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Background: In posterior lumbar surgery, overweight patients are more prone to intraoperative acquired pressure injury (IAPI) due to bleeding, longer operative time, and increased pressure. The current prevention strategies have limited effects. Methods: This was a single-blind, prospective, randomized controlled trial conducted from April 2023 to September 2024. Eligible participants were overweight patients (BMI ≥ 24 kg/m²) scheduled for lumbar posterior surgery under general anesthesia. Patients were randomly assigned to two groups: the micro-movement group and the silicone foam dressing group. The micro-movement group had regular adjustments to the operating table to change the patient's position and alleviate pressure. The silicone foam dressing group used standard foam dressings at pressure points. Results: A total of 277 patients were included in the analysis (137 in the micromovement group and 140 in the silicone foam dressing group). Compared with the silicone foam dressing group (8.6%), the incidence of IAPI in the micromovement group was significantly reduced (2.9%) (P < 0.05). There were no significant differences between the two groups in terms of IAPI stage, duration, or location (P > 0.05). Conclusion: The micromovement protocol is a safe and effective method for preventing IAPI in overweight patients undergoing posterior lumbar surgery. This simple intervention could significantly improve patient outcomes and reduce healthcare costs associated with IAPI. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the risk factors for pressure ulcer development • To familiarise yourself with the PURPOSE T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) and how it can be used in clinical practice • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). The first intervention in pressure ulcer prevention is often the completion of a pressure ulcer risk assessment, which aims to identify a patient’s level of risk of developing a pressure ulcer. Appropriate care planning should then follow. There are several pressure ulcer risk assessment tools that nurses can use in their clinical practice, but it has not always been clear which is the most effective. One of these tools – the PURPOSE T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) – has recently been recommended in national guidelines and is now considered to be the only tool with an up-to-date evidence base. This article examines some of the risk assessment tools used to assess pressure ulcer risk, as well as providing an overview of the PURPOSE T and explaining its significance in pressure ulcer prevention. [ABSTRACT FROM AUTHOR]

The document discusses stress ulcer bleeding as a complication of critical illness and the use of stress ulcer prophylaxis to prevent such ulcers. Proton pump inhibitors are the main agents prescribed for stress ulcer prophylaxis, with histamine-2-receptor blockers being less commonly used. The document also highlights the challenges of predicting the severity of bleeding episodes and the uncertainty surrounding the effect of stress ulcer prophylaxis on mortality. Additionally, it explores the potential impact of enteral nutrition on bleeding risk and the importance of discontinuing stress ulcer prophylaxis when no longer needed. [Extracted from the article]

Background: This study uses an interpretive description approach to explore nurses' experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters. Methods: 10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke's reflexive thematic analysis. Results: The study's findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment. Conclusion: The study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU. Objectives: To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU. Design: Multicentre prospective study. Methods: A total of 18,503 patients from ICUs in 40 tertiary‐level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately. Results: Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high‐risk and very high‐risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high‐risk group. Conclusions: This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups. Implications for Clinical Practice: Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim: To systematically search, evaluate and synthesise the most robust evidence regarding pressure injury prevention in orthopaedic patients admitted to general wards. Design: The present study provides an evidence‐based summary of the most robust findings, adhering to the evidence guidelines established by the Center for Evidence‐Based Nursing of Fudan University. Method: According to the "6S" model, a systematic search was conducted for literature on pressure injury prevention among orthopaedic patients in general wards. The types of literature included guidelines, clinical decisions, expert Consensus, evidence summaries, etc. The search period covered the time from the beginning of the database up to December 2023. Data Source s : The following databases and resources were systematically searched: Up To Date, JBI, NICE, WOCN, NZWCS, etc. Results: Fifteen literature sources were included, comprising one clinical decision, eight guidelines, one systematic review, and one expert Consensus. In these sources, a comprehensive collection of 34 pieces of best evidence was formed across six key topics: risk assessment, position management, skin care, device used for device‐related pressure injury, nutritional assessment, and support, as well as health education and training. Among the evidence gathered, a strong recommendation was made for 18 pieces, while the remaining 16 received a weak recommendation. Conclusion: This study provides a comprehensive synthesis of the most robust evidence on pressure injury prevention in orthopaedic patients, encompassing 34 pieces of evidence that can serve as valuable references for clinical practice. Before implementing this evidence, it is crucial to evaluate the specific contextual factors within different countries and medical institutions, as well as the facilitators and barriers influencing its application by healthcare professionals and patient's preferences. Furthermore, targeted evidence selection should be conducted through careful screening and subsequent adjustments in implementation, thereby offering a more scientifically grounded basis for clinical nursing practice. Future research endeavours should prioritise investigating strategies for effective evidence utilisation. Implications for the Profession and Patient Care: The prevention of pressure injuries poses a significant challenge for orthopaedic patients. This study presents a synthesis of 34 pieces of best evidence to provide guidance on preventive measures for pressure injuries in orthopaedic patients. Adhering to and implementing these 34 pieces of evidence can effectively aid in preventing pressure injuries in clinical practice. This evidence encompasses risk assessment, position management, skin care, device usage for device‐related pressure injuries, nutritional support and evaluation, and health education and training, establishing a comprehensive and systematic implementation process. Assessing the risk of pressure injuries during interventions serves as an essential prerequisite for developing effective strategies to prevent such injuries among orthopaedic patients. Ultimately, this study will offer valuable guidance to healthcare professionals worldwide regarding preventing pressure injuries in orthopaedic patients. Impact: Upon admission to the hospital, it is essential to conduct a risk assessment and implement evidence‐based, individualised prevention measures for pressure ulcers in patients to prevent their occurrence. This study will provide valuable insights into preventing pressure injuries in orthopaedic patients admitted to orthopaedic wards for healthcare workers worldwide. State: The PRIMA manifest is utilised during the text preparation process. Trail Registration: ES20245365 [ABSTRACT FROM AUTHOR]

