This oeportdescribesan enhanced testsystem ( W W ) f o r MW In bulk power system reliability evaluation studies. The value of the tost system is that it will permit comparative and benchmark studios to be perf0me-d on new and existing reliability evaluation techniques. The test system was developed by modifying and updating the original IEEE RTS (referred to as RTS79 hereafter) to reflect changes In evaluation methodologies and to overcome perceived deficiencies. -The first version of the IEEE Reliability Test System (RTS 79) was developed and published in 1979 [ l ] by the Application of Probability Methods (APM) Subcommittee of the Power System Englaeering Committee. It was developed to satisfy the need for a standardized data base to test and compare results from different power system reliability evaluation methodologies. As such, was designed to b@ a reference system that contains the core data and system parameters necessary for composite reliability evaluation methods. It was recognized at that time that enhancements to RTS It should be noted that In developing and adopting the various parameters for RTS-96, there was no Intention to develop a test system which was representative of any specific or typical power system. Forcing such a requirement on RTs-98 would result in a

The aim of this review was to find out what e ect the use of risk assessment tools has on the development of new pressure ulcers, among people at risk of pressure ulcer development. Many di erent pressure ulcer risk assessment tools are used in clinical practice and it is not known which one is the best. Researchers from Cochrane collected and analysed all relevant studies (randomised controlled trials) to answer this question and found two relevant studies. Key messagesWe cannot be certain whether the use of a risk assessment tool makes any di erence to the number of new pressure ulcers that develop among people who are at risk. The certainty of evidence ranged from low to very low. What was studied in the review?Pressure ulcers (also known as bed sores, pressure sores, pressure injuries and decubitus ulcers) are areas of localised injury to the skin and underlying tissue, usually over a bony part of the body such as the hip or heel. These ulcers develop as a result of pressure, or pressure in combination with shear forces (squeezing and stretching so tissues between bony structures and the skin). Pressure ulcers mainly occur in people who have limited mobility or nerve damage, such as older people, people with spinal injuries, or long-term hospital patients. Pressure ulcer risk assessment is part of the process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international guidelines on pressure ulcer prevention. Di erent tools are used for pressure ulcer risk assessment. We wanted to find out which is the most e ective in preventing pressure ulcers from developing. We also wanted to find out which risk assessment tools reduced the time for a pressure ulcer to develop and the severity of the pressure ulcer. What are the main results of the review?Risk assessment tools for the prevention of pressure ulcers (Review)

BackgroundGlobally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.MethodsA quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre-and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s ρ test.ResultsThere was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.ConclusionThrough an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.

Current detection of pressure ulcers relies on visual and tactile changes at the skin surface, but physiological changes below the skin precede surface changes and have a significant impact on tissue health. Inflammatory and apoptotic/necrotic changes in the epidermal and dermal layers of the skin, such as changes in interstitial fluid (also known as subepidermal moisture (SEM)), may precede surface changes by 3-10 days. Those same epidermal and subepidermal changes result in changes in the electrical properties (bioimpedance) of the tissue, thereby presenting an objective, non-invasive method for assessing tissue damage. Clinical studies of bioimpedance for the detection of pressure ulcers have demonstrated that changes in bioimpedance correlate with increasing severity of pressure ulcer stages. Studies have also demonstrated that at anatomical locations with pressure ulcers, bioimpedance varies with distance from the centre of the pressure ulcers. The SEM Scanner, a handheld medical device, offers an objective and reliable method for the assessment of local bioimpedance, and therefore, assessment of tissue damage before signs become visible to the unaided eye. This literature review summarises pressure ulcer pathophysiology, principles of bioimpedance and clinical research using bioimpedance technology to assess pressure ulcers.

Objective: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. Method: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. Results: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. Conclusion: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.

In using mentoring, coaching and action learning interventions, the focus should be on each participant's current role and everyday practice and on helping the participant to develop and demonstrate clinical leadership skills in these contexts.

Aim: To identify how activity and mobility lead to pressure ulcer development, using two objective assessments, one for mobility and one for early pressure ulcer detection.Methods: 150 older persons from long-term settings were followed up for 20 days, using an observational, quantitative, prospective study design. The study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Visual skin assessment and sub-epidermal moisture assessments were undertaken daily. Activity was measured using the Braden subscale.Further, a mobility profile of the participants was identified using a piezoelectric motion sensor which provided a "movement score" (mean number of movements/hour).Movement scores from 22 healthy participants were also measured to better understand the mobility profile in a healthy population.Results: Pressure ulcer incidence using visual skin assessment was 12.7% (low movers = 6.7%; high movers = 6%) and 78.7% using sub-epidermal moisture assessment (low movers = 40.0%; high movers = 38.7%). Sub-epidermal moisture assessment detected pressure ulcers on average 8.2 days before they appeared visually on the skin's surface. Pressure ulcer detection was 25 times greater using sub-epidermal moisture compared to visual skin assessment. Considering the results of the "movement level" assessment using the motion sensor technology, of all those who were determined to be immobile by Braden, 18.8% were assessed as high movers.Discussion & Conclusion: Pressure ulcers occurred both in low and high movers, which was unexpected as a similar finding has not been previously reported in the literature.

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