The "Enseki" sandbath: A novel, safe and effective far-infrared bathing procedure for health.

BACKGROUND: Far-infrared (FIR) is well known with various therapeutic benefits. Recently, we have developed a novel FIR bathing system called the Enseki sandbath. In this regard, we focused on physical nature of ceramic to radiate FIR rays when heated adequately. METHODS: A bathtub was filled with ceramic beads and was equipped with computerized system which enabled to supply hot water over the ceramic beads and to drain out when beads were sufficiently heated. This system was used like sandbathing. Healthy volunteers were laid in bathtubs, covered in heated ceramic beads and were bathed for 15 minutes. Microbiological analysis was done in samples obtained from the skin surface, ceramic beads, or drained water. Furthermore, various physiological parameters were monitored, including blood pressure, heart rates, oral temperature, body weight, and blood viscosity. Blood samples were simultaneously collected and subjected to biochemical analysis, including blood glucose, HbA1c, uric acid, lactate, fatty acid, and others. RESULTS: All data showed no physiological overload for tested individuals, and any biochemical analysis did not present abnormal score. Bacteriological culture grew no pathogens. Results of questionnaires demonstrated that 90% of the participants answered the comfort and wished to further repeat the bathing. LIMITATIONS: This is a nonrandomized prospective case study. CONCLUSION: We concluded that the Enseki method is a safe and well-tolerated FIR bathing procedure for regeneration and relaxation.

Variação do duplo-produto em pacientes pós-infarto agudo do miocárdio submetidos ao banho de aspersão / Variation of the double product in patients after acute myocardial infarction submitted to aspersion bath / Variación de doble producto en pacientes después de un infarto de miocardio agudo presentó rociar baño

Objetivo: Mensurar a variação do duplo-produto nos pacientes com infarto agudo do miocárdio submetidos ao banho de aspersão. Métodos: Pesquisa observacional realizada na Unidade Coronariana de um hospital de referência em cardiologia localizado na cidade do Rio de Janeiro. A amostragem deu-se por conveniência e teve como amostra os banhos de aspersão de pacientes adultos, ambos os sexos, com diagnóstico médico de infarto agudo do miocárdio com supradesnível ou sem supradesnível de segmento ST, e que tivessem indicação de banho de aspersão, fornecida pelo médico e enfermeiro responsáveis. Resultados: Houve aumento do valor médio do duplo-produto em todos os pacientes acompanhados, porém sem significância estatística. Conclusão: A indicação do banho de aspersão nesta amostra foi segura

Objective: To measure the variation of the double product in patients with acute myocardial infarction submitted to spray bath. Methods: Observational study, conducted in the Coronary Care Unit of a referral hospital in cardiology located in the city of Rio de Janeiro. Sampling was given for convenience and was to sample the spray baths adult patients, both sexes, with a diagnosis of AMI with elevation or non-ST segment elevation, and they had spray bath indication provided by the doctor and nurse responsible. Results: There was increase in the average value of the double product in all patients followed, but without statistical significance. Conclusion: The indication of the spray bath in this sample was safe

Objetivo: Medir la variación del doble producto en pacientes con infarto agudo de miocardio sometido a baño de aerosol. Métodos: Estudio observacional, realizado en la Unidad Coronaria de un hospital de referencia en cardiología ubicada en la ciudad de Río de Janeiro. El muestreo se da por conveniencia y era para probar los baños de aspersión pacientes adultos, de ambos sexos, con diagnóstico de IAM con elevación o sin elevación del segmento ST, y que había indicación de baño de aerosol proporcionada por el médico y la enfermera responsable. Resultados: No hubo aumento en el valor medio de la doble producto en todos los pacientes siguió, pero sin significación estadística. Conclusión: La indicación del baño de pulverización en esta muestra era seguro

Inappropriate ICD shock due to hot tub-induced external electrical interference.

BACKGROUND: A 72-year-old white male with a history of rapid nonsustained ventricular tachycardia, hypertrophic cardiomyopathy, and intermittent Brugada-type ECG had a single-lead implantable cardioverter-defibrillator (ICD) implantation and received a sudden ICD shock while in the hot tub. To the best of our knowledge this is the first case report of hot tub jet-induced inappropriate ICD shock. METHODS: ICD interrogation and analysis of intracardiac electrograms and event markers. RESULTS: ICD interrogation revealed inappropriate ICD shocks due to electrical interference of hot tub engine; 60-cycle electrical artifact mimicking fast ventricular fibrillation erroneously detected by the device. The device then delivered a 34.8 joules shock while the patient was actually in sinus rhythm. CONCLUSIONS: Electrical interference due to external sources such as hot tub engines may occur and produce an inappropriate detection and ICD shock. Precaution and patient education is warranted.

