Subjects -> MEDICAL SCIENCES (Total: 8529 journals)
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MEDICAL SCIENCES (2342 journals)            First | 3 4 5 6 7 8 9 10 | Last

Showing 1201 - 1400 of 3562 Journals sorted alphabetically
Journal of Health Economics and Outcomes Research     Open Access   (Followers: 1)
Journal of Health Promotion and Behavior     Open Access  
Journal of Health Research and Reviews     Open Access  
Journal of Health Science and Medical Research     Open Access  
Journal of Health Science Research     Open Access  
Journal of Health Sciences     Open Access   (Followers: 1)
Journal of health sciences     Open Access  
Journal of Health Sciences / Sağlık Bilimleri Dergisi     Open Access  
Journal of Health Sciences and Medicine     Open Access  
Journal of Health Sciences and Surveillance System     Open Access  
Journal of Health Sciences Scholarship     Open Access  
Journal of Health Specialties     Open Access  
Journal of Health Studies     Open Access  
Journal of Healthcare Informatics Research     Hybrid Journal   (Followers: 1)
Journal of Heavy Metal Toxicity and Diseases     Open Access  
Journal of Helminthology     Hybrid Journal   (Followers: 2)
Journal of Herbs Spices & Medicinal Plants     Hybrid Journal  
Journal of HIV for Clinical and Scientific Research     Open Access   (Followers: 1)
Journal of Hospital Medicine     Hybrid Journal   (Followers: 10)
Journal of Huazhong University of Science and Technology [Medical Sciences]     Hybrid Journal  
Journal of Human Hypertension     Hybrid Journal   (Followers: 3)
Journal of Human Rhythm     Open Access  
Journal of Human Transcriptome     Open Access  
Journal of Ideas in Health     Open Access  
Journal of Inflammation     Open Access   (Followers: 2)
Journal of Inflammation Research     Open Access  
Journal of Injury and Violence Research     Open Access   (Followers: 7)
Journal of Innovation in Health Informatics     Open Access   (Followers: 17)
Journal of Institute of Medicine     Open Access  
Journal of Insulin Resistance     Open Access   (Followers: 1)
Journal of Interactional Research in Communication Disorders     Hybrid Journal   (Followers: 5)
Journal of Interferon & Cytokine Research     Hybrid Journal   (Followers: 3)
Journal of International Medical Research     Open Access   (Followers: 4)
Journal of Interventional Medicine     Open Access   (Followers: 1)
Journal of Investigative Medicine     Hybrid Journal   (Followers: 3)
Journal of Islamabad Medical & Dental College     Open Access  
Journal of Istanbul Faculty of Medicine     Open Access  
Journal of Karnali Academy of Health Sciences     Open Access   (Followers: 1)
Journal of Kathmandu Medical College     Open Access   (Followers: 1)
Journal of King Abdulaziz University : Medical Sciences     Open Access   (Followers: 2)
Journal of Laboratory Medicine     Hybrid Journal   (Followers: 27)
Journal of Laryngology and Voice     Open Access   (Followers: 11)
Journal of Lasers in Medical Sciences     Open Access  
Journal of Law, Medicine & Ethics     Hybrid Journal   (Followers: 24)
Journal of Legal Medicine     Hybrid Journal   (Followers: 7)
Journal of Limb Lengthening & Reconstruction     Open Access  
Journal of Lumbini Medical College     Open Access   (Followers: 1)
Journal of Mahatma Gandhi Institute of Medical Sciences     Open Access  
Journal of Manipulative and Physiological Therapeutics     Hybrid Journal   (Followers: 6)
Journal of Manmohan Memorial Institute of Health Sciences     Open Access   (Followers: 1)
Journal of Marine Medical Society     Open Access  
Journal of Materials Science : Materials in Medicine     Hybrid Journal   (Followers: 4)
Journal of Maternal and Child Health     Open Access  
Journal of Mechanics in Medicine and Biology     Hybrid Journal  
Journal of Medical and Biological Engineering     Hybrid Journal   (Followers: 4)
Journal of Medical and Biomedical Sciences     Open Access   (Followers: 2)
Journal of Medical Case Reports     Open Access   (Followers: 1)
Journal of Medical Cases     Open Access   (Followers: 6)
Journal of Medical Colleges of PLA     Full-text available via subscription  
Journal of Medical Disorders     Open Access  
Journal of Medical Economics     Hybrid Journal   (Followers: 8)
Journal of Medical Education and Curricular Development     Open Access   (Followers: 6)
Journal of Medical Ethics     Partially Free   (Followers: 25)
Journal of Medical Ethics and History of Medicine     Open Access   (Followers: 15)
Journal of Medical Humanities     Hybrid Journal   (Followers: 21)
Journal of Medical Hypotheses and Ideas     Open Access  
Journal of Medical Imaging and Health Informatics     Full-text available via subscription   (Followers: 1)
Journal of Medical Investigation and Practice     Open Access  
Journal of Medical Laboratory and Diagnosis     Open Access  
Journal of Medical Law and Ethics     Full-text available via subscription   (Followers: 15)
Journal of Medical Microbiology     Full-text available via subscription   (Followers: 6)
Journal of Medical Sciences     Open Access  
Journal of Medical Sciences     Open Access  
Journal of Medical Screening     Hybrid Journal   (Followers: 6)
Journal of Medical Signals and Sensors     Open Access   (Followers: 3)
Journal of Medical Society     Open Access  
Journal of Medical Systems     Hybrid Journal  
Journal of Medical Toxicology     Hybrid Journal   (Followers: 6)
Journal of Medical Ultrasound     Open Access   (Followers: 2)
Journal of Medicinal Botany     Open Access  
Journal of Medicinal Chemistry     Hybrid Journal   (Followers: 197)
Journal of Medicine     Open Access   (Followers: 1)
Journal of Medicine and Biomedical Research     Open Access   (Followers: 1)
Journal of Medicine and Philosophy     Hybrid Journal   (Followers: 8)
Journal of Medicine and the Person     Hybrid Journal  
Journal of Medicine in Scientific Research     Open Access  
Journal of Medicine in the Tropics     Open Access  
Journal of Medicine Research and Development     Open Access   (Followers: 3)
Journal of Medicine, Physiology and Biophysics     Open Access   (Followers: 5)
Journal of Medicines Development Sciences     Open Access   (Followers: 1)
Journal of Metabolomics & Systems Biology     Open Access  
Journal of Mind and Medical Sciences     Open Access   (Followers: 1)
Journal of Molecular Medicine     Hybrid Journal   (Followers: 11)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Muscle Research and Cell Motility     Hybrid Journal   (Followers: 1)
Journal of Nanotechnology in Engineering and Medicine     Full-text available via subscription   (Followers: 6)
Journal of Natural Medicines     Hybrid Journal  
Journal of Natural Science, Biology and Medicine     Open Access   (Followers: 3)
Journal of Nature and Science of Medicine     Open Access   (Followers: 4)
Journal of Negative and No Positive Results     Open Access  
Journal of Nepalgunj Medical College     Open Access  
Journal of Neurocritical Care     Open Access  
