Objective To validate the content of a fundamental care intervention to prevent venous ulcer recurrence. Methods Methodological study using a modified Delphi method (e-Delphi). An e-Delphi panel was conducted with national experts with clinical experience and/or research expertise in wound care between December 2025 and January 2026. The initial intervention matrix submitted to the expert panel was derived from previous studies and informed by Fundamental Care. An 80% agreement criterion was established as the consensus criterion, and other statistical tests were also performed. Results Two rounds were conducted. In the first round, 29 experts participated, evaluating an intervention organized into 3 dimensions (relationship, integration of care, and context of care) with a total of 113 items. In the second round, participation decreased slightly to 25 experts, who analyzed 124 items organized according to the same 3 dimensions. In the second round, consensus exceeded 80% for each question, and decreases in the standard deviation and interquartile range (IQR) indicated consensus on all items. Kendall's W also fell within the interval that indicates the same level of consensus. Conclusions The intervention design was supported by previous studies, enabling the identification of evidence and the design of the intervention for people at risk of recurrence. Experts reached consensus on a fundamental care intervention to prevent venous ulcer recurrence, integrating relational, psychosocial, physical, and contextual components.
Objective To establish a nurse-led chronic wound management model for vascular surgery under the concept of integrated care, and to evaluate its impact on wound healing, medical costs, and cost-effectiveness ratio. Methods 363 patients with chronic wounds were randomly divided into the control group (conventional management model, n=180) and the observation group (nurse-led full-process management under integrated care concept, n=183) from January 2024 to December 2025. The wound healing rate, healing time, pain score, infection rate, recurrence rate within 6 months, nursing satisfaction, medical costs, and cost-effectiveness ratio (CER) were compared between two groups. Results The wound healing rate of the observation group (92.35%) was significantly higher than that of the control group (72.22%), and the healing time was significantly shorter (P<0.05). The VAS pain score (2.01±0.76), wound infection rate (3.28%), and 6-month recurrence rate (3.28%) in the observation group were all significantly lower than those in the control group (P<0.05). Nursing satisfaction in the observation group (95.63%) was higher than that in the control group (78.89%). The average total medical cost per person in the observation group (CNY 6128.50±819.40) was lower than that in the control group (CNY 8457.30±962.80), and the cost-effectiveness ratio (66.37) was superior to that of the control group (117.11) (all P<0.05). Conclusion The integrated care concept-based, nurse-led chronic wound management model for vascular surgery effectively improved healing efficiency, enhanced clinical outcomes, reduced complication risks, and alleviated the medical economic burden, which warrants it to be a promotable approach for standardized management of chronic wounds.
OBJECTIVES:To investigate the current status of knowledge, attitude, and practice (KAP) regarding foot care among high-risk diabetic foot patients and to identify its associated factors. METHODS:A cross-sectional study was conducted from January 2025 to April 2026 in the Department of Endocrinology of a tertiary hospital in Shanghai, China. A total of 312 high-risk diabetic foot patients were recruited using convenience sampling. Data were collected using a general information questionnaire, the Diabetes Foot Care KAP Scale, the Social Support Rating Scale (SSRS), and the Diabetes Self-Efficacy Scale. Correlation analysis, univariate analysis, and multiple linear regression were performed to identify factors associated with KAP levels. RESULTS:The total KAP score was 37.70 (33.38-41.35), indicating a moderate level. Among the three dimensions, knowledge and attitude scores were relatively higher, while practice scores were the lowest. Multiple linear regression analysis showed that knowledge scores were associated with diabetes duration of 6-10 years (β = 0.136, P = 0.044) and insulin therapy (β = -0.157, P = 0.015). Attitude scores were associated with combination therapy (β = 0.192, P = 0.003), inadequate glycemic control (β = -0.146, P = 0.010), and self-efficacy (β = 0.154, P = 0.006). Practice scores were positively associated with female sex (β = 0.177, P = 0.001), adequate glycemic control (β = 0.221, P < 0.001), social support (β = 0.206, P < 0.001), and self-efficacy (β = 0.162, P = 0.002), whereas rural residence (β = -0.144, P = 0.005) and lack of diabetic foot education (β = -0.134, P = 0.009) were negatively associated with practice scores. The total KAP score was negatively associated with rural residence (β = -0.113, P = 0.035) and lack of diabetic foot education (β = -0.154, P = 0.010), but positively associated with combination therapy (β = 0.141, P = 0.026) and self-efficacy (β = 0.144, P = 0.009). CONCLUSION:High-risk diabetic foot patients demonstrated a moderate level of foot-care KAP, with a noticeable gap between knowledge and practice. Their KAP levels were influenced by multiple factors, including residence, marital status, glucose-lowering therapy, diabetes education, and self-efficacy. These findings suggest that integrated interventions focusing on structured health education, enhancement of self-efficacy, and improvement of healthcare accessibility are needed to improve foot-care KAP, thereby strengthening self-management and preventing diabetic foot complications.
