Swiss medical weekly
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Swiss medical weekly · Jan 2012
Fracture clinic redesign: improving standards in patient care and interprofessional education.
Current fracture clinic models, especially with the advent of reductions in junior doctors' hours, may limit outpatient trainee education and patient care. We have designed a new fracture clinic model, involving an initial consultant-led case review focused on patient management and trainee education. ⋯ Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool that will enhance patient and trainee experience.
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Swiss medical weekly · Jan 2012
The diagnostic value of measuring pressure pain perception in patients with diabetes mellitus.
Repetitive skin trauma and reduced pressure pain sensation are necessary components of plantar ulcer risk in patients with diabetic neuropathy. The diagnostic value of measuring pressure nociception to detect ulcer risk is, however, unknown. Instead, measuring the vibration perception threshold (VPT) by 64 Hz graduated Rydel-Seiffer tuning fork has become standard clinical practice to screen for neuropathy and ulcer proneness. We therefore set up a diagnostic case-control study to compare the VPT, the cutaneous pressure pain perception threshold (CPPPT) and the deep pressure pain perception threshold (DPPPT) at the foot sole in diabetic patients with and without past or present painless plantar ulcer. ⋯ Pressure algometry was not superior to measuring VPT for distinguishing between patients with and without painless plantar ulcers; VPT ≤1/8 was more efficient than ≤4/8 grade in identifying ulcer patients.