Journal of Neurodegenerative Diseases     Open Access   (Followers: 2)
Journal of Neurorestoratology     Open Access  
Journal of Neuroscience and Neurological Disorders     Open Access  
Journal of Nobel Medical College     Open Access  
Journal of Obesity and Bariatrics     Open Access  
Journal of Occupational Health     Open Access  
Journal of Occupational Therapy Education     Open Access   (Followers: 9)
Journal of Ocular Biology, Diseases, and Informatics     Hybrid Journal  
Journal of Oral Biology and Craniofacial Research     Full-text available via subscription  
Journal of Oral Health and Craniofacial Science     Open Access  
Journal of Orofacial Sciences     Open Access  
Journal of Otorhinolaryngology, Hearing and Balance Medicine     Open Access   (Followers: 1)
Journal of Ovarian Research     Open Access  
Journal of Ozone Therapy     Open Access  
Journal of Palliative Medicine     Hybrid Journal   (Followers: 47)
Journal of Paramedical Sciences & Rehabilitation     Open Access  
Journal of Parkinsonism and Restless Legs Syndrome     Open Access   (Followers: 2)
Journal of Parkinson’s Disease and Alzheimer’s Disease     Open Access  
Journal of Participatory Medicine     Open Access  
Journal of Patan Academy of Health Sciences     Open Access  
Journal of Pathogens     Open Access   (Followers: 1)
Journal of Patient Experience     Open Access  
Journal of Patient Safety and Risk Management     Hybrid Journal   (Followers: 1)
Journal of Patient-Centered Research and Reviews     Open Access  
Journal of Patient-Reported Outcomes     Open Access  
Journal of Periodontal Research     Hybrid Journal  
Journal of Personalized Medicine     Open Access   (Followers: 3)
Journal of Pest Science     Hybrid Journal   (Followers: 1)
Journal of Pharmaceutical Policy and Practice     Open Access   (Followers: 4)
Journal of Physiobiochemical Metabolism     Hybrid Journal   (Followers: 2)
Journal of Physiology-Paris     Hybrid Journal   (Followers: 2)
Journal of Pioneering Medical Sciences     Open Access  
Journal of Postgraduate Medicine     Open Access  
Journal of Pregnancy     Open Access   (Followers: 4)
Journal of Prevention & Intervention Community     Hybrid Journal   (Followers: 6)
Journal of Preventive Medicine and Public Health     Open Access  
Journal of Primary Prevention     Hybrid Journal   (Followers: 7)
Journal of Prosthodontic Research     Full-text available via subscription   (Followers: 1)
Journal of Prosthodontics     Hybrid Journal   (Followers: 2)
Journal of Receptor, Ligand and Channel Research     Open Access  
Journal of Regenerative Medicine     Partially Free   (Followers: 3)
Journal of Research in Medical Sciences     Open Access   (Followers: 2)
Journal of Science and Applications : Biomedicine     Open Access   (Followers: 1)
Journal of Science and Technology (Ghana)     Open Access   (Followers: 3)
Journal of Scientific Innovation in Medicine     Open Access  
Journal of Scientific Perspectives     Open Access   (Followers: 1)
Journal of Sensory Studies     Hybrid Journal   (Followers: 4)
Journal of Shaheed Suhrawardy Medical College     Open Access  
Journal of Shoulder and Elbow Arthroplasty     Open Access  
Journal of Sleep Disorders : Treatment & Care     Hybrid Journal   (Followers: 10)
Journal of South American Earth Sciences     Hybrid Journal   (Followers: 5)
Journal of Spinal Cord Medicine     Hybrid Journal   (Followers: 4)
Journal of Spinal Disorders & Techniques     Hybrid Journal   (Followers: 2)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of Stem Cell Therapy and Transplantation     Open Access   (Followers: 1)
Journal of Stomal Therapy Australia     Full-text available via subscription  
Journal of Strength and Conditioning Research     Hybrid Journal   (Followers: 73)
Journal of Substance Use     Hybrid Journal   (Followers: 14)
Journal of Surgical Academia     Open Access   (Followers: 1)
Journal of Surgical and Clinical Research     Open Access  
Journal of Surgical Case Reports     Open Access  
Journal of Surgical Education     Full-text available via subscription   (Followers: 3)
Journal of Surgical Technique and Case Report     Open Access  
Journal of Systemic Therapies     Full-text available via subscription   (Followers: 3)
Journal of Taibah University Medical Sciences     Open Access  
Journal of Telemedicine and Telecare     Hybrid Journal   (Followers: 12)
Journal of The Academy of Clinical Microbiologists     Open Access  
Journal of the American Association for Laboratory Animal Science     Full-text available via subscription   (Followers: 7)
Journal of the American College of Certified Wound Specialists     Hybrid Journal   (Followers: 2)
Journal of the American College of Clinical Wound Specialists     Hybrid Journal   (Followers: 2)
Journal of the American Medical Directors Association     Hybrid Journal   (Followers: 6)
Journal of the American Medical Informatics Association : JAMIA     Hybrid Journal   (Followers: 35)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 7)
Journal of the Anatomical Society of India     Full-text available via subscription  
Journal of the Anus, Rectum and Colon     Open Access  
Journal of The Arab Society for Medical Research     Open Access  
Journal of the Australasian College of Nutritional and Environmental Medicine     Full-text available via subscription  
Journal of the Australasian Society of Aerospace Medicine     Open Access   (Followers: 1)
Journal of the Ceylon College of Physicians     Open Access  
Journal of the Chinese Medical Association     Open Access   (Followers: 2)
Journal of the College of Community Physicians of Sri Lanka     Open Access  
Journal of The Egyptian Public Health Association     Open Access   (Followers: 1)
Journal of the Formosan Medical Association     Open Access   (Followers: 2)
Journal of the Ghana Science Association     Full-text available via subscription   (Followers: 3)
Journal of the Grodno State Medical University     Open Access   (Followers: 1)
Journal of the History of Medicine and Allied Sciences     Hybrid Journal   (Followers: 17)
Journal of the International Society for Telemedicine and eHealth     Open Access   (Followers: 3)
Journal of the Learning Sciences     Hybrid Journal   (Followers: 17)
Journal of the Medical Library Association     Open Access   (Followers: 284)
Journal of the Medical Sciences (Berkala ilmu Kedokteran)     Open Access   (Followers: 1)
Journal of the National Medical Association     Full-text available via subscription  
Journal of the Peripheral Nervous System     Hybrid Journal   (Followers: 3)
Journal of the Postgraduate Institute of Medicine     Open Access  
Journal of the Renin-Angiotensin-Aldosterone System     Open Access   (Followers: 1)
Journal of the Royal Society of Medicine     Hybrid Journal   (Followers: 2)
Journal of the Ruhunu Clinical Society     Open Access  
Journal of the Scientific Society     Open Access   (Followers: 1)
Journal of the Siena Academy of Sciences     Open Access   (Followers: 1)

