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Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12-16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.© Copyright © 2021 Team, Team, Jones, Teede and Weller.

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12-16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.© Copyright © 2021 Team, Team, Jones, Teede and Weller.

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved.

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inabil

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inabil

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inabil

IntroductionHospital-acquired pressure ulcer/injury (HAPU/I) often occurs postoperatively despite preventative interventions. The authors recently found an increasing incidence of HAPU/I in patients having prolonged operating room (OR) procedures in both the bent knee and lithotomy positions.ObjectiveThe aim of this study was to measure and compare 2 different OR surfaces in both the supine with bent knees position and the supine in lithotomy position. The authors sought to identify the most effective pressure redistribution surface in different positions to prevent HAPU/I in surgical patients.Materials and methodsUsing a pressure mapping device, the authors measured and compared 5 volunteers on the standard OR surface and on the standard surface with the static, air-filled cushion on top.ResultsUse of the static, air-filled seat cushion placed on top of the standard OR surface resulted in lower peak pressures and higher skin contact surface area than the standard OR surface alone.ConclusionsThis study showed that use of the static, air-filled seat cushion on top of the standard OR surface resulted in superior pressure redistribution properties in both the supine with bent knees position and supine in lithotomy position compared with the standard OR surface alone.

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inabil

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inabil

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.

Purpose: To assess whether supine mini (11F nephroscope, 18F tract) percutaneous nephrolithotomy (PCNL) is equivalent to our standard PCNL (22F nephroscope, 24F tract) with regards to stone clearance and safety for renal calculi between 10-20 mm. Methodology: Prospective non-blinded randomised controlled pilot trial comparing mini PCNL and standard PCNL. Primary endpoint was stone clearance on post procedure CT. Secondary endpoints included patient reported outcomes (PROMS), analgesia requirements, adverse events, hospital readmissions and length of stay. Result(s): All operations were successfully completed using our standard modified supine position and were totally tubeless. 14 well matched patients (median age 51, range 25-68) with a median stone size of 15 mm (range 13-20 mm). All patients were discharged day 1 postop. Postoperative residual stone fragments were noted in 5 patients (4 in the mini PCNL group and 1 in the standard group). There were no differences in PROMS or analgesia requirements. There were no complications reported in either group. Conclusion(s): Our standard supine PCNL has a better stone free rate compared to mini supine PCNL. There were no differences in patient reported outcomes, length of stay or complications. We recommend using the 22F nephroscope and 24F tract as opposed to mini PCNL.

Objective: The purpose of this study was to quantify and report the intrarater and interrater reliability of hip internal rotation (IR) range of motion supine with the hip and knee at 90° of flexion and for the flexion-adduction-internal rotation (FADIR) test. Hip internal rotation measured in a lying supine position with the hip and knee at 90° of flexion revealed information on hip impairments. To date no simple quantification approach has been presented in this position; therefore, the FADIR test has not been quantified yet. Methods: Twenty participants (mean ± standard deviation [SD] age, 24.0 ± 2.1 years; 10 women and 10 men) without lower-limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. A built-in smartphone compass application was used to obtain the hip IR range of motion in both procedures. Results: Mean (± SD) supine IR was 51.7° (± 9.7°) and 62.6° (± 11.4°) for men and women, respectively. Concerning the FADIR test, mean values were 41.8° (± 9.64°) and 50.1° (± 8.0°) for men and women, respectively. The mean intrarater and interrater reliability coefficients were 0.80 and 0.72 for hip IR and 0.75 and 0.40 for the FADIR test. The standard error of the mean ranged from 4.8° to 8.3° (minimal detectable difference [MDD], 13.3° to 22.9°) for hip IR and from 4.6° to 10.3° (MDD, 12.8° to 28.6°) for the FADIR test. Conclusion: Overall, the smartphone compass application is adequate to quantify hip IR in a lying supine position. However, the poor to moderate interrater reliability in the FADIR test and the size of the MDD values suggest that the FADIR test should be standardized. © 2020

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.