Objective To evaluate the clinical efficacy and safety of a combined regimen (termed the "Sandwich Method") utilizing ethacridine lactate, growth factors, and zinc oxide paste for the prevention and management of moderately severe incontinence-associated dermatitis (IAD) in critically ill patients. Methods A total of 84 patients with IAD (including moderate-severe IAD and mild IAD with a PAT score ≥7) admitted to the emergency intensive care unit of a tertiary hospital in Beijing from May 2024 to April 2025 were randomly assigned to an intervention group (n=42) and a control group (n=42) by a random number table. The intervention group received the "Sandwich Method," which involved sequential application of ethacridine lactate-soaked gauze, growth factor spray, and zinc oxide paste. The control group received conventional care, including routine cleansing and application of tannic acid ointment. Outcomes assessed included healing rate, effective rate, mean healing time, and improvement in IAD severity (measured via the Incontinence-Associated Dermatitis Severity [IADS] score). Results Baseline characteristics were comparable between groups (P>0.05). Post-intervention, the intervention group demonstrated superior outcomes: healing rate increased from 50% (control) to 71% (P<0.05), mean healing time decreased from 8.83±2.82 days (control) to 5.17±1.06 days (P<0.05), the degree of improvement in IAD scores was markedly greater in the intervention group (21.04 ± 7.29) compared to the control group (17.12 ± 11.44, P < 0.05) and daily IADS score reduction was significantly greater (4.02±1.41 vs. 2.06±1.27, P<0.05). Additionally, no cases of progression from mild to moderate-severe IAD occurred in the intervention group, compared to 12% (5 cases) in the control group (P<0.05). The effective rates were 95% (observation) and 86% (control), with no statistical significance (P>0.05). Conclusion The "Sandwich Method" significantly enhances healing outcomes, shortens recovery time, and prevents disease progression in moderately severe IAD. Its structured, cost-effective protocol offers practical guidance for clinical application.
AIM:To evaluate whether a dual-zone wearable sweat biosensor patch could detect biochemical signatures of sacral pressure injury earlier than standard nursing assessment in postoperative patients requiring prolonged bed rest. METHODS:This prospective, observational, single-arm study enrolled postoperative patients requiring prolonged bed rest with a Braden Scale score (a validated tool for pressure ulcer risk assessment) of 18 or lower. Two flexible biosensor patches were applied simultaneously to each participant: one at the sacral pressure zone (T1) and one at a reference site (T2), continuously monitoring sweat lactate, sweat pH, and skin temperature over 72 h. Ward nurses performed daily blinded clinical skin assessments independently of sensor data. RESULTS:Fifty-three patients who developed sacral pressure injury were included. All three biomarker differentials demonstrated progressive divergence over 72 h, with statistically significant between-zone differences emerging from the 12-24 h interval. The biosensor system achieved a mean lead time of 34.1 h over nursing detection, with 77.4% of patients benefiting from advance warning of 24 h or more. CONCLUSION:Continuous dual-zone sweat biomarker monitoring detected evolving sacral pressure injury substantially earlier than conventional nursing assessment, providing a clinically meaningful intervention window in the majority of postoperative patients.
