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To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): • WP1 – Development of two co-operative Inquiry Groups (CIGs) • WP2 - Semi-structured interviews and/or app participation • WP3– Professional and strategic stakeholder engagement • WP4–Systems mapping and Theory of Change (ToC pathway development Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention. • People with Long-Term Neurological Conditions (LTNCs) are at increased risk of Pressure Ulcer (PU) development. • People with LTNCs often manage multiple needs and changing risks across complex health conditions and busy lives. • There is a gap in support, resources, and training for people with LTNCs and their carers, who manage PU risk at home. • Complex health and social care services, and gaps in provision, hamper people's ability to escalate care when needed. • Healthcare Professionals and service users sometimes have different perceptions of PU risk. [ABSTRACT FROM AUTHOR]

Pressure-ulcer occurrence in the seated patient is understudied. Preventative devices have been developed and are prescribed commonly, but there is little quantitative evidence of their effectiveness. This study explores the concept of a lateral pressure device, a prevention device that applies pressure to the sides of the seated buttocks, to reduce the amount of tissue distortion and blood-vessel occlusion. It is hypothesized that this device will reduce deep tissue injury by reducing the pressure at the bone-muscle interface, as demonstrated computationally in previous research. This study aimed to use oximetry to investigate the efficacy of the device in maintaining transcutaneous gas tensions of the tissue as close to baseline as possible. Oximetry electrodes were attached to participants' ischial tuberosity and greater trochanter for different amounts of lateral pressure. The amount of lateral pressure is a given percentage of the pressure due to the participants' underbody pressure. The results show that 50 % lateral pressure is sufficient to produce an improvement in participants' gas tensions at their ischial tuberosity, without negatively impacting the tissue at their greater trochanter, relative to the control of sitting with no application of lateral pressure. Despite a rudimentary prototype device design, and that participants each placed their own oximetry sensors, results support the application of lateral pressure as a method to maintain transcutaneous gas tensions. Further work should be carried out on a larger sample to consolidate these findings. • A novel device for pressure-ulcer prevention was explored. • The device applied lateral pressure to seated participants and gas tensions recorded. • Moderate levels of pressure maintained gas tensions in the buttocks. • Gas tensions on the tissue where lateral pressure was applied were unaffected. [ABSTRACT FROM AUTHOR]

This pilot study assessed text messaging as an early intervention for preventing pressure ulcers (PrUs) in individuals with spinal cord injury (SCI) post-hospital discharge. Thirty-nine wheelchair-users discharged after acquiring a SCI, underwent randomisation into an intervention group (n = 20) with text messages and a control group (n = 19). All participants received standard post-discharge care and completed a skincare questionnaire before and 6-month after discharge. Primary outcomes included feasibility and acceptability of early intervention using text messaging, alongside performance, concordance, and attitudes toward skincare. Secondary outcomes measured perception and the incidence of PrUs. Baseline demographics were comparable between the intervention and control groups. Eight of 20 participants completed 6-month follow-up questionnaires in the intervention group, six participants completed the 6-month questionnaires in the control group,. Participants expressed high satisfaction with text messages, understanding of content, and increased confidence in preventing PrUs. At 6-month post-discharge, the intervention group showed improved prevention practices, heightened awareness of PrU risks, and increased perceived importance of prevention, which were not observed in the control group. However, there were no significant differences in PrU incidence, possibly due to the small sample size and short follow-up. The study demonstrates that using text messaging as an early intervention for PrU prevention in individuals with SCI is feasible and well-received. Preliminary results suggest a positive impact on participants' attitudes and practices, indicating the potential of text messaging to reduce PrU incidence. However, further research with larger samples and extended follow-up is crucial to validate these promising initial findings. • This is the first study evaluating feasibility of text messagings for PrU prevention in spinal cord injury patients. • Participants were highly satisfied with receiving and understanding text messages, recommending them for PrU prevention. • Participants receiving messages showed improved practices, awareness, and reduced barriers of PrU prevention post-discharge. • If future larger studies show significant results, this intervention could be a valuable tool in community healthcare. [ABSTRACT FROM AUTHOR]

The integration of advanced textile materials is crucial to enhance the quality of healthcare solutions. Three-dimensional (3D) knitted spacer fabrics (KSFs) have emerged as a revolutionary class of medical textiles distinguished by their unique ability to provide high breathability, moisture management, and customizable structural properties. This comprehensive review systematically examined the multifaceted applications of 3D KSFs in the healthcare sector. It begins with an overview of various design and manufacturing techniques, including warp and weft knitting processes, that facilitate the production of innovative fabrics. The review then details the distinct structural and functional features of 3D KSFs, emphasizing their cushioning effects, porosity, and adaptability, which enhance their effectiveness in the medical context. Subsequent sections explore diverse applications, including wound care, where their moisture-wicking capabilities promote healing, pressure ulcer prevention, leveraging their ability to evenly distribute pressure, and orthopedic supports, which benefit from their comfort and supportive characteristics. This paper also discusses the potential of 3D KSFs in scaffold development for tissue engineering, as well as their use in assistive devices for enhanced patient mobility. Emerging trends, such as the incorporation of smart technologies for real-time monitoring and commitment to sustainability through washable and reusable designs, are critically analyzed. In turn, this review provides an in-depth resource for healthcare professionals, textile researchers, and product developers, highlighting the transformative potential of 3D KSFs for advancing healthcare solutions and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives Pressure ulcers are one of the most common hospital-acquired major conditions that occur in patients with mobility limitations and result in endangering patient safety, prolonging hospital stay, disability, and death. This study aims to examine the level of nurses’ practices and perceived barriers for preventing pressure ulcers among critically ill patients. Materials and Methods A cross-sectional survey was conducted among nurses working in critical care units (CCUs) at a tertiary teaching hospital in Baghdad, Iraq, between January 2024 and June 2024. A non-probability purposive sampling technique was carried out involving 100 nurses with at least 6 months of experience in critical care units. The data were collected using a structured interviewing questionnaire to assess nurses’ sociodemographic characteristics and an observational checklist to assess nurses’ practice regarding pressure ulcer prevention. The questionnaire also assessed nurses’ perceived barriers for pressure ulcer prevention. Data analysis was performed using SPSS version 26, applying descriptive and inferential statistics, including the Chi-square test, with a significance level set at P < 0.05. Results This study found that 54% of nurses were males with a mean age of 28.21 within years, ranging from 18 to 54 years. Most nurses held bachelor’s degree in nursing (65%), 43% of them had

Background: Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. Aims: This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. Setting and Design: This descriptive, cross-sectional study was conducted among nursing students at Jazan University. Materials and Methods: Data were collected using an electronic questionnaire. Statistical Analysis Used: Data were entered, coded, and analyzed using the SPSS version 23. Results: A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0–16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). Conclusions: The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs. [ABSTRACT FROM AUTHOR]

