The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis.

The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance collaboratively developed three editions of the International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries in 2009, 2014, and 2019. Dissemination and uptake of these guidelines are important to improve care. The aim of this work was to provide an updated and expanded citation analysis of the three published guidelines. Referencing formats, citation counts, and global distribution of citations of the 2009, 2014, and 2019 guidelines were searched in the citation database Scopus from 2009 to 2023. Duplicates were removed manually. The search identified 330 referencing formats with 2887 citations from 2009 to 2023 for the three guideline editions. Citations displayed geographical diversity, with citation peaks observed approximately 4 years after each edition's release and ongoing citations to the present. The International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries updated since 2009 were cited more than 2800 times in the scientific literature exceeding the thresholds of highly cited papers in the field of clinical medicine. This indicates successful dissemination worldwide.

Exploring the effects of lateral pressure to the soft tissue of the buttocks during seating to preserve tissue perfusion.

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

Peer support as pressure ulcer prevention strategy in special school learners with paraplegia.

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

Formative qualitative evaluation of an improvement programme delivered in an English hospital trust to reduce harm from pressure ulcers.

BackgroundPressure ulcers (PUs) are a leading cause of preventable harm globally and can cause patients significant pain, infection and, in rare incidents, death. There is a strong evidence base for how to improve PUs and one UK healthcare trust used this evidence to develop a quality improvement (QI) programme using the Institute of Healthcare Improvement's Breakthrough Series collaborative model. 20 teams, from both acute and community settings, participated in the first two phases of the collaborative. The delivery of both phases used virtual delivery using the Institute of Healthcare Improvement's improvement model. This study sought to formatively evaluate the early phases of the collaborative, to support learning and continual improvements to the collaborative programme and other collaboratives delivered by the organisation based on the formative evaluation. METHODS: Semi-structured interviews were conducted with purposively sampled participants to explore their perspectives about the implementation of the programme, interventions tested as part of the 'change package' provided and the pandemic's impact. RESULTS: A total of seven participants were interviewed, including acute ward managers, a charge nurse (deputy ward manager), a wound healing community nurse and a team leader community nurse. Interview durations varied from 9 min to 28 min. The interviews were kept short and stopped when data saturation was achieved as it was an extremely pressurised time for the organisation where the highest escalation alert was triggered on numerous occasions. CONCLUSION: A sustained reduction in PUs was achieved during the evaluation period and participants felt that the approach helped to achieve this, regardless of the adaptations made to the delivery method due to the pandemic. To support improvements, it is vital to ensure systems such as data collection are accurate and timely. The necessity for building strong foundations for QI capability must not be underestimated, as greater QI knowledge leads to better engagement and outcomes.

Causal association of micronutrients and supplements with pressure ulcer: A Mendelian randomization study.

BACKGROUND: Pressure ulcer (PU) is known to be associated with abnormalities of micronutrient status. However, to date, it is not clear whether a causal relationship exists between circulating levels of micronutrients and their supplementations and PU. METHODS: A two-sample Mendelian randomization (MR) study was conducted using summary statistics from Genome-Wide Association Studies (GWAS). Genetic instrumental variables (IVs) for 13 micronutrients were identified from a GWAS of 67 582 participants, IVs for supplement zinc were acquired from 18 826 cases and 44 255 880 controls, and IVs for PU were obtained from 663 PUs and 207 482 controls. The MR analysis was conducted using the MR base platform. The main analysis method was inverse variance weighted (IVW) analysis, supplemented by MR Egger, Weighted median, Weighted mode, and Simple mode analyses. Heterogeneity was assessed using Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger. Pleiotropy was determined by the MR-Egger regression. Sensitivity analysis was conducted using the leave-one-out method, and publication bias was evaluated using funnel plots. RESULTS: Genetically predicted lower circulating zinc levels were found to be causally linked to the development of PU (OR = 0.758, 95%CI 0.583-0.987, P = 0.040). However, there was no significant evidence of a causal relationship between supplemental zinc intake and PU development (P > 0.05). Additionally, no causal association was observed between the other circulating micronutrients and the occurrence of PU. Furthermore, there was no indication of horizontal pleiotropy or heterogeneity among genetic variants (P > 0.05), and the robustness of the findings was confirmed through leave-one-out tests and funnel plots. CONCLUSIONS: Our findings indicate a potential causal association between circulating zinc levels and decreased risk of PU. However, zinc supplementation did not demonstrate a significant reduction in the risk of PU. Further research is warranted to elucidate the underlying mechanisms through which zinc influences the pathogenesis of PU and evaluate the efficacy of zinc supplementation in the prevention and management of PU.

