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Reuvekamp H, Hekman E, van der Heide E, Matthews D. Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions. Heliyon 2024; 10:e25395. [PMID: 38370189 PMCID: PMC10869805 DOI: 10.1016/j.heliyon.2024.e25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.
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Affiliation(s)
- H. Reuvekamp
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E.E.G. Hekman
- Biomedical Device Design and Production Lab, Department of Biomechanical Engineering (BE), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E. van der Heide
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - D.T.A. Matthews
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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Pauly S, Mo P, Elliott J, Bleakney A, Pappu S, Jan Y. Effects of alternating pressure patterns on sacral skin blood flow responses in people with spinal cord injury. Int Wound J 2024; 21:e14792. [PMID: 38356253 PMCID: PMC10867481 DOI: 10.1111/iwj.14792] [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] [Received: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Alternating pressure support surface (APSS) is a common support surface for treating pressure injury in individuals with spinal cord injury (SCI). However, conflicting results on the effectiveness of APSS have been reported and may be associated with inappropriate configurations of APSS. The objectives of this study were to compare the different pressure amplitudes (75/5 mmHg [alternating between 75 and 5 mmHg] vs. 65/15 mmHg) and cycle periods (5 min [4 cycles] vs. 2.5 min [8 cycles]) of alternating pressure on sacral skin blood flow responses in 10 individuals with SCI. Sacral skin blood flow during and after loading of four alternating pressure protocols was assessed using laser Doppler flowmetry and was normalised to the value before loading (10-min baseline, 20-min loading and 10-min recovery). The results demonstrated that during the high-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (0.3658 ± 0.0688 for 75/5 mmHg and 0.1702 ± 0.0389 for 65/15 mmHg, p < 0.05); and during the low-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (1.7184 ± 0.262 for 75/5 mmHg and 0.5916 ± 0.1378 for 65/15 mmHg, p < 0.05). There were no differences between cycle periods in skin blood flow responses. No adverse events were reported. Our finding indicates that the pressure amplitude of alternating pressure is a significant factor affecting sacral skin blood flow responses. An appropriate configuration of alternating pressure is needed to effectively increase skin blood flow and tissue viability in individuals with SCI.
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Affiliation(s)
- Serah Pauly
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
| | - Pu‐Chun Mo
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jeannette Elliott
- Disability Resources and Educational ServicesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Adam Bleakney
- Disability Resources and Educational ServicesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Suguna Pappu
- Department of NeurosurgeryCarle Foundation HospitalUrbanaIllinoisUSA
| | - Yih‐Kuen Jan
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
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Russell LJ, Dodd T, Kendall D, Lazenbury A, Leggett A, Payton-Haines S, Jiang L, Filingeri D, Worsley PR. A bioengineering investigation of cervical collar design and fit: Implications on skin health. Clin Biomech (Bristol, Avon) 2024; 112:106178. [PMID: 38232471 DOI: 10.1016/j.clinbiomech.2024.106178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Cervical collars restrict cervical spine movement to minimise the risk of spinal cord injury. Collars apply mechanical loading to the skin putting it at risk of skin damage. Indeed, cervical collar-related pressure ulcers are unacceptably prevalent, especially at the occiput, mandibles, and chin. Collar design and fit are often key considerations for prevention. METHODS This comprehensive study evaluated four commercial prehospital and acute care cervical collars. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans. FINDINGS The occiput experienced significantly higher interface pressures than the chin and mandibles for most collar designs. Interface pressure at the occiput was significantly higher for the Stiffneck extrication collar compared to the other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity at the device skin interface was significantly higher for the Stiffneck and Philadelphia collars corresponding to closed cell foam padding, in contrast to the open cell foams lined with permeable fabric used in the other collars. Collar discomfort correlated with both occipital pressure and skin humidity. INTERPRETATION The occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Lined open-cell foams could be used to minimise skin humidity and increase comfort.
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Affiliation(s)
- Laurence J Russell
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Tamara Dodd
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniel Kendall
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Amber Lazenbury
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Abigail Leggett
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sophie Payton-Haines
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Davide Filingeri
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Mbithi F, Worsley PR. Adhesives for medical application - Peel strength testing and evaluation of biophysical skin response. J Mech Behav Biomed Mater 2023; 148:106168. [PMID: 37847959 DOI: 10.1016/j.jmbbm.2023.106168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Medical adhesives are commonly used for securing wound dressings and medical devices used for diagnostic or therapeutic purposes. Mechanical irritation of skin due to adhesive stripping and repeated application can lead to discomfort and device removal. This study aims to examine the peel strength and skin response to different medical adhesives in a cohort of healthy volunteers. METHOD Twelve healthy participants were recruited for peel strength testing of three candidate adhesive tapes, and evaluation of the skin response after adhesive removal. A modified ASTM D903 peel strength testing was performed at 180° peeling angle and a rate of 300 mm/min on the forehead, upper back and forearm skin. A longitudinal study was conducted on the forearm and back, with the adhesive samples left in-situ for up to 60 h for analysis of repeat application. The effects of two skin preparation approaches (water and alcohol cleaning) prior to adhesive application were also assessed. Skin biophysical properties were assessed at baseline and at various timepoints following adhesive removal using transepidermal water loss (TEWL), erythema and hydration. RESULTS Peel strength reduced uniformly with repeat application over prolonged periods for all the adhesive samples tested. Skin preparation with water and alcohol cleansing prior to adhesive application increased peel strength at both the back (1.1% and 2.9%), and forearm (21.3% and 20%) sites. There was statistically significant increase from baseline to post-tape application for TEWL, skin redness and hydration (p < 0.001). However, there were no statistically significant differences between adhesive types (TEWL: p = 0.38, SR: p = 0.53, HY: p = 0.46). TEWL increased the most post-adhesion across all test sites and adhesive samples with repeat application (p < 0.05). Two-way ANOVA tests revealed no statistically significant interactions between the effects of application duration and adhesive on skin redness or TEWL for both the back and forearm sites (p > 0.05), though a significant interaction was indicted for hydration at the back site (p = 0.01). CONCLUSION This study revealed that site and duration of adhesive application effected peel strength. The corresponding changes in skin properties identified that skin barrier function was disrupted with long-term application of adhesives. The back site was identified to be most reliable for adhesion testing and skin response assessment for future work.
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Affiliation(s)
- Florence Mbithi
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK.
| | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK.
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Worsley PR, Greenwood C, Patton D. Professor Dan L Bader, scientist, mentor, and friend. J Tissue Viability 2023; 32:453-454. [PMID: 37980183 DOI: 10.1016/j.jtv.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Affiliation(s)
- Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK.
| | | | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland
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Abiakam NS, Jayabal H, Filingeri D, Bader DL, Worsley PR. Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer. Int Wound J 2023; 20:3164-3176. [PMID: 37060199 PMCID: PMC10502241 DOI: 10.1111/iwj.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.
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Affiliation(s)
- Nkemjika S. Abiakam
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Hemalatha Jayabal
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Davide Filingeri
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Dan L. Bader
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter R. Worsley
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Tang J, Bader DL, Parker DJ, Forghany S, Nester CJ, Moser D, Jiang L. Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention. J Wound Care 2023; 32:587-596. [PMID: 37682784 DOI: 10.12968/jowc.2023.32.9.587] [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] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention. METHOD A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking. Reliability was evaluated, using intra-class correlation coefficient (ICC), while varying the cadences and insole types. Percentage changes in pressure and shear relative to values obtained at self-selected cadence with a flat insole design were investigated. RESULTS Mean±standard deviation of maximum pressure, medial-lateral and anterior-posterior shear of up to 380±24kPa, 46±2kPa and -71±4kPa, respectively, were measured. The ICC in ranges of 0.762-0.973, 0.758-0.987 and 0.800-0.980 were obtained for pressure, anterior-posterior and medial-lateral shear, respectively. Opposite anterior-posterior shear directions between 5MH and 1MH (stretching), and between 1MH and hallux (pinching) were observed for some participants. Increasing cadence increased pressure and anterior-posterior shear (by up to +77%) but reduced medial-lateral shear at the heel and hallux (by up to -34%). Slower cadence increased anterior-posterior shear (+114%) but decreased medial-lateral shear (-46%) at the hallux. The use of a flexible contoured insole resulted in pressure reduction at the heel and 5MH but an increase in anterior-posterior shear at the heel (+69%) and hallux (+75%). CONCLUSION The insole system demonstrated good reliability and is comparable to reported pressure-only systems. Pressure measurements were sensitive to changes in cadence and insole designs in ways that were consistent with the literature. However, our plantar shear showed localised shear changes with cadences and insoles for the first time, as well as stretching and pinching effects on plantar tissue. This opens new possibilities to investigate plantar tissue viability, loading characteristics and orthotic designs aimed towards foot ulcer prevention.
