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At least 811 records · Page 45Linked to original sources
PubMed1992

[Proposal for the nosocomial infection control of methicillin-resistant Staphylococcus aureus (MRSA)].

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in hospital environments, quantitative isolation of MRSA from environmental and human specimens was performed. It was found that as many as 6 x 10(4) colony forming units (CFU)/100cm2 of MRSA and also methicillin-resistant coagulase-negative Staphylococcus (MRCNS) were isolated from 1) 25-100% of the bed-mattresses tested in 10 out of 11 (90%) hospitals, and also 2) bed sheets for patients, floors of patient wards, laundry, bath-room, toilet and laundry storage-room. And seven and eight palms of 20 patients were contaminated with MRCNS and MRSA, respectively, and MRCNS contamination was revealed in six of medical staffs. These results indicate that hospital environments, especially the mattresses and hospital floors are highly contaminated with MRCNS and MRSA, and sanitation and cleanliness of mattresses and floors are necessary to prevent the dissemination of both MRCNS and MRSA in hospital.

Cross Infection↗
PubMedDate not supplied

Dynamic thermal responses of five commercially available infant radiant warmer systems.

Five commercially available infant radiant warmer systems were characterized through radiant-energy measurements at the mattress surface under identical environmental conditions. Average irradiance levels for each warmer were then calculated. In addition, all systems were thermally evaluated for warm-up time using the International IEC standard black anodized aluminum disk simulator. Warm-up time and radiant-energy bed mapping tests were conducted in manual mode. To assess thermal performance under dynamic conditions, skin and core temperatures were measured using a patient simulator test-load device. Dynamic patient simulator response-time data and side-wall temperature data are provided. The radiative heat contribution from the warmer side walls on patient simulator core and skin temperatures was demonstrated. Extreme differences in warmer performances and energy to the mattress surface are documented. Differences in infant radiant warmer performances are principally due to heater-element composition, reflector design, and heater-to-mattress distance.

Analog-Digital Conversion↗
PubMed2001

Backside first in head and neck surgery?: preventing pressure ulcers in extended length surgeries

BACKGROUND: The operating room (OR) presents a high-risk environment for pressure injury. We designed a project to improve performance in the prevention of intraoperative pressure ulcers in extended length head and neck surgeries for malignancies (ELS) using a fluid mattress (RIK(R)) intraoperatively. METHODS: A descriptive design was used to monitor performance improvement in this underrecognized aspect of patient care. A fluid, pressure-reducing OR mattress (RIK) was compared with the use of a standard foam OR mattress (Skytron(R)). A convenience group of 36 consecutive patients, undergoing ELS, was included in the project. Patients were evaluated for presence or absence of a pressure ulcer immediately and 72 hours postoperatively. RESULTS: Patient groups were demographically and surgically comparable at a clinical level. Pressure ulcer incidence before intervention was 21% (4 of 19). This declined to 0% after intervention. CONCLUSIONS: Intraoperative pressure ulcers are a costly complication. Presence of a pressure ulcer extends time in the sick role and disrupts desired aesthetic outcomes. Use of a pressure-reducing device achieved the performance improvement objective. Implications for future research and current care are discussed. Copyright 2000 John Wiley & Sons, Inc. Head Neck 23: 25-28, 2001.

Journal Article↗
PubMed2001

Backside first in head and neck surgery?: preventing pressure ulcers in extended length surgeries.

BACKGROUND: The operating room (OR) presents a high-risk environment for pressure injury. We designed a project to improve performance in the prevention of intraoperative pressure ulcers in extended length head and neck surgeries for malignancies (ELS) using a fluid mattress (RIK) intraoperatively. METHODS: A descriptive design was used to monitor performance improvement in this underrecognized aspect of patient care. A fluid, pressure-reducing OR mattress (RIK) was compared with the use of a standard foam OR mattress (Skytron). A convenience group of 36 consecutive patients, undergoing ELS, was included in the project. Patients were evaluated for presence or absence of a pressure ulcer immediately and 72 hours postoperatively. RESULTS: Patient groups were demographically and surgically comparable at a clinical level. Pressure ulcer incidence before intervention was 21% (4 of 19). This declined to 0% after intervention. CONCLUSIONS: Intraoperative pressure ulcers are a costly complication. Presence of a pressure ulcer extends time in the sick role and disrupts desired aesthetic outcomes. Use of a pressure-reducing device achieved the performance improvement objective. Implications for future research and current care are discussed.