Using polycaprolactone and sodium alginate to prepare self-pumping/super-absorbent/transportable drug dressings for stage 3-4 pressure ulcer treatment.

Pressure ulcer dressings with different functions can enhance wound healing ability to varying degrees; however, pressure ulcer dressings that integrate various functions and break the resistance of bacteria to traditional antibiotics have not been widely studied. We proposed a self-pumping/super-absorbent/transportable drug dressing (PLD-SLD), polycaprolactone (PCL)/sodium alginate (SA) was used to load platelet-derived growth factor (PDGF) and lidocaine hydrochloride (LID) by Janus electrospinning and self-assembly technology, and Ɛ-polylysine was used as a biological bacteriostatic agent to prepare a multi-layer dressing. SEM showed that the dressing had a fluffy structure. The dressing can pump the exudate to the SA layer away from the skin. The swelling ratio reached 1378.667 ±â€¯44.752 %. Coagulate blood in 5 min. On the 8th day, the unclosed area rate of the PLD-SLD dressing group was 16.112 ±â€¯0.088 % lower than that of the model group. Importantly, the dressing can induce the expression of CD31, VEGF, α-SMA, and reduce the expression of CD68, thereby giving priority to wound healing. There was no scar formation after healing. In this study, a new dressing preparation method was proposed for the problems of exudate management, infection control, pain relief and healing promotion of stage 3-4 pressure ulcer healing.

Exposure to volatile ferroptosis inhibitor, TEMPO, reduced cutaneous ischemia-reperfusion injury progression to pressure ulcer formation in a mouse model.

BACKGROUND: Ischemia- reperfusion (I/R) injury-induced oxidative stress is a key factor in the pathogenesis of pressure ulcer formation. Ferroptosis is an iron-dependent programmed cell death that connects oxidative stress and inflammation in various diseases. Recent studies revealed the protective effect of inhibition of ferroptosis in I/R injury. However, the role of ferroptosis in cutaneous I/R injury remains elusive. OBJECTIVE: To assess the role of ferroptosis in the progression of cutaneous I/R injury. METHODS: Cutaneous I/R injury experiments and histopathological studies were performed in wild-type mice with or without exposure to volatile ferroptosis inhibitor, TEMPO (2,2,6,6-Tetramethylpiperidine-1-oxyl). The suppressive effects of TEMPO on ferroptosis inducing cell death and oxidative stress were examined in vitro. RESULTS: Inhibition of ferroptosis with TEMPO significantly reduced ulcer formation after cutaneous I/R injury. Fluctuated ferroptosis markers, such as GPX4, ACSL4, and 4-HNE expression in the I/R skin site, were reversed by TEMPO treatment. Inhibition of ferroptosis reduced apoptosis, CD3+ infiltrating lymphocytes, and improved vascularity in the I/R skin site. Inhibition of ferroptosis also suppressed the enhancement of Nrf2 activation. In vitro, ferroptosis and the activation of ferroptosis-related gene expression by RSL3 stimulation were markedly ameliorated by TEMPO treatment in mouse fibroblasts. Inhibiting ferroptosis also suppressed the elevation of the mRNA levels of NOX2 and HO-1 caused by ferroptosis. CONCLUSION: Cutaneous I/R injury-induced ferroptosis likely promotes cell death, vascular loss, infiltration of inflammatory cells, and oxidative stress. The inhibition of ferroptosis with TEMPO might have potential clinical application as novel therapeutic agent for cutaneous I/R injury.

