ProfiCare: an alternating pressure-relieving mattress

Risk assessment tools should only act as a guide to patient status rather than definitive diagnosis. Emphasis must be placed on not using the Waterlow score in isolation but in conjunction with clinical judgement. We must therefore attempt to minimize opportunities for disagreement over pressure ulcer risk scores through the selection of appropriate support surfaces based on a thorough consideration of costs of pressure ulcers for the patients, institutions and healthcare professionals. This product focus advocates that ProfiCare replacement mattresses are an option as they are designed for use on a hospital bed frame and provide alternating and static patient support surfaces.     

Transfoam Visco: evaluation of a viscoelastic foam mattress

It is both a massive financial commitment and a huge financial decision to standardize mattresses in a large trust. It should only be undertaken after evaluation of the evidence of efficacy supplied by relevant companies, together with independent research and reports by healthcare professionals. In addition, evaluation of the equipment should be made by back care advisers, from a user-safety viewpoint and physiotherapists, occupational therapists concerning rehabilitation. Ward-based nurses and patients need to assess equipment for comfort, ease of repositioning individual, and ability to relieve pressure. This article outlines the process by which a static mattress was evaluated for ease of movement, pressure relief and comfort by patients and healthcare professionals. The possible longevity of the mattress was considered as secondary relevance; however, cost-effectiveness and quality of product are essential in today's acute healthcare setting.     

A clinical evaluation of the Transfoam mattress after 4 years

It is recognized that pressure-reducing foam mattresses can be of benefit in the prevention of pressure sores but it is also recognized that more information is required to demonstrate their long-term efficacy (Cullum et al, 1995). It is therefore necessary to evaluate the pressure-reducing capabilities of this type of mattress some years after purchase to evaluate if in fact it can maintain its initial level of performance. This article presents the results of one such study carried out 4 years after the purchase of Transfoam mattresses.     

Development and evaluation of an air mattress structure and function for reducing discomfort when elevating the head-of-bed

Purpose: To develop a new structure and function of alternating pressure air mattress (APAM) which reduces discomfort during head-of-bed (HOB) elevation and evaluate the effectiveness.

Method: An observational study (Study 1) and randomized crossover experiment (Study 2) were conducted in healthy adult volunteers. External force (interface pressure and shear force), body shift, discomfort (pushing feeling and pulling feeling) and HOB elevation angle were measured in Study 1. We developed a new APAM according to these findings. Study 2 compared the external force and discomfort of the new APAM with a control APAM. The magnitude of the discomfort was measured by visual analogue scale. Results: Study 1 clarified that the external force and discomfort during HOB elevation are positively correlated, and that discomfort can be reduced by decreasing the external force. Thus, we designed an APAM with a low friction layer and a novel mattress air-cell pressure control function to reduce the external force. Study 2 confirmed that the external force and discomfort were significantly decreased in the developed APAM. Conclusions: In this study, we developed a new APAM to reduce discomfort during HOB elevation and confirmed its effectiveness.

• Implications for Rehabilitation

• A positive correlation exists between the external force and the discomfort that arises during head-of-bed (HOB) elevation, and a mattress could be developed to reduce the discomfort by decreasing the external force.

• A new alternating pressure air mattress (APAM) with a low friction layer structure and novel control of mattress air-cell pressure that responds to HOB elevation angle can reduce discomfort during HOB elevation.

• This new APAM should allow more comfortable rehabilitation in bed-bound patients with mobility impairments.

     

Development and evaluation of an electronic drug and therapeutics bulletin

OBJECTIVE: To describe the development, implementation, and initial evaluation of a paperless drug and therapeutics bulletin that is distributed by electronic mail from the pharmacy department of an Australian teaching hospital. OUTCOMES: A standardized format for the bulletin was designed and approved in February 2001. The aim of the bulletin is to facilitate the timely dissemination of concise, factual information about issues of current interest in therapeutics, drug safety, and the cost-effective use of medicines. A simple and attractive graphic design was chosen, and the hospital's clinical pharmacists and drug information staff developed an initial bank of content during the period immediately preceding the launch. The bulletin is presented as a 1-page, read-only file in Word for Windows format and was initially distributed by electronic mail to all users of the hospital's computerized communication network. As the popularity of the bulletin increased, healthcare practitioners from outside of the hospital began to request permission for inclusion on the circulation list, and the content was frequently forwarded by E-mail to workers in other hospitals and community-based settings. The bulletin is now distributed to pharmacists around Australia via 2 separate moderated discussion lists, one of which provides an archive site for previous editions. Healthcare workers in Singapore, the US, Canada, and New Zealand also receive the bulletin, which is now also abstracted by a major Australian pharmacy journal. A readership survey (also electronically distributed) was used to seek feedback after the publication of the first 12 editions. Readers indicated a high level of satisfaction with the content, format, and frequency of distribution of the materials. CONCLUSIONS: Although the concept and execution of this project was relatively simple, an extensive literature review did not reveal any previously published reports describing this type of approach to the distribution of a pharmacy bulletin. The development and implementation of the electronic drug and therapeutics bulletin has provided an opportunity to use modern communication technology to promote safe and effective medication use and appears to have been well received.     