Aim and Objectives: To summarise the evidence and present the state of the science on pressure injury care bundles in the community. Specifically, this review examined (i) the extent of pressure injury by studying its prevalence and incidence in the last 10 years, (ii) the risk factors associated with community‐acquired pressure injury and (iii) the components and outcomes associated with effective pressure injury care bundles in the community. Background: PI care bundles have effectively reduced PI rates; however, there is limited evidence of care bundles used in community settings. Design: Integrative review. Methods: This integrative review is guided by the Whittemore and Knafl framework and follows the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) reporting guidelines. Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aims were extracted, and findings were synthesised and presented. PubMed, Medline, CINAHL and Web of Science were searched. Studies published in the English language between 2012 and 2022 were retrieved. Results: A total of 89 articles were retrieved; 25 met the inclusion criteria. Most studies reported the point prevalence and period prevalence of community‐acquired pressure injuries, and only one study reported the incidence of community‐acquired pressure injuries. The point prevalence and period prevalence of community‐acquired pressure injury were 0.02% to 10.8% and 2.7% to 86.4%, respectively, and the cumulative incidence was 1.3%. The risk factors for community‐acquired pressure injury assessed vary between studies; older age, poor nutrition, immobility and multiple comorbidities are commonly reported. Socioeconomic and caregiving factors were not studied. Very few studies evaluated pressure injury care bundles in the community. Even so, the components of the pressure injury care bundle vary between studies. Conclusions: Pressure injury development is associated with a complex interplay of factors. Socioeconomic and caregiving factors were not examined in any of the papers. There is a lack of understanding of the components and outcomes associated with effective pressure injury care bundles in the community. Relevance to Clinical Practice: Despite their prevalence, community‐acquired pressure injuries (CAPIs) are often underreported due to inadequate follow‐up and reporting mechanisms.Although the risk factors for CAPIs vary across studies, older age, impaired mobility, multiple comorbidities and malnutrition consistently emerge as key contributors.Pressure injury preventive care bundles are more commonly used in the acute care setting rather than the community setting. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: Nurses' knowledge of pressure injuries causes and risk factors helps to prevent their occurrences and protect the patient. Aim: To assess the level of knowledge of medical device‐related pressure injuries and to identify risk factors that affect the knowledge. Methods: A cross‐sectional design was used in this study considering a convenience sample from critical care nurses. The nurses were invited to complete the Medical Device‐Related Pressure Injuries Knowledge Questionnaire. Results: About 71 nurses participated in the study. The mean score of MDRPI_KQ was 23.28 ± 4.14 out of 36. Mann–Whitney Test did not show statistically significant relationships between the MDRPI_KQ mean score and related variables (p > 0.05). The regression results indicated that the three predictors explained 46.4% of the variance (R2 = 0.215, F(3, 6.114) = 3.75, p = 0.001). It was found that the Frequency of encountering a patient with MDRPIs significantly predicted MDRPI_KQ score, job position, and assuming the care responsibility for MDRPIs in the department. Conclusions: Poor knowledge of pressure injuries can negatively affect patient care so training programs and policies should be developed based on the level of knowledge and practices of the staff to be more effective. [ABSTRACT FROM AUTHOR]

Pressure ulcers are often preventable and highlight the broader challenges of maintaining high standards of care, especially in vulnerable patient populations, such as those with psychiatric conditions. This article highlights the difficulties pressure ulcers pose for healthcare organisations, healthcare professionals and patients, while also exploring strategies to address these challenges in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: This Population, Intervention, Comparison, and Outcomes-guided systematic review assesses continuous lateral rotation therapy versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, ICU length of stay (LOS), and hospital LOS as primary outcomes and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events as secondary outcomes. METHODS: This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (International Prospective Register of Systematic Reviews CRD42022384258). Searches spanned databases MEDLINE/PubMed, Embase, Scopus, ScienceDirect, Cochrane, CINAHL, and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized controlled trials (RCTs) and quasi-randomized trials, comparing continuous lateral rotation therapy (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane Collaboration and Grading of Recommendations Assessment, Development, and Evaluation tools. For the quasi-randomized trials, the Risk of Bias in Non-Randomized Studies-of Interventions tool was used. RESULTS: In 18 studies with 1,466 participants (intervention, n = 700, 47.7%; control, n = 766, 52.2%), continuous lateral rotation therapy was predominantly used for prophylactic purposes, with protocols varying from 10-24 h/d. Meta-analysis (16 RCTs) favored continuous lateral rotation therapy for reduced mechanical ventilation duration (standardized mean difference [SMD] -0.17 [CI -0.29 to -0.04] d, P = .008) and lower nosocomial pneumonia incidence (odds ratio 0.39 [CI 0.29-0.52], P < .001). Continuous lateral rotation therapy showed no significant impact on mortality (odds ratio 1.04 [CI 0.80-1.34], P = .77), ICU LOS (SMD -0.11 [CI -0.25 to 0.02] d, P = .11), hospital LOS (SMD -0.10 [CI -0.31 to 0.11] d, P = .33), and incidence of pressure ulcers (odds ratio 0.73 [CI 0.34-1.60], P = .44). CONCLUSIONS: Continuous lateral rotation therapy showed no significant difference in primary outcomes (mortality, ICU and hospital LOS) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on mechanical ventilation duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess continuous lateral rotation therapy effectiveness. [ABSTRACT FROM AUTHOR]

Pressure ulcers, or bedsores, are created by areas of the skin under prolonged pressure and can lead to skin and underlying tissue damage. The present study evaluated the effects of carboxymethyl cellulose/sodium alginate/gelatin (CMC/Alg/Gel) hydrogel containing doxycycline (DOX) on improving the healing process of pressure ulcers. The magnet was used to apply pressure on the dorsum skin rat to induce a pressure ulcer model. Then sterile gauze, CMC/Alg/Gel, and CMC/Alg/Gel/1% w/v DOX hydrogels were used to cover the wounds. Blood compatibility, weight loss, cytocompatibility, drug release rate, cell viability, wound closure, and re‐epithelialization were evaluated in all animals on the 14th day after treatment. In vivo results and histopathological evaluation showed 56.66% wound closure and the highest re‐epithelialization in the CMC/Alg/Gel/1% w/v DOX hydrogel group (14 days after treatment). Furthermore, real‐time PCR results indicated that the hydrogel containing DOX significantly decreased the expression of the MMP family consisting of MMP2 and MMP9 mRNA and also increased the expression of vascular endothelial growth factor VEGF mRNA. This study suggested that the addition of DOX, an antibiotic and MMP inhibitor, to hydrogels may be effective in the healing process of pressure ulcers. [ABSTRACT FROM AUTHOR]

