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  1. Article ; Online: Phantom testing of the sensitivity and precision of a sub-epidermal moisture scanner.

    Peko Cohen, Lea / Gefen, Amit

    International wound journal

    2019  Volume 16, Issue 4, Page(s) 979–988

    Abstract: The majority of pressure ulcers (PUs) including deep tissue injuries (DTIs) are preventable, and even reversible if detected in their early phase. One of the greatest barriers in PU prevention is that clinicians traditionally depended on subjective and ... ...

    Abstract The majority of pressure ulcers (PUs) including deep tissue injuries (DTIs) are preventable, and even reversible if detected in their early phase. One of the greatest barriers in PU prevention is that clinicians traditionally depended on subjective and qualitative techniques, particularly routine visual skin assessments that would only document existing, macroscopic PUs/DTIs, rather than preventing them or detecting them at their microscopic phase. At the early phase of cell damage, when a forming PU is still microscopic, there is a local increase in extracellular fluid contents within affected tissues, which is called sub-epidermal moisture (SEM). This new understanding has led to an emerging technology, a SEM Scanner (BBI LLC, Bruin Biometrics) that has been designed to effectively examine the health status of tissues, by measuring local changes in the biophysical SEM marker. In the present work, the SEM Scanner was tested under controlled laboratory conditions to experimentally determine its sensitivity and precision in identifying small (1 mL) water content changes in phantoms of the human heel and skull/face, which simulated common PU development scenarios. In both phantom configurations, the locally increased water contents resulted in consistent, statistically significant elevated SEM readings, which confirms that the SEM Scanner is able to detect fluid content changes that are as small as 1 mL. In agreement with a simplified theoretical (mathematical) SEM model, which was also developed here, changes in water contents had a consistent trend of effect on SEM delta values, which increased with each 1 mL increment in intra-tissue-substitute water contents.
    MeSH term(s) Early Diagnosis ; Edema/physiopathology ; Epidermal Cells/physiology ; Extracellular Fluid/physiology ; Humans ; Monitoring, Physiologic/instrumentation ; Monitoring, Physiologic/methods ; Pressure Ulcer/prevention & control ; Sensitivity and Specificity
    Language English
    Publishing date 2019-04-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2170920-8
    ISSN 1742-481X ; 1742-4801
    ISSN (online) 1742-481X
    ISSN 1742-4801
    DOI 10.1111/iwj.13132
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Deep tissue loads in the seated buttocks on an off-loading wheelchair cushion versus air-cell-based and foam cushions: finite element studies.

    Peko Cohen, Lea / Gefen, Amit

    International wound journal

    2017  Volume 14, Issue 6, Page(s) 1327–1334

    Abstract: For wheelchair users, a common injury is a sitting-acquired pressure ulcer (PU) which typically onsets near the interface between the ischial tuberosity (IT) and the overlying soft tissues. The risk of developing PUs can be reduced considerably if an ... ...

    Abstract For wheelchair users, a common injury is a sitting-acquired pressure ulcer (PU) which typically onsets near the interface between the ischial tuberosity (IT) and the overlying soft tissues. The risk of developing PUs can be reduced considerably if an adequate cushion is placed on the wheelchair in order to protect tissues from PUs by minimising interface mechanical loads between the body and cushion and also, exposure to internal soft tissue loads. In this work, we studied the biomechanical performances of an off-loading (OL) cushion with limited adjustability, in comparison to a standard foam cushion and a fully adjustable air-cell-based (ACB) cushion. These different cushion design approaches were methodologically and quantitatively analysed and compared here using a finite element (FE) modelling framework. We determined the internal mechanical deformations, strains and stresses in soft tissues of the seated buttocks during symmetric sitting, in a specific anatomy of a person with a spinal cord injury that was acquired during sitting in an open, magnetic resonance imaging configuration. Our results have shown that strains and stresses in muscle, fat and skin tissues are orders of magnitude lower for the ACB cushion with respect to the standard foam and OL cushions. The OL cushion design has taken the approach of protecting at-risk sites of the buttocks by transferring local internal tissue loads away from the ITs and towards the greater trochanters, at the price of increasing exposure to internal tissue loads at sites other than the ITs. The ACB cushion design, however, has taken a different approach, that is, immersion and envelopment of the entire buttocks structure, which is useful for minimising the exposure to internal tissue loads throughout the whole buttocks. Quantifying performances of wheelchair cushions using FE modelling provides insights into deep tissue loads, which is essential for informed decision-making in developing sitting solutions for individuals at risk, as well as for patient groups.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Biomechanical Phenomena/physiology ; Buttocks/physiopathology ; Equipment Design ; Female ; Humans ; Male ; Middle Aged ; Posture/physiology ; Pressure Ulcer/physiopathology ; Pressure Ulcer/prevention & control ; Protective Devices ; Stress, Mechanical ; Wheelchairs
    Language English
    Publishing date 2017-09-06
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 2170920-8
    ISSN 1742-481X ; 1742-4801
    ISSN (online) 1742-481X
    ISSN 1742-4801
    DOI 10.1111/iwj.12807
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Dressings cut to shape alleviate facial tissue loads while using an oxygen mask.

