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1.
Cochrane Database Syst Rev ; 6: CD009958, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484259

RESUMO

BACKGROUND: A pressure injury (PI), also referred to as a 'pressure ulcer', or 'bedsore', is an area of localised tissue damage caused by unrelieved pressure, friction, or shearing on any part of the body. Immobility is a major risk factor and manual repositioning a common prevention strategy. This is an update of a review first published in 2014. OBJECTIVES: To assess the clinical and cost effectiveness of repositioning regimens(i.e. repositioning schedules and patient positions) on the prevention of PI in adults regardless of risk in any setting. SEARCH METHODS: We searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, and EBSCO CINAHL Plus on 12 February 2019. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA: Randomised controlled trials (RCTs), including cluster-randomised trials (c-RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PI incidence in adults in any setting. DATA COLLECTION AND ANALYSIS: Three review authors independently performed study selection, 'Risk of bias' assessment, and data extraction. We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We identified five additional trials and one economic substudy in this update, resulting in the inclusion of a total of eight trials involving 3941 participants from acute and long-term care settings and two economic substudies in the review. Six studies reported the proportion of participants developing PI of any stage. Two of the eight trials reported within-trial cost evaluations. Follow-up periods were short (24 hours to 21 days). All studies were at high risk of bias. Funding sources were reported in five trials. Primary outcomes: proportion of new PI of any stage Repositioning frequencies: three trials compared different repositioning frequencies We pooled data from three trials (1074 participants) comparing 2-hourly with 4-hourly repositioning frequencies (fixed-effect; I² = 45%; pooled risk ratio (RR) 1.06, 95% confidence interval (CI) 0.80 to 1.41). It is uncertain whether 2-hourly repositioning compared with 4-hourly repositioning used in conjunction with any support surface increases or decreases the incidence of PI. The certainty of the evidence is very low due to high risk of bias, downgraded twice for risk of bias, and once for imprecision. One of these trials had three arms (967 participants) comparing 2-hourly, 3-hourly, and 4-hourly repositioning regimens on high-density mattresses; data for one comparison was included in the pooled analysis. Another comparison was based on 2-hourly versus 3-hourly repositioning. The RR for PI incidence was 4.06 (95% CI 0.87 to 18.98). The third study comparison was based on 3-hourly versus 4-hourly repositioning (RR 0.20, 95% CI 0.04 to 0.92). The certainty of the evidence is low due to risk of bias and imprecision. In one c-RCT, 262 participants in 32 ward clusters were randomised between 2-hourly and 3-hourly repositioning on standard mattresses and 4-hourly and 6-hourly repositioning on viscoelastic mattresses. The RR for PI with 2-hourly repositioning compared with 3-hourly repositioning on standard mattress is imprecise (RR 0.90, 95% CI 0.69 to 1.16; very low-certainty evidence). The CI for PI include both a large reduction and no difference for the comparison of 4-hourly and 6-hourly repositioning on viscoelastic foam (RR 0.73, 95% CI 0.53 to 1.02). The certainty of the evidence is very low, downgraded twice due to high risk of bias, and once for imprecision. Positioning regimens: four trials compared different tilt positions We pooled data from two trials (252 participants) that compared a 30° tilt with a 90° tilt (random-effects; I² = 69%). There was no clear difference in the incidence of stage 1 or 2 PI. The effect of tilt is uncertain because the certainty of evidence is very low (pooled RR 0.62, 95% CI 0.10 to 3.97), downgraded due to serious design limitations and very serious imprecision. One trial involving 120 participants compared 30° tilt and 45° tilt with 'usual care' and reported no occurrence of PI events (low certainty evidence). Another trial involving 116 ICU patients compared prone with the usual supine positioning for PI. Reporting was incomplete and this is low certainty evidence. Secondary outcomes No studies reported health-related quality of life utility scores, procedural pain, or patient satisfaction. Cost analysis Two included trials also performed economic analyses. A cost-minimisation analysis compared the costs of 3-hourly and 4-hourly repositioning with 2-hourly repositioning schedule amongst nursing home residents. The cost of repositioning was estimated at CAD 11.05 and CAD 16.74 less per resident per day for the 3-hourly or 4-hourly regimen, respectively, compared with the 2-hourly regimen. The estimates of economic benefit were driven mostly by the value of freed nursing time. The analysis assumed that 2-, 3-, or 4-hourly repositioning is associated with a similar incidence of PI, as no difference in incidence was observed. A second study compared the nursing time cost of 3-hourly repositioning using a 30° tilt with standard care (6-hourly repositioning with a 90° lateral rotation) amongst nursing home residents. The intervention was reported to be cost-saving compared with standard care (nursing time cost per patient EUR 206.60 versus EUR 253.10, incremental difference EUR -46.50, 95% CI EUR -1.25 to EUR -74.60). AUTHORS' CONCLUSIONS: Despite the addition of five trials, the results of this update are consistent with our earlier review, with the evidence judged to be of low or very low certainty. There remains a lack of robust evaluations of repositioning frequency and positioning for PI prevention and uncertainty about their effectiveness. Since all comparisons were underpowered, there is a high level of uncertainty in the evidence base. Given the limited data from economic evaluations, it remains unclear whether repositioning every three hours using the 30° tilt versus "usual care" (90° tilt) or repositioning 3-to-4-hourly versus 2-hourly is less costly relative to nursing time.


