Smart seat cushion feasibility pilot study: automated interface pressure modulation of individuals with spinal cord Injury

This study investigates the functionality and feasibility of a novel smart seat cushion system designed for wheelchair users with spinal cord injuries. The cushion, equipped with air cells that serve as both sensors and actuators, was tested on 24 participants for its real-time pressure mapping, automated pressure redistribution, and pressure offloading functions. A commercial pressure mat was concurrently used to validate the cushion's pressure modulation functions. Additionally, the perceived comfort of the cushion was evaluated using General Discomfort Assessment (GDA) and Discomfort Intensity (DIS) scores, which provided insights into participants' overall comfort and discomfort levels. Real-time pressure profiles generated by the cushion resembled commercial pressure mat readings. During tests with individuals with spinal cord injury, the cushion was able to dynamically generate and display the real-time pressure profile of a seated individual with strong precision (correlation to commercial pressure mat: r ranging from 0.76 to 0.88), providing effective input into pressure modulation functions. Pressure redistribution algorithms eliminated peak pressure and reduced the overall pressure at the interface. Pressure offloading algorithms automatically identified the regions with the highest interface pressure and subsequently relieved the pressure from those areas. User feedback showed that the cushion was comfortable after redistribution and offloading. This work demonstrated the feasibility of an advanced smart seat cushion system for wheelchair users with spinal cord injuries. The cushion was capable of redistributing pressure evenly across the seating surface, ensuring user's comfort. Additionally, it identifies and eliminates high-pressure points, further improving comfort and reducing the risk of pressure injuries.

Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial

BACKGROUND

The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported.

OBJECTIVE

To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.

DESIGN

Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).

SETTING

46 U.S. and Canadian hospitals.

PARTICIPANTS

Patients aged 50 years or older undergoing hip fracture surgery.

INTERVENTION

Spinal or general anesthesia.

MEASUREMENTS

Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.

RESULTS

A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups.

LIMITATION

Missing outcome data and multiple outcomes assessed.

CONCLUSION

Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.

PRIMARY FUNDING SOURCE

Patient-Centered Outcomes Research Institute.

1342 Screening Patients’ Temperature in COVID-era Outpatient Clinics: An Overreliance on Unreliable Devices?

Aim

The Covid-19 pandemic continues to impair patient access to hospital clinics. One way of enabling outpatient services to continue safely is to screen for pyrexia by checking patients’ temperature prior to their clinic appointment. Infrared tympanic thermometers (ITT) are commonly used as a surrogate marker of core temperature. Non-contact infrared cutaneous thermometers (NICT) are increasingly favoured as they require no direct contact with patients. The aim was to measure the concordance of temperature readings between ITT and NICT on patients attending ENT outpatient clinic at one hospital.

Method

Body temperature was recorded using ITT and NICT on 63 sequential patients. Agreement was tested using a Bland-Altman plot with 95% confidence interval and paired T-tests.

Results

Mean body temperature was significantly lower (p < 0.05) for the NICT [36.3 °C (95% CI 36.2 °C-36.4 °C)] compared with the ITT [36.6 °C (95% CI 36.5 °C-36.7 °C)]. The NICT measured on average 0.34 °C (95% CI 0.33 °C-0.35 °C) lower than the ITT. The Bland-Altman plot showed moderate agreement of the two methods (SD 0.46 °C; limits -1.25 °c to 0.57 °c); however, disagreement was greater at higher and lower temperature extremes.

Conclusions

Screening patients for pyrexia aims to help prevent spread of COVID-19. False negatives result in a missed opportunity to break the chain of transmission. A significant proportion of false negatives may reverse any intended benefit. NICT are convenient but may be more susceptible to false negatives when assessing for pyrexia and may provide little more than false reassurance when used for pyrexia screening.

