This study aimed to evaluate the sensitivity and specificity of subepidermal moisture (SEM), a biomarker employed for early detection of pressure injuries (PI), compared to the "Gold Standard" of clinical skin and tissue assessment (STA), and to characterize the timing of SEM changes relative to the diagnosis of a PI. This blinded, longitudinal, prospective clinical study enrolled 189 patients (n = 182 in intent-totreat [ITT]) at acute and post-acute sites (9 USA, 3 UK). Data were collected from patients' heels and sacrums using a biocapacitance measurement device beginning at admission and continuing for a minimum of 6 days to: (a) the patient developing a PI,from care, or (c) a maximum of 21 days. Standard of care clinical interventions prevailed, uninterrupted. Principal investigators oversaw the study at each site. Blinded Generalists gathered SEM data, and blinded Specialists diagnosed the presence or absence of PIs. Of the ITT population, 26.4% developed a PI during the study; 66.7% classified as Stage 1 injuries, 23% deep tissue injuries, the remaining being Stage 2 or Unstageable. Sensitivity was 87.5% (95% CI: 74.8%-95.3%) and specificity was 32.9% (95% CI: 28.3%-37.8%). Area under the receiver operating characteristic curve (AUC) was 0.6713 (95% CI 0.5969-0.7457, P < .001). SEM changes were observed 4.7 (± 2.4 days) earlier than diagnosis of a PI via STA alone. Latency between the SEM biomarker and later onset of a PI, in combination with standard of care interventions administered to at-risk patients, may have confounded specificity. Aggregate SEM sensitivity and specificity and 67.13% AUC exceeded that of clinical judgment alone. While acknowledging specificity limitations, these data Funding information Bruin Biometrics, LLC suggest that SEM biocapacitance measures can complement STAs, facilitate earlier identification of the risk of specific anatomies developing PIs, and inform earlier anatomy-specific intervention decisions than STAs alone. Future work should include cost-consequence analyses of SEM informed interventions.

A pilot study exploring quality of life experienced by patients undergoing negative pressure wound therapy as part of their wound care treatment compared to patients receiving standard wound care AbstractThe use of Negative Pressure Wound Therapy (NPWT) has been widely documented as a technique to help heal complex wounds. This paper presents the findings of a preliminary study which aimed to explore quality of life experienced by patients undergoing negative pressure wound therapy (NPWT) as part of their wound care treatment in comparison to that of patients with a wound using traditional (standard) wound care therapies. A quasi-experimental study was undertaken, with patients treated in wound care/vascular clinics with chronic/acute wounds. Quality of life impact was measured using the Cardiff Wound Impact Schedule and administered post consent at timed intervals. Our results identified that there were no real differences in quality of life scores recorded by patients over the 12 week period. Although there was no overall interaction between the therapies used for wound healing, NPWT did have an effect on social life: during the first 2 weeks of the application of therapy, patients in the NPWT group reported an increase in the social life domain. The authors conclude that true QoL can only be elicited if an accurate baseline is established or if data is collected over a long enough period to allow comparison of scores over time. Key Points1. Health care interventions aim to provide positive benefit to patients, however occasionally unintentionally cause harm. This is reported by way of physical deterioration, as this is easy to measure. However, some therapies clearly have an impact in other perceived health domains such as quality of life.2. Reported quality of life scores one week after treatment indicated no significant effect of therapy on quality of life in either arm.3. The therapy-social isolation interaction was not significant (F 4,9) =0.269; p=0.891), indicating that the effect of therapy type was similar on those who lived alone and those who lived with friends or family. Key WordsNegative pressure wound therapy, quality of life, social isolation Conflict of InterestThis study was funded by a non-restrictive educational grant from Smith and Nephew.

This article describes effective ways of diagnosing and removing slough from a wound bed. It highlights how slough is a key contributor to wound chronicity, and gives practical clinical information on how to address this. The various methods of removing slough will be discussed including the mechanism of action of dressings and other mechanical methods. The ultimate objective of the article is to put the term desloughing on the clinical agenda and increase clinician familiarity with it. The practical focus of the article will help clinicians select a proven method to facilitate the rapid removal of slough, it is hoped that in doing so this will help to prevent chronicity, reduce the potential for bacterial proliferation and promote rapid and effective wound healing outcomes.

Objective: Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. Method: A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. Results: A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. Conclusion: As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.

Recent government documents have identified the move from hospital-based care into the community and have suggested that more complex wound care can now be provided in the community setting with therapies such as negative pressure wound therapy (NPWT). This focus group interview explores community tissue viability specialists' experiences and attitudes towards the use of NPWT in community settings. The study was conducted in compliance with relevant ethical guidelines. Data analysis identified various themes but this paper concentrates on three; untimely referrals; cost implications and mutual benefit and understanding.