Manually adjusting hospital beds presents significant challenges for healthcare professionals, which affects their workflow and patient care outcomes. Manual bed modifications consume a significant amount of time, resulting in nurses being less available for other crucial duties. Patient needs can be delayed, and the quality of care delivered overall can be lowered. Manually adjusting the bed to ensure safety and comfort is a risky practice that could result in incorrect placement that can worsen pre-existing medical issues or cause discomfort and pressure sores. In addition, the demand for accurate and frequent bed changes during the day increases the strain on nurses, especially in situations with high patient turnover or complex care needs. The objective of this study is to create a hospital bed that responds to voice commands to improve patient care and monitoring. The bed's voice recognition technology allows patients to adjust their positions and improve comfort and accessibility, particularly for individuals with mobility issues. It includes sensors that continuously measure the patient's heart rate and temperature while they are in bed. These sensors provide real-time data, enabling prompt detection of any irregularities and facilitating immediate intervention in the patient's heartbeat and temperature. The combination of voice control and continuous health monitoring ensures a higher standard of patient care, improves patient autonomy, and reduces the workload on medical staff. The aim of this innovative bed is to create a healthcare environment that is more responsive and efficient, which ultimately leads to better patient outcomes and enhanced overall hospital efficiency. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose: The main aim of this study was to compare sitting pressure (peak pressure index (PPI) and peak pressure gradient (PPG)) between a daily wheelchair and fixed-frame handcycle, thereby assessing the effect of handcycle backrest angle, movement intensity and cushion type.Materials and methods: Twenty able-bodied participants performed static and dynamic (two intensities) tests in a wheelchair and handcycle. A honeycomb wheelchair cushion and standard foam handcycle cushion were used. Handcycle backrest angles were 45° and 60°. The PPI and PPG at the sacro-coccygeal (SC) and ischial tuberosity (IT) regions were determined with a pressure mat.Results: PPI at the IT-region was higher in the 60° handcycle condition than in the wheelchair (p = 0.04), while PPG at the IT-region did not differ significantly between the wheelchair and handcycle conditions (p > 0.05). PPI and PPG were higher at the 45° handcycle SC-region compared to the wheelchair IT-region (p < 0.03). PPI and PPG at the IT-region were higher with the 60° than with the 45° backrest angle (p < 0.01), while at the SC-region PPI was higher with the 45° backrest angle (p = 0.047). No clear influence of movement intensity was found. PPI and PPG at the IT-region and PPI of the SC-region in the handcycle were significantly lower with the wheelchair cushion than with the handcycle cushion (p < 0.01).Conclusion: Overall, sitting pressure was higher in the handcycle compared to the daily wheelchair. For handcyclists using an upright position, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear.Individuals with a spinal cord injury are at high risk of developing pressure ulcers at the ischial tuberosities (ITs) and the sacro-coccygeal (SC) region due to elevated sitting pressure.The sitting pressure at the IT-region is higher during handcycling in an upright position compared to wheelchair propulsion, while the sitting pressure at the SC-region is higher during handcycling in a less upright position.The use of a honeycomb wheelchair cushion reduces the sitting pressure in the handcycle compared to a standard foam handcycle cushion.For handcyclists, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear.Individuals with a spinal cord injury are at high risk of developing pressure ulcers at the ischial tuberosities (ITs) and the sacro-coccygeal (SC) region due to elevated sitting pressure.The sitting pressure at the IT-region is higher during handcycling in an upright position compared to wheelchair propulsion, while the sitting pressure at the SC-region is higher during handcycling in a less upright position.The use of a honeycomb wheelchair cushion reduces the sitting pressure in the handcycle compared to a standard foam handcycle cushion.For handcyclists, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Relevance to Clinical Practice Prone positioning improves oxygenation in adults with acute respiratory distress syndrome (ARDS) and has been extensively applied in intensive care units (ICU) during the COVID‐19 pandemic. Although some complications due to the manoeuvre are well known, brachial plexus injury after prone positioning is reported as a rare complication and the phenomenon could be either very rare or underestimated.This study aimed to evaluate the effect of swimmer position during prone ventilation on the onset of brachial plexus injury in patients admitted to ICU for ARDS. The study will also evaluate the safety of prolonged prone positioning collecting data on any adverse events occurred.A prospective, observational cohort study will be conducted in a tertiary level ICU in the metropolitan area of Milano (Italy) specialized in advanced treatment of patients with ARDS. This observational study will report clinical data on the electromyography (EMG) and the muscle strength assessment, including comorbidities and cardio‐respiratory status. A baseline EMG will be performed within 2 h from the first pronation manoeuvre and immediately at the end of each pronation cycle. The functional assessment of patients will be also performed at the end of ICU stay and at hospital discharge.The primary outcome is to estimate the prevalence of brachial plexus injury in patients with ARDS placed in the swimmer position during prone ventilation. Secondary outcomes will also include the safety of the manoeuvre by evaluation of all adverse events classified as skin or ocular damage, loss of tube and vascular access and new pressure ulcers.The findings of this study will contribute to understand the possible benefits/harms of prone ventilation performed using swimmer position. Eventually, this will call for the development of specific and tailored rehabilitation programs for patients with upper limb injuries during ICU stay, including also timely follow‐up upon ICU‐discharge. [ABSTRACT FROM AUTHOR]

The objective of this systematic review was to synthesise the evidence of the impact of pressure injuries (PIs) on the health‐related quality of life (HRQoL) of adults aged 18 years and older. Electronic databases (Ovid Medline, Ovid Embase, CINAHL EBSCO, Scopus and Central Register of Controlled Trials) were searched for eligible studies published between January 2019 and April 2024. All identified articles were reviewed by two reviewers against the eligibility criteria. The risk of bias was assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Institute critical appraisal tool. Data were narratively synthesised due to methodological heterogeneity. Twenty‐two studies (12 quantitative; 9 qualitative;1 mixed methods) met the inclusion criteria. The qualitative studies were grouped into four impact areas: symptoms, physical function, psychological well‐being and social functioning. Five instruments were used to assess HRQoL and identified low scores in people with PIs, with the lowest scores mostly reported in physical functioning and role physical and emotional concepts. A complexity of factors influenced theHRQoL of people with PI. This review synthesised both quantitative and qualitative evidence indicating PI was associated with low HRQoL scores and negatively affected all aspects of HRQoL. This review emphasised the complexity of factors related to PI and its impact on HRQoL. Further emphasis on the impact of the complexity of factors on HRQoL of people with PI should be considered in future studies. [ABSTRACT FROM AUTHOR]

Developing machine learning (ML) methods for healthcare predictive modeling requires absolute explainability and transparency to build trust and accountability. Graphical models (GM) are key tools for this but face challenges like small sample sizes, mixed variables, and latent confounders. This paper presents a novel learning framework addressing these challenges by integrating latent variables using fast causal inference (FCI), accommodating mixed variables with predictive permutation conditional independence tests (PPCIT), and employing a systematic graphical embedding approach leveraging expert knowledge. This method ensures a transparent model structure and an explainable feature selection and modeling approach, achieving competitive prediction performance. For real-world validation, data of hospital-acquired pressure injuries (HAPI) among individuals with spinal cord injury (SCI) were used, where the approach achieved a balanced accuracy of 0.941 and an AUC of 0.983, outperforming most benchmarks. The PPCIT method also demonstrated superior accuracy and scalability over other benchmarks in causal discovery validation on synthetic datasets that closely resemble our real dataset. This holistic framework effectively addresses the challenges of mixed variables and explainable predictive modeling for disease onset, which is crucial for enabling transparency and interpretability in ML-based healthcare. [ABSTRACT FROM AUTHOR]

