The stratum corneum of extremely premature infants is thin, requiring appropriate postnatal humidity management against heat loss, secondary damage such as skin fissures, and for general care. Humidity management at our hospital is calibrated to the degree of skin maturity as assessed by macroscopic observation. However, the validity of this method remains unclear. With the aim of improving skin managment, we sequentially observed skin changes in 13 extremely premature infants using a digital camera and microscope to determine whether any correlation existed between the macroscopic and microscopic changes. From postnatal day 3 changes in skin transparency and contour were observable microscopically as was surface unevenness macroscopically. A comparison of infants treated under similar conditions showed that humidity reduction on postnatal day 2 caused microscopic skin texture unevenness earlier than if humidity was reduced on postnatal day 4. Changes visible in the digital images included decreased skin transparency, while unaided visual observation showed reduced skin turgor during body movements. However, the initiation of humidity reduction depended on the infant's general condition, making it difficult to determine the appropriate criteria based on gestational age and weight. In order to improve methods of assessment based on visual observation, indicators that can be shared by all those monitoring a given patient need to be found. The present study showed that humidity management resulted in simultaneous macroscopically and microscopically observable changes in infant skin texture. However, the study design precluded definitively establishing the degree of change in texture, including changes in the sulci, and the cristae cutis.
Introduction: Immobile elderly Japanese patients with joint contractures and/or extreme bony prominences are at a high risk of pressure ulcer development due to localized high interface pressure. To solve this problem, we developed a mechanism for reducing localized high interface pressure by utilizing independent air-cell control based on interface pressure information obtained through continuous monitoring. Objective: The aim of this study was twofold: to develop a new mechanism for controlling inner air-cell pressure to reduce localized high interface pressure by monitoring pressure distribution; and to validate the efficacy of this mechanism for localized pressure redistribution（LPR）among healthy participants. Methods: In 13 healthy adult participants, interface pressure, blood flow, and discomfort at the greater trochanter were measured with or without our newly designed mechanism allowing rapid and dynamic inflation and deflation of air-cells. Results: The results from the healthy adult participants showed that the inflationary and deflationary mechanism successfully redistributed areas of localized high interface pressure continuously, thereby contributing to the recovery of blood flow during air-cell deflation in healthy participants. Pain scores also significantly decreased with LPR. Discussion: Our air mattress, equipped with independently pressure-controlled air-cells responsive to interface pressure distribution, may be useful in preventing pressure ulcer development.
Objective: The concentration of nerve growth factor（NGF）obtained from venous leg ulcer（VLU）exudate was negatively correlated with wound pain in a previous study. The aim of this study was to verify the pathophysiological meaning of NGF as a pain biomarker by using infrared thermographic assessment. Methods: Patients with VLU were recruited in this cross-sectional observational study. During routine wound care, thermal images of the wound and periwound area, and VLU exudate samples were taken. Thermal images were classified according to the periwound temperature pattern into two groups, “normal temperature” or “high temperature”, following a previously established method. NGF concentrations in the VLU exudate, measured with ELISA and standardized according to wound area, were compared between groups. The study protocol was approved by an ethical review board（#10389-2）. Results: Among twenty-eight samples obtained from 13 participants, six were classified as normal temperature and 22 as high temperature. NGF concentrations in the high temperature group were significantly lower than those in the normal temperature group［medians（normal, high）=（3.36, 0.67）, z = -2.30, P = 0.02］. Even when concentrations were stratified by medians of age and wound area, which were non-significantly different between groups, the magnitude relationships of the medians of concentrations between groups were consistent with the results of whole samples. Conclusion: NGF concentrations in VLU exudate were associated with inflammation along with temperature increase caused by the VLU.
Objective: Current plans for employing wound, ostomy, and continence nurses（WOCN）require WOCNs to be distributed in such a way as to enable fair access to their expertise by the community. The present study analyzed the spatial distribution of hospitals with WOCNs in Tokyo using a geographic information system（GIS） with individual hospitals and municipalities as the unit of analysis. Methods: Hospitals with WOCNs in 2014 were identified using the Japan Nursing Association website. A distribution map was created using ArcGIS10.2.1, and the data obtained on all hospitals, demographics, and the long-term care insurance statistics in Tokyo were linked to the base map. Results: There were 98（15.3 % of all hospitals）hospitals with WOCNs in Tokyo. The proportion of hospitals with WOCNs varied according to the number of beds and type of hospital. The peak density was detected in Chiyoda city and the southern area of Tachikawa. Cold spots that significant distances from hospitals with WOCNs were identified in Adachi city. Thirteen of the surveyed areas had no hospitals with WOCNs. The proportion of hospitals with WOCN by each city was negatively associated with population aging rate. The number of hospitals with WOCNs per one hundred thousand elderly citizens varied widely in the secondary medical care area. Conclusion: The distribution of hospitals with WOCNs was skewed by geography and hospital characteristics, suggesting the need to promote WOCN employment in priority areas or through cooperation between hospitals with and without WOCNs.
The prevalence of oedema in elderly individuals is high, but it is unclear whether active intervention is required. The purpose of this prospective study was to examine chronological changes in the severity and anatomical location of oedema among institutionalized elderly individuals. Patients ≥ 65 years of age with oedema were assessed at the initial examination and 3-5 months later. To identify edematous sites, the whole body was divided into 55 parts. The degree of oedema was assessed by measuring the degree of pitting（Grade 0-3 and non-pitting-edema［NPE］）. Patients having oedema ≥ Grade 2 was described as “with oedema”. The severity and number of edematous sites were compared between the initial and follow-up examinations. 205 participants were initially identified as “with oedema.” 111 of these completed the follow-up examination. The number of edematous sites increased from 386 to 452. Newly occurring Grade 2 oedema and NPE were observed at 195 and 25 sites, respectively. Grade 3 oedema persisted at 22 sites. Significant changes in the number of sites and the severity were both limited to the lower extremities, especially the distal posterior legs, toes, and proximal anterior legs. The severity was greater in the proximal posterior legs, the distal anterior legs, and the lateral ankles. In conclusion, among the institutionalized elderly, the number of edematous sites and their severity significantly increased over time to progress to NPE in the lower extremities. This suggests that palliative care is required for elderly patients with lower limb oedema.
Appropriate assessment of pressure ulcers（PUs）is essential for timely and effective management. For this purpose, a non-invasive protein analysis technique, wound blotting, was developed which helps to visualize the distribution of protein secretion. In this pilot study, we evaluated whether detection of transforming growth factor （TGF）β at the wound edge by wound blotting could be used as a marker for predicting epithelialization. A retrospective cohort study was conducted. The inclusion criteria were（a）PUs from which exudate was collected through wound blotting and stained for TGFβ;（b）PUs with a depth score of d2 according to DESIGN-R at the time of wound blotting; and（c）PUs which were followed up after one week of wound blotting. Exclusion criterion was lack of photographs of the PU taken at the time of wound blotting and after one week. For protein collection, a piece of nitrocellulose membrane was attached to the wound surface. The membrane was stained for TGFβ, using immunological techniques. Epithelialization was evaluated from the PU photographs. Cases with and without epithelialization advancement were compared for positivity for TGF β at the wound edge, and the association between location of epithelialization and signal presence was assessed. Twenty-three samples were analyzed. Epithelialization was noted in 20 ulcers and 15 of 20 ulcers showed positive TGFβ signals. TGFβ signals at the wound edge corresponded with the location of epithelialization in nine of 15 ulcers. Hence, topological analysis of TGFβ by wound blotting could serve as a new assessment tool for predicting epithelialization.