Skin disorders and moisture in incontinent nursing home residents: intervention implications. Prevention of work‐related skin problems in student auxiliary nurses A prospective study of patient adherence to topical treatments: 95% of patients underdose. Effective symptomatic treatment for severe and intractable pruritus associated with severe burn-induced hypertrophic scars: A prospective, multicenter, controlled trial. Consensus document on controversial issues in the treatment of complicated skin and skin-structure infections. An open randomized study to compare narrow band UVB, topical pimecrolimus and topical tacrolimus in the treatment of vitiligo. Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy STRUCTURED SKIN CARE REGIMEN TO PREVENT PERINEAL DERMATITIS IN THE ELDERLY Preoperative skin preparation of cardiac patients. Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo. Feasibility, double-blind, randomised, placebo-controlled, multi-centre trial of hand-held NB-UVB phototherapy for the treatment of vitiligo at home (HI-Light trial: Home Intervention of Light therapy) Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal IL-1α in newborns. Randomised controlled study of early pulsed dye laser treatment of uncomplicated childhood haemangiomas: results of a 1-year analysis Effect of a Structured Skin Care Regimen on Patients With Fecal Incontinence: A Comparison Cohort Study Management of superficial to partial-thickness wounds. Increased fluid intake does not augment capacity to lay down new collagen in nursing home residents at risk for pressure ulcers: a randomized, controlled clinical trial.
OBJECTIVE To provide data needed to design an intervention trial to prevent or treat skin disorders in a high risk , incontinent nursing home population . DESIGN The incidence and prevalence of nine common skin disorders were measured prospect ively over a 60-day period using trained observers . Urinary and fecal incontinence frequency were measured over 24 hours , and mobility was measured with subjects both in and out of bed . Direct measures of skin moisture were taken with an impedance device in the presence and absence of urinary incontinence . Multiple regression analyses were used to relate the incontinence and mobility variables to the presence and development of skin disorders . SETTING Four nursing homes . PARTICIPANTS One hundred incontinent nursing home residents . MAIN OUTCOME MEASURES Prospect i ve measures of nine common skin disorders and skin moisture in four perineal regions under continent and incontinent conditions . RESULTS All subjects had at least one skin condition  identified during the 60-day data collection period . The most commonly observed skin condition was blanchable erythema , which occurred in 94 % of the subjects , predominantly in the front and back regions that were closest to the urethra and rectum . Twenty-one percent of residents developed either a Stage 1 ( nonblanchable erythema ) or 2 pressure ulcer . All skin conditions were transient when measured every 3 weeks with the exception of blanchable erythema , which showed stability . Stage 3 or greater pressure ulcers and edema were not observed , and interrater reliability for the measure of papules was poor . Measures of urinary and fecal incontinence severity were correlated with blanchable erythema severity , and blanchable erythema and low bed mobility were predictive of pressure ulcer severity . Blanchable erythema severity was also predictive of Stage 1 and 2 pressure ulcers . Skin moisture levels in the back perineal farthest from the rectum ( peripheral ) were affected most by urinary incontinence . CONCLUSION A trial to detect a 50 % preventive effect on Stage 1 and 2 pressure ulcers would require that 167 subjects be monitored for 60 days . The transient nature of the skin effects require that skin be monitored at least once a week . Because blanchable erythema is so prevalent and appears to be associated with more severe skin conditions , it would make an excellent marker for beginning to assess the potential preventive effects of various interventions on the incidence of pressure ulcers and other related skin disorders in incontinent patients . It is likely that the back area peripheral to the urethra and rectum would experience the greatest benefit from an intervention trial to reduce moisture caused by incontinence The present study was design ed as an intervention study to investigate whether an educational programme was efficient in preventing work‐related skin problems on the h and s. 107 student auxiliary nurses ( 61 in the intervention group and 46 in the control group ) were followed during the first 10 weeks of their initial practical training in county hospitals . The intervention group was given an educational programme before the practical training started . For evaluation the participants had question naires , clinical examination of the h and s , measurement of transepidermal water loss ( TEWL ) and patch testing . The use of h and disinfectants , which was discouraged in the educational programme , was significantly lower in the intervention group as compared to the control group ( p=0.002 ) . 