Aim Background Methods Results Conclusion Implications for nursing and health policy To explore the relationship between patient safety management and each aspect of nurses’ workload and to report the moderating effects of the perceived importance of patient safety management on these relationships.As the importance of patient safety is emphasized, nurses’ work demands, including patient identification, infection control, and prevention of falls and pressure ulcers, are increasing. However, differences according to hospital type and nurses’ increased workload have not been considered when measuring nurses’ workload.This study used a cross‐sectional research design and an online survey, adhering to the STROBE reporting guidelines. The study population consisted of 215 shift‐work nurses employed in tertiary or general hospitals in Korea. Data were collected in January 2024.Patient safety management activities had a positive effect on the pace and amount of work, emotional workload, and mental workload, and a negative effect on work organization (interruption). The perceived importance of patient safety management negatively moderated the effects of perceived patient safety management activities on emotional workload and work organization.This study clarifies the relationship between patient safety activities and each aspect of nurses’ workload. The additional demands on nurses due to patient safety management activities should be considered when measuring their workloads and determining adequate nurse staffing levels.To manage the burden of nurses’ work demands effectively, it is essential to maintain adequate staffing levels and continuously monitor the patient safety climate. This approach will increase nurses’ perception of the importance of patient safety management. Continuous education on patient safety should also be provided. [ABSTRACT FROM AUTHOR]

The Wound Care Association UK (WCAUK) is committed to supporting both the accurate and consistent delivery and reporting of pressure ulcers/injuries based on the best available research and evidence. It is known that strategic and clinical guidance to support the delivery of evidence-based care does have a significant impact. Recent proposals to change pressure ulcer categorisation led the WCAUK to undertake a questionnaire survey of its members. This article outlines the importance of evidence-based guidance on the categorisation and assessment of pressure ulcer, highlighted by the responses to published changes to pressure ulcer categorisation for nurses in England, and presents the results of the survey. The article concludes that, although the discipline of tissue viability is constantly developing, the changes must be based on evidence, and clinicians must be supported strategically and practically to implement any proposed changes. Since publication of the new guidance the document has become the subject of further discussion, following concerns raised by tissue viability nurse specialists with strategic responsibility for change, as well as generalists who are expected to implement the changes. [ABSTRACT FROM AUTHOR]

Pressure injuries, also known as pressure ulcers or 'bed sores', are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS. [ABSTRACT FROM AUTHOR]

Aim Design Method Results Conclusion The purpose is to develop a care package for the prevention of medical device‐related pressure injuries using the Delphi Method.The study is a methodological.The care package was developed using the Delphi Method, a consensus‐based technique. Two expert groups were selected to develop the care package to prevent medical device‐related pressure injuries. The invitation letter and the questionnaire consisting of two questions were sent to the relevant experts via email and completed in three rounds after receiving responses. The scores from the experts were uploaded to the SPSS 25.0 software package. The range (R) was calculated as R = Q3‐Q1. The differences (R) between the quartiles were examined. Items with R < 1.2 were accepted as having reached a consensus.As a result of the evaluation, it was organized as 83 items. As a result of the analysis of the scores of the second round of the Delphi Method, the range values of each item were examined. In the third round of the Delphi Method, it was found that consensus was reached in the third round on items 18, 29, and 56, on which consensus could not be reached in the second round, and the care package was accepted with 83 items.An 83‐item care package was created to prevent medical device‐related pressure injuries in children. [ABSTRACT FROM AUTHOR]

Background: Pressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps. Methods: A retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics. Results: In this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate. Conclusion: Closed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care. Trial registration. The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023). [ABSTRACT FROM AUTHOR]

Interleukin‐33 (IL‐33) is an alarmin released upon epithelial tissue damage. It functions as a nuclear factor for regulating gene expression. We hypothesised that IL‐33 is involved in the formation of decubitus ulcers through damaged epidermis. Therefore, this study aimed to clarify the mechanism of IL‐33 action in decubitus ulcer formation. IL‐33 knockout (KO), soluble stimulation‐2 (ST2) transgenic, and wild‐type (WT) mice were used to construct an ischemia–reperfusion (I/R) injury as a decubitus model. The ulcer area was significantly reduced in IL‐33 KO mice compared to WT mice but was not reduced in ST2 transgenic mice. Anti‐IL‐33 receptor (transmembrane ST2) antibodies effectively prevented ulcer formation; however, an anti‐IL‐33 neutralising antibody was ineffective. The number of infiltrating macrophages was higher, while that of neutrophils and mast cells was lower in IL‐33 KO mice than in WT mice. The number of M2 macrophages increased in IL‐33 KO mice. Characterisation of gene expression levels revealed significantly reduced interleukin‐1 beta (IL‐1β) and increased C‐C motif chemokine ligand 17 expression in IL‐33 KO mice. Macrophages isolated from ulcers in WT or IL‐33 KO mice stimulated with exogenous IL‐33 produced comparable amounts of IL‐1β. In conclusion, our study indicates that IL‐33 is released in response to I/R injury in the skin, contributing to inflammatory macrophage and mast cell infiltration and stimulation, resulting in IL‐1β production and the massive infiltration of effector cells, including neutrophils, which finally induces decubitus ulcer formation. These results suggest that suppressing IL‐33 expression could be beneficial for treating early‐phase decubitus ulcers. [ABSTRACT FROM AUTHOR]

Background: Adult Changes in Thought (ACT), a prospective cohort study, enrolls older adult members of Kaiser Permanente Washington. We describe an ambitious project to abstract medical records facilitating epidemiological investigation. Methods: Abstracted data include medications; laboratory results; women's health; blood pressure; physical injuries; cardiovascular, neurological, psychiatric and other medical conditions. Results: Of 1419 of 5763 participants with completed abstractions, 1387 (97.7%) were deceased; 602 (42.4%) were diagnosed with Alzheimer's Disease and Related Dementias; 985 (69.4%) had a brain autopsy. Each participant had an average of 34.3 (SD = 13.4) years of data abstracted. Over 64% had pharmacy data preceding 1977; 87.5% had laboratory data preceding 1988. Stroke, anxiety, depression and confusion during hospitalization were common among participants diagnosed with dementia. Conclusions: Medical records are transformed into data for analyses with outcomes derived from other ACT data. We provide detailed, unparalleled longitudinal clinical data to support a variety of epidemiological research on clinical-pathological correlations. [ABSTRACT FROM AUTHOR]

