Availability and Types of Pressure Ulcer Medications at Community Pharmacies in the Accra Metropolis of Ghana.

Pressure ulcers (PU) arise from prolonged pressure on the skin and underlying tissue due to pathological changes in blood flow. They usually develop in people who are immobilized due to certain medical conditions. The incidence of chronic diseases such as cancer, cardio-vascular diseases are on the ascendency. These conditions, if not managed adequately could render patients incapacitated, leaving them bedridden for long periods. The chances of these individuals developing PU are very high. Currently in Ghana, information on medications for the management of various stages of PU are not readily available. Prevention of PU has been the goal of nursing care, however, in the case where preventive care is not successful, there should be effective and efficient medications for the management of the PU. Method: The study design was descriptive cross-sectional. To get a good representation of the availability of PU medications in the entire metropolis, a stratified sampling approach was used. The 10 districts within the metropolitan area were taken as the strata. Towns within each district were identified, and mapped out. From each town, community pharmacies were randomly selected. It was ensured that pharmacies selected were well spread out (located distance apart). Researchers had to collect data from three or more pharmacies from each town. Data was collected using a structured questionnaire from pharmacists working in these pharmacies. By this approach, the availability of PU medications across the entire metropolitan area was revealed. Results: 241 pharmacies were visited, out of which 192 respondents took part in the study. Approximately 83.3% of these pharmacies had pressure ulcer medications. Majority of the medications available in the community pharmacies visited were hydrophobic based dressings., while hydrophilic based dressings were less than 1%. Implying that patients having PU that produce scopious exudate will have challenges acquiring the necessary dressings to manage the wounds. The dressings which were mostly available, had other indications apart from Pressure Ulcer. Patronage of the available PU medications in the Accra metropolis was average. Conclusion: There are pressure ulcer medications available in pharmacies within the Accra metropolis of Ghana. Although the medications are averagely patronized, there are not many types available. Hydrophilic based dressings were not readily available.

Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction.

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).

Effect of Pressure Loading on Heel Skin Temperature and Moisture in Healthy Volunteers: Preliminary Results.

Recent studies emphasize the significance of skin microclimate in the prevention of pressure injuries (PI). The objective was to evaluate the effect of pressure loading on skin temperature and moisture in the heels of healthy adults. This is a before-and-after study performed at Brazil, in October 2022. Skin temperature (°C) was measured by an infrared digital thermometer, and skin moisture (%) using electrical bioimpedance. Ten individuals/twenty heels were evaluated. The average temperature of the right and left heel was the same at baseline (27.2 °C). It was recognized that after 30 min of pressure loading on the heels, there was a decrease in temperature, and after 15 min of pressure offloading, the temperature decreased again. It was found that at t0, the moisture of the right heel (12.6%) was lower than the left heel (15.6%). The median moisture in the right heel increased from t0 to t1 and decreased in t2, while in the left heel, there was a small variation of the median from t0 to t1, as well as to t2. The pressure loading leads to a decrease in temperature and changes the skin moisture of the heels of healthy individuals.

Detecting Patient Position Using Bed-Reaction Forces for Pressure Injury Prevention and Management.

A key best practice to prevent and treat pressure injuries (PIs) is to ensure at-risk individuals are repositioned regularly. Our team designed a non-contact position detection system that predicts an individual's position in bed using data from load cells under the bed legs. The system was originally designed to predict the individual's position as left-side lying, right-side lying, or supine. Our previous work suggested that a higher precision for detecting position (classifying more than three positions) may be needed to determine whether key bony prominences on the pelvis at high risk of PIs have been off-loaded. The objective of this study was to determine the impact of categorizing participant position with higher precision using the system prediction F1 score. Data from 18 participants was collected from four load cells placed under the bed legs and a pelvis-mounted inertial measurement unit while the participants assumed 21 positions. The data was used to train classifiers to predict the participants' transverse pelvic angle using three different position bin sizes (45°, ~30°, and 15°). A leave-one-participant-out cross validation approach was used to evaluate classifier performance for each bin size. Results indicated that our prediction F1 score dropped as the position category precision was increased.