The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study.

BACKGROUND: The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use. OBJECTIVES: This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale. METHODS: The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales. RESULTS: Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949-0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values >0.6, whereas two Braden Scale subscales (Mobility, Activity) were below this threshold. Instrument sum scores were strongly correlated (Pearson's r = -0.76 [r2 = 0.58]; p < 0.001), as were three subscale item pairs (mobility rs= -0.56 [r2 = 0.32]; nutrition rs= -0.63 [r2 = 0.39]; level of consciousness/sensory perception rs= -0.67 [r2 = 0.45] p < 0.001). CONCLUSION: Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.

Optimal nocturnal care for pressure injury prevention in the care environment: A scoping review.

AIM: Nursing care activities conducted at night tend to disturb their sleep, but to our knowledge, no nocturnal care protocols for pressure injury prevention have been established. This scoping review aimed to map the nocturnal care for pressure injury prevention and propose nocturnal care recommendations that have a reduced impact on the patient's care environment. METHODS: Literature databases were searched and two independent researchers screened the articles according to the inclusion criteria and extracted the data. The inclusion criteria were original articles/case studies, studies involving human subjects, and studies on nocturnal care for the prevention of pressure injuries. RESULTS: Eight met the inclusion criteria, three studies focused on bedding and five on care activities. Parasympathetic activity was more likely to be maintained or enhanced when an automatic repositioning function was used. Additionally, the time to sleep resumption was significantly shorter when repositioning was performed during deep sleep than during shallow sleep. Significantly fewer awakenings in response to light or sound occurred when incontinence care was provided to awake patients than when it was performed regularly. Moreover, some studies have highlighted the usefulness of the small change method and the 30° side-lying position for repositioning. CONCLUSION: Using a mattress with an automated turning function, providing care during wakefulness or deep sleep, and using repositioning methods with small positional changes may be effective in reducing the impact on patient's care environment. Further research is needed to determine nocturnal care for pressure injury prevention with less impact on the patient's care environment.

Medical device-related pressure injuries in the operating room: A scoping review.

AIMS: To map the existing literature describing medical device-related pressure injuries in patients during surgery, including investigation of the incidence, types of medical devices, risk factors and strategies for preventing medical device-related pressure injuries. DESIGN: A scoping review. DATA SOURCES: In April 2023, three databases were searched. Studies about adult patients undergoing surgery, from 2014 onwards, in English and Chinese were included. Data were extracted about study characteristics and data related to research questions. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework were used to synthesize findings. RESULTS: Two different types of evidence were included in this review; 14 research studies and two quality improvement studies. The incidence of medical device-related pressure injuries in the operating room was 0.56%-24.5% and respiratory devices were the most common medical devices investigated. Length of surgery, age and BMI were risk factors for medical device-related pressure injuries in a few studies. The application of a prophylactic dressing and dressing maintenance was the most common prevention strategy. CONCLUSION: Ongoing research is needed to confirm the incidence of, and risk factors for, medical device-related pressure injuries in the operating room. Additionally, more high-quality evidence is needed to underpin current prevention strategies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Operating room nurses need to be aware of the risks of medical device-related pressure injuries and assess and plan prevention strategies accordingly. Once more high-quality evidence is available, operating room nurses could implement prevention strategies like prophylactic dressings. REPORTING METHOD: Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Efficacy of D33 Sealed Foam in Preventing Skin Injury from Surgical Positioning: Randomized Clinical Trial.

