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Remote site production of sterile purified water from available surface water.

A water purification and sterilization device was tested for its functional capabilities. Challenge water consisting of potable water augmented with bacteria, endotoxin, virus, suspended solids, and dissociable ions (sodium chloride, lead or arsenic salts) was passed through the device. The product water quality attributes were analyzed. The device demonstrated reduction in bacteria of >7 logs, endotoxin was reduced by >4 logs, virus was reduced by >4 logs, and dissociable ions were reduced by >3 logs. The product water of the device met the limits for a range of chemical entities specified by the United States Pharmacopeia and Association for the Advancement of Medical Instrumentation. The product water met the quality attributes of Sterile Water for Injection, USP, Sterile Purified Water, USP, and the Water for Dialysis. The device provides a logistical advantage in reducing the weight of transport of packaged water by 83% and the cube by 67%. It operates manually by gravity and is disposable after a single use. The device provides an effective alternative to the transport and use of packaged sterile water in remote locations by production of sterile water at the point-of-need using available water. It also is capable of producing safe drinking water following the production of clinical waters. This device has been cleared by the US Food and Drug Administration for production of three liters Sterile Purified Water, USP from Environmental Protection Agency (EPA) grade drinking water.

Communicable Disease Control↗

Social skills and sex-role functioning in borderline personality disorder: relationship to self-mutilating behavior.

This study compared the social skills functioning and sex role affiliation of female inpatients diagnosed with borderline personality disorder who engaged in self-mutilating behavior (n = 30) with female patients with borderline personality disorder who did not engage in such behavior (n = 18). Patients with borderline personality disorder who engaged in self-mutilating behavior were found to have relatively poorer skills in communicating non-verbal emotional information to others and in receiving and interpreting such information from others. In terms of sex role orientation, patients who engaged in self-mutilating behavior were significantly more likely than non-mutilators to be typed as undifferentiated using the Bem Sex Role Inventory. These participants were less likely to identify with either masculine or feminine sex roles. Patients who did not self-mutilate were found to be significantly more likely than those who did self-mutilate to identify with the masculine sex role.

Adult↗

[Anesthesiologists at the initial stage of postpartum hemorrhage].

Adequate management of postpartum hemorrhage (PPH) requires, after early recognition, four components undertaken simultaneously: communication, resuscitation, monitoring, investigating the cause of bleeding, arresting the bleeding. Early recognition of PPH relies on either a perceived or a quantified blood loss of 500-1000 ml and over (using a collecting bag), or the presence of clinical signs of shock (hypotension, tachycardia, tachypnea, altered mental status). Precise timing of the diagnosis of PPH must be must annotated. Once the diagnosis is established, appropriate senior professionals, including the anesthesiologist at the early stage, must be called in. The cornerstones of initial resuscitation are restoration of blood volume and oxygen carrying capacity, achieved, with adequate intravenous access, initially with cristalloids, followed by colloids, associated with oxygen by face mask. Initial resuscitation is performed and its efficiency is assessed by continuous monitoring, hemoglobin bedside tests (Hemocue), full blood count and clotting screen. Oxytocine (Syntocinon) efficacy and side-effects are evaluated by anesthesiologists. Adequate anesthetic technique must be performed to permit to the obstetricians to perform a diagnostic procedure (manual removal of placenta, uterine revision), and to most frequently obtain arrest of bleeding. Hemodynamic stability is required for loco-regional anesthesia, while on the other hand, general anesthesia with crush induction and intubation will be performed. Anesthesiologists must anticipate in case of failure of initial measures, including in alerting the blood transfusion service and calling for additional help.

Anesthesia, Obstetrical↗

Suprachiasmatic nucleus communicates with anterior thalamic paraventricular nucleus neurons via rapid glutamatergic and gabaergic neurotransmission: state-dependent response patterns observed in vitro.

