Decubitus Ulcers - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DECUBITUS ULCERS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J A...

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DECUBITUS ULCERS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Decubitus Ulcers: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00339-2 1. Decubitus Ulcers-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on decubitus ulcers. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DECUBITUS ULCERS .................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Decubitus Ulcers........................................................................... 4 E-Journals: PubMed Central ......................................................................................................... 7 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND DECUBITUS ULCERS ........................................................................ 33 Overview...................................................................................................................................... 33 Finding Nutrition Studies on Decubitus Ulcers ......................................................................... 33 Federal Resources on Nutrition ................................................................................................... 34 Additional Web Resources ........................................................................................................... 35 CHAPTER 3. ALTERNATIVE MEDICINE AND DECUBITUS ULCERS .................................................. 37 Overview...................................................................................................................................... 37 National Center for Complementary and Alternative Medicine.................................................. 37 Additional Web Resources ........................................................................................................... 42 General References ....................................................................................................................... 43 CHAPTER 4. DISSERTATIONS ON DECUBITUS ULCERS .................................................................... 45 Overview...................................................................................................................................... 45 Dissertations on Decubitus Ulcers .............................................................................................. 45 Keeping Current .......................................................................................................................... 45 CHAPTER 5. PATENTS ON DECUBITUS ULCERS............................................................................... 47 Overview...................................................................................................................................... 47 Patents on Decubitus Ulcers........................................................................................................ 47 Patent Applications on Decubitus Ulcers.................................................................................... 72 Keeping Current .......................................................................................................................... 80 CHAPTER 6. BOOKS ON DECUBITUS ULCERS .................................................................................. 83 Overview...................................................................................................................................... 83 Book Summaries: Online Booksellers........................................................................................... 83 CHAPTER 7. PERIODICALS AND NEWS ON DECUBITUS ULCERS .................................................... 85 Overview...................................................................................................................................... 85 News Services and Press Releases................................................................................................ 85 Academic Periodicals covering Decubitus Ulcers........................................................................ 86 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................... 89 Overview...................................................................................................................................... 89 U.S. Pharmacopeia....................................................................................................................... 89 Commercial Databases ................................................................................................................. 90 Researching Orphan Drugs ......................................................................................................... 91 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 95 Overview...................................................................................................................................... 95 NIH Guidelines............................................................................................................................ 95 NIH Databases............................................................................................................................. 97 Other Commercial Databases....................................................................................................... 99 APPENDIX B. PATIENT RESOURCES ............................................................................................... 101 Overview.................................................................................................................................... 101 Patient Guideline Sources.......................................................................................................... 101 Finding Associations.................................................................................................................. 104 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 107 Overview.................................................................................................................................... 107 Preparation................................................................................................................................. 107 Finding a Local Medical Library................................................................................................ 107

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Medical Libraries in the U.S. and Canada ................................................................................. 107 ONLINE GLOSSARIES................................................................................................................ 113 Online Dictionary Directories ................................................................................................... 113 DECUBITUS ULCERS DICTIONARY ...................................................................................... 115 INDEX .............................................................................................................................................. 145

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with decubitus ulcers is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about decubitus ulcers, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to decubitus ulcers, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on decubitus ulcers. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to decubitus ulcers, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on decubitus ulcers. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DECUBITUS ULCERS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on decubitus ulcers.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and decubitus ulcers, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “decubitus ulcers” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Ten Years' Experience with CAPD in a Nursing Home Setting Source: Peritoneal Dialysis International. 17(3): 255-261. May-June 1997. Contact: Available from Multimed, Inc. Subscriptions Department, 66 Marton Street, Milton, ON L9T 2R2, Canada. (888) 834-1001 or (905) 875-2456. Fax (905) 875-2864. Email: [email protected]. Summary: This article reports on a study in which the author reviews the experience with end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) in a nursing home setting. The author describes their demographic and clinical characteristics, evaluates CAPD technique success, and reports patient outcomes. In the 10 year period under study (1986 to 1996), the author reviewed 109 patients: 66 (60.5 percent) were female and 59 (54 percent) were white.

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Females were significantly older than males (64.9 years plus or minus 10.7 years for women, versus 59.1 years plus or minus 14.6 years for men). Sixty-eight of the patients (62.4 percent) had diabetes. Six and twelve month survival rates were 51.7 percent and 37.2 percent, respectively. Age greater than 75, poor functional status, coronary artery disease (CAD), and decubitus ulcers (bed sores) were significant mortality risks. Vascular disease was the leading cause (41.7 percent) of death. The peritonitis rate in the nursing home was 1.19 episodes per patient year. Gram positive organisms predominated. The hospitalization rate was 22.4 days per patient year. Gangrene or stump infections and peritonitis accounted for 14 percent and 10 percent of admissions. Those patients admitted for rehabilitation and with higher activity of daily living (ADL) scores were more likely to be discharged, and those with diabetes, age greater than 75, and CAD were less likely to be discharged. The authors conclude that peritoneal dialysis is a reasonable option for ESRD patients placed in nursing homes. Technical problems do not limit its use, but overall poor patient outcomes are an important issue. Patients whose discharge is anticipated on admission are those most likely to return to the community and are the most likely to truly benefit from nursing home placement. 1 figure. 4 tables. 24 references.

Federally Funded Research on Decubitus Ulcers The U.S. Government supports a variety of research studies relating to decubitus ulcers. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to decubitus ulcers. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore decubitus ulcers. The following is typical of the type of information found when searching the CRISP database for decubitus ulcers: •

Project Title: CORNEAL EPITHELIAL CELL SURFACE GLYCOCONJUGATES Principal Investigator & Institution: Panjwani, Noorjahan A.; Professor; Ophthalmology; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 01-AUG-1987; Project End 31-MAR-2007 Summary: (provided by applicant): The failure of the epithelium to migrate over the wound or of the migrated epithelium to remain adherent to the substratum may lead to the development of a number of debilitating clinical conditions of the cornea including recurrent erosions and persistent epithelial defects. We established during the previous funding period that two carbohydrate binding proteins, galectins-3 and -7, are among the key molecules which mediate corneal epithelial cell migration. For an understanding

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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of the mechanism by which galectins-3 and -7 mediate corneal epithelial cell migration, in Aim 1, we shall identify and characterize the corneal epithelial cell surface and extracellular matrix (ECM) glycoproteins which serve as counterreceptors of galectins-3 and -7, and will establish whether the lectins modulate corneal epithelial cell migration by binding to well-known integrins, growth factor receptors, and/or ECM molecules. In Aim 2, using small interfering RNA (siRNA) and/or antisense adenoviral constructs, cDNA microarrays and glycogene arrays, we shall determine whether galectin-3 mediates corneal epithelial cell migration indirectly by modulating the expression of key adhesion and/or signal transduction molecules. In Aim 3, by determining whether galectins-3 and/or -7 modulate the activation of specific kinases (focal adhesion kinase, protein kinase B, MAP kinases) that are well known for their role in cell migration, we shall establish whether the lectins mediate corneal epithelial cell migration by modulating specific signal transduction pathways. The proposed studies will contribute to a better understanding of the molecular basis of corneal epithelial cell migration and should ultimately help find novel therapeutic strategies for treating nonhealing corneal wounds. In addition, this study will contribute to the basic understanding of the general disorders of impaired or delayed re-epithelialization including chronic wounds in the elderly, decubitus ulcers, and venous stasis ulcer of the skin, conditions that together affect millions of individuals worldwide. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF HUMAN EPIDERMAL CELL REPLACEMENT Principal Investigator & Institution: Aneskievich, Brian J.; Assistant Professor of Pharmacology; Pharmaceutical Sciences; University of Connecticut Storrs Unit 1133 Storrs-Mansfield, Ct 06269 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2004 Summary: Aging epidermis in the epidermis is marked by decreases in both cell replication and production of proteins necessary for epidermal integrity. The epidermis thins, cracks and has a significantly reduced barrier function. Intrusion of chemicals and microbes increases; underlying connective tissue becomes more easily desiccated. There is poor resistance to physical trauma and inefficient wound repair. It is of little surprise that three-quarters of patients with decubitus ulcers (pressure sores) are over the age of seventy. Our long-term goal is to improve day- to-day cutaneous health and geriatric wound healing by identifying mechanisms of pharmacological or dietary compounds that enhance keratinocyte replacement or epidermal repair. We have recently demonstrated that a group of synthetic and natural compounds known as peroxisome proliferators (PPs) can increase epidermal keratinocyte growth. We hypothesize that PPs may unequally afect the different sub populations of replication competent keratinocytes. Epidermal replacement is dependent on replication of rare keratinocyte stem cells and more abundant transient amplifying cells. The Specific Aim for this pilot study will focus on detecting possible shifts in these populations. Keratinocytes will be treated with PPs and examined for changes in i)serial growth capacity in clonogenic assays and ii)expression of differentiation-dependent biochemical markers. Results within each assay can distinguish keratinocyte subpopulations of transient amplifying cells versus putative keratinocyte stem cells. PP exposure may increase the transient amplifying compartment by increasing the number of rounds of replication usually limited to 2-3 before withdrawal from the cell cycle and/or induce qualitative and/or quantitative changes in a6 and (31 integrins, proteins known to be essential for maintaining stem cell potential. Future work could address other cell cycle parameters and cellular responses to decipher the PP-induced growth enhancement. A better

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understanding of PP effect on keratinocyte replication may provide improved clinical interventions aimed at maintenance of geriatric cutaneous health and/or decreased time for skin wound-healing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEATED POSTURAL CONTROL WITH ELECTRICAL STIMULATION Principal Investigator & Institution: Wilkenfeld, Ari J.; Orthopaedics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-JUL-2002 Summary: (provided by applicant): This proposal concentrates on the control of seated posture and balance for individuals with low tetraplegia or paraplegia through the application of electrical stimulation. It represents an innovative approach to an unaddressed need of persons with spinal cord injuries and an advance in motor system neural prostheses, which have traditionally focused on upper and lower limb function. Lack of control of the spinal muscles restricts an individual's ability to vary seated position or maintain balance while reaching or manipulating objects in the environment. Moreover, long-term paralysis results in unhealthy postures that lead to skeletal deformities, increases risk for decubitus ulcers, and imposes pressures that compromise internal organ function. This project will determine the feasibility of a closed-loop control system for trunk posture. Through a coordinated series of computer simulations with a musculoskeletal model of the human torso, experimental verification with able bodied volunteers, and testing with subjects with low cervical or high thoracic spinal injuries, an automatic control system based on sensors for trunk orientation and acceleration will be developed to allow paralyzed users to assume and maintain trunk positions away from the backrest. This involves: a. Extending and improving an anatomically-based model of the biomechanics of the trunk and performing meaningful simulations. b. Verifying the model using EMG recordings and kinematic/kinetic data from able-bodied subjects in different trunk postures. c. Using the computer model to design controllers to allow a patient to set trunk position with a feed-forward input device like a joystick and maintain balance using feedback from accelerometers and other body-mounted sensors. d. Testing the controller on current users of neuroprostheses employing electrical stimulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SHEAR & PRESSURE REDUCING INSOLES FOR THE DIABETIC FOOT Principal Investigator & Institution: Higgins, Kevin R.; Xilas Medical, Inc. 12665 Silicon Dr San Antonio, Tx 78249 Timing: Fiscal Year 2002; Project Start 15-JUL-1999; Project End 30-JUN-2004 Summary: (provided by applicant): We will evaluate the feasibility of the ShearSoleTM novel insole to reduce pressure and shear forces on the foot. No commercially available insoles are designed to reduce shear. Although insurance providers spend millions on diabetics? therapeutic insoles, there is no scientific data about shear or pressure reduction. We will evaluate the optimal bonded materials from Phase I compared to the ShearSole TM design using the same combination of viscoelastic materials. We will evaluate 2 patient groups of 150 patients per arm (300 total) in an 18 month trial. The control group patient arm will wear a traditional bonded insole whereas another the second arm will receive the ShearSoleTM. At baseline, and at the end of the 18 month trial, in-shoe gait lab and in vitro biomechanical parameters will measure pressure,

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shear, and material properties as these change with wear. This Phase II eighteen (18) month clinical trial will evaluate the effectiveness of ShearSoleTM reducing the incidence of diabetic ulcers. The overall study hypothesis is that ShearSole TM will provide significant shear reduction as compared to traditional insoles without sacrificing pressure reduction characteristics or durability. In the long-term, this technology will be incorporated into removable cast walkers (to heal ulcers), wheelchair cushions and mattress pads (to prevent development of decubitus ulcers). PROPOSED COMMERCIAL APPLICATION: The low cost of ShearSole TM shear and pressure relieving insole promises to revolutionize diabetic patient care via a simple procedure of weating novel insoles in their shoes. Shear and pressure relieving qualities are provided in a novel insole package. This simple means will serve to decrease neuropathic ulcers, amputations and diabetic morbidity. In effect, the ShearSole TM, should become the insole of choice for diabetic patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “decubitus ulcers” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for decubitus ulcers in the PubMed Central database: •

Pharmacokinetics of amikacin in serum and in tissue contiguous with pressure sores in humans with spinal cord injury. by Segal JL, Brunnemann SR, Eltorai IM.; 1990 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=175993

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with decubitus ulcers, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “decubitus ulcers” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for decubitus ulcers (hyperlinks lead to article summaries): •

A clinical approach to the choice of antimicrobial agents, case number 3. Sepsis from decubitus ulcers and complications of therapy. Author(s): Barnwell PA, Raff MJ, Melo JC. Source: J Ky Med Assoc. 1979 March; 77(3): 116-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=383865

•

A fluid-support mattress and seat for the prevention and treatment of decubitus ulcers. Author(s): Weinstein JD, Davidson BA. Source: Lancet. 1965 September 25; 2(7413): 625-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4157565

•

A multicenter study on the use of pulsed low-intensity direct current for healing chronic stage II and stage III decubitus ulcers. Author(s): Wood JM, Evans PE 3rd, Schallreuter KU, Jacobson WE, Sufit R, Newman J, White C, Jacobson M. Source: Archives of Dermatology. 1993 August; 129(8): 999-1009. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8352625

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A randomized trial of cadexomer iodine in decubitus ulcers. Author(s): Moberg S, Hoffman L, Grennert ML, Holst A. Source: Journal of the American Geriatrics Society. 1983 August; 31(8): 462-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6688261

•

A small pliable humidity sensor, with special reference to the prevention of decubitus ulcers. Author(s): Trandel RS, Lewis DW. Source: Journal of the American Geriatrics Society. 1975 July; 23(7): 322-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1141632

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A ventral contour bed: a new concept in the management of decubitus ulcers. Author(s): Kaufman M. Source: Physical Therapy. 1971 May; 51(5): 535-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5581426

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Administrator's role in prevention and care of decubitus ulcers. Author(s): Lehman KB. Source: J Long Term Care Adm. 1983 Spring; 11(1): 21-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10259133

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Air-current treatment for decubitus ulcers. Author(s): Davis SW, Chu DS. Source: Archives of Physical Medicine and Rehabilitation. 1974 March; 55(3): 138-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4817686

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Air-fluidized therapy brings relief for decubitus ulcers. Author(s): Hanson JE. Source: J Am Health Care Assoc. 1985 November; 11(7): 18-9, 22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10274207

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Alternating-pressure mattresses for the prevention of decubitus ulcers: a study of healthy subjects and patients. Author(s): Neander KD, Birkenfeld R. Source: Intensive Care Nurs. 1990 June; 6(2): 67-73. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2380539

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An alternative to the total-thigh flap for coverage of massive decubitus ulcers. Author(s): Burkhardt BR. Source: Plastic and Reconstructive Surgery. 1972 April; 49(4): 433-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4552356

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An effective approach to treating decubitus ulcers in home healthcare patients. Author(s): Bennis S, Davis S. Source: Home Healthcare Nurse. 1994 January-February; 12(1): 47-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8113091

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Anaerobic and aerobic bacteriology of decubitus ulcers in children. Author(s): Brook I. Source: The American Surgeon. 1980 November; 46(11): 624-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7436139

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Anaerobic bacteria isolated from decubitus ulcers. Author(s): Peromet M, Labbe M, Yourassowsky E, Schoutens E. Source: Infection. 1973; 1(4): 205-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4207921

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Decubitus Ulcers

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Automated bed to aid pulmonary drainage and prevent decubitus ulcers. Author(s): Roemer RB, Meisel H, Parrish WJ. Source: Med Biol Eng. 1975 January; 13(1): 78-83. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1195801

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Autopsy-based assessment of extent and type of osteomyelitis in advanced-grade sacral decubitus ulcers: a histopathologic study. Author(s): Turk EE, Tsokos M, Delling G. Source: Archives of Pathology & Laboratory Medicine. 2003 December; 127(12): 1599602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632571

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Bacteremia associated with decubitus ulcers. Author(s): Bryan CS, Dew CE, Reynolds KL. Source: Archives of Internal Medicine. 1983 November; 143(11): 2093-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6357131

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Bacteria in decubitus ulcers. Author(s): Kontiainen S, Rinne E. Source: Infection. 1988 September-October; 16(5): 305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3215693

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Bacteroides bacteremia from decubitus ulcers. Author(s): Rissing JP, Crowder JG, Dunfee T, White A. Source: Southern Medical Journal. 1974 October; 67(10): 1179-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4412164

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Bilateral hip disarticulation in paraplegics with decubitus ulcers. Author(s): Lawton RL, De Pinto V. Source: Archives of Surgery (Chicago, Ill. : 1960). 1987 September; 122(9): 1040-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3619617

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Biochemical changes in skin composition in spinal cord injury: a possible contribution to decubitus ulcers. Author(s): Rodriguez GP, Claus-Walker J. Source: Paraplegia. 1988 October; 26(5): 302-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3205571

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Blood supply and decubitus ulcers. Author(s): Ryan TJ. Source: International Journal of Dermatology. 1979 March; 18(2): 123-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=422309

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Bucket seat for control of decubitus ulcers. Author(s): Hassard GH, Conry J, Rice W. Source: Archives of Physical Medicine and Rehabilitation. 1971 October; 52(10): 481-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5116033

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Carbon dioxide laser debridement of decubitus ulcers: followed by immediate rotation flap or skin graft closure. Author(s): Stellar S, Meijer R, Walia S, Mamoun S. Source: Annals of Surgery. 1974 February; 179(2): 230-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4590105

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Chronic wounds: myths about decubitus ulcers. Author(s): Parish LC, Witkowski JA. Source: International Journal of Dermatology. 1994 September; 33(9): 623-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8002154

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Clindamycin for treatment of sepsis caused by decubitus ulcers. Author(s): Chow AW, Galpin JE, Guze LB. Source: The Journal of Infectious Diseases. 1977 March; 135 Suppl: S65-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=850093

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CO2 laser in decubitus ulcers: a comparative study. Author(s): Juri H, Palma JA. Source: Lasers in Surgery and Medicine. 1987; 7(4): 296-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3683061

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Collagenase in the treatment of dermal and decubitus ulcers. Author(s): Rao DB, Sane PG, Georgiev EL. Source: Journal of the American Geriatrics Society. 1975 January; 23(1): 22-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=162802

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Collagenase therapy for decubitus ulcers. Author(s): Lee LK, Ambrus JL. Source: Geriatrics. 1975 May; 30(5): 91-3, 97-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=163782

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Cultured autologous outer root sheath cells: a new therapeutic alternative for chronic decubitus ulcers. Author(s): Jeschke MG, Richter W, Ruf SG. Source: Plastic and Reconstructive Surgery. 2001 June; 107(7): 1803-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11391205

12

Decubitus Ulcers

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Debrisan for decubitus ulcers. Author(s): Di Mascio S. Source: The American Journal of Nursing. 1979 April; 79(4): 684-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=255054

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Decubitus ulcers after instituting epidural analgesia for pain relief in labour. Author(s): Offori EM, Popham P. Source: Anaesthesia. 2000 February; 55(2): 194. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10755975

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Decubitus ulcers and amyotrophic lateral sclerosis. Author(s): Parish LC, Smith G, Collins E. Source: Lancet. 1978 March 25; 1(8065): 658-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=76187

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Decubitus ulcers and rehabilitation medicine. Author(s): Staas WE Jr, LaMantia JG. Source: International Journal of Dermatology. 1982 October; 21(8): 437-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6757159

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Decubitus ulcers and wheelchair cushions a review of the literature. Author(s): Bokhaut F. Source: Can J Occup Ther. 1980 June; 47(3): 111-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10297897

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Decubitus ulcers in a geriatric institution. Author(s): Goodfriend SS. Source: J Am Podiatry Assoc. 1965 September; 55(9): 667-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5825022

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Decubitus ulcers in geriatric patients; present status. Author(s): Isiadinso OO. Source: N Y State J Med. 1979 December; 79(13): 2027-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=293524

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Decubitus ulcers in nursing home care: legalities. Case in point: Mellies v. National Heritage, Inc. (630 P. 2d 215 - KA). Author(s): Regan WA. Source: Regan Rep Nurs Law. 1982 February; 22(9): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6916380

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Decubitus ulcers in paraplegics: Financial implications. Author(s): Robinson CE, Coghlan JK, Jackson G. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1978 May-June; 69(3): 199. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=667766

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Decubitus ulcers on admission to nursing homes: prevalence and residents' characteristics. Author(s): Sternberg J, Spector WD, Kapp MC, Tucker RJ. Source: Decubitus. 1988 August; 1(3): 14-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3267087

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Decubitus ulcers, prevention and management: a review. Author(s): Griffin ER 3rd. Source: Military Medicine. 1982 May; 147(5): 369-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6810209

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Decubitus ulcers. Author(s): Guin JD. Source: J Indiana State Med Assoc. 1979 June; 72(6): 403. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=458178

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Decubitus ulcers. Author(s): Rousseau P. Source: Postgraduate Medicine. 1990 August; 88(2): 53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2264854

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Decubitus ulcers. Author(s): Lerman SI. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1989 April-June; 2(2): 141. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2711886

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Decubitus ulcers. Author(s): Perdue RW, Wilson JL. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1989 January-March; 2(1): 43-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2646854

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Decubitus Ulcers

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Decubitus ulcers. Author(s): Webb J. Source: Proc Annu Clin Spinal Cord Inj Conf. 1967 September 27; 16: 113-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5191667

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Decubitus ulcers. An ounce prevention. Author(s): Berger EM, DeGregorie P. Source: Physical Therapy. 1976 December; 56(12): 1374-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=996094

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Decubitus ulcers. How to prevent them--and intervene should prevention fail. Author(s): Shenaq SM, Dinh TA. Source: Postgraduate Medicine. 1990 March; 87(4): 91-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2315260

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Decubitus ulcers: a comparative study. Author(s): Parish LC, Collins E. Source: Cutis; Cutaneous Medicine for the Practitioner. 1979 January; 23(1): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=215386

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Decubitus ulcers: a multidisciplinary view. Author(s): Smith M. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1993 January 6-12; 7(15-16): 25-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8443068

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Decubitus ulcers: a nursing care study. Author(s): Berglas C, Sullivan O. Source: J Nurs Care. 1980 April; 13(4): 16-7, 30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6900098

