AIM:This scoping review examined how patient and public involvement (PPI) is incorporated in pressure ulcer (PU) research. It identified the research stages where PPI occurs, the methods used to support it, the terminology applied, and its reported impact on research quality, practice, organisations, patients, and society. METHODS:Nine electronic databases were searched from inception to March 2025. Studies with an objective to prevent or treat PUs, that actively involved people with lived experience of PUs as PPI contributors during the research lifecycle were included. Articles were independently screened and pre-defined data were extracted by two authors. Results were synthesised using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. Two PPI contributors collaborated across each stage of this review. RESULTS:Twenty studies were included, with a median of 6.5 (1-48) PPI contributors, involved in a median of 2.5 (1-6) research stages. Participatory methods ranged from structured frameworks to flexible, adaptive engagement strategies (i.e., workshops/consultations). Impact of PPI was reported across 80% (n = 16) of studies, predominately in the research quality domain. Limited use of the Guidance for Reporting of Patients and the Public (GRIPP2) checklist was observed (5%, n = 1). Multiple terms were used to describe PPI. CONCLUSION:While PPI in PU research is growing, reporting and integration vary widely. GRIPP2 checklists can enhance transparency. Studies should aim to involve contributors across multiple stages, targeting when and how PPI adds most value. A standardised terminology, agreed with PPI contributors, could enhance clarity and equity, reflecting their level of partnership and expertise.

AIM:To map current evidence on AI integration in nursing education, identifying pedagogical applications, learning outcomes, future research directions. BACKGROUND:The integration of artificial intelligence (AI) into nursing education is expanding rapidly, offering opportunities to enhance learning. As the role of AI in healthcare expands, nursing education must evolve to prepare future nurses with the necessary knowledge and skills to effectively and ethically utilise these technologies. DESIGN:A scoping review following Arksey and O'Malley's framework. METHODS:PRISMA-ScR guidelines and a hybrid AI-human methodology was adopted to ensure transparency and rigour. Covidence software supported blinded dual screening and consensus tracking. Generative AI assisted in structured data extraction, with manual verification by four independent reviewers. Data were analysed through descriptive mapping and reflexive thematic synthesis using Braun and Clarkes Framework. RESULTS:Nine studies (2023-2025) met the inclusion criteria, encompassing undergraduate, postgraduate and faculty contexts. AI tools including ChatGPT, MindMeld NLP and Deepgram were applied mainly as pedagogical enhancers providing simulation, adaptive feedback and reflective learning support. Five themes emerged: (1) knowledge and skills development; (2) self-efficacy and confidence building; (3) clinical reasoning and decision-making; (4) communication and empathy; and (5) engagement and pedagogical acceptability. Collectively, these studies demonstrated consistent improvements across cognitive, affective and behavioural learning domains. CONCLUSION:AI serves as a pedagogical amplifier, augmenting learning through adaptive, reflective and emotionally intelligent interaction. When ethically governed and contextually embedded, AI supports higher-order thinking, empathy and learner engagement, advancing a human-centred vision for technology-enhanced nursing education.

BACKGROUND:Frailty among older adults is an escalating public health challenge, often associated with poorer quality of life (QoL) and increased pressure on healthcare systems. Integrated care is proposed as a strategy to meet the complex needs of this population, though evidence of its effectiveness remains inconclusive. OBJECTIVES:To determine the impact of integrated care on the quality of life of frail, community-dwelling older adults. DESIGN:Systematic review and mixed-methods synthesis, including meta-analysis and narrative synthesis. SETTING:Community-based healthcare systems across six international studies. PARTICIPANTS:A total of 5498 frail, community-dwelling older adults across six studies: four randomised controlled trials and two quasi-experimental designs. INTERVENTION:Integrated care interventions tailored to frailty, including person-centred, multidisciplinary, and value-based models. MEASUREMENTS:Quality of Life was the primary outcome. Secondary outcomes included social functioning and healthcare costs. Standardised tools such as SF-12, SF-36, ICECAP-O, and EQ-5D were used across studies. RESULTS:The meta-analysis showed a small, non-significant improvement in QoL (SMD = 0.13, 95 % CI: -0.09 to 0.35, p = 0.24) with high heterogeneity (I² = 91 %). Tailored, multidimensional models showed greater effects, particularly in preserving social functioning. Findings on cost-effectiveness were inconsistent; some studies reported reduced hospital use, while others found increased primary care visits without cost savings. CONCLUSIONS:. Integrated care may support social functioning but does not demonstrate a consistent improvement in overall QoL. Future trials should standardise QoL measurement, report intervention components clearly, include economic evaluations, and assess longer-term outcomes.

