The Impact of Transport Modality on Efficiency of Simulated Neonatal Endotracheal Intubation.

INTRODUCTION: Although the transport of neonates is generally safe, adverse events can occur where equipment is a contributing factor. The aims of the study were to explore how the types of neonatal intensive care unit bed in use could impact a simulated emergency endotracheal intubation and to identify future areas for training and education. METHODS: The efficiency of endotracheal intubation performed during simulated neonatal transport using 3 different transport modalities (closed incubator bed, open incubator bed, and open radiant warmer bed) was assessed. Twenty participants were enrolled. Outcomes included time to intubation, intubation success, and ease of mannequin access and were compared using Wilcoxon signed-rank tests and McNemar exact tests. RESULT: Median times to intubation were 59, 44, and 37 seconds with the incubator top closed, with the top open, and with the open radiant warmer bed, respectively. Intubation was slowest and subjective ease of access was most difficult with the incubator top closed. CONCLUSIONS: Experienced anesthesia providers had significantly greater difficulty with simulated emergency endotracheal intubation when performing neonatal transport with the incubator top closed compared with available alternative modes.

Investigation of effects of urethane foam mattress hardness on skin and soft tissue deformation in the prone position using magnetic resonance imaging.

AIM: In operating rooms, the occurrence of pressure ulcers caused by being in the prone position is the highest among that of pressure ulcers caused by being in other surgical positions. Thus, we investigated effects of hardness and shape of urethane foam mattresses for preventing pressure ulcers during surgery performed with patients in the prone position. We aimed to elucidate how mattresses of variable hardness and shapes affect compression and displacement of the skin and soft tissues with external force in the prone position. MATERIAL AND METHODS: We assessed effects of two shapes [rectangular cube (RC) and trapezoid cube (TC)] and four degrees of hardness (50, 87.5, 175, and 262.5 N) in each shape. We performed magnetic resonance imaging (MRI) of the iliac crests with external force while participants reclined in the prone position on eight different mattresses. RESULTS: Compression of the skin and soft tissue was significantly higher with 87.5-, 175-, and 262.5-N mattresses than that with 50-N mattresses. Skin and soft tissue displacement was higher with TC mattress than that with RC mattress, and the extent of skin surface and internal soft tissue displacement was different. CONCLUSIONS: Compression of the skin and soft tissue depends on mattress hardness; however, a threshold value (175 N) for hardness exists, above which no further changes in the parameters were observed. Skin and soft tissue displacement does not depend on mattress hardness, but rather on its shape. Furthermore, mattress inclination increases skin surface displacement.

Predicting Pressure Injury in Critical Care Patients: A Machine-Learning Model.

BACKGROUND: Hospital-acquired pressure injuries are a serious problem among critical care patients. Some can be prevented by using measures such as specialty beds, which are not feasible for every patient because of costs. However, decisions about which patient would benefit most from a specialty bed are difficult because results of existing tools to determine risk for pressure injury indicate that most critical care patients are at high risk. OBJECTIVE: To develop a model for predicting development of pressure injuries among surgical critical care patients. METHODS: Data from electronic health records were divided into training (67%) and testing (33%) data sets, and a model was developed by using a random forest algorithm via the R package "randomforest." RESULTS: Among a sample of 6376 patients, hospital-acquired pressure injuries of stage 1 or greater (outcome variable 1) developed in 516 patients (8.1%) and injuries of stage 2 or greater (outcome variable 2) developed in 257 (4.0%). Random forest models were developed to predict stage 1 and greater and stage 2 and greater injuries by using the testing set to evaluate classifier performance. The area under the receiver operating characteristic curve for both models was 0.79. CONCLUSION: This machine-learning approach differs from other available models because it does not require clinicians to input information into a tool (eg, the Braden Scale). Rather, it uses information readily available in electronic health records. Next steps include testing in an independent sample and then calibration to optimize specificity.

