***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: BACKGROUND Data on the prevention and treatment of  pressure ulcers ( PU 's ) among ICU patients is sparse . OBJECTIVE To compare PU outcomes in medial ICU patients nursed on either a reactive mattress overlay ( ROHO , ROHO Inc , Belleville , IL , USA ) or an active alternating pressure mattress  ( NIMBUS3 , ArjoHuntleigh , Luton Bedfordshire , UK ) . DESIGN Pilot prospect i ve single blind r and omised controlled clinical trial . INTERVENTION Two types of pressure redistributing mattress . PATIENTS Two groups of eight patients . METHODS Patients included in the study were those at high risk ( Norton scale < 8) or with a PU on admission . RESULTS The two groups had similar patient characteristics . However , the NIMBUS 3 group presented with more ulcers per patient on admission ( 62.5 % ) and more severe ulcers ( 20 % category 3 ) while four patients ( 50 % ) presented with a single superficial ulcer in the ROHO group . HEALING : The progress of the ulcers showed significant decreases in PU surface area ( p=0.05 ) , total PUSH tool score ( p=0.01 ) in the NIMBUS 3 group compared to the ROHO group . In the NIMBUS 3 group 82 % of the ulcers improved versus none in the ROHO group ( p=0.002 ) and 18 % remained stable versus 33 % . None of the ulcers deteriorated in the NIMBUS 3 group versus 67 % in the ROHO group ( p=0.006 ) . Full thickness wounds ( Category 3 ) were present in 22 % of the NIMBUS 3 group versus 0 % of the ROHO group on admission and in 0 % versus 66.7 % ( p=0.008 ) respectively at the end of the pilot study . PREVENTION Non-blanching erythema occurred equally in both arms at baseline ; skin remained intact for the NIMBUS 3 group while 50 % in the ROHO group worsened with superficial tissue loss . CONCLUSION This small pilot study suggests that ' active ' alternating therapy is a useful adjunct in the care of highly vulnerable patients , while the outcomes may be less favourable when using ' reactive ' , constant low pressure devices BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review OBJECTIVE To estimate the effectiveness of a new high-performance Australian medical sheepskin ( meeting Australian St and ard 4480.1 - 1998 ) in preventing pressure ulcers in a general hospital population at low to moderate risk of these ulcers . DESIGN Open-label r and omised controlled clinical trial . SETTING A large metropolitan teaching hospital in Melbourne , Victoria , in 2000 . PARTICIPANTS 441 patients aged over 18 years admitted between 12 June and 30 November 2000 , with expected length of stay over 2 days and assessed as at low to moderate risk of developing pressure ulcers . INTERVENTION Patients were r and omly allocated to receive a sheepskin mattress overlay for the duration of their hospital stay ( 218 patients ) or usual treatment , as determined by ward staff ( referent group , 223 patients ) . MAIN OUTCOME MEASURES Incidence rate and cumulative incidence of pressure ulcers , assessed daily throughout hospital stay . RESULTS 58 patients developed pressure ulcers ( sheepskin group , 21 ; referent group , 37 ) . Cumulative incidence risk was 9.6 % in the sheepskin group ( 95 % CI , 6.1%-14.3 % ) versus 16.6 % in the referent group ( 95 % CI , 12.0%-22.1 % ) . Patients in the sheepskin group developed new pressure ulcers at a rate less than half that of referent patients ( rate ratio , 0.42 ; 95 % CI , 0.26 - 0.67 ) . CONCLUSIONS The Australian Medical Sheepskin is effective in reducing the incidence of pressure ulcers in general hospital in patients at low to moderate risk of these ulcers Pressure sores are a problem , especially in elderly patients . Our study was design ed to determine the effectiveness in pressure-sore prevention of a new interface-pressure decreasing mattress . In a prospect i ve r and omised controlled clinical trial we tested the Comfortex DeCube mattress ( Comfortex , Winona , USA ) against our st and ard hospital mattress in 44 patients with femoral-neck fracture and concomitant high pressure-sore risk score . In addition both groups were treated according to the Dutch consensus protocol for the prevention of pressure sores . On admission and 1 and 2 weeks after admission , pressure sores were grade d. The two groups were similar in patient characteristics and pressure-sore risk factors . At 1 week , 25 % of the patients nursed on the DeCube mattress and 64 % of the patients nursed on the st and ard mattress had clinical ly relevant pressure sores ( grade 2 or more ) . At 2 weeks the figures were 24 % and 68 % , respectively . The maximum score over the several body regions of the pressure-sore grading , measured on a 5-point sale , was significantly different in favour of the DeCube mattress at 1 week ( p = 0.0043 ) and 2 weeks ( p = 0.0067 ) postoperatively . We show that the occurrence of pressure sores and their severity can be significantly reduced when patients at risk are nursed on an interface-pressure decreasing mattress This study had three aims : to investigate if visco-elastic foam mattresses are more effective than st and ard hospital mattresses in reducing the incidence of  pressure ulcers in patients with hip fractures ; to compare pressure ulcer grade and location and documented nursing prevention and treatment interventions in patients using the two types of mattresses ; to identify possible predictors of pressure ulcer development . Using a prospect i ve r and omised controlled trial design 101 patients ( mean age : 84 years ) were r and omly allocated either a visco-elastic foam mattress or a st and ard mattress . There was no significant difference in the incidence of pressure ulcers between the two groups , but patients on st and ard mattresses tended to develop more severe pressure ulcers . Furthermore , according to the documentation , patients with grade I pressure ulcers who were allocated a st and ard mattress received more preventive interventions , which may have reduced the differences in outcomes between the two groups . The research ers concluded that the results support the use of the test mattress . Significant predictors of pressure ulcer development were long waiting times for surgery and low haemoglobin levels  at hospital admission " Least costly but most effective " has never been more important to healthcare delivery than in the current healthcare environment of changing reimbursement systems . In wound care , the high costs associated with renting advanced support surfaces may be an area where expenses can be decreased if similar outcomes can be attained by using more affordable mattresses . This article compares the healing rates and eventual outcomes of wounds among two groups of patients r and omly assigned to one of two support surfaces . A commonly used low-air-loss mattress was compared with the study mattress , an advanced , non-powered , air and foam surface .  