A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.

Three hospital emergency rooms (ERs) routinely referred all cases of cellulitis requiring outpatient intravenous antibiotics, to a central ER-staffed cellulitis clinic. We performed a retrospective cohort study of all patients seen by the ER clinic in the last 4months preceding a policy change (ER management cohort [ERMC]) (n=149) and all those seen in the first 3months of a new policy of automatic referral to an infectious disease (ID) specialist-supervised cellulitis clinic (ID management cohort [IDMC]) (n=136). Fifty-four (40%) of 136 patients in the IDMC were given an alternative diagnosis (noncellulitis), compared to 16 (11%) of 149 in the ERMC (P<0.0001). Logistic regression-demonstrated rates of disease recurrence were lower in the IDMC than the ERMC (hazard ratio [HR], 0.06; P=0.003), as were rates of hospitalization (HR, 0.11; P=0.01). There was no significant difference in mortality. Automatic ID consultation for cellulitis was beneficial in differentiating mimickers from true cellulitis, reducing recurrence, and preventing hospital admissions.

Background:The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship.

The outline can be used as a descriptive and prescriptive guide for the teacher in determining the child's lowest levels of consistently successful functioning so that language-learning at the higher levels can be reinforced. Since this is a process approach f it is not dependent upon any particular content area and can be adapted for use in any language-learning situation. The Language-Learning Outline describes seven variables of language-learning processes: (A) Relations between self and environment,Sensory channel for communication, (C) The abstraction process, (D) The size and extent of the unit, (E) The symbolic form of the unit, (F) Movement in space, and (G) Memory. Relationships between the various process categories are arbitrary and depend upon situational variables. Within each category there are three levels, ranging from infant development to full language maturity.A teacher who is attempting to help children with language and learning difficulties can choose from a wide variety of methods which fall roughly into two classes: those which tell the teacher what to do, and those which tell the teacher what the child is doing. These are the content approach and the descriptive approach respectively. The content approach gives suggestions for helping the child perform successfully in specific content areas such as reading, writing, spelling, mathematics. The descriptive approach helps the teacher locate gaps in 28 various areas of the child's development, but it does not tell him what to do about them. The present outline represents a process approach to children's language-learning difficulties. It both describes what the child is doing and tellsthe teacher what to do. The processes described in the outline are not those which will help the child master a particular content area directly. Rather, they are processes which help the child "learn how to learn" so he will be prepared to master any content area once he has mastered the processes which underly it. For example, in mathematics, addition is a content area -not a process. When verbal units are added together and transformed in various ways, this is called grammar. Some of the same processes are involved in both mathematical and grammatical content; one of these is the process of sequencing units into a pattern.The Language-Learning Outline consists of a parallel arrangement of interacting process areas. Within each of these categories there is a hierarchy of three process levels representing early infant development at the lowest level and full language maturity at the highest level. The categories represent some of the important variables involved in the processing of information. The arrangement of these variables in this outline is not hierarchical but arbitrary, and depends upon the variables of the particular situation or learning task in which the child and teacher are involved.