Use of prophylactic silicone adhesive dressings for maintaining skin integrity in intensive care unit patients: A randomised controlled trial.

The aims of this randomised controlled study were to determine whether the application of silicone adhesive dressings with standard preventive care would reduce the impairment of skin integrity and to evaluate the subepidermal moisture (SEM) value in anatomical locations to predict impairment of skin integrity. Of the 71 intensive care unit patients enrolled, 35 and 31 were randomly assigned to the intervention and control groups, respectively. The SEM value was measured at each site (the coccyx, sacrum, and both buttocks) repeatedly three times at every dressing change. Collected data were analysed by multivariate linear regression, and least square means analysis was used to compare the SEM value at the sites of pressure injury (PI) and blanching erythema. There were fewer PIs (1 vs 9) and incidences of blanching erythema (5 vs 6) in the intervention group than in the control group (P = 0.006). The SEM value and difference of the SEM value from the initial value was higher in the group with PIs than in the group without PIs (P < 0.0001 and P = 0.001, respectively). There was a statistically significant difference in the incidence of impaired skin integrity between the groups. The SEM value may be an indicator for detecting impairment of skin integrity.

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.

Anterior sacral meningocele presenting as intracystic bleeding.

PURPOSE: To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. METHODS: A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM. RESULTS: Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion. CONCLUSIONS: This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.

Efetividade do protocolo para prevenção de lesões por pressão implantado em Unidade de Terapia Intensiva / Effectivenesses of protocol impremented in an intensive Care Unit for the prevention of pressure ulcers

Este estudo objetivou avaliar efetividade da implantação do protocolo para prevenção de lesão por pressão em unidade de terapia intensiva. Estudo quantitativo descritivo, analítico e documental. Foram aplicados testes Qui-quadrado de Pearson, Exato de Fisher para variáveis categóricas e Mann-Whitney para numéricas; significância de 5% e intervalo de confiança de 95%. A Amostra totalizou 566 pacientes, com médias de idade de 45 anos, escore da escala de Braden de 12,4 e tempo de internamento de 9,8 dias. Predominaram lesão por pressão sacral na admissão (11,1%); do sexo masculino (66,9%) e procedência da emergência (54,0%). Houve redução significativa de lesão por pressão durante o internamento (36,6% para 12,3%), da média do tempo de internamento (11,4 para 7,1 dias), bem como o surgimento de lesão por pressão em regiões calcânea (25,7% para 3,7%) e sacra (9,9% para 2,8%). Foi comprovada a efetividade da implantação do protocolo para prevenção de lesão por pressão.

Grasa y hemorragia en el espacio subaracnoideo intracraneal por fractura sacra con disociación espondilopélvica / Intracranial subarachnoid fat and hemorrhage secondary to sacral fracture with spondylopelvic dissociation

Se describe un caso de aparición de grasa y sangre en el espacio subaracnoideo cerebral en un paciente con fractura sacra compleja sin traumatismo craneal asociado, tras varios días de ingreso. Según la literatura revisada, solo hay un caso publicado con hallazgos similares al presentado sin una lesión subyacente como causa. Se explican las diferencias en el mecanismo de producción entre esta migración grasa directa y el síndrome de embolia grasa cerebral, que es intravascular y presenta manifestaciones radiológicas diferentes. Se detallan las características más importantes de la fractura sacra con disociación espondilopélvica. Finalmente, la entidad presentada debe tenerse en cuenta en el diagnóstico diferencial de las escasas causas de grasa en el espacio subaracnoideo y, en el contexto de un traumatismo de alta energía, deben buscarse fracturas en el sacro o en la columna vertebral como posible causa de este hallazgo intracraneal tan poco frecuente (AU)

We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding (AU)

Assessment of the Biomechanical Effects of Prophylactic Sacral Dressings on Tissue Loads: A Computational Modeling Analysis.

