Sore Areas Research Articles

Detection of Borax Content with Turmeric (Curcuma Longa Linn.) in Meatball Snacks in the Pekenan Area

Meatball snacks are one of the most popular culinary delights in Indonesia, nutrition in the form of animal protein which is important for the growth and development of our bodies can be obtained from consuming meatballs, but what is worrying is that there are irresponsible sellers who are not responsible for maintaining consumer health, namely adding borax as a food additive so that meatballs last longer and are more chewy, the use of borax in food can cause health problems. The Pekenan Pasar Sore area is an area that is one of the places where meatball sellers sell their wares, therefore the author conducted a study on the detection of borax content with turmeric filtrate in meatball snacks sold in the Pekenan Pasar Sore area, with the aim of finding out whether or not there are meatball sellers in the area who add borax to the ingredients for making their meatballs. This research was conducted from June to August 2024. This type of research is qualitative. The meatball samples in this study were meatballs from meatball traders in the Pekenan Pasar Sore area, Beringin District, totaling 12 traders taken by total sampling. Organoleptic tests and detection of borax content were carried out on meatball samples with turmeric filtrate. The data were analyzed descriptively. From the results of the study, it was found that the physical characteristics of the A-L meatball sample included having a natural meat aroma, gray color, and a texture that was not too chewy. And the results of the borax test on the A-L meatball sample with turmeric filtrate produced a yellow color. So from these results it shows that the A-L meatball sample sold by meatball sellers in the Pekenan Pasar Sore area does not contain borax.

P07 Pityriasis amiantacea: a unique presentation of psoriasis associated with tumour necrosis factor-α inhibitor therapy

Abstract Introduction Pityriasis amiantacea (PA) is a rare but distinctive scalp condition. It is characterised by thick, silvery scales that bind together causing matting of multiple hair shafts. This can ultimately result in temporary or permanent hair loss. PA is thought to be a reaction pattern rather than a specific diagnosis and common associated conditions include: scalp psoriasis, seborrhoeic dermatitis, tinea capitis and atopic dermatitis. We report a case of PA presenting in a patient with longstanding rheumatoid arthritis (RA), associated with tumour necrosis factor-α inhibitor (anti-TNF-α) therapy. Case description A 42-year-old was reviewed at her routine rheumatology follow up appointment. She has a 15-year history of seropositive, erosive RA managed with monthly golimumab injections for the last eight years. Prior to this she had been on etanercept for four years, but this lost efficacy. Unfortunately, she had poor disease control on methotrexate, leflunomide and sulphasalazine. She developed a sore area on her scalp nine months previously with accompanying itch. This then spread into an extensive confluent area of redness, associated with soreness, scale, matting onto hair and hair loss. She had been treated unsuccessfully with multiple antibiotic courses, including flucloxacillin, doxycycline and clarithromycin, oral fexofenadine, topical diprosalic and ketoconazole shampoo. The pruritic skin lesions continued to progress and even spread to behind the ears. This had been managed by her general practitioner (GP) as otitis externa. The patient was otherwise well with no joint pains, fever, weight loss or other systemic features. On examination, thickened, hyperkeratotic scaling plaques were seen with clumped hair shafts and underlying erythema of the entire scalp. There were no skin lesions over the rest of the body and nail changes were absent. Swab culture from the scalp was negative for fungal infection but Staphylococcus aureus and Psuedomonas aeruginosa were identified. Dermatology consult was sought, and she was diagnosed with extensive impetiginized pityriasis amiantacea associated with otitis externa. This was thought to be secondary to her anti-TNF-α therapy. Initial management was with scalp oils to soften the scales, Betnovate scalp ointment and a course of antibiotics. However, the mainstay of treatment was stopping the golimumab. Within one month of these interventions she made a dramatic improvement. Discussion The pathogenesis of PA is yet to be definitively established; however, it has been thought that PA may be a manifestation of an underlying inflammatory skin disease. Most commonly, PA is associated with psoriasis and seborrheic dermatitis. Drug induced cases have also been described. There are case reports of PA occurring in patients treated with valproic acid, vemurafenib and minoxidil. The skin symptoms seen in PA are likely a reaction of hair-bearing scalp to various inflammatory and microbial insults. Moreover, a study undertaken in Egypt found that over 96% of patients with PA had Staphylococcus isolates found in skin swabs taken from the affected scalp. Both S. aureus and S.epidermidis were identified; this could suggest incidental colonisation or that these bacteria play a part in development of PA. Multiple studies have looked at distinguishing microbial biofilms and their structure and physical properties. Resilient biological scaffolding of microbial biofilms, rich in polysaccharides, proteins, lipids, and nucleic acids, is triggered by the bacteria and develops on the scalp and hair shafts. As this continues it promotes accumulation of adherent scale and the hair shafts are increasingly bound together and matted to the scalp. TNF-a is an inflammatory cytokine produced by macrophages during acute inflammation. It causes a range of signalling events within cells, leading to necrosis or apoptosis, which contributes to the pathogenesis of many chronic inflammatory diseases, like psoriasis. However, in some cases TNF-a inhibition can paradoxically lead to new psoriasis or worsening of existing psoriasis. This has been observed with the three major anti-TNF-a agents (infliximab, etanercept and adalimumab). Often it is seen in patients receiving treatment for rheumatoid arthritis or inflammatory bowel disease. On average, cutaneous adverse effects are seen approximately 17 months after starting anti-TNF-a therapy. The most frequently seen presentations are of plaque psoriasis and palmoplantar pustulosis. Key learning points Inhibition of TNF-a causes increased production of interferon-a by dendritic cells, which has been associated with induction of psoriasis. Interleukin-1 (IL-1) has also been implicated in the development of psoriasis. Furthermore, TNF-a can activate apoptosis of potentially autoreactive T-cells. Blockade of this action could lead to T-cell mediated tissue and psoriatic pathology. Anti-TNF-a induced PA is a rare adverse reaction that usually requires drug discontinuation. The exact pathogenetic mechanism is unclear but an imbalance of the cytokine environment has been theorised. Our patient highlights the need to stay vigilant for cutaneous adverse reactions and the evolving diverse spectrum of psoriasiform conditions that can be seen secondary to anti-TNF-a therapy.