Background Foot alterations have been identified in the literature as a significant risk factor for falls in older adults. However, the contribution of specific types of alterations, such as digital deformities and skin alterations, has not been studied in detail. These findings highlight the importance of improving understanding of podiatric factors that contribute to fall risk. Objective This study aimed to identify which podiatric alterations, such as hyperkeratosis, corns, reduced plantar fat pad, onychomycosis, heel xerosis, and digital deformities, including hallux valgus (HAV), claw toes, supraductus toes, infraductus toes, hammer toes, and quintus varus, are most predictive of fall risk in older adults, both with and without diabetes mellitus. Materials and methods An analytical, cross-sectional, retrospective study was conducted on 85 individuals over 60 years of age. Foot deformities and dermatological alterations were recorded, and fall risk was assessed using the Tinetti balance and gait scale. Statistical analyses included bivariate tests and binary logistic regression to identify predictors of fall risk. Results The mean age of participants was 71 years; 66% were women, and 46% had type 2 diabetes mellitus. Overall, 66% of participants had a moderate-to-high risk of falling, and a significant association was observed between fall risk and the presence of diabetes (p = 0.048). Logistic regression analysis revealed that reduced plantar fat pad (p = 0.007) and heel xerosis (p = 0.038) were significantly associated with fall risk, irrespective of the presence of diabetes. Conclusion Podiatric alterations, particularly reduced plantar fat pad and heel xerosis, are strong predictors of fall risk in older adults, irrespective of the presence of diabetes. Foot health assessment should be considered a core component of multidisciplinary fall prevention programmes, reinforcing the crucial role of podiatrists in geriatric care to reduce fall risk.
OBJECTIVE:This methodological study was conducted to evaluate the Turkish validity and reliability of the "Instrument of Self-care for Prevention of Diabetic Foot" developed by Herrera-Guerra and Bautista-Arellano. MATERIALS AND METHODS:This research is of methodological type. The study was conducted with 202 diabetic individuals followed up at a university hospital in Türkiye. Translation-back translation was used to assess linguistic validity, and the opinions of 11 experts were consulted for content validity. Confirmatory Factor Analysis (CFA) was applied to assess construct validity, and the Diagonally Weighted Least Squares (DWLS) estimator was used in the analyses. For reliability analysis, internal consistency coefficients (Cronbach's alpha and McDonald's omega) were calculated, and a test-retest reliability test was performed on 26 patients at four-week intervals. RESULTS:The content validity index was found to be 0.98. CFA results showed that the three-factor structure of the scale (Self-Care Monitoring, Self-Care Maintenance, and Self-Care Management) is suitable for the Turkish sample and that the model fit indices are at an excellent level (GFI = 0.989, CFI = 0.995, RMSEA = 0.055, SRMR = 0.061). Cronbach's alpha coefficients for the sub-dimensions of the scale were found to be in the range of 0.859-0.885, and McDonald's omega coefficients were in the range of 0.869-0.887. In the test-retest analysis, it was determined that there was no systematic deviation between the measurements in the Bland-Altman plots and that there was a very high level of positive correlation between test and retest scores (r = 0.992-0.994). CONCLUSION:As a result of the research, it was determined that the Instrument of Self-care for Prevention of Diabetic Foot is a valid and reliable scale in Turkish. This tool can be used as a guide in nursing care in terms of preventing diabetic foot ulcers and monitoring self-care of patients with diabetes in the Turkish population.
OBJECTIVES:This study aims to construct an information-based hospital-community-family whole-course prevention and treatment model for diabetic foot disease. METHODS:An information-based whole-process hospital-community-family management model for diabetic foot prevention and treatment was constructed. A total of 250 subjects were screened from the hospital diabetes database as core intervention participants between June 2022 and April 2023; we then calculated their participation rate in diabetic foot knowledge learning and diabetic foot ulcer incidence. The experimental group included 78 patients enrolled during model implementation, while the control group contained 86 patients recruited prior to program launch, with clinical data collected from May 2021 to March 2022. RESULTS:The core intervention population attained a 97.2% participation rate in diabetic foot knowledge learning, and the overall incidence of diabetic foot ulcers was 2.4%.At the 4-week follow-up, the ulcer healing rate among patients with grade 1 and grade 2 diabetic foot ulcers was markedly higher in the experimental group (53.9%) versus the control group (26.7%). At the 6-week follow-up, the healing rate of patients with grade 2 diabetic foot ulcers was significantly higher in the experimental group (82.9%) than in the control group (18.0%). At the 12-week intervention follow-up, the improvement rate of patients with grade 4 diabetic foot disease in the experimental group reached 80.0%, which was significantly higher than the 27.3% observed in the control group. CONCLUSION:This integrated prevention and treatment model may reduce the incidence of diabetic foot lesions and facilitate the healing of diabetic foot ulcers under single-center clinical conditions.
