Wound Documentation Research Articles

Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach.

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national HAPI rate of 3.5% of observed patients. In rapid response, a multidisciplinary team was formed to address and improve the HAPI rate via a quality improvement project. To achieve the goal of decreased pressure injuries or ulcers, a team of nurses, patient care technicians, nutritionists, infectious disease specialists, radiologists, surgeons, vascular technicians, supply chain administrators, case management and social workers, hyperbaric medicine specialists, and wound care experts was created. The team completed a gap analysis and discovered inconsistencies in documentation and care practices that led to HAPI rates above the national average. The team then standardized a policy, standardized documentation of wounds, and provided staff education. Measures were implemented to proactively prevent pressure injuries. There was a 4.2 percentage point decrease in HAPIs from the beginning of the project (5.76%) to the last survey (1.59%). However, this difference was not statistically significant (P = .07). Overall, there were 6 fewer patients (8 vs 2 patients) with hospital-onset observed injury. Additionally, the length of stay decreased by 46%. Documentation of skin assessments within 24 hours of admission improved to 100%. We implemented a quality improvement program across 10 service lines, monitoring pressure injuries, HAPI incidence, and length of stay in 480 patients over 2 years. Although the reduction in HAPI was not statistically significant (P = .07), our program positively impacted the hospital's response to pressure injuries and warrants further replication.

Optimising Processes in a Severe Burn Intensive Care Unit through the Implementation of a Digital Management System

The treatment of severely burned patients is demanding and necessitates specialised centres capable of providing adequate therapy over several months. The establishment of digital management systems in intensive care units signifies a substantial advancement in modern healthcare. Introducing such a system in a specialised intensive care unit for severe burn patients presents opportunities for optimisation but also potential obstacles. This study aims to provide insights into the perception of change from the perspective of staff and discuss the implementation of digital systems in the field of intensive care medicine. After a selective sample was established, the impacts of the digital management system were examined across various categories. The data collected through a questionnaire and brief interviews were evaluated in terms of average values within each category, with interpretations taking into account characteristics such as professional group and work experience. Overall, the digital management system is considered suitable for use in the intensive care unit for severe burn patients by both medical and nursing staff. The continuous monitoring of vital parameters and the reduction of errors in medication administration are highlighted as positive aspects. However, negative points include the inferior documentation of burn wounds and specialised documentation for burn patients. In due consideration of various factors such as experience, team size, and patient clientele, which impact the usability of the program, some aspects in need of improvement were identified. In summary, however, it can be said that there was a positive and favourable consensus regarding the introduction of such a system in the intensive care unit. Additionally, it can be concluded that the system is described as significantly more effective for a general surgical intensive care unit than for a specialised intensive care unit, e. g. an intensive care unit for severe burn patients.

3D documentation and classification of incense tree Aquilaria sinensis (Lour.) Spreng. wounds by photogrammetry and its potential conservation applications.

In recent years, illegal felling of and damage to the incense tree Aquilaria sinensis (Lour.) Spreng. have been reported in Hong Kong. Their native populations are under increasingly severe threat. Therefore, the development of a standard and efficient method to classify and document wounds on vulnerable trees is urgently needed for conservation purposes. In this study, photogrammetry was used to document wounds in A. sinensis through 3D modeling. A total of 752 wound records from 484 individual A. sinensis trees from Hong Kong were included to establish a new wound classification system. Our major findings include a novel standardized procedure for photogrammetric documentation and a wound classification system. The results of this study will facilitate A. sinensis conservation, by enhancing wound documentation and information transfer to law enforcement and education.

Optimising wound monitoring: Can digital tools improve healing outcomes and clinic efficiency.

