The clinical applicability of sensor technology with body position detection to combat pressure ulcers in bedridden patients

Introduction: Pressure Ulcers (PUs) are a major healthcare issue leading to prolonged hospital stays and decreased quality of life. Monitoring body position changes using sensors could reduce workload, improve turn compliance and decrease PU incidence. Method: This systematic review assessed the clinical applicability of different sensor types capable of in-bed body position detection. Results: We included 39 articles. Inertial sensors were most commonly used (n = 14). This sensor type has high accuracy and is equipped with a 2–4 hour turn-interval warning system increasing turn compliance. The second-largest group were piezoresistive (pressure) sensors (n = 12), followed by load sensors (n = 4), piezoelectric sensors (n = 3), radio wave-based sensors (n = 3) and capacitive sensors (n = 3). All sensor types except inertial sensors showed a large variety in the type and number of detected body positions. However, clinically relevant position changes such as trunk rotation and head of bed elevation were not detected or tested. Conclusion: Inertial sensors are the benchmark sensor type regarding accuracy and clinical applicability but these sensors have direct patient contact and (re)applying the sensors requires the effort of a nurse. Other sensor types without these disadvantages should be further investigated and developed. We propose the Pressure Ulcer Position System (PUPS) guideline to facilitate this.</p

The clinical applicability of sensor technology with body position detection to combat pressure ulcers in bedridden patients

Introduction: Pressure Ulcers (PUs) are a major healthcare issue leading to prolonged hospital stays and decreased quality of life. Monitoring body position changes using sensors could reduce workload, improve turn compliance and decrease PU incidence. Method: This systematic review assessed the clinical applicability of different sensor types capable of in-bed body position detection. Results: We included 39 articles. Inertial sensors were most commonly used (n = 14). This sensor type has high accuracy and is equipped with a 2–4 hour turn-interval warning system increasing turn compliance. The second-largest group were piezoresistive (pressure) sensors (n = 12), followed by load sensors (n = 4), piezoelectric sensors (n = 3), radio wave-based sensors (n = 3) and capacitive sensors (n = 3). All sensor types except inertial sensors showed a large variety in the type and number of detected body positions. However, clinically relevant position changes such as trunk rotation and head of bed elevation were not detected or tested. Conclusion: Inertial sensors are the benchmark sensor type regarding accuracy and clinical applicability but these sensors have direct patient contact and (re)applying the sensors requires the effort of a nurse. Other sensor types without these disadvantages should be further investigated and developed. We propose the Pressure Ulcer Position System (PUPS) guideline to facilitate this.</p

Local delivery of brain-derived neurotrophic factor on the perforated round window membrane in Guinea pigs : A possible clinical application

Hypothesis/Background: Local delivery of neurotrophic factors on the intact round window membrane (RWM) of hair cell-deprived cochleas reduces degeneration of the cochlear nerve. In an animal model of profound hearing loss, we investigated whether this otoprotective effect could be enhanced by perforation of the RWM. Such method could be highly relevant for future clinical applications. Methods: Guinea pigs were deafened by coadministration of kanamycin and furosemide. Two weeks after deafening, Gelfoam cubes infiltrated with brain-derived neurotrophic factor (BDNF) were deposited onto the RWM of the right cochlea. In the experimental condition, the RWM was perforated. Electrically evoked auditory brainstem responses (eABRs) were recorded weekly. Two or four weeks after Gelfoam placement, both left (untreated) and right (BDNF-treated) cochleas were processed for histology. Results: In BDNF-treated cochleas, both with and without perforation, neural survival in the basal turn of the cochlea was significantly larger than in untreated cochleas. Amplitudes of electrically evoked auditory brainstem responses were larger in BDNF-treated cochleas with an RWM perforation than in those without a perforation and comparable to those of normal-hearing controls. Perforation did not lead to collateral cochlear damage. Conclusion: When considering clinical applications of neuroprotective agents such as BDNF, delivery on a perforated RWM seems to be a safe and effective option

Effect of Midface Surgery on Ocular Outcomes in Patients with Orbital and Midface Malformations

