[Bed making in the bedding center or as hotel beds].
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Beds↗
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The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries.
In Europe, the reduction of acute care hospital beds has been one of the measures implemented to restrict hospital expenditure. The aim of this study is to gain insight into the effect bed reductions have on the use of the remaining beds within different healthcare systems. We concentrated on two healthcare system elements: hospital financing system (per diem and global budget systems) and physician remuneration system (fee-for-service and salary systems). We also controlled for technological development and demand for healthcare. We used data from the OECD health data files of 10 North-Western European countries on hospital bed supply and use. The hospital bed indicators used were occupancy rate, average length of stay and admission rate. The data were analysed with multilevel analysis. We found some indication that the different financial incentives of hospital financing systems do indeed influence hospital bed use in the case of reductions in acute care hospital bed supply in different ways. However, we found significant effects only for the hospital bed use indicators "occupancy rate" and "admission rate". For physician financing systems, no significant effects were found.
Bed Occupancy↗
Hazards of mattresses, beds and bedding in deaths of infants.
Of 52 infants who had died suddenly and were referred to autopsy, nine had lain on adult water beds for the first time; five had died as a result of accidents; two had died on water beds; two were in beds with widely spaced slats; and one had died as a result of strangulation. Three deaths were due to overlying. Three other infants had been placed on sheepskin rugs for the first time and were found dead shortly thereafter. These infants ranged in age from 2 to 9 months, except for a severely mentally retarded nine-year-old with spastic paraplegia. We believe that a general warning should be issued concerning water beds and that soft bedding should not be used for infants. Infants should not be placed unattended or left to sleep on water beds; only beds recommended for infants should be used. Overlying of a young infant is most likely to occur on a water bed, or if the parent is obese or has consumed alcohol.
Accidents↗
Modification of bed systems and use of accessories to reduce the risk of hospital-bed entrapment.
Despite the long history of hospital-bed use, only in the past decade have bed-related patient-safety hazards, including falls and life-threatening entrapment, been discussed publicly. Entrapment is an event in which a patient is caught, trapped, or entangled in hospital-bed components, including the bed rail, mattress, or hospital-bed frame. Since 1995, the Food and Drug Administration and the Joint Commission on Accreditation of Healthcare Organizations have issued patient-safety alerts about entrapment. While new beds are being manufactured without large gaps that would allow an individual's head, neck, or chest to become entrapped, it is incumbent upon healthcare providers, including rehabilitation nurses, to ensure the safety of older beds in use. This article describes a facility-based approach for identifying and managing risk related to hospital bed-entrapment to be used in rehabilitation settings.
Accident Prevention↗
Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews.
OBJECTIVES: To examine the relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units and to explore the range of alternative residential options. DESIGN: Cross sectional survey, combined with one day census data; ratings by and interviews with staff; examination of routine data sources. SETTINGS: Nationally representative sample of acute psychiatric units. SUBJECTS: 2236 patients who were inpatients on census day. MAIN OUTCOME MEASURES: Bed occupancy levels, judged need for continuing inpatient care, reasons preventing discharge, scores on the Health of the Nation outcome scales. RESULTS: Bed occupancy was related to social deprivation and total availability of acute beds (r = 0.66, 95% confidence interval 0.19 to 0.88, F = 8.72, df = 2.23; P = 0.002). However, 27% (603/2215) of current inpatients (61% (90/148) of those with stays of > 6 months) were judged not to need continuing admission. The major reasons preventing discharge were lack of suitable accommodation (37% (176/482) of patients in hospital < 6 months v 36% (31/86) of those in hospital > 6 months); inadequate domiciliary based community support (23% (113) v 9% (8)); and lack of long term rehabilitation places (21% (100) v 47% (40)). Scores on the Health of the Nation outcome scale were generally consistent with these staff judgments. CONCLUSIONS: The shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds. Patients currently inappropriately placed on acute admission wards should be relocated into more suitable accommodation, either in hospital or in the community. A range of provisions is required; simply providing more acute beds is not the answer.
Acute Disease↗
Profiling beds versus standard hospital beds: effects on pressure ulcer incidence outcomes.