Chronic wounds present significant challenges for patients and nursing care teams worldwide. Digital health tools offer potential for more standardised and efficient nursing care pathways but require further rigorous evaluation. This retrospective matched cohort study aimed to compare the impacts of a digital tracking application for wound documentation versus traditional manual nursing assessments. Data from 5236 patients with various wound types were analysed. Propensity score matching balanced groups, and bivariate tests, correlation analyses, linear regression, and Hayes' Process Macro Model 15 were utilised for a mediation-moderation model. Digital wound tracking was associated with significantly shorter healing durations (15 vs. 35 days) and fewer clinic nursing visits (3 vs. 5.8 visits) compared to standard nursing monitoring. Digital tracking demonstrated improved wound size reduction over time. Laboratory values tested did not consistently predict healing outcomes. Digital tracking exhibited moderate negative correlations with the total number of nursing visits. Regression analysis identified wound complexity, hospitalizations, and initial wound size as clinical predictors for more nursing visits in patients with diabetes mellitus (p < .01). Digital tracking significantly reduced the number of associated nursing visits for patients with peripheral vascular disease. These findings suggest that digital wound management may streamline nursing care and provide advantages, particularly for comorbid populations facing treatment burdens. This study adhered to STROBE guidelines in reporting this observational research. By streamlining documentation and potentially shortening healing times, digital wound tracking could help optimise nursing resources, enhance wound care standards, and improve patient experiences. This supports further exploration of digital health innovations to advance evidence-based nursing practice. This study involved retrospective analysis of existing patient records and did not directly include patients or the public in the design, conduct, or reporting of the research.

Documentation of wounds in emergency departments through a forensic lens

BackgroundNurses document wounds to direct and evaluate the care. People admitted to emergency departments with wounds should be regarded as potential forensic patients, requiring meticulous documentation for evidence purposes. AimTo explore the documentation of wounds in emergency departments through a forensic lens and compare it between different levels of emergency departments. MethodsIn this descriptive retrospective study, we randomly sampled 515 paper-based medical files of patients who sustained wounds admitted to three selected emergency departments. The files were analysed using a structured data collection tool the data were descriptively analysed. ResultsAll files included information on the type of wound (100%) and the site of the wound (100%) with most files including the mechanisms of injury (98.6%). Few files included information on blood loss (18.1%) and the size of the wound (15%). Only one file included information on the contents of the wound. No files included information on the wound's shape and the surrounding skin's condition. ConclusionWounds were poorly documented in emergency departments, irrespective of the level of care. Nurses in emergency departments should have strict guidelines for documenting wounds since accurate documentation protects patients’ human rights and protects nurses.

Phone cam array – An open-source, modular photogrammetry system made of Android phones

Photogrammetry is a 3D reconstruction technique using photographs of the target from multiple angles. Taking pictures around a static object with a single camera can yield high-quality models, but if the subject moves between images, 3D reconstruction might fail. One way to mitigate this is to use multiple cameras.This project aimed to develop a tool for fast and precise wound documentation for clinical forensic medicine.This paper describes a simple, low-cost modular system, where smartphones of different manufacturers are used as networked cameras. Exposure is initiated at the same time in all the phones with a simple circuit emulating a headset button press.A proof-of-concept device was built, where four phones (Huawei nova 8i (2 pcs), Samsung Galaxy S7 Edge, Oukitel K4000 Pro) were attached to a curved, 3D-printed, handheld frame.The average delay of image capture was 636 ms between the quickest and the slowest phones. When compared to the single-camera approach, the use of different cameras did not reduce the quality of the 3D model. The phone cam array was less susceptible to movement artefacts caused by breathing. Wound assessment was possible based on the 3D models created with this device.

