Usability of a Novel Instrument to Measure Damaged Peristomal Skin in Patients with an Ostomy.

OBJECTIVE: To evaluate the usability of a novel instrument (stoma ruler) to measure damaged peristomal skin in patients with an ostomy. METHODS: A wound ostomy and continence nurse used both the stoma ruler and a linear ruler to assess DET (discoloration, erosion, tissue overgrowth) scores and the height of protrusion above the skin of 10 patients with ileostomies and took photographs. The photographs were presented to five ostomy care nurses for reliability testing. The difference between the two methods was determined using paired Wilcoxon signed ranks test. PRIMARY OUTCOME MEASURE: Interrater reliability of the linear versus stoma ruler. RESULTS: The interrater reliabilities of the stoma ruler versus the linear ruler for the domain-area DET score were 0.95 (95% confidence interval, 0.89-0.99) and 0.68 (95% confidence interval, 0.42-0.89), respectively. Only nurse 5 reported a significant difference between the two rulers (z = -2.24, P = .03). CONCLUSIONS: In busy clinical settings, the stoma ruler is easy for ostomy care nurses to use to obtain accurate DET scores and the height of stoma protrusion above the skin. Observing the position of damaged skin using the clock marks on the stoma ruler enhance clinical description and reduce assessment variation among professionals.

Excessive cleansing: an underestimating risk factor of rosacea in Chinese population.

Appropriate skincare is essential in the prevention and management of rosacea. We sought to investigate whether cleansing habits, the initial step of skin care, would influence the onset and progression of rosacea and their associations with clinical features of rosacea in the Chinese population. We analyzed the daily cleansing habits data collected from 999 rosacea cases and 1010 skin-healthy controls from China. Overall, the high frequency of cleansing (more than once daily) (OR = 1.450) and the large amount of cleansers (> 5 pieces/year) (OR = 1.612) presented a positive correlation with rosacea occurring. The cleansing duration and types of cleansers appeared not to be correlated with the onset of rosacea in this study. Significant risk factors also included the deep cleansing habits, such as the overuse of cleansing tool (more than four times/week) (OR 2.179) and oil control and exfoliating behaviors via daily used products (OR 2.435), facial mask (OR 1.459) or projects in beauty salons (OR 2.688). The analysis of the clinical features of rosacea showed that patients who prefer deep cleansing were more prone to present an initial symptom of papule and pustule (OR 1.63-3.15). What is more, using daily exfoliating products presented a positive correlation with the progression of the symptoms from flushing to erythema (OR = 2.01), papule and pustule (OR = 2.28) and telangiectasis (OR = 2.14), and the affected areas from a single area to pan facial (OR = 1.650). In conclusion, excessive cleansing habits were substantial risk factors for the incidence and progression of rosacea in the Chinese population.

Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study.

AIM: The aim of this quasi-experimental study was to develop an anti-embolism stocking care protocol and assess its effectiveness in preventing associated skin problems on the legs. MATERIALS AND METHODS: The study was conducted between 02 March and July 20, 2016 in the surgical clinics of a private university hospital in Ankara, Turkey. The sample consisted of 27 nurses and 162 patients (three different patients were fitted of anti-embolism stockings by each of the 27 nurses; pre-protocol 81 patients and post-protocol 81 patients). Data were collected using data collection forms developed by the researchers. An anti-embolism stocking care protocol was developed and used. Nurses and patients were evaluated using an observational method. RESULTS: Following implementation of the protocol, nurses' mean knowledge (95.24 ± 5.60) and intervention skill (92.06 ± 10.42) scores were significantly higher than their pre-protocol knowledge (73.54 ± 14.26) and intervention skill (15.30 ± 6.84) scores. Nurses performed almost all steps of the care protocol correctly after the protocol was implemented. The rates of skin problems such as pressure ulcers, neurovascular problems and issues associated with wrinkles or creases in stockings were significantly reduced after implementation of the protocol. CONCLUSIONS: This study demonstrates that nurses' knowledge and intervention skills are increased when a care protocol is used, together with the prevention of errors and improved patient outcomes. The use of care protocols guides nurses in practice, raises awareness and helps to achieve nursing care objectives by standardizing information.

The BaSICS (Baby Skin Integrity Comparison Survey) study: A prospective experimental study using maternal observations to report the effect of baby wipes on the incidence of irritant diaper dermatitis in infants, from birth to eight weeks of age.