Most standard hospital beds are flat based with a pull-out backrest, resulting in a tendency for the patient to slide down the bed. This study aimed to compare the outcome for patients at high risk of developing pressure ulcers nursed on either this type of bed or an electrically operated, multi-sectioned profiling bed. A total of 100 patients were randomly assigned either to the profiling bed with a pressure-reducing foam mattress (experimental group) or a flat-based bed with an appropriate pressure-redistributing mattress (control group) for a maximum of 10 days. Risk status and pressure damage were assessed daily. Both a patient and a nurse questionnaire were completed. Data from 70 patients who participated in the study for five days or more were included in the analysis. Pressure ulcer incidence was 0% in both groups. All patients (35) in the experimental group were able to maintain a sitting position compared with only 12/35 in the control group (p = 0.0001). While the questionnaire results suggest there were significant differences in postural control and ease of transfer between patients in the two groups, it was not possible to map this to pressure ulcer formation. Poor recruitment into the study was due to the 'blocking' of electric beds by heavily dependent patients who did not meet the inclusion criteria, precluding a significant result in terms of pressure ulcer outcomes. This nurse-led use of the profiling beds was examined alongside the main study to investigate why they were allocated in this way.
Adult↗
Changes in spectra of heart rate and blood pressure variabilities during bed rest and head-up tilt after bed rest.
Changes in the spectra of heart rate and systolic blood pressure variabilities (HRV and SBPV) were recorded during head-down bed rest and head-up tilt (HUT) in 15 healthy young men. After bed rest, five subjects failed to complete HUT test. During bed rest, the low-frequency (LF) and high-frequency (HF) powers of HRV and SBPV spectra were all significantly decreased, the ratio of low-frequency to high-frequency power of HRV spectrum (LF:HFHRV) increased on the 16th day. During the first 6min of HUT after bed rest, the heart rate was faster, but the LF:HFHRV and the LF power of SBPV spectrum in all subjects were similar to the data during HUT before bed rest. The diastolic and mean arterial pressure were significantly increased during HUT except in those who failed to complete the HUT test after bed rest. The results suggest that the peripheral vascular sympathetic activity and the cardiac parasympathetic activity are decreased with a relative increase in the cardiac sympathetic activity during bed rest, but the cardiovascular autonomic responsiveness during HUT after bed rest is basically preserved.
Adult↗
Treatment of nail bed avulsions with split-thickness nail bed grafts.
Experimental studies with squirrel monkeys indicated the feasibility of split-thickness grafting of segments of the nail bed. Thin grafts, when taken from the nail bed, achieved excellent take over of the avulsed areas. Thirty-one patients with avulsion of segments of the nail bed were treated with split-thickness nail bed grafts. The injured nail bed had sufficient residual nail bed to serve as a donor site in 24 patients. The remaining seven patients required split-thickness grafts from the lateral one third of the great toe. Of the 31 treated nail beds, there was a total of five deformities in which there was either nonadherence of the nail or irregularity of the nail surface. Twenty-six had nails with no deformity. No deformities occurred in the graft donor area. The split-thickness nail bed graft offers the advantage of frequent availability of tissue on the same injured digit and the absence of donor site deformity, whether on the same injured digit or a donor great toe.
Animals↗
Suppression of agglomeration in fluidized bed coating. II. Measurement of mist size in a fluidized bed chamber and effect of sodium chloride addition on mist size.
It has been reported that the degree of particle agglomeration in fluidized bed coating is greatly affected by the spray mist size of coating solution. However, the mist size has generally been measured in open air, and few reports have described the measurement of the mist size in a chamber of the fluidized bed, in which actual coating is carried out. Therefore, using hydroxypropylmethyl cellulose (HPMC) aqueous solution as a coating solution, the spray mist size of the coating solution in a chamber of the fluidized bed was measured under various coating conditions, such as the distance from the spray nozzle, fluidization air volume, inlet air temperature and addition of sodium chloride (NaCl) into the coating solution. The mist size in the fluidized bed was compared with that in open air at various distances from the spray nozzle. Further, the relationship between the spray mist size and the degree of suppression of agglomeration at various NaCl concentrations during fluidized bed coating was studied. The mist size distribution showed a logarithmic normal distribution in both cases of the fluidized bed and open air. The number-basis median diameter of spray mist (D50) in the fluidized bed was smaller compared with that in open air. D50 increased with the increasing distance from the spray nozzle in both cases. In the fluidized bed, D50 decreased with the increasing fluidization air volume and inlet air temperature. The effect of NaCl concentration on the mist size was hardly observed, but the degree of suppression of agglomeration during coating increased with the increasing NaCl concentration in the coating solution.
Chemistry, Pharmaceutical↗
The difference between activity when in bed and out of bed. III. Nurses on night work.
Eight nurses have been studied during rest days and three successive night shifts. Measurements of wrist activity have been made and used to assess the extent to which the pattern of daily activity changes between control (rest) days and days involving night work. One analysis considered wrist activity during time spent in bed; this appears to decrease in parallel with the amount of time in bed that is lost during night work but, when this effect is corrected for, there is greater activity during time spent in bed in the daytime compared with control days (when time in bed is during the night). The dichotomy of activity (between lower values during time spent in bed and higher values when out of bed) also decreases if time in bed is during the daytime while on night shifts. These changes in the amount of wrist activity and the dichotomy between activity in and out of bed are related to the changed quality and quantity of sleep that has been measured by self-report questionnaires and the sleep EEG. It is concluded that results from wrist actimetry can provide valuable information regarding the process of adjustment to night work, and that its convenience (to subject and experimenter), coupled with the new analytical approaches described here, make it a viable method for field studies.