Utility of Superb Microvascular Imaging in the Assessment of Foot Perfusion in Patients with Critical Limb Ischemia.

(1) Background: Although the ankle-brachial index (ABI) and skin perfusion pressure (SPP) are commonly used to evaluate the peripheral circulation in critical limb ischemia (CLI), they often cannot be performed on sore areas. We investigated the utility of superb microvascular imaging (SMI) for assessing foot perfusion in CLI patients. (2) Methods: We measured the SMI-based vascular index (SMI-VI) at six sites in the foot before and after endovascular treatment (EVT) in 50 patients with CLI who underwent EVT of the superficial femoral artery and compared the results with SPP values and the ABI. (3) Results: SMI visualized foot perfusion in all subjects in accordance with the angiosome, including the toe areas, while the ABI was unmeasurable in three patients on hemodialysis and SPP failed in four patients. SMI-VI values were significantly lower in the CLI group than in controls, and the plantar SMI-VI had the highest diagnostic performance for CLI (sensitivity 88.6%, specificity 95.6%). After EVT, the increase in the SMI-VI was positively correlated with the increase in SPP but not that in the ABI, implying that the SMI-VI reflects foot microcirculation. (4) Conclusions: SMI enables the visualization and quantification of foot microcirculation based on the angiosome. SMI has high utility as a tool for assessing foot perfusion in CLI.