Assuntos
Posicionamento do Paciente/métodos , Lesão por Pressão/prevenção & controle , Idoso , Leitos , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
2.
Artigo em Inglês | MEDLINE | ID: mdl-32408508

RESUMO

COVID-19 is a worldwide emergency since it has rapidly spread from China to almost all the countries worldwide. Italy has been one of the most affected countries after China. North Italian regions, such as Lombardia and Veneto, had an abnormally large number of cases. COVID-19 patients management requires availability of sufficiently large number of Intensive Care Units (ICUs) beds. Resources shortening is a critical issue when the number of COVID-19 severe cases are higher than the available resources. This is also the case at a regional scale. We analysed Italian data at regional level with the aim to: (i) support health and government decision-makers in gathering rapid and efficient decisions on increasing health structures capacities (in terms of ICU slots) and (ii) define a geographic model to plan emergency and future COVID-19 patients management using reallocating them among health structures. Finally, we retain that the here proposed model can be also used in other countries.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Recursos em Saúde/provisão & distribução , Unidades de Terapia Intensiva , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Leitos/provisão & distribução , Humanos , Itália/epidemiologia , Pandemias , Análise Espaço-Temporal
3.
Brasília; IPEA; 20200500. 20 p. (Nota Técnica / IPEA. Diset, 65).
Monografia em Português | LILACS, ECOS | ID: biblio-1102191

RESUMO

Esta nota técnica tem o objetivo de analisar, de modo exploratório, algumas vantagens e desvantagens da eventual adoção de uma fila única, conforme vem sendo proposto, para organizar as internações, inclusive em unidades de terapia intesiva (UTIs), em todos os hospitais públicos e privados brasileiros, no contexto da atual pandemia do novo coronavírus (Sars-COV-2), causador da Covid-19. A análise utiliza elementos teóricos, e de resultados práticos, observados em economia da saúde e, de modo complementar, em teoria das filas (Queueing Theory). Essa análise se justifica em função da gravidade da situação atual e da possibilidade de que a fila única seja adotada na presente pandemia, ou que venha a ser novamente objeto de debate, em eventuais futuras pandemias, ou em epidemias que ocorram no país.