Feeding a corn oil/sucrose-enriched diet enhances steatohepatitis in sedentary rats

The current study investigated the combined effects of feeding a high-fat/high-sucrose (HF/HS) diet to rodents rendered sedentary via hindlimb unloading (HU). For 3 wk before HU, male Wistar rats were fed chow or a diet in which 32% of calories were derived from corn oil fat and 48% of calories from sucrose. Feeding continued during an additional 3-wk period of HU. Subsequently, blood samples were collected for determination of circulating leukocyte counts, insulin levels, and portal vein endotoxin. Inflammation, necrosis, and steatosis were assessed in formalin-fixed liver sections. No biochemical or histological evidence of injury was observed in control rats fed chow or HF/HS. HU increased circulating neutrophils and resulted in hyperinsulinemia. Mild hepatic fat accumulation and minimal focal necroinflammation were observed in this group. Feeding HF/HS during HU exacerbated hyperinsulinemia, hepatic steatosis, Kupffer cell content, and cytokine expression. Significant portal endotoxemia was noted in HU rats but was not influenced by HF/HS diet. On the other hand, feeding HF/HS significantly enhanced lipid peroxidation end products in liver of HU rats by approximately threefold compared with chow-fed rats. In summary, these findings demonstrate that feeding a high-calorie diet potentiates steatosis and injury in sedentary HU rats. Mechanisms underlying enhanced injury most likely involved lipid peroxidation. Importantly, these findings suggest that dietary manipulation combined with physical inactivity can be used to model steatohepatitis.

Effect of dietary intake of omega-3 and omega-6 fatty acids on severity of asthma in children

We assessed the clinical and biochemical effects in asthmatic children of fish oil supplementation and a diet that increases omega-3 and reduces omega-6 fatty acids. Thirty nine asthmatic children aged 8-12 yrs participated in a double-blind, randomized, controlled trial for 6 months during which they received fish oil capsules plus canola oil and margarine (omega-3 group) or safflower oil capsules plus sunflower oil and margarine (omega-6 group). Plasma fatty acids, stimulated tumour necrosis factor alpha (TNFalpha) production, circulating eosinophil numbers and lung function were measured at baseline and after 3 and 6 months of dietary modification. Day and night symptoms, peak flow rates and medication use were recorded for 1 week prior to laboratory visits. Plasma phospholipid omega-3 fatty acids were significantly greater in the omega-3 group at 3 and 6 months compared to the omega-6 group (p<0.001). In the omega-3 group TNFalpha production fell significantly compared with baseline (p=0.026), but the magnitude of change between groups did not reach significance (p=0.075). There were no significant changes in clinical outcome measures. Dietary enrichment of omega-3 fatty acids over 6 months increased plasma levels of these fatty acids, reduced stimulated tumour necrosis factor alpha production, but had no effect on the clinical severity of asthma in these children.

Food preferences and food habits of patients with chronic renal failure undergoing dialysis

OBJECTIVE

To examine and compare the food preferences of patients undergoing maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) with those of age- and sex-matched controls.

DESIGN

We administered two questionnaires, one assessing preferences for 88 food items (according to a nine-point hedonic scale) and the other assessing factors influencing dietary habits.

SUBJECTS

Thirty-three patients on HD, 17 patients on CAPD, and 30 control subjects with normal renal function.

MAIN OUTCOME MEASURES

The 88 foods were grouped into 14 classes to compare preferences. Taste aversions, food preparation details, and psychological and social determinants of food intake were also compared.

STATISTICAL ANALYSIS

The preference ratings of the HD, CAPD, and control groups were compared using analysis of variance. The dietary habits results were examined using a chi 2 analysis.

RESULTS

Sweet foods (P = .002), vegetables (P = .003), red meats (P = .010), and fish and poultry (P = .015) were less pleasant for patients on HD than for control subjects. Red meats (P = .019), fish and poultry (P = .032), and eggs (P = .005) were less pleasant for patients on HD than for patients on CAPD. Red meat was the most unpopular food group for all dialysis patients. The most common factor affecting dietary intake was a loss of interest in food and/or cooking.

CONCLUSION

We conclude that chronic renal failure influences patients' food preferences and food habits. Knowledge of these preferences will help dietitians plan more adequate and enjoyable diets for such patients.