REFERENCEThe wrist and hand were immobilized in the neutral position for two weeks in a short arm splint and for an additional four weeks in a short arm circumferential cast.The Kirscher wires were removed at the outpatient clinic at eight weeks. Radiographs confirmed union…Hand therapy, consisting of protective splinting and active-assisted ROM, was initiated eight week following injury. ….Hand therapy was then progressed to the use of a novel circumferential carpal stabilization brace that the patient wore at all times. The carpal brace extended from the metacarpal heads to the radiocarpal joint. This permitted movement of the radiocarpal and metacarpal joints, while firmly supporting the CMC articulations. Following removal of the cast, the brace was worn at all times. ……
Thursday, September 30, 2010
Wednesday, September 29, 2010
With regard to white roll, vermilion border, scar, Cupid's bow, and lip length, the Afroze incision always gave superior results compared with the Millard or Pfeifer incision.Depending on the cut-off for treatment success, the Afroze incision also showed better results regarding nostril symmetry.With respect to the alar base and alar dome, all three incisions showed comparable outcomes.
The patient with the bull's eye on his glabella preoperatively was operated on with a rotation advancement, and I feel he has the best result of the three. There is a very nice white roll and a discrete Cupid's bow, and the scar comes close to mirroring the normal philtral column on the noncleft side. …..The second patient, with the “1” on his glabella, repaired with the Pfeifer incision, I think has the worst result of the three. The scar runs straight up into the nostril, giving him the appearance of having a runny nose, the lip on the cleft side is a bit short, there is no Cupid's bow, and there is a slight alar slump beneath the soft triangle.The third, with the glabellar black spot, was repaired with the Alfroze technique. He has a nice Cupid's bow, but the lip scar wanders away from the desired area of the philtral column and is distracting. There is a very significant vestibular web, and the alar base on the cleft side lacks definition, as does the footplate area of the medial crus. The commissure-to–high point distance on the cleft side also appears a bit shorter than on the noncleft side.
Tuesday, September 28, 2010
Thank you all for coming. Coffee and bagels are in back. Sign in on the sheet. Medical students, please remember that you're allowed to sit ONLY if there are chairs left after the attendings, fellows, residents, and homeless people (here for the bagels) have been seated.Food was provided by our drug rep Rikki, on behalf of Wirfliss Pharmaceuticals. She asks that when writing a prescription, please keep their many Wirfliss products in mind. …...And we're off! The topic was: THINGS THAT MAKE ME GRUMPY!
To start, I present: THE PHARMACISTS!
65 of them married to her first love. Her only love. The man she’d spend her entire adult life with. The only man she ever looked at according to her daughter.62 of those years spent taking care …...5 years spent grieving the death of her husband and best friend.7 months living with pancreatic cancer. …...
Last Thursday (9/17/10) I had the pleasure of attending a conference on Attention Deficit Disorder. The following are my two interviews. They are both very interesting, and both apply greatly to my practice as a primary care physician.The first is Dr. Ari Tuckman, author of the book More Attention, Less Deficit, as well as the podcast with the same name: ….
On September 16, 2010, I attended Fact or Fiction: ADHD in America, a Capitol Hill Forum, along with Val Jones of Better Health and Rob Lamberts of Musings of a Distractible Mind.The event, coinciding with ADD/ADHD Awareness Week, was a panel discussion discussing the impact ADHD has on our society.It was sponsored by Shire, in partnership with the Entertainment Industries Council (EIC) and the Lab School of Washington [Disclosure: I received a stipend for covering the event.]Below are interviews Rob and I did with some of the panelists. …………
The first is to a WSJ Health article, Teaching Healthy Ways To Doctors in the Kitchen, by Melanie Grayce West. I would enjoy taking this class.
