EUROPEAN PRESSURE ULCER ADVISORY PANEL

What pressures do these devices apply?
The previous issue of the EPUAP Review presented the protocol for a literature review of the pressures applied by special beds and mattresses and the effects of such pressures on pressure ulcer development. Since the publication of the last EPUAP Review, relevant publications have been identified through the use of electronic data-bases (MEDLINE, CINHAL and RECAL) and hand-searching of relevant journals and conference proceedings. In this issue we print the list of references identified to date, both as a resource for EPUAP members and also to search for publications known to members but unreported in the following listing. If you have knowledge of additional references that should also be included please contact the editor at: mclark@glam.ac.uk or send your information to the EPUAP Business Office in Oxford.

Reference list covering pressure measurements made upon special beds and mattresses:
Abu-Own A, Sommerville K, Scurr JH, Coleridge Smith PD. Effects of compression and type of bed surface on the microcirculation of the heel. Euro J of Vascular & Endovascular Surgery 1995; 9(3): 327–34.

Allen V, Ryan D, Murray A. Repeatability of subject/bed pressure measurements. J of Biomedical Engineering 1993; 15: 329–332.

Allen V, Ryan D, Lomax N. Accuracy of interface pressure measurement systems. J of Biomedical Engineering 1993; 15: 344–8.

Allen V, Ryan D, Murray A. Air-fluidized beds and their ability to distribute interface pressures generated between the subject and the bed surface. Physiological Measurement 1993; 14: 359–364.

Allen V, Murray A. Measurements of interface pressure between body sites and the surfaces of four specialised air mattresses. British J of Clinical Practice 1994; 48: 125–129.

Bader DL, Barnhill RL, Ryan TJ. Effect of externally applied skin surface forces on tissue vasculature. Archives of Physical Medicine & Rehabilitation 1986; 67(11): 807–11.

Bader D. The recovery characteristics of soft tissues following repeated loading. J of Rehabilitation Research and Development 1990; 27: 141–150.

Bader D. Pressure Ulcers and the Spinal Cord Injured Patient (Abstract). Second European Pressure Ulcer Advisory Panel Open Meeting. Oxford, 1998.

Bain D. Testing the effectiveness of patient support systems: The importance of indentor geometry. J of Tissue Viability 1998; 8(1): 15–17.

Barnett RI, Ablarde JA. Skin Vascular Reaction to Standard Patient Positioning on a Hospital Mattress. Advances in Wound Care 1994; 7(1): 58–65.

Barnett RI, Shelton FE. Measurement of support surface efficacy: pressure [corrected] [published erratum appears in Adv Wound Care 1997 Mar–Apr; 11(2): 94]. Advances in Wound Care: the Journal for Prevention and Healing 1997; 10(7): 21–9.

Barton AA. Pressure sores viewed by electron microscope and thermographically. Geriatrics. 1973; 28(10): 143–7.

Beach R, Thompson D. Selected soft-tissue research: an overview from Carville. Physical Therapy 1979; 59: 30–33.

Bennett L, Kavner D, Lee B. Shear v pressure as causative factors in skin blood flow. Archives of Physical Medicine and Rehabilitation 1979; 60: 309–314.

Bennett L, Lee M, Lee B. Paraplegic pressure sore frequency versus circulation measurements. J of Rehabilitation Research and Development 1990; 27: 115–126.

Berjian RA, Douglass HO, Holyoke ED, Goodwin PM, Priore RL. Skin pressure measurements on various mattress surfaces in can-cer patients. American J of Physical Medicine 1983; 62(5): 217–26.

Blenkinsop G. An evaluation of the Vaperm mattress: Salisbury Health Authority 1985–6. Care Science and Pract. 1988; 6(3): 81–3.

Bogie K, Nuseibeh I, Bader D. Peri-operative transcutaneous blood gas assessment in SCI patients with pressure ulcers. In: Harding K, Leaper D, Turner T, eds. Proceedings of the First European Conference on Advances in Wound Management. Cardiff: Macmillan Magazines Ltd, 1991: 129–130.

Bos W, de Koning J. Description, pathogenesis and prevention of ulcers caused by tangential forces on the skin. In: Harding K, Cherry G, Dealey C, Turner T, eds. Proceedings of the 2nd European Conference on Advances in Wound Management. Harrogate: Macmillan Magazines Ltd, 1992: 167–9.

Bosboom E, Bouten C, Oomens C. The aetiology of pressure sores – influence of mechanical load on muscle tissue (abstract). J of Biomechanics 1998; 31(Suppl 1):144.

Brearley M, Motloch W. A mechanically-actuated wave mattress. Prosthetics and Orthotics International 1978; 2: 79–80.

Bridel-Nixon J, McElvenny D, Brown J, Mason S. Intra-operative pressure sore risk: a prognostic factor analysis. In: Leaper D, Cherry G, Cockbill S, eds. New Approaches to the Management of Chronic Wounds. Milan: Macmillan Magazines Ltd, 1997: 66.

Burman P. Using pressure measurements to evaluate different technologies. Decubitus 1993; 6(3): 38–42.