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Similar Journals
Journal Cover
Journal of Tissue Viability
Journal Prestige (SJR): 0.467
Citation Impact (citeScore): 2
Number of Followers: 3  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0965-206X
Published by Elsevier Homepage  [3203 journals]
  • Editorial
    • Authors: Amit Gefen; Dan Bader
      First page: 1
      Abstract: Publication date: February 2018
      Source:Journal of Tissue Viability, Volume 27, Issue 1
      Author(s): Amit Gefen, Dan Bader


      PubDate: 2018-02-26T01:02:19Z
      DOI: 10.1016/j.jtv.2018.01.003
      Issue No: Vol. 27, No. 1 (2018)
       
  • The relationship between nurses assessment of early pressure ulcer damage
           and sub epidermal moisture measurement: A prospective explorative study
    • Authors: Gillian O'Brien; Zena Moore; Declan Patton; Tom O'Connor
      Abstract: Publication date: Available online 25 June 2018
      Source:Journal of Tissue Viability
      Author(s): Gillian O'Brien, Zena Moore, Declan Patton, Tom O'Connor
      Aim To explore the relationship between nurses' visual assessment of early pressure ulceration and assessment using sub epidermal moisture measurement (a measure of skin and tissue water). Materials and methods A descriptive prospective observational study design was employed. Following ethical approval and written informed consent, data were collected daily, for four weeks, from at risk patients within an acute care facility in Ireland. Data included nurses documented assessment of the patient's skin condition and researcher led sub epidermal moisture measurement, over the sacrum and both heels. Results A total of 47 patients were included, 38.3% (n = 18) were male and 61.5% (n = 29) were female, with a mean age of 74.7 years. Nineteen patients (40%) developed 21 Stage 1 pressure ulcers and all of these had sustained elevated sub epidermal moisture (SEM) levels before visual signs of damage became evident indicating 100% sensitivity of SEM readings in predicting pressure ulceration. Specificity was 83% with the majority of false positives having insufficient follow-up time. Furthermore a medium correlation between nurses' visual skin assessment (the current gold standard in pressure ulcer detection) and SEM findings (r = .47; p = 0.001) was identified. The mean number of days for nurses to detect this damage was 5.5 (±2,5; max 11, min 2), whereas the mean number of days that it took SEM measurement to detect damage was 1.5 (±1.4; max 7, min 1). SEM measurement identified early damage, on average, 4 days sooner than nurses' assessment. Conclusion Given that pressure ulcers develop from within the deeper tissues, knowing that early pressure ulcer damage is present can facilitate heightening of prevention strategies to avoid extension. This is of importance in clinical practice as the earlier that pressure ulcers can be detected; the earlier interventions can be implemented to prevent further extension, avoiding their associated morbidity and mortality.

      PubDate: 2018-06-26T01:14:04Z
      DOI: 10.1016/j.jtv.2018.06.004
       
  • The effectiveness of lying surfaces in nursing care beds, a comparison of
           spring element systems versus conventional systems: A post marketing
           clinical follow-up pilot study
    • Authors: Beate Beime; Nils A. Lahmann
      Abstract: Publication date: Available online 13 June 2018
      Source:Journal of Tissue Viability
      Author(s): Beate Beime, Nils A. Lahmann
      Background Reduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting. Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS; wooden slats or steel bars). Methods This was a prospective, randomized, controlled study in 29 patients with an age range of 54–95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statistically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor ®. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor ®. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self-rated. Results We screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 ± 9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 ± 1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 ± 10.8%) and the CS group (72.9 ± 16.3%; p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement where plotted per night (p = 0.0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a “shoulder” between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was significantly higher with the SES after night 14 (p = 0.0192) than with CS. Conclusions The study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self-rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.