AIM:The aim of this study was to evaluate the impact of pressure ulcer prevention education for health care assistants on their knowledge, skills, and attitudes towards PU prevention. MATERIALS AND METHODS:A quasi-experimental, one group, pre-test, post-test design was employed. The participants were health care assistants (HCAs) caring for older adults at risk of pressure ulcer development residing in long term care settings. Following ethical approval, the Shanley pressure ulcer prevention programme (SPUPP) (Shanley et al., 2022 May). and the pressure ulcer classification education tool (PUCLAS) (Beeckman, 2017) was delivered to consenting participants. Knowledge was assessed using the knowledge of pressure ulcer prevention tool (KPUP) (Shanley et al., 2020), skills were assessed using images depicting pressure ulcers as per the European Pressure Ulcer Advisory Panel (2019) classification tool, and attitudes were assessed using the Moore and Price attitude tool (APUP) (Moore & Price 2004). Outcomes were assessed at baseline, immediately following the education intervention and again at 4 months. Data were analysed using descriptive and inferential statistics, as appropriate. RESULTS:A total of 129 HCAs completed the education intervention and completed the questionnaires pre (K1) and post intervention (K2), while 52% (n = 67) completed the 4 month (K3) follow up questionnaires. In total, 19% (n = 24) were male and 81% (n = 105) were female, with a mean age of 49 years (SD: 7 years; min 29 years, max 60 years). The average duration of employment was 2.4 (SD:1) years and 33% (n = 42) had received previous education in PU prevention. There was a statistically significant increase in average knowledge scores at K2 compared to K1 (MD: 3.40; 95% CI: 3.10 to 3.70) and K3 compared to K1 (MD: 3.04; 95% CI: 2.65 to 3.42) with large effects (Cohen's d = 1.74 at K2; d = 1.55 at K3), and a decrease in average scores from K2 to K3, but this was not statistically significant (MD: -0.36, 95% CI: -0.75 to 0.02). Similarly, there was a statistically significant increase in average skill scores at S2 compared to S1 (MD: 2.13; 95% CI: 1.95 to 2.30; p < 0.001) and S3 compared to S1 (MD: 1.53; 95% CI: 1.31 to 1.75; p < 0.001) with large effects (Cohen's d = 2.72 at S2; d = 1.95 at S3). Conversely, there was a statistically significant decrease in mean skill scores from S2 to S3 (MD: -0.60; 95% CI: -0.82 to 0.38; p < 0.001). Furthermore, there was a statistically significant MD in attitude scores from A1TS to A2TS and from A1TS to A3TS (MD: 1.81, 95% CI: 1.08 to 2.55, p < 0.001; MD: 2.83, 95% CI: 1.89 to 3.76, p < 0.001, respectively) with a moderate effect at A2TS (Cohen's d = 0.47) and a moderate-to-large effect at A3TS (d = 0.73). There was also a statistically significant difference in attitude scores from A2TS to A3TS (MD: 1.00, 95% CI: 0.77 to 1.95, p = 0.035). CONCLUSIONS:HCAs are an integral component of the health care workforce, and play a very important role in providing direct care to patients within the LTC setting. As such, HCAs need the right knowledge, skills and attitudes to ensure that care delivered is timely and appropriate. Outcomes of this study showed that knowledge, skill and attitude scores improved from baseline and remained higher than baseline at the 4 month follow up. It is evident therefore, that HCAs are a group of health care workers that can be positively impacted by investment in education. Findings also reiterate the need for reinforcement of education at regular intervals, due to the risk of knowledge and skill scores dropping over time.

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.

