The differences in perception of wheelchair performance between direct care and professional staff on a residential unit for individuals with severe developmental disabilities.

A pilot study was conducted on a residential unit in an institution for individuals with severe multiple physical and mental disabilities in order to compare the perceptions of direct care and professional staff members on the functional performance of wheelchairs. The study was a part of a collaborative research project with the OMRDD and School of Education, New York University that focused on enhancing the quality of life of those disabled individuals through the application of assistive technology. The results of the study showed a considerable discrepancy in the perceptions of wheelchair functional performance between two categories of care providers on the unit. The members of the direct care staff perceived the wheelchairs as low functioning in contrast to the members of the professional staff who perceived the same wheelchairs to be close to fully functional. The possible causes of the differences between the members of both categories of care providers on the unit regarding the functional performance of wheelchairs and their accommodation to the specific needs of the clients are discussed.

Database analysis of injury patterns in an institution for developmental disabilities.

This paper reports the results of a statistical analysis of injuries to the clients and the employees of a state facility for people with developmental disabilities, as recorded in the respective databases of the institution. The goal of the analysis was to identify the characteristics and patterns of injuries in order to identify priorities for technological intervention. Databases for 2000 client injuries and for 900 direct care staff injuries between 1988 and 1991 were analyzed retrospectively. Most of the injuries were sustained by the direct care staff and involved their backs. The injuries occurred in the institution's bedrooms (approximately 25%) and bathrooms (approximately 15%) and took place mainly during the early morning (approximately 30%) and evening rush (20%). The time of day and location of the injuries of clients coincided with those of the injuries of employees. These findings direct the focus of technological based interventions.

Pustulotic arthro-osteitis: a cause of atypical chest pain and a new arthritic syndrome.

We have described a 38-year-old white American woman who had a 7-year history of pain in the left anterior chest, neck, right wrist, and buttocks. The pain fluctuated in severity and appeared to coincide with worsening of her skin condition, palmoplantar pustulosis (PPP). She manifested the typical skeletal features of an arthritic condition referred to as pustulotic arthro-osteitis, which is frequently associated with the characteristic rash of PPP. This is an infrequently described disorder in the United States, possibly reflecting lack of familiarity or confusion with related disorders.

Diffuse nail dyschromia in black patients with systemic lupus erythematosus.

Diffuse dark blue-black chromonychia was observed in 17 of 33 (52%) black patients with systemic lupus erythematosus (SLE), but not in 47 non-SLE black patients. About half of these patients had active disease. A comparison was made between patients with SLE with chromonychia and those without but no distinctive clinical or laboratory variable differentiated the 2 groups. This pattern of nail hyperpigmentation has not previously been associated with SLE.

Osteomyelitis of the hand due to Torulopsis holmii.

Yeasts belonging to the genus Torulopsis, though generally considered saprophytes, are capable of causing serious illness in compromised patients. Torulopsis infections in patients with no apparent underlying disease are rare. We have described a previously healthy man who had osteomyelitis due to Torulopsis holmii as a complication of a penetrating hand injury. Despite in vitro susceptibility of the organism to amphotericin B and flucytosine and prolonged therapy with these agents, the infection relapsed after an apparent initial response.

Acute sarcoidosis occurring during the course of systemic lupus erythematosus.

A diagnosis of systemic lupus erythematosus (SLE) was established in a 54-year-old woman with a compatible history, as well as patchy alopecia, anemia, arthralgias, and a positive LE cell preparation. Sixteen months later bilateral hilar and mediastinal lymph nodes appeared on chest roentgenogram. Sarcoidosis was diagnosed when hypercalcemia and noninfectious, noncaseating epithelioid granulomas were found in the skin and liver. The sarcoidosis remitted with corticosteroid therapy, but slowly advancing renal failure ultimately resulted in the patient's death. We believe the concurrence of SLE and sarcoidosis had not been previously reported in the English literature. Immune mechanisms are discussed.

Interstitial immunofluorescence in nephritis of Sjögren's syndrome.

A patient with Sjögren's syndrome (SS) developed mild renal insufficiency without significant proteinuria; the diagnosis of interstitial nephritis secondary to SS was made on the basis of history, serological data and renal biopsy. The renal biopsy revealed immunofluorescence of the interstital infiltrates and the importance of this finding in the differential diagnosis of interstitial nephritis is considered. In addition, further studies to detect anti-renal antibodies and circulating immune complexes are reported and the possible interpretation of the results is discussed in regard to pathogenesis.

Gastrointestinal blood loss. Effect of aspirin, fenoprofen, and acetaminophen in rheumatoid arthritis as determined by sequential gastroscopy and radioactive fecal markers.

The feasibility of determining the exact site and amount of drug-induced gastric bleeding was tested. Fourteen patients with rheumatoid arthritis received equivalent therapeutic doses of the antinflammatory drugs aspirin, 4 gm/day, and fenoprofen calcium, 2.4 gm/day, in randomized order for seven days. Acetaminophen was given for 14 days just prior to each of these periods. By fiberoptic gastroscopy, antral ulceration and acute mucosal lesions were found in seven patients following aspirin ingestion, in one taking fenoprofen, and in none taking acetaminophen. Fecal blood loss in four-day stool collections, quantitated by autologous chromium 51-labeled erythrocytes shed into the stool averaged 5.0 ml/day while taking aspirin, 2.2 ml/day while taking fenoprofen calcium, and 0.8 ml/day while taking acetaminophen. The mean blood loss was greater for those in whom gastric lesions developed while taking aspirin than for those in whom lesions did not develop. The short-term risk of erosive gastritis was greater for aspirin than fenoprofen.