Seating and pressure support needs of people with cancer in the cervix or rectum: a case series on the clinical usefulness of pressure mapping assessment.

Pressure sores present a challenge to people with rectal and cervical cancers due to weight loss, compromised nutrition, chemotherapy and radiotherapy. Affected individuals often experience intense pain on sitting, and prefer to spend the majority of their time lying down. This pilot study, employing a case study design, investigated the pressure care needs of such persons using pressure mapping, a technology designed to measure pressures at the seating interface. Four participants were mapped on a selection of five cushions, three of which were developed to specifically reduce midline posterior pressure/pain relief. Participants rated the cushions for comfort. Findings demonstrated an inconsistent relationship between interface pressures and perceived cushion comfort, suggesting that patient-rated comfort is a poor indicator of high interface pressures. The specialized cushions did not always meet the needs of this target population and no one cushion suited all. This study demonstrated the precarious clinical balance needed between comfort and achieving optimal pressure reduction in cushion prescription for this client group, and suggested that comfort was more important than pressure reduction in terms of their seating needs.

Interface pressure measurements: visual interpretation of pressure maps with MS clients.

PURPOSE: Pressure mapping systems provide useful information for pressure care assessment. Healthcare professionals tend to rely upon their colour-coded pressure maps to assist clinical decision-making, based on ranking these from best to worst pressure distribution. The current study investigated whether such ranking is an appropriate method of assessment when compared to use of the numerical output of average and maximum pressure values (mmHg), yielded by the system. METHOD: This community-based correlational study involved 27 multiple sclerosis clients (15 wheelchair users; 12 non-wheelchair users). Pressure maps were recorded on each participant's current seating surface and on six pressure reducing cushions, using the Force Sensing Array pressure mapping system. Outcome measures included (1) rank order of pressure maps based on visual interpretation by two occupational therapists, (2) average pressure (mmHg) and (3) maximum pressure (mmHg). Visual ranking of the colour-coded pressure maps was correlated with average and maximum pressure values for each map. RESULTS: Correlations between visual ranking of maps and maximum pressures were high for six out of seven surfaces (p < 0.05) for non-wheelchair users; however, they were much less between average pressures and visual interpretation for the same cohort. Similarly, correlations between visual ranking of maps and average pressures for wheelchair users was minimal and was only noted as being high (p < 0.05) on two surfaces when considering maximum pressures and visual interpretation. CONCLUSIONS: This study contests the usefulness of the visual ranking of pressure maps in interpreting interface pressures with MS clients, especially with wheelchair users. Visual interpretation of pressure maps by clinicians may be useful in eliminating inappropriate support surfaces from a selection, or those that display easily identifiable 'extremes' of pressure values. Clinicians need to incorporate and interpret the numerical data as well as pressure maps when conducting their assessment and making provision.

Pressure mapping systems: reliability of pressure map interpretation.

BACKGROUND: Pressure mapping systems offer a new technology to assist with pressure care assessment. Data output from such systems can be presented in three forms: numerical data, a three-dimensional grid and a colour-coded pressure map. OBJECTIVES: To (1) investigate whether sole use of the pressure map was a reliable method of interpreting interface pressures when compared with use of the numerical data; (2) establish the inter- and intra-rater reliability of using pressure maps to assess pressure and determine whether reliability depended upon system operator experience; and (3) examine whether reliability extended to the range of seating surfaces being tested. DESIGN: A reliability study assessing the ranking of pressure maps recorded by the Force Sensing Array pressure mapping system. SETTING: A university occupational therapy department and a community NHS trust. SUBJECTS: Fifteen occupational therapists with experience in pressure mapping and 50 occupational therapy students with no practical experience of pressure mapping. INTERVENTIONS: Two sets of pressure maps were pre-recorded with an able-bodied adult seated on a variety of surfaces, with maps on each individual surface recorded over a 20-minute period at 2-minute intervals. Subjects ranked both sets of maps in terms of 'best to poorest' distribution of pressure. MAIN OUTCOME MEASURES: Rank orders of (1) pressure maps; (2) average interface pressures (mmHg); (3) maximum interface pressures (mmHg). RESULTS: The use of pressure maps to interpret interface pressures was a reliable method. Significant agreement existed within (p < 0.001) and between groups of operators and reliability extended over the range of seating surfaces tested. CONCLUSIONS: The practice of using pressure maps to interpret interface pressures in seating as opposed to using the associated numerical data can be supported. This was shown to be a reliable method of assessment by both experienced and less experienced operators across a range of seating surfaces.

A validation study of the influence of alcohol on handwriting.

The purposes of this article are to report experimental findings and to validate prior selected studies that examined handwriting comparisons and alcohol consumption. Subjects who participated in this experiment were given handwriting testing forms which were completed at assigned intervals throughout the testing period. The setting for the completion of the experiment was within a controlled environment with adult students attending the Breath Tests for Intoxication School for the use of blood alcohol concentration (BAC) instruments for law enforcement purposes. Handwriting data and pertinent information, BAC level and time, were recorded on the testing forms which were completed before, during, and after drinking. This study does not attempt to determine handwriting characteristics that can be predicted at various blood alcohol levels, but rather demonstrate, as noted in prior studies, if handwriting trends develop during or after the consumption of alcohol. The results of the handwriting comparisons, between and among test subjects, are discussed and applied to prior findings.