The sacrum is the most susceptible anatomical site for developing pressure injuries, including deep tissue injuries, during supine lying. Prophylactic dressings generally are designed to reduce friction, alleviate internal tissue shear, manage the microclimate, and overall cushion the soft tissues subjected to sustained deformations under the sacrum. Using computational modeling, the authors developed a set of 8 magnetic resonance imaging-based, 3-dimensional finite element models of the buttocks of a healthy 28-year-old woman for comparing the biomechanical effects of different prophylactic sacral dressing designs when used during supine lying on a standard hospital foam mattress. Computer simulation data from model variants incorporating an isotropic (same stiffness in every direction) multilayer compliant dressing, an anisotropic (directionally dependent stiffness properties) multilayer compliant dressing, and a completely stiff dressing were compared to control (no dressing). Specific outcome measures that were compared across these simulation cases were strain energy density (SED) and maximal shear stresses in a volume of interest (VOI) of soft tissues surrounding the sacrum. The SED and shear stress measurements were obtained in pure compression loading of the buttocks (ie, simulating a horizontal supine bed rest) and in combined compression-and-shear loads applied to the buttocks (ie, 45˚ Fowler position causing frictional and shear forces) on a standard foam mattress. Compared to the isotropic dressing design, the anisotropic dressing facilitated more soft tissue protection through an additional 11% reduction in exposure to SED at the VOI. In this model, use of the anisotropic compliant dressing resulted in the lowest exposures to internal tissue SED and shear stresses. Research to examine the clinical inference of this modeling technique and studies to compare the effects of prophylactic dressings on healthy volunteers and patients in different positions are warranted.

Pediatric Skin Failure.

BACKGROUND: The phenomenon of skin failure as distinct from pressure ulcers has been documented in the adult literature. However, in the pediatric population, skin injury continues to be grouped indiscriminately as various types of pressure ulcers. OBJECTIVE: To identify and describe the phenomenon of skin failure in critically ill children. METHODS: Retrospective chart review of 19 patients who had serious skin injuries develop. Organ dysfunction scores, medications, pressure ulcer prevention techniques used, and laboratory values in the 7 days leading up to the development of a skin lesion were evaluated. RESULTS: At the start of the evaluation period, all patients (N = 19) had pressure ulcer prevention measures in place before the development of a serious skin injury. All of the skin lesions were full-thickness injuries on the day they were identified (as opposed to the more gradual progression from simple to complex skin injuries typically seen in pressure ulcers). As predicted, 18 of 19 patients had multiple organ dysfunction syndrome (MODS) in the week leading up to the skin injury. All patients with MODS had at least 2 dysfunctional systems, and 12 patients had 4 or more dysfunctional systems. Of the 19 patients, 8 (42%) progressed to death, compared with 1.8% in our general pediatric intensive care unit population. CONCLUSION: Although the traditional paradigm is that pressure ulcers are preventable, a subset of pressure ulcers in critically ill children may actually represent acute skin failure as a consequence of MODS.

Diagnóstico radiológico de lesiones lumbares en la zona nor-occidental de Honduras 2014-2016 / Radiological diagnosis of lumbar injuries in the north-west zones of Honduras 2014 - 2016

El dolor lumbar se define como un síndrome mus - culoesquelético cuyo principal síntoma es la pre- sencia de dolor focalizado en el área comprendi - da entre la región costal inferior y la región sacra, y que en ocasiones puede comprometer la región glútea, provocando disminución funcional. Objetivo: Identificar las lesiones lumbares diagnosticadas por medio de estudio radiográfico de columna lumbar. Pacientes y Métodos: Estudio descriptivo, retrospec- tivo, comprendido entre 2014 y 2016, en los pacien - tes que asistieron a Mediscan para la realización de estudio radiográfico de columna lumbosacra con una muestra de 687 pacientes. Resultados: De los 687 pacientes, 309(44.9%) del género masculino, 378(55.1%) del género femenino. 211 tenían en- tre 51-60 años. De los pacientes del género mas- culino 103 (33.33%) tenían espondiloartrosis y 63 (20.39%) tenían canal espinal estrecho, en el gé- nero femenino 162 (42.86%) tenían espondiloartro - sis, 83(21.96%) discopatía lumbar. En 562 pacien - tes, se encontró lesión en el estudio radiológico, 264(46.9%) a nivel de L4- L5 Conclusión: La lum- balgia se presenta más en pacientes del género femenino, con mayor frecuencia entre 51-60 años. La patología más diagnosticada fue la espondi - loartrosis y el segmento más afectado fue L4-L5...(AU)

High frequency ultrasound sacral images in the critically ill: Tissue characteristics versus visual evaluation.