Practices and Challenges of Home Care Pressure Ulcer Management;Perception of Home-visit Nurses Who Have Completed the Specified Medical Acts Training.

PURPOSE OF THE STUDY: This study aims to clarify practices and challenges on pressure ulcer management as perceived by home-visit nurses who have completed the specified medical acts training. METHODS: We gathered 8 home-visit nurses who have completed the training in Japan. First-author conducted in-depth, semi-structured individual interviews, asking for their insights on home care pressure ulcer management. FINDINGS: We found that the home-visit nurses conducted the following practices;[having understandings and empathy as a health care professional who engage with client's lives with developing/worsening pressure ulcer], [pressure ulcer care at its best within limited resources], [systematic advice and guidance to caregivers and other professionals], and [demonstration of nursing as the post-training nurse of the specified medical acts]. We also learn that the home-visit nurses were faced with following challenges:[difficulties in smoothly collaborating with multiple professionals from different organizations], [not reaching a high level of expertise or skill], [limitations under the long-term care and medical insurance systems] and [impact of COVID-19]. CONCLUSION: Home-visit nurses who have completed the specified medical acts training provided the nurses worked toward raising community's awareness of the care by providing leaderships to those involved in health care teams and collaborating with other professionals. J. Med. Invest. 71 : 346-355, August, 2024.

Significant reduction in full-thickness pressure injuries through the quality improvement project that implements alternating pressure air mattresses.

To assess a quality improvement project using alternating pressure air mattresses' impact on reducing full-thickness pressure injuries by enhancing setting accuracy and device utilization. We retrospectively evaluated adult acute care unit patients with inclusion criteria (Braden scores ≤12 or existing full-thickness pressure injuries) between May 2020 and August 2023. A wound team attempted to enhance the accuracy, utilization and effectiveness of alternating pressure air mattress implementation. The implementation outcomes were setting accuracy and accurate utilization rates. The clinical outcome was the full-thickness pressure injury proportion. Utilization and allocation gaps were also calculated. The setting accuracy and accurate utilization rates increased (0.59 to 0.88 and 0.15 to 0.37, respectively). The full-thickness pressure injury proportion decreased (0.17 to 0.06), with a strong negative correlation coefficient (-0.789) (p < 0.001) with accurate utilization rates. The full-thickness pressure injury proportion declined faster during the project's complete phase than the partial phase (-0.0046 vs. -0.0016; p < 0.05). The utilization gap narrowed (99 to 60); however, the allocation gap increased (1 to 13), suggesting increased alternating pressure air mattress usage among ineligible patients. Targeting high-risk patients for alternating pressure air mattress utilization and ensuring correct settings, both performed by a dedicated team, substantially reduces the full-thickness pressure injury incidence.

A randomised controlled phase II trial to examine the feasibility of using hyper-oxygenated fatty acids (HOFA) to prevent facial pressure injuries from medical devices among adults admitted to intensive care-A research protocol.

One in three patients admitted to intensive care will sustain a pressure injury (PI) from a medical device. These injuries are painful and when on the face, head or neck they can result in permanent disfigurement. Preliminary evidence of the efficacy of hyper-oxygenated fatty acids (HOFAs) to prevent facial pressure injuries from medical devices is promising; however, the feasibility of incorporating HOFAs into current standard care to prevent PI from a medical device of the face, head and neck has not been extensively explored. It is intended that the findings from this phase II feasibility study will inform the design of a larger phase III trial, by addressing two primary aims: (1) to assess the feasibility of incorporating HOFAs into standard care to prevent device-related pressure ulcers of the skin associated with the face, head and neck assess the feasibility and (2) efficacy preliminary effectiveness of HOFA. This feasibility study is an investigator-initiated mixed method study incorporating a multi-centre randomised controlled trial of using HOFAs as an adjunct to standard pressure injury prevention and care, compared with standard care alone to prevent facial, head or neck from medical devices among adults admitted to intensive care. The primary outcome of interest is the incidence of facial, head or neck pressure injuries during the first 14 days in intensive care. Secondary outcomes include PI staging, medical device exposure and intensive care and hospital outcomes. The primary analysis will be undertaken using Cox's Proportional Hazards model, and due to the exploratory nature of this phase II trial, efficacy will be based on a one-sided p-value for superiority set at 0.10. Type I and Type II error rates are set at 20%; therefore, a total sample size of 196 study participants is planned. To explore the feasibility of incorporating HOFA into usual care and to design a larger phase III trial, we will aim to interview between 10 and 20 nurses across participating intensive care unit sites. Pressure injuries of the face, head or neck from medical devices, among adults admitted to intensive care, are considered preventable. This phase II study will investigate the feasibility and efficacy of HOFAs as an adjunct to standard care. Importantly, we aim to inform the development of a larger phase III trial.