The effectiveness of lying surfaces in nursing care beds, a comparison of spring element systems versus conventional systems: A post marketing clinical follow-up pilot study.

BACKGROUND: Reduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting. Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS; wooden slats or steel bars). METHODS: This was a prospective, randomized, controlled study in 29 patients with an age range of 54-95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statistically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor®. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor®. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self-rated. RESULTS: We screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 ±â€¯9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 ±â€¯1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 ±â€¯10.8%) and the CS group (72.9 ±â€¯16.3%; p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement was plotted per night (p = 0.0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a "shoulder" between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was significantly higher with the SES after night 14 (p = 0.0192) than with CS. CONCLUSIONS: The study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self-rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.

Automatic RBG-depth-pressure anthropometric analysis and individualised sleep solution prescription.

INTRODUCTION: Sleep surfaces must adapt to individual somatotypic features to maintain a comfortable, convenient and healthy sleep, preventing diseases and injuries. Individually determining the most adequate rest surface can often be a complex and subjective question. OBJECTIVES: To design and validate an automatic multimodal somatotype determination model to automatically recommend an individually designed mattress-topper-pillow combination. METHODS: Design and validation of an automated prescription model for an individualised sleep system is performed through a single-image 2 D-3 D analysis and body pressure distribution, to objectively determine optimal individual sleep surfaces combining five different mattress densities, three different toppers and three cervical pillows. RESULTS: A final study (n = 151) and re-analysis (n = 117) defined and validated the model, showing high correlations between calculated and real data (>85% in height and body circumferences, 89.9% in weight, 80.4% in body mass index and more than 70% in morphotype categorisation). CONCLUSIONS: Somatotype determination model can accurately prescribe an individualised sleep solution. This can be useful for healthy people and for health centres that need to adapt sleep surfaces to people with special needs. Next steps will increase model's accuracy and analise, if this prescribed individualised sleep solution can improve sleep quantity and quality; additionally, future studies will adapt the model to mattresses with technological improvements, tailor-made production and will define interfaces for people with special needs.

General Hospital and Personal Use Devices: Renaming of Pediatric Hospital Bed Classification and Designation of Special Controls for Pediatric Medical Crib; Classification of Medical Bassinet. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to rename pediatric hospital beds as pediatric medical cribs and establish special controls for these devices. FDA is also establishing a separate classification regulation for medical bassinets, previously under the pediatric hospital bed classification regulation, as a class II (special controls) device. In addition, this rule continues to allow both devices to be exempt from premarket notification and use of the device in traditional health care settings and permits prescription use of pediatric medical cribs and bassinets outside of traditional health care settings.

A 13-year retrospective study evaluating the efficacy of using air-fluidised beds for toxic epidermal necrolysis patients.

OBJECTIVES: Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatological disease involving large areas of skin loss with systemic symptoms. This study evaluated the efficacy of air-fluidised bed therapy for TEN patients. METHODS: Of 27 people with TEN, 11 used air-fluidised beds (the air-fluidised group) and 16 used standard beds (the control group). Days to complete re-epithelialisation, re-epithelialisation rate, incidence of complications, mortality, pain measured by visual analogue score and the incidence of cutaneous infection were compared in these groups. RESULTS: The mean body surface area of involvement was 77.0 ± 11.8% and baseline mean severity-of-illness score for TEN (SCORTEN) was 2.81 ± 1.08. The re-epithelialisation rate in the air-fluidised group was 100% but was only 56.3% in the control group (P < 0.05). There was a significant difference in the time taken to complete re-epithelialisation between the air-fluidised group (13 days [95% CI: 9.0-17.0]) and the control group (21 days [16.5-25.5], P < 0.05). Furthermore, the incidence of complications was 18% in the air-fluidised group versus 75% in the control group, including fewer cutaneous infections (P < 0.05). There was a significant reduction in pain among the air-fluidised group compared with the control group (P < 0.05). There were no deaths in the air-fluidised group while 19% of the control group died. CONCLUSION: Air-fluidised beds can reduce the time to complete re-epithelialisation, relieve pain and increase the re-epithelialisation rate of TEN patients, but there was no significant difference between them in mortality rate in our study.