Campi F, Magliaro A, Romanelli M, et al. Skin hardness and transcutaneous oxygen tension in neuropathic diabetic feet. In: Leaper D, Cherry G, Cockbill S, eds. New Approaches to the Management of Chronic Wounds. Milan: Macmillan Magazines Ltd, 1997: 89–91.

Catz A, Philo O, Gilad N. Feasibility study of a novel approach to sore prevention in patients with spinal cord lesions: the computerised dynamic control Matrix 200 system. Clinical Rehabilitation 1999; 13: 44–47.

Chan JSL, Kelley ML, Khan J. The effects of a pressure relief mattress on postnatal head molding in very low birth weight infants. Neonatal Network J of Neonatal Nursing 1993; 12(5): 19–22.

Chen W-S, Higashi L, Chang M. Characteristics of the internal tissue stress: a study using a heel contact model (abstract). Archives of Physical Medicine & Rehabilitation 1999; 80: 1180.

Clark M. Continuous interface pressure measurement using an electro pneumatic sensor: the SCP Monitor. Care Science and Practice 1987; 5(2): 5–8.

Clark M, et al. Comparison of contact pressures measured at the sacrum of young and elderly subjects. J Biomed Eng. 1989; 11(3): 197–9.

Clark M. A comparison between the contact pressures exerted at skeletal prominences by a standard foam mattress and the ‘Sof Care Plus’ inflatable mattress. Care Science and Practice 1989; 7(1): 3–4.

Clark M, Rowland L. Preventing pressure sores: matching patient and mattress using interface pressure measurements. Decubitus 1989; 2(1): 34–39.

Clark M. Comparison of the pressure redistributing attributes of a selection of bed mattresses used to prevent pressure sores. J of Tissue Viability 1991; 1: 65–67.

Clark M, Andrews J. Comparison of interface pressures measured at the sacrum while resting upon two types of foam mattresses and between Platilon and plastic mattress covers. Age and Ageing 1991; 20: 267–270.

Clark M. Problems associated with the measurement of interface (or contact) pressure. J of Tissue Viability 1994; 4: 37–42.

Clark M. Are contact pressure measurements useful when selecting pressure-redistributing support surfaces? In: Leaper DL, Cherry GW, Dealey C, eds. Proceedings of the 6th European Conference on Advances in Wound Management. Amsterdam: Macmillan Press, 1996: 44–45.

Clark M. The aetiology of superficial sacral pressure sores. In: Leaper DL, Cherry GW, Dealey C, eds. Proceedings of the 6th European Conference on Advances in Wound Management. Amsterdam: Macmillan Press, 1996: 167–169.

Clubb M. Water Vapour Permeable Materials for Mattress Coverings. J of Tissue Viability 1988; 8(1): 12–14.

Colin D, Beaudet K, Abraham P, Saumet J-L. Evaluation of three low-airflow supports using transcutaneous oxygen tension measurements. In: Cherry G, Gottrup F, Lawrence J, Moffatt C, Turner T, eds. Proceedings of the 5th European Conference on Advances in Wound Management. Harrogate: Macmillan Magazines Ltd, 1995: 22–25.

Colin D, Abraham P, Preault L, Bregeon C, Saumet J-L. Comparison of 90 degree and 30 degree laterally inclined positions in the prevention of pressure sores using transcutaneous oxygen and transcutaneous carbon dioxide pressures. In: Cherry G, Gottrup F, Lawrence J, Moffatt C, Turner T, eds. Proceedings of the 5th European Conference on Advances in Wound Management. Harrogate: Macmillan Magazines Ltd, 1995: 226–228.

Colin D, Loyant R, Abraham P, Saumet J. Changes in sacral transcutaneous oxygen tension in the evaluation of different mattresses in the prevention of pressure ulcers. Advances in Wound Care: the Journal for Prevention and Healing 1996; 9(1): 25–8.

Colin D. Comparison of 90° and 30° laterally inclined positions in the prevention of pressure ulcers using transcutaneous oxygen and carbon dioxide pressures. Advances in Wound Care 1996; 9(3): 35–38.

Colin D, Desvaux B, Bregeon C, Saumet J-L. Comparison of two pressure-relieving devices in high-risk patients using interface pressure and tcpO2 measurement. In: Leaper D, Cherry G, Dealey C, Lawrence J, Turner T, eds. Proceedings of the 6th European Conference on Advances in Wound Management. Amsterdam: Macmillan Magazines Ltd, 1996: 191.

Colin D, Desvaux B, Finger M, Martin C. Evaluation of an air-relieving pressure mattress in high risk patients using interface pressure and tcpO2 measurement. In: Leaper D, Dealey C, Franks P, Hofman D, Moffatt C, eds. Proceedings of the 7th European Conference on Advances in Wound Management. Harrogate: EMAP Healthcare Ltd, 1997: 126.

Colin D, Abraham P, Nadeau G, Saumet J. Changes in ischial transcutaneous oxygen tension in spinal cord-injured patients according to the position of the wheelchair foot rest. In: Leaper D, Cherry G, Cockbill S, eds. New Approaches to the Management of Chronic Wounds. Milan: Macmillan Magazines Ltd, 1997: 88–89.

