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Contemporary approaches to pressure injury (PI) risk identification rely on the use of risk assessment tools and visual skin assessment. Objective biophysical measures that assess skin hydration, melanin, erythema and lipids have not been traditionally used in PI risk; however, these may prove useful as a risk assessment tool. The relationship between subjective visual assessments of skin condition, biophysical measures and PI risk warrants investigation. This study used a descriptive correlational design to examine the relationship between measures of skin hydration, colour (melanin and erythema) and lipids at PI-prone areas amongst geriatric persons (n = 38), obtained using biophysical skin measures and visual skin assessment. Twice daily measures of epidermal hydration, colour and lipids were assessed using the SD202 Skin Diagnostic (Courage + Khazaka GmBH, Cologne, Germany) over pressure-prone areas of the body of study participants over seven consecutive days. Concurrent visual assessment of skin hydration and colour was performed. Results obtained using the SD202 Skin Diagnostic were compared with results gathered from visual assessment and examined for their association with participants' PI risk based on scores of the Norton Risk Assessment Scale. While epidermal hydration and skin colour reading scores did not vary significantly over the data collection period, lipid readings could not be registered on any occasion. With the exception of skin dryness, skin parameters via both objective and subjective means had significant, positive correlations. Statistically significant correlations emerged between visual assessment of skin wetness at the sacrum (r = -0·441, P < 0·01) and ischia (r = -0·468, P < 0·01) and Norton Risk Assessment Scale scores. It was found that the objective assessment of epidermal hydration (skin wetness) was also significantly associated with PI risk at the sacrum (r = -0·528, P < 0·01), as well as the right ischia (r = -0·410, P < 0·05) and left ischia (r = -0·407, P < 0·05). Erythema, when assessed objectively, was significantly correlated with PI risk at the sacrum (r = -0·322, P < 0·05). Such findings indicating that the finer measures afforded by the SD202 Skin Diagnostic in the assessment of the subtle red hues displayed in erythematous skin may provide an additional advantage over traditional, clinician assessment.
Contemporary approaches to pressure injury (PI) risk identification rely on the use of risk assessment tools and visual skin assessment. Objective biophysical measures that assess skin hydration, melanin, erythema and lipids have not been traditionally used in PI risk; however, these may prove useful as a risk assessment tool. The relationship between subjective visual assessments of skin condition, biophysical measures and PI risk warrants investigation. This study used a descriptive correlational design to examine the relationship between measures of skin hydration, colour (melanin and erythema) and lipids at PI-prone areas amongst geriatric persons (n = 38), obtained using biophysical skin measures and visual skin assessment. Twice daily measures of epidermal hydration, colour and lipids were assessed using the SD202 Skin Diagnostic (Courage + Khazaka GmBH, Cologne, Germany) over pressure-prone areas of the body of study participants over seven consecutive days. Concurrent visual assessment of skin hydration and colour was performed. Results obtained using the SD202 Skin Diagnostic were compared with results gathered from visual assessment and examined for their association with participants' PI risk based on scores of the Norton Risk Assessment Scale. While epidermal hydration and skin colour reading scores did not vary significantly over the data collection period, lipid readings could not be registered on any occasion. With the exception of skin dryness, skin parameters via both objective and subjective means had significant, positive correlations. Statistically significant correlations emerged between visual assessment of skin wetness at the sacrum (r = -0·441, P < 0·01) and ischia (r = -0·468, P < 0·01) and Norton Risk Assessment Scale scores. It was found that the objective assessment of epidermal hydration (skin wetness) was also significantly associated with PI risk at the sacrum (r = -0·528, P < 0·01), as well as the right ischia (r = -0·410, P < 0·05) and left ischia (r = -0·407, P < 0·05). Erythema, when assessed objectively, was significantly correlated with PI risk at the sacrum (r = -0·322, P < 0·05). Such findings indicating that the finer measures afforded by the SD202 Skin Diagnostic in the assessment of the subtle red hues displayed in erythematous skin may provide an additional advantage over traditional, clinician assessment.
Thrombin and thrombin peptides play a role in initiating tissue repair. The potential safety and efficacy of TP508 (Chrysalin) treatment of diabetic foot ulcers was evaluated in a 60-subject, prospective, randomized, double-blind, placebo-controlled phase I/II clinical trial. Chrysalin in saline or saline alone was applied topically, twice weekly, to diabetic ulcers with standardized care and offloading. A dose-dependent effect was seen in the per-protocol population where 1 and 10 mug Chrysalin treatment resulted in 45 and 72% more subjects with complete healing than placebo treatment. Chrysalin treatment of foot ulcers more than doubled the incidence of complete healing (p<0.05), increased mean closure rate approximately 80% (p<0.05), and decreased the median time to 100% closure by approximately 40% (p<0.05). Chrysalin treatment of heel ulcers within this population resulted in mean closure rates 165% higher than placebos (p<0.02) and complete healing in 86% (6/7) of ulcers compared with 0% (0/5) of placebo ulcers (p<0.03). Local wound reactions and adverse events (AEs) were equal between groups with no reported drug-related changes in laboratory tests or serious AEs. These results indicate the potential safety and efficacy of Chrysalin for treatment of diabetic foot ulcers.
The heel continues to be one of the most common sites of pressure damage. This article reviews the anatomy and physiology of the heel and explores significant risk factors, including those found in the critically ill patient. Interventions to prevent heel pressure ulceration by offloading the heel are explored. An evaluation of the Nimbus 4 alternating pressure mattress was undertaken within an intensive care unit (ICU) to consider the efficacy of its unique Wound Valve Technology, which is designed to help prevent heel pressure ulceration. During the evaluation period none of the patients using the Nimbus 4 developed a pressure ulcer. Staff observed that the Wound Valves provided effective pressure redistribution and, although the cells frequently needed to be adjusted, patient safety was maintained throughout. The Wound Valves were most effective on patients who were less prone to voluntary movement.
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