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Affiliation(s)
- Jinghua Tang
- School of Engineering, University of Southampton, Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Daniel J Parker
- School of Health and Society, University of Salford, Salford, UK
| | - Saeed Forghany
- School of Allied Health Professions, Keele University, Keele, UK
| | | | - David Moser
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Health Sciences, University of Southampton, Southampton, UK
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Kottner J, Coleman S. The theory and practice of pressure ulcer/injury risk assessment: a critical discussion. J Wound Care 2023; 32:560-569. [PMID: 37682783 DOI: 10.12968/jowc.2023.32.9.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different approaches, such as clinical judgement, using standardised risk assessment instruments, skin assessments, or using devices to measure skin or tissue properties. A distinction between PU risk assessment and early detection is important. PU risk measures the individual's susceptibility to developing a PU under a specific exposure (primary prevention), and early detection includes the assessment of early (sub)clinical signs and symptoms to prevent progression and to support healing (secondary prevention). PU risk is measured using prognostic/risk factors or prognostic models. Every risk estimate is a probability statement containing varying degrees of uncertainty. It therefore follows that every clinical decision based on risk estimates also contains uncertainty. PU risk assessment and prevention is a complex intervention, where delivery contains several interacting components. There is a huge body of evidence indicating that risk assessment and its outcomes, the selection of preventive interventions and PU incidence are not well connected. Methods for prognostic model development and testing in PU risk research must be improved and follow state-of-the-art methodological standards. Despite these challenges, we do have substantial knowledge about PU risk factors that helps us to make better clinical decisions. An important next step in the development of PU risk prediction might be the combination of clinical and other predictors for more individualised care. Any prognostic test or procedure must lead to better prevention at an acceptable cost.
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Affiliation(s)
- Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
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Jayabal H, Abiakam NS, Filingeri D, Bader DL, Worsley PR. Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients. Int Wound J 2023; 20:2594-2607. [PMID: 36872612 PMCID: PMC10410330 DOI: 10.1111/iwj.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
Pressure Ulcers (PU) are a major burden for affected patients and healthcare providers. Current detection methods involve visual assessments of the skin by healthcare professionals. This has been shown to be subjective and unreliable, with challenges associated with identifying erythema in darker colour skin. Although there exists a number of promising non-invasive biophysical techniques such as ultrasound, capacitance measurements, and thermography, the present study focuses on directly measuring the changes in the inflammatory status of the skin and underlying tissues. Therefore, in this study, we aim to analyse inflammatory cytokines collected through non-invasive sampling techniques to detect early signs of skin damage. Thirty hospitalised patients presenting with Stage I PU were recruited to evaluate the inflammatory response of skin at the site of damage and an adjacent healthy control site. Sebutapes were collected over three sessions to investigate the temporal changes in the inflammatory response. The panel of cytokines investigated included high-abundance cytokines, namely, IL-1α and IL-1RA, and low abundance cytokines; IL-6, IL-8, TNF-α, INF-γ, IL-33, IL-1β and G-CSF. Spatial and temporal differences between sites were assessed and thresholds were used to determine the sensitivity and specificity of each biomarker. The results suggest significant (P < .05) spatial changes in the inflammatory response, with upregulation of IL-1α, IL-8, and G-CSF as well as down-regulation of IL-1RA over the Stage I PU compared with the adjacent control site. There were no significant temporal differences between the three sessions. Selected cytokines, namely, IL-1α, IL-1RA, IL-8, G-CSF, and the ratio IL-1α/IL-1RA offered clear delineation in the classification of healthy and Stage-I PU skin sites, with receiver operating characteristic curves demonstrating high sensitivity and specificity. There were limited influences of intrinsic and extrinsic factors on the biomarker response. Inflammatory markers provided a high level of discrimination between the sites presenting with Stage I PU and an adjacent healthy skin site, in a cohort of elderly inpatients. Indeed, the ratio of IL-1α to IL-1RA provided the highest sensitivity and specificity, indicative that inflammatory homeostasis is affected at the PU site. There was a marginal influence of intrinsic and extrinsic factors, demonstrating the localised effects of the inflammation. Further studies are required to investigate the potential of inflammatory cytokines incorporated within Point of Care technologies, to support routine clinical use.
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Affiliation(s)
| | | | | | - Dan L. Bader
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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10
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Paquin C, Rozaire J, Chenu O, Gelis A, Dubuis L, Duprey S. Studying mechanical load at body-seat interface during dynamic activities such as wheelchair propulsion: a scoping review. Disabil Rehabil Assist Technol 2023:1-11. [PMID: 37610140 DOI: 10.1080/17483107.2023.2248184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities. OBJECTIVES A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. MATERIALS AND METHODS The literature search was performed by applying the PRISMA methodology. RESULTS A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. CONCLUSION Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.
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Affiliation(s)
- Clémence Paquin
- Univ Lyon, Univ Gustave Eiffel, Lyon, France
- Texisense, Torcy, France
| | | | | | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, Montpellier, France
- EPSYLON laboratory, Montpellier, France
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11
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Devin KM, Tang J, Moser D, Jiang L. Assessing Socket Fit Effects on Pressure and Shear at a Transtibial Residuum/Socket Interface. Appl Bionics Biomech 2023; 2023:3257059. [PMID: 37621485 PMCID: PMC10447010 DOI: 10.1155/2023/3257059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Fluctuations in residuum volume during daily activities are known to occur in lower-limb amputees. This can cause frequent changes to fit, which cannot be accommodated by commonly-used prosthetic sockets. The real-time effects, if any, of these minor socket fit changes on interface biomechanics have not been studied extensively. Amputees commonly use different layers of socks to accommodate frequent volume fluctuations, enabling adjustment of socket fit. We, thus, altered socket fit levels via addition/removal of sock layers to a transtibial amputee who habitually-donned two-sock layers to mimic relatively looser and tighter socket fits. Interface pressure and shear sensors were placed at known prominent load-bearing sites of the transtibial residuum/socket interface, i.e., patellar tendon (PT), popliteal fossa (PF), and anterior-distal (AD) end, to measure real-time biomechanical interactions during standing and level walking. Although socket fit level was only slightly modified, changes in interface pressure and shear across anatomical sites were still observed. Tighter fit corresponds to notable pressure reduction at AD during early stance and pressure increase at PT during terminal stance due to the residuum being pushed up. Shear-to-pressure ratios were used to assess comfort, while pressure- and shear-time integrals were used to assess tissue health. We observed more notable changes at tissue sites (e.g., AD and PF). Combined evaluation of pressure and shear, including shear-to-pressure ratio and time integrals, may offer insight for residuum care.
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Affiliation(s)
- Kirstie M. Devin
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - David Moser
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Tang J, Bader DL, Moser D, Parker DJ, Forghany S, Nester CJ, Jiang L. A Wearable Insole System to Measure Plantar Pressure and Shear for People with Diabetes. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23063126. [PMID: 36991838 PMCID: PMC10056665 DOI: 10.3390/s23063126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/12/2023]
Abstract
Pressure coupled with shear stresses are the critical external factors for diabetic foot ulceration assessment and prevention. To date, a wearable system capable of measuring in-shoe multi-directional stresses for out-of-lab analysis has been elusive. The lack of an insole system capable of measuring plantar pressure and shear hinders the development of an effective foot ulcer prevention solution that could be potentially used in a daily living environment. This study reports the development of a first-of-its-kind sensorised insole system and its evaluation in laboratory settings and on human participants, indicating its potential as a wearable technology to be used in real-world applications. Laboratory evaluation revealed that the linearity error and accuracy error of the sensorised insole system were up to 3% and 5%, respectively. When evaluated on a healthy participant, change in footwear resulted in approximately 20%, 75% and 82% change in pressure, medial-lateral and anterior-posterior shear stress, respectively. When evaluated on diabetic participants, no notable difference in peak plantar pressure, as a result of wearing the sensorised insole, was measured. The preliminary results showed that the performance of the sensorised insole system is comparable to previously reported research devices. The system has adequate sensitivity to assist footwear assessment relevant to foot ulcer prevention and is safe to use for people with diabetes. The reported insole system presents the potential to help assess diabetic foot ulceration risk in a daily living environment underpinned by wearable pressure and shear sensing technologies.