Purpose: To assess whether supine mini (11F nephroscope, 18F tract) percutaneous nephrolithotomy (PCNL) is equivalent to our standard PCNL (22F nephroscope, 24F tract) with regards to stone clearance and safety for renal calculi between 10-20 mm. Methodology: Prospective non-blinded randomised controlled pilot trial comparing mini PCNL and standard PCNL. Primary endpoint was stone clearance on post procedure CT. Secondary endpoints included patient reported outcomes (PROMS), analgesia requirements, adverse events, hospital readmissions and length of stay. Result(s): All operations were successfully completed using our standard modified supine position and were totally tubeless. 14 well matched patients (median age 51, range 25-68) with a median stone size of 15 mm (range 13-20 mm). All patients were discharged day 1 postop. Postoperative residual stone fragments were noted in 5 patients (4 in the mini PCNL group and 1 in the standard group). There were no differences in PROMS or analgesia requirements. There were no complications reported in either group. Conclusion(s): Our standard supine PCNL has a better stone free rate compared to mini supine PCNL. There were no differences in patient reported outcomes, length of stay or complications. We recommend using the 22F nephroscope and 24F tract as opposed to mini PCNL.

Objective: The purpose of this study was to quantify and report the intrarater and interrater reliability of hip internal rotation (IR) range of motion supine with the hip and knee at 90° of flexion and for the flexion-adduction-internal rotation (FADIR) test. Hip internal rotation measured in a lying supine position with the hip and knee at 90° of flexion revealed information on hip impairments. To date no simple quantification approach has been presented in this position; therefore, the FADIR test has not been quantified yet. Methods: Twenty participants (mean ± standard deviation [SD] age, 24.0 ± 2.1 years; 10 women and 10 men) without lower-limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. A built-in smartphone compass application was used to obtain the hip IR range of motion in both procedures. Results: Mean (± SD) supine IR was 51.7° (± 9.7°) and 62.6° (± 11.4°) for men and women, respectively. Concerning the FADIR test, mean values were 41.8° (± 9.64°) and 50.1° (± 8.0°) for men and women, respectively. The mean intrarater and interrater reliability coefficients were 0.80 and 0.72 for hip IR and 0.75 and 0.40 for the FADIR test. The standard error of the mean ranged from 4.8° to 8.3° (minimal detectable difference [MDD], 13.3° to 22.9°) for hip IR and from 4.6° to 10.3° (MDD, 12.8° to 28.6°) for the FADIR test. Conclusion: Overall, the smartphone compass application is adequate to quantify hip IR in a lying supine position. However, the poor to moderate interrater reliability in the FADIR test and the size of the MDD values suggest that the FADIR test should be standardized. © 2020

Objective: The purpose of this study was to quantify and report the intrarater and interrater reliability of hip internal rotation (IR) range of motion supine with the hip and knee at 90° of flexion and for the flexion-adduction-internal rotation (FADIR) test. Hip internal rotation measured in a lying supine position with the hip and knee at 90° of flexion revealed information on hip impairments. To date no simple quantification approach has been presented in this position; therefore, the FADIR test has not been quantified yet. Methods: Twenty participants (mean ± standard deviation [SD] age, 24.0 ± 2.1 years; 10 women and 10 men) without lower-limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. A built-in smartphone compass application was used to obtain the hip IR range of motion in both procedures. Results: Mean (± SD) supine IR was 51.7° (± 9.7°) and 62.6° (± 11.4°) for men and women, respectively. Concerning the FADIR test, mean values were 41.8° (± 9.64°) and 50.1° (± 8.0°) for men and women, respectively. The mean intrarater and interrater reliability coefficients were 0.80 and 0.72 for hip IR and 0.75 and 0.40 for the FADIR test. The standard error of the mean ranged from 4.8° to 8.3° (minimal detectable difference [MDD], 13.3° to 22.9°) for hip IR and from 4.6° to 10.3° (MDD, 12.8° to 28.6°) for the FADIR test. Conclusion: Overall, the smartphone compass application is adequate to quantify hip IR in a lying supine position. However, the poor to moderate interrater reliability in the FADIR test and the size of the MDD values suggest that the FADIR test should be standardized. © 2020