The hypothalamic suprachiasmatic nucleus uniquely projects to the midline thalamic paraventricular nucleus. To characterize this projection, patch clamp techniques applied in acute rat brain slice preparations examined responses of anterior thalamic paraventricular nucleus neurons to focal suprachiasmatic nucleus stimulation. Whole cell recordings from slices obtained during daytime (n=40) revealed neurons with a mean membrane potential of -66+/-1.2 mV, input conductance of 1.5+/-0.1 nS and state-dependent tonic or burst firing patterns. Electrical stimulation (one or four pulses) in suprachiasmatic nucleus elicited monosynaptic excitatory postsynaptic potentials (mean latency of 12.6+/-0.6 ms; n=12), featuring both AMPA and N-methyl-D-aspartate-glutamate receptor-mediated components, and monosynaptic bicuculline-sensitive inhibitory postsynaptic potentials (mean latency of 16.6+/-0.6 ms; n=7) reversing polarity at -72+/-2.6 mV, close to the chloride equilibrium potential. Glutamate microstimulation of suprachiasmatic nucleus also elicited transient increases in spontaneous excitatory or inhibitory postsynaptic currents in anterior thalamic paraventricular neurons. Recordings from rats under reverse light/dark conditions (n=22) yielded essentially similar responses to electrical stimulation. At depolarized membrane potentials, suprachiasmatic nucleus-evoked excitatory postsynaptic potentials triggered single action potentials, while evoked inhibitory postsynaptic potentials elicited a silent period in ongoing tonic firing. By contrast, after manual adjustment of membrane potentials to hyperpolarized levels, neuronal response to the same "excitatory" stimulus was a low threshold spike and superimposed burst firing, while responses to "inhibitory" stimuli paradoxically elicited excitatory rebound low threshold spikes and burst firing. These data support the existence of glutamatergic and GABAergic efferents from the suprachiasmatic nucleus to its target neurons. Additionally, in thalamic paraventricular nucleus neurons, responses to activation of their suprachiasmatic afferents may vary in accordance with their membrane potential-dependent intrinsic properties, a characteristic typical of thalamocortical neurons.

Animals↗

Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).

CONTEXT: Delirium is a common problem in the intensive care unit (ICU). Accurate diagnosis is limited by the difficulty of communicating with mechanically ventilated patients and by lack of a validated delirium instrument for use in the ICU. OBJECTIVES: To validate a delirium assessment instrument that uses standardized nonverbal assessments for mechanically ventilated patients and to determine the occurrence rate of delirium in such patients. DESIGN AND SETTING: Prospective cohort study testing the Confusion Assessment Method for ICU Patients (CAM-ICU) in the adult medical and coronary ICUs of a US university-based medical center. PARTICIPANTS: A total of 111 consecutive patients who were mechanically ventilated were enrolled from February 1, 2000, to July 15, 2000, of whom 96 (86.5%) were evaluable for the development of delirium and 15 (13.5%) were excluded because they remained comatose throughout the investigation. MAIN OUTCOME MEASURES: Occurrence rate of delirium and sensitivity, specificity, and interrater reliability of delirium assessments using the CAM-ICU, made daily by 2 critical care study nurses, compared with assessments by delirium experts using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: A total of 471 daily paired evaluations were completed. Compared with the reference standard for diagnosing delirium, 2 study nurses using the CAM-ICU had sensitivities of 100% and 93%, specificities of 98% and 100%, and high interrater reliability (kappa = 0.96; 95% confidence interval, 0.92-0.99). Interrater reliability measures across subgroup comparisons showed kappa values of 0.92 for those aged 65 years or older, 0.99 for those with suspected dementia, or 0.94 for those with Acute Physiology and Chronic Health Evaluation II scores at or above the median value of 23 (all P<.001). Comparing sensitivity and specificity between patient subgroups according to age, suspected dementia, or severity of illness showed no significant differences. The mean (SD) CAM-ICU administration time was 2 (1) minutes. Reference standard diagnoses of delirium, stupor, and coma occurred in 25.2%, 21.3%, and 28.5% of all observations, respectively. Delirium occurred in 80 (83.3%) patients during their ICU stay for a mean (SD) of 2.4 (1.6) days. Delirium was even present in 39.5% of alert or easily aroused patient observations by the reference standard and persisted in 10.4% of patients at hospital discharge. CONCLUSIONS: Delirium, a complication not currently monitored in the ICU setting, is extremely common in mechanically ventilated patients. The CAM-ICU appears to be rapid, valid, and reliable for diagnosing delirium in the ICU setting and may be a useful instrument for both clinical and research purposes.

