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PubMed1988

Pressure relief capabilities of the Sof.Care bed and the Clinitron bed.

The number of support surfaces marketed as pressure relieving devices has escalated during recent years and objective measures are needed to evaluate those that are effective. The purpose of this study was to compare the pressure relief capabilities of a special three-layered plastic air mattress (Sof.Care Bed Cushion--Gaymar), an air-fluidized bed (Clinitron--Support Systems International) and a standard hospital mattress. Sixty-four volunteers served as their own control as they were rotated onto the three sleep surfaces. Tissue interface pressure measurements were taken over bony prominences where pressure ulcers are most likely to occur: the sacrum, the greater trochanter of the femur and the heels. A one-way analysis of variance was computed for interface measurement scores by type of surface and a statistically significant difference was found among the three surfaces. A Newman-Keuls test was employed to compare the mean scores between two groups at a time. Both the Sof.Care Cushion and the Clinitron Bed differed significantly from the hospital mattress in the ability to relieve pressure. There was no statistical difference between the Sof.Care Cushion and the Clinitron Bed in the ability to relieve pressure over the sacrum, trochanter, or heels. However tissue pressure readings under the heels were greater than 32 mm Hg on both the Clinitron and Sof.Care surfaces. The data from this study, by looking at a larger sample supports our prior findings.

Adult↗

PubMed1983

Free nail bed graft for treatment of nail bed injuries of the hand.

Free full-thickness grafts of nail bed of the lesser toes or an amputated fingertip were successfully performed on 11 fingers of 10 patients since 1979. In nine patients in whom the nail beds had been severely crushed or lost, but the nail matrix was intact, the end results of this technique were excellent. In one patient in whom both the nail bed and matrix had been lost, free grafting of the toenail bed and matrix was performed, with a good result. The procedure can be used when restoring the length of the tip in fingertip amputation if used in combination with local skin flaps such as V-Y advancement or local rotation flaps.

Adult↗

PubMed2003

Expanded bed adsorption processing of mammalian cell culture fluid: comparison with packed bed affinity chromatography.

A comparison between expanded bed adsorption and conventional packed bed Protein A Fast Flow to purify the anti-rHBsAg mAbs from feedstock is presented in this work. Direct capture by STREAMLINE expanded bed adsorption chromatography resulted in 92% product recovery and sevenfold more concentrated product with similar purity levels compared to that obtained by the standard packed method. The process time and buffer consumption were reduced in the expanded bed adsorption method not only with the binding-elution conditions but also with the use of NaOH during the cleaning-in-place step. The latter is the most widely accepted agent in downstream processing, being a cost effective technique that provides not only efficient cleaning but also sanitizes complete column systems and destroys pirogens.

Adsorption↗

PubMed1991

A biomechanical and ergonomic evaluation of patient transferring tasks: bed to wheelchair and wheelchair to bed.

A laboratory study was conducted in an effort to reduce back stress for nursing personnel while performing the patient handling tasks of transferring the patient from bed to wheelchair and wheelchair to bed. These patient handling tasks were studied using five manual techniques and three hoist-assisted techniques. The manual techniques involved one-person and two-person transfers. One manual technique involved a two-person lift of the patient under the arms; the others used a rocking and pulling action and included the use of assistive devices (a gait belt using a two-person transfer, a walking belt with handles using a one-person and a two-person transfer, and a patient handling sling with cutout areas to allow for a hand grip (Medesign) for a one-person transfer). The three mechanical hoists were Hoyer, Trans-Aid and Ambulift. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients. Static biomechanical evaluation showed that pulling techniques, as compared to lifting the patient, required significantly lower hand forces and produced significantly lower erector spinae and compressive forces at the L5/S1 disc (P greater than or equal to 0.01). Shear force, trunk moments and the percentage of females who were capable of performing the transfers (based on static strength simulation) also favoured pulling methods. Perceived stress ratings for the shoulder, upper back, lower back and whole body were lower for pulling methods than those for lifting the patient (P less than or equal to 0.01). Patients found the pulling techniques, with the exception of when using the gait belt, felt more comfortable and more secure than the lifting method (P less than or equal to 0.01). However, a number of subjects believed that the patient handling sling (Medesign) and the walking belt with one person making the transfer would not work for those patients who could not bear weight and those who were heavy, contracted or combative. A walking belt with two persons was the preferred manual method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be as physically stressful as manual methods. Patients found these two hoists to be more uncomfortable and felt less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Ambulift was found to be the least stressful, the most comfortable, and the most secure among all eight methods. Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (P less than or equal to 0.01). The two-person walking belt using a pulling technique and Ambulift are recommended for transferring patients from bed to wheelchair and wheelchair to bed. A large-scale field study is needed to verify these recommendations.

