Showing papers in "Advances in Skin & Wound Care in 2020"

The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations.

Abstract: General purpose To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with further discussion of nutrition for pressure injury management in the context of the recommendations. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant should be better able to:1. Distinguish nutrition and malnutrition, especially as they relate to the development and healing of pressure injuries.2. Differentiate the tools and techniques that help clinicians assess nutrition status as well as the causes of pressure injuries in specific populations.3. Identify interventions for improving nutrition status and promoting pressure injury healing. Abstract Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues. Specifically, nutrition plays an important role in the prevention and treatment of pressure injuries. The purpose of this manuscript is to review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Nutrition for pressure injury management is discussed in the context of the recommendations.

Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements.

Abstract: OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.

Telemedicine and the COVID-19 Pandemic: Are We Ready to Go Live?

Abstract: Telemedicine use in the field of wound care had been increasing in popularity when the novel coronavirus 2019 paralyzed the globe in early 2020. To combat the constraints of healthcare delivery during this time, the use of telemedicine has been further expanded. Although many limitations of telemedicine are still being untangled, the benefits of virtual care are being realized in both inpatient and outpatient settings. In this article, the advantages and disadvantages of telemedicine are discussed through two case examples that highlight the promise of implementation during and beyond the pandemic.

Prevalence of Chronic Skin Wounds and Their Risk Factors in an Inpatient Hospital Setting in Northern China.

Abstract: Objective To gain insight into the magnitude of the problem of chronic skin wounds in a hospital in northern China. Methods Researchers conducted a retrospective analysis of electronic health records of cases and controls, including 1,977 patients with chronic skin wounds admitted to the hospital's medical wards over 5 years. Multiple logistic regression was used to establish factors correlating with the development of chronic wounds. Results The total prevalence of chronic wounds increased over the study period, and the occurrence of these wounds was significantly correlated with male sex, married status, unemployment, autumn season, and older age. The primary causes of chronic wounds were infection and diabetic ulcer. There were proportionally more wounds secondary to disease than traumatic wounds. The mean duration of hospitalization for patients with wounds was 13 days, and patients were readmitted an average of 10 times. Conclusions With the rapidly aging population in China, disability and chronic wounds are significant problems. Reducing hospital lengths of stay and readmissions remains a challenge. Palliative care may be appropriate for the management of some chronic wounds to prevent and treat further complications. Establishing funding guarantees and the reasonable allocation of health resources is required.

Pressure Ulcer Risk Factors in Persons with Mobility-Related Disabilities.

Abstract: Objective To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. Methods The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. Main results The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. Conclusions The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.

Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review.

Abstract: OBJECTIVE: To define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in the adult intensive care patient cohort. DATA SOURCES: The Cochrane Library, Joanna Briggs Institute Evidence-Based Practice Database, PubMed, Medical Literature Analysis and Retrieval System, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar. STUDY SELECTION: Studies were selected if they were qualitative or quantitative research that reported ASF in adult human patients in an ICU setting. The preliminary search yielded 991 records and 22 full texts were assessed for eligibility. A total of three records were included. Studies were appraised using the Mixed Methods Appraisal Tool. DATA EXTRACTION: Data from the included studies were extracted by one reviewer and summarized in data collection tables that were checked and verified by a second reviewer. DATA SYNTHESIS: Study authors identified five independent predictors of ASF: peripheral vascular disease, mechanical ventilation longer than 72 hours, respiratory failure, liver failure, and sepsis. However, the term ASF was applied to retrospective cohorts of patients who developed severe pressure injuries. This, combined with the absence of evidence surrounding the assessment, clinical criteria, and diagnosis of ASF, could impact these variables' predictability relative to the condition. CONCLUSIONS: These results highlight a substantial evidence gap regarding the etiology, diagnostic biomarkers, and predictors of ASF. Further research focused on these gaps may contribute to an accurate and agreed-upon definition for ASF, as well as improved skin integrity outcomes.

Wound Healing and Wound Care in Neonates: Current Therapies and Novel Options.

