Pressure ulcer prophylaxis in elderly patients using polyurethane foam or Jay wheelchair cushions.

A significantly lower proportion of the patients in the Jay group (25%) experienced pressure ulcer formation during the three months of observation as compared to the foam group (41%). No statistically significant differences were found between groups on the location, severity, or healing duration of the pressure ulcers. Most lesions (65%) were limited to persistent erythema of intact skin, and healed in three to four weeks. Significantly higher proportions of patients in the Jay groups (7%) rejected their cushion because of discomfort as compared to foam (1%). The incidence of pressure ulcers was significantly higher among those patients who experienced peak interface pressures recorded at 60 mmHg or higher, had low Norton scores (< or = 11), or were malnourished.

Assessment of an infra-red non-contact sensor for routine skin temperature monitoring: a preliminary study.

The accuracy and reproducibility of a new non-contact sensor for monitoring skin temperature was examined. Thirty measurements taken by the device were compared with those taken by a commonly used thermocouple contact sensor. The result was a very high correlation coefficient (r = 0.9999). This accuracy was achieved with the probe held at an angle of 90 degrees 1 cm from the skin. Changes in angle and distance were found to contribute to measurement error. Little difference was found between 39 pairs of measurements taken of the left and right sides of subjects. However, intra-subject variability was noted with respect to the dermotomal segmental fields. Inter-tester reliability analysis resulted in a correlation of r = 0.937 involving two independent testers and 26 pairs of measurements. These preliminary data will be used for power calculations to study further the device which we found to be simple to operate, portable, and practical for routine clinical use. This sensor may have applications in the diagnosis of nerve and vascular disorders and in prospective monitoring of skin conditions such as bony areas at risk of pressure ulcers.

Effectiveness: a neglected dimension in the assessment of rehabilitation devices and equipment.

Effectiveness is a term used by research methodologists when referring to the attributes of a new health care intervention (e.g. device, medication, or procedure) which if lacking may result in its rejection despite its efficacy and efficiency. Administrators and consumers increasingly require evidence to ensure that a proposed new product or manoeuvre not only 'works' (efficacy, efficiency) but is 'practical' (effective). Yet, effectiveness data are rarely described in research literature or adequately measured. Common effectiveness qualities that might be considered in the formal evaluation of new rehabilitation devices and equipment are cost, convenience to the user ('user-friendliness'), and compliance with the local standards. This article identifies some of the most important variables related to these attributes and suggests strategies for appropriate data collection and analysis. A comparison of two products evaluated in an institutional setting is used to illustrate the suggested method.

Comprehensive health promotion for the pregnant woman who is disabled. The role of the midwife.

Increasing numbers of women with physical or sensory disabilities are choosing to bear children. Research and experience seem to indicate serious shortcomings in assisting disabled primiparas toward confident, healthy, and safe childbearing and childcaring. Guidelines are suggested for appropriate referral or direct provision of education and counselling services for such clients during prepregnancy, pregnancy, labor and delivery, and the postpartum period. Useful resources are identified to assist the nurse-midwife in her role.

Costs and acceptability of two special overlays for the prevention of pressure sores.

In a randomized clinical trial, 187 adult patients with chronic neurologic conditions who were at a high risk of developing pressure sores were assigned for 3 months to either an alternating air (AA) mattress overlay or a silicore (S) mattress overlay. Costs associated with each overlay were calculated and compared by adding depreciation and yearly expenses related to maintenance, operation, and repair for 148 patients who completed the trial. Acceptability was measured by questionnaires and interviews involving 45 of the patients' primary nurses and a sample of 40 patients (20 from each overlay group). The annual cost of the AA overlay was 54% more than that of the S overlay. Although most nurses (more than 74%) believed that both overlays helped prevent pressure sores and deter their progression, many (more than 56%) would not recommend either type to other facilities or to patients at home due to specific negative features. Implications for manufacturers, investigators, clinicians, and administrators are identified.

Effect of serial casting for the prevention of equinus in patients with acute head injury.

Ten adults with traumatic head injury received serial casts within 14 days of injury for the prevention or correction of equinus. Eighteen limbs (16 bilateral) with spasticity were involved. An average of five casts for a total duration of four to 64 days were used for each limb. Comparisons of passive dorsiflexion measures before and after casting showed a mean gain of 21 degrees (paired t-test, P less than .05). Of the 18 limbs, 13 reached a passive dorsiflexion of 0 degrees or more (ie, no equinus) which could be maintained without force for at least one hour. The procedures appeared safe and the results of the trial were clinically judged to be favorable. There is a need to further assess the efficacy of serial casting through randomized controlled trials and long-term followups.