IntroductionPressure ulcers are a significant concern in pediatric intensive care units, with prevalence rates ranging from 0.8% to 27%. They pose serious physical and psychological challenges, particularly in neonatal and pediatric intensive care units (NICU and PICU). This study explores nursing strategies, attitudes, and barriers toward pressure ulcer prevention in NICU and PICU settings.MethodsUsing a descriptive study design, data were collected from 80 nurses working in NICU and PICU through validated questionnaires, including a demographic profile and a pressure ulcer survey. Descriptive statistics were employed to calculate mean scores and percentages, while inferential statistics assessed associations between variables.ResultsThe study revealed specific nursing strategies, along with significant barriers and attitudes toward pressure ulcer prevention in NICU and PICU. The total attitude mean score was 3.57, with the highest positive response (mean = 4.29) for “most pressure sores can be avoided”, and the highest negative response (mean = 3.86) for “pressure sore prevention is a low priority for me”. Among participants, 72.5% conducted risk assessments on all patients, 60% had written prevention care plans, and 76.3% implemented preventive strategies. Barriers such as staff shortages and time constraints were reported by 76.2% of nurses. Multivariate analysis indicated that nurses with more than 10 years of qualification (OR = 3.67) and permanent staff with over 10 years of employment (OR = 4.31) were significantly more likely to engage in preventive practices. The use of a pressure ulcer grading tool (OR = 2.49, P < 0.05) and participation in formal training (OR = 3.14, P < 0.05) were also positively associated with preventive practices.DiscussionThese findings underscore the importance of structured assessment tools, ongoing education, and the need to foster positive attitudes among nurses to effectively reduce pressure ulcer prevalence and enhance patient outcomes in NICU and PICU settings.

To assess the knowledge, attitudes, and practices of Palestinian nursing students towards pressure injury prevention. A descriptive cross-sectional study was conducted with 455 nursing students recruited from Arab American University-Palestine, employing a total population sample. Data collection forms include socio-demographic information, the Pressure Ulcer Knowledge Assessment Tool, Attitude towards Pressure Ulcer Prevention Instrument and Pressure Injury Preventive Practices scale. The study found that students had a mean knowledge score of 54% (14.04/26), a positive attitude score of 75.8% (39.42/52), and demonstrated a fair level of practice 75.3% (30.12/40). Significant differences were observed in the Knowledge, Attitude, and Practice total scores, linked to academic year, clinical experience, and the number of attended departments during clinical training (p < 0.001). Additionally, weak but significant positive relationships were found between practice and attitude scores (r = 0.303, p < 0.001), practice and knowledge score (r = 0.211, p < 0.001), and a moderate positive significant relationship between knowledge and attitude scores (r = 0.567, p < 0.001). The study revealed insufficient knowledge, positive attitudes, and somewhat unsafe practices among nursing students regarding pressure injury prevention. It highlights the need for specific revisions in the nursing curriculum. Improvements can be achieved through detailed coverage in classrooms and laboratories, integrating simulation methods. Additionally, ensuring that students gain adequate experiences in clinical units, with a specific emphasis on pressure injury prevention, is crucial for improving students' capability and contribute to better pressure injury management. • Nursing students in this study displayed inadequate knowledge but positive attitudes and to somewhat unsafe practice towards PI prevention. • Higher education and clinical exposure associated with higher knowledge, positive attitudes, and implemening preventive practices for PIs among NSs. • Implementing a holistic strategy is necessary to enhance the understanding of PI prevention and management among Palestinian nursing students. [ABSTRACT FROM AUTHOR]

This study aimed to predict tissue deformation based on the pressure applied while lying in the prone position and physiological factors. Healthy volunteers were instructed to lie on mattresses of four different hardness levels (50, 87.5, 175, and 262.5 N). The order in which the mattresses were used was randomized per participant. Pressure at the iliac crests was measured using a pressure mapping sensor sheet. Participants were placed in the prone position for 10 min, with pressure data used from the latter 5 min. For the tissue deformation at the iliac crests, our previous study data were used. Multiple regression analysis was used to identify predictive mechanical and physiological factors. The distance between the left and right greater trochanters, maximum interface pressure and age were significant predictors for compression of the skin and soft tissue. Significant predictors of internal soft tissue displacement were the distances between the left and right anterior superior iliac spines and greater trochanters. No factors predicted skin surface displacement. Our study provided predictive factors that may be measured easily in a clinical setting to reduce the risk of pressure ulcers during surgery in the prone position. • The distance between the left and right greater trochanters, the maximum interface pressure, and age are significant predictors for skin and soft tissue compression. • The distances between the left and right anterior superior iliac spines and the greater trochanters are important predictors of internal soft tissue displacement. • The 87.5-N and 175-N mattresses are superior in terms of contact area, maximum interface pressure, and degree of displacement by the mattress's hardness level. [ABSTRACT FROM AUTHOR]

Background: Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown. Objectives: To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school. Method: A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants’ narratives. Results: The participants’ perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support. Conclusion: Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes. Clinical implications: Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention.

To compare fluidized positioners and gel pads for skin protection in neurosurgery patients placed in lateral and prone positions. It is one of the major challenges that operating room nurses face in protecting the skin during the long duration of neurosurgery. Currently, there are increasing tools available to protect the skin under pressure, and various tools practice well in the clinic. Fluidized positioners are newly emerging protective pads that have been clinically effective in protecting the skin, but no studies have compared them to previous pads. This is a retrospective cohort study. Data from 706 patients who underwent neurosurgery between January 2018 and December 2021 were systemically reviewed. Patients undergoing long‐term neurosurgery in the neurosurgical lateral and prone positions were divided into two groups: fluidized positioners or gel pads. Propensity score matching (PSM) was performed for group balance (1:1 ratio) using the following baseline characteristics: age, gender, ASA (American Society of Anesthesiologists) classification, duration of surgery, surgical position and underlying disease. The incidence of decubitus, and length of stay (LOS) in the hospital were compared between the two groups. The results were obtained for 394 patients in the fluidized positioner group with a 3.8% incidence of pressure ulcers and 312 patients in the gel pad group with an 8% incidence of pressure ulcers, which were unbalanced in terms of gender, ASA, hypertension and diabetes data. After a PSM, patients were compared in terms of pressure ulcer incidence (3.7% vs. 7.8%, p = 0.034) and LOS (22.35 vs. 25.65 days, p < 0.001). Fluidized positioners can effectively reduce the incidence of pressure injury in lateral and prone positions of neurosurgery. The results of this study may contribute to the development of policies to prevent the development of pressure ulcers during neurosurgical procedures. [ABSTRACT FROM AUTHOR]