Assuntos
Teoria de Sistemas , Leitos , Sistema Único de Saúde , Infecções por Coronavirus , Coronavirus , Pandemias , Instituições Privadas de Saúde , Hospitalização
4.
Eur Heart J Acute Cardiovasc Care ; 9(3): 248-252, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32347745

RESUMO

The current outbreak of SARS-CoV-2 has and continues to put huge pressure on intensive care units (ICUs) worldwide. Many patients with COVID-19 require some form of respiratory support and often have prolonged ICU stays, which results in a critical shortage of ICU beds. It is therefore not always physically possible to treat all the patients who require intensive care, raising major ethical dilemmas related to which patients should benefit from the limited resources and which should not. Here we consider some of the approaches to the acute shortages seen during this and other epidemics, including some guidelines for triaging ICU admissions and treatments.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/organização & administração , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/epidemiologia , Triagem/ética , Leitos/provisão & distribução , Doença Catastrófica/epidemiologia , Doença Catastrófica/enfermagem , Tomada de Decisão Clínica/ética , Comunicação , Ética Médica/educação , Recursos em Saúde/provisão & distribução , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Pandemias , Alocação de Recursos/ética , Alocação de Recursos/métodos , Índice de Gravidade de Doença , Triagem/organização & administração
7.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32034081

RESUMO

OBJECTIVE: To assess the prevalence of and factors associated with actual recent practice and near-future intention for infant sleep location in a national sample. METHODS: There were 3260 mothers from 32 US hospitals who responded to a survey at infant age 2 to 6 months regarding care practices, including usual and all infant sleep locations in the previous 2 weeks and intended location for the next 2 weeks. Mothers were categorized as (1) having practiced and/or intending to practice exclusive room-sharing without bed-sharing, (2) having practiced anything other than exclusive room-sharing but intending to practice exclusive room-sharing, (3) intending to have the infant sleep in another room; and (4) intending to practice bed-sharing all night or part of the night. Multivariable multinomial logistic regression examined associations between sleep-location category, demographics, feeding method, doctor advice, and theory of planned behavior domains (attitudes, social norms, and perceived control). RESULTS: Fewer than half (45.4%) of the mothers practiced and also intended to practice room-sharing without bed-sharing, and 24.2% intended to practice some bed-sharing. Factors associated with intended bed-sharing included African American race and exclusive breastfeeding; however, the highest likelihood of bed-sharing intent was associated with perceived social norms favoring bed-sharing (adjusted odds ratio [aOR] 5.84; 95% confidence interval [CI] 4.14-8.22) and positive attitudes toward bed-sharing (aOR 190.1; 95% CI 62.4-579.0). Women with a doctor's advice to room-share without bed-sharing intended to practice bed-sharing less (aOR 0.56; 95% CI 0.36-0.85). CONCLUSIONS: Sleep-location practices do not always align with the recommendation to room-share without bed-sharing, and intention does not always correspond with previous practice. Attitudes, perceived social norms, and doctor advice are factors that are amenable to change and should be considered in educational interventions.


Assuntos
Cuidado do Lactente/métodos , Comportamento Materno , Sono , Adulto , Leitos , Feminino , Humanos , Lactente , Masculino , Adulto Jovem
8.
Nursing ; 50(2): 41-44, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31904618

RESUMO

This article discusses an evidence- and consensus-based support-surface algorithm designed to help clinicians choose the most appropriate support surface for preventing or treating pressure injuries based on patient, nurse, and institutional considerations.


Assuntos
Algoritmos , Leitos , Tomada de Decisão Clínica/métodos , Enfermeiras Clínicas/psicologia , Lesão por Pressão/enfermagem , Consenso , Prática Clínica Baseada em Evidências , Humanos , Fatores de Risco
9.
Ann Emerg Med ; 75(6): 704-714, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31983501

RESUMO

Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only 3 peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed, and how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.


