Do pressure ulcer risk assessment scales improve clinical practice?

Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU) risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed

Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study

Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer

Effects of loading and prophylactic dressings on the sacral and heel skin: An exploratory cross‐over trial

Pressure ulcers/injuries are caused by sustained loading and deformation of skin and underlying soft tissues. Prophylactic dressings are recommended as an adjunct to other preventive measures such as repositioning and offloading. The aim of this study was to investigate the effects of prophylactic soft silicone multi-layered foam dressings on the skin structure and function of the two most common pressure areas, sacrum and heel, with and without loading. An exploratory randomised cross-over trial using intra-individual comparisons was conducted. Eight healthy volunteers (mean age 27.5 years) were assigned to three groups and either spent 2.5 hours on a standard hospital mattress lying in supine position with and without dressings or spent 2.5 hours with dressings applied but without loading. Skin temperature, stratum corneum, and epidermal hydration increased in all groups irrespective of wearing a dressing and/or loading. Mean roughness decreased at the heels. Reactive hyperaemia and the release of interleukin 1 alpha were associated with loading only. Results suggest that the occlusive effects of dressings are similar or only slightly greater than those observed with non-loading or loading without dressings. Thus, a dressing does not cause additional irritation or skin changes during loading but it may reduce the inflammatory response

Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals

Aims: To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin. Design: Two multicentre descriptive cross-sectional prevalence studies. Methods: The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score. Results: In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future

Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00-0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99-1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11 degrees C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research

Using the iPhone's LiDAR technology to capture 3D forensic data at crime and crash scenes

Background: Three-dimensional (3D) documentation of crime and crash scenes is common practice during forensic and medicolegal investigations. Such documentation at a scene is usually carried out by specially trained personnel using various 3D imaging devices and methods, such as terrestrial laser scanners. Unfortunately, this causes the implementation of 3D documentation at the scenes to be expensive and not readily accessible. In 2020, Apple introduced a light detection and ranging (LiDAR) sensor into their high-end mobile devices. In 2022, Recon-3D, an iOS application (app), was launched. This app turns an iPhone or iPad into a 3D scanner and is specifically targeted at crime and crash scene applications. Objectives: The aim of this study was to test the Recon-3D app based on exemplary scenarios to see whether this technology is generally applicable to document crime or crash scenes. Materials and Methods: An iPhone 13 Pro in combination with the Recon-3D app was used to document two indoor scenarios, a mock-up crime scene and a garage, as well as an outdoor scenario of a parked car. Each scenario was documented multiple times. Results: On average, data acquisition for one scene took less than 2 min. Known distances within the scenes were measured with a mean absolute error of 0.22 cm and a standard deviation of 0.18 cm. Conclusion: The imaging workflow was simple and quick, enabling any person to perform 3D documentation at a crime or crash scene. Overall, Recon-3D appeared to be a useful application for forensic investigators

a multicentre prevalence study

Objectives: The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics. Design: Descriptive multicentre prevalence study. Setting and participants: The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included. Results: In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics. Conclusion: Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector. Trial registration number: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526

Sperm hunting on optical microscope slides for forensic analysis with deep convolutional networks – a feasibility study

Microscopic sperm detection is an important task in sexual assault cases. In some instances, the samples contain no or only low amounts of semen. Therefore, the biological material is transferred onto a glass slide and needs to be manually scanned using an optical microscope. This work can be very time consuming, especially when no spermatozoa is present. In such a case, the result needs to be validated. In this article we show how convolutional neural networks can perform this task and how they can reduce the scanning time by locating the sperm cells on images taken under the microscope. For this purpose, we trained a VGG19 network and a VGG19 variation with 1942 images, some containing sperm cells and some not