48 % of the intervention group and 58 % of the control group had aggravation of skin problems during practical training ( p>0.05 ) . Use of h and disinfectant  agents was significantly associated with aggravation of skin problems ( p=0.016 ) . A significant increase in TEWL for the control group ( p<0.005 ) , but not for the intervention group , was seen after 10 weeks of practical training . In conclusion , the present intervention study shows promising results from the use of an educational programme BACKGROUND Adherence is essential to a positive treatment outcome . Whether adequate doses of topically applied drugs are used among patients with dermatologic conditions has not been investigated adequately . OBJECTIVES The objective of this prospect i ve study was to determine to what extent first-time out patients with dermatologic conditions apply the appropriate dosage of initial treatment with topically administered medication . METHODS Consultations with first-time patients in the dermatologic outpatient clinic were observed . Patients receiving a prescription for a previously untried topically administered drug were eligible . The expected quantity of topical treatment  to be used by each patient was calculated from the affected skin area to be treated . The affected area was estimated in numbers of palms of the h and , and an amount of 0.25 g of ointment or cream was chosen as sufficient treatment to cover the area of one palm . Two weeks after the consultation , a question naire with items regarding the size of the affected area , intentions to follow the treatment , and the applied dose the previous day was mailed to each patient . The question naires were personally collected from the patients ' homes and at the same visit the patients ' topical drug containers were weighed on a balance . Both patients and staff were blinded to the particular study purpose concerning adherence and dosing . RESULTS In all , 17 patients were eligible . The majority received a prescription for  topical corticosteroids  , and the median area to be treated was 3 palms of the h and ( interquartile range : 1.5 - 8 ) . Two patients did not redeem their prescriptions . Only one patient used the expected dosage ; in general median 35 % ( interquartile range : 22%-50 % ) of the expected individual dosages were used . LIMITATIONS Only first-time patients who received a new and previously untried topical treatment were included , result ing in a small study size . CONCLUSIONS Most first-time patients with dermatologic conditions underdose new topical treatments . Consequently , clinicians should always consider nonadherence when topical therapies fail BACKGROUND Burn-induced hypertrophic scars are disfiguring and can be associated with severe and intractable pruritus . No effective treatment modalities are currently available for symptomatic control of pruritus for most patients . We assessed the effect of the Antipruritic Hydrogel ( CQ-01 ) in the symptomatic treatment of severe and intractable pruritus associated with burn-induced hypertrophic scars in a prospect i ve , multicenter , controlled trial . METHODS A pilot study was conducted in healthy adult volunteers to identify the most appropriate hydrogel formulation . A selected preparation called Chongqing No. 1 ( CQ-01 ; a guar gum-based hydrogel impregnated with peppermint oil , menthol , and methyl salicylate by a nanoemulsion ) , showed an excellent symptomatic relief in an exploratory study in 2 patients with intractable pruritus . A statistically powered , prospect i ve , multicenter , controlled study was then conducted in 74 patients to evaluate the efficacy and safety of a 24-h application of CQ-01 compared to a gel control and a negative control on three separate areas in each patient . Symptom assessment was based on our visual analog JW scale ( ranging from 0 to 100 ) at baseline and various time points up to 7 days after application . Follow-up studies were conducted to determine the reproducibility of CQ-01 in repeated applications . RESULTS Of the 74 enrolled subjects , the only observed adverse event was skin irritation reported in 6 patients ( 8 % ) and resolved shortly after gel removal . Compared to the baseline , the gauze negative control had a mean JW score reduction of 7 ; while the gel control and CQ-01 had a drop of 18 ( p<0.001 ) and 36 ( p<0.001 ) , respectively . The CQ-01 clinical effect was significant for up to 3 days and waned slowly from 3 to 7 days . There was no statistical correlation between the treatment response and any of the demographic , patient or burn-related factors . Further studies showed a trend that repeated applications might be more effective , suggesting the absence of