Factors associated with intention to use care robots among people with physical disabilities.

BACKGROUND: As the disabled population ages and the demand for care increases, Socially, the need for care robots is emerging but, perceptions of care robots among care recipients is unknown. PURPOSE: To determine the level of intention to use care robots among care recipients and identify predictors of intention to use care robots. METHODS: A cross-sectional survey was conducted using a convenience sample of 163 persons with disabilities from January to March 2022 at the Veterans Health Service Medical Center. DISCUSSION: Overall, 64.42% of respondents intended to use care robots. Predictors included perceived behavioral control, participants' perceptions of the caregiver's burden, attitude toward robot use, subjective norms, and age. CONCLUSION: These findings suggest that individuals who are community-dwelling desire the use care robots to maintain their independence and may provide useful insignt for the introduction various care robots in acute care and long-term care settings.

Nurses' Perception and Performance of End-of-Life Care in a Tertiary Hospital.

Purpose: This study aimed to identify levels of perception and performance of end-of-life care among nurses and to investigate correlations between perception and performance. Methods: This cross-sectional descriptive survey included 321 nurses from a tertiary hospital in Seoul, Korea. The participants had at least 6 months of work experience and had been involved in end-of-life care at least once, in either ward or intensive care unit settings. A structured questionnaire was utilized to assess their perception and performance of end-of-life care. Results: The mean score for perception of end-of-life care was 3.23±0.34, while the score for performance of end-of-life care was 3.08±0.34. There was a significant positive correlation between nurses' perception of end-of-life care and their performance in this area (r=0.78, P<0.001). Conclusion: It is necessary to change perceptions regarding end-of-life care and to develop systematic and standardized education programs including content such as assessing the hydration status of dying patients, evaluating mental aspects such as suicidal ideation, and providing spiritual care for nurses working in end-of-life departments.

Risk factors for device-related pressure injuries in general ward inpatients of a tertiary general hospital: A case-control study.

AIMS: To identify the characteristics of device-related pressure injuries (DRPI) in general ward inpatients, and to confirm the DRPI risk factors by examining differences between a DRPI and non-DRPI group. METHODS: This study is a retrospective case-control study. High-risk adult patients for pressure injuries (rated at 16 points or less on the Braden scale) who were admitted to a general ward of a tertiary general hospital in South Korea from January 1 to September 30, 2021 were enrolled in this study. Among them, participants were selected by matching the patients with DRPI (n = 50) to the non-DRPI patient group (n = 100) in a ratio of 1:2. RESULTS: As for risk factors, longer hospitalization periods and the presence of oedema increased DRPI risk. In blood tests, higher glucose levels increased the risk by 1.03 times, and lower albumin levels increased the risk by 0.08 times. Furthermore, the risk of developing DRPI was 7.89 times higher when sedatives were administered. CONCLUSIONS: Based on the DRPI risk factors identified in this study, patients who have oedema, who have long hospital stays, use sedatives and devices, have a low albumin level, and whose blood glucose is not well controlled should be recognized as having a high risk of developing DRPI. In order to prevent the development of DRPI, it is necessary to recognize risk factors at an early stage, increase actively preventive interventions. The results of this study contribute to recognizing the risk of DRPI in patients and evaluating risk factors for DRPI prevention.

Effectiveness and methods of cryotherapy in reducing swelling after total knee arthroplasty: A systematic review on randomized controlled trials.

AIM: This study aims to investigate the effect and methods of cryotherapy in reducing swelling after total knee arthroplasty. DESIGN: Systematic review. METHODS: We searched PubMed, Embase, CINAHL, Cochrane Library, KoreaMed, KERIS and National Science Digital Library for randomized controlled trials on 19 August 2021. This systematic review was conducted according to the PRISMA 2009 checklist. RESULTS: A total of eight randomized controlled trials were systematically reviewed to determine the effect and methods of cryotherapy on reducing postoperative swelling. The effects were not significantly different in six studies. Application time per cryotherapy session was 10-20 min when using an ice pack and up to 48 h when using an automated device. The duration ranged from 2 days to 1 week or until discharge, and the frequency varied from 2 to 72 times per day.

A Phenomenological Study of Nurses' Experience in Caring for COVID-19 Patients.

