Comparing Pressure Injury Incidence Based on Repositioning Intervals and Support Surfaces in Acute Care Settings: A Quasi-Experimental Pragmatic Study.

OBJECTIVE: To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. METHODS: This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. RESULTS: There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). CONCLUSIONS: The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.

A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery.

INTRODUCTION: Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS: A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS: Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS: The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.

A comparison of air-cell and gel surgical table pads and an evaluation of the influence of pressure distribution and other factors on pressure injury prevention.

Guidelines for pressure injury prevention consider the use of pressure-redistributing pads to prevent tissue deformation. However, limited research exists to assess the pressure distribution provided by the operating tables and the effectiveness of pressure-redistributing pads in preventing pressure injuries. In this study, we compared the pressure distribution properties of two surgical table pads and identified parameters influencing pressure injury outcomes after a lengthy surgical procedure. Twenty-seven patients undergoing left ventricular assist device implantation surgery participated in the study. Participants were randomly assigned to use either an air cell-based pad or a gel pad. Interface pressure was recorded during the surgery. We analyzed the effect of surgical table pad type, interface pressure distribution and pressure injury outcomes and analyzed what characteristics of the patients and the interface pressure are most influential for the development of pressure injuries. Comparing the interface pressure parameters between the air-cell group and the gel group, only the peak pressure index x time was significantly different (p < 0.05). We used univariate logistic regression analysis to identify significant predictors for the pressure injury outcome. The support surface was not significant. And, among patient characteristics, only age and BMI were significant (p ≤ 0.05). Among the interface pressure parameters, pressure density maxima, peak pressure index x time, and coefficient of variation were significant for pressure injury outcome (p ≤ 0.05). Peak pressure index, average pressure, and the surgery length were not statistically significant for pressure injury outcomes.

A DEA-Based Complexity of Needs Approach for Hospital Beds Evacuation during the COVID-19 Outbreak.

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.

Coletiva de imprensa: anúncios do Governo SP - 17/08/2020

Nesta segunda-feira (17), o Estado de São Paulo registra 26.899 óbitos e 702.665 casos confirmados do novo coronavírus. Entre o total de casos diagnosticados de COVID-19, 502.107 pessoas estão recuperadas, sendo que 81.573 foram internadas e tiveram alta hospitalar. As taxas de ocupação dos leitos de UTI são de 55,5% na Grande São Paulo e 57,4% no Estado (outros dados no link abaixo). O número de pacientes internados é de 11.257, sendo 6.457 em enfermaria e 4.800 em unidades de terapia intensiva, conforme dados das 10h desta segunda (17). Hoje, dos 645 municípios, houve pelo menos uma pessoa infectada em 643 cidades, sendo 506 com um ou mais óbitos. Entre as vítimas fatais estão 15.531 homens e 11.368 mulheres. Os óbitos continuam concentrados em pacientes com 60 anos ou mais, totalizando 75,6% das mortes. Observando faixas etárias, nota-se que a mortalidade é maior entre 70 e 79 anos (6.749), seguida pelas faixas de 60 a 69 anos (6.311) e 80 e 89 anos (5.450). Entre as demais faixas estão os: menores de 10 anos (37), 10 a 19 anos (48), 20 a 29 anos (219), 30 a 39 anos (808), 40 a 49 anos (1.809), 50 a 59 anos (3.663) e maiores de 90 anos (1.805). Os principais fatores de risco associados à mortalidade são cardiopatia (59% dos óbitos), diabetes mellitus (43,3%), doenças neurológicas (10,9%) e renal (9,5%), pneumopatia (8,1%). Outros fatores identificados são obesidade (7,3%), imunodepressão (5,7%), asma (3,1%), doenças hepáticas (2,1%) e hematológica (1,9%), Síndrome de Down (0,5%), puerpério (0,1%) e gestação (0,1%). Esses fatores de risco foram identificados em 21.519 pessoas que faleceram por COVID-19 (80%). Entre as pessoas que já tiveram confirmação para o novo coronavírus estão 327.005 homens e 369.514 mulheres. Não consta informação de sexo para 6.146 casos. A faixa etária que mais concentra casos é a de 30 a 39 anos (167.862), seguida pela faixa de 40 a 49 (148.802). As demais faixas são: menores de 10 anos (15.591), 10 a 19 (30.278), 20 a 29 (115.365), 50 a 59 (106.686), 60 a 69 (64.316), 70 a 79 (32.933), 80 a 89 (16.127) e maiores de 90 (4.303). Não consta faixa etária para outros 402 casos.Saiba mais em: www.saopaulo.sp.gov.br/coronavirus/planosp

Interface Pressures of New and Worn Standard and Viscoelastic Hospital Mattresses: A Comparative Study.

