Biophysical Measure To Predict Pressure Ulcers In Nursing Home Residents

项目摘要 本研究将测试I期压疮（PU）非视觉评估策略的有效性， 采用多中心纵向队列设计，对浅肤色或深肤色的疗养院（NH）居民进行研究。个pu 常见的，通常是可预防的，而且费用昂贵;早期PU的检测很重要，因为干预可能 防止下降到更严重的PU。标准的检测方法，非皮肤视觉评估， 发白性红斑，对于肤色较浅的人来说有些可靠，但在皮肤老化后检测到变化。 损害已经发生。此外，视觉皮肤评估无法检测人的皮肤颜色变化 肤色黝黑记录的非裔美国人和高加索人之间的健康差异， I期PU的发生率和预防干预可能与检测缺陷有关。在我们之前的 研究中，我们发现，一种评估表皮下水分（SEM）的手持设备， 组织中的炎性变化引起的水肿，确定为I期PU。此外，SEM更高（例如， 水肿和炎症增加），当时没有可见的皮肤损伤，但I期PU 一周后在皮肤上可见; SEM值预测26%的后续I期PU。发现 类似的一个小的子样本的NH居民与深肤色。我们建议测试这个的有效性 检测PU的创新方法，特别关注深色肤色的居民;测试阈值 用于检测I期PU和检测I期PU向II+期PU的进展的SEM值。我们将 招募389名NH居民，其中62人将具有深色肤色，根据最小值，他们有PU的风险 来自24个NH的数据集评估。皮肤目视评估和设盲SEM测量将由以下人员完成： 研究人员至少每周一次为同意的居民提供4个月。将评估NH居民的肤色 使用彩色瓷砖，而不是像以前的研究那样通过种族的替代措施。此外，参与者 将获得人口统计学、功能水平的MDS评估数据和共病医学状况 医疗记录审查。将使用Braden压疮预测量表进行风险评估， 在基线时收集。广义有序逻辑模型，适当地模拟重复 观察和时间依赖性措施，将用于评估SEM措施的有效性， 识别未来的皮肤损伤。SEM的测量代表了用于减少 不同肤色的人之间预防干预措施的差异。

Project Abstract This study will test the validity of a non-visual assessment strategy for stage I pressure ulcers (PUs) among nursing home (NH) residents with light or dark skin tones using a multi-site, longitudinal cohort design. PUs are common, often preventable, and costly; detection of early-stage PUs is important because intervention may prevent decline to more severe PUs. The standard method of detection, visual skin assessment for non- blanchable erythema, is somewhat reliable for individuals with light skin tones but detects changes after skin damage has already occurred. In addition, visual skin assessment fails to detect skin color changes in persons with darkly pigmented skin. Documented health disparities between African Americans and Caucasians for incidence of stage I PUs and prevention intervention may be related to deficiencies in detection. In our prior studies, we showed that a hand-held device that assesses sub-epidermal moisture (SEM), a measure of edema from inflammatory changes in the tissues, identified stage I PUs. Further, SEM was higher (e.g., increased edema and inflammation) when there was no visible skin damage at the time but a stage I PU was visible on the skin one week later; SEM values predicted 26% of the subsequent stage I PUs. Findings were similar in a small sub-sample of NH residents with dark skin tones. We propose to test the validity of this innovative approach to detecting PUs, particularly focusing on residents with dark skin tones; to test threshold SEM values for detecting stage I PUs and detecting progression of stage I PUs to stage II+ PUs. We will recruit 389 NH residents, 62 of whom will have dark skin tones, who are at risk for PU based on the Minimum Data Set Assessment from 24 NHs. Visual skin assessments and blinded SEM measures will be completed by research staff at least weekly for consented residents for 4 months. Skin tone of NH residents will be assessed using color tiles rather than by proxy measures of ethnicity as in previous research. In addition, participant demographics, MDS assessment data on functional level, and comorbid medical conditions will be obtained from medical record review. Risk assessments using the Braden Scale for Predicting Pressure Sores will be collected at baseline. Generalized ordered logistic modeling, appropriately modeling the repeated observations and time-dependent measures, will be used to evaluate the effectiveness of SEM measures to identify future skin damage. Measurement of SEM represents a potentially important tool for decreasing the disparity of prevention interventions between persons with different skin tones.