Collier ME. Pressure-reducing mattresses. J of Wound Care 1996; 5(5): 207–211.

Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Annals of Emergency Medicine 1995; 26(1): 31–6.

Counsell C, Seymour S, Guin P, Hudson A. Interface skin pressures on four pressure-relieving devices. J of Enterostomal Therapy 1990; 17(4): 150–3.

Crisp AH, Stonehill E, Eversden ID. The design of a motility bed including its calibration for the subject’s weight. Medical and Biological Engineering 1970; 8: 455–463

Cullum N, Deeks J, Fletcher A, et al. The prevention and treatment of pressure sores. Effective Health Care 1995; 2(1): 1–16.

Czerniecki J, Harrington R, Wyss C. The effects of age and peripheral vascular disease on the circulatory and mechanical response of skin to loading. American J of Physical Medicine and Rehabilitation 1990; 69: 302–306.

David J. A Survey of the Use of the LAL Bed in the UK. Care Science and Practice 1986; 4(3): 32–36.

Davis M, Newman P. Skin temperature measurement with respect to pressure sores and their development. Care Science and Practice 1981; 1(1): 46–49.

de Laat E. The influence of 30° laterally inclined position on the haemodynamic condition of IC Patients following coronary artery surgery (Abstract). Third European Pressure Ulcer Advisory Panel Open Meeting. Amsterdam, 1999.

Dealey C. A Comparative Study of Two Types of Foam Within Vaperm Mattresses. J of Tissue Viability 1992; 2(2): 69.

Dealey C, Davies J, Davies C, et al. A study of the peri-operative period to identify factors relating to pressure sore development in patients undergoing cardiac surgery. In: Cherry G, Gottrup F, Lawrence J, Moffatt C, Turner T, eds. Proceedings of the 5th European Conference on Advances in Wound Management. Harrogate: Macmillan Magazines Ltd, 1995: 90–91.

Dealey C. Managing pressure sore prevention: the effective use of pressure-relieving equipment. In: Leaper D, Cherry G, Cockbill S, eds. New Approaches to the Management of Chronic Wounds. Milan: Macmillan Magazines Ltd, 1997: 17–18.

Defloor T. The effect of posture and mattress on the development of pressure ulcers. In: Leaper D, Dealey C, Franks P, Hofman D, Moffatt C, eds. Proceedings of the 7th European Conference on Advances in Wound Management. Harrogate: EMAP Healthcare Ltd, 1997: 121.

Defloor T, Grypdonck M, Haalboom J. The effect of different turning intervals on the development of pressure ulcers (abstract). Third European Pressure Ulcer Advisory Panel Open Meeting. Amsterdam, 1999.

Dinsdale S. Decubitus ulcers: role of pressure and friction in causation. Archives of Physical Medicine and Rehabilitation 1974; 55: 147–152.

Ek A-C, Lewis DH, Zetterqvist H, Svensson P-G. Skin blood flow in an area at risk for pressure sore. Scandinavian J of Rehab. Medicine 1984; 16: 85–89.

Ek A-C, Gustavsson G, Lewis DH. The Local Skin Blood Flow in Areas at Risk for Pressure Sores Treated With Massage. Scandinavian J of Rehab. Medicine 1985; 17(2): 81–86.

Ek A-C, Gustavsson G, Lewis DH. Skin blood flow in relation to external pressure and temperature in the supine position on a standard hospital mattress. Scandinavian J of Rehab. Medicine 1987; 19: 121–126.

Ewald U, et al. Skin reactive hyperemia recorded by a combined TcPO2 and laser Doppler sensor. Adv Exp Med Biol. 1987; 220: 231–4.

Ferguson-Pell M, Hagisawa S. Biochemical changes in sweat following prolonged ischemia. J of Rehab. Research and Development 1988; 25(3): 57–62.

Ferguson-Pell M, Cardi M. Pressure mapping systems. TeamRehab Report 1992; 3(7): 28–32.

Ferguson-Pell M, Hagisawa S, Masiello RD. A skin indentation system using a pneumatic bellows [published erratum appears in J Rehabil Res Dev 1994; 31(2): 178]. J of Rehab. Research and Development 1994; 31(1): 15–9.

Flam E, Isayeva E, Kipervas Y, Shklyarevsky V, Raab L. Skin temperature and moisture management with a low air loss surface. Ostomy Wound Management 1995; 41(9): 50–2.

Fletcher J, Billingham G. Mattress replacements: assessment and evaluation. J of Tissue Viability 1993; 3: 123–126.

Fontaine R, Risley S, Castellino R. A quantitative analysis of pressure and shear in the effectiveness of support surfaces. Journal of Wocn 1998; 25(5): 233–9.

Frantz R, Xakellis GC, Arteaga M. The effects of prolonged pressure on skin blood flow in elderly patients at risk for pressure ulcers. Decubitus 1993; 6(6): 16–20.

Garfin SR, et al. Surface pressure distribution of the human body in the recumbent position. Arch Phys Med Rehabil. 1980; 61(9): 409–13.