Objective: To examine risk factors for pressure ulcer (PU) development among adults undergoing surgery. Method: A total of five electronic databases were searched from inception to March 2024. Study selection, data extraction and quality appraisal were performed by two independent reviewers, using the Crowe Critical Appraisal Tool (CCAT v1.4; Michael Crowe, James Cook University, Australia), with scores ≥75% indicating high methodological quality. Results were categorised and reported as preoperative, intraoperative and postoperative risk factors, with percentages representing the proportion of studies assessing each risk factor in which it was statistically significant. Due to methodological heterogeneity, findings were synthesised narratively. Results: A total of 41 studies were included, 20 (48.8%) of which had retrospective designs. Among the preoperative risk factors, Braden score was statistically significant in 11 (68.8%) of the 16 studies assessing this factor, age in 19 (61.3%) of 31 studies, and diabetes in 11 (61.1%) of 18 studies. Among intraoperative risk factors, duration of surgery was statistically significant in 15 (53.6%) of 28 studies assessing this factor, patient positioning in nine (60.0%) of 15 studies, and type of surgery in nine (60.0%) of 15 studies. Postoperatively, Braden Scale score was statistically significant in five (83.3%) of six studies, while sepsis and pneumonia were each statistically significant in all three (100%) studies assessing these factors. The mean methodological quality score was 82±9.7%. Conclusion: This systematic review identified several risk factors for PU development across the included studies during the preoperative, intraoperative, and postoperative surgical period. Due to the complex interplay between competing factors that impact PU development during surgery, the development of a core outcome set of risk factor variables for inclusion in future studies may enhance homogeneity and support risk stratification alongside optimisation of modifiable exposure factors.

Question What are the psychometric properties of the tools measuring outcomes of educational interventions on pressure injury prevention? Background Given the significant prevalence and incidence of pressure injuries and their detrimental effects, the implementation of pressure injury prevention education is fundamental for all involved in the care of the at “risk” patient population. To assess the outcome of the educational programmes and determine their impact, the use of a validated tool is required to assess outcomes such as knowledge, attitudes and behaviours towards PI prevention. There has been an increased focus in health care on instrument development and psychometric testing, as this allows both researchers and educators to assess and measure the challenges in a valid and reliable way. Objective The aim of this systematic review is to examine the psychometric properties in current tools/instruments used to measure outcomes of educational interventions on pressure injury prevention. Methods A systematic search was conducted in PubMed, CINAHL, and Embase in March 2025. Studies reporting psychometric properties of tools/instruments measuring the impact of pressure injury prevention educational interventions were included. Two authors independently screened titles, abstracts, and full texts for eligibility. Data on tool characteristics, reliability and validity were extracted from included studies. Review methods The search identified 147 records, of which 16 studies met the inclusion criteria. Conclusion This review found considerable variability in the psychometric quality of tools used to evaluate pressure ulcer prevention education outcomes. Most tools demonstrated only partial validation, focusing on internal consistency with limited assessment of other properties.

Aim: Temperature is a marker of inflammation. Research has shown that by measuring skin surface temperature in those with a history of diabetic foot ulceration (DFU), tissue damage can be identified early and reduce rates of subsequent DFU. This study considered whether measuring skin surface temperature using infra-red thermometry can identify early tissue damage and inform clinical practice in a general population with Diabetes Mellitus (DM). Method: The data presented was taken from a prospective observational study of risk factors in patients with Diabetes. As part of this study, temperature measurements using the Flir E6 Infra-red camera were taken from 216 individuals attending outpatient diabetes clinics in a large urban teaching hospital in Ireland as part of a comprehensive diabetic foot assessment. Measurements were taken at foot sites associated with increased risk at baseline received repeat temperature measurement on 2 subsequent occasions in the following week. Any ulceration was subsequently recorded. Results: Discussion: Of the 216 participants, 4 % (n = 9) developed visual ulceration within 7 days. All of these had been identified at high risk at baseline assessment and had a history of foot disease. A temperature differential of >= 2.2 degrees C between sites of interest was recorded. Temperature ranges varied from 29.1 degrees C to 37.6 degrees C. High temperature was considered if over 35 degrees C. Of those who developed a diabetic foot ulceration within the 7 day follow up period, 78 % (n = 7) had a high temperature. The remaining 22 % (n = 2) who developed ulceration had a temperature reading in the normal range. Conclusion: Elevated skin surface temperature was seen prior to the development of DFU in all cases in this study. Initial analysis suggests that neither the 35 degrees C threshold nor a 2.2 degrees C temperature difference is indicative of inevitable tissue damage in this population due to the high number of false positives seen.