Why do pressure injuries still occur? A multicenter qualitative study of nurses and caregivers.

Background: The frequent occurrence of pressure injuries despite their preventability raises important questions about our understanding of the barriers to care. This study explores the lived experience of nurses and caregivers in Singapore to establish a conceptual framework for better understanding of pressure injuries arising in the community. Methods: A multicenter qualitative study was conducted utilizing semistructured interviews and focused group discussions of nurses and caregivers of patients with pressure injuries. Data were collected with a narrative inquiry approach and analyzed with grounded theory. An iterative cycle of interviewing, coding, discussion, and reflection was conducted until theoretical saturation. Results: Ten inpatient nurses and 10 caregivers from the community were recruited. Analysis identified cognitive (awareness and caregiver training), emotional (motivation and empowerment), resource (human and infrastructural), and biomedical factors which collectively impacted the effectiveness of prevention. Additionally, constructs of learning and sustainability of caregiving played a crucial role in long term prevention. Limitation: The derived framework requires further validation with quantitative data and may not be generalizable to other cultural and economic populations. Conclusion: Multiple constructs have been identified to have a synergistic effect in prevention. Targeted measures should be implemented by healthcare institutions to better equip caregivers in prevention.

An inter-assessor reliability study on the categorization and staging of pressure injuries.

BACKGROUND: The first step in effective management of pressure injuries (PIs) is to assess, categorize and stage correctly. PURPOSE: This study aims to examine the agreement regarding the classification and staging of PIs among nurse academicians working on chronic wounds and with different stage of expertise. METHODS: Three nurse academicians were assigned as assessors according to Benner's stages of clinical competence (Competent, Proficient, and Expert). The assessors independently evaluated PIs photographs (n = 694). The assessors then met for the wounds where there was disagreement, and a Consensus agreement was reached. Kappa Statistics analysed the agreement between two assessors; Fleiss Kappa Statistics analysed the agreement between Competent, Proficient, Expert, and Consensus. RESULTS: Statistically, almost perfect agreement was obtained between Competent, Proficient, Expert, and Consensus assessments, respectively (Ƙ = 0.871; p < 0.001, Ƙ = 0.842; p < 0.001, Ƙ = 0.937; p < 0.001). The highest agreement between the assessors were Unstageable PIs, Deep Tissue PIs, and Stage 3 PIs respectively. The most common disagreements were between Deep Tissue PIs and Stage 1 PIs, and between Deep Tissue PIs and Stage 2 PIs. CONCLUSION: In the study, it was found that the categorization, and staging of PIs had varying degrees of reliability among the assesors, although at a statistically acceptable level.

Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study.

BACKGROUND: Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. METHOD: A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman. RESULTS: The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). CONCLUSION: HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.

Topical hADSCs-HA Gel Promotes Skin Regeneration and Angiogenesis in Pressure Ulcers by Paracrine Activating PPARß/δ Pathway.

