Conventional transcutaneous electrical nerve stimulation was applied to 114 patients diagnosed as having peripheral neuropathy (N = 18), peripheral nerve injury (N = 21), radiculopathy (N = 36) and musculoskeletal disorders (N = 39) to determine optimal electrode placements and stimulation parameters for pain relief. Treatment outcomes were assessed primarily through evaluation of the present pain intensity (PPI) rating scale, Immediate improvements in PPI scores occurred in patients in all these diagnostic categories. One month follow-up data on 25 subjects showed that improvement was of limited duration. No clear correlation between stimulation parameters or electrode placements and pain relief was ascertained. In certain instances (subjects with radiculopathy or peripheral nerve injury) a positive relationship existed between higher intensity stimulation and amelioration of pain. Greater pain relief was reported among patients with minimal previous medical or surgical treatment in every diagnostic group.

Numerous publications devoted to the topic of transcutaneous electrical nerve stimulation (TENS) have appeared since the presentation of a special issue of Physical Therapy (December, 1978). This update article addresses contemporary information on efficacy, mode of application, treatment outcomes, and neurophysiological mechanisms relevant to this modality. Investigators have become far more specific when presenting this information in the current literature on treating acute pain conditions with TENS than they were in the literature for the 1978 special issue. Improvement has been made in providing specific details to enable replication of TENS stimulating characteristics among patients with chronic pain; yet several clinical researchers still fail to evaluate treatment outcomes adequately. Perhaps the greatest advances in our understanding of TENS involve the recent development of mechanisms that might account for how different types of TENS work. Suggestions for predicting patient responses to TENS and for avenues of future inquiry are offered.

The Health Care Team Challenge TM (HCTC) is an innovative, versatile, low cost interprofessional (IP) learning activity that is used to simulate "real-life" team based problem solving. The HCTC model can easily be adapted to meet core competencies for collaborative care in all health professions programs. Key characteristics of a HCTC are described and one example of how the HCTC model has been successfully implemented is highlighted. The HCTC is a clinical cased-based competition between two or more interprofessional teams of students representing at least two health and social service disciplines (6-8 is ideal). Student participants receive the initial patient scenario at least one week, preferably 2 to 3 weeks, in advance of the live event. Teams are instructed to work collaboratively to formulate a patient-centered plan of care. On the day of the event, the teams present their plan in front of a live audience of faculty, peers and community members. Then, teams are presented with additional information relevant to the case, challenging each team to adjust its management plan to incorporate the new information. Additionally, teams are asked to respond to "process questions" such as, "How did your team resolve conflicts?" and "What do you view as the strengths of your team?" Teams alternate in the presentation of the care plans and responses to team process questions. At the conclusion of the event, teams are evaluated by an IP panel of judges that may include the patient or family member, faculty, and / or a practicing community-based interprofessional care team. An "audience choice award" may also be presented. Teams are judged on both the quality of the management plan and the level of collaboration as illustrated by responses to the team process questions. All team participants, judges, and event sponsors receive recognition for their involvement. Winning team members may also receive prizes or scholarship funding.

No abstract

The purpose of this article is to describe a multifaceted approach to wound care in an outpatient setting for a patient with an infected, nonhealing surgical wound with hypergranulation tissue following fasciotomy for acute compartment syndrome. A 44-year-old male underwent an anterior and lateral lower extremity compartment fasciotomy and developed a persistent right anterolateral lower leg wound. Thirty-six days after fasciotomy he came to the authors' clinic after 2 failed skin grafts with an infected wound covered in hypergranulation tissue. Treatment included sharp debridement, saline irrigation, patient education, and dressing changes during 9 treatment sessions. The patient's total wound surface area decreased from 5.2 cm x 17.3 cm to 4 cm x 15 cm with increased epithelialization from approximately 40% to 85% after 29 days of treatment. This article demonstrates the positive effect of a multifaceted approach for facilitation of wound healing in a lower extremity wound following fasciotomy.