***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: on admission to hospital and a further 22 % subsequently developed them at some time during their stay . The average length of time the patients suffered from sores was three-fifths of their total length of stay and ranged from one day to more than six months . Contrary to popular opinion , they were not always a terminal event ( 31 % of these patients were eventually discharged ) , but even in those patients who died the average duration of the sores before death was 3.1 weeks . In a small work study conducted in the geriatric wards ( to be published ) the average nursing-time per patient was shown to be increased by 50 % in patients with pressure sores compared with that of equally ill patients without sores . A large amount of this STUDY OBJECTIVES We hypothesized that continuous , automatic turning utilizing a patient-friendly , low air loss surface would reduce the incidence of early ICU pneumonia in selected groups of critically ill medical patients . DESIGN Prospect i ve , r and omized , controlled clinical trial . SETTING Medical ICU of a large community teaching hospital . PATIENTS One hundred twenty-four critically ill new admissions to the medical ICU at Charity Hospital in New Orleans . INTERVENTIONS Patients were prospect ively r and omized within one of five diagnosis-related groups (DRG)--sepsis ( SEPSIS ) , obstructive airways disease ( OAD ) , metabolic coma , drug overdose , and stroke -- to either routine turning on a st and ard ICU bed or to continuous turning on an oscillating air-flotation bed for a total of five days . MEASUREMENTS AND RESULTS Patients were monitored daily during the treatment period for the development of pneumonia . The incidence of pneumonia during the first five ICU days was 22 percent in patients r and omized to the st and ard ICU bed vs 9 percent for the oscillating bed ( p = 0.05 ) . This treatment effect was greatest in the SEPSIS DRG ( 23 percent vs 3 percent , p = 0.04 ) . Continuous automatic oscillation did not significantly change the number of days of required mechanical ventilation , ICU stay , hospital stay , or hospital mortality overall or within any of the DRGs . CONCLUSIONS We conclude that air-supported automated turning during the first five ICU days reduces the incidence of early ICU pneumonia in selected DRGs ; however , this form of automated turning does not reduce other measured clinical outcome parameters A comparison of pressure reducing properties of alternating air , static air , and water mattress overlays was conducted with 57 patients in a surgical intensive care unit . Sacral and heel pressures in both recumbent and semi-Fowler 's positions were tested for each surface using a repeated measures design . Mean pressures for the alternating air mattress were significantly higher than pressures with other surfaces , regardless of position or site . There were significant main effects for position and site , with higher pressures in the semi-Fowler 's position and at the sacral site . A significant interaction between surface , site , and position was found . Pressure sores developed in eight patients , but the incidence was not significantly different across groups . A pressure measuring device constructed from available clinical material s proved to be both sensitive and reliable . The findings suggest alternating air overlays should be avoided , and that positioning and periodic position change to reduce sacral pressures for patients requiring prolonged upper body elevation is important 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 There is limited research related to pressure ulcers in the ICU patient population and even less has focused on patients who have undergone cardiovascular surgery and IABP support . The objective of this article was to determine the incidence of pressure ulcers in the postoperative CVS patient with IABP support and to determine if LAL therapy was more effective in the prevention of pressure ulcers in this patient population . In a quasiexperimental design , a convenience sample of 36 adults was used . Patients who were placed on IABP support the day of surgery were enrolled into the study within 24 hours of admission to the cardiovascular recovery room . Data collection was daily for 4 days and continued if the patient developed a pressure ulcer . Final measurements were obtained on the day of hospital discharge . Instruments used were demographic data form , APACHE II , Patient Identification for Rotation Therapy , and the Braden Scale . The most common surgical patient in this pilot underwent aortocoronary bypass with IABP support .  Pressure ulcers developed in 9 of 36 ( 25 % ) patients for a total of 17 ulcers . Patients who developed pressure ulcers were generally older , had a history of cerebrovascular disease , renal insufficiency , a higher APACHE II score , and Braden score of 9 on POD 1 . In addition , these patients generally had a lower hemoglobin level , higher serum creatinine level , and an altered level of consciousness on POD 1 . The results suggest that LAL therapy does make a difference in the prevention of pressure ulcers in the aortocoronary bypass patient with IABP support Intensive care wards have a high incidence of pressure sores . This trial , in an eight-bed unit , aim ed to compare the cost-effectiveness of constant-low-pressure and alternating-pressure support systems for preventing pressure sores .  