Application of three different methods to determine the prevalence, the abundance and the environmental drivers of culturable Vibrio cholerae in fresh and brackish bathing waters.

AIMS: Three cultivation methods were used to study the prevalence and abundance of Vibrio cholerae in Eastern Austrian bathing waters and to elucidate the main factors controlling their distribution. METHODS AND RESULTS: Vibrio cholerae abundance was monitored at 36 inland bathing sites with membrane filtration (MF), a standard most probable number (MPN) approach and direct plating (DP). Membrane filtration yielded the most reliable and sensitive results and allowed V. cholerae detection at 22 sites with concentrations up to 39 000 CFU per 100 ml, all belonging to serogroups other than O1 and O139 and not coding for cholera toxin and toxin coregulated pilus. Direct plating turned out as an easy method for environments with high V. cholerae abundances, conductivity was the only significant predictor of V. cholerae abundance in the bathing waters at warm water temperatures. CONCLUSIONS: Vibrio cholerae nonO1/nonO139 are widely prevalent in Eastern Austrian bathing waters. Instead of the standard MPN approach, MF and DP are recommended for V. cholerae monitoring. Conductivity can be used as a first easy-to-measure parameter to identify potential bathing waters at risk. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrio cholerae nonO1/nonO139 infections associated with bathing activities are an increasing public health issue in many countries of the northern hemisphere. However, there are only limited data available on the prevalence and abundance of V. cholerae in coastal and inland bathing waters. For monitoring V. cholerae prevalence and abundance, reliable and simple quantification methods are needed. Moreover, prediction of V. cholerae abundance from environmental parameters would be a helpful tool for risk assessment. This study identified the best culture-based quantification methods and a first quick surrogate parameter to attain these aims.

A robotic shower system : Acceptance and ethical issues.

BACKGROUND: Being able to maintain personal hygiene plays a crucial role for independent living in old age or when suffering from disabilities. Within the European project ICT Supported Bath Robots (I­SUPPORT) an intelligent robotic shower system is being developed, which enables patients to shower independently at home or in institutionalized settings. OBJECTIVE: The aim of this contribution is the identification of ethical issues in the development of a robotic shower system utilizing the model for the ethical evaluation of socio-technical arrangements (MEESTAR). MATERIAL AND METHODS: In I­SUPPORT a variety of concepts and methods are implemented in order to achieve technology acceptance such as user-centered requirements analysis, usability-tests and analysis of sociocultural and ethical aspects. This article reports the analysis of focus groups with 14 older adults and 9 professional caregivers utilizing MEESTAR as a heuristic approach for analyzing sociotechnical arrangements and identifying ethical problems. RESULTS AND DISCUSSION: The MEESTAR procedure was adapted to the research question and client groups and implemented as a discursive method. This gave an insight into the meaning and background of ethical aspects and also a deeper insight into nursing processes as well as the requirements which the system should fulfil. Shortcomings are that the ethical dimensions are not everyday language and the time restrictions. In the next step a standardized assessment instrument will be developed and piloted.

Bath for dependent patients: theorizing aspects of nursing care in rehabilitation / Baño del paciente dependiente: aspectos teorizantes de la atención de Enfermería en rehabilitación / Banho no cliente dependente: aspectos teorizantes do cuidado de Enfermagem em reabilitação

ABSTRACT Objective: to produce a reflective essay on what has been produced in relation to bath as a procedure related to nursing care and diagnosis for dependent patients undergoing mediate and immediate rehabilitation processes after a traumatic event. Method: discursive, reflective study supported by classical content analysis consisting of the following stages: a) reading of the texts in their most comprehensive form; b) emphasizing the relevant elements produced about bathing; c) reflection on texts and what is produced about bathing. Results: the texts point out to three categories for nursing practice and reflection: Meaning to patients on the purposes of bathing; Representation for nurses in the work process; Representation for nurses in the management of care and nursing care planning. Conclusion: the reflection points out understandings on bathing as a care focused on the autonomy of nursing rehabilitation patients, requiring further investigations.

