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      Support pressure distribution for positioning in neutral versus conventional positioning in the prevention of decubitus ulcers: a pilot study in healthy participants

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          Abstract

          Background

          Decubitus ulcers are associated with a burden for the patients and cause enormous costs. One of the reasons for the development of decubitus is prolonged exposure to pressure. The aim of this pilot study was to examine the pressure distribution of healthy individuals either positioned in Positioning in Neutral (LiN) or conventional positioning (CON).

          Methods

          Four healthy participants were positioned in a supine, 30° degree side lying and 90° side lying position both in LiN and CON. A thousand pressure sensors in a mattress enabled a visual presentation of low, medium and high pressure on a screen. This presentation was processed by Photoshop in order to count the pixels representing the total support pressure surface and the pressure intensity.

          Results

          LiN showed, on average, a smaller surface with measurable pressure compared to CON (46,293 versus 64,090 pixels). The areas of medium pressure were comparable. Mean areas of low and high pressure were both smaller in LiN as compared to CON (low: 8315 versus 22,790 pixels; high: 3744 versus 7277 pixels).

          Conclusion

          The results of this pilot study indicate that LiN is suitable for pressure sore prophylaxis because LiN showed less support surface and less maximum pressure as compared to CON.

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          Most cited references17

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          Preventing pressure ulcers: a systematic review.

          Pressure ulcers are common in a variety of patient settings and are associated with adverse health outcomes and high treatment costs. To systematically review the evidence examining interventions to prevent pressure ulcers. MEDLINE, EMBASE, and CINAHL (from inception through June 2006) and Cochrane databases (through issue 1, 2006) were searched to identify relevant randomized controlled trials (RCTs). UMI Proquest Digital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic, reduction, randomized, and clinical trials. Bibliographies of identified articles were further reviewed. Fifty-nine RCTs were selected. Interventions assessed in these studies were grouped into 3 categories, ie, those addressing impairments in mobility, nutrition, or skin health. Methodological quality for the RCTs was variable and generally suboptimal. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear. Given current evidence, using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers. Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. There is a need for well-designed RCTs that follow standard criteria for reporting nonpharmacological interventions and that provide data on cost-effectiveness for these interventions.
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            Pressure ulcer prevalence in Europe: a pilot study.

            Numerous prevalence studies have been conducted. The problem with these studies is that prevalence proportions cannot be compared with each other, because of differences in performance of each survey. There is no agreed standardized method for determining prevalence proportions. This study aimed to develop and pilot a uniform data collection instrument and methodology to measure the pressure ulcer prevalence and to get some insight into pressure ulcer prevalence across different patient groups in Europe. Pressure ulcer experts from different European countries developed a data collection instrument, which included five categories of data: general data, patient data, risk assessment, skin observation and prevention. A convenience sample of university and general hospitals of Belgium, Italy, Portugal, UK and Sweden participated in the study. In each participating hospital, teams of two trained nurses who collected the data on the wards were established. All patients admitted before midnight on the day of the survey and older than 18 years were included. The data collection instrument and study procedure of the survey were found to be effective by all participants. 5947 patients were surveyed in 25 hospitals in five European countries. The pressure ulcer prevalence (grade 1-4) was 18.1% and if grade 1 ulcers were excluded, it was 10.5%. The sacrum and heels were the most affected locations. Only 9.7% of the patients in need of prevention received fully adequate preventive care. The methodology is sufficiently robust to measure and compare pressure ulcer prevalence in different countries. The pressure ulcer prevalence was higher than expected and relatively few patients received adequate prevention. This indicates that more attention to prevention is needed in Europe.
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              A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers.

              BACKGROUNDL: Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. Ethical approval was received. Study sites (n=12) were allocated to study arm using cluster randomisation. The experimental group (n=99) were repositioned three hourly at night, using the 30° tilt; the control group (n=114) received routine prevention (six-hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks. All participants (n=213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p=0·035; 95% CI 0·031-0·038; ICC=0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β=-0·246, 95% CI=-0·319 to -0·066; p=0·003); (β=0·227, 95% CI=0·041-0·246; p = 0·006). Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one. © 2011 Blackwell Publishing Ltd.
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                Author and article information

                Contributors
                +49 21 59 679 50 67 , heidrun.pickenbrock@stmtk.de
                V.U.Ludwig@gmail.com
                Antonia.Zapf@med.uni-goettingen.de
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                16 October 2017
                16 October 2017
                2017
                : 16
                : 60
                Affiliations
                [1 ]St. Mauritius Therapieklinik, Bereich Motorik, Strümper Straße 111, 40670 Meerbusch, Germany
                [2 ]ISNI 0000 0001 2248 7639, GRID grid.7468.d, Berlin School of Mind and Brain, , Humboldt Universität zu Berlin, ; Berlin, Germany
                [3 ]ISNI 0000 0001 0482 5331, GRID grid.411984.1, Department of Medical Statistics, , University Medical Center Göttingen, ; Göttingen, Germany
                Author information
                http://orcid.org/0000-0002-7901-9972
                Article
                253
                10.1186/s12912-017-0253-z
                5644252
                63c84db5-e2ff-4da0-aea9-37903cd3be42
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 May 2017
                : 2 October 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Nursing
                positioning,pressure measurement,decubitus,positioning in neutral,pressure distribution
                Nursing
                positioning, pressure measurement, decubitus, positioning in neutral, pressure distribution

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