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The article discusses the adoption of the 6-category classification system by the European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) guidelines. Topics discussed include the 2014 guidance from the National Institute for Health and Care Excellence (NICE), the argument for a three-category classification system, and an advice when trying to record the incidence of pressure ulcers within the organisation.

The effects of declining anthropogenic aerosols in representative concentration pathway 4.5 (RCP4.5) are assessed in four models from phase 5 the Coupled Model Intercomparison Project (CMIP5), with a focus on annual, zonal-mean atmospheric temperature structure and zonal winds. For each model, the effect of declining aerosols is diagnosed from the difference between a projection forced by RCP4.5 for 2006-2100 and another that has identical forcing, except that anthropogenic aerosols are fixed at early twenty-first-century levels. The response to declining aerosols is interpreted in terms of the meridional structure of aerosol radiative forcing, which peaks near 40°N and vanishes at the South Pole. Increasing greenhouse gases cause amplified warming in the tropical upper troposphere and strengthening midlatitude jets in both hemispheres. However, for declining aerosols the vertically averaged tropospheric temperature response peaks near 40°N, rather than in the tropics. This implies that for declining aerosols the tropospheric meridional temperature gradient generally increases in the Southern Hemisphere (SH), but in the Northern Hemisphere (NH) it decreases in the tropics and subtropics. Consistent with thermal wind balance, the NH jet then strengthens on its poleward side and weakens on its equatorward side, whereas the SH jet strengthens more than the NH jet. The asymmetric response of the jets is thus consistent with the meridional structure of aerosol radiative forcing and the associated tropospheric warming: in the NH the latitude of maximum warming is roughly collocated with the jet, whereas in the SH warming is strongest in the tropics and weakest at high latitudes. [ABSTRACT FROM AUTHOR]

As climate change accelerates, societies and climate-sensitive socioeconomic sectors cannot continue to rely on the past as a guide to possible future climate hazards. Operational decadal predictions offer the potential to inform current adaptation and increase resilience by filling the important gap between seasonal forecasts and climate projections. The World Meteorological Organization (WMO) has recognized this and in 2017 established the WMO Lead Centre for Annual to Decadal Climate Predictions (shortened to "Lead Centre" below), which annually provides a large multimodel ensemble of predictions covering the next 5 years. This international collaboration produces a prediction that is more skillful and useful than any single center can achieve. One of the main outputs of the Lead Centre is the Global Annual to Decadal Climate Update (GADCU), a consensus forecast based on these predictions. This update includes maps showing key variables, discussion on forecast skill, and predictions of climate indices such as the global mean near-surface temperature and Atlantic multidecadal variability. it also estimates the probability of the global mean temperature exceeding 1.5°C above preindustrial levels for at least 1 year in the next 5 years, which helps policy-makers understand how closely the world is approaching this goal of the Paris Agreement. This paper, written by the authors of the GADCU, introduces the GADCU, presents its key outputs, and briefly discusses its role in providing vital climate information for society now and in the future. [ABSTRACT FROM AUTHOR]

Aims. To assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention. Background. Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis was conducted to identify the most cost-effective repositioning strategy for the prevention of pressure ulcers. Design. The economic analysis took the form of a cost-utility model. Methods. The clinical inputs to the model were taken from a systematic review of clinical data. The population in the model was older people in a nursing home. The economic model was developed with members of the guideline development group and included costs borne by the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years. Conclusion. Despite being marginally more clinically effective, alternating 2 and 4 hourly repositioning is not a cost-effective use of UK National Health Service resources (compared with 4 hourly repositioning) for this high risk group of patients at a cost-effectiveness threshold of £20,000 per quality adjusted life years. These results were used to inform the clinical guideline recommendations for those who are at high risk of developing pressure ulcers. [ABSTRACT FROM AUTHOR]

: Mora and colleagues show that ongoing greenhouse gas emissions are likely to have a considerable effect on several biogeochemical properties of the world's oceans, with potentially serious consequences for biodiversity and human welfare. [ABSTRACT FROM AUTHOR]

The annual cost to the NHS of managing 3.8 million patients with a wound was estimated in 2020 to be £8.3 billion, of which £5.6 billion was spent on the 30% of wounds that did not heal and £2.7 billion on the 70% of wounds that healed (Guest, 2020). One of the main symptoms associated with chronic 'hard-to-heal' wounds is the production of excess exudate (Atkin et al, 2019). This is due to a prolonged chronic inflammatory response stimulated by a physiological cause. This article describes what exudate is and its importance in the wound healing process, highlighting the consequences of too little or excessive wound exudate associated with any wound. The article goes on to describe a case series observational study involving a range of patients ( n =47; 33 male/14 female), aged between 33 and 91 years (mean 67.4 years), with a variety of acute ( n =11) and chronic exuding wounds ( n =44). In total, 55 wounds of various aetiologies were managed with DryMax Super (a dressing whose design includes superabsorbent polymers) in order to evaluate and report on the absorption and fluid-handling properties of the product.

Pressure ulcer (PU) prevention is a high priority for health professionals in all settings. While PU incidence is expected to rise given the ageing population in the UK and Europe, PUs can occur in people of any age. It is therefore imperative that all practitioners know about the causes and consequences of PUs and be aware of up-to-date guidance on the prevention and management in patients who have developed a PU or who are at risk of developing a PU. Health professionals should also be aware of preventive equipment highlighted in national and local guidance, prevention strategies and protocols. This article discusses these issues and the Devon (Cardinal Health) prevention and repositioning product range.

The principle of collaborative working was widely promoted by the World Health Organisation (WHO) in 2010 when they wrote 'that professionals who actively bring the skills of different individuals together, with the aim of clearly addressing the health-care needs of patients and the community, will strengthen the health system and lead to enhanced clinical and health related outcomes'. As a result of this, the development of a multidisciplinary team approach to the management of patients with wounds was actively promoted by various International organisations, such as the European Wound Management Association (EWMA) in 2014, however this article illustrates an example of how a collaborative working protocol has been incorporated within Tissue Viability and wound care environments within an NHS Trust for the past two decades.

This article aims to reintroduce readers to biologically based and tissue-engineered wound management products. Indications for their use in clinical practice are suggested. It also examines two well-established wound management interventions, topical negative pressure therapy and larval therapy, which could have a positive effect on the outcome of biologically based and tissue-engineered wound management products.

This article provides an overview of and rationale for wound bed preparation. It seeks to increase nurses' knowledge and understanding of the roles of the main cells and growth factors, involved in the wound healing process, and also to highlight how theory relates to practice.

The past two decades have seen many advances in tissue viability. Our knowledge of the processes involved in wound healing has increased vastly, and as a result many products and techniques have been developed to speed it up. However, patients with wounds, and the professionals who care for them, still experience a number of challenges.

Most chronic wounds have become stuck in the late inflammatory phase of wound healing. This can be distressing and frustrating for patients who may have lived with such a wound for many months. The key to the concept of wound-bed management is to prepare the wound so that modern methods of promoting healing can then be applied.

The aim of this Learning Unit is to develop your knowledge of wound assessment, and to increase your understanding of the rationale for effective planning, implementation and valuation of wound care.