APACHE↗

[Postoperative infection outbreak of M. chelonae subsp. abscessus].

OBJECTIVE: To study the pathogen of postoperative infection outbreak in a hospital in Shenzhen. METHODS: According to the Laboratory Science Procedure of Diagnostic Bacteriology in Tuberculosis published by Chinese Antituberculosis Association, Bergey's Manual of Determinative Bacteriology (ninth edition), and the Clinical Bacteriology Examination & Development, 97 wound exudates were cultivated by the traditional bacteriologic method. The strains were identified with three standard strains of M. chelonae subsp. chelonae, M. chelonae subsp. abscessus and M. fortuitum as controls. RESULTS: 26 fast-acid positive and fast growth nontuberculous mycobacterium were isolated from 97 exudates, then 41 strains including other 15 strains which were collected from the hospital were identified as M. chelonae subsp. abscessus. CONCLUSION: The outbreak of the postoperative infection happened in the hospital was caused by M. chelonae subsp. abscessus.

Adult↗

An appraisal of the DSM-III system.

DSM-III is a major document in the history of psychiatry. The DSM-III system is here seen as an instrument that promotes the scientific development of psychiatry and the clarity of communication among psychiatrists. However a major theme of this review is that reliability does not ensure validity. While making this point it is recognized that the major defects in the DSM-III system result from scientific inadequacies inherent in present day psychiatry. This review also may be taken as an amplification of the statement in DSM-III-R that it is not a textbook. In particular the data required to arrive at diagnoses in the DSM-III system do not provide sufficient information to arrive at a comprehensive biopsychosocial case formulation, a shortcoming that has relevance for teaching and clinical practice.

Diagnosis, Differential↗

AIDS education for primary school children in Tanzania: an evaluation study.

OBJECTIVE: To test the effects of an HIV/AIDS education program. DESIGN: A quasi-experimental, nested cross-sectional design including baseline and 6-month follow-up surveys. Schools, stratified according to location, were randomly assigned to intervention (n = 6) or comparison conditions (n = 12). SETTING: Public primary schools in Arusha and Kilimanjaro regions, Tanzania. PARTICIPANTS: A total of 2026 sixth and seventh grade pupils (average age, 14.0 years) participated at baseline (85%) and 1785 at follow-up. INTERVENTION: The program was designed to reduce children's risk of HIV infection and to improve their tolerance of and care for people with AIDS. Local teachers and health workers attended a 1-week training workshop before implementing the program over a 2-3-month period (averaging 20 school hours per class). MAIN OUTCOME MEASURES: Self-reported exposure to AIDS information, communication regarding AIDS; AIDS knowledge, attitudes towards people with AIDS, attitudes towards having sexual intercourse, subjective norms regarding sexual intercourse, and intention to engage in sexual intercourse. RESULTS: Following this program, intervention pupils reported significantly higher scores for the following outcome measures than pupils attending the comparison schools: AIDS information (13.1 versus 10.5; P = 0.0001), AIDS communication (10.9 versus 7.8; P = 0.0001) AIDS knowledge (14.5 versus 11.5; P = 0.0001), attitudes towards people with AIDS (9.0 versus 6.7; P = 0.0008), subjective norms (45.5 versus 43.9; P = 0.011), and intention (1.3 versus 1.4; P = 0.020). No program effect was seen for attitudes towards sexual intercourse (47.0 versus 46.3, P = 0.44). CONCLUSIONS: These results indicate that it is feasible and effective to provide AIDS education for Tanzanian primary school children.

Acquired Immunodeficiency Syndrome↗

Imitation and pantomime in high-functioning adolescents with autism spectrum disorders.