RESUMEN Objetivo: Analizar en la perspectiva de un ensayo reflexivo sobre lo que está siendo producido acerca del baño, como procedimiento de atención y diagnóstico de enfermería para pacientes dependientes, en proceso de rehabilitación mediato e inmediato, posterior a evento traumático. Método: Discursivo, reflexivo, respaldado por análisis de contenido clásico, incluyendo las etapas: a) lectura integral de los textos; b) énfasis en elementos relevantes producidos sobre el baño; c) reflexión sobre los textos y sobre la producción sobre el baño. Resultados: Los textos determinaron tres categorías para reflexión y práctica de enfermería: Significado para el paciente de la práctica de enfermería; Representación para enfermeros en el proceso de trabajo; representación para enfermeros en la gestión del cuidado y planificación de atención de enfermería. Conclusión: La reflexión refiere una comprensión del baño como cuidado enfocado en la autonomía del paciente de enfermería de rehabilitación, y carece de investigaciones futuras.

RESUMO Objetivo: versar na perspectiva de um ensaio reflexivo do que vem sendo produzido sobre o banho, como um procedimento do cuidado e do diagnóstico de enfermagem para clientes dependentes, em processo de reabilitação mediata e imediata, após evento traumático. Método: discursivo reflexivo, apoiado pelo método de análise de conteúdo clássica, constituída pelas seguintes etapas: a) leitura dos textos em sua forma mais abrangente; b) destaque para os elementos relevantes produzidos sobre o banho; c) reflexão sobre os textos e o que é produzido sobre o banho. Resultados: os textos apontam três categorias para reflexão e prática de enfermagem: Significado para o cliente nos propósitos desta; representação para enfermeiros no processo de trabalho; representação para estes na gestão do cuidado e planejamento da assistência de enfermagem. Conclusão: a reflexão aponta entendimentos do banho como cuidado focado na autonomia dos clientes da enfermagem de reabilitação e carece de futuras investigações.

Bath for dependent patients: theorizing aspects of nursing care in rehabilitation.

OBJECTIVE: to produce a reflective essay on what has been produced in relation to bath as a procedure related to nursing care and diagnosis for dependent patients undergoing mediate and immediate rehabilitation processes after a traumatic event. METHOD: discursive, reflective study supported by classical content analysis consisting of the following stages: a) reading of the texts in their most comprehensive form; b) emphasizing the relevant elements produced about bathing; c) reflection on texts and what is produced about bathing. RESULTS: the texts point out to three categories for nursing practice and reflection: Meaning to patients on the purposes of bathing; Representation for nurses in the work process; Representation for nurses in the management of care and nursing care planning. CONCLUSION: the reflection points out understandings on bathing as a care focused on the autonomy of nursing rehabilitation patients, requiring further investigations.

Effects of grab bar on utilized friction and dynamic stability when elderly people enter the bathtub.

BACKGROUND: The effect of the grab bar on dynamic stability when elderly people enter the bathtub remains unclear. The purpose of the present study is to examine the age-related effect of the grab bar on dynamic stability during lateral stepping over an obstacle when entering bathtub. METHODS: Sixteen young, healthy adults and sixteen elderly adults participated. The subjects performed lateral stepping over an obstacle with and without vertical and horizontal bars. Displacement and velocity of the center of mass and utilized friction, which is the required coefficient of friction to avoid slipping, were simultaneously measured by a three-dimensional motion analysis system and two force plates. FINDINGS: A post hoc test for two-way ANOVA revealed that velocity of the center of mass in the vertical direction (p<0.05) and peak-to-peak values of the center of mass in the lateral (p<0.05) and vertical directions (p<0.05) with each grab bar were significantly slower and smaller than those without the grab bar in young and elderly people. Moreover, the utilized friction at push off of the trailing leg with the vertical bar in elderly people was lower (p<0.05) than that in participants without the grab bar. INTERPRETATION: The use of each grab bar while performing a lateral step over an obstacle may help maintaining balance in lateral and vertical directions. However, use of the vertical bar while lateral stepping over an object in elderly people may need low utilized friction to prevent slipping.

Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning.

Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.

Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams.