Pain and Self-Management Status Among Chinese Patients With Cancer During the COVID-19 Pandemic

BackgroundTo investigate the pain and self-management status of patients with cancer and the influencing factors of pain and self-management status during the COVID-19 pandemic. MethodsA cross-sectional design was used. Eighty-one Chinese patients with cancer were recruited in December 2020. The Brief Pain Inventory, the Pain Management Inventory, and the Pain Self-efficacy Questionnaire were used to evaluate patients’ pain and self-management status. Descriptive statistical analysis and multiple linear regression models were conducted for the research aims. ResultsTwo thirds of the participants experienced moderate to severe pain. Cancer pain had moderate to severe interference on 90.12% of patients’ lives. Self-management of pain in these participants was low. The most commonly used methods of pain management included adjusting activity intensity to avoid fatigue, using distraction techniques, and massaging the sore area. The most effective methods to manage pain included taking analgesics prescribed by doctor, taking over-the-counter analgesics, and massaging the sore area. Fifteen patients (18.5%) believed that the COVID-19 pandemic had an impact on pain management and 26 patients (32.1%) needed support. Pain education, pain interference on sleep, chemotherapy, and payment status were significantly associated with cancer patients 'pain self-management. ConclusionsDuring the COVID-19 pandemic, patients with cancer had moderate to severe pain intensity with low levels of self-management and self-efficacy towards that pain.

A Pilot Study to Assess the Feasibility of a Web-Based Survey to Examine Patient-Reported Symptoms and Satisfaction in Patients with Ankylosing Spondylitis Receiving Secukinumab.

PurposeThis real-world study evaluated the feasibility of assessing patient-reported symptom improvement and treatment satisfaction using a web-based survey among patients with ankylosing spondylitis (AS) treated with secukinumab.MethodsThis cross-sectional, web-based survey collected data on demographics, symptoms, treatment history, and treatment satisfaction from US patients with AS who were receiving secukinumab at survey participation. Patients reported AS symptoms experienced before and after secukinumab initiation, time to symptom improvement, and satisfaction with secukinumab treatment.ResultsOf 2755 patients screened, 200 with AS were included in the analysis. The mean (SD) age of patients was 34.4 (10.6) years; 86.5% were biologic experienced. Most (74.0%) reported overall improvement (“a little,” “moderately,” or “much better”) in AS symptoms since secukinumab initiation compared with before secukinumab initiation; a similar trend was observed for all the individual symptoms analyzed (pain disrupting sleep, fatigue, morning stiffness, pain and stiffness in lower back or neck, sore areas other than joints, and ankle or heel pain [indicating enthesitis]). Approximately 41.9% of patients reported overall symptom improvement within 4 weeks of secukinumab treatment. Most expressed overall satisfaction (“very,” “mostly,” or “somewhat satisfied”) with secukinumab regarding symptom improvement (99.0%), speed of symptom improvement (97.0%), frequency and method of administration (96.0% and 91.5%, respectively), ease of use (93.5%), patient support services (97.0%), and side effects, if any (93.0%).ConclusionMost patients reported overall symptom improvement and satisfaction with treatment. Our study indicates that patient-reported perspectives may be feasibly collected using a web-based survey to provide insights into treatment experience and satisfaction.Electronic supplementary materialThe online version of this article (10.1007/s40801-019-0154-4) contains supplementary material, which is available to authorized users.

Plantar pressure sore formation during advanced phases of pregnancy and the effect of special footwear

Plantar pressure sore occurrence is an indicator of increased plantar pressures which may develop into subsequent foot problems and pain. Therefore, the aim of this study was to assess the effect of special footwear on plantar pressure sore distribution. 67 healthy pregnant women participated at all data collection session at their 27, 32 and 37 gestational weeks. At each data collection session, the plantar pressure sore distribution was assessed for both feet. During the first data collection session participants were randomly divided into a control and experimental group. Experimental group obtained the special footwear. For the control group, the results show an increased in pressure sores occurrence in the medial edge of thumb and first metatarso-phalangeal joint. The special footwear introduction in the experimental group increased the pressure sore occurrence at the edge of the heel, probably associated with the plantar pressure redistribution more to the heel area. The distribution of pressure sore areas of the control and experimental group is in accordance with our hypothesis that the special footwear redistributes the plantar pressures, however, the trend of these changes is not clear as there are many factors influencing the foot condition during advanced stages of pregnancy.