Gebhardt K. The evidence for support surfaces (Abstract). Second European Pressure Ulcer Advisory Panel Open Meeting. Oxford, 1998.

Goossens RH, Zegers R, Hoek van Dijke GA, Snijders CJ. Influence of shear on skin oxygen tension. Clinical Physiology 1994; 14(1): 111–8.

Goossens R, Snijders C. Design criteria for the reduction of shear forces in beds. J of Biomechanics 1995; 28: 225–230.

Goossens R. Biomechanics of body support; a study of load distribution, shear, decubitus risk and form (PhD thesis summary). J of Rehabilitation Science 1995; 8: 63–64.

Goossens RH, et al. Shear stress measured on beds and wheelchairs. Scand J Rehabil Med. 1997; 29(3): 131–6.

Gorton B, Thorne L, Rithalia S. An Evaluation of Eight Non-Mechanical Mattresses and Overlays (abstract). J of Tissue Viability 1992; 2(2): 67.

Gorton B, Driscoll P, Rithalia S. Comparison of Pressure Distribution in Hospital trolley Mattresses and Overlays (Abstract). J of Tissue Viability 1993; 3(1): 33–34.

Grant L. Interface pressure measurement between a patient and a support surface. Care – The British J of Rehabilitation and Tissue Viability 1985; 1(1): 7–9.

Gunther R, Clark M. Can an Airwave mattress counter the lymphatic insufficiency associated with standard hospital mattresses? In: Leaper D, Cherry G, Dealey C, Lawrence J, Turner T, eds. Proceedings of the 6th European Conference on Advances in Wound Management. Amsterdam: Macmillan Magazines Ltd, 1996: 194.

Hagisawa S, Ferguson-Pell M, Cardi M, Miller SD. Assessment of skin blood content and oxygenation in spinal cord injured subjects during reactive hyperemia [published erratum appears in J Rehab. Res. Dev. 1994; 31(2): 178]. J of Rehab. Research and Development 1994; 31(1): 1–14.

Hargest T, Aetz C. A new concept in patient care: the air-fluidized bed. AORN J 1969; 24: 50–53.

Hey SJ. Pressure measurements in the management of tissue viability. Journal of Tissue Viability 1998; 8(4): 23–25.

Hickerson W, Parks J, Bishop J. A new measuring device and mattress to augment the prevention of pressure sores. In: Leaper D, Cherry G, Cockbill S, eds. New Approaches to the Management of Chronic Wounds. Milan: Macmillan Magazines Ltd, 1997: 65.

Holley L, Long J, Stewart J. A new pressure measuring system for cushions and beds – with a review of the literature. Paraplegia 1979; 17: 461–474.

Holscher T, Goossens R, Snijders C. A new low-cost anti-decubitus mattress for home care: requirements and development. J of Rehab Science 1994; 7: 53–58.

Holscher T, Goossens R, Snijders C. A new low-cost anti-decubitus mattress for home care; a comparison with other mattresses. J of Rehabilitation Science 1995; 8: 72–75.

Houben AJ, et al. Diurnal variations in total forearm and skin microcirculatory blood flow in man. Scand J Clin Lab Invest. 1994; 54(2): 161–8.

Husain T. An experimental study of some pressure effects on tissues with reference to the bed sore problem. J Pathol Bact 1953; 66: 347–358.

Iaizzo PA, Kveen GL, Kokate JY, Leland KJ, Hansen GL, Sparrow EM. Prevention of Pressure Ulcers by Focal Cooling: Histological Assessment in a Porcine Model. Wounds 1995; 7(5): 161–169.

Jackson BS, Chagares R, Nee N, Freeman K. The effects of a therapeutic bed on pressure ulcers: an experimental study. J of Enterostomal Therapy 1988; 15(6): 220–6.

Jacobs MA. Comparison of capillary blood flow using a regular hospital bed mattress, ROHO mattress, and Mediscus bed. Rehabilitation Nursing 1989; 14(5): 270–2.

Jay R. Pressure and shear: their effects on support surface choice. Ostomy Wound Manage. 1995; 41(8): 36–8, 40–2, 44–5.

Jay E. How different pressure reducing support surfaces address pressure and shear forces. J of Tissue Viability 1995; 5: 118–123.

Jensen JH, Sorensen JL, Hauge EN, Sejrsen P, Bojsen J. A semiconductor silicon PIN diode matrix detector for measurement of 133Xe washout in small regional skin areas. Physiological Measurement 1993; 14(2): 205–16.

Jester J, Weaver V. A report of clinical investigation of various tissue support surfaces used for the prevention, early intervention and management of pressure ulcers. Ostomy Wound Management 1990; 26: 39–45.

Justham D, Michael C, Harris D. A healthy volunteer study of skin-surface interface pressure experienced in X-ray departments. J of Tissue Viability 1996; 6(4): 107–110.

Kabagambe M, Swain I, Shakespeare P. An investigation of the effects of local pressure on microcirculation of the skin (reactive hyperaemia) in spinal cord injured patients. J of Tissue Viability 1994; 4: 110–123.