Slough is a well‐known feature of non‐healing wounds. This pilot study aims to determine the proteomic and microbiologic components of slough as well as interrogate the associations between wound slough components and wound healing. Ten subjects with slow‐to‐heal wounds and visible slough were enrolled. Aetiologies included venous stasis ulcers, post‐surgical site infections and pressure ulcers. Patient co‐morbidities and wound healing outcome at 3‐months post‐sample collection was recorded. Debrided slough was analysed microscopically, through untargeted proteomics, and high‐throughput bacterial 16S‐ribosomal gene sequencing. Microscopic imaging revealed wound slough to be amorphous in structure and highly variable. 16S‐profiling found slough microbial communities to associate with wound aetiology and location on the body. Across all subjects, slough largely consisted of proteins involved in skin structure and formation, blood‐clot formation and immune processes. To predict variables associated with wound healing, protein, microbial and clinical datasets were integrated into a supervised discriminant analysis. This analysis revealed that healing wounds were enriched for proteins involved in skin barrier development and negative regulation of immune responses. While wounds that deteriorated over time started off with a higher baseline Bates‐Jensen Wound Assessment Score and were enriched for anaerobic bacterial taxa and chronic inflammatory proteins. To our knowledge, this is the first study to integrate clinical, microbiome, and proteomic data to systematically characterise wound slough and integrate it into a single assessment to predict wound healing outcome. Collectively, our findings underscore how slough components can help identify wounds at risk of continued impaired healing and serves as an underutilised biomarker. [ABSTRACT FROM AUTHOR]

Background: The pandemic profoundly stressed practicing nurses and could have thereby affected trends in nursing-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. Objectives: The aim of the study was to determine if NSIs have worsened in response to the pandemic and then returned to prepandemic levels using data from 2019 through 2022. Methods:We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. Results: In decreasing order of prevalence, the mean prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% increase in CAUTI to 49% for CLABSI. Discussion: NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to examine the changes in the burden of secondary health conditions and their risk factors among newly injured individuals with spinal cord injury after discharge from inpatient rehabilitation to community living. Design: This is a prospective cohort study. Results: Among 280 included persons, the majority were men with traumatic spinal cord injury and paraplegia. The most common secondary health conditions at discharge from rehabilitation and in the community setting were pain (60.8%vs. 75.9%), urinary tract infections (27.8% vs. 47.6%), and pressure sores (9.9% vs. 27.5%). Therewas also a significant increase in reported heart disease (9.3% vs. 14.8%) and diabetes (0% vs. 4.2%). The odds of experiencing pain, pressure sores, depression and urinary tract infections increased after discharge from rehabilitation, whereas the odds of respiratory problems decreased significantly during the observation period. Factors such as sex, injury severity, activity limitations, and duration of follow-up were identified as potential risk factors influencing secondary health condition occurrence. Conclusions: Our study emphasizes a significant rise in secondary health conditions after the transition to community living. Future research should prioritize development of targeted intervention programs tailored to address the unique needs of affected individuals at this pivotal stage in the continuum of spinal cord injury care. [ABSTRACT FROM AUTHOR]

Aim: To measure the prevalence and incidence of nursing home‐acquired pressure injuries in older adults residing in Sri Lankan nursing homes. Background: Pressure injury prevalence and incidence are indicators of safety and quality of care. A significant portion of the global population has a skin color dominated by the presence of melanin. Yet, the number of nursing home residents with darker skin tones who develop pressure injuries in nursing homes is relatively unknown. Design: Prospective multisite cohort study conducted in nine nursing homes in Sri Lanka. The sample comprised 210 residents aged ≥60 years old. Methods: Semi structured observations and chart audits were used to gather data from July to October 2023. Head‐to‐toe visual skin assessment to check for nursing home‐ acquired pressure injuries, Braden pressure injury risk scale and Fitzpatrick skin tone assessments were conducted on all recruited residents at baseline. All recruited residents were followed‐up weekly for 12 weeks until detection of a new pressure injury, death, discharge, or transfer. Results: Pressure injury point prevalence at baseline was 8.1% (17/210). Cumulative incidence was 17.1% (36/210). Incidence density was 15.8 per 1000 resident weeks. Most nursing home‐acquired pressure injuries were located on the ankle at baseline (29.4%; 5/17) and in the follow‐up period (27.8%; 10/36). Stage I pressure injuries were most common: 58.8% (10/17) and 44.4% (16/36) at baseline and during follow‐up respectively. Conclusions: About one in six nursing home residents developed a new pressure injury over the 12‐week follow‐up period. Despite staff and resource constraints, there remains a need to focus on the prevention of pressure injuries in Sri Lankan nursing homes. Clinical Relevance: Studies on the burden of pressure injuries among darker skin tone nursing home residents are lacking and the current evidence available are predominantly from Western countries. The findings of this study highlight the need of targeted preventive measures for nursing home residents with darker skin tones. [ABSTRACT FROM AUTHOR]

Background: Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric‐pertinent data, are limited. Methods: The ACS NSQIP geriatric database (2014–2018) was used to abstract older adults (≥65 years) undergoing inpatient general surgery procedures. Thirty‐day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric‐pertinent complications: delirium and new/worsening pressure ulcers. Results: There were 9062 patients; 41.9% were ≥75 years. Mean age was 73.9 years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30‐day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric‐pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound‐related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality. Conclusions: Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement. [ABSTRACT FROM AUTHOR]

This study investigates the functionality and feasibility of a novel smart seat cushion system designed for wheelchair users with spinal cord injuries. The cushion, equipped with air cells that serve as both sensors and actuators, was tested on 24 participants for its real-time pressure mapping, automated pressure redistribution, and pressure offloading functions. A commercial pressure mat was concurrently used to validate the cushion's pressure modulation functions. Additionally, the perceived comfort of the cushion was evaluated using General Discomfort Assessment (GDA) and Discomfort Intensity (DIS) scores, which provided insights into participants' overall comfort and discomfort levels. Real-time pressure profiles generated by the cushion resembled commercial pressure mat readings. During tests with individuals with spinal cord injury, the cushion was able to dynamically generate and display the real-time pressure profile of a seated individual with strong precision (correlation to commercial pressure mat: r ranging from 0.76 to 0.88), providing effective input into pressure modulation functions. Pressure redistribution algorithms eliminated peak pressure and reduced the overall pressure at the interface. Pressure offloading algorithms automatically identified the regions with the highest interface pressure and subsequently relieved the pressure from those areas. User feedback showed that the cushion was comfortable after redistribution and offloading. This work demonstrated the feasibility of an advanced smart seat cushion system for wheelchair users with spinal cord injuries. The cushion was capable of redistributing pressure evenly across the seating surface, ensuring user's comfort. Additionally, it identifies and eliminates high-pressure points, further improving comfort and reducing the risk of pressure injuries. IMPLICATIONS FOR REHABILITATION: Majority of wheelchair users acquire pressure injuries in their lifetime, where the magnitude and duration of sitting interface pressure are major contributing factors to develop pressure injuries. Compliant cushions and frequent weight shifting can reduce the magnitude and duration of sitting interface pressure; however, the long-term effectiveness of these cushions and the user's lack of compliance to the weight shifting protocols impact their efficacy drastically. An automated cushion system that can reduce the magnitude of the pressure based on the user's current pressure profile and offload pressure from vulnerable areas would improve the effectiveness of the cushion and compensate for poor adherence to weight shifting protocols. Automated solutions will significantly improve the quality of care provided to wheelchair users and reduce the risk of developing pressure injuries. [ABSTRACT FROM AUTHOR]