The second one is a NY Times Health article, Expert Tips From the Stir-fry Chef.Thirteen of Lenox Hill Hospital's doctors-in-training gather for one more class at the end of another long day of lectures and rounds: How to peel onions and chop garlic. ……The program—which organizers say is the first of its kind in the city—includes six seminars on everything from nutrition, to weight management to exercise and a cooking class at the Institute of Culinary Education in Manhattan. It is based loosely on a joint project of the Culinary Institute of America and Harvard Medical School called Healthy Kitchens, Healthy Lives. …….
Grace Young, author of the recently published “Stir-Frying to the Sky’s Edge,” from Simon and Schuster, recently joined the Consults blog to answer readers’ questions about healthful stir-fry cooking. ……
I too hate eggplant that is greasy. I find that if you steam the eggplant first, you can dramatically reduce the amount of oil necessary for stir-frying. Cut about a pound of eggplant into bite-size pieces and place them in a heatproof bowl. Then steam the eggplant for five to eight minutes, depending on the size of your pieces, until the eggplant is just tender when pierced with a knife. Don’t overcook it, as the eggplant will be stir-fried. I find that I don’t need more than 3 tablespoons of oil and that the steamed eggplant can be stir-fried within one to two minutes with your seasonings. ….
Here’s an inspiring story: H/T to @bobcoffield
RT @boltyboy: Kaiser Permanente's own Jamie Oliver and the reason they have 30 farmers markets http://nyti.ms/aRfRG4
DR. PRESTON MARING ……. Though Dr. Maring blithely refers to himself as “that food nut around the hospital,” he is serious about the role he believes doctors should play in creating awareness of healthy food choices. To that end, he has worked to obtain fresh local food for hospital trays and in cafeterias. He began a Web site and blog that offers recipes and advice on meal planning and budgeting. He spent the summer working on a series of three-minute Web videos to explain the basics of shopping for healthful foods and efficient preparation techniques. ……
Uremic Frost: The Kidney Diet: How to Eat in Order to Protect Your Kidneys and Avoid Dialysis http://bit.ly/byA7II
Baby caps are a simple and effective tool that can keep babies warm and ultimately contribute to reducing newborn deaths in the developing world.In many developing countries, something as simple as a knit or crocheted cap can help the baby keep warm, which is key to helping newborns survive. ……This is where you can help by making a cap! Your caps will be sent to Save the Children’s newborn health programs in Africa, Asia and Latin America.
10/7: Dana Lewis
Monday, September 27, 2010
"Use of Sunless Tanning Products Among US Adolescents Aged 11 to 18 Years"; Vilma E. Cokkinides, PhD; Priti Bandi, MS; Martin A. Weinstock, MD, PhD; Elizabeth Ward, PhD; Arch Dermatol. 2010;146(9):987-992. doi:10.1001/archdermatol.2010.220
Saturday, September 25, 2010
Glossing over the risks involved with surgery to promote your product makes me grumpy.
E! Reality Show is “hawking” plastic surgery as part of the prize package for brides in their new show “Bridalplasty.”
Friday, September 24, 2010
Even though I pieced it, designed it, and did the binding, I paid Peg Reese (Peg’s Quality Quilting) to do the machine quilting.
Thursday, September 23, 2010
In Little Rock/North Little Rock region, the sites include:
If you do not find a collection site near you, please check back frequently, sites are added every day.
Arkansas Game & Fish Commission
War Memorial Stadium Parking Lot
1 Stadium Drive, Little Rock, AR
UAMS Police Department
Reynolds Institute on Aging, First Floor
629 Jack Stephens Drive, Little Rock, AR
Cammack Village Police Department
Cammack Village City Hall
2710 N McKinley, Little Rock, AR
University Plaza Parking Lot
2801 S. University Ave, Little Rock, AR
Pulaski County Sheriff’s Department
Pulaski County Regional Detention Center
3201 W Roosevelt Road, Little Rock, AR
Little Rock Police Department
Pulaski County Regional Detention Facility
3201 W Roosevelt Road, Little Rock, AR
North Little Rock Police Department
NLR High School
Charging Wildcat Arena
2200 Main Street, NLR, AR
Pulaski County Sheriff’s Department
Oak Grove Volunteer Fire Department
18122 Hwy 365 N, NLR, AR
Wednesday, September 22, 2010
For example, our survey asks the respondent to choose between living for 40 years with a prosthetic hand and living for x years with a healthy hand. The value of x is varied until the respondent feels that the choices are equivalent. If the respondent judges that living for 40 years with a prosthetic hand is equivalent to living for 20 years with a healthy hand, the utility of living with a prosthetic hand is calculated as 20/40, or 0.50.