Kabagambe M. Effects of loading pressure on microcirculation in spinal cord injured patients (Abstract). J of Tissue Viability 1994; 4(3): 94.

Kang J-W, Chang G-L, Chou Y-L. Study on surface and tissue pressures related to pressure sores (abstract). J of Biomechanics 1992; 25: 801.

Karlsmark T, Kristensen JK. A method for testing the effect of pressure-relieving materials in the prevention of pressure ulcers. Acta Dermato-Venereologica 1987; 67(3): 260–3.

King DA. Guide to flexible polyurethane foams. J of Tissue Viability 1998; 8(1): 19–25.

Knox DM, Anderson TM, Anderson PS. Effects of different turn intervals on skin of healthy older adults. Advances in Wound Care: the Journal for Prevention and Healing 1994; 7(1): 48–52.

Kokate JY, Leland KJ, Held AM, et al. Temperature-Modulated Pressure Ulcers: A Porcine Model. Archives of Physical Medicine and Rehabilitation 1995; 76: 666–673.

Kosiak M, Kubicek W, Olson M. Evaluation of pressure as a factor in the production of ischial ulcers. Archives of Physical Medicine and Rehabilitation 1958; 39: 623–629.

Kosiak M. Etiology and pathology of ishemic ulcers. Archives of Physical Medicine and Rehabilitation 1959; 40: 62–69.

Krouskop TA, Williams R, Krebs M, Herszkowicz I, Garber S. Effectiveness of mattress overlays in reducing interface pressures during recumbency. J of Rehabilitation Research and Development 1985; 22: 7–10.

Larsen B, Holstein P, Lassen NA. On the pathogenesis of bedsores. Skin blood flow cessation by external pressure on the back. Scandinavian J of Plastic and Reconstructive Surgery 1979; 13(2): 347–50.

Laubscher NF. A statistical evaluation of the effectiveness of medical sheepskins for the prevention of pressure sores. S Afr Med J. 1966; 40(25): 599–601.

Lindan O, Greenway R, Piazza J. Pressure distribution on the surface of the human body: I evaluation in lying and sitting positions using a ‘bed of springs and nails’. Archives of Physical Medicine and Rehabilitation 1965; 46: 378–385.

Mahanty SD, et al. Thermal response of skin to application of localized pressure. Arch Phys Med Rehabil. 1979; 60(12): 584–90.

Mahanty SD, Roemer RB. Thermal and circulatory response of tissue to localized pressure application: a mathematical model. Arch of Phys Medicine and Rehabil. 1980; 61(8): 335–40.

Mahanty SD, Roemer RB, Meisel H. Thermal response of paraplegic skin to the application of localized pressure. Arch of Phys Medicine and Rehabil. 1981; 62(12): 608–11.

Mak AF, et al. A biphasic poroelastic analysis of the flow dependent subcutaneous tissue pressure and compaction due to epidermal loadings: issues in pressure sore. J Biomech Eng. 1994; 116(4): 421–9.

Maklebust J, Mondoux L, Sieggreen M. Pressure relief characteristics of various support surfaces used in prevention and treatment of pressure ulcers. J of Enterostomal Therapy 1986; 13: 85–89.

Mayrovitz HN, Regan MB, Larsen PB. Effects of Rhythmically Alternating and Static Pressure Support Surfaces on Skin Microvascular Perfusion. Wounds 1993; 5(1): 47–55.

Mayrovitz HN, et al. Heel blood perfusion responses to pressure loading and unloading in women. Ostomy Wound Management 1997; 43(7): 16–20, 22, 24 passim.

Mayrovitz HN, Smith J, Delgado M. Variability in skin microvascular vasodilatory responses assessed by laser-Doppler imaging. Ostomy Wound Management 1997; 43(9): 66–70, 72, 74.

Mayrovitz HN. Pressure and blood flow linkages and impacts on pressure ulcer development. Adv Wound Care. 1998; 11(3 Spl): 4.

McGovern T, Reger S, Waters K. Digital interface pressure evaluation. J of Clinical Engineering 1989; 14: 63–67.

Medical Devices Agency. Evaluation – Foam Mattresses. PS-1. London: Medical Devices Agency, 1993.

Meijer JH, Schut GL, Ribbe MW, et al. Method for the measurement of susceptibility to decubitus ulcer formation. Medical and Biological Engineering and Computing 1989; 27(5): 502–6.

Meijer JH, Germs PH, Schneider H, Ribbe MW. Susceptibility to decubitus ulcer formation. Arch of Phys Medicine and Rehabil. 1994; 75(3): 318–23.

Moore E, Green K, Rithalia S. A Survey of Operating Table Pads and Patient Trolley Mattresses. J of Tissue Viability 1992; 2(2): 67.

Moore E, Rithalia S, Gonsalkorale M. Assessment of the Charn-wood Operating Table and Hospital Trolley Mattresses. J of Tissue Viability 1992; 2(2): 71–72.

Murray A. Interface pressure measurements (Abstract). J of Tissue Viability 1994; 4(3): 94.

