Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial.

BACKGROUND: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital-acquired pressure ulcers (PUs). OBJECTIVES: To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. METHODS: This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At-risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) - pooled as the treatment group - and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. RESULTS: In the intention-to-treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41-0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35-0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34-1·68, P = 0·49). CONCLUSIONS: Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at-risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas.

Short Communication: effect of positive handling of sows on litter performance and pre-weaning piglet mortality.

Fear and environmental stressors may negatively affect the welfare of farm animals such as pigs. The present study investigated the effects of music and positive handling on reproductive performance of sows (n = 1014; parity 1 to 8) from a commercial pig farm practicing a batch farrowing system. Every 2 weeks, 56 sows were moved from the gestation unit to conventional-crated farrowing houses 1 week prior to expected farrowing. Treated (T; n = 299) and control (C; n = 715) sows were included in the study. In the farrowing houses, auditory enrichment (music from a radio) was provided to sows of T groups daily from 0600 to 1800 h until the end of lactation. Until the day of farrowing, T sows were additionally subjected, for 15 s per day per sow, to continuous back scratching by one member of farm staff. Litter performance and piglet mortality were recorded and analysed between T and C sows using linear mixed regression models. The number of liveborn piglets (C 13.85 v. T 13.26) and liveborn corrected for fostering (C 13.85 v. T 13.43) was significantly higher (P < 0.05) in C groups compared to the T groups. The number of stillborn piglets was 0.60 and 0.72 in T and C groups, respectively (P > 0.05). With regard to piglet mortality, a linear mixed regression model showed a significant overall effect of treatment in reducing piglet mortality (P < 0.01). Yet, the effect of treatment varied according to litter size (number of liveborn piglets) with a diminishing treatment effect in sows with a high litter size (P < 0.01). Pre-weaning survival was improved in the current study by the combined effect of daily back scratching of sows prior to farrowing and providing music to sows and piglets during lactation. Further research is needed to assess the separate effects of both interventions.

Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES: To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS: The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS: The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS: The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.