to put it in the words of one physician from the Louisville team that performed the first U.S. hand transplant, the patient will likely “have difficulty with buttons, perhaps not be able to pick up a dime.”Gerald Fisher, the second of the Louisville recipients, returned to work hanging gutters just two months after his operation
According to the Lyon team, the world’s first double-hand transplant recipient is able to shave and take care of other personal hygiene tasks that he was unable to do before his transplant
The toxicity of immunosuppressive medication, however, brings about an ethical dilemma. In solid organ transplantation, 40 percent of posttransplant deaths were attributed to infection; transplant recipients have a seven-fold 5-year risk over the general population of developing malignancies.
Lifetime costs for single hand transplantation average $528,293, whereas costs for double hand transplantation average $529,315.Total costs of prosthesis adoption for unilateral and bilateral amputation are $20,653 and $41,305, respectively.The mean surgical cost, including preoperative evaluation, hospitalization, and physician fee, are $13,796 for single hand transplantation and $14,608 for double hand transplantation.The cost of immunosuppressive therapy for 40 years, including drugs and clinic visit, is $433,283 ($362,894-503,672).The cost of productivity loss for hand transplantation and prosthetic adaptation are $42,265 and $9753, respectively.
For unilateral hand amputation, prosthetic use was favored over hand transplantation (30.00 QALYs versus 28.81 QALYs; p = 0.03).Double hand transplantation was favored over the use of prostheses (26.73 QALYs versus 25.20 QALYs; p = 0.01). The incremental cost-utility ratio of double transplantation when compared with prostheses was $381,961/QALY, exceeding the accepted cost-effectiveness threshold of $100,000/QALY.
REFERENCESUltimately, while the costs and worthiness of this technique may be debated in scientific journals, it will certainly not be decided in them. There are industry and governmental agencies with far sharper pencils than we have that will look very closely at the cost-benefit ratio before deciding whether this will be an acceptably “covered” procedure for their respective constituents. Perhaps the biggest hurdle in the implementation of limb transplantation will involve mastery not of the immune system but of actuarial tables.
Tuesday, September 21, 2010
Pallimed.org is the host for this week’s Grand Rounds. You can read this week’s edition here.
I am not sure if Nick(@blogborygmi) realized this when he approached me about a date to host, but this is the last edition of Grand Rounds for Volume 6. A hospice blog as final chapter to a great year of medical blogging, there are things in life that are more serendipitous than this of course. But of course here at Pallimed (@pallimed), we do cover things beyond just the last few days of life. So feel free to take a look at our 1,000 other posts.On to the best of the medical blogosphere! No themes here but I did ask (like GruntDoc) to include a post of other than your submission to help broaden our reach this week…….
I can’t believe two weeks has passed already, but the calendar says that, indeed, it is time for the latest edition of Change of Shift!Quite the eclectic collection of stories this week!Before you begin, I just want to remind everyone that I still have discount codes available for BlogWorld/New Media Expo 2010. We’ll be getting together in Vegas next month! Check the button on the top bar for details. I’d love to meet as many nurse bloggers as possible!And now, I am proud to present……..
