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Physiologic responses during rest on a sleep system at varied degrees of firmness in a normal population.

This study explores the hypothesis that a high degree of sustained muscle activity associated with a sub-optimal spinal orientation may compromise an individual's ability to relax or initiate sleep. Data from 22 participants who were considered to be part of a normal, back-pain-free population were used in these studies. Participants laid down on a mattress in a foetal position (i.e. on their sides) at three varying bed pressures while EMG activities, heart rates, blood pressures, subjective comfort levels and spinal alignment data were recorded. Minor effects of mattress inflation pressures were associated with changes in EMG activity, heart rate, blood pressure and/or subjective comfort. In contrast, spinal alignment assessment revealed significant differences between the three different inflation pressures studied (827.4, 2413.2 and 3999.0 Pa). It was concluded that in a population of normal participants, although mattress inflation pressure induced significant changes in spinal alignment, these changes were of little physiological consequence. Nevertheless, this data provides baseline information needed to assess similar correlations in a symptomatic population (e.g. those with either acute or chronic neck or back pain).

Adult↗

Comparison of perceived pain with different immobilization techniques.

OBJECTIVE: To compare the locations and severities of pain generated by a hard wooden spine board vs a soft vacuum mattress splint on immobilized volunteers. METHODS: This was a prospective randomized crossover study conducted in an emergency medical services (EMS) classroom within a university teaching hospital. Participants were 18 healthy volunteers with no history of acute or chronic back pain, pregnancy, or recent analgesic use. The subjects were placed in one of three immobilization boards (hard spine board and two different vacuum splint models, identified as red and blue) for 60 minutes. At 0, 30, and 60 minutes the subjects rated their pain at multiple locations on their body using a visual analog scale (VAS). After a two-day washout period, this procedure was repeated on a different board and later a third board until all the subjects had been tested on all three boards. RESULTS: Although many pressure point locations were studied, only three had results that appeared statistically significant: the occiput, lower back, and sacrum. The hard spine board had higher mean pain scores as well as a higher percentage of subjects who reported any pain when compared with the two vacuum mattress splints. Mean scores for the 30- and 60-minute times were: occiput 2.06 and 2.78 for the hard board compared with 0.78 and 0.56 for red and 0.44 and 0.67 for blue; lower back 1.39 and 1.44 for the hard board compared with 0.28 and 1.11 for red and 0.06 and 0.17 for blue; and sacrum 1.56 and 2.06 for the hard board compared with 0.33 and 0.39 for red and 0.89 and 1.06 for blue. CONCLUSION: The hard-board method of spinal immobilization generates higher self-reported pain scale scores than the two vacuum mattresses.

Adolescent↗

Endometrial cancer incidence in relation to electric blanket use.

Endometrial cancer is associated with endogenous and exogenous estrogen excess. Some investigators have posited that electromagnetic fields may influence cancer risk through estrogenic hormonal mechanisms; however, there have been no studies reporting on electric blanket exposure in relation to endometrial cancer. The authors examined this possible association between endometrial cancer risk and electric blanket or mattress cover use as part of a population-based, case-control study. This analysis included incident endometrial cancer cases 40-79 years of age, interviewed during 1994 (n = 148; response rate, 87%) and identified from the Wisconsin tumor registry. Female controls of similar age were randomly selected from population lists (n = 659; response rate, 85%). Information regarding electric blanket and mattress cover use and endometrial cancer risk factors was obtained through structured telephone interviews approximately 1 year after diagnosis. After adjustment for age, body mass index, and postmenopausal hormone use, the risk of endometrial cancer was similar among ever users (odds ratio = 1.04, 95% confidence interval: 0.70, 1.55) and among current users (odds ratio = 0.87, 95% confidence interval: 0.49, 1.54) as compared with never users. Despite its small size and potential misclassification of exposure, this study provides evidence against an association between electric blanket or mattress cover use and endometrial cancer.

Adult↗

A simple technique for producing supravalvular aortic stenosis in animals.