AbstractSustained mechanical loading on skeletal muscle tissue can lead to degeneration and cell damage over time, resulting in the development of pressure ulcers, particularly in hospital mattresses or for wheelchair-bound users. The primary risk factors for this damage are tissue ischemia caused by pressure in the contact area and tissue compressive strain. In this study, a multi-cell, multi-material foam mattress for the upper comfort layer was developed, with the aim of simultaneously minimizing soft tissue compressive strain and maximum surface pressure on the human buttocks zone. The levels of these factors were estimated using the finite element method (FEM). A multi-objective optimization (MOO) approach was employed, coupling the non-dominated sorting genetic algorithm (NSGA-II) with FEM. This algorithm helped determine the required compressive strength and the optimal cell configurations to achieve the desired outcomes. The majority of the optimal solutions exhibited contact pressures (Cpresss) below the recommended threshold to avoid local tissue ischemia. The optimized cellular material configurations resulted in soft tissue compressive strain of 12% and Cpress of 3.4 kPa, indicating longer safety times for supine support on the foam mattress without the need for repositioning. The optimization process utilized 5 softer foam materials out of the 9 firmness levels tested to achieve these results. The proposed multi-cell, multi-material foam mattress model shows promise for the prevention of pressure sores, as suggested by the optimization findings. [ABSTRACT FROM AUTHOR]

Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'. Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9‐year period. Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30‐day readmission rate and inpatient mortality. Results: There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries. Conclusions: Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity. [ABSTRACT FROM AUTHOR]

Background: Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. Aim: This study investigated the incidence of, characteristics of and risk factors for ETT‐related pressure injuries for ICU patients. Study Design: This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube‐Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. Results: The study revealed that 80.14% of the patients developed ETT‐related pressure injuries. Over half of the ETT‐related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT‐related pressure injuries (OR: 1.15, 95% CI: 1.05–1.26, p =.003). None of the other variables were statistically significant in the development of pressure injuries. Conclusions: The incidence of ETT‐related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT‐related pressure injuries. Intensive care nurses should implement interventions to prevent ETT‐related pressure injuries in critically ill patients receiving mechanical ventilation support. Relevance to Clinical Practice: ETT‐related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT‐related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT‐related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used. [ABSTRACT FROM AUTHOR]

Background: Nurses are vital in identifying and preventive pressure injuries (PIs) in hospitalized patients undergoing open heart surgery. Interventions to prevent PIs are crucial for every critical patient, and it's essential to recognize that preventing PIs involves a complex intervention. Aim: To examine the nursing interventions for the prevention of PI in patients with open heart surgery. Method: A systematic review study. Web of Science, Science Direct, PubMed, Scopus, MEDLINE Ultimate, CINAHL Ultimate, ULAKBIM, Cochrane Library, Google Scholar and university library databases were scanned. The initial search performed in the databases was updated on 4 February 2023, and on 7 April 2024, for potential publications included in that period. Data between February 2013 and April 2024 were scanned. The databases were searched with the keywords 'pressure injury', 'nursing interventions' and 'open heart surgery'. The systematic compilation process was carried out in accordance with the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guide. Results: Seventeen studies were examined using nursing interventions that applied to the selected study population. Care packages included an inflatable head pad, a pressure sensor mattress cover, multi‐layer silicone foam, pressure‐reducing coatings, endotracheal tube (ETT) repositioning and cuff pressure regulation. Interventions to reduce PI in open heart surgery patients are applied in the preadmission, perioperative and postoperative periods. Conclusion: It was concluded that care packages, inflatable head pads, pressure sensor bedspreads, multi‐layered silicone foam, pressure‐reducing covers, ETT repositioning and cuff pressure regulation were effective in all nursing interventions. The strength of the available evidence was rated from strong to weak. Relevance to Clinical Practice: These findings reveal an efficient combination of multi‐component nursing interventions for preventing PIs in planning patient care in the intensive care. The interventions that are used throughout the patient's entire care process are crucial for the prevention of PIs. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness. Aim: To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive‐related skin injury (MARSI) associated with the securement device. Study Design: Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in‐house device piloted as part of this trial. Controls (n = 181) received standard care, including non‐securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log‐rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups. Results: Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%. Conclusion: Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in‐house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement. Relevance to Clinical Practice: Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in‐house devices is safe and effective. [ABSTRACT FROM AUTHOR]

Background: Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. Aim: This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. Methods: This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP‐EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. Results: In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91–2.59). There were significant differences between the right foot (99%; F = 99.229; p =.000) and left foot (99%; F = 100.519; p =.000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). Conclusion: The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. Relevance for Clinical Practice: This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures. [ABSTRACT FROM AUTHOR]

Background: Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. Aim: The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. Study Design: This was an observational prospective study undertaken over a period of 1 year (July 2021–June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. Results: Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872–0.942); 0.881 (0.842–0.920); 0.877 (0.835–0.920) and 0.749 (0.667–0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high‐risk group (>13 points). Conclusions: The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. Relevance for Clinical Practice: Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level. [ABSTRACT FROM AUTHOR]

Background: Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment. Aim: The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates. Methods: This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment. Results: A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates. Conclusion: Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations. Relevance to Clinical Practice: In the context of neonatal skin, with its unique characteristics and heightened risk for injury, clinicians must stage, categorise, and describe injury locations to provide objective information on injury severity. Given the risk for injuries across the entire body, including mucous membranes, describing the depth of the injury is essential regardless of the anatomical site. Although not originally designed for this population, a modified version of the National Pressure Injury Advisory Panel (NPIAP) classification system, which incorporates additional classifications (e.g., skin tears), remains the most applicable severity assessment system currently available. This should be supplemented by clinical images or detailed descriptive language (e.g., subtle redness) until rigorously validated severity and assessment scales, based on neonatal data, are developed—particularly for infants born at less than 27 weeks gestation. [Correction added on 25 October 2024, after first online publication: The Relevance to Clinical Practice subsection in Abstract has been added on this version.] [ABSTRACT FROM AUTHOR]

