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Dissemond J, Protz K, Erfurt-Berge C, Kröger K, Kottner J. [Wound treatment without curative intention: position paper of the Initiative Chronische Wunden (ICW) e. V.]. Hautarzt 2022; 73:550-555. [PMID: 35296922 DOI: 10.1007/s00105-022-04973-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
Today, patients with chronic wounds are treated in many different fields of medicine. Despite this great interdisciplinary and interprofessional importance, there is still a lack of uniformly accepted definitions and classifications. Therefore, a group of experts from the professional society Initiative Chronische Wunden (ICW) e. V. translated and adapted the classification of chronic wounds into healable, maintenance and nonhealable wounds on the basis of the internationally published literature into German. This classification results in the aim of curative, limited respectively non-curative or palliative wound care, which are very important for everyday clinical practice. It thus becomes clear that complete wound closure is not always the central intention of wound treatment. For many patients with chronic wounds, other aspects such as the best possible quality of life and the promotion of health-related self-management as well as the avoidance of complications are important for treatment concepts. These therapy intentions should be differentiated and individually discussed with patients in order to facilitate shared decision making.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| | - Kerstin Protz
- CompetenzzentrumVersorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | | | - Knut Kröger
- Klinik für Angiologie, Helios Klinikum, Krefeld, Deutschland
| | - Jan Kottner
- Centrum für Human- und Gesundheitswissenschaften - Einheit Klinische Pflegewissenschaft, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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García-Fernández FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Pancorbo-Hidalgo PL. Skin injuries associated with severe life-threatening situations: A new conceptual framework. J Nurs Scholarsh 2021; 54:72-80. [PMID: 34741398 DOI: 10.1111/jnu.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.
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Dalgleish L, Campbell J, Finlayson K, Barakat-Johnson M, Beath A, Ingleman J, Parker C, Coyer F. Understanding Skin Failure: A Scoping Review. Adv Skin Wound Care 2021; 34:542-550. [PMID: 34175867 DOI: 10.1097/01.asw.0000755844.87283.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.
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Affiliation(s)
- Lizanne Dalgleish
- At the School of Nursing, Queensland University of Technology, Brisbane, Australia, Lizanne Dalgleish, PhD, RN, is PhD Candidate; Jill Campbell, PhD, RN, is Senior Research Fellow; Kathleen Finlayson, PhD, RN, is Lecturer; Jessica Ingleman, MSN, RN, is Lecturer; Christina Parker, PhD, RN, is Senior Lecturer; and Fiona Coyer, PhD, RN, is Professor. Michelle Barakat-Johnson, PhD, RN, is Senior Lecturer, University of Sydney, Camperdown. Amy Beath, BSN, RN, is Transitional Nurse Practitioner-Wounds, Murrumbidgee Local Health District, New South Wales. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2020; accepted in revised form December 1, 2020; published online ahead of print June 23, 2021
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Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
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Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Solmos S, LaFond C, Pohlman AS, Sala J, Mayampurath A. Characteristics of Critically Ill Adults With Sacrococcygeal Unavoidable Hospital-Acquired Pressure Injuries: A Retrospective, Matched, Case-Control Study. J Wound Ostomy Continence Nurs 2021; 48:11-19. [PMID: 33427805 DOI: 10.1097/won.0000000000000721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To identify characteristics of critically ill adults with sacrococcygeal, unavoidable hospital-acquired pressure injuries (uHAPIs). DESIGN Retrospective, matched, case-control design. SUBJECTS/SETTING Patients admitted to adult intensive care units (ICUs) at an urban academic medical center from January 2014 through July 2016. METHODS Thirty-four patients without uHAPI were matched to 34 patients with sacrococcygeal uHAPI. Time points of interest included admission to the ICU, the week preceding the definitive assessment date, and hospital discharge status. Variables of interest included length of stay, any diagnosis of sepsis, severity of illness, degree of organ dysfunction/failure, supportive therapies in use (eg, mechanical ventilation), and pressure injury risk (Braden Scale score). RESULTS All 34 sacrococcygeal pressure injuries were classified as uHAPI using the pressure injury prevention inventory instrument. No statistically significant differences were noted between patients for severity of illness, degree of organ dysfunction/failure, or pressure injury risk at ICU admission. At 1 day prior to the definitive assessment date and at discharge, patients with uHAPI had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores (greater organ dysfunction/failure) and lower mean Braden Scale scores (greater pressure injury risk) than patients without uHAPI. Patients with uHAPI had significantly longer lengths of stay, more supportive therapies in use, were more often diagnosed with sepsis, and were more likely to die during hospitalization. CONCLUSION Sacrococcygeal uHAPI development was associated with progressive multiorgan dysfunction/failure, greater use of supportive therapies, sepsis diagnosis, and mortality. Additional research investigating the role of multiorgan dysfunction/failure and sepsis on uHAPI development is warranted.
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Affiliation(s)
- Susan Solmos
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Cynthia LaFond
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Anne S Pohlman
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Jennifer Sala
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Anoop Mayampurath
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
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Abstract
GENERAL PURPOSE To present a systematic review of the literature conducted to define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in adult intensive care patients. 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. Outline the background information helpful for understanding the authors' systematic review of ASF in adult intensive care patients.2. Summarize the results of the authors' review of the risk factors, causes, and antecedent conditions of ASF in adult intensive care patients. ABSTRACT 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.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.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 from the included studies were extracted by one reviewer and summarized in data collection tables that were checked and verified by a second reviewer.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.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.
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Graser M, Day S, Buis A. Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review. BMC Biomed Eng 2020; 2:2. [PMID: 32903320 PMCID: PMC7422482 DOI: 10.1186/s42490-020-0036-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both. Results A systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing. Conclusion We therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.
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Affiliation(s)
- Marisa Graser
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Arjan Buis
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
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Pressure ulcer/injury classification today: An international perspective. J Tissue Viability 2020; 29:197-203. [DOI: 10.1016/j.jtv.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
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Maintaining skin integrity in the aged: A systematic review. Int J Nurs Stud 2019; 103:103509. [PMID: 31945604 DOI: 10.1016/j.ijnurstu.2019.103509] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/11/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population. OBJECTIVES The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field. DESIGN An update of a previous systematic review published in 2013 was conducted. DATA SOURCES Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted. METHODS A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies. RESULTS Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments. CONCLUSION Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.
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