Hospital mattresses have been found to be used for up to 10 years in Norway. Few studies have investigated how wear and tear affects foam qualities. PURPOSE: This descriptive comparative study investigated interface pressures in a sample of 5 new and worn standard and viscoelastic hospital mattresses and compared their comfort and mobility ratings. METHODS: Using convenience sampling methods, 20 healthy individuals (75% female, average age 41.3 years [SD ± 12.25]) volunteered to lay supine for 10 minutes on 5 different mattresses. Mattresses had been in use for up to 7 years (since 2011). Using a bed-size pressure mapping system, interface pressures (mm Hg) were obtained after 10 minutes. Comfort and ease of turning oneself (very poor to very good) were evaluated after the pressure mapping was completed. RESULTS: Differences were found between viscoelastic mattresses and standard mattresses, with mean interface pressures ranging from 30.28 to 38.37 mm Hg (P = .011), and for the mean number of cells 60 mm Hg or above (P = .025) and 80 mm Hg or above (P = .046) between the different mattresses after 10 minutes. One standard mattress from 2014 had the highest mean interface pressure (38.37 ± 7.43 mm Hg). Viscoelastic foam mattresses had the highest comfort, and standard mattresses had the highest ease of mobility scores; however, the differences were not significant. The mean interface pressures differed between participants weighing > 100 kg and those weighing < 100 kg on the standard mattress from 2011 (46.50 ± 4.83 vs. 33.86 ± 5.83; P = .012). Similarly, the values were 41.25 ± 7.70 versus 29.78 ± 5.99 on the new viscoelastic mattress (P = .040) and 42.87 ± 4.09 versus 28.05 ± 6.16 (P = .012) on the old viscoelastic mattress. CONCLUSION: Older standard mattresses were found to be less comfortable and had higher interface pressures compared to the new standard and viscoelastic foam mattresses.

The Discharge Lounge: A Patient Flow Process Solution.

BACKGROUND: Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage. LOCAL PROBLEM: Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting. METHODS: Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles. INTERVENTIONS: After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written. RESULTS: The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased. CONCLUSION: The DL is an effective tool to improve patient flow and decrease hospital overcrowding.

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients.

OBJECTIVE: To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING: A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION: In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES: The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS: Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS: The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.

The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding.

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.

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015.

OBJECTIVES: To understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis. SETTING: EDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015. PARTICIPANTS: All patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015. INTERVENTION: The system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question. RESULTS: Three of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration. CONCLUSIONS: Findings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration.

Use of 2 Types of Air-cell Mattresses for Pressure Ulcer Prevention and Comfort Among Patients With Advanced-stage Cancer Receiving Palliative Care: An Interventional Study.

Patients with advanced- or terminal-stage cancer and persons receiving palliative care are at high risk for pressure ulcers (PUs). PURPOSE: The purpose of this study was to examine the rate of PU development and levels of comfort of a dual-fit, air-cell mattress compared with an alternating, 2-layer overlay air-cell mattress in patients with advanced- or terminal-stage cancer receiving palliative care. METHODS: From January 2011 to December 2013, hospitalized patients with advanced- or terminal-stage cancer who were referred to a palliative care team, at least 20 years of age, able to communicate, experiencing pain, and did not have a PU were recruited to participate. Patients who consented were alternately placed on the intervention (dual-fit, air-cell) or control (2-layer air) mattress until hospital discharge or death. Demographic and clinical data, pain scores, performance status, Palliative Performance Scale scores, Braden Scale scores, tissue interface pressure, and comfort were assessed via interview using closed-end questions. If a PU developed, clinical characteristics were assessed using DESIGN-R. Descriptive statistics and the Mann-Whitney U, chi-squared, and Fisher's exact tests were used to analyze the data. RESULTS: Of the 123 eligible patients, 73 were randomized and 52 completed the study (23 intervention patients, median age 63 [range 27-80] years; and 29 control group patients, median age 61.0 [range 27-82] years). Mattresses were used a median of 17 (range 4-113) days in the intervention group and a median of 32 (range 3-270) days in the control group. The incidence of PUs did not significantly differ between the 2 groups (13% in the intervention and 17.2% in the control group). Interface pressures were significantly higher in the intervention group (27.0 mm Hg vs. 24.3 mm Hg). Comfort scores at rest were significantly better in the intervention than in the control group (sinking into bed [3 vs. 14, respectively]; slipping on bed [o vs. 16, respectively]; and feel pressure of air cell [2 vs. 14, respectively]), as were scores with movement (instability during movement [4 vs. 18, respectively] and feeling of floating of the buttocks [6 vs. 21, respectively]) (P <.05). CONCLUSION: Dual-fit, air-cell mattresses may help prevent PUs and improve comfort at rest and during activity among patients with end-stage cancer receiving palliative care. Further research regarding mattress selection protocols for this patient population is warranted.

