Objective: The purpose of this review was to identify prognostic models for clinical application in patients with venous leg ulcers (VLUs).Methods: Literature searches were conducted in Embase, Medline, Cochrane, and CINAHL databases from inception to December 22, 2021. Eligible studies reported prognostic models aimed at developing, validating, and adjusting multi -variable prognostic models that include multiple prognostic factors combined, and that predicted clinical outcomes. Methodological quality was assessed using the CHARMS checklist and PROBAST short form questionnaire.Results: Thirteen studies were identified, of which three were validation studies of previously published models, four reported derivation and validation of models, and the remainder reported derivation models only. There was substantial heterogeneity in the model characteristics, including 11 studies focused on wound healing outcomes reporting 91 different predictors. Three studies shared similar predicted outcomes, follow-up timepoint and used a Cox proportional hazards model. However, these models reported different predictor selection methods and different predictors and it was therefore not feasible to summarize performance, such as discriminative ability.Conclusions: There are no standout risk prediction models in the literature with promising clinical application for pa-tients with VLUs. Future research should focus on developing and validating high-performing models in wider VLU populations. (J Vasc Surg Venous Lymphat Disord 2024;12:101673.)

Advances in Wound CareVol. 12, No. 10 Letter to the EditorRe: “How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs” by Gefen et al.Jan Kottner, Michael Clark, Joyce M. Black, William V. Padula, and Peter R. WorsleyJan KottnerDepartment of Nursing Science, Charité—University Medicine Berlin, Berlin, Germany.European Pressure Ulcer Advisory Panel (EPUAP), London, United Kingdom.Search for more papers by this author, Michael ClarkFaculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, United Kingdom.Prophylactic Dressing Standards Initiative (PDSI) Task Force, EPUAP-NPIAP, London, United Kingdom.Search for more papers by this author, Joyce M. BlackProphylactic Dressing Standards Initiative (PDSI) Task Force, EPUAP-NPIAP, London, United Kingdom.Department in Nursing, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA.Search for more papers by this author, William V. Padula*Correspondence: Department of Pharmaceutical and Health Economics, University of Southern California School of Pharmacy, Los Angeles, CA 90089, USA E-mail Address: [email protected]https://orcid.org/0000-0003-1161-6954Department of Pharmaceutical and Health Economics, University of Southern California School of Pharmacy, Los Angeles, California, USA.National Pressure Injury Advisory Panel (NPIAP), Massachusetts, USA.Search for more papers by this author, and Peter R. WorsleyEuropean Pressure Ulcer Advisory Panel (EPUAP), London, United Kingdom.Department of Healthcare Technologies, University of Southampton, Southampton, United Kingdom.Search for more papers by this authorPublished Online:27 Jul 2023https://doi.org/10.1089/wound.2022.0087AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Re: “How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs” by Gefen et al.." Advances in Wound Care, 12(10), pp. 601–602FiguresReferencesRelatedDetails Volume 12Issue 10Oct 2023 InformationCopyright 2023, Copyright © 2023 by Mary Ann Liebert, Inc., publishersTo cite this article:Jan Kottner, Michael Clark, Joyce M. Black, William V. Padula, and Peter R. Worsley.Re: “How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs” by Gefen et al..Advances in Wound Care.Oct 2023.601-602.http://doi.org/10.1089/wound.2022.0087Published in Volume: 12 Issue 10: July 27, 2023Online Ahead of Print:February 13, 2023Online Ahead of Editing: December 7, 2022 TopicsDressingsWound careWound therapies PDF download

Objective It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. Data sources A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review methods Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (+/- 95% confidence intervals), using Hedge's g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. Results In total, 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press (g = -0.34, 95% CI [-0.64, -0.03]) and leg press (g = -0.25, 95% CI [-0.49, -0.02]) existed between adult women with fibromyalgia and active community women. Conclusion There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women.