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Affiliation(s)
- Jinghua Tang
- School of Engineering, University of Southampton, Southampton SO17 1BJ, UK
| | - Dan L. Bader
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - David Moser
- School of Engineering, University of Southampton, Southampton SO17 1BJ, UK
| | - Daniel J. Parker
- School of Health and Society, University of Salford, Salford M6 6PU, UK
| | - Saeed Forghany
- School of Allied Health Professions, Keele University, Keele, Newcastle ST5 5BG, UK
| | | | - Liudi Jiang
- School of Engineering, University of Southampton, Southampton SO17 1BJ, UK
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13
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John AJUK, Galdo FD, Gush R, Worsley PR. An evaluation of mechanical and biophysical skin parameters at different body locations. Skin Res Technol 2023; 29:e13292. [PMID: 36823505 PMCID: PMC10155800 DOI: 10.1111/srt.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Skin is the largest organ in the body, representing an important interface to monitor health and disease. However, there is significant variation in skin properties for different ages, genders and body regions due to the differences in the structure and morphology of the skin tissues. This study aimed to evaluate the use of non-invasive tools to discriminate a range of mechanical and functional skin parameters from different skin sites. MATERIALS AND METHODS A cohort of 15 healthy volunteers was recruited following appropriate informed consent. Four well-established CE-marked non-invasive techniques were used to measure four anatomical regions: palm, forearm, sole and lower lumbar L3, using a repeated measures design. Skin parameters included trans-epidermal water loss (TEWL), pH (acidity), erythema, stratum corneum hydration and stiffness and elasticity using Myoton Pro (skin and muscle probe). Differences between body locations for each parameter and the intra-rater reliability between days were evaluated by the same operator. RESULTS The results indicate that parameters differed significantly between skin sites. For the Myoton skin probe, the sole recorded the highest stiffness value of 1006 N/m (SD ± 179), while the lower lumbar recorded the least value of 484 N/m (SD ± 160). The muscle indenter Myoton probe revealed the palm's highest value of 754 N/m (± 108), and the lower lumbar recorded the least value of 208 N/m (SD ± 44). TEWL values were lowest on the forearm, averaging 11 g/m2/h, and highest on the palm, averaging 41 g/m2/h. Similar skin hydration levels were recorded in three of the four sites, with the main difference being observed in the sole averaging 13 arbitrary units. Erythema values were characterised by a high degree of inter-subject variation, and no significant differences between sites or sides were observed. The Myoton Pro Skin showed excellent reliability (intra-class correlation coefficients > 0.70) for all sites with exception of one site right lower back; the Myoton pro muscle probes showed good to poor reliability (0.90-017), the corneometer showed excellent reliability (>0.75) among all the sites tested, and the TEWL showed Good to poor reliability (0.74-0.4) among sites. CONCLUSION The study revealed that using non-invasive methods, the biophysical properties of skin can be mapped, and significant differences in the mechanical and functional properties of skin were observed. These parameters were reliably recorded between days, providing a basis for their use in assessing and monitoring changes in the skin during health and disease.
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Affiliation(s)
| | - Francesco Del Galdo
- Raynaud's and Scleroderma Programme, NIHR Biomedical Research CentreLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of LeedsLeedsUK
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14
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Neumann EE, Doherty S, Bena J, Erdemir A. Role of multi-layer tissue composition of musculoskeletal extremities for prediction of in vivo surface indentation response and layer deformations. PLoS One 2023; 18:e0284721. [PMID: 37083580 PMCID: PMC10121013 DOI: 10.1371/journal.pone.0284721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
Emergent mechanics of musculoskeletal extremities (surface indentation stiffness and tissue deformation characteristics) depend on the underlying composition and mechanics of each soft tissue layer (i.e. skin, fat, and muscle). Limited experimental studies have been performed to explore the layer specific relationships that contribute to the surface indentation response. The goal of this study was to examine through statistical modeling how the soft tissue architecture contributed to the aggregate mechanical surface response across 8 different sites of the upper and lower extremities. A publicly available dataset was used to examine the relationship of soft tissue thickness (fat and muscle) to bulk tissue surface compliance. Models required only initial tissue layer thicknesses, making them usable in the future with only a static ultrasound image. Two physics inspired models (series of linear springs), which allowed reduced statistical representations (combined locations and location specific), were explored to determine the best predictability of surface compliance and later individual layer deformations. When considering the predictability of the experimental surface compliance, the physics inspired combined locations model showed an improvement over the location specific model (percent difference of 25.4 +/- 27.9% and 29.7 +/- 31.8% for the combined locations and location specific models, respectively). While the statistical models presented in this study show that tissue compliance relies on the individual layer thicknesses, it is clear that there are other variables that need to be accounted for to improve the model. In addition, the individual layer deformations of fat and muscle tissues can be predicted reasonably well with the physics inspired models, however additional parameters may improve the robustness of the model outcomes, specifically in regard to capturing subject specificity.
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Affiliation(s)
- Erica E Neumann
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
- Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Sean Doherty
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
- Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - James Bena
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
- Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
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15
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Abiakam N, Jayabal H, Mitchell K, Bader D, Worsley P. Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID-19 pandemic. Skin Res Technol 2023; 29:e13239. [PMID: 36382670 PMCID: PMC9838774 DOI: 10.1111/srt.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. MATERIALS AND METHODS A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. RESULTS The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). CONCLUSIONS The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.
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Affiliation(s)
- Nkemjika Abiakam
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Hemalatha Jayabal
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Kay Mitchell
- Critical Care Team, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Dan Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
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16
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Aoki Y, Suzuki M, Takahashi H, Nakajima A, Sonobe M, Kotani T, Nakajima T, Sato Y, Inoue M, Saito J, Norimoto M, Eguchi Y, Orita S, Ohtori S, Nakagawa K. Comparison of pain and discomfort in supine and lateral positions after surgery for lumbar degenerative disease: A prospective randomized controlled study. Int J Orthop Trauma Nurs 2022; 47:100959. [PMID: 36055074 DOI: 10.1016/j.ijotn.2022.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To compare postoperative pain and discomfort between supine and lateral positions after lumbar surgery, a prospective randomized controlled study was performed. METHODS Forty-three patients with lumbar degenerative disease, treated by decompression (n = 23) or fusion surgery (n = 20), were randomly assigned to be placed in either the supine (supine group: n = 21) or lateral (lateral group: n = 22) position postoperatively, and asked to maintain their position until a day after the surgery. Postoperative back pain and discomfort (visual analog scale [VAS], 0-100 mm) and the number of patients who could maintain their position were examined. RESULTS The VAS scores for back pain (supine: 64.9 ± 22.0, lateral: 55.7 ± 21.4) showed no significant difference between the positions. However, the supine group showed significantly more severe discomfort (75.6 ± 15.7) than the lateral group (64.9 ± 15.7, p = 0.039). Significantly fewer patients maintained their position in the supine group (28.2%) than in the lateral group (68.2%; p = 0.022). Among patients who underwent fusion surgery, significantly fewer patients maintained their position in the supine group (10.0%) than those in the lateral group (60.0%, p = 0.029). CONCLUSION Postoperative discomfort was significantly reduced in the lateral position than in the supine position; thus, the lateral position is more suitable after lumbar surgery in terms of postoperative discomfort.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
| | - Makoto Suzuki
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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17
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Caggiari S, Bader DL, Foxell F, Pipe N, Couch S, Turner A, Worsley PR. Biomechanical and Physiological Evaluation of Respiratory Protective Equipment Application. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:241-252. [PMID: 35928220 PMCID: PMC9343257 DOI: 10.2147/mder.s370142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory protective equipment is widely used in healthcare settings to protect clinicians whilst treating patients with COVID-19. However, their generic designs do not accommodate the variability in face shape across genders and ethnicities. Accordingly, they are regularly overtightened to compensate for a poor fit. The present study aims at investigating the biomechanical and thermal loads during respirator application and the associated changes in local skin physiology at the skin–device interface. Materials and Methods Sixteen healthy volunteers were recruited and reflected a range of gender, ethnicities and facial anthropometrics. Four single-use respirators were evaluated representing different geometries, size and material interfaces. Participants were asked to wear each respirator in a random order while a series of measurements were recorded, including interface pressure, temperature and relative humidity. Measures of transepidermal water loss and skin hydration were assessed pre- and post-respirator application, and after 20 minutes of recovery. Statistical analysis assessed differences between respirator designs and associations between demographics, interface conditions and parameters of skin health. Results Results showed a statistically significant negative correlation (p < 0.05) between the alar width and interface pressures at the nasal bridge, for three of the respirator designs. The nasal bridge site also corresponded to the highest pressures for all respirator designs. Temperature and humidity significantly increased (p < 0.05) during each respirator application. Significant increases in transepidermal water loss values (p < 0.05) were observed after the application of the respirators in females, which were most apparent at the nasal bridge. Conclusion The results revealed that specific facial features affected the distribution of interface pressures and depending on the respirator design and material, changes in skin barrier function were evident. The development of respirator designs that accommodate a diverse range of face shapes and protect the end users from skin damage are required to support the long-term use of these devices.