Background: Pressure ulcer is common in the bedridden elderly with high mortality and lack of effective treatment. In this study, human-adipose-derived-stem-cells-hyaluronic acid gel (hADSCs-HA gel) was developed and applied topically to treat pressure ulcers, of which efficacy and paracrine mechanisms were investigated through in vivo and in vitro experiments. Methods: Pressure ulcers were established on the backs of C57BL/6 mice and treated topically with hADSCs-HA gel, hADSCs, hyaluronic acid, and normal saline respectively. The rate of wound closure was observed continuously during the following 14 days and the wound samples were obtained for Western blot, histopathology, immunohistochemistry, and proteomic analysis. Human dermal fibroblasts (HDFs) and human venous endothelial cells (HUVECs) under normal or hypoxic conditions were treated with conditioned medium of human ADSCs (ADSC-CM), then CCK-8, scratch test, tube formation, and Western blot were conducted to evaluate the paracrine effects of hADSCs and to explore the underlying mechanism. Results: The in vivo data demonstrated that hADSCs-HA gel significantly accelerated the healing of pressure ulcers by enhancing collagen expression, angiogenesis, and skin proliferation. The in vitro data revealed that hADSCs strengthened the proliferation and wound healing capabilities of HDFs and HUVECs, meanwhile promoted collagen secretion and tube formation through paracrine mode. ADSC-CM was also proved to exert protective effects on hypoxic HDFs and HUVECs. Besides, the results of proteomic analysis and Western blot elucidated that lipid metabolism and PPARß/δ pathway mediated the healing effect of hADSCs-HA gel on pressure ulcers. Conclusion: Our research showed that topical application of hADSCs-HA gel played an important role in dermal regeneration and angiogenesis. Therefore, hADSCs-HA gel exhibited the potential as a novel stem-cell-based therapeutic strategy of treating pressure ulcers in clinical practices.

Nurse knowledge, attitudes, and barriers to pressure injuries: A cross-sectional study in an Australian metropolitan teaching hospital.

BACKGROUND: Pressure injuries are associated with significant clinical complications with negative effects on the patient's emotional, psychological, social and physical wellbeing. However, in Australia little is known about the knowledge and attitudes of nurses towards hospital-acquired pressure injuries. OBJECTIVE: To determine nurse knowledge and attitudes towards hospital-acquired pressure injuries and to identify barriers towards prevention. METHODS: A cross-sectional study following the STROBE statement was conducted between May to July in 2017. All nurses at a major metropolitan teaching hospital in Western Australia were invited to participate. Nurse knowledge and attitude to pressure injury were assessed using validated Pressure Ulcer Knowledge Assessment tool, and Attitude towards Pressure Ulcer Prevention tool. An open-ended question asked about the barriers to pressure injury prevention. Quantitative data were analysed using descriptive and inferential statistics and answers for the open-ended question were analysed using thematic analysis. RESULTS: Data from 224 nurses (response rate 19.0 %) were analysed. While nurses displayed a satisfactory attitude towards hospital-acquired pressure injury prevention, most nurses lacked adequate knowledge of the stages, causes and prevention of pressure injuries. Thematic analysis of responses to the open-ended question yielded two main themes: modifiable barriers to pressure injury prevention were lack of knowledge, attitude of pressure injury prevention and the scarcity of resources. Non-modifiable barriers to pressure injury prevention were the nursing environment and patient characteristics. CONCLUSION: Most nurses have satisfactory attitude towards pressure injury prevention, but inadequate knowledge about pressure injuries. Barriers to pressure injury prevention are attributed to nurse working environments, particularly impeded by staffing, time constraints and resources.

Intensive care nurses' knowledge and practices regarding medical device-related pressure injuries: A descriptive cross-sectional study.

This study aims to determine the levels of knowledge and practices of intensive care nurses regarding medical device-related pressure injuries (MDRPIs). This descriptive cross-sectional study was carried out between September 2023 and February 2024, involving 143 nurses working in intensive care units across three hospitals in Türkiye. The data were collected using the demographic form and the Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool (MDPI-ASSET). Of the nurses, 74.1% have encountered MDRPIs in their unit, 63.6% feel that their knowledge about MDRPIs is insufficient and 90.2% express a desire to receive training about MDRPIs. The participants' total mean MDPI-ASSET score was 11.12 (out of 21). The nurses achieved the highest mean score on the Aetiology/risk factors sub-scale and the lowest mean score on the Staging sub-scale. The analysis revealed significant differences in the mean MDPI-ASSET total scores among nurses based on the status of previous encounters with MDRPIs (t = 2.342; p = 0.021) and their feelings of responsibility for the development of MDRPIs (t = -2.746; p = 0.007). In this study, the knowledge and practices of intensive care nurses regarding medical device-induced pressure injuries were found to be inadequate. Given the frequent occurrence of MDRPIs in intensive care units, it is necessary to support nurses with continuous organizational-level training to improve the quality of care for critically ill patients.

