Effects of a Skin Barrier Cream on Management of Incontinence-Associated Dermatitis in Older Women: A Cluster Randomized Controlled Trial.

PURPOSE: The purpose of this study was to examine the effects of a skin barrier cream with moisturization and skin-protectant characteristics for improving the severity of incontinence-associated dermatitis (IAD) pertaining to the skin physiology and appearance. We measured the following outcomes: (1) skin physiological characteristics indicating skin protection and enhancement of the skin's moisture barrier (stratum corneum hydration, dermis hydration level, transepidermal water loss, and skin pH); and (2) changes in skin appearance (the degree of erythema and pigmentation, and the sulcus cutis condition). DESIGN: Single-blind, cluster randomized controlled trial. SUBJECTS AND SETTING: The study was conducted in a long-term care facility in Japan between November 7, 2011, and May 6, 2012. We used block randomization to obtain a random sample of 6 (4 experimental and 2 control) out of 10 available wards. All subjects were elderly women with IAD of the buttock or inner thigh. We assessed 295 patients, but only 33 met inclusion criteria; 18 were allocated to the experimental group and 15 were allocated to the control group. METHODS: All participants were managed with cleansing with a skin cleanser and application of a moisturizer daily. In addition, a skin barrier cream designed to enhance the skin's moisture barrier and act as a protective barrier was applied to the skin of patients in the experimental group 3 times a day when absorptive briefs were changed. Skin physiological and appearance characteristics were scored only at the buttock or thigh area. All data were collected on days 1 and 14 of the study. RESULTS: Univariate analysis found that the erythema index was lower in the intervention group than in the control group at day 14 (P = .004). Multivariate analysis found significant associations between use of the skin barrier cream and increased stratum corneum hydration (ß= .443, P = .031), decreased skin pH (ß=-.439, P = .020), and magnitude of erythema (ß=-.451, P = .018). CONCLUSIONS: Study findings suggest that a barrier cream designed to enhance the skin's moisture barrier and act as a skin protectant increased stratum corneum hydration, reduced cutaneous pH, and reduced erythema.

Microclimate and development of pressure ulcers and superficial skin changes.

This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate.

Using an extreme bony prominence anatomical model to examine the influence of bed sheet materials and bed making methods on the distribution of pressure on the support surface.

Bed sheets generate high surface tension across the support surface and increase pressure to the body through a process known as the hammock effect. Using an anatomical model and a loading device characterized by extreme bony prominences, the present study compared pressure distributions on support surfaces across different bed making methods and bed sheet materials to determine the factors that influence pressure distribution. The model was placed on a pressure mapping system (CONFORMat; NITTA Corp., Osaka, Japan), and interface pressure was measured. Bed sheet elasticity and friction between the support surface and the bed sheets were also measured. For maximum interface pressure, the relative values of the following methods were higher than those of the control method, which did not use any bed sheets: cotton sheets with hospital corners (1.28, p = 0.02), polyester with no corners (1.29, p = 0.01), cotton with no corners (1.31, p = 0.003), and fitted polyester sheets (1.35, p = 0.002). Stepwise multiple regression analysis indicated that maximum interface pressure was negatively correlated with bed sheet elasticity (R(2) = 0.74). A statistically significant negative correlation was observed between maximum interface pressure and immersion depth, which was measured using the loading device (r = -0.40 and p = 0.04). We found that several combinations of bed making methods and bed sheet materials induced maximum interface pressures greater than those observed for the control method. Bed sheet materials influenced maximum interface pressure, and bed sheet elasticity was particularly important in reducing maximum interface pressure.

Corrigendum: A Comparison of Techniques for Collecting Skin Microbiome Samples: Swabbing Versus Tape-Stripping.

[This corrects the article DOI: 10.3389/fmicb.2018.02362.].

A Comparison of Techniques for Collecting Skin Microbiome Samples: Swabbing Versus Tape-Stripping.

The swabbing and tape-stripping methods have traditionally been used for collecting skin microbiome samples for skin bacterial analysis, although no reports have compared the outcome of these methods for collecting skin bacteria. Our purpose was to show the differences in microbial composition between samples collected using the swabbing and tape-stripping methods, by both the next generation sequencing and culture studies. The skin microbiome was collected by both methods, and the samples were processed for a sequence-based microbiome analysis and culture study. The next-generation sequencing results showed that skin bacteria collected using the tape-stripping method were comparable to those collected using the swabbing method. In the culture study, the tape-stripping method collected a greater number and wider variety of viable skin bacteria than the swabbing method. These results suggest that the tape-stripping method is comparable to the swabbing method for collecting viable skin bacteria, without losing fidelity to the composition of skin microbiome.

Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation.

This study aims to assess the fecal retention in elderly patients using colonic ultrasonography (US) in Japanese long-term care facility and determine the correlation between nutrition management methods and the fecal retention by US. This cross-sectional, single-center study was conducted in a long-term care facility in Japan. Patients with chronic constipation fulfilled the Rome III criteria for the diagnosis of functional constipation. US was performed on constipation patients with 4-day fecal retention before starting the standard management of constipation. After patients had defecated, nurses checked the outside of feces using King's Stool Chart and Bristol Stool Chart. All of 32 patients underwent the management of suppository laxative, the daily life independence level in grade C. In all cases, the King's Stool Chart did not detect > 200 g of fecal matter; the Bristol Stool Chart revealed type 5-7 in 56.2% of patients. The total parenteral nutrition and tube feeding did not completely detect type 1-2 in 0%. While the fecal retention groups comprised 15.6%, the non-fecal retention groups comprised 84.4%. The total parenteral nutrition did not completely detect the fecal retention in 0%. In the non-fecal retention groups, the King's Stool Chart indicated < 100 g in 81.8%, and the Bristol Stool Chart indicated type 5-7 in 100%. In conclusion, fecal properties of elderly constipation patients with the long-term parenteral nutrition should be assessed in follow-up examination by US, which is possible for personalized medical care by US, to avoid the administered regular management of constipation.

Objective assessment of leg edema using ultrasonography with a gel pad.

Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.

Dermal Structure in Lymphedema Patients with History of Acute Dermatolymphangioadenitis Evaluated by Histogram Analysis of Ultrasonography Findings: A Case-Control Study.

BACKGROUND: Acute dermatolymphangioadenitis (ADLA) is a risk factor for increasing of edema and worsening severity. Reducing ADLA frequency is an important objective of lymphedema management because ADLA episodes are strongly associated with poor quality of life. Lymphedema changes dermal and subcutaneous structure, favoring ADLA; ADLA recurrence may be caused by structural change of the dermis. However, the structure of the skin following ADLA episodes has not been studied in depth. The aim of this study was to examine changes in the skin after episodes of ADLA in breast cancer-related lymphedema (BCRL) using histogram analysis of ultrasonography findings. METHODS AND RESULTS: This was a case-control study with matching for the duration of lymphedema. We compared 10 limbs (5 BCRL patients, Cases) with a history of ADLA and 14 limbs (7 BCRL patients, Controls) without. Ultrasonography was performed using a 20-MHz probe, and measurements were made at a site 10 cm proximal to the ulnar styloid process. We compared "skewness" of the images in the dermis from the histogram analysis. This study was approved by the Ethics Committee of Kanazawa University. Skewness was significantly different between the affected and unaffected limbs (p = 0.02). Cases showed a positive value (median 0.74, range -0.18 to 1.26), whereas Controls showed a negative value (median -0.21, range -0.45 to 0.31). CONCLUSIONS: Episodes of ADLA changed the distribution of echogenicity on imaging, which indicates a change in the collagen fibers in the dermis. These findings might contribute to improving the management of lymphedema and prevention of recurrent ADLA.

Associations between the treatments and outcomes of patients with upper and lower lymphoedema in Japan: a cross-sectional observational study.

BACKGROUND: Lymphoedema is not currently curable, and it is important that symptoms are alleviated by appropriate treatment. Treatments aim to delay the progression of swelling and to improve patients' quality of life (QOL). There are many objective and subjective outcomes of lymphoedema, but it is unclear which outcomes should be used to evaluate lymphoedema treatments. OBJECTIVE: This study aimed to examine the associations between lymphoedema treatments and outcomes. DESIGN: A cross-sectional observational study. SETTING: Lymphoedema outpatient clinics in Japan. PARTICIPANTS: A total of 170 patients with lymphoedema were recruited from four outpatient clinics. METHODS: The data were collected from medical records, physical assessments, and interviews. The following objective outcomes were evaluated: circumference measurements, Stemmer sign, cellulitis, and skin hardness. The following subjective outcomes were evaluated: satisfaction with treatment, subjective symptoms, EuroQol-5 dimensions, and a quality of life measure for limb lymphoedema (LYMQOL). Multiple regression analysis was performed to examine the associations between lymphoedema treatments and their outcomes. RESULTS: Secondary lymphoedema was present in 158 patients (92.9%), and 91 patients (53.5%) had lower lymphoedema. The patients using compression garments were 2.63 times more likely to have a positive Stemmer sign and 2.85 times more likely to be satisfied with their treatment than those who were not using compression garments (p=0.02 for Stemmer sign, p<0.01 for satisfaction). The patients treated with simple lymphatic drainage (SLD) exhibited a 2.26-fold greater level of satisfaction with treatment than those not receiving this treatment (p<0.01). The patients treated with complete decongestive therapy (CDT) had higher QOL than did those not receiving this therapy (ß=-0.19, p=0.04). CONCLUSIONS: The progression of swelling can be evaluated using the Stemmer sign with regard to compression therapy. The degree of satisfaction can be evaluated as the patient's satisfaction with their lymphoedema regarding compression garments and SLD, and improvements in QOL can be evaluated using the LYMQOL with regard to CDT. The subjective outcomes were not associated with every lymphoedema treatment in this study, and the effectiveness of lymphoedema treatment can be evaluated using several different outcomes.

