***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 AIM This study identified risk factors for pressure ulcer development early in the admission stage to determine what appropriate interventions might be conducted early in the admission stage to decrease the risk of pressure ulcer development . BACKGROUND Among patients who develop pressure ulcers , 8 - 40 % of them occur in a critical care setting . Therefore , the development of pressure ulcers is a common problem . DESIGN Prospect i ve cohort study . METHODS The study facility was a 606-bed tertiary care hospital . Ninety eight patients admitted to the intensive care unit ( ICU ) or the high care unit ( HCU ) from 16 April 2003 - 15 July 2003 were evaluated in the final analysis . RESULTS The mean patient age was 62.3 ( SD 16.1 ) years , and the incidence of pressure ulcers in this study was 11.2 % during the observation period . Multivariate analysis showed that ' emergency ICU/HCU patients ' and ' infrequent turning ' were related to pressure ulcer development .  Patients with pressure ulcers experienced significantly fewer turns and repositionings ( OR = 0.452 , 95 % CI : 0.212 - 0.966 ] , p < 0.05 . Fewer pressure ulcers developed in scheduled ICU/HCU patients than in emergency ICU/HCU patients ( OR = 0.041 [ 95 % CI : 0.004 - 0.470 ] , p < 0.01 ) . CONCLUSION There was no relationship between pressure ulcer development and APACHE II score , or any medication that affected skin integrity . The frequency of turning and repositioning and patients with an emergency admission to the ICU/HCU can be the prognostic indicators for developing scoring system in critical care setting s. RELEVANCE TO CLINICAL PRACTICE These patients admitted directly to ICU or HCU were in a high risk group , further preventive strategies will be required 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 AIMS To determine the incidence of  pressure ulcers occurring at least 48 hours after admission and risk factors for  pressure ulcers grade 2 - 4 in a long-stay surgical Intensive Care Unit ( ICU ) population . BACKGROUND The incidence of  pressure ulcers  in intensive care units is larger than in non-intensive environments . DESIGN Prospect i ve descriptive research design . METHODS Using pressure ulcers grade 2 - 4 as an outcome measure , a multivariate logistic regression analysis was used to identify the risk factors . Data were obtained on a daily basis in a surgical intensive care unit of the University Hospital Leuven between November 2003-March 2004 . A total of 520 long-stay ( > or= 24 hours ) intensive care patients were included . RESULTS Cumulative incidence of pressure ulcers grade 2 - 4 was 20.1 % . The following variables were positively associated with pressure ulcers grade 2 - 4 : history of vascular disease , treatment with Dopamine or Dobutamine , intermittent haemodialysis ( IHD ) or continuous veno-venous haemofiltration ( CVVH ) , mechanical ventilation .  Also preventive measures were statistically positively associated with pressure ulcers grade 2 - 4 : turning , floating heels , alternating mattresses , adequate prevention . The use of sedatives , body temperature above 38.5 degrees C and sitting in chair where negatively associated with pressure ulcers . Pressure ulcers are statistically associated with different risk factors and preventive measures . CONCLUSION The identified risk factors are eligible to be included in a new risk assessment scale for patients admitted to intensive care units . RELEVANCE TO CLINICAL PRACTICE The novel insights have implication s for risk assessment for patients in intensive care units . Patients admitted to intensive care units have other risk factors for pressure ulcers which are eligible to be included in a new risk assessment scale OBJECTIVES To identify care setting s associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period . DESIGN Prospect i ve cohort study . SETTING Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged . PARTICIPANTS Hip fracture patients aged 65 and older who underwent surgery for hip fracture .  MEASUREMENTS A  full-body skin examination  was conducted at baseline ( as soon as possible after hospital admission ) and repeated on alternating days for 21 days . Patients were deemed to have an acquired pressure ulcer ( APU ) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission . RESULTS In 658 study participants , the APU cumulative incidence at 32 days after initial hospital admission was 36.1 % ( st and ard error 2.5 % ) . The adjusted APU incidence rate was highest during the initial acute hospital stay ( relative risk (RR)=2.2 , 95 % confidence interval (CI)=1.3 - 3.7 ) and during re-admission to the acute hospital ( RR=2.2 , 95 % CI=1.1 - 4.2 ) . The relative risks in rehabilitation and nursing home setting s were 1.4 ( 95 % CI=0.8 - 2.3 ) and 1.3 ( 95 % CI=0.8 - 2.1 ) , respectively . CONCLUSION Approximately one-third of hip fracture patients developed an APU during the study period . The rate was highest in the acute setting , a finding that is significant in light of Medicare 's policy of not reimbursing hospitals for the treatment of hospital-APUs . Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals AIMS AND OBJECTIVES The study aim ed to evaluate the predictive validity and accuracy of a new pressure ulcer risk assessment scale  in two Indonesia intensive care units ( ICUs ) . BACKGROUND Several risk assessment scales have been design ed to identify patients at risk of developing pressure ulcers in ICU . However , the relative weight of each variable that contributes to pressure ulcer development in these scales is not described to enable design ing of a risk assessment scale . Currently , the risk factors contributing to pressure ulcer development include interface pressure , body temperature and cigarette smoking . DESIGN A prospect i ve cohort study was conducted in two ICUs in Pontianak , Indonesia . METHODS A total of 253 patients were recruited to the study from both hospitals . Data collection included new risk assessment scale  [ i.e. the Suriadi and Sanada ( S.S. ) scale ]  scoring , demographic , pressure ulcer severity scores ( based on the National Pressure Ulcer Advisory Panel ) and skin condition measures . Using the S.S. scale , trained data collectors scored patients once and assessed the body temperature daily until patients were discharged . Additionally , daily data were also collected in relation to the patient 's skin condition and stage of pressure ulcer . RESULTS Out of the 253 patients , 72 ( 28.4 % ) developed pressure ulcers . In ICU A , the incidence was 27 % ; pressure ulcers developed into stage I ( 41.7 % ) , stage II ( 45.8 % ) , stage III ( 10.4 % ) and stage IV ( 2.1 % ) . In ICU B , the incidence was 31.6 % ; the development of pressure ulcers was 48 % in stage I and 52 % in stage II . Using the predictive validity test , the S.S. scale balanced sensitivity ( 81 % ) and specificity ( 83 % ) at a cut-off score of 4 . The area under the receiver-operating characteristic curve was 0.888 ( confidence interval : 0.84 - 0.93 ) . CONCLUSION The S.S. scale was found to be a valid risk assessment tool to identify the patients at risk of developing pressure ulcers in Indonesia ICU OBJECTIVE A trial of a self-adhesive hydropolymer foam dressing ( Tielle , Johnson & Johnson ) demonstrated that it prevented the development of friction-generated pressure ulcers on the heels of ICU patients . Following the trial , use of the foam dressing became a st and ard preventive measure in the ICU and the prevalence of heel ulcers decreased by 72 % in two years . This follow-up study evaluated the foam 's effectiveness in preventing heel  pressure ulcers in surgical patients . METHOD A total of 140 surgical patients were screened over a four-month period . They were assigned to one of two groups , depending on their pressure ulcer risk score and the anticipated length of the surgical procedure . The foam dressing was used as a barrier on the heels , depending on the patient 's risk status , which was assessed using a modified Norton scale , and the duration of their surgery . Heels were inspected on a daily basis for up to 10 days . All 23 patients in the group whose surgery lasted less than 90 minutes dropped out of the study as they were discharged with insufficient data . RESULTS A 76.7 % reduction in heel pressure ulcers was achieved with this preventive measure . CONCLUSION Use of an adhesive foam dressing on surgical patients can prevent heel ulcers . Research is needed on the effects of friction on the heel during the transfer and movement of surgical patients . DECLARATION OF INTEREST This study was sponsored by Johnson & Johnson Medical PURPOSE The aim of this study was to determine the incidence of pressure ulcers ( PUs ) in ventilated patients in all intensive care units ( ICUs ) in Granada ( Spain ) and identify risk factors for their development . MATERIAL S AND METHODS A prospect i ve cohort study in 9 medical-surgical ICUs was conducted . Two hundred ninety-nine patients with more than 24 hours on mechanical ventilation ( MV )  were enrolled during 2 periods in a 5-month study . Pressure ulcers of patients were measured according to the European Pressure Ulcer Advisory Panel . RESULTS Of the 299 patients 
    Output:
    
The findings suggest that the risk of pressure ulcer development was higher when the patient was identified as having impaired mobility , as assessed using the Braden subscale mobility or other similar mobility scales .
However , there is little conclusive evidence to indicate that using mobility assessment alone is comparable to using Braden or other risk assessment scales in reducing the incidence of pressure ulcer .
Evidence for association between assessment of mobility and endorsement of preventive interventions was significant .
No evidence found on the reliability of  mobility assessment  as a tool to predict pressure ulcer risk .
Nor was there evidence on the frequency of assessment using the  mobility assessment tool .
However , there is not enough evidence to conclude that  mobility assessment  alone can replace the more common risk assessment scales such as Braden scale in predicting incidence of pressure ulcer .