Karen Van den Bussche

Independent risk factors for the development of skin erosion due to incontinence (incontinence-associated dermatitis category 2) in nursing home residents: results from a multivariate binary regression analysis.

The aim of this study was to identify characteristics independently associated with a higher risk of developing skin damage because of incontinence [incontinence‐associated dermatitis (IAD) category 2] in nursing home residents. As part of a larger randomised controlled trial, IAD incidence was monitored for 1 month in a sample of 381 incontinent residents using a validated IAD Severity Categorisation Tool. Data on demographical, physical, functional and psychological characteristics were collected. The overall IAD incidence (category 1–2) was 30·0%, and 6% of the participants developed skin damage (IAD category 2). Residents who developed IAD category 2 were less mobile [odds ratio (OR) 2·72, 95% confidence interval (CI) 1·06–6·94], had more friction and shear issues (OR 2·54; 95% CI 1·02–6·33) and had more erythema due to incontinence (OR 3·02; 95% CI 1·04–8·73) before IAD category 2 occurrence. Care providers should give full attention to risk factors to both detect residents at risk for IAD development and to start prevention in time.

Core outcome domains in incontinence-associated dermatitis research

AIM To report the development of a core set of outcome domains for clinical research involving adults with incontinence-associated dermatitis or at risk, independently from any geographical location or skin colour. BACKGROUND The management of incontinence-associated dermatitis is important in caring for incontinent patients. The lack of comparability of clinical trial outcomes is a major challenge in the field of evidence-based incontinence-associated dermatitis prevention and treatment. Core outcome sets may therefore be helpful to improve the value of clinical incontinence-associated dermatitis research. DESIGN Systematic literature review, patient interviews and consensus study using Delphi procedure. METHODS A list of outcome domains was generated through a systematic literature review (no date restrictions-April 2016), consultation of an international steering committee and three patient interviews. The project team reviewed and refined the outcome domains prior to starting a three-round Delphi procedure conducted between April-September 2017. The panellists, including healthcare providers, researchers and industry were invited to rate the importance of the outcome domains. RESULTS We extracted 1,852 outcomes from 244 articles. Experts proposed 56 and patients 32 outcome domains. After refinement, 57 panellists from 17 countries rated a list of 58 outcome domains. The final list of outcome domains includes erythema, erosion, maceration, IAD-related pain and patient satisfaction. CONCLUSION Erythema, erosion, maceration, incontinence-associated dermatitis -related pain and patient satisfaction are the most important outcome domains to be measured in incontinence-associated dermatitis trials. Based on this international consensus on what to measure, the question of how to measure these domains now requires consideration. Registration: This project has been registered in the Core Outcome Measures in Effectiveness Trials (COMET Initiative) database and is part of the Cochrane Skin Group-Core Outcomes Set Initiative (CSG-COUSIN).

School Policy on Drinking and Toilets: Weaknesses and Relation With Children's Hydration Status

Objective To investigate school policies and practices related to drinking fluids and toileting and test their association with childrens hydration status and toilet behaviors. Design Cross‐sectional study in 2014. Setting Seventeen Belgian primary schools. Participants A total of 416 children (aged 7–13 years). Main Outcome Measures Hydration was measured by urinary osmolality in a pooled school‐day sample and by impedance‐based body water percentage. Children reported how much they liked school toilets. School policy and practices were reported by schools on 59 items over 10 policy components. Analysis Multilevel logistic regression analyses adjusted for age, sex, region and socioeconomic status. Results Schools weaknesses were the lack of policy participation by parents and children; official agreements (only in 11%); organizing education on drinking and toilet visits; and toilet infrastructure. Childrens hydration was higher in schools that (1) made water available, (2) organized toilet and drinking related education, (3) had formal agreements on drinking and toilet visits, and (4) had good toilet maintenance. Children liked school toilets more in schools that (1) organized toilet and drinking related education, (2) had an official policy on drinking, (3) had good toilet infrastructure, and (4) allowed policy participation by parents and children. Conclusions and Implications Specific action points for school management and government to improve childrens hydration at school were detected by focusing on both drinking and toilet practices/infrastructure.

The Ghent Global IAD Monitoring Tool (GLOBIAD‐M) to monitor the healing of incontinence‐associated dermatitis (IAD): Design and reliability study

The aim of this study was to design and evaluate the reliability of the Ghent Global incontinence‐associated dermatitis (IAD) Monitoring Tool (GLOBIAD‐M). The tool was designed based on the internationally validated Ghent Global IAD Categorisation Tool (GLOBIAD). After designing and validation by experts, one trained researcher carried out 36 observations of 9 patients affected with IAD. Photographs of the IAD lesions were independently assessed by a second trained researcher. Measures for inter‐rater agreement (po) and reliability [Cohens Kappa (ĸ) and intra‐class correlation coefficients (ICC)] were analysed. The po ranged between 0.86 for the item ‘maceration’ and 0.97 for the item ‘clinical signs of infection’. The ĸ for the item ‘GLOBIAD classification’ was 0.61 [95% confidence interval (CI) 0.28‐0.95] and 0.72 (95% CI 0.50‐0.95) for ‘maceration’. The lowest ĸ was found for the item ‘oedema’ (0.27; 95% CI −0.24‐0.79). The ICC of the item ‘redness’ was 0.83 (95% CI 0.69‐0.91) and 0.87 (95% CI 0.76‐0.93) for ‘skin loss’. The inter‐rater agreement and reliability of the GLOBIAD‐M appears to be good for the assessment of photographs by experts. This tool could support clinical decision‐making for IAD treatment. Further validation with clinicians is, however, needed.