This study aimed to understand and describe the experiences of nurses who cared for patients with COVID-19. A descriptive phenomenological approach was used to collect data from individual in-depth interviews with 14 nurses, from 20 October 2020 to 15 January 2021. Data were analyzed using the phenomenological method of Colaizzi. Five theme clusters emerged from the analysis: (1) nurses struggling under the weight of dealing with infectious disease, (2) challenges added to difficult caring, (3) double suffering from patient care, (4) support for caring, and (5) expectations for post-COVID-19 life. The findings of this study are useful primary data for developing appropriate measures for health professionals' wellbeing during outbreaks of infectious diseases. Specifically, as nurses in this study struggled with mental as well as physical difficulties, it is suggested that future studies develop and apply mental health recovery programs for them. To be prepared for future infectious diseases and contribute to patient care, policymakers should improve the work environment, through various means, such as nurses' practice environment management and incentives.

Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials.

BACKGROUND: Pressure injury (PI) is a significant health problem among inpatients that affects their health, quality of life, and expenses. AIM: This systematic review aimed to compare effects of alternating pressure air mattresses (APMs) with other types of supporting surfaces as a tool for PI prevention. METHODS: The literature published between 2009 and 2020 was searched using the databases PubMed, EMBASE, CINAHL, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses process was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane Risk of Bias Tool (RoB 2.0). RESULTS: A total of six randomized controlled trials (RCTs) were analyzed. The incidence of hospital-acquired PIs at stage 1 or higher was reported in the APM group from 0.3% to 25%. In one study, APMs were found to be less effective than static air mattresses (SAMs); in contrast, two studies found no difference. In one study, the APM was reported to be more effective than the viscoelastic foam mattress (VFM). On the contrary, in a more recent study, the APM was reported to be less effective than the VFM, and there was no difference compared with high-specification foam mattresses in another study. Using the RoB 2.0 tool, one study was evaluated at "low risk of bias," another as "some concern," and four as "high risk." LINKING EVIDENCE TO ACTION: There is insufficient evidence to suggest that APM is more effective in preventing PIs than other supporting surfaces. Evidence to date suggests that APM can be used in patients at risk for PIs. It is important to change position regardless of the type of support surface used. Highly controlled RCTs with low risk of bias are needed to provide strong evidence for identifying the most effective PI prevention support surfaces.

A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler's Position.

Insufficient research exists for position change intervals to eradicate pressure ulcers. We tried to provide evidence for the position change interval by comparing peak pressure, risk area ratio, and the time to reach 30 mmHg and 60 mmHg, and presented this in detail, according to the angle in the three positions. The study conducted RCTs on a total of 64 healthy adults. For two hours, interface pressure measurements were compared with 30° and 90° tilting at the inclined, 0° and 45° head-of-bed (HOB) elevation at the supine, and 30° and 45° HOB elevation at the Fowler's position. The peak pressure on 30° tilting remained less than 60 mmHg for 2 h, unlike 90° tilting. To reach 60 mmHg took 78.18 min at 30° tilting, within 30 min at the 30° supine, 30° and 45° at the Fowler's position, and 39.55 min at 0° supine. The pressure difference according to the angles was only significant at 30° and 90° tilting, with no difference in the other groups. To prevent pressure ulcers, position changes are required every 2 h in the 30° tilting position, every 1.5 to 2 h at 0° supine, and at least every 1.5 h for all the other positions.

Psychometric Properties of the Korean Family Reported Outcome Measure for Family Members of Patients With Acquired Brain Injury.

