Venipuncture versus heel prick for blood glucose monitoring in neonates.
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INTRODUCTION: The aim of this study was to determine whether there was a difference in the pain indicators and effectiveness between venipuncture (VP) and heel prick (HP) for blood glucose monitoring in term neonates (recently, venipuncture was shown superior for the Guthrie test). METHODS: 66 term neonates undergoing blood glucose monitoring underwent VP or HP. Primary outcome measures included the Neonatal Facial Scoring System (NFCS) score, duration of the first cry, total duration of cry and duration of procedure. Secondary outcome measured was the number of skin punctures needed to obtain blood. RESULTS: The NFCS score was not significantly different between the two groups and the duration of the procedure was significantly longer for the VP than the HP group (median 27 s vs. 7 s; p-value is less than 0.001). The differences between the two groups in the duration of the first cry, total duration of cry and number of skin punctures needed to obtain blood were not statistically significant, but these parameters displayed a trend, favouring the HP. CONCLUSION: The HP is still the preferred method of drawing blood in neonates for blood glucose monitoring, as only one drop of blood is required. (+info)
Heel pressure ulcers in orthopedic patients: a prospective study of incidence and risk factors in an acute care hospital.
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Heel pressure ulcers (PU) are a major concern in orthopedic patients. A prospective 6-month study was conducted in an acute care hospital in Canada to determine the incidence of heel PU in an orthopedic population, evaluate the effect of patient and care variables on heel PU incidence, and describe the natural history/sequelae of Stage I heel PU. One hundred and fifty (150) patients (average age 70.6 years) admitted for elective orthopedic surgery or treatment of a fractured hip participated in the study. A direct heel skin assessment was performed following admission and before discharge. Patients with a Stage I ulcer were assessed or contacted 1 week following discharge. The incidence of heel PU in this population was 13.3% CI (range 8% to 19%). Incidence was 16% in the hip fracture and 13% in the elective surgery group. PU incidence in the hip fracture group was significantly lower (P = 0.016) for patients receiving heel pressure relief measures (pillows, rolled sheets). In the elective surgery group, PU incidence rates were higher for patients with respiratory disease, lower hemoglobin, low pulse rate, and altered mental status (P <0.05). When both patient groups were combined, only the presence or absence of respiratory disease significantly affected PU incidence. Length of stay was an average of 3 days longer in all groups with a heel PU but the difference was not statistically significant. One week following discharge, 13 of the 17 (76%) Stage I heel PU had resolved, one remained unchanged, and two were assessed as deep tissue injury (11%) and one as Stage II. These incidence rates are similar to those reported in other countries and confirm that efforts to reduce heel PU incidence rates are needed. (+info)
Regular heel-raise training focused on the soleus for the elderly: evaluation of muscle thickness by ultrasound.
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The soleus, one of the triceps surae muscles, greatly contributes to standing and walking. Strength training focused on the soleus could be important to prevent age-related deterioration in these functions. We therefore investigated the effects of regular heel-raise training focused on the soleus for the elderly. Forty-nine healthy women aged 60 to 79 years trained for at least 40 days in a period of two months. Training consisted of a set of 100 repetitions per day of heel-raise with both legs in a standing position. The training effect was evaluated by changes in each muscle thickness of the soleus and gastrocnemius medialis, which was measured using an ultrasound scanner, as well as plantar flexor strength. The subjects' ability to perform the training and their subjective opinions of its effects were assessed by a questionnaire survey. Plantar flexor strength and thicknesses of the soleus and gastrocnemius medialis were increased significantly by the training. The percentage increase in thickness was significantly greater for the soleus than for the gastrocnemius medialis (12.7% vs. 6.6%). These improvements did not significantly correlate with age. The questionnaire results suggested that the elderly were able to safely and easily perform the heel-raise training at home. This study demonstrated that regular heel-raise training is an effective muscle training method for the elderly, focused on the soleus. (+info)
Task failure during standing heel raises is associated with increased power from 13 to 50 Hz in the activation of triceps surae.
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Heel ulcer incidence following orthopedic surgery: a prospective, observational study.
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People undergoing orthopedic surgery receive care at many points along the healthcare continuum. Although heel pressure ulcer (HPU) incidence in the orthopedic population has been reported to be 13.3%, information is limited. The purpose of this prospective observational study was to evaluate: 1) the cumulative incidence of HPUs in orthopedic patients across the continuum of care, and 2) the outcome of HPUs once they occurred. Of the 72 study participants (average age 76 +/- 16 years, 60% women, 53% required surgery for hip fractures), 57 were recruited consecutively upon admission to a rehabilitation center from one of two acute care facilities and 15 were assessed upon admission to one of the acute care sites and at discharge to the home. All but two study participants were followed-up in the community 1 month after discharge from the acute care or rehabilitation facility. Medical charts were reviewed and study participants underwent a bedside assessment, with direct examination of both heels and staging of the ulcer at admission and discharge. The cumulative incidence of HPUs was 17% (95% CI 8%-26%). All ulcers were identified upon admission to the rehabilitation center; 41% of HPUs were either suspected deep tissue injury (sDTI) or unstageable. Both of the Stage I and two of the five Stage II ulcers were resolved at the time of follow-up; three of the five sDTI or unstageable ulcers were unresolved. HPUs occurred in 17% of people undergoing orthopedic procedures. All ulcers occurred in acute care and severe ulcers persisted while patients received rehabilitation and community care. This is the first study to follow orthopedic patients across the continuum of care. (+info)
The mechanical properties of the human subcalcaneal fat pad in compression.
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The subcalcaneal fat pads of Homo sapiens were subjected to cyclic compressive loading in a materials testing machine. Rates of loading and the absolute loads to which pads were subjected were chosen to simulate the pattern of forces that the pad would be exposed to during the ground contact phase of the running step. Heel pads were found to be resilient, returning approximately 70% of the energy used to deform them. This was modified little by changes in loading frequency. A reduction of temperature from 37 degrees C to 10 degrees C produced a small, but significant, increase in the percentage energy dissipation. (+info)
Variability of neural activation during walking in humans: short heels and big calves.
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