A quantitative study of transepidermal water loss (TEWL) on conventional and microclimate management capable mattresses and hospital beds.

BACKGROUND: Transepidermal water loss (TEWL) is regarded as one of the most important parameters characterizing skin barrier integrity and has found to be higher in impaired skin barrier function. Reduced or low TEWL instead indicates skin barrier integrity or improvement. We evaluated if different mattresses/hospital beds can influence this skin barrier function by measuring TEWL before and after subjects lying in conventional and microclimate management capable mattresses/hospital beds. METHODS: We included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Tewameter TM300 to determine TEWL before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany). RESULTS: While there was no statistically significant difference in standard mattresses/hospital beds (22.19 ±â€¯12.99 and 19.80 ±â€¯11.48 g/hm2), the decrease of TEWL was statistically significant in both microclimate management capable mattresses/hospital beds we investigated (16.89 ±â€¯8.586 g/hm2 and 17.41 ±â€¯7.203 g/hm2) compared to baseline values (35.85 ±â€¯24.51 g/hm2). CONCLUSION: As higher TEWL announces impaired skin barrier function these findings indicate that the choice of the mattress/hospital bed is important for skin barrier function and microclimate management systems improve skin barrier function of the skin.

Admission to bed 13 in the ICU does not reduce the chance of survival.

PURPOSE: To examine whether admission to bed number 13 on our intensive care unit has any negative impact on the patient's hospital mortality. MATERIALS AND METHODS: We conducted a retrospective cohort study of 1568 patients admitted to our ICU over a two-year period. Observed hospital mortality, predicted mortality using the ICNARC and APACHE II scoring systems and standardised mortality ratios were used to compared patients admitted to bed number 13 with those admitted to beds number 14-24. RESULTS: Of the 1568 patients admitted to ICU, 110 were placed in bed number 13 and 1458 into bed numbers 14-24. Demographics and ICNARC and APACHE II scores were similar between the two groups. There was no significant difference in the ICNARC predicted hospital mortality (mean 21.0%, median8.5% in bed 13 compared with a mean 17.5%, median 6.4% in beds 14-24, p = 0.33), APACHE II predicted hospital mortality (mean 18.4%, median 9.9% in bed 13 compared with mean 18.7%, median 8.9% in beds 14-24, p = 0.74), or observed hospital mortality (20.2% compared with 15.2%, OR 1.41 (CI 0.87 to 2.30), p = 0.17). CONCLUSIONS: Admission to bed number 13 was not associated with a significant increase in hospital mortality when compared to admission to other bed numbers.

Large-Scale Hospital Mattress Switch-Out Leads to Reduction Hospital-Acquired Pressure Ulcers: Operationalization of a Multidisciplinary Task Force.

BACKGROUND: Identifying strategies to protect patients most at risk for hospital-acquired pressure ulcers (HAPU) is essential. HAPUs have significant impact on patients and their families and have profound cost and reimbursement implications. AIMS: This article describes the successful implementation of a hospital-wide mattress switch-out program using a Multidisciplinary Task Force, which resulted in a decrease in HAPUs and significant cost savings. RESULTS: As a result of this quality improvement project supported by evidence, the hospital realized a 66.6% decrease in Stage III and IV HAPUs, a 50% reduction in patient complaints about mattress comfort, a cost savings of $714,724, and an endorsement of bedside nurse clinical autonomy by nursing and executive leaders. LINKING EVIDENCE TO ACTION: Nursing leaders can effectively realize large-scale initiatives by developing and implementing wide-ranging operational projects, like this 2.5-day, 275-bed hospital mattresses switch-out.

Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population.

