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PubMed2003

Environmental exposure reduction in high-risk newborns: where do we start?

BACKGROUND: When analyzing the effect of environmental exposure reduction measures on asthma in high-risk children, one must know how far asthmatic families already have applied such measures, because this would affect the effectiveness and efficiency of interventions aimed at reducing environmental exposure. OBJECTIVE: To describe the room for improvement by asthmatic families in mite, pet, and food allergen reducing measures and in parental passive smoking and to determine the resulting levels of mite and pet allergens by the applied sanitation measures. METHODS: Data were sampled by observation, weekly diary entries, and questionnaire when the infant was 6 months old and 1 year old. Dust samples were collected by vacuuming the living room floor and the parental and infant mattresses. Multiple logistic regression analyses were applied with the use of mattress encasing, having a smooth floor covering, having pets, exclusive breast-feeding and/or hypoallergenic formula during the infant's first 6 months, and passive smoking as the dependent variables. RESULTS: Frequencies of applied measures were as follows: having a smooth floor covering, 36%; daily house cleaning, 27%; use of parental and infant antimite mattress encasings, 13% and 9%, respectively; keeping no pets, 66%; no cow's milk-based regular formula, 13%; no solid foods in the first 6 months of life, 28%; and abstinence of smoking by the mother prenatally, 89%; by the mother postnatally, 85%; and by her partner, 76%. Having a smooth floor covering and daily cleaning but not use of antimite mattress encasings resulted in significantly lower mite and pet allergen levels. CONCLUSIONS: There is (still) enough room for improvement to reduce exposure to inhalant and food allergens, especially by application of mattress encasings, exclusive breast-feeding and/or hypoallergenic formula feeding, and postponing the time until first solids are given.

Air Pollution, Indoor↗

PubMed2000

Levels of house-dust-mite allergen in homes of nonallergic people in Pavia, Italy.

BACKGROUND: HDM distribution varies between geographic areas and may be affected by housing characteristics. We quantified Der p 1 and Der f 1 and assessed the relationships between their levels and housing characteristics in homes of nonallergic subjects. METHODS: Der f 1 and Der p 1 were measured by ELISA in dust samples from living-room floors and mattresses of 44 homes of nonallergic subjects in Pavia. Information about household characteristics was obtained by questionnaire. RESULTS: Der p 1 and Der f 1 concentrations (microg/g dust, median) were 0.34 and 7.8 on mattresses, and 0.15 and 0.83 on living-room floors. Higher Der f 1 levels on mattresses were associated with synthetic pillows (P<0.05), and (only when expressed as microg/m2) with bedding washing temperature of < or = 60 degrees C (P<0.05). Der f 1 levels were higher on the living-room floors of homes located on lower (< or =first) floors (P<0.05). Good correlations were found between Der p 1 and Der f 1 expressed as microg/g dust and microg/m2 on both mattresses and living-room floors. CONCLUSIONS: In homes of nonallergic subjects in northern Italy, Der f 1 exceeded the threshold for sensitization in a high proportion of mattress samples.

Animals↗

PubMed2003

Medical Indoor Environment Counselor (MIEC): role in compliance with advice on mite allergen avoidance and on mite allergen exposure.

BACKGROUND: In order to improve patient compliance in allergen avoidance, a new occupational activity was created: Medical Indoor Environment Counselor (MIEC). The aim of this study was to assess the impact of an MIEC on compliance with advice for mite allergen reduction in patients sensitized and exposed to mite allergens, and on mite allergen levels. METHODS: The study included 378 patients from four centers (Marseilles, Montpellier, Paris, Strasbourg) in a randomized prospective study. Patients in group A received advice from doctors only, and those in group B from doctors and MIEC. Mite allergen levels were measured on mattresses, mattress bases, and floors. Compliance and mite allergen levels were assessed 5 months later. RESULTS: Compliance for changing the mattress bases, removing or treating the carpets, washing duvets, pillows and stuffed animals were significantly higher in group B than in group A. A significant decrease in mite allergen was obtained for group B in mattress bases (83.8-22.9 micro g/g) and in carpets (15.8-6.3 micro g/g), but not in group A. CONCLUSION: Our results suggest that the home visit by the MIEC 1) increased the compliance to mite reduction methods advised; 2) induced a significant difference in mite reduction levels on mattress bases and on carpets; 3) avoided nonestablished avoidance advice.