Abstract: General purpose To provide wound care information that considers the specific physiology of neonates. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant will:1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population.2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. Abstract OBJECTIVETo discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. Data sources Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. Study selection Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. Data extraction Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. Data synthesis Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. Conclusion This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.

Acute Skin Failure in the Critical Care Patient

Abstract: OBJECTIVE The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population. METHODS Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model. RESULTS Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively. CONCLUSIONS The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.

Marjolin Ulcer: A Comprehensive Review

Abstract: General purpose To provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant will:1. Describe the epidemiology, pathogenesis, and clinical manifestations of MU.2. Summarize the diagnostic and treatment approaches for patients who have an MU. Abstract This article aims to provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. Marjolin ulcer presents with clear signs and symptoms of malignant degeneration in chronic wounds. It can be prevented by raising awareness and educating wound care providers appropriately about its signs and symptoms.

The Effect of Pressure Injury Training for Nurses: A Systematic Review and Meta-analysis.

Abstract: OBJECTIVE To conduct a meta-analysis of the literature on training programs that aimed to improve nurses' pressure injury management skills. METHODS Literature searches were conducted using Ovid-MEDLINE, Cochrane Library, CINAHL, and Korean databases. The search terms used were: (nurse* AND ((pressure OR decubitus) AND (ulcer* OR injur*)) OR bed sore OR bedsore OR decubitus) AND (program* OR training)). Random-effects models were used to calculate the standardized mean difference and odds ratios, with 95% confidence intervals (CIs) to analyze the effects. MAIN RESULTS Initial searches yielded 1,067 studies. Of these, 23 met the selection criteria. Nurses' knowledge (standard mean difference, 1.23; 95% CI, 0.50-1.96; P < .001), visual discrimination ability (standard mean difference, 1.13; 95% CI, 0.88-1.38; P < .001), and clinical judgment (odds ratio, 1.52; 95% CI, 1.46-1.57; P < .001) improved after the programs. CONCLUSIONS Pressure injury training programs can improve nurses' competency. The results from this study indicate that such programs may help improve nurses' knowledge, visual discrimination ability, and clinical judgment and can be considered continuing education programs. However, large-scale studies are needed to confirm this conclusion.

Using Subepidermal Moisture Level as an Indicator of Early Pressure Damage to Local Skin and Tissue.

Abstract: Objective Inflammation triggered by tissue injury increases blood flow to the injured area, resulting in fluid accumulation below the epidermis known as subepidermal moisture (SEM). This accumulation can be assessed using an SEM scanner. The primary aim of this study was to determine whether levels of SEM from repeated measures at a localized area confirm the absence of a pressure injury at that site in healthy participants. Methods Fifty patients attending a specialized pain clinic who were at very low risk of or unaffected by pressure injuries were enrolled. Subepidermal moisture readings were gathered at the center and near-proximate to the bony prominences of the heel and sacrum. Main results Among the participants, repeated localized measurements did not differ significantly at or around a single anatomic site. The heel had a slightly higher variation than the sacrum, although the variance was less than 0.6 SEM units, indicating that there is likely no inflammation at these sites in patients who are not at risk of pressure injuries and who show no visual signs of localized tissue inflammation. Demographic and other potential confounder data were gathered, but no statistically significant findings emerged from these data. Conclusions The relatively flat pattern of SEM values around the bony prominences of the heels and sacrum in healthy participants supports the hypothesis that healthy tissue is not inflamed.

Associations Among Skin Surface pH, Temperature, and Bacterial Burden in Wounds.

