Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses

BackgroundThere are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF).AimThe specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols.MethodsTwo studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant.ResultsFor the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant).ConclusionThis study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.     

Repeatability and reliability of the diabetic foot self-care questionnaire in Arabic patients: A transcultural adaptation

PurposeThe diabetic foot self-care questionnaire is considered a self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, the DFSQ has been validated in different languages, but an Arabic version was lacking. Consequently, the purpose of this study was to translate and validate the Arabic version of the DFSQ (DFSQ-AR).MethodA suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Arabic. Regarding the total marks from each sub-scale, agreement degrees and confidence were analyzed using Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± standard deviation differences between pre and post-tests were calculated and completed using Bland-Altman distribution plots.ResultsExcellent agreement between the two versions was demonstrated based on Cronbach's α. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care and shoe and socks sub-scales. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (P = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland-Altman plots or clinically pertinent variations were not statistically significantly different.ConclusionsThe DFSQ-AR is considered a strong and valid questionnaire with adequate repeatability in the Arabic language population.     

Adaptation of a MR imaging protocol into a real-time clinical biometric ultrasound protocol for persons with spinal cord injury at risk for deep tissue injury: A reliability study

BackgroundHigh strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound.Material and methodsPart 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed.ResultsAB between-operator reliability was good (ICC = 0.81–0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = −0.028 and −0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75–0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = −0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10).ConclusionA MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.     

The Podoprint® plantar pressure platform: Evaluation of reliability and repeatability,and determination of the normality parameters

IntroductionThe Podoprint® pressure platform system is widely used in routine podiatric clinical practice to measure plantar pressures. It allows non-invasive examination of the patient, and provides fast results with high levels of precision, reliability, and repeatability. Once these conditions have been demonstrated, the clinical and/or research use of baropodometry allows results to be obtained in the field of podology that are far from inconsiderable.The study was designed to evaluate the repeatability and reliability of the platform, and to identify the normal foot pressure parameters.MethodsRecords were collected from 52 random healthy individuals, 10 men and 42 women, in two sessions separated by one week. The study variables were: maximum pressure, mean pressure, support surface areas (heel, midfoot, and forefoot), and contact time. Repeatability and reliability were evaluated by calculating the interclass correlation coefficient (ICC) and the coefficient of variation (CV) in the three tests.ResultsThe ICCs showed moderate to good repeatability for the variables of interest, and the CVs were all less than 18%. The maximum pressure was under the forefoot (mean 2675.4 ± 513.8 g/cm²). The mean contact time of the steps was 0.72 ± 0.07 s.ConclusionsThe Podoprint® system is a reliable tool for evaluating the distribution of plantar pressures in the dynamic study of the barefoot gait of healthy individuals.     

A quantitative analysis of microcirculation in sore-prone pressure areas on conventional and pressure relief hospital mattresses using laser Doppler flowmetry and tissue spectrophotometry

BackgroundPressure ulcers are associated with severe impairment for the patients and high economic load. With this study we wanted to gain more insight to the skin perfusion dynamics due to external loading. Furthermore, we evaluated the effect of different types of pressure relief mattresses.MethodsA total of 25 healthy volunteers were enrolled in the study. Perfusion dynamics of the sacral and the heel area were assessed using the O2C-device, which combines a laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin. Three mattresses were evaluated compared to a hard surface: a standard hospital foam mattress bed, a visco-elastic foam mattress, and an air-fluidized bed.ResultsIn the heel area, only the air-fluidized bed was able to maintain the blood circulation (mean blood flow of 13.6 ± 6 versus 3.9 ± 3 AU and mean relative amount of hemoglobin of 44.0 ± 14 versus 32.7 ± 12 AU.) In the sacral area, all used mattresses revealed an improvement of blood circulation compared to the hard surface.ConclusionThe results of this study form a more precise pattern of perfusion changes due to external loading on various pressure relief mattresses. This knowledge may reduce the incidence of pressure ulcers and may be an influencing factor in pressure relief mattress selection.     

Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study

AimThe aim of this quasi-experimental study was to develop an anti-embolism stocking care protocol and assess its effectiveness in preventing associated skin problems on the legs.Materials and methodsThe study was conducted between 02 March and July 20, 2016 in the surgical clinics of a private university hospital in Ankara, Turkey. The sample consisted of 27 nurses and 162 patients (three different patients were fitted of anti-embolism stockings by each of the 27 nurses; pre-protocol 81 patients and post-protocol 81 patients). Data were collected using data collection forms developed by the researchers. An anti-embolism stocking care protocol was developed and used. Nurses and patients were evaluated using an observational method.ResultsFollowing implementation of the protocol, nurses’ mean knowledge (95.24 ± 5.60) and intervention skill (92.06 ± 10.42) scores were significantly higher than their pre-protocol knowledge (73.54 ± 14.26) and intervention skill (15.30 ± 6.84) scores. Nurses performed almost all steps of the care protocol correctly after the protocol was implemented. The rates of skin problems such as pressure ulcers, neurovascular problems and issues associated with wrinkles or creases in stockings were significantly reduced after implementation of the protocol.ConclusionsThis study demonstrates that nurses’ knowledge and intervention skills are increased when a care protocol is used, together with the prevention of errors and improved patient outcomes. The use of care protocols guides nurses in practice, raises awareness and helps to achieve nursing care objectives by standardizing information.     

Effectiveness of hyaluronic acid in post-surgical cures following partial matricectomies with the phenol/alcohol technique: A randomized clinical trial

BackgroundPost-operative cures with hyaluronic acid (HA) could potentially shorten the period recovery involved in the phenol technique for ingrown toenail. The aim of this study was therefore to compare a standard healing protocol with the experimental one based on hyaluronic acid cream.Material and methods70 patients who had undergone phenol technique surgery for ingrown toenail were divided into two groups – control (n = 35) who received post-operative cures following the standard protocol with povidone iodine gel, and experimental (n = 35) who received cures with HA in the first 3 visits. Bleeding, total healing time, and perceived pain were assessed.ResultsPatients in the control group recovered from the intervention in a total of 26.17 ± 7.75 days, while those in the HA group recovered in a significantly shorter time – 22.42 ± 2.41 days (p = 0.007, effect size 0.653). However, there were no between-group statistical differences in bleeding or perceived pain over the course of the post-surgery visits.ConclusionsThe use of low molecular weight hyaluronic acid is effective in reducing the phenol-technique healing time by 4 days compared with the standard cure. However, no extra effects such as reductions in bleeding or perceived pain can be expected in choosing this healing protocol.     

Not just quantity: Gluteus maximus muscle characteristics in able-bodied and SCI individuals – Implications for tissue viability

Study aimSome individuals with spinal cord injury (SCI) remain pressure ulcer (PU) free whilst others experience a recurring cycle of tissue breakdown. Detailed analysis of gluteal muscle characteristics may provide insights to local tissue viability variability. The study hypothesis was that SCI individuals have altered muscle composition compared to able-bodied (AB).MaterialsTen AB and ten SCI received a supine pelvic CT scan, with contrast.MethodsCross-sectional area (CSA) and overall muscle volume were derived using image analysis. Gluteal muscle tissue type was classified at the S2/S3 sacral vertebrae midpoint, the superior greater trochanters margin (GT) and the inferior ischial tuberosities margin (IT) using the linear transformation Hounsfield Unit scale.ResultsSCI gluteal CSA was less than for AB throughout the muscle, with the greatest relative atrophy at the IT (48%). Average AB gluteal volume was nearly double SCI. Eight SCI had over 20% infiltrative adipose tissue, three with over 50%. SCI gluteal CSA and intramuscular fat infiltration were significantly negatively correlated (p < 0.05). SCI IT axial slices showed less lean muscle and higher intramuscular fat infiltration than more proximally (p < 0.05).ConclusionSCI gluteal muscle characteristics were indicative of impaired tissue viability. SCI disuse muscle atrophy was anticipated; the analytic approach further indicated that intramuscular atrophy was not uniform. SCI muscle composition showed increased proportions of both low density muscle and adipose tissue. CT scan with contrast is effective for gluteal muscle characterization. This assessment technique may contribute to determination of personalized risk for PU development and other secondary complications.     