Safety and effectiveness of percutaneous electrical nerve stimulation on pain reduction in patients suffering from neuropathic or mixed pain

Pain is a harmful symptom, strongly influencing HRQoL and rehabilitative treatment and often refractory to pharmacological and non-pharmacological therapeutic strategies. In recent years, percutaneous electrical nerve stimulation (PENS) has been proved to be an effective procedure in the management of refractory neuropathic pain and some conditions of refractory mixed pain like low back pain. However, up to date, evidences in literature about the effectiveness of PENS in terms of pain reduction and HRQoL improvement in the rehabilitation field are scarce. Therefore, aim of our study was to evaluate safety and effectiveness of PENS on short-term pain reduction in patients suffering from neuropathic or mixed pain, non-responders to conventional therapies in a rehabilitative setting. This retrospective study was performed on a cohort of 75 adults (25 men and 50 women), mean aged 70.05 ± 14.16 years, suffering from neuropathic or mixed pain non responsive for more than 3 months to both pharmacological and non-pharmacological therapies. From 2014 to 2017, patients were treated by subcutaneous needle-electrode insertion in the sore area and return-on-skin electrode placement, both connected to a generator (AS SUPER 4 digital by TÜV Rheinland) for a 40-minute session at alternate frequencies of 2 and 100 Hz. Pain was assessed by Numerical Rating Scale (NRS) before and immediately after the treatment. Five patients experienced self- limiting and short-term pain mainly due to subcutaneous needle placement. No complication affected the continuation of the procedure. There was a significant reduction in NRS (defined as > 50%) after treatment in 70% of patients. PENS has been proven to be a safe and effective procedure in the treatment of neuropathic and mixed pain in patients non-responders to both pharmacological and non-pharmacological treatments. Its use in Physical and Rehabilitative Medicine should be encouraged and supported by other studies.

The gastro protective effects of Cibotium barometz hair on ethanol-induced gastric ulcer in Sprague-Dawley rats.

Background Cibotium barometz is a medical herb used traditionally in the Malaysian peninsula for several ailments, including gastric ulcer. The aim of this study was assessment the anti-ulcer effects of C. barometz hair on ethanol-induced stomach hemorrhagic abrasions in animals. Seven groups of Sprague Dawley (SD) rats were administered 10% Tween 20 in the normal control and ulcer control groups, and omeprazole 20 mg/kg and 62.5, 125, 250, and 500 mg/kg of C. barometz hair extract in the experimental groups. After 60 min, the normal control group of rats was orally administered 10% Tween 20, while absolute ethanol was orally administered to the groups of ulcer control, omeprazole and experimental groups. Stomachs of the rats were examined macroscopically and histologically. Homogenates of stomachs were used to evaluate endogenous antioxidant enzyme activities.ResultsRats pre-fed with plant extract presented a significant decrease in the sore area, increased pH of gastric contents and preserved stomach wall mucus compared to the ulcer group. Histologically, rats pre-fed with C. barometz hair extract showed mild to moderate disruptions of the surface epithelium while animals pre-fed with absolute ethanol showed severe disruptions of the stomach epithelium with edema and leucocyte penetration of the submucosal layer. A Periodic acid Schiff (PAS) staining revealed that each rat pre-treated with the plant extract displayed an intense uptake of stomach epithelial glycoprotein magenta color compared to the ulcer control group. Immunohistochemical analysis revealed that rats pre-fed with the plant extract showed an up-regulation of the heat shock protein 70 (HSP70) and down-regulation of Bax proteins compared to ulcer control rats. Homogenates of the stomach tissue demonstrated significant increases in the endogenous antioxidant enzymatic activity and decreased lipid peroxidation (MDA) in rats pre-treated with C. barometz hair extract compared with the ulcer control rats. In acute toxicity, the liver and kidney revealed no hepatotoxic or nephrotoxic effects histologically.ConclusionsThe gastric cytoprotective action of C. barometz hair extract might be attributed to antioxidants, an increase in gastric pH, stomach mucus preservation, increased endogenous antioxidant enzymes, decreased lipid peroxidation, up-regulation of HSP70 and down-regulation of Bax proteins.

