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Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study


Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.


A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.


Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p


The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

Population-based otoscopic and audiometric assessment of a birth cohort recruited for a pneumococcal vaccine trial 15-18 years earlier: a protocol

Por: Chan · K. · Carosone-Link · P. · Bautista · M. T. G. · Sanvictores · D. · Uhler · K. · Tallo · V. · Lucero · M. G. · De Jesus · J. · Simoes · E. A. F.

A cohort of 12 000 children in the Philippines who had enrolled in a 2000–2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort’s current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis.

Methods and analysis

Reliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.

Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data.

Ethics and dissemination

The study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.

Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers.

Trial registration number

ISRCTN 62323832; Post-results.

Impact of parental socioeconomic status on offsprings mental health: protocol for a longitudinal community-based study

Por: Li · M. · O'Donnell · K. J. · Caron · J. · D'Arcy · C. · Meng · X.

Socioeconomic status (SES) affects physical and mental health and cognitive functioning. The association between SES changes (SES mobility) and health has ethical and political implications in that the pernicious effects of inequality and the differential impact on social classes of economic and social policies. There is a lack of research conducted to explore the intergenerational transmission of parental SES changes on the offspring’s mental health and cognitive functioning. We aim to fill this gap and identify roles of parental SES changes in offspring’s mental health and cognitive outcomes.

Methods and analysis

This study will be based on a longitudinal cohort from the most populous municipality in the Canadian province of Quebec. Participants and their biological offspring will be invited to this study. For those with informed consent, we will collect their information on mental health, psychiatric disorders, cognitive functioning and early life experiences for offspring. Latent class growth analysis will be used to identify parental SES mobility groups. Multivariate regression analyses will be used to explore the roles of early life stress, parental SES mobility and their interactions in psychiatric disorders and cognitive functioning. Subgroup analyses (males and females) are also planned.

Ethics and dissemination

This study has been given ethical approval by the Research Ethics Board of the Douglas Mental Health University Institute (IUSMD-18/17). Each participant will provide informed consent on participation. We will disseminate research findings through publication in peer-reviewed academic journals and presentations at conferences. Lay summaries of major research findings will also be shared annually with our partners in the health system and community agencies located in the catchment area.

Cognitive decline in patients with prostate cancer: study protocol of a prospective cohort, NEON-PC

Por: Araujo · N. · Morais · S. · Costa · A. R. · Braga · R. · Carneiro · A. F. · Cruz · V. T. · Ruano · L. · Oliveira · J. · Figueiredo · L. P. · Pereira · S. · Lunet · N.

Prostate cancer is the most prevalent oncological disease among men in industrialised countries. Despite the high survival rates, treatments are often associated with adverse effects, including metabolic and cardiovascular complications, sexual dysfunction and, to a lesser extent, cognitive decline. This study was primarily designed to evaluate the trajectories of cognitive performance in patients with prostate cancer, and to quantify the impact of the disease and its treatments on the occurrence of cognitive decline.


Participants will be recruited from two main hospitals providing care to approximately half of the patients with prostate cancer in Northern Portugal (Portuguese Institute of Oncology of Porto and São João Hospital Centre), and will comprise a cohort of recently diagnosed patients with prostate cancer proposed for different treatment plans, including: (1) radical prostatectomy; (2) brachytherapy and/or radiotherapy; (3) radiotherapy in combination with androgen deprivation therapy and (4) androgen deprivation therapy (with or without chemotherapy). Recruitment began in February 2018 and is expected to continue until the first semester of 2021. Follow-up evaluations will be conducted at 1, 3, 5, 7 and 10 years. Sociodemographic, behavioural and clinical characteristics, anxiety and depression, health literacy, health status, quality of life, and sleep quality will be assessed. Blood pressure and anthropometrics will be measured, and a fasting blood sample will be collected. Participants’ cognitive performance will be evaluated before treatments and throughout follow-up (Montreal Cognitive Assessment and Cube Test as well as Brain on Track for remote monitoring). All participants suspected of cognitive impairment will undergo neuropsychological tests and clinical observation by a neurologist.

Ethics and dissemination

The study was approved by the Ethics Committee of the hospitals involved. All participants will provide written informed consent, and study procedures will be developed to ensure data protection and confidentiality. Results will be disseminated through publication in peer-reviewed journals and presentation in scientific meetings.

Formative peer assessment in higher healthcare education programmes: a scoping review

Por: Stenberg · M. · Mangrio · E. · Bengtsson · M. · Carlson · E.

Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions.


A scoping review.

Data sources

Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct.

Eligibility criteria

Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature.

Data extractions and synthesis

Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis.


The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning.


Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students’ and teachers’ experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.

Trend of pneumonia diagnosis in emergency departments as a COVID-19 surveillance system: a time series study

Por: Murtas · R. · Decarli · A. · Russo · A. G.

In Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. Given the rapid spread of the infection in the population, it was suggested that in Europe, and specifically in Italy, the virus had already been present in the last months of 2019. In this paper, we aim to evaluate the hypothesis on the early presence of the virus in Italy by analysing data on trends of access to emergency departments (EDs) of subjects with a diagnosis of pneumonia during the 2015–2020 period.


Time series cohort study.


We collected data on visits due to pneumonia between 1 October 2015 and 31 May 2020 in all EDs of the Agency for Health Protection of Milan (ATS of Milan). Trend in the winter of 2019–2020 was compared with those in the previous 4 years in order to identify unexpected signals potentially associated with the occurrence of the pandemic. Aggregated data were analysed using a Poisson regression model adjusted for seasonality and influenza outbreaks.

Primary outcome measures

Daily pneumonia-related visits in EDs.


In the studied period, we observed 105 651 pneumonia-related ED visits. Compared with the expected, a lower occurrence was observed in January 2020, while an excess of pneumonia visits started in the province of Lodi on 21 February 2020, and almost 10 days later was observed in the remaining territory of the ATS of Milan. Overall, the peak in excess was found on 17 March 2020 (369 excess visits compared with previous years, 95% CI 353 to 383) and ended in May 2020, the administrative end of the Italian lockdown.


An early warning system based on routinely collected administrative data could be a feasible and low-cost strategy to monitor the actual situation of the virus spread both at local and national levels.

Cost-utility analysis of a multicomponent intervention for fibromyalgia syndrome in primary care versus usual clinical practice: study protocol for an economic evaluation of a randomised control trial

Por: Arfuch · V. M. · Aguilar Martin · C. · Berenguera · A. · Caballol Angelats · R. · Carrasco-Querol · N. · Gonzalez Serra · G. · Sancho Sol · M. C. · Fuste Anguera · I. · Fernandez Saez · J. · Goncalves · A. Q. · Casajuana · M.

Fibromyalgia syndrome (FMS) imposes a high cost on society. The significant economic burden from the use of healthcare and, especially, social resources is a spur to revising the usual clinical care (UCC) and to improving treatment strategies. FMS has a deleterious effect on the quality of life (QOL) and productivity, which considerably increase the indirect costs to society. This study reports an economic evaluation comparing the cost and health benefits in a multicomponent intervention programme and UCC of patients with FMS who attend primary healthcare centres of the Gerència Territorial Terres de L’Ebre region of Catalonia, Spain. This article is linked to the pre-results of a randomised control trial study on the implementation of this intervention programme ( NCT04049006).

Method and analysis

A cost–utility analysis will be conducted from a societal perspective. Quality-adjusted life years will be calculated from the results of the SF-36 questionnaire, a QOL measurement instrument. Direct and indirect healthcare costs will be obtained from official prices and reports published by the Spanish Public Health Administration and the National Statistics Institute. The incremental cost–utility ratio will be estimated to compare the two healthcare practices. Deterministic sensitivity analysis will also be used to compare different cost scenarios, modifying the items with the highest weight in the cost composition.

Ethics and dissemination

The Clinical Research Ethics Committee of the IDIAPJGol Institute approved this study on 25 April 2018 (code P18/068) in accordance with the Helsinki/Tokyo Declaration. Information will be provided orally and in writing to participants, and their informed consent will be required. Participant anonymity will be guaranteed. The dissemination strategy includes publications in scientific journals and presentations in local and national media and at academic conferences.

Trial registration number: NCT04049006; Pre-results.

How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery

Por: Finucane · A. M. · Bone · A. E. · Etkind · S. · Carr · D. · Meade · R. · Munoz-Arroyo · R. · Moine · S. · Iyayi-Igbinovia · A. · Evans · C. J. · Higginson · I. J. · Murray · S. A.

To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery.


We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need.


Scotland, population of 5.4 million.


All decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey.

Primary and secondary outcomes

Estimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively.


We project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred.


By 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.

La cultura de seguridad en emergencias sanitarias

Introducción. La seguridad del paciente es una pieza angular de la asistencia sanitaria y un elemento clave de la calidad asistencial. Dentro de la seguridad del paciente está considerada la cultura de seguridad como un pilar básico. Objetivos. Analizar el grado de cultura de seguridad de los profesionales que trabajan en las unidades móviles de emergencias, e identificar las fortalezas y las posibles oportunidades de mejora en la cultura de seguridad en emergencias extrahospitalarias. Metodología. Diseño: estudio observacional descriptivo, de corte transversal, prospectivo. Población de referencia: los 414 profesionales sanitarios de las unidades de soporte vital avanzado y soporte vital avanzado de enfermería. Tamaño muestral: poblaciones finitas, nivel de confianza 95%, precisión +/- 5 unidades porcentuales y proporción esperada de cumplimiento 50% (p=q=0.5), resultaría un tamaño inicial de 200 sujetos. Ajustado a pérdidas estimadas del 40% (formulario autocumplimentado), resultaría un total de 333 sujetos. Tamaño muestral resultante próximo a población de referencia, decidiendo tomar la población total de 414 sujetos. Instrumento de medición: versión española de la encuesta Hospital Survey on Patient. El cuestionario final consta de 42 ítems y nos proporcionará información sobre la percepción de seguridad en las 12 dimensiones de la cultura de seguridad establecidas. Aplicabilidad práctica de los resultados. Posibilidad de conocer la situación actual sobre el objeto de estudio, así como, poder determinar las fortalezas y oportunidades de mejora, derivadas del análisis, brindando así, la posibilidad de iniciar futuras líneas de acción e investigación.