Background: Preterm infants in NICU are often placed prone to improve respiratory function. Clinical guidelines recommend preterm infants are slept supine at >32 weeks of postmentrual age. However, neonatal respiratory disease is related to gestational and postnatal age rather than postmentrual age. We investigated the effects of sleep position on bradycardias and desaturations in preterm infants, in relation to gestational and postnatal age, taking into account the sleep states. Method(s): Twenty-three extremely preterm (24-28 weeks' gestation) and 33 very preterm(29-34 weeks' gestation) infants were studied weekly until discharge, in prone and supine positions, in active (AS) and quiet sleep (QS). Episodes of bradycardia (heart rate <= 100 bpm) and desaturation (arterial oxygen saturation, SaO2 <= 80%) were analysed. Two-way RM ANOVA assessed the effect of sleep position/state at each postnatal week. Mixed-model analysis assessed overall effects of sleep position/state with postnatal age. Result(s): In extremely preterm infants, bradycardias were overall more frequent in supine than prone, and in AS than QS. Desaturations were more frequent and longer when supine during weeks 1, 2 and 6, but were not affected by sleep state. In contrast, in very preterm infants, bradycardia frequency was not affected by sleep position but was higher in AS. Desaturation frequency and duration were greater in supine only at week 3, and desaturation frequency was higher in AS during weeks 1-4. Conclusion(s): In extremely preterm infants, the prone position is associated with less bradycardias and desaturations, whilst in very preterm infants, respiratory events are less affected by sleep position, but increased with AS.

Introduction & Objective: There are no published randomised studies comparing extracorporeal shock wave lithotripsy (SWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL) as treatments for 10-20mm renal stones. We have conducted a pilot study to assess the practicality of a sufficiently powered randomised controlled trial. Method(s): All adult patients with a maximum stone diameter of 10-20mm on CT scan were eligible for enrolment. Patients were randomised to SWL, URS or PCNL. Treatments were carried out using standard protocols-all SWL conducted without anaesthesia, URS with Holmium: YAG laser dusting and PCNL in the modified supine position. Repeat or alternative treatments were performed as clinically appropriate until the patients were considered stone free. All patients had a post-treatment CT scan to assess stone free rate (SFR). Images were reviewed by a radiologist blinded to treatment. Data collected included pre-treatment stone size and Hounsfield units, pre-/post-treatment global health scores, number/duration of treatments, complications and SFR. Ethical approval was obtained. Data were analysed using Kruskal-Wallis and Chi-square tests. Result(s): Thirty one patients were randomised; 11 treated with URS and 10 each for SWL and PCNL. There were no significant differences in age, sex and stone size/position between the groups. SFR were 60%, 55% and 80% for SWL, URS and PCNL respectively (p = 0.33). PCNL patients received significantly fewer procedures (median 1, range 1-3) than both SWL (median 2, range 1-5) and URS (median 2, range 1-3) (p = 0.015) with an overall similar stay in hospital. Overall complications were more common with SWL (50%), compared to 20% for PCNL and 9% URS (p = 0.019) and the only complications greater than Clavien Grade 1 were following SWL (steinstrasse in 30%). Conclusion(s): PCNL achieves the highest SFR with the lowest number of procedures, with a comparable overall length of hospital stay to URS and SWL. URS of

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Material(s) and Method(s): A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a 'bottom-up', all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Result(s): There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) (P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusion(s): Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of Evidence: Not applicable for this multicentre audit.Copyright © British Association of Urological Surgeons 2018.

