An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy.

AIMS AND OBJECTIVES: To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy. BACKGROUND: It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway. DESIGN: An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process. CONCLUSION: There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity. RELEVANCE TO CLINICAL PRACTICE: The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment skin framework into their daily routine. Such validated tools may add value to postradiotherapy patient care by providing a consistency of management and accordingly refining best practice.

Patient knowledge and experience of hyperbaric oxygen treatment.

INTRODUCTION: This paper presents a quantitative and qualitative study exploring patients' knowledge and experience of hyperbaric oxygen treatment (HBOT). METHODS: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description. RESULTS: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a 'diver'; and (4) burdens of HBOT. CONCLUSIONS: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a 'diver' and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.

Comparison of venous, capillary and interstitial blood glucose data measured during hyperbaric oxygen treatment from patients with diabetes mellitus.

INTRODUCTION: Patients undergoing hyperbaric oxygen treatments (HBOT) have been shown to experience a reduction in blood glucose (BG) levels during a treatment. This necessitates frequent assessment of BG levels. Continuous glucose monitoring (CGM) may represent an alternative to the current finger prick monitoring method in-chamber, however, continuous sensor glucose (SG) data has not been validated in situ. The aim was to determine the validity of continuous SG and intermittent BG monitoring with serum BG levels in diabetic patients during HBOT. METHODS: Measurements were obtained (finger prick [capillary sample], CGM [interstitial fluid], and serum [venous sample]) at baseline, and at 30, 60, 90 and 120 minutes during the hyperbaric treatment. Data were analysed by calculating intraclass correlation coefficients (ICC) and using mixed effects linear regression. RESULTS: The ICC results (n = 10 patients) between the three methods indicated very high and statistically significant absolute agreement at baseline (pre-dive) (ICC = 0.90, 95% CI 0.74-0.97), at 30 minutes (ICC = 0.85, 95% CI 0.61-0.96), 60 minutes (ICC = 0.86, 95% CI 0.58-0.96), 90 minutes (ICC = 0.87, 96% CI 0.63-0.96) and 120 minutes (ICC = 0.90, 95% CI 0.70-0.97). Capillary glucose and CGM SG readings were each within 1 mmol·L-1 on average of the serum glucose reading, with multi-level linear regression finding the average difference between the CGM SG and capillary glucose methods of BG sampling was not statistically significant (P = 0.81). CONCLUSIONS: The CGM SG data were comparable with glucose readings from capillary monitoring. Both CGM and capillary data were consistent with serum values.

Evaluation of the Abbot FreeStyle Optium Neo H blood glucose meter in the hyperbaric oxygen environment.

INTRODUCTION: This study investigated the effects of hyperbaric oxygen treatment (HBOT) on the accuracy and reliability of point-of-care fingertip capillary blood glucose values in euglycaemic non-diabetic participants compared against venous serum blood glucose samples processed in an accredited pathology laboratory. METHOD: Ten non-diabetic hyperbaric staff members (age 35-55 years) underwent a standard 243 kPa HBOT exposure for 95 minutes. Blood glucose levels were measured via (i) finger-prick capillary test using the FreeStyle Optium™ Neo H glucometer and (ii) venous serum test using the Cobas 6000 laboratory analyser. Samples were taken at (T1) 0 minutes (pre-HBOT), (T2) 25 minutes, and (T3) 55 minutes into HBOT. RESULTS: All participants were euglycaemic at T1 (BGL 3.8-5.4 mmol·L⁻¹). The highest venous serum value was 5.90 mmol·L⁻¹ at T3 and the highest capillary value was 6.30 mmol·L⁻¹ at T1. Post hoc tests showed a statistically significant difference between the mean capillary result pre-dive (T1) and readings at T2 (P = 0.001) and T3 (P < 0.001) while differences between T2 and T3 capillary results were not statistically significant, illustrating the effect of HBOT on capillary beds. Differences in venous values across the time points were not significant. CONCLUSION: Venous serum glucose samples processed in an accredited laboratory may be more consistently accurate, but capillary point-of-care testing avoids delays in sample processing and provides glucose data that are of clinical relevance. The FreeStyle Optium™ Neo H glucometer is safe to use and provides a reliable measurement of blood glucose in the HBOT environment.

Performance of the Baxter Infusor LV10 under hyperbaric conditions.

INTRODUCTION: Elastomeric drug delivery devices are a simple way to provide long-term IV therapy to patients in the outpatient setting. Patients receiving hyperbaric oxygen therapy occasionally need these devices. This study compared the performance of the Baxter infusor LV10 elastomeric device in repetitive conditions at pressures of 101.3 kPa and 243 kPa. METHODS: Ten Baxter infusor LV10 elastomeric devices were pressurised in a hyperbaric chamber to 243 kPa over a two-hour period consistent with a standard medical treatment run. This process was repeated 10 times for each device giving a total of 20 hours under pressure. The fluid delivered by each device was measured and the device weighed at the end of each pressurisation. Ten control devices containing identical drugs were tested in the same manner at 101.3 kPa over the same time period. RESULTS: No significant differences in output of the devices were observed between hyperbaric and control conditions. The flow rates measured in both study groups were 35% lower than the manufacturer's stated flow rate, possibly due to lower test environment temperature and outdated devices used in the tests. CONCLUSION: Despite lower than expected flow rates, this study demonstrated no significant difference in the delivery rate of the Baxter infusor LV10 under 243 kPa hyperbaric conditions compared with room pressure.

Perceptions amongst Tasmanian recreational scuba divers of the value of a diving medical.

An online survey was offered to recreational divers in Tasmania to ascertain if they have an understanding of how pressure affects their health and if they considered an annual dive medical necessary. A total of 98 recreational divers completed the survey, five of these had never had a dive medical while 74 felt that if they passed their dive medical they do not have any potential illness. Sixty five saw the dive medical as a comprehensive health check. This project provided an insight to Tasmanian recreational divers' understanding of and attitude towards the value of a dive medical.