Objectives: To explore nurse’s perceptions on barriers for Implementing Pressure Ulcers Preventive Measures among critically ill patients. Research Design: An exploratory qualitative study design was employed. In-depth interviews were conducted with 15 nurses to explore their perceptions on barriers for preventing pressure ulcers among critically ill patient. Qualitative thematic analysis approach was used to analyze data. Study settings: Medical high dependent unit, surgical high dependent unit, medical Intensive Care unit and surgical intensive care units at tertiary teaching hospital. Findings: Seven themes emerged that describes nurses’ perceptions on barriers for implementing pressure ulcers preventive measures among patients with critical illness. The themes are: Restrictions from therapeutic interventions and severity of patient condition; Shortage of staff and equipment for pressure ulcer prevention; Unbalanced shift staffing and competing need for patient care; health care providers’ incompetence and carelessness; Lack of guidelines on implementing best practice for pressure ulcer prevention; Lack of accountability measures for negligence; and Minimal management’s commitment for PUs prevention. Conclusion: This study reveals contextual based barriers for effective prevention of ppressure ulcers among critically ill patients. Nurses should be continuously empowered with competence for pressure ulcers prevention. This should go along with staffing and equipping critical care settings for pressure ulcers prevention. Managerial oversight is required for effective implementation of pressure ulcer preventive measures. This should include development of guidelines and policies, establishing accountability measures for negligence, malpractice as well as initiating clinical audit for reflective learning purpose.

Skin tissue assessment is traditionally used to identify early signs of pressure damage from changes observed at the skin surface. However, the early onset of tissue damage induced by pressure and shear forces is likely to be on soft tissues beneath the surface of the skin. Subepidermal moisture (SEM) is a biophysical marker for the detection of early and deep pressure‐induced tissue damage. Measurement of SEM can detect early pressure ulcers up to 5 days before visible skin changes occur. The aim of this study was to evaluate the cost‐effectiveness of SEM measurement compared with visual skin assessment (VSA). A decision‐tree model was developed. Outcomes are the incidence of hospital‐acquired pressure ulcers, quality‐adjusted life‐years (QALYs) and costs to the UK National Health Service. Costs are at 2020/21 prices. The effects of parameter uncertainty are tested in univariate and probabilistic sensitivity analysis. In a representative NHS acute hospital, the incremental cost of SEM assessment as an adjunct to VSA is −£8.99 per admission, and SEM assessment is expected to reduce the incidence of hospital‐acquired pressure ulcers by 21.1%, reduce NHS costs and lead to a gain of 3.634 QALYs. The probability of cost‐effectiveness at a threshold of £30 000 per quality‐adjusted life year is 61.84%. Pathways that include SEM assessment make it possible to implement early and anatomy‐specific interventions which have the potential to improve the effectiveness of pressure ulcer prevention and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Pressure ulcers can develop in bedridden or immobile patients which physiotherapists frequently encounter. Although physiotherapists receive training for preventing pressure ulcers, there is limited evidence of physiotherapists' knowledge level. Our study evaluated physiotherapists' pressure ulcer prevention knowledge. The level of knowledge for pressure ulcer prevention was inquired with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI‐T). Two hundred and sixty‐five physiotherapists participated in our study. The median PUPKAI‐T total score ranged from 8 to 21. Only two physiotherapists (0.8%) got good points from the questionnaire. The highest score was Nutrition (Theme 4; 59.2%), and the lowest score belonged to the contact preventive interventions that reduce pressure/shearing (Theme 5; 26.7%). The question with the lowest success rate was the positioning question of Theme 5 (Question 2; 12.5%). In our study, physiotherapists' pressure ulcer prevention knowledge was evaluated with a relatively high number of participants compared to the literature. These results brought to mind that training programs that specifically emphasise techniques to prevent pressure ulcers and positioning manoeuvres to be organised increase the knowledge level of physiotherapists. [ABSTRACT FROM AUTHOR]

Scoping review. To obtain an overview of initiatives, organisational components, and stakeholders' perspectives on PU prevention in transitional care. Scoping review searching the databases: MEDLINE, EMBASE), CINAHL, Cochrane Library, Web of Science, and SCOPUS in May 2022. Inclusion of English-written research on pressure ulcer prevention in adult people with spinal cord injury in transition from hospital or rehabilitation centre to the home care environment. Fifteen studies of different types are included in this study: six qualitative studies, four randomized controlled trials, three cohort studies, one cross-sectional study and an interventional study. The included studies are relatively low-level evidence but of acceptable quality. Continuous tailored education and information about PU prevention and follow-up services are essential components in preventing PUs and rehabilitating people with SCI. The complexity of SCI requires adaptations, equipment and access to specialist care and treatment after discharge. However, there is a discrepancy between the international recommendations, the perceived needs, and the delivered healthcare services. The consequences are a lower quality of life and a higher risk of PUs for people with SCI. • There is a discrepancy between recommendations and delivered care in pressure ulcer prevention in people with spinal cord injuries. • Pressure ulcers cause missed opportunities for the most optimal life for people with spinal cord injuries. • There is a potential for improvement in pressure ulcer prevention in the transition of people with spinal cord injuries. • There is a need for lifelong education and information about pressure ulcer prevention for people with spinal cord injuries. [ABSTRACT FROM AUTHOR]

It is estimated that there are currently 944,000 older people living with dementia in the UK, and that 593,200 of those people are living with advanced symptoms. People living with advanced dementia have a significantly higher prevalence of pressure ulcers (PUs), compared to those living without dementia with similar comorbidities. The care and support required to prevent pressure ulcers in people living with dementia needs to be individualised, following a holistic and person-centred assessment of the person and their unique circumstances. An improved understanding of the increased risk and causal factors of developing pressure ulcers in high risk groups, such as people living with advanced dementia, can support practitioners to conduct a more through and person-centred risk assessment and management plan, including choosing the most appropriate products to meet a person's needs. [ABSTRACT FROM AUTHOR]

Previous research shows that maximum interface pressure increases when the patient is lying in the lateral position. However, it was unclear whether it was better to increase or decrease the internal air pressure to reduce the maximum interface pressure in the lateral position; thus, this study investigated this issue. In this study, we investigated the change in pressure redistribution because of the difference in internal air pressure between the supine and lateral positions on an active air mattress for pressure ulcer prevention management. Each participant's five internal air pressure values served as the independent variables. The interface pressure on the active air mattress was measured for 20 minutes. The sacral left iliac crest and left greater trochanteric interface pressures were measured using a portable pressure‐measuring device. When seven of the 10 participants switched from the supine position to the left lateral position, there was a decrease in the maximum interface pressure as the internal air pressure increased. The maximum interface pressure in the greater trochanter in the lateral position was twice that in the sacral region in the supine position. These results show that increasing the internal air pressure in the lateral position might help reduce the maximum interface pressure. [ABSTRACT FROM AUTHOR]