Significance: Chronic wounds are associated with significant morbidity, marked loss of quality of life, and considerable economic burden. Evidence-based risk prediction to guide improved wound prevention and treatment is limited by the complexity in their etiology, clinical underreporting, and a lack of studies using large high-quality datasets. Recent Advancements: The objective of this review is to summarize key components and challenges in the development of personalized risk prediction tools for both prevention and management of chronic wounds, while highlighting several innovations in the development of better risk stratification. Critical Issues: Regression-based risk prediction approaches remain important for assessment of prognosis and risk stratification in chronic wound management. Advances in statistical computing have boosted the development of several promising machine learning (ML) and other semiautomated classification tools. These methods may be better placed to handle large number of wound healing risk factors from large datasets, potentially resulting in better risk prediction when combined with conventional methods and clinical experience and expertise. Future Directions: Where the number of predictors is large and heterogenous, the correlations between various risk factors complex, and very large data sets are available, ML may prove a powerful adjuvant for risk stratifying patients predisposed to chronic wounds. Conventional regression-based approaches remain important, particularly where the number of predictors is relatively small. Translating estimated risk derived from ML algorithms into practical prediction tools for use in clinical practice remains challenging.

International Wound JournalEarly View EDITORIALOpen Access The vision and scope of the prophylactic dressing standard initiative of the European Pressure Ulcer Advisory Panel and National Pressure Injury Advisory Panel David Brienza, Corresponding Author David Brienza dbrienza@pitt.edu Departments of Rehabilitation Science and Technology and Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Correspondence David Brienza, Departments of Rehabilitation Science and Technology and Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Email: dbrienza@pitt.eduSearch for more papers by this authorAmit Gefen, Amit Gefen The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorMichael Clark, Michael Clark Welsh Wound Innovation Centre, Ynysmaerdy Wales, UK School of Nursing and Midwifery, Birmingham City University, Birmingham, UKSearch for more papers by this authorJoyce Black, Joyce Black Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USASearch for more papers by this author David Brienza, Corresponding Author David Brienza dbrienza@pitt.edu Departments of Rehabilitation Science and Technology and Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Correspondence David Brienza, Departments of Rehabilitation Science and Technology and Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Email: dbrienza@pitt.eduSearch for more papers by this authorAmit Gefen, Amit Gefen The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorMichael Clark, Michael Clark Welsh Wound Innovation Centre, Ynysmaerdy Wales, UK School of Nursing and Midwifery, Birmingham City University, Birmingham, UKSearch for more papers by this authorJoyce Black, Joyce Black Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USASearch for more papers by this author First published: 14 June 2022 https://doi.org/10.1111/iwj.13859AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat National and international standards exist to enable testing of the properties and performance of dressings used upon wounded skin and soft tissues. However, these same dressings can and are often used upon intact skin to provide an effective component of pressure ulcer/injury prevention.1-6 To date, there are no established and accepted standards that can be used to evaluate the prophylactic function of dressing materials. The use of dressings for wound prevention is recommended in international clinical practice guidelines7 and has become the standard of care in some clinical settings. The industry has responded to the market demands stemming from these promising outcomes by promoting the use of existing wound dressings for prophylactic use. Unfortunately, two factors conspire to cause considerable problems for all parties including clinicians who want to use prophylactic dressings, for regulators and third-party payors who need to know which products to fund in specific clinical circumstances, and also for manufacturers seeking to both improve their products and develop new products (including specific for prophylactic use) First, the clinical studies reported to date have not been designed such that they elucidate the mechanism of action of the prophylactic effects. Second, the products that have been evaluated and/or marketed for prophylactic use have substantially different characteristics related to pressure ulcer/injury prevention. For example, some provide more cushioning, while others insulate heat more than comparable products indicated for the same clinical purpose. Without knowing which characteristics affect outcomes and without having standard methods for comparing performance, none of the stakeholders have all the information needed to make proper choices for prescribing, developing, improving, and reimbursing wound dressings when they are being used to prevent pressure ulcers/injuries. Responding to this need, the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Injury Advisory Panel (NPIAP) have joined forces with clinicians, manufacturers, researchers, and others to form the Prophylactic Dressing Standards Initiative (PDSI) to develop methods specifically for assessing performance of prophylactic dressings. The PDSI's intent is to eventually