Adult↗
Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest.
BACKGROUND: Outcome after mild traumatic brain injury (MTBI) is determined largely by the appearance of post-traumatic complaints (PTC). The prevalence of PTC after six months is estimated to be between 20 and 80%. Bed rest has been advocated to prevent PTC but its effectiveness has never been established. OBJECTIVE: To evaluate the effect of bed rest on the severity of PTC after MTBI. METHODS: Patients presenting with MTBI to the emergency room were randomly assigned to two intervention strategies. One group was advised not to take bed rest (NO) and the other to take full bed rest (FULL) for six days after the trauma. The primary outcome measures were severity of PTC on a visual analogue scale and physical and mental health on the medical outcomes study 36 item short form health survey (SF-36) at two weeks and three and six months after the trauma. RESULTS: Between October 1996 and July 1999, 107 (54 NO, 53 FULL) patients were enrolled. Outcome variables in both groups clearly improved between two weeks and six months. After adjustment for differences in baseline variables, most PTC tended to be somewhat more severe in the FULL group six months after the trauma, but no significant differences were found. Neither were there any significant differences in the outcome parameters between the two groups after three months. Two weeks after the trauma, most PTC in the FULL group were slightly less severe than those in the NO group, and physical subscores of the SF-36 in the FULL group were slightly better. These differences were not significant. Patients in the FULL group reported significantly less dizziness during the intervention period. CONCLUSIONS: As a means of speeding up recovery of patients with PTC after MTBI, bed rest is no more effective than no bed rest at all. Bed rest probably has some palliative effect within the first two weeks after the trauma.
Activities of Daily Living↗
Crisis in admission beds. A four-year survey of the bed state of Greater London's acute psychiatric units.
BACKGROUND: This study was carried out to measure bed occupancy in Greater London's psychiatric units, in response to the apparent shortage of admission beds. METHOD: The bed occupancy of London's 54 National Health Service (NHS) acute psychiatric units within 29 districts was ascertained by telephone on 16 bank holidays covering the period 1990-93. RESULTS: The mean occupancy level for all London over the 4 years was 97.54% (95% CI- +/- 0.94%). The number of beds occupied in inner London was significantly greater (99.79 +/- 1.11%) than in outer London (95.1 +/- 1.49%) (t = 3.85, d.f. = 462, P < 0.001). Bed occupancy for inner London units was > or = 100% on over 49% of occasions. There has been a steady decline in the number of beds over the four-year period. There was a clear correlation between occupancy levels and the Jarman UPA8 Underprivilege Score (r = 0.504) and between bed provision and the UPA8 (r = 0.67). CONCLUSION. Occupancy rates have become unacceptably high and require careful monitoring. Corrective action may be required in order to prevent a breakdown in services.
Bed Occupancy↗
Perceptions of bed nets and malaria prevention before and after a randomized controlled trial of permethrin-treated bed nets in western Kenya.
A study of mothers' perceptions regarding bed nets and malaria was conducted before and after a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya. Awareness about the trial and the rationale for bed net use increased by the end of the trial. Knowledge that mosquitoes caused malaria also increased; however, a higher proportion of mothers from control, rather than intervention villages, cited this (44.4% versus 27.9%; P < 0.001). Mothers from intervention villages were more knowledgeable about the use and maintenance of bed nets and re-treatment with insecticide. Both groups specified advantages of ITNs. Mothers from intervention villages noted practical advantages such as protection against bedbugs and falling roof debris. Few (< 1%) mothers indicated that ITNs protected children against malaria. Intervention homes used significantly fewer mosquito coils, insect spray, medicines, and burned cow dung less often compared with those in control villages. Mothers were willing to pay approximately 4.5 U.S. dollars for a regular bed net, but only 10.5 U.S. cents (intervention) and 0.036 (control) for re-treating a bed net. This study suggests that, despite two years of experience of use, bed nets and insecticides would not be purchased as a household priority in this impoverished rural community.
Adult↗
The use of bed distribution and service population indexes for hospital bed allocation.