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Decubitus ulcers: a survey picture at two hospitals. Author(s): Childs L, Rimmington PM. Source: Aust Nurses J. 1983 July; 13(1): 35, 52. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6556061

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Decubitus ulcers: cause, prevention, and treatment. Author(s): Merlino AF. Source: Geriatrics. 1969 March; 24(3): 119-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4885553

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Decubitus ulcers: new treatments for an old problem. Author(s): Milem MM, Chambers JK. Source: J Pract Nurs. 1981 May; 31(5): 17-20, 41. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6909290

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Decubitus ulcers: prevention and treatment. Author(s): Guthrie RH Jr, Goulian D Jr. Source: Geriatrics. 1973 August; 28(8): 67-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4578786

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Decubitus ulcers: preventive techniques for the elderly patient. Author(s): Seiler WO, Stahelin HB. Source: Geriatrics. 1985 July; 40(7): 53-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4007498

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Decubitus ulcers: principles of prevention and management. Author(s): Reddy MP. Source: Geriatrics. 1983 July; 38(7): 55-6, 59-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6852539

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Decubitus ulcers: treatment through five therapeutic principles. Author(s): Seiler WO, Stahelin HB. Source: Geriatrics. 1985 September; 40(9): 30-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4029622

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Decubitus ulcers: update on new approaches to treatment. Author(s): Mulder GD, LaPan M. Source: Geriatrics. 1988 September; 43(9): 37-9, 44-5, 49-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3261704

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Decubitus ulcers: when to suspect osteomyelitis. Author(s): Dimant J, Tanael L. Source: Geriatrics. 1987 June; 42(6): 74, 79, 83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3582988

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Dental water irrigating device used for cleaning decubitus ulcers. Author(s): Nourse AM, Myers W. Source: Physical Therapy. 1978 October; 58(10): 1219. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=693582

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Decubitus Ulcers

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Dramatic decrease in decubitus ulcers. Author(s): Blom MF. Source: Geriatric Nursing (New York, N.Y.). 1985 March-April; 6(2): 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3844361

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Drugs and the elderly. Products to treat decubitus ulcers. Author(s): Todd B. Source: Geriatric Nursing (New York, N.Y.). 1984 May-June; 5(3): 196, 199. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6562063

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Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial. Author(s): Lucas C, van Gemert MJ, de Haan RJ. Source: Lasers in Medical Science. 2003; 18(2): 72-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928815

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Etiology of decubitus ulcers. Author(s): Berecek KH. Source: Nurs Clin North Am. 1975 March; 10(1): 157-70. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1038626

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Experience with a flotation unit for prevention of decubitus ulcers. Author(s): Harper PJ, Rocko JM, Timmes JJ. Source: J Med Soc N J. 1975 October; 72(10): 824-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1058976

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Factors associated with presence of decubitus ulcers at admission to nursing homes. Author(s): Spector WD, Kapp MC, Tucker RJ, Sternberg J. Source: The Gerontologist. 1988 December; 28(6): 830-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3267006

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Factors influencing the development of decubitus ulcers in critically ill surgical patients. Author(s): Eachempati SR, Hydo LJ, Barie PS. Source: Critical Care Medicine. 2001 September; 29(9): 1678-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11546964

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Floatation pad therapy for decubitus ulcers. Author(s): Paradis R, Williams M, Manthey A, Nickerson J, Roberts C, Himmelwright M. Source: Archives of Physical Medicine and Rehabilitation. 1975 January; 56(1): 40-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1115592

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Flotation as an aid in the treatment of decubitus ulcers. Author(s): Harris C. Source: Journal of the American Geriatrics Society. 1967 July; 15(7): 605-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6027635

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Fluid support in the prevention and treatment of decubitus ulcers. Author(s): Weinstein JD, Davidson BA. Source: Am J Phys Med. 1966 December; 45(6): 283-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5956110

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Free sensory and nonsensory plantar flap transfers in the treatment of ischial decubitus ulcers. Author(s): Sekiguchi J, Kobayashi S, Ohmori K. Source: Plastic and Reconstructive Surgery. 1995 January; 95(1): 156-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7809232

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Gel support for prevention of decubitus ulcers. Author(s): Spence WR, Burk RD, Rae JW Jr. Source: Archives of Physical Medicine and Rehabilitation. 1967 June; 48(6): 283-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6025088

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Gelfoam for decubitus ulcers. Author(s): Lang C, McGrath A. Source: The American Journal of Nursing. 1974 March; 74(3): 460-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4492908

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Gluteus maximus musculocutaneous island flaps and their use in sacral decubitus ulcers. Author(s): Stockarova D, Pilnacek J, Rubin J. Source: Acta Chir Plast. 1985; 27(3): 176-84. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4060966

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Gold leaf occlusive therapy in the management of decubitus ulcers. Author(s): Oden PW. Source: Proc Annu Clin Spinal Cord Inj Conf. 1967 September 27; 16: 72-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5191697

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Decubitus Ulcers

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Healing of decubitus ulcers of patients in neuro-kinesthetic program with the ElectroAcuscope 80. Author(s): Chalker M. Source: Crit Care Update. 1983 March; 10(3): 50-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6601565

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Hemicorporectomy for intractable decubitus ulcers. Author(s): Pearlman NW, McShane RH, Jochimsen PR, Shirazi SS. Source: Archives of Surgery (Chicago, Ill. : 1960). 1976 October; 111(10): 1139-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=971090

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Hemipelvectomy for severe decubitus ulcers in patients with previous spinal cord injury. Author(s): Chan JW, Virgo KS, Johnson FE. Source: American Journal of Surgery. 2003 January; 185(1): 69-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12531450

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Heterotopic bone formation about the hip and unilateral decubitus ulcers in spinal cord injury. Author(s): Hassard GH. Source: Archives of Physical Medicine and Rehabilitation. 1975 August; 56(8): 355-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1156127

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Hip disarticulation for paraplegics with decubitus ulcers. Author(s): Goldberg B. Source: Archives of Surgery (Chicago, Ill. : 1960). 1988 February; 123(2): 258. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3341907

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Homicide by decubitus ulcers. Author(s): Di Maio VJ, Di Maio TG. Source: The American Journal of Forensic Medicine and Pathology : Official Publication of the National Association of Medical Examiners. 2002 March; 23(1): 1-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11953485

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Honey for decubitus ulcers. Author(s): Bromfield R. Source: Jama : the Journal of the American Medical Association. 1973 May 7; 224(6): 905. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4739699

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How we treat decubitus ulcers. Author(s): Adams LA, Bluefarb SM. Source: Postgraduate Medicine. 1968 September; 44(3): 269-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5678992

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Impaired migration of epidermal cells from decubitus ulcers in cell cultures. A cause of protracted wound healing? Author(s): Seiler WO, Stahelin HB, Zolliker R, Kallenberger A, Luscher NJ. Source: American Journal of Clinical Pathology. 1989 October; 92(4): 430-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2801609

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Investigation into the microbial flora of healing and non-healing decubitus ulcers. Author(s): Daltrey DC, Rhodes B, Chattwood JG. Source: Journal of Clinical Pathology. 1981 July; 34(7): 701-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6790579

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Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index. Author(s): Ehrenkranz NJ, Alfonso B, Nerenberg D. Source: Journal of Clinical Microbiology. 1990 November; 28(11): 2389-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2254414

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Island flap coverage of extensive decubitus ulcers. Author(s): Weeks PM, Brower TD. Source: Plastic and Reconstructive Surgery. 1968 November; 42(5): 433-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4880834

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Magnetic resonance imaging examinations of gluteal decubitus ulcers in spinal cord injury patients. Author(s): Hencey JY, Vermess M, van Geertruyden HH, Binard JE, Manchepalli S. Source: J Spinal Cord Med. 1996 January; 19(1): 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8673511

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Management of decubitus ulcers in paraplegic patients. Author(s): Zackin HJ. Source: Southern Medical Journal. 1978 May; 71(5): 574-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=347588

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Management of decubitus ulcers. Author(s): Coodley E, Lincer F, Parham A, Uesu C. Source: Compr Ther. 1983 July; 9(7): 61-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6192969

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Managing decubitus ulcers. Author(s): Fellin R. Source: Nursing Management. 1984 February; 15(2): 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6560330

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Managing decubitus ulcers. Author(s): Morley M. Source: Can Nurse. 1990 October; 86(9): 19-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2224819

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Mediscus Low Air-Loss Beds and the prevention of decubitus ulcers. Author(s): Beaver MJ. Source: Critical Care Nurse. 1986 September-October; 6(5): 32-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3639004

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Microbiological studies of decubitus ulcers in children. Author(s): Brook I. Source: Journal of Pediatric Surgery. 1991 February; 26(2): 207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2023086

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Modified foot cradles for decubitus ulcers to permit weight bearing. Author(s): Weinstein MV, Diaz J. Source: Physical Therapy. 1973 May; 53(5): 519-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4695560

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Monitoring decubitus ulcers: a monthly survey method. Author(s): Morrison S. Source: Qrb Qual Rev Bull. 1984 April; 10(4): 112-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6427731

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Monitoring skin care eliminates decubitus ulcers. Author(s): Eusanio PL. Source: J Am Health Care Assoc. 1976 November; 2(6): 50-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1049595

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Namely a name: atopic dermatitis, decubitus ulcers, scabies. Author(s): Parish LC, Witkowski JA. Source: Skinmed. 2002 November-December; 1(2): 83-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14673331

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New perspectives in the treatment of decubitus ulcers. Author(s): Guggisberg E, Terumalai K, Carron JM, Rapin CH. Source: Journal of Palliative Care. 1992 Summer; 8(2): 5-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1378900

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Nursing innovation for prevention of decubitus ulcers in long term care facilities. Author(s): Brown MM, Boosinger J, Black J, Gaspar T. Source: Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses. 1985 Summer; 5(2): 57-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3925473

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Nursing innovation for prevention of decubitus ulcers in long term care facilities. Author(s): Brown MM, Boosinger J, Black J, Gaspar T. Source: J Plast Reconstr Surg Nurs. 1981 May; 1(2): 51-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6813458

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Nutrition in prevention and treatment of decubitus ulcers. Author(s): Natow AB. Source: Top Clin Nurs. 1983 July; 5(2): 39-44. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6553418

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Nutritional management of decubitus ulcers in the elderly. Author(s): Kaminski MV Jr, Pinchcofsky-Devin G, Williams SD. Source: Decubitus. 1989 November; 2(4): 20-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2510755

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Oscillating wheelchair seat for prevention of decubitus ulcers. Author(s): Roemer RB. Source: Medical & Biological Engineering & Computing. 1979 May; 17(3): 379-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=161600

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Our experience with the use of musculocutaneous flaps in trochanteric decubitus ulcers. Author(s): Stockarova D, Pilnacek J. Source: Acta Chir Plast. 1984; 26(4): 238-45. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6084384

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Overcoming the red menace: preventing and treating decubitus ulcers. Author(s): Byrne N, Feld M. Source: Nursing. 1984 April; 14(4): 55-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6561427

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Overwhelming cranial and spinal subdural empyema secondary infected sacral decubitus ulcers. Author(s): Baker RP, Brown EM, Coakham HB. Source: British Journal of Neurosurgery. 2003 December; 17(6): 572-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14756492

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Penetration of antibiotics into decubitus ulcers. Author(s): Berger SA, Barza M, Haher J, Bell D, Waintraub S, Burtyk ML, Kane A. Source: The Journal of Antimicrobial Chemotherapy. 1981 February; 7(2): 193-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6783609

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Penetration of clindamycin into decubitus ulcers. Author(s): Berger SA, Barza M, Haher J, McFarland JJ, Louie S, Kane A. Source: Antimicrobial Agents and Chemotherapy. 1978 September; 14(3): 498-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=708028

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Plantar decubitus ulcers in rats and rabbits. Author(s): Honma M, Kast A. Source: Jikken Dobutsu. 1989 July; 38(3): 253-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2792208

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Preliminary observations on the effect of oral zinc sulfate on the healing of decubitus ulcers. Author(s): Brewer RD Jr, Leal JF, Mihaldzic N. Source: Proc Annu Clin Spinal Cord Inj Conf. 1966 November 7; 15: 93-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6015343

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Preliminary observations on the effect of oral zinc sulfate on the healing of decubitus ulcers. Author(s): Brewer RD Jr, Leal JF, Mihaldzic N. Source: Proc Annu Clin Spinal Cord Inj Conf. 1966; 15: 93-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6003567

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Pressure ulcers (bedsores or decubitus ulcers). Author(s): Hendricks WM. Source: N C Med J. 1990 May; 51(5): 224-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2342609

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Prevalence of decubitus ulcers: issues of concern. Author(s): Sternberg J. Source: Decubitus. 1989 May; 2(2): 50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2787657

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Preventing and treating decubitus ulcers. Author(s): Steerman PH. Source: Contemp Adm Long Term Care. 1983 July; 6(7): 18. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10295269

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Primary closure of trochanteric decubitus ulcers: the bipedicle tensor fascia lata musculocutaneous flap. Author(s): Vasconez LO. Source: Plastic and Reconstructive Surgery. 1980 November; 66(5): 745. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7001521

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Primary closure of trochanteric decubitus ulcers: the bipedicle tensor fascia lata musculocutaneous flap. Author(s): Schulman NH. Source: Plastic and Reconstructive Surgery. 1980 November; 66(5): 740-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7001520

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Prognostic factors in decubitus ulcers of the aged. Author(s): Vasile J, Chaitin H. Source: Geriatrics. 1972 April; 27(4): 126-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5012279

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Prophylaxis and treatment of decubitus ulcers with a rocking bed. Author(s): Hook O, Gabrielsson L, Lagerman U. Source: Scandinavian Journal of Rehabilitation Medicine. 1982; 14(1): 33-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7063819

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Prospective study of decubitus ulcers in two long term care facilities. Author(s): Nicolle LE, Orr P, Duckworth H, Brunka J, Kennedy J, Urias B, Murray D, Harding GK. Source: Can J Infect Control. 1994 Summer; 9(2): 35-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8000069

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Relationship between internal risk factors for development of decubitus ulcers and the blood flow response following pressure load. Author(s): van Marum RJ, Meijer JH, Ooms ME, Kostense PJ, van Eijk JT, Ribbe MW. Source: Angiology. 2001 June; 52(6): 409-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11437031

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Sepsis associated with decubitus ulcers. Author(s): Galpin JE, Chow AW, Bayer AS, Guze LB. Source: The American Journal of Medicine. 1976 September; 61(3): 346-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=961699

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Sinography in management of decubitus ulcers. Author(s): Putnam T, Calenoff L, Betts HB, Rosen JS. Source: Archives of Physical Medicine and Rehabilitation. 1978 May; 59(5): 243-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=655839

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Special mattresses: effectiveness in preventing decubitus ulcers in chronic neurologic patients. Author(s): Daechsel D, Conine TA. Source: Archives of Physical Medicine and Rehabilitation. 1985 April; 66(4): 246-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3985778

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Successful management of decubitus ulcers by the general surgeon. Author(s): Bunt TJ. Source: Southern Medical Journal. 1983 April; 76(4): 453-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6836359

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Surgical management of decubitus ulcers. Author(s): Granick MS, Eisner AN, Solomon MP. Source: Clinics in Dermatology. 1994 January-March; 12(1): 71-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8180947

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Surgical repair of decubitus ulcers in paraplegics. Author(s): Nally C, O'Riain S. Source: Ir Med J. 1983 July; 76(7): 317-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6885330

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Surgical treatment of decubitus ulcers in paraplegic patients. Author(s): Braver SD. Source: Ohio State Med J. 1968 May; 64(5): 582-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5655970

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Surgical treatment of decubitus ulcers in paraplegics. Author(s): Sanchez S, Eamegdool S, Conway H. Source: Plastic and Reconstructive Surgery. 1969 January; 43(1): 25-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4885275

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Surgical treatment of ischial decubitus ulcers with buried derma-fat flap. Author(s): Tulenko JF. Source: Plastic and Reconstructive Surgery. 1967 July; 40(1): 72-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5338777

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The carbon dioxide surgical laser in neurological surgery, decubitus ulcers, and burns. Author(s): Stellar S. Source: Lasers in Surgery and Medicine. 1980; 1(1): 15-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6801403

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The care of decubitus ulcers pressure sores. Author(s): Michocki RJ, Lamy PP. Source: Journal of the American Geriatrics Society. 1976 May; 24(5): 217-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1262677

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The effect of oral zinc sulfate on the healing of decubitus ulcers in spinal cord injured patients. Author(s): Brewer RD Jr, Mihaldzic N, Dietz A. Source: Proc Annu Clin Spinal Cord Inj Conf. 1967 September 27; 16: 70-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4887340

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The etiology, prevention and management of decubitus ulcers. Author(s): Schell VC, Wolcott LE. Source: Mo Med. 1966 February; 63(2): 109-12 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5946491

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The management of decubitus ulcers by muscle transposition. An 8-year review. Author(s): Ger R, Levine SA. Source: Plastic and Reconstructive Surgery. 1976 October; 58(4): 419-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=785509

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The management of decubitus ulcers by musculocutaneous flaps: a five-year experience. Author(s): Mandrekas AD, Mastorakos DP. Source: Annals of Plastic Surgery. 1992 February; 28(2): 167-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1567119

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The management of decubitus ulcers. Author(s): Saunders DE, Jasion AR. Source: Del Med J. 1966 May; 38(5): 129-36. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5932754

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The need for skin and muscle saving techniques in the repair of decubitus ulcers. A consecutive series of 72 patients and 100 ulcers over 5 years (1979/1984). A case report. Author(s): Kauer C, Sonsino G. Source: Scand J Plast Reconstr Surg. 1986; 20(1): 129-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3775282

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The pressure is on: midwives and decubitus ulcers. Author(s): Prior J. Source: Rcm Midwives J. 2002 May; 5(5): 196-200. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12046196

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The reversed dermis graft in the repair of decubitus ulcers. Author(s): Wesser DR, Kahn S. Source: Plastic and Reconstructive Surgery. 1967 September; 40(3): 252-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6037156

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The role of alternating air and Silicore overlays in preventing decubitus ulcers. Author(s): Conine TA, Daechsel D, Lau MS. Source: International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation. 1990; 13(1): 57-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2394540

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The scrotal flap repair for ischial decubitus ulcers: a follow-up. Author(s): Kaplan I. Source: British Journal of Plastic Surgery. 1976 January; 29(1): 34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=773470

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The surgical management of decubitus ulcers by muscle transposition. Author(s): Ger R. Source: Surgery. 1971 January; 69(1): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4923361

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The tensor fasciae latae musculocutaneous flap in operations for trochanteric decubitus ulcers. Author(s): Riebelova V. Source: Acta Chir Plast. 1985; 27(1): 17-25. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2581409

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The treatment of decubitus ulcers with dextranomer. Author(s): Shrosbree RD, Engel P. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1981 June 13; 59(25): 902-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6165087

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The treatment of decubitus ulcers with polyester foam-rubber. Author(s): Schmidtmadel W. Source: Ger Med Mon. 1967 November; 12(11): 539-40. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6078951

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The treatment of superficial decubitus ulcers. Author(s): Braverman AM, Nasar MA. Source: The Practitioner. 1981 December; 225(1362): 1842-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7038658

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The use of a calcium alginate dressing in the management of decubitus ulcers in patients with spinal cord lesions. Author(s): Chapuis A, Dollfus P. Source: Paraplegia. 1990 May; 28(4): 269-71. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2235034

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The use of dextranomer in decubitus ulcers: a histopathologic evaluation. Author(s): Parish LC, Witkowski JA. Source: International Journal of Dermatology. 1981 January-February; 20(1): 62-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6162814

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The use of Limberg flaps for repairing small decubitus ulcers. Author(s): Hoehn JG, Elliott RA Jr, Stayman JW 3rd. Source: Plastic and Reconstructive Surgery. 1977 October; 60(4): 548-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=333485

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The value of sinography in the management of decubitus ulcers. Author(s): Lopez EM, Aranha GV. Source: Plastic and Reconstructive Surgery. 1974 February; 53(2): 208-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4590750

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Thermographical investigation of decubitus ulcers. Author(s): Trandel RS, Lewis DW, Verhonick PJ. Source: Bull Prosthet Res. 1975 Fall; (10-24): 137-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1227684

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Thermography in the study of decubitus ulcers: preliminary report. Author(s): Verhonick PJ, Lewis DW, Goller HO. Source: Nursing Research. 1972 May-June; 21(3): 233-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4481918

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Three nursing home patients who, due to inadequate care and poor nutrition, developed severe bed sores. Author(s): Hurley HJ. Source: Ostomy Wound Manage. 1996 April; 42(3): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8716030

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Topical application of insulin in decubitus ulcers. Author(s): Gerber RM, Van Ort SR. Source: Nursing Research. 1979 January-February; 28(1): 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=252699

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Topical application of insulin in the treatment of decubitus ulcers: a pilot study. Author(s): Van Ort SR, Gerber RM. Source: Nursing Research. 1976 January-February; 25(1): 9-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1107960

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Topical application of sugar and povidone-iodine in the management of decubitus ulcers in aged patients. Author(s): Shimamoto Y, Shimamoto H, Fujihata H, Nakamura H, Matsuura Y. Source: Hiroshima J Med Sci. 1986 June; 35(2): 167-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3771275

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Topical metronidazole gel. The bacteriology of decubitus ulcers. Author(s): Witkowski JA, Parish LC. Source: International Journal of Dermatology. 1991 September; 30(9): 660-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1938084

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Topical metronidazole therapy for infected decubitus ulcers. Author(s): Pierleoni EE. Source: Journal of the American Geriatrics Society. 1984 October; 32(10): 775. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6481058

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Topical phenytoin treatment of stage II decubitus ulcers in the elderly. Author(s): Rhodes RS, Heyneman CA, Culbertson VL, Wilson SE, Phatak HM. Source: The Annals of Pharmacotherapy. 2001 June; 35(6): 675-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11408983

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Total thigh flaps for extensive decubitus ulcers. A 16 year review of 41 total thigh flaps. Author(s): Royer J, Pickrell K, Georgiade N, Mladick R, Thorne F. Source: Plastic and Reconstructive Surgery. 1969 August; 44(2): 109-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4895070

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Transient bacteremia associated with debridement of decubitus ulcers. Author(s): Glenchur H, Patel BS, Pathmarajah C. Source: Military Medicine. 1981 June; 146(6): 432-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6787475

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Treating and preventing decubitus ulcers with a new flotation unit. Author(s): Timmes JJ, Harper PJ, Rocko JM. Source: American Family Physician. 1974 November; 10(5): 150-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4424683

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Treating decubitus ulcers using four proven steps. Author(s): Kavchak-Keyes MA. Source: Nursing. 1977 October; 7(10): 44-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=242745

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Treating decubitus ulcers: two methods that work. Author(s): Arnell I. Source: Nursing. 1983 June; 13(6): 50-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6191261

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Treatment of decubitus ulcers by use of a water mattress. Author(s): Dewis LS, Caplan HI, Pache HL. Source: Archives of Physical Medicine and Rehabilitation. 1968 May; 49(5): 290-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5651682

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Treatment of decubitus ulcers in paraplegic patients: a comparison of three topical agents--absorable gelatin sponge, gelatin powder, and enzyme ointment. Author(s): Young CG, Oden PW. Source: Southern Medical Journal. 1973 December; 66(12): 1375-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4271441

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Treatment of decubitus ulcers. A new approach. Author(s): Barron JJ, Jacobson WE, Tidd G. Source: Minn Med. 1985 February; 68(2): 103-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3871897

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Treatment of dermal and decubitus ulcers. Author(s): Nierman MM. Source: Drugs. 1978 March; 15(3): 226-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=205402

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Treatment of severe decubitus ulcers using the Beaufort-Winchester flotation bed. Author(s): Kemp WA, Grahame R, Burry HC, Broomhead IW. Source: Rheumatol Phys Med. 1972 November; 11(8): 401-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4646487

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Treatment of severe decubitus ulcers using the Beaufort-Winchester water bed. Author(s): Grahame R, Broomhead IW, Burry HC, Kemp WA, Morris AM. Source: British Journal of Plastic Surgery. 1973 January; 26(1): 75-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4568140

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Treatment precautions for paraplegic and quadriplegic patients with sacral decubitus ulcers. Author(s): Brejcha FA. Source: Plastic and Reconstructive Surgery. 2001 October; 108(5): 1457-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11604676

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Universities unraveling mysteries of decubitus ulcers. Author(s): Watkins R. Source: Contemporary Longterm Care. 1986 September; 9(9): 104-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10280729

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Use of a dental irrigating device in the treatment of decubitus ulcers. Author(s): Diekmann JM. Source: Nursing Research. 1984 September-October; 33(5): 303-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6566134

•

Utility of direct current in decubitus ulcers. Author(s): Margolis DJ. Source: Archives of Dermatology. 1994 May; 130(5): 660-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8179350

Studies

•

31

Wheelchair pads and decubitus ulcers. Author(s): Dewey D. Source: Physical Therapy. 1977 June; 57(6): 725-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=866429

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CHAPTER 2. NUTRITION AND DECUBITUS ULCERS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and decubitus ulcers.

