No abstract

No abstract

No abstract

In a modified sequential trial, we randomly assigned 288 elderly patients, who were assessed to be at high risk of pressure sores (Norton score ≤14), to use slab foam or customized contoured foam cushions in their wheelchairs for 3 months. A total of 359 sores developed in 169 (68%) of the 248 at-risk patients who completed the study. The sores were mostly of the persistent erythema level (57%) in severity and took an average of 28 days to heal. No significant differences were found in the overall incidence, severity, or healing time of the sores in the patients who developed sores and used the slab (n=85) or the contoured (n=84) cushions. Significantly more sores developed in the area of ischial tuberosities in the slab cushion group, and in the sacrococcygeal area of the contoured cushion group. Age and severe malnourishment were found to be associated with the incidence of sores but the number of hours seated daily and other patient characteristics were not related. We concluded that customized cushions should be offered only to those elderly patients who do not have a tendency to slide in the chair. Implications of the findings for prophylactic practice in extended care facilities are identified.

In a randomized clinical trial, 187 adult patients with chronic neurologic conditions who were at a high risk of developing pressure sores were assigned for 3 months to either an alternating air (AA) mattress overlay or a silicore (S) mattress overlay. Costs associated with each overlay were calculated and compared by adding depreciation and yearly expenses related to maintenance, operation, and repair for 148 patients who completed the trial. Acceptability was measured by questionnaires and interviews involving 45 of the patients' primary nurses and a sample of 40 patients (20 from each overlay group). The annual cost of the AA overlay was 54% more than that of the S overlay. Although most nurses (more than 74%) believed that both overlays helped prevent pressure sores and deter their progression, many (more than 56%) would not recommend either type to other facilities or to patients at home due to specific negative features. Implications for manufacturers, investigators, clinicians, and administrators are identified.