Fifty years ago, a newly appointed medical officer at the FDA stood up to corporate pressure and refused to approve thalidomide, the drug already used for morning sickness in other parts of the world. The case transformed how Americans think about medicine and the FDA's drug-testing policy. Diane and guests explore how thalidomide is being used today and discuss how Frances Kathleen Oldham Kelsey saved thousands of babies from the perils of thalidomide.
Orac has written a thoughtful response to the New York Time story by Amy Harmon: New Drugs Stir Debate on Rules of Clinical Trials. His post is titled: Balancing scientific rigor versus patient good in clinical trials
A critical aspect of both evidence-based medicine (EBM) and science-based medicine (SBM) is the randomized clinical trial. …..The ethics of clinical trials, however, demand a characteristic known as clinical equipoise. Stated briefly, for purposes of clinical trials, clinical equipoise demands that there be a state of genuine scientific uncertainty in the medical community over which of the drugs or treatments being tested is more efficacious and safer……In oncology clinical trials, as in clinical trials for treatments of any life-threatening disease, there is always a tension between wanting the "cleanest" possible results versus doing the best for each individual patient. It is a balancing act that relies on the ethics of physicians and a combination of hope and altruism in the patients who become subjects in such trials. … How to maximize the good for as many patients as possible is the goal, but, as we have seen, this is a goal that is not so easily accomplished, just as clinical equipoise is a concept that is easy stated but not so easily applied. PLX4032 teaches us that.
Few mental illnesses are as complex and confusing as schizophrenia, a mental disorder in which people may experience hallucinations or delusions, hear voices or have confused thinking and behavior.Although the word “schizophrenia” means “split mind,” the disorder does not cause a split personality, as is commonly believed.The latest Patient Voices segment by Karen Barrow, a Web producer, offers rare insights into schizophrenia and schizoaffective disorder, a related condition that combines thinking and mood problems, as seven men and women share their experiences. ………….To hear these and other stories of schizophrenia, click on the Patient Voices audio link. And then please join the discussion below.
January 16th, 1970.
The greatest rock guitarist to ever play the instrument, Jimi Hendrix, has eight months and two days to live. He spends part of the day at New York City's Record Plant laying down some tracks. After a few busted takes, Jimi launches into one of the most amazing instrumentals that few people have ever heard.Hendrix called the piece "Sending My Love to Linda," and ……. Despite being a Hendrix fan, I had to go back and find out more about who this Linda was……….
Monday, September 20, 2010
RE: PECOS Enrollment
To our referring physicians and their office managers:
At __________we have begun a project to identify ordering physicians who are not enrolled in Medicare’s Provider Enrollment, Chain and Ownership System (PECOS). Our purpose is to remind physicians of the importance of enrollment to them and to us.Beginning in January, 2011 those providers filing Medicare claims listing an NPI number on the claim of an unenrolled provider will have their claims denied. This would apply to any claim you send in and to any claim we submit for services provided to your patients because we are required to list your NPI number on our claims. This applies both to patients referred to our private offices and the hospitals where we provide radiology professional interpretations or services.So, you can see our effort is not purely altruistic. We have a financial interest in reminding you of the importance of PECOS enrollment. In trying to ascertain whether you are enrolled, we are using an online program you can find at www.oandp.com/pecos. Simply enter your NPI number in the entry block and press enter. If you enter a valid NPI number, your name will appear and beside it will be a symbol indicating where Medicare recognizes your PECOS enrollment.Since Medicare is continually updating the files, we may have accessed the system before your enrollment was completed. We will continue to monitor the situation in hopes you will enroll if you intend to continue seeing Medicare patients. If you have already enrolled or have no plans to enroll, please excuse our intrusion.Sincerely,
Physicians who have validly opted out of Medicare will not need to complete a Medicare enrollment application.
Sunday, September 19, 2010
Toward the end of August and first of September, I seem to have gotten into a fabric postcard groove.
This “Iris in a Vase” is my 6th postcard. It was made by fussy cutting the flower and leaves, then appliquéing them onto the background fabric before adding the vase. It is 8.75 in X 6 in.
