Camera System Development for Pressure Injury Screening in Veterans with SCI

患有脊髓损伤(VwSCI)的退伍军人是压力性损伤(PI)的高危人群。VwSCI中PI的危险因素 包括在受伤水平以下缺乏知觉，相对不能动弹，臀肌张力差。这个 有压力性损伤的脊髓损伤患者平均增加的医疗费用估计为70,000美元， 住院可能需要几周到几个月的时间才能治愈压力性损伤。此外，招致 压力伤可导致严重感染、肢体丧失，甚至死亡。预防性行为以招致 在康复期间，压力损伤被教授给VwSCI。每隔15分钟就会有压力缓解等行为 每隔两个小时卧床一次，定期进行皮肤评估 建议用于预防PI。大多数VwSCI被教导使用长把手上的镜子来查看风险 坐位区域(例如，骶骨、坐骨粗隆、尾骨区和粗隆)每天至少两次作为证据。 皮肤的变化。如果镜像用户发现皮肤发生变化，则鼓励他/她完全卸载 那个区域。许多VwSCI住在离VA SCI诊所很远的地方，因此医疗保健提供者可以更好地 如果退伍军人可以看到危险皮肤的图像，建议他们选择合适的路径。长期目标 这项工作的目的是帮助VwSCI预防早期发现的压力损伤的进展和严重程度。这个 短期目标是：1)为VwSCI提供一种更有效的工具[视觉摄像系统]，以 检查他们的高危皮肤区域；以及2)提供安全和高效的沟通流程 关于关注区域的医疗保健提供者或皮肤专家。 该项目的第一个目标将涉及N=18 VwSCI(C7级及以下)。在第一次访问期间，退伍军人将 描述他们目前使用长柄镜子进行皮肤筛查的情况，并将展示他们的能力 用镜子查看关键位置。他们还将填写Quest 2.0的辅助设备部分，以 提供他们对长柄镜子的满意。视距摄像系统将被展示给 退伍军人和他们将接受研究护士如何使用该系统的培训。退伍军人队将在那时 展示他们使用摄像系统查看关键位置的能力。受试者将填写辅助装置 这是Quest 2.0关于相机系统的一部分，并将提供关于如何改进系统的反馈。这 我们的工程团队将使用反馈来改进相机系统。在第二次访问中，精致的 摄像机系统将使用相同的协议通过相同的N=18 VwSCI重新测试。Quest 2.0设备 子量表分数将有助于量化改进过程中对设备的改进。 第二个目标将使用改进的摄像系统在家中测试N=6 VwSCI(C7级及以下)。 在第一次访问退伍军人之家时，退伍军人将对长柄 研究护士将培训退伍军人如何使用近视相机 系统和退伍军人将在家中使用该系统3个月。退伍军人将每周发送图像(使用 MyHealtheVet)发送给明尼阿波利斯VA SCI/D中心的伤口护理护士，或者如果他们发现 担忧。研究护士将每周给退伍军人打电话，以确定他们是否有任何问题 系统并提供关于图像质量的反馈(基于与伤口护理人员的讨论 护士)。研究结束后，研究护士将回到退伍军人家中，退伍军人将 演示他们对摄像系统的使用，并填写Quest 2.0的辅助设备部分。我们 期望证明摄像系统优于长柄反射镜，并建立了可行性 用于未来的临床试验，比较不同的皮肤筛查技术。

Veterans with spinal cord injury (VwSCI) are at high risk for pressure injury (PI). Risk factors for PI in VwSCI include lack of sensation below the level of injury, relative immobility, and poor gluteal muscle tone. The average added healthcare cost for a person with SCI with a pressure injury is estimated to be $70,000, and hospitalization may be required for weeks to months to heal the pressure injury. Furthermore, incurring a pressure injury can result in severe infection, limb loss, or even death. Preventative behavior to incurring a pressure injury is taught to the VwSCI during rehabilitation. Behaviors such as pressure reliefs every 15 minutes, turning every two hours when lying in bed, and conducting regular skin assessments are recommended for PI prevention. Most VwSCI are taught to use a mirror on a long handle for viewing at-risk seated areas (e.g., sacrum, ischial tuberosities, coccyx area, and trochanters) at least twice a day for evidence of skin changes. If the mirror user discovers a change in the skin, he/she is encouraged to completely offload that area. Many VwSCI live great distances from the VA SCI clinic thus healthcare providers could better advise Veterans to the appropriate pathway if they could view an image of the at-risk skin. The long term goal of this work is to help VwSCI prevent the progression and severity of an early detected pressure injury. The short term goals are to 1) provide VwSCI a more efficient and efficacious tool [In-Sight camera system] to examine their at-risk skin areas; and to 2) provide a secure and efficient communication process with their health care provider or skin specialist regarding areas of concern. The first aim of the project will involve N=18 VwSCI (level C7 and below). During a first visit, Veterans will describe their current use of the long-handled mirror to conduct skin screening and will demonstrate their ability to see key locations with the mirror. They will also fill out the Assistive Device section of the QUEST 2.0 to provide their satisfaction with the long-handled mirror. The In-Sight camera system will be presented to the Veterans and they will be trained on how to use the system by the research nurse. The Veterans will then demonstrate their ability to see key locations with the camera system. Subjects will fill out the Assistive Device section of the QUEST 2.0 for the camera system and will provide feedback on how to improve the system. This feedback will be used by our engineering team to refine the camera system. During a second visit, the refined camera system will be retested by the same N=18 VwSCI using the same protocol. QUEST 2.0 device subscale scores will assist in quantifying improvements to the device during the refinement. The second aim will use the refined camera system in at-home testing of N=6 VwSCI (level C7 and below). During a first visit to the Veteran's home, the Veteran will conduct the same testing with the long-handled mirror as described for Aim 1. The research nurse will train the Veteran on how to use the In-Sight camera system and the Veteran will use the system at home for 3 months. Veterans will send images weekly (using MyHealtheVet) to a wound care nurse at the Minneapolis VA SCI/D Center or more often if they find areas of concern. The research nurse will call Veterans weekly to determine if they are having any issues with the system and to provide feedback regarding the image quality (based on discussions with the wound care nurse). At the end of the study, the research nurse will return to the Veteran's home and the Veteran will demonstrate their use of the camera system and fill out the Assistive Device section of the QUEST 2.0. We expect to show that the camera system is preferred to the long-handled mirror and to establish the feasibility for a future clinical trial comparing different skin screening technologies.