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The Selfi wound study: self-taken images of surgical wounds
Exploring the feasibility of collecting patient/carer-taken images
of surgical wounds after leaving hospital
Rhiannon Macefield
Senior Research Associate, University of Bristol
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Surgical site infection (SSI)
• Accurate assessment is challenging
• Many problems occur post-discharge
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Wound Healing Questionnaire
• Designed for patient or healthcare professional completion to ascertain SSI after discharge
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Wound images
• Supplementary data for ascertaining SSI
• Advantages for blinded outcome assessment
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Aim
• To explore the feasibility of a method for the collection of self/carer-taken images of primary surgical wounds after leaving hospital
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Pre-test
EvaluateRefine
Face-to-face
cognitive
interviews with
patients/carers
Phase A:
development and pre-testing
Phase B:
remote pilot
Remote pilot
Follow-up
telephone
interviews
Draft photography
instructions & system for
uploading images
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Wound photography
Existing guidance
e.g. Institute of Medical Illustrators National Guideline 2012
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1. Preparation – clothing, cleaning, dressing removal
2. Location where photo is taken
3. Type of camera
4. Lighting, use of flash
5. Background
6. Position of participant
7. Distance from wound
8. Framing / use of zoom
9. Angle / plane of camera to wound
10. Focus
11. Shadows
12. Resolution
13. Calibrated colour
14. Use of scaling tool (i.e. ruler)
15. Identifiable body markings
16. Processing, downloading, labelling images
17. Participant ID
18. Storage
Considerations for photographing wounds
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Photography
instructions for
participants
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System for transmitting images
• Electronic ‘survey’ with facility to upload images
• Additional questions e.g. demographics, device used, experience with technology, time
• Online completion, suitable for use with mobile devices
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Phase A: pre-testing
• Face to face cognitive interviews (n=16)
• Patients undergoing abdominal and vascular surgery
• Recruited from 2 NHS trusts
• Mean age 51, range 27 to 85
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• Challenges - e.g. no flash with front facing camera, body piercings
• Majority were able to take and transmit images
• Refined instructions and system for uploading
Phase A: findings
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Phase B:
Remote pilot
Surgery
Follow up phone call
Phone call / email
remindersPhotography instructions
Email with link to upload images + simple survey
2-3 weeks
Hospital discharge
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Inclusion criteria
• Patients undergoing abdominal or vascular surgery
Access to smart phone / other device with camera
Access to email
Willing to take photograph of wound
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Participants (n=61)
• Median age: 53, range 21 to 84
• Ethnicity: 97% white
59%
41%
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Participants (n=61)
• 56 (92%) abdominal, 5 (8%) vascular surgery
Elective (66%)
Unplanned (33%)
Laparoscopic (54%)
Open surgery (43%)
• Median number of wounds: 3, range 1 to 5
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Response rates
• Number of participants uploading images: 32/61 (52%)
• Without a reminder: 18/32 (56%)
• With a reminder: 14/32 (44%)
• Median time to respond: 4 days, range 0 to 24
• 2 further participants took images but did not upload to system
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Survey results
• Devices used to take images
27 (84%) smart phones
5 (16%) tablets
• Majority (84%) took < 5 minutes
• Experience with using deviceNot experienced 1 (3%)
Somewhat experienced 3 (9%)
Moderately experienced 10 (31%)
Very experienced 15 (47%)
Expert 3 (9%)
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Survey results
• 44% took images themselves
• 84% uploaded images without help
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Wound images
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Wound images
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Image quality assessment
• Focus
• Lighting
• View of wound – entire wound, obstructions
• Adherence to instructions e.g. includes measurement ruler, no shadows, clothing, plain background
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Wound assessment
• Bluebelle Wound Healing Questionnaire (WHQ)
Median score = 5 range 0 to 11
• Time since surgery: median 29 days, range 17 to 51
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Challenges
• Dressings
• Email addresses
• Response rates
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Summary and future work
• Simple method for taking and transmitting images using participants’ own devices
• Remote collection of clear, standardised images is possible; reminders are key
• Explore ways to increase response rates e.g. using text messages
• Explore real-time data collection; use of images for remote SSI assessment; supplement to WHQ data
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Acknowledgements
Kerry AveryJane Blazeby
Barney ReevesAnni Skilton
Jonathan ReesAnne Pullyblank
UHBristol and North Bristol NHS Trust surgical research teams
Please contact: [email protected]