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Summary: Background: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital‐acquired pressure ulcers (PUs). Objectives: To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. Methods: This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At‐risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) – pooled as the treatment group – and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. Results: In the intention‐to‐treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41–0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35–0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34–1·68, P = 0·49). Conclusions: Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at‐risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas. What is already known about this topic?The incidence of hospital‐acquired pressure ulcers (PUs) remains high despite the implementation of best‐practice recommendations.The concept of using silicone foam dressings as an additional prophylactic strategy in PU prevention has been investigated in previous studies but with some limitations.Most RCTs were monocentric studies, restricted to either critically ill or acute care patients and did not observe more than two anatomical at‐risk skin sites, which limited the generalizability of the findings. What does this study add?This large pragmatic RCT suggests that it is beneficial to use silicone adhesive multilayer foam dressings on the sacrum, in addition to standard of care, to help prevent hospital‐acquired PUs.Clinical decision making for heel dressings should be based on the clinical effectiveness of the intervention weighed against the potential risk of falling. Linked Comment: F. Coyer. Br J Dermatol 2021; 185:4–5. [ABSTRACT FROM AUTHOR]

Summary: In order to overcome inconsistencies in the reporting of outcomes in clinical trials, core outcome sets (COSs) have been developed in many clinical areas and the awareness of this concept is growing steadily. The Outcomes for Pressure Ulcer Trials (OUTPUTs) project aims to improve the quality of evidence from pressure ulcer prevention trials by developing a COS. As an initial step in the COS process we aimed to identify and classify both outcomes and concepts that represent potential outcomes for future trials that have been reported in pressure ulcer prevention research. A review was conducted in 12 major databases covering the literature indexed until 2016. Outcomes and relevant concepts reported in primary studies and/or reviews on pressure ulcer prevention in adult patients were extracted as presented in the articles, and afterwards inductively grouped into outcome domains. The domains were then categorized according to the outcome domain taxonomy recently proposed by the COMET group. In total 332 studies were included and 68 outcome domains were identified, covering multiple aspects of pressure ulcer prevention. Pressure ulcer occurrence was reported in 71% of all included studies, representing the most frequent outcome, followed by costs (22% of all studies) and acceptability of intervention and comfort (18% of all studies). A plethora of different outcomes are applied in pressure ulcer prevention research and substantial variations in definitions and reporting of similar outcomes were observed. A COS for pressure ulcer prevention trials is needed to overcome the noncomparability of outcomes. Linked Comment: Lechner. Br J Dermatol 2021; 184:587. [ABSTRACT FROM AUTHOR]

Summary: Results of clinical trials are the most important information source for generating external clinical evidence. The use of different outcomes across trials, which investigate similar interventions for similar patient groups, significantly limits the interpretation, comparability and clinical application of trial results. Core outcome sets (COSs) aim to overcome this limitation. A COS is an agreed standardized collection of outcomes that should be measured and reported in all clinical trials for a specific clinical condition. The Core Outcome Set Initiative within the Cochrane Skin Group (CSG‐COUSIN) supports the development of core outcomes in dermatology. In the second CSG‐COUSIN meeting held in 2017, 11 COS development groups working on skin diseases presented their current work. The presentations and discussions identified the following overarching methodological challenges for COS development in dermatology: it is not always easy to define the disease focus of a COS; the optimal method for outcome domain identification and level of detail needed to specify such domains is challenging to many; decision rules within Delphi surveys need to be improved; appropriate ways of patient involvement are not always clear. In addition, there appear to be outcome domains that may be relevant as potential core outcome domains for the majority of skin diseases. The close collaboration between methodologists in the Core Outcome Set Initiative and the international Cochrane Skin Group has major advantages for trialists, systematic reviewers and COS developers. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to describe the development and evaluation of the psychometric properties of a tool used to assess clinician knowledge of incontinence-associated dermatitis (IAD). Materials & methods: The instrument was developed in three phases: Phase 1 involved item development, Phase 2 evaluated content validity of the instrument by surveying clinicians and lay stakeholders within a single state of Australia and Phase 3 used a pilot multi-site cross-sectional survey design to determine composite reliability and evaluate scores of the knowledge tool. In Phase 1, the instrument was developed by five persons with clinical and research subject expertise. In Phase 2, content validity was evaluated by a group of 13 clinicians (nurses, physicians, occupational therapists, dietitians, and physiotherapists) working in an acute care health service and two consumer representatives. In Phase 3, clinicians, working across five health services and on wards with patients who were diagnosed with IAD, participated in pilot-testing the instrument. During Phase 1, a group of local and international experts developed a preliminary tool based on an international consensus document, our prior research evaluating IAD knowledge, and consensus among an expert panel of clinicians and researchers. Phase 2 used a survey design to determine content validity of the knowledge tool. Specifically, we calculated item- and scale-level content validity ratios and content validity indices for all questions within the draft instrument. Phase 3 comprised pilot-testing of the knowledge tool using a cross-sectional survey. Analysis involved confirmatory factor analysis to confirm the hypothesised model structure of the knowledge tool, as measured by model goodness-of-fit. Composite reliability testing was undertaken to determine the extent of internal consistency between constituent items of each construct. Results: Phase 1 developed the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge tool (Know-IAD)1, comprising 19 items and divided into three domains of IAD-related knowledge: 1) Aetiology and Risk, 2) Classification and Diagnosis, and 3) Prevention and Management. In Phase 2, 18 of the 19 items demonstrated high scale content validity ratios scores on relevance (0.75) and clarity (0.82); and high scale-content validity indices scores on relevance (0.87) and clarity (0.91). In Phase 3, 204 respondents completed the survey and the Know-IAD tool. The final 18-item Know-IAD tool demonstrated construct validity by model goodness-of-fit, as measured by the root mean square error of approximation (RMSEA), which was excellent for the Aetiology and Risk domain (RMSEA=0.02) and Prevention and Management domains (RMSEA=0.02); and good in the Classification and Diagnosis domain (RMSEA=0.04). Composite reliability (CR) was good in the Aetiology and Risk domain (CR=0.76) and Prevention and Management domains (CR=0.75) and adequate in the Classification and Diagnosis domain (CR=0.64). Respondents had good understanding of aetiology and risk (72% correct responses); fairly good understanding of prevention and management of IAD (64% correct responses) and moderate understanding of classification and diagnosis (40% correct responses). Conclusion: The Know-IAD demonstrated good psychometric properties and provides preliminary evidence that it can be applied to evaluate clinician knowledge of IAD. [ABSTRACT FROM AUTHOR]