ABSTRACT: BACKGROUND: Acquired brain injury (ABI) affects not only survivors but also their family members' quality of life in various ways. The Family Reported Outcome Measure (FROM-16), a self-reported instrument, has been developed to evaluate the impact of diseases on the lives of family members of patients. This study aimed to assess the reliability and validity of the Korean FROM-16 for family members of individuals with ABI. METHODS: A total of 200 family members of patients with ABI in South Korea participated in this study. Internal consistency was assessed using Cronbach α. To establish the validity, we evaluated the semantic equivalence, content, known-group, conduct, concurrent, and convergent validity of the Korean FROM-16. For exploratory factor analysis, common factor analysis with oblique rotation, parallel analysis, an eigenvalue greater than 1.0, and a scree plot were used. RESULTS: Exploratory factor analysis revealed 2 factors for the 16 items, which explained 67.4% of the total variance. Concurrent validity was established by comparison with the Korean World Health Organization Quality of Life Scale Brief (r = -0.57), and regarding the convergent validity, the Korean FROM-16 score positively correlated with the Korean Neurobehavioral Functioning Inventory. Known-group validity was confirmed by showing that family members with advanced age, the burden of caring, and insufficient income, as well as spouses, had a statistically higher score in the Korean FROM-16. Cronbach α was .92, indicating high internal consistency reliability. CONCLUSION: The Korean FROM-16 is a valid and reliable instrument for evaluating the impact of diseases on family members of individuals with ABI in South Korea.

Discharge Transition Experience for Lumbar Fusion Patients: A Qualitative Study.

ABSTRACT: BACKGROUND: Support should be provided to individuals who are ready to be discharged; however, quantitative research is lacking in understanding the challenges of postsurgery lumbar fusion patients' discharge and transition. This article delves into the in-depth experience of lumbar fusion patients with discharge transitions. METHODS: We conducted semistructured individual interviews with 11 patients who had lumbar fusion surgery at one of Korea's most equipped general hospitals. These interviews focused on the patients' discharge transition experiences. The data were analyzed using phenomenological analysis. RESULTS: Lumbar fusion patients' experiences of discharge transition fit into 4 categories: anticipation of surgical transition, the process of transition to discharge, the difficult process of recovery, and recovery strategy. CONCLUSION: To further expedite the discharge process and make better use of cooperative hospital resources, conducting preoperative treatment planning, identifying family and social support systems, and sharing treatment procedures are all required. Furthermore, thorough health information services and step-by-step courses on predicted problems and everyday living after surgery should be considered for postoperative education. It is critical to broadening the scope of preoperative and postoperative education programs, as well as assistance for the social support system, such as the family-based support system and cooperative hospitals.

Effects of Localized Heating on Pain, Skin Perfusion, and Wound Healing After Lumbar Decompression.

BACKGROUND: Current evidence regarding the effectiveness and safety of localized heating after spinal surgery for pain, peripheral tissue perfusion, and wound healing is conflicting. METHODS: This study was a prospective, single-blind, randomized controlled trial; 58 adult patients were randomized to an experimental group or a control group after spinal decompression surgery. All participants received localized cooling on postoperative days 1 and 2. The experimental group received localized heating at the surgical wound on postoperative days 3 and 4, and the control group kept normothermia without localized heating. Outcome variables were evaluated 1 hour after surgery and on day 4. RESULTS: Postoperative pain was significantly lower in the experimental versus control group (13.8 vs 23.0, P = .01). Skin perfusion was better in the experimental versus control group (4.7 vs 2.8, P = .001). There was no statistically significant difference in the wound healing status between the groups. CONCLUSION: Localized heating can effectively relieve postoperative pain and improve skin perfusion. These results suggest that localized heating tailored to the wound healing process may be beneficial for patients undergoing spinal surgery.

The effects of cryotherapy on perineal pain after childbirth: A systematic review and meta-analysis.

BACKGROUND: Most women experience perineal pain after childbirth. Sustained perineal pain affects mother's daily living. Various methods have been used to relieve postpartum perineal pain, such as cold or warm therapy, but the pain-control effects of cryotherapy are still controversial. AIMS: The purpose of this study was to verify the effectiveness of cryotherapy in relieving perineal pain in women after childbirth. METHODS: The researchers searched the CINAHL, Cochrane, EMBASE, PubMed, Korea Education and Research Information Service, NDSL, KoreaMed, LILACS and SciELO databases for studies to include in this review, and selected studies using PICO criteria. Methodological quality was assessed based on Cochrane's risk of bias 2 for randomized controlled trials. Data were analyzed with the Comprehensive Meta-Analysis program. FINDINGS: Eleven published studies encompassing 1,492 participants were included. Cryotherapy significantly reduced pain two days postpartum. Ice packs and gel packs had similar pain-relieving effects. Cryotherapy did not differ significantly from Epifoam therapy (hydrocortisone-pramoxine) in its effects on perineal pain one day or five days after childbirth. CONCLUSIONS: Cryotherapy can be an effective non-pharmacological nursing intervention to reduce pain after childbirth.

