The benefits of reducing anxiety in a Podiatric Surgical Unit in the UK with Midazolam

La sedación se ha utilizado con frecuencia junto a muchas de las intervenciones quirúrgicas realizadas bajo anestésicos locales (AL) . En la cirugía podológica, hay una escasez de literatura sobre los efectos de la sedación ante las señales fisiológicas de los pacientes. La anestesia general se practica con mayor frecuencia que la sedación con anestésico local en podología . El objetivo de esta estudioa fue analizar la presión arterial ( PA) y frecuencia cardiaca (FC ) en contra de la administración de midazolam. Se realizó una evaluación retrospectiva de las registros de sedación antes de los procedimientos de podología llevadas a cabo durante los años 2008/2009 . La PA ( sistólica / diastólica mm de Hg ) y la FC ( latidos / min ) se registraron antes de la administración de midazolam y durante los primeros 30 minutos después de la administración . Noventa y cuatro pacientes ( 74 mujeres, 20 hombres) fueron ingresados para cirugía podológica . Se realizaron Noventa y nueve intervenciones , con cinco de los sujetos sometidos a dos procedimientos. La edad media fue de 59 ± 13,5 años ( 21-87 ) y la dosis media de midazolam administrado fue 2,8 ± 1,3 mg ( 0,5-8 ) . La media de la PA antes de administrar midazolam fue de 148 /85 mmHg y la FC 80. A los 30 minutos la PA era de 136 /80 y la FC 71 . La PA y la FC fueron significativamente diferentes con una p < 0,001 para la lectura antes de la administración. Los resultados presentados indican el uso de este fármaco junto con el anestesico local en un contexto de sedación tiene resultados favorables.Sedation has been frequently used alongside many surgical interventions under local anaesthetics (LA). In podiatric surgery, there is a paucity of literature on the effects of sedation drugs on surrogate measures of patients’ physiological signs. General anaesthetic is practised more frequently than sedation assisted local anaesthetic in podiatry. The aim of this audit was to analyse blood pressure (BP) and heart rate (HR) against the administration of midazolam. A retrospective assessment of sedation notes prior to podiatric procedures undertaken during the years 2008/2009 was performed. BP (systolic/diastolic mm Hg) and heart rate (beats/min) were recorded prior to the administration of midazolam and for the first 30 minutes following administration. Ninety-four consecutive patients (74 women, 20 men) were admitted for podiatric surgery. Ninety-nine interventions were performed, with five of the subjects undergoing two procedures. The mean age was 59±13.5 years (21-87) and average midazolam administered 2.8±1.3 mg (0.5-8). Average BP prior to midazolam was 148/85 mm Hg and HR 80. At 30 minutes assessment BP was 136/80 and HR 71. BP and HR differences were significantly different at p<0.001 to the reading prior to administration. The results presented indicate the use of such a drug as an adjunct to LA in a sedation context has favourable results

The effect of topical anti blister products on the risk of friction blister formation on the foot

Introduction Foot blisters are a common injury, which can impact on activity and lead to infection. Increased skin surface hydration has been identified as a risk factor for blister formation, indicating that a reduction in hydration could reduce the risk of blister formation. Method Thirty healthy adults were randomised into 3 groups, each receiving a preventative foot blister treatment (2Toms® Blister Shield®; Flexitol® Blistop and Boots Anti–Perspirant Foot Spray). Cycles of compression and shear loads where applied to heel skin using a mechanism driven by compressed air. Temperature changes were measured during load application using a thermal imaging camera (FLIR Systems Inc. and Therm CAM™ Quick Report). Near surface hydration of the skin was measured using a Corneometer® (C & K, Germany). Results There was no significant difference in the rate of temperature change of the skin between the three groups compared to not using products (p = 0.767, p = 0.767, p = 0.515) or when comparing each product (p = 0.551). There was a significant decrease in near surface skin hydration, compared to baseline, after the application of powder (−8.53 AU, p = 0.01). There was no significant difference in hydration after the application of film former and antiperspirant (−1.47 AU, p = 0.26; −1.00 AU, p = 0.80, respectively). Conclusion With the application of external load we found no significant difference in the effect of the three products on temperature change. The powder product demonstrated an effect on reducing the risk of blister. It is postulated that powder may have a barrier effect

Clinical photographic observation of plantar corns and callus associated with a nominal scale classification and inter- observer reliability study in a student population

Abstract Background The management of plantar corns and callus has a low cost-benefit with reduced prioritisation in healthcare. The distinction between types of keratin lesions that forms corns and callus has attracted limited interest. Observation is imperative to improving diagnostic predictions and a number of studies point to some confusion as to how best to achieve this. The use of photographic observation has been proposed to improve our understanding of intractable keratin lesions. Methods Students from a podiatry school reviewed photographs where plantar keratin lesions were divided into four nominal groups; light callus (Grade 1), heavy defined callus (Grade 2), concentric keratin plugs (Grade 3) and callus with deeper density changes under the forefoot (Grade 4). A group of ‘experts’ assigned from qualified podiatrists validated the observer rated responses by the students. Results Cohen’s weighted statistic (k) was used to measure inter-observer reliability. First year students (unskilled) performed less well when viewing photographs (k = 0.33) compared to third year students (semi-skilled, k = 0.62). The experts performed better than students (k = 0.88) providing consistency with wound care models in other studies. Conclusions Improved clinical annotation of clinical features, supported by classification of keratin- based lesions, combined with patient outcome tools, could improve the scientific rationale to prioritise patient care. Problems associated with photographic assessment involves trying to differentiate similar lesions without the benefit of direct palpation. Direct observation of callus with and without debridement requires further investigation alongside the model proposed in this paper