Finding Nutrition Studies on Decubitus Ulcers The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “decubitus ulcers” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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Decubitus Ulcers

The following information is typical of that found when using the “Full IBIDS Database” to search for “decubitus ulcers” (or a synonym): •

9 clinical cases of nonhealing pressure ulcers in patients with spinal cord injury treated with an anabolic agent: a therapeutic trial. Author(s): Mount Sinai School of Medicine, New York, NY, USA. Source: Spungen, A M Koehler, K M Modeste Duncan, R Rasul, M Cytryn, A S Bauman, W A Adv-Skin-Wound-Care. 2001 May-June; 14(3): 139-44 1527-7941

•

A double-blind clinical trial to compare the efficacy of an active based cream F14001 against a placebo non-active based cream for the treatment of pressure ulcers in a population of elderly subjects. Author(s): National Research Institute of Gerontology and Geriatric Medicine, Mount Royal Hospital, Parkville, Victoria, Australia. Source: LeVasseur, S A Helme, R D J-Adv-Nurs. 1991 August; 16(8): 952-6 0309-2402

•

Age-specific characteristics of patients who develop pressure ulcers in the tertiarycare setting. Source: Stotts, N A Nurs-Clin-North-Am. 1987 June; 22(2): 391-8 0029-6465

•

An Australian experience of managing pressure ulcers in persons with SCI. Author(s): School of Nursing, Deakin University, Burwood, Victoria, Australia. Source: Wellard, S J SCI-Nurs. 2001 Spring; 18(1): 11-7 0888-8299

•

Clinical evaluation of Dermagran spray and ointment in the treatment of pressure ulcers in spinal cord injury. Source: Veit, N Bailey, B L Swoager, L SCI-Nurs. 1993 December; 10(4): 135-6 0888-8299

•

Clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents of nursing facilities. Author(s): Institution Management Department, Iowa State University, Ames 50011, USA. Source: Gilmore, S A Robinson, G Posthauer, M E Raymond, J J-Am-Diet-Assoc. 1995 September; 95(9): 984-92 0002-8223

•

Local treatment of pressure sores in the elderly: amino acid copolymer membrane versus hydrocolloid dressing. Author(s): Synthelabo Recherche, Recherche Clinique, Bagneux, France. Source: Honde, C Derks, C Tudor, D J-Am-Geriatr-Soc. 1994 November; 42(11): 1180-3 0002-8614

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

Nutrition

35

•

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

•

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

•

WebMDHealth: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to decubitus ulcers; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND DECUBITUS ULCERS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to decubitus ulcers. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to decubitus ulcers and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “decubitus ulcers” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to decubitus ulcers: •

A holistic approach to pressure sore management. Author(s): Oke S, Davies S. Source: British Journal of Nursing (Mark Allen Publishing). 1995 March 23-April 12; 4(6): 319-20, 322, 339-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7727949

•

A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Author(s): Houwing RH, Rozendaal M, Wouters-Wesseling W, Beulens JW, Buskens E, Haalboom JR. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 August; 22(4): 401-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12880608

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•

Antiseptic efficacy of disinfecting solutions in suspension test in vitro against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli in pressure sore wounds after spinal cord injury. Author(s): Michel D, Zach GA. Source: Dermatology (Basel, Switzerland). 1997; 195 Suppl 2: 36-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9403253

•

Brine bath treatments for decubitus ulcers. Author(s): NYQUIST RH. Source: J Am Med Assoc. 1959 February 28; 169(9): 927-32. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13630707

•

Classification of pressure sores: 1. Author(s): Young T. Source: British Journal of Nursing (Mark Allen Publishing). 1996 April 11-24; 5(7): 438, 440, 442 Passim. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8788393

•

Creative approaches to pressure sore problems. Author(s): Stephens SJ. Source: Orthopaedic Nursing / National Association of Orthopaedic Nurses. 1985 JulyAugust; 4(4): 40-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3848790

•

Decubitus ulcers and the karaya treatment program. Author(s): Love-Mignogna S, Wind S. Source: Ona J. 1978 September; 5(9): 17-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=249911

•

Decubitus ulcers: healing effect of an enzymatic spray. Author(s): Yucel VE, Basmajian JV. Source: Archives of Physical Medicine and Rehabilitation. 1974 November; 55(11): 517-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4441265

•

Does vitamin C supplementation promote pressure ulcer healing? Author(s): Gray M, Whitney JD. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2003 September; 30(5): 245-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560282

Alternative Medicine 39

•

Effect of half the standard dose of Mao-bushi-saishin-to in two MRSA patients and one decubitus ulcer patient. Author(s): Kamei T, Nagura S, Toriumi Y, Kumano H, Kondoh T, Tomioka H. Source: The American Journal of Chinese Medicine. 2000; 28(2): 301-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10999449

•

Electromagnetic therapy for the treatment of pressure sores. Author(s): Flemming K, Cullum N. Source: Cochrane Database Syst Rev. 2001; (1): Cd002930. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279778

•

Eradication of methicillin-resistant Staphylococcus aureus from pressure sores using warming therapy. Author(s): Ellis SL, Finn P, Noone M, Leaper DJ. Source: Surgical Infections. 2003 Spring; 4(1): 53-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12744767

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Gluteal neuromuscular stimulation in therapy and prophylaxis of recurrent sacral pressure ulcers. Author(s): Lippert-Gruner M. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2003 June; 41(6): 365-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12746744

•

Hydrotherapy and topical collagenase for decubitus ulcers. Author(s): Vetra H, Whittaker D. Source: Geriatrics. 1975 August; 30(8): 53-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=168126

•

Knowledge, beliefs and use of nursing methods in preventing pressure sores in Dutch hospitals. Author(s): Halfens RJ, Eggink M. Source: International Journal of Nursing Studies. 1995 February; 32(1): 16-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7730002

•

Low pressure hyperbaric oxygen treatment of decubiti and skin ulcers. Author(s): Fischer BH. Source: Proc Annu Clin Spinal Cord Inj Conf. 1966 November 7; 15: 97-107. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6015344

•

Low pressure hyperbaric oxygen treatment of decubiti and skin ulcers. Author(s): Fischer BH.

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Decubitus Ulcers

Source: Proc Annu Clin Spinal Cord Inj Conf. 1966; 15: 97-107. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6003568 •

Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Author(s): Sherman RA. Source: Wound Repair and Regeneration : Official Publication of the Wound Healing Society [and] the European Tissue Repair Society. 2002 July-August; 10(4): 208-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12191002

•

Management of pressure ulcers. Author(s): Summers JB, Kaminski JM. Source: Jama : the Journal of the American Medical Association. 2003 May 7; 289(17): 2210; Author Reply 2210-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734127

•

New checklist for pressure ulcer prevention. Author(s): Rosenberg CJ. Source: Journal of Gerontological Nursing. 2002 August; 28(8): 7-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12219555

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Ostomy skin barriers for decubitus ulcers. Author(s): Greene R. Source: Can Nurse. 1975 February; 71(2): 34-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1116118

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Perceptions of pressure ulcers among young men with a spinal injury. Author(s): Gibson L. Source: British Journal of Community Nursing. 2002 September; 7(9): 451-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12362141

•

Pressure sore prevention system: a new biofeedback approach. Author(s): Rosenberg L, Loch E. Source: Plastic and Reconstructive Surgery. 1985 June; 75(6): 926-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4001217

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Pressure sore risk assessment in palliative care. Author(s): Chaplin J. Source: J Tissue Viability. 2000 January; 10(1): 27-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10839093

•

Pressure sores. Author(s): Narsete TA, Orgel MG, Smith D.

Alternative Medicine 41

Source: American Family Physician. 1983 September; 28(3): 135-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6613794 •

Pressure sores: treatment using stomahesive. Author(s): Ryan DM. Source: Nurs Times. 1976 February 26; 72(8): 299-300. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1257075

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Pressure ulcer risk assessment in patients with darkly pigmented skin. Author(s): Scanlon E, Stubbs N. Source: Prof Nurse. 2004 February; 19(6): 339-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14983607

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The effect of high voltage galvanic stimulation on the rate of healing of decubitus ulcers. Author(s): Akers TK, Gabrielson AL. Source: Biomed Sci Instrum. 1984; 20: 99-100. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6608962

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The effectiveness of massage in preventing pressure sores: a literature review. Author(s): Buss IC, Halfens RJ, Abu-Saad HH. Source: Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses. 1997 September-October; 22(5): 229-34, 242. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9341542

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The holistic management of pressure sores in terminal illness. Author(s): Chambers N. Source: J Wound Care. 1997 September; 6(8): 359-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9341422

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The local skin blood flow in areas at risk for pressure sores treated with massage. Author(s): Ek AC, Gustavsson G, Lewis DH. Source: Scandinavian Journal of Rehabilitation Medicine. 1985; 17(2): 81-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4023663

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The treatment of decubitus ulcers: a century of misinformation in the textbooks. Author(s): Anthony D. Source: Journal of Advanced Nursing. 1996 August; 24(2): 309-16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8858435

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The treatment of pressure sores in geriatric patients: a trial of sterculia powder. Author(s): Rhodes B, Daltrey D, Chattwood JG.

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Source: Nurs Times. 1979 March 1; 75(9): 365-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=254138 •

The use of papaya on pressure ulcers. Author(s): Hewitt H, Wint Y, Talabere L, Lopez S, Bailey E, Parshad O, Weaver S. Source: The American Journal of Nursing. 2002 December; 102(12): 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12473933

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Topical hyperbaric oxygen for decubitus ulcers. Author(s): Torelli M. Source: The American Journal of Nursing. 1973 March; 73(3): 494-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4486136

•

Topical hyperbaric oxygen; treatment of pressure sores and certain skin ulcerations. Author(s): Fischer BH. Source: Nurs Times. 1970 May 14; 66(20): 613-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5450318

•

Treatment of decubitus ulcers. Author(s): Berecek KH. Source: Nurs Clin North Am. 1975 March; 10(1): 171-210. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1038627

•

Wound care forum: Readers' remedies for pressure sores. Author(s): Cuzzell JZ. Source: The American Journal of Nursing. 1986 August; 86(8): 923-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3638127

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

Alternative Medicine 43

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to decubitus ulcers; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Wounds Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Calendula Alternative names: Calendula officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON DECUBITUS ULCERS Overview In this chapter, we will give you a bibliography on recent dissertations relating to decubitus ulcers. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “decubitus ulcers” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on decubitus ulcers, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Decubitus Ulcers ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to decubitus ulcers. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

An examination of the relationship between the incidence of decubitus ulcers in two long-term care facilities and educational program by Hylton, Donette Charissee, MS from California State University, Long Beach, 2003, 77 pages http://wwwlib.umi.com/dissertations/fullcit/1416761

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON DECUBITUS ULCERS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “decubitus ulcers” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on decubitus ulcers, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Decubitus Ulcers By performing a patent search focusing on decubitus ulcers, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Decubitus Ulcers

The following is an example of the type of information that you can expect to obtain from a patent search on decubitus ulcers: •

Air distribution device for the prevention and the treatment of decubitus ulcers and pressure sores Inventor(s): Biggie; John (Lighthouse Point, FL), Biggie; Lydia B. (Lighthouse, FL) Assignee(s): Sentech Medical Systems, Inc. (Ft. Lauderdale, FL) Patent Number: 5,926,884 Date filed: August 5, 1997 Abstract: An air distribution device with a plurality of sheets is provided to prevent and treat decubitus ulcers. Air from an air source is provided between sheets of the coverlet which are air tight except for a plurality of very tiny apertures that are provided in the top sheet. The device is used between a support surface such as an alternating pressure mattress and a patient. The air escaping from the tiny apertures circulates around the patient to remove excess moisture from the patient's skin and wounds. The top sheet of the coverlet is made of a low friction nylon with an undercoating of a waterproof yet vapor permeable polyurethane. The top sheet has a plurality of apertures punched through the material. The central sheet is made out of the identical material of the top sheet, except there are no tiny apertures. The central sheet is a diffuser sheet, in that no air flow passes through it, but it spreads the air throughout the air tight portion of the device, allowing air to escape through the apertures in the top sheet directly to the patient. The bottom sheet is preferably a quilted synthetic material such as DACRON.TM. to provide a space for the vapor molecules, once they have passed through the coated nylon, to travel into and disperse. Excerpt(s): This invention relates to bed and chair coverlets, pads, and covers for preventing, reducing, and treating decubitus ulcers, known as pressure sores and bed sores, by providing a low friction surface against a patient's skin, by absorbing vapor and moisture coming from the patient, and by circulating an amount of air beyond normal ambient air convection to keep wounds dry, to promote healing, and to regulate body temperature. It is well known that patients that stay in bed or chairs for extended periods of time can develop decubitus ulcers, pressure sores, or bed sores. The ulcers are often caused by the reduction of blood flow to soft tissues that are compressed by the weight of the patient between the bed or chair surface and bony prominences of the patient. The continued lack of blood flow, and resultant lack of oxygen, cause cells to die and eventually cause the ulcers. The time-frame for occurrence of these ulcers depends on various factors such as the firmness and friction of the surface against the patient's skin, temperature, moisture, and the health and susceptibility of the skin due to age or illness. To allow blood to flow to the areas of restriction, the patients are often turned regularly by nursing or hospital personnel to reduce the occurrence of the ulcers. Turning of the patients is not always possible, especially if the patient is not in a facility that provides such services. Web site: http://www.delphion.com/details?pn=US05926884__

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Anti-decubitus mattress pad Inventor(s): Denton; Grant C. (Boulder, CO), Dinsmoor, III; John C. (Westminster, CO), Jay; Eric C. (Boulder, CO), Runkles; Richard R. (Englewood, CO) Assignee(s): Jay Medical, Ltd. (Boulder, CO) Patent Number: 5,201,780 Date filed: September 6, 1991 Abstract: A mattress pad primarily intended for use with a standard hospital bed frame to reduce the development of decubitus ulcers or bed sores in patients using the pad. The pad is multi-layered and includes a cover or casing containing interior strata of a plastic film layer atop a fluid bladder layer supported on an underlying layer of foam. The pad is specially designed to reduce lateral and normal pressures and forces on the patient which can lead to the development of such ulcers. The reduction of the lateral shearing forces is accomplished in a number of ways including by oversizing the plastic film layer and fluid bladder layer on the underlying layer of foam and by positioning microbeads between the plastic film layer and fluid bladder layer to dramatically reduce the frictional drag or lateral shearing forces between the layers. Similarly, the normal pressures and forces are reduced and controlled in a number of manners including oversizing, modifying the configuration, filling, and size of the discrete fluid pouches of the fluid bladder layer, and varying the spring characteristics of the support columns in the underlying foam layer by hollowing them out to differing degrees, adjusting their spacing, and selectively tying adjacent columns together. Excerpt(s): This invention relates to the field of mattress and cushion pads primarily intended for hospital use to reduce the development of decubitus ulcers in patients using the pads. Decubitus ulcers, commonly referred to as bed or pressure sores, are a major health concern for patients that become bed or chair bound for prolonged periods of time. They are also frequent complications for burn victims and tall, thin patients and other patients with particularly bony protuberances. The ulcers generally develop at such bony protuberances as well as other relatively bony areas of the patient's body including the trochanteric (hip) area, scapula (shoulder blade) area, spinal area, and coccyx (tailbone) area where relatively little flesh is present and blood circulation is often poor. Factors contributing to the development of the decubitus ulcers are numerous including the general overall condition of the patient's skin and underlying tissue; however, forces generated on the patient's body by the mattress pad or other support are also critical. These forces include both normal and lateral or shearing forces. Reduction of such forces has been attempted and accomplished in a variety of product designs with varying degrees of success and widely varying costs. Such product designs extend the gambit from, for example, standard hospital mattresses on one end to more exotic and expensive designs such as fluidized, specialty beds on the other. Web site: http://www.delphion.com/details?pn=US05201780__

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Apparatus for treating and preventing development of bed sores Inventor(s): Sokol; Edward W. (Warren, MI) Assignee(s): Anderson; Rosalie M. (Mt. Clemens, MI) Patent Number: 5,345,634 Date filed: July 9, 1993

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Abstract: An apparatus for preventing the development of bed sores, and once developed, successfully treating them, composed partly of an rigid elongate member which is transversely disposed across a hospital bed, wherein each end of the elongate member is engaged with a respective side rail of the hospital bed. The apparatus is further composed partly of a depression member which substantially vertically depends from the elongate member so as to depressably abut the mattress of the hospital bed. The depression member may be selectively located anywhere along the elongate member, and is preferably held abuttingly with respect to the elongate member by a frictional interface therebetween. Excerpt(s): The present invention relates to treatment and prevention of bed sores, and more particularly to an apparatus which effects to locally depress the patient's bed mattress so as to eliminate pressure upon an affected area of the patient's body. When a patient is bed-ridden for an extended period of time, one of the unfortunate discomforts to be endured is the development of bed sores. Bed sores occur because of constant pressure of the bed mattress upon parts of the body which are not structured to endure such pressure, as are, for example the bottom of the feet. As a result of this pressure caused by the weight of the body at the contact location, circulation is adversely affected, eventually leading to a bed sore. Bed sores range in severity from painful skin areas to ulceration. Bed sores create great discomfort for the patient, and are a major source of concern to hospital personnel. What is needed is some way to prevent the development of bed sores, and once developed, successfully treating them. Web site: http://www.delphion.com/details?pn=US05345634__ •

Bed sore pad Inventor(s): Carver; Juanita (9866 Reagan Rd. #126, San Diego, CA 92126) Assignee(s): none reported Patent Number: 5,364,339 Date filed: April 7, 1993 Abstract: A stratiform pad for surrounding and protecting a bed sore from pressure while the patient is in bed. The pad comprises a median layer containing a closed cell air bubble film, a body-contacting layer bonded to one surface of the median layer to adhere the pad to the patient's body, and a bed-contacting layer bonded to the other surface of the median layer to adhere the pad to the bed surface. The pad contains an interior bed sore receiving aperture and provides sustained lift of the body away from the bed in the area of the sore, thus relieving the pain of pressure and providing space for the flow of healing air. Excerpt(s): The present invention relates generally to a pad for surrounding and protecting a bed sore on a person's body while in bed. The pad is effective in lifting the body away from the bed in the area of the sore, and thus promotes healing by avoiding pressure and providing a flow of air around the sore. As Americans live longer, the number of hospitals and nursing homes for treating long-care patients increases constantly. One of the most common problems in the care of long-term bedridden patients is the possible development of decubitus ulcers or bed sores. They result from the pressure exerted on the skin and subcutaneous tissues by the skeletal bony prominences and the object on which the patient rests, such as a bed. The cutaneous tissues are progressively broken down leading to destruction of underlying soft tissue. Once this ulcer forms it is quite painful and very slow to heal. Bacterial infections are

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difficult to avoid and frequently prolong the healing process. Numerous efforts have been put forth in the past to devise various cushions, pads, bandages, dressings, mattress modifications, and the like, for attempting to alleviate the pressure on bed sores and thereby promote healing. However, because of the materials used, or the configurations developed, or the expense of making and using the more elaborate devices, there has been no completely satisfactory solution to the problem. The prior devices have failed to offer a configuration which effectively avoids pressure against the sore and permits freedom of air flow around the sore. Web site: http://www.delphion.com/details?pn=US05364339__ •

Bed sore treatment and prevention method and apparatus Inventor(s): Neviaser; Thomas J. (11499 Lakewood La., Fairfax Station, VA 22039) Assignee(s): none reported Patent Number: 6,009,873 Date filed: August 27, 1998 Abstract: A light weight, inflatable, readily compactible, inexpensive bed sore treatment and prevention method and apparatus. Two inflatable wedges are held in close approximation to a patient/person by a plurality of straps that each encircle the person and the two wedges to a moderate and readily adjustable degree of snugness. Internal partitions help maintain the shapes of the respective wedges. The edges of the wedges can be rounded to optimize comfort for the user. The device is readily portable due to its light weight and its fabrication from flexible, foldable material, which can be plastic, rubber, or any other suitable material that is durable, resilient, and air tight. The wedges are used for a predetermined period of time to maintain the person in one position, after which the person is moved to a different position. The wedges can be used to treat and/or prevent various conditions, such as sleep apnea, snoring, bed sores, etc. The wedges may also be made from foam rubber or the like in which case the inflation is not required. Excerpt(s): The present invention relates generally to body restraint devices used to hold a patient or other person in a selected position on a bed or other support surface. In particular, the present invention relates to an inflatable, light weight, readily compactible, inexpensive body restraint device used to treat and/or prevent bed sores and other wounds or sores, especially for patients who are not readily mobile, or who detrimentally tend to move excessively while resting and sleeping. Bedridden patients who are immobilized for medical cause (e.g., to allow a broken bone to heal) or who are immobile for any reason (e.g., depression, coma, etc.) tend to develop bed sores on body surfaces that are in prolonged contact with bed sheeting or with the covering of any other support surface. Furthermore, the bedridden patient may unconsciously favor resting on body surfaces that have recovering wounds resulting, e.g., from surgery, accident or other trauma. No matter what the cause, when air/oxygen is prevented from reaching the skin of a body part, and when normal perspiration is prevented for a prolonged period, the result is nonoptimal healing and possible infection of an existing wound, or, in the case of no wound at the outset, the formation of bed sores. Thus, whether there is an existing wound at the commencement of bed stay, or bed sores form over time, the possibility of non-healing infections is greatly increased in the bedridden, immobile patient who does not frequently change his position in bed, which, in the extreme, can lead to septicemia and possible death if not quickly diagnosed and properly treated. A variety of devices have been disclosed for positioning a person. One