      PubDate: 2018-06-19T21:52:22Z
      DOI: 10.1016/j.jtv.2018.06.003
       
  • Microclimate evaluation of strap-based wheelchair seating systems for
           persons with spinal cord injury: A pilot study
    • Authors: Christine M. Olney; Amanda Simone; Kristin Hanowski; Thomas S. Rector; Gary D. Goldish; Andrew H. Hansen; John E. Ferguson
      Abstract: Publication date: Available online 12 June 2018
      Source:Journal of Tissue Viability
      Author(s): Christine M. Olney, Amanda Simone, Kristin Hanowski, Thomas S. Rector, Gary D. Goldish, Andrew H. Hansen, John E. Ferguson
      Study purpose The purpose of this pilot study was to assess microclimate characteristics of two versions of a strap-based wheelchair seating system (perforated and solid straps) and to conduct preliminary microclimate comparisons of subjects' current wheelchair seating systems. Materials and methods In this pilot study, the microclimate properties of two variations (solid and perforated) of a strap-based seating system were compared with two commonly used seating systems. Six subjects sat on three different seating systems each for 100-min test periods, while temperature and relative humidity were measured with a single sensor adjacent to the skin-seat interface. Additionally, thermal images of the seat interface were collected before and after each test period. Results The thermal images revealed that the maximum surface temperature of the solid-strap-based seating system was significantly lower than the other seating systems, −1.21 °C. (95% CI -2.11 to −0.30, p = 0.02), immediately following transfer out of the seat. Five minutes after transferring out of the seat, the perforated-strap seat was significantly cooler than the other seats −0.94 °C. (95% CI -1.59 to −0.30), p = 0.01, as was the solid-strap-based seat, −1.66 °C. (95% CI -2.69 to −0.63), p = 0.01. There were no significant differences in interface temperature or relative humidity measured with the single sensor near the skin-seat interface. Conclusion This pilot study offers preliminary evidence regarding the microclimate of the strap-based seating systems compared with other common seating systems. Clinically, the strap-based seating system may offer another option for those who struggle with microclimate management.

      PubDate: 2018-06-19T21:52:22Z
      DOI: 10.1016/j.jtv.2018.06.001
       
  • Evaluation of comfort associated with the use of a robotic mattress with
           an interface pressure mapping system and automatic inner air-cell pressure
           adjustment function in healthy volunteers
    • Authors: Manaka Saegusa; Hiroshi Noguchi; Gojiro Nakagami; Taketoshi Mori; Hiromi Sanada
      Abstract: Publication date: Available online 11 June 2018
      Source:Journal of Tissue Viability
      Author(s): Manaka Saegusa, Hiroshi Noguchi, Gojiro Nakagami, Taketoshi Mori, Hiromi Sanada
      Aim of the study A robotic mattress equipped with an interface pressure mapping system and an automatic inner air-cell pressure adjustment function had been developed to aid in the management of pressure ulcers, but its effects on comfort remained unclear. The present study aimed to investigate whether use of the mattress with continuous, automatic, interface pressure mapping-based regulation of inner air-cell pressure (i.e., robotic mattress) improves comfort over that provided by body weight-based pressure regulation (traditional approach) in healthy volunteers. Materials and methods A robotic mattress was used with two settings (i.e., interface pressure-vs. body weight-based regulation). First, 20 healthy volunteers were recruited, and the level of comfort, interface pressure distribution, body immersion, and tissue oxygenation were measured and compared between the two settings. Results The level of comfort (20.5 vs 47.5, p = 0.014), contact area (2263.9 vs 2145.2 cm2, p = 0.002), and body immersion for healthy participants were significantly larger when using the interface pressure-based setting. Conclusion The robotic mattress provided improved comfort, which might be caused by increased contact area, and improved body immersion. The robotic mattress is expected to be effective both for managing pressure ulcers and increasing comfort.

      PubDate: 2018-06-19T21:52:22Z
      DOI: 10.1016/j.jtv.2018.06.002
       
  • Oximetry for the evaluation of sitting induced ischemia
    • Authors: Pierre Abraham; Samir Henni Myriam Ammi
      Abstract: Publication date: Available online 7 June 2018
      Source:Journal of Tissue Viability
      Author(s): Pierre Abraham, Samir Henni, Myriam Ammi


      PubDate: 2018-06-07T09:15:23Z
       
  • Response to the title of 2018_39
    • Authors: Peter R. Worsley; Dan L. Bader
      Abstract: Publication date: Available online 31 May 2018
      Source:Journal of Tissue Viability
      Author(s): Peter R. Worsley, Dan L. Bader


      PubDate: 2018-06-01T18:10:54Z
      DOI: 10.1016/j.jtv.2018.05.006
       
  • Frailty and body mass index are associated with biophysical properties of
           the skin in community-dwelling older adults
    • Authors: Shinji Iizaka
      Abstract: Publication date: Available online 23 May 2018
      Source:Journal of Tissue Viability
      Author(s): Shinji Iizaka
      Aim of the study This study aimed to investigate the association of frailty and body mass index (BMI) with biophysical properties of the skin in community-dwelling older people. Materials and methods A cross-sectional study was conducted in a suburban Japanese city. Older adults aged ≥65 years and participating in a health checkup program were recruited (n = 128). Stratum corneum hydration, clinical manifestations of dry skin, skin elasticity and condition of the dermis (as measured by ultrasonography) were evaluated on the volar forearm. Frailty phenotype and BMI were also evaluated. Results The mean age of participants was 74.5 years, and 96.1% were women. Skin thickness was significantly decreased in frail participants compared with non-frail participants in an age-adjusted multivariate model (p = 0.009). Frail participants showed significantly lower skin elasticity values than non-frail participants in a univariate analysis (p = 0.024), but this was not significant in the multivariate model. In participants with BMI ≥25 kg/m2, clinical manifestations of dry skin were significantly decreased compared with BMI <21.5 kg/m2 (p = 0.002). Participants with BMI ≥25 kg/m2 and with 21.5 kg/m2 < BMI ≤25 kg/m2 showed significantly higher skin elasticity values than participants with BMI <21.5 kg/m2 (p = 0.014 and p = 0.042, respectively). Conclusion Frailty was associated with decreased skin thickness and decreased skin elasticity partially via the influence of chronological aging. Low body mass was associated with increased xerosis manifestations and decreased skin elasticity in community-dwelling older adults.

      PubDate: 2018-05-29T05:24:21Z
      DOI: 10.1016/j.jtv.2018.05.004
       
  • Patterns and associations of structural and functional cutaneous responses
           during loading at heel and sacral skin in aged females: A reanalysis of
           clinical study data
    • Authors: Eva K.B. Pfannes; Ulrike Blume-Peytavi; Jan Kottner
      Abstract: Publication date: Available online 10 May 2018
      Source:Journal of Tissue Viability
      Author(s): Eva K.B. Pfannes, Ulrike Blume-Peytavi, Jan Kottner
      Aim of the study The aim of this study was to explore possible interrelationships and cutaneous response patterns at the heel and sacral skin due to prolonged loading. Materials and methods Skin stiffness, elasticity, roughness and transepidermal water loss, stratum corneum hydration, erythema, and temperature of n = 20 aged females (mean age 69.9 years) were measured before and after 90 and 150 min loading in supine position. Delta values were calculated and correlated using Spearman's rho. Strengths and directions of associations and similar patterns were subsequently identified for the heel and sacrum areas. Results At the sacral area decreased stiffness (Uf) was associated with increased TEWL and there was a positive relationship between mean roughness (Rz) and erythema. At the heel there was a positive association between TEWL and decreasing stiffness (Uf). Conclusions Our results indicate a dynamic interaction between skin changes during loading and different physiological response patterns for sacral and heel skin. There seems to be close association between transepidermal water loss and stiffness changes during loading.