Introduction: Obstructive sleep apnoea (OSA) commonly manifests with greater severity in the supine position. Over 60% of patients with OSA have supine predominant OSA (supine apnoea-hypopnoea index [AHI] greater than twice of non-supine AHI) and 25% have supine isolated OSA (non-supine AHI< 5 events/hour). Therefore, for the majority of patients, the proportion of total sleep time in the supine body position necessarily impacts on the severity of OSA assessed by polysomnography (PSG). We previously reported that the proportion of time in the supine position is significantly higher during laboratory PSG compared to habitual sleep. Here we report the interim results of our current study comparing sleeping position during unattended home PSG to habitual sleeping position. Material(s) and Method(s): This is a prospective observational study of patients referred for unattended PSG through our tertiary academic sleep unit. We use the Night ShiftTM positional therapy device to record body position during the unattended PSG and subsequently for up to three additional nights to sample habitual sleeping position. The Night ShiftTM was programmed to record only; the feedback intervention function was disabled. A paired t-test was used to compare the mean difference in proportion of sleep time in the supine position during unattended PSG compared to habitual sleep. We then calculated a modified AHI "corrected" for habitual sleeping position. Night-to-night variability in habitual sleeping position was assessed using a correlation matrix, and a repeated measures one-way ANOVA. Result(s): To date, fifty-two patients have been recruited, out of a target of 79 patients. 38.5% female, age 47 +/- 12.8 years, body mass index 30.9 (range: 27.5-37.5) kg/m2. Median total AHI 19 (range: 3.2-27.9) events/hour, supine AHI 22 (0.9-45.3) events/hour, non-supine AHI 9.4 (1.3-24.9) events/hour. Fifteen patients (29.4%) had supine predominant OSA and 1 (2%) had supine isolated OSA. Proportion o

IntroductionUltrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance.Materials and methodsOnce in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane.ResultsThe 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract.ConclusionsThis video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radi

Background: Preterm infants in NICU are often placed prone to improve respiratory function. Clinical guidelines recommend preterm infants are slept supine at >32 weeks of postmentrual age. However, neonatal respiratory disease is related to gestational and postnatal age rather than postmentrual age. We investigated the effects of sleep position on bradycardias and desaturations in preterm infants, in relation to gestational and postnatal age, taking into account the sleep states. Method(s): Twenty-three extremely preterm (24-28 weeks' gestation) and 33 very preterm(29-34 weeks' gestation) infants were studied weekly until discharge, in prone and supine positions, in active (AS) and quiet sleep (QS). Episodes of bradycardia (heart rate <= 100 bpm) and desaturation (arterial oxygen saturation, SaO2 <= 80%) were analysed. Two-way RM ANOVA assessed the effect of sleep position/state at each postnatal week. Mixed-model analysis assessed overall effects of sleep position/state with postnatal age. Result(s): In extremely preterm infants, bradycardias were overall more frequent in supine than prone, and in AS than QS. Desaturations were more frequent and longer when supine during weeks 1, 2 and 6, but were not affected by sleep state. In contrast, in very preterm infants, bradycardia frequency was not affected by sleep position but was higher in AS. Desaturation frequency and duration were greater in supine only at week 3, and desaturation frequency was higher in AS during weeks 1-4. Conclusion(s): In extremely preterm infants, the prone position is associated with less bradycardias and desaturations, whilst in very preterm infants, respiratory events are less affected by sleep position, but increased with AS.

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Material(s) and Method(s): A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a 'bottom-up', all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Result(s): There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) (P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusion(s): Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of Evidence: Not applicable for this multicentre audit.Copyright © British Association of Urological Surgeons 2018.