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class of such devices is that of restraining devices to prevent Sudden Infant Death Syndrom (SIDS) in infants. One such device for preventing SIDS is disclosed in U.S. Pat. No. 5,347,669 to Nevaiser, et al., which presents a means for restraining an infant through the use of one smaller and one larger wedge shaped pad, each of which is removably secured to a support member that is placed under the user. A generally vertical face of the smaller wedge shaped pad is placed against the abdomen of the infant, who is on his side, and a generally vertical face of the larger wedge shaped pad is securely positioned against the back of the infant. A belt or strap is used to hold the infant in the desired position between the two wedge shaped pads and upon the support member to which the wedge shaped pads are removably attached. An alternative embodiment employs a diaper-like strapping device that is secured to the infant, with the wedge shaped pads then being removably attached thereto via fastening strips. Web site: http://www.delphion.com/details?pn=US06009873__ •

Composition and process for the treatment of epidermal traumas such as decubitus ulcers Inventor(s): Redmond; Mary L. (Chicago, IL) Assignee(s): Curlor Healthcare Technologies, LLC (Chicago, IL) Patent Number: 6,224,896 Date filed: July 24, 1998 Abstract: A novel composition for use in the treatment of epidermal traumas is disclosed. The composition comprises a nitroimadazole, an occlusive skin barrier composition, and an occlusive synthetic dressing. Furthermore, the invention comprises a method of treatment of the epidermal trauma using the novel composition. Excerpt(s): This invention relates to a novel composition useful for the treatment of epidermal traumas. Furthermore, the invention also relates to the novel method of treatment of these epidermal traumas using the composition of the instant invention. Epidermal traumas include, for example, but not limited to, maladies such as pressure sores, burns, cuts, abrasions, wounds, rashes, lesions, skin conditions, skin infections and decubitus ulcers. Generally, these epidermal traumas are treated with ointments or preparations, sometimes with little or no success. Pressure sores and decubitus ulcers are particularly painful for the patients and difficult to treat. Pressure on a area of skin for an extended time period may cause pressure sores. Generally, pressure sores occur at weight bearing sites. Patients eventually develop necrosis at these pressure sores since the pressure at the weight bearing sites can exceed local perfusion pressure. As the skin sloughs, bacteria tends to colonize at these sites. Abetted by further pressure induced necrosis, the infection tends to get deeper and deeper, possibly resulting in decubitus ulcers. Other factors which contribute to pressure sores include skin over bony prominence, anemia, malnutrition and immobilization. Pressure sores are especially prevalent among individuals incapable of moving, such as patients who are bedridden due to various infirmities such as strokes, quadriplegia, paraplegia or those who are in a coma. These patients suffer greatly from the pain caused by these wounds. Web site: http://www.delphion.com/details?pn=US06224896__

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Decubitus ulcer prevention device Inventor(s): Fujita; Sanai (107 Green Park Kotesashi, 12-1, 4-chome Kotesashi-cho, Tokorozawa-shi, Saitama-ken, JP) Assignee(s): none reported Patent Number: 5,652,987 Date filed: April 29, 1996 Abstract: The present invention relates to a decubitus ulcer prevention device, which comprises an air generator having a fan, an air mattress for receiving air, from the air generator, that is discharged at a surface through minute air discharge holes, and a hose for connecting the air mattress to the air generator. Along a flow path of the air that passes through the fan, are located, in order as named, a heater and an alkaline chlorine dioxide gas generator, in which is internally provided a ceramic body that is impregnated with an alkaline chlorine dioxide solution. Air that is heated, by passing through the heater, is brought into contact with the ceramic body, so that air that includes alkaline chlorine dioxide gas is thus supplied to the air mattress. Excerpt(s): 1. The present invention relates to a device for supplying deodorized, sterilized air that contains alkaline chlorine dioxide gas for drying, deodorizing and sterilizing the human epidermis and clothing, bedding, etc., to clean them and to prevent the occurrence of decubitus ulcers. When it is physically difficult for people, such as bedridden elderly persons or patients with advanced diseases, to raise themselves without help and as a result they are confined to their beds for extended periods of time, blood circulation is impeded at those portions of their bodies that press against their beds. Then, when those areas become hot and are kept moist by perspiration, or when wounds or insect bites in those areas become infected, so-called decubitus ulcers occur. Furthermore, when a patient is confined to bed for a long time, the patient's clothing, such as underwear, and bed sheets and other bedding become soiled, bad odors are generated, and the load placed on care providers and nursing personnel is increased. In addition, the possibility that care providers and nursing personnel may contract a viral infection, particularly MRSA, becomes a serious problem. Web site: http://www.delphion.com/details?pn=US05652987__

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Diaper to eliminate bed sores Inventor(s): LaPointe; Lynn (10667 Oak La., Apt. 18104, Belleville, MI 48111) Assignee(s): none reported Patent Number: 6,146,368 Date filed: October 1, 1999 Abstract: A diaper to eliminate bed sores includes a front section, a back section and a middle section extending longitudinally between the front section and the back section. The middle section includes a liquid-permeable inner sheet, a liquid-impermeable outer sheet aligned with and secured to the inner sheet, and an absorbent body disposed between the inner sheet and the outer sheet. The middle section includes an aperture extending through the inner sheet and the absorbent body and the outer sheet and having a thickened portion completely surrounding the aperture. The aperture is adapted to be located over a bed sore on a body of person with the middle portion disposed between legs of the person and the front section disposed in front of the

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person and the back section disposed in back of the person and attached to the front portion when the diaper is in use. Excerpt(s): The present invention relates generally to diapers and, more specifically, to a diaper to eliminate bed sores. People who are confined to a bed or chair for a long time frequently develop decubitus ulcers, or bed sores, due to forces between their skin and the bed--more accurately, the sheets of the bed--or chair. Specifically, bed sores result from the continuous pressure and friction over extended periods of time exerted on the skin and underlying tissues between the person's bones and the bed or chair. Such pressure and friction, resulting in the interruption of blood flow to the skin, progressively break down and destroy the soft tissue. These sores can be extremely painful and highly susceptible to bacterial infections, thereby impeding the healing process. As a result, it is desirable to prevent bed sores. In the past, many devices have attempted to permit healing of bed sores by minimizing or eliminating the pressure and friction exerted on the sores. For example, U.S. Pat. No. 4,962,769 to Garcia discloses the use of bubble packaging film for relieving decubitus ulcers or pressure ulcers. In this patent, a body fluid absorbing cushion includes a laminate structure with at least three layers, including an inner water absorbent layer, a center layer consisting of an array of generally closely spaced enclosures defining air supported closed cells, and an outer generally water impervious layer. The array of cells includes a number of cells with varying diameters, wherein the center cells of relatively larger diameter are disposed where forces are greater and radially outwardly positioned cells are of relatively reduced diameter. Web site: http://www.delphion.com/details?pn=US06146368__ •

Flotation therapy bed for preventing decubitus ulcers Inventor(s): Hagopian; Mark (Indian Rocks Beach, FL) Assignee(s): Biologics, Inc. (St. Petersburg, FL) Patent Number: 5,072,468 Date filed: January 22, 1991 Abstract: A flotation therapy bed that prevents formation of decubitus ulcers. A threechambered mattress has three configurations, each having a different utility. In a first configuration, a lowermost chamber is filled with water and the other two chambers are empty so that the patient is supported by the water. In a second configuration, a second chamber, co-extensive with the water-filled chamber, is filled with air. This facilitates turning the patient over, or lifting the patient from the bed. In a third configuration, a third, wedge-shaped chamber is filled with air and holds the patient in a sitting up position. The second chamber is evacuated when the third chamber is filled. A motordriven linkage raises and lowers the bed in a vertical plane in the absence of longitudinal or transverse movement. Excerpt(s): This invention relates, generally, to specialty beds that are designed to minimize the chances of bed sores forming on a bed-ridden patient and to treat preexisting severe bed sores. Decubitus ulcers, commonly known as bed sores, are caused when the capillaries of a patient are occluded by pressure over long periods of time. With most people, the capillaries begin to occlude when the pressure thereagainst reaches about thirty two millimeters of mercury (32 mm of Hg). A conventional bed having a conventional mattress supplies a pressure of about eighty mm of Hg to the capillaries, and this easily causes capillary occlusion. However, most people spend

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relatively short periods of time in bed and the capillaries recover during the time spent out of bed so bed sores do not develop. Comatose patients, on the other hand, spend long and unrelieved periods of time in bed and such patients will develop bed sores if not turned periodically. Web site: http://www.delphion.com/details?pn=US05072468__ •

Mattress for relieving pressure ulcers Inventor(s): Flick; Roland E. (Elma, NY), Rechin; Michael P. (Silver Creek, NY), Whitney; John K. (Dorado, PR), Wortman; Ronald D. (Angola, NY) Assignee(s): Gaymar Industries, Inc. (Orchard Park, NY) Patent Number: 5,794,289 Date filed: November 12, 1996 Abstract: A mattress wherein at least one fabric strip bridges a foam crib for an inflatable cushion to provide lateral stability thereto such as when the mattress is tilted for turning a patient over or otherwise. The fabric strip position is selected so as not to interfere with pressure relief to a portion of the patient's body where pressure ulcers frequently occur. In order to accurately and quickly monitor the tilt of a mattress, transmitting and receiving coils are provided on opposite sides of an assembly of lifting bladders for the side of the mattress being lifted, and the signal strength is measured when a signal is transmitted therebetween, and the angle of tilt is determined therefrom. In order to reduce exposure of lines leading to an inflatable mattress, a notch is provided in a crib for receiving a pump for pressurizing a cushion within the crib so that the pump is positioned to face exteriorly of the crib to allow heat dissipation. In order to extend the life of a cubed foam mattress, the mattress comprises at least two identical interchangeable cubed foam sections. In order to effectively provide pressure relief to a person lying on a mattress while preventing bottoming-out when a person sits on the mattress, the mattress is provided with an upper alternating pressure cushion and a lower cushion which allows the pressure in the upper cushion to be reduced and which is of a non-alternating pressure type. Side-by-side bladders are provided between upper and lower side-by-side cushions respectively for inclining the mattress. Hip bladders are provided to apply pressure to the hip area of a person lying on the mattress on a side opposite to the side of the mattress being inclined in order to maintain body alignment. Excerpt(s): The present invention relates generally to mattresses, i.e., two or more components contained as a unit within a mattress cover. More particularly, the present invention relates to mattresses in which are contained air-pressurized cushions in order to provide pressure relief to patients or the like in a hospital or home setting so that the development of pressure ulcers may be prevented or retarded. Features of the present invention also relate to foam mattresses. Gaymar Industries, Inc. of Orchard Park, N.Y., the assignee of the present invention, provides a pressurized cushion known as Sof-Care Plus long-term bed cushion (Gaymar model SC-427) for pressure relief. This cushion, which has been supported by a conventional non-pressurized mattress for use, has a multitude of lower individual air chambers and a multitude of upper individual air chambers with air transfer channels therebetween. Air is transferred through the interconnecting channels to redistribute the patient's weight over the entire bed cushion. A three-layer cushion known as Sof-Care II cushion (Gaymar model SC-440) continually redistributes patient weight through 300 air-filled chambers and has hand grips at the side of the cushion to assist in patient positioning. In these types of cushions, the individual air chambers remain pressurized. Thus, these cushions are of a non-

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alternating pressurized type. Gaymar Industries, Inc. also provides a pad or cushion (model PAF-350) and pump (model AFP-355) combination known as Airflo Plus alternating pressure system. In this system, alternate air chambers are alternately inflated and deflated to relieve excess pressure on patients at risk of developing or having pressure ulcers. Micro vents are provided to produce a gentle flow of air beneath the patient to help minimize moisture build-up. Such a system is described in U.S. Pat. No. 3,148,391 to Whitney, which is incorporated herein by reference. Other art showing alternating pressure pads or cushions includes U.S. Pat. No. 5,243,723 to Cotner et al, U.S. Pat. No. 5,103,518 to Gilroy et al, U.S. Pat. No. 2,998,817 to Armstrong, and U.S. Pat. No. 1,772,310 to Hart, which are also incorporated herein by reference. Web site: http://www.delphion.com/details?pn=US05794289__ •

Mattress for retarding development of decubitus ulcers Inventor(s): Hopper; Christopher J. (Oshtemo Township, Kalamazoo County, MI), Tappel; James G. (Prairieville Township, Barry County, MI), Travis; Stephen C. (Paw Paw Township, VanBuren County, MI) Assignee(s): Stryker Corporation (Kalamazoo, MI) Patent Number: 5,325,551 Date filed: June 16, 1992 Abstract: A mattress unit for retarding the development of decubitus ulcers includes a fabric cover having therein a foam material, and includes an inflatable bladder and a control unit disposed within openings in the foam material. The inflatable bladder contains a foam material having spaced holes in it. The control unit includes a pump which can selectively supply pressurized air to the bladder, a valve which can selectively bleed air from the bladder, and a pressure sensor which can determine the current pressure in the bladder. The pressure sensor is coupled to an input of a control circuit which controls the pump and valve. The control circuit receives power from an AC/DC converter and is remotely controlled by a hand-held pendant, the converter and pendant each being physically separate from the mattress unit and being connected to the control circuit by respective cables. Excerpt(s): The present invention relates to a mattress and, more specifically, to a mattress designed to retard the development of decubitus ulcers. In situations where an invalid or medical patient must spend a relatively long period of time confined to a bed, a frequent problem is the eventual development of decubitus ulcers, commonly known as bedsores. A variety of mattresses have been developed over the years to treat decubitus ulcers once they have developed. However, more recently, attention has been turned to the design of mattresses which can be adopted for use prior to the development of decubitus ulcers and which are relatively effective in retarding the development of decubitus ulcers. However, although preexisting mattresses of this type have been generally adequate for their intended purposes, they have not been satisfactory in all respects. One common problem is that they are large and structurally complex, to the point where they are typically constructed as an integral part of an entire bed. An object of the present invention is to provide an improved mattress which is effective in retarding the development of decubitus ulcers, and which is structurally simple in comparison to existing units and utilizes relatively inexpensive components. Web site: http://www.delphion.com/details?pn=US05325551__

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Mattress overlay for avoidance of decubitus ulcers Inventor(s): Fenner, Sr.; William G. (Richmond, VA) Assignee(s): E. R. Carpenter Company, Inc. (Richmond, VA) Patent Number: 5,031,261 Date filed: March 15, 1990 Abstract: A laminated foam mattress overlay for preventing the formation of decubitus ulcers in bedridden individuals. The mattress overlay includes an upper layer of polyurethane foam laminated to a base layer of a different polyurethane foam. The upper lay features a polyurethane foam which is of a higher density than the base layer. The upper layer also includes a higher initial softness ratio than the base layer. The base layer has higher 5, 25 and 65% indentation load deflection values (ILD) than the corresponding ILD values for the upper layer which is attributable to the firmer support provided by the foundation or base layer. The base layer is preferably thicker than the upper layer which can include a checkerboard-like upper surface. The combination of layers provides for a reduction in pressure points in the areas of greatest concern such as the hip and heel. The combination of layers work together to provide firm, comfortable support while distributing loads in the high risk areas of the body to help in avoiding the formation of ulcers. Excerpt(s): This invention relates to a mattress overlay for avoiding formation of decubitus ulcers. More particularly, the present invention is directed at a laminated foam mattress overlay which avoids tissue trauma. For patients and other persons restricted to bed for extended periods of time, there arises the possibility of decubitus ulcers forming. Decubitus ulcers (also referred to as bed sores, pressure sores or pressure ulcers) are formed due to an interruption of blood flow in the capillaries below skin tissue due to pressure against the skin. The highest risk areas for such ulcers to form are those areas where there exists a bony prominence which tends to shut down capillaries sandwiched between the bony prominence and the underlying support surface. When considering the redistribution of body weight and the formation of decubitus ulcers, the trochanter (hip) and the heels are the body sites of greatest concern since these two areas are most frequently involved in decubitus ulcer formations. Web site: http://www.delphion.com/details?pn=US05031261__

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Method and apparatus for providing improved blood circulation to a seated person Inventor(s): Addison, Jr.; Kenneith F. (P.O. Box 27291, Tulsa, OK 74149) Assignee(s): none reported Patent Number: 5,083,551 Date filed: October 26, 1987 Abstract: A method and apparatus for providing improved blood circulation to a person seated in a wheelchair or a stationary chair used by handicapped persons, or by those who must remain inactive in a seated position for extended periods of time. The apparatus imparts an undulating, wave-like motion to the flexible seat portion of the chair which stimulates the circulation of blood in the lower extremities and prevents the development of ischaemic or decubitus ulcers by providing changing points of pressure on the buttocks and thighs of a seated individual. The apparatus is of lightweight,

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compact construction which may be readily applied to a conventional wheelchair or chair, and may be powered by a small storage battery mounted thereon. Excerpt(s): It is well known that individuals who are confined to wheelchairs or stationary chairs for extended periods of time are susceptible to the development of ischaemie or decubitus ulcers on their buttocks and thighs, particularly in areas where only small amounts of tissue separate bony structure from the surface of the skin. These ulcers are caused by a lack of circulation of blood in the lower extremities, and by prolonged pressure on thin tissue areas. Many months of treatment, and quite often surgery, are required to heal these ulcerations, to say nothing of the pain, the expense and the complete loss of productivity of the patient, with no assurance that the condition will not recur. Many devices and appliances have been developed to provide relief to individuals who suffer from these ulcers. Pernell, in U.S. Pat. No. 3,158,878, discloses a foam cushion with cut-out areas in the zones most susceptible to ulceration, and Green, In U.S. Pat. No. 4,132,228, discloses a contoured and relieved cushion. Trenchard, in U.S. Pat. No. 3,721,232, discloses a surgical pad filled with gelatinous compound, and Graves et al, in U.S. Pat. No. 3,858,379, teaches a process for making such a pad, while Panaia et al, in U.S. Pat. No. 4,493,488, discloses a varied density pad, and its installation in a conventional folding wheelchair. These cushions and pads, while providing greater comfort to a seated patient, do nothing to enhance the circulation of blood in the critical areas. Web site: http://www.delphion.com/details?pn=US05083551__ •

Method and apparatus for treating or preventing bed sores Inventor(s): DiMatteo; Paul (Dix Hills, NY) Assignee(s): Nova Technologies, Inc. (Hauppauge, NY) Patent Number: 5,526,543 Date filed: December 30, 1993 Abstract: A method and apparatus for preventing or treating bed sores is disclosed which includes a mattress arrangement having a mattress and depressing means for depressing from underneath the mattress at least one area in the mattress to relieve pressure on at least one bed sore area of a patient. The depressing means includes at least one depression pad connected to a cable threaded through the mattress and attached to a pulling means. Further, a plurality of depression pads can be used to alternatively tilt the patient to relieve pressure from a bed sore area and may be used in conjunction with a mattress raising means to further tilt the patient. An optional conveyor sheet is provided for positioning the patient over the various depressed areas and/or for transferring the patient off the mattress to a wheelchair or other support area. Excerpt(s): The present invention relates to a method and apparatus for preventing or treating bed-ridden patients from suffering from pressure ulcers (decubitus ulcers), commonly known as bed sores. Bed sores are a major concern to health care providers in acute care rehabilitation, nursing homes and home care facilities. Aside from the physical discomfort bed sores cause to the patient, complications from bed sores can arise including osteomyelitis and sepsis. Many patients suffering from bed sores or those at risk of developing bed sores are also unable to be easily and/or comfortably transferred between a bed and a wheelchair. U.S. Pat. No. 3,221,349 to Bradley discloses a mattress depressor which can create a depression in a selected area of a mattress. The

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device consists of a lower arm underneath the mattress and an upper arm above the mattress. A depression is formed in the mattress by pressing down on the upper arm. Further, location of the depression area is chosen by moving the arms to a desired position. Web site: http://www.delphion.com/details?pn=US05526543__ •

Method and composition for topical treatment of Aphthous stomatitis histamine using phosphate as active ingredient Inventor(s): Jack; Bruce A. (Albuquerque, NM), White; B. Thomas (Albuquerque, NM) Assignee(s): Professional Pharmaceutical, Inc. (Albuquerque, NM) Patent Number: 5,679,337 Date filed: June 7, 1995 Abstract: A pharmaceutical composition of water, water soluble vinyl polymer gel, amine alcohol dispersant and IEP is used topically to treat herpes labialis and aphthous stomatitis lesions, and also to treat herpes genitalis chicken pox, allergic conjunctivitis, giant papillary conjunctivitis, stomatitis secondary to chemotherapy, thermal burn, sunburn, decubitus ulcers and shingles. Excerpt(s): The invention relates to compositions and methods for the treatment of the viral diseases herpes labialis (cold sores or fever blisters), herpes genitalis, herpes zoster (shingles), varicella zoster (chickenpox); inflammatory diseases and/or diseases demonstrating compromise or reaction of the immune system including aphthous stomatitis (canker sores), oral mucositis (stomatitis) secondary to chemotherapy, allergic conjunctivitis, giant papillary conjunctivitis; and lesions of injury to the skin including photodermatitis (sunburn, specifically second degree sunburn), thermal burns and pressure sores (decubitus ulcers). Histamine phosphate previously has been used as a diagnostic agent for determining a condition known as achlorhydria. Histamine phosphate also has been used intradermally to produce a flare-up reaction of the skin to test the ability of certain drugs to inhibit this histamine-induced wheal, thereby indicating clinical response for disease processes which liberate histamine. The histamine phosphate referred to is the compound 1H-imidazole-4ethanamine,phosphate (IEP), and is currently used in subcutaneous administration for the diagnosis of gastric function. Principle effects of IEP from subcutaneous, intramuscular or intravenous administration occur on the vascular system, smooth muscles, and exocrine glands. In humans, IEP produces vasodilation in the blood vessels and capillaries, causing a flushing of the face, reduction in systemic blood pressure, increase in skin temperature, and increased capillary permeability sufficient to produce exudation of fluid, plasma proteins, and erythrocytes into extracellular spaces. Web site: http://www.delphion.com/details?pn=US05679337__