Abstract: General purpose To present a cross-sectional cohort study conducted to assess the association between wound pH, local infection, and deep/surrounding infection. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant should be better able to:1. Synthesize the background information associated with the study assessing the association between wound pH, local infection, and deep/surrounding infection.2. Summarize the results of the study presented here. Abstract BACKGROUNDWounds with a higher pH often demonstrate lower rates of healing. Local and deep/surrounding infection can be diagnosed with the validated NERDS and STONEES clinical signs, respectively. This study assessed the association between wound pH, local infection, and deep/surrounding infection. Methods A 100-patient prospective cross-sectional cohort study was conducted with leg and foot wounds. Wound pH was measured using pH indicator strips. The wounds were assessed for clinical signs of local or deep/surrounding infection with the NERDS and STONEES criteria, respectively. Temperature measurements were documented with a handheld infrared skin thermometry device at the wound/periwound site, the equivalent site on the opposite side of the same leg/foot, and the wound mirror image site on the opposite leg/foot. Results There was no significant difference in the mean wound bed pH in patients with superficial critical colonization and those without (P = .837). The wound and periwound maximum temperature measurements were compared with an equivalent temperature on the mirror image on the opposite leg. There was a statistically significant difference in the mean temperature (ΔT) value between patients with deep/surrounding wound infection and three or more positive STONEES criteria (P = .002). Conclusions Nontouch infrared thermometry comparing maximum mirror image wound temperatures versus the opposite extremities when combined with two or more other STONEES criteria is a significant indicator of deep and surrounding infection. Surface wound bed pH indicator strip measurements do not correlate with local wound infection using the NERDS criteria.

Patient-Centered Health Education Intervention to Empower Preventive Diabetic Foot Self-care.

Abstract: Background Diabetes impairs the body's ability to produce or respond to the hormone insulin resulting in abnormal metabolism of carbohydrates and elevated glucose levels in the body. Because of these factors, diabetes can cause several complications that include heart disease, stroke, hypertension, eye complications, kidney disease, skin complications, vascular disease, nerve damage, and foot problems. Diabetes education allows patients to explore effective interventions into living their life with diabetes and incorporate the necessary changes to improve their lifestyle. Objective To educate patients diagnosed with diabetes or followed up for diabetes management by other departments with regard to their own responsibility in maintaining preventive foot self-care. Methods Ten patients completed a validated educational foot care knowledge assessment pretest to determine their existing knowledge about their own foot care after a thorough foot assessment. Preventive diabetic foot self-care education was conducted through a lecture, visual aids, and a return demonstration. Patients then took a posttest questionnaire with the same content as the pretest to determine their uptake of the educational content. Results Correct toenail cutting was the most identified educational need. It was a limitation in the pretest (30%), and it remained the lowest-scoring item on the posttest (70%). Walking barefoot was thought to be safe by 60% of participants pretest, but with remedial education, all participants identified this as a dangerous activity posttest. Participants also understood the high importance of having corns and calluses looked after by a health professional. Conclusions Effective communication with patients by healthcare providers who can mold educational content to identified patient needs by teaching much needed skills is a key driver in rendering safe, quality healthcare education interventions.

The Management of Postsurgical Wound Complications with Plasma Rich in Growth Factors: A Preliminary Series.

Abstract: Background Postsurgical wound complications constitute a relevant public health issue because of their frequency. There is growing evidence regarding platelet-based autologous therapies that support their use in promoting cutaneous regeneration. Objective To provide preliminary data regarding the potential benefit of plasma rich in growth factors (PRGF) in the management of postsurgical wound complications. Design Three patients suffering from poorly healing severe full-thickness wounds were treated with either one or a combination of different formulations derived from their own blood: autologous clot, fibrin membrane, injectable plasma, or topical ointment. Different treatment protocols are described, and follow-up results are reported. Results Within 4 to 12 months, the treated wounds healed completely with no signs of infection, tissue necrosis, or functional impairment. No adverse events were reported. Conclusion Additional clinical trials with long-term follow-up periods and larger patient populations are needed to establish the efficacy of PRGF technology. However, these preliminary findings suggest that PRGF merits further randomized controlled studies exploring its capacity to accelerate re-epithelialization and restore functional integrity to cutaneous ulcers resulting from surgical complications.

Clinical Aspects of Aging Skin: Considerations for the Wound Care Practitioner.