(1) Background: Orbital and midface malformations occur in multiple craniofacial disorders. Depending on the deformity, surgical corrections include orbital box osteotomy (OBO), Le Fort III (LFIII), monobloc (MB), and facial bipartition (FB). The aim of this study was to determine the effect of these procedures on ocular outcomes. (2) Methods: A retrospective analysis was performed. All patients with craniofacial disorders who had previously undergone midface surgery were included. The Wilcoxon signed ranks test was used for statistical analysis. (3) Results: In total, 63 patients were included: two patients were treated by OBO, 20 by LFIII, 26 by MB, and 15 by FB. Pre-operatively, strabismus was present in 39 patients (61.9%), in whom exotropia was most common (n = 27; 42.9%), followed by esotropia (n = 11; 17.5%). Postoperatively, strabismus significantly worsened (p = 0.035) in the overall population (n = 63). Pre-operative binocular vision (n = 33) was absent in nine patients (27.3%), poor in eight (24.2%), moderate in 15 (45.5%), and good in one (3.0%). Postoperatively, binocular vision significantly improved (p < 0.001). Before surgery, the mean visual acuity (VA) in the better eye was 0.16 LogMAR (Logarithm of the Minimum Angle of Resolution), and 0.31 LogMAR in the worse eye. Furthermore, pre-operative astigmatism was present in 46 patients (73.0%) and hypermetropia in 37 patients (58.7%). No statistical difference was found for VA (n = 51; p = 0.058) postoperatively. (4) Conclusions: Midface surgery has a direct and indirect substantial effect on several ocular outcomes. This study emphasizes the importance of appropriate ophthalmological evaluation in patients with craniofacial disorders undergoing midface surgery

Salvaging a Failed Total Nasal Reconstruction Using Radial Forearm and Forehead Flaps

Reconstruction of a saddle nose deformity, as a result of subtotal septum and hard palate necrosis due to cocaine abuse, requires a stepwise, multistaged approach using a free flap for lining and a forehead flap for cover including careful preparation and monitoring of the patient. The patient presented with a collapsed and contracted nose and scarred forehead and cheeks after previously failed nasal reconstruction attempts with multiple rib and concha cartilage grafts, local intranasal and buccogingival transposition flaps, a paramedian forehead flap, nasolabial flaps, and a facial artery musculomucosal (FAMM) flap. A stepwise nasal reconstruction consisting of nine stages was subsequently performed with a folded radial forearm free flap, cartilage rib grafts, and two forehead flaps for reconstruction of the nasal inner lining, support, and cover, respectively. The reconstruction was complicated by partial flap necrosis of the radial forearm free flap and extrusion of the tissue expander due to breakdown of the forehead skin. This case demonstrates that in patients with substance abuse cessation is essential, and that free flap surgery is a preferred choice for reconstruction of the inner lining in this population. It shows that, despite multiple previous operations and the occurrence of complications, still a satisfactory functional and esthetic outcome may be achieved, provided that the reconstructive plan and handling of complications are good

Who Should Fill Out a Pediatric PROM? Psychometric Assessment From a Clinical Perspective in 567 Children With a Cleft

Background:The CLEFT-Q is a questionnaire developed for patients with a cleft lip and/or palate (CL/P). Numerous scales have been implemented as part of the ICHOM Standard Set for CL/P. Although validated for completion by patients only, clinicians noted that caregivers are often involved in completion of the scales. Aim of the study was to promote further standardization of Patient Reported Outcome Measures (PROMs) in pediatric patients by examining the preferences of patients and parents concerning the reporter type. Moreover, possible discrepancies in outcomes between reporter types were explored. Methods: Data from 567 patients with CL/P and their caregivers that completed scales of the CLEFT-Q questionnaire were collected. Reporter group sizes and proportions were examined at the ages of 8, 12, and 15 years to determine the preferred manner of completion. Mean outcomes were analyzed per scale at the 3 ages, and compared between the 3 reporter groups: “patient,” “caregiver,” and “together.” Results: In all age-groups, the majority completed the PROMs together. Concerning the reporter types per age-group, an upward trend was seen in the proportion of patients that completed the scales alone. In the caregiver group, a downward trend was observed, and the highest proportion of parents that completed the scales was found at age 8. No significant differences were found between the reporter types in any of the scales. Conclusion: Even if a PROM questionnaire is validated for patient report only, it is recommended to record the reporter type when a pediatric PROM is completed. In order to capture outcomes that represent the patient’s voice validly and reliably, though with support of the caregiver, a pediatric PROM should be filled out by the patient alone and thereafter evaluated with the caregiver(s). Concerning the CLEFT-Q, there seems to be demand for a validated parent-version of the scales.</p