I made it for my friends Vickie and Ben who will be celebrating their 20th wedding anniversary next month.
#7 Postcard is called “Primitive.” The people were fussy cut and then appliqued onto the background fabric. It measures 5.5 in X 7.5 in.
Here is the back
#8 Postcard is called “Deserted Island.” It was also fussy cut and then appliqued onto the background fabric. It measures 6 in X 8 in.
#9 Postcard is simply called “Parrot.” The background fabric is two pieces sewn together. The fussy cut parrot was then appliqued onto the background. It measures 5.25 in X 7 in.
Friday, September 17, 2010
This nine-patch quilt began as a way to use up some of the leftover 2.5 in squares. I gathered together the browns and tans. I had enough of a unifying cream-colored fabric to use in the nine-patches and the “solid” connecting 6 in squares.
The quilt is machine pieced and quilted. I mailed it to a blog friend whom I think will enjoy it.
Thursday, September 16, 2010
Public reporting creates an incentive to maximize performance but does not specify the manner in which this is achieved. Broadly speaking, 2 approaches are possible. Hospitals can adopt evidence-based strategies designed to improve patient outcomes that will also improve the publicly reportable indicator, or they can adopt indicator-based strategies designed to improve the reported indicator that may not improve outcomes and may even cause harm. Evidence-based improvement strategies would be favored in an environment in which organizations focus on improving patient outcomes—when such strategies exist and are easy to implement. Conversely, indicator-based improvement strategies would be favored in an environment in which the hospital focuses on protecting its reputation, when evidence-based improvement strategies are unproven or resource intensive, or when measurement of the indicator is easily manipulated to show improvement. …
Between the scrapes from paper cuts, the finger on which a ring is worn, and the color of nail polish, the hands of the human body tell a story. They are the most mysterious reflection of character. The hands ….. Surgeons are blessed with steady hands for a reason: they reduce the trembling in the hands of worried family members, counteract pain and destruction, and alter creation for the better by fixing fault and disease within the body. A surgeon has the remarkable gift of a set of multifunctional and dexterous hands.I have always admired my father's hands. From a very early age I could tell his grace and dedication to detail were apparent in how he moved and touched, felt and experienced the world around him. …... His hands seemed inexplicably and effortlessly linked to his every thought: as a young child I always dreamed of having hands like his.…….When I see my father's hands ……. His hands are a mere reflection of his heart, an attribute I hope to see in my hands as I follow in his footsteps.…. Hands reflect ability, accomplishment, and passion. …………., I have learned to trust my instincts, follow my heart, and, most of all, not to underestimate the power of my own hands.
Wednesday, September 15, 2010
- complete when the fingers are fused all the way to the tip, including the nail folds
- incomplete when the nail folds are not involved
- simple when the fingers are fused by a skin bridge
- complex when the bones are fused together
- Mild constriction ring is often asymptomatic.
- Moderate constriction ring causes lymphedema distal to the ring.
- Severe constriction ring blocks circulation of the arterial and venous system and causes nerve palsy resulting from nerve compression.
I : bifid distal phalanx (DP)(bone under the finger nail)
II: duplicated DP
III: bifid proximal phalanx (PP) (digit bone nearest the palm)
IV: most common type with duplication of proximal phalanx which rest on broad metacarpal
V: bifid metacarpal (MC) (bone in palm)
VI: duplicated MC
A prospective investigation of 1166 neonates showed no trigger thumb at birth, but two cases were observed at a 1-year follow-up. Several other studies have also supported the opinion that childhood trigger thumb is an acquired rather than congenital condition. However, cases of trigger thumb associated with trisomy 13 (Patau syndrome), fraternal twins, and families with generational occurrence indicate that there may be a heritable component in certain patient populations.
This article and the companion videos are worth your time.