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes.

Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Revolutionizing pressure ulcer regeneration: Unleashing the potential of extracellular matrix-derived temperature-sensitive injectable antioxidant hydrogel for superior stem cell therapy.

Pressure ulcers are a common issue in elderly and medically compromised individuals, posing significant challenges in healthcare. Human umbilical cord mesenchymal stem cells (HUMSCs) offer therapeutic benefits like inflammation modulation and tissue regeneration, yet challenges in cell survival, retention, and implantation rates limit their clinical application. Hydrogels in three-dimensional (3D) stem cell culture mimic the microenvironment, improving cell survival and therapeutic efficacy. A thermosensitive injectable hydrogel (adEHG) combining gallic acid-modified hydroxybutyl chitosan (HBC-GA) with soluble extracellular matrix (adECM) has been developed to address these challenges. The hybrid hydrogel, with favorable physical and chemical properties, shields stem cells from oxidative stress and boosts their therapeutic potential by clearing ROS. The adEHG hydrogel promotes angiogenesis, cell proliferation, and collagen deposition, further enhancing inflammation modulation and wound healing through the sustained release of therapeutic factors and cells. Additionally, the adEHG@HUMSC composite induces macrophage polarization towards an M2 phenotype, which is crucial for wound inflammation inhibition and successful healing. Our research significantly propels the field of stem cell-based therapies for pressure ulcer treatment and underscores the potential of the adEHG hydrogel as a valuable tool in advancing regenerative medicine.

The value of epidemiological data for pressure ulcer/injury management.

Pressure ulcers/injuries (PU/Is) are a burden on healthcare systems worldwide. They are costly and have a negative impact on the quality of life of patients. PU/Is cause discomfort, prolong hospital stays and can even lead to death. Data on the incidence and prevalence of PU/Is are used to implement effective, tailored prevention practices. The aim of this paper is to highlight the importance and value of collecting epidemiological data in terms of its practical use in Slovakia. The prevalence of PU/Is was found to be low compared to global data. Shortcomings in the collection of epidemiological data are highlighted; however, the use of those available data in amending national standards, such as the mandatory reporting of PU/Is, is summarised. Several steps and activities related to the prevention and care of PU/Is have been carried out in Slovakia. It is important to know not only the prevalence in terms of field of care, time and provider, but also, more specifically, the risk characteristics and/or presence of PU/I in order to initiate more individualised and tailored patient care.

Innovative air mattress for the prevention of pressure ulcers in neonates.

OBJECTIVE: Pressure ulcers (PUs) severely impact health outcomes in neonatal intensive care, with up to 28% prevalence and doubled mortality rates. Due to their only partially developed stratum corneum, neonates are highly susceptible to PUs because of a lack of adequate support surfaces. The occipital region of the head and hip are the main risk areas due to immobility and newborn body proportions. The main goal of the study was to investigate the impact of reduction in local pressure in these body areas by two air mattress designs and different filling states. METHOD: Two innovative air-filled mattress prototypes (prototype 1 and prototype 2), consisting of three different segments (head, trunk and feet regions), were developed to reduce local interface pressures by optimising pressure distribution, and were assessed with three air pressure filling states (0.2kPa, 0.4kPa and 0.6kPa). A baby doll was used to investigate pressure distribution and local pressure impact. It measured 51cm and the weight was modified to be 1.3kg, 2.3kg and 3.3kg, representing premature to term newborn weights, respectively. A specialised foam mattress and an unsupported surface were considered as controls. RESULTS: The interface pressures at the hip region for newborn models could be reduced by up to 41% with mattress prototype 1 and 49% with prototype 2 when filled with 0.2kPa air pressure. It was found that the size and the pressure inside air segments was crucial for interface pressure. CONCLUSION: Our results demonstrated that air mattresses achieved lower interface pressures compared to conventional support surfaces, and that the benefit of the air mattresses depended on their filling status. The importance of using innovative, segmented designs that were tailored to meet the specific needs of highly vulnerable paediatric patients was demonstrated.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home.

AIM: To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. METHODS: A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FINDINGS: Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. CONCLUSIONS: The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

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.