MEASUREMENTS OF INTERFACE PRESSURE BETWEEN BODY SITES AND THE SURFACES OF FOUR SPECIALISED AIR MATTRESSES

SUMMARY Four specialised air mattresses had interface pressure measured under six body sites prone to pressure sores in 10 subjects, supine and sitting. The mattresses were the Clinirest (SSI) and FirstStep (KCI) continuous airflow mattress overlays, and Airwave (Pegasus) and Nimbus (Huntleigh) alternating pressure air mattresses. On the mattress overlays, average supine interface pressures were 2.33 kPa (scapula), 4.15 kPa (elbow), 1.94 kPa (sacrum) and 2.79 kPa (buttock), although they were higher at the occiput (7.97 kPa) and heel (11.7 kPa). The alternating pressure air mattresses had an average minimum interface pressure close to zero for three sites, rising to 4.28 kPa under the heel. Average maximum interface pressures were 8.61 kPa (occiput), 5.21 kPa (scapula), 4.90 (elbow), 4.85 kPa (sacrum), 4.61 kPa (buttock) and 13.2 kPa (heel). No accepted scientific method exists for comparing the two types of mattress. Our data suggest a clinical benefit at the occiput and heel (supine) in using an alternating pressure air mattress and a benefit in using a continuous airflow mattress overlay at other sites.     

Radiology and the Health Policy Agenda for the American People

Eleven radiologists appointed by the major radiological societies participated for the past 5 years in the development of the Health Policy Agenda for the American People. The Agenda is an action plan to address a wide variety of serious problems in medicine. The first phase involved establishment of 159 principles, broad value statements that were the foundation of the project. Phase 2 involved the development of policy proposals on 38 urgent issues for action in medical science; education; health resources; delivery mechanisms; evaluation, assessment, and control; and payment for services. These proposals are summarized in this report. The activities and recommendations of representatives for the field of radiology are described. The Agenda has been released, and an implementation phase has begun. It will likely be of great importance to the practice of radiology over the next decade. Important issues can be addressed by acting with the coalitions that are being formed from among the more than 150 participating organizations.     

Epidemiology, the humanities, and public health.

Epidemiologists may benefit from the disciplines of history, philosophy of science, ethics, literature, and art. Within these disciplines lie answers to the questions of who we are, what is right, how to think, and when to act. Studying and participating in the humanities may also help epidemiologists focus their professional concerns on the humanity their methods serve. A parallel phenomenon in the clinical sciences--medical humanities--provides support for the approach (and some lessons).     

Evaluation of calcium alginate-tipped aluminum swabs transported in Culturettes containing ampules of 2-sucrose phosphate medium for recovery of Chlamydia trachomatis

Two calcium alginate-tipped wire swab specimens were obtained from 94 men and 106 women attending a sexually transmitted disease clinic. One swab was extracted thoroughly in 2-sucrose phosphate (2SP) immediately after obtaining the specimen. The second swab was returned to the Culturette cylinder (Marion Scientific, Kansas City, MO), and the ampule containing 2SP was crushed to moisten the swab during transport to the laboratory. After receipt in the laboratory, the swab was removed from the Culturette and extracted into 2 mL of 2SP. Both specimens then were cultured for the presence of Chlamydia trachomatis in McCoy's cells. C. trachomatis was recovered from 22 of 94 men (23.4%); 16 isolates came from both the Culturette swabs and vials. Six isolates were recovered exclusively from vials. Of 106 women, 13 (12.3%) were positive for C. trachomatis. In five instances, both vials and swabs yielded C. trachomatis; the organism was recovered eight times from vials but not swabs. The 2SP transport system for the 200 specimens was superior to the Culturettes for the recovery of C. trachomatis (P less than 0.01). Based on our results, swab specimens taken for laboratory diagnosis of C. trachomatis should be extracted immediately after collection in a vial containing 2SP. In addition, experiments comparing swab fibers indicated that there was a trend indicating higher inclusion counts with rayon-tipped swabs, compared with those containing calcium alginate. Because of possible toxicity of substances in calcium alginate fibers for several organisms causing sexually transmitted disease, rayon-tipped swabs or swabs of other composition should be used.