The QUATTRO ACUTE mattress and pressure ulcer prevention

There are a plethora of mattresses on the market and nurses are not always sure which mattress to select for each individual patient. This article outlines the issues in preventing and understanding pressure ulcers and the performance of the QUATTRO ACUTE trade mark mattress, manufactured by Talley Medical.     

The Pentaflex pressure-reducing mattress replacement

Support surfaces play a crucial role in pressure sore prevention. This article outlines the use of polyurethane foam as a versatile and effective support surface. It briefly describes a number of tests which are used to determine foam quality and summarizes the characteristics and clinical evidence supporting the use of the Pentaflex pressure-reducing foam mattress.     

The Theracute alternating pressure replacement mattress

The use of alternating pressure mattresses is still acknowledged as an effective adjunct in the prevention and treatment of pressure damage; however, with the plethora of equipment now available, there is an increasing need to provide information that supports the practitioners' decisions ensuring individual patients' clinical needs are met. This article reviews a new addition to the Talley Medical range of alternating pressure mattresses, the Theracute mattress replacement system.     

气悬浮过床垫的设计及应用

目的 设计气悬浮过床垫,探讨其在患者搬运中的应用效果。方法 采用便利抽样法,选取33例卧床患者,每例患者分别在3次搬运中采用气悬浮过床垫、滑板、床单搬运。比较气悬浮过床垫在搬运前后,患者生命体征的变化,比较不同搬运工具的搬运时间、搬运拉力、清醒患者满意度以及搬运护士满意度。结果 使用气悬浮过床垫搬运前后,患者生命体征的比较,差异无统计学意义（P>0.05）;气悬浮过床垫搬运组与滑板搬运组搬运时间的比较,差异无统计学意义（P=0.859）;气悬浮过床垫搬运组的搬运拉力为（87.32 ± 24.40）N ,滑板搬运组为（151.02 ± 40.57）N,两组相比,差异有统计学意义（P＜0.001）;采用气悬浮过床垫搬运,患者和搬运护士满意度得分均高于其他两组,差异有统计学意义（P<0.001）。结论 使用气悬浮过床垫搬运患者更安全、舒适,搬运不增加耗时,轻松省力。     

SimCair: a simple mattress system to support pressure ulcer prevention

Assessing skin is a simple method of reducing pressure ulcer occurrence and is easily accomplished by both trained and untrained staff. The important issue, once the risk has been identified, is to supply equipment in the shortest time possible. A new mattress, SimCair, developed by Hill-Rom Ltd, is designed for just such a reason. It is a lightweight overlay that combines air and viscoelastic foam in order to redistribute the body weight and thus reduce risk. SimCair is easily transported and can be ready for instant and automatic inflation as soon as it is required. It is also durable and simple to clean between patients. A small evaluation was undertaken in one nursing home to assess the benefits to the residents.     

The mattress sutures: vertical,horizontal, and corner stitch

The interrupted vertical and horizontal mattress suture techniques are two of the most commonly used skin closure methods. These mattress sutures promote wound edge eversion and less prominent scarring. Vertical and horizontal mattress sutures allow for skin edges to be closed under tension when wound edges have to be brought together over a distance. The corner stitch, a variation of the horizontal mattress suture, is commonly used for closure of angled skin flaps or wounds. Although mattress sutures can produce surface scarring or "railroad marks," early removal of these sutures can limit this damage.     

心脏机械瓣膜置换术后抗凝治疗的护理新进展

随着现代医学的不断发展，心脏机械瓣膜置换手术已普遍开展，术后抗凝治疗不当所致的出血与栓塞等并发症直接影响手术的成功率。而加强术后抗凝治疗的护理成了防止术后抗凝不当所致的出血和血栓的并发症的重要环节。术后正确采集PT标本，掌握食物、药物及其他疾病对抗凝效果的影响，有效的健康教育，规范住院期间抗凝治疗的护理，科学的出院抗凝治疗指导等已成为减少此类并发症的有效措施。     

Transair Paediatric Mattress replacement system evaluation

While a plethora of pressure-relieving and reducing equipment is available to nurses for the prevention and treatment of pressure ulcers, very little of it is specifically designed or appropriate for paediatric patients. The limited choice that does exist concentrates on neonates or babies, which is problematic for the nurse dealing with the older child. Children may be at increased risk of developing pressure injury as a result of the forces of friction, shearing and pressure that results from being nursed on a support system designed for the adult patient. This gap in service provision may cause dilemmas for the nurse who has a duty to 'cause no harm' (UKCC, 1992) in his/her attempt to protect and treat a child. This article introduces a new product available from Karomed (a division of the Verna Group) that has been specifically designed with the child in mind.     