Adolescent↗

PubMed1998

Indoor factors associated with concentrations of house dust mite allergen, Der p 1, in a random sample of houses in Norwich, UK.

BACKGROUND: Studies of house dust mite allergen concentrations suggest large variations both within and between homes. It is likely that different household characteristics influence allergen levels in different locations within the house. OBJECTIVES: To investigate household characteristics associated with higher concentrations of house dust mite allergen in a random sample of houses. METHODS: Information on indoor environment was obtained from 158 adults aged 20-44. Dust samples were collected from their living room floor, bedroom floor and mattress. Concentrations of Der p 1, the major allergen from the house dust mite Dermatophagoides pteronyssinus, were measured by monoclonal antibody immunoassay. Associations between mite allergen concentrations and household characteristics were examined using censored-normal regression models. Factors that were related to Der p 1 (P </= 0.2) in univariate analyses were included in multivariable regression models. RESULTS: Der p 1 was not detected in any location in 10 (6.3%) houses. Geometric mean concentrations of Der p 1 were 1.9 microg/g in living room floor dust, 1.7 microg/g in bedroom floor dust and 2.0 microg/g in mattress dust. Approximately 25% of living room floor and mattress, and over 30% of bedroom floor samples had Der p 1 concentrations greater than 10 microg/g. Household characteristics associated with Der p 1 concentrations in both living room and bedroom were floor level, extractor fan in the kitchen, and age of carpet. Living room Der p 1 concentrations were also associated with gas oven/hob, window condensation, open fires, vacuum cleaner type, smokers in the house and age of house. Bedroom Der p 1 concentrations were also associated with use of blankets and wash temperature of bedding. Mattress Der p 1 concentrations were associated with window condensation, concrete bedroom floor and age of mattress. CONCLUSION: Different household characteristics were associated with high Der p 1 concentrations in different parts of the house. These findings are relevant to design of allergen avoidance regimes or formulation of policy recommendations for reduction of disease associated with allergen exposure.

Adult↗

PubMed2002

House dust mites and their allergens at selected locations in the homes of house dust mite-allergic patients.

BACKGROUND: Knowledge of the occurrence of house dust mites (HDM) and their allergens in domestic locations is important when planning intervention. OBJECTIVE: The aim of this study was to describe the distribution of HDMs and their allergens before intervention in multiple locations in the homes of newly diagnosed HDM-allergic patients with a known high Der 1 concentration in their mattress dust. METHODS: Dust was collected from ten locations in the homes of eight HDM-allergic patients. Dust was analysed for allergen content with ELISAs for Der f 1, Der p 1 and Der m 1; and HDM were counted. Total allergen concentrations ( micro g Der 1/g dust) were expressed as the sum of Der f 1, Der p 1 and Der m 1. RESULTS: On mattresses the median concentration was 86 micro g Der 1/g dust (range 30-288) and 188 mites/g dust (range 12-1910). Der 1 exceeded 10 micro g/g dust in mattresses (8/8), duvets/pillows (3/8), a bedroom carpet (1/1), a living room carpet (1/6), upholstered furniture (2/8) and a curtain (1/5). Uncarpeted floors, upholstered furniture, bookshelves and walls had significantly lower Der 1 concentration than the mattresses. The relative contribution of Der p 1, Der f 1 or Der m 1 to Der 1 was related to homes, rather than to the location. Der m 1 only occurred in minute amounts. CONCLUSION: For HDM intervention, our results indicate that priority should be given to the removal of allergens from mattresses, and in addition from carpets, duvets/pillows and upholstered furniture. Dust from walls, uncarpeted floors, bookshelves and curtains appear to contribute insignificantly to the domestic HDM allergen load.

Animals↗

PubMed2003

Stringent environmental control in pregnancy and early life: the long-term effects on mite, cat and dog allergen.

