Pulse oximetry index: a simple arterial assessment for patients with venous disease.

OBJECTIVE: To provide additional safety data comparing ankle brachial pressure index (ABPI) and pulse oximetry (Lanarkshire Oximetry Index, LOI) as measures of arterial circulation in patients with venous disease of the leg. METHOD: A total of 107 (195 legs) attending hospital leg ulcer clinics participated in this prospective open study. We attempted to measure brachial and foot arterial pressures in all patients using both the handheld Doppler method (ABPI) and pulse oximeter method (LOI). Features of patients with limbs in which either the ABPI or LOI could not be assessed were documented. ABPI and LOI values were compared, and agreement between the two assessment methods was assessed. RESULTS: We found the LOI measurement to be a simpler technique than Doppler ABPI measurement, with an endpoint less prone to the subjective variability associated with the Doppler method. Of the 195 legs assessed,we obtained LOI in 10 in which an ABPI could not be recorded. LOI could not be recorded in only one leg. There was a linear association (p<0.001) and fair agreement (kappa=0.303) between LOI and ABPI in the 184 legs in which both ratios could be measured. There was no evident tendency for LOI to read either low or high compared with ABPI. CONCLUSION: Pulse oximetry LOI is a simple alternative to Doppler ABPI in the screening of patients for arterial disease that could be a contraindication to, or require modification of, compression therapy. It can be measured in some legs that cannot be assessed by Doppler ultrasound.

Erosive pustular dermatosis of the leg associated with compression bandaging and fungal infection.

BACKGROUND: Erosive pustular dermatosis of the leg (EPDL) has been described in association with venous insufficiency and atrophy of the skin of the lower leg. Like erosive pustular dermatosis of the scalp, this disease has also been reported to be a non-infective condition. OBJECTIVES: To investigate the clinicopathological features and, where possible, the aetiology of clinical EPDL. METHODS: We identified a group of patients undergoing continuous compression bandaging for venous dermatitis of the legs and/or predominantly venous leg ulceration with clinical features described in patients with EPDL. They were investigated by skin biopsy, patch testing and microbiological tests for the presence of bacteria and fungi. RESULTS: Twenty-four of 400 (6%) patients were noted to have pustules on the leg(s). There was laboratory evidence of fungal infection in 13 of 24 patients (54%), with complete and sustained resolution of pustules after antifungal treatment. Pustulation in the other 11 patients (46%) was unresponsive to antibiotics for confirmed bacterial infection; some improvement was seen with potent topical corticosteroids but full clearance was achieved only after a switch from continuous four-layer compression bandaging to the use of intermittent long stretch compression. CONCLUSIONS: EPDL is a fairly common clinical picture seen in patients undergoing continuous compression bandaging. It may be produced by opportunistic, particularly fungal, infection. In almost half an infective aetiology cannot be demonstrated and a pyoderma gangrenosum-like process may be implicated.

Anemia.

PURPOSE/OBJECTIVES: To review the current knowledge of anemia associated with cancer management and nursing interventions. DATA SOURCES: Published theory, research, and clinical practice sources. DATA SYNTHESIS: Anemia often is overlooked as a priority associated with quality patient care. The diagnosis of cancer and associated treatments magnify the incidence of anemia among the cancer population. Untreated anemia negatively affects the success of radiation therapy, activities of daily living, quality of life, and morbidity and mortality. CONCLUSIONS: Identifying the underlying cause(s) of anemia in patients with cancer is critical to positive care outcomes and requires early nursing assessment and interventions. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role in maintaining and improving well-being and quality of life of patients at risk for anemia by understanding erythropoiesis, pathophysiology, nursing assessment (including laboratory data assessment), and nursing interventions related to anemia.

Pulse oximetry: a new tool to assess patients with leg ulcers.

The objective of the study was to investigate pulse oximetry as a guide to assessing patients with leg ulcers before treatment. Graduated elastic compression is the treatment of choice for uncomplicated venous leg ulcers, but is contra-indicated in patients with significant arterial disease. The standard assessment of arterial insufficiency by Doppler ultrasound ankle branchial pressure index (ABPI) has shortcomings which prompted this investigation of pulse oximetry as a possible additional, or alternative, method of assessment of patients with leg ulcers, prior to treatment with compression. The study, carried out on a population of patients attending hospital leg ulcer clinics, was designed to evaluate pulse oximetry assessment in the selection and monitoring of patients with venous leg ulceration leading to a prospective controlled study of ulcer healing in groups of patients with reduced and normal ABPI, selected for compression therapy by pulse oximetry criteria. Outcome measurement required follow-up of patients selected for compression therapy by pulse oximetry to record time to healing and rate of healing of leg ulcers. Results from the study show a fair correlation between the toe-finger oximetry index (TFOI) and Doppler ABPI. There is no difference between ulcer healing in patients with reduced and normal ABPI selected for treatment on the basis of pulse oximetry maximum compression pressure (MCP). In conclusion, pulse oximetry is an aid to the selection of patients who will benefit from compression therapy, but would be excluded on the basis of Doppler ABPI.

An electroretinogram protocol for toxicological screening in the canine model.

A five-step electroretinogram protocol was developed for the dog to be used as a painless screening test for ocular effects of drugs or pesticides. Standard conditions of frequency band width, stimulus intensity, dark adaptation time and non-confounding anesthesia method were selected to allow analysis of wave components. The protocol demonstrated an acceptable level of inter-subject variability for compiling an age appropriate database, and for the detection of possible retinal component toxicities in chronic dog studies. This electrophysiologic procedure may serve to corroborate biochemical, clinical and pathology data, in establishing a compound's no-observable-effect-level (NOEL).