PURPOSE: High frequency ultrasound (HFUS) systems may identify tissue injury. We compared HFUS tissue characteristics (dermal thickness and dermal density) with visual image examination. METHODS: Longitudinal study in critically ill mechanically ventilated adults, from three ICUs (Surgical Trauma, Medical Respiratory, Neuroscience) enrolled within 24hours of airway intubation. Sacral HFUS images were obtained daily for up to seven days. Expert evaluation of the best image per day was completed and compared to HFUS generated tissue characteristics (dermal thickness and dermal density). RESULTS: Of the113 subjects with 1614 comparisons analysed, 73.2% to 84% were normal, and 6.3% to 11.8% of the comparisons had injury present but no change was noted in the injury observed. There were no significant differences in one-day comparisons among type of injury and mean dermal thickness (p=0.6645) or dermal median intensity (adjusted p=0.06-0.17). All other day-to-day comparisons were similarly non-significant. CONCLUSIONS: We found no association among dermal density, dermal thickness and visual examination of changes in sacral HFUS images for any day-to-day comparison. The use of sacral HFUS as a screening tool for the development of tissue injury is in its infancy. Additional comparative studies should be conducted to identify its future clinical usefulness.

Spinal Fractures in Older Adult Patients Admitted After Low-Level Falls: 10-Year Incidence and Outcomes.

OBJECTIVES: To evaluate the incidence of spinal fractures and their outcomes in the elderly who fall from low-levels in a suburban county. DESIGN: Retrospective county-wide trauma registry review from 2004 to 2013. SETTING: Suburban county with regionalized trauma care consisting of 11 hospitals. PARTICIPANTS: Adult trauma patients aged ≥65 years who were admitted after falling from <3 feet. MEASUREMENTS: Demographic characteristics, comorbidities, and outcomes. RESULTS: Spinal fractures occurred in 18% of 4,202 older adult patients admitted following trauma over this 10-year time period, in the following distribution: 43% cervical spine, 5.7% thoracic, 4.9% lumbar spine, 36% sacrococcygeal, and 9.6% multiple spinal regions. As compared to non-spinal fracture patients, more spinal fracture patients went to acute/subacute rehabilitation (47% vs 34%, P < .001) and fewer were discharged home (21% vs 35%, P < .001). In-hospital mortality rate in spinal and non-spinal fracture patients was similar (8.5% vs 9.3%, P = .5). CONCLUSION: Low-level falls often resulted in a spinal fracture at a variety of levels. Vigilance in evaluation of the entire spine in this population is suggested.

Técnica de Karydakis modificada para el tratamiento del sinus pilonidal gigante / Modified Karydakis procedure for giant pilonidal sinus

No disponible

Sacral stress fracture in an amateur rugby player: a case report.

BACKGROUND: Sacral stress fracture is an uncommon cause of back pain. The majority of previously reported cases have been in runners. The purpose of this case report was to describe a case of sacral stress fracture in an amateur rugby player. CASE PRESENTATION: A healthy 18-year-old Japanese boy who was a rugby player presented with a 3-week history of lumbago. Sagittal and axial magnetic resonance imaging failed to reveal any reason for lumbago in his lumbar region. On his second presentation, 4 weeks later, his lumbago was so severe that he could not walk without a cane. A second magnetic resonance imaging revealed bone marrow edema with T1-weighted hypointensity and short inversion time inversion recovery hyperintensity at his left sacrum in coronal sections, consistent with stress fracture. Pain was relieved with rest and 1 year later he was able to return to rugby without lumbago or left buttock pain. CONCLUSIONS: Sacral stress fracture can cause low back pain in athletes. Coronal magnetic resonance imaging appears to be an effective option for diagnosis.

A Prospective, Descriptive, Quality Improvement Study to Investigate the Impact of a Turn-and-Position Device on the Incidence of Hospital-acquired Sacral Pressure Ulcers and Nursing Staff Time Needed for Repositioning Patients.

