Topical anaesthetic effects on skin vasculature with potential implications for laser treatment.

Laser treatment of vascular lesions is affected by parameters including the diameter and depth of the vessels and flow within the vessels. Topical anaesthetics are in common use prior to laser treatment but may have effects on vessel parameters and, subsequently, the efficacy of laser treatment. Eleven patients with capillary vascular malformations were investigated for vessel diameter before and after elective application of a topical anaesthetic, Eutectic Mixture of Local Anaesthetics (EMLA) (AstraZeneca) or Ametop (S&N Health), prior to pulsed dye laser treatment. EMLA contains 2.5% lidocaine ad 2.5% prilocaine, and Ametop gel contains 4% tetracaine. Patients' capillary malformations were assessed using confocal laser scanning microscopy (CLSM) (Vivascope 1500 Mavig GmbH, Munich). Six of the 11 patients recruited had EMLA topical anaesthetic, and five had Ametop. Four hundred twenty-one diameters were measured. The mean vessel diameter was 50.87 µm. Previous laser treatments undergone by each patient were noted to exclude this as a confounding variable, and no significant difference was found between topical anaesthetic groups. Statistical calculations were made using GenStat and Minitab. There is no evidence that Ametop affects mean diameter (p value is 0.361). EMLA reduces the mean diameter of vessels (p = 0.002), with a 27% reduction in post-EMLA diameter. This study demonstrates that the use of EMLA cream has a statistically significant reduction vessel diameter. As it is known that vessel diameter is important for the response of laser treatment, the use of EMLA may affect outcome.

Evidence of purinergic neurotransmission in isolated, intact horse sweat glands.

BACKGROUND: Fluid secretion by sweat glands in response to heat and exercise is underpinned by increases in intracellular calcium. In horses, this is primarily via ß2-adrenoceptors, but studies in equine sweat gland cell lines have indicated a possible role for purinergic agonists. Knowledge of equine sweating stimulus-secretion mechanisms in intact glands from healthy animals would allow future comparison to determine whether these mechanisms are affected in equine anhidrosis. HYPOTHESIS/OBJECTIVES: To determine whether purinergic agonists can induce changes in intracellular calcium in intact, freshly isolated equine sweat glands. ANIMALS: Eleven healthy thoroughbred horses from the Hong Kong Jockey Club were used in this study. METHODS: Freshly isolated equine sweat glands were loaded with the calcium-sensitive fluorescent dye fura-2 AM, and changes in intracellular calcium were recorded before, during and after stimulation by purinergic agonists. RESULTS: Purinergic agonists ATP and UTP generated significant increases in intracellular calcium. CONCLUSIONS AND CLINICAL IMPORTANCE: The results show that it is possible to investigate stimulus-secretion coupling mechanisms by fluorescence imaging in equine sweat glands that have been isolated from fresh skin samples. Such isolated glands retain functional ß2-adrenoceptors and P2Y purinergic receptors that couple to a calcium-signalling pathway. Using isolated, intact sweat glands therefore offers a very useful model for the further study of secretory processes in equine sweat glands, and using this experimental approach could facilitate a better understanding of how these mechanisms are affected in equine anhidrosis.

Older people's views on what they need to successfully adjust to life with a hearing aid.

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit.

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis.

Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.

Analyzing free-living physical activity of older adults in different environments using body-worn activity monitors.

This study measured objectively the postural physical activity of 4 groups of older adults (> or =65 yr). The participants (N = 70) comprised 3 patient groups--2 from rehabilitation wards (city n = 20, 81.8 +/- 6.7 yr; rural n = 10, 79.4 +/- 4.7 yr) and the third from a city day hospital (n = 20, 74.7 +/- 7.9 yr)--and a healthy group to provide context (n = 20, 73.7 +/- 5.5 yr). The participants wore an activity monitor (activPAL) for a week. A restricted maximum-likelihood-estimation analysis of hourly upright time (standing and walking) revealed significant differences between day, hour, and location and the interaction between location and hour (p < .001). Differences in the manner in which groups accumulated upright and sedentary time (sitting and lying) were found, with the ward-based groups sedentary for prolonged periods and upright for short episodes. This information may be used by clinicians to design appropriate rehabilitation interventions and monitor patient progress.

A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations.

