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The purpose of this article is to describe how lay peer leaders perceived their involvement as a volunteer in the implementation of a peer-led education program focused on diabetic foot care and prevention of diabetic foot ulcers/amputations. The peer-led education program was conducted in 10 Canadian provinces and 12 communities (two Aboriginal communities). Six months into the program, 12 out of 17 peer leaders completed online questions about their role. The program was focused on the operationalization of the PEP Talk: Diabetes Healthy Feet & You program. This program was supported by the Canadian Association of Wound Care and Public Health Agency of Canada. Peer leaders were recruited by a health care professional that knew them. Peer leaders volunteered as they wanted to give back to the healthcare system; they wanted to prevent others from experiencing foot ulcers and amputations; and overall they wanted foot care education to be delivered by a person who lived with the disease. [ABSTRACT FROM AUTHOR]

This article describes the collaborative process undertaken by the Canadian Association for Enterostomal Therapy and the Canadian Association of Wound Care in an effort to improve the quality of wound prevention and management education and programming. The end result of this process is the Wound CARE Instrument which promotes an interprofessional, collaborative appraisal process to support the development, adoption or adaption of wound management educational events and programs. [ABSTRACT FROM AUTHOR]

Inlow's 60-second Diabetic Foot Screen is a paper-pencil tool developed to guide professionals in the completion of a quick foot assessment of persons with diabetes mellitus to determine recommended frequency of assessments. The tool has been used in various healthcare settings and its reliability and validity previously tested in acute and long-term care settings. The purpose of this study was to assess content, time to complete assessment, ease of use, and reliability of the tool in a complex continuing care setting. The tool includes questions about 10 variables; skin, nails, deformities, footwear, temperature, range of motion, sensation, pulses, dependent rubor, and erythema. Answers convert to a score ranging from 0 (low risk, yearly screenings) to 23 (high risk, weekly screenings). Using the tool, the study questionnaire, and a watch, three nurse assessors experienced in assessing the feet of persons with diabetes completed 70 assessments on 35 patients during a period of 30 days. Content areas assessed included significance of comorbidities and interval screening times. Mean time to complete the assessment was 7 minutes (range 2 to 21 minutes); 39% of assessments took 6 to 7 minutes. Times to perform assessment varied widely due to the functional and cognitive well-being of the patient. Inter-rater reliability was low (ICC 0.608 [95% confidence interval 0.349-0.781]), perhaps due to varying interpretations of assessment parameters related to the complexity of the study patient population. Comments suggest that some tool revisions may increase ease of use as well as tool validity and reliability, especially for complex care patients with multiple comorbidities.

Monitoring wound progress is essential for evaluating and documenting treatment outcomes. The Pressure Ulcer Scale for Healing (PUSH) was developed to track pressure ulcer (PU) progress but information about its utility for other types of chronic wounds is limited. A 10-month, descriptive, multicenter study was conducted to examine the responsiveness and concurrent validity of the PUSH when used to monitor wound changes in diabetic foot (DFU), venous leg (VLU), and PU. Using a convenience sample of participants (n = 98, mean age 60 [range 20 to 89] years, the majority [85%] male), PUSH score and acetate wound surface area tracings were obtained at baseline and approximately 4 weeks later from 47 Stage II to Stage IV PU, 23 VLU, and 28 patients with a DFU. After an average of 32 days, wound surface area, total PUSH scores, and individual PUSH component scores decreased significantly between baseline and follow-up (P = 0.000). The mean PUSH score change was significantly different between healing and nonhealing wounds (P = 0.000). A strong relationship (r = .66) was found between total PUSH score and surface area. Results suggest the PUSH tool is a valid, responsive, evaluative tool to monitor and document wound progress of PU, VLU, and DFU. Additional studies to assess use of this tool for DFU and to ascertain the predictive validity of the PUSH tool are warranted.