574 The Impact of Age on Wound Healing Progression in Burns

Abstract Introduction Increasing incidences of wound healing disorders are a growing problem in our aging society. Moreover, the survival rate of the elderly is diminished when it comes to extensive high-grade burn injuries. Here, we characterized the systemic and local reactions towards burn injuries in young, middle aged and aged rats. Additionally, we provide a comparison in wound healing progression between burn wounds and full-thickness wounds of the same sizes. Methods For this study, 54 male Wistar rats from three different age groups (11; 27; and 56 weeks) either received high-grade contact burns, full-thickness skin wounds (2x2 wounds, Ø 10 mm each) or served as unwounded controls. Throughout the study regular wound documentation and non-invasive imaging methods were performed. Blood was sampled from the tail vein to detect differences in plasma cytokine concentrations. Moreover, body weight and food intake were measured daily. On the final study day (day 7), tissue biopsies were collected from the wound and control areas and were analyzed on a histological and molecular level. Mainly inflammatory markers (interleukins, TGFb, TNFa etc.) and markers for tissue perfusion (VEGFa, HIF1a) were quantified by qPCR. Repeated measures analysis of variance was performed to compare the means among groups. Results We found that epidermal thickness of unwounded skin declined with age and was lowest in 56-weeks-old rats. On day 4 after wounding, tissue perfusion was significantly impaired in 27- and 56-weeks-old rats compared to 11-weeks-old rats (p &amp;lt; 0.001). Histological scores for the immune response showed an age-dependent effect in both burns and excisional wounds. Neutrophil and lymphocyte counts were highest in the 27-weeks-old rats (11 weeks vs. 27 weeks: p &amp;lt; 0.001). Eosinophil counts, however, were significantly increased in burn wounds compared to excisional wounds (p = 0.013), regardless of age. We did not detect any age-dependent effects in wound sizes on the final day, nor in the animals’ weight loss after wounding. Conclusions Although there are significant age-related differences in the thickness of the epidermis, the angiogenic potential of the skin and the local immune response, these differences do not seem to affect healing. It is reasonable to assume that decreased wound healing progression occurs only when additional factors, such as impaired perfusion, diabetes etc are involved. Applicability of Research to Practice We believe the precise knowledge of processes involved in wound healing is crucial for the development of new therapeutic strategies and to support healing after burns. Our results might challenge the paradigm of impaired healing in aged individuals and draw attention to the necessity to dig for other influential factors. However, as skin morphology and healing dynamics differ between rodents and humans, we plan to implement a translational approach using human abdominal skin flaps of donors from different age groups.

The state of wound assessment tools in Singapore: an evaluation study

Variations in wound assessment and documentation remain an issue for clinicians despite efforts to standardise practices using national guidelines such as the Wound Care Assessment Minimum Data Set (WCA-MDS). As little is known about the quality of the wound assessment tools (WATs) used in Singapore, this study aimed to determine whether the existing WATs used meet the WCA-MDS criteria and clinicians' needs. The study adopted an action evaluation methodology to evaluate seven well-established WATs, such as the Applied Wound Management (AWM) and National Wound Assessment Form (NWAF), and eight locally-designed WATs against the 34-item WCA-MDS criteria. Two clinicians reviewed the WATs using a self-developed audit form between June and July 2020. The results show that only five WATs met at least 50% of the 34 criteria indicators, with the MEASURE assessment framework achieving the most at 68%, followed by TIME-CDST at 65%, Hospital C WAT at 56%, NWAF at 53%, and AWM form at 50%. The five most common criteria indicators included wound type/classification, date and time of wound, wound size, wound bed tissue type, and exudate information. Most criteria indicators under the 'patient information' and 'specialist's referral' subdomains were omitted, reflecting the lack of focus on these areas in the local WATs. Despite advances in WAT development in the literature, the current state of wound assessment and documentation across healthcare institutions remains inconsistent. There is a need to focus on clinician training and establishing a nationally-validated WAT in Singapore.

Evidence-Based Mobile Wound Application to Support Professionals in State-of-the-Art Chronic Wound Treatment.

One of the most important tasks within wound management and the basis of successful wound care is a clear and accurate nursing documentation which can be created in various ways. However, this documentation is only partially standardized mainly due to the interdisciplinarity of this task. The goal is to overcome interdisciplinary boundaries in home care between health professionals, and to increase the patient's motivation to actively participate in wound healing by providing consistent structure and guidance. In this paper, the development of a mobile wound documentation application is described. Comprehensive literature reviews were conducted on state-of-the-art wound documentation as well as on machine learning frameworks, databases and mobile app development technologies. As a result, a mobile wound application with Flutter, SQLite and Tensorflow Lite was developed. During the development process interoperability was considered to enable future extensibility. Further development in respect of backend and API is planned, involving user field tests.

Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID-19 pandemic.

Wound documentation is integral to effective wound care, health data coding and facilitating continuity of care. This study evaluated the usability and effectiveness of an artificial intelligence application for wound assessment and management from a clinician‐and‐patient user perspective. A quasi‐experimental design was conducted in four settings in an Australian health service. Data were collected from patients in the standard group (n = 166, 243 wounds) and intervention group (n = 124, 184 wounds), at baseline and post‐intervention. Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively, and bivariate statistics were used to determine between‐group differences. Thematic analysis of interviews was conducted. Compared with the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% vs 70%, P < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99%). Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. The use of the application facilitated remote patient monitoring and reduced patient travel time while maintaining optimal wound care.