BACKGROUND: As part of a primary prevention of asthma study, we measured the effect of environmental control measures on Der p 1, Fel d 1 and Can f 1 over a 3.5-year period. METHODS: High-risk infants (both parents atopic) without pets, were randomized to the Active group (n = 142, vinyl flooring in child's room, allergen-impermeable cot mattress, hot-washable toy, mite allergen-impermeable encasings to parental bed and to child's bed when older, high filtration vacuum cleaner, hot-washing of bedding) or the Control group (n = 136, no intervention), in early pregnancy. Dust samples from the parental mattress, living room floor, child's mattress and floor at baseline (pregnancy), birth and at 3 years were analysed for Der p 1, Fel d 1 and Can f 1. RESULTS: A total of 278 families completed the baseline visit, 259 the birth visit and 239 the 3-year visit. In the Active group at 3 years, 58% remained compliant with all measures likely to reduce the child's exposure to allergen and 77% of parents still used encasings on their bed. Levels of Der p 1, Fel d 1 and Can f 1 were significantly lower in the Active group in the child's floor and the child's mattress at 3 years compared to the Control group (P < 0.001). For the parental mattress, the levels of Der p 1 and Fel d 1 were lower in the Active group (P < 0.001) and there was a strong trend towards a lower level for Can f 1. There was no difference in the levels of any of the allergens between the groups in the living room floor. Childrens' bedrooms with no detectable mite, cat or dog allergen were significantly more common in the Active than the Control group (25 vs. 2, P < 0.001). CONCLUSIONS: Environmental control measures are effective in substantially reducing levels of Der p 1, Fel d 1 and Can f 1 in homes without pets in the long term and are acceptable to families. The effect of this environmental manipulation on the development of sensitization and allergic disease remains to be seen.

Adult↗

PubMed2003

Evaluation of rebreathing potential on bedding for infant use.

BACKGROUND: Rebreathing is thought to be associated with sudden infant death syndrome (SIDS). The aim of the present study was to evaluate the rebreathing potential of different types of Japanese infant bedding. METHODS: The rebreathing potential of various combinations of infant bedding was measured using a mechanically simulated breathing model. The types of bedding included five types of mattresses, four types of o-nesyo sheets (waterproof sheets) and a towel. The half-life of the expiratory CO2 concentration, t1/2-value was calculated as the index of the rebreathing potential. The softness of the bedding was also measured. RESULTS: There was a moderate proportional correlation between the t1/2-value and the softness (correlation coefficient = 0.509). When a new hard infant mattress was used, the t1/2-values were 13.6-14.1 s, and when o-nesyo sheet was added, the values were 14.1-16.2 s. When other mattresses were used with the o-nesyo sheet, the values were 14.1-19.2 s. Adding a towel onto the bedding, the t1/2-value (18.5-22.3 s) was prolonged without exception. CONCLUSION: It is difficult to estimate the rebreathing potential of the bedding on the basis its appearance or its softness. All infants should be placed on appropriate bedding in case they turn to a prone-sleeping position. Our recommendations to avoid rebreathing are as follows: (i) a new hard mattress specifically designed for babies should be used; (ii) a towel should not be used; (iii) an o-nesyo sheet may be used with a new hard infant mattress if necessary.

Bedding and Linens↗

PubMed2002

Comparison of interface pressures in the pediatric population among various support surfaces.

OBJECTIVE: The purpose of this study was to evaluate the interface pressures under the bony prominences of children on several support surfaces to evaluate benefit, in terms of the lowest interface pressures, and cost-effectiveness. DESIGN: A descriptive study design was used. SETTING/SUBJECTS: A convenience sample of 54 healthy children from the community ranging in age from infancy through 16 years was enrolled through advertisements in the hospital newsletter. The study was conducted in the General Clinical Research Center located within Texas Children's Hospital, Houston, Texas. INSTRUMENTS: The instrument used to measure the interface pressures was the Mini-Texas Interface Pressure Evaluator. METHODS: A comparison was done to evaluate interface pressures under the occiput for infants to children younger than 6 years of age and under the occiput, coccyx, and heel for 6- to 18-year-olds. Five surface combinations were used for measurements: a standard hospital bed or crib mattress; mattress with Delta foam overlay; a mattress with a Gel-E-Donut pillow; a mattress with a Delta foam overlay plus Gel-E-Donut pillow; and an Efica low-air-loss bed. RESULTS: The standard hospital mattress yielded the highest interface pressures. The Delta Foam overlay alone or in combination with the Gel-E-Donut pillow produced the lowest occipital pressures in all age groups. The Delta foam overlay produced comparable pressures to the Efica low-air-loss bed when measuring the coccyx and heel interface pressures. CONCLUSIONS: The Delta Foam overlay alone or in combination with the Gel-E-Donut pillow is a cost-effective and therapeutic choice for pressure reduction as demonstrated in this study of healthy children.

