Support surfaces for pressure ulcer prevention.

BACKGROUND: Pressure ulcers (also known as bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions: to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the incidence of pressure ulcers compared with standard support surfaces? how effective are different pressure-relieving surfaces in preventing pressure ulcers, compared to one another? SEARCH STRATEGY: The Specialised Trials Register of the Cochrane Wounds Group (compiled from regular searches of many electronic databases including MEDLINE, CINAHL and EMBASE plus handsearching of specialist journals and conference proceedings) was searched up to January 2004, Issue 3, 2004 of the Cochrane Central Register of Controlled Trials was also searched. The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure ulcers, in any patient group, in any setting. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as incidence and severity of new of pressure ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: 41 RCTs were included in the review. Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of alternating and constant low pressure devices, and of the different alternating pressure devices for pressure ulcer prevention are unclear.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure ulcer incidence, although one study indicated that an overlay resulted in adverse skin changes. One trial indicated that Australian standard medical sheepskins prevented pressure ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure ulcer incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and an operating theatre overlay are harmful. REVIEWERS' CONCLUSIONS: In people at high risk of pressure ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in post-operative incidence of pressure ulcers. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated

Diversité et Stabilité des Alpes. De la fragilité des méthodes d'analyse globale d'un espace transnational

Bridel Laurent. Diversité et Stabilité des Alpes. De la fragilité des méthodes d'analyse globale d'un espace transnational. In: Le Globe. Revue genevoise de géographie, tome 125, 1985. Les Alpes dans le temps et dans l'espace. pp. 31-59

Chronique helvétique : les lieux de vacances (1962-1964) d'une population de touristes interrogés dans le canton de Vaud

Bridel Laurent. Chronique helvétique : les lieux de vacances (1962-1964) d'une population de touristes interrogés dans le canton de Vaud. In: Revue Géographique de l'Est, tome 10, n°1-2, Janvier-juin 1970. Varia. pp. 125-138

Les candidatures suisses aux Jeux Olympiques d'hiver

ENG : Olympic Winter Games! political geography! SwitzerlandFRE : Jeux Olympiques d'hiver! géographie politique! SuisseBridel Laurent. Les candidatures suisses aux Jeux Olympiques d'hiver. In: Revue de géographie alpine, tome 79, n°3, 1991. pp. 37-44

La géographie appliquée au tourisme

Bridel Laurent. La géographie appliquée au tourisme. In: Le Globe. Revue genevoise de géographie, tome 109, 1969. pp. 5-6

L'économie rurale de la cluse alpestre du Rhône

Zone de transition, la cluse alpestre du Rhône comprend deux secteurs: l'étroit défilé de Martigny à St-Maurice, d'une faible activité agricole et la large plaine qui s'étend jusqu'au lac, où l'industrie le dispute en importance à l'agriculture. L'équipement et l'aménagement du terroir étant presqu' achevés, le développement agricole dépend avant tout de la politique économique officielle.Bridel Laurent. L'économie rurale de la cluse alpestre du Rhône. In: Revue de géographie de Lyon, vol. 33, n°2, 1958. pp. 153-172

Les Alpes : Espace cloisonné ou solidaire ?

Summary. — The author, with the assistance of mathematical methods, try an analysis of the regional alpine diversity as a function made of nineteen variables. He founds upon the study of administrative units. At once twenty seven major units which include parts of the borderland down to Munchen, Milano and Marseille; and then a hundred and three smaller ones.Riassunto. — L'autore tenta l'analisi matematica délia diversità régionale délie Alpi, secondo 19 fattori. Prende in esame unità amminis- trative : prima, 27 grandi unità (regioni) conglobando zone estese dipianura (fino a Monaco, Milano, Marsiglia); poi, 103 unità più piccole (provincie).Résumé. — L'auteur s'interroge sur la pertinence des frontières entre nations comme fondement d'une géographie régionale des Alpes. S 'appuyant sur différentes méthodes quantitatives, il compare des critères socio-économiques selon un cadre macro-régional, puis micro-régional. Des typologies spatiales sont mises en évidence, typologies qui peuvent servir de base de réflexion pour un aménagement global de l'Arc Alpin.Bridel Laurent. Les Alpes : Espace cloisonné ou solidaire ?. In: Revue de géographie alpine, tome 73, n°3, 1985. pp. 273-296

Jean-Pierre Gaudin : Le milieu du monde.

Bridel Laurent. Jean-Pierre Gaudin : Le milieu du monde.. In: Revue de géographie alpine, tome 83, n°4, 1995. pp. 118-119

Jean-Pierre Gaudin : Le milieu du monde.

Bridel Laurent. Jean-Pierre Gaudin : Le milieu du monde.. In: Revue de géographie alpine, tome 83, n°4, 1995. pp. 118-119

Gestion du risque d'avalanche et action collective dans les Alpes suisses

Abstract : The residents of mountain communities exposed to avalanches know the risks associated with such events through their own field of experience. Under pressure from the public authorities, the risks are managed through the implementation of protective, zoning and monitoring measures, which are generally well accepted by the local population. However, two case studies show that effective action may be delayed for a long time because of financial reasons or disagreement between the social players involved. The local population is more concerned about economic and social developments than a possible aggravation of the situation regarding avalanche risks.Partie III - Action collective et gestion territoriale Part III - Collective Action and planning Gestion du risque d'avalanche et action collective dans les Alpes suisses Management of avalanche risks and collective action in the Swiss Alps Laurent Bridel, Sylvie Dulex Putallaz, Anne Herold-Revaz Résumé : Les résidants des communes montagnardes exposées aux avalanches connaissent ce risque dans la mesure de leur proche expérience. Sous la pression des autorités, le risque est géré par des mesures de protection, de zonage ou de surveillance de manière générale bien acceptées par la population. Toutefois, les deux études de cas montrent que les actions efficaces peuvent être longuement différées pour des raisons financières ou de désaccord entre les divers acteurs sociaux concernés. La population de montagne est plus soucieuse de l'évolution économique et sociale que d'une possible aggravation du risque d'avalanche.Bridel Laurent, Dulex Putallaz Sylvie, Herold-Revaz Anne. Gestion du risque d'avalanche et action collective dans les Alpes suisses. In: Revue de géographie alpine, tome 86, n°2, 1998. pp. 77-90