Reducing Surgical Site Infection by Prophylactic Negative Pressure Wound Therapy in a Cohort of General Surgery Patients

Background: Surgical site infection (SSI) is one of the leading complications in health care. Negative pressure wound therapy (NPWT) is meanwhile widely prophylactically used for preventing SSIs. For evaluating the results of the implantation of this technique, we used the Simon single-arm study design and examine whether NPWT has a prophylactic effect on reducing SSIs in a cohort of general surgery patients. Methods: This single-arm, two-stage study includes 81 elective general surgery patients and corresponds to the Simon’s design. The sample size calculation was based on a reduction in the superficial SSI rate from 12 to 4% (power 80%, significance level 5%) using a NPWT system. In compliance with Simon’s two-Stage design, the study required the recruitment of 34 patients in stage I and 47 patients in stage II. The two-stage design method would be discarded in case of a wound infection in 3 or more patients in stage I or 6 or more patients in stage II. Using the NPWT system in the operating room, a negative pressure wound dressing was applied post-operatively and removed after 7 days. According to the criteria of the Centres for Disease Control and Prevention (CDC), post-operative wound documentation followed on day 7 and 30. Results: In stage I, no SSI was apparent. In stage II, 3 patients had SSIs (CDC grade I). Conclusion: A prophylactic NPWT can significantly reduce the wound infection rate in elective general surgery.

Automatic Classification of Diabetic Foot Ulcer Images - A Transfer-Learning Approach to Detect Wound Maceration.

Diabetic foot ulcer (DFU) is a chronic wound and a common diabetic complication as 2% - 6% of diabetic patients witness the onset thereof. The DFU can lead to severe health threats such as infection and lower leg amputations, Coordination of interdisciplinary wound care requires well-written but time-consuming wound documentation. Artificial intelligence (AI) systems lend themselves to be tested to extract information from wound images, e.g. maceration, to fill the wound documentation. A convolutional neural network was therefore trained on 326 augmented DFU images to distinguish macerated from unmacerated wounds. The system was validated on 108 unaugmented images. The classification system achieved a recall of 0.69 and a precision of 0.67. The overall accuracy was 0.69. The results show that AI systems can classify DFU images for macerations and that those systems could support clinicians with data entry. However, the validation statistics should be further improved for use in real clinical settings. In summary, this paper can contribute to the development of methods to automatic wound documentation.

S2k-Guideline for Teledermatology.

S2k-Guideline for Teledermatology.

Grabcut Algorithm: A New Assessment of Burn Wound Area from Digital Images

Background: As far as high technology is concerned, digital images of burn patients are widely used for wound documentation and specialist consultation. Wound area can be approximated from the photographs to aid further treatment for the patients. However, objective estimation of the wound areas in the digital images is still problematic. Objective: To calculate sizes of burn wounds from digital images. Materials and Methods: A computer application, Burn Percentage Calculation (BPC), was developed based on image segmentation algorithm called Grabcut. This image processing tool extracted an object of interest out of the background by using differences of pixel color and contrast in the image. The probabilistic models of being foreground and background were created to distinguish object pixels from the rest of the input image. The BPC application effectively extracted patient&rsquo;s body parts and burn wounds from the background. By mapping to Lund and Browder chart in the application, the wound area in a unit of percent total body surface area (%TBSA) was obtained. To validate the application, 10 plastic surgery residents were assigned to assess burn wound areas from 5 digital photographs using BPC application compared to conventional Lund and Browder chart. Results: Forty-one digital images of burn patients were processed by BPC application. The application clearly separated the burn wounds from the background, and calculated wound areas in a unit of %TBSA. Burn sizes calculated by BPC application were not significantly different from those using conventional Lund and Browder diagram. Conclusion: Grabcut algorithm is a powerful image segmentation tool which can sufficiently extract burn wounds from a 2D photograph. Our study demonstrated that sizes of burn wounds in the photographs were accurately calculated using an image segmentation-aided computer application. The resulting burn areas can guide individualized treatment for burned patients. Keywords: Burn wound area; Digital image; Grabcut algorithm; Image segmentation; TBSA

Effect on healing rates of wounds treated with direct cold atmospheric plasma: a case series.

