Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries— To Be or Not To Be?

BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries- To Be or Not To Be?

BACKGROUND

Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered.

PURPOSE

The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is.

METHODS

Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article.

RESULTS

Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described.

CONCLUSION

A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

Medicaid managed care in New York City: recent performance and coming challenges

OBJECTIVES

This study evaluated New York City's voluntary Medicaid managed care program in terms of health care use and access.

METHODS

A survey of adults in Medicaid managed care and fee-for-service programs during 1996-1997 was analyzed.

RESULTS

Responses showed significant favorable risk selection into managed care but little difference in use of health care services. Although some measures of access favored managed care, many others showed no difference between the study groups.

CONCLUSIONS

The early impact of mandatory enrollment will probably include an increase in the average risk of managed care enrollees with little change in beneficiary use and access to care.

A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy

OBJECTIVE

To determine the effect of a specific exercise regimen on clinical measures of postural stability and confidence in a population with peripheral neuropathy (PN).

DESIGN

Prospective, controlled, single blind study.

SETTING

Outpatient clinic of a university hospital.

PARTICIPANTS

Twenty subjects with diabetes mellitus and electrodiagnostically confirmed PN.

INTERVENTION

Ten subjects underwent a 3-week intervention exercise regimen designed to increase rapidly available distal strength and balance. The other 10 subjects performed a control exercise regimen.

MAIN OUTCOME MEASURES

Unipedal stance time, functional reach, tandem stance time, and score on the activities-specific balance and confidence (ABC) scale.

RESULTS

The intervention subjects, but not the control subjects, showed significant improvement in all 3 clinical measures of balance and nonsignificant improvement on the ABC scale.

CONCLUSION

A brief, specific exercise regimen improved clinical measures of balance in patients with diabetic PN. Further studies are needed to determine if this result translates into a lower fall frequency in this high-risk population.

Monaural and binaural adaptation in sequence: SDLB analogue?

Magnitude estimates (M.E.) of loudness of a 1-kc/s tone in the R ear at 60 db SPL were required over three 3-phase sessions from 15 normal-hearing young adults. The initial tone in the session was arbitrarily assigned a value of "60 units" in instructions to the S. The session was arranged to be analogous to that commonly used in Simultaneous Dichotic Loudness Balancing (SDLB). In a baseline Phase I in any of 3 sessions both ears received identical, simultaneous, intermittent stimulation. In each session, one of 3 duty cycles (randomized) were used (all on-times of .5 sec, off-times of .5, 4.5, or 24.5 sec). An M.E. judgment was requested every 10 sec for just over 1 min. Then immediately in Phase II the L ear received nothing while the R ear received continuous stimulation at 60 db SPL for 7 min, with M.E. Judgements requested every 10 sec during Min 1 and every min thereafter. Then in Phase III the R ear continued to receive continuous stimulation at 60 db SPL for 1 min while in the contralateral ear the condition of Phase I was re-introduced. M.E. loudness judgements for the R ear were requested as in Phase I. During Phase I there was, as expected, no loudness adaptation. During the adapting Phase II, M.E. group values declined progressively and significantly, but without significant differences among duty cycles. M.E. values in Phase III continued to decline significantly even though the contralateral ear was being given intermittent stimulation (irrespective of duty cycle). Previous studies had found that, for most listeners, M.E. loudness adaptation does not occur when the continuous stimulation is presented by itself. As far as is known, the present study is the first M.E. loudness adaptation study to present binaural intermittent stimulation before the continuous monaural stimulus. It is suggested that the redundancy of the continuous monaural stimulation, in comparison with the similar intermittent stimulus, is associated with the diminution of loudness.