Heel pressure ulcers (PU) are a major concern in orthopedic patients. A prospective 6-month study was conducted in an acute care hospital in Canada to determine the incidence of heel PU in an orthopedic population, evaluate the effect of patient and care variables on heel PU incidence, and describe the natural history/sequelae of Stage I heel PU. One hundred and fifty (150) patients (average age 70.6 years) admitted for elective orthopedic surgery or treatment of a fractured hip participated in the study. A direct heel skin assessment was performed following admission and before discharge. Patients with a Stage I ulcer were assessed or contacted 1 week following discharge. The incidence of heel PU in this population was 13.3% CI (range 8% to 19%). Incidence was 16% in the hip fracture and 13% in the elective surgery group. PU incidence in the hip fracture group was significantly lower (P = 0.016) for patients receiving heel pressure relief measures (pillows, rolled sheets). In the elective surgery group, PU incidence rates were higher for patients with respiratory disease, lower hemoglobin, low pulse rate, and altered mental status (P <0.05). When both patient groups were combined, only the presence or absence of respiratory disease significantly affected PU incidence. Length of stay was an average of 3 days longer in all groups with a heel PU but the difference was not statistically significant. One week following discharge, 13 of the 17 (76%) Stage I heel PU had resolved, one remained unchanged, and two were assessed as deep tissue injury (11%) and one as Stage II. These incidence rates are similar to those reported in other countries and confirm that efforts to reduce heel PU incidence rates are needed.

Objective: To identify intermittent catheterization (IC) practices and factors associated with urinary tract infection (UTI) in community-dwelling people living with spinal cord injury (SCI) in Canada., Study Design: A national survey employing a 36-item self-report questionnaire that was mailed to members of the Canadian Paraplegic Association (CPA)., Results: There were 912 respondents with SCI of either traumatic or nontraumatic etiology. Fifty-five percent of the respondents used IC. The mean age of users (47+/-14 years) was significantly younger than non-users (53+/-13 years) and a greater percentage of males (57%) than females (50%) used IC. Of those who used IC, 26% use hydrophilic catheters either exclusively or sometimes. The mean frequency of UTIs in the past 12 months for IC users was 2.6+/-2.6. Among IC users, females had a significantly greater number of UTIs than males (p=0.003). Linear regression analysis revealed that the variables of sex, number of catheterizations per day, age, and tetraplegia versus paraplegia were individually correlated with infection rate but collectively only explained a small proportion of the variance. Time lost from social activities due to UTIs was associated with compromised quality of life more so than the actual number of UTIs or days lost from work., Conclusion: The survey identifies existing IC practices and confirms previous reports of UTI rate being dependent on frequency of catheterization and reduced infection rates in individuals using hydrophilic catheters. UTI rates were significantly associated with several clinical and demographic variables but only poorly modeled by the IC practices and lifestyle variables investigated in this study.

The purpose of this study was to examine the relationships of diagnosis and treatment of depression with anhedonic and dysphoric symptom presentation, using the Minimum Data Set 2.0. Participants were from two sectors of longterm care: 70 nursing home residents and 92 residents in a Veterans' Care Service. The samples differed in their sex distribution and in cognition. A series of logistic regressions that controlled for demographics, type of facility, and cognition showed that dysphoric symptoms predicted diagnosed depression, whereas anhedonic symptoms predicted anti-depressant medication use without a concomitant diagnosis. The findings are consistent with a hypothesis that, in long-term care settings, anhedonic symptoms contribute less to a diagnosis of depression than do dysphoric symptoms. However, findings that anhedonic symptoms relate to treatment have implications for care-planning protocols.