Subjects were patients admitted to either of two long-term healthcare setting s for the treatment of wounds . The result ing two groups of 10 patients each were evenly matched for average age and percentage of patients who were nutritionally deficient as indicated by albumin or pre-albumin levels . The presence of gastrointestinal tubes and ventilator dependency also was recorded . Consistent wound care protocol s were used on both groups , including turning schedules , nutrition , topical medication , and dressings . The study period covered a maximum of 8 weeks ; interest was centered on the rate of wound healing and progress toward a goal rather than the length of time to completely close a wound . After 8 weeks , or upon discharge from the study pressure ulcers in the study mattress group closed at an average rate per week of 9.0 % + /- 4.8 versus 5.0 % + /- 3.7 in the low-air-loss mattress group . This study indicates that the study mattress can provide benefits to the wound healing process similar to or better than low-air-loss mattresses at a substantially reduced cost Polyurethane foam cushions in a slab form or a customized contoured form are commonly used in wheelchairs to prevent the development of decubitus ulcers ( DU )  in elderly chronically ill persons . Sixty-two consenting subjects , 60 years or older , were r and omly assigned to sit on one of the two types of cushions for 3 or more hours daily for 5 months . A total of 72 DU  developed in the 52 subjects who completed the study . These were mostly in the areas of ischial tuberosities , buttocks , and thighs ; were of persistent erythema level in severity ; and took an average of 6 to 8 weeks to heal . No statistically significant differences were found in the incidence , location , severity , or healing time of the sores that developed in the subjects who used the slab ( N = 26 ) and those who used the contoured ( N = 26 ) cushions . But , more severe sores did develop among the slab cushion group in the area of ischial tuberosities . It appears that foam customization for elderly persons could be justified only if DU have been a particular problem in this region . Incontinence as a contributory factor to DU formation should receive careful attention with respect to prevention . The trials described are being continued , using a larger number of subjects The purpose of this study was to determine the efficacy and safety of a multi-cell pulsating dynamic mattress system in comparison with conventional management for the prevention of pressure ulcers in the operative and postoperative period in patients having cardiovascular surgery . The study was a single center , prospect i ve , r and omized , controlled trial . Patients who were having cardiovascular surgery for a duration of at least 4 hours were r and omly assigned , prior to surgery , to dynamic mattress system or conventional management -- both of which were initiated in the operating room and continued for up to 7 days postoperatively . Patients were assessed daily using a st and ardized scoring system . The results of the study showed that 198 patients in the dynamic pressure system ( n = 98 ) or conventional management group ( n = 100 ) were similar at baseline . A strong trend of decreased pressure ulcers existed in the dynamic pressure system group ( n = 2 ) compared to the conventional management group ( n = 7 ) . The study concluded that a multi-cell pulsating dynamic mattress system is safe and mitigates risks for and decreases incidence of pressure ulcers in patients who undergo cardiovascular surgery AIMS AND OBJECTIVES In this experimental study , a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the st and ard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients . BACKGROUND Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5 % . The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population . Pressure-reducing devices on the operating room (OR)-table should reduce the patients ' interface pressure and thus the hazard of skin breakdown . METHODS A r and omized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table ( test OR-table ) compared with the st and ard OR-table ( a water-filled warming mattress , no pressure-reducing device ) on the postoperative pressure ulcer incidence in cardiac surgery patients . INSTRUMENTS The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel ( EPUAP ) was used for pressure ulcer grading . RESULTS The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer ( 17.6 % ) than patients on the st and ard OR-table without the foam overlay ( 11.1 % ) . Because of the clinical relevance of the results , the r and omized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients . CONCLUSIONS The combination of a 4-cm viscoelastic foam overlay and a warming source can not be recommended for pressure ulcer prevention on the operating room table . RELEVANCE TO CLINICAL PRACTICE Foam overlays are used to prevent pressure ulcers in patients . It is necessary to use 
    Output:
    
RESULTS ( GRADE A ) : In prevention , a structured foam mattress is more efficient than a st and ard hospital mattress .
An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers , but those that do occur are more serious .
A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers .
Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients .
Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers .
An air-fluidized bed improves pressure ulcer healing .
However , the effectiveness of some support surfaces reaches a sufficient level of evidence , especially when they are associated with postural , hydration and nutritional measures .
Support surfaces are recommended in prevention and treatment of patients at risk and /or already suffering from pressure ulcer , and their use should constitute part of an overall preventive or curative strategy