Tuesday, September 14, 2010
The Schwartz Center is the host for this week’s Grand Rounds. You can read this week’s edition here (photo credit).
The theme of this week’s Grand Rounds is hot topics in healthcare communication. Since this is also the last issue of summer, I’m including photos from my summer vacation to Yellowstone National Park, a hotbed of geothermal activity. (Just for fun see if you can identify Yellowstone’s mascot, the American bison, hidden in one of the photos.)
Fireflies, by a medical resident
Song for my Father, II, by Pal MD
TO SYLVIA, by Maria A. Basile, M.D.
The Harvest, by C.L. Wilson
If I Were Frida Kahlo, by Amanda Hempel
@drval Save the date: @kevinmd @doc_rob @drval live coverage of ADHD awareness on Ustream Thurs, (9.16.10) 12-2 ET. http://bit.ly/d4G67t
Fact or Fiction: ADHD in America, A Capitol Hill Forum
Rayburn House Office Building Room B-338
Washington, District of Columbia
To coincide with ADD/ADHD Awareness Week, join us for "Fact or Fiction: ADHD in America, a Capitol Hill Forum," a lunch and panel discussion which will dispel myths and shed light on the diagnosis, treatment and management of ADD/ADHD in people's everyday lives.
On the 50th anniversary of the first successful prosthetic mitral valve replacement, how far has cardiac surgery come, and where are we headed? Tune in to hear Dr. Albert Starr, co-founder of the first artificial mitral valve,……, recounts his first foray into the field of valvular disease and the extraordinary process of inventing the first artificial mitral valve. …… What does Dr. Starr see as the "next big thing" in cardiac surgery? Dr. Janet Wright hosts.
9/18: Saturday Nite
9/23: Follow-up school name change & value of alumni
9/30: EMS Newbie Podcast
10/7: Dana Lewis
Monday, September 13, 2010
May be due to granulation tissue or to tumor erosion into a blood vessel.
For minor bleeding, agents such as calcium alginates are readily available as a wound dressing. Calcium, as part of the alginate, is released into the wound in exchange for sodium, potentially triggering the coagulation cascade. The sodium alginate then converts the fiber to a hydrogel, promoting local comfort and protection. In severe cases, suturing a proximal vessel, intravascular embolization, laser treatment, cryotherapy, radiotherapy, and electrical cauterization may be necessary.
Topical application of metronidazole is readily available as a gel and cream. ….. Some patients derive the greatest benefit if the metronidazole is administered orally.Activated charcoal dressing has been used to control odor with some success. To ensure optimal performance of charcoal dressing, edges should be sealed, and the contact layer should be kept dry.If topical treatment is not successful or practical, putting odor-absorbing agents such as kitty litter or baking soda (not charcoal; only works as a filter) beneath the bed may reduce odor.
In addition to the choices of dressing supplies, when possible the frequency of dressings can be reduced. Gentle technique can also reduce the pain of dressing changes.Careful selection of dressings with atraumatic and nonadherent interfaces, such as silicone, has been documented to limit skin damage/trauma with dressing removal and minimize pain at dressing changes.
E: ExudateFor severe pain, clinicians may need to consider oral agents combining long-acting narcotics (oral, patch), as outlined in the World Health Organization Pain Ladder, with adjunctive agents for the neuropathic component and short-acting agents for breakthrough. In resistant cases, clinicians may consider using general anaesthesia, local neural blockade, spinal analgesia, or general anesthesia or using mixed nitrous oxide and oxygen
S: Superficial infectionMoisture is contraindicated in nonhealable wounds; hydrating gels and moisture-retentive dressings (hydrocolloids) should be avoided.To contain and remove excess exudate from the wound, a plethora of absorbent dressings has been developed. Major categories of dressings include foams, alginates, and hydrofibers, along with superabsorbent products based on diaper technology
Debridement is a crucial step to remove devitalized tissue, such as firm eschar or sloughy material, which serves as growth media for bacteria. …….Topical antimicrobial products are available, but no one product is indicated or suitable for all patients…….In nonhealable wounds where bacterial burden was more of a concern than tissue toxicity, antiseptics including povidone-iodine, chlorhexidine, and their derivatives are propitious treatment options (Table 5).Other topical antimicrobial agents are summarized in Table 6. If the infection is promulgated systemically, systemic agents must be administered. Prophylactic use of antibiotics has not been demonstrated to facilitate wound healing.