Adult↗

PubMed2004

Purification of L-lysine in simulated moving bed and fixed-bed chromatography.

L-Lysine was produced by a microbial process utilizing a Corynebacterium glutamicum (ATCC 21799) strain. L-Lysine was purified from the cultivated medium by fixed-bed and simulated moving bed (SMB) chromatography. The separation conditions including pH, eluent concentration and Lys+ and Lys2+ adsorption isotherms were studied in batch adsorption. The column capacity, eluent flow rate and eluent concentration have been studied in fixed-bed chromatography. Maximum purification rate of lysine was obtained as 0.066 g/(g x h) (per gram resin and per hour) at an eluent flow rate of 10 mL/min in fixed-bed chromatography. The results obtained from SMB were 0.11 g/(g x h) for L-lysine purification rate and 96% for L-lysine recovery.

Chromatography, Ion Exchange↗

PubMed1989

Controlled trial of hydration and bed rest versus bed rest alone in the evaluation of preterm uterine contractions.

Patients who are seen with uterine contractions but without documented change in cervical dilation or effacement are often treated with intravenous hydration before the initiation of intravenous tocolytic therapy. This is done with the intention of stopping uterine activity in patients with false preterm labor. A prospective randomized study was conducted to evaluate the effect of hydration on preterm uterine contractions in patients without proved preterm labor. A total of 28 patients were treated with bed rest and an intravenous bolus and subsequent continuous infusion of 5% dextrose in lactated Ringer's solution. A control group of 20 patients were treated with bed rest alone. Uterine activity and arrest of uterine contractions were compared between the two groups. Contractions stopped in 54% of the patients treated with hydration, whereas contractions stopped in 40% of the patients in the control group. This difference was not statistically significant. As a crossover study, those in the control group with contractions that continued after the initial observation period were subsequently treated with intravenous fluids. Only one patient in this group stopped contracting. Of all patients whose contractions with either therapy, 18% eventually were delivered of preterm infants. This included 20% of the hydration group and 14% of the control group. The use of hydration as a pretherapy indicator to differentiate true preterm labor from false preterm labor could not be supported by this study. In addition, patients whose contractions stopped with either hydration or bed rest are at increased risk of subsequent preterm delivery.

Bed Rest↗

PubMed1993

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 8. Cost-effectiveness of bed net impregnation alone or combined with chemoprophylaxis in preventing mortality and morbidity from malaria in Gambian children.

In The Gambia, insecticide impregnation of bed nets, used alone or combined with Maloprim, reduced morbidity and mortality from malaria amongst children between one and 4 years of age. Taking expenditure of both time and money by public authorities and village volunteers into account, the costs and cost-effectiveness of each intervention were estimated. Bed net impregnation alone and the combined strategy cost US $5.65 and US $7.49 per child-year protected respectively (1990 figures). Insecticide (and drugs) accounted for more than 80% of the costs of each intervention strategy. They were both highly cost-effective. Estimated costs per death and per clinical episode of malaria averted were US $188 and US $28 for bed net impregnation and $257 and $19 for impregnation combined with chemoprophylaxis. Estimated costs per healthy year of life saved, discounted at 3%, were US $7.90 and US $10.84.

Antimalarials↗

PubMed1992

A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term.

OBJECTIVE: The objective of our study was to test the hypothesis that treatment with nifedipine for mild preeclampsia remote from term reduces the number of days of maternal hospitalization and improves pregnancy outcome. STUDY DESIGN: A total of 200 patients at 26 to 36 weeks' gestation were randomly allocated to treatment with either bed rest alone (n = 100) or bed rest in combination with nifedipine (n = 100). RESULTS: Patients receiving nifedipine had significantly lower systolic (p < 0.0001) and diastolic (p < 0.0001) blood pressures during therapy. Severe hypertension as an indication for delivery was significantly (p < 0.05) more frequent in the bed-rest-alone group. The two study groups had similar average days of maternal hospitalization (12.6 +/- 7.9 vs 12.3 +/- 10.3) and pregnancy prolongation (22.3 +/- 13.5 vs 22.5 +/- 15.7). There were no differences between groups with respect to birth weight, incidences of small-for-gestational-age infants and preterm birth, number of days spent in special care unit, or cord blood gas measurement. CONCLUSION: Nifedipine therapy for preeclampsia reduces maternal blood pressure but does not reduce number of days of maternal hospitalization or improve perinatal outcome.

Bed Rest↗

PubMed2000

'The day of the soft towel?': comparison of the current bed-bathing method with the soft towel bed-bathing method.