Aged↗
PubMed2000

Household distribution of house dust mite in central Taiwan.

House dust mite (HDM) is a common inhalant allergen which can precipitate atopic disease episodes including asthma and allergic rhinitis. However, the relationship between HDM and asthma in subtropical regions of Asia, which may be affected by differences in climate and environmental variables, has not been widely studied. To assess this relation in the subtropical region of central Taiwan, we collected HDM samples from the houses of eight asthmatic patients as well as four normal subjects over a 1-year period. HDMs were collected by vacuum from the following four areas: living room floor, sofa, the top surface of child's mattress and bedroom floor. The mite concentrations, site distribution, seasonal variation, individual species and correlation with asthmatic attacks were studied. The HDM concentration had a seasonal variation, with the highest concentrations noted from July to November with gradually decrease from December to June. Among the four areas of collection, the highest concentration of mites was found on the child's mattress (p < 0.05). Dermatophagoides pteronyssinus was the dominant species (77%) and Dermatophagoides farinae was the second (13%). Our data showed that: 1. The highest concentrations of HDM occurred during the period from July to November. 2. The child's mattress was the household region with the highest percentage of HDM and thus should be considered of great concern as a likely source of the exacerbation of asthma. 3. D. pteronyssinus was the dominant species.

Animals↗
PubMed2001

Otoplasty.

When multiple techniques are described to address a single condition, it is axiomatic that no single technique is ideal. Using mattress sutures to create an antihelical fold when one is absent provides benefits that outweigh the risks of this technique. It is a technique that can be learned quickly and mastered with experience. Goode's successful revision otoplasties with mattress sutures suggest that excessively springy ears are not the reason for failure. His results suggest that technical errors may be responsible for the lack of success at the initial procedure. No technique is without complications or limitations, and this technique is no exception. Conservative resection of the concha just medial to the lateral edge with reapproximation to the cauda helicis offers a quick, reliable approach to prominent conchal bowls. Prominence of the lobule was not described in detail. The lobule should, of course, be corrected if it contributes to the ear deformity. Chosen operative techniques should be adaptable to various deformities, and it is preferable, therefore, that the surgeon is comfortable with multiple techniques. The first step in this level of comfort is to acquire a detailed knowledge of ear anatomy. Only by having a firm grasp of the normal can the abnormal be understood precisely. Although a sound technical platform is required to achieve superior results, excellence is achieved only by a thorough, detailed preoperative analysis. A combination of mattress sutures to address the antihelix and lateral resection of the conchal bowl produces excellent results in most cases. Applying a rote technique to all deformities, however, is ineffective and will compromise results. Superior outcomes can be attained only with command of a combination of acute diagnostic skills, knowledge of various surgical techniques, and the ability to execute those techniques.

Adolescent↗
PubMed2002

House dust mite allergen levels in individual bedding components in New Zealand.

AIMS: House dust mite allergen (Der p 1) levels are high in New Zealand and bedding Der p 1 levels have been shown to be associated with the clinical severity of asthma. The aim of this study was to measure Der p 1 levels in synthetic and feather duvets and other individual bedding items, and to examine factors affecting these levels. METHODS: Reservoir dust samples were collected and analysed for Der p 1 content by ELISA from 65 duvets, 81 pillows, and 65 mattresses of 34 children and 31 adults in 34 households. RESULTS: Der p 1 geometric mean levels (95% confidence interval) were: 13.4 microg/g (9.5-18.9) in pillows; 29.4 microg/g (19.8-43.5) in duvets; and 53.8 microg/g (39.4-73.4) in mattresses. Synthetic pillows and duvets yielded significantly more Der p 1 than feather pillows and duvets (about 7-fold and 15-fold respectively). The presence of under-bedding resulted in significantly higher pillow and duvet Der p 1 levels. Mattresses >10 years old had significantly higher Der p 1 levels. CONCLUSIONS: Synthetic pillows and duvets contain higher levels of Der p 1 than feather pillows and duvets. Advise for house dust mite sensitized individuals to use synthetic bedding does not prevent house dust mite allergen exposure.