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Affiliation(s)
- Silvia Caggiari
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
- Correspondence: Silvia Caggiari, Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK, Email
| | - Dan L Bader
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Finn Foxell
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Nicholas Pipe
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Seana Couch
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Abbie Turner
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Peter R Worsley
- Clinical Academic Facility, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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18
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Jan YK, Major MJ, Pu F, Sonenblum SE. Editorial: Soft Tissue Biomechanics in Wound Healing and Prevention. Front Bioeng Biotechnol 2022; 10:897860. [PMID: 35449596 PMCID: PMC9017806 DOI: 10.3389/fbioe.2022.897860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- *Correspondence: Yih-Kuen Jan,
| | - Matthew J. Major
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Sharon Eve Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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19
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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20
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Kelly ES, Worsley PR, Bowen CJ, Cherry LS, Keenan BE, Edwards CJ, O'Brien N, King L, Dickinson AS. Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling. Front Bioeng Biotechnol 2022; 9:803725. [PMID: 35004656 PMCID: PMC8733946 DOI: 10.3389/fbioe.2021.803725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Foot orthoses are prescribed to reduce forefoot plantar pressures and pain in people with rheumatoid arthritis. Computational modelling can assess how the orthoses affect internal tissue stresses, but previous studies have focused on a single healthy individual. This study aimed to ascertain whether simplified forefoot models would produce differing biomechanical predictions at the orthotic interface between people with rheumatoid arthritis of varying severity, and in comparison to a healthy control. The forefoot models were developed from magnetic resonance data of 13 participants with rheumatoid arthritis and one healthy individual. Measurements of bony morphology and soft tissue thickness were taken to assess deformity. These were compared to model predictions (99th% shear strain and plantar pressure, max. pressure gradient, volume of soft tissue over 10% shear strain), alongside clinical data including body mass index and Leeds Foot Impact Scale–Impairment/Footwear score (LFIS-IF). The predicted pressure and shear strain for the healthy participant fell at the lower end of the rheumatoid models’ range. Medial first metatarsal head curvature moderately correlated to all model predicted outcomes (0.529 < r < 0.574, 0.040 < p < 0.063). BMI strongly correlated to all model predictions except pressure gradients (0.600 < r < 0.652, p < 0.05). There were no apparent relationships between model predictions and instances of bursae, erosion and synovial hypertrophy or LFIS-IF score. The forefoot models produced differing biomechanical predictions between a healthy individual and participants with rheumatoid arthritis, and between individuals with rheumatoid arthritis. Models capable of predicting subject specific biomechanical orthotic interactions could be used in the future to inform more personalised devices to protect skin and soft tissue health. While the model results did not clearly correlate with all clinical measures, there was a wide range in model predictions and morphological measures across the participants. Thus, the need for assessment of foot orthoses across a population, rather than for one individual, is clear.
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Affiliation(s)
- Emily S Kelly
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Catherine J Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Lindsey S Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Bethany E Keenan
- Cardiff School of Engineering and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Neil O'Brien
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Leonard King
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alex S Dickinson
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
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21
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Masri S, Zawani M, Zulkiflee I, Salleh A, Fadilah NIM, Maarof M, Wen APY, Duman F, Tabata Y, Aziz IA, Bt Hj Idrus R, Fauzi MB. Cellular Interaction of Human Skin Cells towards Natural Bioink via 3D-Bioprinting Technologies for Chronic Wound: A Comprehensive Review. Int J Mol Sci 2022; 23:476. [PMID: 35008902 PMCID: PMC8745539 DOI: 10.3390/ijms23010476] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Skin substitutes can provide a temporary or permanent treatment option for chronic wounds. The selection of skin substitutes depends on several factors, including the type of wound and its severity. Full-thickness skin grafts (SGs) require a well-vascularised bed and sometimes will lead to contraction and scarring formation. Besides, donor sites for full-thickness skin grafts are very limited if the wound area is big, and it has been proven to have the lowest survival rate compared to thick- and thin-split thickness. Tissue engineering technology has introduced new advanced strategies since the last decades to fabricate the composite scaffold via the 3D-bioprinting approach as a tissue replacement strategy. Considering the current global donor shortage for autologous split-thickness skin graft (ASSG), skin 3D-bioprinting has emerged as a potential alternative to replace the ASSG treatment. The three-dimensional (3D)-bioprinting technique yields scaffold fabrication with the combination of biomaterials and cells to form bioinks. Thus, the essential key factor for success in 3D-bioprinting is selecting and developing suitable bioinks to maintain the mechanisms of cellular activity. This crucial stage is vital to mimic the native extracellular matrix (ECM) for the sustainability of cell viability before tissue regeneration. This comprehensive review outlined the application of the 3D-bioprinting technique to develop skin tissue regeneration. The cell viability of human skin cells, dermal fibroblasts (DFs), and keratinocytes (KCs) during in vitro testing has been further discussed prior to in vivo application. It is essential to ensure the printed tissue/organ constantly allows cellular activities, including cell proliferation rate and migration capacity. Therefore, 3D-bioprinting plays a vital role in developing a complex skin tissue structure for tissue replacement approach in future precision medicine.
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Affiliation(s)
- Syafira Masri
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Mazlan Zawani
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Izzat Zulkiflee
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Atiqah Salleh
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nur Izzah Md Fadilah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Manira Maarof
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Adzim Poh Yuen Wen
- Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Fatih Duman
- Department of Biology, Faculty of Science, University of Erciyes, 38039 Kayseri, Turkey
| | - Yasuhiko Tabata
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
- Department of Biomaterials, Institute of Frontier Medical Science, Kyoto University, 53 Kawara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Izhar Abd Aziz
- 3D Gens Sdn Bhd, 18, Jalan Kerawang U8/108, Bukit Jelutong, Shah Alam 40150, Malaysia
| | - Ruszymah Bt Hj Idrus
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
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Chaturvedi P, Worsley PR, Zanelli G, Kroon W, Bader DL. Quantifying skin sensitivity caused by mechanical insults: A review. Skin Res Technol 2021; 28:187-199. [PMID: 34708455 PMCID: PMC9298205 DOI: 10.1111/srt.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin sensitivity (SS) is a commonly occurring response to a range of stimuli, including environmental conditions (e.g., sun exposure), chemical irritants (e.g., soaps and cosmetics), and mechanical forces (e.g., while shaving). From both industry and academia, many efforts have been taken to quantify the characteristics of SS in a standardised manner, but the study is hindered by the lack of an objective definition. METHODS A review of the scientific literature regarding different parameters attributed to the loss of skin integrity and linked with exhibition of SS was conducted. Articles included were screened for mechanical stimulation of the skin, with objective quantification of tissue responses using biophysical or imaging techniques. Additionally, studies where cohorts of SS and non-SS individuals were reported have been critiqued. RESULTS The findings identified that the structure and function of the stratum corneum and its effective barrier properties are closely associated with SS. Thus, an array of skin tissue responses has been selected for characterization of SS due to mechanical stimuli, including: transepidermal water loss, hydration, redness, temperature, and sebum index. Additionally, certain imaging tools allow quantification of the superficial skin layers, providing structural characteristics underlying SS. CONCLUSION This review proposes a multimodal approach for identification of SS, providing a means to characterise skin tissue responses objectively. Optical coherence tomography (OCT) has been suggested as a suitable tool for dermatological research with clinical applications. Such an approach would enhance the knowledge underlying the multifactorial nature of SS and aid the development of personalised solutions in medical and consumer devices.