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Method for treating pressure ulcers Inventor(s): Caldera; Manuel (74-900 Hwy. 111, Suite 221, Indian Wells, CA 92210), Pearsall; Charles W. (7 W. Highpoint Rd., Stuart, FL 34996) Assignee(s): none reported Patent Number: 5,723,140 Date filed: January 30, 1996 Abstract: A method for treating an individual to prevent the occurrence of pressure ulcers and facilitate the healing of previously existing pressure ulcers. In accordance with the present invention, a responsible individual must first determine which linens will contact pressure points on the individual as the individual lies upon a support surface. Once the appropriate linens are determined, they are prepared by cleaning the linens in ozonated wash water to limit chemical residuals and maintain neutral pH levels on the linens, wherein the linens exhibiting no chemical residuals and neutral pH cause no chemical reaction with the skin of the individual. Finally, the linens are placed into use so that they contact the skin of the individual at pressure points. Excerpt(s): The invention relates to a method for treating individuals to reduce the occurrence of pressure ulcers in and to improve the healing process for those individuals already suffering from pressure ulcers. More particularly, the invention relates to a method for treating individuals by exposing the skin of the individuals to health care linens that have been cleaned in ozonated water. Pressure ulcers, that is, bedsores, often occur in bedridden and immobile patients as a result of long periods of time spent in one position. The ulcers are caused by the pressure from the body weight of the patient. The pressure causes skin surfaces and deeper tissue layers to restrict blood flow to the points of contact. The application of this pressure over an extended period of time causes ulcers commonly referred to as pressure ulcers. Pressure ulcers are painful and normally heal very slowly. They can be prevented in some cases by proper nutrition and patient care, as well as prompt attention to symptoms when they appear. Treating pressure ulcers once they appear is time consuming and expensive. Currently, patients are treated by physically moving or turning the patients several times a day. Each time the patient is turned the affected areas are cleaned and the dressings applied to the affected areas are changed. Frequently, pressure ulcers are also treated with hydrotherapy (i.e., whirlpools). Using these techniques it can take weeks to many months before the pressure ulcers are properly healed. Web site: http://www.delphion.com/details?pn=US05723140__

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Method for treating pressure ulcers using calendula Inventor(s): Cannon; Karen A. (14 Randall St., North Easton, MA 02356) Assignee(s): none reported Patent Number: 5,266,330 Date filed: June 18, 1992 Abstract: A method for treating human pressure ulcer conditions of bedridden patients using an effective amount of the plant extract calendula officinalis L. in a topical pharmaceutical carrier selected from the group consisting of ointments, lotions, pastes, solvents, jellies, sprays and aerosols. The calendula is present by weight from about 1.0

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to 25.0%. Preferably, pressure ulcers are treated by soaking sterile dressings in a 2.5% solution of calendula in saline, and then applying such dressings to the affected area. Excerpt(s): The present invention relates generally to methods for treating human disease conditions and more particularly to use of the plant extract calendula to treat ulcerative skin conditions. Patients bedridden in hospitals or other long-term care facilities often exhibit ancillary health problems due to the nature of the care itself. Such patients are typically incontinent and remain prone and in bed for extended periods of time, and as a result often develop pressure ulcers or other similar maladies which require medical intervention. Often these secondary problems are more discomforting than the primary ailment being treated. It is known in the prior art to treat such pressure ulcers with a wide variety of medicaments. Commercial products include Granulex, Silvadene and Domeboro soak solutions. Typically, the patient is treated with the soak solution several times per day depending on the patient's physical condition and nutritional status. These prior art substances and techniques, however, do not provide satisfactory results. Web site: http://www.delphion.com/details?pn=US05266330__ •

Method for treatment of soft tissue wounds by electrical stimulation Inventor(s): Chandler; Mark H. (Pinehurst, NC), McWhorter; Luther S. (Pinehurst, NC) Assignee(s): Trillion Medical Resources, Inc. (Pinehurst, NC) Patent Number: 5,158,081 Date filed: May 29, 1991 Abstract: A method for treating pressure sores, decubitus ulcers, or other soft tissue wounds involves the application of a pulsed DC current to the patient's body to stimulate healing of the soft tissue wound. In accordance with the present invention, a pair of electrodes are applied to the patient's body outside the area of the sore, but closely adjacent the outer edges of the sore. The electrodes are placed on opposite sides of the sore and a current is applied to the patient's skin through the electrodes so that the current path is across the sore. The current is applied for a short duration and the probes are repositioned. The process is repeated as many times as necessary to direct current across the entire surface area of the wound. Unlike prior art methods of electrotherapy, the method of the present invention takes only a few minutes to treat each sore. Excerpt(s): The present invention relates generally to methods for treating soft tissue wounds, especially decubitus ulcers and more particularly to methods for accelerating healing of soft tissue wounds by electrical stimulation. It is well-know that immobilized persons experience skin ulcerations, or pressure sores, which occur when the skin is subjected to external pressure for prolonged periods. The increased tissue pressure results in reduced oxygen delivery to the tissue and ultimately to the development of ulcers in the muscle, skin and connective tissue. Ischemic skin ulcers also result from chronic venous stasis, peripheral arterial insufficiency (as in diabetics), certain infections, venomous bites, sickle cell anemia, and numerous other pathophysiologic and physical factors. Conventional methods for treating soft tissue wounds include applications of various ointments or medicaments to aid the natural body healing process. Another method is to relieve the pressure which caused the sore. A variety of mattresses, beds, wheelchair cushions and other pads have been devised to reduce pressure or distribute pressure more evenly over the body. However, it has been found

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that some wounds, including chronic wounds, do not respond to conventional treatment methods and resist healing. Web site: http://www.delphion.com/details?pn=US05158081__ •

Pharmaceutical preparation for the treatment of topical wounds and ulcers Inventor(s): Niazi; Sarfaraz K (20 Riverside Dr., Deerfield, IL 60015) Assignee(s): none reported Patent Number: 6,555,118 Date filed: February 22, 2001 Abstract: A pharmaceutical preparation for the treatment of wounds and ulcers in humans and animals and a method of preparation of the same are provided here. The composition consists of an alcoholic extract of Huangqin, Huanglian, Huangbai, Opuntia, Dilong, and.beta.-sitosterol (from Soybean extract), in a vegetable oil-wax base, from where the alcohol is essentially removed by evaporation. The composition is used as a topical ointment for the treatment of wounds in its preferred embodiment. Wounds, in particular those occurring in the skin as second and third degree burns, stasis ulcers, trophic lesions, such as decubitus ulcers, diabetic ulcers, surgical wounds, severe cuts, diaper rash, cracked nipples and abrasions which are commonly resistant to the natural healing process, may be treated with this composition. The application of this combination to wounds greatly accelerates the rate of healing and reduces scarring as the mechanism of action proposed here involves regeneration of skin through stimulation of stem cells that allows healing without substantial scar formation. Excerpt(s): Wound healing involves a complex but orderly sequence of cellular events that culminates in the restoration of structural integrity of tissue. The orderly influx of inflammatory cells, proliferation of stromal elements, in-growth of blood vessels, and production of an extra-cellular matrix are essential for rapid and efficient healing. Maximum tissue strength is achieved through the regulated remodeling and maturation of the extra-cellular matrix. Tissue repair is regulated in part by cells at the wound site that control the local production of growth factors, including transforming growth factor beta. Wound healing begins with a repair cascade, which culminates in the formation of new granulation tissue. Cutaneous ulcers are a common, chronic problem and are primarily developed as pressure (decubital) sores. In addition to causing pain and discomfort and predisposing the patient to superficial and chronic infection, significant costs are associated with the treatment that is often long-term. Chronic ulcers may also arise as a result of chronic steroid therapy for autoimmune disease or atopic dermatitis as well as chemotherapy for cancer. These conditions and their treatment regimens may impair the normal wound healing process and often result in chronic ulcers. While the etiology of pressure sores or ulcers resulting from chronic steroid or chemotherapy may be different, the underlying manifestation is the lack of formation of granulation tissue and re-epithelialization of the defect. Depending on the health and background of the patient, these cutaneous open wounds and ulcers can persist chronically for extended periods of time. Each of these types of cutaneous open wounds and ulcers results in considerable discomfort to the patient and presents a continuing opportunity for even more serious infections or complications to occur. In addition to these common cutaneous open wounds and ulcers, a variety of other skin defects are known to occur in both animals and humans, including lacerations, perforations, wounds which are traumatic in origin, venous stasis ulcers, and other types of lesions. These types of wounds also occur in other vertebrates such as birds and reptiles. The

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fundamental pathogenesis of wounds and processes for wound healing is similar for all vertebrates, and therefore the person of ordinary skill will realize that the methods and compositions of the present invention are useful for treating chronic wounds and ulcers in all vertebrates. Web site: http://www.delphion.com/details?pn=US06555118__ •

Portable mattress for treating decubitus ulcers Inventor(s): Tappel; James G. (Hickory Corners, MI) Assignee(s): Stryker Corporation (Kalamazoo, MI) Patent Number: 5,542,136 Date filed: August 5, 1994 Abstract: A portable mattress system has a mattress unit, a control unit, and a control panel. The mattress unit has a plurality of sleeves with transverse openings which each receive an elongate bladder, and has in a foot section a recess that can receive the control unit. A coupling arrangement detachably operatively couples the control unit to the mattress unit. The control panel is flat and thin and is coupled to the control unit by a cable. An arrangement is provided to support the mattress unit on the control unit when the mattress unit is in a deflated condition, and the control unit has rotatable wheels and a handle for facilitating easy transport of the entire mattress system to or from a bed. Excerpt(s): The present invention relates to a mattress system for treating or for avoiding development of decubitus ulcers and, more particularly, to such a mattress system having an inflatable bladder and a control unit for controlling a pressure within the bladder. Decubitus ulcers, commonly known as bedsores, typically develop when a patient is required to spend a relatively long period of time recuperating in bed with a minimal amount of movement. Various different types of beds and mattresses have been designed to avoid the development of decubitus ulcers and/or to treat decubitus ulcers which have already developed. One known type of system uses a mattress containing an inflatable bladder arrangement with a number of separate zones, and a control unit which separately controls the pressure in each zone. While units of this type have been generally adequate for their intended purposes, they have not been satisfactory in all respects. First, at least where there are a plurality of zones, the mattress unit is often an integral part of an entire bed, as opposed to a separate component which can be moved from bed to bed. Further, the mattress unit can be relatively difficult to clean, in that all air bladders must be individually removed and laundered, and can be damaged if laundered at the wrong temperature or by the wrong procedure. Moreover, the procedure required to program the unit for the needs of a particular patient can be relatively complex. Those who do not program such systems on a regular basis must refer to an instruction manual, and even then may not achieve optimum settings for the particular circumstances. Web site: http://www.delphion.com/details?pn=US05542136__

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Pressure relieving pad with graduated pillars Inventor(s): Castellino; Robin L. (Louisville, CO), Gabel; Dustin E. (Boulder, CO), Marino; Gregory S. (Westminster, CO) Assignee(s): KCI-RIK Acquisition, Corp. (San Antonio, TX) Patent Number: 5,960,497 Date filed: August 22, 1997 Abstract: A pressure relieving pad with graduated pillars to effectively reduce the development of decubitus ulcers. The pad is preferably made of foam to keep the manufacturing costs down and includes a first plurality of large pillars or columns. A second plurality of smaller pillars or columns is then positioned atop each of the larger pillars forming a progression or graduation of pillars. Adjacent larger pillars are preferably attached to one another at their bases to form an underlying, support platform or level for the pad. In operation, the weight or force of the patient using the pad is progressively transferred from the small pillars on top downwardly through the larger pillars to the underlying support platform or level. Excerpt(s): This invention relates to the field of mattress and other cushion pads primarily intended for medical use to prevent or reduce the development of decubitus ulcers in patients using the pads. Decubitus ulcers, commonly referred to as bed or pressure sores, are a major health concern for patients that become bed or chair bound for prolonged periods of time. They are also frequent complications for burn victims and tall, thin patients and other patients with particularly bony protuberances. The ulcers generally develop at such bony protuberances as well as other relatively bony areas of the patient's body including the trochanteric (hip) area, scapula (shoulder blade) area, spinal area, and coccyx (tailbone) area where relatively little flesh is present and blood circulation is often poor. Factors contributing to the development of the decubitus ulcers are numerous including the general overall condition of the patient's skin and underlying tissue. Forces generated on the patient's body by the mattress pad or other support are also critical. Examples of a popular mattress pad design that effectively reduces the development of decubitus ulcers using a pillared or columned layer of foam are disclosed in commonly owned U.S. Pat. Nos. 5,201,780, 5,225,404, 5,303,436, and 5,511,260. The basic approach of these patents involves placing a fluid bladder layer over a layer of foam which has had pillars or columns cut into it. While this approach is very effective, it is also relatively expensive as are similarly effective designs such as the fluidized bead bed of U.S. Pat. No. 4,483,029. Presently, many medical insurers will not routinely qualify patients to use such costly but effective devices unless they are at extreme risk of developing decubitus ulcers or have already developed them. Most patients at risk or who even have minor, existing ulcers are currently directed by their insurance carriers to use lower cost devices such as pillared or convoluted foam pads. These pads are commonly categorized as preventative products. They usually provide some reduction in pressure (i.e., as compared to a standard mattress) but cannot approach the pressure relief or patient outcome of the high-end products. Web site: http://www.delphion.com/details?pn=US05960497__

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Pressure-relieving wheelchair seating apparatus Inventor(s): Ezra; Arthur A. (Huntington Station, NY), Shah; Mahendra C. (East Northport, NY) Assignee(s): The Research Foundation of State University of New York (Albany, NY) Patent Number: 6,557,937 Date filed: April 9, 2001 Abstract: A seating apparatus for supporting a lower body region of an immobilized person for avoidance and relief of decubitus ulcers which provides regular intervals of seating pressure reduction below a predetermined seating pressure for a predetermined relief period. The seating apparatus includes a plurality of slats/cushions which may be displaced between a first support position wherein each of the slats/cushions is coplanar with a defined plane and a second displaced position wherein each of the slats/cushions is displaced a distance D from the defined plane for the predetermined relief period whereby capillary blood pressure is reduced below the predetermined seating pressure in the unsupported portion of the lower body region. Excerpt(s): The present invention relates to a seating apparatus and, more particularly, to a pressure-relieving wheelchair seating apparatus for avoidance and relief of decubitus ulcers (i.e., pressure sores). Decubitus ulcers develop on the skin of immobilized people, particularly under bony locations like the ischial tuberosities and coccyx, when the seating pressure exceeds a typical value of 32 mm Hg for a period of time, such pressure stopping blood flow to the tissues under pressure. While other factors such as diet, moisture, and shear stress on the skin contribute to the formation of decubitus ulcers, they can generally be avoided by physically moving the immobilized person at frequent intervals to restore blood flow to the pressurized areas. The medical industry has recognized that a general relationship exists between seating pressure and seating time. That is, the greater the seating pressure, the less time a person may sit in that same position without suffering damage to the skin and tissue located at that position. Although each person exhibits a different pressure/time relationship (based on such factors as body weight, shape and structure), a general relationship was established by J. B. Reswick and J. E. Rogers which plots the maximum suggested seating pressure vs. the maximum suggested seating time for tissue under a bony location. This relationship is commonly referred to as the Reswick/Rogers curve, and provides general seating guidelines for an average person. For example, the Reswick/Rogers curve provides that a seating pressure of 500 mm Hg will allow the immobilized person to remain seated for approximately 1.1 hours, while a seating pressure of 200 mm. H.g. will allow the immobilized person to remain seated for approximately 2 hours. Web site: http://www.delphion.com/details?pn=US06557937__

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Protective medical boot with pneumatically adjustable orthotic splint Inventor(s): Lamont; William D. (54283 Meadowood Ct., Shelby Township, Macomb County, MI 48316) Assignee(s): none reported Patent Number: 5,453,082 Date filed: February 7, 1994

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Abstract: A protective medical boot for treating or avoiding decubitus ulcers has an outer leg covering formed with a pair of cover panels having their seams hot-stamped together to provide a soft edge. An orthotic splint has a leg portion that is supported adjacent the back of the patient's leg, and a foot portion that supports the sole of the patient's foot. A heel device connects the leg portion to the foot portion at a selected angle with respect to the leg portion. A pneumatically-operated bladder is disposed between the foot portion and the patient's foot to provide a very fine adjustment of the angle of the patient's foot to his leg to assist in preventing or treating contracture of the patient's foot. Excerpt(s): This invention is related to a medical boot for avoiding ulcers, and a supporting splint for treating a contracture condition of the patient's foot. My copending application, and my prior U.S. Pat. No. 5,226,245 which was issued Jul. 13, 1993 for "Protective Boot Structure" disclose a soft medical boot for covering a patient's foot to prevent decubitus ulcers. The boot has panels formed of a soft material which are stitched around their edges. Occasionally the stitched edges tend to abrade the patient's skin. In my co-pending patent application, I disclosed an orthotic splint having a leg portion and a foot portion. A heel device allows the user to quickly and easily set the splint at three positive positions. The three positions are 0.degree. for holding the foot at a normal upright position when the user's leg is in a horizontal position; -30.degree. for plantar flexion; and +10.degree. for dorsi flexion. Web site: http://www.delphion.com/details?pn=US05453082__ •

Seat cushion for minimizing decubitus ulcers Inventor(s): Kohnle; Robert C. (4834 N. Interstate, Portland, OR 97217) Assignee(s): none reported Patent Number: 6,230,351 Date filed: April 21, 1999 Abstract: A seat cushion which increases the surface area contacting the patient's skin, and which conforms evenly to the skin over the skin/surface interface. A seat cushion includes a flat layer of foam that is temperature sensitive and which has rate-dependent deflection which provides maximal hysteric dampening and maximal tissue/surface interface contact. Different stiffnesses of foam are used under key areas to allow support and at the same time to allow the tissue to reach mechanical equilibrium. The maximal surface contact will apply constant low pressure to the tissues, thus reducing the shear force and the risk of tissue injury. Excerpt(s): This invention is related to the decubitus ulcer disease, and in particular to an improved seat cushion for reducing the occurrence of decubitus ulcer disease. Decubitus ulcer disease (pressure sores) is a secondary condition which frequently occurs in elderly patients, and others whose mobility is limited. Pressure sores are a growing problem for patients, and for health care providers. Twenty percent of all patients admitted to long-term care facilities arrive with pressure sores. An additional 12% develop new sores over each subsequent six-month period. 1.7 million patients developed bedsores in 1993. The cost to treat bedsores was estimated at 8.5 billion in 1993. The number of patients requiring treatment for bedsores, and the associated costs, can be expected to increase in the coming years as the number of persons over 50 years of age increases. Patients confined to wheelchairs may also experience pressure sores as well. The persistent and increasing problem of pressure sores has prompted

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investigation into their causes. Kosiak, who is referred to as the father of modern pressure sore research, defined pressure sores as localized areas of cellular necrosis. From his studies with dogs, he concluded that ischemia resulting from supracapillary pressures was one of the main causes of ulceration. Pressure ulcers were the result of ischemic, neurophic, and metabolic factors. Ulcers almost always occur in the tissue that overrides a bony prominence. When pressure exceeds tissue capillary pressure, ischemic changes result in ulceration. Web site: http://www.delphion.com/details?pn=US06230351__ •

Seating system with pressure relieving fluid pad Inventor(s): Dinsmoor, III; John C. (Westminster, CO), VanEveren; Barry (Loveland, CO) Assignee(s): Jay Medical Ltd. (Boulder, CO) Patent Number: 5,490,299 Date filed: October 3, 1994 Abstract: A seating system primarily intended for use in wheelchairs and similar applications for reducing the development of decubitus ulcers. The seating system includes a relatively rigid, shaped tray and a pressure relieving fluid pad. The tray has a thigh supporting shelf and a depressed seating well. The fluid pad preferably has a plurality of fluid pouches positionable over the thigh supporting shelf of the tray and an array of rearward pouches positionable over the depressed seating well. The rearward pouches in the seating well are wedge shaped and taper downwardly in vertical thickness from one end portion to the other. Each rearward pouch has its thicker end portion overlying a central part of the seating well and its thinner end portion positioned over the upwardly inclined, outer rim section of the seating well. In this manner, the resulting arrangement of the rearward pouches concentrates the bulk of the fluid toward the center or middle of the seating well to substantially prevent any undesirable bottoming out of the user's ischial tuberosities and coccyx on the rigid tray. Excerpt(s): This invention relates to the field of seating systems and more particularly, to the field of anti-decubitus seating systems for wheelchairs for reducing the development of pressure sores. As set forth in the prior invention of U.S. Pat. No. 5,352,023, growing children present a unique problem to seating and back systems for wheelchairs in that the fitting requirements of the child are continually changing sometimes on a month-tomonth basis. The basic objective of such pediatric seating and positioning systems is to maintain the pelvic and spinal alignments to a desired configuration so that normal growth may occur without risk of permanent physical deformity. Children are more prone to skeletal deformities because their bones are soft and are very susceptible to being pulled into permanent deformities, particularly during growth spurts. The previous invention of U.S. Pat. No. 5,352,023 disclosed a seat and back structure that was essentially adjustable in numerous aspects so that the positioning requirements of the growing user could be continually met throughout a period of growth. The present invention is directed to further improving the capabilities of the seating system by substantially improving the pressure relieving qualities of the fluid bladder or pad component of the previous invention of U.S. Pat. No. 5,352,023. Research has shown that most pediatric wheelchair bound users are not substantially at risk for decubitus ulcers (pressure sores, bed sores). This is true primarily because the diagnoses do not involve the loss of sensation in the lower extermities as would for example spinal cord injuries. However, there are some instances where the diseases (e.g., cerebral palsy and spinabifida) have progressed to the point where sensation is impaired and the user requires a

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seating system that not only maintains the appropriate pelvic alignment but also provides a quality of pressure and shear relief to the underlying soft tissue of the user. In the past, most of the fluid--filled, pressure-relieving bladder configurations have employed oversized fluid segments or pouches that are bunched or gathered into a defined seating well. The excess bladder material serves a dual purpose in that it prevents hammocking of the bladder membranes or covers and also provides the necessary stroke or displacement tangentially to the fluid support surface so that shear forces on the supported body are kept at a minimum. The prior use of these types of fluid bladders has proven to be very successful when applied to cushion bases or trays where the user's position on the cushion is predictable (i.e., hips to the back and centered). Furthermore, in these prior applications, it was assumed that the majority of the fluid pad would be in contact with the user and thus the need to restrain certain portions of the bladder from ballooning or billowing around the user was not required. The ballooning or billowing described is detrimental to the function of the fluid pad because the supporting fluid volume would then be allowed to accumulate in these ballooning volumes. This would cause the user to sink farther into the cushion and eventually bottom out on the underlying rigid foam tray of the cushion structure. Web site: http://www.delphion.com/details?pn=US05490299__ •