Abstract: GENERAL PURPOSETo provide information about changes associated with aging skin and the implications for wound care practitioners.TARGET AUDIENCEThis continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care

Using Wireless Near-Infrared Spectroscopy to Predict Wound Prognosis in Diabetic Foot Ulcers.

Abstract: Objective To use wearable near-infrared spectroscopy (NIRS) to determine the effect of Buerger exercises on diabetic foot ulcer (DFU) healing. Methods Study authors enrolled 50 consecutive patients in a 1-year prospective observational study of DFUs. The patients were divided into groups by their arterial statuses: group A (no peripheral arterial disease [PAD]), group B (PAD without angioplasty), and group C (PAD with angioplasty). Tissue perfusion was assessed through wireless wearable NIRS to determine the effects of Buerger exercises on wound healing. Main results The patients in group C were older, were more likely to have had an amputation, and had more severe wounds than did the patients in other groups. The requirements of insulin injection for diabetes mellitus control differed significantly (P = .024) among the three groups. At the end of the survey, 19 patients (38%) had unhealed DFUs. The NIRS revealed that most nonhealed patients in groups B and C shared higher resting hemoglobin levels and tissue blood volume and lower tissue oxygen concentration, which indicated inflammation accompanied by higher blood flow and oxygen consumption. Notably, the nonhealed patients in group C showed paradoxically reduced hemoglobin and tissue blood volume after the exercises. Conclusions Although DFUs remain a challenge to treat, NIRS may prove valuable in predicting wound healing by identifying risk factors for poor wound prognosis, such as reduced hemoglobin and tissue blood volume after exercise.

Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries: Results of the 2019 Terminology Survey.

Abstract: General purpose To present the results of the 2019 study of healthcare professionals' consensus and opinions regarding terminology for terminal ulcers, Skin Changes At Life's End, skin failure, and unavoidable pressure injuries to improve clinical care and to foster research into current criteria for unavoidable skin changes at the end of life. Target audience This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. Learning objectives/outcomes After completing this continuing education activity, the participant should be better able to:1. Explain the survey methodology and identify the consensus statements.2. Synthesize the open-ended questions and respondent comments and their implications for clinical care and research. Abstract This article reports the results of a global wound care community survey on Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, skin failure, and unavoidable pressure injury terminology. The survey consisted of 10 respondent-ranked statements to determine their level of agreement. There were 505 respondents documented. Each statement required 80% of respondents to agree (either "strongly agree" or "somewhat agree") for the statement to reach consensus. Nine of the 10 statements reached consensus. Comments from two additional open-ended questions were grouped by theme. Conclusions and suggested recommendations for next steps are discussed. This summary is designed to improve clinical care and foster research into current criteria for unavoidable skin changes at the end of life.

Advantages of Maggot Debridement Therapy for Chronic Wounds: A Bibliographic Review.

Abstract: General purpose To present an overview of the advantages of maggot debridement therapy as a treatment for chronic wounds through the review of several larval properties. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant will be able to:1. Summarize the use, process, and precautions for maggot debridement to treat chronic wounds.2. Synthesize the results of the bibliographic review of the use of maggot debridement to treat chronic wounds. Abstract Maggot debridement therapy (MDT) is effective for ulcer debridement, achieving it in less time than other therapies. It offers a benefit to healing. However, it is unclear whether maggots reduce treatment time and there is considerable controversy around the treatment's potential antimicrobial action and cost-effectiveness. Nevertheless, it can be effective in preventing amputations and reducing the need for systemic antibiotics. This bibliographic review assesses the advantages of MDT as a treatment for chronic wounds through the review of several larval properties. The review was carried out by consulting biomedical databases including CINAHL, MEDLINE (PubMed), and Scopus, and concludes that MDT is an effective debridement and potential technique to facilitate healing. However, more data is needed on the wound type application frequency and the efficacy of treatment.

Validity of the Fitzpatrick Skin Phototype Classification in Ecuador.