Sacral interface pressure can be alleviated by repositioning with a small-angle change using an automated bed in patients with spinal cord injury

Aim of the studyThis study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group.Materials and methodsAn intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee.ResultsPositions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°.Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = −0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = −0.52, p = 0.017), and body mass index (BMI; β = −0.34, p = 0.041) were significant independent predictors of peak pressure.ConclusionsFor repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.     

The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study

BackgroundSubepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM.AimThis study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner.MethodA 2 × 2 randomised crossover study compared the effects of 30-min of 30? versus 60? HOBE on sacral and heel SEM in healthy adults.Results48 participants were randomly allocated to 30? or 60? HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30? versus 60? HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk.ConclusionThe HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12622001456741.     

Psychometric testing and evaluation of user acceptance of an automatic lateral turning device for the prevention of pressure ulcers

IntroductionRepositioning of patients with reduced or impaired mobility could lessen pressure ulcers (PU). Automated preventive devices can support nurses, but user acceptance must be determined with valid and reliable tools. This study measured user acceptance of an automatic lateral turning device, using a self-developed questionnaire.MethodThe study included 194 nurses in leadership positions from 75 institutions. A two-page user acceptance questionnaire was designed and tested for internal validity (exploratory factor analysis; EFA) and reliability (Cronbach's-α). A linear regression analysis was used to test the model's theoretical framework.ResultsThe overall response rate was 74.9%. The EFA revealed five exploratory factors (“pain/well-being”, “PU prevention”, “handling”, “nurse support”, and “obese patient support”) from the two outcomes (“general satisfaction” and “can replace manual repositioning”). The adjusted r² was 0.607 for “general satisfaction”, with the maximum standardized β for “PU prevention” (0.476), “pain/well-being” (β = 0.197) and “handling” (β = 0.145). The adjusted r² for “can replace manual positioning” was 0.458. The β for “nurse support” was 0.264, followed by “pain-wellbeing” (β = 0.224) and “obese patient support” (β = 0.218).ConclusionThe psychometric testing results were satisfactory. Overall user acceptance of the automatic lateral turning device was high. A positive evaluation of the system's functionality, regarding the prevention of PU, is essential for patient and staff satisfaction, as well as user recommendation.     

Close correlation of herpes zoster‐induced voiding dysfunction with severity of zoster‐related pain: A single faculty retrospective study

Herpes zoster (HZ), a common vesiculo‐erythematous skin disease associated with reactivation of varicella zoster virus in the cranial nerve, dorsal root, and autonomic ganglia, is accompanied by several related symptoms represented by postherpetic neuralgia. Among them, involvement of vesicorectal dysfunction is relatively rare. The vesicorectal symptom can usually be recovered in transient course, but is quite important in terms of impaired quality of life. Male individuals affected with HZ and skin lesions on sacral dermatome have been reported as independent risk factors of zoster‐related voiding dysfunction. In this study, urinary symptoms were focused upon and six patients with zoster‐related voiding dysfunction at a single faculty of dermatology in Japan from 2009 to 2014 were retrospectively analyzed. All patients showed HZ lesions on the sacral area and the urinary symptom recovered in approximately 2 months (14 days to 7 months). The term of treatment for zoster‐associated urinary dysfunction was positively correlated with that for zoster‐related pain without significance (r = 0.661, P = 0.153). Average treatment term for pain relief of sacral HZ accompanied by voiding dysfunction (91.3 ± 76.44 days) was significantly longer than that of sacral HZ without urinary symptom (18.9 ± 20.42 days) (P = 0.032). These results suggested that zoster‐related voiding dysfunction would mainly be involved in sacral HZ and closely associated with severity of zoster‐related pain. Dermatologists should be aware that severe zoster‐related pain accompanied by sacral HZ, which is related to prolonged treatment of pain relief, can be a predictive factor of voiding dysfunction.     

Reliability and agreement of skin barrier measurements in a geriatric care setting

BackgroundThe non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings.Material and methodsTransepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement.ResultsTwo hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 °C were calculated for skin surface pH.ConclusionRelative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements.     

