• 대한간호학회지
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• 제45권3호
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• pp.357-366
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• 2015

Purpose: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. Methods: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. Results: The experimental group had significantly less severe IAD (t=6.69, p <.001), lower occurrence of pressure ulcers (${\chi}^2=7.35$, p =.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p =.009) than the control group. Conclusion: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.275-284
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• 2022

Background Population aging has led to an increased incidence of pressure ulcers, resulting in a social burden and economic costs. We developed a three-dimensional knitted fabric (3-DKF) with a pressure-reducing function that can be applied topically in the early stages of pressure ulcers to prevent progression. Methods We evaluated the effects of the 3-DKF in a streptozotocin-induced diabetes mellitus pressure ulcer mouse model, and the fabric was preliminarily applied to patients. Twelve-week-old male C57BL/6 mice were used for the animal experiments. In the pressure ulcer mouse model, an ischemia-reperfusion injury was created using a magnet on the dorsa of the mice. Pressure was measured with BodiTrak before and after applying the 3-DKF to 14 patients at risk of sacral pressure ulcers. Results In the 3-DKF-applied mice group, the ulcers were shallower and smaller than those in the control group. Compared with the mice in the control group, the 3-DKF group had lower platelet-derived growth factor-α and neutrophil elastase expression, as parameters related to inflammation, and increased levels of transforming growth factor (TGF)-β1, TGF-β3, proliferating cell nuclear antigen, and α-smooth muscle actin, which are related to growth factors and proliferation. Additionally, typical normal tissue staining patterns were observed in the 3-DKF group. In the preliminary clinical analysis, the average skin pressure was 26.2 mm Hg before applying the 3-DKF, but it decreased to an average of 23.4 mm Hg after 3-DKF application. Conclusion This study demonstrated that the newly developed 3-DKF was effective in preventing pressure ulcers through testing in a pressure ulcer animal model and preliminary clinical application.

• 대한인간공학회지
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• 제29권4호
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• pp.639-646
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• 2010

The APAM's quantitative effectiveness and comparative study in preventing and treating pressure ulcer has not been sufficiently evaluated mainly because of uncertainty of pressure load input and lack of interpretation of dynamic perfusion recovery characteristics of soft tissue. The purpose of this paper was to quantify and analyze the alternating pressure characteristics of APAM as a preventive measure for pressure ulcers. To quantify the alternating load to human body, we introduced alternating pressure profile concept and developed parametric model of the profile. Regarding pressure level and cycle time, 3 global and 7 local periodic parameters were used to define the profile such as light, standard, typical and heavy duty profile shape. Pressure impulse ratio of light duty is the lowest but pressure fluctuation is significantly high. For the same duty shape, contact conditions are changed with alternating cycle time and more dramatically in shorter alternating cycle time conditions. We can conclude that if we use shorter alternating cycle time on APAM's operation we can get more positive effects regarding to inflated contact time condition. We proposed the quantitative methods on tissue viability study of external loading by simultaneous measurement of interface pressure and tissue perfusion with proper alternating pressure profile conditions.

• 성인간호학회지
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• 제27권3호
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• pp.347-357
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• 2015

Purpose: This study was conducted to assess the prevalence rate of, and the risk factors for pressure ulcers in critical patients at the time of intensive care unit (ICU) admission. Methods: We reviewed the electronic medical records of 2,107 patients who were admitted to the intensive care units in D university hospital between January 1 and December 31, 2012. The collected date were analyzed by ${\chi}^2$-test, t-test, and multi-variate logistic regression with forward stepwise selection using the SPSS program version 21. Results: The prevalence rate of pressure ulcers at the ICU admission was 23.7%. Risk factors significantly affecting pressure ulcers carrying were the age of 80 years or older (OR=3.70, 95% CI: 1.80~7.60), body weight less than 50 kg (OR=2.82, 95% CI: 1.74~4.56), sedated consciousness (OR=6.10, 95% CI: 3.57~10.40), use of ventilator (OR=1.60, 95% CI: 1.02~2.49), use of vasopressors (OR=1.53, 95% CI: 1.09~2.14), ICU admission via operation room (OR=0.49, 95% CI: 0.29~0.85), and hospital admission from nursing homes (OR=13.65, 95% CI: 3.02~61.72). Conclusion: The findings of this study suggested that the prevention efforts for pressure ulcers should be given in prior to ICU admission. Further research is necessary for developing nursing interventions for preventing pressure ulcers in the pre-ICU stage.