Local Wound Care for Malignant and Palliative Wounds; Woo, Kevin Y., Sibbald, R.Gary; Advances in Skin & Wound Care. 23(9):417-428, September 2010
Sunday, September 12, 2010
A buffet-style dinner will be provided by The Texas Tea Room, and we're inviting our local officials and community leaders of Wood County to model the bras for us. Men, of course! Then, as they stroll the crowd, we'll stuff their bras with dollars to vote for our favorite one!It's going to be a really fun night, and the proceeds will benefit the Susan G. Komen Foundation. Tickets are available only until October 1st at Stitchin' Heaven. Both in our shop, and online.
Requirements for bra entry can be any style 38+D Bra.The bra will need to be completely covered inside and out, including straps.You can embellish the bra in your choice of design and material, but please make it sturdy for display and “wearing”.Your bra will need to be hung and pinned on a non-slip hanger so it won’t fall off.
I would love it if some of my Texas friends would actually attend the event. If you do, please, take and share photos. Thanks
Friday, September 10, 2010
The pattern directions called for using plastic canvas to make supporting structure for the bag. I used Pellon Peltex 70 instead. I covered each Peltex piece with brown fabric so the white wouldn’t be an issue showing through the linen knit pattern. Here you can see the band strip.
Here is a photo of the fabric-covered Peltex sewn together to form a “box” which then was sewn into the bag. This “box” lays between the knitted linen and the lining. It is indeed the skeleton of the bag.
I wanted extra pockets in the bag. You know we have cell phone, camera, etc that you don’t want to end up lost in the bottom.
This photo shows the three parts – knitted bag, skeleton, and lining.
Thursday, September 9, 2010
Wednesday, September 8, 2010
- Pneumatonometer uses pressure to objectively measure skin pliability. It is composed of a sensor, a membrane, and an air-flow system that measures the amount of pressure needed to lock the system. Most commonly used to measure intra-ocular pressure.
- Cutometer is a noninvasive suction device that has been applied to the objective and quantitative measurement of skin elasticity. It measures the viscoelasticity of the skin by analyzing its vertical deformation in response to negative pressure. (photo credit)
- Durometer measures tissue firmness by applying a vertically directed indentation load on the scar. It was originally described for use in scleroderma.
- Chromameter (Minolta, Tokyo, Japan)
- DermaSpectrometer (cyberDERM, Inc, Media, PA, USA)
- Mexameter (Courage-Khazaka, Cologne, Germany)
- Tristimulus colorimeter
- Ultrasound scanners, such as the tissue ultrasound palpation system (TUPS) -- “TUPS was found to demonstrate a moderate correlation in terms of reliability. TUPS does have drawbacks, however, in that it requires technical training and experience in image interpretation and is relatively expensive compared to other modalities.”
- 3-dimensional optical profiling system (Primos imaging) made by GFMesstechnik (Germany)
- The Vancouver Scar Scale (VSS) -- first described by Sullivan in 1990. It assesses 4 variables: vascularity, height/thickness, pliability, and pigmentation. Patient perception of his or her respective scars is not factored in to the overall score.
- Manchester Scar Scale (MSS) -- proposed in 1998. It assesses and rates 7 scar parameters: scar color (perfect, slight, obvious, or gross mismatch to surrounding skin), skin texture (matte or shiny), relationship to surrounding skin (range from flush to keloid), texture (range normal to hard), margins (distinct or indistinct), size (<1 cm, 1–5 cm, >5 cm), and single or multiple.