Adolescent↗

PubMed1990

Pressure relief characteristics of an alternating pressure system.

The pressure relieving characteristics of an alternating pressure mattress are compared to the characteristics of a traditional hospital mattress. The trochanteric pressures of 20 healthy volunteers had a mean of 95 (SD = 49) on a hospital mattress while the trochanteric pressures on the alternating pressure mattress had a mean of 67 (SD = 9) for the inflated cells and a mean of 23 (SD = 7) for the deflated cells. Statistical analysis revealed significantly lower interface pressure for the alternating pressure mattress.

Adult↗

PubMed2004

Determinants of endotoxin levels in living environments of farmers' children and their peers from rural areas.

BACKGROUND: Lower frequencies of asthma and hayfever have been observed in children with contact to livestock. At school age, the amount of endotoxin measured in the dust of children's mattresses is inversely related to the occurrence of atopic asthma, hayfever and atopic sensitization both in children from farming and non-farming households. OBJECTIVE: The aim of the present study was to investigate which home and lifestyle characteristics of farm and non-farm families contribute to endotoxin levels measured in different indoor home environments. METHODS: In the framework of the Allergy and Endotoxin (ALEX) Study, endotoxin was measured in dust samples from the living room floor and the child's mattress of 319 farmers' families and 493 non-farming families, and in settled dust from stables. Endotoxin content of all dust samples was determined by a kinetic Limulus assay (Limulus-Amebocyte-Lysate test). Information about the child's activities on farms, home characteristics and cleaning behaviours was obtained from parental questionnaires. RESULTS: Endotoxin levels in stables did not predict the amount of endotoxin measured in floors or mattresses. However, a dose-dependent association between the child's activity on the farm and indoor home endotoxin levels was observed, both in farm and non-farm children. In non-farm children pet keeping and the frequency of floor cleaning were additionally associated with endotoxin levels, whereas in farm children parental farm activities, study area, time since last cleaning, the mattress type as well as younger age of the children contributed to increased microbial exposure. CONCLUSION: These results demonstrate that regular contact to farm animals increases indoor home endotoxin concentrations, both in farm and non-farm children, and might thus explain the protective effect of contact to livestock on atopic outcomes. To assess children's individual exposure to a microbial environment, measures of mattress dust exposure are needed as stable endotoxin concentrations were not associated with indoor home levels.

Agriculture↗

PubMed2006

Repeated measurements of mite and pet allergen levels in house dust over a time period of 8 years.

BACKGROUND: Studies of the association between indoor allergen exposure and the development of allergic diseases have often measured allergen exposure at one point in time. OBJECTIVE: We investigated the variability of house dust mite (Der p 1, Der f 1) and cat (Fel d 1) allergen in Dutch homes over a period of 8 years. METHODS: Data were obtained in the Dutch PIAMA birth cohort study. Dust from the child's mattress, the parents' mattress and the living room floor was collected at four points in time, when the child was 3 months, 4, 6 and 8 years old. Dust samples were analysed for Der p 1, Der f 1 and Fel d 1 by sandwich enzyme immuno assay. RESULTS: Mite allergen concentrations for the child's mattress, the parents' mattress and the living room floor were moderately correlated between time-points. Agreement was better for cat allergen. For Der p 1 and Der f 1 on the child's mattress, the within-home variance was close to or smaller than the between-home variance in most cases. For Fel d 1, the within-home variance was almost always smaller than the between-home variance. Results were similar for allergen levels expressed per gram of dust and allergen levels expressed per square metre of the sampled surface. Variance ratios were smaller when samples were taken at shorter time intervals than at longer time intervals. CONCLUSION: Over a period of 4 years, mite and cat allergens measured in house dust are sufficiently stable to use single measurements with confidence in epidemiological studies. The within-home variance was larger when samples were taken 8 years apart so that over such long periods, repetition of sampling is recommended.

