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At least 937 records · Page 52Linked to original sources

PubMed1995

Forced-air warming maintains normothermia during orthotopic liver transplantation.

We evaluated the efficacy of forced-air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating-water mattress set at 42 degrees C, intravenous fluid warming to 37 degrees C and passive insulation) or routine management with additional forced-air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. Morphometric and demographic characteristics were similar in each group, as was total administered fluid volume replacement. Core temperatures in each group decreased by about 0.6 degrees C during the first 70 min of anaesthesia and then by 0.9 degree C within 90 to 120 min in the patients given routine thermal management, but only by 0.4 degree C in those warmed with forced-air. Subsequently, core temperatures in the control group increased to only 35.7, SD 0.25 degree C whereas those in the patients given forced-air warming increased to 36.5, SD 0.2 degree C. Despite the relatively high ambient temperature, patients warmed only with a circulating-water mattress and passive insulation became hypothermic during surgery. In contrast, when forced-air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced-air warming prevented intra-operative hypothermia during liver transplantation.

Body Temperature↗

PubMed1996

The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers.

Twenty healthy volunteers were placed in four different surgical prone positions: on pillows, on an evacuatable mattress, on pelvic props and in the knee-chest position. The normal supine position was used as a control for the measurement of cardiovascular parameters. Mean arterial pressure was measured by automated oscillotonometry. Transthoracic electrical bioimpedance was used to measure cardiac output and heart rate. Cardiac index and total vascular resistance index were derived from these data. No significant changes in heart rate or mean arterial pressure occurred when the volunteers were moved from the supine position to any of the four prone positions or when returned to the supine position again. Cardiac index decreased significantly on going from the supine to the knee-chest position (20%) and onto the props (17%) but not onto the evacuatable mattress (11%) or the pillows (3%).

Adult↗

PubMed1989

Atopic dermatitis and house dust mites.

The occurrence of house dust mites (Dermatophagoides spp) was investigated in the homes of 26 patients with atopic dermatitis (AD), 20 patients with psoriasis and 41 randomly selected homes in Arhus, Denmark. The AD patients with moderate to severe eczema had an increased concentration of mites (median 85 mites/0.1 g mattress dust) compared with the controls (median 8 mites/0.1 g mattress dust). The higher exposure to house dust mites corresponded to a relative risk of 4.6 and a clear dose-response relationship between exposure and disease could be demonstrated. Our results illustrate a clear association between moderate to severe atopic dermatitis and increased exposure to house dust mites in the patients' homes, and support the hypothesis that mite antigens could be an aetiological factor in atopic dermatitis.

Adolescent↗

PubMedDate not supplied

A study of normal baby movements.

Twenty-five normal newborns aged between 3 and 6 days had their movements recorded by clinical observation in a controlled environment, chart recording from an automatic movement mattress over 4 hours, and cine photography triggered by the movement mattress. Over 80 different individual types of movement were grouped into six categories: progression movements (obligatory reciprocal movements), symmetrical movements (slower flexion or extension movements), startle movements, asymmetrical tonic neck reflex and 'Moro', facial movements and athetoid movements. The normal newborn's motor activity is significantly related to the level of arousal, gestational age, and environmental variables such as position, temperature, light and noise.

Arousal↗

PubMed1986

Use of liquid nitrogen in the control of house dust mite populations.

Laboratory and field studies on the use of liquid nitrogen as an acaricide, combined with vacuum cleaning, demonstrated this inert freezing agent to be extremely efficient in reducing the number of live mites in mattresses when compared to vacuum cleaning only. Preliminary observations suggest this treatment does no physical damage to mattresses. Any strategy in the control of house dust mites should incorporate procedures both for the reduction of the mite population and the removal of the allergen pool of faecal pellets and dead mites.

Beds↗

PubMed1990

Ecology of house dust mites in Oxfordshire.

In a survey of the mite fauna in 30 homes in Oxfordshire, Dermatophagoides pteronyssinus and Euroglyphus maynei were found to be the most abundant species but D. farinae was absent. Of a total of 14 parameters investigated for their influence on mite numbers, relative humidity was apparently the most important factor. Bedrooms with humidities above 64% contained significantly more mites in mattresses than those with lower humidities. Bedroom humidity and thus mattress mite numbers were apparently related and were influenced by the bedroom minimum temperature, the age of the house and the use of central heating. These trends were not seen in the numbers of mites found in living-room carpets. Atopic and non-atopic participants involved in this study did not differ significantly in the numbers of mites found in their homes.