tachyphylaxis . CONCLUSIONS This prospect i ve , multicenter , controlled study showed that this novel hydrogel CQ-01 is safe and provides significant symptomatic relief for severe and intractable pruritus associated with hypertrophic scars , an unmet medical need for these patients . This effect is independent of the etiology of the burn trauma , extent of the scarring , and duration of the scar formation BACKGROUND Complicated skin and skin-structure infections ( cSSSI ) , including surgical site infections ( SSI ) , cellulitis , and abscesses , have been extensively studied , but controversial issues still exist . CONTROVERSIAL ISSUES The aim of this GISIG ( Gruppo Italiano di Studio sulle Infezioni Gravi ) working group - a panel of multidisciplinary experts - was to define recommendations for the following controversial issues : ( 1 ) What is the efficacy of topical negative pressure wound treatment as compared to st and ard of care in the treatment of severe surgical site infections , i.e. , deep infections , caused by Gram-positive microorganisms ? ( 2 ) Which are the most effective antibiotic therapies in the treatment of cSSSI , including SSI , due to methicillin-resistant staphylococci ? Results are presented and discussed . METHODS A systematic literature search using the MEDLINE , EMBASE , Cochrane Central Register of Controlled Trials , and www . clinical trials.gov data bases of r and omized controlled trials and /or non-r and omized studies was performed . A matrix was created to extract evidence from original studies using the CONSORT method to evaluate r and omized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies , longitudinal cohorts , and retrospective studies . The GRADE method was used for grading quality of evidence . An analysis of the studies published between 1990 and 2008 is presented and discussed in detail Vitiligo is an acquired loss of pigmentation and its treatment remains very difficult up to date . Narrow b and ultraviolet B ( NB-UVB ) and topical immunomodulators are included among the most innovative approaches to vitiligo . We evaluated the efficacy and tolerability of NB-UVB , topical pimecrolimus and tacrolimus in the treatment of vitiligo . Adult patients with chronic and stable vitiligo refractory to conventional therapies were enrolled in an open parallel groups study . The patients were scheduled on the basis of a computer-generated r and omization into three groups : 13 patients received NB-UVB phototherapy 3 times a week , 15 patients were treated with pimecrolimus 1 % cream b.i.d . and 16 patients applied tacrolimus 0.1 % ointment b.i.d . All three treatment regimens were performed for 24 weeks . At baseline and every three weeks for the whole period of therapy the patients were examined through digital photographs and , at the end of the study , based on the percentage of repigmentation , treatment outcome was classified as " absent " ( 0 ) , " slight " ( < 25 % ) , mild ( 25 - 49 % ) , " moderate " ( 50 - 74 % ) , and " excellent " ( > 75 % ) . During the whole period of the study , possible side effects were recorded . The response to treatments varied according to the anatomical location of the lesions . No statistically significant differences in repigmentation for any anatomical site were recorded with the three treatments . The best results were obtained for lesions of the face with pimecrolimus cream and tacrolimus ointment and of the neck with NB-UVB . Statistically significant differences in repigmentation between photo-exposed and covered skin areas were recorded although the patients were asked to avoid direct UV exposition and to apply a very high protection sun screen on vitiligo lesions . All three treatments should be considered as a good option in the treatment of vitiligo . NB-UVB irradiation may represent the optimal choice in generalized vitiligo with topical immunomodulators in localized vitiligo Objective : To provide information and recommendations to assist women with breast cancer and their physicians in making decisions regarding the use of locoregional post-mastectomy radiotherapy ( PMRT ) . Outcomes : Locoregional control , disease-free survival , overall survival and treatment-related toxicities . Evidence : This guideline is based on a review of all meta-analyses , consensus statements and other guidelines published between 1966 and November 2002 . Search es of MEDLINE and CANCERLIT for English- language r and omized controlled trials published between 1995 and November 2002 were also conducted to supplement the literature previously review ed by the American Society of Clinical Oncology ( ASCO ) Health Services Research Committee panel in its published guideline . A non systematic review of the literature was continued through June 2003 . Recommendations : Locoregional PMRT is recommended for women with an advanced primary tumour ( tumour size 5 cm or greater , or tumour invasion of the skin , pectoral muscle or chest wall ) . Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes . The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear . These women should be offered the opportunity to participate in clinical trials of PMRT . Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes . Other patient , tumour and treatment characteristics , including age , histologic grade , lymphovascular invasion , hormone receptor status , number of axillary nodes removed , axillary extracapsular extension and surgical margin status , may affect locoregional control , but their use in specifying additional indications for PMRT is currently unclear . PMRT should encompass the chest wall and the supraclavicular , infraclavicular and axillary apical lymph node areas . To reduce the risk of lymphedema , radiation of the entire axilla should not be used routinely after complete axillary dissection of level I and II lymph nodes . A definite recommendation regarding the inclusion of the internal mammary lymph nodes in PMRT can not be made because of limited and inconsistent data . The use of modern techniques in radiotherapy planning is recommended to minimize excessive normal tissue exposure , particularly to the cardiac and pulmonary structures . Common short-term side effects of PMRT , including fatigue and skin erythema , are generally tolerable and not dose-limiting . Severe long-term side effects , including lymphedema , cardiac and pulmonary toxicities , brachial plexopathy , rib fractures and secondary neoplasms , are relatively rare . The optimal sequencing of PMRT and systemic therapy is currently unclear . Regimens containing anthracyclines or taxanes should not be administered concurrently with radiotherapy because of the potential for increased toxicity . Validation : The authors ' original text was su bmi tted for review , revision and approval by the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer . Subsequently , feedback was provided by 11 oncologists from across Canada . The final document was approved by the steering committee . Sponsor : The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada . Completion date : November 2003 A preliminary investigation was conducted to determine the efficacy of a structured skin care regimen to prevent perineal dermatitis in incontinent geriatric psychiatry patients . A 10-week , prospect i ve , clinical trial was conducted ( n = 15 ) . Four weeks ( weeks 2 to 5 ) were devoted to monitoring the unstructured pretreatment nursing skin care practice and to determining the incidence of perineal dermatitis in incontinent patients . Four weeks ( weeks 7 to 10 ) were also spent implementing and observing the structured nursing skin care regimen . The study revealed that 33 % ( three ) of the subjects in the unstructured skin care group and 33 % ( two ) of the subjects in the structured skin care group had perineal dermatitis . In subjects with a combination of urine and stool incontinence  perineal dermatitis developed within 2 days . The findings suggest that perineal dermatitis occurs quickly in the presence of urine and stool incontinence . Further research is needed to vali date the efficacy of a structured skin care regimen to prevent perineal dermatitis Nurses at a large southwestern hospital undertook an initiative to optimize the preoperative skin preparation of patients undergoing open heart surgery .  After an extensive review of the literature , a proposal was su bmi tted to and accepted by the surgeons and internal review board of the hospital . High-risk patients were identified before surgery and r and omized into groups to receive one of four different skin preps . The incidence of infection was lower in the two groups of patients who were prepped with insoluble iodine , indicating that the type of surgical skin prep could affect whether patients develop surgical site infections . The clinical practice of skin preparation in this hospital changed based on the results OBJECTIVE To provide information and recommendations for women and their physicians when making decisions about the management of lymphedema related to breast cancer . OPTIONS Compression garments , pneumatic compression pumps , massage and physical therapies , other physical therapy modalities , pharmaceutical treatments . OUTCOMES Symptom control , quality of life , cosmetic results . EVIDENCE Systematic review of English- language literature retrieved primarily from MEDLINE ( 1966 to April 2000 ) and CANCERLIT ( 1985 to April 2000 ) . Non systematic review of breast cancer literature published to October 2000 . RECOMMENDATIONS Pre- and postoperative measurements of both arms are useful in the assessment and diagnosis of lymphedema . Circumferential measurements should be taken at 4 points : the metacarpal-phalangeal joints , the wrists , 10 cm distal to the lateral epicondyles and 15 cm proximal to the lateral epicondyles . Clinicians should elicit symptoms of heaviness , tightness or swelling in the affected arm . A difference of more than 2.0 cm at any of the 4 measurement points may warrant treatment of the lymphedema , provided that tumour involvement of the axilla or brachial plexus , infection and axillary vein thrombosis have been ruled out . Practitioners may want to encourage long-term and consistent use of compression garments by women with lymphedema . One r and omized trial has demonstrated a trend in favour of pneumatic compression pumps  compared with no treatment . Further r and omized trials are required to determine whether pneumatic compression provides additional benefit over compression garments alone . Complex physical therapy , also called complex decongestive physiotherapy , requires further evaluation in r and omized trials . In one r and omized trial no difference in outcomes was detected between compression garments plus manual lymph drainage versus compression garments alone . Clinical experience supports encouraging patients to consider some practical advice regarding skin care , exercise and body weight . [ A patient version of these guidelines appears in Appendix 2 . ] VALIDATION An initial draft of this document was developed by a task force sponsored by the BC Cancer Agency . It was up date d and revised substantially by a writing committee and then su bmi tted for further review , revision and approval by the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer . SPONSOR The steering committee was convened by Health Canada . COMPLETION DATE : October 2000 Vitiligo is a common , idiopathic , acquired , depigmenting disease characterized by loss of normal melanin pigments in the skin . The most interesting treatment methods for extensive vitiligo involve psoralen plus ultraviolet A ( PUVA ) therapy and ultraviolet (UV)-B phototherapy , particularly narrow-b and UV-B. In this r and omized and comparative study , we investigated the safety and efficacy of narrow b and ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo . Of the 40 vitiligo patients enrolled in the study , 15 were treated with the calcipotriol plus narrow-b and UV-B ( NBUVB ) and 25 with narrow b and UV-B alone . The patients were r and omized into two NBUVB treatment groups . The first group , consisting of 24 patients ( all male ) , received only NBUVB treatment ; the second group , consisting of 13 patients ( all male ) applied 0.05 % topical calcipotriol ointments twice daily . Both groups were irradiated with NBUVB ( 311 nm ) . In the NBUVB group , the percentage of the body surface affected was reduced from 27.21 + /- 10.41 % to 16.25 + /- 8.54 % after a mean of 30 treatment sessions . The mean repigmentation percentage was 41.6 + /- 19.4 % . In clinical evaluation ( moderate and marked/complete response was accepted as an effective treatment ) , 19 patients ( 19/24 ; 79.17 % ) had clinical ly good results . In the NBUVB plus calcipotriol group , the percentage of the body surface affected was reduced from 23.35 + /- 6.5 % to 13.23 + /- 7.05 % after a mean of 30 treatment sessions . The mean repigmentation percentage was 45.01 + /- 19.15 % . In clinical evaluation ( moderate and marked/complete response was accepted as an effective treatment ) , 10 patients ( 10/13 ; 76.92 % ) had clinical ly good results . Statistically significant intragroup reductions from the baseline percentage of the body surface affected were seen at the endpoint of treatment for the two treatment groups ( P < 0.001 ) . However , there was no statistically significant difference between the two treatment groups at the end of therapy with respect to the reduction of repigmentation rates ( P > 0.05 ) . The present study reconfirmed the efficacy of NBUVB phototherapy in vitiligo . It can be a therapeutic option considered in the management of patients with vitiligo . However , addition of topical calcipotriol to NBUVB did not show any advantage Background H and -held NB-UVB units are lightweight devices that may overcome the need to treat vitiligo in hospital-based phototherapy cabinets , allowing early treatment at home that may enhance the likelihood of successful repigmentation . The pilot Hi-Light trial examined the feasibility of conducting a large multi-centre r and omised controlled trial ( RCT ) on the use of such devices by exploring recruitment , adherence , acceptability , and patient education . Methods This was a feasibility , double-blind , multi-centre , parallel group r and omised placebo-controlled trial of h and -held NB-UVB phototherapy for the treatment of vitiligo at home . The overall duration of the trial was seven months ; three months recruitment and four months treatment . Participants were r and omly allocated to active or placebo groups ( 2:1 ratio ) . The primary outcome measure was the proportion of eligible participants who were willing to be r and omised .  