Pressure Ulcer (PU) or pressure sore is localized injury to the skin or underlying tissue or both that occur over a bony prominence when a patient is subjected to direct pressure for a lengthy period. Research have shown that skin blood flow response (SBFR) is a useful signal in PU evaluation due to its ability to determine ischemic stress response. In previous animal study, peak reactive hyperaemia (RH), a feature of SBFR has been measured for three loading-unloading cycles to indicate tissue recovery. However, in that study, peak SBFR feature cannot discriminate between tissue injury and tissue recovery effectively for short recovery time. In this study, the potential use of other SBFR signal features including time domain features i.e time to peak and frequency domain features i.e peak of power spectrum and total of power spectrum are investigated. The results show that for the samples taken, peak RH and area under the curve are both effective at discriminating between short of insufficient recovery time while other investigated features are ineffective.

People with limited mob ility such as the elderly in long-term care and home care are exposed to severe illness such as Pressure Ulcer (PU). Malaysian Registry of Intensive Care (M RIC) reported that the rate of pressure ulcer in Malaysia was 3.4 per 1000 ICU days [1] and increases year by year. PU can occur within the first two weeks for patients in ICU [2]. When skin is broken over pressure area leading to Stage 4, the cost of treating pressure ulcer can be very expensive [2]. PU is also related to mortality. Several research [2] has found that mortality rates for hospitalized patient are higher when they are subjected to pressure ulcer. Develop ment of PU can be worsened by prolonged external pressure loading on the soft-tissues [3-5], friction and [4-7] and also shear forces [4-6]. Those factors may lead to localized ischemia [6] [8] and capillaries occlusion [9] which results in tissue damage [10-11]. Several studies have established the relationship between mechanical loading and t issue condition including reperfusion injury [12], inflammation [13], ly mphatic drainage [14], impaired interstitial fluid flow and sustained swelling of cells [15]. However, many studies Abstract: Pressure Ulcer (PU) is an area of the skin in which cutaneous tissue is compromised and there is progressive damage on the underlying tissue caused by blood flow obstruction due to prolonged externa l direct pressure. Research has shown that ischemic stress response can be evaluated using skin blood flow response (SBFR) signal features which are useful for pressure ulcer evaluation. Trends of peak reactive hyperemia (RH) were observed for three repetitive loading-unloading cycles in prev ious animal study to investigate tissue recovery. However, t issue recovery and tissue damage cannot be discriminated by the trends of pe ak RH fo r short recovery time. The trends of alternative time-domain SBFR features such i.e total hyperemic response as well as frequencydomain features using Fast Fourier Transform (FFT) and Short Time Fourier Transform (STFT) i.e total power spectrum are further investigated to indicate tissue recovery. The results show that total hyperaemic response outperforms peak RH at detecting insufficient tissue recovery with 72% of samples with increasing trend in the short recovery time group compared to 57% of samples for peak RH. Total hy peremic response is effective at discriminating insufficient recovery time while other investigated features are only effective at dete cting sufficient recovery time.

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follow up clinics notes and via phone calls. Data interpreted by using logistic regression analysis. Results: 176 patients were studied. Mean age 54.0 years, of which 86.9% were male. 11 patients (6.3%) died within 30 days after PPCI. No significant difference in outcome for gender and age groups. Prolonged door in door out (DIDO) at primary hospital showed higher mortality rate (b30 minutes: 4.8% p=0.549, 30-60min: 5.3% p=0.708, N60min: 11.1% p=0.165). Longer door to device (DTD) duration is associated with higher mortality rate in both PCI-capable Hospital (b90minutes: 4.8% vs N90min: 12.5%, p=0.342) and non-PCI-capable hospitals (b120min: 3.6% vs N120min: 9.1% p=0.359). Systolic blood pressure(BP) is significant factor affecting patients' outcome (Odd Ratio (OR)=0.959 (0.935-0.983), p=0.001). Systolic BP b 100mmHg (OR 4.339 (1.295-14.543), p=0.045), and diastolic BP b 60mmHg (OR= 4.339 (1.295-14.543), p=0.045) are associated with high mortality. Patients presented with Killip I (OR 0.202 (0.062-6.59), p=0.008) had favorable outcome while patients presented with Killip IV (OR 6.151 (2.056-18.40), p=0.04) had poor outcome in this study. Conclusion: PPCI for acute STEMI 30 days mortality rate is 6.3%. Outcome of patients with Killip IV remained poor despite immediate intervention. Blood pressure is an important factor predicting patients' outcome. Shorter transfer time associated with better outcome but not statistically significant. As STEMI network in this region is expanding, a more comprehensive outcomes study will be obtained with longer study period and bigger sample size.

Pressure Ulcers (PUs) are localized tissue damage that usually occur over the soft tissue of body prominence when a subject is exposed to prolonged external mechanical loading. Several studies have proposed that skin blood flow response (SBFR) can be used in PU evaluation to determine tissue ischemic accumulation due to insufficient time of tissue recovery. In previous study, twenty one Sprague Dawley rats weigh 388-481g that were divided into three different group have been used to investigate the trends of SBFR signal using time domain features like peak reactive hyperaemia (RH), time to peak RH and area under the RH curve as well as frequency domain features like peak power spectral density (PSD) and total PSD. However, the results indicate that both frequency domain features are not effective at determining individual insufficient recovery time. In this study, Continuous Wavelet Transform (CWT) based features such as average amplitude and relative amplitude based on Morlet wavelet function scale 200 are investigated. The results show that the samples representing inconsistent trend of average amplitude for metabolic frequency range are dominant in all short (3 samples) , moderate (4 samples) and prolonged groups (4 samples), while no clear pattern can be established for relative amplitude. Hence both features may not suitable at distinguishing between sufficient and insufficient recovery time due to the low percentage in number of samples.