The impressions of 200 patients (both medical and surgical) and 200 nursing staff (registered, enrolled and trainee enrolled nurses) in relation to two bed-bathing methods were compared by means of questionnaires and semi-structured interviews. Data regarding costs were obtained from appropriate cost centre managers. The results of the study found the soft towel bed-bathing method to be more cost effective and provide more patient and nurse satisfaction than the current bed-bathing method.

Attitude of Health Personnel↗

PubMed1995

Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer.

Since the early days of human in-vitro fertilization and embryo transfer, rest in bed for hours immediately following the transfer has been advocated and widely practised. However, there is no scientific validation for this practice which is both time-consuming for the patient and increases space occupancy in the hospital or clinic. We report here on a study of 103 in-vitro fertilization cycles with no bed rest in hospital following the embryo transfer. The mean number of embryos transferred was 2.7 (range 1-3) and the clinical pregnancy rate per embryo transfer procedure was 40%. These results suggest that bed rest is not necessary following embryo transfer.

Adult↗

PubMed1995

Quantifying the potential of infant bedding to limit CO2 dispersal and factors affecting rebreathing in bedding.

Rebreathing may impair ventilation and lead to sudden death among sleeping infants. To estimate the potential for rebreathing imposed by an infant's sleep microenvironment, we developed a mechanical model to assess the rate of CO2 dispersal away from an infant's face. We compared the mechanical model results with changes in arterial blood gases of rabbits. The rabbits breathed into the same microenvironments used for the model studies. In the rabbits, rebreathing (documented by capnometry) caused hypercarbia and in some cases death. The mechanical model consisted of the mannequin head positioned as in the rabbit studies and connected to a 100-ml syringe filled with CO2. CO2 was washed out of the system using 30-ml "breaths" (rate = 15/min). The half times (t1/2) for CO2 dispersal served to quantify the rebreathing potential of 16 items of bedding. The t1/2 values correlated with increments in the rabbits' arterial PCO2 (r = 0.789). The threshold for the increase in the rabbits' arterial PCO2 corresponded to t1/2 values of > or = 18.7 s; the 90% point for lethality in the rabbit model was 28.1 s. The mechanical model was also used to show the independent effects of softness and porosity of bedding on its rebreathing potential. By describing the potential for rebreathing within bedding, the mechanical model should be useful in future quantitative studies of infants' respiratory adaptation to sleep microenvironments.

Animals↗

PubMed1991

Factors affecting the supply of private hospital beds in the UK: private insurance, NHS pay beds, or NHS waiting list?

This study attempts to isolate the determinants of private hospital growth in the United Kingdom. Thirty-six variables, representing private medicine, the socio-economic environment, the political and government conditions, and the health care systems characteristics were selected for analysis. Multiple regression analysis shows that the number of independent hospital beds in the UK can be explained almost entirely by the number of persons with private health insurance, the number of NHS pay beds, and the overall bed level. Further analysis reveals that the number of persons with private health insurance can be explained to a large extent by the length of the NHS waiting list.

Health Benefit Plans, Employee↗

PubMed1996

The difference between activity when in bed and out of bed. I. Healthy subjects and selected patients.

The activity records of five groups of healthy or ill subjects have been measured for 4-26 days by an accelerometer placed on the nondominant wrist. These data, together with a record of times retiring to/rising from bed, have been used to produce a series of dichotomy indices for comparing the amounts of activity when in bed and out of bed. Reliable differences between individuals were found, with healthy subjects showing a greater degree of dichotomy than one subject with delayed sleep phase syndrome or three subjects with colorectal cancer. The method is convenient for extended data collection and offers the possibility of describing an individual's activity profile in a variety of circumstances.

Adolescent↗

PubMed1995

"How many beds are needed?": evaluating bed need in managed care setting.

After downsizing, re-engineering, consolidating and merging, health care administrators are still asking the eternal question, "How many beds are needed in my hospital?" The significant capital and operating cost required to support a staffed bed warrants a thorough and in-depth examination of the factors leading to bed need, writes Steven D. Sauer, consultant with Hamilton/KSA.

Bed Occupancy↗

PubMed1994

Let the bed take the strain. An ergonomic approach to hospital bed provision.

1. The use of an ergonomic approach to risk assessment is advocated by the Manual Handling Operations Regulations. 2. Selection of hospital beds is a key factor in reducing the risk of injury from manual handling. 3. The use of electrically operated beds has eliminated many patient handling episodes. 4. The electrically operated beds have increased patient independence.