Neander KD, Birkenfeld R. The influence of various support systems for decubitus ulcer prevention on contact pressure and percutaneous oxygen pressure. Intensive Care Nursing 1991; 7(2): 120–7.

Neander K-D, Birkenfeld R. Decubitus prophylaxis in the operating theatre? J of Tissue Viability 1991; 1: 71–73.

Newman P, et al. Thermography as a predictor of sacral pressure sores. Age Ageing 1981; 10(1): 14–8.

Newson TP, Pearcy MJ, Rolfe P. Skin Surface PO2 Measurement and the Effects of Externally Applied Pressure. Arch of Phys Medicine and Rehabil. 1981; 62: 390–392.

Newson TP, Rolfe P. Skin surface PO2 and blood flow measurements over the ischial tuberosity. Arch of Phys Medicine and Rehabil 1982; 63(11): 553–6.

Nicol K, et al. Pressure distribution on mattresses. J Biomech. 1993; 26(12): 1479–86.

Nicol K, Natrup J, Peikenkamp K. Pressure distribution on soft surfaces (abstract). Gait Posture 1994; 2: 242–243.

Nola GT, Vistnes LM. Differential response of skin and muscle in the experimental production of pressure sores. Plastic and Recon Surgery 1980; 66(5): 728–33.

Norman D, Dunford C, Swain I. Assessment of Support Surfaces: First Technicare Mistral Mattress and Bodipillo Foam Chip Overlay. J of Tissue Viability 1995; 5(4): 115–117.

Ostrander LE, et al. Noninvasive evaluation of the cutaneous circulation in the management of pressure sores. Decubitus. 1989; 2(3): 62.

Patel UH, Jones JT, Babbs CF, Bourland JD, Graber GP. The evaluation of five specialized support surfaces by use of a pressure-sensitive mat. Decubitus 1993; 6(3): 28–31.

Patterson R, Cranmer H, Fisher S. The impaired response of spinal cord injured individuals to repeated surface pressure loads. Arch of Phys Medicine and Rehabil. 1993; 74: 947–953.

Petrie LA, Hummel RS, III. A study of interface pressure for pressure reduction and relief mattresses. J of Enterostomal Therapy 1990; 17(5): 212–6.

Porter J, Swain I. Non-invasive measurement of limb and digit blood flow. Care Science and Practice 1990; 8(1): 7–11.

Preston KW. Positioning for comfort and pressure relief: the 30° alternative. Care-Science and Practice 1988; 6(4): 116–119.

Pring J, Millman P. Measuring interface pressures in mattresses. J of Wound Care 1998; 7(4): 173–4.

Pye G, Bowker P. Skin temperature as an indicator of stress in soft tissue. Engineering in Medicine 1976; 5: 58–60.

Redfern SJ, Jeneid PA, Gillingham ME, Lunn HF. Local pressures with ten types of patient-support sytem. Lancet 1973; 2(7824): 277–80.

Reswick J, Nickel V, Simoes N. Rancho flotation bed. Prosthetics and Orthotics International 1977; 1: 47–51.

Rithalia S, Ferris R, Elliott J. Evaluation of the Huntleigh alternating pressure relief system. Care Science and Practice 1987; 5(3): 24–27.

Rithalia S. What inflation pressure and which air mattress. Care Science and Practice 1988; 6: 45–47.

Rithalia S. Pressure sores: methods used for the assessment of patient support surfaces. Clinical Rehabilitation 1991; 5: 323–329.

Rithalia S, Edwards J, Gonsalkorale M. An Evaluation of Three Methods Used for Comparing Patient Support Surfaces (abstract). J of Tissue Viability 1992; 2(2): 68.

Rithalia S. Comparison of performance characteristics of the Nimbus and Airwave mattresses. International J of Rehabilitation Research 1995; 18: 182–185.

Rithalia S. Pressure sores: which foam mattress and why? J of Tissue Viability 1996; 6(4): 115–120.

Rithalia S, Gonsalkorale M. Comparison of four alternating pressure air mattresses using a time based pressure threshold technique and continuous measurements of transcutaneous gases (Abstract). First European Pressure Ulcer Advisory Panel Open Meeting. Oxford, 1997: 19.

Rithalia S, Gonsalkorale M. Assessment of alternating air mattresses using a time-based interface pressure threshold technique. J of Rehabil. Research and Develop. 1998; 35: 225–230.

Rithalia S, Kenney L. Improvements made to two different alternating-pressure air mattresses (abstract). J of Tissue Viability 1999; 9: 26–27.

Rithalia S, Heath G, Gonsalkorale M. Assessment of alternating-pressure air mattresses using a time-based pressure threshold technique and continuous measurements of transcutaneous gases. J of Tissue Viability 2000; 10(1): 13–20.

Robertson J, Shah J, Amos H. An interface pressure sensor for routine clinical use. Engineering in Medicine 1980; 9: 151–156.

Robertson J, et al. An interface pressure sensor for routine clinical use. Care Science and Practice 1989; 7(2): 50–54.

Rogers JE. Body support testing and rating. Hosp Mater Manage Q. 1992; 14(1): 63–78.

