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Mites in dust samples from mattress surfaces from single beds or cribs in the south Brazilian city of Londrina.

The aim of this study was to investigate the mite fauna in mattresses dust samples from cribs or beds in the south Brazilian city of Londrina, State of Parana. A total of 133 dust samples from upper and lower mattress surfaces, and bed frames were aspirated once from 38 dwellings (18 cribs and 21 beds), and one day nursery (six cribs). A total of 758 mite bodies were counted in slides: 233 (30.7%) from cribs and 525 (69.3%) from beds (p<0.001). House dust mites--mainly Dermatophagoides pteronyssinus, represented 72% and 84% of total mite count in crib and bed dust samples, respectively. The mean HDM body concentration in crib or bed slides were, respectively, 289.9+/-136.7 and 875.0+/-183.6 mites/g. Statistical analysis showed a significantly higher mite bodies count on lower mattress surface compared with upper surface in bed samples only (p=0.025). Data herein show that cribs like mattress have sufficient mite bodies to cause sensitization to humans. The use of mattress covers for cribs and beds should be encouraged in order to avoid allergens exposure.

Adult↗

The modified buried vertical mattress suture. A new technique of buried absorbable wound closure associated with excellent cosmesis for wounds under tension.

BACKGROUND: Recent modifications of mattress suturing techniques have been reported producing rapid and effective skin eversion and excellent tensile strength while producing cosmetically elegant results. OBJECTIVE: Presented here is a new modification of the buried vertical mattress suture. Results employing this technique compared with conventional bi-layered wound closure are presented. METHODS: One hundred patients were analyzed in a double-blind randomized study where excision was carried out on benign pigmented lesions of the upper back. Fifty patients were treated by a conventional bi-layered closure technique while another 50 patients were treated by the newly described buried vertical mattress suture technique. Parameters of infection, hypertrophic scar/keloid formation, dehiscence, suture reaction, wound spread, and patient satisfaction were examined. RESULTS: The modified buried vertical mattress suture technique produced less hypertrophic scar/keloid formation (2% vs 16%) as well as less wound scar spread (6% vs 24%) compared with conventional bi-layered suturing techniques. In addition, it was associated with a high degree of patient satisfaction (96%). CONCLUSION: The modified buried dermal mattress suture technique produces excellent cosmetic results in closing elliptical excisions on thick dermal cutaneous anatomic areas under considerable wound tension. Its decreased requirement for postoperative wound care makes it an excellent alternative for patients living long distances from physician referral centers.

Cicatrix, Hypertrophic↗

A vacuum-formable mattress for veterinary radiotherapy positioning: comparison with conventional methods.

This prospective study was undertaken to compare the positioning repeatability and setup time of a rigid immobilization device (Vac-Lok mattress) to conventional positioning methods (sandbags, tape, foam wedges) in the clinical veterinary radiotherapy setting. Positioning repeatability was determined by using port films to verify appropriate patient positioning. Setup time was determined by recording the time required to set up each patient using each positioning method. Sixty-seven patients receiving radiotherapy were positioned using both the Vac-Lok mattresses and conventional positioning methods during their treatments. Seventy-eight total sites were treated. Forty-eight were treated daily (Monday through Friday, 2 to 4 weeks) and 30 were treated once weekly (4 weeks). Patients were grouped according to the site treated: head (29), neck/body (24), and limb (25). Vac-Lok mattresses were similar to conventional means in positioning repeatability and setup time. Vac-Lok mattresses are potentially advantageous in specific situations, including use during pre-radiotherapy tumor imaging. These mattresses are not recommended for distal limb positioning.

Animals↗

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial.

OBJECTIVE: To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN: Pragmatic, open, multicentre, randomised controlled trial. SETTING: 11 hospitals in six NHS trusts. PARTICIPANTS: 1972 people admitted to hospital as acute or elective patients. INTERVENTIONS: Participants were randomised to an alternating pressure mattress (n = 982) or an alternating pressure overlay (n = 990). MAIN OUTCOME MEASURES: The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability. RESULTS: Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7% overlay patients, 10.3% mattress patients; difference 0.4%, 95% confidence interval--2.3% to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). CONCLUSION: No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer. TRIAL REGISTRATION: ISRCTN 78646179.

Adult↗

Comparison of a long spinal board and vacuum mattress for spinal immobilisation.