BACKGROUND:Crohn's disease (CD) is a long-term inflammatory condition and a chronic immune-mediated inflammatory disorder characterized by recurrent gastrointestinal symptoms and substantial physical and psychological burden. However, evidence regarding kinesiophobia in patients with CD remains scarce. OBJECTIVES:To compare kinesiophobia levels between patients with CD and age-, sex-, and body mass index-matched healthy controls using the Spanish short version of the Tampa Scale of Kinesiophobia Spanish Version (TSK-11SV). MATERIAL AND METHODS:A matched case-control study was conducted including 108 participants (54 patients with CD and 54 healthy controls). Demographic and anthropometric variables were collected, and all participants completed the TSK-11SV questionnaire. Group differences in continuous variables were analyzed using appropriate inferential statistics after assessment of data distribution. Kinesiophobia severity categories were compared using Contingency tables and measures of association. Effect sizes were calculated to improve clinical interpretation of the findings. RESULTS:Patients with Crohn's disease presented significantly higher TSK-11SV scores than healthy controls (27.35 ± 6.19 vs. 23.39 ± 5.33 points, respectively). The mean difference was 3.96 points (p < 0.001), corresponding to a moderate effect size (Cohen's dz = 0.69). Moderate-to-extreme kinesiophobia was identified in 70.4% of patients with CD compared with 40.7% of healthy controls (p = 0.015). Extreme kinesiophobia was observed exclusively in the CD group. CONCLUSIONS:Individuals with CD exhibit significantly greater fear of movement than healthy controls. These findings suggest that kinesiophobia may constitute an important psychological barrier to physical activity in CD and should be routinely considered during multidisciplinary disease management. Early identification of patients with elevated kinesiophobia may facilitate the implementation of individualized exercise-based interventions aimed at improving long-term physical and psychological outcomes.
AIM:The aim was to evaluate the impact of topical insulin therapy vs normal saline on wound healing in adults with diabetic foot ulcers. BACKGROUND:Diabetic foot ulcers are among the most debilitating complications of diabetes, associated with high morbidity, risk of amputation, and significant healthcare costs. Insulin, beyond its glycaemic effects, exhibits regenerative and angiogenic properties that may support wound healing when applied topically. MATERIALS AND METHODS:A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA 2020 guidelines. A literature search was conducted across a number of databases, including MEDLINE, CINAHL, PubMed, EMBASE, and clinical trial registries. Only randomised controlled trials (RCTs) comparing topical or locally injected insulin with standard wound care in adult diabetic patients were eligible. Risk of bias was assessed using the Cochrane RoB 1.0 tool. Meta-analyses were conducted using Review Manager (RevMan) 5.4, employing a random-effects model. The certainty of the evidence was assessed using the GRADE process. RESULTS:Sixteen RCTs met the inclusion criteria. No study reported the number of wounds healed. Meta analysis of 2 studies demonstrated that topical insulin therapy was associated with a statistically significant reduction in time to wound healing (MD: -6.05 days, 95% CI: -7.55 to 4.55; p < 0.00001), in favour of the insulin group. A narrative analysis of 2 further studies concurs with the findings of the meta-analysis. Meta-analysis of 10 studies showed a statistically significant difference in wound size reduction (MD: -3.39 cm2 (95% CI: -5.34 to 1.45; p = 0.0006), in favour of the insulin group, with a narrative analysis of 5 further studies, concurring with the findings of the meta-analysis. The certainty of the evidence is low or very low certainty evidence, as it was downgraded mainly for high or unclear risk of bias across multiple domains. CONCLUSIONS:Study findings show that topical insulin therapy may enhance wound healing in adults with DFUs. However, due to methodological limitations, inconsistent application of the intervention and outcome measures, yielding low or very low certainty evidence, definitive conclusions cannot be drawn. Therefore, further large, high-quality, multicentre trials are needed to validate the findings here.