Patients in critical care areas are at risk for developing hospital-acquired pressure ulcers (HAPUs) due to their physical conditions and limited ability to reposition themselves. A prospective, 2-phase quality improvement study was conducted from September to November 2011 and from February to April 2012 in 1 medical and 1 surgical ICU to investigate the impact of a turn-and-assist device on the incidence of HAPUs and the time and personnel required to reposition patients reported as person/minutes (staff x minutes). A consecutive, convenience sample of patients was selected from newly admitted ICU patients who were at least 18 years old, nonambulatory, and required 2 or more people to assist with turning and repositioning. Sociodemographic data (patient age, gender, height, weight, body mass index, incontinence status); total Braden score and subscores for Activity, Mobility, and Moisture on admission; length of ICU stay and ventilator days; and sacral pressure ulcer incidence and stage and turn-and-assist data were collected. Fifty (50) patients participated in each phase. In phase 1, standard care for positioning included pillows, underpads, standard low-air-loss beds and additional staff as required for turning. In phase 2, the study product replaced standard care repositioning products including pillows; and a larger disposable moisture-wicking underpad (included as part of the turn study project kit) was substituted for the smaller, standard moisture-wicking disposable underpad. Turning procedures were timed with a stopwatch. Data were collected for a total of 32 hours during the observation periods; all patients were followed from admission until discharge from the ICU for a maximum of 14 days. T-tests were used to compare patient characteristics and person-minutes needed for repositioning differences, and Fisher's exact test was used to compare the incidence of sacral HAPUs during phase 1 and phase 2 of the study. No statistically significant sociodemographic or clinical differences were noted between the 2 groups. During phase 1, 14 patients (28%) developed a Stage 2 sacral HAPU. During phase 2, no patients developed a sacral HAPU (P <0.0001). The average time spent for repositioning was 16.34 person/minutes (range 4-60, SD 10.08) during phase 1 and 3.58 minutes (range 1.12-8.48, SD 2.31) during phase 2. The mean difference between person/minutes for the 2 phases was 12.76 minutes (P = 0.0006). In this population of ICU patients, the rate of sacral HAPUs and person/time needed for repositioning were significantly lower following implementation of a turn-and-assist product. Future research is indicated on the effect of this type of product on improving outcomes for patients and making the work of patient care safer and more efficient.

Coccigectomía subperióstica total en la coccigodínia traumática crónica refractaria / Total subperiosteal coccygectomy for chronic traumatic refractory coccygodynia

Fundamento: la coccigodínia o dolor a nivel del cóccix es una condición poco frecuente con una incidencia no bien definida, que afecta cinco veces más a mujeres que hombres entre 30 y 50 años de edad y se asocia a la obesidad. La causa más común es el trauma como resultado de una caída sobre los glúteos, microtraumas repetitivos o el parto.Objetivo: presentar un caso de coccigectomía subperióstica total para el tratamiento de la coccigodínia traumática crónica refractaria.Caso clínico: paciente femenina de 51 años de edad, que acude a consulta con dolor en la región del cóccix, de cinco años de evolución debido a una caída sobre sus glúteos que se incrementaba a la defecación y el coito. Recibió numerosos tratamientos conservadores, sin mejoría clínica evidente por lo que dos años después se le practicó una coccigectomía parcial sin éxito. A la exploración física se constató dolor a la palpación, a nivel de la proyección de cóccix y tacto rectal doloroso con esfínter anal con buen tono y ampolla rectal vacía. Se realizó Rx de cóccix que no fue conclusivo para diagnóstico, por lo que se practicó una tomografía axial computarizada de sacro-cóccix con reconstrucciones en tercera dimensión que confirmaron la presencia íntegra del cóccix. Se realizó coccigectomía subperióstica total.Conclusiones: la coccigectomía subperióstica total es una técnica quirúrgica segura y factible en los enfermos con coccigodínia crónica refractaria, que puede mejorar los síntomas con un escaso porciento de complicaciones, siempre y cuando se llegue al diagnóstico adecuado de la causa que la provoca(AU)

Background: coccygodynia or coccyx pain is an infrequent condition with an incidence that is not well defined. It affects women of 30 to 50 years of age five times more than men and it is associated with obesity. Trauma caused by falls, repetitive microtrauma or labor are the common causes.Objective: to present a case of total subperiosteal coccygectomy for the treatment for chronic traumatic refractory coccygodynia.Clinical case: a fifty-one year-old female patient, who attends a health center, with pain around the coccyx from five years of evolution due to a fall, increasing when defecating and having sexual intercourse. Numerous conservative treatments were given, without seeing evident clinical recovery. As a result, two years later, partial coccygectomy was performed. However, it did not have success. When examined physically, the patient felt pain in the coccyx projection and rectal examination with anal sphincter good tone and empty rectal ampulla. A coccyx X-ray that was not conclusive for diagnosis was carried out. Therefore, CT scans of sacrococcyx with 3D reconstructions which confirmed the complete presence of coccyx. Total subperiosteal coccygectomy was performed.Conclusions: total subperiosteal coccygectomy is a safe and feasible surgical technique in patients with chronic refractory coccygodynia, that can improve the symptoms with an scarce percentage of complications, as long as physicians give a right prognosis according to the cause that leads to it(AU)

A comparative, descriptive study of systemic factors and survival in elderly patients with sacral pressure ulcers.