BACKGROUND: Baby wipes have been shown to be safe and effective in maintaining skin integrity when compared to the use of water alone. However, no previous study has compared different formulations of wipe. The aim of the BaSICS study was to identify any differences in incidence of irritant diaper dermatitis (IDD) in infants assigned to three different brands of wipe, all marketed as suitable for neonates, but which contained varying numbers of ingredients. METHODS: Women were recruited during the prenatal period. Participants were randomly assigned to receive one of three brands of wipe for use during the first eight weeks following childbirth. All participants received the same nappies. Participants reported their infant's skin integrity on a scale of 1-5 daily using a bespoke smartphone application. Analysis of effect of brand on clinically significant IDD (score 3 or more) incidence was conducted using a negative binomial generalised linear model, controlling for possible confounders at baseline. Analysts were blind to brand of wipe. RESULTS: Of 737 women enrolled, 15 were excluded (admitted to neonatal intensive care, premature or other infant health issues). Of the 722 eligible babies, 698 (97%) remained in the study for the full 8-week duration, 24.6% of whom had IDD at some point during the study. Mothers using the brand with the fewest ingredients reported fewer days of clinically significant nappy rash (score≥3) than participants using the two other brands (p = 0.002 and p < 0.001). Severe IDD (grades 4 and 5) was rare (2.4%). CONCLUSIONS: Rarity of severe IDD suggested that sensitive formula baby wipes are safe when used in cleansing babies from birth to eight weeks during nappy changes. The brand with fewest ingredients had significantly fewer days of clinically significant IDD. Daily observations recorded on a smartphone application proved to be a highly acceptable method of obtaining real-time data on IDD. CLINICAL TRIAL REGISTRATION: This study was not designed or registered as a clinical trial as no intervention in normal patterns of infant care took place. Mothers who had already decided to use disposable nappies and a baby wipe product agreed to observe and report on their infants' skin condition; in return they received a 9-week supply of free nappies and wipes.

A Cohort Study Using a Facial Cleansing Brush With Acne Cleansing Brush Head and a Gel Cleanser in Subjects With Mild-to-Moderate Acne and Acne-Prone Skin

Introduction: Acne vulgaris is a highly prevalent skin condition that can adversely affect the quality of life. Acne-predisposed skin is in a state of subclinical inflammation leading to skin barrier dysfunction. A multi-center cohort study was designed to evaluate clinical efficacy and safety of twice daily facial cleansing using an oscillatory sonic brush, acne brush head, and cleansing gel for 4 weeks. Methods: Subjects with mild-to-moderate acne and acne-prone skin used the cleansing regime after which they applied the skin care products they routinely used. Physician-assessed skin condition comparing baseline versus week 4 using the FDA/IGA scale and subject satisfaction with cleansing efficacy and handling properties of the regime were scored during the last visit. Results: Forty-six subjects completed the study. Physician-scored skin condition showed a statistically significant improvement in FDA/IGA scores and a significant reduction of inflammatory and non-inflammatory lesions comparing baseline versus 4 weeks. Thirty-five (76.0%) subjects had cleared or almost cleared. Subjects similarly assessed their skin to be improved. Conclusion: Both the physician and subject scores revealed the gentle cleansing routine using the sonic brush to be effective reducing the number of acne lesions, improving skin condition. No adverse events were reported during the study period. The cleansing regime may offer an attractive, safe option for maintenance and treatment of subjects with mild-to-moderate acne and acne-prone skin. J Drugs Dermatol. 2019;18(11):1140-1145.

Development and Validation of a Manual of Skin Care for Persons Deprived of Liberty in the São Paulo State Prison System: A Descriptive Study.