A safe and reproducible technique to create supravalvular aortic stenosis was developed, which avoids many of the difficulties encountered in the production of aortic stenosis. Dogs were anaesthetised and artificially ventilated. The chest was opened and the venae cavae were encircled with umbilical tapes. The ascending aorta was then encircled by a 1.5-2 cm wide, 6-7 cm long dacron patch, venous return was stopped by tightening the tapes, and a J-shaped clamp applied to the ascending aorta at the dacron patch. Two layers of continuous mattress suture were placed adjacent to the clamp, plicating the aortic diameter by about 50%. After releasing the clamp and restoring normal venous return, left ventricular (LV) and aortic (AO) pressures were measured. Subsequently, one or two deep mattress sutures were placed below the running mattress sutures to increase the stenosis and to obtain the desired gradient. The LV-AO systolic pressure gradients obtained immediately after the operation ranged from 40 to 75 mm Hg. Two to 6 months after the operation the pressure gradients ranged from 50 to 200 mm Hg. Left ventricular to body weight ratios were 6.41 (SEM 0.26) v 4.24(0.20) for the controls. Heart weight to body weight ratios were 8.37(0.35) v 5.65(0.33). LV end diastolic pressures were normal. This technique can be used either in puppies or adult animals. The problem of aortic rupture is eliminated. The pressure gradient can be easily controlled during the operation and reproducible LV hypertrophy can be obtained in a shorter time than with aortic banding of puppies.

Animals↗

Implementation of a new policy results in a decrease of pressure ulcer frequency.

OBJECTIVE: To determine the effects of a new policy on the efficiency of pressure ulcer care. DESIGN: Series of 1-day pressure ulcer surveys before and after the implementation. SETTING: A 900-bed University Medical Centre in The Netherlands. PARTICIPANTS: On the days of the surveys, 657 patients were included before the implementation, 735 patients at 4 months after the implementation, and 755 patients at 11 months after the implementation. INTERVENTION: Implementation of a hospital guideline for pressure ulcer care combined with the introduction of viscoelastic foam mattresses on the efficiency of the prevention and treatment of pressure ulcers. MAIN OUTCOME MEASURES: Comparisons before versus after the implementation were made regarding the care behaviour of nurses and the frequency of patients with pressure ulcer. RESULTS: Inadequate prevention decreased from 19 to 4% after 4 months and to 6% after 11 months (P < 0.001), and inadequate treatment decreased from 60 to 31% (P = 0.005). Excluding the use of mattresses as a positive indicator for care behaviour, we found no significant increase in adequate care to prevent pressure ulcers. Also, in adequate treatment activities, we found no significant difference. Overall, we found a significant decrease in hospital-acquired pressure ulcer frequency from 18 to 13% (P = 0.003) after 4 months and 11% (P < 0.001) after 11 months. CONCLUSION: The number of pressure ulcer patients in hospital can successfully be reduced. General measures such as the introduction of adequate mattresses and guidelines for prevention and treatment are promising tools in this respect.

Aged↗

Tissue oxygenation and blood flow on specialized and conventional hospital beds.

Despite the widespread use of specialty bed products, the physiological mechanism of their benefit has not been evaluated. In this study, healthy subjects were used to study transcutaneous oxygen tension (TcPo2) and laser Doppler blood flow in pressure sore-prone areas on air-fluidized, low-air-loss, and adjustable air-mattress beds relative to a standard hospital mattress with and without an egg-crate mattress overlay. Measurements were obtained over the sacrum with the subject in the prone and supine positions, and over a greater trochanter with the subject in the prone and 90-degree lateral positions. Our results on healthy volunteers suggest that the specialty bed products maintain TcPo2 better than a standard bed when tissue is weighted. Further, the Clinitron had significantly higher TcPo2 when weighted than each of the other beds. Laser Doppler blood flow was much more variable. The weighted trochanter on the standard bed had the lowest blood flow, which is consistent with the TcPo2 readings. However, the variability made the laser Doppler flow data less valuable than the TcPo2. In conclusion, these data indicate that several products, particularly the Clinitron, maintain TcPo2 of weight-bearing tissue, which may be an important mechanism in protecting against pressure sores.

Beds↗

Comparison of otoplasty techniques in the rabbit model.

The relative merit of cartilage scoring versus suturing in otoplasty remains a subject of debate among leading plastic surgeons. We compared a variety of otoplasty techniques in 42 rabbit ears using anterior or posterior scoring, horizontal or vertical mattress sutures, and combinations of scoring and suturing. The ears were splinted with a right-angle fold for 10 postoperative days, and the animals were killed after 8 weeks. Suturing techniques, alone or in combination with scoring, maintained an angulation significantly closer to the desired 90 degrees than anterior or posterior cartilage scoring (p < 0.05). The greatest accuracy and consistency were seen with horizontal mattress suturing, which provided an average angle (+/- SD) of 86 +/- 8.5 degrees. Histological analysis demonstrated a significant increase in cartilage hyperplasia with suturing alone, whereas the other techniques achieved only mild to moderate increases. Our findings support the usage of horizontal mattress sutures to create the antihelical fold in otoplasty.