The secondary outcomes included proportion of participants expressing interest in the trial and fulfilling eligibility criteria , withdrawal rates and missing data , proportion of participants adhering to and satisfied with the treatment , and incidence of NB-UVB short-term adverse events . Results Eighty-three percent ( 45/54 ) of vitiligo patients who expressed interest in the trial were willing to be r and omised . Due to time and financial constraints , only 29/45 potential participants were booked to attend a baseline hospital visit . All 29 ( 100 % ) potential participants were confirmed as being eligible and were subsequently r and omised . Willingness to participate in the study for General Practice ( family physicians ) surgeries and hospitals were 40 % and 79 % , respectively ; 86 % ( 25/29 ) of patients adhered to the treatment and 65 % ( 7/11 ) of patients in the active group had some degree of repigmentation . Only one patient in the active group reported erythema grade 3 ( 3 % ) . Both devices ( Dermfix 1000 NB-UVB and Waldmann NB-UVB 109 ) were acceptable to participants . Conclusions H and -held NB-UVB devices need evaluation in a large , pragmatic RCT . This pilot trial has explored many of the uncertainties that need to be overcome before embarking on a full scale trial , including the development of a comprehensive training package and treatment protocol . The study has shown strong willingness of participants to be r and omised , very good treatment adherence and repigmentation rates , and provided evidence of feasibility for a definitive trial . Trial registration Adaptation of skin barrier function and interleukin-1α ( IL-1α ) content in diapered and nondiapered skin are poorly characterized in newborns receiving st and ard skin care . In a monocentric , prospect i ve pilot study 44 healthy , full-term neonates were r and omly assigned to skin care with baby wipes ( n = 21 ) or water-moistened washcloth ( n = 23 ) at each diaper change . Transepidermal water loss ( TEWL ) , skin hydration , skin-pH , IL-1α , and epidermal desquamation were measured on days 2 , 14 , and 28 postpartum . Microbiological colonization was evaluated at baseline and on day 28 . Significantly lower TEWL was found on the buttock in the group using baby wipes compared to water . IL-1α and skin hydration significantly increased and pH decreased independent of skin care regimen . IL-1α was significantly higher in diapered skin compared to nondiapered skin . Although skin care with wipes seems to stabilize TEWL better than using water , the skin condition and microbiological colonization were comparable using both cleansing procedures . Increase of epidermal IL-1α may reflect postnatal skin barrier maturation . These data suggest that neither of the two cleansing procedures harms skin barrier maturation within the first four weeks postpartum . Longer observations on larger population s could provide more insight into postnatal skin barrier maturation INTRODUCTION The role of pulsed dye lasers ( PDL ) in the treatment of childhood haemangiomas is controversial . Our aim was to compare treatment with PDL with a wait- and -see policy . METHODS We did a prospect i ve , r and omised controlled trial in which we enrolled 121 infants aged 1 - 14 weeks with early haemangiomas . We assigned infants to PDL treatment ( n=60 ) or observation ( n=61 ) , and followed them up to age 1 year . The main outcome measures assessed were proportion of lesions completely clear or with minimum residual signs , adverse reactions , including pigmentary disturbance and skin atrophy , complications such as ulceration and infection , proportion of children whose parents considered the haemangioma a problem , characteristics of the haemangioma , and an independent assessment of the haemangioma problem by a panel of five parents . Analysis was by intention to treat . FINDINGS All infants completed the study . The number of children whose lesions showed complete clearance or minimum residual signs at 1 year was not significantly different in the PDL treated and observation groups ( 25 , 42 % , vs 27 , 44 % ; p=0.92 ) . However , PDL treated infants were more likely to have skin atrophy ( 17 , 28 % , vs 5 , 8 % ; p=0.008 ) and hypopigmentation ( 27 , 45 % , vs 9 , 15 % ; p=0.001 ) . The frequency of complications was similar between groups . The only objective measure of resolution that improved with PDL treatment was haemangioma redness . The number of children whose parents considered the haemangioma to be a problem at 1 year did not differ much between groups ( 11 of 60 , 18 % , vs 9 of 61 , 15 % ; p=0.78 ) . The independent parent panel vali date d this result . INTERPRETATION PDL treatment in uncomplicated haemangiomas is no better than a wait- and -see policy PURPOSE : The purpose of this study was to measure the effect of a structured skin care regimen for critically ill patients with fecal incontinence . DESIGN : A nonr and omized , quasi-experimental research design ( comparison cohort ) was used for data