The response of different critical acute and hard-to-heal wounds to an innovative wound care modality-direct application of cold atmospheric plasma (CAP)-was investigated in this clinical case series. Over an observation period of two years, acute wounds with at least one risk factor for chronification, as well as hard-to-heal wounds were treated for 180 seconds three times per week with CAP. CAP treatment was additional to standard wound care. Photographs were taken for wound documentation. The wound sizes before the first CAP treatment, after four weeks, after 12 weeks and at wound closure/end of observation time were determined using image processing software, and analysed longitudinally for the development of wound size. A total of 27 wounds (19 hard-to-heal and eight acute wounds) with a mean wound area of 15cm2 and a mean wound age of 49 months were treated with CAP and analysed. All (100%) of the acute wounds and 68% of the hard-to-heal wounds healed after an average treatment duration of 14.2 weeks. At the end of the observation period, 21% of hard-to-heal wounds were not yet closed but were reduced in size by >80%. In 11% of the hard-to-heal wounds (n=2) therapy failed. The results suggested a beneficial effect of additional CAP therapy on wound healing. This work was carried out within the research projects 'Plasma for Life' (funding reference no. 13FH6I04IA) with financial support from the German Federal Ministry of Education and Research (BMBF). In the past seven years AFS has provided consulting services to Evonik and has received institutional support by Heraeus, Johnson & Johnson and Evonik. There are no royalties to disclose. The Department for Trauma Surgery, Orthopaedics and Plastic Surgery received charitable donations by CINOGY GmbH. CINOGY GmbH released the di_CAP devices and electrodes for the study. WV and AH were involved in the development of the used di_CAP device (Plasmaderm, CINOGY GmbH). WV is shareholder of the outsourced start-up company CINOGY GmbH.

Expressiveness of an International Semantic Standard for Wound Care: Mapping a Standardized Item Set for Leg Ulcers to the Systematized Nomenclature of Medicine-Clinical Terms.

BackgroundChronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT).ObjectiveThis study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions.MethodsA clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.ResultsThe developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%).ConclusionsThe results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

Comparison of superficial wound documentation using 2D forensic photography, 3D photogrammetry, Botscan\xa9 and VR with real-life examination

Evidence acquisition, interpretation and preservation are essential parts of forensic case work that make a standardized documentation process fundamental. The most commonly used method for the documentation and interpretation of superficial wounds is a combination of two modalities: two-dimensional (2D) photography for evidence preservation and real-life examination for wound analysis. As technologies continue to develop, 2D photography is being enhanced with three-dimensional (3D) documentation technology. In our study, we compared the real-life examination of superficial wounds using four different technical documentation and visualization methods.To test the different methods, a mannequin was equipped with several injury stickers, and then the different methods were applied. A total of 42 artificial injury stickers were documented in regard to orientation, form, color, size, wound borders, wound corners and suspected mechanism of injury for the injury mechanism. As the gold standard, superficial wounds were visually examined by two board-certified forensic pathologists directly on the mannequin. These results were compared to an examination using standard 2D forensic photography; 2D photography using the multicamera system Botscan©, which included predefined viewing positions all around the body; and 3D photogrammetric reconstruction based on images visualized both on screen and in a virtual reality (VR) using a head-mounted display (HMD).The results of the gold standard examination showed that the two forensic pathologists had an inter-reader agreement ranging from 69% for the orientation and 11% for the size of the wounds. A substantial portion of the direct visual documentation showed only a partial overlap, especially for the items of size and color, thereby prohibiting the statistical comparison of these two items. A forest plot analysis of the remaining six items showed no significant difference between the methods. We found that among the forensic pathologists, there was high variability regarding the vocabulary used for the description of wound morphology, which complicated the exact comparison of the two documentations of the same wound.There were no significant differences for any of the four methods compared to the gold standard, thereby challenging the role of real-life examination and 2D photography as the most reliable documentation approaches. Further studies with real injuries are necessary to support our evaluation that technical examination methods involving multicamera systems and 3D visualization for whole-body examination might be a valid alternative in future forensic documentation.

Wound Image Quality From a Mobile Health Tool for Home-Based Chronic Wound Management With Real-Time Quality Feedback: Randomized Feasibility Study.