Wearable sensors and monitoring systems are increasingly used in clinical and home-care settings, often requiring prolonged contact with skin over bony prominences such as the sacrum. Tissue deformation beneath sustained loading is recognized as a key mechanical factor in pressure-induced tissue damage. However, device geometry influence on stress and strain distribution within underlying soft tissues remains insufficiently characterized. A three-dimensional finite element model of the sacral region was developed, incorporating skin, adipose tissue, muscle, and sacral bone. Two wearable-device geometries were simulated: a circular skin-mounted sensor and an elongated cable segment. Static pressures of 2, 6, 8, and 10 kPa were applied. Tissue stiffness was varied by ±10% and ±20% to represent inter-individual variability. Mechanical exposure was quantified using layer-resolved stress and strain distributions and a normalized risk index derived from cumulative histograms within a defined region of interest. Sensor loading produced predominantly superficial stress concentrations in skin, whereas cable loading redistributed mechanical exposure toward deeper tissues. At 10 kPa, strain-based risk indices in adipose tissue and muscle approached maximal values under cable loading across stiffness conditions, while stress-based risk remained highest in skin. Increasing tissue stiffness elevated stress-based risk but had limited influence on strain-based risk, especially in deeper tissues. We show that device geometry strongly determines tissue-level mechanical exposure. Sensor-like devices concentrate stress superficially, whereas cable-like geometries produce persistent strain in deeper tissues, which is relatively insensitive to moderate stiffness changes. Our results emphasize the need for geometry-aware, deformation-based assessment of wearable-device loading risk in pressure-vulnerable anatomical regions.
AIM OF THE STUDY:Postoperative wound care after reconstructive surgery in epidermolysis bullosa (EB) remains challenging because of extreme skin fragility, delayed epithelialization, and severe pain during dressing changes. Amniotic membrane has anti-inflammatory and regenerative effects that may support wound healing and provide mechanical protection. This study aimed to evaluate the clinical impact of amniotic membrane applied immediately after reconstructive surgery in patients with EB, focusing on wound healing, pain reduction, wound stability, and postoperative management. MATERIALS AND METHODS:This case series included four patients with EB who underwent surgical release of pseudosyndactyly and correction of flexion contractures between 2025 and 2026 at a specialized national EB center. Surgical defects were covered with either lyophilized amniotic membrane (Amnioderm®) or cryopreserved amniotic membrane. Postoperative evaluation included epithelialization, wound stability, bleeding, exudation, and pain during dressing changes, assessed using the FLACC scale where applicable. RESULTS:All patients demonstrated favorable postoperative wound healing, with complete epithelialization achieved within 14 days to 3.5 weeks after surgery. Dressing changes were tolerated at the bedside without analgosedation or general anesthesia. In two hand-surgery cases, FLACC scores on amniotic membrane-treated wounds were low (2 and 4), compared with 9 on the conventionally treated side. Sustained correction without recurrence was observed at 9-month follow-up in the revision case. CONCLUSION:Amniotic membrane appears to be a safe and effective adjunct in EB reconstructive surgery supporting wound healing and reducing pain during dressing changes. However, findings from this case series are preliminary and require confirmation in larger prospective studies.
BACKGROUND:High-altitude hypoxia increasingly draws attention for its effects on wound healing. Because oxygen critically regulates inflammation and angiogenesis, hypoxic conditions often delay tissue repair. However, studies disagree on how hypoxia specifically alters inflammatory pathways and angiogenic responses. To resolve these discrepancies, we performed a systematic review and meta-analysis synthesizing existing evidence to quantify the impact of high-altitude hypoxia on inflammation and angiogenesis during wound healing. OBJECTIVE:To systematically investigate the impact of low-oxygen environments at high altitudes on wound healing and to establish a theoretical basis for developing wound-care and intervention strategies suitable for high-altitude conditions. DESIGN:Meta-analysis and Review. SETTINGS:Wound Healing in Hypoxic Exposure at High-Altitudes. PARTICIPANTS:8 studies. METHODS:We searched PubMed, Embase, Web of Science, and Cochrane Library (CENTRAL). We included Randomized controlled trials and animal experiments on plateau hypoxia exposure and wound healing from the early years to 11 January 2026. Two researchers independently checked the literature, extracted data and assessed quality. We analyzed the data using RevMan 5.3 and sensitivity analysis to evaluate heterogeneity and robustness using one-by-one exclusion. RESULTS:We included 8 studies in the meta-analysis, we found that wound healing rate of high altitude group was lower than control group (SMD = -3.31, 95% CI -4.72 to -1.91, P < 0.05) and CD31 expression was lower in high altitude group than control group (SMD = -2.57, 95% CI -4.31 to -0.83, P < 0.05). Sensitivity analysis showed robustness. Pool effect size of IL-1β did not differ significantly between the groups (SMD = 1.47, 95% CI -2.4 to 5.36, P > 0.05). CONCLUSIONS:Current evidence from animal models suggests an association between high-altitude hypoxia and delayed wound healing, which may be linked to reduced expression of the angiogenesis marker CD31. The role of specific mediators like IL-1β remains unclear due to inconsistent findings across studies. Overall, the existing research, which is limited in both scope and methodological diversity, precludes definitive conclusions. This suggests that in high-altitude clinical settings, greater attention may be required for wound care, and future research could explore targeted adjunctive interventions. REGISTRATION:The meta-analysis protocol is registered with PROSPERO under registration number CD420251250487, Registered 11/01/2026. the implementation follows the registered protocol.