Background/Aims: Nursing home residents are at higher risk of developing pressure ulcers as a result of comorbidities, changes in skin texture and function, incontinence, and limited mobility, such as residents who are mostly bedbound. The aim of this study was to evaluate the introduction and use of a static air-foam hybrid mattress based on the experiences of nurses and to assess the incidence of pressure ulcers in a nursing home population at risk for developing pressure ulcers over a 14-day period. Methods: A multicentre clinical trial, followed by focus group interviews with nurses, was conducted between August and October 2020 to evaluate the implementation and use of a static air-foam hybrid mattress. Residents (n=29) at risk of developing pressure ulcers were placed on the mattress for 14 days. Skin and risk assessments were performed daily. At the end of the study, nurses (n=9) were invited to participate in focus group interviews to share their experiences. Results: During the study period, none of the residents developed stage 2–4 pressure ulcers. Based on nurses' experiences with the mattress, five themes were identified: design and guidance, pump use, mobility and positioning, mattress appearance and clinical opinion. Results indicated that the mattress provided a clinically effective support surface in the prevention of pressure ulcers and was easy to use. Conclusions: A static air-foam hybrid mattress provides a clinically effective support surface in the prevention of pressure ulcers. Nurses preferred the mattress to an alternating pressure mattress and a static air mattress overlay. [ABSTRACT FROM AUTHOR]

Pressure ulcers have been part of tissue damage without effectiveness in medical, surgical, and intensive care units. This study aims to focus on developing lateral tilt positions for effective pressure ulcer relief for bedridden patients. A repositioning mattress was placed in the side-lying left lateral tilt position (15°, 30°, 45°), sheering (0.680, 1.323, 1.870), interface pressure (2.550, 2.290, 2.830), and placed at 1.5 m long piece of polyethylene rubber. The design strength was set at 6000 N and 2100 mm x 1105 mm (σt,0,d = 42, σc,0,d = 34). The design shows the greatest supine position at 30°, 1.323, 2.290, pressure load (Δp0 = 1.125 (1820) ≈ 2050 psi, Δp3000 = 1.125 (620) ≈ 700 psi), tensile stress (σt,0,d (MPa) = 42), compressive stress (σc,0,d (MPa) = 34), and FOS (σt,0,d = 42, σc,0,d = 34). The factor of safety illustrated that the 30° lateral tilt position is more consistent in repositioning for pressure ulcer prevention compared to the supine-to-tilt region. Further, an application of repositioning mattresses was developed to test in bedridden patients with tissue ulcers in nursing homes. [ABSTRACT FROM AUTHOR]

Background Pressure ulcers are significant health issues affecting elderly patients, leading to severe complications, prolonged hospital stays, and high healthcare costs. Preventive care by home caregivers plays a crucial role in mitigating the development of pressure ulcers. Objective This study aims to assess home caregivers' knowledge of pressure ulcer prevention and investigate the factors associated with knowledge levels in elderly patients in Al Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted involving 231 home caregivers of elderly patients registered in Home Health Care, Al-Ahsa Health Cluster. Data were collected using an online questionnaire assessing demographic information and knowledge of pressure ulcer prevention, adapted from the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data analysis was performed using SPSS version 29.0 (IBM Corp., Armonk, USA), with a Chi-square test used for bivariate analysis of categorical outcomes. Results The majority of caregivers were female (64.5%), aged between 35 and 50 years (47.6%), and primarily family members (83.5%). Most caregivers had been providing care for 5 years or less (79.7%), with 67.5% never having received training in pressure ulcer prevention. Knowledge levels were generally sufficient, with 87.0% of caregivers showing adequate knowledge of pressure ulcer prevention. Significant associations were found between knowledge levels and caregiving duration (p=0.006) as well as training in pressure ulcer prevention (p=0.001). However, other demographic factors, such as age and gender, were not significantly associated with knowledge levels. Conclusion The study found that most home caregivers possess sufficient knowledge of pressure ulcer prevention, although training and caregiving duration significantly influence knowledge levels. These findings underscore the need for comprehensive training programs to improve caregivers' knowledge and practice, thereby enhancing the quality of care for elderly patients and reducing the incidence of pressure ulcers., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Prince Saud Bin Jalawi Hospital (Al Ahsa Health Cluster) Institutional Review Board issued approval H-05-HS-135. Dear Dr. ABDULHADI ABDULAZIZ ABDULHADI ALABDULHADI, PSBJH-IRB (H-05-HS-135) is pleased to inform you that your study mentioned below has been expeditedly reviewed and approved. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alabdulhadi et al.)

Introduction: Pressure ulcers are a significant concern in pediatric intensive care units, with prevalence rates ranging from 0.8% to 27%. They pose serious physical and psychological challenges, particularly in neonatal and pediatric intensive care units (NICU and PICU). This study explores nursing strategies, attitudes, and barriers toward pressure ulcer prevention in NICU and PICU settings., Methods: Using a descriptive study design, data were collected from 80 nurses working in NICU and PICU through validated questionnaires, including a demographic profile and a pressure ulcer survey. Descriptive statistics were employed to calculate mean scores and percentages, while inferential statistics assessed associations between variables., Results: The study revealed specific nursing strategies, along with significant barriers and attitudes toward pressure ulcer prevention in NICU and PICU. The total attitude mean score was 3.57, with the highest positive response (mean = 4.29) for "most pressure sores can be avoided", and the highest negative response (mean = 3.86) for "pressure sore prevention is a low priority for me". Among participants, 72.5% conducted risk assessments on all patients, 60% had written prevention care plans, and 76.3% implemented preventive strategies. Barriers such as staff shortages and time constraints were reported by 76.2% of nurses. Multivariate analysis indicated that nurses with more than 10 years of qualification (OR = 3.67) and permanent staff with over 10 years of employment (OR = 4.31) were significantly more likely to engage in preventive practices. The use of a pressure ulcer grading tool (OR = 2.49, P < 0.05) and participation in formal training (OR = 3.14, P < 0.05) were also positively associated with preventive practices., Discussion: These findings underscore the importance of structured assessment tools, ongoing education, and the need to foster positive attitudes among nurses to effectively reduce pressure ulcer prevalence and enhance patient outcomes in NICU and PICU settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Mostafa, Zakari and Al Salem.)