Prognostic Evaluation of Preserving Palatal Mucosa After Resection of Maxillary Myxoma

This study was carried out to assess the clinical and radiological outcomes of preserving palatal mucosa after resection of odontogenic maxillary myxomas. Fifteen patients (9 females and 6 males) with odontogenic maxillary myxomas participated in this study. Their ages ranged between 22 and 40 years. They were diagnosed as having myxomas by clinical and computed tomographic examinations as well as by performing biopsies on them. All lesions were treated by maxillary resection with preserving palatal mucosa. After surgery, the resultant surgical defects were followed up for 10 years. No clinical or radiological evidence of recurrence was observed after 20 years' follow-up. The healing process was rapidly progressing without any serious complications. However, 6 patients complained of sore areas in their palatal mucosa because of the acrylic stents. They were successfully treated with mouthwash, anti-inflammatory drugs, and relief of the acrylic stents. After surgery, numbness of the upper lip was observed in all cases; however, it improved gradually in 5 patients over a period of 2 years. Computed tomographic scan of the surgical sites has shown incomplete filling of the resultant surgical defects. Constantly, there was empty space beneath the orbital floor in all computed tomographic images. Maxillary resection with preserving palatal mucosa is a recommended treatment modality for odontogenic maxillary myxomas as it minimizes the unpleasant sequelae after surgery without recurrence. However, this technique should be restricted only to the cases having intact palatal bone.

Mechanical Evaluation of Spectacles at Contact Area around Ear

When the relationship between the dimensions of face form and those of spectacle frames is poor, it may cause problems such as slipping frames and sore areas on the nose and behind the ears. In this study, mechanical characteristics in face-spectacles interface are discussed. CAD models of face form and spectacle frames were constructed from the three dimensional measurements of the human face that wore spectacles. The finite element method (FEM) model of the face was constructed by using CT images of the scalp organization. Next, the FEM model of spectacles constructed with the 3 D measurements was synthesized to the face model. Then, mechanical behavior in the interface between the face and spectacles was investigated by FEM analysis. In the result of the frame which was adjusted to the face, contact area between tip and skin is so wide that the effect of holding spectacles stably was recognized with the end of tip hold head. At the frame which was not adjusted, contact area is so small that enough pressure was not generated to hold spectacles stably.

Relationship between quantity of suppurative moxibustion and its effect on allergic asthma

Purpose: To investigate the relationship between quantity of suppurative moxibustion and its effect on allergic asthma. Methods: The patients were randomly divided into suppurative moxibustion 9 cones group, 3 cones group and 6 cones group. The biggest area, scar-losing time, suppurating time and scarring time of post-moxibustion sore, and the clinical effects of each group were observed. Results: The biggest post-moxibustion sore area of 9 cones group was bigger than 3 cones group but had no difference with 6 cones group, and scar-losing time, suppurating time and scarring time of post-moxibustion sore of each group were of no difference. The clinical effects of 9 cones were better than 3 cones group but have no difference with 6 cones group. Conclusion: The quantity of suppurative moxibustion is in close association with the effects in the treatment of allergic asthma, and eventually becomes the key factor for good results.

Effects of local pressure and vibration on muscle pain from eccentric exercise and hypertonic saline

In human subjects the triceps surae of one leg was exercised eccentrically by asking subjects to walk backwards on an inclined treadmill. Before the exercise controlled local pressure, applied to the muscle with an electromagnet, produced mild soreness, which was reduced when the pressure was combined with vibration. When delayed-onset muscle soreness (DOMS) had set in, 24–48 h after the exercise, vibration increased pain from local pressure. Vibrating at different frequencies suggested 80 Hz as the optimal frequency. During 2-h testing post-exercise, evidence of a change in character of the effects of vibration was first detected at 6 h. It persisted up to 72 h post-exercise. When muscle pain was generated in an unexercised triceps by injection of hypertonic (5%) saline, controlled local pressure applied to the sore area increased pain levels by 32% while pressure plus vibration reduced this to 11%. In a subject with DOMS, local pressure again increased pain from saline by 32% but combining it with vibration increased pain further by an additional 20%. The effect of vibration on DOMS could be abolished with a large nerve fibre block applied to the sciatic nerve. It is concluded that the vibration effects are the result of stimulation of large-diameter mechanoreceptive afferents in the muscle which, it is speculated, play a role in generating DOMS.

