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International Wound Journal Oct 2021In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is...
In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00-0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99-1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11°C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research.
Topics: Epidermis; Humans; Pressure Ulcer; Reproducibility of Results; Skin; Skin Care; Skin Physiological Phenomena
PubMed: 33626239
DOI: 10.1111/iwj.13574 -
Ostomy/wound Management Oct 2007Although it is well accepted that pressure ulcers occur as a result of mechanical loading of tissue, their specific etiology of development remains unknown. Knowledge of... (Review)
Review
Although it is well accepted that pressure ulcers occur as a result of mechanical loading of tissue, their specific etiology of development remains unknown. Knowledge of tissue response to pressure is critical to understanding and elucidating the specific mechanism of pressure ulcer development. A literature review to appraise the histology of pressure ulcer tissue shows that numerous in vitro and in vivo studies examining tissue changes in response to pressure have been conducted. In vitro findings indicate that relatively small loads cause structural changes to the dermal component of tissue. Studies examining tissue from humans with pressure ulcers have shown that changes visible at the surface are often minor compared to the damage seen in deeper tissue layers. In vivo animal studies evaluating the changes in tissue histology following application of various loads support findings related to human pressure ulcer tissue and further elucidate the tissue changes seen in response to load. Studies to evaluate whether the visible changes in human and animal tissue are precursors to ulcer development or remodeling responses to loading are needed to increase understanding of pressure ulcer formation.
Topics: Animals; Biomechanical Phenomena; Dermis; Humans; Pressure; Pressure Ulcer; Skin; Soft Tissue Injuries
PubMed: 17978414
DOI: No ID Found -
International Wound Journal Mar 2019The incidence rate of patients developing pressure ulcers associated with medical device use is underreported in Korea. This study aims to determine clinical nurses'...
The incidence rate of patients developing pressure ulcers associated with medical device use is underreported in Korea. This study aims to determine clinical nurses' perceived importance and performance towards medical device-related pressure injury prevention. A total of 620 nurses from seven hospitals attending continuing education programmes in Korea responded to self-administered questionnaires. Data were collected from March to December 2017 on a 4-point-Likert scale on nurses' perceived importance and performance for prevention of medical device-related pressure ulcer (MDRPU). Secondary data analysis was performed through reported pressure injury incidence, and questionnaire data were analysed using descriptive statistics, t-test, and anova. The overall rates of hospital-acquired pressure ulcers and MDRPU were 16.9% and 0.8%, respectively. The proportion of MDRPU was 5.02%. Its perceived importance (3.56 ± 0.48) was also higher than prevention performance (3.13 ± 0.90) among nurses. Education level and participation in pressure injury management training was found to enhance prevention performance by nurses. Therefore, informational and educational programmes based on clinical practice are necessary for clinical nurses to focus on perceived importance and performance towards prevention of medical device-related pressure injury and pressure ulcer care.
Topics: Adult; Attitude of Health Personnel; Critical Care Nursing; Equipment and Supplies; Female; Humans; Male; Middle Aged; Nursing Staff, Hospital; Pressure Ulcer; Republic of Korea
PubMed: 30793861
DOI: 10.1111/iwj.13023 -
Ostomy/wound Management Apr 2009The phrasing of the National Pressure Ulcer Advisory Panel's (NPUAP) definition of deep tissue injury (DTI) was based on case reports, clinical observations, and... (Review)
Review
The phrasing of the National Pressure Ulcer Advisory Panel's (NPUAP) definition of deep tissue injury (DTI) was based on case reports, clinical observations, and experience. Although etiological studies of DTI, primarily related to characterizing biomechanical factors affecting onset and progression, support and strengthen parts of the NPUAP's definition, some recent findings suggest a need to re-evaluate the wording and perhaps refine future definitions of DTI. Application of existing bioengineering research to underlying biological, physical, biomechanical, and biochemical mechanisms involved in the definition of DTI suggests the following: 1) changes in skin color - ie, deviation of the local skin color from the surroundings - may indicate a DTI might be present, but color is not useful for quantifying the severity of injury; 2) the pressure and/or shear definition is inaccurate because it creates an artificial distinction between pressure and shear, which are physically coupled, and because it ignores tensional loads; 3) palpating tissue firmness at the wound site provides limited assessment information because tissue firmness will depend on the point in time along the course of DTI development. Damaged tissues might appear stiffer than surrounding tissues if examined when muscle tissue is locally contracted due to local rigor mortis but at a later stage damage might manifest as tissues that are softer than their surroundings when digestive enzymes start decomposing necrotic tissues; 4) skin temperature changes near the DTI site may reflect inflammatory response, causing local heating, or ischemic perfusion, causing local cooling; and 5) rapid deterioration of DTI is likely occurring due to muscle tissue stiffening at the rigor mortis phase; stiffened tissues abnormally deform adjacent tissues and this effect is amplified if muscles are atrophied. The application of interdisciplinary research may help clinicians and researchers move from evolving jargons, staging systems, and injury definitions to valid and reliable clinical instruments, which will improve clinical practice.