Structural Model of Professional Socialization of Nursing Students With Clinical Practice Experience.

BACKGROUND: This study developed a structural model of the professional socialization of nursing students with clinical practice experience and tested its validity based on Meleis's transition theory. METHOD: Participants were third- and fourth-year nursing students with at least one semester of clinical experience. Cross-sectional data from 412 participants were analyzed. RESULTS: The goodness of fit of the model was satisfactory. Regarding the differences in educational year, the effects of the clinical learning environment on adaptation to a clinical practicum were not significant for third-year students but were significant for fourth-year students. The effects of clinical practice competency on professional socialization were significant only for fourth-year students. Transition shock and adaptation to clinical practicum paths were significant factors in both groups. CONCLUSION: Clinical adaptation is important for developing professional socialization in nursing students. Clinical adaptation can be achieved by improving the clinical learning environment and facilitating the development of clinical practice competency. [J Nurs Educ. 2020;59(3):133-141.].

Mothers' Perceptions of Quality of Family-Centered Care and Environmental Stressors in Neonatal Intensive Care Units: Predictors of and Relationships with Psycho-emotional Outcomes and Postpartum Attachment.

OBJECTIVES: Maternal attachment to promote role development in mothers of preterm infants is critical for babies' optimal growth and development. However, few models specify how neonatal intensive care units (NICUs) and their environments work to foster postpartum attachment (PPA) after preterm birth. We investigated relationships of quality of family-centered care and NICU environmental stressors with maternal PPA, to determine whether these are mediated by mothers' psycho-emotional response and whether pathways to PPA are moderated by developmental immaturity (gestation, birthweight). METHODS: A cross-sectional study using structural equation modeling was conducted on 294 mothers of premature infants with experience in NICUs in over 49 tertiary hospitals in 12 cities or provinces of South Korea. Data were collected using Korean versions of instruments including the Quality of Family-centered Care, Parental Stressor Scale: NICU, and Maternal Postpartum Attachment Scale. RESULTS: Maternal self-representation was a key predictor of PPA (ß = .68), accounting for 42.2% of variance. Multi-group analysis indicated that NICU environmental stressor sensitivity (ß = .26) and maternal self-representation (ß = .67) were predictive of PPA in mothers of moderately preterm and low birthweight (32-36 weeks' gestation, 1500-2499 g birthweight) infants. Quality of family-centered developmental care (ß = .11) and NICU environmental stressor sensitivity (ß = - .16) had significant indirect effects on PPA through psycho-emotional responses. CONCLUSIONS FOR PRACTICE: Healthcare professionals should be aware of the importance of family-centered interventions focusing on psychosocial support and family participation in baby care, based on their environmental role in promoting PPA.

Effects of Education on the Use of Personal Protective Equipment for Reduction of Contamination: A Randomized Trial.

INTRODUCTION: Accurate doffing personal protective equipment (PPE) is one of the key practices of infection control because of increased risk of infection transmission caused by medical garments or environmental contamination. OBJECTIVES: The study aimed to develop a reality-based education program and identify its effects on nurses' knowledge, attitudes, and contamination after PPE doffing. METHODS: Randomized control group pretest-posttest design. A total of 56 nurses were randomly assigned to experimental (n = 28) and control (n = 28) groups. The experimental group underwent a new reality-based education program to improve PPE use. Subsequently, participants were assessed on knowledge of and attitude toward PPE use, as well as number and area of contaminated sites after removing PPE and mask fitting test. RESULTS: There were no significant differences in knowledge and attitude to PPE use. The experimental group had significantly fewer contaminated sites than the control group (42 vs. 89), and a significantly lower mean contaminated site area (16.63 ± 24.27 vs. 95.41 ± 117.51 cm2). The tuberculosis mask fitting test success rates were 68% and 50% in the experimental and control groups, respectively, but the difference was not significant. CONCLUSION: The reality-based education on use of PPE helps to reduce contamination and improve performance related to the use of PPE for infection control.

Long-term trends in airborne SO2 in an air quality monitoring station in Seoul, Korea, from 1987 to 2013.