Patients without sores with a Norton risk score of < 13 were allocated to either alternating- or constant-low-pressure supports according to their hospital number . The cheapest supports were used initially , and changed for more sophisticated types if the patient 's pressure areas deteriorated . None of the 23 patients using low-cost  alternating-pressure supports developed open sores and only one had to be transferred to a more sophisticated mattress because of persistent erythema . Eleven out of 20 patients on  constant-low-pressure mattresses or overlays developed either persistent erythema ( three ) or sores ( eight ) . Ten were transferred to more expensive support systems . The mean cost of supports per patient in the alternating-pressure group was 44.50 pounds and in the constant-low-pressure group 86.20 pounds 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 The Pegasus Airwave mattress has been used for many years in the Eastbourne NHS Trust and has proven its efficiency in the prevention of  pressure sores .  Pegasus has now produced a new , improved , model : the Cairwave Therapy System . This article looks at criteria that may be used to determine whether the new model is suitable for patient care . The evaluation took the form of a r and omized controlled study in which 12 mattresses were r and omly allocated to patients --six Airwave mattresses and six Cairwave Therapy Systems -- over a 4-month period . The results of the evaluation showed that patients found the mattress comfortable . An encompassing cover reduced the risk of cross-infection , rehabilitation was supported by the firm edges of the bed and patient movement was easier due to the soft cover . During the trial all patients remained free from pressure sores & NA ; In a r and omized clinical trial , 187 adult patients with chronic neurologic conditions who were at a high risk of developing pressure sores were assigned for 3 months to either an alternating air ( AA ) mattress overlay or a silicore ( S ) mattress overlay . Costs associated with each overlay were calculated and compared by adding depreciation and yearly expenses related to maintenance , operation , and repair for 148 patients who completed the trial .  Acceptability was measured by question naires and interviews involving 45 of the patients ’ primary nurses and a sample of 40 patients ( 20 from each overlay group ) . The annual cost of the AA overlay was 54 % more than that of the S overlay . Although most nurses ( more than 74 % ) believed that both overlays helped prevent pressure sores and deter their progression , many ( more than 56 % ) would not recommend either type to other facilities or to patients at home due to specific negative features . Implication s for manufacturers , investigators , clinicians , and administrators are identified Specialised beds which are design ed to prevent unacceptably high levels of pressure loads on skin surfaces are frequently used in the management of patients with , or at risk of developing , pressure sores . This study compares the intersurface pressure on ' at risk ' body sites of six subjects on a new design of water bed with those obtained from  resting on a King 's Fund bed .  The findings show flotation on the water bed offers more effective support to body tissue than that provided by the King 's Fund bed This experimental study was design ed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development . Surgical patients ( N = 413 ) were r and omized to receive " usual perioperative care " or the new mattress overlay . Over six postoperative days , 89 patients ( 21.5 % ) developed pressure ulcers , primarily stage I. Only 2 % developed stage II or IV ulcers . Patients with ulcers were statistically older , had diabetes , were smaller in body mass , had lower Braden Scale scores on admission , and used the new mattress overlay ( P < .02 ) . Pressure ulcers that presented as " burns " or ecchymosis did not deteriorate to stage III or IV ulcers during the study . The mattress overlay was not effective in preventing pressure ulcer development Abstract Objective To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital . Design Cost effectiveness analysis carried out alongside the pressure relieving support surfaces ( PRESSURE ) trial ; a multicentre UK based pragmatic r and omised controlled trial . Setting 11 hospitals in six UK NHS trusts . Participants Intention to treat population comprising 1971 participants . Main outcome measures Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital . Results Alternating pressure mattresses were associated with lower overall costs ( £ 283.6 per patient on average , 95 % confidence interval - £ 377.59 to £ 976.79 ) mainly due to reduced length of stay in hospital , and greater benefits ( a delay in time to 
    Output:
    
There is one high quality trial comparing the different alternating pressure devices for pressure ulcer prevention which suggests that alternating pressure mattresses may be more cost effective than alternating pressure overlays .
A study of Accident & Emergency trolley overlays did not identify a reduction in pressure ulcer incidence .
There are tentative indications that foot waffle heel elevators , a particular low air loss hydrotherapy mattress and two types of operating theatre overlays are harmful .
The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear but alternating pressure mattresses may be more cost effective than alternating pressure overlays .
Medical grade sheepskins are associated with a decrease in pressure ulcer development .