Implementation of a symptomatic approach leads to increased efficiency of a cholera treatment unit.

Cholera is a disease of poverty that remains prevalent in resource-limited countries. The abrupt emergence of an epidemic frequently takes communities and health systems by surprise. Spread is rapid and initial mortality high: delays in organizing an appropriate response, lack of health worker training, and high patient numbers contribute to high rates of complications and deaths.

The effectiveness of three types of alternating pressure air mattresses in the prevention of pressure ulcers in Belgian hospitals.

To compare the effectiveness of multi-stage and one-stage alternating low-pressure air mattresses (ALPAM) and alternating pressure air mattress (APAM) overlays in preventing pressure ulcers among hospitalized patients, data were pooled (N = 617) from a study of patients allocated to multi-stage ALPAM (n = 252) or one-stage ALPAM (n = 264), and another study of patients allocated to APAM overlay (n = 101). Cumulative pressure ulcer incidence was 4.9% (n = 30) over 14 days. Fewer ulcers developed on multi-stage ALPAM compared with APAM overlay (OR = 0.33; 95% CI [0.11, 0.97]), but no difference was found between one-stage ALPAM and APAM overlay (OR = 0.40; 95% CI [0.14, 1.10]). Time to develop ulcers did not differ by mattress type.

An epidemiologic analysis of low back pain in primary care: a hot humid country and global comparison.

BACKGROUND: Low back pain is one of the most common conditions for which patients seek medical care. AIM: The aim of the study was to study the epidemiology of low back pain in primary care setting with emphasis on frequency, sociodemographic factors, and impact of low back pain on lifestyle habits. SUBJECTS AND METHODS: This is a cross-sectional study. A representative sample of 2742 patients was approached and 2180 subjects agreed to participate in this study (79.5%). The survey was conducted among primary health care visitors during the period from March to October 2012. The questionnaire collected the sociodemographic characteristics, lifestyle habits, and type of treatment taken for relief from recruited subjects. RESULTS: Of the subjects studied, 52.9% were males and 47.1% were females. The prevalence of low back pain in the study sample was 59.2%. Low back pain was more prevalent among women (67.7%) than among men (51.6%). The proportion of low back pain was highest in the age-group 45 to 55 years in both the genders (37.6% and 36.4%, respectively). Nearly half of the men (45.7%) and women (45.2%) with low back pain were overweight with a significant difference (P < .001). More than half of the women with low back pain were housewives (50.4%), whereas most of the men had clerical jobs (36.8%). There was a significant difference observed between men and women in terms of nationality (P < .001), body mass index (P < .001), and occupation (P < .001). Prolonged standing (41.2% vs 29.5%; P < .001) and use of sponge mattress (50.9% vs 45.8%; P .041) was significantly higher among male patients with low back pain compared with females. Coughing/sneezing/straining (9.7% vs 5.9%; P = .01) were more frequent triggering factors in male patients with low back pain as compared with females. CONCLUSION: The study findings revealed that the prevalence of low back pain was higher among women than among men. Low back pain was observed more frequently among older people and among those who were overweight.

Seasonal trends in house dust mite allergen in children's beds over a 7-year period.