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Affiliation(s)
- Pakhi Chaturvedi
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands.,School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Giulia Zanelli
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands
| | - Wilco Kroon
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands
| | - Dan L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
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23
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The Efficacy and Safety of Botulinum Toxin Injections in Preventing Postoperative Scars and Improving Scar Quality: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2350-2362. [PMID: 33674930 DOI: 10.1007/s00266-021-02196-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Scars exposed on the body surface lead to a large psychological burden on patients. However, no satisfactory scar treatments exist. Botulinum toxin type A is a neurotoxin that has been widely applied in the plastic and cosmetic surgery field. The purpose of this meta-analysis was to assess the efficacy and safety of botulinum toxin in scar management. METHODS PubMed, the Cochrane Library, EMBASE, MEDLINE, and Web of Science were searched for randomized controlled trials that evaluated the efficacy of botulinum toxin injections in preventing postoperative scars and improving scars quality and were published prior to Dec. 29, 2020. The outcome indicators were the visual analog scale score, Vancouver scar scale score, Stony Brook scar evaluation scales score, scar width, patient self-assessment results, and complications. RESULTS Seventeen randomized controlled trials with a total of 633 cases were identified in this meta-analysis. The quantitative synthesis results showed that compared with the control group, the botulinum toxin group had a significantly lower VSS score (MD = -0.97, 95%CI = -1.56 to -0.39, p = 0.001), higher VAS score (MD = 1.26, 95%CI = 1.04 to 1.47, p < 0.00001), thinner scar width (MD = -0.25, 95%CI = -0.37 to -0.12, p < 0.0001) and higher patient satisfaction (RR = 3.38 95%CI = 1.45 to 7.89, p = 0.005). There were no significant differences between the two groups in the number of adverse events. CONCLUSIONS This meta-analysis demonstrated that botulinum toxin injections can significantly improve cosmetic appearance and postoperative scar quality. At the therapeutic dose, no significant complications were observed, indicating that botulinum toxin injections are safe. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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24
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Bryant RA, Moore ZE, Iyer V. Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning. Expert Rev Med Devices 2021; 18:833-847. [PMID: 34338565 DOI: 10.1080/17434440.2021.1960505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need. AREAS COVERED This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice. EXPERT OPINION The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).
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Affiliation(s)
- Ruth A Bryant
- Principal Research Scientist/Nursing, President, Association for the Advancement of Wound Care (AAWC), Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Zena Eh Moore
- Director of the Skin Wounds and Trauma (Swat)research Centre, MSc (Leadership in Health Professionals Education), MSc (Wound Healing & Tissue Repair), FFNMRCSI, Professor and Head of the School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Ireland.,Department is School of Medicine, Honorary Visiting Professor, Cardiff University, Cardiff, Wales.,Adjunct Professor, Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Professor, Vakgroep Maatschappelijke Gezondheidkunde, Department of Public Health; Faculteit Geneeskunde En Gezondheidswetenschappen, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium.,Department is School of Nursing, Honorary Professor, Lida Institute, Shanghai, China
| | - Vignesh Iyer
- MS Biotechnology and Clinical Lab Sciences, MSc Biotechnology, Senior Manager, Clinical R&D and Medical Affairs, Bruin Biometrics, LLC, Los Angeles, CA
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25
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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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26
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Boyle CJ, Higgins CA. Can plantar fibroblast implantation protect amputees from skin injury? A recipe for skin augmentation. Exp Dermatol 2021; 30:1829-1833. [PMID: 34173264 DOI: 10.1111/exd.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Skin injuries remain a persistent problem for users of lower-limb prostheses despite sustained progress in prosthesis design. One factor limiting the prevention of skin injuries is that skin on the residual limb is not suited to bear the mechanical loads of ambulation. One part of the body that is suited to this task is the sole of the foot. Here, we propose a novel strategy to actively augment skin's tolerance to load, increasing its resistance to mechanically induced injuries. We hypothesise that the load tolerance of skin can be augmented by autologous transplantation of plantar fibroblasts into the residual limb dermis. We expect that introducing plantar fibroblasts will induce the overlying keratinocytes to express plantar-specific keratins leading to a tougher epidermis. Using a computational finite element model of a weight-bearing residual limb, we estimate that skin deformation (a key driver of pressure ulcer injuries) could be halved by reprogramming skin to a plantar-like phenotype. We believe this strategy could yield new progress in pressure ulcer prevention for amputees, facilitating rehabilitation and improving quality of life for patients.
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Affiliation(s)
- Colin J Boyle
- Department of Bioengineering, Imperial College London, London, UK.,Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire A Higgins
- Department of Bioengineering, Imperial College London, London, UK
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27
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Yunir E, Tahapary DL, Tarigan TJE, Harbuwono DS, Oktavianda YD, Kristanti M, Iswati E, Sarumpaet A, Soewondo P. Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia. J Diabetes Metab Disord 2021; 20:805-813. [PMID: 34178865 PMCID: PMC8212257 DOI: 10.1007/s40200-021-00827-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Diabetic foot ulcer (DFU) is a common chronic complication of type 2 diabetes mellitus (T2DM) in Indonesia, with a prevalence of 7.3%. However, the characteristics of these patients remain unclear. We investigated the characteristics of patients with DFU without peripheral arterial disease (PAD) and analyzed non-vascular factors related to severity of DFU in a tertiary care national referral hospital in Indonesia. METHODS This was a cross-sectional study including 123 hemodynamically stable DFU patients without PAD recruited from Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from 2010-2015. RESULTS DFU patients were predominantly over 50 years old (75.6%) and diagnosed with T2DM for 5 years with poor glycemic control (82.7%) and peripheral neuropathy (91.3%). Most patients had anemia (86.7%), leukocytosis (84.6%), and were undernourished, as characterized by a low lipid profile (90.8%) and hypoalbuminemia (83.7%). Most had extensive size of ulcer at the initial visit, with a median size of 16.23 (2.92-60.16) cm2. Ulcers were mostly located of the forefoot (62.5%) and were caused by mechanical trauma (46.2%). Bivariate analysis revealed that significant factors for the development of DFU were related to DFU size, including duration of T2DM (p = 0.04), leukocyte levels (p = < 0.01), and thrombocyte levels (p = < 0.01). Multivariate analysis showed leucocyte (p = 0.03) and thrombocyte (p = 0.023) had significantly correlated with DFU severity. CONCLUSION Leucocyte and thrombocyte may be the greatest contributing non-vascular factors for severity of DFU in Indonesia.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dicky L. Tahapary
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dante Saksono Harbuwono
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yoga Dwi Oktavianda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Melly Kristanti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Eni Iswati
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Angela Sarumpaet
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Pradana Soewondo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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28
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Jayabal H, Bates-Jensen BM, Abiakam NS, Worsley PR, Bader DL. The identification of biophysical parameters which reflect skin status following mechanical and chemical insults. Clin Physiol Funct Imaging 2021; 41:366-375. [PMID: 33934487 DOI: 10.1111/cpf.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Skin is constantly exposed to mechanical and chemical insults, in the form of prolonged loading, overhydration or exposure to irritants. An array of non-invasive biophysical tools has been adopted to monitor the changes in skin response. The present study aims to identify a set of robust parameters sensitive to mechanical and chemical challenges to skin integrity. MATERIALS AND METHODS Eleven healthy participants were recruited to evaluate the skin response following mechanical loading, tape stripping, overhydration and chemical irritation. Forearm skin responses were recorded at baseline and at three time points following the insult. Measurements included transepidermal water loss, sub-epidermal moisture, erythema and laser Doppler imaging. Thresholds were informed by basal values, and the sensitivity of parameters to detect skin changes was evaluated. RESULTS High degree of variability in skin response was observed with selected biophysical parameters, such as sub-epidermal moisture, laser Doppler imaging and erythema, even in the absence of an applied insult. Temporal skin response revealed distinct response profiles during each evoked insult. Indeed, the sensitivity of the biophysical parameters was influenced by the threshold values and time point of measurement. Some statistically significant correlations were determined between the biophysical parameters. CONCLUSION The study revealed that thresholds derived from single biophysical parameters were limited in detecting skin changes following insults. A complementary evaluation using combined parameters has the potential to provide a more sensitive assessment. Further research is required to identify robust biophysical parameters, to aid the early detection of skin damage in clinical settings.
