecutive patients were studied before aortic or aortofemoral surgery by ambulatory ECG monitoring for 24 hours. CHIEF OUTCOME MEASURES: An ischaemic episode by ECG criteria was defined as a > or = 1 mm horizontal or downsloping ST segment depression measured 60 msec after the J point and persisting for at least 40 sec. MAIN RESULTS: Twenty-four patients had preoperative ambulatory ischaemia. Twenty patients had postoperative cardiac events including three with fatal myocardial infarction, one with a nonfatal infarction, eight with unstable angina, three with pulmonary oedema and five with atrial fibrillation. Sixteen out of 24 (67%) patients with ambulatory ischaemia had postoperative cardiac events (p < 0.01). Only four events occurred among 76 patients without ischaemia (p < 0.005). The sensitivity of ambulatory ischaemia predicting cardiac events was 80% with a specificity of 90%, the predictive value of ischaemia was 67% and the predictive value of a negative result was 95%. CONCLUSIONS: Preoperative ECG monitoring for myocardial ischaemia could non-invasively identify patients at high risk for postoperative cardiac morbidity and mortality after vascular surgery.

[The healing process in chronic and infected wounds]. / Kroonisen ja infektoituneen haavan paikallishoito.

The healing process of a chronic and infected wound and factors to stimulate or to slow down it are discussed in the present article. Wound treatment, locally used substances and their effect are dealed in detail. Though the local wound treatment is very important it is not the only way in reaching the optimal result. A patient and his/her living also has to be considered. To take care of pain and to prevent wound infection are essential in wound treatment.

[Quality of nursing care seen from the Scandinavian nurse's viewpoint]. / Sykepleiekvalitet sett fra de nordiske sykepleieres perspektiv.

The aim of this study was to do the nurses' perception of quality of care explicit and to describe the quality of nursing from the nurses' perspective using a grounded theory approach. Sixteen nurses in four Nordic countries were interviewed. On the basis of the analysis a system theoretical model was generated. In the model there is a core category: patient focused outcome, and three mutual dependent categories; nursing capacity, organisation and physical environment. These categories are dynamically interrelated with the categories, relation and knowing the patient. The model is discussed in relation to relevant theories.