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Background: This paper presents the results of one area of a tripartite study; laboratory testing; focus group and clinical case series investigating the use and effectiveness of the Somlent Serene Hybrid Mattress. The prevention and management of pressure ulcers (PUs) has long been a key indicator of quality of care and a major focus for health care providers, as the ageing population continues to grow there is an increased risk of skin damage to this vulnerable patient group (Fletcher et al, 2015). Similarly, the quality of care delivered by health care professionals and the National Health Service Trust (NHS) is being monitored through the incidence of PUs e.g data collected via the NHS Safety Thermometer (Cooper et al, 2015). Adequate reduction of excessive pressure and/or shearing forces is essential to enable sufficient tissue perfusion for the successful prevention or healing of PUs. The use of support surfaces, including high quality foams, hybrids and alternating pressure air mattresses (APAMs), are an effective strategy for relieving/redistributing pressure (Moore et al, 2014). Hybrid support surfaces are a more recent technology in comparison to foams and APAMs which are becoming increasingly accepted as an alternative treatment option. Innova Care Concepts have launched their new ‘active’ Hybrid mattress, the Somlent Serene. The aim of this study was to explore and investigate perceptions of the mattress and its application in the clinical setting. \ud \ud Method: A qualitative approach was implemented using a focus group design. Key opinion leaders were invited to participate (n=5); an academic, infection control specialist and tissue viability specialists. Ethical approval to undertake and publish results was successfully received prior to the focus group. To stimulate discussion participants were asked “what their initial thoughts of the mattress were?” Subsequent questions followed to promote discussion. All information was recorded, transcribed verbatim and data was analysed thematically. All participants were assured of confidentiality and anonymity. \ud \ud Results and discussion: All participants admired its simplicity, ease of use, quietness and design. The fact the foam does not lie on top of the air cells was highlighted as good practice as it potentially reduced pressure and/or shearing forces. Four key themes were identified; patient suitability, unit cost per system, importance of inter-professional working and promotion of cost effectiveness. Patient suitability for hybrids was highlighted as participants discussed potential confusion of clinicians who often found it difficult to decide when a hybrid should be the mattress of choice. The development of an evidence based flow chart that would assist clinicians to make an informed choice was recommended to allow for the matching of clinical need with the appropriate mattress available to prevent avoidable pressure damage. \ud \ud The second major theme emanating was that of unit cost per system. In an economic climate that demands cost effectiveness and saving of money, costs of hybrids can be more expensive than other systems. It was suggested that research and evidence supporting each system should comprise of clear patient outcomes including the effect of hybrids on skin (prevention and management of skin damage); cost effectiveness; ease of use for the clinician; comfort for the patient and infection prevention qualities of the system. \ud The importance of inter-professional working with mattress development emerged as another key theme. This multi-disciplinary group of participants was intentionally selected as infection control and tissue viability specialists do not always work collaboratively. Significant aspects of the hybrid mattress were identified, for instance strategies for preventing infection control risk. \ud \ud An additional theme was promoting cost effectiveness of the hybrid mattress. Ensuring appropriate equipment use whilst providing high quality care was identified. Participants suggested inclusion of a unique bar code on the mattress, cover and pump emphasising this could potentially prevent mattresses being misplaced, inappropriate use and act as a tool for audits. \ud \ud Conclusion: The consensus was that there is a place for hybrid mattresses in preventing and managing pressure damage effectively. The importance of TV and infection prevention working collaboratively with industry to develop an effective product was identified. The development of a flowchart guideline, supported by high quality evidence, was recommended for all heath care areas to access and refer to thus ensuring correct choice of appropriate equipment. Mattress choices for use in clinical practice should be based on research evidence assessing benefit, harm and cost effectiveness. Further research, in a clinical and laboratory setting, investigating the use of this Somlent Serene Hybrid mattress is currently being conducted, and will be reported at a later date.

Background\ud The management of painful plantar corns form a key aspect of routine podiatric care. Existing research focuses on treatments to remove the corn rather than interventions that address the causative factors responsible for its development. Treatments aimed at removing corn tissue, including standard treatment of sharp scalpel debridement and enucleation, are associated with short lived outcomes for patients necessitating repetitive podiatric intervention. Since pressure is regarded as an important factor in the development of corns, the literature focuses around implementation of pressure-relieving strategies alongside corn removal treatments, to improve patient outcomes by preventing recurrence. Metatarsal padded insoles are commonly used by podiatrists to reduce pressure in the management of corns, yet there is currently no research available supporting this clinical practice. This research aimed to address this gap in the literature by investigating a currently ambiguous issue in routine podiatric practice: do metatarsal aperture padded insoles, in conjunction with debridement, improve patient outcomes significantly more than sharp debridement alone in the management of corns?\ud \ud \ud Methods\ud A pragmatic, parallel group, randomised controlled pilot trial was conducted, whereby 30 participants were allocated to receive either sharp scalpel debridement alone (control group, n = 15) or sharp scalpel debridement alongside a metatarsal padded insole (intervention group, n = 15). The primary outcomes measured were the presence of an\ud improved plantar corn at six months following treatment and time-to-resolution. Secondary outcomes were; pain, foot disability, and health-related quality of life.\ud \ud \ud Prior to conducting a proof of concept pilot study, several preliminary investigations were undertaken to determine the type of forefoot padded insole to be tested, which involved: extensive analysis of the research regarding forefoot pads, a survey to investigate current practice, compressional stiffness testing of materials, patients’ perspective of metatarsal padded insoles, and pressure analysis.\ud \ud \ud Results\ud The preliminary investigations determined that the preferable insole for reducing pressure at the forefoot was a metatarsal pad made from a medium-density polyurethane material. Further to this, an aperture at the site of the corn should provide greater reductions in pressure.\ud \ud \ud Results of the pilot study showed that a larger-scale study is feasible with recommendations, including; recruitment strategies, efficacy of expanding the study over multiple sites using multiple researchers, and extending the evaluation from six to 12 months. At six months 29% (4/14) of the corns had completely resolved in the control group compared with 13% (2/16) in the intervention group (p = 0.793). Partial resolution (a greater than 50% reduction in baseline area measurement) occurred in 50% of the participants in both control (n = 7) and intervention (n = 8) groups. Time-to-resolution was greater in the intervention group than those in the control (χ2(1) = 0.325; p = 0.569). The intervention group showed a greater reduction in mean pain of 23 mm, in comparison to 17 mm in the\ud control, when compared to baseline mean scores (62 mm (SD 21 mm), 47 mm (SD 30 mm), respectively).\ud \ud \ud Conclusion\ud These preliminary investigations have emphasised that a larger-scale study evaluating metatarsal padded insoles is feasible and warranted to determine if this common intervention is effective in managing painful plantar corns. Findings from the pilot suggest that there is no significant difference in resolution rates and time-to-resolution between those receiving debridement and insole therapy to those receiving debridement alone. Conclusions should not be drawn from these findings as considerable imbalances between participants at baseline were found, which could have substantially impacted on the effectiveness of the treatment. Future research should continue to investigate treatments that address the cause of corn development, rather than simply the removal of the lesion to improve outcomes for patients.