Allergens↗

PubMed1992

Comparative efficacy of house dust mite extermination products.

The acaricidal efficacy of nine marketed products, i.e. Acardust, Acarosan (foam and powder), Actelic 50, Artilin 3A (spirit and water base), liquid nitrogen, Paragerm AK, and Tymasil, and of intensive vacuum-cleaning have been compared on four different test surfaces: mattress, tufted carpet, gypsum board and rough wooden board, all covered with artificial house dust. They were inoculated with the house dust mite, Dermatophagoides pteronyssinus or the house-dust fungus Aspergillus repens for evaluation of the fungistatic claims of some products. The acaricidal activity of Tymasil did not surpass that of vacuuming; its fungistatic effect was not apparent. The other products showed complete to almost complete eradication on at least one of the substrates tested. Taking into account the results of acaricidal efficacy as well as the data on safety and practicality acquired earlier, Acarosan powder was considered first choice for carpet treatment. Acarosan and liquid nitrogen, were found to be effective in the treatment of mattress, pillow, upholstered furniture and heavy curtains. On wooden surfaces Acarosan was found to be both effective and safe, while Acardust, Actelic 50, Artilin 3A (both fungistatic as well as acaricidal), liquid nitrogen and Paragerm also passed the efficiency test.

Animals↗

PubMed1993

Mite fauna, Der p I, Der f I and Blomia tropicalis allergen levels in a tropical environment.

Fifty dust samples were collected from the mattresses and bedroom floors of 25 subjects with allergic asthma in Cartagena, Colombia, in order to identify house dust mites and quantitate Der p I, Der f I and Blomia tropicalis allergens. The geometric mean of the total mite density per gram of dust was 418 (range, 40-2280). Twenty-two samples (44%) had more than 500 mites and four, less than 100. B. tropicalis and Dermatophagoides pteronyssinus were found in 96% and 90% of the samples, accounting for 40.1% and 35.7% of the total mites, respectively. Cheyletus malaccensis, Chortoglyphus arcuatus, Pyroglyphus africanus, Oribatids, Grallacheles bakeri, Tarsonemus spp., Suidasia spp., Dermatophagoides farinae and unidentified mites accounted for the rest. The geometric mean of the total mites/gram of dust in mattresses (563.9) was significantly higher than in floor dust (309.1), P < 0.01. Allergen concentrations and mite numbers were analysed by Spearman rank correlations: B. tropicalis mites vs B. tropicalis allergen, r = 0.54, P < 0.001; D. pteronyssinus mites vs Der p I, r = 0.52, P < 0.001. A negative correlation was obtained between B. tropicalis mites and Der p I. Allergens derived from B. tropicalis and other domestic mite species may play an important role in sensitization and allergic symptoms in Cartagena, Colombia.

Allergens↗

PubMed1994

Reduced mite allergen levels in dwellings with mechanical exhaust and supply ventilation.

Seventy similar bungalows constructed between 1968 and 1970 in the same suburban area of Stockholm were investigated regarding the content of house dust mite allergen, absolute indoor humidity, type of ventilation and basement construction. Houses with mechanical exhaust and supply ventilation had an indoor humidity above 7 g/kg less often than houses without this type of ventilation (Odds ratio 0.1, 95% confidence interval 0.0-0.2). Furthermore, only five of the 24 houses with exhaust and supply ventilation contained mattress dust mite allergen concentrations exceeding the median value (98.5 ng/g) compared with 30 of 46 hours which did not have such ventilation (odds ratio = 0.1, C.I. 0.0-0.5). Houses with both natural ventilation and crawl space basement harboured significantly less mattress mite allergen than houses having the same type of ventilation, but with a concrete slab basement. In a cold temperature climate, type of building construction and ventilation seem to be important for the occurrence of house dust mite allergens in dwellings. Our results indicate that modern energy-efficient houses should be equipped with mechanical exhaust and supply ventilation to reduce indoor air humidity during the dry winter months and the risk of mite infestation.

Air Pollution, Indoor↗

PubMed1994

House dust mite allergen (Der p I) and respiratory symptoms in children: a case-control study.