Assessment of the interstitial fluid in the subcutaneous tissue of healthy adults using ultrasonography.

OBJECTIVE: Lymphoedema involves swelling, especially in the subcutaneous tissues. For lymphoedema management to be successful, it is necessary to remove the interstitial fluid. Subcutaneous echogenicity may be associated with interstitial fluid, but echogenicity is not an indicator for the evaluation of management because we do not directly compare echogenicity with the interstitial fluid. We aimed to identify an outcome indicator for the evaluation of interstitial fluid using ultrasonography. We assessed the correlation between echogenicity and transverse relaxation rate (R2) on magnetic resonance imaging. METHODS: This was an observational study. Healthy adults with leg swelling after activity for >8 h were recruited. The legs of 13 women were evaluated using ultrasonography, magnetic resonance imaging and measurements of the limb circumference before and after an intervention to reduce the swelling. RESULTS: Echogenicity in the oedema group was greater than that of the controls. Echogenicity decreased with reductions in oedema. The range of the strongest correlations with the changes in R2 occurred at echogenicity values of 48-144 (Pearson's correlation coefficient: r = -0.63 and p < 0.01). Thus, it was possible to evaluate the interstitial fluid using echogenicity. CONCLUSION: The outcome indicators for the evaluation of interstitial fluid using ultrasonography were echogenicities in the range of 48-144, and these values were valid for assessing the interstitial fluid in the subcutaneous tissue.

Evaluation of the effects of honey on acute-phase deep burn wounds.

This study aimed to clarify the effects of honey on acute-phase deep burn wounds. Two deep burn wounds were created on mice which were divided into four groups: no treatment, silver sulfadiazine, manuka honey, and Japanese acacia honey. Wound sizes were calculated as expanded wound areas and sampled 30 minutes and 1-4 days after wounding for histological observation. The wound sections were subjected to hematoxylin and eosin and immunohistological staining to detect necrotic cells, apoptotic cells, neutrophils, and macrophages. The no treatment group formed a scar. The redness around the wound edges in the silver sulfadiazine group was the most intense. All groups exhibited increased wound areas after wounding. The proportions of necrotic cells and the numbers of neutrophils in the manuka and acacia honey groups were lower than those in the no treatment and silver sulfadiazine groups until day 3; however, there were no significant differences between all groups on day 4. These results show that honey treatment on deep burn wounds cannot prevent wound progression. Moreover, comparing our observations with those of Jackson, there are some differences between humans and animals in this regard, and the zone of hyperemia and its surrounding area fall into necrosis, which contributes to burn wound progression.

Effects of three types of Japanese honey on full-thickness wound in mice.

Although many previous studies reported that honey promotes wound healing, no study has examined the effects of Japanese honey. The aim of this study was to investigate the effects of three types of Japanese honey, Acacia, Buckwheat flour, and Chinese milk vetch honey, on wound healing in comparison with hydrocolloid dressing. Circular full-thickness skin wounds were produced on male mice. Japanese honey or hydrocolloid dressing was applied daily to the mice for 14 days. The ratio of wound area for the hydrocolloid dressing group increased initially in the inflammatory and early proliferative phases and then decreased rapidly to heal with scarring. However, the ratios of wound area for the Japanese honey groups decreased in the inflammatory phase, increased in the proliferative phase, and decreased in the proliferative phase, and some wounds were not completely covered with new epithelium. These findings indicate that using Japanese honey alone has limited benefit, but since it reduces wound size in the inflammatory phase, it is possible to apply a combined treatment in which Japanese honey is applied only in the inflammatory phase, followed by hydrocolloid dressing from the proliferative phase, which would effectively contract the wound.