Reactive air surfaces for preventing pressure ulcers.
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ABSTRACT:
SUBMITTER: Shi C
PROVIDER: S-EPMC8127698 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:To determine the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly nursing home population.Clinical trial with participants assigned at random to a skin protection or segmented foam cushion. Two hundred thirty-two participants were recruited between June 2004 and May 2008 and followed for 6 months or until pressure ulcer incidence.Twelve nursing homes.Nursing home residents aged 65 and older who were using wheelchairs for 6 or more hours per day and had a Braden score of 18 or less and a combined Braden activity and mobility score of 5 or less. Participants were recruited from a referred sample.All participants were provided with a fitted wheelchair and randomized into skin protection (SPC, n=113) or segmented foam (SFC, n=119) cushion groups. The SPC group received an air, viscous fluid and foam, or gel and foam cushion. The SFC group received a 7.6-cm crosscut foam cushion.Pressure ulcer incidence over 6 months for wounds near the ischial tuberosities (IT ulcers) were measured. Secondary analysis was performed on combined IT ulcers and ulcers over the sacrum and coccyx (sacral ulcers).One hundred eighty participants reached a study end point, and 42 were lost to follow-up. Ten did not receive the intervention. There were eight (6.7%) IT ulcers in the SFC group and one (0.9%) in the SPC group (P=.04). There were 21 (17.6%) combined IT and sacral ulcers in the SFC group and 12 (10.6%) in the SPC group (P=.14).Skin protection cushions used with fitted wheelchairs lower pressure ulcer incidence for elderly nursing home residents and should be used to help prevent pressure ulcers.
| S-EPMC3065866 | biostudies-literature
Project description:When immobile or neuropathic patients are supported by beds or chairs, their soft tissues undergo deformations that can cause pressure ulcers. Current support surfaces that redistribute under-body pressures at vulnerable body sites have not succeeded in reducing pressure ulcer prevalence. Here we show that adding a supporting lateral pressure can counter-act the deformations induced by under-body pressure, and that this 'pressure equalisation' approach is a more effective way to reduce ulcer-inducing deformations than current approaches based on redistributing under-body pressure. A finite element model of the seated pelvis predicts that applying a lateral pressure to the soft tissue reduces peak von Mises stress in the deep tissue by a factor of 2.4 relative to a standard cushion (from 113 kPa to 47 kPa)-a greater effect than that achieved by using a more conformable cushion, which reduced von Mises stress to 75 kPa. Combining both a conformable cushion and lateral pressure reduced peak von Mises stresses to 25 kPa. The ratio of peak lateral pressure to peak under-body pressure was shown to regulate deep tissue stress better than under-body pressure alone. By optimising the magnitude and position of lateral pressure, tissue deformations can be reduced to that induced when suspended in a fluid. Our results explain the lack of efficacy in current support surfaces and suggest a new approach to designing and evaluating support surfaces: ensuring sufficient lateral pressure is applied to counter-act under-body pressure.
| S-EPMC6941906 | biostudies-literature
Project description:The polymer residues still present on a chemical vapour-deposited graphene surface after its wet transfer by the poly(methyl methacrylate) method to the arbitrary substrates, tend to cause problems such as electrical degradation and unwanted intentional doping. In this study, by using an effective cleaning method for the graphene surface by air-assisted plasma, the graphene surface was cleaned significantly without damaging the graphene network, which resulted in the reduction (approx. 71.11%) of polymer residues on its surface. The analysis reveals that this approach reduced the D-band (impurities, polymer residues) formation while maintaining the ?-bonding of the graphene, which affects conductivity. By characterizations of the optical microscope, Raman spectroscopy and atomic force microscopy, we obtained a significantly cleaner graphene surface (roughness of 4.1?nm) compared to pristine graphene (roughness of 1.2?nm) on a SiO2 substrate. In addition, X-ray photoelectron spectroscopy data revealed that the C1s peak of the air-assisted graphene film was higher than the one of a pristine graphene film, indicating that a cleaner graphene surface was obtained.
| S-EPMC5990796 | biostudies-literature
Project description:The aims of this study were to identify, assess, and summarise available evidence about the effectiveness of static air mattress overlays to prevent pressure ulcers. The primary outcome was the incidence of pressure ulcers. Secondary outcomes included costs and patient comfort. This study was a systematic review. Six electronic databases were consulted: Cochrane Library, EMBASE, PubMed (Medline), CINAHL (EBSCOhost interface), Science direct, and Web of Science. In addition, a hand search through reviews, conference proceedings, and the reference lists of the included studies was performed to identify additional studies. Potential studies were reviewed and assessed by 2 independent authors based on the title and abstract. Decisions regarding inclusion or exclusion of the studies were based on a consensus between the authors. Studies were included if the following criteria were met: reporting an original study; the outcome was the incidence of pressure ulcer categories I to IV when using a static air mattress overlay and/or in comparison with other pressure-redistribution device(s); and studies published in English, French, and Dutch. No limitation was set on study setting, design, and date of publication. The methodological quality assessment was evaluated using the Critical Appraisal Skills Program Tool. Results were reported in a descriptive way to reflect the exploratory nature of the review. The searches included 13 studies: randomised controlled trials (n = 11) and cohort studies (n = 2). The mean pressure ulcer incidence figures found in the different settings were, respectively, 7.8% pressure ulcers of categories II to IV in nursing homes, 9.06% pressure ulcers of categories I to IV in intensive care settings, and 12% pressure ulcers of categories I to IV in orthopaedic wards. Seven comparative studies reported a lower incidence in the groups of patients on a static air mattress overlay. Three studies reported a statistical (P < .1) lower incidence compared with a standard hospital mattress (10 cm thick, density 35 kg/m3 ), a foam mattress (15 cm thick), and a viscoelastic foam mattress (15 cm thick). No significant difference in incidence, purchase costs, and patient comfort was found compared with dynamic air mattresses. This review focused on the effectiveness of static air mattress overlays to prevent pressure ulcers. There are indications that these mattress overlays are more effective in preventing pressure ulcers compared with the use of a standard mattress or a pressure-reducing foam mattress in nursing homes and intensive care settings. However, interpretation of the evidence should be performed with caution due to the wide variety of methodological and/or reporting quality levels of the included studies.
| S-EPMC7949547 | biostudies-literature
Project description:Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%.Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement.The mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm(2), and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement.Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions.
| S-EPMC2691928 | biostudies-other