How effective are prevention strategies in reducing the prevalence of pressure ulcers?

The prevalence of pressure ulcers has remained constant at about 7% over the past 20 years, even though considerable time and money has been invested in various prevention strategies. This literature review explores whether pressure-prevention programmes can reduce the prevalence rate still lower or whether they are working but are limited by an increasingly aged population and rising patient acuity.

Binding of tissue plasminogen activator to cultured human fibroblasts.

The binding of 125I-labeled, one-chain tissue plasminogen activator (t-PA) by WI-38 cultured human lung fibroblasts was investigated. Binding of t-PA to WI-38 monolayers was specific, saturable and temperature dependent. One and two-chain t-PAs were comparable in their ability to compete with 125I-labeled, one-chain t-PA for binding to fibroblasts, while no inhibition of binding was observed with a 500-fold molar excess of urokinase. Studies with various compounds suggest that neither the catalytic site, the fibrin binding site, nor the carbohydrate moieties on t-PA are involved in its binding to WI-38 cells. At higher temperatures, the amount of cell-bound 125I-t-PA that was removed by either incubation in binding buffer containing an excess of unlabeled t-PA, or by brief treatment with acidic buffer, was small (approximately 20%) suggesting that much of the t-PA is internalized. Electrophoretic analysis of extracts prepared from cells that had been incubated with 125I-t-PA revealed the presence of a major band of 70,000 Mr, which corresponds to intact t-PA. Our results suggest that WI-38 fibroblasts are capable of binding and internalizing t-PA, and that these processes involve a receptor site specific for t-PA.

Emotional stresses on the psychotherapist.

The practice of psychotherapy is a stressful occupation, both emotionally and physically. Becoming a better psychotherapist probably results in increasing the stress rather than decreasing it. If we do not recognize this we will respond in ways that are damaging either to our patients or to ourselves. Rather than attempting to be emotional supermen or superwomen, therapists need to be aware of their own needs and limitations and plan both their private and work lives accordingly.

Stresses associated with career success for women.

In recent years, more women have pursued careers in business and the traditionally male professions. Those that have succeeded live with a high degree of environmental stress. Since some of them are now consulting psychiatrists it is important that the psychiatrist be able to differentiate difficulties which have a cultural basis from those stemming from individual psychodynamics. Cultural stresses have been reviewed under three headings: inaccurate stereotypes; inadequate cultural supports; and role overload. It has been suggested that contact with her peer group is extremely important for this type of woman patient. The peer group provides both support and a frame of reference within which individual problems may be understood.