      PubDate: 2018-05-29T05:24:21Z
      DOI: 10.1016/j.jtv.2018.05.003
       
  • Measuring the impact of cushion design on buttocks tissue deformation: An
           MRI approach
    • Authors: Sharon E. Sonenblum; Jason Ma; Stephen H. Sprigle; Thomas R. Hetzel; John McKay Cathcart
      Abstract: Publication date: Available online 9 May 2018
      Source:Journal of Tissue Viability
      Author(s): Sharon E. Sonenblum, Jason Ma, Stephen H. Sprigle, Thomas R. Hetzel, John McKay Cathcart
      Aim To establish a research approach for describing how different wheelchair cushion designs impact buttocks tissue deformation during sitting. Materials and methods The buttocks of 4 individuals with spinal cord injury and significant atrophy were scanned sitting in a FONAR Upright MRI. Scans were collected with the individuals' buttocks fully suspended without pelvic support, and seated on 3 different commercially available wheelchair cushions. Multi-planar scans were analyzed to provide 3D renderings and measurements of tissue thickness and shape. Results Bulk tissue thicknesses at the ischium, which rarely included muscle, were reduced by more than 60% on enveloping cushion designs studied (i.e., Roho HP and Matrx Vi), and more variably (23–60%) on an orthotic off-loading design (i.e., Java). Adipose was typically displaced posterior and superior from the unloaded condition, with more lateral displacement on the Roho HP and Matrx Vi and more medial displacement present on the Java. Large changes in angle at the sacro-coccygeal joint indicated significant loading on the region. Deformation at the greater trochanter was more consistent across surfaces. Greater interface pressures tended to be associated with greater deformation, but the relationship varied by individuals and was highly non-linear. Conclusions The buttocks in this study all deformed significantly, but at different locations and in different manners across all 3 surfaces. Attention needs to be paid to the regions of greatest deformation. A future metric of shape compliance should consider cushion performance at all high risk regions, and changes to the amount and shape of tissue in the regions of interest.

      PubDate: 2018-05-29T05:24:21Z
      DOI: 10.1016/j.jtv.2018.04.001
       
  • The relationship of subepidermal moisture and early stage pressure injury
           by visual skin assessment
    • Authors: Chul-Gyu Kim; Seungmi Park; Ji Woon Ko; Sungho Jo
      Abstract: Publication date: Available online 8 May 2018
      Source:Journal of Tissue Viability
      Author(s): Chul-Gyu Kim, Seungmi Park, Ji Woon Ko, Sungho Jo
      Aim The purpose of this study was to examine the relationship of subepidermal moisture and early stage pressure injury by visual skin assessment in elderly Korean. Methods Twenty-nine elderly participated at a particular nursing home. Data were collected for 12 weeks by one wound care nurse. Visual skin assessment and subepidermal moisture value were measured at both buttocks, both ischia, both trochanters, sacrum, and coccyx of each subject once a week. Results Subepidermal moisture value of stage 1 pressure injury was significantly higher than that of no injury and blanching erythema. After adjustment with covariates, odds ratios of blanching erythema to normal skin and stage 1 pressure injury to blanching erythema/normal skin were statistically significant (p < 0.05). Odds ratio of blanching erythema to normal skin was 1.003 (p = .047) by 1-week prior subepidermal moisture value, and that of concurrent subepidermal moisture value was 1.004 (p = .011). Odds ratio of stage 1 pressure injury to normal skin/blanching erythema was 1.003 (p = .005) by 1-week prior subepidermal moisture value, and that for concurrent subepidermal moisture value was 1.007 (p = .030). Subepidermal moisture was associated with concurrent and future (1 week later) skin damage at both trochanters. Conclusion Subepidermal moisture would be used to predict early skin damage in clinical nursing field for the effective pressure injury prevention.

      PubDate: 2018-05-29T05:24:21Z
      DOI: 10.1016/j.jtv.2018.05.002
       
  • Quantitative ultrasound imaging over the ischial tuberosity: An
           exploratory study to inform tissue health
    • Authors: Sharon Gabison; Sunita Mathur; Mary C. Verrier; Ethne Nussbaum; Milos R. Popovic; Dany H. Gagnon
      Abstract: Publication date: Available online 4 May 2018
      Source:Journal of Tissue Viability
      Author(s): Sharon Gabison, Sunita Mathur, Mary C. Verrier, Ethne Nussbaum, Milos R. Popovic, Dany H. Gagnon


      PubDate: 2018-05-29T05:24:21Z
      DOI: 10.1016/j.jtv.2018.04.002
       
  • Calendar of Events
    • Abstract: Publication date: May 2018
      Source:Journal of Tissue Viability, Volume 27, Issue 2


      PubDate: 2018-05-29T05:24:21Z
       
  • Investigating thermal performance of different chairs at the user-seat
           interface by a temperature sensor array system while participants perform
           office work
    • Authors: Zhuofu Liu; Ye Yuan; Meimei Liu; Vincenzo Cascioli; Peter W. McCarthy
      Abstract: Publication date: Available online 27 March 2018
      Source:Journal of Tissue Viability
      Author(s): Zhuofu Liu, Ye Yuan, Meimei Liu, Vincenzo Cascioli, Peter W. McCarthy


      PubDate: 2018-04-25T05:23:46Z
      DOI: 10.1016/j.jtv.2018.03.001
       
  • Calendar of Events
    • Abstract: Publication date: February 2018
      Source:Journal of Tissue Viability, Volume 27, Issue 1


