In a regional Health District with a population of 198,900, 357 patients with 424 ulcerated legs were documented, an overall prevalence of 0.18 per cent. The prevalence of ulceration in the 92,100 aged greater than 40 years was 0.38 per cent. Fifty per cent of the lesions had been present for more than one year, and 62 per cent of patients had never attended any hospital. The patients were stratified by history of peripheral arterial disease. A random sample (100 patients, 193 legs) was examined by ultrasound and photoplethysmography to assess the venous and arterial circulation; 38 per cent had evidence of deep vein involvement and 43 per cent had superficial vein incompetence. An ischaemic element was present either in isolation (9 per cent) or combined with venous disease (22 per cent) in a total of 31 per cent, with a mean pressure index of 0.62 (s.d. 0.14). Simple objective methods of assessment together with dedicated community staff with ready access to specialized facilities can enhance the service provided to patients with leg ulcers.

Objective-To evaluate the prognostic factors in uncomplicated venous leg ulcer healing.Design-Randomised parallel group controlled trial with subjects stratified by initial ulcer diameter and four months' maximum duration offollow up.Setting

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SummaryA total of 333 patients with stable intermittent claudication at recruitment were followed up for 6 years to determine risk factors associated with subsequent mortality. Cardiovascular diseases were the underlying cause of death in 78% of the 114 patients who died. The strongest independent predictor of death during the follow-up period was the plasma fibrinogen level, an increase of 1 g/l being associated with a nearly two-fold increase in the probability of death within the next 6 years. Age, low ankle/brachial pressure index and a past history of myocardial infarction also increased the probability of death during the study period. The plasma fibrinogen level is a valuable index of those patients with stable intermittent claudication at high risk of early mortality. The results also provide further evidence for the involvement of fibrinogen in the pathogenesis of arterial disease.

Background: This study was carried out to determine the extent and characteristics of bedside ultrasound teaching in medical schools across Canada.Methods: A cross-sectional, survey-based study was used to assess undergraduate bedside ultrasound education in the 17 accredited medical schools in Canada. The survey, consisting of 19 questions was pilot-tested, web-based, and completed over a period of seven months in 2014.Results:  Approximately half of the 13 responding medical schools had integrated bedside ultrasound teaching into their undergraduate curriculum. The most common trends in undergraduate ultrasound teaching related to duration (1-5 hours/year in 50% of schools), format (practical and theoretical in 67% of schools), and logistics (1:4 instructor to student ratio in 67% of schools). The majority of responding vice-deans indicated that bedside ultrasound education should be integrated into the medical school curriculum (77%), and cited a lack of ultrasound machines and infrastructure as barriers to integration.Conclusions: This study documents the current characteristics of undergraduate ultrasound education in Canada.