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Journal articles on the topic 'Sub epidermal Moisture'

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Author: Grafiati

Published: 10 December 2022

Last updated: 29 January 2023

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1

Padula, William V., Shreena Malaviya, Ellen Hu, Sue Creehan, Barbara Delmore, and Jonothan C. Tierce. "The cost-effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. health systems." Journal of Patient Safety and Risk Management 25, no. 4 (March 26, 2020): 147–55. http://dx.doi.org/10.1177/2516043520914215.

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Objective Hospital-acquired pressure injuries harm over 2.5 million patients at a U.S. cost of $26.8 billion. Sub-epidermal moisture scanning technology supports clinicians to anatomically identify locations at-risk of developing hospital-acquired pressure injuries. Our objective was to evaluate the cost-effectiveness of adopting sub-epidermal moisture scanners in comparison to existing hospital-acquired pressure injury prevention guidelines structured around subjective risk assessments. Methods A Markov cohort model was developed to analyze the cost-effectiveness of sub-epidermal moisture scanners in comparison to existing prevention guidelines, based on current clinical trial data from the U.S. health care sector perspective in the acute, acute rehabilitation and skilled nursing facility settings. A hypothetical cohort was simulated over a time horizon of one year. An incremental cost-effectiveness ratio was measured using U.S. dollars per quality-adjusted life year at a willingness-to-pay threshold of $100,000/quality-adjusted life year, and uncertainty was tested using probabilistic sensitivity analysis. Results Integration of sub-epidermal moisture scanners yielded cost-savings of $4054 and 0.35 quality-adjusted life years gained per acute care admission, suggesting that sub-epidermal moisture scanners are a dominant strategy compared to standard care and producing a net monetary benefit of $39,335. For every 1000 admissions in high-risk acute care, sub-epidermal moisture scanners could avert around seven hospital-acquired pressure injury-related deaths and decrease hospital-acquired pressure injury-related re-hospitalization by approximately 206 bed-days. Conclusions Acute care, acute rehabilitation and skilled nursing settings that adopt sub-epidermal moisture technology could achieve a return on investment in less than one year. Providers may want to consider these types of technology that aid clinical judgment with objective measures of risk in quality improvement bundles.

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2

Jayabal, Hemalatha, Barbara M. Bates-Jensen, Nkemjika S. Abiakam, Peter R. Worsley, and Dan L. Bader. "Anatomical variability of sub-epidermal moisture and its clinical implications." Journal of Tissue Viability 30, no. 3 (August 2021): 434–38. http://dx.doi.org/10.1016/j.jtv.2021.04.003.

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3

Ross, Graham, and Amit Gefen. "Assessment of sub-epidermal moisture by direct measurement of tissue biocapacitance." Medical Engineering & Physics 73 (November 2019): 92–99. http://dx.doi.org/10.1016/j.medengphy.2019.07.011.

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4

Peko, Lea, and Amit Gefen. "Sensitivity and laboratory performances of a second‐generation sub‐epidermal moisture measurement device." International Wound Journal 17, no. 3 (March 11, 2020): 864–67. http://dx.doi.org/10.1111/iwj.13339.

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5

Musa, Louisa, Nicky Ore, Gillian Raine, and Glenn Smith. "Clinical impact of a sub-epidermal moisture scanner: what is the real-world use?" Journal of Wound Care 30, no. 3 (March 2, 2021): 198–208. http://dx.doi.org/10.12968/jowc.2021.30.3.198.

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Objective: The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management. Method: The study used a pragmatic ‘real-world’ approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making. Results: There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making. Conclusion: In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.

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6

Park, Seungmi, Chul-Gyu Kim, and Ji Woon Ko. "The use of sub-epidermal moisture measurement in predicting blanching erythema in jaundice patients." Journal of Wound Care 27, no. 5 (May 2, 2018): 342–49. http://dx.doi.org/10.12968/jowc.2018.27.5.342.

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7

Budri, Aglecia. "Identification of increased risk of pressure damage with a sub-epidermal moisture scanner: clinical outcomes and cost-effectiveness." British Journal of Healthcare Management 26, no. 10 (October 2, 2020): 1–10. http://dx.doi.org/10.12968/bjhc.2020.0035.

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Hospital-acquired pressure ulcers and subsequent interventions are a substantial burden to patients. This article reviews the use of a sub-epidermal moisture (SEM) scanning device as an early and robust method of identifying the increased risk of pressure damage before it is visible on the surface of the skin. This could allow the implementation of early interventions and potentially decrease the frequency of hospital-acquired pressure ulcers.

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8

Bryant, Ruth A., Zena EH Moore, and Vignesh Iyer. "Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning." Expert Review of Medical Devices 18, no. 9 (September 2, 2021): 833–47. http://dx.doi.org/10.1080/17434440.2021.1960505.