Links between nutrition and pressure ulcer (PU) prevention and wound healing are well known and documented (Saghaleini et al, 2018). Less well documented is the link between hydration and pressure care. It was recognised that many patients admitted to acute hospitals are dehydrated (El-Sharkawy et al, 2015); this is particularly relevant to Gastroenterology patients based on the classifications of dehydration (Posthauer, 2016), although all patients are at risk. Dehydration status is not routinely assessed without painful and costly blood tests. Through the use of an adapted version of the GULP Dehydration risk screening tool (Food First Nutrition and Dietetics Team, 2012) and the implementation of a hydration-focussed care plan, it may be possible for a nurse-led assessment to identify dehydration risk and plan care accordingly. A pilot study showed that 50% of the sample group gained an improved level of hydration throughout their hospital admission and a decrease in their Waterlow score. [ABSTRACT FROM AUTHOR]

Pressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review aimed to evaluate the knowledge, attitude, and practice of Iranian nurses towards PU prevention. A systematic search was conducted on PubMed, Web of Science, Scopus databases, Google Scholar Search Engine, as well as Magiran, Iranmedex, and Scientific Information Database (SID) Persian databases using the relevant keywords, from the earliest date available to August 21, 2020. Studies were appraised using the appraisal tool for cross-sectional studies (AXIS tool). Among a total of 1,543 Iranian nurses included in the 9 studies, 80.53% were female with a mean age of 31.14 (SD = 5.52) years. The mean work experience of the participants was 7.94 years (SD = 5.44). The knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. Also, the present study showed that nurses' attitudes toward PU prevention were contradictory. Age, gender, level of education, work experience, and participation in previous educational workshops were possible factors related to nurses' knowledge about PU prevention. Women with higher work experience had a more positive attitude. This review found inappropriate knowledge, attitude, and practice of Iranian nurses toward PU prevention and highlights the importance of regular upgrading of nurses' knowledge and practice related to PU prevention. • Knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. • The present study showed that nurses' attitudes toward PU prevention were contradictory. • Age, gender, level of education, and work experience were factors related to nurses' knowledge about PU prevention. [ABSTRACT FROM AUTHOR]

A series of super-soft polyurethanes was prepared by synthesizing lightly crosslinked polyurethane with low isocyanate:hydroxyl ([NCO]:[OH]) molar ratios. The starting materials were polymeric isocyanate (pMDI), polypropylene glycol (PPG), and 1,1,1-tris(hydroxymethyl)propane (TMP). The effects of the [NCO]:[OH] molar ratio and concentrations of the crosslinking agent TMP on the crosslink density and the thermal, dynamic-mechanical, and mechanical properties of the polyurethanes were determined. In addition, TMP generates chemical and physical crosslinks within polyurethane; therefore, data calculated using the Flory-Rehner equation and the rubber elasticity were compared. The success of the reaction between pMDI and PPG was confirmed using Fourier-transform infrared spectroscopy. The synthesized polyurethanes exhibited a mixing phase between soft and hard segments. The addition of TMP increased the crosslinking density, resulting in increased glass transition temperature, tensile properties, and hardness; however, the pressure distribution was suppressed. The synthesized polyurethane showed effective properties for pressure ulcer relief applications.

Biomechanical parameters have the potential to be used as physical markers for prevention and diagnosis. Finite Element Analysis (FEA) is a widely used tool to evaluate these parameters in vivo. However, the development of clinically relevant FEA requires personalisation of the geometry, boundary conditions, and constitutive parameters. This contribution focuses on the characterisation of mechanical properties in vivo which remains a significant challenge for the community. The aim of this retrospective study is to evaluate the sensitivity of the computed elastic parameters (shear modulus of fat and muscle tissues) derived by inverse analysis as a function of the geometrical modelling assumption (homogenised monolayer vs bilayer) and the formulation of the cost function. The methodology presented here proposes to extract the experimental force-displacement response for each tissue layer (muscle and fat) and construct the associated Finite Element Model for each volunteer, based on data previously collected in our group (N = 7 volunteers) as reported in (Fougeron et al., 2020). The sensitivity analysis indicates that the choice of the cost function has minimal impact on the topology of the response surface in the parametric space. Each surface displays a valley of parameters that minimises the cost function. The constitutive properties of the thigh (reported as median ± interquartile range) were determined to be (μ = 198 ± 322 P a , α = 37) for the monolayer and (μ m u s c l e = 1675 ± 1127 P a , α m u s c l e = 22 ± 14 , μ f a t = 537 ± 1131 P a , α f a t = 32 ± 7) for the bilayer. A comparison of the homogenised monolayer and bilayer models showed that adding a layer reduces the error on the local force displacement curves, increasing the accuracy of the local kinematics of soft tissues during indentation. This allows for an increased understanding of load transmission in soft tissue. The comparison of the two models in terms of strains indicates that the modelling choice significantly influences the localization of maximal compressive strains. These results support the idea that the biomechanical community should conduct further work to develop reliable methodologies for estimating in vivo strain in soft tissue. [ABSTRACT FROM AUTHOR]

Prevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP). In this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I2 index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software. Twelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34–75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69–82.97) and competence (70.11%, 95% CI: 67.24–72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10–77.20 vs. 67%, 95% CI: 53.80–80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036). The attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential. • Nurses' attitudes toward pressure ulcer prevention were slightly unfavorable. • The highest and lowest scores were related to the dimensions of priority and competence, respectively. • Nurses had a more favorable attitude towards pressure ulcer prevention than nursing students. [ABSTRACT FROM AUTHOR]

For bedridden elderly people, pressure ulcer is the most common and serious complication and could be prevented by regular repositioning. However, due to a shortage of long-term care workers, repositioning might not be implemented as often as required. Posture monitoring by using modern health/medical caring technology can potentially solve this problem. We propose a RGB-D camera system to recognize the posture of the bedridden elderly patients based on the analysis of 3D human skeleton which consists of articulated joints. Since practically most bedridden patients were covered with a blanket, only four 3D joints were used in our system. After the recognition of the posture, a warning message will be sent to the caregiver for assistance if the patient stays in the same posture for more than a predetermined period (e.g., two hours). Experimental results indicate that our proposed method is capable of achieving a high accuracy in posture recognition (above 95%). To the best of our knowledge, this application of using human skeleton analysis for patient care is novel. The proposed scheme is promising for clinical applications and will undertake an intensive test in health care facilities in the near future after redesigning a proper RGB-D (Red-Green-Blue-Depth) camera system. In addition, a desktop computer can be used for multi-point monitoring to reduce cost, since real-time processing is not required in this application. [ABSTRACT FROM AUTHOR]