codify these laboratory-based methods as international standards. The PDSI was launched in the spring of 2021 with strong support from all stakeholders. The group consists of experts from dressing manufacturers, research organisations, clinicians, and testing experts. The group has made significant progress during the first year. The PDSI participants have organised into working groups that are developing and evaluating test methodologies for individual classifications of performance including mechanical behaviour and durability, thermal performance, moisture management, and adhesiveness properties. Each working group has developed a scope of work to include identifying potential metrics, terminology, and test methods. As a guiding philosophy, PDSI has adopted a rigorous validation requirement for any new methods that might be developed by the group. For example, the working group focusing on moisture management is currently reviewing alternatives for synthetic sweat test fluids for moisture handling testing of dressings in prophylactic use. Similarly, the working group on adhesiveness reviews options for skin-mimicking substrata, the appropriate adherence time before a peel testing, and the temperature at which peel tests should be conducted. PDSI's activities are supported by participation fees and in-kind contributions from members and member organisations. The targeted date for completion of initial test methods is by the spring of 2024. At that time, it is anticipated that an international standards committee will be formed within the International Organisation of Standardisation committee structure, to advance identified and developed methods as recognised international standards. The PDSI initiative provides an important example of academic, clinical, and commercial partnership to fill the current void around the technical evaluation of dressing materials used to support pressure ulcer/injury prevention. Standards exist for wound dressings concerning their characteristics related to treatment of existing wounds (EN 137268). However, EN 13726 has been criticised in the literature for lack of clinical relevance.9 Moreover, the application of dressings for prophylaxis is not currently addressed in any existing test standard, including in the EN 13726. Accordingly, and despite there being some overlap between characteristics important to pressure ulcer/injury prevention and factors important to wound healing, the PDSI chose to limit its scope to prophylactic use of dressings only, and as related to pressure ulcers/injuries (but not other wound aetiologies), to focus energy on the current urgent need for validated methods to compare dressing products for these preventative purposes. The multidisciplinary group will provide updates about their work at national meetings and via editorials. Please direct specific questions to the members of the guidance group, who are authors of this material. REFERENCES 1Kalowes P, Messina V, Li M. Five-layered soft silicone foam dressing to prevent pressure ulcers in the intensive care unit. Am J Crit Care. 2016; 25(6): e108- e119. CrossrefPubMedWeb of Science®Google Scholar 2Aloweni F, Lim ML, Chua TL, Tan SB, Lian SB, Ang SY. A randomised controlled trial to evaluate the incremental effectiveness of a prophylactic dressing and fatty acids oil in the prevention of pressure injuries. Wound Pract Res J Aust Wound Manag Assoc. 2017; 25(1): 24- 34. Web of Science®Google Scholar 3Santamaria N, Gerdtz M, Sage S, et al. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J. 2015; 12(3): 302- 308. Wiley Online LibraryPubMedWeb of Science®Google Scholar 4Brindle CT, Wegelin JA. Prophylactic dressing application to reduce pressure ulcer formation in cardiac surgery patients. J Wound Ostomy Cont Nurs. 2012; 39(2): 133- 142. CrossrefPubMedWeb of Science®Google Scholar 5Santamaria N, Gerdtz M, Kapp S, Wilson L, Gefen A. A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: the border III trial. Int Wound J. 2018; 15(3): 482- 490. Wiley Online LibraryPubMedWeb of Science®Google Scholar 6Beeckman D, Fourie A, Raepsaet C, et al. Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial. Br J Dermatol. 2020; 185: 52- 61. Wiley Online LibraryPubMedGoogle Scholar 7 EPUAP/NPIAP/PPPIA. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. Osborne Park: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance: Cambridge Media; 2019. Google Scholar 8 European_Standards, EN 13726-2 Test methods for primary wound dressings—Part 2: moisture vapour transmission rate of permeable film dressings. 2002. Google Scholar 9Gefen A, Alves P, Beeckman D, et al. How should clinical wound care and management translate to effective engineering standard testing requirements from foam dressings? Mapping the existing gaps and needs. Adv Wound Care. 2022. CrossrefGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Cervical artery dissection is a major cause of ischaemic stroke in young adults. The diagnosis can be challenging as some patients may present with seemingly benign symptoms such as a headache, neck pain or dizziness. However, the neurological sequelae of a transient ischaemic attack, vision loss or ischaemic stroke are potentially devastating. All hospital clinicians must be able to recognise this diagnosis and organise timely and appropriate investigations as antithrombotic treatment reduces the risk of stroke recurrence. This article reviews the literature to provide practical information for clinicians to recognise key risk factors and features of history and examination which should raise suspicion of cervical artery dissection. Diagnosis can now be made using the non-invasive, commonly available modalities of computed tomography angiography or magnetic resonance angiography. Timely treatment with antithrombotic agents is recommended to reduce the rate of an ischaemic stroke.