The role of alternating air and Silicore overlays in preventing decubitus ulcers.

Patients with chronic neurological diseases who were at high risk of decubitus ulcers were randomly assigned to alternating air on silicore mattress overlays for a period of 3 months. Of 148 subjects who completed the trial, more than 50% in each group developed one or more ulcers. No statistically significant differences between groups were found in the incidence, severity, healing duration or the location of the ulcers; with the exception of a significant difference (p less than 0.001) in the categorical location of the trochanters.

The user--friendliness of protective support surfaces in prevention of pressure sores.

Special mattress overlays and seat cushions for the prevention of pressure sores constitute a large portion of the rehabilitation products market. Consumers frequently face economic concerns in choosing among these products. This article summarizes the favorable and unfavorable features of major support surface types: foam, air-filled, flotation, and alternating air. A careful consideration of characteristics, such as fire safety, patient comfort, and ease of transfer and handling, may facilitate selection and result in more satisfied users and caregivers.

The Vancouver microstomia orthosis.

Eighteen microstomia orthoses are compared with respect to their characteristics, use, and limitations. A new prosthesis, the Vancouver microstomia orthosis, was designed to incorporate the advantages of many of the orthoses and eliminate some drawbacks. Ten adults with microstomia secondary to second- or third-degree circumoral flame burns were fitted with the prosthesis and observed over a 12-month period. In 9 weeks or less, microstomia was corrected with an average gain of 7 mm in the horizontal and 13 mm in the vertical active range of motion. The measures before and after this treatment were statistically significant for increase in both dimensions (paired t-test, p less than .01).

Prevention instead of remediation: changing the nature of faculty development.

This article suggests preventive measures for the elimination of continuous and costly faculty development remediation programs. Directors and deans may consider clear and reinforced communication of expectations, appropriate selection and hiring practices, identifying mentors, creating suitable role models, encouraging collaborative networks, and offering incentives as faculty motivators. The success-oriented faculty member should actively adopt effective preventive measures against failure by seeking continuous appraisal, formulating goals, arranging for a planned positive socialization process, and documenting achievements.

Clinical trial of foam cushions in the prevention of decubitis ulcers in elderly patients.

Polyurethane foam cushions in a slab form or a customized contoured form are commonly used in wheelchairs to prevent the development of decubitus ulcers (DU) in elderly chronically ill persons. Sixty-two consenting subjects, 60 years or older, were randomly assigned to sit on one of the two types of cushions for 3 or more hours daily for 5 months. A total of 72 DU developed in the 52 subjects who completed the study. These were mostly in the areas of ischial tuberosities, buttocks, and thighs; were of persistent erythema level in severity; and took an average of 6 to 8 weeks to heal. No statistically significant differences were found in the incidence, location, severity, or healing time of the sores that developed in the subjects who used the slab (N = 26) and those who used the contoured (N = 26) cushions. But, more severe sores did develop among the slab cushion group in the area of ischial tuberosities. It appears that foam customization for elderly persons could be justified only if DU have been a particular problem in this region. Incontinence as a contributory factor to DU formation should receive careful attention with respect to prevention. The trials described are being continued, using a larger number of subjects.

Static orthoses for the management of microstomia.

Microstomia is a complication of facial burns, traumatic injuries, scleroderma, or surgical reconstructions involving the oral aperture. A variety of orthoses for the correction or prevention of microstomia are offered by dentists, occupational therapists, physical therapists, and other specialists. This paper provides an overview of the structural and clinical features of 12 common tissue-borne or tooth-borne microstomia appliances. The review is intended to facilitate the selection of suitable orthoses, and to indicate the need for interdisciplinary management of microstomia patients.

Dynamic orthoses for the management of microstomia.

Oral wounds and burns may result in microstomia with significant management problems. An important early management decision involves the selection of an appliance capable of applying forces that will halt and reverse the condition. A selection appropriate to the patient may be based on the need for teeth suitably placed to retain and position a particular device. Limited access to the patient's mouth because of recent trauma, surgery, wiring, inability to tolerate anesthetic, etc., may further restrict choices. Thus, the process of selection involves a weighing of the specific patient's condition and program of treatment against an understanding of the unique features, including complexity of fabrication and durability, of the range of prostheses available. This article provides an overview of the structural and clinical characteristics of seven dynamic intraoral and extraoral microstomia appliances. The need for interdisciplinary management of microstomia with appliances has been noted, and opportunities for research have been pointed out.

Methods of selection of hospital equipment.

With increasingly specialized and sophisticated equipment on the market, our procedures for evaluating possible alternative products must become more scientific and reliable than simply performing cost comparisons and depending on good faith.