Nurse educators are expected to teach nursing students the necessary knowledge and attitudes to prevent pressure injuries (Pİ) development. This study aims to assess the knowledge levels and attitudes of nursing students towards Pİ prevention and to analyze the relationship between their knowledge and attitudes. This study adopted a cross sectional, descriptive, and correlational research design. 259 students of the nursing department of a private university in the Turkish Republic of Northern Cyprus during the spring semester of the 2018–2019 academic year constituted the population of the study. Student information form, the Turkish version of Pİ prevention knowledge assessment instrument (PUPKAI-T), and attitude towards Pİ prevention instrument (APuP) were used for data collection. Data were analyzed by Kruskal-Wallis, Mann- Whitney U tests and Spearman's correlation. Ethics committee approval was received. Mean PUPKAI-T score was 10.16 ± 2.44 (range: ≥ 16). Participants obtained the lowest score from the etiology and causes (32.3%) and classification and observation (33.5%) subscales of the PUPKAI-T. The mean score obtained by the participants from the APuP was 44.62 ± 3.54 (range; min; 13, max; 52). We found a positive, weak, and statistically significant correlation between the PUPKAI-T and the APuP scores (r = 0.131, p = 0.034). The study found that the mean PUPKAI-T scores of the nursing students were low and their APuP scores indicated a positive attitude. The findings imply that the nursing curriculum might be revised and new courses might be introduced to increase the knowledge levels of nursing students on Pİ prevention. • The pressure wound knowledge score of nursing students was low. • The nursing students showed high, positive attitude scores toward pressure injuries prevention. • There was a positive, statistically significant relationship between knowledge levels and attitudes. • The use of new teaching strategies in nursing education can improve knowledge and attitudes towards the prevention of Pİ. [ABSTRACT FROM AUTHOR]

Abstract Background Pressure ulcer is largely avoidable, but its prevalence rate increased more than 80% in a 13 years study. Nurses have a great position to advance best practices towards the prevention of pressure ulcers. Therefore they should be knowledgeable of the signs and symptoms of pressure ulcers, and preventive strategies to reduce its incidence, but there is limited evidence on nurses’ knowledge and its associated factors to prevent pressure ulcers in Ethiopia. Methods A hospital-based cross-sectional study was conducted from March 25 – April 23/ 2018. A total of 356 nurses were selected by stratification with a simple random sampling technique. Pretested structured questionnaire with closed and open-ended questions was used to collect data. Frequency distribution and percentage were computed to describe each variable. Bivariate and multivariable logistic regression with a 95% confidence interval was also carried out to see the effect of each independent variable on the dependent variable and declared statistically significant association with P

Abstract Objectives Pressure ulcers are localized cellular damages to the skin and underlying tissues caused by pressure, shearing and frictional force. The aim of this study is to assess practices towards pressure ulcer prevention among nurses in the Central Zone of Tigray, Ethiopia, from September 10, 2017 to June 15, 2018. This study has also identified the major barriers that hamper nurses from preventing pressure ulcers. These barriers were heavy workload, inadequate training, and lack of universal guideline and shortage of resource. 17.2% of the participants had a good practice and 82.2% of the respondents had a poor practice of pressure ulcer prevention. Result Finding of this study showed that respondents have inadequate knowledge which may have led to their poor practice towards pressure ulcer prevention. Immediate intervention should be done on public hospitals of central Tigray to improve nurses’ practice towards pressure ulcer prevention.

Background: Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown., Objectives: To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school., Method: A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants' narratives., Results: The participants' perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support., Conclusion: Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes., Clinical Implications: Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

There has recently been an increased focus on the use of patient information leaflets as a means of communicating key information and engaging patients in preventative measures. The prevention and management of pressure ulcers depends on proactive and effective communication between nurses and other healthcare professionals and the patients themselves. This is particularly important in community settings, with the increasing responsibility placed on patients to self-manage their conditions. However, despite the use of patient information leaflets as part of the nursing process, there is little research evidence to support their use with regards to pressure ulcer prevention and, in particular, whether patients themselves engage with and understand the information. This article discusses the existing literature and knowledge around patient information leaflets, looking at it in light of a recent study around pressure ulcer prevention in Birmingham Community Healthcare NHS Trust. [ABSTRACT FROM AUTHOR]

Background: Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long‐term older people care. Aim: To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long‐term older people care. Design: A quasi‐experimental intervention study. Methods: Two long‐term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence‐Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument. Results: In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure‐relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices. Conclusions: The results of this study support the implementation of PU prevention guidelines in long‐term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care. [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, prone position (PP) has been frequently used in the intensive care units to improve the prognosis in patients with respiratory distress. However, turning patients to prone imply important complications such as pressure ulcers. The aim of this paper is to describe the prevalence and characteristics of prone-positioning pressure sores (PPPS) and analyze the related risk factors. A case-control study was performed in Gregorio Maranon hospital in Madrid during the COVID-19 pandemic between April and May 2020. We enrolled 74 confirmed COVID-19 patients in critical care units with invasive mechanical ventilation who were treated with pronation therapy. There were 57 cases and 17 controls. Demographic data, pronation maneuver characteristics and PPPS features were analyzed. In the case group, a total number of 136 PPPS were recorded. The face was the most affected region (69%). Regarding the severity, stage II was the most frequent. The main variables associated with an increased risk of PPPS were the total number of days under pronation cycles, and PP maintained for more than 24 h. The prealbumin level at admission was significantly lower in the case group. All of the ulcers were treated with dressings. The most frequent acute complication was bleeding (5%). According to our study, PPPS are related to the characteristics of the maneuver and the previous nutritional state. The implementation of improved positioning protocols may enhance results in critical patient caring, to avoid the scars and social stigma that these injuries entail. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PU) are deep scars on the skin that cause pain, infections and severe health complications. Most movement-impaired subjects are vulnerable to PU, leading to permanent and irreversible skin damage. The system proposed in this paper aims to prevent PU formation with the design and implementation of a wirelessly controlled device that predicts PUs before their occurrence and attempts to prevent it using therapeutic feedback. A flexible pad that consists of multiple types of sensors is used, theses sensors continuously and non-invasively monitor ulcer-related vital signs in vulnerable areas, and uses these data to predict PU with a decision-making process. When PU is detected an electrical stimulation (ES) unit is automatically activated. Stimulation prevents PU formation by increasing local blood flow to the simulated area and eliminating the main factor that leads to PU formation. The system successfully monitored and predicted PU; tests were performed on three healthy volunteers and one volunteer with sacral ulcers. Results including readings of blood oxygenation, force, humidity and temperature were recorded as graphs to monitor decay/increase in values more efficiently. [ABSTRACT FROM AUTHOR]