Assuntos
Leitos/provisão & distribução , Serviço Hospitalar de Emergência/organização & administração , Alta do Paciente/tendências , Leitos/estatística & dados numéricos , Aglomeração/psicologia , Serviço Hospitalar de Emergência/tendências , Implementação de Plano de Saúde/métodos , Humanos , Pacientes Internados , Admissão do Paciente , Alta do Paciente/normas , Segurança do Paciente/normas , Revisão por Pares/tendências , Fatores de Tempo , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
11.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818863

RESUMO

OBJECTIVES: In most recent studies, authors combine all cases of sudden infant death syndrome, other deaths from ill-defined or unknown causes, and accidental suffocation and strangulation in bed as a single population to analyze sudden unexpected infant death (SUID). Our aim with this study is to determine if there are statistically different subcategories of SUID that are based on the age of death of an infant. METHODS: In this retrospective, cross-sectional analysis, we analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41 125 233 births and 37 624 SUIDs). Logistic regression models were developed to identify subpopulations of SUID cases by age of death, and we subsequently analyzed the effects of a set of covariates on each group. RESULTS: Two groups were identified: sudden unexpected early neonatal deaths (SUENDs; days 0-6) and postperinatal SUIDs (days 7-364). These groups significantly differed in the distributions of assigned International Classification of Diseases, 10th Revision code, live birth order, marital status, age of mother, birth weight, and gestational length compared to postperinatal SUIDs (days 7-364). Maternal smoking during pregnancy was not a significant risk factor for deaths that occurred in the first 48 hours. CONCLUSIONS: SUEND should be considered as a discrete entity from postperinatal SUID in future studies. These data could help improve the epidemiological understanding of SUEND and SUID and provide clues to a mechanistic understanding underlying the causes of death.


Assuntos
Morte Súbita do Lactente , Fatores Etários , Asfixia , Leitos , Causas de Morte , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos
13.
IEEE J Biomed Health Inform ; 24(1): 101-110, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30762571

RESUMO

Pressure ulcer prevention is a vital procedure for patients undergoing long-term hospitalization. A human body lying posture (HBLP) monitoring system is essential to reschedule posture change for patients. Video surveillance, the conventional method of HBLP monitoring, suffers from various limitations, such as subject's privacy, and field-of-view obstruction. We propose an autonomous method for classifying the four state-of-the-art HBLPs in healthy adults subjects: supine, prone, left and right lateral, with no sensors or cables attached on the body and no constraints imposed on the subject. Experiments have been conducted on 12 healthy adults (age 27.35 ± 5.39 years) using a collection of textile pressure sensors embedded in a cover placed under the bed sheet. Histogram of oriented gradients and local binary patterns were extracted and fed to a supervised artificial neural network classification model. The model was trained based on the scaled conjugate gradient backpropagation. A nested cross validation with an exhaustive outer validation loop was performed to validate the classification's generalization performance. A high testing prediction accuracy of 97.9% with a Cohen's Kappa coefficient of 97.2% has been interestingly obtained. Prone and supine postures were successfully separated in the classification, in contrast to the majority of previous similar works. We found that using the information of body weight distribution along with the shape and edges contributes to a better classification performance and the ability to separate supine and prone postures. The results are satisfactorily promising toward unobtrusively monitoring posture for ulcer prevention. The method can be used in sleep studies, post-surgical procedures, or applications requiring HBLP identification.


Assuntos
Leitos , Redes Neurais de Computação , Polissonografia/métodos , Postura/fisiologia , Processamento de Sinais Assistido por Computador , Adulto , Feminino , Humanos , Masculino , Pressão , Lesão por Pressão/prevenção & controle , Têxteis , Adulto Jovem
14.
Behav Sleep Med ; 18(1): 120-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30585091

