***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Heels are susceptible to pressure ulcer ( PU ) development . Some evidence suggests dressings may provide mechanical cushioning , reduce friction with support , and lower localized internal tissue loading , which together may minimize the risk for heel ulcers ( HUs ) . To examine the effect of dressing application on pressure ulcer prevention , 20 computer simulations were performed . Volumetric exposure of soft tissues to effective and shear strains and stresses , with and without a multilayered foam dressing , were assessed , with the extent of tissue exposure considered as measures of the theoretical risk for PUs . The simulations , conducted using the finite element method , provided the mechanical strain and stress magnitudes and distributions in the weight-bearing tissues of the heel , which were visualized and analyzed post-hoc for comparing diabetic to healthy tissue loads with/without prophylactic dressings and at different foot ( plantar flexion ) postures . The volumetric exposure of the soft tissues of the heel to elevated strains and stresses was considerably reduced by the presence of the dressing , whether diabetic or nondiabetic tissue conditions existed , and for the entire range of the simulated plantar flexion positions . Further , greater plantar flexion , which occurs with elevation of the head of the bed , reduced the volumetric exposure of subcutaneous fat to increased effective strains and stresses , again , particularly when the dressing was on . Specifically , peak ( maximum of raw data ) effective strains in the soft tissues of the heel decreased by 14.8 % and 13.5 % with the use of the dressing for healthy persons and persons with diabetes , respectively . Additionally , volumetric exposures of the soft tissues to large effective strains , defined as exposures to > 50 % strain , decreased substantially , by at least a factor of 2 , with the angle of plantar flexion and with respect to a neutral foot posture . Volumetric exposures to midrange ( less than 50 % ) strains were more mildly affected by the foot posture ( ie , less than 10 % difference was noted across plantar flexion angles ) . The differences in tissue exposures to strains and stresses between the dressing and nondressing models suggest this dressing provides an important biomechanical protective effect , specifically when diabetic tissue conditions exist . In addition , the data suggest alleviating shear by repositioning the heels after elevating the head of the bed may be critical in order to limit the increase in tissue stress and subsequent PU risk . R and omized , controlled clinical studies to examine the efficacy of dressings for the prevention of heel PUs are warranted Background Hazardous healthcare setting s , for example acute care , need to focus more on preventing adverse events and preventive actions across the care delivery chain ( i.e pre-hospital and emergency care , and further at the hospital ward ) should be more studied . Pressure ulcer prevalence is still at unreasonably high levels , causing increased healthcare costs and suffering for patients . Recent biomedical research reveals that the first signs of cell damage could arise within minutes . However , few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process , e.g. in the ambulance care or at the emergency department . The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain , for older patients with neurological symptoms or reduced general condition . Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain . Methods Existing data collected from a multi-centre r and omized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used . Totally 183 patients participated . The setting s for the study were five ambulance stations , two emergency departments and 16 wards at two hospitals in Sweden . Results A total of 39 individual patients ( 21 % ) developed heel pressure ulcer at different stages across the care delivery chain . Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer . Preventive action was taken . However , all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay . Discussion and Conclusions In the ambulance and at the emergency department , skin inspection seems to be appropriate for preventing pressure ulcer . However , carrying out risk assessment with a vali date d instrument is of significant importance at the ward level . This would also be an appropriate level of re source use . Context -specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain . Trial registration IS RCT N85296908 OBJECTIVES To determine the national and state incidence levels of newly hospital-acquired pressure ulcers ( PUs ) in Medicare beneficiaries and to describe the clinical and demographic characteristics and outcomes of these individuals . DESIGN Retrospective secondary analysis of the national Medicare Patient Safety Monitoring System ( MPSMS ) data base . SETTING Medicare-eligible hospitals across the United States and select territories . PARTICIPANTS Fifty-one thous and eight hundred forty-two r and omly selected hospitalized fee-for-service Medicare beneficiaries discharged from the hospital between January 1 , 2006 , and December 31 , 2007 . MEASUREMENTS Data were abstract ed from the MPSMS , which collects information on multiple hospital adverse events . RESULTS Of the 51,842 individuals in the MPSMS 2006/07 sample , 2,313 ( 4.5 % ) developed at least one new PU during their hospitalization . The mortality risk-adjusted odds ratios were 2.81 ( 95 % confidence interval ( CI ) = 2.44 - 3.23 ) for in-hospital mortality , 1.69 ( 95 % CI=1.61 - 1.77 ) for mortality within 30 days after discharge , and 1.33 ( 95 % CI = 1.23 - 1.45 ) for readmission within 30 days . The hospital risk-adjusted main length of stay was 4.8 days ( 95 % CI = 4.7 - 5.0 days ) for individuals who did not develop PUs and 11.2 days ( 95 % CI = 10.19 - 11.4 ) for those with hospital-acquired PUs ( P < .001 ) . The Northeast region and Missouri had the highest incidence rates ( 4.6 % and 5.9 % , respectively ) . CONCLUSION Individuals who developed PUs were more likely to die during the hospital stay , have generally longer hospital lengths of stay , and be readmitted within 30 days after discharge OBJECTIVE Critically ill patients are at high risk of developing pressure ulcers ( PU ) , with the sacrum and heels being highly susceptible to pressure injuries . The objective of our study was to evaluate the clinical effectiveness of a new multi-layer , self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit ( ICU ) . METHOD A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital . Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department . The dressings were retained with a tubular b and age for the duration of the patients ' stay in the ICU . The skin under the dressings was examined daily and the dressings were replaced every three days . The comparator for our cohort study was the control group from the recently completed Border Trial . RESULTS Of the 191 patients in the initial cohort , excluding deaths , loss to follow-up and transfers to another ward , 150 patients were included in the final analysis . There was no difference in key demographic or physiological variables between the cohorts , apart from a longer ICU length of stay for our current cohort . No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort ( n=152 ; p<0.001 ) who developed a total of 19 heel PUs . CONCLUSION We conclude , based on our results , that the multi-layer soft silicone foam dressing under investigation was clinical ly effective in reducing ICU-acquired heel PUs . The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU AIM The aim of this study was to test the effectiveness of polyurethane foam in contact with the heel inside a plaster cast to decrease the rate of pressure sores in the population at most risk . BACKGROUND The rate of pressure sores caused by the plaster cast is reported to be 14 - 15 % in the paediatric population , 33.3 % in patients having undergone chemotherapy for bone tumours and 43 % in orthopaedic patients who already have sore skin when the cast is applied ( grade 1 lesion ) to the heel . DESIGN Controlled clinical trial . METHODS From November 2007-January 2009 , all consecutive subjects requiring lower limb casts having undergone chemotherapy and /or presenting heel soreness received polyurethane foam in contact with the skin of the heel before applying the cast . The results were compared with those of patients with the same risk factors but were not administered the foam and were enrolled from May 2005-August 2006 . RESULTS In total , 156 patients were enrolled , 85 in the control group and 71 in the experimental group . In the experimental group , 2 of the 56 patients ( 3.6 % ) with sore skin developed a pressure sore compared with 21 of 49 ( 42.9 % ) in the control group without polyurethane foam ( p < 0.0005 ) . In the experimental group , one of the 24 patients ( 4.2 % ) patients undergoing chemotherapy developed a pressure sore compared with 18 of 54 ( 33.3 % ) in the control group ( p = 0.005 ) . CONCLUSIONS Placing polyurethane foam in contact with the skin of the heel inside a plaster cast prevents the formation of pressure sores . RELEVANCE TO CLINICAL PRACTICE This study provides evidence that using polyurethane foam to prevent sores even inside plaster casts in population s at most risk is a simple and cost-effective strategy and decreases the discomfort , pain and risks in these patients The heels are the most common site for facility-acquired pressure ulcers ( PUs ) , and are also the most susceptible location for deep tissue injuries . The use of multilayer prophylactic dressings to prevent heel PUs is a relatively new prevention concept , generally aim ed at minimizing the risk for heel ulcers ( HUs ) through mechanical cushioning and reduction of friction at the dressing-support interface . We used 9 finite element model variants of the posterior heel in order to evaluate the biomechanical performance of a multilayer dressing in prevention of HUs during supine lying . We compared volumetric exposures of the loaded soft tissues to effective and maximal shear strains , as well as peak stresses in the Achilles tendon , without any dressing and with a single-layer or a multilayer dressing ( Mepilex ( ® ) Border Heel-type ) , on supports with different stiffnesses . The use of the multilayer dressing consistently and considerably reduced soft tissue exposures to elevated strains at the posterior heel , on all of the tested support surfaces and when loaded with either pure compression or combined compression and shear . The aforementioned multilayer design showed ( i ) clear benefit over a single-layer dressing in terms of dissipating tissue strains , by promoting internal shear in the dressing which diverts loads from tissues ; ( ii ) a protective effect that was consistent on supports with different stiffnesses . Recent r and omized controlled trials confirmed the efficacy of the simulated multilayer dressing , and so , taken together with this modeling work , the use of a prophylactic multilayer dressing indicates a great promise in taking this route for prevention The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia , Portugal , UK and USA . After review of literature , they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings ( Mepilex Border Sacrum ( ® ) and 3 layer Mepilex Heel ( ® ) dressings by Mölnlycke Health Care , Gothenburg , Sweden ) for pressure ulcer prevention in the sacrum , buttocks and heels in high-risk patients , those in Emergency Department ( ED ) , intensive care unit ( ICU ) and operating room ( OR ) . Literature on which this recommendation is based includes one prospect i ve r and omised control trial , three cohort studies and two case series . Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided PURPOSE : To determine whether application of a silicone foam dressing is associated with decreased interface pressures when applied to the heel . DESIGN : Prospect i ve , within-subjects design . SUBJECTS AND SETTING : The study was conducted in a community-based hospital using a convenience sample of 50 healthy volunteers with a mean age of 39.6 years and mean body mass index of 26.6 ; 70 % were female . METHODS : Application of the silicone border foam dressing was r and omized between the left and right heels . Participants were asked to lie down in the supine position on a viscoelastic foam mattress . Interface pressure measurements were captured using a pressure mapping system ; measurements were taken once with the dressing applied to the heel ( intervention map ) and once without ( control map ) . Data were captured after a 4-minute time period allowing stabilization . Analysis was based on mean interface pressure ; data points were collected for both heels in each of the 2 frames , yielding 4 observations per subject . RESULTS : Application of the dressing was associated with a significant decrease in average pressure measurements as compared to the heel with no dress 
    Output:
    
All of the studies identified suggest that the use of prophylactic foam dressings reduces the development of pressure injuries on the heel when used in conjunction with a pressure injury prevention program .
/ RECOMMENDATION : The use of prophylactic multilayer foam dressings applied to the heels , in conjunction with an evidence -based pressure injury prevention program , is recommended for prevention of pressure injuries on the heel ( SORT level 1 )