      PubDate: 2018-02-26T01:02:19Z
       
  • Laminin peptide YIGSR enhances epidermal development of skin equivalents
    • Authors: Young-Yoon Kim; Hailan Li; Yu Seok Song; Hyo-Soon Jeong; Hye-Young Yun; Kwang Jin Baek; Nyoun Soo Kwon; Yong Kyoo Shin; Kyoung-Chan Park; Dong-Seok Kim
      Abstract: Publication date: Available online 7 February 2018
      Source:Journal of Tissue Viability
      Author(s): Young-Yoon Kim, Hailan Li, Yu Seok Song, Hyo-Soon Jeong, Hye-Young Yun, Kwang Jin Baek, Nyoun Soo Kwon, Yong Kyoo Shin, Kyoung-Chan Park, Dong-Seok Kim
      Since the use of animal experimentation is restricted with regard to cosmetic materials, alternative in vitro models such as skin equivalents (SEs) are needed. Laminin is one of the major non-collagenous glycoproteins. The pentapeptide YIGSR (Tyr-Ile-Gly-Ser-Arg) is a functional motif of laminin that binds to the laminin receptor. In the present study, we examined whether YIGSR could improve the reconstruction of SEs. YIGSR has no effects on monolayer cell proliferation of CCD25-Sk fibroblasts or HaCaT keratinocytes. Interestingly, YIGSR decreased TGF-β1 levels, although it promoted type Ι collagen synthesis in CCD25-Sk cells. In HaCaT cells, YIGSR decreased the expression of involucrin and loricrin, which are differentiation markers. Furthermore, YIGSR increased levels of proliferating cell nuclear antigen (PCNA), p63, and integrin α6, and decreased involucrin in SE models. In addition, two models containing YIGSR (mixed with dermal equivalents or added into media) did not show any differences in expression levels of PCNA, p63, integrin α6, and involucrin. Therefore, YIGSR is a useful agent for reconstruction of SEs, independent of its method of application. These results indicate that YIGSR stimulates epidermal proliferation and basement membrane formation while inhibiting keratinocyte differentiation of SEs. Taken together, these results indicate that YIGSR promotes the reconstruction of SEs, potentially via decreased TGF-β1 levels and consequent inhibition of epidermal differentiation.

      PubDate: 2018-02-16T01:16:30Z
      DOI: 10.1016/j.jtv.2018.02.001
       
  • Pressure ulcer incidence and Braden subscales: Retrospective cohort
           analysis in general wards of a Portuguese hospital
    • Authors: Pedro Miguel Garcez Sardo; Jenifer Adriana Domingues Guedes; José Joaquim Marques Alvarelhão; Paulo Alexandre Puga Machado; Elsa Maria Oliveira Pinheiro de Melo
      Abstract: Publication date: Available online 2 February 2018
      Source:Journal of Tissue Viability
      Author(s): Pedro Miguel Garcez Sardo, Jenifer Adriana Domingues Guedes, José Joaquim Marques Alvarelhão, Paulo Alexandre Puga Machado, Elsa Maria Oliveira Pinheiro de Melo
      Aim To study the influence of Braden subscales scores (at the first pressure ulcer risk assessment) on pressure ulcer incidence using a univariate and a multivariate time to event analysis. Materials and methods Retrospective cohort analysis of electronic health record database from adult patients admitted without pressure ulcer(s) to medical and surgical wards of a Portuguese hospital during 2012. The hazard ratio of developing a pressure ulcer during the length of inpatient stay was calculated by univariate Cox regression for each variable of interest and by multivariate Cox regression for the Braden subscales that were statistically significant. Results This study included a sample of 6552 participants. During the length of stay, 153 participants developed (at least) one pressure ulcer, giving a pressure ulcer incidence of 2.3%. The univariate time to event analysis showed that all Braden subscales, except “nutrition”, were associated with the development of pressure ulcer. By multivariate analysis the scores for “mobility” and “activity” were independently predictive of the development of pressure ulcer(s) for all participants. Conclusion (Im)“mobility” (the lack of ability to change and control body position) and (in)“activity” (the limited degree of physical activity) were the major risk factors assessed by Braden Scale for pressure ulcer development during the length of inpatient stay. Thus, the greatest efforts in managing pressure ulcer risk should be on “mobility” and “activity”, independently of the total Braden Scale score.

      PubDate: 2018-02-04T20:55:55Z
      DOI: 10.1016/j.jtv.2018.01.002
       
  • Never too old to regenerate' Wound induced hair follicle neogenesis
           after secondary intention healing in a geriatric patient'
    • Authors: Tak-Wah Wong; Michael Hughes; Szu-Han Wang
      Abstract: Publication date: Available online 4 January 2018
      Source:Journal of Tissue Viability
      Author(s): Tak-Wah Wong, Michael Hughes, Szu-Han Wang
      Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient's wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.

      PubDate: 2018-01-06T07:19:45Z
      DOI: 10.1016/j.jtv.2018.01.001
       
  • The impact of hoist sling fabrics on interface pressure whilst sitting in
           healthy volunteers and wheelchair users: A comparative study
    • Authors: J. Webb; M. Twiste; L.A. Walton; P. Hogg
      Abstract: Publication date: Available online 6 December 2017
      Source:Journal of Tissue Viability
      Author(s): J. Webb, M. Twiste, L.A. Walton, P. Hogg
      Aim of the study To evaluate the effect of three sling fabrics on gluteal interface pressure whilst sitting in a population of wheelchair users and to compare these to data previously collected in a pilot study with a healthy population. Materials and methods A repeated measures experimental design was used with 32 adult wheelchair users (15 women, 17 men). Healthy population pilot study consisted of 61 participants (51 women, 10 men) recruited from staff and students at The University of Salford. Methods Gluteal pressures at six pressure zones were recorded using the X-sensor PX100 pressure sensor at 30 s intervals for 10 min. Data were collected in 4 conditions with participants seated in a standardised chair, followed by the chair with slings made of three different fabrics. Results The spacer fabric reduced the mean gluteal pressure more effectively than slipfit and polyester (p = 0.014 and p = 0.01 respectively, 95%CI) and reduced peak pressure at the left ischial tuberosity and coccyx when compared to the slipfit (p = 0.003 and p = 0.005) with the wheelchair users. When comparing data with the pilot study, the mean gluteal pressure and peak pressures at the ischial tuberosities and coccyx were significantly higher in the wheelchair user group (p < 0.005). Conclusion The fabric identified as the most effective in reducing mean and peak pressures in both groups was the spacer fabric, suggesting that a spacer fabric sling is more likely to reduce the risk of pressure ulcer development. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      PubDate: 2017-12-12T06:22:40Z
      DOI: 10.1016/j.jtv.2017.12.001
       
