The National Single Assessment Tool (SAT) a pilot study in older persons care-survey results.

Following a consultation and review process, the interRAI suite of assessment tools was chosen as the most suitable instrument for assessment of the care needs of older people in Ireland. We used previously validated questionnaires to examine the usability, practicality and acceptability of these tools to professionals, carers and clients in rural and urban acute, long-term care and community settings. Of the 45 professionals, 42-44 (93-98%) agreed or strongly agreed with 14 of 15 positive statements regarding the acceptability, clinical value and ease of use of the interRAl tools; 39 (87%) felt the terminology was consistent and familiar, although 35 (78%) felt some areas would require further explanation. Responses from carers (n = 15) and clients (n = 68) were similarly overwhelmingly positive regarding the experience of being assessed using these tools. These results support the clinical utility and practicality of using this approach to assess older people in Irish clinical practice.

Prevalence of wounds in a community care setting in Ireland.

OBJECTIVE: To establish the prevalence of wounds and their management in a community care setting. METHOD: A multi-site, census point prevalence wound survey was conducted in the following areas: intellectual disability, psychiatry, GP practices, prisons, long-term care private nursing homes, long-term care, public nursing homes and the community/public health (district) nursing services on one randomly selected day. Acute services were excluded. Formal ethical approval was obtained. Data were collected using a pre-piloted questionnaire. Education was provided to nurses recording the tool (n=148). Descriptive statistical analysis was performed. RESULTS: A 97.2% response rate yielded a crude prevalence rate of 15.6% for wounds across nursing disciplines (290/1,854 total census) and 0.2% for the community area (290/133,562 population statistics for the study area). Crude point prevalence ranged from 2.7% in the prison services (7/262 total prison population surveyed) to 33.5% in the intellectual disability services (72/215 total intellectual disability population surveyed). The most frequent wounds recorded were pressure ulcers (crude point prevalence 4%, 76/1,854 total census; excluding category l crude point prevalence was 2.6%, 49/1,854 total census), leg ulcers (crude point prevalence 2.9%, 55/1,854 total census), self-inflicted superficial abrasions (crude point prevalence 2.2%, 41/1,854 total census) and surgical wounds (crude point prevalence 1.7%, 32/1,854 total census). CONCLUSION: These results support previous international research in that they identify a high prevalence of wounds in the community. The true community prevalence of wounds is arguably much higher, as this study identified only wounds known to the nursing services and excluded acute settings and was conducted on one day.

MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation.

OBJECTIVE: The goal of this study was to compare MR imaging with arthroscopy in evaluating triangular fibrocartilage (TFC) pathology. MATERIALS AND METHODS: The results of 178 MR imaging examinations of the wrist were independently reviewed by two musculoskeletal radiologists who were unaware of the the clinical history, including any subsequent surgery. One hundred forty-nine of these studies were obtained from symptomatic patients. Of these patients, 56 underwent arthroscopic evaluation of the TFC. The remaining 29 studies were obtained from control volunteers and duplicate cases to reduce bias. The data were divided into categories based on Palmer's classification of TFC injury. Diagnostic sensitivity, specificity, and accuracy were calculated for each category. RESULTS: Of the 56 patients who underwent arthroscopic evaluation of the TFC, 27 had TFCs that were intact at surgery. Also, 27 complete perforations and two partial defects were found at surgery. Sensitivity for detecting central degenerative perforations was 91% for both observers I and II. Sensitivity for detecting radial slitlike tears was 100% and 86% for observers I and II, respectively. Sensitivity for detecting ulnar-sided avulsions was 25% and 50% for observers I and II, respectively. CONCLUSION: MR imaging is accurate in revealing TFC perforations.

MR imaging of the painful wrist.

Magnetic resonance (MR) imaging is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons. MR imaging is useful in the detection, characterization, and staging of osseous injury and disease, although computed tomography provides superior detail in the depiction of bone. MR imaging may demonstrate irregular cartilage loss in noninflammatory arthropathies such as osteoarthritis, and its superior soft-tissue contrast makes it the method of choice for evaluating the synovial processes. Although arthrography remains the standard of reference in the detection of perforations of the principal intrinsic ligaments of the wrist, three-dimensional MR imaging has shown promise in depicting the small interosseous ligaments. Tendinitis, tenosynovitis, ganglia, and anatomic variants can be diagnosed and accurately assessed with MR imaging. Radiologists need to be aware of the full spectrum of wrist abnormalities and the characteristic MR imaging findings that accompany them.

MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions.

The triangular fibrocartilage complex (TFCC) is a complex anatomic and biomechanical structure. Injury to the TFCC is a recognized cause of ulnar wrist pain. The TFCC may be injured in its horizontal portion, in its peripheral portions, or at its attachments. In the Palmer classification, TFCC lesions are categorized as traumatic or degenerative. Traumatic lesions are subclassified according to the location of the injury; degenerative lesions are subclassified according to the extent of degeneration. This classification is helpful in determining the mechanism of injury and directing clinical management. Magnetic resonance (MR) imaging may be more useful than arthrography in prospective evaluation of TFCC lesions. MR images accurately demonstrate the structural abnormalities that contribute to ulnocarpal instability and pain. The presence or absence of chondromalacia is a factor in the Palmer classification and is also considered in treatment planning. However, only advanced cases of chondromalacia are reliably detected with MR imaging.

Neurologic recovery in quadriplegia following operative treatment.

Records and radiographs of 90 patients suffering complete or motor-complete quadriplegia and treated surgically were reviewed. There were 76 men or boys and 14 women or girls; ages ranged from 15 to 75. Eighty-one were complete quadriplegics and nine had some degree of sensory preservation. After surgery 30 were unchanged, 47 obtained root recovery, and 13 recovered cord function, including two who became ambulatory. Fifty-three of the 74 (71%) patients undergoing decompressive procedures showed neurological improvement while seven of the 16 (49%) patients with fusion and no root decompression had improvement (p less than 0.05). All 26 patients with dislocations underwent closed or open reduction as part of their operative procedures; this did not appear to improve the likelihood of nerve root recovery. Since independence and quality of life may be improved by cord and root recovery, decompression of all neural structures should be considered in cervical spinal cord injury.

Short term androgen production by rat ovarian follicles and long term steroidogenesis by thecal explants in culture.

To characterize the aromatizable and 5 alpha-reduced androgens produced by developing ovarian follicles, small antral (SA) and preovulatory (PO) follicles, theca and granulosa cells were incubated for 4 h with or without 8-bromo-cAMP and androstenedione. In addition, thecal explants were cultured for 10 days with or without ovine LH (oLH) to determine if the hormone-induced changes in androgen synthesis by developing follicles could be mimicked in vitro. Short term incubations of SA and PO follicles, theca and granulosa cells in medium alone resulted in limited accumulation of androgen [testosterone, 5 alpha-androstan-17 beta-ol-3-one (DHT), 5 alpha-androstan-3 alpha, 17 beta-diol (3 alpha diol), and androsterone], as determined by RIA. In the presence of 8-bromo-cAMP, PO follicles produced large quantities of testosterone (3 ng), DHT (1 ng), 3 alpha diol (15 ng), and androsterone (14 ng), while SA follicles accumulated much less androgen (0.69, 0.05, 1.23, and 1.3 ng, respectively). In the presence of androstenedione and 8-bromo-cAMP, both SA and PO follicles and theca produced large amounts of aromatizable and 5 alpha-reduced androgens. SA and PO granulosa cells required the presence of the substrate androstenedione to produce androgens, primarily testosterone and 3 alpha diol. Therefore, progesterone, androstenedione, and 5 alpha-reduced androgens were used to monitor LH action on thecal cell function in culture. Small antral theca cultured in basic culture medium alone (containing 10% fetal calf serum) displayed an increased ability to accumulate androstenedione by day 6, approximately 3 times that observed on day 2. However, a 5-fold further increase in androstenedione accumulation was observed by day 6 for SA theca cultured in the presence of oLH. Maintenance of progesterone accumulation by SA theca throughout the culture period also was dependent on the presence of LH. In contrast, androstenedione accumulation by PO theca required the presence of LH in the culture medium, while progesterone accumulation in these cultures did not. Little or no 5 alpha-reduced androgen accumulated in the media of SA and PO theca cultured in basic culture medium alone. However, SA and PO theca cultured with oLH accumulated approximately 1 ng androsterone by day 10. We conclude that 1) SA and PO follicles, theca and granulosa cells possess the enzymes required to produce large amounts of 3 alpha diol and androsterone; 2) low concentrations of oLH are required to stimulate SA thecal steroidogenesis and to maintain PO thecal androstenedione accumulation in culture.(ABSTRACT TRUNCATED AT 400 WORDS)