BackgroundTravel to clinics for chronic wound management is burdensome to patients. Remote assessment and management of wounds using mobile and telehealth approaches can reduce this burden and improve patient outcomes. An essential step in wound documentation is the capture of wound images, but poor image quality can have a negative influence on the reliability of the assessment. To date, no study has investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status.ObjectiveOur goal was to develop a mobile health (mHealth) tool for the remote self-assessment of digital ulcers (DUs) in patients with systemic sclerosis (SSc). We aimed to define and validate objective measures for assessing the image quality, evaluate whether an automated feedback feature based on real-time assessment of image quality improves the overall quality of acquired wound images, and evaluate the feasibility of deploying the mHealth tool for home-based chronic wound self-monitoring by patients with SSc.MethodsWe developed an mHealth tool composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We introduced 2 objective image quality parameters based on the sharpness and presence of the color checker to assess the quality of the image during acquisition and enable a quality feedback mechanism in an advanced version of the app. We randomly assigned patients with SSc and DU to the 2 device groups (basic and feedback) to self-document their DU at home over 8 weeks. The color checker detection ratio (CCDR) and color checker sharpness (CCS) were compared between the 2 groups. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior and timings, and the overall quality of the wound images.ResultsA total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher (P<.001) CCS compared to the basic group. The usability questionnaire results showed that the majority of patients were satisfied with the tool, but could benefit from disease-specific adaptations. The median assessment duration was <50 seconds in all patients, indicating the mHealth tool was efficient to use and could be integrated into the daily routine of patients.ConclusionsWe developed an mHealth tool that enables patients with SSc to acquire good-quality DU images and demonstrated that it is feasible to deploy such an app in this patient group. The feedback mechanism improved the overall image quality. The introduced technical solutions consist of a further step towards reliable and trustworthy digital health for home-based self-management of wounds.

Software-Based Method for Automated Segmentation and Measurement of Wounds on Photographs Using Mask R-CNN: a Validation Study.

In clinical routine, wound documentation is one of the most important contributing factors to treating patients with acute or chronic wounds. The wound documentation process is currently very time-consuming, often examiner-dependent, and therefore imprecise. This study aimed to validate a software-based method for automated segmentation and measurement of wounds on photographic images using the Mask R-CNN (Region-based Convolutional Neural Network). During the validation, five medical experts manually segmented an independent dataset with 35 wound photographs at two different points in time with an interval of 1month. Simultaneously, the dataset was automatically segmented using the Mask R-CNN. Afterwards, the segmentation results were compared, and intra- and inter-rater analyses performed. In the statistical evaluation, an analysis of variance (ANOVA) was carried out and dice coefficients werecalculated. The ANOVA showed no statistically significant differences throughout all raters and the network in the first segmentation round (F = 1.424 and p > 0.228) and the second segmentation round (F = 0.9969 and p > 0.411). The repeated measure analysis demonstrated no statistically significant differences in the segmentation quality of the medical experts over time (F = 6.05 and p > 0.09). However, a certain intra-rater variability was apparent, whereas the Mask R-CNN consistently provided identical segmentations regardless of the point in time. Using the software-based method for segmentation and measurement of wounds on photographs can accelerate the documentation process and improve the consistency of measured values while maintaining quality and precision.

Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project.

The purpose of this quality improvement project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline ("The Guideline") for patients with minor skin lesions, including candidiasis, skin tears, incontinence-associated dermatitis, and stage 1 and stage 2 pressure injuries that would not require a WOC nurse consultation. The Guideline was developed for nurses working on inpatient adult acute care units in a large community hospital in southwest Minnesota. The Guideline was validated for its clarity and appropriateness by internal and external hospital-based wound care nurses and implemented through in-person rounding on the nursing units and distribution of badge cards and required completing an online education module. Surveys and wound documentation audits were conducted to measure changes in knowledge and skin care pre- and postimplementation of The Guideline. We conducted wound documentation audits of approximately 491 records that assessed whether patients received appropriate treatment and found an improvement from 45% (104 of 231) to 80% (209 of 260). Nurses' self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 of 89) agreement to 57% (55 of 96). Nurses' self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 of 89) agreement to 65% (62 of 96). Although there is evidence for a variety of dressings or products to treat wounds, this quality improvement project demonstrated increased adherence with providing appropriate care when fewer treatment options were recommended to nursing staff through our structured guideline. The Guideline continues to be used at the project site and is now being implemented at affiliate hospitals.