Support system for reducing formation of decubitus ulcers Inventor(s): Barnett; Richard I. (Bath, CA), Knapp; William C. (Kingston, CA) Assignee(s): Du Pont Canada Inc. (Mississauga, CA), Queen's University at Kingston (Kingston, CA) Patent Number: 5,010,608 Date filed: October 11, 1989 Abstract: A support system that reduces the likelihood of breakdown of human skin, and hence formation of decubitus ulcers, is disclosed. The system comprises two sheets of flexible material bonded together to provide a plurality of separate cells that are capable of being alternately and repeatedly inflated and deflated by means of a fluid contained in the cells. The flexible material is impermeable to the fluid. The cells are of a size and shape and with an intercellular spacing such that in at least one of the width and length of the system, the distance between centers of adjacent inflated cells is less than the human two-point discrimination threshold and the support system is capable of supporting a human body with bottoming out either of or between the inflated cells. In particular embodiments, the support system is in the form of a mattress. The support system may be used with persons who are confined to bed, wheelchairs or the like for periods of time or who are otherwise fully or partially immobilized, including for therapeutic reasons. Excerpt(s): The present invention relates to a clinical support system and related devices for use in the reduction of the breakdown of human skin, and especially to reduce the likelihood of formation of decubitus ulcers in persons who are confined to beds, wheelchairs or the like for periods of time or who otherwise are fully or partially immobilized. "human two point discrimination threshold" is measured on a person's back, being the minimum distance at which two objects may be distinguished by touch when the objects are placed on the skin, that distance being understood in the anatomy profession and being approximately 25 mm on a person's back. Persons may become confined to a support surface e.g. beds, wheel chairs or other devices for a large variety of reasons, for instance as a result of injury or illness or as a consequence of the

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requirements of a job function during employment. Elderly persons may be confined to bed or other devices for extended periods of time. Web site: http://www.delphion.com/details?pn=US05010608__ •

Therapeutic mattress, in particular for preventing or curing decubitus ulcers Inventor(s): Seiler; Walter O. (Allschwil, CH) Assignee(s): OBA AG and Hans Vollmin (CH) Patent Number: 4,947,500 Date filed: July 11, 1989 Abstract: The therapeutic mattress comprises an elastic but hard base layer of foam material. Over this base layer is applied a frame composed of a hard part and a soft part. On its upper side the mattress is bounded by a soft cover layer. Between or inside the aforementioned parts is disposed a core comprising essentially two groups of three aircushions each and an insert. Each of the two air-cushion groups has its own connection to a pumping station equipped with a programmable control device. Using this control device it is possible to set up the most varied programs and cycles for moving a patient and positioning him, or repositioning him, as often as needed. In this way, decubitus ulcers may be prevented from developing, but in addition, conditions may be created to enable ulcers already developed to be healed. Excerpt(s): The present invention refers to a therapeutic mattress, in particular for preventing or curing decubitus ulcers. The decubitus ulcer is not an independent illness but develops secondarily to a primary illness that forces the patient into immobility. It develops invariably against the background of a protein deficiency syndrome, a consequence of malnutrition frequently found in the aged. This deficiency affects the mechanical properties of the patient's bodily tissues, which thus become less resistant to the pressures they are subjected to as the weight of the patient's body presses such tissues against the mattress the patient is lying on. Such ulcers are very common in the chronically ill and represent feared complications frequently more dangerous than the primary illness itself. Once developed, the wound gets easily infected and must be treated against such infections. Also, the mattresses to be used for such patients are designed to make the patient's total body weight relatively uniformly distributed on the surface of the mattress, to make the specific pressure at any one point of the skin as small as possible, to prevent any further damage to the tissue. In addition, the time during which the pressure acts on a particular region of the skin is kept within allowable limits by moving the patient periodically and keeping his exposure compatible with the status of his tissues. These measures must be applied in all cases in which a decubitus ulcer has already developed if a cure thereof is endeavoured, but they are advisable if only the prevention of such ulcers is aimed at. Known therapeutic mattresses of the aforementioned kind are excessively soft. One such known mattress having a height of about 20 cm is referred to as alternating pressure mattress and is composed of two parts tapered in cross-section and disposed on top of each other, and is arranged to have cushions individually inflatable and deflatable. On this mattress is placed a very soft second mattress of a thickness of 12 to 15 cm. These alternating pressure mattresses have not been very successful. On the one hand, they are too high when used together with the stated second mattress. On the other hand, they do not properly adapt to a class of bed frames that comprise hinges extending perpendicular to the longitudinal direction of the bed to form a head wedge and a foot wedge. Also when deflating one of the mattress components, the patient will be in danger of rolling out of

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bed, or of rolling against the safety grid that may be provided. Hence from what has been explained heretofore it is apparent that there is still needed a therapeutic mattress, in particular for preventing or curing decubitus ulcers, which does not have the drawbacks and limitations of the prior art proposals. Web site: http://www.delphion.com/details?pn=US04947500__ •

Therapeutic support for the reduction of decubitus ulcers Inventor(s): Gronsman; Steven M. (Grand Rapids, MI) Assignee(s): Sand Therapeutic, Inc. (Hudsonville, MI) Patent Number: 6,367,106 Date filed: September 28, 1998 Abstract: The invention relates to a therapeutic seat or bed for reducing the likelihood of decubitus ulcers, which can form in the skin surrounding a weight-bearing bony protrusion. The seat or bed includes one or more compressible supports in a cushion that can be moved between a compressed, relaxed, or inflated state to relieve pressure from the skin surrounding the bony protrusion to increase the blood flow or stimulate the blood flow through the area surrounding the bony protrusion. Excerpt(s): The present invention relates to a therapeutic support for the human body; and, more particularly, to a therapeutic support such as a seat or a bed that aids in the healing of decubitus ulcers and reduces the likelihood of formation of such ulcers. It is well known that non-ambulatory or partially immobile people who are confined to beds, chairs, wheelchairs, and the like may suffer from the formation of decubitus ulcers, also known as pressure ulcers, pressure sores, and bedsores. Decubitus ulcers are generally formed by a reduction or absence of capillary blood flow in the sufferer's skin. For a non-ambulatory or partially immobile person, the reduction or absence of capillary blood flow is primarily caused by the weight-bearing bony protrusions compressing the skin against a support such as a bed or wheelchair, with the person remaining in the same position for an extended period of time. The compression of the skin by the weight-bearing bony protrusion reduces or stops the capillary blood flow in that area of the skin, leading to necrosis and the formation of a decubitus ulcer. The formation of a decubitus ulcer is exacerbated by the existence of moisture from perspiration or incontinence, for example, which are often associated with nonambulatory or partially immobile persons. Web site: http://www.delphion.com/details?pn=US06367106__

•

Use of bubble packaging film for relieving decubitus ulcers or pressure ulcers Inventor(s): Garcia; Mario C. (West St. Paul, MN) Assignee(s): Prevent Products, Inc. (St. Louis Park, MN) Patent Number: 4,962,769 Date filed: March 20, 1989 Abstract: Body fluid absorbing cushioning means for use by invalids and bed-ridden persons for absorption of body waste fluids and for relief of pressure areas on the skin. The cushioning means comprises a laminate with at least three layers including an inner water absorbent layer, an outer generally water impervious layer, and a center layer

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consisting of an array of generally closely spaced enclosures defining air supported closed cells. Further, in order to accommodate transfer of body fluids from the inner layer, bores may be formed in the center layer between individual enclosures, wherein a second water absorbing layer is provided on the opposite side of the impervious cell layer. Excerpt(s): The present invention relates generally to cushioning means for use by invalids, bed-ridden persons, as well as others who may be required to spend extended periods of time in either a sitting or prone position, and more specifically to body fluid absorbing cushioning means which are adapted to control and/or reduce the unit pressures exerted against the skin of such persons while so confined. The present invention is adapted primarily for reduction of the occurrence of decubitus ulcers, commonly known as bed sores, which frequently develop on the surface of skin of invalids and persons who may be bed-ridden or otherwise required to remain in a given position over extended periods of time, without being able to change positions on their own. Normally, humans are supported by surfaces such as chairs and/or beds, and the bodies press against the skin surface with a total force generally equal to the body weight. Pressure, which may be defined as force per unit area, is exerted on the body surface over various ranges, depending upon the location, the physiology of the person, as well as the nature of the supporting surface. These pressures frequently become substantial at certain localized areas, but may be reduced when the body is floated in water or upon other cushioning means. While higher pressures can be tolerated by most individuals for short periods of time, extended exposures to high pressures at certain localized areas of the skin and/or body will eventually lead to skin necrosis and/or tissue anoxia. The creation of decubitus ulcers or "bed sores" is an example of skin necrosis. When the blood supply to the skin is obstructed due to application of continuous pressures over extended periods of time, skin necrosis occurs, and a decubitus ulcer or bed sore may develop. Interruption of blood flow from the subcutaneous tissue over periods in excess of a few hours will generally lead to such conditions. Web site: http://www.delphion.com/details?pn=US04962769__ •

Visual cue foot floater foot positioner Inventor(s): Sells, II; Haskell Lee (3900 Yew Cir., Raleigh, NC 27612) Assignee(s): none reported Patent Number: 6,488,031 Date filed: March 27, 1995 Abstract: In the healthcare field there are specific wounds generally referred to as "pressure ulcers" or "decubitus ulcers". These wounds are generally caused by: direct constant pressure to body tissues; internal disease or disorders which surfaces on the skin; urine or fecal material constantly in contact with skin causing breakdown; lack of proper nutrition; or, a combination of all these factors. These wounds occur mostly on "bed-ridden patients" whose debilitation is such that they cannot react to their body's neurological signals for them to adjust their position. Most of these patients are prone and lay on standard mattresses.These "pressure ulcers" can occur in any area of the body but are predominantly found in the shoulders, coccyx, hip, legs, and heels. Actually, any "bony-prominence" is a candidate for breakdown if pressure is allowed to be against it constantly.There have been many attempts to "cure" or "treat" these "pressure ulcers". There are nursing attempts to turn the patient every two hours to prevent these wounds

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from occuring. There have been products produced to give "floatation" to these patients to help relieve pressure. These products range from low air loss active floatation beds to static air mattresses to foam (trapped air) overlays to body positioners. Excerpt(s): This invention relates to the problem of "pressure ulcers" of the heel area. This invention relates to foot positioners and more particularly to a practical, effective method of positioning feet to help prevent skin and heel breakdown which leads to the formation of pressure ulcers on the heel. In the past, foot positioners have consisted of such items as standard pillows, air filled boots, "bean-bag" cushions, and foam cradles. The problems with these "manufactured products" include; difficulty in determining for which foot the positioner is indicated; quick visual assessment of skin on the foot (due to the foot being "wrapped in" the positioner); heat build up causing odor and discomfort; maintaining proper heel positioning; consequence of straps being too tight (causing breakdown) or too loose (non-functional); and,choosing the correct size. Pillows have their own set of problems in that they are not clearly defined as a "foot" product; they do not stay in position; they can be too high, possibly causing a hyper-extended knee; they can be too low, accomplishing nothing. An appropriate positioner should be cool, comfortable, and well accepted by the patient. It should provide the healthcare personnel immediate visual assessment of the patient's foot position and skin condition. It should be uniform in it' size so that there is no guessing on the part of the healthcare personnel as to sizing, it should be a "one size fits all". It should be non-incapsulating to help prevent heat build up or pressure from straps. It should be a low profile positioner to help prevent hyper-extention of the knee. Web site: http://www.delphion.com/details?pn=US06488031__

Patent Applications on Decubitus Ulcers As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to decubitus ulcers: •

Air cushion control system Inventor(s): Graebe, William F. JR.; (Collinsville, IL) Correspondence: John W Kepler, Iii; 7733 Forsyth BLVD., 12th Floor; ST Louis; MO; 63105; US Patent Application Number: 20040083550 Date filed: October 23, 2003 Abstract: An air cushion control system having an air chamber sensor including an air chamber, a bottom out sensor and an overinflation sensor, an air pump to inflate the air chamber, an air valve to release air from the air chamber, connections for the air cushion control system to an air cushion, and a microprocessor to control the inflation and the release of air from the air chamber. The air cushion control system reduces decubitus ulcers by incorporating both an automatic adjustment system to prevent the seated individual from bottoming-out in the air cushion and measure immersion depth to maximize pressure reduction.

9

This has been a common practice outside the United States prior to December 2000.

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Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application No. 60/421,036, filed Oct. 23, 2002. The present invention relates to an air cushion control system. The system automatically adjusts inflation and immersion levels for a person using an air cushion to reduce the occurrence of decubitus ulcers. Individuals who are wheelchair dependent generally need special cushioning to help prevent the formation of decubitus ulcers, which are often commonly referred to as pressure sores or bedsores. These individuals are often paralyzed and have lost sensation or have impaired sensation in their lower extremities. This loss or impairment of sensation presents problems associated with both bottoming-out in and the adjustment level of the cushion that the individual is sitting on. Bottoming-out raises the peak pressures on the skin in the bottomed-out areas of the individual to levels such that the blood flow in the capillary bed in the bottomed-out areas will be stopped (occluded) or reduced, which prevents vital nutrition from reaching the cells. This may cause necrosis or cell death and result in the onset of a decubitus ulcer. Improper adjustment or immersion can also result in decubitus formation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Air-powered low interface pressure support surface Inventor(s): Benedict, Joseph; (Mauldin, SC), Raburn, Richard W.; (Simpsonville, SC), Totton, Wanda J.; (Greer, SC), Weston, Russell J.; (Greer, SC) Correspondence: Dority & Manning, P.A.; Post Office Box 1449; Greenville; SC; 296021449; US Patent Application Number: 20020073489 Date filed: July 18, 2001 Abstract: An air inflatable mattress and mattress coverlet are provided for the prevention and treatment of decubitus ulcers (i.e., pressure sores or bedsores). The mattress incorporates a user selectable static or alternating air powered support surface for more uniformly redistributing pressure exerted on a patient's skin. The mattress coverlet encompasses a low air loss feature independent of the mattress's user selectable air powered support surface. Such low air loss feature provides a patient contact surface exhibiting a high moisture vapor transfer ratio in conjunction with a forced air flow to aid in reducing the moisture and heat near the patient's body. Both the mattress and mattress coverlet are driven by an external control system which houses the user controls, as well as the necessary pumps, regulators, and valving. Excerpt(s): This application claims benefit of U.S. Provisional Application No. 60/219,074, filed Jul. 18, 2000. This invention generally relates to mattresses and mattress coverlets for preventing, reducing, and/or treating decubitus ulcers, also known as pressure sores or bedsores. More particularly, this invention concerns therapeutic mattresses or mattress coverlets capable of transferring or dissipating moisture vapor and heat from a patient's skin. Often, patients that are bedridden or immobile can develop decubitus ulcers (pressure sores or bedsores). Such ulcers are often caused by pressure, friction, shear, moisture, and heat. Pressure results in a reduction of blood flow to the soft tissues of the body, particularly the skin. Continuous lack of blood flow, and the resultant lack of oxygen, can cause the skin to die and ulcers or sores to form. Friction and shear of the skin against the support surface can lead to skin tears and decubitus ulcers. Moisture and heat may lead to skin maceration. Other factors play a part in determining the speed with which such ulcers will form or heal including the overall health of the patient and such patient's nutritional status.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for reducing the risk of decubitus ulcers Inventor(s): Cooper, Craig L.; (Inola, OK), Smith, Toby E.; (Broken Arrow, OK) Correspondence: Fellers Snider Blankenship; Bailey & Tippens; The Kennedy Building; 321 South Boston Suite 800; Tulsa; OK; 74103-3318; US Patent Application Number: 20040046668 Date filed: September 9, 2003 Abstract: There is provided herein a sensor for use in patient monitoring, wherein the level of patient activity in a chair or bed is tracked to determine whether or not that patient has exhibited sufficient activity to merit eliminating a scheduled assisted relocation to a new position. The instant device senses the time since a patient last relocated into a different sitting or lying position. If the patient has not moved during some predetermined time period, the nursing staff will be notified that it is time to manually reposition the patient. On the other hand, if the patient has significantly changed position, the device will not signal to the caregiver that a move is necessary, thereby eliminating the need in some cases to rouse the patient from an otherwise sound sleep. Excerpt(s): This application is a continuation-in-part of application Ser. No. 09/591,887, filed on Jun. 9, 2000, the disclosure of which is incorporated herein by reference. This invention relates generally to apparatus and methods for reducing the risk of immobile patients developing decubitus ulcers. It is well known that patients who are confined to a bed or chair for extended periods of time are at risk of developing decubitus ulcers, i.e., pressure sores, or bed sores as they are more commonly known. These ulcers are often seen to develop within soft tissue that is compressed between a bed or chair surface and a patient's weight-bearing bony prominences, the compressed tissue being at least partially deprived of oxygenated blood flow. A continued lack of blood flow, and resultant lack of oxygen, can result in cell death which may be evidenced in the form of pressure sores. Pressure sores do not become apparent immediately, but rather form over time, with the development speed depending on a number of factors including the firmness and friction of the supporting surface against the patient's skin, the patient/ambient temperature, the amount of moisture in contact with the skin, and the health and susceptibility of the skin due to age or illness. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Blanching response pressure sore detector apparatus and method Inventor(s): Taylor, Geoffrey L.; (Winnipeg, CA) Correspondence: Law Offices OF William L. Chapin; 16791 Sea Witch Lane; Huntington Beach; CA; 92649; US Patent Application Number: 20040054303 Date filed: July 29, 2002 Abstract: A portable, hand-holdable Blanching Response Tester apparatus (BRT) pressable against the skin of a human patient to provide an indication of a nonblanchable erythema indicative of an incipient pressure sore includes a housing having

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in a front end wall thereof an optically transmissive window and within the housing a broad-band light source electrically energizable to emit light including energy in the near infrared (0.8.mu. to 1.5.mu.) outwards through the window. A first, leading photodetector spaced laterally apart from the light source and a second, trailing photodetector spaced equidistant from the light source in an opposite direction have fields of view which include regions of the skin ahead of an behind a central area of the skin illuminated by the light source. Electronic signal processing circuitry within the BRT housing includes a pair of differential amplifiers having opposite pairs of inputs connected to the pair of photodetectors, one amplifier driving a first, "NO-GO" red, light-emitting diode mounted in an upper wall panel of the housing, and the other amplifier driving a second, "GO" green LED. When the BRT window is pressed against the skin and the light source energized, if light reflected from the skin by leading photodetector over a questionable area of the skin exceeds light reflected from a known healthy sample area of skin beneath the trailing photodetector the red, NO-GO LED is illuminated if the difference in light values exceeds a first threshold values signifying a pressure sore, and if light received by the trailing photodetector exceeds that received by the leading photodetector by a second threshold value, the green, GO LED is illuminated. Excerpt(s): The present invention relates to methods and apparatus for detecting incipient or first stage pressure sores in humans. More particularly, the invention relates to a hand-held detector apparatus which is pressed against the skin of a patient to provide detection of non-blanchable erythemas which are indicative of existing or potential pressure sores, and a method for detecting pressure sores. If an external part of a person's body is subjected to a localized external pressure sufficient to inhibit blood flow to tissue below the skin for substantially long periods of time, a sore or lesion can develop at the area of the skin where the pressure is applied. Such sores are referred to as pressure sores, and are common among medical patients and elderly persons who are required to lie in a hospital bed or be seated in a wheel chair for extended time periods. Typically, pressure sores develop in areas of tissue which overlie a bony prominence of the body. Even a relatively light pressure exerted by covering bed clothes on the toes of a recumbent patient is sufficient to cause a pressure sore on the toe, if exerted for a long period of time. The probability of a pressure sore forming is proportional to both the magnitude of the pressure and the time period which the pressure is exerted. Accordingly, areas of the body on which large portions of a patient's weight are supported by a bed or wheel chair are particularly likely candidate areas for the formation of a pressure sore in a relatively short period of time. These include the heels, ischial tuberosities at the ends of the hip bones, sacrum, scapula, and occiput (back part of the skull). While the exact mechanism for the formation of the beginning or first stage pressure sore is not known, it is known that a prolonged deficiency of oxygenated blood supplied to tissues is a primary cause of the pathology. Prolonged here means longer than a localized and temporary deficiency of blood supply to an area of tissue caused by obstruction of blood flow to that area, a condition known as ischemia, which can cause a temporary whitening or blanching of the skin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for inhibiting skin lesion formation using histamine as the active ingredient Inventor(s): Jack, Bruce; (Albuquerque, NM), White, B. Thomas; (Albuquerque, NM) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20030187048 Date filed: September 24, 2002 Abstract: A pharmaceutical composition of water, water soluble vinyl polymer gel, amine alcohol dispersant and IEP is used topically to treat herpes labialis and aphthous stomatitis lesions, and also to treat herpes genitalis, chicken pox, allergic conjunctivitis, giant papillary conjunctivitis, stomatitis secondary to chemotherapy, thermal burn, sunburn, and decubitus ulcers and shingles. Excerpt(s): This application is a continuation of allowed application Ser. No. 09/511,085, filed Feb. 23, 2000, entitled "METHOD FOR INHIBITING SKIN LESION FORMATION USING HISTAMINE AS THE ACTIVE INGREDIENT", which is a continuation of allowed application Ser. No. 09/196,840 filed Nov. 20, 1998, entitled "METHOD AND COMPOSITION FOR TOPICAL TREATMENT OF DAMAGED TISSUE USING HISTAMINE PHOSPHATE AS AN ACTIVE INGREDIENT", which is a continuation of allowed application Ser. No. 09/020,321 filed Feb. 9, 1998, which is a divisional of allowed application Ser. No. 08/691,446 filed Aug. 2, 1996, which is a continuation of application Ser. No. 08/199,103 filed Feb. 22, 1994, now abandoned, which is a continuation-in-part of allowed application Ser. No. 07/886,304 filed May 21, 1992 entitled "COMPOSITION FOR THE TREATMENT OF COLD SORES AND THE LIKE", which is a continuation of application Ser. No. 07/715,410, filed Jun. 14, 1991, now abandoned. The invention relates to compositions and methods for the treatment of the viral diseases herpes labialis (cold sores or fever blisters), herpes genitalis, herpes zoster (shingles), varicella zoster (chickenpox); inflammatory diseases and/or diseases demonstrating compromise or reaction of the immune system including aphthous stomatitis (canker sores), oral mucositis (stomatitis) secondary to chemotherapy, allergic conjunctivitis, giant papillary conjunctivitis; and lesions of injury to the skin including photodermatitis (sunburn, specifically second degree sunburn), thermal burns and pressure sores (decubitus ulcers). Histamine phosphate previously has been used as a diagnostic agent for determining a condition known as achlorhydria. Histamine phosphate also has been used intradermally to produce a flare-up reaction of the skin to test the ability of certain drugs to inhibit this histamine-induced wheal, thereby indicating clinical response for disease processes which liberate histamine. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for treating wounds to promote healing Inventor(s): Gans, Arnold M.; (Englewood, NJ) Correspondence: Lerner, David, Littenberg,; Krumholz & Mentlik; 600 South Avenue West; Westfield; NJ; 07090; US Patent Application Number: 20040082502 Date filed: October 20, 2003 Abstract: A method of treating a mammal to promote wound healing in the mammal in need thereof, comprising orally administering to the mammal an effective amount of a

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palatable, concentrated protein composition comprising an effective amount of hydrolyzed gelatin and tryptophan, and an ingestible carrier, the composition comprising the essential amino acids required by the mammal. Palatability is preferably achieved by the use of an effective amount of a sweetener. The method is particularly useful for treating wounds resulting from decubitus ulcers and bariatric surgery. Excerpt(s): The present application claims the benefit of U.S. Provisional Application No. 60/422,164 filed Oct. 29, 2002, the entire disclosure of which is incorporated herein by reference. The present invention is directed to a method and a composition for treating wounds in a mammal, preferably a person, wherein the composition is taken orally, i.e., ingested, in order to promote healing of such wounds. The composition provides a concentrated and complete source of protein in a palatable form. Consequently, the palatable nature of the composition encourages compliance with a regimen of ingestion by a person in need of such treatment. In U.S. Pat. No. 4,025,650, and its divisional patents, U.S. Pat. No. 4,042,687, U.S. Pat. No. 4,042,688, and U.S. Pat. No. 4,053,589, A. M. Gans, et al. disclose a method and composition for preventing nutritional deficiency and preventing or treating various medical conditions, including body wastage during oncologic treatment of cancer, obesity, providing rapid body build-up, treatment of nutritional deficiency, particularly that associated with surgery, cardiac cachexia, diabetes, hypoglycemia, gastroenterology, skin conditions related to lipid, cell glycogen and keratin deficiencies, and alcoholism. The disclosure of these patents is incorporated herein by reference to the extent permitted. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Ointment composition for treating decubitus ulcers and methods for its making and its use Inventor(s): Goulbourne, Mary J.; (St. Albans, NY) Correspondence: Richard L. Miller; 12 Parkside Drive; Dix Hills; NY; 11746-4879; US Patent Application Number: 20040013744 Date filed: July 17, 2002 Abstract: An ointment composition for treating decubitus ulcers and methods for its making and its use. The composition includes a skin protestant ointment, a rash cream, an antibiotic ointment, virgin olive oil, and boric acid powder. The skin protestant ointment includes active ingredients petroleum 53.4%, lanolin 15.5%, and inactive ingredients cod liver oil containing vitamin A & vitamin D, a fragrance, light mineral oil, microcrystalline wax, and paraffin. The rash cream includes active ingredients dimethicone 1% and zinc oxide 10%, and inactive ingredients aloe barbadensis extract, benzyl alcohol, coconut oil, cod liver oil containing vitamin A & vitamin D, a fragrance, glycerol oleate, light mineral oil, ozokerite, paraffin, propylene glycol, sorbitol, synthetic beeswax, and water. The antibiotic ointment includes active ingredients polymyxin B sulfate 5,000 units, bacitracin zinc 400 units, and neomycin base (as sulfate) 3.5 mg., and an inactive ingredient white petroleum. Excerpt(s): The present invention relates to an ointment composition. More particularly, the present invention relates to an ointment composition for treating decubitus ulcers and methods for its making and its use. Numerous innovations for compositions for treating skin irritations have been provided in the prior art that will be described. Even though these innovations may be suitable for the specific individual purposes to which they address, however, they differ from the present invention. A FIRST EXAMPLE, U.S.