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9

Ousey, Karen, John Stephenson, and Joanna Blackburn. "Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence." Journal of Wound Care 31, no. 3 (March 2, 2022): 208–16. http://dx.doi.org/10.12968/jowc.2022.31.3.208.

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Objective: To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. Method: Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. Results: A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. Conclusion: The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.

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10

Martins de Oliveira, Ana Lúcia, Tom O'Connor, Declan Patton, Helen Strapp, and Zena Moore. "Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients." Journal of Wound Care 31, no. 3 (March 2, 2022): 254–64. http://dx.doi.org/10.12968/jowc.2022.31.3.254.

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Objective: To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. Method: A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. Results: Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. Conclusion: Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.

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11

Budri, Aglecia Moda Vitoriano, Zena Moore, Declan Patton, Tom O'Connor, Linda Nugent, and Pinar Avsar. "Sub‐epidermal moisture measurement: an evidence‐based approach to the assessment for early evidence of pressure ulcer presence." International Wound Journal 17, no. 6 (July 19, 2020): 1615–23. http://dx.doi.org/10.1111/iwj.13437.

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12

O'Brien, Gillian, Zena Moore, Declan Patton, and Tom O'Connor. "The relationship between nurses assessment of early pressure ulcer damage and sub epidermal moisture measurement: A prospective explorative study." Journal of Tissue Viability 27, no. 4 (November 2018): 232–37. http://dx.doi.org/10.1016/j.jtv.2018.06.004.

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13

Smith, Glenn. "Improved clinical outcomes in pressure ulcer prevention using the SEM scanner." Journal of Wound Care 28, no. 5 (May 2, 2019): 278–82. http://dx.doi.org/10.12968/jowc.2019.28.5.278.

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Objective: An in-practice evaluation of an sub-epidermal moisture (SEM) scanner, to detect non-visible pressure damage, allowing appropriate, targeted pressure ulcer (PU) prevention interventions. Method: The evaluation included patients on a single medical-surgical ward over a period of two months. Results: The evaluation included 35 patients. The outcomes of the evaluation suggest that the SEM scanner provided objective evidence that both the interventions being employed and the increase in repositioning and assessment prevented further incipient skin damage. Conclusion: We conclude that the early detection of non-visible tissue injury using the SEM scanner as an adjunct to the usual PU risk assessment strategies can reduce PU incidence, leading to improved patient outcomes and released productivity.

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14

Ousey, Karen, John Stephenson, and Joanna Blackburn. "Sub-epidermal moisture assessment as a prompt for clinical action in treatment of pressure ulcers in at-risk hospital patients." Journal of Wound Care 31, no. 4 (April 2, 2022): 294–303. http://dx.doi.org/10.12968/jowc.2022.31.4.294.

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Objective: This study assesses anonymous patient-level data on the use of sub-epidermal moisture (SEM) assessment technology as a tool in the prevention of pressure ulceration in at-risk hospital patients. Method: The relationship between technology-generated prompts for clinical action (patient turning, application of pressure redistributing equipment, heel protection or cream) and consequent clinical action was evaluated using data cross-tabulations (using data aggregated over multiple anatomical sites); in a multilevel model with patients clustered within wards, clustered in turn within hospitals, and controlling for additional patient- and institution-level factors; and using receiver operating characteristic (ROC) analyses of anatomy-specific data. The ability of the SEM assessment technology to detect deep and early-stage pressure ulcers/injuries on specific anatomical areas of a patient's body on admission, earlier than visual and tactile skin tissue assessments (STA), was assessed. Results: A total of 15,574 patient assessments (‘cases’) were reported on 1995 patients. Most incidences of nurse action were in response to a prompt from SEM assessments (4944/5494; 90.0%). An SEM delta (Δ)≥0.6 resulted in nurse action in 4944/13,071 cases (37.8%). The multilevel model revealed strong evidence that SEM Δ prompts were significantly associated with nurse action (p<0.001; adjusted odds ratio: 1.99). Conclusion: In this study, SEM assessment technology effectively prompted nurse action moreso than skin reddening diagnosed via trained clinician judgement and STAs. While baseline responses of nurses' actions remained low, with or without SEM Δ prompts, findings verified the ‘clinical utility’ of SEM assessment technology as an objective prompt for early clinical action over and above existing mechanisms.

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15

Raine, Gillian. "Is it time to re-evaluate the inevitability of ulcers at the end of life?" International Journal of Palliative Nursing 27, no. 9 (November 2, 2021): 440–48. http://dx.doi.org/10.12968/ijpn.2021.27.9.440.

