Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.

Observing small changes (SCs) at specific sites is a new form of managing changes in position. We investigated SCs at specific sites considering interface pressure, contact area, body alignment and physical sensation in nine healthy female adults and evaluated SCs using the air mattress that was divided into six cells (A-F). Thirty-three SC combinations at one or several sites were evaluated. Pressure in the sacral region significantly decreased in 28 SC combinations compared with the supine position (p < 0.05), and the effect of pressure redistribution was greater when SCs were applied at several instead of a single site. The contact area at 17 of the 28 SC combinations significantly increased (p < 0.05). Among sites ranked based on interface pressure, body alignment and physical sensation, SCs at sites BCE, AE and BD were the most favorable. The common feature among these three combinations was that they involved tilting the buttock region and one other site. The findings suggested that SCs at the buttock region could reduce disruptions in alignment as well as the impact on physical sensation caused by the body sinking into the mattress and improve interface pressure redistribution via increased contact area with the mattress.

A monitoring tool for the wound-healing process of diabetic foot ulcers (DFUs) was developed. It comprises seven domains, namely, depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining. It was named "DMIST" based on the initials of its domains. Although DMIST is useful for assessing wound-healing processes, the monitoring items related to wound healing remain unclear, thereby making the selection of optimal care based on the assessment difficult. We identified the relationship between the DMIST items and wound healing. This study was a secondary analysis of five previous investigations and was conducted using DMIST based on the diabetic foot ulcer assessment scale score and DFU images. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) after simultaneously controlling for potential confounders. The examined DFU healing status revealed that some DFUs healed at 4 weeks from baseline, whereas some DFUs did not. Variables considered in the models were the scores of each DMIST domain. The study population comprised 146 Indonesian patients and 33 Japanese patients. Depth, maceration, and size were associated with DFU healing at 4 weeks from baseline [depth: OR = 0.317 (95% CI: 0.145-0.693, P = 0.004); maceration: OR = 0.445 (95% CI: 0.221-0.896, P = 0.023); size: OR = 0.623 (95% CI: 0.451-0.862, P = 0.004)]. Our findings suggest that appropriate management of maceration promotes DFU healing.diabetic foot ulcers, maceration, wound healing Key Messages• This study revealed the relationship between the items of DMIST and wound healing • Depth, maceration and size were associated with diabetic foot ulcer healing at 4 weeks from baseline • Our findings suggest that appropriate management of maceration promotes diabetic foot ulcer healing

Aim The purpose of this study is to describe the influences of lower limb edema on the daily lives of elderly individuals in elderly day care to describe the necessity of care for lower limb edema. Methods Semi‐structured interviews based on a quality of life questionnaire for limb lymphedema were conducted. Two types of text mining analysis methods were used: a frequent word analysis and a content analysis. The edema severity was graded on a scale of 0 to 3, and the sum of the numerical values of the grades for each person was defined as the pitting score. Results The seven participants had a mean age of 83.4 ± 4.6 years (mean ± SD). The pitting scores ranged from 1 to 25 in the participants. The words “think” (389 times), “walk” (136 times), and “put on” (135 times) were extracted frequently. The content analysis focused on the words “walk” and “put on.” The participants complained of difficulty walking, pain, and numbness when walking, weakness of their lower limbs, difficulty putting on shoes, restrictions on shoe types, and difficulty finding shoes. Conclusions These results demonstrate that elderly individuals experienced troubles during their daily lives caused by lower limb edema, which highlights the necessity of symptom management. Active interventions for edema by nurses are necessary to improve quality of life in elderly individuals.

BackgroundElderly individuals can easily develop leg edema that can become chronic, which may result in various problems. Therefore, appropriate care for the edema should be provided. In some cases, chronic leg edema among elderly individuals cannot be controlled by the standard care such as leg elevation or compression. A previous study reported that vibration benefited upper limb lymphedema; however, its effects on chronic leg edema are not yet clarified. Therefore, this study aimed to clarify the effects of vibration for reducing chronic leg edema among chair-bound elderly individuals.MethodsFor participant allocation, a computer-generated list of random numbers was used. Nursing home residents aged ≥65 years with chronic leg edema who spent more time sitting than standing or lying during the day were randomly assigned to the intervention (n = 7) or control group (n = 7). The intervention group underwent vibration therapy three times a day for 2 weeks at 47 Hz and 1.78 m/s2 frequency and horizontal vibration acceleration, respectively. The pitting test was performed at 22 sites, and participants’ pitting scores were calculated based on the pitting depth. Pitting score changes at pre- and post-intervention were compared between the intervention and control groups. Both participants and investigators were not blinded to group assignment.ResultsThe median age of the intervention and control groups was 86 and 84 years, respectively. Participants’ characteristics and edema severity at baseline were not significantly different. The median total pitting score change in the intervention group was −0.4 (interquartile range: −5.3–1.8), which was significantly lower than that of the control group (2.0 [interquartile range: 1.0－5.3], P = 0.01). The intervention group was more likely to have controlled edema (64.3%) than the control group (21.4%) (χ2 (1) = 5.25, P = 0.02).ConclusionsThe intervention group was more likely to have controlled edema than the control group, suggesting that vibration could prevent the worsening of chronic leg edema in chair-bound elderly individuals.Trial registration: UMIN Clinical Trials Registry, UMIN000017716. Registered 1 July 2015, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020522