- Patient and Observer Scar Assessment Scale (POSAS) -- includes subjective symptoms of pain and pruritus and expands on the objective data captured in the VSS. It consists of 2 numerical numeric scales: The Patient Scar Assessment Scale and the Observer Scar Assessment Scale. It assesses vascularity, pigmentation, thickness, relief, pliability, and surface area, and it incorporates patient assessments of pain, itching, color, stiffness, thickness, and relief. The POSAS is the only scale that considers subjective symptoms of pain and pruritus, but like other scales it also lacks functional measurements as to whether the pain or pruritus interferes with quality of life.
- Visual Analog Scale (VAS) -- is a photograph-based scale derived from evaluating standardized digital photographs in 4 dimensions (pigmentation, vascularity, acceptability, and observer comfort) plus contour. It sums the individual scores to get a single overall score ranging from "excellent" to "poor." It has demonstrated high observer reliability and internal consistency when compared to expert panel evaluation, but it has shown only moderate reliability when used among lay panels.
- Stony Brook Scar Evaluation Scale (SBSES) -- was proposed in 2007. It is a 6-item ordinal wound evaluation scale developed to measure short-term cosmetic outcome of wounds 5 to 10 days after injury up to the time of suture removal. It incorporates assessments of individual attributes with a binary response (1 or 0) for each, as well as overall appearance, to yield a score ranging from 0 (worst) to 5 (best). It was designed to measure short-term rather than long-term wound outcomes.
Tuesday, September 7, 2010
Dr. Dino, Musings of a Dinosaur, is the host for this week’s Grand Rounds. You can read this week’s edition here (photo credit).
Ah, fall. That wonderful season when the heat recedes, the leaves descend, the children go back to school…and the pennant races heat up. Once again this year my Phillies are in the thick of it, so as the host of Grand Rounds I avail myself of the privilege of dragging you all down to the ballpark with me. ……
Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 5) which is in its 5th year! You can find the schedule and the COS archives at Emergiblog. (photo credit)……………………………………….
Welcome to Change of Shift!
Boy, that was a fast two weeks!
For those who don’t follow me on Facebook, I’m a little slow on the computer front as I am recovering from Lasik – please excuse any typos that have made it through my blurry proof-read.Also – I have discount codes for BlogWorld/New Media Expo 10, so if you are planning on attending the second annual Social Health track (and you should!!), shoot me an email via the “Contact” button. Details can be found up top under the “BlogWorld” button!Time to dive in…
……Many physicians are surprised by the findings of a group of Yale researchers who were recently published in the Archives of Internal MedicineThey found a huge disconnect and a huge communication gap existed between patients and physicians. ……
Above is …. a series of 3 stamps for the New Zealand Post, that portrayed New Zealand Innovations. Carly Hitchcock created these medical stamps …. Cool work!
I love that plastic surgery connection: Harold Gillies.
TEACH YOURSELF TO SEW
- Project: Make a Felt Jewelry Bag
- Knit Fabrics
- Woven Fabrics
- Project: How to Sew a Bias-strip Scarf
- How to Sew a Basic Seam
- How to Sew French and Lapped Seams
- How to Mark a Dart
- How to Sew a Dart
- Project: How to Sew a Skirt
- Sleeves 101
- How to Sew a Sleeve
Monday, September 6, 2010
I have read the studies the promote the use of silicone sheets for scar treatment. I know the claims Mederma and other silicone gel scar treatments make. What do I tell my patients?
Topical Silicone Gel versus Placebo in Promoting the Maturation of Burn Scars: A Randomized Controlled Trial; van der Wal, Martijn B. A.; van Zuijlen, Paul P.; van de Ven, Peter; Middelkoop, Esther; Plastic & Reconstructive Surgery. 126(2):524-531, August 2010; doi: 10.1097/PRS.0b013e3181e09559