Prevalence of skin tears in the extremities among elderly residents at a nursing home in Denmark.

OBJECTIVE: The aim of the study was to determine the prevalence of skin tears in the extremities and explore factors in relation to skin tears in elderly residents at a Danish nursing home. METHOD: The study was designed as a point prevalence survey and conducted at a nursing home with 140 residents >65 years of age. The residents were assessed for presence, number and location of skin tears. Data were collected using a data collection sheet developed for this study. The survey team consisted of four expert nurses from a university hospital (two dermatology and two wound care nurses). Data were collected over a period of 10 hours spread over two days. RESULTS: Of the 128 participating residents six had skin tears, yielding a prevalence of 4.6 %. In total, 10 skin tears were observed in the 6 residents. The frequency of previous skin tears was 19.5 %. This frequency was significantly higher in residents with skin tears than in those without skin tears (83.3 % versus 16.4 %, p<0.001). Analysis of the relation between skin tears or previous skin tears versus without skin tears or previous skin tears showed significant differences related to the presence of ecchymosis (76.9 %versus 14.7 %, p<0.0001). There were no other significant factors observed. CONCLUSION: The low prevalence found in this study may reflect the focus on prevention of skin tears that the nursing home has maintained over the past year. Nevertheless, the appropriate prevention and management of residents with skin tears is an ongoing challenge for health professionals.

Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System.

OBJECTIVE: The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. METHOD: Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN) and social and health-care assistants (non-RN) from both primary health care and a Danish university hospital in Copenhagen. Thirty photographs, with equal representation of the three types of skin tears, were selected to test validity. The photographs chosen were those originally used for internal and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. RESULTS: The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists. The ISTAP classification system was validated by 241 RNs, and 29 non-RN. The results indicated a moderate level of agreement on classification of skin tears by type (Fleiss' Kappa=0.460). A moderate level of agreement was demonstrated for both the RN group and the non-RN group (Fleiss' Kappa=0.464 and 0.443, respectively). CONCLUSION: The ISTAP Skin Tear Classification System was developed with the goal of establishing a global language for describing and documenting skin tears and to raise the health-care community's awareness of skin tears. The Danish translation of the ISTAP classification system supports the earlier ISTAP study and further validates the classification system. The Danish translation of the classification system is vital to the promotion of skin tears in both research and the clinical settings in Denmark.

Patients with psoriasis have insufficient knowledge of their risk of atherothrombotic disease and metabolic syndrome.

BACKGROUND: Knowledge is crucial to allow patients to increase their level of self-care. OBJECTIVES: To examine the extent to which patients with moderate to severe psoriasis feel informed about their disease, to investigate their level of knowledge about psoriasis and the associated risk of atherothrombotic disease and metabolic syndrome, and to assess the importance of the kind of treatment received and of membership of a patients' association. METHODS: In total, 218 patients with psoriasis (mean age 45.5 years, range 18-83), who were being treated with methotrexate or biological drugs responded to a questionnaire. RESULTS: Patients were well informed about their skin disease, but were less well informed about their risk of atherothrombotic disease/metabolic syndrome (visual analogue scale values of 6.91 and 5.15, respectively). Patients' knowledge of the disease was reflected by 74.2-99.1% correct answers (CA). The risk of arthritis elicited 88% CA and of depression 41.7% CA, while the risk of atherothrombotic disease and metabolic syndrome produced only 11.9-15.3% CA. Patients treated with biological drugs had a significantly stronger sense of being more well informed about the risk of disease (P = 0.02) and their risks (P < 0.001) compared with patients treated with methotrexate. Members of a patients' association had significantly more knowledge than nonmembers about the risk of depression (P = 0.01), hypertension (P = 0.001), diabetes mellitus (P = 0.01) and obesity (P = 0.04). CONCLUSIONS: This study shows that few patients with moderate to severe psoriasis are aware of their increased risk of atherothrombotic disease and metabolic syndrome. This indicates the need for patients to be offered education concerning the risk and prevention of atherothrombotic disease and metabolic syndrome.

Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate.

BACKGROUND: Pain during photodynamic therapy (PDT) is a considerable problem that needs to be studied to improve this otherwise attractive treatment of skin diseases. OBJECTIVES: To compare pain during PDT using two different fluence rates, and also to evaluate the association between pain and protoporphyrin IX (PpIX) fluorescence, lesion type, lesion preparation and lesion localization. METHODS: Twenty-six patients with actinic keratoses (AKs) in different localizations and 34 patients with facial acne vulgaris were treated with methyl aminolaevulinate-PDT. Patients with acne were illuminated using two different fluence rates. Pain score during PDT and PpIX fluorescence prior to illumination were measured. RESULTS: The study showed that pain during illumination was associated with the PpIX fluorescence in the treatment area (P = 0.0003, R(2) = 0.31). When using a fluence rate of 34 mW cm(-2) patients with acne had a pain score of 6 [interquartile range (IQR) 5-7] compared with 8 (IQR 6-10) when using a fluence rate of 68 mW cm(-2) (P = 0.018). After correcting the pain score for PpIX fluorescence no differences in pain scores were found between first and second acne treatment, locations of AK lesions or between the two types of lesions. CONCLUSIONS: Pain during PDT was correlated with the PpIX fluorescence in the treatment area prior to illumination. Pain was reduced using a lower fluence rate during PDT of acne.