A study was designed to test 2 alternative hypotheses--a symbolic hypothesis and an executive function hypotheses--for the imitation and pantomime deficits found in previous studies of autism. The subjects were 17 adolescent high-functioning subjects with autism spectrum disorders and 15 clinical comparison subjects who were matched on chronological age and verbal IQ. Meaning and sequence were manipulated in facial and manual imitation tasks. Sequence was manipulated in the pantomime and control tasks. Recognition memory and motor control tasks were matched to the experimental tasks. The results provided no support for the symbolic deficit hypothesis; meaning aided rather than hindered the performance of the group with autism. Partial support for the executive deficit hypothesis was found. There were no group differences on motor control tasks, and few on the memory control tasks, arguing against deficits in motor initiation, basic motor coordination, or visual recognition memory.

Adolescent↗

Programmed learning in the microtraining paradigm with hotline workers.

Twenty-five hotline workers were randomly assigned to three skill-training conditions. Nine microtraining subjects were trained in the use of attending behavior, open inquiry, and reflection of feeling and content using the standard microtraining paradigm. Seven programmed-learning subjects were trained in the same skills using programmed manuals and role-play interviews with feedback. The remaining nine subjects acted as a no-training control group. Pretraining and post-training interviews and telephone calls with pseudoclients were audiotaped for each subject. Subjects were assessed on empathy, the Therapist Error Checklist, attending behavior, and three modes of skill interaction. For interviews the main effect of training on each measure was significant. Both microtraining and programmed learning resulted in superior interview performance over no-training, and differed little from each other. For telephone calls microtraining resulted in higher empathy ratings than progammed learning or no-training.

Adult↗

Psychiatric illness among the mentally retarded. A swedish population study.

Object--The aim of this investigation was in the first place to study the relation between mental retardation and other mental disturbances. The second aim was to study the frequency of severe and mild mental retardation in an adult Swedish population and to throw some light on the socio-medical situation of the adult mentally retarded. Methods--A primary sample, stratified with respect to population density, was extracted from the population in the age group 20-60 years, resident in Kopparberg County, Sweden, on 1 July 1977. The mildly and severely mentally retarded in this sample were identified. Enquiry was made into the presence of additional handicaps in the mentally retarded. Social conditions including alcohol consumption and the occurrence of abuse and criminality were studied in the two retarded groups and a control group representing the rest of the population. The three groups were compared by rating with the Comprehensive Psychopathological Rating Scale (CPRS), by classification of any mental illness present according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and by determining their intake of psychotropic drugs and anti-epileptics. The mildly mentally retarded and the control group were also compared with respect to neuroticism and extraversion-introversion by rating with the Eysenck Personality Inventory (EPI). Results--The study revealed a prevalence of 0.27% for severe (IQ less than 53) and 0.32% for mild (IQ 53-73.7) mental retardation in the age group 20-60 years. All the severely retarded, but only just over half the mildly retarded, were known to the care authority. The majority of the former were living in some form of institution, whereas this applied to only 15% of the mildly retarded. Nineteen per cent of the severely retarded and 4% of the mildly retarded had manifest epilepsy. Defects of movement and of hearing were most prominent among the mildly retarded, while the frequency of specific speech disturbances was greater among the severely retarded, approximately 10% of whom had no power of verbal communication. Visual defects were recorded in about one-third of both groups. The study showed that alcohol intake was lower among both the severely and mildly mentally retarded than among the persons in the control group and that the frequency of abuse and criminality was as high among persons of higher intelligence as among the mentally retarded. The severely retarded, particularly the men, showed a raised psychiatric morbidity as compared with the mildly retarded and the control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Developing evidence-based interdisciplinary care standards and implications for improving patient safety.