Air Pollution, Indoor↗

PubMed2005

Pressure ulcers: guideline development and economic modelling.

AIM: This paper presents the development process for clinical guidelines on the use of pressure-relieving devices (beds, mattresses and overlays), with emphasis on incorporating economic evidence. BACKGROUND: Previous UK guidelines on the use of pressure-relieving devices to prevent pressure ulcers have not considered whether any recommendations made are cost effective. The routine inclusion of cost effectiveness evidence in guidelines is a recent policy development, and there has been little research into its potential role in the guideline process. METHODS: We systematically reviewed the literature to assess both the clinical and cost effectiveness of pressure-relieving devices for prevention of pressure ulcers. Where there was sufficient evidence on the comparative clinical effectiveness between alternative devices, economic modelling was undertaken to assess comparative cost effectiveness. A guideline development group (comprising both clinicians and patient representatives) reviewed all the available evidence to formulate clinical practice guidelines and recommendations for further research. RESULTS: Studies showed that caring for people vulnerable to developing pressure ulcers on high-specification foam mattresses compared with standard hospital mattresses significantly reduced their risk of developing a pressure ulcer. Cost effectiveness modelling indicated that, because of savings accruing through treating fewer pressure ulcers, high-specification foam mattresses are likely to cost less overall and are more effective. The resulting clinical practice guideline was uncompromising on the use of high-specification foam mattresses as the minimum provision in patients vulnerable to pressure ulcers. Significant weaknesses were identified in both the quality and availability of evidence for most of the other pressure relieving devices considered. CONCLUSIONS: Cost effectiveness assessment was an integral part of the guideline development process. It clarified the shortcomings of some of the clinical effectiveness evidence and helped in formulating pragmatic clinical practice recommendations.

Bedding and Linens↗

PubMed2005

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery.

AIMS AND OBJECTIVES: To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. BACKGROUND: The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. DESIGN: A prospective randomized pre/post-test experimental design. METHODS: Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. RESULTS: Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi2 = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi2 = 0, P = 0.987). CONCLUSIONS: Clear, concise written instruction improved practice but verbal education was not additionally beneficial. RELEVANCE TO CLINICAL PRACTICE: Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Attitude of Health Personnel↗

PubMed1998

House-dust-mite allergen (Der p 1) levels in university colleges.

BACKGROUND: In coastal Australia, mean house-dust-mite allergen concentration is 20-40 times higher in homes than in public buildings. Allergen concentrations in university colleges, which share some characteristics of both homes and public buildings, are not known. The study aimed to compare bed mite-allergen concentration in colleges with local homes. METHODS: Mattress dust was collected from three colleges (n = 60 in each) and local homes (n = 68) during summer. Der p 1 was measured by ELISA. Information was collected on the floor plan of the colleges, cleaning practices, age of building, and orientation of room. RESULTS: Most college mattresses (94%) had Der p 1 concentrations less than the mean of homes in the same climate. The geometric means of Der p 1 in the mattresses of the colleges were as follows: A, 8.9 micrograms Der p 1/g fine dust (95% CI 6.9, 11.5); B, 1.9 (1.5, 2.3); and C, 1.5 (1.2, 2.0), compared to homes, 22.5 (17.6, 28.7). The percentages of college mattresses with less than 2 micrograms/g were 7%, 48%, and 58%, respectively, compared to 4% for homes. Higher Der p 1 concentrations were weakly associated with age of building in college A, and orientation in college B. Der p 1 concentrations were independent of floor level and age of mattress. CONCLUSIONS: These findings indicate that low allergen concentrations are achievable without extreme hygiene and cleaning measures in a climate which supports mite proliferation in homes.

Animals↗

PubMed2004

Concentrations of domestic mite and pet allergens and endotoxin in Palestine.