Abstract: BACKGROUND The Fitzpatrick Skin Phototype Classification (FSPC) is the most common tool used to assess skin phototype in White populations according to the amount of pigment the skin has and its reaction to sun exposure. Scientific evidence about the use of this scale for persons with darker skin is limited. OBJECTIVE To assess the internal consistency, reliability, and construct validity of the FSPC for Ecuadorians. METHODS This observational cross-sectional study recruited participants of both sexes between 40 and 90 years of age living in a rural area of Quito, Ecuador. Cronbach α values were used to assess the internal consistency of the scale. Construct validity was assessed with confirmatory factor analysis. RESULTS The internal consistency coefficients indicated that the reliability of the responses to the scale was fair. Total α value was .515, whereas the α values of the two factors were .42 and .67. Most item-to-factor correlations had a low to moderate magnitude, ranging from r = 0.30 to 0.37. Confirmatory factor analysis supported a two-factor solution and achieved good overall fit as indicated by root mean square error of approximation = 0.08, and nonnormed fit index = 0.88 was mediocre. Goodness-of-fit χ = 177.10, P < .001. The factor loads were greater than 0.30, ranging from 0.30 to 0.99. CONCLUSIONS The FSPC showed an acceptable construct validity and a fair internal consistency. The five-item scale could potentially be used as an effective instrument for assessing skin phototype in non-White people.

Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients.

Abstract: OBJECTIVE To determine the incidence and influencing factors of medical adhesive-related skin injury (MARSI) among ICU patients. METHODS Study authors enrolled patients admitted to two ICUs at a class 3, grade A hospital in Beijing between January and June 2018 in this prospective cohort study. A data collection sheet was designed, and the data were collected by querying the electronic medical record and via direct assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that independently influenced MARSI incidence. The STROBE checklist was used. RESULTS In total, 39 of 356 patients (27 men and 12 women with an average age of 61.51 ± 17.49 years) developed MARSI, an incidence of 10.96%. The median time from admission to MARSI occurrence was 26 days. Multivariate logistic regression analysis revealed that the ICU length of stay, Braden Scale score, and mechanical ventilation all independently influenced incidence. The Braden Scale score (odds ratio [OR], 0.758; 95% confidence interval [CI], 0.636-0.904; P < .05) was a protective factor against MARSI, with higher scores indicating lower risk. The ICU length of stay (OR, 1.098; 95% CI, 1.061-1.136; P < .05) and mechanical ventilation (OR, 3.373; 95% CI, 0.889-12.795; P < .05) were independent risk factors for MARSI. CONCLUSIONS The incidence of MARSI in ICU patients was relatively high. Awareness of MARSI should be increased among medical staff, and proper skin care should be provided to prevent and treat MARSI effectively.

Infrared Thermography as a Diagnostic Tool for Peripheral Artery Disease.

Abstract: OBJECTIVE: The prevalence of peripheral arterial disease (PAD) is increasing worldwide The ankle-brachial index (ABI) is considered the criterion standard of noninvasive screening, but it does have limitations The present study aimed to clarify the clinical diagnostic potential of infrared thermography (IRT) compared with conventional noninvasive measurements for PAD METHODS: Patients were divided into two groups: the healthy control group (n = 93) and the PAD group (n = 164) Control participants had an ABI 09 to 14 and no former PAD diagnosis The PAD group was divided into three subgroups based on ABI classifications and two subgroups based on toe pressure measurements Investigators performed IRT using a standardized protocol with temperature measurements at five different foot sites MAIN RESULTS: Differences in skin temperatures between feet were greater (P < 001) in the PAD group than in healthy controls In general, mean foot temperatures were lower in the PAD group than in controls but did not differ significantly among PAD subgroups based on ABI classifications or toe pressure measurements CONCLUSIONS: Infrared thermography effectively distinguished temperature differences between feet and thus might be diagnostically useful However, because normal skin surface temperature varies among individuals, IRT alone cannot be recommended for evaluating PAD However, it does have potential to provide additional information about circulation, subclinical infections, and the severity of vascular disease

A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients.

Abstract: OBJECTIVE To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.