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Background: The prevention of pressure injuries/ulcers (PI/PUs) in patients at the end of life is achievable, albeit challenging. Objective diagnostic tools, such as sub-epidermal moisture (SEM) scanning, support healthcare practitioners' clinical judgment in preventing PI/PUs. Aim: A pragmatic study was conducted to assess the feasibility of preventing PI/PUs using SEM technology as an adjunct to routine care in a 22-bed inpatient hospice. Methods: Daily SEM scanning was introduced to support the device-trained practitioners' clinical judgment in detecting developing, non-visible PI/PUs. Preventive interventions were initiated by clinical judgment informed by Waterlow scores, visible, tactile skin and tissue assessments and scanner readings. Results: Prior to the study, the incidence of PI/PUs was 9%. The 6 month study period reported a 4.8% PI/PU incidence, 7/146 consenting patients developed a PI/PU, resulting in a 47% reduction in incidence rates. Conclusion: Preventing the development of PI/PUs is possible with clinical judgment aided by SEM data.

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16

Gershon, Steve, and Henry Okonkwo. "Evaluating the sensitivity, specificity and clinical utility of algorithms of spatial variation in sub-epidermal moisture (SEM) for the diagnosis of deep and early-stage pressure-induced tissue damage." Journal of Wound Care 30, no. 1 (January 2, 2021): 41–53. http://dx.doi.org/10.12968/jowc.2021.30.1.41.

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Background: Sub-epidermal moisture (SEM) is a measurable biomarker detecting early pressure damage in order to objectively support current ‘gold standard’ skin tissue assessments (STA) for the detection of deep and early-stage pressure-induced injuries or ulcers (PI/PUs). Objective: A multi-site, dual arm, cross sectional, retrospective study was conducted to evaluate the sensitivity, specificity and clinical utility of spatial variation in SEM readings between healthy and damaged skin tissue. Method: The study enrolled 175 subjects: 125 with confirmed PI/PUs or suspected deep tissue injury (sDTI), and 50 confirmed healthy subjects. Expert principal investigators and PI/PU healthcare practitioners (HCPs) evaluating all subjects were trained in SEM measurements but blinded to clinical interpretation of SEM readings. Sequential and spatial SEM readings of the sacrum and heels, subjects' demographic data, STAs, risk assessment tool scores (RATS), pain assessment and potential confounders were recorded. Independent statistical analyses were performed. Results: Mean spatial SEM measures within subjects with healthy tissue and within subjects with damaged tissue were statistically similar. Mean spatial SEM measures within anatomies of subjects with damaged tissue were significantly different (p<0.05). There was no significant difference between spatial readings in healthy subjects. Algorithms computing a range of SEM delta thresholds indicated a sensitivity of 82–87% and a specificity of 51–88% at an SEM delta ≥0.6. Receiver operating characteristic (ROC) curves computed areas under the curve (AUC) of 0.7809–0.9181 (95% CI: 0.7221–0.8817, 0.8397–0.9545, p<0.0001) exceeding clinical judgement. Conclusion: These SEM data augment clinical decision-making for developing intact skin PI/PUs including sDTIs and Stage I PI/PUs. Informing HCPs of this subclinical, non-visible skin and tissue damage and providing opportunities for alternative PI/PU care pathways is an exciting prospect.

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17

Peko Cohen, Lea, and Amit Gefen. "Phantom testing of the sensitivity and precision of a sub‐epidermal moisture scanner." International Wound Journal, April 16, 2019. http://dx.doi.org/10.1111/iwj.13132.

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18

Byrne, Sorcha, Declan Patton, Pinar Avsar, Helen Strapp, Aglecia Budri, Tom O'Connor, Linda Nugent, and Zena Moore. "Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development." International Wound Journal, December 27, 2022. http://dx.doi.org/10.1111/iwj.14061.

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19

Campbell, Jill, Wendy Chaboyer, Georgia Tobiano, Emma Harbeck, Tracy Nowicki, Zena Moore, Gary Allen, Brigid Gillespie, Fiona Coyer, and Rachel Walker. "The effect of sub-epidermal moisture on pressure injury prevention strategies and incidence of pressure injuries: A feasibility pilot randomised controlled trial." Journal of Tissue Viability, July 2022. http://dx.doi.org/10.1016/j.jtv.2022.07.008.

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20

Lustig, Maayan, Dafna Schwartz, Ruth Bryant, and Amit Gefen. "A machine learning algorithm for early detection of heel deep tissue injuries based on a daily history of sub‐epidermal moisture measurements." International Wound Journal, January 12, 2022. http://dx.doi.org/10.1111/iwj.13728.

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21

McEvoy, Natalie, Declan Patton, Ger Curley, Fiona Boland, Cathal Kearney, Grace Hogan, Aoife Keogh, Jennifer Clarke, and Zena Moore. "Biomarkers for the early detection of pressure ulcers in the intensive care setting: A comparison between sub‐epidermal moisture measurements and interleukin‐1α." International Wound Journal, August 21, 2022. http://dx.doi.org/10.1111/iwj.13930.

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