A Prospective Randomized Clinical Trial of a Novel, Noninvasive Perfusion Enhancement System for the Prevention of Hospital-Acquired Sacral Pressure Injuries.

PURPOSE: The purpose of this study was to determine the effectiveness of a novel, noninvasive perfusion enhancement system versus beds with integrated alternating pressure capabilities for the prevention of hospital-acquired sacral region (sacral, coccygeal, and ischium) pressure injuries in a high-risk, acute care patient population. DESIGN: A prospective randomized trial of high-risk inpatients without preexisting sacral region pressure injuries was conducted. SUBJECTS AND SETTING: The sample comprised 431 randomly enrolled adult patients in a 300-bed tertiary care community teaching hospital. METHODS: Subjects were randomly allocated to one of 2 groups: control and experimental. Both groups received "standard-of-care" pressure injury prevention measures per hospital policy, and both were placed on alternating pressure beds during their hospital stays. In addition, patients in the experimental group used a noninvasive perfusion enhancement system placed on top of their alternating pressure beds and recovery chairs throughout their hospital stay. Fischer's exact probability test was used to compare group differences, and odds ratio (OR) were calculated for comparing pressure injury rates in the experimental and control groups. RESULTS: Three hundred ninety-nine patients completed the trial; 186 patients were allocated to the experimental group and 213 patients to the control group. Eleven patients in the control group versus 2 in the experimental group developed hospital-acquired sacral region pressure injuries (51.6% vs 1.07%; P = .024). Control patients were 5.04 times more likely to develop hospital-acquired sacral region pressure injuries (OR = 0.1996; 95% CI, 0.0437-0.9125). CONCLUSIONS: Patients using a noninvasive perfusion enhancement system developed significantly fewer hospital-acquired sacral pressure injuries than those using an alternating pressure bed without the perfusion enhancement system. These findings suggest that a perfusion enhancement system enhances the success of use of pressure redistributing beds for prevention of hospital-acquired sacral pressure injuries.

Comparison of the magnitude and time course of macular thinning induced by different interventions for diabetic macular edema: implications for sequence of application.

PURPOSE: To determine estimates of the magnitude and time course of macular thinning induced by three interventions for diabetic macular edema (DME). DESIGN: Retrospective observational case series. PARTICIPANTS: Two hundred eleven eyes of 133 patients of a private retina practice, each diagnosed with DME in > or =1 eye. METHODS: Review of clinical charts and optical coherence tomography measurements of eyes receiving focal laser photocoagulation, intravitreal triamcinolone injection (IVTA), or vitrectomy compared to untreated fellow eyes without DME. MAIN OUTCOME MEASURES: Central subfield mean thickness (CSMT; in micrometers), total macular volume (cubic millimeters), visual acuity, and rates of increased macular thickening at follow-up. RESULTS: At 6 months follow-up, predicted change in CSMT is 0 mum for untreated fellow eyes without DME, -28 mum for eyes receiving focal laser, -83 mum for eyes receiving triamcinolone, and -92 mum for eyes receiving vitrectomy. The predicted change in Early Treatment Diabetic Retinopathy Study letters read at 6 months is 0 for untreated fellow eyes without DME, 0 for eyes receiving focal laser, +3 for eyes receiving IVTA, and -1 for eyes receiving vitrectomy. Increased thickening of the macula after interventions designed to thin it were 25.4% for focal laser, 3.8% for IVTA, and 19.0% for vitrectomy. CONCLUSIONS: Interventions for DME differ in effect size, durability of effects, and potential for subsequent increases in macular thickness. A prospective study to elucidate a preferred sequence of interventions in DME may be worthwhile.

Diagnosis of placental abscess in association with recurrent maternal bacteremia in a twin pregnancy.

BACKGROUND: Placental abscess formation is rarely recognized prenatally. We present a case detected ultrasonographically that developed from a central line infection and caused recurrent maternal bacteremia. CASE: A young woman with a 21-week twin gestation presented with recurrent fevers. She had received treatment for bacteremia due to Serratia marcescens. The initial source of the infection was a peripherally inserted central catheter line placed in the first trimester for hyperemesis gravidarum. Fevers continued throughout the second course of antibiotics. An abscess seen sonographically in twin A's placenta was aspirated using a spinal needle, revealing Serratia bacteria. Aspiration was performed at 22 weeks of gestation. Amniotic fluid samples obtained from both sacs were negative for infection. Over 4 weeks, the abscess enlarged and she was delivered. Twin A died of sepsis and twin B had a relatively favorable neonatal course. CONCLUSION: Prenatal diagnosis of placental abscess presents a difficult management dilemma. Traditional amniotic fluid studies did not predict the poor outcome of the affected fetus.