• 성인간호학회지
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• 제22권4호
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• pp.353-364
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• 2010

Purpose: The purpose of this study was to develop an algorithm for preventing and managing of pressure ulcer and to verify the its appropriateness. Methods: The first step was development of a pre-algorithm through a literature review and expert opinion. The second step was to establish content validity by submitting the algorithm questionnaires about the content to 12 experts. The third step was the revision of the algorithm. The fourth and last step was to establish the clinical validity of the algorithm with 25 experienced nurses. Results: For the ease of the practitioner the algorithm for prevention and the management of pressure ulcers was confined to one page depicting the main algorithm pathway and seven stepwise guidelines. The guidelines included skin care of pressure ulcer prevention, mechanical loading care, support surface care, reposition care of pressure ulcer, and Stages II, III and IV explanations along with debridement/wound irrigation and infection control. Most of all algorithm courses chosen more than 80% of agreement by expert index of content validity. The usefulness, appropriateness, and convenience of the algorithm were demonstrated through clinical validity with intensive care unit and ward nurses. Conclusion: The algorithm will improve the quality of pressure ulcer nursing care as it provides a model for decision making for clinical nurses as well as providing consistent and integrated nursing care for patients with pressure ulcer throughout an institution.

• 문화기술의 융합
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• 제6권3호
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• pp.353-359
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• 2020

본 연구에서는 욕창 예방과 치유를 위해 개발된 의료용 로봇 침대의 제어기 구조와 제어 알고리즘에 대해 기술한다. 상용의 기존 욕창 예방 매트리스는 수동으로 동작하고 잔존 최대 체압이 욕창 발생 임계 체압을 넘어서기 때문에 이론적으로는 항상 욕창이 발생할 여지가 있지만, 본 연구에 개발된 시스템은 능동형 전기구동 건반을 사용하여 침대의 건반이 하강하면 체압이 0으로 떨어져서 욕창이 발생하지 않는다. 또한, 침대의 건반이 상승하여 욕창 임계 체압 이상이더라도 지속시간을 욕창 발생 임계시간 이내로 하도록 기구와 제어 알고리즘이 설계되어 있어서 욕창 발생 자체가 일어나지 않으며, 이는 바로 상용화가 가능한 욕창 예방 로봇 침대임을 뜻한다. 침대 건반의 모터는 의료용으로 적합한 BLDC 서보 드라이버를 설계한 모터로 되어있고 전장이 단순하여 쉽게 사용할 수 있도록 설계되었으며, CAN(Car Area Network)방식으로 서로 통신한다. 제작된 시스템은 욕창 예방에 효과적인 새로운 의료용 로봇 침대로 욕창으로 고통받는 많은 환자들에게 제공될 수 있도록 보급할 예정이다.

• 한국인터넷방송통신학회논문지
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• 제18권5호
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• pp.215-222
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• 2018

최근 다양한 전동 침대의 개발과 보급이 활발하게 이루어지고 있다. 전동침대는 높이조절, 등판상승, 무릅상승, 틸트기능 및 좌우회전의 기능을 가지고 있으며 리모콘을 통해 편리하게 환자가 스스로 또는 보호자가 환자를 움직일 수 있다. 그러나 이미 나와 있는 의료용 전동침대에는 욕창방지, 시트교환, 환자의 이송기능이 없으므로 욕창 방지를 위해서는 욕창 방지 매트릭스를 사용하여 체압을 분산하고, 시트 교환이나 환자의 이송시에는 간병 인력이 붙어 일을 하게 된다. 하지만 이러한 일은 근력과 중노동을 수반함으로서 간호사들이 힘든 간호를 기피하는 현상이 발생하고 있다. 본 연구에서는 이러한 간호 업무를 수월하게 보조하기 위해 욕창방지, 시트교환 및 환자이송을 자동으로 행하는 다기능 병상을 개발하는 것을 목표로 하여 세계 최초의 시제품을 개발하고 시스템이 정상적으로 동작하는 것을 확인하였다. 앞으로 제안된 자동화된 다기능 전동 침상은 스마트 헬쓰케어를 위한 의료용 로봇의 한 모델이 될 수 있을 것으로 기대 된다.