Objective: To evaluate the efficacy of density-33 (D33) sealed foam in preventing skin injuries from surgical positioning. Approach: The study, reported according to the Consolidated Standards of Reporting Trials, is characterized as a randomized clinical trial, double mask, with 64 adult patients undergoing elective surgery, 35 allocated to the control group (CG), positioned on a conventional surgical table, and 29 to the experimental group (EG), positioned on a conventional surgical table overlaid with a D33 sealed foam support surface (SS) in the occipital, sacral, and heel regions. Simple randomization was carried out, as was masking of the researcher who evaluated the skin of the patient and the statistician. Data collection was carried out immediately preoperatively, intraoperatively, and postoperatively until the third day or until patient discharge. Statistical analysis included measures of association in contingency tables, χ2, and relative risk to compare the incidence of injuries between groups. Results: Skin injuries were greater in the CG, with blanchable erythema being the main injury. The use of D33 sealed foam reduced the incidence of injury in the EG by 61.2% (relative risk: 0.39; 95% confidence interval: 0.220-0.684; p < 0.001). Innovation: One of the first clinical studies to demonstrate that using a D33 sealed foam SS decreased the incidence of blanchable erythema from surgical positioning. Conclusion: D33 sealed foam was effective in preventing skin injury from surgical positioning in patients undergoing elective surgeries.

Osteomyelitis in Late-Stage Pressure Sore Patients: A Retrospective Analysis.

BACKGROUND: Late-stage pressure sore (PS) patients are particularly susceptible to osteomyelitis (OM), as bony prominences commonly constitute the focal point of the ulcer. There are lack of data regarding the associated factors and the clinical relevance of this diagnosis in the context of PS treatment. METHODS: This retrospective analysis investigated the clinical characteristics, blood markers indicative of infection in PS patients, and development of histologically evident OM. A total of 125 patient were included from 2014 to 2019. The patient records were especially scanned for histological diagnosis of OM. RESULTS: OM was detected in 39% (37/96) of the samples taken during the index procedure. OM prevalence increased to 56% (43/77) at the second and 70% (41/59) at the third debridement. Therefore, the diagnosis of OM was acquired during treatment in 35 cases. Patients diagnosed with initial OM presented significantly higher blood markers, indicative of infection upon admission. Only patients with consistent OM (three positive biopsies) showed higher flap revision rates. CONCLUSION: This study found no compelling evidence linking OM to worse clinical outcomes in PS patients. In the absence of elevated inflammatory markers, reducing bone biopsy frequency and adopting a less aggressive bone debridement approach may help prevent OM in PS patients.

Pressure ulcers/injuries prevention in emergency services: A scoping review.

AIM OF THE STUDY: To map the available evidence on nursing care provided to prevent the development of pressure ulcers/injuries in emergency services. MATERIAL AND METHODS: Scoping review that follows the Preferred Reporting Items for Systematic reviews and the Meta-Analyses extensions for Scoping Reviews and the Joanna Briggs Institute guidelines. The inclusion criteria were based on the PCC mnemonic. The main variables of interest were the nursing care provided to prevent the development of pressure ulcers/injuries (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The scoping review protocol was registered on the OSF platform. RESULTS: During the selection process, 175 articles were identified in different databases. Applying the inclusion and exclusion criteria, 20 studies were included in this scoping review. The preventive measures for the development of pressure ulcers/injuries were grouped into 9 categories: "risk factors and risk assessment", "support surfaces", "dressings for pressure ulcer/injury prevention", "skin and tissue assessment", "repositioning and early mobilization", "preventive skin care", "nutrition in pressure ulcer/injury prevention", "health education" and "vital signs management". The instruments for assessing the risk of developing pressure ulcers/injuries mentioned in the studies are the Braden, Waterlow and Norton scales. The most documented tool for assessing the risk of developing pressure ulcers/injuries in hospital emergency services was the Braden Scale. CONCLUSION: International literature identified several preventive interventions that could be implemented in emergency services to avoid pressure ulcers/injuries development. However, is crucial that those preventive interventions were systematic implemented (in combination) since hospital admission.

Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review.

Objective: This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods: Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results: Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion: The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.

Using PURPOSE-T in clinical practice: A realist evaluation.