Introduction & Objective: There are no published randomised studies comparing extracorporeal shock wave lithotripsy (SWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL) as treatments for 10-20mm renal stones. We have conducted a pilot study to assess the practicality of a sufficiently powered randomised controlled trial. Method(s): All adult patients with a maximum stone diameter of 10-20mm on CT scan were eligible for enrolment. Patients were randomised to SWL, URS or PCNL. Treatments were carried out using standard protocols-all SWL conducted without anaesthesia, URS with Holmium: YAG laser dusting and PCNL in the modified supine position. Repeat or alternative treatments were performed as clinically appropriate until the patients were considered stone free. All patients had a post-treatment CT scan to assess stone free rate (SFR). Images were reviewed by a radiologist blinded to treatment. Data collected included pre-treatment stone size and Hounsfield units, pre-/post-treatment global health scores, number/duration of treatments, complications and SFR. Ethical approval was obtained. Data were analysed using Kruskal-Wallis and Chi-square tests. Result(s): Thirty one patients were randomised; 11 treated with URS and 10 each for SWL and PCNL. There were no significant differences in age, sex and stone size/position between the groups. SFR were 60%, 55% and 80% for SWL, URS and PCNL respectively (p = 0.33). PCNL patients received significantly fewer procedures (median 1, range 1-3) than both SWL (median 2, range 1-5) and URS (median 2, range 1-3) (p = 0.015) with an overall similar stay in hospital. Overall complications were more common with SWL (50%), compared to 20% for PCNL and 9% URS (p = 0.019) and the only complications greater than Clavien Grade 1 were following SWL (steinstrasse in 30%). Conclusion(s): PCNL achieves the highest SFR with the lowest number of procedures, with a comparable overall length of hospital stay to URS and SWL. URS of

Introduction: Obstructive sleep apnoea (OSA) commonly manifests with greater severity in the supine position. Over 60% of patients with OSA have supine predominant OSA (supine apnoea-hypopnoea index [AHI] greater than twice of non-supine AHI) and 25% have supine isolated OSA (non-supine AHI< 5 events/hour). Therefore, for the majority of patients, the proportion of total sleep time in the supine body position necessarily impacts on the severity of OSA assessed by polysomnography (PSG). We previously reported that the proportion of time in the supine position is significantly higher during laboratory PSG compared to habitual sleep. Here we report the interim results of our current study comparing sleeping position during unattended home PSG to habitual sleeping position. Material(s) and Method(s): This is a prospective observational study of patients referred for unattended PSG through our tertiary academic sleep unit. We use the Night ShiftTM positional therapy device to record body position during the unattended PSG and subsequently for up to three additional nights to sample habitual sleeping position. The Night ShiftTM was programmed to record only; the feedback intervention function was disabled. A paired t-test was used to compare the mean difference in proportion of sleep time in the supine position during unattended PSG compared to habitual sleep. We then calculated a modified AHI "corrected" for habitual sleeping position. Night-to-night variability in habitual sleeping position was assessed using a correlation matrix, and a repeated measures one-way ANOVA. Result(s): To date, fifty-two patients have been recruited, out of a target of 79 patients. 38.5% female, age 47 +/- 12.8 years, body mass index 30.9 (range: 27.5-37.5) kg/m2. Median total AHI 19 (range: 3.2-27.9) events/hour, supine AHI 22 (0.9-45.3) events/hour, non-supine AHI 9.4 (1.3-24.9) events/hour. Fifteen patients (29.4%) had supine predominant OSA and 1 (2%) had supine isolated OSA. Proportion o

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is an imaging methodology that uses blood as an endogenous contrast agent to quantify flow. One limitation of this method of capillary blood quantification when applied in the lung is the contribution of signals from non-capillary blood. Intensity thresholding is one approach that has been proposed for minimizing the non-capillary blood signal. This method has been tested in previous in silico modeling studies; however, it has only been tested under a restricted set of physiological conditions (supine posture and a cardiac output of 5 L/min). This study presents an in silico approach that extends previous intensity thresholding analysis to estimate the optimal "per-slice" intensity threshold value using the individual components of the simulated ASL signal (signal arising independently from capillary blood as well as pulmonary arterial and pulmonary venous blood). The aim of this study was to assess whether the threshold value should vary with slice location, posture, or cardiac output. We applied an in silico modeling approach to predict the blood flow distribution and the corresponding ASL quantification of pulmonary perfusion in multiple sagittal imaging slices. There was a significant increase in ASL signal and heterogeneity (COV = 0.90 to COV = 1.65) of ASL signals when slice location changed from lateral to medial. Heterogeneity of the ASL signal within a slice was significantly lower (P = 0.03) in prone (COV = 1.08) compared to in the supine posture (COV = 1.17). Increasing stroke volume resulted in an increase in ASL signal and conversely an increase in heart rate resulted in a decrease in ASL signal. However, when cardiac output was increased via an increase in both stroke volume and heart rate, ASL signal remained relatively constant. Despite these differences, we conclude that a threshold value of 35% provides optimal removal of large vesse

IntroductionUltrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance.Materials and methodsOnce in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane.ResultsThe 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract.ConclusionsThis video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radi

INTRODUCTION: Ultrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance. MATERIALS AND METHODS: Once in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane. RESULTS: The 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract. CONCLUSIONS: This video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the ne

BackgroundLate stillbirth, which occurs ≥28 weeks' gestation, affects 1.3-8.8 per 1000 births in high-income countries. Of concern, most occur in women without established risk factors. Identification of potentially modifiable risk factors that relate to maternal behaviors remains a priority in stillbirth prevention research. This study aimed to investigate, in an international cohort, whether maternal sleep practices are related to late stillbirth.MethodsAn Internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days before completing the survey (n = 153) and women with an ongoing third-trimester pregnancy or who had delivered a live born child within 30 days (n = 480). Bivariate and multivariate logistic regressions were used to determine unadjusted and adjusted odds ratios (OR and aOR, respectively) with 95% confidence intervals (95% CIs) for stillbirth.ResultsSleeping >9 hours per night in the previous month was associated with stillbirth (aOR 1.75 [95% CI 1.10-2.79]), as was waking on the right side (2.27 [1.31-3.92]). Nonrestless sleep in the last month was also found to be associated with stillbirth (1.73 [1.03-2.99]), with good sleep quality in the last month approaching significance (1.64 [0.98-2.75]). On the last night of pregnancy, not waking more than one time was associated with stillbirth (2.03 [1.24-3.34]). No relationship was found with going to sleep position during pregnancy, although very few women reported settling in the supine position (2.4%).ConclusionsLong periods of undisturbed sleep are associated with late stillbirth. Physiological studies of how the neuroendocrine and autonomic system pathways are regulated during sleep in the context of late pregnancy are warranted.

INTRODUCTION: Several studies have suggested that supine posture during pill ingestion prolongs oesophageal transit time. Whether ingesting prasugrel in an upright position leads to reduced platelet reactivity during percutaneous coronary intervention remains unclear.METHODS: A total of 20 people were randomly assigned to ingest 60 mg of prasugrel in either the supine or upright position. Platelet reactivity was analysed using the point-of-care assay VerifyNow.RESULTS: In the upright position, the velocity of platelet inhibition was highest between 20 and 40 min. (Δ = 101.9 P2Y12 reaction units (PRU)). In the supine position, the highest value was seen between 40 and 60 min. (Δ = 56.85 PRU). Time to reach the cut-off for reducing peri- and post-operative risk of thrombosis showed a mean difference of 8 min. in favour of the upright group.CONCLUSIONS: A trend towards faster reduction of platelet reactivity was seen when ingesting prasugrel in the upright position compared with the supine position.FUNDING: This work was supported by Oda and Hans Svenningsens Foundation (grant number: BOF-10109). The foundation had no part in the collection, analysis or interpretation of data, or in the writing of the report or the decision to submit the work for publication.TRIAL REGISTRATION: This trial was registered with clinicaltrials.gov (NCT01365741).

Objective: To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. Study design: Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. Result(s): In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. Conclusion(s): At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.Copyright © 2018 Elsevier Inc.