PURPOSE: To determine if non-occupational therapists (non-OTs) with different job titles using Algo, a clinical algorithm for recommending bathroom modifications (e.g., bath seat) for community-dwelling elders in "straightforward" situations, will make clinically equivalent recommendations for standardized clients. METHOD: Eight non-OTs (three social workers, two physical rehabilitation therapists, two homecare aides and one auxiliary nurse) were trained on Algo and used it with six standardized clients. Bathroom adaptations recommended (one of nine options) by non-OTs were compared to assess interrater agreement using Fleiss adapted kappa. RESULTS: Estimated kappa was 0.43 [0.36; 0.49] qualified as a moderate agreement, according to Landis and Koch's arbitrary divisions, among the recommendations of non-OTs. However, clinical equivalence is reached, since safety and client needs were met when raters selected two different options (e.g., with or without a seat back). CONCLUSIONS: Non-OTs using Algo in the same simulated clinical scenarios recommend clinically equivalent bathroom adaptations, increasing the confidence regarding the interrater reliability of Algo used by non-OT members of homecare interdisciplinary teams Implications for Rehabilitation In homecare services, non-occupational therapists from different health care disciplines (e.g., homecare aides, social workers, physical rehabilitation therapists) may be asked to select assistive devices for the hygiene care of clients living at home. Algo was designed to guide non-occupational therapists in the selection of assistive devices when performed with clients in straightforward cases. This study indicates that non-occupational therapists using Algo recommend similar and acceptable bathroom adaptations to enhance client safety.

Controlling Legionella and Pseudomonas aeruginosa re-growth in therapeutic spas: implementation of physical disinfection treatments, including UV/ultrafiltration, in a respiratory hydrotherapy system.

The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties.

Guidelines for bath PUVA, bathing suit PUVA and soak PUVA.

BACKGROUND: The aim of these guidelines is to encourage dermatologists to use bath psoralen plus ultraviolet A (PUVA), bathing suit PUVA and soak PUVA in the treatment of psoriasis vulgaris and other conditions. METHODS: Evidence was collected using searches of the PubMed, MEDLINE and COCHRANE databases using the keywords "bath PUVA," "soak PUVA," "bathing suit PUVA" and "turban PUVA." Only publications in English were reviewed. RESULTS: One hundred and thirty-eight studies were evaluated, 57 of which fulfilled the criteria for inclusion. CONCLUSIONS: Both bath PUVA and bathing suit PUVA are very effective and safe treatments for generalized stable plaque psoriasis (strength of recommendation, A). Soak PUVA is very effective in the treatment of both palmoplantar psoriasis and chronic palmoplantar eczema (strength of recommendation, A).

Comparison between a new electronic bidet and conventional sitz baths: a manometric evaluation of the anal resting pressure in normal healthy volunteers.

BACKGROUND: A bidet has been proposed as a replacement for the sitz bath. Like a sitz bath, it brings water into contact with the perineum. However, the high force of water from commercially used electronic bidets may harm the anus. We developed a new electronic bidet and evaluated its effects on anal resting pressure compared with a warm sitz bath. METHODS: Forty volunteers used the electronic bidet and sitz bath on separate days. The electronic bidet was newly designed with warm (38 °C) water and very low force (10 mN) with a fountain type of flow. Anal resting pressure at the high-pressure zone was measured before (control) and after the electronic bidet and sitz bath. Pressure changes after bidet or sitz bath were expressed as percentages compared with control. Water temperatures and rectal temperatures were also recorded. RESULTS: The anal resting pressures before the electronic bidet and sitz bath were 90.2 ± 24.6 and 88.1 ± 16.8 mmHg, respectively. At 3 min after the electronic bidet and sitz bath, the anal resting pressures were 71.3 ± 23.4 and 69.6 ± 19.8 mmHg, respectively. The pressure changes compared with the control were 78.2 ± 12.9 and 78.1 ± 12.5%, respectively, which were not significantly different. The maximal increase and minimal decrease were not significantly different. The rectal temperature was not elevated, and the water temperature decreased significantly with the sitz bath (p < 0.001). CONCLUSIONS: Our new electronic bidet may reduce the anal resting pressure much like a warm sitz bath does.

Development, construction, and content validation of a questionnaire to test mobile shower commode usability.