There has been debate regarding the correct terminology for a wound upon the heel of diabetic patients; are these pressure ulcers (PUs) or diabetic foot ulcers (DFUs)? Diabetic foot wounds should be referred quickly to podiatrists or multidisciplinary specialist foot clinics; imperfections in healthcare systems indicate that such referrals may be rare leading to few marked differences in the care of heel PUs or heel DFUs. This chapter considers the limited evidence for improved healing of heel ulcers in nondiabetic patients based on clinical studies and two wound registries. The challenges of using wound registries to address specific questions around the healing of wounds at specific anatomical locations are highlighted.

Successful prevention of pressure ulcers is the end product of a complex series of care processes including, but not limited to, the assessment of vulnerability to pressure damage; skin assessment and care; nutritional support; repositioning; and the use of beds, mattresses, and cushions to manage mechanical loads on the skin and soft tissues. The purpose of this review was to examine where and how Statistical Process Control (SPC) measures have been used to assess the success of quality improvement initiatives intended to improve pressure ulcer prevention. A search of 7 electronic bibliographic databases was performed on May 17th, 2017, for studies that met the inclusion criteria. SPC methods have been reported in 9 publications since 2010 to interpret changes in the incidence of pressure ulcers over time. While these methods offer rapid interpretation of changes in incidence than is gained from a comparison of 2 arbitrarily selected time points pre‐ and post‐implementation of change, more work is required to ensure that the clinical and scientific communities adopt the most appropriate SPC methods.

This chapter considers how wound dressings are used in the treatment of wounds identifying the ideal properties of a wound dressing. Changes in the treatment of wounds with dressings since 1980 are discussed highlighting the current availability of a wide range of advanced wound dressings that clinicians have to select from for each wound they treat. Alginate wound dressings are introduced with their chemistry briefly considered and their indications and contraindications for clinical use reported. The clinical evidence supporting the use of alginate wound dressings is discussed highlighting the generally weak evidence underpinning the use of all advanced wound dressings. Recent reviews of the effectiveness of alginate dressings noted that across all the studies, there were no statistically significant differences between the outcomes achieved using the alginate dressings and the comparison groups. It is concluded that alginate dressings are currently not in widespread use in the UK National Health Service and may now be considered as comparisons against which new technologies may be compared.

Objective The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Methods Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Results Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. Conclusions This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales.

Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution.