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Pat. No. 3,943,248 to Shulman teaches chemotherapeutic compositions and methods for topically traumatic, diseased and degenerative skin disorders. One of the invention compositions comprises abietic acid and a-tocopherol contained in a pharmaceutically acceptable carrier. One or more of the invention compositions are suitable for the alleviation of severe burn injuries, and in the treatment of other skin disorders such as diabetic ulcers, decubitus ulcers, gangrene, abrasions, lacerations, puncture wounds, localized infections, and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pressure sore pad having self-limiting electrosurgical return electrode properties and optional heating/cooling capabilities Inventor(s): Borgmeier, Paul R.; (Salt Lake City, UT), Fleenor, Richard P.; (Englewood, CO), Isaacson, James D.; (Salt Lake City, UT), Kieda, David B.; (Salt Lake City, UT) Correspondence: Workman Nydegger & Seeley; 1000 Eagle Gate Tower; 60 East South Temple; Salt Lake City; UT; 84111; US Patent Application Number: 20010029367 Date filed: January 31, 2001 Abstract: A self-limiting electrosurgical electrode for use with electrosurgery and various other surgical procedures. The electrode can include a pad and a conductive element that collectively has an effective bulk impedance equal to or greater than about 4,000.OMEGA.multidot.cm. The effective bulk impedance of the electrode arises from resistive components, capacitive components, inductive components, or combinations thereof of both the pad and the conductive element. Through the selection of the impedance characteristics for the electrode materials, and through tailoring of electrode geometries, the electrode of the present invention is self-regulating and self-limiting as to current density and temperature rise so as to prevent patient trauma. Additionally, the selection of materials and electrode geometries can prevent the creation of pressure sore or decubitus ulcers on a patient resting upon the electrode. Further, alternate configurations of the electrosurgical electrode can heat and/or cool a patient during the performance of a surgical procedure. Excerpt(s): This invention relates to both electrosurgery and pressure sore pads. More particularly, this invention relates to pressure sore pads that conform to a patient's body to minimize the incidence of decubitus ulcers or pressure sores, while being capable of acting as an effective and safe electrosurgical energy return without the need for conducting or dielectric gels. This is a continuation-in-part application of co-pending U.S. patent application Ser. No. 09/569,998, filed May 12, 2000, and entitled "SelfLimiting Electrosurgical Return Electrode," that is a continuation-in-part application of co-pending U.S. patent application Ser. No. 09/201,998, filed Nov. 30, 1998, and entitled "Resistive Reusable Electrosurgical Return Electrode," that is a continuation-in-part application of U.S. patent application Ser. No. 08/741,468, filed Oct. 30, 1996, and entitled "Reusable Electrosurgical Return Pad." Reference is made to co-pending U.S. patent application Ser. No. 09/435,498, filed Oct. 6, 1999, and entitled "Capacitive Reusable Electrosurgical Return Electrode", and U.S. patent application Ser. No. 08/741,469, filed Oct. 30, 1996, and entitled "Capacitive Reusable Electrosurgical Return Electrode," the disclosures of which are incorporated by this reference. It is well known in the medical field that patients may develop decubitus ulcers, also known as pressure sores during a prolonged period of immobility. Typically, pressure sores develop in elderly patients who are confined to their beds or otherwise have limited movement.

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The pressure sores arise in those areas of the patient's body where a prolonged pressure is applied to the patient's tissue, usually over an underlying bony prominence. The prolonged pressure causes ischemic damage and tissue necrosis due to the maintenance of blood pressure above the normal capillary blood pressure of 32 mmHg. Although pressure sores typically occur in those patients who remain in one position for an extended period of time, pressure sores may arise from application of an intense pressure applied over a short period of time, approximately two hours, to a localized area, such as during various surgical procedures. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Process for reducing the cost associated with the prevention and treatment of pressure ulcers Inventor(s): Bender, Stacy A.; (Pickerington, OH), Cook, Abby S.; (Gahanna, OH), Mayer, Kathleen E.; (Columbus, OH), Voss, Anne Coble; (Columbus, OH) Correspondence: Ross Products Division OF Abbott Laboratories; Department 108140Ds/1; 625 Cleveland Avenue; Columbus; OH; 43215-1724; US Patent Application Number: 20040049408 Date filed: February 27, 2001 Abstract: A process for reducing the cost associated with providing patient care including the costs associated with the prevention and treatment of pressure ulcers is provided. The process provides for the review of the present status and medical history of a patient, and the presence of one or more triggers is then evaluated. The process then matches each one of the triggers with a plurality of protocols. One or more protocols are then performed, dependent upon each of the triggers matched. The ongoing status of the patient is then monitored to determine any change therein, and the performance of the protocols is correspondingly adjusted. In one aspect of the invention at least a portion of the process is performed by a risk evaluation unit, wherein information associated with the present status, medical history, and ongoing status is supplied thereto. The process further generates a report including an intervention schedule. In another aspect of the invention, data including incidence rates of patients developing a pressure ulcer, costs for treating a pressure ulcer, cost associated with implementing a preventative measure, and an adjustment factor to the incidence rate corresponding to the implementation of the preventative measure is provided in an economic model. The economic model then determines an anticipated change in treatment costs corresponding to the anticipated reduction in pressure ulcers resulting from the implementation of the preventative measure. The economic model then compares the change in treatment costs to the cost of implementing the corresponding preventative measure, and produces the results of the comparison. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/186,639, filed Mar. 3, 2000. The invention pertains to a process for reducing the cost and increasing the quality associated with providing patient care. More specifically, the invention pertains to a process for reducing the costs associated with the prevention and treatment of pressure ulcers. Pressure ulcers are defined as localized areas of tissue necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. Millions of dollars are spent each year on pressure ulcer prevention and management. In fact at least one source, Bergstrom et al., Pressure Ulcer Treatment, Clinical Practice Guideline No. 15, published by the U.S. Department of Health and Human Services, Public Health Service,

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Agency for Health Care Policy and Research, AHCPR Publication No. 95-0652, states that over one million people will develop pressure ulcers each year. Furthermore it has been estimated, that the national cost associated with the treatment of pressure ulcers is approximately 1.335 billion dollars per year, Miller et al., Cost Implications of the Pressure Ulcer Treatment Guideline, Center for Health Policy Studies. In addition to being expensive to treat, pressure ulcers also contribute to varying degrees of discomfort, as well as increased susceptibility to other ailments, such as infection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Wound covering pressure relief pads Inventor(s): Narula, Dipak; (Louisville, KY), Narula, Vinod K.; (Louisville, KY) Correspondence: Middleton & Reutlinger; 2500 Brown & Williamson Tower; Louisville; KY; 40202 Patent Application Number: 20020007136 Date filed: June 26, 2001 Abstract: A pressure relief pad for use by persons suffering from or subject to the formation of decubitus ulcers or bedsores is described. The pressure relief pad is made from viscoelastic foam layers which provide for the redistribution of pressure around an affected or wounded area allowing the wound to heal faster. The contoured viscoelastic foam pad can be positioned over a separately applied dressing or an exudate absorbing material can be included in the pad. The contouring for the pad may be achieved by molding the foam as desired or by using a multiplicity of foam layers joined by adhesive to form the pad. Excerpt(s): This application claims priority to provisional patent application No. 60/214,085, filed on Jun. 27, 2000. The present invention relates to a pressure relief pad for use by persons having limited mobility which may lead to the formation of bedsores, and by persons suffering from bedsores or similar wounds which generate exudates. When a person has limited mobility or is confined to bed for an extended period of time, poor or compromised circulation can cause blood and other bodily fluids to pool in certain areas of the body--usually at points or regions where a higher degree of pressure is generated between the body and the surface upon which it is resting. If the pressure is not relieved and if the fluids are not forced to move within the body, the area may become devitalized resulting in the breakdown of the integrity of the skin and leading to decubitus ulcers or bedsores, which may become infected. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with decubitus ulcers, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “decubitus ulcers” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on decubitus ulcers.

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You can also use this procedure to view pending patent applications concerning decubitus ulcers. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON DECUBITUS ULCERS Overview This chapter provides bibliographic book references relating to decubitus ulcers. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on decubitus ulcers include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “decubitus ulcers” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “decubitus ulcers” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “decubitus ulcers” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Practical Guide for Treatment of Pressure Ulcers (Briggs Guide Book Series, 7124) by Geri Gomez, Linda Jo Banks; ISBN: 0941353052; http://www.amazon.com/exec/obidos/ASIN/0941353052/icongroupinterna

•

Factors associated with presence of decubitus ulcers at admission to nursing homes (SuDoc HE 20.6502:D 35) by U.S. Dept of Health and Human Services; ISBN: B00010DPQA; http://www.amazon.com/exec/obidos/ASIN/B00010DPQA/icongroupinterna

•

Preventing decubitus ulcers (Using research to improve nursing practice); ISBN: 080891328X; http://www.amazon.com/exec/obidos/ASIN/080891328X/icongroupinterna

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•

Preventing pressure ulcers : a patient's guide (SuDoc HE 20.6520:P 92) by U.S. Dept of Health and Human Services; ISBN: B00010A8Q0; http://www.amazon.com/exec/obidos/ASIN/B00010A8Q0/icongroupinterna

•

The Decubitus Ulcer in Clinical Practice by Lawrence Charles Parish, et al; ISBN: 3540615261; http://www.amazon.com/exec/obidos/ASIN/3540615261/icongroupinterna

•

The Market for decubitus ulcer treatment products, drugs, and devices: A business information report; ISBN: 0931634504; http://www.amazon.com/exec/obidos/ASIN/0931634504/icongroupinterna

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CHAPTER 7. PERIODICALS AND NEWS ON DECUBITUS ULCERS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover decubitus ulcers.

News Services and Press Releases One of the simplest ways of tracking press releases on decubitus ulcers is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “decubitus ulcers” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to decubitus ulcers. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “decubitus ulcers” (or synonyms). The following was recently listed in this archive for decubitus ulcers: •

Postmortems show decubiti in many German elderly Source: Reuters Medical News Date: January 08, 2003

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “decubitus ulcers” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “decubitus ulcers” (or synonyms). If you know the name of a company that is relevant to decubitus ulcers, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “decubitus ulcers” (or synonyms).

Academic Periodicals covering Decubitus Ulcers Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to decubitus ulcers. In addition

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to these sources, you can search for articles covering decubitus ulcers that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for decubitus ulcers. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with decubitus ulcers. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to decubitus ulcers: Ascorbic Acid (Vitamin C) •

Vitamin C - U.S. Brands: Ascorbicap; Cebid Timecelles; Cecon; Cecore 500; Cee500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Mega-C/A Plus; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Benzoyl Peroxide •

Topical - U.S. Brands: 10 Benzagel; 5 Benzagel; Acne-Aid Aqua Gel; Acne-Aid Vanishing Cream; Ambi 10 Acne Medication; Benoxyl 10 Lotion; Benoxyl 5 Lotion; Benzac 10 Gel; Benzac 5 Gel; Benzac AC 10 Gel; Benzac AC 2Â½ Gel; Benzac AC 5 Gel; Benzac AC Wash 10; Benzac AC Wash 2Â½; Benzac AC Wash 5; Benzac W 10 Gel; Benzac W 2Â½ Gel; Benzac W 5 Gel; Benzac W Wash 10; Benzac W Wash 5; BenzaShave 10 Cream; BenzaShave 5 Cream; Brevoxyl-4 Cleansing Lotion; Brevoxyl-4 Gel; Brevoxyl-8 Cleansing Lotion; Brevoxyl-8 Gel; Clean & Clear Persagel 10; Clean & Clear Persagel 5; Clear By Design 2.5 Gel; Clearasil Maximum Strength Medicated Anti-Acne 10 Tinted Cream; Clearasil Maximum Strength Medicated Anti-Acne 10 Vanishing Cream; Clearasil Maximum Strength Medicated Anti-Acne 10 Vanishing Lotion; Clearplex 10; Clearplex 5; Cuticura Acne 5 Cream; Del-Aqua-10 Gel; Del-Aqua-5 Gel; Desquam-E 10 Gel; Desquam-E 2.5 Gel; Desquam-E 5 Gel; Desquam-X 10 Bar; Desquam-X 10 Gel; Desquam-X 10 Wash; Desquam-X 2.5 Gel; Desquam-X 5 Gel; Desquam-X 5 Wash; Exact 5 Tinted Cream; Exact 5 Vanishing Cream; Fostex 10 Bar; Fostex 10 BPO Gel; Fostex 10 Cream; Fostex 10 Wash; Fostex 5 Gel; Loroxide 5.5 Lotion; Neutrogena Acne Mask 5; Noxzema Clear-ups Maximum Strength 10 Lotion; Noxzema Clear-ups On-The-Spot 10 Lotion; Oxy 10 Balance Emergency Spot Treatment Cover-Up Formula Gel; Oxy 10 Balance Emergency Spot Treatment Invisible Formula Gel; Oxy 10 Balance Maximum Medicated Face Wash; Oxy Balance Deep Action Night Formula Lotion; Oxy Balance Emergency Spot Treatment Invisible Formula Gel; PanOxyl 10 Bar; PanOxyl 10 Gel; PanOxyl 5 Bar; PanOxyl 5 Gel; PanOxyl AQ 10 Gel; PanOxyl AQ 2Â½ Gel; PanOxyl AQ 5 Gel; Student's Choice Acne Medication; Triaz; Triaz Cleanser http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202086.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to decubitus ulcers by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “decubitus ulcers” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for decubitus ulcers: •

Metronidazole (topical) (trade name: Flagyl) http://www.rarediseases.org/nord/search/nodd_full?code=18

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “decubitus ulcers” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 6220 152 983 40 62 7457

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “decubitus ulcers” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on decubitus ulcers can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to decubitus ulcers. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to decubitus ulcers. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “decubitus ulcers”:

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Assisted Living http://www.nlm.nih.gov/medlineplus/assistedliving.html Caregivers http://www.nlm.nih.gov/medlineplus/caregivers.html Circulatory Disorders http://www.nlm.nih.gov/medlineplus/circulatorydisorders.html Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Diabetic Kidney Problems http://www.nlm.nih.gov/medlineplus/diabetickidneyproblems.html Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Elder Abuse http://www.nlm.nih.gov/medlineplus/elderabuse.html Leishmaniasis http://www.nlm.nih.gov/medlineplus/leishmaniasis.html Medicines http://www.nlm.nih.gov/medlineplus/medicines.html Mouth Disorders http://www.nlm.nih.gov/medlineplus/mouthdisorders.html Multiple Sclerosis http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html Pressure Sores http://www.nlm.nih.gov/medlineplus/pressuresores.html Rehabilitation http://www.nlm.nih.gov/medlineplus/rehabilitation.html Spinal Cord Injuries http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html

Within the health topic page dedicated to decubitus ulcers, the following was listed: •

Organizations National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ National Pressure Ulcer Advisory Panel http://www.npuap.org

•

Prevention/Screening Preventing Bedsores Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00187

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Prevention of Pressure Sores through Skin Care Source: University of Alabama at Birmingham http://www.spinalcord.uab.edu/show.asp?durki=21486 •

Research Nerve Growth Factor Improves Healing of Pressure Ulcers of the Foot Source: American College of Physicians http://www.annals.org/cgi/content/full/139/8/I-10

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “decubitus ulcers” (or synonyms). The following was recently posted: •

Nursing management of pressure ulcers in adults Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2001 December; 27 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3276&nbr=2502&a mp;string=decubitus+AND+ulcers

•

Prediction and prevention of pressure ulcers in adults Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2001 March; 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3277&nbr=2503&a mp;string=decubitus+AND+ulcers

•

Preventing pressure ulcers and skin tears Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 37 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3511&nbr=2737&a mp;string=decubitus+AND+ulcers The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an

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ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to decubitus ulcers. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to decubitus ulcers. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with decubitus ulcers. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about decubitus ulcers. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines.

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The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “decubitus ulcers” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “decubitus ulcers”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “decubitus ulcers” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “decubitus ulcers” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

113

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

115

DECUBITUS ULCERS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Achlorhydria: A lack of hydrochloric acid in gastric juice despite stimulation of gastric secretion. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH]

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Alpha-helix: One of the secondary element of protein. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amikacin: A broad-spectrum antibiotic derived from kanamycin. It is reno- and ototoxic like the other aminoglycoside antibiotics. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier

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for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Aphthous Stomatitis: Inflammation of the mucous membrane of the mouth. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringent: Causing contraction, usually locally after topical application. [EU] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most

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important. [NIH] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benzyl Alcohol: A colorless liquid with a sharp burning taste and slight odor. It is used as a local anesthetic and to reduce pain associated with lidocaine injection. Also, it is used in the manufacture of other benzyl compounds, as a pharmaceutic aid, and in perfumery and flavoring. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the

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blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calendula: Genus of annuals in the family Asteraceae that contains carotenoids, essential oils (oils, volatile), flavonoids, mucilage, saponins, and sterols. It is used both topically and internally. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU]

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Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chickenpox: A mild, highly contagious virus characterized by itchy blisters all over the body. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a

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powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in

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addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH]

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Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaper Rash: A type of irritant dermatitis localized to the area in contact with a diaper and occurring most often as a reaction to prolonged contact with urine, feces, or retained soap or detergent. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can

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use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretic: A drug that increases the production of urine. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Empyema: Presence of pus in a hollow organ or body cavity. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers:

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1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Exocrine: Secreting outwardly, via a duct. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatus: Gas passed through the rectum. [NIH]

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Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fumigation: The application of smoke, vapor, or gas for the purpose of disinfecting or destroying pests or microorganisms. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genitals: Sex organs, including the penis and testicles in men and the vagina and vulva in women. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

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Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granulation Tissue: A vascular connective tissue formed on the surface of a healing wound, ulcer, or inflamed tissue. It consists of new capillaries and an infiltrate containing lymphoid cells, macrophages, and plasma cells. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Genitalis: Herpes simplex of the genitals. [NIH] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH]

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Histology: The study of tissues and cells under a microscope. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperaemia: An excess of blood in a part; engorgement. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoxic: Having too little oxygen. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be

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clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU]

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Ischial: A pointed projection on the posterior margin of the ischium. [NIH] Kanamycin: Antibiotic complex produced by Streptomyces kanamyceticus from Japanese soil. Comprises 3 components: kanamycin A, the major component, and kanamycins B and C, the minor components. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lacerations: Torn, ragged, mangled wounds. [NIH] Lanolin: A yellow fat obtained from sheep's wool. It is used as an emollient, cosmetic, and pharmaceutic aid. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lubricants: Oily or slippery substances. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mineral Oil: A mixture of liquid hydrocarbons obtained from petroleum. It is used as laxative, lubricant, ointment base, and emollient. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it

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occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with

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other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Diseases: A general term encompassing lower motor neuron disease; peripheral nervous system diseases; and certain muscular diseases. Manifestations include muscle weakness; fasciculation; muscle atrophy; spasm; myokymia; muscle hypertonia, myalgias, and musclehypotonia. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nipples: The conic organs which usually give outlet to milk from the mammary glands. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Orderly: A male hospital attendant. [NIH] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing

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and balance. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Particle: A tiny mass of material. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal

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cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroxisome Proliferators: A class of nongenotoxic carcinogens that induce the production of hepatic peroxisomes and induce hepatic neoplasms after long-term administration. [NIH] Perspiration: Sweating; the functional secretion of sweat. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photodermatitis: Dermatitis caused or elicited by exposure to ultraviolet light, may be phototoxic or photoallergic. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plant Oils: Oils derived from plants or plant products. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH]

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Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymyxin: Basic polypeptide antibiotic group obtained from Bacillus polymyxa. They affect the cell membrane by detergent action and may cause neuromuscular and kidney damage. At least eleven different members of the polymyxin group have been identified, each designated by a letter. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Povidone-Iodine: An iodinated polyvinyl polymer used as topical antiseptic in surgery and for skin and mucous membrane infections, also as aerosol. The iodine may be radiolabeled for research purposes. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]

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Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propylene Glycol: A clear, colorless, viscous organic solvent and diluent used in pharmaceutical preparations. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases;

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neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each

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consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scabies: A contagious cutaneous inflammation caused by the bite of the mite Sarcoptes scabiei. It is characterized by pruritic papular eruptions and burrows and affects primarily the axillae, elbows, wrists, and genitalia, although it can spread to cover the entire body. [NIH]

Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins

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have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in