Atmospheric concentration of sulfur dioxide (SO2) was intermittently measured at an air quality monitoring (AQM) station in the Yong-san district of Seoul, Korea, between 1987 and 2013. The SO2 level was compared with other important pollutants concurrently measured, including methane (CH4), carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), ozone (O3), and particulate matter (PM10). If split into three different periods (period 1, 1987-1988, period 2, 1999-2000, and period 3, 2004-2013), the respective mean [SO2] values (6.57 ± 4.29, 6.30 ± 2.44, and 5.29 ± 0.63 ppb) showed a slight reduction across the entire study period. The concentrations of SO2 are found to be strongly correlated with other pollutants such as CO (r = 0.614, p = 0.02), which tracked reductions in reported emissions due to tighter emissions standards enacted by the South Korean government. There was also a clear seasonal trend in the SO2 level, especially in periods 2 and 3, reflecting the combined effects of domestic heating by coal briquettes and meteorological conditions. Although only a 16% concentration reduction was achieved during the 27-year study duration, this is significant if one considers rapid urbanization, an 83.2% increase in population, and rapid industrialization that took place during that period. IMPLICATIONS: Since 1970, a network of air quality monitoring (AQM) stations has been operated by the Korean Ministry of Environment (KMOE) for routine nationwide monitoring of air pollutant concentrations in urban/suburban areas. To date, the information obtained from these stations has provided a platform for analyzing long-term trends of major pollutant species. In this study, we examined the long-term trends of SO2 levels and relevant environmental parameters monitored continuously in the Yong-san district of Seoul between 1987 and 2013. The data were analyzed over various time scales (i.e., monthly, seasonal, and annual intervals). The results obtained from this study will allow us to assess the effectiveness of abatement strategy and to predict future concentrations trends in association with future abatement strategies and technologies.

Differences in Type Composition of Symptom Clusters as Predictors of Quality of Life in Patients with Meningioma and Glioma.

OBJECTIVE: Objectives of this study were to identify and compare symptom clusters in patients with meningioma and glioma and to assess and compare predictors of quality of life (QoL) in both patient groups. METHODS: Data were collected using the MD Anderson Symptom Inventory-Brain Tumor Module, Functional Assessment of Cancer Therapy-General, and Karnofsky Performance Sale. Of 158 participating patients, 77 had meningioma, and 81 had glioma. RESULTS: In patients with meningioma, 4 symptom clusters were identified with 55.4% total variance: 1) physical, 2) cognitive, 3) elimination-appearance, and 4) motor-sensory symptoms. In patients with glioma, 4 clusters with 67.3% total variance were identified: 1) treatment-related, 2) cognitive, 3) appearance-elimination, and 4) gastrointestinal symptoms. Predictors of QoL in patients with meningioma were Karnofsky Performance Scale score (ß = 0.41, P < 0.001), cognitive symptom cluster (ß = -0.36, P < 0.001), and physical symptom cluster (ß = -0.32, P = 0.001), whereas treatment-related symptom cluster (ß = -0.55, P < 0.001) was identified as a predictor of QoL in patients with glioma. CONCLUSIONS: In this study, the type and composition of symptom clusters differed between patients with meningioma and glioma. Our data also provide evidence that even when participants reported mild symptoms, these clusters could be used to predict QoL in patients with meningioma and glioma.

Effects of combination oral care on oral health, dry mouth and salivary pH of intubated patients: A randomized controlled trial.

Intubated patients are at risk of oral health problems. Although a variety of oral care regimens for intubated patients have been studied, there is a lack of research on the effects of combination oral care that includes tooth brushing, chlorhexidine and cold water. This open-labelled, randomized, controlled trial aimed to evaluate the effects of combination oral care on oral health status. Participants aged 20 years and older were recruited on the first day after intubation through convenience sampling in a medical intensive care unit. Random assignment was performed using an internet randomization service. The primary outcome was oral health status. Data were collected during May and June 2013. Participants were randomized to one of two groups (23 intervention and 21 control). The final analysis included 18 patients with combination oral care and 17 in the control group. The intervention group had better oral health (effect size = 1.56), less dry mouth and higher salivary pH than the control group. Any additional burden of providing combination oral care to patients who are mechanically ventilated is worthwhile in terms of clinical outcomes.

