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Understanding skin microclimate—the temperature and humidity at the interface between the skin and other surfaces—is critical for preventing pressure injury (PI). This prospective case series evaluated the performance of a hydrofibre multilayer foam dressing with silicone coating in managing the sacral microclimate in intensive care patients with intact skin at high PI risk when used with a standard PI prevention protocol. Sacral temperature and humidity were measured using a thermographic imaging camera and electrical bioimpedance device, respectively. These data were collected daily for a maximum of 7 consecutive days. Data of 25 patients were analysed. The mean sacral humidity during the first 4 days of dressing use was 20.7%. Its levels reduced on Days 5 and 6 and later returned to Day 2 levels on Day 7. The sacral temperature showed no sudden change with dressing use. Correlations between sacral microclimate and smoking, alcohol, systemic arterial hypertension, and diabetes mellitus were determined. There was no evidence of PI among the participants during the 7-day follow-up. The hydrofibre multilayered foam dressing with silicone coating effectively managed the sacral microclimate in high-risk intensive care patients, highlighting its potential utility in PI prevention protocols.
To assess the validity of a modified Neonatal Skin Risk Assessment scale (Dev-NSARS) for neonatal pressure injuries (PIs) in the neonatal intensive care unit (NICU) and neonatal sub-intensive care unit (NICU-Sub) environment.
Medical devices are the leading cause of pressure injuries (PIs) in neonates, a key cause of morbidity in neonatology, significantly impacting the length of stay (LOS) and public hospital resources.
The Dev-NSRAS scale, considering the presence of medical devices, was tested on a national multicenter prospective study on newborns. The discrimination power of the Dev-NSRAS scale was compared to that of the more commonly used Glamorgan scale.
Nine newborns (6.6%) developed PIs, with a total of 16 injuries, 75% (12 out of 16) of which were device related. Newborns with postconceptional age ≤ 30.8 weeks were at higher risk of developing PIs. First 24-h total Dev-NSRAS scores were compared with first 24-h Glamorgan scores, to obtain and compare respective sensitivity and specificity. During the first 24 h from admission, a very good discriminative performance was evidenced for Dev-NSRAS ≤ 11 (AUC 0.921, 95% CI: 0.899–0.940, p < 0.0001; 81.6% sensitivity and 93.6% specificity) as compared to a moderate discriminative performance shown by a Glamorgan score > 28 (AUC 0.752, 95% CI: 0.634–0.660, p < 0.0001; 92.1% sensitivity and 65.5% specificity).
Early application (i.e., in the first day from hospital admission) of Dev-NSRAS by the nursing personnel shows excellent accuracy in predicting the risk of developing PUs in newborns admitted to NICU and NICU-Sub, as compared to the Glamorgan scale.
The STROBE statement for cohort observational studies was used as the reference reporting method.
The study addressed the lack of a risk assessment scale for pressure injuries in neonates. Development and testing of a scale that demonstrated high sensitivity and specificity in the early prediction of pressure injury risk in neonates within the first 24 h. The research will have an impact in NICUs and NICU-Sub units, enabling nurses to plan personalised care to prevent pressure injuries in neonates, thereby reducing the length of hospital stays and overall healthcare costs.
Introduce a validated scale for improving neonatal pressure injury prevention worldwide. Enhance early detection tools, reduce hospital stays and global costs.
The study protocol has been approved by the Paediatric Tuscany Region Ethical Committee (date: 18 January 2021; protocol code 18/2021).
Selection of antiseizure medications (ASMs) for newly diagnosed epilepsy remains largely a trial-and-error process. We have developed a machine learning (ML) model using retrospective data collected from five international cohorts that predicts response to different ASMs as the initial treatment for individual adults with new-onset epilepsy. This study aims to prospectively evaluate this model in Australia using a randomised controlled trial design.
At least 234 adult patients with newly diagnosed epilepsy will be recruited from 14 centres in Australia. Patients will be randomised 1:1 to the ML group or usual care group. The ML group will receive the ASM recommended by the model unless it is considered contraindicated by the neurologist. The usual care group will receive the ASM selected by the neurologist alone. Both the patient and neurologists conducting the follow-up will be blinded to the group assignment. Both groups will be followed up for 52 weeks to assess treatment outcomes. Additional information on adverse events, quality of life, mood and use of healthcare services and productivity will be collected using validated questionnaires. Acceptability of the model will also be assessed.
The primary outcome will be the proportion of participants who achieve seizure-freedom (defined as no seizures during the 12-month follow-up period) while taking the initially prescribed ASM. Secondary outcomes include time to treatment failure, time to first seizure after randomisation, changes in mood assessment score and quality of life score, direct healthcare costs, and loss of productivity during the treatment period.
This trial will provide class I evidence for the effectiveness of a ML model as a decision support tool for neurologists to select the first ASM for adults with newly diagnosed epilepsy.
This study is approved by the Alfred Health Human Research Ethics Committee (Project 130/23). Findings will be presented in academic conferences and submitted to peer-reviewed journals for publication.
ACTRN12623000209695.
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