RESUMO

Objective/Background: Our primary objective was to describe and identify predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum among Chinese-Canadian mothers. Participants: We conducted a longitudinal study of 570 Chinese immigrant and Canadian-born women in Toronto, Ontario. Methods: Any bed-sharing, defined as sharing a bed or mattress for any part of the night on any night in the previous week, and predominant bed-sharing, defined as sharing a bed or mattress for most of the night, on more than half the nights of the previous week, were evaluated at 4 and 12 weeks postpartum. Predictors of bed-sharing, evaluated in multivariable logistic regression models, were background (age, parity, education, household size, delivery mode, social support), cultural (immigrant status, acculturative stress, acculturation, postpartum ritual uptake), and postpartum variables (mental health, breastfeeding problems, fatigue, sleep knowledge, plans for bed-sharing, perceptions of infant sleep problems, cognitions about infant sleep). Results: One in five women (20.7%) reported bed-sharing as the predominant sleep location for their infant at 4 weeks postpartum, with nearly half (45.6%) reporting any bed-sharing at this time. The prevalence of any bed-sharing remained relatively stable at 12 weeks postpartum (46.5%), while predominant bed-sharing increased to 30.1%. The most consistent predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum were lower education level, greater acculturative stress, and predelivery plans to bed-share. Conclusions: These findings have implications for the development of clinical recommendations given to expectant and new parents to promote infant sleep practices that are consistent with American Academy of Pediatrics recommendations.


Assuntos
Cuidado do Lactente/métodos , Relações Mãe-Filho/psicologia , Período Pós-Parto/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático , Leitos , Canadá , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
15.
Water Sci Technol ; 80(6): 1134-1144, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31799957

RESUMO

A two-phase anaerobic system comprised of upflow anaerobic sludge bed (UASB) reactor for hydrogen production and internal circulation reactor (IC) for methane production was proposed and investigated at laboratory scale and mesophilic temperature (35 °C). Hydrogen was efficiently produced from the UASB with the highest production rate of 3.00 ± 0.04 L · L-1 reactor · d-1 at optimum hydraulic retention time (HRT) of 6 h and in the IC, methane was also produced from residual organic matter and soluble metabolite products (SMP) with a production rate of 2.54 ± 0.04 L · L-1 reactor · d-1 at optimum HRT of 15 h. Finally, system HRT of 21 h was determined to be the optimum HRT at which energy conversion efficiency increased from 9.6 ± 0.1% (hydrogen only production) to 72.4 ± 2.5% (hydrogen and methane coproduction) and system chemical oxygen demand (COD) removal reached up to the high level of 90.1 ± 2.1%.


Assuntos
Esgotos , Águas Residuárias , Anaerobiose , Leitos , Reatores Biológicos , Medicina Herbária , Hidrogênio , Metano , Eliminação de Resíduos Líquidos
16.
J Wound Care ; 28(10): 676-682, 2019 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-31600104

RESUMO

OBJECTIVE: Active mattresses are used to prevent, treat and relieve pressure ulcers (PU) by intermittent contact pressure/relief. However, no studies have directly assessed the vascular endothelial response to long-term active mattress use. This study investigated the hypothesis that eight weeks use of an active mattress would lead to improvements in vascular endothelial function in healthy participants. METHODS: Physiological parameters of baseline skin temperature (BskT), resting blood flow (RBF) and endothelial function as measured using post-occlusive reactive hyperaemia (PORH), were assessed at baseline (week 0); following eight weeks of sleeping on an active mattress, and after an eight week washout period (at week 16). RESULTS: We recruited 10 healthy participants (four male, age 52.7±8.5 years, six female age 51.8±17.5 years). Following active mattress use RBF, PORH and BskT at the hallux pulp increased by 336%, 197% and 3.5ºC, respectively. Mean values increased from 24.3±38.3 perfusion units to 106.0±100.3 perfusion units (p=0.021) and from 13,456±10,225 to 40,252±23,995 perfusion units x seconds (p=0.003) and from 22.9±2.5ºC to 26.4±1.9ºC (p<0.001), respectively. CONCLUSION: Active mattress use for eight weeks leads to significant improvements in RBF, PORH, and BskT. These results suggest that active mattress use can improve endothelial function. Future research is required to explore the potential of active mattress use in the treatment and management of diseases and conditions that would benefit from an improved endothelial function.