OBJECTIVES: This study was designed to compare the stability and comfort afforded by the long spinal board (backboard) and the vacuum mattress. METHODS: Nine volunteers wearing standardised clothing and rigid neck collars were secured on to a backboard and vacuum mattress using a standard strapping arrangement. An operating department table was used to tilt the volunteers from 45 degrees head up to 45 degrees head down, and additionally 45 degrees laterally. Movements of the head, sternum, and pubic symphysis (pelvis) from a fixed position were then recorded. The comfort level during the procedure was assessed using a 10 point numerical rating scale (NRS) where 1=no pain and 10=worst pain imaginable. RESULTS: The mean body movements in the head up position (23.3 v 6.66 mm), head down (40.89 v 8.33mm), and lateral tilt (18.33 v 4.26mm) were significantly greater on the backboard than on the vacuum mattress (p<0.01 for all planes of movement). Using the NRS the vacuum mattress (mean score=1.88) was significantly more comfortable than the backboard (mean score=5.22) (p<0.01). CONCLUSIONS: In the measured planes the vacuum mattress provides significantly superior stability and comfort than a backboard.

Beds↗

Clinical evaluation of the effect of anti-allergic mattress covers in patients with moderate to severe asthma and house dust mite allergy: a randomised double blind placebo controlled study.

BACKGROUND: The use of anti-allergic mattress covers in patients with asthma can result in a large reduction in the level of house dust mite allergen in dust samples. Apart from a reduction in histamine induced bronchial hyperresponsiveness, there are few data on the effect of mattress covers on clinical efficacy and quality of life in patients with moderate to severe asthma. METHODS: Thirty patients with asthma and house dust mite allergy were studied in a randomised, double blind, placebo controlled study. Before and after using anti-allergic covers for 1 year, dust was collected from the mattresses to determine concentrations of Dermatophagoides pteronyssinus (Der p 1), and bronchial hyperresponsiveness and quality of life were measured. The patients scored their symptoms (lungs and nose), morning and evening peak flow values, and rescue medication for 14 days before and after the intervention period. RESULTS: There was a significant reduction in the concentration of Der p 1 in the dust collected from the mattresses in the actively treated group after 1 year compared with before treatment; no change was found in the placebo group. In both the actively treated and placebo groups there was no significant improvement in PC(20) histamine. Quality of life improved similarly in both groups. The symptom score of the lower airways did not significantly change in either group. A significant decrease in nasal symptom score was seen in the actively treated group compared with before treatment, but there was no significant difference between the groups. No changes in morning and evening peak flow values, peak flow variability, nor in the use of rescue medication were found in either group. CONCLUSION: The use of anti-allergic mattress covers results in significant reductions in Der p 1 concentrations in carpet-free bedrooms. However, in patients with moderate to severe asthma, airways hyperresponsiveness and clinical parameters are not affected by this effective allergen avoidance.

Adolescent↗

Identification of Hev b1 in natural latex mattresses.

BACKGROUND: Type 1 hypersensitivity to natural rubber latex proteins is a well-recognized health problem. Recent data have shown that allergens can be extracted from natural latex mattresses. As Hev b 1 (rubber elongation factor) and Hev b 6.02 (hevein) were described as major allergens, the present work was carried out to evaluate their presence in latex mattresses as well as in latex gloves. METHODS: Extracted proteins from latex mattresses and gloves were separated by SDS-PAGE or two-dimensional gel electrophoresis, transferred onto nitrocellulose and detected with monoclonal antibodies specific for Hev b 1 and Hev b 6.02. RESULTS: The results showed that various forms of Hev b 1, as well as degradation products of Hev b 1 were detected in latex mattresses and gloves, whereas Hev b 6.02 was not detected either in mattresses or in gloves. In a standardized latex extract, Hev b 1 and Hev b 6.01 (prohevein) were identified by the monoclonal antibodies. CONCLUSION: The fact that only Hev b 1 was detected by immunoblot in latex articles indicates that Hev b 1 may be the last protein to be washed out of latex products and that the Hev b 1 content may be used as a criterion for the estimation of the allergenicity of the latex products.

Allergens↗

Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows.

BACKGROUND: A meniscal repair technique that combines the strength of vertical mattress sutures and the decreased tissue morbidity of an all-inside technique would be advantageous. HYPOTHESIS: The FasT-Fix Meniscal Repair Suture System will provide load at failure, stiffness, and displacement equivalent to that of vertical mattress sutures and superior to that of Meniscus Arrows. STUDY DESIGN: In vitro biomechanical study. METHODS: After repair of a 2-cm vertical longitudinal medial meniscal lesion, three groups of six human cadaveric knees were biomechanically tested in a random order on a servohydraulic device, and three groups of five specimens underwent cyclic loading. RESULTS: Specimens repaired with Meniscus Arrows had reduced load at failure, stiffness, and displacement, but there were no differences between the FasT-Fix and vertical mattress suture methods. During cyclic loading, specimens repaired with two Meniscus Arrows failed before test completion, whereas specimens repaired with two vertical mattress sutures (6.0 +/- 3.7 mm) or with two FasT-Fix implants (5.1 +/- 1.4 mm) maintained fixation with comparable displacements. CONCLUSIONS: The FasT-Fix provided load at failure, stiffness, and displacement comparable with that of vertical mattress sutures. CLINICAL RELEVANCE: The results suggest that the FasT-Fix may be preferable to Meniscus Arrows for meniscal repair with minimal associated tissue morbidity.