Clinical evaluation of an automated turning bed

PURPOSE: The purposes of this study were to assess client comfort and sleep quality, client physiologic response (skin and respiratory status), the effect on the need for caregiver assistance, and cost when using an automated turning bed. DESIGN: Nonexperimental, evaluative study. SAMPLE: Twenty-four adult home or long-term care resident subjects who had a degenerative disease, spinal cord injury, stroke, cerebral palsy, or back surgery. METHODS: Each subject agreed to use the automated turning bed for four weeks. Researchers completed a demographic survey and skin assessment, and assessed each subject for pressure ulcer risk and for the need of assistance of a care giver for turning before and after the four weeks of using the turning bed. Subjects rated the turning bed in terms of comfort and sleep quality. FINDINGS: Subjects rated the turning bed as more comfortable than their own bed and expressed satisfaction at the pain relief attained when on the turning bed. While using the turning bed, there was a significant improvement in sleep quality. No skin breakdown or deterioration in respiratory status occurred. Fewer subjects required the assistance of a caregiver for turning when on the turning bed. CONCLUSION: This automated turning bed shows great promise in meeting a need for patients with limited mobility whether they are homebound or in a residential community. IMPLICATIONS FOR NURSING RESEARCH: Future studies that further investigate use of the turning bed for postoperative back patients while still in the acute care setting are indicated. Replicative studies with a larger sample size are also indicated.     

Overview of research to investigate pressure-relieving surfaces

Pressure-relieving equipment plays a key role in the prevention and treatment of pressure ulcers. Every year an increasing amount of equipment is launched on to the market. The efficacy of this equipment is traditionally qualified with interface pressure and case studies, but rarely with randomized controlled trials. With the advent of The New NHS: Modern, Dependable (Department of Health (DoH), 1997) and Pressure Ulcer Risk Assessment and Prevention (National Institute for Clinical Excellence (NICE), 2001), a clinical governance system has started to be put into place and hopefully more evidence will be produced by the manufacturers and the NHS. With some 200 different types of mattresses on the market, emphasis needs to be placed on good quality randomized clinical trials to establish effectiveness of what can be costly equipment. This article gives an overview of how, historically, pressure-relieving mattresses were marketed on case studies and interface measurement. Recently, randomized controlled clinical trials are being used to demonstrate the efficacy of the mattress and reduction in the incidence of pressure ulcers. Seating is also an important aspect in continuing 24-hours pressure area prevention and treatment. Patient posture in a chair needs to be fully understood by the practitioner and key strategies are made in this article. Little research into seating has been undertaken and is urgently required.     

十字缝合法治疗腱鞘囊肿46例效果观察

目的：观察使用十字缝合法治疗腱鞘囊肿的疗效。方法：局部麻醉后,用穿丝线的角针经一侧腱鞘囊肿至对侧穿出,与上一缝线的垂直方向再缝一针,然后分别结扎缝线。12～14d后拆线。结果：43例在拆线时囊肿已经不明显;2例在拆线时囊肿仍明显,给予再次穿刺抽吸同时注射入利多卡因加曲安缩松,3个月后复查囊肿完全消失;1例在拆线时囊肿仍可见,因故未处理,2个月后囊肿消失。所有患者随诊观察1～2年,无复发。结论：十字缝合法治疗腱鞘囊肿疗效较满意,值得推广。     

A nurse-led randomised trial of pressure-relieving support surfaces

A nurse-led trial is currently collecting data comparing interventions for the prevention and treatment of pressure ulcers. The aim is to provide reliable guidance on the relative merits of alternating-pressure mattresses and overlays for people at moderate to high risk of pressure ulceration. This paper outlines the main objectives, methodology and progress of the study.     

A comparison of healing rates on two pressure-relieving systems

The authors have previously reported the preliminary results of a randomized-controlled trial comparing the relative efficacy of two pressure-relieving systems: Huntleigh Nimbus 3 and Aura Cushion, and Pegasus Cairwave Therapy System and ProActive Seating Cushion (Russell et al, 2000). Although both the mattresses and cushions were effective treatments for pressure ulcers, the Huntleigh equipment was demonstrated to be statistically more effective for heel ulcers, but no differences were demonstrated for sacral ulcers. This article gives a more detailed analysis of the 141 patients assessed using computerized-image analysis of the digital images of sacral ulcers captured during the trial and specifically discusses the healing rates and other patient characteristics. Ninety-eight per cent of ulcers examined were deemed superficial (Torrance grade 2a, 2b, 3). Precision of image analysis assessed by within- and between-batch coefficients of variation was excellent: calibration CV 0.93-1.84%; area CV 4.61-5.72%. The healing rates on the two mattresses were not shown to be statistically different from each other.     

预防压疮床垫的设计

压疮是长期卧床病人,特别是老年、昏迷、截瘫、坐轮椅者的常见并发症.长期卧床病人由于机体局部受压组织长期循环障碍,发生持续缺血、缺氧、营养不良而引起的组织溃烂、坏死.压疮一旦发生,既增加病人的痛苦、加重病情和经济负担,又给护理工作带来一定的困难,预防压疮的发生是临床护理工作的一项极为重要的内容.