BACKGROUND: Complex wounds impose a substantial health economic burden worldwide. As wound care is managed across multiple settings by a range of healthcare professionals with varying levels of expertise, the actual care delivered can vary considerably and result in the underuse of evidence-based interventions, the overuse of interventions supported by limited evidence and low value healthcare. OBJECTIVES: To quantify the number, type and management of complex wounds being treated over a two-week period and to explore variations in care by comparing current practices in wound assessment, prevention and treatment. DESIGN: A multiservice cross-sectional survey. SETTING: This survey spanned eight community services within five Northern England NHS Trusts. RESULTS: The point prevalence of complex wounds in this community-based population was 16.4 per 10 000 (95% CI 15.9 to 17.0). Based on data from 3179 patients, antimicrobial dressings were being used as the primary dressing for 36% of patients with complex wounds. Forty per cent of people with leg ulcers either had not received the recommended Doppler-aided Ankle Brachial Pressure Index assessment or it was unclear whether a recording had been taken. Thirty-one per cent of patients whose most severe wound was a venous leg ulcer were not receiving compression therapy, and there was limited use of two-layer compression hosiery. Of patients with a pressure ulcer, 39% were not using a pressure-relieving cushion or mattress. CONCLUSIONS: Marked variations were found in care, underuse of evidence-based practices and overuse of practices that are not supported by robust research evidence. Significant opportunities for delivering better value wound care therefore exist. Efforts should now focus on developing strategies to identify, assess and disinvest from products and practices supported by little or no evidence and enhance the uptake of those that are.

The Effect of a Slowly Rocking Bed on Sleep.

Rocking movements appear to affect human sleep. Recent research suggested a facilitated transition from wake to sleep and a boosting of slow oscillations and sleep spindles due to lateral rocking movements during an afternoon nap. This study aimed at investigating the effect of vestibular stimulation on sleep onset, nocturnal sleep and its potential to increase sleep spindles and slow waves, which could influence memory performance. Polysomnography was recorded in 18 males (age: 20-28 years) during three nights: movement until sleep onset (C1), movement for 2 hours (C2), and one baseline (B) without motion. Sleep dependent changes in memory performance were assessed with a word-pair learning task. Although subjects preferred nights with vestibular stimulation, a facilitated sleep onset or a boost in slow oscillations was not observed. N2 sleep and the total number of sleep spindles increased during the 2 h with vestibular stimulation (C2) but not over the entire night. Memory performance increased over night but did not differ between conditions. The lack of an effect might be due to the already high sleep efficiency (96%) and sleep quality of our subjects during baseline. Nocturnal sleep in good sleepers might not benefit from the potential facilitating effects of vestibular stimulation.

A Retrospective Study on Infant Bed-sharing in a Clinical Practice Located in an Urban Cluster.

OBJECTIVES: This retrospective study evaluates infant bed-sharing at a Missouri family practice with OB care. METHODS: After Institutional Review Board (IRB) approval, data were extracted from the first four well-child visits of 2374 infants between Sept. 2003 and Dec. 20 11. RESULTS: Bed-sharing decreased after 2005 (25%, 39%, respectively, p = 0.000). For infants who bed-shared, the frequency of bed-sharing did not decline. CONCLUSIONS: Nearly 20% of infants bed-share before the first visit; safe sleep prenatal education is warranted.

Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia.

BACKGROUND: Forced-air warming is a commonly used warming modality, which has been shown to reduce the incidence of inadvertent perioperative hypothermia (<36°C). The reusable resistive heating mattresses offer a potentially cheaper alternative, however, and one of the research recommendations from the National Institute for Health and Care Excellence was to evaluate such devices formally. We conducted a randomized single-blinded study comparing perioperative hypothermia in patients receiving resistive heating or forced-air warming. METHODS: A total of 160 patients undergoing non-emergency surgery were recruited and randomly allocated to receive either forced-air warming (n=78) or resistive heating (n=82) in the perioperative period. Patient core temperatures were monitored after induction of anaesthesia until the end of surgery and in the recovery room. Our primary outcome measures included the final intraoperative temperature and incidence of hypothermia at the end of surgery. RESULTS: There was a significantly higher rate of hypothermia at the end of surgery in the resistive heating group compared with the forced-air warming group (P=0.017). Final intraoperative temperatures were also significantly lower in the resistive heating group (35.9 compared with 36.1°C, P=0.029). Hypothermia at the end of surgery in both warming groups was common (36% forced air warming, 54% resistive heating). CONCLUSION: Our results suggest that forced-air warming is more effective than resistive heating in preventing postoperative hypothermia. CLINICAL TRIAL REGISTRATION: NCT01056991.