BACKGROUND: House dust mite (HDM) allergy is closely linked to the expression of asthma and other allergic diseases. Understanding factors influencing variation in allergen may help in controlling allergic disease. The objective of this study was to investigate the effects of seasonal changes in climate, type of bed used in very early childhood and anti-mite interventions on HDM allergen concentration. METHODS: Participants were enrolled in a randomized-controlled trial of HDM avoidance. Der p 1 was measured in dust samples from children's beds on 13 occasions, from birth to age 5 years, between 1997 and 2004. Bed types were categorized as bassinette, cot or bed. The effects of study month, type of bed and intervention group on HDM allergen concentration were estimated by multiple linear regression. The relation between climatic variables and HDM allergen concentration was investigated using a polynomial distributed lag model. RESULTS: House dust mite allergen concentrations were initially low in cots and bassinettes in 1997/1998, peaked in bassinettes and beds between 1999 and 2001 and then slowly declined during the period 2002/2004. Seasonal fluctuations occurred with minima in summer and two- to threefold higher maxima during late autumn. Allergen peaks were correlated with relative humidity peaks 2 months previously. Seasonal changes in allergen were not affected by the HDM avoidance intervention. CONCLUSIONS: House dust mite allergen concentrations in Sydney beds fluctuate approximately two- to threefold on an annual cycle, partly determined by relative humidity, with peaks in late autumn and minima in summer. Fluctuations of this magnitude might be sufficient to influence asthma symptoms.

Physician recommendations regarding SIDS risk reduction: a national survey of pediatricians and family physicians.

BACKGROUND: Sudden infant death syndrome (SIDS) is a leading cause of death among infants. Recently, new SIDS risk factors have emerged. OBJECTIVE: To determine knowledge and recommendations of pediatricians and family physicians regarding SIDS-relevant practices. METHODS: Cross-sectional survey of 3005 pediatricians and family physicians. RESULTS: Of the 783 respondents, pediatricians comprised 64% and females 52%; 78% recognized supine as the recommended sleep position; 69% recommended supine. Almost all physicians recommended a firm mattress, 82% recommended a crib or bassinet, and 42% recommended a separate room for infants; 63% had no preference about or did not recommend restricting pacifier use. Pediatricians were more likely to discuss infant sleep position and room sharing at every well-child visit. CONCLUSIONS: Knowledge about recommended infant sleep position is relatively high, but there are gaps in physician knowledge regarding safe sleep recommendations. Greater dissemination of information is required, and barriers to implementation need to be identified and addressed.

Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis.

BACKGROUND: Immobility is associated with complications involving many body systems. OBJECTIVE: To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. METHODS: Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. RESULTS: A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. CONCLUSIONS: Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

Sleep disturbance in patients with chronic low back pain.

OBJECTIVE: To document the relationship between sleep disturbance and chronic low back pain in patients referred to a physical medicine and rehabilitation clinic. DESIGN: This is a prospective cross-sectional survey of 268 patients 18 yrs or older being evaluated for low back pain of greater than 6 months at a tertiary medical center. The survey consisted of a 43-item composite form that contained the Short-Form McGill Pain Questionnaire (SF-MPQ); the Pittsburgh Sleep Quality Index (PSQI); a pain visual analog scale (VAS); and questions regarding bed type, sleep position, and patients' sleep description. RESULTS: There was a significant relationship between pain and sleep (P<0.0005) with a 55% increase in the proportion of subjects reporting restless/light sleep after pain onset. There was no corresponding increase in sleep medication use. There was a significant direct correlation between SF-MPQ and PSQI (r=0.44, P<0.0005); between PSQI and VAS (r=0.41, P<0.0005); and between overall quality of sleep and VAS (r=0.31, P<0.0005). Finally, PSQI scores were the worst in subjects sleeping on an orthopedic mattress (P=0.001). CONCLUSIONS: Chronic low back pain significantly affects quality of sleep. Sleep problems should be addressed as an integral part of the pain management plan.

Do split-side rails present an increased risk to patient safety?