The association between house dust mite allergen in house dust and childhood respiratory symptoms was investigated in a case-control study of 259 children with reported chronic respiratory symptoms and 257 control children without reported respiratory symptoms. The Der p I concentration in floor dust of the living room and bedroom and in mattress dust was determined using an enzyme immunoassay. Venous blood samples were taken from all children for serum IgE determination against house dust mite (Dermatophagoides pteronyssinus) by radioallergosorbent assay (RAST). A questionnaire was administered to the parents of the children to elicit information about the home, about changes made to the home in the past in relation to respiratory symptoms, and about a number of risk factors for childhood respiratory disease. In 83% of the dwellings of cases and 89% of those of controls, Der p I concentrations higher than 2000 ng/g were found, and in 54% of the dwellings of cases and 57% of those of controls, the concentrations exceeded 10,000 ng/g dust. In a crude analysis, cases were generally exposed to lower Der p I concentrations than controls. Restriction of the analysis to cases sensitized to dust mites, and non-sensitized controls, taking the type of floor covering into account, showed not significantly higher Der p I concentrations in bedroom floor dust of cases. However, restriction of the analysis to cases sensitized to dust mites and cases not sensitized to house dust mites--adjusting for allergen avoidance measures taken in the past--revealed a positive association between the Der p I concentrations in bedroom floor dust and mattress dust and sensitization.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗

PubMed1995

House dust mite allergen levels in two cities in Canada: effects of season, humidity, city and home characteristics.

The homes of 120 patients with asthma, 57 in Vancouver and 63 in Winnipeg, were studied. The characteristics of the homes were assessed by a questionnaire. Dust samples were collected and the indoor relative humidity was measured four times during the year covering all four seasons in both cities. Mite allergen levels were determined using monoclonal antibodies against Der p I and Der f I by the ELISA method. The mean levels of both mite allergens in mattress and floor samples in the homes in Vancouver and in Winnipeg were relatively low for all seasons. Mite allergen levels were found to be associated with city, season and individual home differences. They were significantly higher in Vancouver than in Winnipeg. Der p I and Der f I in mattress samples in both cities and Der f I in floor samples in Vancouver, varied by season. The indoor relative humidity level in the homes in Vancouver were also significantly higher than those in Winnipeg. There was, however, no significant association between the levels of indoor relative humidity and the levels of mite allergens after adjusting for variations in city, season and individual home. Although individual home differences were highly associated with mite allergen levels, only a few home characteristics were found to be related to mite allergen levels such as the type and the age of the home, the type of heating, the use of feather pillows and the number of occupants in the homes. Whether low levels of mite allergens are partially responsible for the relatively low prevalence of childhood asthma in Canada remains to be investigated.

Allergens↗

PubMed2003

A randomized controlled trial of mite allergen-impermeable bed covers in adult mite-sensitized asthmatics.

BACKGROUND: Mite-allergic patients with allergic disease should benefit from avoiding mite allergens. Many physicians, however, are yet to be convinced that allergen avoidance can make a significant contribution to asthma management in these patients. Many allergen-avoidance regimes include multiple measures of allergen reduction, but as mite exposure in the home is most likely to be greatest in bed dust, bedding is usually the first target for intervention. OBJECTIVE: This study selected adult patients considered to be most likely to benefit from avoiding mite allergens, namely diagnosed asthmatics, sensitized to house dust mites and exposed to mite allergen in their mattresses. Patients were randomized into a placebo-controlled trial of the use of allergen-impermeable bed covers for 12 months, without any other form of mite-reduction measures. METHODS: Adults with asthma were selected from general practices and asthma clinics in south-east London. Their serum IgE to mite allergens and allergen content of mattress dust samples were measured. Those with >0.70 kU/L mite-specific IgE and >2 microg/g Der p 1 were randomized into active or placebo treatments. Information was collected on allergic symptoms and medication use and quarterly peak flow diaries were kept throughout the trial. Dog or cat allergic patients were excluded if they had a pet at home to which they were sensitized. RESULTS: The mean decrease in microg/g Der p 1 was 25.7 (95% CI 8.9, 74.1) in the active group and 4.5 (95% CI 1.8, 11.5) in the placebo group. Der p 1 concentrations in the active and placebo groups at the end of the trial were not significantly different. There was no effect on peak flow or asthma symptoms in a simple comparison of the treatment and placebo groups. CONCLUSION: In this group of patients, mite allergen avoidance in the bed by the use of allergen-impermeable bedding alone cannot be recommended as an effective way of relieving asthma symptoms.