Air mattress sensor system with balancing tube for unconstrained measurement of respiration and heart beat movements

The cardio-respiratory signal is a fundamental vital sign used for assessment of a patient's status. Additionally, the cardio-respiratory signal provides a great deal of information to healthcare providers wishing to monitor healthy individuals. The air mattress sensor system allows the measurement of the respiration and heart beat movements without the use of a harness or sensor on the subject's body, which eliminates the difficulties these pose for long term measurements. In order to increase the sensitivity, a differential measurement technique between two air cells was used. The concept of a balancing tube between two air cells is suggested in order to increase the robustness against postural changes during the measurements. With this balancing tube, the meaningful frequency range could be selected using a pneumatic method. A mathematical model was constructed and validation experiments were performed for step and sinusoidal input signals. This technique was applied to measurements of respiration and heart beat movements in the supine posture on the bed, which showed potential for applications in sleep analysis, unconstrained healthcare monitoring and neonate monitoring.     

The case for hormone replacement: new studies that should inform the debate

The Women's Health Initiative found that the risks of hormone replacement therapy (HRT) exceeded its benefits in a large group of older postmenopausal women, but did not consider the efficacy of HRT in relieving vasomotor symptoms. Another recent study found that low-dose HRT was as effective as standard-dose HRT while causing fewer side effects. Smaller studies suggest that HRT may improve depression. HRT is not to be used for cardiovascular risk reduction. Genetic testing may point the way to more rational use of HRT.     

呼吸机管路及湿化装置更换周期的研究

目的：探讨有创机械通气条件下呼吸机管路及湿化装置合理的更换周期。方法：将11例呼吸衰竭行机械通气患者随机分为3天组、4天组和5天组,3组分别于机械通气开始后3、4、5天采集呼吸机管路吸气段、呼气段、螺纹管、吸气段及呼气段冷凝器、湿化罐6个部位标本,并进行细菌学检测。结果：呼吸机管路、冷凝器连续使用5天更换细菌阳性率明显高于3天、4天更换;呼吸机管路中螺纹管带菌率高于吸气段、呼气段;3组湿化罐细菌检测均未有细菌;患者APACHEⅡ评分、意识、咳嗽反射强弱与管路带菌率的关系,不同组、咳嗽反射强弱与管路带菌率有相关性。结论：通过3组患者的观察,认为呼吸机管路合理的更换时间为连续使用第5天更换。     

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury

Purpose. To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention.

Method. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis.

Results. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositionings, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositionings, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs.

Conclusions. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.     

The TAFI system. The new role of fibrinolysis

The primary focus of the blood coagulation system is the prevention of blood loss. The system is regulated by various inhibitors, and by the fibrinolytic system, which removes the final product of the blood coagulation system, the fibrin clot. The fibrinolytic system is activated in the course of coagulation activation. The thrombin-activated fibrinolysis inhibitor (TAFI) is an important regulator of fibrinolysis. TAFI is activated by thrombin, and activation is enhanced in the presence of thrombomodulin. TAFIa, the product of TAFI activation, removes lysine residues from fibrin, which are essential for the binding of t-PA, plasminogen, and plasmin to fibrin. The fibrin loses its cofactor activity in t-PA-induced plasminogen activation, resulting in less plasmin, and the remaining plasmin finds less binding sites on fibrin, resulting in an increased resistance of the clot towards plasmin proteolysis. High concentrations of thrombin result in high TAFIa-activity and consequently in highly resistant fibrin clots. Patients with hyperprothrombinaemia consequently display elevated TAFIa-levels, which may contribute to the risk for thrombosis. Treatment with recombinant factor VIIa also leads to high concentrations of thrombin, resulting in fibrin clots with enhanced resistance towards fibrinolysis. At low thrombin concentration, as observed in patients with bleeding disorders or patients treated with anticoagulant drugs, less TAFIa is produced in the course of coagulation activation, and the clots are less resistant towards fibrinolysis. TAFIa-inhibitors are currently being developed for the treatment of throboembolic disorders or hypofibrinolytic DIC. Enhancement of TAFIa-activity may be helpful in patients with bleeding.     

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury

Purpose. To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention.

Method. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis.

Results. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositionings, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositionings, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs.

Conclusions. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.