Allergens↗
PubMed2002

Infant bed-sharing among Pacific families in New Zealand.

AIM: To describe infant bed-sharing among Pacific families in New Zealand. METHODS: The data were gathered as part of the Pacific Island Families: First Two Years of Life (PIF) Study in which 1376 mothers were interviewed when their infants were six-weeks-old. Maternal reports of infant bed-sharing practices were assessed by questions about infant sleep location and the number of people who usually shared a mattress with the infant. RESULTS: Over half of the mothers (54.9%) reported that their infants shared a mattress with other people, 44.2% sharing with one other person, the remainder sharing with two or more people. Of the bed-sharing infants, 4.7% slept on a mattress on top of the bed, and 4.7% only slept part of the night in the shared bed. CONCLUSIONS: Together with effective information delivery, the educational and housing issues that many Pacific families in New Zealand face need to be addressed so that parents can make informed decisions about infant care practices.

Adult↗
PubMed1990

Comparison of temperatures at different sites in term and pre-term neonates.

Temperatures of 30 term and 20 preterm neonates were recorded by mercury-in-glass thermometer at 4 measurement sites; rectum (2 cm beyond anus), external auditory canal, axilla and between skin and mattress. Whereas, the mean rectal and aural temperatures in term infants were significantly higher than their preterm counterparts (p less than 0.01), axillary and skin mattress temperatures did not differ significantly in the two groups. The variation between stabilized temperature at four measurement sites was less marked in preterm as compared to term infants. The skin mattress temperature measurement is a simpler technique and it closely approximates the rectal temperature in preterm infants. Temperatures at all the measurement sites stabilized by 5 minutes both in term and preterm infants.

Body Temperature↗
PubMed1988

Pressure relief capabilities of the Sof.Care bed and the Clinitron bed.

The number of support surfaces marketed as pressure relieving devices has escalated during recent years and objective measures are needed to evaluate those that are effective. The purpose of this study was to compare the pressure relief capabilities of a special three-layered plastic air mattress (Sof.Care Bed Cushion--Gaymar), an air-fluidized bed (Clinitron--Support Systems International) and a standard hospital mattress. Sixty-four volunteers served as their own control as they were rotated onto the three sleep surfaces. Tissue interface pressure measurements were taken over bony prominences where pressure ulcers are most likely to occur: the sacrum, the greater trochanter of the femur and the heels. A one-way analysis of variance was computed for interface measurement scores by type of surface and a statistically significant difference was found among the three surfaces. A Newman-Keuls test was employed to compare the mean scores between two groups at a time. Both the Sof.Care Cushion and the Clinitron Bed differed significantly from the hospital mattress in the ability to relieve pressure. There was no statistical difference between the Sof.Care Cushion and the Clinitron Bed in the ability to relieve pressure over the sacrum, trochanter, or heels. However tissue pressure readings under the heels were greater than 32 mm Hg on both the Clinitron and Sof.Care surfaces. The data from this study, by looking at a larger sample supports our prior findings.

Adult↗
PubMed1984

Evaluation of suture techniques for mitral valve replacement.

Although periprosthetic leak is presently uncommon after mitral valve replacement, suture line disruption still occurs and may be significant in some patients. Suture technique is obviously an important factor in preventing disruption, but few authors have examined this variable. The purpose of this study was to determine which of four suture methods for mitral valve replacement maximized prosthetic stability in the mitral anulus. Horizontal mattress sutures with subannular pledgets, horizontal mattress sutures with supra-annular pledgets, figure-of-eight sutures, and interrupted simple sutures were compared. A Carpentier-Edwards sewing ring was sutured to the mitral anulus of intact canine left ventricles, each technique randomly assigned to eight hearts. Suture size, number of bites, and annular depth were maintained constant in all groups. Progressively increasing force was applied across the suture line until disruption occurred. The yield force at initial suture disruption was measured by a semiconductor strain-gauge transducer and defined the experimental end point. Subannular pledget-supported sutures required the greatest force (38.4 +/- 0.8 N) to produce prosthetic dehiscence and were significantly more secure than supra-annular pledgets (32.7 +/- 0.5 N). The two suture techniques in which pledgets were used were better than the nonsupported sutures, the mean yield force averaging 28.3 +/- 0.3 N for figure-of-eight and 21.3 +/- 0.7 N for interrupted simple sutures. Although clinical techniques may vary with prosthetic valve design, surgical preference, or pathological anatomy, this study suggests that horizontal mattress sutures with subannular pledgets provide the best prosthetic valve stability during mitral valve replacement.