collection . SUBJECTS AND SETTING : Seventy-six patients with fecal incontinence , Bristol stool form 5 , 6 , and 7 , and Braden Scale score of 16 or less in the intensive care units ( ICUs ) at Samsung Medical Center in Seoul , South Korea , participated in the study . METHODS : Of the 76 subjects enrolled , 38 were assigned to the experimental group and 38 to the control group . Participants in the active intervention group were being cared for in an ICU ; participants in the comparison group were cared for on cardiac , thoracic surgery , general surgery , and neurosurgical ICUs . A structured skin care regimen was developed and implemented , which included the regular use of a no-rinse skin cleanser , application of a skin protectant , and an indwelling fecal drainage system when indicated . Stool consistency was evaluated via the Bristol stool chart . Nurses trained in data collection determined Incontinence-Associated Dermatitis and its Severity ( IADS ) scores and assessed the perianal and sacral skin for occurrence of pressure ulcers daily over a 7-day period . RESULTS : Patients in the intervention group had significantly lower IADS scores ( t = 4.836 , P < .001 ) than subjects in the control group and were less likely to develop a pressure ulcer than were patients in the control group ( 5 vs 19 , & khgr;2 = 11.936 , P = .001 ) . Patients with higher IADS scores were significantly more likely to develop a pressure ulcer ( OR = 1.168 , 95%CI = 1.074–1.271 ) . CONCLUSION : A structured skin care regimen  decreased IADS scores and occurrence of pressure ulcers . Higher IADS scores were associated with an increased risk for development of pressure ulcers REFERENCE/CITATION Wiechula R. The use of moist wound-healing dressings in the management of split-thickness skin graft donor sites : a systematic review . Int J Nurs Pract . 2003 ; 9:S9-S17 . CLINICAL QUESTION Do rates of healing , infection , and pain differ depending on whether  nonmoist or moist dressings  are used to manage superficial to partial-thickness wounds ? DATA SOURCES Investigations were identified by CINAHL , MEDLINE , Pre- MEDLINE , Cochrane Library , Current Contents , Health STAR , EMBASE , Exp and ed Academic Index , and Dissertation Abstract s International search es . The search terms included skin , graft , and donor . Additional search es were performed with reference lists and bibliographies of retrieved studies . STUDY SELECTION To be included in the review , each study had to fulfill the following criteria : it had to be an intraindividual or prospect i ve r and omized controlled trial of human subjects ; it had to include patients with postharvest split-thickness skin graft donor sites ; it had to evaluate the effectiveness of primary and secondary wound dressings ; and it had to have outcome measures that included healing ( objective ) , infection ( subjective ) , and pain ( objective ) . DATA EXTRACTION Data extraction and study quality assessment procedures were developed specifically for this review based on Cochrane Collaboration , Centre for Review s and Dissemination , and Joanna Briggs Institute protocol s and were performed independently by the author . Details of the procedures were not fully explained . The principal outcome measures were healing ( proportion of sites healed within the study period or time to complete healing ) , rate of infection , and pain scores . The studies were grouped according to broad dressing type ( nonmoist and moist ) and specific types of moist dressings ( hydrocolloids and polyurethane semipermeable transparent films ) . When comparable , study results were pooled and analyzed with a fixed-effects model . Data within broader dressing categories ( nonmoist and moist ) were analyzed with a r and om-effects model . chi ( 2 ) analysis was used to determine heterogeneity among the studies . RevMan software ( version 4.04 ; Cochrane Centre , Oxford , UK ) was used for statistical analysis . MAIN RESULTS The search es identified 111 studies and 1 integrative review , of which 58 studies met the inclusion and exclusion criteria . Inconsistency and variation in outcome measures and incomplete reporting of results prevented analysis of many studies . Wound healing was measured by days to complete healing ( when dressings could be removed without trauma and pain ) and wounds healed by day X ( removal of dressings at regular intervals ) . Wound infection was subjectively measured based on clinical signs of infection ( edema , heat , pain , or smell ) . Visual analog scales were used to measure pain levels . Among the broad categories of  nonmoist ( sterile gauze , fine mesh gauze , Xerofoam [ Tyco Healthcare Group LP , Mansfield , MA ] ) and moist ( DuoDERM hydrocolloid [ ConvaTec , Princeton , NJ ] , Tegaderm transparent film [ 3 M Health Care , St Paul , MN ] , Opsite transparent film [ Smith & Nephew , London , UK ] ) dressings  , the outcomes of healing , infection , and