  • Grand convergence in wound healing - The imperative for collaboration in
           research, innovation and quality improvement
    • Authors: Ray Samuriwo
      Abstract: Publication date: Available online 1 November 2017
      Source:Journal of Tissue Viability
      Author(s): Ray Samuriwo


      PubDate: 2017-11-05T19:41:46Z
      DOI: 10.1016/j.jtv.2017.10.003
       
  • Dynamic computational simulations for evaluating tissue loads applied by
           Regulated negative pressure-assisted wound therapy (RNPT) system for
           treating large wounds
    • Authors: Rona Katzengold; Moris Topaz; Amit Gefen
      Abstract: Publication date: Available online 28 October 2017
      Source:Journal of Tissue Viability
      Author(s): Rona Katzengold, Moris Topaz, Amit Gefen
      Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems.

      PubDate: 2017-10-29T12:08:59Z
      DOI: 10.1016/j.jtv.2017.10.004
       
  • Monitoring the biomechanical and physiological effects of postural changes
           during leisure chair sitting
    • Authors: Peter R. Worsley; Dan Rebolledo; Sally Webb; Silvia Caggiari; Dan L. Bader
      Abstract: Publication date: Available online 12 October 2017
      Source:Journal of Tissue Viability
      Author(s): Peter R. Worsley, Dan Rebello, Sally Webb, Silvia Caggiari, Dan L. Bader
      Background Individuals with limited mobility can spend prolonged periods in leisure chairs, increasing their risk of developing a seated acquired pressure ulcer. The present study aims to use objective measures of posture and tissue viability to identify the associated risks of leisure chair related pressure ulcers. Methods Healthy participants (n = 13) were recruited to sit on a leisure chair with either a viscoelastic foam or air cushion. Participants were asked to adopt four different postures for a period of 10 min followed by a 10 min refractory period. Measurements at the leisure chair-participant interface included interface pressure, transcutaneous tissue gas tensions at the ischial tuberosities, accelerometer data collected from the sternum and subjective comfort levels. Results Results indicated that interface pressures remained consistent, with peak pressure index values of less than 60 mmHg across all conditions. A proportion of participants exhibited decreased oxygen tensions associated with increased carbon dioxide tensions during one or more test condition. This was particularly prevalent during the right lean posture on the air cushion (46%). In all cases, normal tissue viability was restored during standing. The accelerometer was able to detect significant changes (p < 0.05) in relative trunk angles during slump and right lean when compared to optimal sitting posture. Conclusion Commercially available leisure chairs have little evidence to support their pressure relieving properties. This study revealed that a proportion of healthy individuals demonstrated a compromised tissue viability in specific postures. Further research is required to assess the impact of these sitting conditions in vulnerable individuals.

      PubDate: 2017-10-16T17:13:51Z
      DOI: 10.1016/j.jtv.2017.10.001
       
  • Developing the tissue viability seating guidelines
    • Authors: Melanie Stephens; Carol Bartley; Ria Betteridge; Ray Samuriwo
      Abstract: Publication date: Available online 13 September 2017
      Source:Journal of Tissue Viability
      Author(s): Melanie Stephens, Carol Bartley, Ria Betteridge, Ray Samuriwo
      Background Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on seating and preventing pressure ulcers. At the request of the UK Tissue Viability Society the aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. Methods and findings The evidence base informing the guidelines was obtained by applying a triangulation of methods: a literature review, listening event and stakeholder group consultation. The purpose was to engage users and carers, academics, clinicians, inspectorate and charities, with an interest in seating, positioning and pressure management to: gather views, feedback, stories, and evidence of the current practices in the field to create a greater awareness of the issue. Conclusion The new guidelines are inclusive of all people with short and long-term mobility issues to include all population groups. The document includes evidence on where pressure ulcers develop when seated, risk factors, best possible seated position and what seat adjustments are required, the ideal seating assessment, interventions, self-help suggestions and key seating outcomes. The updated TVS CPGs have been informed by the best available evidence, the insights and wisdom of experts, stakeholders and people who spend extended periods of time sitting.

      PubDate: 2017-09-18T05:34:45Z
      DOI: 10.1016/j.jtv.2017.09.006
       
  • Understanding the association between pressure ulcers and sitting in
           adults what does it mean for me and my carers' Seating guidelines for
           people, carers and health & social care professionals
    • Authors: M. Stephens; C. Bartley
      Abstract: Publication date: Available online 6 September 2017
      Source:Journal of Tissue Viability
      Author(s): M. Stephens, C. Bartley
      The aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. This publication was developed at the request of the Tissue Viability Society in order to revise the original seating guidelines from 2008 as evidence and subsequent care has moved forward in relation to this area. Since 2008, the costs for the prevention and management of pressure ulcers have increased significantly and there is limited published advice from health and social care organisations on seating and preventing pressure ulcers. These guidelines have been written for: • People • Carers • Health and Social Care professionals • Education and training staff • Independent sector. Who live or work in primary, secondary, and tertiary settings.

      PubDate: 2017-09-11T05:36:37Z
      DOI: 10.1016/j.jtv.2017.09.004
       
  • Adaptation of a MR imaging protocol into a real-time clinical biometric
           ultrasound protocol for persons with spinal cord injury at risk for deep
           tissue injury: A reliability study
    • Authors: Jillian M. Swaine; Andrew Moe; William Breidahl; Daniel L. Bader; Cees W.J. Oomens; Leanne Lester; Edmond O'Loughlin; Nick Santamaria; Michael C. Stacey
      Abstract: Publication date: Available online 1 August 2017
      Source:Journal of Tissue Viability
      Author(s): Jillian M. Swaine, Andrew Moe, William Breidahl, Daniel L. Bader, Cees W.J. Oomens, Leanne Lester, Edmond O'Loughlin, Nick Santamaria, Michael C. Stacey
      Background High strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound. Material and methods Part 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed. Results AB between-operator reliability was good (ICC = 0.81–0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = −0.028 and −0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75–0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = −0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10). Conclusion A MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.