Prospective Multicenter Evaluation of an Advanced Extracellular Matrix for Wound Management.

Abstract: Objective To evaluate an advanced extracellular matrix made of ovine forestomach matrix (OFM) for healing a variety of wound types. Methods Participants were enrolled from inpatient, outpatient, and home healthcare settings. The OFM was used to treat all wounds and applied to the wound bed every 3 to 7 days until closure. Results Researchers enrolled 29 participants with 33 wounds. Average time to wound closure was 8.2 weeks, the percentage of wounds that reduced in size by 50% or more at 4 weeks was 64%, the average wound area reduction at 4 weeks was 66%, and 73% of wounds had closed at 12 weeks. No adverse effects were observed. Conclusions This represents the first Canadian evaluation of OFM for the treatment of wounds, and the positive healing outcomes observed could support more widespread adoption of this matrix.

Putting the 2019 Nutrition Recommendations for Pressure Injury Prevention and Treatment into Practice.

Abstract: General purpose To explore the changes in the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries (CPG) nutrition recommendations and strategies for implementation Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care Learning objectives/outcomes After participating in this educational activity, the participant will:1 Synthesize the current evidence regarding nutrition approaches to medical conditions, including pressure injury prevention and treatment2 Summarize the changes and recommendations in the 2019 edition of the CPG Abstract Healthy diets provide essential nutrients needed to maintain healthy skin and prevent or manage pressure injuries The 2019 Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries published by the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance includes specific nutrition recommendations for patients with pressure injuries The purpose of this CE/CME article is to explore the changes in the nutrition recommendations and strategies for implementation

The Promise of Smartphone Applications in the Remote Monitoring of Postsurgical Wounds: A Literature Review.

Abstract: Objective To review the clinical and scientific literature on remote monitoring and management of postsurgical wounds using smartphone applications (apps). Data sources MEDLINE, PubMed, EMBASE, and Cochrane libraries were searched for relevant articles on patients who received surgery and were monitored postdischarge via an app. Study selection Articles were selected with the terms "mobile phones," "smartphones," "wounds," "monitor," and "patient preference." Data extraction The authors found 276 review articles related to telemedicine in wound care. Investigators reviewed the titles and abstracts of the search results and selected 83 articles that were relevant to the remote monitoring of wounds using smartphone apps. Data synthesis The topics explored in selected literature included smartphone app importance to telemedicine, benefits (medical and financial), app examples, and challenges in the context of wound monitoring and management. The authors identified several challenges and limitations that future studies in the field need to address. Conclusions Remote monitoring and management of wounds using smartphone apps is a valuable technique to enhance the quality of and access to healthcare. However, although some patients may prefer this technology, some lack technological competence, limiting telemedicine's applicability. In addition, issues remain with the reliable interpretation of data collected through apps.

Recommended Surgical Margins for Basal Cell Carcinoma: Is 3 mm Safe Enough?

Abstract: OBJECTIVE The primary aim of treatment of basal cell carcinoma (BCC) is the complete excision of the tumor. Reconstruction of the defect after surgical excision varies, depending on the location and size of the defect and the skin to be used in the reconstruction. In this study, investigators compared the rates of tumor positivity at the edges of BCC specimens excised with 3- or 5-mm surgical margins. METHODS Researchers analyzed data related to 113 patients with a preliminary diagnosis of BCC between August 2016 and June 2018. In total, 99 lesions from 91 patients not exceeding 2 cm in size excised with 3-mm (n = 53) or 5-mm (n = 46) surgical margins were included. Statistical analysis was performed using the χ test. RESULTS After histopathologic assessment, 3 of 53 lesions that were excised with 3-mm surgical margins had a positive surgical margin, whereas none of the 46 lesions excised with 5-mm margins indicated a positive tumor presence. However, there was no statistical difference between the groups. CONCLUSIONS A 3-mm surgical margin may be sufficient and safe for BCC excision.

Effect of an Oral Nutrition Supplement Containing Collagen Peptides on Stratum Corneum Hydration and Skin Elasticity in Hospitalized Older Adults: A Multicenter Open-label Randomized Controlled Study.