AIM: To explain how the clinical and organisational context influenced the way the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) is used by nursing staff to support their clinical judgement and decision making about care planning and delivery. METHODS: A realist process evaluation was undertaken in a large acute hospital trust using mixed methods incorporating organisational policy review, staff semi-structured, ethnographic observation of clinical care and patient record review. Approximately 75 h of ethnographic field work involving 72 patients, 15 patient record reviews and 16 staff interviews were undertaken on 4 wards. FINDINGS: Findings suggest PURPOSE-T assisted nurses differently depending on their level of experience. Those with less experience use it as an educational guide, while those with more experience made an initial clinical judgement and used PURPOSE-T as a safety net to ensure they hadn't missed anything. Nurses were concerned about demonstrating good documentation of assessment, care planning and delivery in order to underpin consistent communication about care and because they had an underlying fear of being blamed if things went wrong. There is an array of other contextual features that impact the planning and delivery of pressure area care that go beyond the use of PURPOSE-T alone, including systematic equipment provision, competing patient safety initiatives and rehabilitation requirements. CONCLUSION: The findings reinforce the assertion that PU-RAIs are complex interventions and could inform the development of a more integrated system of care which takes into account the contextual features associated with PU prevention in modern hospitals.

Assessing pressure injury knowledge among Jordanian and Turkish nursing students: A cross-cultural comparison.

AIM: Pressure injuries, a prevalent issue in healthcare settings, have profound physical and emotional implications for patients and healthcare providers. However, further evidence is needed regarding the level of nursing students' knowledge of pressure injuries in the Middle East, a region where healthcare is rapidly evolving. This study examines the knowledge levels regarding pressure injuries among nursing students in Jordan and Turkey. MATERIALS AND METHODS: This cross-sectional study collected data from a randomly selected sample of 282 nursing students studying in two private and two Public Universities in Turkey and Jordan. Data was collected using a demographic survey and the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). RESULTS: The overall knowledge scores among students were alarmingly low, with significant differences between Jordanian and Turkish cohorts, with Turkish students scoring higher. Moreover, a significant difference was observed between students' knowledge levels from public and private universities in Jordan, but no difference was found between students of the two Turkish universities. CONCLUSION: The knowledge gap among nursing students regarding pressure ulcers is a critical issue that needs immediate attention. These findings highlight the urgent need for improved educational strategies and standardized competencies in this aspect. This study strongly advocates for changing teaching strategies and incorporating evidence-based pressure injury prevention education into nursing curricula, interprofessional education initiatives, and continuous professional development for faculty. These measures can significantly enhance nursing students' knowledge and improve patient care.

Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital.

BACKGROUND: The increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency. OBJECTIVES: 1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system's technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management. METHODS: A computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL's procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient's data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients' Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured. RESULTS: QA scores from the geriatric nurse, with and without system's support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system's assistance, highlighting the system's efficiency potential in clinical practice. CONCLUSION: The QA system based on QATP, produces scores consistent with an experienced nurse's assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.

Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings.

BACKGROUND: Pressure ulcer (PU) are prevalent among critically ill trauma patients, posing substantial risks. Bundled care strategies and silver nanoparticle dressings offer potential solutions, yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated. AIM: To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients. METHODS: A total of 98 critically ill trauma patients with PUs in intensive care unit (ICU) were included in this study. Patients were randomly assigned to either the control group (conventional care with silver nanoparticle dressing, n = 49) or the intervention group (bundled care with silver nanoparticle dressing, n = 49). The PU Scale for Healing (PUSH) tool was used to monitor changes in status of pressure injuries over time. Assessments were conducted at various time points: Baseline (day 0) and subsequent assessments on day 3, day 6, day 9, and day 12. Family satisfaction was assessed using the Family Satisfaction ICU 24 questionnaire. RESULTS: No significant differences in baseline characteristics were observed between the two groups. In the intervention group, there were significant reductions in total PUSH scores over the assessment period. Specifically, surface area, exudate, and tissue type parameters all showed significant improvements compared to the control group. Family satisfaction with care and decision-making was notably higher in the intervention group. Overall family satisfaction was significantly better in the intervention group. CONCLUSION: Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients. This approach holds promise for improving PUs management in the ICU, benefiting both patients and their families.

Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial.

Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.