Brazil has the third largest prison population in the world. Studies on the health status of prisoners have shown that skin diseases, especially infectious skin diseases, are prevalent in this population. Because some skin diseases can be prevented, strategies to inform and guide incarcerated persons may be helpful. PURPOSE: The purpose of this study was to develop and validate a manual of skin care for use by prisoners in the São Paulo State Prison System. METHODS: To develop the manual, a Google search to ensure originality of the concept was conducted, followed by an integrative literature search of the MEDLINE and the Latin American and Caribbean Health Science Literature, and the medical records of the prison system were reviewed for content. The Delphi technique was used to validate content; the content validity index (CVI) was determined based on the ratings of an expert panel of 10 prison employees who were health professionals and have experience providing care to prisoners. Twenty (20) target-users (prisoners) also evaluated the manual. The experts responded to questionnaires (sent by email) containing 19 items related to the manual's objective, structure and presentation, and relevance. Items were rated on a Likert-type scale where 1 = inadequate, 2 = partially inadequate, 3 = adequate, 4 = very adequate, and NA = not applicable, and participants also could provide suggestions and comments on the manual. The prisoners used a paper-and-pencil questionnaire to assess the manual that included 14 items with 3-choice answers (agree, undecided, disagree) on the utility and ability to understand the manual topics and space to write concerns and suggestions regarding the utility of the content; they also could offer their thoughts and opinions about the manual. The proportion of agreement among responses was calculated. RESULTS: The overall CVI of the first round of evaluations was 1.0. Suggested changes were to include guidelines on the proper use of medications and modify some wording. The overall CVI of the next round was 1.0 (100% agreement). The evaluation by target users showed an agreement of 98.6%. The final version of the manual has 8 topics, 12 subtopics, and 29 illustrations; topics include skin, hair, and nail care and skin diseases. A printed version is available in the prison library and an electronic copy was sent to all prisons in the State of São Paulo to be printed as needed. CONCLUSION: A manual providing guidelines on skin care for prison populations was developed and validated with the intent to improve prisoner quality of life and care. Research to examine overall manual usage and the effect of the information and guidance on healthy behaviors, prevention, and management of skin diseases is warranted.

Patient Attitudes and Their Awareness Towards Skin Cancer-Related Apps: Cross-Sectional Survey.

BACKGROUND: In the emerging era of digitalization and electronic health, skin cancer-related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. OBJECTIVE: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer-related apps. METHODS: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer-related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. RESULTS: A total of 98.9% (195/197) of patients had never used skin cancer-related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. CONCLUSIONS: The experience and knowledge of skin cancer-related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source.

Facial cleansing with a sonic brush-A review of the literature and current recommendations.

INTRODUCTION: Skin cleansing is important for removal of dirt, debris, and sebum and plays an important role in reduction of pollution-induced skin aging. Cleansing is an established part of treatment recommendations and procedures in dermatology. Different methods for facial skin cleansing are established but recommendations on use of special devices are not fully integrated into clinical practice. AIM: We review the current literature on sonic cleansing to demonstrate that a gentle and effective cleansing routine using a sonic brush followed by appropriate additional methods for rehydration and skin protection may improve both inflammatory conditions including acne vulgaris and skin damage associated with overexposure to exogenous light and pollution. METHODS: A working group of experienced clinicians managing facial inflammatory skin conditions convened for a meeting. The panel reviewed the literature surrounding sonic brush cleansing and discussed clinical questions aiming to optimize facial cleansing outcomes. RESULTS: The panel agreed there are increasing concerns over the rise of atmospheric pollution globally and its impact on health and skin aging and that cleansing in combination with nonspecific skin care is able to support physiological microenvironmental skin conditions including pH levels on the skin surface, barrier function, and hydration. CONCLUSION: Cleansing poses a challenge in balancing debris removal while avoiding excess sebum removal, thereby maintaining an intact stratum corneum barrier. The sonic brush may offer a safe and effective treatment for various conditions.

A Novel Silicon Device for the Packing of Cutaneous Abscesses.

BACKGROUND: Superficial skin abscesses are commonly encountered in emergency medicine practice. Standard treatment includes incision, drainage, and often packing with a gauze strip. The packing component of the procedure has several negative potential outcomes, is painful, and necessitates a return visit for removal. DISCUSSION: Here we report the first case in which a novel silicon packing device was utilized. The patient presented with a facial abscess, which was incised and drained. The novel device was inserted, and removed by the patient independently, without complication. Both patient and provider reported satisfaction with the novel procedure, and noted low pain scores. CONCLUSIONS: This device has the potential to replace traditional packing, and will require further study through a controlled trial to assess for safety and efficacy.

Dry skin in home care: A representative prevalence study.