To provide an empirical base for bed reallocation within a hospital planning jurisdiction in Canada, this article proposes a population-based method to measure the distribution of acute care beds for each district and the service load for each hospital. The measure for the bed distribution (BDI) is the number of beds per 1,000 age-sex-adjusted number of residents in a district, while the service load of a hospital is measured by the number of persons being served per bed (SPI). The number of beds allocated to each district, or the number of persons served by each hospital, was estimated by applying the hospital service population model, which employs both relevance- and commitment-index methods. The method thus proposed was applied to Alberta data. It appears that both BDI and SPI measures are stable across the variation of methods or data sources, yet sensitive enough to detect changes over the years. Using these indexes, potentially over- or underbedded districts and over- or underloaded hospitals can be identified for further investigation so that possible reallocation of acute care beds among the hospitals may take place.
Adolescent↗
Thin split-thickness toenail bed grafts for avulsed nail bed defects.
Avulsed defect of a fingernail bed is a common injury in acute hand trauma. Insufficient management for this type of nail bed avulsion often leads to an irregular and nonadherent nail. The use of thin split-thickness sterile matrix graft from the great toe for immediate replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail. Between May of 1998 and December of 2001, we used thin split-thickness toenail bed grafts in 13 fingers of 12 patients with avulsed defects of the nail bed. The end results of this technique were excellent and no deformities occurred in the graft donor area. Thin split-thickness toenail bed graft is a good choice for the treatment of acute nail bed avulsion.
Adult↗
Co-bedding versus traditional bedding of multiple-gestation infants in the NICU.
This study was part of a large departmental performance improvement initiative to implement and evaluate developmental and family-centered care as "best practice" in the neonatal intensive care unit (NICU). The goal was to evaluate the safety, effect on infant clinical and developmental outcomes, and maternal satisfaction of co-bedding of multiple-gestation infants compared to traditionally bedded infants/mothers. A secondary purpose was to evaluate co-bedding and American Academy of Pediatrics-recommended "back to sleep" behaviors in the same infants/mothers after discharge. A retrospective, comparative, descriptive design was used. Chart reviews and mailed written surveys were used to collect study data. Findings showed no significant differences in demographic variables or clinical and developmental outcomes between the total traditionally bedded and co-bedded groups. All mothers reported positive experiences with the NICU. Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes. Once policies and education are in place, parents should be offered the option to co-bed multiple-gestation infants in the NICU. There is a performance improvement opportunity regarding the education provided to parents of multiple-gestation infants before discharge on the "back to sleep" recommendations.
Benchmarking↗
Treatment of depressed patients in general hospitals with scatter beds, cluster beds, and psychiatric units.
Records of 725 patients with a primary discharge diagnosis of depression were reviewed at nine general hospitals: three with psychiatric units, three in which patients were treated in beds grouped together on a medical or surgical floor (cluster beds), and three in which patients were treated in beds dispersed among medical and surgical beds (scatter beds). Patients treated in psychiatric units most commonly presented with suicidal or homicidal indicators, most frequently received antidepressants, and had the longest stays. Patients treated in scatter beds tended to present with somatic complaints, were least likely to receive antidepressants, and had the shortest hospital stays. Patients treated in cluster beds presented with intermediate symptoms and had stays of intermediate duration. Although dangerous or psychotic patients may be most appropriately treated in units, other patient groups may be safely and effectively treated at lower cost in less specialized inpatient settings.
Adult↗
Influence of biomass accumulation on bed expansion characteristics of a down-flow anaerobic fluidized-bed reactor.
This article describes the bed expansion characteristics of a down-flow anaerobic fluidized bed reactor treating a synthetic wastewater. Experiments were carried out in a 0.08 m diameter and 1 m length PVC column. The carrier used was ground perlite (an expanded volcanic rock). Particles characteristics were 0.968 mm in diameter, specific density of 213 kg x m-3 and Umf (minimal fluidization velocity): 2.3 m x h-1. Experimental data of terminal velocities and bed expansion parameters at several biofilm thicknesses were compared to different models predicting the bed expansion of up-flow and down-flow fluidized beds. Measured bed porosities at different liquid superficial velocities for the different biofilm thicknesses were in agreement with the Richardson-Zaki model, when Ut (particle terminal velocity) and n (expansion coefficient) were calculated by linear regression of the experimental data. Terminal velocities of particles at different biofilm thicknesses calculated from experimental bed expansion data, were found to be much smaller than those obtained when Cd (drag coefficient) is determined from the standard drag curve (Lapple and Sheperd, 1940) or with others' correlations (Karamanev and Nikolov, 1992a,b). This difference could be explained by the fact that free-rising particles do not obey Newton's law for free-settling, as proposed by Karamanev and Nikolov (1992a,b) and Karamanev et al. (1996). In the present study, the same free-rising behavior was observed for all particles (densities between 213 and 490 kg x m-3).
Anaerobiosis↗