BACKGROUND: Concerns have been raised about the safety of split-side bed rails for patients in the UK. OBJECTIVES: To investigate whether split-side rails were more likely to be associated with entrapment and injury of patients than other bed rail types. To establish whether there was a difference in the site of injury caused by different bed rail types and whether the outcome of the injury (death versus survival) varied by bedrail type. METHODS: A search of the USA Food and Drug Administration MAUDE database was carried out. The reports were screened using rigorous inclusion/exclusion criteria and then coded for rail type, incident outcome, and area of body involved. RESULTS: Split-side rail incidents only accounted for 5% of the reports and were more likely to involve the chest or pelvis. Although the biggest overall risk by rail type cannot be determined from these data, the severity of the outcome changed with the equipment type. Incidents involving half rails were more likely to be associated with head, neck, or face entrapments and were also more likely than other bed rail types to result in death. DISCUSSION: Split-side rail entrapments were not a common occurrence. However, our findings suggest that bed rails are associated with some level of risk of entrapment that potentially could result in death. Healthcare providers should therefore ensure that they follow the guidelines for risk assessment and rail use from the MHRA and other professional bodies so that the cultural norm in the UK continues to be "opt in", where no bed rails are used unless indicated by a documented clinical assessment.

The validity of the static-charge-sensitive bed in the detection of fentanyl-induced respiratory depression.

BACKGROUND: Only a few methods for the measurement of breathing are non-invasive and do not interfere with measured parameters. The static-charge-sensitive bed (SCSB) could be such a monitor. The aim of this study was to evaluate the validity of the SCSB compared with the respiratory inductive plethysmograph (RIP) using a fentanyl-induced respiratory depression model. METHODS: Eight healthy male volunteers were infused with intravenous (i.v.) fentanyl (15 microg/kg/h) until a decrease in SpO2 below 90% for 1 min emerged. Breathing was continuously and simultaneously measured with SCSB and RIP. Oxygenation, hemodynamics, arterial blood gas analysis, and subjective opioid-related effects were monitored. Fentanyl concentration was measured from an arterial blood sample. The respiratory rate data of the SCSB (automated analysis and manual calculation) were compared with the corresponding RIP data, using analysis of variance for repeated measures. The validity of the SCSB compared with RIP was evaluated using an intra-class correlation coefficient. RESULTS: Mean fentanyl dose was 629 microg. A statistically significant association was found between the RIP and SCSB data in the manual SCSB analysis (P < 0.0001), but not in the automated SCSB analysis (P = 0.91). After adjusting for the effect of time and the SCSB method, an intra-class correlation coefficient between the manually calculated SCSB values and the RIP values was 0.66. CONCLUSION: Clinically significant changes in respiratory rate were detected with the SCSB, but the results had to be analyzed manually. The SCSB best suits situations, where comprehensive data are needed. It is not suitable for on-line respiratory monitoring, as the automated analysis did not calculate the respiratory rate correctly.

Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid.

Limited research has been done to determine the effectiveness of the multitude of pressure reduction devices currently available for patient care. The purpose of this investigation was to examine the relative effectiveness of a dynamic low-air-loss (LAL) mattress and a static fluid mattress in reducing the risk of pressure ulcer development. The investigation consisted of two components: a comparative laboratory study and a retrospective clinical study. In the laboratory study, tissue interface pressures were measured on the two surfaces at three interface sites in a sample of six healthy adult volunteers. In the clinical study, a retrospective chart review was conducted to compare the actual incidence of pressure ulcer formation in a sample of 73 postoperative transplant patients who were placed on either the static fluid or LAL product. The instruments used were the Xsensor Pressure Mapping System (laboratory) and chart review tool (clinical). The main outcome measures included tissue interface pressures and incidence of pressure ulcer formation. The results were as follows: the laboratory study revealed significantly lower sacral pressures (t = -5.30, P = .003) on the low-air-loss mattress than on the static fluid mattress. Pressures did not differ significantly at the heel or trochanter sites. In the clinical study, the overall incidence of skin breakdown was 8.2%, with 5 occurrences (13.8%) in the LAL group and 1 occurrence (2.7%) in the static fluid group. However, this difference was not significant (Fisher's exact test = 0.107, P = .09). When considered jointly, the results of the two studies suggest that the static fluid and LAL products may be comparable in efficacy. Although the relatively small sample sizes used in the investigation limit generalizability, the results provide some initial direction for further clinical research in this area.