Adolescent↗

PubMed2003

Repeated measurements of allergens and endotoxin in settled house dust over a time period of 6 years.

BACKGROUND: Studies investigating the effect of exposure to indoor allergens and endotoxin on human respiratory health usually take dust samples only at one single point of time and consider them to be representative for the indoor biocontaminant burden during a time period of several years. This singly measured biocontaminant concentration is related to adverse respiratory outcomes such as asthma, wheeze or others. OBJECTIVE: We analysed two repeated measurements of mite and cat allergens in mattress and living room floor dust as well as endotoxin concentrations in living room floor dust. The repeated samples were taken over a time period of about 6 years. We investigated the repeatability over time of their concentrations by determining correlation coefficients and computing within- and between-home variance components. METHODS: Our analysis was based on the population of a study on Indoor Factors and Genetics in Asthma (INGA) being carried out in 1995/96 and followed up in 2000/01. Complete data were available from 152 participants. RESULTS: The measured allergen concentrations were low and a considerable percentage of the values was below the limit of detection. The crude Spearman's rank correlation coefficients between the two measurements taken in 1995/96 and 2000/01 ranged from 0.32 to 0.61 for the dust mites allergens, from 0.21 to 0.44 for cat allergen and from 0.35 to 0.51 for endotoxin. Correlations were higher if measurements were performed on the same floor or the same mattress at both sampling time-points. The within-home variance for all measured biocontaminant concentrations was of about the same order as the between-home variance. CONCLUSION: For studies like ours with low allergen and endotoxin concentrations, the repeatability of these concentrations over a time period as long as 6 years is low and a single measurement does not accurately reflect the true long-term exposure in the homes.

Allergens↗

PubMed2003

Measurement of Dermatophagoides mite allergens on bedding and human skin surfaces.

BACKGROUND: The level of the Dermatophagoides mite group 1 (Der 1) allergens in reservoir dust has been used as an index of exposure in most studies. However, the mite allergen level in reservoir dust cannot directly reflect the personal exposure level. OBJECTIVE: We sought to develop a new method for quantifying the Der 1 allergens on bedding and human skin surfaces as an index of exposure to mite allergens. METHODS: Samples were obtained with a small adhesive tape from the forearm skin of 30 healthy volunteers and from their regularly used mattresses. The level of Der 1 allergens collected onto the adhesive tape was measured by a newly developed sensitive fluorometric ELISA for Der p 1 and Der f 1. RESULTS: The Der 1 allergens could be detected in all the samples from bedding surfaces and in 28 of the 30 samples from skin surfaces. The Der 1 levels by adhesive tape sampling from the mattresses correlated with those by reservoir dust sampling. The sampling of the skin and bedding surface with adhesive tape correlated, but skin sampling did not correlate with reservoir sampling. CONCLUSION: The Der 1 allergens on bedding surfaces and on human skin surfaces could be quantified with a very simple sampling technique. The system developed in this study will provide a new tool for the assessment of mite allergen exposure in daily life.

Adolescent↗

PubMed2004

Compliance of asthmatic families with a primary prevention programme of asthma and effectiveness of measures to reduce inhalant allergens--a randomized trial.

BACKGROUND: Compliance to and the effect of pre- and post-natal exposure reduction measures to prevent asthma in high-risk children from asthmatic families were studied. METHOD: Families were randomized to a special care group (n=222) and a control group (n=221). Educational advice on measures to reduce their newborn's exposure to allergens and smoke was provided to the special care group during three visits (two pre-natal and one post-natal). The control group (n=221) received usual care. RESULT: After the intervention, the special care group differed significantly (P<0.01) from the usual care group in: use of anti-mite encasings (parental: 88% vs. 14%; baby: 98% vs. 10%); keeping pets outside (51% vs. 19%); combined breast- and hypoallergenic formula feeding (55% vs. 22%); first solids postponement until after the sixth month (71% vs. 28%); maternal post-natal smoking (52% vs. 28%). Little or no compliance was found for other sanitary measures (cleaning habits, providing a smooth floor covering, ventilation/airing, pet removal), exclusive breastfeeding, pre-natal smoking and partner smoking. In spite of pre-existent low allergen levels in both groups, there was a significant reduction of mite, cat, and dog allergens on the mattresses and mite and cat allergens in the living room in the special care group and were significantly lower compared with the usual care group after 1 year. CONCLUSION: High compliance was found for the use of anti-mite encasings; substantial compliance for using hypoallergenic formula, solid food postponement, keeping pets outside and reported post-natal maternal smoking. There was no compliance for sanitary measures and the reduction of maternal pre-natal passive smoking. Mite and pet allergens on mattresses were strongly reduced by anti-mite encasings.