Analysis of Variance↗

Conductive heat exchange with a gel-coated circulating water mattress.

The use of forced-air warming is associated with costs for the disposable blankets. As an alternative method, we studied heat transfer with a reusable gel-coated circulating water mattress placed under the back in eight healthy volunteers. Heat flux was measured with six calibrated heat flux transducers. Additionally, mattress temperature, skin temperature, and core temperature were measured. Water temperature was set to 25 degrees C, 30 degrees C, 35 degrees C, and 41 degrees C. Heat transfer was calculated by multiplying heat flux by contact area. Mattress temperature, skin temperature, and heat flux were used to determine the heat exchange coefficient for conduction. Heat flux and water temperature were related by the following equation: heat flux = 10.3 x water temperature - 374 (r(2) = 0.98). The heat exchange coefficient for conduction was 121 W . m(-2) . degrees C(-1). The maximal heat transfer with the gel-coated circulating water mattress was 18.4 +/- 3.3 W. Because of the small effect on the heat balance of the body, a gel-coated circulating water mattress placed only on the back cannot replace a forced-air warming system.

Adult↗

The Modular Propad and the Softform mattress.

Constant low-pressure supports such as soft mattresses can feel comfortable because they conform well to the shape of the body. When such mattresses are provided with a highly convoluted surface made up of contiguous foam pillars, their efficacy is improved. The Modular Propad is a highly convoluted, but shallow, foam mattress. It is used as an overlay for an ordinary mattress and seems to be superior to earlier forms of convoluted foam overlay. The Softform is a new mattress which has replaceable sections. The outermost sections of the Softform are convoluted foam sheets similar to the Modular Propad. This article discusses the advantages and disadvantages of these products and some potential problems with their covers. It also suggests that the use of a pressure sore risk assessment tool can facilitate the allocation of patients to these special supports.

Beds↗

Randomized comparison trial of the RIK and the Nimbus 3 mattresses.

A randomized comparison trial was carried out at Queen's Hospital, Burton-on-Trent, to compare patient outcomes on the RIK mattress (KCI) and the Nimbus 3 mattress (Huntleigh Healthcare). One hundred and fifty-eight patients, who were assessed to be at particular risk of development of pressure ulcers using the Waterlow score (85 on RIK mattress, 83 on Nimbus), completed the trial. There were no statistically significant differences in baseline parameters at recruitment or pressure ulcer progress. Lack of difference can be as useful as evidence of superiority. Other factors such as nursing interventions required accessible equipment, and costs are important when making equipment choices. For a significant proportion of patients, a static (RIK) mattress can be as effective as an active (Nimbus 3) mattress for management of pressure ulcers.

Aged↗

Measurement of interface pressures in the evaluation of operating theatre mattresses.

This study compared the sacral interface pressures obtained in four mattresses (all supplied by the same manufacturer), in two positions adopted for surgical procedures, to determine the similarities and differences between them. The mattresses were all variations of the standard product used in operating departments. The null hypotheses were that there are no differences in interface pressures between the mattresses or between the two surgical positions, and that measurements are not influenced by subject body mass index. The measurement technology was also tested for reliability and suitability for intra-operative use. Sacral interface pressures of 25 healthy volunteers were recorded using each of the four mattresses (order individually randomised) in both the supine and the Lloyd Davies positions. A pressure-sensitive mat was used and one-way analysis of variance was the main statistical approach. Statistical significance was determined by p-values of < or = 0.05. One mattress recorded significantly lower interface pressures than the others and all pressures were influenced by body mass index. Surgical position was a significant factor, measurements in the Lloyd Davies position being 9.5-14.2% higher than in the supine position. The pressure measurement technique has proved to be reliable and easy to calibrate, position and use. Indications are that it can be used safely and effectively in operating departments. These results have implications for researchers and clinicians.

Adult↗

Evaluation of mattresses using interface pressure mapping.

OBJECTIVE: To compare the ranking of mattresses using several different performance indices, calculated from interface pressure-mapping data. METHOD: Five mattresses were compared using interface pressure-mapping on 10 healthy volunteers. Mattresses were ranked in order, on the basis of several different specified performance indices. RESULTS: Different performance indices ranked the mattresses in different orders. CONCLUSION: Elaborate performance indices should be used with care, since it is possible to construct a 'tailor-made' performance index to make any chosen mattress rank as the best. Care should be taken to ensure that a performance index is validated, preferably by some demonstrated link to clinical outcomes.

Aged↗

The effects of a newly designed air mattress upon sleep and bed climate.