AIM: Establish an organizational infrastructure to foster the delivery of quality clinical care through the development of interdisciplinary patient care standards that are evidenced-based and consistent throughout IHC. DESIGN: Develop a process for document development, review, and approval that includes best evidence from research and input from clinical experts. RESULTS: After six years of development, the electronic reference InfoBase (a searchable online reference manual which provides easy access to standards for clinical practice throughout the organization) contains over 700 interdisciplinary patient care standards (e.g., protocols, procedures, standards of care) and over 1000 "information chunks" (e.g., assessments, instructions, scales, tables, graphics) that support consistency in care delivery. All documents have been written, based on the best evidence available from research and reviewed by a group of clinicians at IHC facilities and approved for use throughout the company. An example of how standardization of interdisciplinary standards can improve patient safety in the area of falls is also included.

Accidental Falls↗

Medication-assisted spinal manipulation.

BACKGROUND CONTEXT: The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local, epidural and intra-articular injections. PURPOSE: This report provides a review of the literature and presents a description of current clinical practice methods for the application of the different techniques of medication-assisted spinal manipulation therapy followed by a discussion of the current clinical support and the published indications, contraindications and complications for each of these procedures. STUDY DESIGN/SETTING: This technical report integrates a literature review with information gathered through personal interviews, review of medicine-assisted manipulation courses and observations of clinical procedures. METHODS: A PubMed search from 1966 to the present was performed to identify appropriate articles concerning the combination of spinal manipulation therapy with such medical procedures as the use of anesthetic, conscious sedation, local injection of analgesic, anti-inflammatory and proliferant agents and intra-articular injections. Additional articles and information were gathered through review of pertinent references, attendance of various technique specific seminars and communication with experts familiar with these procedures. RESULTS: Four categories of medication-assisted manipulation were identified: manipulation under general anesthesia or sedation, manipulation under epidural anesthesia with or without epidural steroid injection, manipulation under joint anesthesia/analgesia, and manipulation with injectants, such as steroids or proliferant agents. The literature consists primarily of case reports and case series with two randomized controlled trials and one cohort study. CONCLUSIONS: Medicine-assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years. However, evidence for the effectiveness of these protocols remains largely anecdotal, based on case series mimicking many other surgical and conservative approaches for the treatment of chronic pain syndromes of musculoskeletal origin. There is, however, sufficient theoretical basis and positive results from case series to warrant further controlled trials on these techniques.

Anesthesia, Epidural↗

Testing DSM-III symptom criteria for schizotypal and borderline personality disorders.

Schizotypal and borderline personality disorders (SPD and BPD, respectively) appear to be different at follow-up, yet they are poorly discriminated from each other by current DSM-III symptom criteria. In the Chestnut Lodge Follow-up Study, three axis II study cohorts (pure SPD, n = 10; pure BPD, n = 81; mixed SPD/BPD, n = 18) with distinctive outcomes are defined using current borderline systems. This study compares the relative frequency with which individual symptom criteria from each system discriminate across study cohorts. Findings suggest that for SPD, the most characteristic (core) DSM-III symptoms are odd communication, suspiciousness/paranoid ideation, and social isolation, while the least discriminating symptom is illusions/depersonalization/derealization; the core DSM-III symptoms for BPD are unstable relationships, impulsivity, and self-damaging acts, while the least discriminating symptoms are inappropriate anger and intolerance of aloneness; depression as a symptom does not discriminate between SPD and BPD; and transient psychoses and brief paranoid experiences and/or regression in treatment discriminate for SPD but against BPD and therefore fit better as SPD criteria. Results support the retention of some, but the elimination of other, DSM-III symptom criteria for the diagnosis of SPD and BPD.

Borderline Personality Disorder↗

Psychiatric diagnosis: some implications for mental health nursing care.

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.

Attitude of Health Personnel↗

[User's requests (from a practitioner's perspective)].