The Effect of Low Level Laser Therapy (LLLT) on Stage III Decubitus Ulcers (Pressure Sores); a Prospective Randomised Single Blind, Multicentre Pilot Study

. This study had four main objectives (a) multicentre trial feasibility in nursing homes; (b) the applicability of registration methods; (c) the extent of wound size reduction and (d) the LLLT effect(s) on pressure sores stage III. The study was designed as a prospective randomised, single blind, multicentre clinical trial in four nursing homes, using the same prospective protocol. A total of 20 patients were enrolled into the study: 16 patients were randomised, and four patients were excluded. Treatment was the prevailing consensus decubitus treatment (n=8); one group (n=8) had 904 nm LLLT in addition, five times a week over a period of 6 weeks. The main outcome measure was the median wound size at six weeks after intervention. No statistical significant difference in wound size was found between the two groups (Mann Whitney U test; p=0.47). The sores in the LLLT group healed to a median of 83%, wounds in the control group to a median of 95% of their initial size. There was significant wound decrease within treatment arms (Friedman two-way analysis, p<0.001). It was concluded that (a) a multicentre study is feasible in nursing homes; (b) the evaluation methods are accurate, adequate and reproducible; (c) there was significant sore area reduction within groups, but there were no significant differences between treatments; and (d) the efficacy of LLLT in healing of full thickness pressure sores stage III was not demonstrated and is still a matter of debate.

Numb Toes and Aching Soles: Coping with Peripheral Neuropathy.

Professor and Chair University of New Mexico School of Medicine Department of Anesthesiology and Critical Care Medicine Albuquerque, New Mexico 87131-5216 Numb Toes and Aching Soles: Coping with Peripheral Neuropathy. By John A. Senneff. San Antonio, MedPress, 1999. Pages: 336. Cost: $29.95.I read the first several chapters of this book before reading the preface and was surprised to find that the author is not a physician. John Seneff is a person with a long history of painful neuropathy who has had no medical training. His writing style and approach to his topic resembles that of a well-informed clinician writing a review article for professional colleagues.The book is directed toward a sophisticated, nonmedical audience. I would not recommend the book to a patient who is content to trust a physician to make all his or her healthcare decisions. The book is for the person who would like to actively participate in the medical decision-making process. It is thorough, accurate, and relatively unbiased. Most recognized medical treatments for painful neuropathy are moderately effective at best, and the author presents examples of scientific studies with positive and negative results for each form of therapy.In a document of this scope, it is impossible to provide a detailed assessment of every form of therapy. On a few occasions, such lack of detail may lead to misleading implications. For example, the author points to promising results with SNX-111 (ziconotide), but fails to inform the reader that the studies involved intrathecal administration of the drug via a surgically implanted device. Similarly, his positive comments regarding cyclooxygenase-2 inhibitors might lead one to believe that they are more effective than older nonsteroidal antiinflammatory drugs (NSAIDs) for neuropathic pain, which is unlikely. With few exceptions, Senneff’s coverage of mainstream medical therapy for neuropathic pain, was thorough (although not exhaustive), accurate, and unbiased. His discussions of medical therapies that are not a part of my practice (e.g. , plasmapheresis, immunosuppressants, and IVIg) are most informative. His coverage of some new variations on the trancutaneous electrical nerve stimulation theme (e.g., “microcurrent therapy”) was a bit optimistic, referring only to “company claims of substantial benefit.” I also thought Seneff’s discussion of “aerobic oxygen” (i.e. , stabilized oxygen in a nontoxic form) should have been more disparaging. Perhaps fear of legal retribution discouraged him from denouncing it as pure flim flam.I found myself considering whether ginkgo biloba or St. John’s Wort might have a positive effect on my well-being. I agree with Seneff’s opposition to the Food and Drug Administration’s regulation of herbal remedies, which are based upon his belief that such regulation would unnecessarily raise prices. He correctly states that few manufacturers would spend research funds on products that lack patent protection. Nevertheless, we should vigorously support public funding for good scientific studies of safety and effectiveness of herbal derivatives.A valuable feature of this book is the testimonials, which include comments from internet bulletin boards, forums, and news groups concerning patients’ experiences with the treatments discussed. There are comments about dramatic successes, dismal failures, and terrible side effects. Several entertaining comments about magnetic therapy include “The magnet draws blood to the sore area, and it becomes very warm and then the pain seems to ease”; “If a doctor makes a statement to me that ‘magnets bring warmth to the area,’ that doctor is incompetent a quack, on drugs, all of the above, or worse. Beware of this guy”; and “No, I don’t stick to the refrigerator door.” Following several positive comments about chelation therapy, Seneff comments “If anyone has been injured in a chelation related incident, please contact me regarding suing the doctor that charged you so much for your ineffective therapy.”In summary, this book is informative and entertaining, and is recommended for patients who are willing to take an active role in their own pain management. The best testimonial I can make is the fact that I have sent the book to a physician friend who recently asked me about treatment options for his peripheral neuropathy. It is certainly worth the modest price of $19.95 (paperback) or $29.95 (hard cover).