BACKGROUND: Usability is an emerging domain of outcomes measurement in assistive technology provision. Currently, no questionnaires exist to test the usability of mobile shower commodes (MSCs) used by adults with spinal cord injury (SCI). OBJECTIVE: To describe the development, construction, and initial content validation of an electronic questionnaire to test mobile shower commode usability for this population. METHODS: The questionnaire was constructed using a mixed-methods approach in 5 phases: determining user preferences for the questionnaire's format, developing an item bank of usability indicators from the literature and judgement of experts, constructing a preliminary questionnaire, assessing content validity with a panel of experts, and constructing the final questionnaire. RESULTS: The electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0) questionnaire tests MSC features and performance during activities identified using a mixed-methods approach and in consultation with users. It confirms that usability is complex and multidimensional. The final questionnaire contains 25 questions in 3 sections. The eMAST 1.0 demonstrates excellent content validity as determined by a small sample of expert clinicians. CONCLUSION: The eMAST 1.0 tests usability of MSCs from the perspective of adults with SCI and may be used to solicit feedback during MSC design, assessment, prescription, and ongoing use. Further studies assessing the eMAST's psychometric properties, including studies with users of MSCs, are needed.

Use, performance and features of mobile shower commodes: perspectives of adults with spinal cord injury and expert clinicians.

PURPOSE: The purpose of this article is to explore the use of Mobile Shower Commodes (MSCs) by adults with Spinal Cord Injury (SCI) and to understand how adults with SCI and expert clinicians identify and select MSC designs and features. METHOD: Semi-structured interviews were conducted with seven adults with SCI and eight expert clinical prescribers using semi-structured guides. Transcripts were analysed thematically using the Policy, Human, Activity, Assistance and Technology, and Environment (PHAATE) model as the underpinning theoretical framework. RESULTS: Analysis of the interview transcripts revealed 3 themes and 12 sub-themes. The main themes were: (1) Activities, routines and interacting factors, (2) Features for functioning and (3) Getting it right. Substantial links existed between and across the themes and subthemes. CONCLUSIONS: The use of MSCs by adults with SCI is complex. MSC performance varies across activities, and during interactions between the user, the MSC, other assistive technologies, assistance and physical environments. Future studies should explore service delivery processes and develop validated clinical assessment instruments and outcome measures for MSC provision. Implications for Rehabilitation Mobile shower commode use is complex, involving nine distinct activities and three types of routines. Mobile shower commodes used by Australian adults with SCI are individualised to users and include customisations and custom-made components. Trialling individualised mobile shower commodes prior to funding is problematic and not reflected in assistive service delivery models. Validated clinical instruments for assessing and selecting mobile shower commode features are needed.

Unintentional drowning mortality, by age and body of water: an analysis of 60 countries.

BACKGROUND: To examine unintentional drowning mortality by age and body of water across 60 countries, to provide a starting point for further in-depth investigations within individual countries. METHODS: The latest available three years of mortality data for each country were extracted from WHO Health Statistics and Information Services (updated at 13 November 2013). We calculated mortality rate of unintentional drowning by age group for each country. For countries using International Classification of Disease 10 (ICD-10) detailed 3 or 4 Character List, we further examined the body of water involved. RESULTS: A huge variation in age-standardised mortality rate (deaths per 100 000 population) was noted, from 0.12 in Turkey to 9.19 in Guyana. Of the ten countries with the highest age-standardised mortality rate, six (Belarus, Lithuania, Latvia, Russia, Ukraine and Moldova) were in Eastern Europe and two (Kazakhstan and Kyrgyzstan) were in Central Asia. Some countries (Japan, Finland and Greece) had a relatively low rank in mortality rate among children aged 0-4 years, but had a high rank in mortality rate among older adults. On the contrary, South Africa and Colombia had a relatively high rank among children aged 0-4 years, but had a relatively low rank in mortality rate among older adults. With regard to body of water involved, the proportion involving a bathtub was extremely high in Japan (65%) followed by Canada (11%) and the USA (11%). Of the 13 634 drowning deaths involving bathtubs in Japan between 2009 and 2011, 12 038 (88%) were older adults aged 65 years or above. The percentage involving a swimming pool was high in the USA (18%), Australia (13%), and New Zealand (7%). The proportion involving natural water was high in Finland (93%), Panama (87%), and Lithuania (85%). CONCLUSIONS: After considering the completeness of reporting and quality of classifying drowning deaths across countries, we conclude that drowning is a high-priority public health problem in Eastern Europe, Central Asia, Japan (older adults involving bathtubs), and the USA (involving swimming pools).