Assuntos
Leitos , Endotélio Vascular/fisiologia , Lesão por Pressão/prevenção & controle , Velocidade do Fluxo Sanguíneo , Desenho de Equipamento , Feminino , Voluntários Saudáveis , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pele/irrigação sanguínea , Temperatura Cutânea
17.
Sensors (Basel) ; 19(20)2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31640256

RESUMO

With the aging of society, the number of fall accidents has increased in hospitals and care facilities, and some accidents have happened around beds. To help prevent accidents, mats and clip sensors have been used in these facilities but they can be invasive, and their purpose may be misinterpreted. In recent years, research has been conducted using an infrared-image depth sensor as a bed-monitoring system for detecting a patient getting up, exiting the bed, and/or falling; however, some manual calibration was required initially to set up the sensor in each instance. We propose a bed-monitoring system that retains the infrared-image depth sensors but uses semi-automatic rather than manual calibration in each situation where it is applied. Our automated methods robustly calculate the bed region, surrounding floor, sensor location, and attitude, and can recognize the spatial position of the patient even when the sensor is attached but unconstrained. Also, we propose a means to reconfigure the spatial position considering occlusion by parts of the bed and also accounting for the gravity center of the patient's body. Experimental results of multi-view calibration and motion simulation showed that our methods were effective for recognition of the spatial position of the patient.


Assuntos
Leitos , Processamento de Imagem Assistida por Computador/instrumentação , Raios Infravermelhos , Monitorização Fisiológica/instrumentação , Algoritmos , Automação , Calibragem , Análise de Componente Principal
18.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31636142

RESUMO

OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. METHODS: Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice. RESULTS: Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10-20 percentage points) than receipt of advice (∼5-10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09-1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21-1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics. CONCLUSIONS: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices.


Assuntos
Roupas de Cama, Mesa e Banho , Cuidado do Lactente/estatística & dados numéricos , Sono , Adulto , Leitos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Mães , Prevalência , Fatores Socioeconômicos , Morte Súbita do Lactente/prevenção & controle , Decúbito Dorsal , Adulto Jovem
19.
PLoS One ; 14(10): e0221854, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618205

RESUMO

Various situations, such as injuries or long-term disabilities, can result in people receiving physical assistance while in bed. We present a robotic system for bedside assistance that consists of a robotic bed and a mobile manipulator (i.e., a wheeled robot with arms) that work together to provide better assistance. Many assistive tasks depend on moving with respect to the person's body, and the complementary physical and perceptual capabilities of the two robots help with respect to this general goal. The system provides autonomy for common tasks, as well as an interface for direct teleoperation of the two robots. Autonomy handles coarse motions of the robots by estimating the person's pose using a pressure sensing mat and then moving the robots to configurations optimized for the task. After completing these motions, the user is given fine control of the robots to complete the task. In an evaluation using a medical mannequin, we found that the robotic bed's motion and perception each improved the assistive robotic system's performance. The system achieved 100% success over 9 trials involving 3 tasks. Using the system with the bed movement or the body pose estimation capabilities turned off resulted in success in only 33% or 78% of the trials, respectively. We also evaluated our system with Henry Evans, a person with severe quadriplegia, in his home. In a formal test, Henry successfully used the bedside-assistance system to perform 3 different tasks, 5 times each, without any failures. Henry's feedback on the system was positive regarding usefulness and ease of use, and he noted benefits of using our system over fully manual teleoperation. Overall, our results suggest that a robotic bed and a mobile manipulator can work collaboratively to provide effective personal assistance and that the combination of the two robots is beneficial.


Assuntos
Leitos , Pessoas com Deficiência , Sistemas Automatizados de Assistência Junto ao Leito , Quadriplegia , Robótica , Humanos
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