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Affiliation(s)
- Hemalatha Jayabal
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Barbara M Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Peter R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
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29
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Van Asten JGMV, Fung MT, Oomens CWJ, Bader DL, Worsley PR. A combined experimental and computational approach to evaluate microclimate control at the support surface interface. J Tissue Viability 2021; 30:395-401. [PMID: 34030943 DOI: 10.1016/j.jtv.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
Temperature and humidity conditions at the interface between a support surface and the skin, termed microclimate, has been implicated in the development of pressure ulcers. Support surface technologies have been developed to control microclimate conditions, although only a few standard test methods exist to evaluate their performance. This study describes a combined experimental-computational approach to analyzing microclimate control systems. The study used a modified physical model protocol to evaluate two specific support surface systems involving a spacer fabric cover with i) no air flow and ii) an active fan. The physical model deposited moisture at a controlled rate for 25 min, and the microclimate conditions under the model and the surrounding area were monitored for 24 h. Using the experimental data as boundary conditions, a finite element model was developed using mass transport principles, which was calibrated using experimental results. Model inputs included mass density and mass diffusivity, resulting in an estimated absolute humidity change over time. The physical model tests revealed distinct differences between the support surfaces with and without active airflow, with the former having little effect on local humidity levels (RH>75% for 24hr). By contrast, there was a spatial and temporal change in microclimate with the active fan, with sensors positioned towards the source of airflow reaching ambient conditions within 24hr. The computational model was refined to produce comparable results with respect to both the spatial distribution of microclimate and the change in values over time. The combined experimental and computation approach was able to distinguish distinct difference in microclimate change between two support surface designs. The approach could enable the efficient evaluation of different mattress design principles to aid decision making for personalized support surface solutions, for the prevention of pressure ulcers.
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Affiliation(s)
- J G M V Van Asten
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - M-T Fung
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - C W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - D L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - P R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK.
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30
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Lichterfeld-Kottner A, Vogt A, Tomova-Simitchieva T, Blume-Peytavi U, Kottner J. Effects of loading and prophylactic dressings on the sacral and heel skin: An exploratory cross-over trial. Int Wound J 2021; 18:909-922. [PMID: 33939289 PMCID: PMC8613394 DOI: 10.1111/iwj.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023] Open
Abstract
Pressure ulcers/injuries are caused by sustained loading and deformation of skin and underlying soft tissues. Prophylactic dressings are recommended as an adjunct to other preventive measures such as repositioning and offloading. The aim of this study was to investigate the effects of prophylactic soft silicone multi‐layered foam dressings on the skin structure and function of the two most common pressure areas, sacrum and heel, with and without loading. An exploratory randomised cross‐over trial using intra‐individual comparisons was conducted. Eight healthy volunteers (mean age 27.5 years) were assigned to three groups and either spent 2.5 hours on a standard hospital mattress lying in supine position with and without dressings or spent 2.5 hours with dressings applied but without loading. Skin temperature, stratum corneum, and epidermal hydration increased in all groups irrespective of wearing a dressing and/or loading. Mean roughness decreased at the heels. Reactive hyperaemia and the release of interleukin 1 alpha were associated with loading only. Results suggest that the occlusive effects of dressings are similar or only slightly greater than those observed with non‐loading or loading without dressings. Thus, a dressing does not cause additional irritation or skin changes during loading but it may reduce the inflammatory response.
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Affiliation(s)
- Andrea Lichterfeld-Kottner
- Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Nursing Research Group, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Charite Center for Health and Human Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
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31
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Tanner L, Rappl L, Oberg C, Call E. Keeping Patients Under the Damage Threshold for Pressure Injury: Addressing Microclimate Through Allostasis. J Nurs Care Qual 2021; 36:169-175. [PMID: 32657999 DOI: 10.1097/ncq.0000000000000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries (PI) are an ongoing problem in health care. Current interventions, both from clinicians and support surface technologies, do not sufficiently address PI prevention. PROBLEM Patient microclimate is a contributing risk factor for PI, one which can be more adequately addressed. However, the acceptable range for microclimate is unknown, in part because the body adapts to changing conditions. APPROACH Two key concepts in allostasis are finite resources and responding to intrinsic and extrinsic demands. These concepts have not previously been applied to PI treatment or interventions. Addressing microclimate, when coupled with an increasing awareness of the cumulative effect of individual patient risk factors, can help resolve the risk of PI by lowering the cumulative inputs to keep patients under the threshold for tissue damage. CONCLUSION This new approach, which places microclimate risk into the broader conceptual framework of allostasis, can produce more effective products and interventions to prevent PI.
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Affiliation(s)
- Laurel Tanner
- EC Service, Centerville, Utah (Ms Tanner); Rappl & Assoc, Simpsonville, South Carolina (Dr Rappl); and Department of Microbiology, Weber State University, Ogden, Utah (Dr Oberg and Mr Call)
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32
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Caggiari S, Worsley PR, Fryer SL, Mace J, Bader DL. Detection of posture and mobility in individuals at risk of developing pressure ulcers. Med Eng Phys 2021; 91:39-47. [PMID: 34074464 DOI: 10.1016/j.medengphy.2021.03.006] [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: 10/30/2020] [Revised: 01/30/2021] [Accepted: 03/25/2021] [Indexed: 02/01/2023]
Abstract
Pressure mapping technologies provide the opportunity to estimate trends in posture and mobility over extended periods in individuals at risk of developing pressure ulcers. The aim of the study was to combine pressure monitoring with an automated algorithm to detect posture and mobility in a vulnerable population of Spinal Cord Injured (SCI) patients. Pressure data from able-bodied cohort studies involving prescribed lying and sitting postures were used to train the algorithm. This was tested with data from two SCI patients. Variations in the trends of the centre of pressure (COP) and contact area were assessed for detection of small- and large-scale postural movements. Intelligent data processing involving a deep learning algorithm, namely a convolutional neural network (CNN), was utilised for posture classification. COP signals revealed perturbations indicative of postural movements, which were automatically detected using individual- and movement-specific thresholds. CNN provided classification of static postures, with an accuracy ranging between 70-84% in the training cohort of able-bodied subjects. A clinical evaluation highlighted the potential of the novel algorithm to detect postural movements and classify postures in SCI patients. Combination of continuous pressure monitoring and intelligent algorithms offers the potential to objectively detect posture and mobility in vulnerable patients and inform clinical-decision making to provide personalized care.
