The cost effectiveness of larval therapy in venous ulcers.

The treatment of necrotic ulcers involves considerable nursing time and expense. The current standard treatment involves repeated application of hydrogels. Larval debridement therapy (LDT) has been shown anecdotally to clear ulcers of necrotic slough but has never been compared directly with 'modern' therapies.

Punctum to punctum adhesion after dacryocystorhinostomy using silicone tubes.

Adhesion between the upper and lower punctum is described after dacryocystorhinostomy with silicone stent intubation. The cause is attributed to trauma at the punctal openings and a tight silicone stent loop. Advice is given on how to avoid the complication.

Psychometric properties of the Hospital Anxiety and Depression Scale with a population of members of a depression self-help group.

This paper reports the psychometric properties of the Hospital Anxiety and Depression Scale when used with 341 members of a self-help group for people with depression. We report internal reliability and factor structure for the complete data set and factor structure for groups split by gender, previous hospitalization for depression and current use of medication for depression. In each instance the factor structure reflects the intended depression and anxiety subscales.

Accident prevention in the A&E department.

Accident and Emergency units are often regarded as the 'shop window' of a health service. While the priority is to attend to those in need of emergency services, there may also be opportunities for health education amongst a 'captive audience', particularly in relation to accident prevention. This report illustrates how the influence of one A&E department was used amongst primary school children to increase their awareness of cycle safety.

Are ophthalmic surgeons aware that starch powdered surgical gloves are a risk factor in ocular surgery?

Purpose: To assess the level of awareness among UK ophthalmic surgeons of the potential risks from starch powdered surgical gloves during ophthalmic surgery and to show by electron microscopy that starch granule contamination can occur during ophthalmic surgery.

Setting: A sample (N = 46) of UK ophthalmologists from the North of England, UK.

Methods: Type of glove usage and awareness of the possible risks from starch powdered surgical gloves were assessed by means of a questionnaire sent to ophthalmic surgeons in the North of England.

Social comparison, self-esteem and depression in people with intellectual disability.

The present study explores the relationship between social comparison processes, self-esteem and depression in people with intellectual disability. Forty-three people with mild and moderate intellectual disability completed adapted measures of self-esteem and social comparison. The social comparison scale offers subscale scores on achievement, social attractiveness and group belonging dimensions.

Spiral computed tomography with two- and three-dimensional reconstruction in the management of tibial plateau fractures.

Spiral computed tomography (CT) with three-dimensional and multiplanar reconstructions was used in the evaluation of tibial fractures in nine patients. Computed tomography added important information to that obtained by plain radiographs. Five (55%) fractures were reclassified.

A longitudinal study of the quality of life of older people with intellectual disability after leaving hospital.

A study was made of the quality of life of 29 older people with intellectual disability who left hospital to live in ordinary three- or four-bedroom houses. A short version of the Questionnaire on Quality of Life was used to measure quality of life before moving and at three points in the first 53 months after changing residence. Results showed that there were improvements in quality-of-life subscales in the first 41 months with an eventual levelling out after 53 months.

Care staff responses to people with learning disabilities and challenging behaviour: a cognitive-emotional analysis.

This study explores the application of Weiner's cognitive-emotional model of helping behaviour to care staff responses to challenging behaviour of people with learning disabilities. Participants were 20 residential care staff who worked with people with challenging behaviour and 20 who did not. Six examples of challenging behaviour were presented, and for each behaviour participants were asked to give a probable cause, rate attributions of stability, internality, globality and controllability for their cause, their optimism for change of the behaviour, their evaluation of the behaviour and a person showing the behaviour, their emotional response to the behaviour and their willingness to put extra effort in to helping change the behaviour.

Steroid sulphatase deficiency: identification of heterozygotes using hydrolysis of dehydroepiandrosterone sulphate by peripheral leucocytes.

Diagnosis of X-linked recessive ichthyosis, which is expressed only in males, can readily be made by measurement of leucocyte steroid sulphatase activity. However, because the gene for steroid sulphatase activity partly escapes from the process of X-chromosome inactivation associated with gene dosage compensation, identification of heterozygotes (females) is more difficult. We have measured the steroid sulphatase (by hydrolysis of dehydroepiandrosterone sulphate) and beta-glucuronidase (by hydrolysis of methylumbelliferyl glucuronide) activities in leucocytes from 18 heterozygotes, 100 normal females, 100 normal males and 11 affected subjects.

Sensible footwear can avoid litigation.

In response to the letter 'Some parts of the uniform don't fit' (Letters September 12) the writer states she hates wearing duty shoes and tights and feels the hierarchy makes her wear them for insurance purposes.

Does routine ultrasound have a role in the investigation of children with urinary tract infection?

The results of investigations in children with urinary tract infection (UTI) were studied in a district general hospital in order to assess the relative value of the two most widely used screening tests, namely ultrasound (US) and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. A total of 193 children had undergone both US and DMSA scintigraphy as part of an investigation of proven single or multiple urinary tract infections over a 27 month period. DMSA scintigraphy revealed abnormalities in 22 of the children (11%).

Soft tissue neck radiography for displaced dental prostheses.

Modern dental prostheses continue to be made of acrylic resins which can be difficult or impossible to recognize by conventional radiography. We discuss the difficulties that can arise and the recognition of such objects in the neck using three illustrative cases.

Is the death rate from asthma exaggerated? Evidence from west Cumbria.

Although the death rate from asthma in England and Wales is reported to be about 2000 a year, clinical experience suggests that it is much rarer. Doctors in West Cumbria health district could recall only seven cases in 14 years. Examination of case notes of patients officially recorded as dying of asthma showed that many were aged over 60 and cigarette smokers.

Fell walking injuries in Cumbria: a review.

An analysis of injuries sustained during fell walking in Cumbria and seen at the West Cumberland Hospital over a 3-year period is presented. There were 90 patients, including 19 multiple injuries and four deaths. This report focuses attention on the seriousness and magnitude of injuries associated with a pastime often thought to be harmless and risk-free.

Macrodystrophia lipomatosis in the foot. A case report and review of the literature.

A rare case of macrodystrophia lipomatosis in the foot is reported. The literature is reviewed and the different presentations of macrodactyly are discussed.

No concern for the cap?

With reference to the letter from the nurse at St George's Hospital ( The cap fits', Letters, Nursing Standard week ending October 10), I would like to point out that the belief that West Cumbrian nurses are defying the management decision regarding caps is mistaken.