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the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spinal Injuries: Injuries involving the vertebral column. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Stabilization: The creation of a stable state. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stratiform: Arranged in the form of strata; composed of layers or strata. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by

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clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and

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pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Varicella: Chicken pox. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH]

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Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venter: Belly. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] Wheelchairs: Chairs mounted on wheels and designed to be propelled by the occupant. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Zinc Oxide: A mild astringent and topical protectant with some antiseptic action. It is also used in bandages, pastes, ointments, dental cements, and as a sunblock. [NIH] Zoster: A virus infection of the Gasserian ganglion and its nerve branches, characterized by discrete areas of vesiculation of the epithelium of the forehead, the nose, the eyelids, and the cornea together with subepithelial infiltration. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX A Abdomen, 52, 115, 130, 134, 141, 142 Abdominal, 115, 134, 135 Abdominal Pain, 115, 135 Achlorhydria, 59, 76, 115 Acrylonitrile, 115, 138 Adaptability, 115, 120 Adjustment, 66, 72, 73, 79, 115 Adjuvant, 115, 126 Adverse Effect, 115, 135, 140 Aerobic, 9, 115 Aerosol, 115, 136 Airway, 115, 140 Albumin, 115, 136 Algorithms, 115, 118 Alkaline, 53, 115, 116, 119 Allylamine, 115, 116 Aloe, 43, 77, 115 Alpha-helix, 116, 130 Alternative medicine, 86, 116 Amebiasis, 116, 131 Amikacin, 7, 116 Amine, 59, 76, 116, 127 Amino acid, 34, 77, 116, 127, 134, 136, 137, 139, 143 Ammonia, 116, 142 Amyloid, 116 Anabolic, 34, 116 Analog, 116, 121 Anatomical, 116, 124, 128, 139 Anemia, 52, 61, 116 Aneurysm, 116, 143 Anoxia, 71, 116 Antibacterial, 116, 121 Antibiotic, 77, 116, 119, 130, 132, 136 Antibody, 116, 117, 121, 129, 138 Anticoagulant, 117, 137 Anticonvulsant, 117, 135 Antigen, 116, 117, 121, 129 Anti-infective, 117, 129, 140 Anti-inflammatory, 117, 123, 134 Antimicrobial, 8, 22, 117, 123 Antiseptic, 38, 117, 136, 144 Aphthous Stomatitis, 59, 76, 117 Apnea, 117 Arterial, 61, 115, 117, 137 Arteries, 117, 118, 123, 131 Arterioles, 117, 118, 119

Artery, 4, 116, 117, 123, 137 Aspiration, 19, 117 Assay, 5, 117 Astringent, 117, 144 Atmospheric Pressure, 117, 128 Atopic, 20, 62, 117 Autoimmune disease, 62, 117 Autologous, 11, 117 B Bacteremia, 10, 29, 117 Bacteria, 9, 10, 52, 116, 117, 125, 139, 143 Bacterial Infections, 54, 117 Bacteriophage, 117, 143 Basement Membrane, 118, 125 Benzyl Alcohol, 77, 118 Bilateral, 10, 118, 134 Bile, 118, 126, 130, 141 Biochemical, 5, 10, 118, 130, 139 Biological therapy, 118, 127 Biomechanics, 6, 118 Biotechnology, 7, 86, 97, 118 Bladder, 49, 56, 63, 64, 66, 67, 118, 122, 128, 143 Blood Coagulation, 118, 119, 142 Blood pressure, 59, 65, 79, 118, 132 Blood vessel, 59, 62, 118, 125, 129, 134, 140, 141, 142, 143 Blood Volume, 118, 136 Body Fluids, 71, 118, 124 Bone Marrow, 118, 131, 141 Bradykinin, 118, 136 Brain Diseases, 119, 134, 137 Brain Stem, 119, 138 Broad-spectrum, 116, 119 Bronchial, 119, 127 Buccal, 119, 141 Bulbar, 119, 138 Burns, 25, 52, 59, 62, 76, 119 Burns, Electric, 119 C Cachexia, 77, 119 Calcium, 27, 119, 121 Calendula, 43, 60, 61, 119 Capillary, 54, 59, 65, 67, 70, 73, 79, 119, 144 Capillary Permeability, 59, 119 Capsules, 119, 126 Carbohydrate, 4, 119, 123, 126 Carbon Dioxide, 25, 119, 120, 123, 138

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Decubitus Ulcers

Carcinogen, 120, 131 Carcinogenic, 120, 133, 141 Cardiac, 77, 115, 120, 124, 130, 132, 141 Carotenoids, 119, 120 Carrier Proteins, 120, 136 Case report, 26, 120 Cell Adhesion, 120, 129 Cell Cycle, 5, 120 Cell Death, 73, 74, 120, 132 Cell Division, 117, 120, 127, 132, 135 Cell membrane, 120, 135, 136 Cell Survival, 120, 127 Cerebral, 67, 119, 120 Cerebral Palsy, 67, 120 Cerebrum, 120 Cervical, 6, 120 Cervix, 120 Character, 120, 123 Chemotherapy, 22, 59, 62, 76, 120 Chickenpox, 59, 76, 120 Chlorine, 53, 120 Cholesterol, 118, 121, 141 Chromosome, 121, 130 Chronic, 5, 8, 11, 24, 61, 62, 116, 119, 121, 129, 131, 141 Chronic Disease, 119, 121 Clindamycin, 11, 22, 121 Clinical trial, 4, 7, 16, 34, 97, 121, 122, 124, 132, 138 Cloning, 118, 121 Collagen, 116, 118, 121, 126 Collapse, 121, 140 Complement, 121, 122, 129, 136 Complementary and alternative medicine, 37, 43, 121 Complementary medicine, 37, 122 Compliance, 77, 122 Computational Biology, 97, 122 Computer Simulation, 6, 122 Congestion, 122, 125 Conjunctiva, 122 Conjunctivitis, 59, 76, 122 Connective Tissue, 5, 61, 118, 121, 122, 123, 125, 126, 127, 131 Connective Tissue Cells, 122 Constipation, 122, 135 Constriction, 122, 129 Contracture, 66, 122 Contraindications, ii, 122 Control group, 6, 122 Conventional therapy, 122 Conventional treatment, 62, 122

Cornea, 4, 122, 144 Corneum, 122, 125 Coronary, 4, 123, 131 Coronary Thrombosis, 123, 131 Cortex, 119, 123, 133, 136 Corticosteroid, 123, 141 Cranial, 22, 123, 134, 138 Curative, 123, 133, 142 Cutaneous, 5, 14, 50, 62, 123, 130, 139 Cytoskeleton, 123, 129 D Decarboxylation, 123, 127 Degenerative, 78, 123, 131 Density, 57, 58, 78, 123, 133 Dermal, 11, 30, 123 Dermatitis, 20, 62, 123, 135 Dermis, 26, 123, 142 Detergents, 123, 140 Diagnostic procedure, 47, 86, 123 Diaper Rash, 62, 123 Diffusion, 119, 123, 129 Digestion, 118, 123, 130, 141 Digestive system, 123, 126, 132 Dilatation, Pathologic, 124, 143 Dilation, 119, 124, 143 Direct, iii, 8, 30, 61, 71, 89, 124, 126, 138 Discrete, 49, 124, 144 Discrimination, 68, 124 Distal, 124 Diuretic, 124, 140 Double-blind, 34, 37, 124 Drug Interactions, 90, 91, 124 Duct, 124, 125, 142 E Efficacy, 16, 34, 38, 124 Elastic, 69, 124 Electrode, 78, 124 Emodin, 115, 124 Emollient, 124, 126, 130, 131, 133 Empyema, 22, 124 Enamel, 124, 130 Environmental Health, 96, 98, 124 Enzymatic, 38, 116, 119, 121, 124, 127 Enzyme, 29, 124, 136, 142, 144 Enzyme Inhibitors, 124, 136 Epidermal, 5, 19, 52, 124, 130 Epidermis, 5, 53, 122, 123, 124, 130, 136 Epidural, 12, 125 Epithelial, 4, 125 Epithelial Cells, 125 Epithelium, 4, 118, 125, 129, 144 Erythema, 74, 125

147

Erythrocytes, 59, 116, 118, 125 Esophagus, 124, 125, 126, 141 Exocrine, 59, 125, 134 Expander, 125, 136 Extracellular, 5, 59, 116, 122, 125, 129 Extracellular Matrix, 5, 122, 125, 129 Extracellular Space, 59, 125 Exudate, 80, 125 Eye Movements, 125, 138 F Family Planning, 97, 125 Fat, 25, 118, 123, 125, 130, 140 Feces, 122, 123, 125, 141 Fetus, 125, 131, 143 Fibrinogen, 125, 136, 142 Fibrosis, 115, 122, 125, 139 Flatus, 125, 126 Flushing, 59, 126 Forearm, 118, 126 Friction, 48, 54, 73, 74, 126 Fumigation, 126 G Gait, 6, 126 Gallbladder, 115, 124, 126 Ganglion, 126, 144 Gangrene, 4, 78, 126 Gas, 53, 116, 120, 123, 125, 126, 128, 133 Gastric, 59, 115, 126, 127, 128 Gastroenterology, 77, 126 Gelatin, 29, 77, 126, 127, 142 Gels, 78, 126 Gene, 118, 126, 143 Generator, 53, 126 Genitals, 126, 127 Geriatric, 5, 12, 16, 34, 41, 103, 126 Giardiasis, 126, 131 Glucose, 126, 127, 129, 139, 140 Glycerol, 77, 126, 135 Glycine, 116, 127, 133 Glycogen, 77, 127 Glycoprotein, 125, 127, 130, 142 Gonadal, 127, 141 Governing Board, 127, 136 Grade, 10, 127 Graft, 26, 127 Granulation Tissue, 62, 127 Growth factors, 62, 127 H Hair follicles, 123, 127 Hemoglobin, 116, 125, 127 Hemorrhage, 127, 141 Hemostasis, 127, 129, 139

Hepatic, 115, 127, 135 Herpes, 59, 76, 127 Herpes Genitalis, 59, 76, 127 Herpes Zoster, 59, 76, 127 Heterodimers, 127, 129, 143 Histamine, 59, 76, 127 Histidine, 127 Histology, 128, 131, 134 Homodimer, 128, 143 Hormone, 123, 128, 129, 136, 142, 143 Hydrochloric Acid, 115, 128 Hydrogen, 116, 119, 128, 132 Hydroxyproline, 116, 121, 128 Hygienic, 128, 140 Hyperaemia, 122, 128 Hyperbaric, 39, 42, 128 Hyperbaric oxygen, 39, 42, 128 Hypoglycemia, 77, 128 Hypoxic, 128, 131 I Imidazole, 59, 127, 128 Immersion, 72, 73, 128 Immune function, 128, 143 Immune response, 115, 117, 123, 128, 144 Immune system, 59, 76, 118, 128 Immunoglobulins, 128, 136 Impairment, 73, 128 In vitro, 6, 38, 128 In vivo, 128 Incontinence, 70, 128 Infarction, 123, 128, 131 Infection, 9, 10, 51, 52, 53, 62, 80, 116, 118, 126, 128, 130, 131, 141, 143, 144 Infiltration, 129, 144 Inflammation, 115, 117, 122, 123, 125, 127, 129, 133, 135, 136, 137, 139, 141 Ingestion, 77, 129, 136 Inhalation, 115, 129, 136 Insulin, 28, 129 Insulin-dependent diabetes mellitus, 129 Insurance Carriers, 64, 129 Integrins, 5, 129 Intermittent, 129, 131, 135 Intoxication, 129, 144 Intracellular, 129 Intramuscular, 59, 129 Intravenous, 59, 129 Iodine, 8, 129, 136 Iris, 122, 129, 137 Ischemia, 67, 75, 129 Ischial, 17, 25, 26, 65, 67, 75, 130

148

Decubitus Ulcers

K Kanamycin, 116, 130 Kb, 96, 130 Keratin, 77, 130 Keratinocytes, 5, 130 Kinetic, 6, 130 L Lacerations, 62, 78, 130 Lanolin, 77, 130 Laser therapy, 16, 130 Laxative, 124, 130, 131, 140 Lectins, 5, 130 Leishmaniasis, 102, 130 Lesion, 75, 76, 130, 138 Lidocaine, 118, 130 Ligaments, 123, 130 Ligands, 129, 130 Lincomycin, 121, 130 Linkage, 54, 130 Lipid, 77, 119, 126, 129, 130 Liver, 77, 115, 118, 124, 125, 126, 127, 130 Localized, 67, 71, 75, 78, 79, 123, 129, 131, 133, 135 Long-Term Care, 45, 61, 66, 131 Loop, 6, 131 Lubricants, 131, 135 Lymph, 120, 131 Lymph node, 120, 131 Lymphatic, 129, 131 Lymphoid, 127, 131 M Maceration, 73, 131 Malnutrition, 52, 69, 115, 119, 131 Mammary, 131, 133 Mediate, 4, 131 MEDLINE, 97, 131 Membrane, 34, 117, 120, 121, 122, 130, 131, 132, 135, 136 Mercury, 54, 131 Metronidazole, 28, 91, 131 MI, 49, 53, 56, 63, 65, 70, 113, 131 Migration, 4, 19, 131 Mineral Oil, 77, 131 Mitochondrial Swelling, 131, 132 Mitosis, 130, 132 Mobility, 66, 80, 132 Modification, 116, 132 Molecular, 5, 97, 99, 118, 122, 125, 132, 136, 138 Molecule, 117, 119, 121, 132, 144 Monitor, 55, 132, 133 Motor Activity, 132, 138

Mucins, 132 Mucocutaneous, 130, 132 Mucosa, 132, 141 Mucositis, 59, 76, 132 Multicenter study, 8, 132 Muscle relaxant, 132, 135 Muscle Spindles, 132, 135 Muscular Diseases, 132, 133, 134, 138 Myocardium, 131, 132 N Necrosis, 52, 67, 70, 71, 73, 79, 128, 131, 132 Neomycin, 77, 132 Neoplasms, 132, 135 Nerve, 103, 126, 132, 133, 134, 139, 141, 144 Nervous System, 119, 126, 132, 133, 134, 139 Neural, 6, 116, 133 Neurologic, 24, 133 Neuromuscular, 39, 133, 134, 136, 138 Neuromuscular Diseases, 133, 134, 138 Neurotransmitter, 116, 119, 127, 133 Niacin, 133, 143 Nipples, 62, 133 Nitrogen, 116, 133, 143 Nuclear, 126, 132, 133 Nursing Care, 14, 133 Nursing Staff, 74, 133 Nutritional Status, 61, 73, 133 O Obstetrics, 131, 133 Ointments, 52, 60, 61, 133, 134, 140, 144 Oncogenic, 129, 133 Opacity, 123, 133 Orderly, 62, 133 Osteomyelitis, 10, 15, 58, 133 Ototoxic, 116, 133 P Palate, 134, 140, 141, 143 Palliative, 21, 40, 134, 142 Pancreas, 115, 124, 126, 129, 134 Papilla, 134 Papillary, 59, 76, 134 Paraffin, 77, 134 Paralysis, 6, 119, 134, 138 Paraplegia, 6, 10, 27, 39, 52, 134 Particle, 134, 143 Pathogenesis, 63, 134 Pathologic, 119, 123, 134, 141 Pelvic, 67, 134 Pelvis, 115, 134, 143

149

Peptide, 116, 130, 134, 136, 137 Perfusion, 52, 134 Peripheral Nervous System, 133, 134, 137 Peripheral Nervous System Diseases, 133, 134, 137 Peritoneal, 3, 134 Peritoneal Cavity, 134, 135 Peritoneal Dialysis, 3, 134 Peritoneum, 134, 135 Peritonitis, 4, 135 Peroxisome Proliferators, 5, 135 Perspiration, 51, 53, 70, 135 Petroleum, 77, 131, 134, 135 Pharmaceutical Preparations, 126, 135, 137 Pharmacologic, 135, 143 Phenytoin, 29, 135 Phospholipids, 125, 135 Phosphorus, 119, 135 Photodermatitis, 59, 76, 135 Physiology, 71, 126, 130, 135 Pilot study, 5, 28, 135 Plant Oils, 133, 135 Plants, 120, 124, 126, 135, 138, 143 Plasma, 59, 115, 118, 120, 125, 126, 127, 135, 136 Plasma cells, 127, 135 Plasma protein, 59, 115, 136 Platinum, 131, 136 Pleated, 116, 130, 136 Pneumonia, 122, 136 Poisoning, 129, 131, 136, 139 Polymyxin, 77, 136 Polypeptide, 116, 121, 125, 136, 144 Posterior, 129, 130, 134, 136, 143 Postnatal, 136, 141 Povidone, 28, 136 Povidone-Iodine, 28, 136 Practice Guidelines, 98, 103, 136 Precursor, 124, 136, 143 Prevalence, 13, 22, 136 Prickle, 130, 136 Progesterone, 136, 141 Progression, 64, 136 Progressive, 132, 137 Projection, 130, 137 Prone, 61, 67, 71, 137 Prone Position, 71, 137 Prophylaxis, 23, 39, 137 Propylene Glycol, 77, 137 Protein C, 77, 115, 117, 130, 137 Protein S, 118, 132, 137

Proteins, 4, 5, 116, 117, 120, 121, 127, 128, 130, 132, 133, 134, 135, 136, 137, 139, 143 Protozoa, 130, 137 Pruritic, 137, 139 Psychoactive, 137, 144 Public Policy, 97, 137 Publishing, 7, 37, 38, 137 Pulmonary, 10, 118, 121, 137 Pulmonary Artery, 118, 137 Pulmonary Edema, 121, 137 Pulse, 132, 137 Pupil, 122, 124, 137 Putrefaction, 126, 137 Pyogenic, 133, 137 Q Quadriplegia, 52, 137 R Race, 131, 138 Radiation, 128, 131, 138 Radiation therapy, 128, 138 Radiolabeled, 136, 138 Radiopharmaceutical, 126, 138 Randomized, 8, 124, 138 Reagent, 121, 128, 138 Rectum, 124, 125, 126, 128, 138, 142 Recur, 58, 138 Refer, 1, 63, 119, 121, 127, 138 Regeneration, 40, 62, 138 Regimen, 77, 124, 138 Respiration, 117, 120, 132, 138 Risk factor, 23, 138 Rubber, 27, 51, 115, 138 S Saline, 61, 138 Saponins, 119, 138, 141 Scabies, 20, 139 Schizoid, 139, 144 Schizophrenia, 139, 144 Schizotypal Personality Disorder, 139, 144 Scleroproteins, 130, 139 Sclerosis, 12, 102, 139 Screening, 102, 121, 139 Sebaceous, 123, 139 Sebaceous gland, 123, 139 Secretion, 115, 123, 127, 129, 132, 135, 139, 143 Seizures, 135, 139 Semisynthetic, 121, 139 Sensor, 8, 56, 72, 74, 139 Sepsis, 8, 11, 24, 58, 139 Septicemia, 51, 139 Serotonin, 133, 139, 143

150

Decubitus Ulcers

Serum, 7, 115, 121, 135, 139 Shock, 140, 143 Side effect, 89, 91, 115, 118, 140, 142 Skeletal, 6, 50, 67, 132, 140 Skeleton, 140 Skin Care, 20, 103, 140 Skin graft, 11, 140 Skull, 75, 140 Sleep apnea, 51, 140 Smooth muscle, 59, 115, 122, 127, 132, 140 Snoring, 51, 140 Soaps, 140 Soft tissue, 48, 50, 54, 61, 68, 73, 74, 79, 118, 140 Solvent, 126, 137, 140 Sorbitol, 77, 140 Specialist, 104, 124, 140 Species, 130, 131, 132, 138, 140 Spinal cord, 6, 7, 10, 18, 19, 25, 27, 34, 38, 67, 119, 121, 125, 126, 133, 134, 137, 140, 141 Spinal Cord Diseases, 134, 137, 141 Spinal Injuries, 6, 141 Spinous, 125, 130, 141 Splint, 65, 66, 141 Stabilization, 135, 141 Stasis, 5, 61, 62, 141 Stem Cells, 5, 62, 141 Sterile, 61, 141 Steroid, 62, 139, 141 Steroid therapy, 62, 141 Stimulant, 127, 141 Stimulus, 124, 141, 142 Stomach, 115, 124, 125, 126, 128, 134, 141 Stomatitis, 59, 76, 141 Stool, 128, 141 Stratiform, 50, 141 Stress, 65, 126, 138, 141 Stroke, 68, 96, 102, 141 Stromal, 62, 141 Styrene, 138, 141 Subacute, 129, 141 Subclinical, 129, 139, 141 Subcutaneous, 50, 59, 71, 142 Supplementation, 37, 38, 142 Suppositories, 126, 142 Survival Rate, 4, 142 Sweat, 123, 135, 142 Sweat Glands, 123, 142 Systemic, 59, 118, 129, 138, 139, 141, 142 T Tachycardia, 117, 142

Tachypnea, 117, 142 Therapeutics, 91, 142 Thermal, 59, 76, 142 Thigh, 9, 29, 67, 142 Thoracic, 6, 142 Thorax, 115, 142 Threshold, 68, 75, 142 Thrombin, 125, 137, 142 Thrombomodulin, 137, 142 Thrombosis, 129, 137, 141, 142 Thyroid, 129, 142 Topical, 28, 29, 39, 42, 59, 60, 62, 90, 91, 117, 134, 136, 140, 142, 144 Toxic, iv, 141, 142, 143 Toxicity, 124, 131, 142 Toxicology, 98, 142 Toxins, 117, 129, 139, 143 Transduction, 5, 143 Transfection, 118, 143 Transforming Growth Factor beta, 62, 143 Translation, 116, 132, 143 Trauma, 5, 51, 52, 57, 78, 132, 143 Trees, 138, 143 Trichomoniasis, 131, 143 Trophic, 62, 143 Tryptophan, 77, 121, 139, 143 U Ulceration, 50, 58, 67, 143 Urethra, 143 Urinary, 128, 143 Urine, 71, 118, 123, 124, 128, 143 Uterus, 120, 131, 136, 143 Uvula, 140, 143 V Varicella, 59, 76, 143 Vascular, 4, 59, 115, 123, 127, 128, 129, 141, 143 Vasodilation, 59, 143 Vasodilator, 119, 127, 143 Vector, 143, 144 Vein, 116, 129, 133, 144 Venous, 5, 61, 62, 137, 144 Venter, 144 Ventral, 8, 144 Venules, 118, 119, 144 Vertebrae, 141, 144 Vertebral, 141, 144 Vesicular, 127, 144 Veterinary Medicine, 97, 144 Viral, 53, 59, 76, 133, 143, 144 Virus, 117, 120, 143, 144 Visceral, 130, 135, 144

151

Vitro, 144 W Walkers, 7, 144 Weight-Bearing, 70, 74, 144 Wheelchairs, 58, 66, 67, 68, 70, 144 Withdrawal, 5, 144

Wound Healing, 5, 19, 35, 40, 62, 76, 129, 144 Z Zinc Oxide, 77, 144 Zoster, 59, 76, 144 Zymogen, 137, 144

152

Decubitus Ulcers

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