INTRODUCTION: Several studies have reported laser treatment of Capillary Malformations (CMs) using systems other than pulsed dye lasers (PDL). Few, however, have compared different systems in the same patients. This study aimed to directly compare CM fading using five different systems. METHODS: Eighteen previously PDL-treated patients were test-patched using the alexandrite, KTP, and Nd:YAG lasers and intense pulsed light (IPL) with additional PDL patches as a control. Pre- and post-treatment videomicroscopy, and colour measurements using Munsell colour charts were carried out. RESULTS: Four patients failed to respond to any test patches. The alexandrite laser test patches had the largest mean improvement in Munsell colour following treatment (P = 0.023) and resulted in CM fading in 10 patients, although 4 patients developed hyperpigmentation, and 1 patient scarring, following treatment. In addition, the alexandrite laser caused a significant decrease in mean post-treatment capillary diameter (P = 0.007), which was not mirrored by the other systems. The KTP and Nd:YAG lasers were least effective, with fading seen in two patients for both systems, whilst IPL patches resulted in CM fading in six patients. In addition, five patients had further CM fading using double-passed PDL treatment. Mean pre-treatment capillary diameter measurements were predictive of those patients likely to respond to laser treatment. CONCLUSIONS: Alexandrite laser treatment was the most effective, but resulted in hyperpigmentation and scarring in four patients, probably due to its deeper penetration and lower specificity for oxyhaemoglobin causing non-specific dermal damage. Double passing of the PDL can result in further CM fading even in previously treated patients. Videomicroscopy measurements of capillary diameter before treatment may be predictive of the likelihood for patient's to respond to laser treatment.

Gait characteristics of subjects with chronic fatigue syndrome and controls at self-selected and matched velocities.

BACKGROUND: Gait abnormalities have been reported in individuals with Chronic Fatigue Syndrome (CFS) however no studies exist to date investigating the kinematics of individuals with CFS in over-ground gait. The aim of this study was to compare the over-ground gait pattern (sagittal kinematics and temporal and spatial) of individuals with CFS and control subjects at their self-selected and at matched velocities. METHODS: Twelve individuals with CFS and 12 matched controls participated in the study. Each subject walked along a 7.2 m walkway three times at each of three velocities: self-selected, relatively slow (0.45 ms-1) and a relatively fast (1.34 ms-1). A motion analysis system was used to investigate the sagittal plane joint kinematics and temporal spatial parameters of gait. RESULTS: At self-selected velocity there were significant differences between the two groups for all the temporal and spatial parameters measured, including gait velocity (P = 0.002). For the kinematic variables the significant differences were related to both ankles during swing and the right ankle during stance. At the relatively slower velocity the kinematic differences were replicated. However, the step distances decreased in the CFS population for the temporal and spatial parameters. When the gait pattern of the individuals with CFS at the relatively fast walking velocity (1.30 +/- 0.24 ms-1) was compared to the control subjects at their self-selected velocity (1.32 +/- 0.15 ms-1) the gait pattern of the two groups was very similar, with the exception of both ankles during swing. CONCLUSION: The self-selected gait velocity and/or pattern of individuals with CFS may be used to monitor the disease process or evaluate therapeutic intervention. These differences may be a reflection of the relatively low self-selected gait velocity of individuals with CFS rather than a manifestation of the condition itself.

Staff attitudes towards working with drug users: development of the Drug Problems Perceptions Questionnaire.

AIM: To evaluate the psychometric properties of an adaptation of the Alcohol and Alcohol Problems Perceptions Questionnaire to measure the attitudes of staff to working with drug users (the DDPPQ). DESIGN: Postal survey: a questionnaire was mailed to participants on two occasions. SETTING: A large urban National Health Service (NHS) mental health service. PARTICIPANTS: A stratified random sample of medical staff, clinical psychologists, occupational therapists and nurses (n = 672) who work within generic mental health, adolescent psychiatry, forensic psychiatry and alcohol and drug services. Response rate at Time 1 was 56% and 68% at Time 2. MEASUREMENTS: A structured demographic questionnaire; individual item and total scores for the DDPPQ administered on two occasions 4 weeks apart; data relating to the content validity of the instrument. FINDINGS: A principal component analysis confirmed the DDPPQ's construct validity and participants confirmed its content validity. Following analysis of the instrument's test-retest reliability and its principal component structure it was reduced to a 20-item scale. Its five subscales related to role adequacy, role support, job satisfaction, role-specific self-esteem and role legitimacy. CONCLUSION: The refined DDPPQ was shown to be a valid and reliable tool which can be used to measure attitudes of people in relation to working with drug users.