AIMS AND OBJECTIVES: To measure the prevalence and severity of dry skin in the home care nursing setting in Germany and to determine demographic and health characteristics associated with skin dryness. BACKGROUND: Advanced age and skin care dependency are risk factors for the development of skin dryness. Dry skin has a negative impact on the quality of life and increases the risk for secondary cutaneous infections and other adverse skin conditions. The prevalence of dry skin in home care is unknown. DESIGN: A representative multicenter prevalence study was conducted in home care services in Germany during July 2015. METHODS: A random selection of home care services and clients was performed. Nurses, who were instructed how to perform the data collection using standardized forms, performed data collection. Demographic, functional and health variables were documented and analyzed. RESULTS: More than half of all participating clients (n = 923; median age 83 years (range 21-104)) were affected by dry skin (51.7 (95% CI 48.5 to 54.9). The most often affected skin areas were the distal extremities. Males and immobile clients were more often affected than females and mobile clients. In the adjusted analysis pruritus and the presence of incontinence-associated dermatitis were most strongly associated with dry skin. CONCLUSION: Dry skin occurs widely in home care and is strongly associated with pruritus. Fundamental skin care is an easy but powerful nursing intervention to treat this condition successfully. Preventive skin care strategies need to be implemented in the home care setting to improve skin health and integrity either by nurses and/or informal caregivers.

An Observational, Prospective Cohort Pilot Study to Compare the Use of Subepidermal Moisture Measurements Versus Ultrasound and Visual Skin Assessments for Early Detection of Pressure Injury.

Pressure ulcers (PUs) are detected by visual skin assessment (VSA). Evidence suggests ultrasound (US) and subepidermal moisture (SEM) scanner technology can measure tissue damage before it is visible. PURPOSE: A pilot study was conducted to evaluate consistency between SEM and US examinations of suspected deep tissue injury (sDTI). METHOD: Using an observational, prospective cohort study design, patients >55 years of age were recruited. VSA, SEM, and US assessments were performed daily for a minimum of 3 and maximum of 10 consecutive days following enrollment. US results were considered indicative of sDTI if hypoechoic lesions were present. SEM readings were considered abnormal when ∆ ≥0.6 was noted for at least 2 consecutive days. Boolean analysis was utilized to systematically determine consistency between US and SEM where sDTI was the clinical judgment. RESULTS: Among the 15 participants (10 women, mean age 74 ± 10.9 years), there was consistent agreement between SEM and US when sDTIs existed. For 1 patient who developed a heel sDTI during the study, SEM readings were abnormal 2 days before VSA indicated tissue damage and 3 days before the appearance of a hypoechoic lesion in the US. CONCLUSION: US and SEM results were similar, and in an evolving sDTI case, SEM detected a lesion earlier than US.

Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale.

AIM: To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability. BACKGROUND: Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants. METHOD: The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed. For the second stage, the inter-rater/intra-rater agreement and construct validity were evaluated using a cross-sectional design. Finally, in the third stage, a cohort study to analyse pressure ulcers' incidence, diagnostic tests and the cut-off points of the scale was performed. RESULTS: In the first phase, the content validity index was 0.93. In the second phase (336 neonates), the intra-rater reliability was 0.93 and the inter-rater reliability was 0.97. The construct validity has shown a two-dimensional model that fits better, representing "pressure duration and intensity" and "skin immaturity." In the third phase (268 neonates) the best values were those presented by the score 17: receiver operating characteristic curve was 0.84, showing a sensitivity of 91.18%, specificity of 76.50%, positive predictive value of 36.05% and negative predictive value of 98.35%. CONCLUSION: The scale has shown evidence of validity and reliability to measure the neonatal risk of pressure ulcers in the Spanish context. IMPLICATIONS FOR NURSING MANAGEMENT: Pressure ulcers are an adverse event recognised in paediatric units and specifically in neonatal units. The intent of the Spanish Neonatal Skin Risk Assessment Scale is to identify hospitalised neonates requiring prevention measures and their specific risk factors, to provide useful diagnostic information to improve the neonatal skin care into Spanish speaking countries. The Neonatal Skin Risk Assessment Scale could ensure the efficient and effective allocation of limited preventive resources, support clinical and management decisions, allow risk-adjusted cases in epidemiological studies, facilitate the development of risk assessment protocols and serve as evidence in litigation cases. All these features could facilitate developing best practice in nursing management and improve the quality and safety of neonatal care.

Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. METHODS: Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. RESULTS: None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P < .001). Patients in the intervention group had a significantly greater decrease in goniometric scores (mean decrease = 1.4 ± 2.25) compared to the control group by day 3 (mean decrease = 0.1 ± 0.52 P = .004) and the last study day (mean decrease = 2.0 ± 3.02 for the intervention group vs 0.07 ± 0.96 for the control group; P < .001). CONCLUSIONS: Study findings indicate that a heel protector that ensures off-loading and maintains the foot in a neutral position is more effective for prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.

Pressure ulcers in maturing skin - A clinical perspective.

While the problem of Pressure Ulcers (PU) in adults has received a great deal of attention, far less is known about PUs in neonates and children. The overall health status of children is generally better and multi-morbidity is limited to a small percentage of patients, like very low term neonates (born before 32 weeks of gestation age), newborns with congenital abnormalities, genetic disorders, perinatal distress syndrome or children with a limited immunity. Survival rates of both critically and chronically ill neonates, infants and children have improved dramatically in recent years, introducing new challenges for medical and nursing care. Children's skin undergoes several changes throughout the first 18 years of life. The most important function of the skin is to protect against water loss, absorptions of noxious substances, intrusions of microorganisms and physical trauma. Effective PU prevention includes device related under-padding and careful positioning and fixation of such devices. At least regular head-to-toe-skin assessment of neonates and infants at risk of PUs should be performed.

Systematic mapping review about costs and economic evaluations of skin conditions and diseases in the aged.

BACKGROUND: Skin conditions and dermatological diseases associated with advanced age (e.g. fungal infection, dry skin and itch) receive increasingly attention in clinical practice and research. Cost and economic evaluations are important sources to inform priority setting and ressource allocation decisions in healthcare. The economics of skin conditions in aged populations has not been systematically reviewed so far. OBJECTIVES: The aim of this mapping review was to summarize the economic evidence of selected skin conditions in the aged (65 + years). METHODS: A mapping literature review and evidence summary was conducted. Searches were conducted in data bases Medline and Embase via OVID. Cinahl was searched using EBSCO. References lists of potential eligible studies, reviews, guidelines or other sources were screened for additional literature. For evaluation of methodological quality of full economic analyses the Consensus on Health Economic Criteria (CHEC) checklist was used. RESULTS: Database searches resulted in 1388 records. A total of 270 articles were read in full-text. Thirty-five publications were finally included in the data analysis reporting 38 economic analyses. Ten cost of illness analyses and 26 cost-effectiveness analyses reporting about pressure ulcers, skin tears, pressure ulcers, incontinence associated dermatitis and intertrigo/contact dermatitis/candidiasis treatment and prevention and onychomycosis testing were identified. Limited evidence indicated that low air loss beds were more cost effective than standard beds for prevention of pressure ulcers. Standardized skin care regimens seem to lower the incidence of pressure ulcers, skin tears and IAD but a cost saving effect was not always observed. CONCLUSIONS: Findings of this mapping review indicate that there is a paucity of high quality evidence regarding the economic impact of age-associated skin conditions and diseases. Substantial heterogeneity in terms of study design, evaluation perspective, time period, and way of cost estimation was identified. Because of the overall low methodological quality clear cut conclusions cannot be drawn. Robust and large scales economic evaluations about skin conditions and disease in aged populations are needed in the future.

The Euromelanoma campaign / La campaña del euromelanoma

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Glove Use and Glove Education in Workers with Hand Dermatitis.

BACKGROUND: Occupational skin diseases are common. The occurrence of occupational skin diseases represents a failure of primary prevention strategies that may include the use of personal protective equipment, most commonly gloves. OBJECTIVE: The objective of this study was to describe current glove use and education practices related to gloves in workers being assessed for possible work-related hand dermatitis. METHODS: Participants included consecutive patients being assessed for possible work-related hand dermatitis. A self-administered questionnaire obtained information on demographics, workplace characteristics and exposures, glove use, and education regarding gloves. RESULTS: Ninety percent of the 105 participants reported using gloves. Only 44% had received training related to glove use in the workplace. Major gaps in training content included skin care when using gloves, warning signs of skin problems, and glove size. If the worker indicated no glove training received, the majority reported they would have used gloves if such training was provided. CONCLUSIONS: Although the majority of workers being assessed wore gloves, the minority had received training related to glove use. Particular gaps in training content were identified. Those who had not received training noted they would likely have used gloves if training had been provided.