Amaç: Araştırma hemşirelerin basınç ülserlerini önlemeye yönelik tutumlarını ölçmek amacıyla tanımlayıcı olarak yapılmıştır.Yöntem: Araştırmanın örneklemini Kasım 2017-Ocak 2018 tarihleri arasında İstanbul’da özel bir sağlık kuruluşunda çalışan, araştırma kriterlerine uyan ve araştırmaya katılmayı kabul eden 131 hemşire oluşturdu. “Basınç Ülserlerini Önlemeye Yönelik Tutum Ölçeği” (BÜÖYTÖ) uygulandı. Çalışmada veriler IBM SPSS Statistics 24 (IBM SPSS, Türkiye) programı kullanılarak analiz edildi. Tanımlayıcı istatistiksel metotlar (Frekans, Yüzde, Ortalama, Standart sapma), Kolmogorov-Smirnov dağılım testi, Mann Whitney U testi, Kruskal Wallis testi ve Spearman Korelasyon Analizi kullanıldı. Bulgular: Hemşirelerin BÜÖYTÖ puan ortalaması 44,69±3,00 (%85,9) saptanmıştır. Hemşirelerin yaş ortalaması 24,3±2,511 bulunmuştur. Hemşirelerin %54,2’si 1 yıldan az çalışma deneyimine sahip, %42’si Cerrahi Servisiler, %34,4 Dahili Servisler, %27,7’si Yoğun Bakımlarda çalışmaktadır. Hemşirelerin sosyodemografik özellikleri ile BÜÖYTÖ puanları arasındaki ilişki istatistiksel açıdan anlamlı bulunmamıştır (p>0,05). Basınç ülseri ile her zaman karşılaşan hemşirelerin BÜÖYTÖ puanlarının daha yüksek olduğu saptanmıştır (p

• Continuous pressure monitoring provides a robust means for detection of postural movements. • Movements detection was achieved by combining pressure parameters and intelligent processing. • Posture and mobility were successfully detected in a cohort of Spinal Cord Injured patients. • The novel algorithm could offer the potential for targeted interventions for pressure ulcer prevention. Pressure mapping technologies provide the opportunity to estimate trends in posture and mobility over extended periods in individuals at risk of developing pressure ulcers. The aim of the study was to combine pressure monitoring with an automated algorithm to detect posture and mobility in a vulnerable population of Spinal Cord Injured (SCI) patients. Pressure data from able-bodied cohort studies involving prescribed lying and sitting postures were used to train the algorithm. This was tested with data from two SCI patients. Variations in the trends of the centre of pressure (COP) and contact area were assessed for detection of small- and large-scale postural movements. Intelligent data processing involving a deep learning algorithm, namely a convolutional neural network (CNN), was utilised for posture classification. COP signals revealed perturbations indicative of postural movements, which were automatically detected using individual- and movement-specific thresholds. CNN provided classification of static postures, with an accuracy ranging between 70-84% in the training cohort of able-bodied subjects. A clinical evaluation highlighted the potential of the novel algorithm to detect postural movements and classify postures in SCI patients. Combination of continuous pressure monitoring and intelligent algorithms offers the potential to objectively detect posture and mobility in vulnerable patients and inform clinical-decision making to provide personalized care. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) negatively affect quality of life (QoL) and cause problems for patients, such as pain, distress and often specific difficulties with treatments used to manage the wound. Thus, it is important to implement appropriate prevention strategies in order to achieve high-quality care, thereby reducing the burden of PUs on patients, the healthcare system and society as a whole. PU development arises due to the adverse effects of pressure, shear, friction and moisture at the skin/surface interface. Preventive interventions typically include risk assessment, reducing pressure and minimising shear and friction. More recently, certain wound dressings, as a potential additional protective strategy for preventing PUs, have been introduced. This review explores the mechanisms of action of dressings for preventing PUs. Findings from the review indicate that decreasing frictional forces transmitted to the patient's skin is achieved by use of a dressing with an outer surface made from a low friction material. Furthermore, the ability of dressings to absorb and redistribute shear forces through good adhesion to the skin, high loft and lateral movement of the dressing layers is important in reducing shear forces. This is achieved when the dressing reduces pressure transmitted to the patient's tissues by the propriety of high loft/thickness and padding that allows a degree of cushioning of bony prominences. Further, dressings may reduce humidity at the skin/dressing interface, i.e., the dressing is absorbent and/or permits moisture to evaporate quickly. As part of an established PU prevention protocol, dressings may help decrease PU incidence. [ABSTRACT FROM AUTHOR]

In recent years, the number of senior citizens needing nursing care has been increasing rapidly. Pressure ulcer is a major health issue for such people. In this study, for early detection of pressure ulcer, we developed a monitoring system by using a fabric sensor sheet that can monitor the degree of progress of pressure ulcer daily. This sheet is made using conductive knitting, and it functions as a sensor for measuring body pressure distributions of a user sleeping directly on the sensor sheet. It does not disturb the movement of the user and has an advantage of superior breathability and flexibility in comparison with existing pressure sensors. Moreover, our new design comprises a laminar structure for the wiring of the device, for ease of use. We measured the sleep postures of six subjects using this system and monitored those clearly. For our experiment results, we used a deep neural network (DNN) to distinguish each sleep posture and used a support vector machine (SVM) to determine the positions that caused pressure ulcer the most. As a result of these examinations, we showed that it was possible to distinguish the sleep postures with a high accuracy of 98% or more, and it was also possible to identify the positions that caused pressure ulcer the most.

For bedridden elderly people, pressure ulcer is the most common and serious complication and could be prevented by regular repositioning. However, due to a shortage of long-term care workers, repositioning might not be implemented as often as required. Posture monitoring by using modern health/medical caring technology can potentially solve this problem. We propose a RGB-D camera system to recognize the posture of the bedridden elderly patients based on the analysis of 3D human skeleton which consists of articulated joints. Since practically most bedridden patients were covered with a blanket, only four 3D joints were used in our system. After the recognition of the posture, a warning message will be sent to the caregiver for assistance if the patient stays in the same posture for more than a predetermined period (e.g., two hours). Experimental results indicate that our proposed method is capable of achieving a high accuracy in posture recognition (above 95%). To the best of our knowledge, this application of using human skeleton analysis for patient care is novel. The proposed scheme is promising for clinical applications and will undertake an intensive test in health care facilities in the near future after redesigning a proper RGB-D (Red-Green-Blue-Depth) camera system. In addition, a desktop computer can be used for multi-point monitoring to reduce cost, since real-time processing is not required in this application.