      PubDate: 2017-08-09T05:45:06Z
      DOI: 10.1016/j.jtv.2017.07.004
       
  • Personalized modeling for real-time pressure ulcer prevention in sitting
           posture
    • Authors: Vincent Luboz; Mathieu Bailet; Christelle Boichon Grivot; Michel Rochette; Bruno Diot; Marek Bucki; Yohan Payan
      Abstract: Publication date: Available online 15 June 2017
      Source:Journal of Tissue Viability
      Author(s): Vincent Luboz, Mathieu Bailet, Christelle Boichon Grivot, Michel Rochette, Bruno Diot, Marek Bucki, Yohan Payan
      Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up.

      PubDate: 2017-06-17T05:38:53Z
      DOI: 10.1016/j.jtv.2017.06.002
       
  • Beware of the toilet: The risk for a deep tissue injury during toilet
           sitting
    • Authors: Maayan Lustig; Ayelet Levy; Kara Kopplin; Zehava Ovadia-Blechman; Amit Gefen
      Abstract: Publication date: Available online 23 April 2017
      Source:Journal of Tissue Viability
      Author(s): Maayan Lustig, Ayelet Levy, Kara Kopplin, Zehava Ovadia-Blechman, Amit Gefen
      A pressure injury (PrI) compromises quality of life and can be life-threatening. The fundamental cause of PrIs is sustained deformations in weight-bearing soft tissues, e.g., during prolonged sitting on inadequate surfaces such as a toilet seat. In nursing homes and geriatric facilities, patients need assistance using the restroom, and patients being left on the toilet for tens-of-minutes is a real-world scenario, unfortunately. Nevertheless, there are no published studies regarding sustained tissue loads during toilet sitting and their effects on tissue physiology. Here, the biomechanical and microcirculatory responses of the buttock tissues to toilet sitting were investigated using finite element modeling and cutaneous hemodynamic measurements, to explore the potential etiology of PrIs occurring on the toilet. We found that prolonged sitting on toilet seats involves a potential risk for PrI development, the extent of which is affected by the seat design. Additionally, we found that specialized toilet seat cushions are able to reduce this risk, by lowering instantaneous tissue exposures to internal stresses (by up to 88%) and maintaining reduced interface pressures. Furthermore, hemodynamic variables were altered during the toilet sitting; in particular, tcPO2 was decreased by 49% ± 7% (44 ± 2[mmHg] to 22 ± 4[mmHg]) during sitting. The current study confirms that investing in expensive PrI prevention (PIP) products is likely to be ineffective for an immobilized patient who is left to sit on a bare toilet seat for long times. This argument highlights the need for a holistic-care approach, employing PIP devices that span across the entire environment where bodyweight forces apply to tissues.

      PubDate: 2017-04-25T05:45:46Z
      DOI: 10.1016/j.jtv.2017.04.005
       
  • An MRI investigation of the effects of user anatomy and wheelchair cushion
           type on tissue deformation
    • Authors: David Brienza; Jaxon Vallely; Patricia Karg; Jonathan Akins; Amit Gefen
      Abstract: Publication date: Available online 11 April 2017
      Source:Journal of Tissue Viability
      Author(s): David Brienza, Jaxon Vallely, Patricia Karg, Jonathan Akins, Amit Gefen
      Aim of the study Tissue deformation is recognized as an important risk factor for pressure injuries. This study investigated the effects of anatomy and wheelchair cushion type on tissue deformation. Materials and methods Direct 3-dimensional tissue deformation response was measured for six participants sitting on six different wheelchair cushions using MR imaging. Two participants had a traumatic spinal cord injury (SCI) within one year of the assessment, two sustained traumatic SCI at least 13 years prior, and two were without SCI. Tissue deformation was quantified using the difference in volume of tissue beneath the ischial tuberosity (IT) between unloaded and loaded (sitting) conditions. Results The participants with SCI tended to have less muscle tissue volume beneath their ITs while sitting compared to participants without SCI. Reductions in muscle and fat volumes in the loaded conditions varied depending on both cushion and participant. Higher interface pressures tended to be associated with lower unloaded tissue thicknesses. Conclusion The study showed no single cushion type tested produced the lowest amount of tissue deformation across all participants. Individual anatomy and cushion type effect deformation response of tissue and related pressure injury risk.

      PubDate: 2017-04-18T05:44:22Z
      DOI: 10.1016/j.jtv.2017.04.001
       
  • Preliminary development of an advanced modular pressure relief cushion:
           Testing and user evaluation
    • Authors: Tyler Freeto; Steven J. Mitchell; Kath M. Bogie
      Abstract: Publication date: Available online 20 March 2017
      Source:Journal of Tissue Viability
      Author(s): Tyler Freeto, Steven J. Mitchell, Kath M. Bogie
      Study aim Effective pressure relief cushions are identified as a core assistive technology need by the World Health Organization Global Cooperation on Assistive Technology. High quality affordable wheelchair cushions could provide effective pressure relief for many individuals with limited access to advanced assistive technology. Materials Value driven engineering (VdE) principles were employed to develop a prototype modular cushion. Low cost dynamically responsive gel balls were arranged in a close packed array and seated in bilayer foam for containment and support. Two modular cushions, one with high compliance balls and one with moderate compliance balls were compared with High Profile and Low Profile Roho® and Jay® Medical 2 cushions. Methods ISO 16480-2 biomechanical standardized tests were applied to assess cushion performance. A preliminary materials cost analysis was carried out. A prototype modular cushion was evaluated by 12 participants who reported satisfaction using a questionnaire based on the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) instrument. Results Overall the modular cushions performed better than, or on par with, the most widely prescribed commercially available cushions under ISO 16480-2 testing. Users rated the modular cushion highly for overall appearance, size and dimensions, comfort, safety, stability, ease of adjustment and general ease of use. Cost-analysis indicated that every modular cushion component a could be replaced several times and still maintain cost-efficacy over the complete cushion lifecycle. Conclusion A VdE modular cushion has the potential provide effective pressure relief for many users at a low lifetime cost.
      Graphical abstract image

      PubDate: 2017-03-21T13:32:49Z
      DOI: 10.1016/j.jtv.2017.03.001
       
 
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