BACKGROUND: A few studies have compared indoor allergens and endotoxin levels between urban and rural settings as important determinants for asthma and atopy in children. However, no study was done in the Middle East or investigated refugee camps. METHODS: As part of a nested case-control study in Ramallah in 2001, we measured house dust mite and pet allergens, as well as endotoxin in dust collected from 110 children's mattresses and living room floors. RESULTS: Geometric mean (GM) concentrations of Dermatophagoides pteronyssinus (Der p1) antigen were 4.48 microg/g in mattress dust and 1.23 microg/g floor dust. The highest Der p1 levels were seen in refugee camps. Concentrations of Dermatophagoides farinae antigen (Der f1) were much lower (<0.08 microg/g dust). Concentrations of cat allergen (Fel d1) were highest in villages, and those of dog allergen (Can f1) were highest in mattresses from cities and in floor dust from refugee camps. GM of endotoxin levels were 25.7 EU/mg in mattress dust and 49 EU/mg dust in floor dust. CONCLUSIONS: Concentrations of Der p1 were high compared to Western European countries, but were lower compared to UK and Australia. Levels of pet allergens were lower than in Western Europe. Endotoxin levels were higher compared to developed countries. Indoor environmental factors such as dampness seemed to be important determinants for allergen and endotoxin, but living habits such as lack of mattress cover appeared unimportant.

Air Pollution, Indoor↗

PubMed2006

House dust mite allergen reduction and allergy at 4 yr: follow up of the PIAMA-study.

Exposure to high allergen levels in early life is a risk factor for the development of allergy. We previously reported limited effects of mite allergen impermeable mattress covers in the prevention and incidence of asthma and mite allergy (PIAMA) cohort at the age of 1 and 2 yr. We now present the results of follow-up at 4 yr objectives. To examine the effects of early reduction of house dust mite (HDM) allergen exposure by means of mattress covers on the incidence of allergy and asthma symptoms in the PIAMA birth cohort at the age of 4 yr. High-risk children (allergic mother) were prenatally recruited and randomly allocated to three groups; receiving mite allergen impermeable mattress covers (n = 416), placebo covers (n = 394) or no intervention (n = 472). At 4 yr of age, atopy was assessed by questionnaire; specific Immunoglobulin E (IgE) to inhalant and food allergens was measured in serum. Dust samples collected from the children's mattresses were analysed for mite allergens. Dermatophagoides farinae1 allergen (Der f 1) levels in dust were reduced in the active group. However, Dermatophagoides pteronissinus 1 (Der p 1) levels, sensitization and atopic symptoms were similar in all groups. We found no effect of mite allergen impermeable mattress covers on sensitization and atopy at 4 yr. Moreover, the allergen reducing effects of the covers had disappeared for one of the two mite allergens that were measured.

Antigens, Dermatophagoides↗

PubMed2006

Pullout strength for three suture patterns used for canine tracheal anastomosis.

OBJECTIVE: To compare pullout strength of 3 suture patterns used for canine tracheal anastomosis. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric canine tracheae (n = 20). METHOD: Tracheal segments were anastomosed with 1 of 3 suture patterns: simple continuous, simple interrupted, and simple interrupted reinforced with horizontal mattress, each encircling annular cartilage rings adjacent to the transection site. Horizontal mattress sutures encircled the annular rings proximal and distal to the rings closest to the anastomosis. Each construct was distracted (0.5 mm/s) in a materials testing machine to failure. Load-displacement curves were generated and failure load (pullout strength) determined and mode of failure recorded. RESULTS: Tracheal anastomosis with a simple interrupted pattern was significantly weaker (mean+/-SD pullout strength, 102.55+/-30.14 N) than simple continuous (135.53+/-15.47 N) or simple interrupted plus horizontal mattress (132.39+/-21.46 N), which were not different from each other. Mode of failure was consistently by suture tear out. CONCLUSIONS: Both simple continuous and simple interrupted reinforced with horizontal mattress suture patterns have significant biomechanical advantage over a simple interrupted pattern alone in canine cadaveric tracheal anastomosis. The simple continuous pattern had the least variability in pullout strength. CLINICAL RELEVANCE: A simple continuous technique should be considered when selecting a tension-relieving pattern for canine tracheal anastomosis. It offers the same biomechanical advantage as a simple interrupted pattern reinforced with a horizontal mattress pattern and its strength appears to be reliably maintained when tested in canine cadaver tracheae.

Anastomosis, Surgical↗

PubMed2006

Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

OBJECTIVE: To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. DESIGN: Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. SETTING: 11 hospitals in six UK NHS trusts. PARTICIPANTS: Intention to treat population comprising 1971 participants. MAIN OUTCOME MEASURES: Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. RESULTS: Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. CONCLUSION: Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

Adult↗