pain were analyzed . In 6 studies , the findings significantly favored moist dressings , compared with nonmoist dressings , for days to complete healing ( weighted mean difference [ WMD ] = -3.97 , 95 % confidence interval [ CI ] = -5.91 , -2.02 ) . In 9 studies , wounds healed by day X ( day 7 , 8 , 9 , 10 , or 12 ) were analyzed . The results were varied and inconclusive because of a small number of trials and subjects . Among 10 studies , no significant difference was noted in infection rates between nonmoist and moist dressings ( odds ratio [ OR ] = 0.41 , 95 % CI = 0.14 , 1.18 ) . Three studies using visual analog scales for the outcome of pain were converted into a uniform scale of 1 to 10 ( 10 representing most painful ) . The findings significantly favored moist dressings over nonmoist dressings ( WMD = -1.75 , 95 % CI = -2.94 , -0.56 ) . Among nonmoist and specific types of moist dressings , a subset analysis was performed to examine the outcomes of healing , infection , and pain . For days to complete healing , 2 investigations significantly favored hydrocolloid dressings over nonmoist dressings ( WMD = -2.19 , 95 % CI = -2.89 , -1.49 ) . Additionally , in 2 studies , hydrocolloid dressings were significantly favored over other moist dressings ( semiocclusive hydrocolloid and transparent film ) for days to complete healing ( WMD = -1.45 , 95 % CI = -2.17 , -0.74 ) . In 3 studies , the data significantly favored polyurethane semipermeable transparent film dressings over nonmoist dressings for days to complete healing ( WMD = -2.82 , 95 % CI = -3.58 , -2.07 ) . For infection rates , 4 studies significantly favored hydrocolloid dressings over nonmoist dressings ( OR = 0.21 , 95 % CI = 0.07 , 0.65 ) . In 4 other studies , polyurethane semipermeable transparent film dressings were significantly favored over nonmoist dressings with regard to infection rates ( OR = 0.28 , 95 % CI = 0.09 , 0.91 ) . For the outcome of pain , varied outcome measures and insufficient data prevented analysis among specific types of moist dressings . CONCLUSIONS Moist dressings decreased the days to complete healing and pain scores when compared with nonmoist dressings . Among the broad categories of nonmoist and moist dressings , no differences were found in infection rates . The data on specific types of moist dressings revealed that days to complete healing were decreased with hydrocolloid dressings compared with nonmoist and other moist dressings . Hydrocolloid dressings also decreased infection rates compared with nonmoist dressings . Polyurethane semipermeable transparent film dressings also decreased days to complete healing and infection rates compared with nonmoist dressings . Overall , the data indicated that hydrocolloid dressings are more effective than nonmoist dressings in terms of rates of healing , infection , and pain in the management of superficial to partial-thickness wounds . The variations in outcome measures among the included studies should be considered in interpreting these findings Prevention of pressure ulcers is fundamental to safe care of nursing home residents yet the role of hydration in pressure ulcer prevention has not been systematic ally examined . This r and omized clinical trial was undertaken to determine whether administration of supplemental fluid to nursing home residents at risk for pressure ulcers would enhance collagen deposition , increase estimated total body water , augment subcutaneous tissue oxygenation , and was safe . After a baseline period , 64 subjects were r and omized to receive the fluid volume prescribed or additional fluid ( prescribed plus 10 mL/kg ) for 5 days . Participants ' potential to heal as measured with hydroxyproline was low at baseline and did not increase significantly during treatment when additional fluid was systematic ally provided . Fluid intake increased significantly during treatment . Estimates of total body water and subcutaneous oxygen did not increase , indicating hydration was not improved . Supplemental fluid did not result in overhydration as measured by clinical parameters . Further work is needed to examine the relationship between fluid intake and hydration in nursing home residents as well as the role of hydration in pressure ulcer prevention
Although most study - authors were positive , we could not draw firm conclusions about any of the pharmaceutical interventions .
Even patients that received placebo intervention showed improvement .
There is weak evidence that reduction mammaplasty may be helpful to treat inframammary intertrigo .
Conclusions There is no evidence at all about the prevention of intertrigo and there is no firm evidence about its treatment .
Background Intertrigo in the large skin folds is a common problem .
There is a plethora of treatments , but a lack of evidence about their efficacy .
A nursing guideline on this matter had to be up date d and broadened in scope to other health care professionals .