Context The safety and efficacy of nutritional management for pressure injuries (PIs) have been the subjects of ongoing interest. Some evidence demonstrated that nutrition is essential for skin and tissue viability, supporting tissue repair for healing the pressure injury. Objective This investigation aimed to systematically review clinical practice guidelines (CPGs) for the nutritional management of PIs and furnish an evidence map to assess research trends and CPG gaps. Methods The PubMed, Embase, and guidelines databases, and society websites were searched for CPGs for the nutritional management of PIs. The basic recommendations for the nutritional management of PIs, method quality, and reporting CPGs quality were identified and imported into Excel. Four researchers independently elucidated each CPG's quality via the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. All bubble charts were generated using Excel software. Results This review included 12 CPGs with a combined 23 recommendations. The nutrition screening and assessment were summarized on the basis of the PI recommendations for 6 major items, 12 items on nutrition management, and 3 on PI education. The assessed CPGs had mixed quality, and the highest score  ± standard deviation based on the clarity of presentation was 83.46 ± 7.62, whereas the lowest mean score based on AGREE II applicability was 53.31 ± 16.90. Field 1 (basic information) in the RIGHT checklist had the greatest reporting rate (68.06%), whereas field 5 (review and quality assurance) had the lowest CPGs quality (41.67%). Conclusion This investigation furnishes an evidence map and provides new perspectives on the CPGs for the nutritional management of PIs. However, the CPGs included still need improvement, especially in the applicability and editorial independence domains. [ABSTRACT FROM AUTHOR]

Aim: To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. Design: Interrater agreement study. Methods: Data were collected from November 2019 to December 2022. Paired nurse‐assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence‐adjusted and bias‐adjusted kappa. Results: Ninety‐four nurse assessors participated. Absolute agreement of not‐at‐risk versus at‐risk‐any‐level was substantial, but absolute agreement of risk‐level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower‐risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher‐risk patients. Conclusion: There were clear differences in pressure injury risk‐level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation. Impact: The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool. Reporting Method: This study adhered to the GRRAS reporting guideline. Patient/Public Contribution: No patient or public involvement in this study. Implications for the profession and/or patient care: Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention. [ABSTRACT FROM AUTHOR]

Aim: To examine the personal experiences and perceptions of people with dark skin tones and their carers, in relation to pressure injury. Design: Qualitative study using semi‐structured interviews. Methods: Twenty‐two interviews with people with dark skin tone and/or their family carers, who were known to and visited by community nurses for pressure area management or who had been identified as being at high risk for developing a pressure injury were carried out. Results: Thematic analysis of the interview transcripts revealed that skin discolouration towards a darker hue than usual was the commonest symptom identified by participants as a sign of altered skin integrity and potential pressure damage. Four main overarching themes were revealed through comprehensive analysis of the transcripts: (1) indicators of pressure injury; (2) experienced symptoms of pressure damage; (3) trust in healthcare workers; and (4) improving care for populations with dark skin tones. Conclusion: The findings from this study clearly present how early‐stage pressure damage is identified among people with dark skin tones. Implications for the Profession and/or Patient Care: These findings have the potential to reduce health inequality by influencing and informing clinical policies and strategies in practice. Findings could also lead to the development of patient‐informed educational strategies for nurses and health workers which will enable the early identification of pressure ulcers among people with dark skin tones. Further research is needed to better understand health disparities in relation to preventable patient safety harm. Impact: The findings demonstrate the importance of engaging with and listening to the stories and experiences of people living with pressure damage to help in the early recognition of pressure injuries. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed. Patient or Public Contribution: A project steering group reviewed information sheets for participants and checked the interview questions were relevant and suitable. [ABSTRACT FROM AUTHOR]

Individuals in the community with reduced mobility are at risk of exposure to prolonged lying and sitting postures, which may cause pressure ulcers. The present study combines continuous pressure monitoring technology and intelligent algorithms to evaluate posture, mobility, and pressure profiles in a cohort of community dwelling patients, who had acquired pressure ulcers. This study represents a secondary analysis of the data from the Quality Improvement project 'Pressure Reduction through COntinuous Monitoring In the community SEtting (PROMISE)'. 22 patients with pressure ulcers were purposely selected from 105 recruited community residents. Data were collected using a commercial continuous pressure monitoring system over a period of 1–4 days, and analysed with an intelligent algorithm using machine learning to determine posture and mobility events. Duration and magnitude of pressure signatures of each static posture and exposure thresholds were identified based on a sigmoid relationship between pressure and time. Patients revealed a wide range of ages (30–95 years), BMI (17.5–47 kg/m2) and a series of co-morbidities, which may have influenced the susceptibility to skin damage. Posture, mobility, and pressure data revealed a high degree of inter-subject variability. Largest duration of static postures ranged between 1.7 and 19.8 h, with 17/22 patients spending at least 60 % of their monitoring period in static postures which lasted >2 h. Data revealed that many patients spent prolonged periods with potentially harmful interface pressure conditions, including pressure gradients >60 mmHg/cm. This study combined posture, mobility, and pressure data from a commercial pressure monitoring technology through an intelligent algorithm. The community residents who had acquired a pressure ulcer at the time of monitoring exhibited trends which exposed their skin and subdermal tissues to prolonged high pressures during static postures. These indicators need further validation through prospective clinical trials. • Community-dwelling individuals experience prolonged periods of static lying postures. • A novel sigmoid threshold analysis has been used to identify the magnitude and exposure to prolonged postures. • Combination of continuous pressure monitoring and algorithms could provide feedback to support patient centred care for PU risk. [ABSTRACT FROM AUTHOR]

Pressure Injuries are a prevalent and concerning issue in critical care settings, impacting patient well-being and healthcare systems. Measure the point prevalence of acquired pressure injuries in Omani critical care units and assess the adequacy of preventive measures. A multicenter cross-sectional survey was conducted in four major Omani hospitals, encompassing various geographical regions and health sectors. A convenient sample of 156 adult patients in critical care units was examined using the European Pressure Ulcer Advisory Panel methodology. Data on prevalence, risk assessment, and prevention measures were collected and analyzed. The study revealed a prevalence rate of 21.8 % for hospital-acquired pressure injuries (including stage I) and 19.2 % (excluding stage I) in Omani critical care units. The sacrum was the most affected area, with stage II being predominant. Alarmingly, some at-risk patients did not receive appropriate preventive equipment, while low-risk patients received unnecessary measures. Approximately 73.3 % of at-risk patients received adequate prevention. This pioneering study in Oman addresses the prevalence of Pressure Injuries, revealing rates that are higher than international norms. Additionally, the research underscores deficiencies in preventive measures, such as inadequate prevention for at-risk patients and unnecessary measures for low-risk individuals. • Omani critical care units show a higher prevalence of pressure injuries, including stage I, than international norms. • Research finds gaps in PI prevention: some at-risk patients lacked care, while low-risk patients received unnecessary care. • Study shows need for risk assessment in PI prevention, revealing many at-risk patients lacked proper preventive measures. [ABSTRACT FROM AUTHOR]