Animals↗

A new postoperative management scheme for preventing sacral pressure sores in patients with spinal cord injuries.

Although the reliability of pressure sore surgery has improved with the advent of many different types of flaps, it is well known that the recurrence rate of pressure sores is still remarkably high in spinal cord-injured patients. This article reports the very low relapse rate of postsurgical pressure sores using air mattresses, which also helps relieve manpower requirements for care. We measured interface pressures at the sacrum for 18 spinal cord-injured patients with a ROHO air mattress (ROHO International, Inc, Belleville, IL). Based on the results, we used this mattress immediately after surgery for 19 spinal cord-injured patients with sacral pressure sores. Minimal repositioning was performed for each patient during the hospital stay. Minimal repositioning was similarly performed at home. All pressure sores healed, regardless of the type of surgical procedure, size, and degree of sore. No relapse has been found, with an average of 33.4 months after surgery. With this management, we could achieve a very low recurrence rate, require less manpower for postoperative management, as well as minimize stress for the patients.

Adult↗

The fire-safe cigarette: a burn prevention tool.

Cigarettes are the most common ignition source for fatal house fires, which cause approximately 29% of the fire deaths in the United States. A common scenario is the delayed ignition of a sofa, chair, or mattress by a lit cigarette that is forgotten or dropped by a smoker whose alertness is impaired by alcohol or medication. Cigarettes are designed to continue burning when left unattended. If they are dropped on mattresses, upholstered furniture, or other combustible material while still burning, their propensity to start fires varies depending on the cigarette design and content. The term "fire-safe" has evolved to describe cigarettes designed to have a reduced propensity for igniting mattresses and upholstered furniture. Legislative interest in the development of fire-safe smoking materials has existed for more than 50 years. Studies that showed the technical and economic feasibility of commercial production of fire-safe cigarettes were completed more than 10 years ago. Despite this, commercial production of fire-safe smoking materials has not been undertaken. The current impasse relates to the lack of consensus on a uniform test method on which to base a standard for fire-safe cigarettes. Although the fire-safe cigarette is a potentially important burn prevention tool, commercial production of such cigarettes will not occur until a standard against which fire-starting performance can be measured has been mandated by law at the state or federal level. The burn care community can play a leadership role in such legislative efforts.

Burns↗

A metabolic bed for collecting excreta in premature infants.

A mattress and plastic bed for collection of urine and feces in premature infants housed in isolettes is described. The dimensions of the bed are 65.5 x 34.4 x 13.5 cm. A drainage hole is located 18 cm from the foot of the bed and midway (16.5 cm) from either side. The angle of the depression in the bed for the drainage hole is approximately 12.5 degrees. The bed is covered with a plastic-backed foam rubber mattress. The plastic surface on which the infant lies is impervious to water. The method of excreta collection using the bed does not involve the need for restraints; urine and/or feces are washed off the undiapered infant and the bed into a container beneath the drainage hole. The bed has been well tolerated in over 30 studies of 4 days duration, and laboratory experiments with urine and feces applied to the mattress for 15-60 min have indicated excellent recovery of total nitrogen.

Beds↗

Otoplasty: an analysis of technique over a 33-year period.

OBJECTIVE: To compare the merits of otoplasty technique with a diverse patient population as experienced spanning a period greater 30 years. STUDY DESIGN: A review of a series of otoplasty cases that occurred in two distinctly different clinical settings during a 33-year period. METHODS: A retrospective analysis of 211 patients undergoing otoplasty from 1969 to 1982 in a military hospital setting was compared with 118 patients receiving otoplasty from 1982 to 2002 in a university/private practice setting. The patient population consisted of 180 adults and 149 children. RESULTS: Otoplasty patients in the military setting were primarily adults, whereas those in the university/private practice setting were primarily children. In the adult population, 98.9% of patients required use of lateral conchal cartilage resection combined with a mattress suture technique. In the pediatric population, all patients required use of a mattress suture technique and in 83.2% of selected cases limited lateral conchal cartilage resection was required. CONCLUSION: Otoplasty technique involving lateral conchal cartilage resection, mattress suture fixation, or a combination of both is applicable to diverse patient populations.

