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Drink a green drink daily to set the proper pH in the gastro-intestinal tract. Eat more fermented soy foods daily with a sea vegetable. Eliminate all sources of caffeine. Avoid sugary, sweet and salty foods. Eat more protein at each and every meal. Eat only organic vegetables, fruits and animal products, which are free of hormones and drugs. Use supplemental diindolylmethane (DIM), an extract from cruciferous vegetables, daily to balance mood-related hormones. Use an herbal formula specifically for PMS daily.
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1. In your own user account, start Windows Media Player. 2. Click the button under Library and click Media Sharing. 3. Select (check) Share my media and click OK to extend the Media Sharing dialog box as in Figure 53.6.
A variety of wound management products can be used when treating pressure ulcers. The range of wound management products available is discussed in 4. At present, there is insuf cient evidence to determine which dressing is the most appropriate for each grade of pressure ulcer (Bradley et al., 1999). It is, of course, entirely possible that such prescriptive wound care would never be appropriate and that a range of products is needed in order to address individual situations. Many of the studies compare two products and nd little or no difference in performance. This may be because there truly is no difference or because the sample size is too small to detect any differences. Some examples of clinical trials are given below. Colin et al. (1997) compared a lm dressing with a thin hydrocolloid dressing for the management of grade 1 and 2 pressure ulcers (n = 40). They found no difference in healing rates but there was a signi cantly greater reduction in wound size in the lm group compared to the thin hydrocolloid group. Teot et al. (1998a) compared two thin hydrocolloids on grade 1 and 2 pressure ulcers and found no differences in outcome (n = 41). Both lm and thin hydrocolloid dressings would seem to be suitable for this grade of ulcer. Several studies have considered appropriate products for grade 2 4 pressure ulcers. Teot et al. (1998b) compared a hydro bre dressing with a traditional tulle dressing (n = 62). The hydro bre dressing produced a better healing rate and a greater reduction in wound size. However, these results were not signi cant. Sopata (1997) compared a gel dressing with an adhesive foam dressing and found no differences in performance between the two (n = 34). Seeley et al. (1998) found no difference in healing rates in a comparison of a hydrocolloid and an adhesive hydrocellular foam dressing (n = 40). A similar study in the UK of the same dressings produced the same results (n = 61) (Bale et al., 1997). However, the researchers found a high drop-out rate (26%), unrelated to the dressings, mainly due to patient discharge or death. They proposed that future study designs should include larger patient numbers. Thomas et al. (1997) com-
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Dealey (1997) cited a number of external factors that can exacerbate the factors discussed above. They include: inappropriate positioning, which may increase pressure or shear. restrictions to movement, such as lying for long periods on a trolley. lying for long periods in one position on hard surfaces, such as the X-ray table. poor lifting and handling techniques which increase the risk of friction and shear. poor hygiene that leaves the skin surface moist from urine, faeces or sweat. drugs such as sedatives that make the patient drowsy and less likely to move.
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