Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management.

Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.

Perceptions of research integrity climate differ between academic ranks and disciplinary fields: Results from a survey among academic researchers in Amsterdam.

Breaches of research integrity have shocked the academic community. Initially explanations were sought at the level of individual researchers but over time increased recognition emerged of the important role that the research integrity climate may play in influencing researchers' (mis)behavior. In this study we aim to assess whether researchers from different academic ranks and disciplinary fields experience the research integrity climate differently. We sent an online questionnaire to academic researchers in Amsterdam using the Survey of Organizational Research Climate. Bonferroni corrected mean differences showed that junior researchers (PhD students, postdocs and assistant professors) perceive the research integrity climate more negatively than senior researchers (associate and full professors). Junior researchers note that their supervisors are less committed to talk about key research integrity principles compared to senior researchers (MD = -.39, CI = -.55, -.24). PhD students perceive more competition and suspicion among colleagues (MD = -.19, CI = -.35, -.05) than associate and full professors. We found that researchers from the natural sciences overall express a more positive perception of the research integrity climate. Researchers from social sciences as well as from the humanities perceive less fairness of their departments' expectations in terms of publishing and acquiring funding compared to natural sciences and biomedical sciences (MD = -.44, CI = -.74, -.15; MD = -.36, CI = -.61, -.11). Results suggest that department leaders in the humanities and social sciences should do more to set fairer expectations for their researchers and that senior scientists should ensure junior researchers are socialized into research integrity practices and foster a climate in their group where suspicion among colleagues has no place.