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Affiliation(s)
- Silvia Caggiari
- Skin Health Research Group, Faculty of Environmental and Life Sciences, School of Heath Sciences, University of Southampton, SO17 1BJ, United Kingdom.
| | - Peter R Worsley
- Skin Health Research Group, Faculty of Environmental and Life Sciences, School of Heath Sciences, University of Southampton, SO17 1BJ, United Kingdom
| | - Sarah L Fryer
- Skin Health Research Group, Faculty of Environmental and Life Sciences, School of Heath Sciences, University of Southampton, SO17 1BJ, United Kingdom; Spinal Cord Injury Centre, Duke of Cornwall Spinal Centre, Salisbury NHS Foundation Trust, United Kingdom
| | - Joseph Mace
- Skin Health Research Group, Faculty of Environmental and Life Sciences, School of Heath Sciences, University of Southampton, SO17 1BJ, United Kingdom
| | - Dan L Bader
- Skin Health Research Group, Faculty of Environmental and Life Sciences, School of Heath Sciences, University of Southampton, SO17 1BJ, United Kingdom
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33
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Kottner J, Blume-Peytavi U. Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research. Int Wound J 2021; 18:716-727. [PMID: 33626239 PMCID: PMC8450794 DOI: 10.1111/iwj.13574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00‐0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99‐1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11°C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research.
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Affiliation(s)
- Jan Kottner
- Charité Center for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Lechner A, Rancan F, Hadam S, Vogt A, Blume‐Peytavi U, Kottner J. Comparing the effects of three different multilayer dressings for pressure ulcer prevention on sacral skin after prolonged loading: An exploratory crossover trial. Wound Repair Regen 2020; 29:270-279. [DOI: 10.1111/wrr.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Anna Lechner
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Fiorenza Rancan
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Sabrina Hadam
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jan Kottner
- Charité Center Health and Human Sciences Charité – Universitätsmedizin Berlin Berlin Germany
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Lemmens J, Peko Cohen L, Worsley PR, Everitt C, Broadbridge J, Gefen A, Rees RW, Drake M, Macaulay MC, Fader M, Bader DL. Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820920511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases.Methods:Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state.Results:The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp.Conclusions:MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage.Level of evidence:4
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Affiliation(s)
- Joe Lemmens
- School of Health Sciences, University of Southampton, UK
| | - Lea Peko Cohen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | | | | | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | - Marcus Drake
- University of Bristol, Bristol Urological Institute, UK
| | | | - Mandy Fader
- School of Health Sciences, University of Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, UK
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Results of Laboratory Testing for Immersion, Envelopment, and Horizontal Stiffness on Turn and Position Devices to Manage Pressure Injury. Adv Skin Wound Care 2020; 33:S11-S22. [DOI: 10.1097/01.asw.0000696412.04000.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Henshaw FR, Bostan LE, Worsley PR, Bader DL. Evaluating the effects of sedentary behaviour on plantar skin health in people with diabetes. J Tissue Viability 2020; 29:277-283. [PMID: 32943281 DOI: 10.1016/j.jtv.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Diabetes-Related Foot Ulcers (DRFUs) are a common and devastating consequence of Diabetes Mellitus and are associated with high morbidity, mortality, social and economic costs. Whilst peak plantar pressures during gait are implicated cited as a major contributory factor, DRFU occurrence has also been associated with increased periods of sedentary behaviour. The present study was designed aimed to assess the effects of sitting postures on plantar tissue health. METHODS After a period of acclimatisation, transcutaneous oxygen tensions (TCPO2) and inflammatory cytokines (IL-1α and IL-1RA) were measured at the dorsal and plantar aspects of the forefoot before, during and after a 20-min period of seated-weight-bearing in participants with diabetes (n = 11) and no diabetes (n = 10). Corresponding interface pressures at the plantar site were also measured. RESULTS During weight-bearing, participants with diabetes showed increases in tissue ischaemia which were linearly correlated proportional to plantar pressures (Pearson's r = 0.81; p < 0.05). Within the healthy group, no such correlation was evident (p > 0.05). There were also significant increases in post seated weight-bearing values for ratio for IL-1α and IL-1RA, normalised to total protein, post seated weight-bearing in participants with diabetes compared to healthy controls. CONCLUSION This study shows that prolonged sitting may be detrimental to plantar skin health. It highlights the need to further examine the effects of prolonged sitting in individuals, who may have a reduced tolerance to loading in the plantar skin and soft tissues.
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Affiliation(s)
- F R Henshaw
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - L E Bostan
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - P R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - D L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Use of a Support Surface Standard to Test the Effects of a Turning and Positioning Device Versus Low-Air-Loss Therapy on Temperature and Humidity. Adv Skin Wound Care 2020; 33:S3-S10. [PMID: 32932289 DOI: 10.1097/01.asw.0000695744.57734.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Turning and repositioning devices (TRDs) help to reduce strain on caregivers, but clinicians question their effects on humidity and temperature (microclimate) at the skin surface that may increase risk of pressure ulcers. OBJECTIVE To pilot the use of a standard test for support surfaces to compare microclimate at the skin surface in three scenarios: (1) on a low-air-loss (LAL) surface, (2) on a representative TRD with a basic underpad (TRDU) placed on a LAL surface, and (3) on a negative control with full occlusion. The results are designed to inform clinical decision-making in using a TRD on a LAL surface and the viability of using this test to study TRDs. DESIGN Measuring humidity and temperature at the device-surface interface using a heated moisture-exuding bronze thermodynamic human model in a laboratory setting. MAIN OUTCOME MEASURE Humidity and temperature levels across 3 hours 15 minutes of continuous loading with a 45-second complete unloading to simulate a position change at 3 hours. MAIN RESULTS Relative humidity on the TRDU was below that on the LAL surface for the first 110 minutes and was markedly lower than the negative control for the remainder of humidity testing. Temperature on the TRDU was well below the negative control and negligibly higher than the surface alone throughout testing. The position change enhanced the effects of the TRDU. CONCLUSIONS The support surface standard test appears useful in evaluating TRDs. This TRD along with the basic underpad is more comparable to a LAL surface than to full occlusion in managing the microclimate of the skin and pressure ulcer risk.
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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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40
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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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41
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Budri AMV, Moore Z, Patton D, O'Connor T, Nugent L, Avsar P. Sub-epidermal moisture measurement: an evidence-based approach to the assessment for early evidence of pressure ulcer presence. Int Wound J 2020; 17:1615-1623. [PMID: 32683789 DOI: 10.1111/iwj.13437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/27/2022] Open
Abstract
This paper aims to discuss the literature pertaining to early pressure-shear induced tissue damage detection, with emphasis on sub-epidermal moisture measurement (SEM). The current method for pressure detection is visual skin assessment (VSA); however, this method is fraught with challenges. Advances in early detection of pressure ulcers are reported in the literature and mainly involve measuring inflammation markers on weight-bearing anatomical areas in order to capture the first signs of tissue damage. One novel technique currently in use is SEM measurement. This biophysical marker is the product of plasma that leaks as a response to local inflammation arising due to pressure-shear induced damage over bony prominences. The early detection of tissue damage is beneficial in two different ways. First, it enables early intervention when the damage is still microscopic and reversible and, therefore, has the potential to prevent further aggravation of healthy surrounding tissue. This arises by avoiding the causation of the problem and stopping the knock-on effect of inflammation, especially when the rapid pressure ulceration pathway of deformation is in place. Second, when the slow ischaemic-reperfusion related mechanism is undergoing, cell death can be avoided when the problem is identified before the cell reaches the "death threshold," completely averting a pressure ulcer.
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Affiliation(s)
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Worsley PR, Crielaard H, Oomens CWJ, Bader DL. An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: Implication of lymphatic impairment in pressure ulcers. Microcirculation 2020; 27:e12645. [DOI: 10.1111/micc.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Peter R. Worsley
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
| | - Hanneke. Crielaard
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
| | - Cees W. J. Oomens
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
| | - Dan L. Bader
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
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Moda Vitoriano Budri A, Moore Z, Patton D, O’Connor T, Nugent L, Mc Cann A, Avsar P. Impaired mobility and pressure ulcer development in older adults: Excess movement and too little movement—Two sides of the one coin? J Clin Nurs 2020; 29:2927-2944. [DOI: 10.1111/jocn.15316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Aglecia Moda Vitoriano Budri
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Zena Moore
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Cardiff University Cardiff UK
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Monash University Melbourne Vic. Australia
- UGent Ghent University Ghent Belgium
| | - Declan Patton
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- University of Wollongong Wollongong NSW Australia
| | - Tom O’Connor
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Lida Institute Shanghai China
| | - Linda Nugent
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Aisling Mc Cann
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Pinar Avsar
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
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Bramley JL, Worsley PR, Bostan LE, Bader DL, Dickinson AS. Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use. Med Eng Phys 2020; 78:39-47. [PMID: 32035813 DOI: 10.1016/j.medengphy.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading. METHODS An in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers. FINDINGS At the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading. INTERPRETATION The protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.