Introduction: Obstructive sleep apnoea (OSA) is frequently worse when sleeping in the supine position. Previous data have shown that at least 60% of patients with OSA have supine predominant OSA (OSA that occurs at least twice as frequently in the supine position). In this context, the proportion of time patients spend sleeping supine will influence interpretation of OSA severity. Patients sometimes report that sleeping position during laboratory polysomnography (PSG) does not represent their habitual sleeping position at home. We therefore designed a study to compare sleeping position during PSG compared to home in OSA patients, and hypothesised that there will be less time spent supine when at home compared to PSG. Method(s): Prospective observational study at a large, tertiary academic sleep unit. Patients referred for diagnostic PSG were provided with a body position sensor (Night ShiftTM) to record sleeping position in the laboratory during PSG and at home over the subsequent 3 nights. Night ShiftTM was set to record position only and the feedback intervention function was disabled. Result(s): Since May 4th 2018, we have recruited 19 patients to date. Majority of patients were of male gender (63.2%). Mean age was 48 years (range 26-67). Mean body mass index (BMI) was 31.1kg/m2. Mean total AHI = 27.4 events/hour. Eighteen patients (94.7%) had supine predominant OSA. 89.5% of patients reported the PSG equipment did not alter their habitual sleeping position. When comparing data during PSG to that when the device was worn at home, 13 patients (68.4%) had a reduction in the amount of time spent in the supine position. Overall percentage time spent supine was 35.1 % (+/- 25.1) during PSG vs 25% (+/- 21.4) at home (P = 0.07). Discussion(s): Results to date suggest a greater proportion of time is spent supine in the sleep laboratory compared to home. Recruitment is ongoing with target n of 50 patients. Results from this study may have implications as to how we interpr

Introduction: Placing a preterm infant in the prone position, the opposite to that recommended for the care of term infants, is frequently employed to improve respiratory function in the neonatal intensive care unit (NICU). Prone positioning impairs cerebral oxygenation in term and preterm infants after term-corrected age, however the effect of prone sleeping on cerebral oxygenation and cerebral fractional oxygen extraction (CFOE) in preterm infants in the NICU remains unknown and was the focus of this study. Method(s): Fifty-six preterm infants, divided into 2 groups: 23 extremely preterm (24-28 weeks gestational age (GA)) infants and 33 very preterm (29-34 weeks GA) infants were studied weekly until discharge, in both the prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2), mean arterial blood pressure and heart rate were recorded. CFOE was calculated as CFOE = (SaO2-TOI)/SaO2. Two-way RM ANOVA assessed effects of sleep position and state at each postnatal week. The effect of postnatal age was determined using a linear mixed model in each group and sleep state, with postnatal age and sleep position as fixed effects and subject as the random effect. Result(s): In extremely preterm infants, SaO2 and CFOE significantly increased in the prone position in both sleep states during the first week of life (p < 0.05). Sleep position had only minimal effects on cerebral TOI with values averaging 1%-2% lower in the prone position. In contrast, in the very preterm infants sleep position did not affect CFOE, SaO2 or TOI until week 6, however post-hoc testing could not identify where the differences lay. TOI decreased and CFOE increased with increasing postnatal age, in the very preterm infants (p < 0.05) but not in the extremely preterm infants. Discussion(s): In extremely preterm infants, the increase in CFOE in the prone position during the first postnatal week represents a lower cerebral oxy

Objective: To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. Study design: Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. Result(s): In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. Conclusion(s): At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.Copyright © 2018 Elsevier Inc.

Introduction: Obstructive sleep apnoea (OSA) is frequently worse when sleeping in the supine position. Previous data have shown that at least 60% of patients with OSA have supine predominant OSA (OSA that occurs at least twice as frequently in the supine position). In this context, the proportion of time patients spend sleeping supine will influence interpretation of OSA severity. Patients sometimes report that sleeping position during laboratory polysomnography (PSG) does not represent their habitual sleeping position at home. We therefore designed a study to compare sleeping position during PSG compared to home in OSA patients, and hypothesised that there will be less time spent supine when at home compared to PSG. Method(s): Prospective observational study at a large, tertiary academic sleep unit. Patients referred for diagnostic PSG were provided with a body position sensor (Night ShiftTM) to record sleeping position in the laboratory during PSG and at home over the subsequent 3 nights. Night ShiftTM was set to record position only and the feedback intervention function was disabled. Result(s): Since May 4th 2018, we have recruited 19 patients to date. Majority of patients were of male gender (63.2%). Mean age was 48 years (range 26-67). Mean body mass index (BMI) was 31.1kg/m2. Mean total AHI = 27.4 events/hour. Eighteen patients (94.7%) had supine predominant OSA. 89.5% of patients reported the PSG equipment did not alter their habitual sleeping position. When comparing data during PSG to that when the device was worn at home, 13 patients (68.4%) had a reduction in the amount of time spent in the supine position. Overall percentage time spent supine was 35.1 % (+/- 25.1) during PSG vs 25% (+/- 21.4) at home (P = 0.07). Discussion(s): Results to date suggest a greater proportion of time is spent supine in the sleep laboratory compared to home. Recruitment is ongoing with target n of 50 patients. Results from this study may have implications as to how we interpr