Air Pollutants↗

PubMed2005

Reliability of pressure ulcer classification and diagnosis.

AIM: To assess the inter-rater reliability of the PRESSURE Trial pressure ulcer diagnosis (>/=Grade 2) and skin classification for all grades between the clinical research nurse (CRN) team leader and CRNs working across different hospital sites; and CRNs and ward-based nurses. BACKGROUND: The United Kingdom National Health Service Health Technology Assessment Programme has funded a multi-centre, randomized controlled trial to compare the clinical and cost-effectiveness of alternating pressure mattress overlays and mattress replacements - PRESSURE Trial. Outcome skin assessments were recorded by qualified ward-based nurses daily, and expert CRNs twice weekly. METHOD: Paired assessments were undertaken and skin assessed on seven body sites. The per cent agreement between nurses in the diagnosis of a pressure ulcer was determined and the Kappa statistic and confidence intervals calculated. Per cent agreement between nurses in classifying skin for all grades was also determined. RESULTS: Assessments were undertaken by 378 pairs: 16 paired patient assessments (107 site comparisons) by the CRN team leader and CRNs, and 362 paired patient assessments (2396 site comparisons) between CRNs and ward-based nurses. There was 100% agreement between the CRN team leader and CRNs in the diagnosis of a pressure ulcer, and the Kappa statistics indicated 'very good' agreement. There were only two (1.9%) disagreements in classifying skin for all grades between these nurses. The agreement in the diagnosis of a pressure ulcer between CRNs and ward-based nurses varied by skin site, ranging from 93.6% to 100%, with the Kappa statistics indicating 'good' and 'very good' agreement. However, there were 508 (21.2%) disagreements in classifying skin for all grades. CONCLUSIONS: Overall agreement and Kappa statistics indicated 'very good' and 'good' agreement between expert nurses, and between expert nurses and qualified ward-based staff, respectively. However, the high prevalence of normal skin concealed clinically important disagreements in both the diagnosis of pressure ulcers and skin classification for all grades.

Buttocks↗

PubMed2007

Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions.

AIM: This paper reports a study investigating whether repositioning patients lying on a pressure-reducing mattress alternately for 2 hours in a lateral position and 4 hours in a supine position reduces the incidence of pressure ulcers in comparison with repositioning every 4 hours. BACKGROUND: Repositioning is commonly recognized as an effective preventive measure. Almost no research has been carried out so far on the necessary turning frequencies to prevent pressure ulcer lesions. The pressure is higher in a lateral than in a supine position. METHOD: A two-arm randomized controlled trial was conducted in 16 Belgian elder care nursing homes. Patients with non-blanchable erythema were randomly assigned to either an experimental or a control group. In the experimental group (n = 122), patients were repositioned alternately 2 hours in a lateral position and 4 hours in a supine position. In the control group (n = 113), patients were repositioned every 4 hours. The sitting protocol was identical in both groups. Pressure areas were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. RESULTS: In the experimental group, 16.4% patients developed a pressure ulcer lesion (grade 2-4), while 21.2% did so in the control group. The incidence was not statistically significantly different between the two groups (P = 0.40). The severity (P = 0.65) and location (P = 0.19) of pressure ulcer lesions, and the time to developing them (P = 0.29) were also similar in both groups. No patient developed a pressure ulcer at the hips. A considerable number of patients changed from a lateral to a supine position between the turning intervals. CONCLUSION: More frequent repositioning on a pressure-reducing mattress does not necessarily lead to fewer pressure ulcer lesions and consequently cannot be considered as a more effective preventive measure.

Aged, 80 and over↗

PubMed2006

A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery.

AIMS AND OBJECTIVES: In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. BACKGROUND: Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. METHODS: A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. INSTRUMENTS: The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. RESULTS: The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. CONCLUSIONS: The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. RELEVANCE TO CLINICAL PRACTICE: Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

Adult↗