INTRODUCTION:There is a growing shift toward greater inclusion of patients and the public in the design, conduct, and implementation of research to ensure it is more meaningful, relevant and impactful. This involvement creates a partnership in which patients and the public contribute to decisions throughout the research lifecycle. While the impact and importance of patient and public involvement (PPI) in research is becoming increasingly recognised, the extent of PPI in pressure ulcer (PU) research has yet to be fully established. This scoping review aims to provide insights into how PPI has been included and reported in PU research, ultimately placing a spotlight on the impact and importance of reporting PPI to guide future PU research. METHODS AND ANALYSIS:Through synthesising literature from a diverse global landscape, this scoping review aims to achieve the following objectives (1) To explore and map the stage(s) of the PU research cycle where PPI has been incorporated (2) To identify and describe the range of participatory methods, including frameworks, guidelines, or tools, that have been used to facilitate the involvement of patients and the public in PU research. (3) To identify and synthesise reporting impacts of including PPI in PU research, and (4) To map and analyse the terminology commonly used to describe PPI in PU research. The Joanna Briggs Institute scoping review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews framework will guide the conduct and reporting of this review. Nine databases will be included in the search strategy and all articles will be independently screened for eligibility by two authors. Data from eligible articles will be extracted using a pre-defined data extraction table, and the results will be analysed and synthesised using the PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework. ETHICS AND DISSEMINATION:Ethics approval will not be required considering the nature of this scoping review. PPI advisory partners will be consulted for disseminating the results in a format that is accessible and understood by a layperson, in order to communicate the findings to a wide audience and diverse communities. This scoping review will be published in a peer reviewed journal and results will be disseminated at local national and international conferences. REGISTRATION:This scoping review is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/JHT34). As is typical with scoping reviews, this protocol may evolve over time. Any updates will be documented on the Open Science Framework platform, along with a clear rationale for the changes.

AIM:This meta-review examined the incidence and prevalence rates of pressure ulcers in paediatric populations, to place in context the scope of the problem in this cohort of patients. The findings provide a foundation for future research on early factors contributing to paediatric pressure ulcers, aiming to improve understanding and prevention. METHOD:A protocol for this study was registered with the International Prospective Register of Systematic Reviews. This meta-review followed the recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A comprehensive electronic literature search was undertaken of seven databases in February 2025. Search terms and keywords were identified to try and identify as many relevant articles as possible. Inclusion and exclusion criteria were applied, and articles which were identified were critically appraised using the Joanna Briggs Institute checklist for systematic reviews. Individual studies were extracted from the systematic reviews, duplicates were removed manually. From these individual studies, data points were identified for extraction and inclusion in this meta-review. Reported incidence and prevalence rates were broken into categories based on the type of pressure ulcer: hospital-acquired, medical device-related and tracheostomy-related pressure ulcers. RESULTS:Five systematic reviews met the inclusion criteria and were included in this review. Three types of pressure ulcers were discussed in the included studies: hospital-acquired pressure ulcers, medical device-related pressure ulcers, and tracheostomy-related pressure ulcers. Pooled incidence and prevalence rates were calculated using the STATA application and the Metaprop command. The pooled incidence rate for hospital-acquired pressure ulcers was 8 % (95 % Confidence Interval [CI]: 4 %-13 %), and for medical device-related pressure ulcers was 9 % (95 % CI: 2 %-19 %). The pooled prevalence rate for hospital-acquired pressure ulcers was 8 % (95 % CI: 5 %-12 %), and for medical device-related pressure ulcers was 10 % (95 % CI: 1 %-26 %). Studies related to tracheostomy-related pressure ulcers showed a pooled risk ratio of 0.35 (95 % CI 0.26-0.49). CONCLUSION:Pressure ulcers are a concern in paediatric populations, with comparable incidence and prevalence rates between hospital-acquired and medical device-related pressure ulcers. Children with tracheostomies face a significantly higher risk of developing pressure ulcers, highlighting the need for tailored preventive interventions. The findings here point to the need for vigilant preventive measures and tailored interventions to safeguard the well-being of young patients against pressure ulcers.

AIM:To explore existing literature examining physiological differences in pressure ulcer response among individuals with differing skin tones. METHODS:This was a scoping review. Articles meeting the inclusion criteria were retrieved from electronic databases including PubMed, CINAHL, Scopus, Cochrane, and EMBASE, using the keywords "pressure ulcer," "skin pigmentation," "melanin," and "risk factor." Data were extracted using a predesigned data extraction tool and analysed using a narrative synthesis. RESULTS:Five papers met the inclusion criteria. Analysis of findings suggests there are potential mechanisms which may influence the skin's ability to withstand mechanical stress and its inflammatory response to damage among those with different skin tones; the structure of the stratum corneum, collagen density, fibroblast activity, mast cell density, and transepidermal water loss (TEWL). The stratum corneum can compromise skin resilience, while collagen density and fibroblast activity may impact skin strength and repair. Mast cells affect inflammation, which can exacerbate pressure ulcer damage, and increased TEWL in those with dark skin tones can result in lower water content in the stratum corneum, affecting hydration.Conversely, factors like melanosome size, hair follicle and hair fiber characteristics, sebaceous gland activity, vitamin D production, UVR protection, and desquamation rate, although relevant to overall skin health, may not directly affect the mechanical processes leading to pressure ulcer formation. CONCLUSIONS:Physiological differences in skin structure may contribute to alterations in the response to pressure ulcer development among individuals with dark skin. Recognising these differences is important for targeted prevention strategies within diverse populations. However, further research is needed to explore the mechanisms underlying this association in greater detail.