In our previous study, an air mattress with three series of air cells with inflation pressure, that was increased/decreased in time interval of 20 min, did not affect sleep quality and quantity, although the relative and absolute humidity inside the bedding was kept significantly higher than that of a Futon. The purpose of this study was to confirm the effects of a newly designed air mattress upon sleep and bed climate. In this newly designed air mattress, the cell series and time interval was reduced. Six healthy female volunteers, aged 18-22, served as subjects. The experiment was carried out under two conditions: using a regular Futon (Futon), and a newly-designed air mattress with the timer and pump activated (Airmat). The room temperature and relative humidity were controlled at 22-23 degrees C and RH 50-60%, respectively. The subjects' sleep was monitored by using an EEG machine and their skin temperatures and bed climates were also measured continuously. Subjective evaluations of bed comfort and sleep were obtained before and after the recording sessions. Sleep onset latency, wake after sleep onset and the sleep efficiency index showed no significant differences between the two conditions. A significant difference was observed in the bed climate of the waist area. The temperature of the waist was lower overall under the Airmat than the Futon, while relative humidity was higher under the Airmat. Absolute humidity also tended to be higher in the Airmat. Sleep evaluation and comfort sensation were good under both conditions. Although sleep was not disturbed and subjective sleep evaluation tended to be better in Airmat, our results indicate that changing the time intervals and cell series until this air mattress level is not effective in decreasing the bed climate humidity.

Adolescent↗

The mattress sutures: vertical, horizontal, and corner stitch.

The interrupted vertical and horizontal mattress suture techniques are two of the most commonly used skin closure methods. These mattress sutures promote wound edge eversion and less prominent scarring. Vertical and horizontal mattress sutures allow for skin edges to be closed under tension when wound edges have to be brought together over a distance. The corner stitch, a variation of the horizontal mattress suture, is commonly used for closure of angled skin flaps or wounds. Although mattress sutures can produce surface scarring or "railroad marks," early removal of these sutures can limit this damage.

Dermatologic Surgical Procedures↗

A proposed method for quantifying low-air-loss mattress performance by moisture transport.

Because they are believed to control the microclimate of the skin by removing or reducing perspiration accumulation and providing localized cooling, low-air-loss mattress systems are used for the treatment and prevention of pressure ulcers. However, no clear, universally agreed upon definition exists for their design, and reproducible standards on which to base their performance or assess their anticipated clinical effect are lacking. A clinically relevant, reproducible, mechanistic, controlled laboratory test methodology was developed to assess and compare the moisture transport properties of a variety of low-air-loss products by measuring and balancing the complete moisture transport into and out of low-air-loss mattress systems. Using a controlled and defined operating environment, the low-air-loss system is moisture- and weight-loaded using a patient skin moisture analog. Moisture and air transport properties into and out of the environment are measured. Total moisture balance, comparing total moisture change of the analog against the time-based moisture transport data, validates the results. Using mattresses from various manufacturers, time-based data using the study method showed important differences in low-air-loss characteristics related to mattress system design, performance, and function. The observed time-averaged moisture transport performance values indicate that several systems meet an acceptable minimum level of performance, but performance levels between different low-air-loss mattress systems vary markedly.

Beds↗

Soft cot mattresses and the sudden infant death syndrome.

AIMS: To investigate whether soft cot mattresses are a risk factor for the sudden infant death syndrome (SIDS). METHODS: A follow up postal questionnaire was sent to the subjects who were interviewed 3.8 years (range 2.2 to 5.2 years) previously as part of the New Zealand Cot Death Study, a large nationwide case-control study. RESULTS: 105 European SIDS cases were compared with 828 European controls. Soft cot mattresses were associated with an increased risk of SIDS (adjusted OR = 2.36; 95% CI = 1.06, 5,25) compared with average or hard mattresses. The firmness of the mattress did not interact with the sleeping position of infant. CONCLUSIONS: Soft cot mattresses should be avoided.

Beds↗

New mattresses: how fast do they become a significant source of exposure to house dust mite allergens?

BACKGROUND: Sensitization and exposure to mite allergens is a major risk factor for asthma. Little is known about the rate of build-up of allergens in the mite micro-habitats. OBJECTIVES: To investigate the rate of increase in mite allergen levels in new mattresses. METHODS: Der p 1 was measured in the dust samples collected from six identical new single mattresses over a period of 2 years. RESULTS: Der p 1 increased significantly at 4 months as compared with baseline level (P < 0.01), but no difference was found between the concentrations at 4, 8, 12 and 24 months. There was a significant correlation between Der p 1 concentration in mattresses at 4, 8, 12 and 24 months and Der p 1 levels in the bedroom carpet at the beginning of the study. CONCLUSIONS: New mattresses can become a significant source of exposure to mite allergens after a short period of time (< 4 months). There is little justification for advising mite sensitive patients to replace their mattresses as a part of avoidance regime.

Allergens↗