Use of the vapor permeable membrane for cutaneous ulcers: details of application and side effects.

Vapor permeable membranes (VPM) are commonly being used to treat cutaneous wounds where partial or full thickness skin is lost. Five years of experience with one particular VPM has taught a great deal concerning its proper use. Correct preparation of the treatment site to allow adhesion followed by application of the VPM with the right amount of tension and border are of paramount importance or aggravation rather than improvement of the cutaneous defect may occur.

The Way we Teach… Interviewing Skills.

Being able to interview well-eliciting elearly the information required whilst establishing and maintaining a rapport with the patient-is one of the doctor's greatest assets. Yet very little attention is paid to the teaching of interviewing skills. In this article Dr Maguire describes a short, successful course in interviewing skills which he and his colleagues at Manchester teach to medical students during their psychiatric attachment.

The effect of counselling on physical disability and social recovery after mastectomy.

A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss. Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit. Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery, return to work, adaptation to breast loss and satisfaction with their breast prostheses.

Locus of control and cognitive behaviour therapy with mastectomy patients: a pilot study.

A cognitive behaviour therapy programme was designed for use with mastectomy patients, and a pilot study performed to test the efficacy of the programme. This article reports the locus of control data collected during the pilot study and the relationship between these data and the clinical assessment measures. Lower chance scores at pre-treatment are associated with greater clinical improvement as predicted.

The teaching of interviewing skills: comparison of experienced and novice trainers.

During a clerkship in psychiatry thirty-six medical students were randomly allocated to one of three teachers who differed widely in their experience of teaching essential interviewing skills. Each teacher taught two groups of six medical students using videotape feedback and discussion of practice interviews. Independent raters who were blind to the teachers to whom the students had been assigned rate pre- and post-training interviews.

Visual evoked responses and immunoglobulin abnormalities in the diagnosis of multiple sclerosis.

Visually evoked responses (VERs), CSF IgG/albumin ratio and CSF oligoclonal IgG were examined in 136 patients with multiple sclerosis (MS) admitted to hospital for investigation, and compared to the CSF findings in 87 patients with other neurological diseases (OND). 33% of patients with OND had abnormal CSF IgG/albumin ratios but only 9% had CSF oligoclonal IgG banding. In clinically definite MS, VERs were abnormal in 87% and CSF oligoclonal banding was found in 80% of patients, but CSF oligoclonal banding was found significantly more frequently than abnormal VERs in patients with suspected MS.

Moist wound healing under a vapor permeable membrane.

Ten ambulatory patients with unilateral and eight with bilateral ulcers of various etiologies were studied to determine the effects of keeping a wound bed moist under a water vapor and oxygen permeable membrane (VPM). In the bilateral group, VPM healing was compared with a debriding enzyme ointment and 10% benzoyl peroxide in the same patient. The faster healing rate with VPM was compared to the healing rate with control substances by the paired t test, with significance at less than 0.

Cost of counselling women who undergo mastectomy.

The psychiatric morbidity associated with mastectomy and brest cancer was substantially reduced by a specialist nurse who counselled women before and after surgery and monitored their progress. A controlled study was, therefore, carried out to determine what this cost. National Health Service costs were almost wholly covered by savings made because counselled subjects who developed psychiatric problems were recognised and treated much earlier than control patients.

Dilemmas in general practice: the care of the cancer patients.

Recent investigations of the care provided for cancer patients in the community have revealed substantial shortcomings, both in the identification of problems and in the help offered to patients and their families. While some explanations have been sought for these omissions, it has generally been assumed that they are due to practitioners' ignorance of problems encountered by families. Focusing on general practitioners, this paper argues that these deficiencies in care arise not only from ignorance, but also from the conceptual and structural framework within which practitioners operate.

Hypocalcemia associated with a calcitonin-producing hepatocellular carcinoma.

We report a case of symptomatic hypocalcemia with a calcitonin-producing tumor. This case is unusual for two reasons. First, the primary tumor was a hepatocellular carcinoma that was producing large amounts of calcitonin.

Teaching skills in communication to medical students--a critical review of the methodology.

Over the past decade, there has been a substantial increase in papers concerned with training medical students in communication skills. In this paper, we consider what constitutes an adequate methodology for such research and whether recent papers meet this standard.

Effect of counselling on the psychiatric morbidity associated with mastectomy.

A controlled trial was conducted to determine whether counselling by a specialist nurse prevented the psychiatric morbidity associated with mastectomy and breast cancer. Seventy-five patients were counselled by the nurse and monitored during follow-up, while 77 patients received only the care normally given by the surgical unit. Counselling failed to prevent morbidity, but the nurse's regular monitoring of the women's progress led her to recognise and refer 76% of those who needed psychiatric help.

Should skills in communicating with patients be taught in medical schools?

Doctors' skills in communication affect the adequacy of their clinical interviews, their patients' satisfaction, recall of offered advice, compliance, and the impact of potentially distressing medical and surgical procedures. Yet traditional clinical courses do not include formal teaching in these skills and several reasons probably account for this. Recent research has demonstrated that training in communication skills is both feasible and effective.

The incidence of headache following various techniques of metrizamide myelography.

The relationship between various technical factors and the incidence of side effects, particularly headache, following metrizamide myelography has been investigated in 203 patients. The higher incidence of side-effects which has been demonstrated in females was of statistical significance, whilst the higher incidence which followed cervical myelography via lateral C1-2 puncture was not. None of the other parameters considered (needle size, weight of iodine injected, or patient's age) had any influence.

Effect of deflector shields fitted in the milking machine teatcup liner on bovine udder disease.

Deflector shields were inserted in the teatcup to prevent 'impacts' against the teat end, and their effect on the rate of new udder infections was studied on 15 commercial dairy farms in Britain and 16 in Australia. Small metal shields were fitted between the liner barrel and short milk tube of 2 teatcups in each cluster in a milking installation so that all cows in a herd always had the same 2 quarters shielded. Half-udder comparisons were made using 1039 cows in the British herds and 1268 in the Australian herds.