A prediction model of falls for patients with neurological disorder in acute care hospital.

For the prevention of falls, individual fall risk assessment is the necessary first step. Thus, we attempted to identify independent risk factors for falls and develop a prediction model using a scoring system for patients with neurological disorders in acute hospital settings. This study was a secondary analysis of a previous study performed to compare the reliability and validity of three well-known fall assessment tools in patients with neurological disorders. We considered comorbid diseases and potential medications in addition to variables included in the three tools. Multiple logistic regression analysis was used to develop a prediction model for falls. Predictive scores were calculated using the proportional odds ratio (OR) of each predictor. The discriminative power of this model was evaluated by receiver-operating characteristic (ROC) area under the curve (AUC) analysis. A total of 32 falls were noted among 1018 patients. History of falls (OR, 4.01; 95% CI, 1.61-9.98; p=.003), cerebrovascular disease (CVD) (OR, 2.61; 95% CI, 1.11-6.14; p=.028), severe impaired gait (OR, 7.28; 95% CI, 2.45-21.65; p<.001), and overestimate of one's own gait ability (OR, 9.14; 95% CI, 3.89-21.45; p<.001) were identified as meaningful predictors for falling after adjusting for age, diabetes, confusion or disorientation, up-and-go test, altered elimination, and antipsychotics by univariate analysis. The discriminative power of fall risk score calculated by the prediction model was 0.904 of AUC (p<.001). Our results suggest that in addition to fall history and the presence of CVD, neurological assessment for gait and insight into gait ability are imperative to predict falls in patients with neurological disorders.

Validation of the Korean version of the European Organization for Research and Treatment of Cancer brain cancer module (EORTC QLQ-BN20) in patients with brain tumors.

BACKGROUND: The European Organization for Research and Treatment of Cancer Quality of Life Brain Cancer Module has been translated into Korean, but to date, its reliability and validity have been evaluated in a pilot study alone. The European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire is, overall, a valid instrument to assess the health-related quality of life in Korean cancer patients, although its reliability and validity have not yet been evaluated in patients with brain tumors. This study aimed at evaluating the psychometric properties of these instruments in patients with brain tumors. FINDINGS: The 2 instruments were used for 307 Korean patients with brain tumors. Multi-trait scaling confirmed the scale structure of the instruments with good item convergent and discriminant validity. The reliability was acceptable for all scales except for cognitive functioning and nausea and vomiting. The instruments could be used to distinguish between clinically distinct groups of patients. CONCLUSIONS: The study findings indicate that the instruments are valid and suitable for the assessment of the health-related quality of life in patients with brain tumors as well as in those with primary brain cancer.

The effects of uncoated paper on skin moisture and transepidermal water loss in bedridden patients.

AIMS AND OBJECTIVES: The aims of this study were to measure skin moisture and transepidermal water loss after application of uncoated paper and to compare skin moisture and transepidermal water loss after use of uncoated paper and disposable underpads. STUDY DESIGN: The study was a cross-over, prospective, open-labeled, randomized trial. SAMPLE AND SETTING: Bedridden patients aged≥18 years at a medical center in Korea were included. Treatment order was randomly assigned using block randomization, with a block size of 4 and an assignment rate of one-by-one. METHODS: Skin moisture was measured using a Corneometer 825 and transepidermal water loss was measured using a Tewameter 300. RESULTS: Skin moisture after application of an uncoated paper was significantly lower than observed after application of a disposable underpad (mean 40.6 and SD 13.1 vs. mean 64.6 and SD 23.7, p<0.001). Transepidermal water loss also showed greater health scores after using uncoated paper (mean 11.1 and SD 5.7 g/m2/hour) than after applying a disposable underpad (mean 23.2 and SD 11.1 g/m2 /hour, p<0.001). There were no statistical between-group differences in room temperature, relative humidity, and body temperature. CONCLUSION: We found that uncoated paper was helpful in avoiding excessive moisture without adverse effects. RELEVANCE TO CLINICAL PRACTICE: As indicated by the results of this study, uncoated paper can be applied to bed-ridden patients who required incontinence care. Nurses may consider using uncoated paper as one of nursing methods in the routine care of bed-ridden patients for moisture control.