Animals↗
PubMed1995

Accuracy and precision of neonatal electronic incubator scales.

Measurement of weight in the neonatal intensive care unit demands accuracy and precision. To date, however, no studies exist that independently document the accuracy of infant incubator bed scales. The purpose of this study is to evaluate the Airshields-Vickers Warm Weigh internally mounted incubator bed scale with foam and water mattresses using 500 gm and 1,500 gm standard weights to ascertain the precision of electronic bed scales and to evaluate the differences between nurse weighers. Two experienced neonatal nurses evaluated new incubator bed scales. Each nurse independently collected data and kept the results masked. Eight measurements were obtained from each incubator. Results indicated error beyond +/- 2 gm at 500 gm with the foam mattress and in both weight groups with the water mattress using the Technical Error Measurement (TEM) method. This indicates that the bed scales did not perform within the manufacturer's rated accuracy of +/- 2 gm at the smallest weights found in the clinical area. Weight errors were not judged to be clinically significant by a group of NNP experts.

Anthropometry↗
PubMed1993

Determining the right mix of support surfaces to minimize hospital acquired pressure ulcers.

In acute care settings, one variable in the incidence of hospital acquired pressure ulcers is support surfaces. Following a major change in the use of support surfaces, a retrospective study was conducted at a major university teaching hospital over a 12 month period. The study sample was based on ET Nurse referrals for skin and wound management and as such did not reflect hospital census or acuity. The purpose of the study was to examine the effect of the introduction of hospital replacement mattresses and the decreased use of 2-inch convoluted foam overlays and static air overlays, on the incidence of hospital acquired pressure ulcers. Initially, hospital replacement mattresses were implemented in the hope of eliminating overlays. Yet this study experience demonstrated a significant correlation between the decreased number of static air overlays used and an increased number of hospital acquired pressure ulcers during the first two months following introduction of hospital replacement mattresses. After reintroduction of static air overlays, the incidence in our study returned to baseline. The key is the right mix of products to minimize hospital acquired pressure ulcers and concomitantly minimize associated costs.

Beds↗
PubMedDate not supplied

Interface pressure measurements of support surfaces with subjects in the supine and 45-degree Fowler positions.

In the past 20 years there has been a dramatic increase in different types of support surfaces to reduce the incidence of pressure ulcers. The purpose of this study was to determine the effect of static air overlays (Sof-Care and Tendercloud), replacement mattresses (Dermarest and Therarest), and a standard hospital mattress on tissue interface pressures in healthy subjects. A convenience sample of 25 subjects had tissue interface measurements obtained under the sacrum and heel bony prominences on the five support surfaces in the supine and 45-degree Fowler's positions. A repeated measures analysis of variance (p < 0.05) indicated that the Dermarest, Therarest, Sof-Care, and Tendercloud support surfaces reduced pressure significantly under the sacral bony prominence compared with the standard hospital mattress. Heel interface pressure measurements were significantly higher than sacral interface pressure measurements. There was no significant difference between supine and 45-degree Fowler's positions with respect to tissue interface pressures.

Adult↗
PubMed1996

The respiratory effects of reduction of mite allergen in the bedrooms of asthmatic children--a double-blind controlled trial.