    Peko Cohen, Lea / Ovadia-Blechman, Zehava / Hoffer, Oshrit / Gefen, Amit

    International wound journal

    2019  Volume 16, Issue 3, Page(s) 813–826

    Abstract: Non-invasive ventilation (NIV) masks are commonly used for respiratory support where intubation or a surgical procedure can be avoided. However, prolonged use of NIV masks involves risk to facial tissues, which are subjected to sustained deformations ... ...

    Abstract Non-invasive ventilation (NIV) masks are commonly used for respiratory support where intubation or a surgical procedure can be avoided. However, prolonged use of NIV masks involves risk to facial tissues, which are subjected to sustained deformations caused by tightening of the mask and microclimate conditions. The risk of developing such medical device-related pressure ulcers can be reduced by providing additional cushioning at the mask-face interface. In this work, we determined differences in facial tissue stresses while using an NIV mask with versus without using dressing cuts (Mepilex Lite; Mölnlycke Health Care, Gothenburg, Sweden). First, we developed a force measurement system that was used to experimentally determine local forces applied to skin at the bridge of the nose, cheeks, and chin in a healthy sample group while using a NIV mask. We further demonstrated facial temperature distributions after use of the mask using infrared thermography. Next, using the finite element method, we delivered the measured compressive forces per site of the face in the model and compared maximal effective stresses in facial tissues with versus without the dressing cuts. The dressings have shown substantial biomechanical effectiveness in alleviating facial tissues deformations and stresses by providing localised cushioning to the tissues at risk.
    MeSH term(s) Adolescent ; Adult ; Bandages ; Equipment Design/methods ; Female ; Humans ; Male ; Masks ; Noninvasive Ventilation/methods ; Respiration, Artificial/methods ; Sweden ; Young Adult
    Language English
    Publishing date 2019-03-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2170920-8
    ISSN 1742-481X ; 1742-4801
    ISSN (online) 1742-481X
    ISSN 1742-4801
    DOI 10.1111/iwj.13101
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Sacral Soft Tissue Deformations When Using a Prophylactic Multilayer Dressing and Positioning System: MRI Studies.

    Peko Cohen, Lea / Levy, Ayelet / Shabshin, Nogah / Neeman, Ziv / Gefen, Amit

    Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society

    2018  Volume 45, Issue 5, Page(s) 432–437

    Abstract: Purpose: The sacrum is the most common location of pressure injuries (PIs) in bedridden patients. The purpose of this study was to measure the effect of specific pressure preventive devices on sacral skeletal muscle, subcutaneous fat, and skin tissue ... ...

    Abstract Purpose: The sacrum is the most common location of pressure injuries (PIs) in bedridden patients. The purpose of this study was to measure the effect of specific pressure preventive devices on sacral skeletal muscle, subcutaneous fat, and skin tissue deformations.
    Subjects and setting: The sample comprised 3 healthy adults residing in a community setting in Tel Aviv, Israel.
    Design: Descriptive, comparative design.
    Methods: Tissue thickness changes of 3 healthy adults were measured using magnetic resonance imaging (MRI) in weight-bearing sacral skin, subcutaneous fat, and muscle. Changes in tissue thickness were compared under the following conditions: (1) lying supine on a rigid surface (unpadded MRI table), (2) lying on a standard foam mattress, (3) lying on a mattress after application of a prophylactic multilayer dressing, and (4) lying on a standard foam mattress with a prophylactic multilayer dressing and a positioning system. One-way analysis of variance and post hoc Tukey-Kramer multiple pairwise comparisons were used to compare outcomes.
    Results: The mattress, the prophylactic multilayer dressing, and the turning and positioning device when applied together resulted in significantly lower deformation levels of each of the soft tissue layers (ie, skin, subcutaneous fat, and muscle separately) as well as of the total soft tissue bulk, with respect to the rigid MRI table (P < .05).
    Conclusion: Study findings suggest that a combination of preventive interventions may reduce the risk of developing a sacral PI.
    MeSH term(s) Adult ; Analysis of Variance ; Bandages/standards ; Bandages/statistics & numerical data ; Female ; Humans ; Israel ; Magnetic Resonance Imaging/methods ; Male ; Patient Positioning/instrumentation ; Patient Positioning/methods ; Pressure ; Pressure Ulcer/prevention & control ; Sacrococcygeal Region/physiology ; Sacrococcygeal Region/physiopathology
    Language English
    Publishing date 2018-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1188388-1
    ISSN 1528-3976 ; 1071-5754
    ISSN (online) 1528-3976
    ISSN 1071-5754
    DOI 10.1097/WON.0000000000000461
    Database MEDical Literature Analysis and Retrieval System OnLINE

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