The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20–2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00–1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04–2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03–2.00 if LOS 90–260 h, OR = 2.34, 95 % CI: 1.63–3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment. • The overall prevalence of pressure ulcers (PUs) was 15.3%, with ICU-acquired PUs at an incidence of 14.1%. • The front of the body had most pressure ulcers (45.35%), with 38.40% in Category 2 and 22.71% in Category 3. • Patients with COVID-19 are almost twice as likely to develop pressure ulcers compared to those without the virus (OR=1.58). • Age, COVID-19, mec. ventilation, vasopressors, Braden score ≤16, and stay length are linked to ICU-acquired pressure ulcers. [ABSTRACT FROM AUTHOR]

Background: Approximately 2.5 million hospital visits in the United States are due to pressure injuries (PIs), costing $11 billion and resulting in 60,000 deaths annually. Objective: The objective of the study is to decrease the incidence of PIs in a hospital setting using Situation, Background, Assessment, Recommendations, Wounds (SBARW) report sheets, turn clocks, and team engagement in a nurse-led quality improvement initiative. Methods: Four rapid Plan–Do–Study–Act cycles were implemented over 8 weeks. Aggregate data, run charts, staff feedback, and field notes were studied and guided new tests of change for each cycle. Results: The incidence of PIs decreased from a baseline of 40% to 17% over the 8-week period, which exceeded the goal of 20%. The average mean prevention score reached 74%, from a baseline of 45%. Skin assessment documentation increased from a baseline of 35% to 95%. Conclusions: The project was successful; the aim was exceeded through utilizing the best practice guidelines and toolkits, implementation of tools, and team participation. The project improved safety and communication while maintaining cost-effectiveness. Implications for Nursing: The SBARW and care audit tools can support the best practices to reduce PI incidence and show promise for improving quality nursing care. [ABSTRACT FROM AUTHOR]

Although widely considered to be preventable, pressure ulcers (PU) are common and cause a significant burden to the individual, their carers and healthcare services. International collaborative panels publish consensus documents and guidelines aiming to standardize PU classification, assessment and management. There is a huge emphasis on prevention, which requires awareness and education for clinicians, patients and carers. Surgeons may be referred patients with PU for advice on surgical options or management of infected wounds. Surgical patients may develop PU after prolonged surgical procedures, during periods of critical illness or in association with their surgical condition. Additionally, as some PU become chronic and non-healing, individuals with PU may be referred for assessment of other medical issues. An awareness and understanding of PU aetiology, management strategies and complications are therefore important for the surgical trainee. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the changing perceptions of Korean care workers regarding a robotic bed designed to assist with repositioning and prevent pressure ulcers. With the primary aim of assessing the technology acceptance among care workers using the robotic bed to solve the problem of a shortage of care workers in Korea, we sought to examine the possibility of applying care robots in the field. Methods: A total of 20 long-term care workers participated in the experiment, and their attitudes were measured before and after using the robot. Frequency analysis and paired t-tests were conducted using Stata 17 to analyze the data. Results: The results show significant changes in the perceived ease of use (PEOU), facilitating conditions (FCs), and gerontology anxiety (GA), with the PEOU increasing by 19.87%, FC increasing by 20.63%, and GA decreasing by 17.2%. However, there was no significant change in the perceived usefulness (PU) and intention to use (IU). Conclusions: The results showing that the perception of technology acceptance changed significantly mean that the use of the care robot means that there is a high possibility of positive perceptions in Korean care settings when care robots are distributed in the field in the future, considering that the experimental environment was limited due to the early stage of development of care robots. This study highlights the need for practical demonstrations and thorough training to improve technology acceptance among care workers before the application of care technology in the long-term care environment in South Korea. [ABSTRACT FROM AUTHOR]

The article discusses the management of end-stage chronic limb-threatening ischaemia (CLTI), focusing on symptom relief and maintaining quality of life for patients not eligible for revascularisation. Topics include conservative management strategies, pain management approaches, and the importance of a multidisciplinary care team.

Aims: The aim of this study was to evaluate the relationship between hip fractures and pressure ulcers in patients aged 65 and over, and to determine the risk factors associated with pressure ulcer development. Methods: Patients aged 65 and over treated for femur neck fracture and pertrochanteric femur fracture at Trakya University School of Medicine, Department of Orthopedics between January 2021 and December 2022 were included in this retrospective, cross-sectional study. Patients' age, gender, type of fracture, date of fracture, date of hospital admission, surgery date, comorbidities, medications, use of anti-decubitus mattresses, body mass index, location of pressure ulcers, grade, and Pressure Ulcer Scale for Healing scores according to the National Pressure Ulcer Advisory Panel were obtained. Results: Pressure ulcers developed in 21 (7.6%) of the 276 patients, and multiple pressure ulcers developed in 6 (2.2%) patients. The mean preoperative waiting time was 9.1 days for patients who developed pressure ulcers. No significant relationship was found between gender, presence of comorbidities, and pressure ulcer development, including multiple ulcers. A significant relationship was found between the type of fracture and pressure ulcer development. Conclusion: Etiology, pathophysiology, risk factors, and preventive measures against the development of pressure ulcers are well described. This study emphasizes the relationship between the type of hip fracture and the development of pressure ulcers. [ABSTRACT FROM AUTHOR]

According to Tamara Chilver, author and home-schooling mum: "fun + learning = the best educational experience." This article describes how the tissue viability team in Glasgow set about introducing a fun element into wound care education. The article also includes practical guidance on some of the games played by delegates at the education sessions. [ABSTRACT FROM AUTHOR]

Pressure ulcers are recognised as one of the top 10 harms in the NHS, and over the years, there have been a number of approaches to investigating these, the most recent being the Serious Incident Framework which classified higher-grade pressure ulcers as Serious Incidents (SI) and subject to Root Cause Analysis investigations. However, it became clear that the resources deployed in conducting these investigations were not proportionate to the outcomes in terms of reduction of harm. So in 2022 NHS England brought in a new approach, known as Patient Safety Incident Response Framework. This article describes one community provider's experience of implementing this framework and comparing it with the previous SI system. Key differences and benefits are outlined. [ABSTRACT FROM AUTHOR]