• 대한인간공학회지
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• 제29권6호
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• pp.875-887
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• 2010

The quantitative effectiveness of powered support surfaces such as APAM in preventing and treating pressure ulcers has not been sufficiently evaluated because of uncertainty of alternating pressure load input and lack of interpretation of dynamic perfusion characteristics of soft tissue. The aim was to verify the dynamic loading effects to sacral tissue perfusion characteristics from alternating set pressure changes. We developed integrated experiment system to supply alternating load to supinely positioned sacrum and concurrently measured $TcPO_2$, $TcPCO_2$ and air cell pressure. Ten aged subjects (5 female, 5 male) were tested with alternating set pressure 20, 30, 40, 50 and 60mmHg. From the dynamic perfusion response eight characteristic parameters were proposed such as average, minimum, maximum and perfusion range regarding to $TcPO_2$ and $TcPCO_2$. A one-way ANOVA was carried out to determine whether the manipulation of alternating set pressure had any effect on $TcPO_2$ and $TcPCO_2$. From the dynamic tissue perfusion response we found mean $TcPO_2$ decreased exponentially as alternating pressure load increased and perfusion range varied mainly because of minimum level change of $TcPO_2$. And perfusion range of $TcPCO_2$ affected by increase of maximum value of $TcPCO_2$. From the results we can get more strict insights about actual physiological dynamic tissue perfusion mechanism under alternating pressure load.

• International Journal of Internet, Broadcasting and Communication
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• 제16권3호
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• pp.146-157
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• 2024

Despite numerous air mattresses marketed to prevent Pressure Ulcers (PU), none have fully succeeded due to residual pressure surpassing critical levels. We introduces an innovative medical bed system aiming at complete PU prevention. This system employs a unique 4-bar link mechanism, moving keys up and down to manage body pressure. Each of the 17 keys integrates a sensor controller, reading pressure from 10 sensors. By regulating motor input, we maintain body pressure below critical levels. Keys are equipped with a servo drive and sensor controller, linked to the main controller via two CAN series. Using fuzzy or PI/IP controllers, we adjust keys to minimize total error, dispersing body pressure and ensuring comfort. In case of controller failure, keys alternate swiftly, preventing ulcer development. Through experimental tests under varied conditions, the fuzzy controller with tailored membership functions demonstrated swift performance. PI control showed rapid convergence, while IP control exhibited slower convergence and oscillations near zero error. Our specialized medical robot bed, incorporating 4-bar links and pressure sensors, underwent testing with three controllers-fuzzy, PI, and IP-showcasing their effectiveness in keeping body pressure below critical ulcer levels. Experimental results validate the proposed approach's efficacy, indicating potential for complete PU prevention.

• 중환자간호학회지
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• 제11권1호
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• pp.79-88
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• 2018

Purpose : This study was performed to evaluate the effects of a prolonged a $30^{\circ}$ side-lying position on comfort and skin condition by applying the trunk maintenance repositioning method, which can keep the $30^{\circ}$ side-lying position effective for preventing pressure ulcers. Method : Fifty-four healthy nurses working at a general hospital in Seoul were randomly assigned to an experimental group (n=27) or a control group (n=27) and assumed a position of lying on their right or left side for two hours. The trunk maintenance repositioning method was applied to the experimental group using the pillow made by the researcher, while the original repositioning method was applied to the control group using the regular pillow from the subject hospital. Participants' posture angles, comfort, and skin condition were measured at the time of the intervention, as well as at one and two hours after the intervention. Results : There was no statistically significant difference in position angle, comfort, skin condition change, or sacrum and greater trochanter pressure change between the two groups over time. Conclusion : It is necessary to review the method and frequency of change of position in each hospital. In addition, a proper position changing pillow should be developed in consideration of patients' various body shapes.