Sacral pressure ulcers (PUs) are a serious complication in frail elderly patients. Thin tissue in the sacral area, low body mass index, and anatomical location contribute to the development of sacral PUs. A comparative, descriptive study was conducted to identify patient systemic factors associated with sacral PUs and to compare survival time in patients with and without PU. All consecutive patients with PUs (n = 77) and without sacral PUs (n = 53) admitted to the skilled nursing department of a geriatric hospital in Jerusalem, Israel between July 1, 2008 and December 31, 2011 were eligible to participate. Charts of previously admitted patients were abstracted and patients were prospectively followed until discharge, death, or the end of the study. Patient demographics, comorbidities, nutritional status, physical and cognitive function (measured using the Reisberg's Functional Assessment Staging Tool [FAST], Stages of Dementia of Alzheimer Scale, and the Glasgow Coma Scale), PU status, number of courses of antibiotic treatment during admission, length of hospitalization, and mortality were compared between patients admitted with and without a sacral PU using descriptive and univariate statistics. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for sacral PU versus without PU by study covariate. The association between sacral PU and survival time was assessed using Kaplan-Meier models. Patients with a sacral PU were significantly older (average age 81.60 ±10.78 versus 77.06±11.19 years old, P = 0.02) and had a higher prevalence of dementia (70% versus 30%, P = 0.007), Parkinson's disease (92.3% versus 7.7%, P = 0.03), and anemia (67.7% versus 32.3%, P = 0.06) than patients admitted without a PU. Patients with a sacral PU also had a lower body mass index (23.1 versus 25.4, P = 0.04), and lower hemoglobin (10.54 versus 11.11, P = 0.03), albumin (26.2 versus 29.7, P = 0.002), and total protein levels (61.3 versus 65.7, P = 0.04). In addition, antibiotic treatment was significantly higher in the patients with PU (50.6% versus 28.3%, P = 0.01). Patients with a sacral PU also had significantly lower physical and cognitive functioning scores and their median survival time was 70 days compared to 401 days in the non-PU group (P <0.001). These findings are generally consistent with the literature regarding risk factors for PU development and confirm the need for preventive measures. In addition, clinicians need to address the overall goal of patient care and patient quality of life when considering PU management interventions in this patient population.

A prospective assessment of sacral pressures in healthy volunteers seated upright and reclined with legs elevated in a recliner.

Prolonged, unrelieved pressure is a major risk factor for pressure ulceration, and interface tissue pressures have been shown to be very high when a person is sitting. Using convenience sampling methods, 23 healthy participants (four men, 19 women, mean age 45 years, body mass index [BMI] range 20-45) participated in a prospective pilot study to evaluate the effect of BMI and two commonly used seating positions in standard hospital reclining chairs on tissue (especially sacral) interface pressures. Measurements were obtained when volunteers were seated upright with plantar surfaces of feet touching the floor (Position 1) and reclining with legs resting on an elevated surface (Position 2). Measurements were obtained for 6 minutes using a thin, flexible force sensing array 430-mm x 430-mm seat mat. Average pressure, maximum pressure, and the number of sensors reading >60 mm Hg and >80 mm Hg were used for analysis across the total surface and at the sacrum. Participants were categorized by BMI (category 1: 20-22, category 2: 23-28, category 3: 29+; no participants had a BMI <20). Leg elevation reduced average pressure across the total surface (from 42.9 mm Hg to 40.0 mm Hg, P = 0.015) and the number of sensors reading >60 mm Hg at the sacrum (from 31.4 to 27.1, P = 0.047). BMI and position were significantly correlated with the number of sensors reading >80 mm Hg (P = 0.008) and average pressure (P = 0.031). Pairwise comparisons showed significant differences existed between BMI categories 1 (average delta: -3.63, indicating down position is better) and 3 (average delta: 4.67, indicating up position is better) for the difference in number of sensors above 80 mm Hg (P = 0.030). Research is needed to further explore the relationship between BMI and tissue pressure, but the results of this study suggest that for patients with a BMI >29, elevating the heels/reclining the chair significantly reduces sacral tissue interface pressure. Further research specific to pressure relief in the sitting position is needed, as neither position examined in this study was found to reduce interface pressures to generally considered safe levels for reduced-mobility patients.