Abstract: Objective The purpose of this randomized open-label study was to investigate the effect of an oral nutrition supplement containing collagen peptides on stratum corneum hydration and skin elasticity. Methods The study protocol was registered at the UMIN Clinical Trials Registry (UMIN 000027347). Once-a-day oral administration of a nutrition supplement containing collagen peptides (10.0 g) was instituted in 39 inpatients 65 years or older who were assigned to either the intervention or the control group using a block-randomization design. Stratum corneum hydration and skin elasticity were measured at baseline and at 2, 4, 6, and 8 weeks after the start of the intervention. Results Mean stratum corneum hydration was significantly increased from 43.7 at baseline to 51.7 at postintervention week 8 in the intervention group (P = .001). Differences in skin elasticity from baseline were significant at postintervention week 6 (P = .026) and week 8 (P = .049). Conclusions Oral nutrition supplements containing collagen peptides may reduce skin vulnerability in older adults and thus prevent conditions such as skin tears.

Topical analgesic and local anesthetic agents for pain associated with chronic leg ulcers: A systematic review

Abstract: General purpose To provide information about the effectiveness of topical analgesic and local anesthetic agents for reducing pain associated with chronic leg ulcers. Target audience This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant will:1. Distinguish adverse reactions to topical analgesics and local anesthetic agents.2. Evaluate the effectiveness of topical analgesics and local anesthetic agents for pain associated with chronic leg ulcers.3. Identify substances used as topical analgesics and local anesthetic agents and the application of those agents. Abstract To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers.A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019.A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomized controlled trials; however, the reported methodology for most of studies was poor, so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved wound-related pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective.Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers.

"Virtual Biopsies" of Normal Skin and Thermal and Chemical Burn Wounds.

Abstract: The search for noninvasive methods to image and measure the mechanical properties of skin has been a frequent subject of research for many years. Although suction testing, elastography, and other testing can be noninvasive, these tests fail to yield comparable results to destructive tests such as uniaxial tensile testing. Accordingly, researchers have developed a technique to combine optical coherence tomography with vibrational analysis (vibrational optical coherence tomography) to image and analyze the biomechanical properties of tissues noninvasively and nondestructively. The result of this analysis is a "virtual biopsy" of skin, along with a physical analysis of the major components of the epidermis and dermis.In this study, the authors compare virtual biopsies of thermal and chemical burns to that of normal skin. They conclude that the enhanced optical coherence tomography images and measurements of the resonant frequency after thermal or chemical burns exhibit large differences when compared with the morphology and moduli of normal skin. Using vibrational optical coherence tomography, it is possible to follow changes in the morphology and physical properties of the epidermis and dermis associated with skin diseases and therapeutic treatments in situ.

The Effect of Sunflower Seed and Almond Oil on Preterm Infant Skin: A Randomized Controlled Trial.

Abstract: Objective To investigate the effect of sunflower seed oil (SSO) and almond oil (AO) on stratum corneum hydration and Neonatal Skin Condition Scores (NSCSs) of preterm infants. Methods This randomized controlled trial recruited 90 preterm infants whose gestational ages were between 32 and 37 weeks in the neonatal ICU. Infants were randomly assigned to three groups (SSO, AO, or control). The oils were applied to the whole body of each infant except for the head and face by a nurse researcher four times a day (4 mL/kg) for 5 days. Main outcome measures Skin condition of the infants as evaluated with the NSCS; hydration as measured by a skin moisture meter before and after application. Main results When average stratum corneum hydration was compared, infants in the SSO and AO groups had better hydration than infants in the control group. The NSCS scores in the control group were significantly higher than in the intervention groups, but there was no difference between the SSO and AO groups. Conclusions Neither SSO nor AO has harmful effects on the skin, and their use may improve stratum corneum hydration. These oils can be used by nurses to hydrate the skin of preterm infants. Further studies are needed to evaluate the efficacy of natural oils on infant skin.