Rojas MG, Reynolds A. Pressure-reducing capability of the Therarest hospital replacement mattress. Journal of Wocn 1996; 23(2): 100–4.

Romanus M. Microcirculatory reactions to local pressure induced ischaemia. A vital microscopic study in hamster cheek pouch and a pilot study in man. Acta Chirurgica Scandinavica (Supplement) 1977; 479: 5–30.

Rondorf-Klym LM, Langemo D. Relationship between body weight, body position, support surface, and tissue interface pressure at the sacrum. Decubitus 1993; 6(1): 22–5.

Ryan D, Byrne P. A study of contact pressure points in specialised beds. Clin Phys Physiol Meas 1990; 10: 331–335.

Sachse RE, Fink SA, Klitzman B. Comparison of supine and lateral positioning on various clinically used support surfaces. Annals of Plastic Surgery 1998; 41(5): 513–8.

Sachse RE, Fink SA, Klitzman B. Multimodality evaluation of pressure relief surfaces. Plastic and Reconstructive Surgery 1998; 102(7): 2381–7.

Sacks A, Perkash I, O’Neill H. Skin deformation and blood flow under external loading (report 70). Rehabilitation Research and Development Center 1988 Progress Report. Palo Alto, Ca: Veterans Administration Medical Center, 1988: 153–154.

Sacks AH, Ksander G, O’Neill H, Perkash I. Difficulties in laser Doppler measurement of skin blood flow under applied external pressure. J of Rehabil. Research and Develop. 1988; 25(3): 19–24.

Sacks AH. Theoretical prediction of a time-at-pressure curve for avoiding pressure sores. J Rehabil Res Dev. 1989; 26(3): 27–34.

Salisbury RE. Transcutaneous PO2 Monitoring in Bedridden Burn Patients: A Physiological Analysis of Four Methods to Prevent Pressure Sores. In: Lee BY, ed. Chronic Ulcers of the Skin. New York: McGraw-Hill Book Company, 1985: 189–196.

Salisbury Rehabilitation Research Group. Assessment of bedding surfaces. Care Science and Practice 1988; 6(3): 84–85.

Sanada H, Nagakawa T, Yamamoto M, Higashidani K, Tsuru H, Sugama J. The role of skin blood flow in pressure ulcer development during surgery. Advances in Wound Care 1997; 10(6): 29–34.

Sangeorzan B, Harrington R, Wyss C. Circulatory and mechanical response of skin to loading. J of Orthopaedic Research 1989; 7: 425–431.

Schregel W, Hube M, Finsterwalder H. Static and Dynamic Anti-Decubitus Systems for ITU Care Patients. J of Tissue Viability 1993; 3(4): 108–113.

Schubert V, Fagrell B. Local skin pressure and its effects on skin microcirculation as evaluated by laser-Doppler fluxmetry. Clinical Physiology 1989; 9(6): 535–45.

Schubert V. Hypotension as a risk factor for the development of pressure sores in elderly subjects Age Ageing. 1991; 20(4): 255–61.

Schubert V, Fagrell B. Postocclusive reactive hyperemia and thermal response in the skin microcirculation of subjects with spinal cord injury. Scandinavian J of Rehabil. Medicine 1991; 23(1): 33–40.

Schubert V, Heraud J. The effects of pressure and shear on skin microcirculation in elderly stroke patients lying in supine or semi-recumbent positions. Age and Ageing 1994; 23(5): 405–10.

Schubert V, Perbeck L, Schubert PA. Skin microcirculatory and thermal changes in elderly subjects with early stage of pressure sores. Clinical Physiology 1994; 14(1): 1–13.

Schubert V, Schubert PA, Breit G, Intaglietta M. Analysis of arterial flowmotion in spinal cord injured and elderly subjects in an area at risk for the development of pressure sores. Paraplegia 1995; 33(7): 387–97.

Seiler WO, Stahelin HB. Skin Oxygen Tension As a Function of Imposed Skin Pressure: Implications for Decubitus Ulcer Formation. J of the American Geriatrics Soc. 1979; 27(7): 298–301.

Seiler WO, Allen S, Stahelin HB. Decubitus ulcer prevention: a new investigative method using transcutaneous oxygen tension measurement. J of the American Geriatrics Soc. 1983; 31(12): 786–9.

Seiler WO, Allen S, Stahelin HB. Influence of the 30° laterally inclined position and the ‘super-soft’ 3-piece mattress on skin oxygen tension on areas of maximum pressure-implications for pressure sore prevention. Gerontology 1986; 32(3): 158–166.

Sideranko S, Quinn A, Burns K, Froman RD. Effects of position and mattress overlay on sacral and heel pressures in a clinical population. Research in Nursing and Health 1992; 15: 245–251.

Solis I, Krouskop T, Trainer T, Marburger R. Supine interface pressure in children. Arch of Phys Medicine and Rehabil. 1988; 69(7): 524–6.

Sorensen JL, et al. Cutaneous and subcutaneous blood flow rates in paraplegic humans investigated by 133xenon wash-out. Methodological considerations. Clin Physiol. 1994; 14(3): 281–9.