Ultraviolet light C (light wavelength 200 nm to 290 nm) has been shown to kill cultures of antibiotic resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus. To evaluate the ability of ultraviolet light C to reduce the amount and type of bacteria present in chronically infected ulcers, as well as to establish the test-retest reliability of the semi-quantitative swab technique, a prospective, one-group, pre-post treatment study was conducted among patients receiving treatment in several in- and outpatient facilities and nursing homes. Individuals with chronic ulcers exhibiting at least two signs of infection and critically colonized with bacteria (n = 22) received a single 180-second treatment using an ultraviolet light C lamp (wavelength = 254 nm) placed 1 inch from the wound bed. Semi-quantitative swabs taken immediately before and after UVC treatment were used to assess changes in the bacterial bioburden present within the wound bed. Results demonstrated excellent test-retest reliability of the semi-quantitative swab technique used to evaluate the type and amount of bacteria present in chronic wounds (Cohen's kappa = 0.92). Assessment of wound bioburden using semi-quantitative swabs revealed a statistically significant (P <0.0001) reduction in the relative amount of bacteria following a single treatment of ultraviolet light C. The greatest reduction in semi-quantitative swab scores following ultraviolet light C treatment were observed for wounds colonized with the bacteria Pseudomonas aeruginosa and wounds colonized with only one species of bacteria. Significant (P <0.05) reductions in the relative amount of bacteria also were observed in 12 ulcers in which methicillin-resistant Staphylococcus aureus was present. These results confirm previous laboratory studies and demonstrate that ultraviolet light C can kill bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus present in superficial layers of chronic wounds.

Although statistics regarding the number of pressure ulcers in the US and other countries are available, little information is known about the number of individuals in Canada who have pressure ulcers. Such information is important to assess the scope and healthcare costs of pressure ulcers and develop public policies. To obtain estimated pressure ulcer prevalence rates in Canada, existing data (gathered between 1990 and 2003) from different healthcare settings across the country were obtained from peer-reviewed published studies and from unpublished studies provided by individuals and pressure ulcer support surface manufacturers. Methods used to gather and report prevalence data in each study were critically appraised using a modified version of published criteria. Retrospective chart audit studies that did not involve direct patient assessment were excluded. The data included information from 18 acute care facilities involving 4,831 patients, 23 non-acute care facilities with 3,390 patients, 19 mixed healthcare settings with 4,200 patients, and five community care agencies that surveyed 1,681 patients. Estimates of pressure ulcer prevalence were 25.1% (95% Confidence Interval, 23.8% to 26.3%) for acute care settings, 29.9% (95% Confidence Interval, 28.3% to 31.4%) in non-acute care settings, 22.1% (95% Confidence Interval, 20.9% to 23.4%) in mixed health settings, and 15.1% (95% Confidence Interval, 13.4% to 16.8%) in community care. The overall estimate of the prevalence of pressure ulcers in all healthcare institutions across Canada was 26.0% (95% Confidence Interval, 25.2% to 26.8%). The Canadian prevalence estimates differed among the healthcare settings and were higher than those reported in the US and the Netherlands. Although additional studies are needed, the data suggest that pressure ulcers are a significant concern in all healthcare settings in Canada.

The prevalence of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus is rapidly increasing in healthcare facilities and spreading to the community. Methicillin-resistant S. aureus colonize the skin and open wounds and can interfere with wound healing. Recent studies have shown that ultraviolet light C can kill antibiotic-resistant strains of bacteria such as methicillin-resistant S. aureus in both laboratory cultures and animal tissue. This clinical report describes the effects of ultraviolet light C on wound bioburden and closure in three people with chronic ulcers infected with methicillin-resistant S. aureus. In all three patients, ultraviolet light C treatment reduced wound bioburden and facilitated wound healing. Two patients had complete wound closure following 1 week of ultraviolet light C treatment. This case study suggests that ultraviolet light C is a promising adjunctive therapy for chronic wounds containing antibiotic-resistant bacteria such as methicillin-resistant S. aureus.