Introduction: Placing a preterm infant in the prone position, the opposite to that recommended for the care of term infants, is frequently employed to improve respiratory function in the neonatal intensive care unit (NICU). Prone positioning impairs cerebral oxygenation in term and preterm infants after term-corrected age, however the effect of prone sleeping on cerebral oxygenation and cerebral fractional oxygen extraction (CFOE) in preterm infants in the NICU remains unknown and was the focus of this study. Method(s): Fifty-six preterm infants, divided into 2 groups: 23 extremely preterm (24-28 weeks gestational age (GA)) infants and 33 very preterm (29-34 weeks GA) infants were studied weekly until discharge, in both the prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2), mean arterial blood pressure and heart rate were recorded. CFOE was calculated as CFOE = (SaO2-TOI)/SaO2. Two-way RM ANOVA assessed effects of sleep position and state at each postnatal week. The effect of postnatal age was determined using a linear mixed model in each group and sleep state, with postnatal age and sleep position as fixed effects and subject as the random effect. Result(s): In extremely preterm infants, SaO2 and CFOE significantly increased in the prone position in both sleep states during the first week of life (p < 0.05). Sleep position had only minimal effects on cerebral TOI with values averaging 1%-2% lower in the prone position. In contrast, in the very preterm infants sleep position did not affect CFOE, SaO2 or TOI until week 6, however post-hoc testing could not identify where the differences lay. TOI decreased and CFOE increased with increasing postnatal age, in the very preterm infants (p < 0.05) but not in the extremely preterm infants. Discussion(s): In extremely preterm infants, the increase in CFOE in the prone position during the first postnatal week represents a lower cerebral oxy

Aims Several genes are related to blood pressure (BP) levels in adults, but it is largely unknown whether these genes also determine BP early in life. Methods Systolic BP (SBP) and diastolic BP (DBP) were measured in 720 5-year-old children from the WHeezing-Illnesses-STudy-LEidsche-Rijn (WHISTLER) birth cohort in sitting and supine positions using a semi-automatic oscillometric device. Illumina chip technology was used to genotype 18, 19, 11 and 12 single nucleotide polymorphisms associated with adult SBP, DBP, mean arterial pressure (MAP) and hypertension, respectively, in the children's DNA and separate weighted genetic risk scores (GRSs) were constructed. The associations are reported as linear regression coefficients (mmHg BP in childhood/GRS score point) or odds ratios (highest childhood BP quintile/hypertension GRS score point). Results A higher GRS for SBP was related to higher supine SBP (0.37, 95% CI 0.01 to 0.7), but not to supine DBP (-0.05, 95% CI -0.4 to 0.3) or supine MAP (0.19, 95% CI -0.1 to 0.5). A higher GRS for DBP was related to a higher supine SBP (0.66, 95% CI 0.1 to 1.2), but not to supine DBP (-0.07, 95% CI -0.6 to 0.4) or supine MAP (0.28, 95% CI -0.2 to 0.7). With the sitting BP measurements, the GRSs for SBP and DBP were related to neither SBP nor DBP. No association was found between GRS for MAP and SBP, DBP or MAP. Hypertension GRS was not associated with a higher BP in children. Conclusions Higher scores for adult derived diastolic and systolic BP genes appear to be related to higher supine systolic BP at age 5 years.