Relationship of Cues to Assessed Infant Pain Level

Cues that 46 pediatric nurses with a BS in Nursing reported as key to their pain assessments of 88 videotaped infants, ages 0 to 12 months, are identified. Frequencies with which these cues were used for infants of different ages and the relationships between key cues and assessed levels of pain are described. Greater pain was strongly associated with tears, stiff posture, guarding, and fisting. Greater pain was moderately associated with inadequate type or dosage of analgesia, more recent surgery, inconsolability, difficult to distract, does not focus on surroundings, frown, grimace, wrinkled face, flushed face, pain cry, and increased arousal in response to touch of sore area. Internurse variability in cue use was sizable. Most of the often-used cues had weak or no association with assessed pain level. Only consolability, pain cry, grimace, and stiff posture were frequently used and correlated > .51 with assessed level of pain.

A Method for Consistent Documentation of Pressure Sores

To effectively prevent and manage pressure sores, healthcare professionals need an accurate assessment and precise communication of the status of skin and soft tissue. A study by French et al. (1983) found inconsistency in staff nurses' descriptions of pressure sores. Consistency in documentation was significantly improved immediately after a standardized teaching session, but these improvements were much less evident after 6 months. Based on these findings, a pressure sore flow sheet was developed at the authors' institution, the Rehabilitation Institute of Chicago, as a result of the study. The purpose of this form is to assist the nurse in conducting a more thorough, objective, and consistent evaluation of pressure sores. The form contains assessment parameters, key descriptor words, and a diagram with axes on which to draw the sore and label significant areas such as necrotic tissue. A grading key also is included on the form to ensure consistency in grading of pressure sores.

Prevention by Egg Yolk of the Dermatitis in Chicks Due to Egg White

TULLY and Franke (1934) showed that when dried whole egg was used as 15 percent of a grain ration fed to chicks a “pellagra-like syndrome” was produced. This condition was not prevented by the inclusion of 5 percent of yeast in the ration or 5 percent of yeast plus 3 percent of meat and bone scraps. In about three weeks the syndrome was characterized by scabby sore areas involving the corners of the mouth, which spread to include the area under the lower mandible. At four to five weeks foot lesions appeared with hardening and cracking of the skin of the bottom of the foot and between the toes. A similar condition has been obtained in this laboratory (Lease and Parsons, 1934) in chicks fed a diet containing 30 percent of egg white. This was cured by the inclusion of 8 to 16 percent of liver residue from Lilly liver .