Knowledge,attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study

IntroductionPressure ulcers (PU) are a major, but preventable health problem in all health settings, but especially in intensive care units (ICUs). This study aimed to investigate the knowledge, attitude, and practice (KAP) of Iranian ICU nurses related to the prevention of PU.MethodsIn a cross-sectional study, data obtained from 183 ICU nurses working in four hospitals affiliated to Mazandaran University of Medical Sciences, Sari, Iran were evaluated. The study was conducted from July to October 2020. Data were collected using a four-part questionnaire including demographic characteristics, Pieker Pressure Ulcer Knowledge Test (PPUKT), Attitude toward Pressure Ulcer Prevention (APUP) tool, and the practice of nurses related to the prevention of PU.FindingsThe mean scores of KAP of ICU nurses toward PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. There was a positive correlation between nurses' attitude and practice (r = 0.232, P = 0.002), and a negative correlation between knowledge and attitude (r = ?0.156, P = 0.035) of nurses regarding PU prevention. Additionally, a positive correlation was found between nurses' years of working experience in ICU and their knowledge regarding PU prevention (r = 0.159, P = 0.032).ConclusionAccording to the results of the present study, the level of KAP of Iranian ICU nurses related to PU prevention were desirable, positive, and relatively desirable. Therefore, nurse managers and policymakers should try to eliminate the main barriers such as heavy workload, inadequate nurse staffing, and lack of appropriate guidelines for PU prevention which consequently affect the practice of ICU nurses in the prevention of PU.     

Effect of foot health-related quality of life in rural population: A case-control study

BackgroundFoot health problems can affect quality of life and general health producing a source of discomfort and pain. Low levels of foot health-related quality of life (HRQoL) are present in patients with foot disabilities, such as hallux valgus, plantar fasciitis, or minor toe deformities.ObjectiveThe objective was to analyze the foot health status in patients with and without foot problems in a rural population and its relationship with quality of life.Material and methodsA prospective case-control study was developed with a sample of 152 patients, 76 subjects with podiatric pathologies and 76 without, in a rural population. HRQoL was measured through the SF-36 Health Questionnaire in the Spanish version.ResultsThe case group had a mean age of 49.18 ± 14.96 and the control group 44.16 ± 11.79. Regarding the score of the lowest levels of quality of life related to foot problems, the case group compared to the controls showed: for physical function (79.86 ± 26.38 vs. 92.63 ± 11 0.17, p < 0.001); for the physical role (73.68 ± 41.00 vs. 88.48 ± 27.51, p < 0.0022); for body pain (45.81 ± 27.18 vs. 73.68 ± 41.00, p < 0.035); and for general health (60.36 ± 30.58 vs. 68.71 ± 18.52, p < 0.047). The differences between groups were analyzed using the Mann-Whitney U test, which showed statistical significance (P < 0.05).ConclusionsIn the rural population, people with foot pathologies present a worse quality of life compared to those who do not present foot pathology, especially for the health domains: physical function, physical role, body pain and health general.     

A pilot randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention and treatment of pressure ulcers among medical ICU patients

BackgroundData on the prevention and treatment of pressure ulcers (PU's) among ICU patients is sparse.ObjectiveTo compare PU outcomes in medial ICU patients nursed on either a reactive mattress overlay (ROHO^®, ROHO Inc, Belleville, IL, USA) or an active alternating pressure mattress (NIMBUS^®3, ArjoHuntleigh, Luton Bedfordshire, UK).DesignPilot prospective single blind randomised controlled clinical trial.InterventionTwo types of pressure redistributing mattress.PatientsTwo groups of eight patients.MethodsPatients included in the study were those at high risk (Norton scale <8) or with a PU on admission.ResultsThe two groups had similar patient characteristics. However, the NIMBUS 3 group presented with more ulcers per patient on admission (62.5%) and more severe ulcers (20% category 3) while four patients (50%) presented with a single superficial ulcer in the ROHO group.HealingThe progress of the ulcers showed significant decreases in PU surface area (p = 0.05), total PUSH tool score (p = 0.01) in the NIMBUS 3 group compared to the ROHO group. In the NIMBUS 3 group 82% of the ulcers improved versus none in the ROHO group (p = 0.002) and 18% remained stable versus 33%. None of the ulcers deteriorated in the NIMBUS 3 group versus 67% in the ROHO group (p = 0.006). Full thickness wounds (Category 3) were present in 22% of the NIMBUS 3 group versus 0% of the ROHO group on admission and in 0% versus 66.7% (p = 0.008) respectively at the end of the pilot study.PreventionNon-blanching erythema occurred equally in both arms at baseline; skin remained intact for the NIMBUS 3 group while 50% in the ROHO group worsened with superficial tissue loss.ConclusionThis small pilot study suggests that ‘active’ alternating therapy is a useful adjunct in the care of highly vulnerable patients, while the outcomes may be less favourable when using ‘reactive’, constant low pressure devices.     

