Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey.

Background And Method: In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option).

Personal Wellbeing Score (PWS)-a short version of ONS4: development and validation in social prescribing.

Aims: Our aim was to develop a short generic measure of subjective well-being for routine use in patient-centred care and healthcare quality improvement alongside other patient-reported outcome and experience measures.

Methods: The Personal Wellbeing Score (PWS) is based on the Office of National Statistics (ONS) four subjective well-being questions (ONS4) and thresholds. PWS is short, easy to use and has the same look and feel as other measures in the same family of measures.

Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit.

This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow.

Results of prosthetic-vein composite graft with remote popliteal arteriovenous fistula in infragenicular bypass.

Objective: The purpose of this study is to report the results of a novel procedure for femoral-distal bypass grafting using a composite graft with an adjunctive remote popliteal fistula distal to the prosthetic portion of the graft. This reconstruction was developed for use in limb salvage in the absence of satisfactory autogenous vein.

Method: Data were collected prospectively on all patients undergoing this procedure from January 1, 1993 to December 31, 1999.

An aggressive local approach to vascular graft infection.

Purpose: To present the use of sartorius myoplasty (SM) and superficial femoral vein (SFV) in a graft-sparing approach to vascular graft infection.

Methods: Twenty-five patients were treated for Szilagyi grade III groin infections during the last 10 years. Fifteen presented early (E), mean 2 months; 10 late (L), mean 6.

Prosthetic-vein composite graft with remote popliteal arteriovenous fistula.

Background: Inadequate autogenous vein is often the limiting factor in femoral-distal reconstruction. Sequential grafts, distal arteriovenous fistulae (AVF), and autogenous cuffs have been recommended in this setting. This paper describes a new method of composite reconstruction, enhanced with a popliteal AVF.

Superficial femoral vein: a useful autogenous harvest site.

Purpose: The purpose of this study was to present the use of superficial femoral vein (SFV) as an arterial bypass graft when ipsilateral saphenous vein is inadequate.

Methods: Data collected prospectively were reviewed on 24 patients (25 limbs) who had an arterial bypass with SFV performed by the authors between January 1, 1988, and December 31, 1991. Many anatomic sites are represented.

Exposure of the anterior tibial artery by medial popliteal extension.

This report describes exploration of the proximal anterior tibial artery by extension of the standard below-knee approach to the popliteal artery. The anterior tibial artery is "poplitealized," giving excellent access to perform an anastomosis. The proximal medial approach depends on precise arteriography and is particularly suited to the in situ saphenous vein bypass and redo surgery.

Thrombolysis for occluded vein bypass grafts through surgical access.

Purpose: This report describes surgical access to occluded vein grafts for thrombolysis by direct cutdown where indirect angiographic techniques have failed.

Method: A sheath is introduced directly into the proximal vein graft. Distal thrombus is lysed following standard protocol.

Sartorius myoplasty in the treatment of exposed arterial grafts.

The long-term success of sartorius myoplasty in 14 of 16 patients who presented with an exposed vascular graft in an infected groin is described. The presenting complications were wound dehiscence (ten patients), hemorrhage (two), skin erosion (two), late bilateral fistulas (one) and false aneurysm (one). Ten grafts were prosthetic and six autogenous.

Atherectomy. Early use of three different methods.

The authors report their initial experience in 52 patients with three different techniques of peripheral artery atherectomy--the Tracwright (Kensey), used in 19 patients, the Simpson AtheroCath, used in 19 patients and the transluminal extraction catheter, used in 14 patients. The indications for atherectomy were claudication in 42 (80%) and limb-threatening ischemia in 10 (19%). There were no deaths.

Sizing of crimped Dacron grafts.

The aim of this study was to correlate the stated size of Dacron grafts (Microvel) with their actual internal diameter and to compare this with measurements by ultrasound in the early postoperative period. Grafts of stated diameters of 7, 8, 9, and 10 mm were studied. Grafts were measured by graded probes and by measuring the width of the longitudinally opened graft and calculating the diameter.

Harvest of brachio-basilic vein complex for arterial bypass.

Brachial vein has been overlooked as a conduit for arterial bypass. It can be harvested with very little morbidity. A deep incision placed on the medial aspect of the upper arm allows exposure of the brachial and basilic veins, giving access to vein of adequate length and diameter for many applications.

Color flow duplex screening of infrainguinal grafts combining low- and high-velocity criteria.

The aim of this prospective study was to evaluate the ability of duplex ultrasonography to identify infrainguinal grafts at high risk for failure. The criteria used identified low flow by low peak systolic velocity (less than 45 cm/s) and stenosis by high velocity (greater than 300 cm/s) or by velocity at the stenosis three times the velocity in the adjacent normal graft. A total of 114 patent grafts were scanned and compared with concurrent angiograms.

Reoperation within 2 years of aortofemoral bypass.

The authors analysed 267 consecutive primary aortofemoral grafts to identify the reasons for reoperation within the first 2 years postoperatively. Forty-one (8%) of the 521 limbs required a second operation. Precursors to reoperation were: occlusion of a superficial femoral artery (12%), gangrene (27%) and severe acute ischemia (35%).

Aortic surgery and horseshoe kidney: a challenging surgical problem.

Horseshoe kidney is a rare abnormality that complicates aortic surgery. Three such cases are presented and the literature is reviewed. Although the diagnosis was not made preoperatively in any patient, all were managed safely.

Late rupture of prosthetic aortic grafts. Presentation and management.

Eight patients were treated for complications arising from actual holes in prosthetic aortofemoral or aortoiliac grafts. All occurred more than 8 years after implantation. Presentations varied and included shock from a graft-to-enteric fistula, a rapidly expanding painful femoral aneurysm, an acutely ischemic limb, and rest pain.

Flush ligation and compression sclerotherapy for the control of venous disease.

Tailoring treatment to the individual limb, by using flush ligation for the incompetent long saphenous vein and compression sclerotherapy for perforating veins and major control points, gives good control of venous disease. The long saphenous vein can be preserved in these circumstances. Compression sclerotherapy is easily repeated if necessary.

Cumulative patency and actual palliation in patients with claudication after aortofemoral bypass. Prospective long-term follow-up of 100 patients.

This report assesses patency, subsequent surgery, and the effect of late mortality in a series of 100 consecutive aortofemoral grafts performed for significant claudication on the basis of aortoiliac occlusive disease. Considering thrombosis or elective revision as failure, the primary patency rate at 5 and 10 years was 84 percent and 78 percent, respectively. However, most of these grafts were easily revised and remained patent for long periods, giving a secondary patency rate of 93 percent at 10 years.

Canadian Society for Vascular Surgery. Presidential Address 1985: Collecting.

We are all collectors--collecting and organizing information being a very important part of medical practice. Viewing and collecting medical data are just the same as collecting stamps, and the personal computer has made it much easier for us. But we must get started, decide what to collect and how to display it.

Life tables using Lotus 1-2-3 software on a personal computer.

An automated program to calculate life tables of cumulative patency on a personal computer is described. This program can be set up quickly, and the tables can be displayed graphically and are automatically updated as new information is added.

Complicated deep venous insufficiency: conservative management.

An understanding of venous pathophysiology is helpful in managing deep venous insufficiency. Examination of the patient after standing for 10 minutes by searching for perforator tenderness and milking away the edema will reveal incompetent perforators. A sponge pump improves calf pumping and reduces local tissue damage from the systolic peak pressures of walking.