Accurate and precise wound measurements are a critical component of every wound assessment. To examine the reliability and validity of a new computerized technique for measuring human and animal wounds, chronic human wounds (N = 45) and surgical animal wounds (N = 38) were assessed using manual and computerized techniques. Using intraclass correlation coefficients, intrarater and interrater reliability of surface area measurements obtained using the computerized technique were compared to those obtained using acetate tracings and planimetry. A single measurement of surface area using either technique produced excellent intrarater and interrater reliability for both human and animal wounds, but the computerized technique was more precise than the manual technique for measuring the surface area of animal wounds. For both types of wounds and measurement techniques, intrarater and interrater reliability improved when the average of three repeated measurements was obtained. The precision of each technique with human wounds and the precision of the manual technique with animal wounds also improved when three repeated measurement results were averaged. Concurrent validity between the two techniques was excellent for human wounds but poor for the smaller animal wounds, regardless of whether single or the average of three repeated surface area measurements was used. The computerized technique permits reliable and valid assessment of the surface area of both human and animal wounds.

Objectives: To determine what proportion of patients referred with a clinical suspicion of carpal tunnel syndrome (CTS) have negative electrodiagnostic studies and identify their clinical diagnoses and to identify clinical features that predict the outcome of electrodiagnostic testing in patients referred with suspected CTS., Design: Retrospective review of patients consecutively referred to the electrodiagnostic center with suspected CTS over a 1-year period., Setting: Community-based electrodiagnostic center., Participants: Three hundred forty-eight patients with suspected CTS., Interventions: Not applicable., Main Outcome Measure: The diagnosis of CTS was based on the electrodiagnostic findings., Results: Of the 348 patients enrolled, 179 (51.4%) had electrodiagnostic studies that were inconsistent with a diagnosis of CTS. Twenty-seven patients (15.1%) had other electrodiagnostic abnormalities (eg, ulnar neuropathy, cervical radiculopathy), whereas the remaining 152 (84.9%) patients had studies within normal limits. Seventy-one patients (46.7%) with normal studies were diagnosed with musculoskeletal disorders, with myofascial pain and musculotendinous strain being most common. By using a multiple logistic regression model, clinical variables that may predict the outcome of electrodiagnostic testing for CTS included gender, duration of symptoms, nocturnal symptoms, sensory symptoms, wrist pain, neck pain, pinprick sensation, abductor pollicis brevis strength, and thenar bulk., Conclusions: Many patients referred to an electrodiagnostic laboratory with a clinical suspicion of CTS have other diagnoses, most commonly musculoskeletal disorders. Because these various conditions may be mistaken for CTS, the electrodiagnostic evaluation is therefore an important diagnostic tool. Although traditional clinical findings including Tinel and Phalen sign were found to have limited clinical use, further validation of the groups of positive and negative clinical features may potentially enable the referring physician to identify more accurately patients who would benefit most from electrodiagnostic testing., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Goal: The goal of this study was to determine recovery rates from swallowing disorders, or dysphagia, at 3 weeks and 3 months poststroke by tracking changes in nutritional management., Materials and Methods: Ninety-one newly diagnosed stroke patients were studied. Patients with suspected dysphagia were referred for bedside swallowing assessment, performed by a speech-language pathologist, and, where indicated, a videofluoroscopic modified barium swallow. Patients with confirmed dysphagia were initiated on either an oral dysphagia diet or enteral feeding, and they continued to receive swallowing treatment as both inpatients and out-patients. Recovery from dysphagia, based on the patient's type of diet, was assessed at days 21 and 90 poststroke., Findings: On admission, 48 of 91 (53%) newly diagnosed stroke patients presented with clinical evidence of a swallowing abnormality. Forty-two percent of these patients were managed by enteral tube feedings, and 58% received a dysphagia diet. By day 21 poststoke, 13 (27%) of the initially dysphagic patients were consuming a regular diet. By day 90, 36 (75%) of these patients were consuming a regular diet; 5 patients (10%) remained dysphagic and were nutritionally managed either with a dysphagia diet or enteral feeding. A total of 7 (15%) of the 48 patients were lost to follow-up., Conclusions: Three quarters of stroke patients initially presenting with dysphagia were consuming their prestroke diet by 3 months. Using assessment-based diet type as a proxy for the ongoing identification of dysphagia poststroke, this study found a substantial recovery rate in patients presenting with swallowing disorders.