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study

BackgroundPressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK.ObjectiveTo examine healthcare support workers’ knowledge and attitudes regarding pressure ulcer prevention.MethodsA cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool.ResultsA total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005).ConclusionWhile positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers’ pressure ulcer knowledge and to inform a national continuous education strategy.     

Measuring disease activity and damage in discoid lupus erythematosus

Background Discoid lupus erythematosus (DLE) is a disfiguring inflammatory skin disease. There is no specific tool for measuring disease severity. Objectives To determine the features needed in a score measuring activity and damage in DLE and to investigate the score’s reliability and its correlation with the physician’s global assessment of disease severity and the patient‐reported Dermatology Quality of Life Index (DLQI). Methods The content of the score was determined following a peer review, pilot work in patients and a preliminary inter‐rater reliability study. The Score of Activity and Damage in DLE (SADDLE) measures severity of activity (erythema, scale, induration) and damage (scarring/atrophy and dyspigmentation) attributable to DLE. Summed scores range between 0 and 195. Inter‐ and intrarater reliability of the score was tested using six assessors and nine patients with DLE. Intraclass correlation coefficients (ICCs) > 0·7 were considered evidence of good inter‐ and intrarater agreement. Results The mean ± SD SADDLE score of nine patients in the inter‐rater reliability study was 47 ± 22 (range 14–102). There was good inter‐rater agreement for the total score [ICC 0·82; 95% confidence interval (CI) 0·61–0·95] and for the activity and damage scales, the individual physical signs and the total scores at individual body sites. The total score demonstrated excellent intrarater reliability (ICC 0·98; 95% CI 0·86–1·00). Although there was poor inter‐rater agreement for global assessments (ICC 0·28; 95% CI 0·06–0·66), a good correlation was demonstrated between total scores and global assessments (r = 0·7). A weaker positive correlation was observed between disease activity scores and DLQI (r = 0·4). Conclusions The SADDLE measures activity and damage in patients with DLE. It demonstrates good inter‐ and excellent intrarater agreement, over and above that for global assessment. It correlates well with global assessment scores. Further studies are required to investigate SADDLE’s responsiveness to change with therapy.     

Associations between skin structural and functional changes after loading in healthy aged females at sacral and heel skin: A secondary data analysis

Aim of the studyMechanical loading causes skin occlusion and deformation, which influences structural and functional skin properties. Aims of the study were to measure structural and functional skin parameters after loading at the sacral and heel skin and to describe possible associations.Material and methodsA secondary data analysis based on a clinical trial with n = 15 aged women was conducted. Changes of transepidermal water loss, stratum corneum hydration, epidermal hydration, erythema, temperature, structural stiffness, elastic recovery, elastic function, and mean roughness after 120 min loading were described and compared. Spearman's rho (r_s) was used to estimate possible associations.ResultsLoading caused an increase of transepidermal water loss, stratum corneum and epidermal hydration, erythema and temperature at sacral and heel skin. There was a decrease of median roughness at the heel skin surface (-8.5 (IQR -10.5 to 5.5) μm). Strongest positive associations were observed between changes of elastic function and elastic recovery (r_s = 0.9 at heel and sacral skin) and between changes of epidermal and stratum corneum hydration at both skin areas (r_s = 0.7 at sacral skin and r_s = 0.5 at the heel).ConclusionTwo hours loading on a standard foam mattress leads to skin occlusion at the skin surface and mechanical deformation. Skin occlusion seems primarily to increase temperature, stratum corneum and epidermal hydration that may affect mechanical skin properties. Mechanical deformation seems to be responsible for the erythematous response of the dermal skin layer.