AIM:This scoping review aimed to identify and map clinical decision support tools (both digital and non-digital) used by clinicians for wound management in acute, primary, and community health settings globally, with a focus on the use of artificial intelligence, and the barriers and enablers to implementation. MATERIALS AND METHODS:Studies published between January 2015, and August 2024 were identified through systematic searches of Scopus, Embase, MEDLINE, and CINAHL, conducted in accordance with JBI methodology and reported using the PRISMA-ScR guidelines. Eligible studies included quantitative, qualitative, and mixed-methods research examining non-digital and AI-supported clinical decision support tools for wound management across healthcare settings. RESULTS:Seventeen studies were included, two evaluating AI-supported clinical decision support tools. Most clinical decision support tools had structured wound assessment and treatment planning, though evidence of clinical effectiveness was limited, with only one tool fully validated. Adoption by nurses was influenced by experience, trust, training, and workflow integration, with senior nurses less likely to rely on clinical decision support tools. AI-enabled tools, and a convolutional neural network-based model, improved assessment consistency, documentation, and workflow efficiency. Key barriers included concerns about trust, clinical autonomy, and usability. CONCLUSIONS:Both traditional and AI-supported clinical decision support tools are used for chronic wound management across acute, primary, and community care, but evidence of effectiveness and validation remains limited. The absence of experimental studies highlights the need for rigorous evaluation, clinician education, and strategies to support integration of AI-enabled clinical decision support tool into routine practice.
BACKGROUND:Prolonged surgical periods and specific positioning significantly increase the risk of pressure injuries. While various risk assessment tools are available, comparative studies evaluating their predictive performance specifically within the intraoperative setting remain limited. This study aimed to compare the predictive performance of the Braden Scale, the 3 S Intraoperative Pressure Injury Risk Assessment Scale, and the Scott Triggers Pressure Injury Risk Assessment Tool. METHODS:A prospective and descriptive study was conducted with 120 adult patients (aged >18 years) undergoing surgeries with an operative duration of ≥3 h. Patient data were collected using a demographic form, along with the Braden, 3 S Scale, and Scott Triggers scales. The study was reported in accordance with the STROBE checklist. RESULTS:Patients were assessed for pressure injuries immediately upon admission to the post-anesthesia care unit (PACU). All identified pressure injuries were Stage I, occurring most frequently following urology procedures (30%). Patients who developed a pressure injury exhibited significantly higher 3 S Scale scores compared to those who did not (p = 0.003). Furthermore, the 3 S Scale demonstrated significant discriminatory power (Area Under the Curve [AUC] = 0.658; p = 0.001), whereas the Scott Triggers and Braden scales exhibited discrimination levels close to chance (p > 0.05). CONCLUSION:The Scott Triggers and Braden scales exhibited limited predictive ability for intraoperative use. In contrast, the 3 S Scale demonstrated a statistically significant association with pressure injury risk and may represent a potentially useful tool for intraoperative assessment; however, its predictive performance appears to be moderate. Overall, current assessment tools are often inadequate for the dynamic surgical environment. There is a critical need to revise existing scales or develop new, comprehensive tools that integrate dynamic intraoperative variables, including surgical positioning, duration of exposure, and hemodynamic instability, to enhance the accuracy and clinical applicability of risk prediction models.