Topics: Bias; Biomedical Engineering; Color; Computer Simulation; Disease Progression; Humans; Inflammation; Magnetic Resonance Imaging; Necrosis; Patient Care Team; Physical Examination; Pressure Ulcer; Reproducibility of Results; Risk Assessment; Risk Factors; Severity of Illness Index; Shear Strength; Skin Temperature; Stress, Mechanical; Time Factors
PubMed: 19387094
DOI: No ID Found -
Ostomy/wound Management Oct 2008Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers... (Review)
Review
Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or without historical controls) as well as pressure ulcer guideline recommendations suggest the most important aspect of heel ulcer prevention is pressure relief (offloading). It also has been documented that the incidence of heel ulcers can be reduced using a total-patient care approach and heel offloading devices. Guidelines, observational studies, and expert opinion intimate that reducing heel ulceration rates can be expected to improve patient outcomes, decrease costs associated with their care, and avoid costs related to hospital-acquired pressure ulcers. The heel pressure ulcer prevention strategies reviewed should be implemented until the results of prospective, randomized controlled studies to compare the effectiveness and cost-effectiveness of these strategies are available.
Topics: Foot Diseases; Heel; Humans; Pressure Ulcer; Prevalence; Risk Assessment
PubMed: 18927483
DOI: No ID Found -
Journal of Rehabilitation Research and... 2015Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support... (Review)
Review
Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.
Topics: Humans; Pressure Ulcer; Self Care; Self-Help Devices; Spinal Cord Injuries
PubMed: 26237111
DOI: 10.1682/JRRD.2014.02.0064 -
The Surgical Clinics of North America Jun 1997Skin ulcers are the most common chronic wounds. Current management principles and theories of causation of the most common ulcers--pressure, diabetic, and venous--are... (Review)
Review
Skin ulcers are the most common chronic wounds. Current management principles and theories of causation of the most common ulcers--pressure, diabetic, and venous--are described. Issues related to occlusive dressings, compression dressings, topical antimicrobials, debridement, growth factors, grafting, and bioengineered tissue therapy are discussed. Special emphasis is placed on regulatory concerns.
Topics: Administration, Topical; Anabolic Agents; Anti-Bacterial Agents; Bandages; Chronic Disease; Debridement; Diabetes Complications; Growth Substances; Humans; Leg Ulcer; Pressure Ulcer
PubMed: 9194887
DOI: 10.1016/s0039-6109(05)70575-2 -
Machine learning-based prediction models for pressure injury: A systematic review and meta-analysis.International Wound Journal Dec 2023Despite the fact that machine learning (ML) algorithms to construct predictive models for pressure injury development are widely reported, the performance of the model... (Meta-Analysis)
Meta-Analysis Review
Despite the fact that machine learning (ML) algorithms to construct predictive models for pressure injury development are widely reported, the performance of the model remains unknown. The goal of the review was to systematically appraise the performance of ML models in predicting pressure injury. PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Grey literature and other databases were systematically searched. Original journal papers were included which met the inclusion criteria. The methodological quality was assessed independently by two reviewers using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed with Metadisc software, with the area under the receiver operating characteristic curve, sensitivity and specificity as effect measures. Chi-squared and I tests were used to assess the heterogeneity. A total of 18 studies were included for the narrative review, and 14 of them were eligible for meta-analysis. The models achieved excellent pooled AUC of 0.94, sensitivity of 0.79 (95% CI [0.78-0.80]) and specificity of 0.87 (95% CI [0.88-0.87]). Meta-regressions did not provide evidence that model performance varied by data or model types. The present findings indicate that ML models show an outstanding performance in predicting pressure injury. However, good-quality studies should be conducted to verify our results and confirm the clinical value of ML in pressure injury development.
Topics: Humans; Pressure Ulcer; Sensitivity and Specificity; ROC Curve; Machine Learning; Software
PubMed: 37340520
DOI: 10.1111/iwj.14280 -
European Journal of Medical Research Feb 2023Patients who have undergone vascular operations are thought to be at an increased risk for developing pressure injuries; however, the extent to which pressure injuries... (Review)
Review
BACKGROUND
Patients who have undergone vascular operations are thought to be at an increased risk for developing pressure injuries; however, the extent to which pressure injuries occur in this population is not clear. This scoping review sought to summarize what is known about the incidence of pressure injuries, and the risk factors for the development of pressure injuries in patients who have undergone vascular operations. MAIN: An initial search identified 2564 articles, and 9 English language studies were included. Results showed that due to study design limitations in the available literature preventing hospital-acquired and present on admission pressure injuries to be distinguished, it is difficult to ascertain the incidence rate of pressure injuries in this population.
CONCLUSION
Certain vascular procedures were found to be higher risk for the development of pressure injuries such as major amputations and lower extremity bypass surgery. In addition to procedural risk factors, patient factors were identified that may be associated with the development of pressure injuries in the vascular population, and these in the authors' view deserve further exploration. Overall, this scoping review identified an area ripe for future research, the results of which would have implications for wound care in healthcare institutions and at home.
Topics: Humans; Incidence; Pressure Ulcer; Vascular Surgical Procedures; Risk Factors; Hospitalization; Retrospective Studies
PubMed: 36782315
DOI: 10.1186/s40001-023-01036-3 -
Journal of Wound Care Oct 2017
Topics: Health Services Needs and Demand; Humans; Models, Organizational; Physician Assistants; Practice Patterns, Physicians'; Pressure Ulcer; United States
PubMed: 28976833
DOI: 10.12968/jowc.2017.26.Sup10.S3