Reliability of a Skin Diagnostic Device in Assessing Hydration and Erythema

The correlation between sub-epidermal moisture assessment and other early indicators of pressure ulcer development: A prospective cohort observational study. Part 2. The correlation between sub-epidermal moisture assessment, temperature, epidermal hydration and pain

There is growing interest in the roles of temperature, epidermal hydration (EH) and pain in pressure ulcer (PU) development. Investigating correlations between these measures and sub-epidermal moisture (SEM) will address this knowledge deficit. A prospective observational study enrolled 60 surgical patients from February to November 2021. SEM, temperature, EH and pain were assessed using a SEM scanner, thermography imaging, skin hydration device and numeric pain intensity scale, respectively. Measurements were taken at the sacrum, both heels and a control site, before and after surgery for 3 days. Data were analysed using Pearson or Spearman's correlation. Of the participants, 50% were male with a mean age of 58 years (±13.46). Low positive/negative correlations between SEM and temperature were found at the sacrum. However, after removing outliers, these results were not statistically significant. Other sites and follow-up days showed negligible correlations. No evidence of a correlation, to low correlations between SEM and EH were observed, but unreliable due to little variation in EH at the heels. Pain showed negligible correlations with SEM. This study did not find consistent evidence of a correlation between SEM, temperature, EH and pain, highlighting the unreliability of temperature and EH for early PU detection. Post-operative pain may also confound accurate pain assessments.

Research hotspots and trends in nursing for diabetic foot ulcers: A bibliometric analysis from 2013 to 2023

Background

Nursing can effectively prevent and ameliorate diabetic foot ulcers (DFU). However, there is a lack of literature on the bibliometric analysis of DFU nursing. This study aimed to analyze the research hotspots and development trends in DFU nursing over the past 10 years to provide references for future related research.

Methods

The Web of Science Core Collection was used to retrieve literature related to DFU nursing from 2013 to 2023. Analyses included the annual publication trends; author, institution, and country collaborations; journal and literature co-citation; and keyword co-occurrence, clustering, and bursting, performed using CiteSpace 5.8 R3.

Results

A total of 229 papers were included, showing an upward trend in annual publications. American scholar David G Armstrong (n = 3) and King's College Hospital London (n = 4) were the most productive authors and institutions, respectively. The United States ranked first (n = 45) in national contributions, followed by China and Brazil. The overall research strength between authors and institutions was relatively scattered, and intensive cooperation has not yet been formed. National collaborations resulted in a core team dominated by Europe and North America with concentrated research strengths. The most frequently co-cited journal and co-cited reference were Diabetes Care (111 citations) and Armstrong DG (2017) (131 citations), separately. Research hotspots mainly focused on risk assessment, classification systems, protective measures, and clinical management of DFU. "Primary care" and "intervention efficacy" were identified as the research trends in the coming years.

Conclusion

The field of DFU nursing requires more attention. Academic exchange and cooperation between authors, institutions, and countries should be strengthened. Our future research will focus on the latest hotspots and trends, conducting more in-depth and comprehensive studies on DFU management.

The Science of Skin: Measuring Damage and Assessing Risk

Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.

Skin hydration measurement and the prediction of the early development of pressure ulcers among at risk adults: A systematic review

This systematic review aimed to examine skin hydration and determine if this biophysical parameter can predict pressure ulcer development in at risk adults. A literature search was conducted in March 2022, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 1727 records were returned, with 9 studies satisfying the inclusion criteria. Data were extracted using a pre-designed extraction tool and a narrative synthesis of the data was undertaken. The methodological quality of the included articles was assessed using the evidence-based librarianship checklist. Included studies were published between 1997 and 2021, with most using a prospective cohort design (88.9%, n = 8). The mean sample size was 74 participants (SD = 38.6; median 71). All studies measured skin hydration objectively, with 55.6% (n = 5) using the Corneometer® CM825 and 33.3% (n = 3) of studies reported a statistically significant association between skin hydration and pressure ulcer development. The mean evidence-based librarianship percentage was 66.6% (SD: 20.7%), however, only 33.3% (n = 3) of studies scored ≥75%, indicating validity. The quality of included studies, methodology variation, and reported results has reduced the homogeneity of outcomes. This review highlights the requirement for future research evidence to ascertain the role of skin hydration in pressure ulcer development.

Brief intermittent pressure off-loading on skin microclimate in healthy adults - A descriptive-correlational pilot study

AIM

This study examined microclimate changes to the skin as a result of pressure over a 1 h period. The results were compared to skin parameter results following brief consecutive off-loading of pressure-prone areas.

DESIGN

A descriptive-correlational pilot study was undertaken.

METHOD

A convenience sample of 41 healthy adults aged 18-60 years was recruited. Participants engaged in four 1 h data collection sessions. The sessions were conducted in both semi-recumbent and supine positions. Measures of erythema, melanin, stratum corneum hydration, and skin temperature were taken at pressure-prone areas at baseline and after 1 h in an uninterrupted method (continuous pressure-loading) and every 10 min in an interrupted method (brief off-loading). The Corneometer and Mexameter (Courage + Khazaka Electronics GMbH, 2013) and Exergen DermaTemp DT-1001 RS Infrared Thermographic Scanner (Exergen Corporation, 2008) provided a digital appraisal of skin parameters. Intraclass correlation coefficients (ICC) were calculated to indicate test-retest reliability and absolute agreement of results between the two methods.

RESULTS

Strong agreement between the interrupted and uninterrupted method was observed with ICCs ranging from 0.72 to 0.99 (supine) and 0.62-0.99 (semi-recumbent). Endpoint measures tended to be higher compared to baseline measures for all skin parameters. Differences in skin parameters results by anatomical location were evident particularly for erythema and stratum corneum hydration; the elbows and heels yielded lower scores compared to the sacrum. Erythema had the most variation across methods. The supine and semi-recumbent positions had negligible effect on measured skin parameters.

CONCLUSIONS

Minimal variation between skin parameter results indicates that brief off-loading in the interrupted method did not significantly change the outcomes; minor shifts in positioning do not alter changes to the skin from pressure. Skin parameters varied by anatomical location and changed over a 1 h period of pressure-loading.

RELEVANCE TO CLINICAL PRACTICE

Biophysical techniques may be able to assist accurate assessment of skin microclimate and skin colour. As brief off-loading (interruptions) to enable skin parameter measurement does not alter skin readings, researchers can proceed with some confidence regarding the use of this protocol in future studies assessing skin parameters. This study data provides a library of cutaneous changes at pressure-prone areas of healthy adults and is expected to inform innovative approaches to pressure injury risk assessment.