AIM:This study aimed to determine the point prevalence of skin tears and to identify demographic, clinical, functional, and laboratory factors associated with the presence of skin tears among hospitalized older adults. METHODS:A point prevalence study was conducted in a tertiary-level city hospital in Türkiye. The study included 343 hospitalized patients aged 65 years and older from medical, surgical, and intensive care units. Skin tears were identified and classified using the International Skin Tear Advisory Panel (ISTAP) classification system. Data on demographic characteristics, comorbidities, cognitive status, skin assessment findings, nutritional status, pressure injury risk, and laboratory parameters were collected. Statistical analyses included descriptive statistics and unadjusted comparative analyses between patients with and without skin tears. Because of the limited number of participants with skin tears, the findings were interpreted as exploratory associations rather than independent predictors. RESULTS:The overall point prevalence of skin tears was 9.6% (n = 33). Most patients with skin tears were hospitalized in intensive care units (78.8%), where the prevalence reached 26%. Skin tears were most frequently located on the arms (33.3%) and hands (27.3%), and 57.6% were classified as ISTAP Type 3. Medical adhesive-related skin injury was documented in 60.6% of participants with skin tears. Advanced age (≥85 years), cognitive impairment, reduced level of consciousness, incontinence, high Braden risk classification, malnutrition, and previous history of skin tears were more frequently observed among participants with skin tears. CONCLUSION:Skin tears are a common and multifactorial clinical problem among hospitalized older adults, particularly in intensive care settings. The frequent documentation of medical adhesive-related skin injury among participants with skin tears suggests the importance of structured prevention strategies focusing on skin integrity assessment, appropriate adhesive selection, and targeted care for patients with fragile skin.
PURPOSE:This study aimed to identify the distinct latent profiles of exercise fear trajectories and to explore the factors influencing membership in these profiles among patients with DFU. METHODS:A multicenter, cross-sectional study was conducted from March 2025 to August 2025. Using convenience sampling method, 179 patients with DFU were recruited from five tertiary hospitals in China. Participants completed a battery of questionnaires, including a General Information Form, the Tampa Scale for Kinesiophobia, the Exercise Self-Efficacy Scale, the Mini-Nutritional Assessment, and the Activity of Daily Living Scale. Latent profile analysis was employed to identify distinct subgroups of exercise-related fear. Univariate analysis and multivariate logistic regression were used to determine factors influencing profile membership. RESULTS:The response rate was 98.90%. Latent profile analysis revealed three distinct classes of exercise fear: "low fear-functional adaptation" (n = 40,22.30%), "moderate fear-cautious engagement" (n = 58,32.40%), and "high fear-exercise avoidance" (n = 81,45.30%). Multivariate logistic regression identified that poorer nutritional status、self-paid medical expenses、advanced age、comorbid chronic conditions、higher Wagner grade、and a greater number of DFU-related hospitalizations in the preceding year were significant factors associated with an increased likelihood of belonging to the more severe fear profiles (all P < .05). CONCLUSION:The exercise-related fear trajectory in DFU patients exhibits significant heterogeneity, categorized into three distinct profiles. Healthcare providers should routinely assess patients for kinesiophobia and identify patients' specific profile. Tailored interventions, including nutritional support, psychological counseling for those with financial or comorbidity burdens, and graded exposure exercise protocols for high-fear levels, are recommended to mitigate fear and promote safe physical activity participation.
OBJECTIVES:This systematic review and meta-analysis aimed to identify risk factors for facial pressure injuries. METHODS:The study adhered to the PRISMA reporting guidelines and conducted a comprehensive search across nine databases: PubMed, Web of Science, Cochrane Library, OVID, Embase, Chinese Biomedical Database, China Knowledge Resource Integrated Database, Wanfang Database, and Weipu Database, to identify the risk factors for facial pressure injuries. Observational studies investigating these risk factors were included, with data collection up to April 15, 2026, for database construction. The quality of the literature was assessed using the 2016 edition of the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Evaluation Criteria and the Newcastle-Ottawa Scale. RESULTS:19 studies involving 4119 samples were included. The findings indicated that the overall prevalence of facial pressure injuries was 32%. Ten factors associated with the development of facial pressure injuries included non-invasive ventilation protocol, fever, cumulative duration of non-invasive ventilation, the use of vasoactive drugs, PCO2 ≥ 50 mmHg, diabetes, acute physiology and chronic health evaluation II score, Glasgow coma scale, albumin levels, and age. CONCLUSIONS:Comprehending the risk factors linked to facial pressure injuries can facilitate the early identification of high-risk individuals and mitigate the occurrence of such injuries.