Medical device related pressure ulcers (MDR PUs) are defined as pressure injuries associated with the use of devices applied for diagnostic or therapeutic purposes wherein the PU that develops has the same configuration as the device. Many institutions have reduced the incidence of traditional PUs (sacral, buttock and heel) and therefore the significance of MDR PU has become more apparent. The highest risk of MDR PU has been reported to be patients with impaired sensory perception, such as neuropathy, and an impaired ability for the patient to communicate discomfort, for example, oral intubation, language barriers, unconsciousness or non-verbal state. Patients in critical care units typify the high-risk patient and they often require more devices for monitoring and therapeutic purposes. An expert panel met to review the evidence on the prevention of MDR PUs and arrived at these conclusions: (i) consider applying dressings that demonstrate pressure redistribution and absorb moisture from body areas in contact with medical devices, tubing and fixators, (ii) in addition to dressings applied beneath medical devices, continue to lift and/or move the medical device to examine the skin beneath it and reposition for pressure relief and (iii) when simple repositioning does not relieve pressure, it is important not to create more pressure by placing dressings beneath tight devices.

Although this article is a stand‐alone article, it sets the scene for later articles in this issue. Pressure ulcers are considered to be a largely preventable problem, and yet despite extensive training and the expenditure of a large amount of resources, they persist. This article reviews the current understanding of pressure ulcer aetiology: pressure, shear and microclimate. Individual risk factors for pressure ulceration also need to be understood in order to determine the level of risk of an individual. Such an assessment is essential to determine appropriate prevention strategies. The main prevention strategies in terms of reducing pressure and shear and managing microclimate are studied in this article. The problem of pressure ulceration related to medical devices is also considered as most of the standard prevention strategies are not effective in preventing this type of damage. Finally, the possibility of using dressings as an additional preventive strategy is raised along with the question: is there enough evidence to support their use?

Dr George Cherry receiving his lifetime achievement award at World Union 2008 in Toronto. George, American by birth, started his wound healing research interests in New Orleans in 1965 followed by his first spell in Oxford where he gained his doctorate followed by a stint in South Africa as the Christiaan Barnard Research Fellow at the University of Cape-town before returning once again to Oxford. A spell as Director of Plastic Surgery research at the University of Michigan in the late 1970s was followed by his return to Oxford in 1982 as part of Department of Dermatology in Oxford. George remained in Oxford until his death. Professor Terence Ryan who brought George back to Oxford in 1982 noted how ‘huge developments in the leg ulcer field were led by George Cherry’ 1. George was a pioneer not only in terms of his academic and clinical studies in wound healing using initially animal models and then human subjects but also in the promotion and support of nursing research in wound healing. For many, George will be remembered also for his immense role in founding and developing a number of wound healing organizations. His enthusiasm was boundless and without George the growth of the European Tissue Repair Society and perhaps especially the European Pressure Ulcer Advisory Panel would have been severely hampered. George was not only a supporter of UK and European initiatives – over the years he helped build bridges between wound healers in Europe and the United States with colleagues in China, Thailand, Vietnam, Latin America among many other parts of the world. In all of this work George received great support from his wife, Christine, and together they formed a formidable team helping to organize multiple conferences and events. Many will have cause to give George thanks for the opportunity to attend the Oxford Wound Healing Summer School. Whether you were part of the teaching team or a Summer School participant the opportunity to meet and discuss wound healing within the warm environment of Oxford University was a firm part of the wound healing annual calendar. The Oxford Wound Healing Summer School was one part of the Oxford International Wound Healing Foundation established in 1992 by George and Terence Ryan, which served both as a platform for on-going wound healing research as well as the growing international collaboration George was instrumental in creating. George was a great supporter of new and established wound healing investigators – this shines through from his work in Asia and Latin America. On a personal note as a new post-doctoral fellow finding his feet with his first substantial grants in the mid-1980s George was a constant source of advice, encouragement and friendship to me. George will be rightly remembered for his work in wound healing, particularly in leg ulceration; but his warmth and great enthusiasm marked him as a special man who will be much missed by all who knew him.