sodium-ethylxanthate and Pressure-Ulcer

This Report puts forward a plan for the management of physical disability. It recognises that the subject is administratively complex and that many different organisations, including Social Services, are involved. The Report concentrates upon the role of the NHS in general, and upon the position of physicians in particular. The Report starts by reviewing some of the evidence that services for the physically disabled are in many respects deficient. The evidence includes accounts given by disabled people themselves, the fact that many patients are 'follow-up' by inexperienced junior hospital staff, and the lack of agreed standards of provision in many areas (see Section 3) such as pressure sores, incontinence, wheelchairs, and the care of head injured patients. Disabled people between the ages of 15 and 65 are identified as requiring particular attention (Paediatric and Geriatric Services probably cater reasonably well for the young and the old). The 'size' of the problem of physical disability is examined. For instance, the average Health District (of 250,000 persons) will contain 25,000 physically disabled people, of whom 6,250 will be severely, or very severely disabled; and 1,800 will have a wheelchair; 40 per cent of disabled people are under the age of 65. The Working Party on Rehabilitation Medicine of the Royal College of Physicians (1978) was of the opinion that rehabilitation is an integral part of total patient care, and is therefore the concern of all clinicians. The implication of this view is that Medical Disability Services should be developed without a major specialty of Rehabilitation or its equivalent, such as exists in most western countries. The Report explores the practical implications of this principle in the light of evidence discussed above.

Topics: Adolescent; Adult; Aged; Automobile Driving; Child; Communication Aids for Disabled; Craniocerebral Trauma; Delivery of Health Care; Disabled Persons; England; Female; Hearing Disorders; Humans; Male; Middle Aged; Orthotic Devices; Pressure Ulcer; Prostheses and Implants; Quality of Health Care; Regional Medical Programs; Rehabilitation; Research; Sex; Urinary Incontinence; Vision Disorders; Wales; Wheelchairs

All traumatic SCI patients in Iceland come to the Neurosurgical Department of Borgarspítalinn, the City Hospital in Reykjavík for their initial treatment. From 1973-1989, 79 (93%) were rehabilitated at Borgarspítalinn. The purpose of this study was to look at the most common complications and the social functions of SCI patients after discharge from the Rehabilitation Department. A questionnaire was sent to 59 of the 79 patients. They represent almost the whole population of the spinal cord injured population in Iceland. Forty-five patients (76.3%) answered the questionnaire, 69% male, 31% female. Sixty-seven percent were under the age of 30 years at the time of injury. Twenty-nine percent had a complete spinal cord injury; 53.3% were wheelchairbound (Frankel grade A, B, C); 55.6% were quadriplegic, and 44.4% paraplegic. The commonest complications were pain (64.4%), urinary tract infections (62.2%) and spasticity (60%); and 58% of the wheelchairbound patients had had pressure sores. Fifty-five point five percent were married; 71% had an active sexual life after the injury; 54% of the wheelchairbound patients were not quite independent and required some assistance with activities of daily living (ADL) tasks; and 29% were not working or studying compared to 11%, who were, before the injury. No significant changes were seen in social function after the injury. The results show that more emphasis must be placed on the prevention of complications such as urinary tract infections and pressure sores and on the treatment of chronic pain and spasticity.

Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Aged; Child; Education; Employment; Female; Follow-Up Studies; Housing; Humans; Iceland; Male; Marriage; Middle Aged; Muscle Spasticity; Pressure Ulcer; Self Care; Sex; Spinal Cord Injuries; Urinary Bladder Diseases; Urinary Tract Infections

Topics: Female; Humans; Male; Paralysis; Pressure Ulcer; Reproduction; Sex; Spinal Cord Diseases