BACKGROUND: Inhalation of house dust mite (HDM) allergen may provoke attacks of asthma. OBJECTIVE: We investigated whether a double-blind placebo-controlled community-based study aimed at reducing the HDM allergens in the bedrooms of HDM sensitive asthmatic children using the best methods available would prove beneficial to the children's health. METHODS: The children (mean age 9.9 years, 34 boys) were recruited by a questionnaire submitted to 7386 families in a geographically-defined area of the UK. Subjects were chosen to take part in the double-blind placebo-controlled trial if they were asthmatic, skin sensitive to mites, and had mite allergen in their mattresses. Seventy children were randomly allocated to groups. In the active group, the children's bedrooms were treated with an acaricide (Acarosan) and the mattresses, pillows and duvets were encased in exclusion covers. The control group received placebo treatments. RESULTS: Forty-nine complete data sets were obtained. Applying bedding covers and Acarosan led to a median reduction of 480 ng (100%) in mite allergen on the mattress vs 215 ng (53%) reduction in placebo-treated group by 6 weeks. No evidence was found that the acaricide reduced mite allergen level. A change in bronchial reactivity to histamine was observed in the children after 6 weeks. This was not associated with any change in thrice-daily records of peak expiratory flow rate. By 24 weeks, the actively-treated children had improved forced expiratory volume in 1s (FEV1) and fewer required bronchodilator therapy or reported asthmatic symptoms than did the controls. CONCLUSIONS: The results suggest that mite removal procedures may modestly improve mite-sensitive asthmatics and could perhaps be of value in exceptionally mite-sensitive and/or highly mite-exposed individuals whose response to the attempted removal should be measured.

Allergens↗
PubMed1997

[Effect of vacuum cleaning of room floors and bed clothes of patients on house dust mites counts and clinical scores of atopic dermatitis. A double blind control trial].

By a randomized double blind control trial we studied the effect of vacuum cleaning of room floors, mattresses and quilts for twelve months on clinical symptoms and laboratory data of atopic dermatitis patients. All patients used the identical new vacuum cleaners. Thirty patients (3-12 years of age) with relatively stable skin conditions were randomly allocated to either of the following two groups. In the monitor group we visited patient's home every three weeks and mite specialists cleaned drastically the room floors, mattresses and quilts and the patient continued to clean in the same way in-between. In the control group we visited similarly but the cleaning was made insufficiently which was also followed by the patient. But, at 2 occasions (the first and the last visits), cleaning was made drastically also in the control group. Thus the mite numbers were counted precisely at the start and the end of the experiment both in the monitor and control groups. Each patient was seen every six weeks by the same doctor and estimated of his symptoms using our unique scoring system (Fig. 1). At the start and the end of the study, total IgE and specific IgE antibodies to house dust mites in the serum were evaluated. The monitor group showed a tendency to count smaller number of mites than the control group after a year, when there was a significant difference only in quilts. However, a statistically significant decrease in the mite counts was observed only in room floors and not in mattresses and quilts both in the monitor and control groups (Fig. 2). Clinical scores after a year significantly improved only in the monitor group and not in the control group (Fig. 3). Serum IgE value and specific antibody titer to house dust mites were not changed significantly after the trial in both groups. As a conclusion, vacuum cleaning of the patient's room improved the clinical symptoms of atopic dermatitis but this could not be related to the reduction of house dust mite number.

Animals↗
PubMedDate not supplied

Bending of the upper lateral cartilages for nasal valve collapse.

BACKGROUND: As a consequence of removal of the nasal hump, the upper lateral cartilages are separated from the septal cartilage in reductive rhinoplasty. A decrease in the nasal airway cross-sectional area and collapse of the internal nasal valve (INV) are inevitable unless additional surgical measures are taken. OBJECTIVE: To determine the efficacy of the horizontal mattress bending suture in treating patients with nasal valve collapse. METHODS: Each upper lateral cartilage was separately bent to a certain degree with a horizontal mattress suture following nasal dorsum reduction in the external septorhinoplasty as a preventive or corrective measure for the INV stenosis. The efficacy of this suture was assessed in 28 patients who presented with tension nose by comparing the INV angles preoperatively and 12 months postoperatively, as determined photographically by means of a rigid nasal endoscope. RESULTS: The mean +/- SD preoperative INV angle was calculated as 9.1 degrees +/- 4.2 degrees (range, 0 degrees -18.3 degrees ). The mean postoperative INV angle was increased to 25.3 degrees +/- 3.8 degrees (range, 18.4 degrees -34.5 degrees ) (P<.001). CONCLUSIONS: This method reconstitutes the normal anatomy of the INV, reestablishes stiffness or resistance of the nasal side walls so that they do not bend inwardly with inspiration, improves the airflow at this area, and avoids postoperative nasal valve stenosis in functional-cosmetic rhinoplasty cases that require considerable nasal hump reduction.

Adolescent↗