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Biomedical subjects

R Nieveen

Publications and source records attributed to R Nieveen.

2 recordsLinked to original sources

Water activity limbs.

With advances in technology there is an increasing availability of Water Activity Limbs (WALs) and subsequently a greater number of requests for their provision. This study aims to establish a national consensus for indications, recommended best practice and procedures. The study was conducted with 2 rounds of questionnaires sent to 40 doctors, prosthetists and therapists each. The first questionnaire had a list of possible tasks requiring a WAL and respondents were asked to record their personal rating for prescription of each of the indications. Following analysis of the 91 responses, a list of indications, guidelines and procedures was sent to the same 120 respondents, enquiring whether they agreed or disagreed to each recommendation. The tasks orientated questionnaire showed that more than 50% of respondents considered occupation as an absolute indication. Other indications were some specific water sports. Occasional swimming and beach activity were only considered as possible indications. Showering was not considered an indication. The second questionnaire showed an overwhelming agreement to most of the procedures and indications recommended except social reasons for leisure. The authors present recommendations for prescription of WALs as guidelines and procedures based on the national consensus amongst peers. They also recommend a process for establishing evidence in a speciality where there is very little published evidence to recommend best practice.

Amputees↗

ICEROSS--a consensus view: a questionnaire survey of the use of ICEROSS in the United Kingdom.

The management of the individual with a trans-tibial amputation has been strongly influence by the increasing use of the ICEROSS socket system over recent years. Despite this growth in clinical experience, there has been very little research into its place in current prosthetic practice, and prescribing activity is largely determined by personal experience. In order to formulate the current consensus view on the use of ICEROSS, questionnaire were sent to 42 doctors and 43 senior prosthetists around the UK. The influence of 38 different factors on prescribing activity was assessed using a grading system (ranging from "primary indication" to "absolute contraindication"). An 85% response rate was achieved and no significant differences in response between the two professional groups were identified. Those factors considered by most to be positive indications for using ICEROSS were "pistoning", "shear-sensitive skin/split-skin grafts", "patient unsuccessful with supracondylar (s/c) or cuff suspension" and "insufficient suspension due to change in type or level of activity". Those considered by most to be absolute contra-indications were "ulceration/unhealed scars", "poor patient hygiene" and "poor commitment to prosthetic rehabilitation". This consensus of opinion is in keeping with the results of the few published adults of ICEROSS usage. There was a lack of consensus, however, about the use of ICEROSS in some situations, including skin complications. Whilst some consensus does exist about the use of ICEROSS, the results of this survey indicate significant variations in clinical practice with serve to illustrate the urgent need for data from prospective clinical trials.

Adult↗