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Affiliation(s)
- J L Bramley
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield Campus, University Rd, Southampton SO17 1BJ, UK
| | - P R Worsley
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - L E Bostan
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - D L Bader
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - A S Dickinson
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield Campus, University Rd, Southampton SO17 1BJ, UK.
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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Boyle CJ, Carpanen D, Pandelani T, Higgins CA, Masen MA, Masouros SD. Lateral pressure equalisation as a principle for designing support surfaces to prevent deep tissue pressure ulcers. PLoS One 2020; 15:e0227064. [PMID: 31899778 PMCID: PMC6941906 DOI: 10.1371/journal.pone.0227064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
When immobile or neuropathic patients are supported by beds or chairs, their soft tissues undergo deformations that can cause pressure ulcers. Current support surfaces that redistribute under-body pressures at vulnerable body sites have not succeeded in reducing pressure ulcer prevalence. Here we show that adding a supporting lateral pressure can counter-act the deformations induced by under-body pressure, and that this 'pressure equalisation' approach is a more effective way to reduce ulcer-inducing deformations than current approaches based on redistributing under-body pressure. A finite element model of the seated pelvis predicts that applying a lateral pressure to the soft tissue reduces peak von Mises stress in the deep tissue by a factor of 2.4 relative to a standard cushion (from 113 kPa to 47 kPa)-a greater effect than that achieved by using a more conformable cushion, which reduced von Mises stress to 75 kPa. Combining both a conformable cushion and lateral pressure reduced peak von Mises stresses to 25 kPa. The ratio of peak lateral pressure to peak under-body pressure was shown to regulate deep tissue stress better than under-body pressure alone. By optimising the magnitude and position of lateral pressure, tissue deformations can be reduced to that induced when suspended in a fluid. Our results explain the lack of efficacy in current support surfaces and suggest a new approach to designing and evaluating support surfaces: ensuring sufficient lateral pressure is applied to counter-act under-body pressure.
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Affiliation(s)
- Colin J. Boyle
- Department of Bioengineering, Imperial College London, London, United
Kingdom
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
- * E-mail:
| | - Diagarajen Carpanen
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Thanyani Pandelani
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Claire A. Higgins
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Marc A. Masen
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
| | - Spyros D. Masouros
- Department of Bioengineering, Imperial College London, London, United
Kingdom
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Van Damme N, Van Hecke A, Remue E, Van den Bussche K, Moore Z, Gefen A, Verhaeghe S, Beeckman D. Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review. Wound Repair Regen 2019; 28:242-265. [DOI: 10.1111/wrr.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Eline Remue
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Karen Van den Bussche
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Zena Moore
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv University Tel Aviv Israel
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Department of Health CareVIVES University of Applied Sciences Roeselare Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health SciencesUniversity of Southern Denmark Odense Denmark
- School of Nursing and MidwiferyMonash University Melbourne Australia
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Lechner A, Kottner J, Coleman S, Muir D, Bagley H, Beeckman D, Chaboyer W, Cuddigan J, Moore Z, Rutherford C, Schmitt J, Nixon J, Balzer K. Outcomes for Pressure Ulcer Trials (OUTPUTs): protocol for the development of a core domain set for trials evaluating the clinical efficacy or effectiveness of pressure ulcer prevention interventions. Trials 2019; 20:449. [PMID: 31331366 PMCID: PMC6647312 DOI: 10.1186/s13063-019-3543-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background Core outcome sets (COS) are being developed in many clinical areas to increase the quality and comparability of clinical trial results as well as to ensure their relevance for patients. A COS represents an agreed standardized set of outcomes that describes the minimum that should be consistently reported in all clinical trials of a defined area. It comprises a core domain set (defining what core outcomes should be measured) and a core measurement set (defining measurement/assessment instruments for each core domain). For pressure ulcer prevention trials a COS is lacking. The great heterogeneity of reported outcomes in this field indicates the need for a COS. Methods/design The first part of this project aims to develop a core domain set by following established methods, which incorporates four steps: (1) definition of the scope, (2) conducting a scoping review, (3) organizing facilitated workshops with service users, (4) performing Delphi surveys and establishing consensus in a face-to-face meeting with different stakeholders. Discussion After achieving consensus on the core domain set, further work will be undertaken to determine a corresponding core measurement set. This will lead to better pressure ulcer prevention research in the future. There are a number of methodological challenges in the field of COS development. To meet these challenges and to ensure a high-quality COS, the OUTPUTS project affiliates to current standards and works in close collaboration with international experts and with existing international service user groups. Trial registration The OUTPUTs project is registered in the COMET database: (http://www.comet-initiative.org/studies/details/283). Registered on 2015.
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Affiliation(s)
- Anna Lechner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Susanne Coleman
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Delia Muir
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Heather Bagley
- Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Health Sciences, Nursing and Midwifery, University of Surrey, Guildford, UK.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Menzies Health Institute Queensland, Griffith University and Gold Coast Hospital and Health Service, Southport, Qld, Australia
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Lida Institute, Shanghai, China.,Cardiff University, Cardiff, Wales
| | - Claudia Rutherford
- Faculty of Science, Quality of Life Office, School of Psychology, University of Sydney, Sydney, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jane Nixon
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Katrin Balzer
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK.,Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
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49
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Abstract
Pressure injuries are caused by prolonged pressure to an area of the body, which can result in open wounds that descend to the bone. Pressure injuries should not occur in healthcare settings, and yet, they still affect 2.5 million patients in the United States and have an impact on quality of life. Pressure injuries come at a cost of $11 billion in the United States, and 90% of pressure injuries are a secondary condition. In this paper, we survey the literature on preventative techniques to address pressure injures, which we classify into two categories: active prevention strategies and sensor-based risk-factor monitoring. Within each category of techniques, we discuss the literature and assess each class of strategies based on its commercial availability, results of clinical trials when available, the ability for the strategy to save time for healthcare staff, and whether the technique can be tuned to an individual. Based on our findings, the most promising current solutions, supplementary to nursing guidelines, are electrical stimulation, pressure monitoring, and inertial measurement unit monitoring. We also find a need for a clinical software system that can easily integrate with custom sensors, use custom analysis algorithms, and provide visual feedback to the healthcare staff.
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50
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Bader DL, Worsley PR, Gefen A. Bioengineering considerations in the prevention of medical device-related pressure ulcers. Clin Biomech (Bristol, Avon) 2019; 67:70-77. [PMID: 31077978 DOI: 10.1016/j.clinbiomech.2019.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, it has become increasingly apparent that medical device-related pressure ulcers represent a significant burden to both patients and healthcare providers. Medical devices can cause damage in a variety of patients from neonates to community based adults. To date, devices have typically incorporated generic designs with stiff polymer materials, which impinge on vulnerable soft tissues. As a result, medical devices that interact with the skin and underlying soft tissues can cause significant deformations due to high interface pressures caused by strapping or body weight. METHODS This review provides a detailed analysis of the latest bioengineering tools to assess device related skin and soft tissue damage and future perspectives on the prevention of these chronic wounds. This includes measurement at the device-skin interface, imaging deformed tissues, and the early detection of damage through biochemical and biophysical marker detection. In addition, we assess the potential of computational modelling to provide a means for device design optimisation and material selection. INTERPRETATION Future collaboration between academics, industrialists and clinicians should provide the basis to improve medical device design and prevent the formation of these potentially life altering wounds. Ensuring clinicians report devices that cause pressure ulcers to regulatory agencies will provide the opportunity to identify and improve devices, which are not fit for purpose.
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Affiliation(s)
- D L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - P R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK.
| | - A Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
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