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Aims: The purpose of this study was to construct a model for oral assessment using deep learning image recognition technology and to verify its accuracy. Background: The effects of oral care on older people are significant, and the Oral Assessment Guide has been used internationally as an effective oral assessment tool in clinical practice. However, additional training, education, development of user manuals and continuous support from a dental hygienist are needed to improve the inter‐rater reliability of the Oral Assessment Guide. Design: A retrospective observational study. Methods: A total of 3,201 oral images of 114 older people aged >65 years were collected from five dental‐related facilities. These images were divided into six categories (lips, tongue, saliva, mucosa, gingiva, and teeth or dentures) that were evaluated by images, out of the total eight items that comprise components of the Oral Assessment Guide. Each item was classified into a rating of 1, 2 or 3. A convolutional neural network, which is a deep learning method used for image recognition, was used to construct the image recognition model. The study methods comply with the STROBE checklist. Results: We constructed models with a classification accuracy of 98.8% for lips, 94.3% for tongue, 92.8% for saliva, 78.6% for mucous membranes, 93.0% for gingiva and 93.6% for teeth or dentures. Conclusions: Highly accurate diagnostic imaging models using convolutional neural networks were constructed for six items of the Oral Assessment Guide and validated. In particular, for the five items of lips, tongue, saliva, gingiva, and teeth or dentures, models with a high accuracy of over 90% were obtained. Relevance to Clinical Practice: The model built in this study has the potential to contribute to obtain reproducibility and reliability of the ratings, to shorten the time for assessment, to collaborate with dental professionals and to be used as an educational tool. [ABSTRACT FROM AUTHOR]

Undermining is one of the most challenging complications of deep pressure ulcers. Recommendations in most guidelines are based only on expert opinions. Here, we examined the relationship between surgical incision of the undermined space and pressure ulcer healing through a Japanese multicenter prospective cohort study. A total of 162 patients with undermining in 40 national hospitals in Japan were enrolled from July 2007 to June 2009. The incision group included 39 patients (24.1%) whose undermining was surgically incised during the observational period. Their 4-week follow-up data on pressure ulcer severity and areas of healthy granulation tissue were recorded as outcome variables using the DESIGN-R pressure ulcer assessment tool. The 4-week follow-up was restarted after the incision in the incision group. The outcome variables over time were compared between the two groups using a linear mixed model with or without adjustment for demographic and other variables. The incision group showed more rapid improvement in the total and granulation DESIGN-R scores compared with the nonincision group ( p < 0.001 and p = 0.007, respectively, in the crude models). This study may provide the first considerable evidence to support that surgical incision of undermining may promote healing of deep pressure ulcers. [ABSTRACT FROM AUTHOR]

This multicenter prospective cohort study examined the predictive validity of granulation tissue color evaluated by digital image analysis for deep pressure ulcer healing. Ninety-one patients with deep pressure ulcers were followed for 3 weeks. From a wound photograph taken at baseline, an image representing the granulation red index ( GRI) was processed in which a redder color represented higher values. We calculated the average GRI over granulation tissue and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (% GRI80) and wound surface (%wound red index 80). In the receiver operating characteristics curve analysis, most GRI parameters had adequate discriminative values for both improvement of the DESIGN -R total score and wound closure. Ulcers were categorized by the obtained cutoff points of the average GRI (≤80, >80), % GRI80 (≤55, >55-80, >80%), and %wound red index 80 (≤25, >25-50, >50%). In the linear mixed model, higher classes for all GRI parameters showed significantly greater relative improvement in overall wound severity during the 3 weeks after adjustment for patient characteristics and wound locations. Assessment of granulation tissue color by digital image analysis will be useful as an objective monitoring tool for granulation tissue quality or surrogate outcomes of pressure ulcer healing. [ABSTRACT FROM AUTHOR]

Lack of a valid and reliable assessment instrument may have contributed to a lack of wound healing research in China. The DESIGN-R tool scores the severity of pressure ulcers (PUs) and monitors healing using the observable state assessment; it was developed by the Scientific Education Committee of the Japanese Society of Pressure Ulcers (JSPU) and tested for reliability and validity. A Chinese version of DESIGN-R was developed based on Brislin's model of translationand tested for validity and reliability. Using a purposive sampling method, 44 practicing registered nurses (RNs) and 11 physicians (MDs) were recruited from 52 departments of Nanfang Hospital, Guangdong, China. Based on their experience, they were classified as general medical staff (gMS) or experienced medical staff (eMS). All used the Chinese version of DESIGN-R to assess eight photographs of PUs and descriptors. In addition, eight eMS also used the Bates- Jensen Wound Assessment Tool (BWAT) to assess the same wounds. Inter-rater reliability was high (total ICC score = 0.960). ICC inflammation/infection scores were 0.530 and 0.759 for gMS and eMS, respectively; granulation ICC scores were 0.532 and 0.794 in gMS and eMS, respectively. The correlation coefficients between the BWAT and DESIGN-R tool were >0.80 for all eight raters. The results suggest the Chinese version of DESIGN-R is valid and reliable and may be a useful scoring tool for RNs and MDs to monitor PU status in daily clinical practice. Additional research is warranted, and clinical instruments for inflammation/infection and granulation assessment must be developed for gMS.