Adult↗

Bed surfaces and pressure sore prevention: an abridged report.

PURPOSE: This article summarizes the results of a systematic review of randomized controlled trials testing the effectiveness of special beds, mattresses, and cushions in preventing and treating pressure sores. The review's citation is Cullum, N., Deeks, J., Sheldon, T.A., Song, F., & Fletcher, A.W. (2000). Beds, mattresses and cushions for pressure sore prevention and treatment (Cochrane Review). The Cochrane Library, 4. DESIGN: An integrative research review. SAMPLE: 37 studies were included in the analysis. METHODS: A broad search of databases and unpublished studies was conducted. Data were extracted from those that met the inclusion criteria. Studies were grouped in various ways but mainly by type of product evaluated. FINDINGS: Many special products designed to prevent or treat pressure sores are more effective than standard hospital foam mattresses in preventing and treating pressure sores. CONCLUSIONS: Special pressure-relieving surfaces should be used for patients at risk for skin breakdown. IMPLICATIONS FOR NURSING PRACTICE: Individual practitioners and agencies should have a systematic protocol for assessing patients' risk of skin breakdown and for taking action when patients are determined to be at risk. The findings of this review provide some guidance for choosing particular products, albeit not definitive evidence for matching risk levels to products.

Beds↗

In search of the most suitable technique for truncal spinal immobilization with associated radiography.

The spineboard (SB) and the vacuum mattress (VM) are utilized for prehospital and emergency department (ED) immobilization of the spine. While permitting excellent pictures to be taken, the SB is a very painful device that can only be used for a limited time. The current study investigated the feasibility of different models of the VM for radiography. Computed tomography for each of seven VMs showed different degrees of shadows from the sac containing the polystyrole balls. This was related first of all to a high contrast of the sac in comparison with its contents and to a sometimes considerable shrinkage of the latter that resulted in further folding into the sac and, secondly, also to very broad mattresses, additional chambers within the VM and various grips and supports for lifting the mattress. Therefore, some features designed for prehospital use of the VM are actually acting against its use for diagnostic purposes. The aim of this study was to discuss and identify possible properties of a device that is useful for both immobilization and diagnostic purposes.

Artifacts↗

Exposure to house dust mites in homes of people with atopic dermatitis.

The median relative density of house dust mite populations was determined in mattresses in the homes of 23 people with atopic dermatitis (AD) who were mite-sensitive. It was significantly higher (total mites [dead and live] 174/0.1 g of dust: live mites 45.5/0.1 g) than in those of 23 healthy non-atopics (total mites 52/0.1 g; live mites 7.5/0.1 g; P < 0.05, < 0.01, respectively; Mann-Whitney U-test). There was no significant difference between mite population densities in mattresses in damp homes (n = 27; total mites 188/0.1 g; live mites 36/0.1 g) and those in homes with no damp (n = 19; total mites 116/0.1 g; live mites 26/0.1 g). These data demonstrate a clear association between AD and exposure to large numbers of mites, independent of the presence of domestic damp. People with AD were exposed to densities of > 500 mites/0.1 g of mattress dust five times more frequently than non-atopics, corresponding to a relative risk of 25.0, but were exposed to densities of < or = 50 mites/0.1 g five times less frequently. The overall relative risk for AD, with a cutoff of 50 mites (total)/0.1 g, was 8.1. There was an obvious positive correlation between magnitude of exposure and frequency of disease. It is hypothesized that the association between high densities of mites and AD is related to differences in lipid composition of the shed squames on which the mites feed: those of people with AD may be of greater nutritional value than those of non-atopics, thus enhancing mite population growth.

Adolescent↗

A combined approach to reduce mite allergen in the bedroom.