The effect of varying pulse duration, wavelength, spot size, and fluence on the response of previously treated capillary vascular malformations to pulsed-dye laser treatment.

Modern lasers allow different parameters to be altered in an effort to gain further improvement in otherwise resistant capillary vascular malformations (CMs). The aim of this study was to examine the effect of changing the pulse duration, wavelength, spot size, and fluence on the color and capillary architecture of 585-nm pulsed-dye, laser-resistant CMs. Eighteen patients were assessed with a depth measurement videomicroscope (DMV) before and after 12 test patches with ScleroPlus and V-Beam lasers at specified parameters. In the majority of the test patch areas, there was little improvement after treatment. However, 44% of patients had greater than 75% clearance in at least 1 test patch site. This study demonstrates that both lasers can achieve further lightening in 585 nm 0.45 msec pulsed-dye laser-resistant CMs. However, in CMs consisting of small-diameter deep vessels, further improvement is unlikely.

Influence of policies on nursing practice in long-term care environments for older people.

AIM: This paper reports a study exploring nurses' awareness of, access to and use of policies within long-term care environments for older people in Scotland. BACKGROUND: The provision of the highest quality of nursing care for older people with continuing care needs is facilitated through a number of strategic mechanisms. These encompass regulatory systems, national and local policies and care guidance. Failure of practitioners to engage with the 'policy context' may compromise care standards. METHOD: This was a two-stage investigation. A Delphi approach with 33 panel members was used to generate consensus as to the 10 most important current policies in this area of practice. A postal survey was undertaken with 2072 nurses to identify the practice impact of policies, including the 10 identified items. FINDINGS: Identification of the 10 most important policies proved challenging for panel members. Initially they identified 137 policy items, which were reduced after clustering and two further rounds to 10 items (consensus agreement 57%). Completed questionnaires were returned by 986 (48%) nurses. A long list of problems limited access to policy information. Nurses reported little time to keep up to date, compounded by communication inefficiencies and limited access to the internet. Awareness of the 10 selected items ranged from 46 to 83% and clarity of the practice message was high (85-94%); however, the reported influence on practice varied, with 10-26% of respondents indicating no effect. Professional priorities did not coincide with the priorities of older people themselves. CONCLUSION: Nurses appear bewildered by the number and status of policy items. Current methods to provide nurses with information and keep them up to date were not ideal. Processes need to be developed that will engage nurses in policy and pursue closer alignment with the priorities of older people. Strategies are required to identify key policies and promote their implementation.

Perception of risk: a study of A&E nurses and NHS managers.

This exploratory study investigates perceptions of two groups of NHS staff, of a range of risks, topical and relevant to accident and emergency (A&E). Literature suggests that the effectiveness of a risk management strategy is lessened if staff exposed to risk, and managers, have different perceptions of the nature and severity of the risk. A self-administered questionnaire was distributed to registered A&E nurses and to Trust managers at directorate level and above, working in five large inner-city NHS Trusts. Managers and nurses were asked to quantify their perceptions of nine defined adverse events. They were also asked to identify the jobholder with day-to-day responsibility for managing four specific risks. Completed forms were obtained from 38 per cent of managers and nurses. Results showed broadly that managers tended to quantify risks of violence and stress to A&E nurses less highly than did nurses. By contrast, they tended to quantify risks to patients more highly than did nurses. Overall, a coherent pattern of difference in risk perception between the two groups was identified. It is argued that identification of differences of perception is an essential part of the risk management process. Illustrations are given of ways in which these differences can undermine the effectiveness of a risk management strategy.

The use of an air filtration system in podiatry clinics.

A small-scale study was conducted to ascertain the efficiency and effectiveness of an air filtration system for use in podiatry/chiropody clinics (Electromedia Model 35F (A), Clean Air Ltd, Scotland, UK). Three clinics were identified, enabling comparison of data between podiatry clinics in the West of Scotland. The sampling was conducted using a portable Surface Air Sampler (Cherwell Laboratories, Bicester, UK). Samples were taken on two days at three different times before and after installation of the filtration units. The global results of the study indicate the filter has a statistically significant effect on microbial counts, with an average percentage decrease of 65%. This study is the first time, to the authors' knowledge, such a system has been tested within podiatric practice.