The object of this study was to develop a method to assess the accuracy of an image-free total knee replacement navigation system in legs with normal or abnormal mechanical axes. A phantom leg was constructed with simulated hip and knee joints and provided a means to locate the centre of the ankle joint. Additional joints located at the midshaft of the tibia and femur allowed deformation in the flexion/extension, varus/valgus and rotational planes. Using a digital caliper unit to measure the coordinates precisely, a software program was developed to convert these local coordinates into a determination of actual leg alignment. At specific points in the procedure, information was compared between the digital caliper measurements and the image-free navigation system. Repeated serial measurements were undertaken. In the setting of normal alignment the mean error of the system was within 0.5 degrees . In the setting of abnormal plane alignment in both the femur and the tibia, the error was within 1 degrees . This is the first study designed to assess the accuracy of a clinically-validated navigation system. It demonstrates in vitro accuracy of the image-free navigation system in both normal and abnormal leg alignment settings.

Objective: To evaluate health-related quality of life (HRQoL) in a prospective randomized trial of patients suffering from venous ulceration comparing a generic four-layer elastic bandage (4LB) with a new cohesive short stretch bandage system (CSSB). Methods: Randomized prospective open parallel groups trial in community leg ulcer clinics within twelve trusts in England and Northern Ireland. Patients newly presenting for treatment suffering from chronic venous ulceration, with ankle brachial pressure index (ABPI) >0.8 were entered into the trial. Patients were asked to complete the Nottingham Health Profile (NHP) at entry, at end of trial period (withdrawal or healing), and at 24 weeks. Principal analysis was the comparison of final NHP scores using linear regression with baseline scores entered as a covariate. Results: In all, 154 of the 156 patients who entered the trial completed the initial questionnaire, with 139/154 (90.2%) patients completing at least one follow-up questionnaire. Improvements were noted for all scores after 24 weeks. The improvements were significantly greater in the 114 patients whose ulcers had healed compared with the 40 whose ulcers remained open in the domains of bodily pain (mean difference [d]=13.2, 95% CI 3.6-22.9, P =0.008), emotional reactions (d=10.5, 95% CI 2.8-18.1, P =0.007) and social isolation (d=8.5, 95% CI 1.2-15.9, P =0.024). There were similar mean scores between the 72 patients treated with the 4LB and the 82 patients treated with CSSB for all domains of the NHP, the largest adjusted difference favoured CSSB for energy (d=3.6, 95% CI-4.3-11.4, P =0.37). Conclusions: Patients suffering from leg ulceration show improvements in perceived health following effective ulcer management. The two bandage systems achieved similar improvements in perceived health over 24 weeks.

This article is in two parts. The overall aim is to review the literature relating to the management of pilonidal sinus disease and to explore the impact the disease has on those who suffer with it, predominantly young people. Part one reviews the literature and provides the rationale for the study design. Part two will detail the study and outline implications for practice. In addition to stimulating debate of the pathophysiology of pilonidal sinus disease and its surgical management, most importantly, this study is designed to increase understanding of the impact the disease has on young people and the professional lessons that can be learned to support those who live with it over many months and sometimes years.

Part two of this paper outlines a qualitative study, in which a Heideggarian hermeneutic phenomenological approach was used to answer the question, 'What is it like to live with chronic pilonidal disease?' A review of the condition and the background to this study, including the rationale for the research approach, are presented in part one of this article.

Over the years, graduated compression stockings exerting varying ankle pressures have been used with differing degrees of effectiveness in the prevention of deep venous thrombosis and ulcer recurrence, and the treatment of venous ulceration (Stemmer et al, 1980; Partsch and Horakova, 1994; Veraart et al, 1997). Whether in the hospital or community setting, nurses often have the responsibility of measuring the limb and fitting the compression stocking on the patient and it is he/she who often influences the patient on the type of stocking and level of compression required. Understanding the influence of graduated compression on the venous haemodynamics of the lower limb and having a good working knowledge of the claims of the manufacturers as to expected levels of compression from each garment will aid the nurse and patient in decision making. An awareness of the hazards of inappropriate use of compression therapy should ensure that the nurse is a safe practitioner.