As a practitioner, I have to rely on outside clinical laboratories and affiliated hospitals to perform laboratory tests. In this abstract, I describe specific problems I have encountered with third-party laboratories, and propose solutions for these problems to optimize use of laboratory tests. BLOOD TESTS: The most frequent problem in ordering blood tests is the lack of detailed information regarding sampling conditions. I often have to call laboratories to check whether the sample should be serum or plasma, what volume is needed, whether the sample should be cooled, etc. I propose that clinical laboratories should provide practitioners' manuals that describe specific sampling information. ULTRASONOGRAPHY: Most laboratories do not keep the data from ultrasonographic tests. The lack of these is most problematic when test results are interpreted differently by laboratories and by practitioners. Retaining the data would also help private laboratories improve the quality of the test by enabling them to compare their interpretations with others'. ANNUAL MEDICAL SCREENING: Even if an abnormal finding is detected at medical screening clinics, the final diagnosis is usually not sent back to the screening facilities. This is highly recommended to establish an official system that mediates the feedback to screening centers. MRI: Due to miscommunication between practitioners and radiologists, the test is sometimes performed inappropriately. A thorough consultation should occur before the test to clarify specific goals for each patient. PATHOLOGICAL TESTS: Interpretation of results is often inconsistent among laboratories. Independent clinical laboratories tend to report results without indicating sample problems, while pathology departments at affiliated hospitals tend to emphasize sample problems instead of diagnosis or suggesting ways to improve sample quality. Mutual communication among laboratories would help standardize the quality of pathological tests.

Clinical Laboratory Techniques↗

CARREL: an internet platform for the distribution of human organs for transplantation.

BACKGROUND: Human organs for transplant from a deceased donor are presently distributed in Spain by means of manual handling and telephone or fax transmission of data. This procedure is conducted organ by organ with the information transmitted sequentially. This process has several inherent drawbacks, the main one being the long length of time to allocate organs on many occasions. A difficulty of this type could be solved by means of an electronic system of data management and transmission through the Internet. CARREL is a platform that could provide an alternative organ distribution procedure. The main objective of CARREL was to increase the efficiency, safety, rapidity, and quality of organ distribution for transplantation, thereby helping the allocation process. MATERIALS AND METHODS: CARREL is a database system, accessible through the Internet, to which any medical center authorized to perform organ transplants in Spain may subscribe. CARREL allows information share between centers, including administrative, anthropometric, immunological, analytical, and clinical data, as well as parameters concerning donor maintenance. CONCLUSIONS: CARREL is an online system that can reduce organ distribution time, directly store complete information concerning the donor, and also share data between centers. It facilitates communication between transplant coordinators at different centers, thereby improving and hastening candidate selection.

Databases, Factual↗

Wound measurement comparing the use of acetate tracings and Visitrak digital planimetry.

AIMS: This study aimed to compare acetate tracing with the new digital planimetry system Visitrak (Smith + Nephew). It also aimed to compare the percentage change in wound size after four weeks using both methods. BACKGROUND: There is a need for development and more widespread use of objective tools in wound management. Wound measurement is an integral part of wound assessment and provides possibly the most objective tool available. To achieve this, practitioners use a variety of methods including acetate tracing and digital planimetry. Studies have demonstrated good inter- and intrarater reliability using both methods. METHODS: A retrospective, random selection of wound tracings of superficial leg ulcers was completed until 25 tracings of <10 cm2 and 25 tracings of >10 cm2 were obtained. Wound area was calculated firstly by manually counting squares completely within the wound border and those half or more within the border as 1 cm2. The area was then calculated using the Visitrak system. RESULTS: The difference between the acetate and Visitrak for wounds <10 cm2 not significant (P = 0.330). For wounds >10 cm2 the difference between both methods was significant (P = 0.008). After four weeks the number of tracings available was too small for any conclusions to be made. CONCLUSION: Wound measurement should become part of routine practice. Acetate offers a good indicator of wound size and digital planimetry can enhance the precision of the measurement. RELEVANCE TO CLINICAL PRACTICE: Accurate and objective wound measurement is a vital component of wound management. It is essential that nurses have adequate training and skills in wound measuring to assess wounds correctly and objectively. Findings from this study can be used when deciding which method should be used in a particular setting when outcomes and cost have been considered. Accurate on-going wound measuring contributes to improved quality of patient care, more effective communication between professionals, as a predictor to wound healing, to document progress and assess treatment efficacy.

Body Weights and Measures↗