Comparison of tissue-interface pressure in healthy subjects lying on two trauma splinting devices: The vacuum mattress splint and long spine board.

BACKGROUND: Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth. METHODS: To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3kPa, and 3) maximal pressure (Pmax). RESULTS: In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8kPa, p<0.001). CONCLUSION: This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.

Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association.

OBJECTIVE: To determine current practice patterns, we mailed a questionnaire regarding urethral stricture evaluation, treatment, and follow-up to members of the American Urological Association (AUA). The minimally invasive methods used for treating and evaluating anterior urethral strictures vary widely among clinicians. METHODS: A nationwide survey of practicing members of the AUA was performed by mailed questionnaires. Surveys were mailed to 1262 Urologists, randomly selected from all 50 states. Four-hundred thirty-one urologists (34%) completed the questionnaire and formed the basis for our analysis. RESULTS: Most urologists (63%) treat 6-20 urethral strictures per year. The most common minimally invasive procedures used for managing anterior urethral strictures were dilation (92.8%), cold-knife optical internal urethrotomy (85.6%), endourethral stent (23.4%), laser urethrotomy (19%), and periurethral steroid injection after urethrotomy (7.9%). Most urologists will perform urethrotomy on bulbar strictures up to 2 cm (68.7%) and leave a Foley catheter in place for 1 week or less (86.5%). Technical method of urethrotomy is commonly 1 cut at 12 o'clock (86.3%) or radial cuts (12.1%). Recommended follow-up diagnostic tests after urethrotomy included flow rate (62.9%) and, to a lesser degree (with roughly one-third each), cystoscopy, urethral calibration, and the International Prostate Symptom Score (IPSS). Other tests, such as ultrasonography or urethrography were rarely used. CONCLUSION: Our survey provides information regarding current minimally invasive management and follow-up practice strategies recommended by members of the AUA for anterior urethral strictures. Many common practices in the treatment of anterior urethral stricture disease are not supported in the literature.