Stapelton M. Preventing pressure sores – an evaluation of three products. Geriatric Nursing 1986; 6: 23–25.

Steele BM. Evaluation of the role of direct pressure influence on ‘pressure sore’ formation: measurement of heel-surface interface pressures during spot flotation. Rush University, College of Nursing, 1988(SC).

Strunk H, Osterbrunk J. Pressure induced skin lesions in cardiac surgery. Care Science and Practice 1988; 6(4): 113–115.

Suarez CH, Reynolds A. Pressure reduction with a hospitalized population using a mattress overlay. Ostomy Wound Management 1995; 41(1): 58–60.

Swain I, Forder F, Todd S. Assessment of bedding surfaces. Care Science and Practice 1988; 6: 84–85.

Swain I, Grant L. Methods of measuring skin blood flow. Care Science and Practice 1990; 8(1): 31–45.

Swain I, Nash R, Robertson J. Assessment of support suraces: comparison of Nimbus and Pegasus mattresses. J of Tissue Viability 1992; 2: 43–45.

Swain I, Stacey P, Dunford C, Robertson J. Assessment of support surfaces: Comparison of the B.A.S.E. and Quattro Mattresses and Comparison of B.A.S.E and Standard 3 inch Foam Cushion. J of Tissue Viability 1992; 2(4): 123–125.

Swain I, Stacey P, Dunford C, Robertson J. Assessment of Support Surfaces: Comparison of Pegasus Biwave and Nimbus Mattresses. J of Tissue Viability 1992; 2(3): 87.

Swain I. Objective evaluation of support surfaces: The standard hospital mattress and its replacements (Abstract). J of Tissue Viability 1993; 3(3): 96.

Swain I. Report on DoH Study of Alternating Pressure Overlays (Abstract). J of Tissue Viability 1994; 4(3): 95.

Swain I, Norman D. Comparison of an overlay with heel elevation (OHE), a foam wedge, a foam wedge plus foam overlay and a standard King’s Fund mattress. J of Tissue Viability 1997; 7: 130–133.

Swain I. The case for measuring interface pressure (abstract). J of Tissue Viability 1998; 8(3): 32–33.

Tamura T, et al. Multichannel bed temperature recorder as a monitor of pressure sores. J Clin Eng. 1990; 15(4): 315–20.

Thompson J, Postans N, Dennis M, Dealey C. Peri-operative interface pressures in cardiac surgery patients. In: Cherry G, Gottrup F, Lawrence J, Moffatt C, Turner T, eds. Proceedings of the 5th European Conference on Advances in Wound Management. Harrogate: Macmillan Magazines Ltd, 1995: 20.

Thompson-Bishop JY, Mottola CM. Tissue interface pressure estimated subcutaneous pressures of 11 different pressure-reducing support surfaces. Decubitus 1992; 5(2): 42–6.

Trandel RS, et al. Thermographical investigation of decubitus ulcers. Bull Prosthet Res. 1975(10–24): 137–55.

van Marum RJ, et al. Impaired blood flow response following pressure load in diabetic patients with cardiac autonomic neuropathy. Arch Phys Med Rehabil. 1997; 78(9): 1003–6.

Verhonick PJ, et al. Thermography in the study of decubitus ulcers: preliminary report. Nurs Res. 1972; 21(3): 233–7.

Volker H, Roper G, Willy C, Gerngoss H. Measurement of Subcutaneous Tissue pressure and pO2 over the Os Sacrum (Abstract). Third European Pressure Ulcer Advisory Panel Open Meeting. Amsterdam, 1999.

Welch R. Sub-Capillary Pressure Monitor. Care Science and Practice 1987; 5(1): 16.

Wells P, Geden E. Paraplegic Body-Support Pressure on Convoluted Foam, Waterbed and Standard Mattress. Research in Nursing and Health 1984; 7: 127–133.

Wells JA, Karr D. Interface pressure, wound healing, and satisfaction in the evaluation of a non-powered fluid mattress. Ostomy Wound Management 1998; 44(2): 38–40.

Whittemore R, Bautista C, Smith C, Bruttomesso K. Interface pressure measurements of support surfaces with subjects in the supine and 45° Fowler positions. J of et Nursing 1993; 20(3): 111.

Wild D. Body pressures and bed surfaces. Nurs Stand. 1991; 5(27): 23, 25–7.

Williams C, Lewis F, Rithalia S. An Evalution of Four Replacement Mattresses (Abstract). J of Tissue Viability 1993; 3(1): 32–33.

Williams-Marburger R. An evaluation of the pressure relief characteristics of the Akros mattress. Care Science and Practice 1988; 6: 78–80.

Wytch R, Neil G, Kalisse C. Skin-orthosis interface pressure transducer. A review. Care Science and Practice 1989; 7(4): 100–104.

Xakellis GC, Frantz RA, Arteaga M, Meletiou S. A comparison of changes in the transcutaneous oxygen tension and capillary blood flow in the skin with increasing compressive weights. American J of Phys Medicine and Rehabil. 1991; 70(4): 172–7.