BACKGROUND: Asthma is a common chronic disease of childhood. House dust mite (HDM) are known to be a major source of allergen affecting atopic asthmatics. No single control method has been demonstrated to consistently reduce asthma. OBJECTIVE: We investigated the effect of a combination of two methods of HDM allergen control on HDM allergen content in the bedding and carpets of asthmatic children. METHODS: This was a double-blind placebo-controlled trial treating the bedrooms of 56 mite-sensitive asthmatic children. The carpet and the mattress, duvet and pillows (bedding) in the bedroom of children of the active group were treated with the acaricide Acarosan (benzyl benzoate). The bedding was then encased in vapour permeable waterproof fabric (Intervent--cotton coated with polyurethane) for 24 weeks. The carpet and bedding of the control group were treated with placebo and the bedding encased in cotton covers for 24 weeks. Dust samples were collected from all these items in a standard manner at regular intervals and Der p I content analysed. RESULTS: The group with active treatment had a median reduction of 480 ng (100%) in mite allergen from the mattress vs 215 ng (53%) reduction in placebo-treated group by 6 weeks. The Der p I content of the active group's bedding was always less than the placebo group after treatment (P < 0.01). The acaricide applied to the carpets or inside the mattress covers was ineffective in reducing allergen content. CONCLUSION: This study confirms the effectiveness of encasing covers in reducing the mite allergen exposure but indicates there is no further advantage in applying acaricide simultaneously.

Allergens↗

Fungal propagules in house dust. II. Relation with residential characteristics and respiratory symptoms.

As part of a case-control study on the relation between home dampness and respiratory symptoms of children, house-dust samples were collected from bedroom floors and mattresses in 60 homes in The Netherlands. The house-dust samples were analyzed for the presence of fungal propagules by plating 30 mg of dust directly onto DG18 agar. A checklist and questionnaire were used to obtain information on the home characteristics and occupant behavior that may have an effect on the presence of fungal propagules in house dust. The geometric mean (GM) numbers of colony-forming units (CFU)/g dust collected from the floors was 8990. The number of CFU/g dust was significantly higher in dust from carpeted floors than in dust from smooth floors (GM, respectively, 12,880 CFU/g dust and 3530 CFU/g dust). The GM number of CFU/g dust collected from mattresses was 6760. Overall, the mean numbers of CFU/g dust collected from floors and mattresses were higher in bedrooms where damp spots mold growth, or both were observed. However, these differences were not statistically significant. The relation between home characteristics and the number of CFU/g dust of the most frequently isolated mold species (n = 17), including Alternaria alternata, Cladosporium cladosporioides, Penicillium brevicompactum, and Scopulariopsis brevicaulis, was also investigated. Only the type of flooring had a significant and consistent effect on the number of CFU/g floor dust of the different mold species.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

House-dust mite allergen Der p 1: amount or concentration?

There is a lack of consensus as to the best way to quantify settled house-dust mite Der p 1 allergen from planar and nonplanar surfaces. To investigate the most appropriate measure of settled house-dust mite Der p 1 allergen, we determined the relationship between Der p 1 allergen content and collected dust weight from planar-surface (mattress) and nonplanar-surface (living-room) samples in 58 homes. There was a direct relationship between Der p 1 content and dust weight for both planar-surface (mattress, n = 217) samples (r = 0.50, P < 0.0001) and nonplanar-surface (living-room, n = 48) samples (r = 0.61, P < 0.0001). Correction for the surface area of the planar surface (mattress) vacuum-cleaned resulted in no additional benefit. We conclude that expression of Der p 1 levels per weight of collected dust appears to be the best method for both planar and nonplanar surfaces.

Allergens↗

Indoor environmental factors associated with house-dust-mite allergen (Der p 1) levels in south-eastern Australian houses.

BACKGROUND: Eighty households in the Latrobe Valley, Victoria, Australia, were sampled for house-dust-mite allergen (Der p 1). Allergen levels vary greatly between houses within climate regions. The reasons for this are not well understood. METHODS: House-dust-mite allergen samples were collected on six occasions between March 1994 and February 1995. All participating households contained at least one child between 7 and 14 years with a total of 148 subjects, 53 of whom were asthmatic. A detailed house survey was performed during every sampling visit, and a dwelling questionnaire was completed. Relative humidity was measured at the time of sample collection. RESULTS: The median bed allergen level was 30 microg/g during the first sampling period. Significantly higher allergen levels were associated with wool bedding and inner-spring mattresses (P < 0.001). As estimated from a multiple linear regression model, up to 70% reduction in bed allergen levels may be achieved by avoiding wool bedding and inner-spring mattresses. Other risk factors for high allergen levels included high indoor relative humidity, presence of substantial visible mould growth, brick cladding, and concrete slab foundation of the house. CONCLUSIONS: Avoiding wool bedding and replacing inner-spring mattresses with foam could substantially reduce bed allergen levels.

Adolescent↗