Anatomical variability of sub-epidermal moisture and its clinical implications

Jayabal, Hemalatha; Bates‐Jensen, Barbara M.; Abiakam, Nkemjika; Worsley, Peter; Bader, Dan L.

doi:10.1016/j.jtv.2021.04.003

Cited by 12 publications

(20 citation statements)

References 26 publications

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“…Patients and nurses in our study desired more high‐quality evidence about SEMS, potentially influencing acceptability and highlighting the need for further research. It is interesting to see that despite the fact there is limited RCT evidence for SEMS effectiveness, some research showing limitations in the predictive value of SEMS (Okonkwo et al, 2020) and other work identifying variation in site‐specific SEM values in healthy participants with no tissue loading (Jayabal et al, 2021) it is being used routinely in some settings (Musa et al, 2021; Nightingale & Musa, 2021; Ousey et al, 2022; Raizman et al, 2018). Thus, given this study has demonstrated SEM scanner acceptability, it provides good foundations to plan effectiveness research.…”

Section: Discussionmentioning

confidence: 99%

End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study

Tobiano

Campbell

Allen

et al. 2023

Journal of Advanced Nursing

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Aims To assess patients' and nurses' perceptions and experiences of subepidermal moisture scanning acceptability. Design Descriptive, qualitative, sub‐study, embedded within a pilot randomized control trial. Methods Ten patients who were in the intervention arm of the pilot trial and 10 registered nurses providing care for these patients on medical‐surgical units participated in individual semi‐structured interviews. Data were collected from October 2021 to January 2022. Interviews were analysed using inductive qualitative content analysis, and perspectives (patient and nurse), were triangulated. Results Four categories were found. The first category ‘Subepidermal moisture scanning is acceptable as part of care’ showed that patients and nurses were willing to use subepidermal moisture scanning and viewed subepidermal moisture scanning as non‐burdensome. The category ‘Subepidermal moisture scanning may improve pressure injury outcomes’ demonstrated that although subepidermal moisture scanning was believed to prevent pressure injuries, more research evidence about its benefits was required. ‘Subepidermal moisture scanning augments existing pressure injury prevention practices’, the third category, highlighted that subepidermal moisture scanning aligns with current pressure injury prevention practices while making these practices more patient‐centred. In the final category, ‘Important considerations when making subepidermal moisture scanning routine practice’, practical issues were raised relating to training, guidelines, infection control, device availability and patient modesty. Conclusion Our study demonstrates that using subepidermal moisture scanning is acceptable for patients and nurses. Building the evidence base for subepidermal moisture scanning and then addressing practical issues prior to implementation, are important next steps. Our research suggests that subepidermal moisture scanning enhances individualized and patient‐centred care, persuasive reasons to continue investigating subepidermal moisture scanning. Impact For an intervention to be successfully implemented it must be both effective and acceptable, however, there is limited evidence of patients' and nurses' views of SEMS acceptability. SEM scanners are acceptable to use in practice for patients and nurses. There are many procedural aspects that need to be considered when using SEMS such as frequency of measurements. This research may have benefit for patients, as SEMS may promote a more individualized and patient‐centred approach to pressure injury prevention. Further, these findings can assist researchers, providing justification to proceed with effectiveness research. Patient or public contribution A consumer advisor was involved in study design, interpretation of data and preparation of manuscript.

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Section: Discussionmentioning

confidence: 99%

End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study

Tobiano

Campbell

Allen

et al. 2023

Journal of Advanced Nursing

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“…While the current analysis was conducted at the patient level, research by Jayabal et al 26 has revealed differences in SEM values across different anatomical sites in a healthy cohort of participants. Hence consideration of both site specific and individual demographic factors may be required in the assessment of the utility of the SEM scanner as a predictive tool, which will be addressed in a future analysis.…”

Section: Discussionmentioning

confidence: 99%

Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence

2022

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Objective: To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. Method: Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. Results: A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. Conclusion: The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.

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“…While an agreed definition of a healthy adult or volunteer is not provided in the associated literature, two features were evident: individuals lived in the community and had undamaged skin at the study site as determined by the visual and palpation assessment of a clinical skin expert. 31,[41][42][43][44] These two considerations were applied to our recruited healthy participants increasing the comparability of our findings. While individuals of all ages living in the community might describe themselves as 'healthy adults', it is likely many have one or more chronic conditions 45 and therefore may be at risk of PI in the community or during hospitalisation.…”

Section: Sem Research In Healthy Adultsmentioning

confidence: 99%

“…47 In the published literature on healthy adults, baseline SEM data is reported based on the study's data collection and analytic approach. 41,43,44 For example, we collected six SEM values measured at closely positioned skin locations across the sacrum and reported baseline sacral SEM values and the mean SEM delta. In contrast, two recent studies on healthy adults collected seven, 44 and nine 43 T A B L E 3 Independent-samples t-test: mean sacral SEM delta during prolonged 60 HOBE for males and females (n = 20).…”

Section: Baseline Sacral Sem Measurementsmentioning

confidence: 99%

The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study

Latimer

Bone

Walker

et al. 2023

International Wound Journal

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Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point‐of‐care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120‐min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20‐min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one‐way repeated measures analysis of variance and an independent t‐test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.

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Anatomical variability of sub-epidermal moisture and its clinical implications

Cited by 12 publications

References 26 publications

End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study

End‐user perceptions of sub‐epidermal moisture scanning (SEMS) acceptability: A descriptive qualitative study

Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence

The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study

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