Background Chronic wounds can pose a significant challenge for patients and healthcare professionals including the morbidity and associated costs. It is therefore essential to understand the specific challenges faced by patients to make wound care services more effective and convenient for the patient population. Aim Using the PEO model, this systematic review aims to explore the specific challenges patients with chronic wounds encounter when attending medical appointments related to wound care. Method A systematic search of publications using MEDLINE, Ovid EMBASE, CINAHL databases was conducted in April 2024, and relevant articles were reviewed. Data extraction and a narrative synthesis approach was undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the studies included. The primary outcome was to identify the specific challenges faced by patients with chronic wounds who attend medical appointments related to wound care. The secondary outcome was to determine wound healing progression, quality of life, complications of wound care, and adverse effects of wound care. Results Six studies between the years 2014 and 2024 described the specific challenges faced by patients with chronic wounds in a hospital or clinic setting. All six studies mentioned the pain and unwanted physical inactivity collectively affected the daily life of the patients and their capability of attending appointments. Increased cost of attending wound care appointments and travelling were elucidated by four studies. Increased waiting time during the appointments were also described by four studies. Additionally, two studies mentioned the difficulties of accessing public transport and heavy reliance on private transport because of the physical inability associated with the wound. Conclusion This systematic review identified several challenges faced by patients with chronic wounds when attending medical appointments. Key issues include increased waiting times, and the excessive cost of appointments. Pain, discomfort, and physical limitations further complicated attendance, particularly for distant clinics, leading to reliance on expensive private transport. Additionally, three studies reported decreased quality of life. These findings highlight the need for more effective and convenient wound care services for patients.

This systematic review evaluated the clinical utility and diagnostic accuracy of autofluorescence imaging in detecting bacterial presence in wounds. A literature search was conducted in January 2025 across PubMed, Scopus, Cochrane, and EMBASE databases. Eligible studies included clinical trials and observational studies assessing autofluorescence imaging for wound bacterial detection. Seventeen studies were included; sixteen assessed the MolecuLight i:X device, and one evaluated PRODIGI. Autofluorescence imaging demonstrated higher accuracy than White Light and Clinical Signs and Symptoms-based assessment in detecting bacterial burden. Five studies highlighted its role in enhancing swabbing techniques, with fluorescence-guided sampling yielding higher bacterial counts than conventional methods. Ten studies reported significant bacterial reduction with autofluorescence-guided debridement. Six studies emphasized its role in refining treatment decisions and accelerating wound healing. Quality appraisal was undertaken using Evidence-Based Librarianship criteria, which deemed 10 studies valid, while 7 had limitations related to population representation. In conclusion, autofluorescence imaging enhances wound assessment by improving bacterial detection and may support more targeted clinical interventions. However, further research is needed to clarify its impact on infection control and long-term healing outcomes.

Forecasting indicates that the National Health Service in England may face a workforce shortage of up to 360,000 staff by 2036, reflecting challenges that resonate with wider international concerns. This means that wound care must evolve if it is to remain safe, effective and sustainable. One approach that could help is involving patients and carers more closely in their own wound care as evidence suggests that patients want to feel informed, involved and supported in playing a more active role in their wound care. When combined with the right dressing technology, shared wound care could release up to 3.5 billion hours of nursing time globally by 2030. Although many healthcare practitioners already support aspects of shared care, it has not yet become routine. This article sets out the foundations for how shared wound care can become routine practice. Incorporating evidence from key published studies, insights from a key opinion leaders-led ‘Hackathon’, and input from a patient focus group, work has been undertaken to shape what shared wound care could look like in real-world clinical practice. Practical ideas from the Hackathon included: a clinician checklist; a simplified wound care diary (with the option of a patient contract); visual explainers to show what shared wound care looks like in practice; and step-by-step guides for the care of different wound types. Feedback from the patient focus group showed that patients want to be empowered. With the right support and materials, such as wound diaries and change indicators, patients can often manage their wound care confidently and safely, positively improving their quality of life.