Incontinence-As sociated Dermatitis (IAD) is a type of ir ritant contact dermatitis related to chemical and physical ir ritation of the skin bar rier, trigger ing infl am mation and subsequent skin damage. The lack of an ICD-10 cod ing contributes to the variation in prevalence and incidence fi gures. Clinicians experience diffi culties to cor rectly identify IAD and to distinguish it from pres sure ulcers. In healthcare systems where pres sure ulcers are used to as sess the quality of care and are linked with reimbursement and litigation, misdia gnosis has potential ly serious implications. Management of IAD should focus on skin cleans ing to remove dirt, debris and microorganisms; skin moisturization to repair the skin‘s bar rier, retain and/ or increase its water content, reduce transepidermal water loss and restore the intercel lular lipid structure; and the application of a skin bar rier product by provid ing an impermeable or semi-permeable bar rier on the skin. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a review conducted to describe the current evidence about the prevention and treatment of incontinence-associated dermatitis and to formulate recommendations for clinical practice and research. BACKGROUND: Incontinence-associated dermatitis is a common problem in patients with incontinence. It is a daily challenge for healthcare professionals to maintain a healthy skin in patients with incontinence. DATA SOURCES: PubMed, Cochrane, Embase, the Cumulative Index to Nursing and Allied Health Literature, reference lists and conference proceedings were explored up to September 2008. REVIEW METHODS: Publications were included if they reported research on the prevention and treatment of incontinence-associated dermatitis. As little consensus about terminology was found, a very sensitive filter was developed. Study design was not used as a selection criterion due to the explorative character of the review and the scarce literature. RESULTS: Thirty-six publications, dealing with 25 different studies, were included. The implementation of a structured perineal skin care programme including skin cleansing and the use of a moisturizer is suggested. A skin protectant is recommended for patients considered at risk of incontinence-associated dermatitis development. Perineal skin cleansers are preferable to using water and soap. Skin care is suggested after each incontinence episode, particularly if faeces are present. The quality of methods in the included studies was low. CONCLUSIONS: Incontinence-associated dermatitis can be prevented and healed with timely and appropriate skin cleansing and skin protection. Prevention and treatment should also focus on a proper use of incontinence containment materials. Further research is required to evaluate the efficacy and effectiveness of various interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives. To detect problems when classifying pressure ulcers and to examine whether an e-learning program is able to increase the classification skills of qualified nurses and nursing students. Background. Both the distinction between pressure ulcer grades and the differentiation between moisture lesions is difficult. Misclassification and incorrect identification of the lesions results in inadequate preventive and therapeutic measures. Education and training are important for spreading evidence-based insights about this topic. Design. Repeated measure design, consisting of one pretest and three posttests. Methods. The experimental intervention consisted of a one-hour session during which the participants independently went over an e-learning program. The control intervention consisted of a one-hour lecture. Both interventions had the same learning contents. A convenience sample of 212 qualified nurses and 214 final-year nursing students was randomly assigned to an experimental-and a control group. Results. In the pretest, the classification skills were low. After the intervention, these skills improved significantly in both groups. The nursing students achieved better results when using the e-learning program. Among the qualified nurses, there was no difference between the learning methods. Although the classification skills decreased in the posttests, they did not drop under the level of the pretest. Conclusion. The actual classification system does not provide the necessary information about the severity of a pressure ulcer. The differential diagnosis between a moisture lesion was complicated. The classification skills of the qualified nurses and nursing students increased by both learning methods. Repetition remains, however, necessary. Relevance to clinical practice. Both instruction methods are adequate to acquire the knowledge about the differences between moisture lesions and pressure ulcers. E-learning allows studying in one's own time and place, and could therefore be very suitable for repetition of the training. How to organise this training could be a subject for further research. [ABSTRACT FROM AUTHOR]