Abstract Background The presence or absence of pressure ulcers has been generally regarded as a performance measure of quality nursing care and overall patient health. The aim of this study- wasto explorenurses’ attitude about pressure ulcer prevention’and to identify staff nurses’ perceived barriers to pressure ulcer prevention public hospitals in Addis Ababa, Ethiopia. Methods A self-reported multi-center institutional based cross sectional study design was employed to collect data from staff nurses (N = 222) working in six (6) selected public hospitals in Addis Ababa, from April 01–28/2015. Results Majority of the nurses had (n = 116, 52.2%) negative attitude towards pressure ulcer prevention. The mean scores of the test for all participants was 3.09out of 11(SD =0.92, range = 1–5). Similarly, the study revealed several barriers need to be resolved to put in to practice the strategies of pressure ulcer prevention; Heavy workload and inadequate staff (lack of tie) (83.1%), shortage of resources/equipment (67.7%) and inadequate training (63.2%) were among the major barriers identified in the study. Conclusions The study finding suggests that Addis Ababa nurses have negative attitude to pressure ulcer prevention. Also several barriers exist for implementing pressure ulcer prevention protocols in public hospitals in Addis Ababa, Ethiopia. Suggestion for improving this situation is attractive.

Pressure ulcers (PU) are known to be a high-cost disease with a risk of severe morbidity. This paper evaluates a new clinical strategy based on an innovative medical device [Tongue Display Unit (TDU)] that implements perceptive supplementation in order to reduce prolonged excessive pressure, recognized as one of the main causes of PU. A randomized, controlled, and parallel-group trial was carried out with 12 subjects with spinal cord injuries (SCI). Subjects were assigned to the control (without TDU, n = 6) or intervention (with TDU, n = 5) group. Each subject took part in two sessions, during which the subject, seated on a pressure map sensor, watched a movie for one hour. The TDU was activated during the second session of the intervention group. Intention-to-treat analysis showed that the improvement in adequate weight shifting between the two sessions was higher in the intervention group (0.84 [0.24; 0.89]) than in the control group (0.01 [-0.01; 0.09]; p = 0.004) and that the ratio of prolonged excessive pressure between the two sessions was lower in the intervention group (0.74 [0.37; 1.92]) than in the control group (1.72 [1.32; 2.56]; p = 0.06). The pressure map sensor was evaluated as being convenient for use in daily life; however, this was not the case for the TDU. This paper shows that persons with SCI could benefit from a system based on perceptive supplementation that alerts and guides the user on how to adapt their posture in order to reduce prolonged excessive pressure, one of the main causes of PU.

Preventive care was recently identified as a Government priority, which is likely to affect pressure ulcer (PU) preventive care in the NHS. Contemporary economic analyses of PU prevention interventions are undermined by factors including methodological challenges and poor inter-rater reliability of PU risk assessment tools. Healthcare demands on the NHS created by PU prevention remain unclear, although the burden is high, with litigation costs rising continuously. The poorly understood economics of PU prevention may create variation in practice. Patient expectations of PU prevention may be influenced by mainstream media, national awareness campaigns and the varied information and advice offered by professionals. Patient expectations and low levels of functional health literacy may create confusion and unrealistic expectations. This article critically examines the impact of recent changes in Government priorities related to PU prevention, considering the effects of healthcare demand, economics and patient expectations. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) constitute a health issue that has a high prevalence and incidence rate in acute and long-term care, requiring long-term nursing care for treatment and prevention. Therefore, nurses should have adequate knowledge of the interventions and practices used to prevent PUs. This study employed a descriptive and cross-sectional design to assess the level of nurses' knowledge concerning preventive interventions for PUs. Based on data found in the literature, researchers developed a 16-question Participant Information Form (including age, gender, level of education, employed ward, and training on PUs) and used this form, along with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), to collect data. A group of 471 nurses working in two foundation hospitals in 2018 participated in the study by completing a questionnaire. Among the participants, 44.2% worked in surgery, 21.2% in internal medicine, and 34.6% in other wards (such as intensive care, pediatrics, and the operating theater). Most of the nurses(73.5%) held a bachelor's degree, and their average work experience was 7.27 ± 7.00 years. It was determined that 69.4% of the nurses had not received in-service training relating to PUs, 55.6% did not attend lectures/conferences or read articles on the prevention of PUs, and 59.7% rated themselves as "adequate" in interventions used to prevent PUs. Based on the use of PUPKAI-T, 17 individuals (3.6%) scored equal to or more than the 60% cut-off value, and 454 individuals (96.4%) scored less than 60%. The mean level of knowledge on PUs was calculated as 11.1 ± 2.659 (range: 1-18) out of 26 questions. Results of the study showed that the general level of knowledge of nurses in preventing PUs are extremely insufficient. Therefore, various strategies should be developed to increase nurses' level of knowledge on the etiology and development, classification and observation, and risk assessment of PUs, as well as on nutrition plans and preventive interventions. • The results of this study showed that nurses' level of knowledge on the prevention of pressure ulcers (PUs) was inadequate at two foundation hospitals. • Nurses' inadequate level of knowledge on the prevention of Pus may reduce patient care quality and increase the risk of PU formation in patients. • Furthermore, participating nurses expressed desire to follow the latest developments in their work environment and receive training to prevent pressure ulcer. • In addition, we recommend that health institutions provide appropriate training to prevent PUs, establish various protocols for preventive interventions against PUs, and support and encourage participation in various seminars, congresses, certificate programs, and in-service training for nurses. [ABSTRACT FROM AUTHOR]

The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the 'SEM scanner'. We also describe the mode of operation of the SEM scanner in monitoring tissue health and detecting subtle abnormal changes in tissue physiology in patients and anatomical sites at a risk of a pressure ulcer (PU: also known as a pressure injury). The technology of the SEM scanner was approved last year for sales in the US by the Food and Drug Administration (FDA). The SEM scanner detects changes in fluid contents of human skin and subdermal tissues, to a tissue depth of several millimetres, by measuring 'capacitance', an electrical property of the locally examined tissue site to store electric charge. The capacitance of tissues, called 'biocapacitance', is strongly affected by the amount of fluid (water) in the tissue. When the first cells die in a forming PU, inflammatory signalling causes the permeability of blood vessel walls to increase and oedema to develop. Simply, the scanner detects the early appearance of oedema, which is called 'micro-oedema.' Calculation of a 'SEM-delta' value, which compares biocapacitance measurements, acquired across several tissue sites, some of which are healthy and others where the PU may evolve, eliminates potential effects of systemic changes in tissue fluid contents and provides a consistent quantitative measure of the tissue health conditions at the monitored anatomical site. Here, we describe SEM scanner technology, how it operates and has been laboratory tested (in computer simulations, in silico) before commercial launch. We explain why targeting the physical biomarker of oedema leads to the documented success of the SEM scanner in the multiple published clinical trials, proving its ability to early detect PUs that form under intact skin. [ABSTRACT FROM AUTHOR]