Beds↗

PubMed1999

Process intensification by direct product sequestration from batch fermentations: application of a fluidised bed, multi-bed external loop contactor

A critical comparison has been made of the relative efficacy of the primary purification of an extracellular acid protease produced by the yeast Yarrowia lipolytica. The performance of conventional, discrete sequences of fermentation, broth clarification and fixed bed, anion exchange chromatography has been compared with fluidised bed adsorption directly interfaced with post-term fermentation broth and fluidised bed adsorption directly integrated with productive fermentations (so-called direct product sequestration; DPS). Advantages of the latter, in terms of the improved yield and molecular quality of the protease end product are discussed in terms of the design, assembly and operation of component parts of DPS devices and their generic application to other extracellular bioproducts of microbial fermentations. Copyright 1999 John Wiley & Sons, Inc.

Journal Article↗

PubMed1999

The influence of complex biological feedstock on the fluidization and bed stability in expanded bed adsorption

The stability of expanded bed adsorption systems (EBA) was studied in biomass containing culture broth by residence time distribution (RTD) experiments, using pulse inputs of fluorescent molecules as tracers. Different commercial adsorbents (Streamline DEAE, SP, Phenyl, Chelating, and AC) were tested at various biomass concentrations (2.5-12 %, wet weight) of whole (Saccharomyces cerevisiae) yeast, yeast cell homogenate, and Escherichia coli homogenate. Analyzing the RTD according to the PDE model (PDE: axially dispersed plug-flow exchanging mass with stagnant zones) allowed the calculation of three parameters: the number of transfer units for mass exchange between mobile and stagnant fraction (N), the Peclet number for overall axial dispersion (P), and the mobile fraction of the liquid in axially dispersed plug flow (varphi). When fluidization was performed in particle-free buffer the normalized response signal (after perfect input pulse) was symmetric (N:0; P: 50-100; varphi: 1), thus, demonstrating the formation of a homogeneous fluidized (expanded) bed. Upon application of suspended biomass the RTD was skewed, depending on the adsorbent used and the type and level of biomass present in the sample. This situation leads to three different characteristic pictures: the well-fluidized system (N: >/= 7-10; P: >/= 40; varphi: 0.80-0.90), the system exhibiting bottom channeling (N: < 1-2; P: >/= 40; varphi: 0.5-0.7) and, the system where extensive agglomeration develops (N: 4-7; P: 20-40; varphi: < 0.5). These results demonstrate that changes in the hydrodynamics of EBA already take place in the presence of moderate concentrations of biomass. Furthermore, those changes can be quantitatively described mainly in terms of the fraction of stagnant zones in the system, which are formed due to the interaction of biomass and adsorbent. The technique described here can be used to evaluate a certain combination of adsorbent and biomass with regard to its suitability for expanded bed adsorption from whole broth. Copyright 1999 John Wiley & Sons, Inc. Biotechol Bioeng 64: 484-496, 1999.

Journal Article↗

PubMed1984

Morphology of the microvascular bed in primary human carcinomas of lung. Part II. Morphometric investigations of microvascular bed of lung tumors.

A comparative investigations of peripheral microvascular bed in various histological types of human primary lung carcinomas (squamous cell carcinomas, oat-cell carcinomas, adenocarcinomas and large cell carcinomas) have been performed. The study was performed on 52 cases of lung carcinoma (there were 49 cases from autopsy and 3 cases from surgery) and on 8 normal comparative cases for evaluation of unchanged bronchial mucosa. Tissue blocks were obtained from standardized parts of bronchus and contained the intra- and extrabronchial parts of tumour as well as the bordering bronchial mucosa. The relative capacities of: 1. anaplastic cells, 2. connective tissue in stroma, 3. intraluminal space of blood vessels, 4. degenerative anaplastic cells, 5. necrotic detritus, and 6. haemorrhages and erytrorrhages were estimated in carcinomatous tissue by the hit points method. In bronchial mucosa the capacities of: 1. intraluminal space of blood vessels, and 2. haemorrhages and erythrorrhages were recorded. Furthermore, the structure of peripheral microvascular bed was evaluated by constructing the distributive series of diameters of blood vessels. These distributive series were approximated with the analitical function. It was found that the largest capacity of blood vessels (with an extremely developed capillary segment of vascular bed) is in the intrabronchial part of squamous cell carcinomas. In the extrabronchial part of this type of carcinoma, the capacity of blood vessel is about three-times smaller than in the intrabronchial part (3.36% and 9.26%, respectively). The finest blood vessels of extrabronchial part undergo the most considerable reduction, in comparison with the ones in the intrabronchial part of squamous cell carcinoma. Oat-cell carcinomas show the smallest difference in vascularization of intra- and extrabronchial parts of tumor (4.38% and 3.33%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