Introduction. Patient safety is a cornerstone of healthcare and a key element of quality of care. Within patient safety, the safety culture is considered a main point. Objectives. Analyze the degree of safety culture of professionals who work in mobile emergency units, and identify the strengths and possible opportunities for improvement in the safety culture in out-of-hospital emergencies. Methodology. Design: descriptive, cross-sectional, prospective observational study. Reference population: the 414 health professionals from the advanced life support and advanced life support nursing. Sample size: finite populations, 95% confidence level, precision +/- 5 percentage units and expected proportion of compliance 50% (p = q = 0.5), an initial size of 200 subjects would result. Adjusted for estimated losses of 40% (self-completed form), a total of 333 subjects would result. Resulting sample size close to the reference population, deciding to take the total population of 414 subjects. Measurement instrument: Spanish version of the Hospital Survey on Patient. The final questionnaire consists of 42 items and will provide us with information on the perception of safety in the 12 dimensions of the established safety culture. Practical applicability of the results. Possibility of knowing the current situation on the object of study, as well as, being able to determine the strengths and opportunities for improvement, derived from the analysis, thus offering the possibility of starting future lines of action and research.

Clinical and economic burden of diabetic foot ulcers: A 5‐year longitudinal multi‐ethnic cohort study from the tropics


Diabetic foot ulcers (DFUs) present a substantial clinical and economic burden to healthcare systems around the world, with significant reductions in quality of life for those affected. We aimed to analyse the clinical and economic burden of DFU via a 5‐year longitudinal multi‐ethnic cohort study. A longitudinal analysis of inpatient and outpatient DFUs data over 5 years from a university tertiary hospital in Singapore was performed. Data included baseline characteristics, clinical outcomes, hospitalisation, and outpatient details. Descriptive statistics, Kaplan–Meier survival analyses, and Cox proportional hazard models were performed. Patients treated for DFUs (n = 1729, mean patient age of 63·4 years) were assessed. The cohort consists of Chinese (61.4%), Malay (13.5%), and Indian (18.4%) patients. Common comorbidities included peripheral arterial disease (74.8%), peripheral neuropathy (14.5%), and a median haemoglobin A1c of 9.9%. Patients underwent toe(s) amputation (36.4%), transmetatarsal amputations (16.9%), or major amputations (6·5%). The mean length of inpatient stay for ulcer‐only, minor amputation, and major amputation was 13.3, 20.5, and 59.6 days, respectively. Mean cost per patient‐year was US $3368 (ulcer‐only), US $10468 (minor amputation), and US $30131 (major amputation). Minor amputation‐free survival was 80.9% at 1 year and 56.9% at 5 years, while major amputation‐free survival was 97.4% at 1 year and 91.0% at 5 years. In conclusion, within our multi‐ethnic cohort of patients from the tropics, there was significant clinical and economic burden of DFUs, with a high wound per patient ratio and escalating healthcare costs corresponding to more proximal amputation levels.

ORIGINAL: Encuesta de hábitos en la demanda de urgencias de pediatría durante el período de desescalada COVID-19

Objetivo: Conocer cómo la población se adapta durante la fase de desescalada, después de la pandemia por SARS-CoV-2 en la demanda del  Servicio de Urgencias Pediátricas del Hospital Universitario Valle Hebrón. Métodos: Estudio observacional, descriptivo y transversal realizado en el citado hospital entre mayo y junio de 2020. Se recogieron datos sobre la edad de los pacientes, nivel de prioridad de atención, motivo de consulta, recursos asistenciales alternativos utilizados y opinión sobre medidas de protección adoptadas. La información se recogió mediante una encuesta autoadministrada de elaboración propia. Resultados: Disminuyó la demanda en la asistencia durante los meses de mayo y junio del 2020 respecto a los mismos meses el año anterior (2019). Existe un aumento del 3,5% de pacientes con nivel 3 de prioridad de atención. Los motivos principales de consulta fueron fiebre y problemas digestivos. El 85% de los pacientes encuestados han sido visitados en varias ocasiones durante el último año en el citado hospital. El 80% de los encuestados tuvieron la necesidad de venir a urgencias durante el confinamiento y no lo hicieron por miedo al contagio. El 62% priorizaron otros recursos antes de acudir al hospital. El recurso sanitario más utilizado fue el Centro de Atención Primaria vía telefónica/presencial.  Conclusiones: Durante el periodo de desescalada ha habido una disminución de la asistencia a urgencias pediátricas, recurriendo a otros recursos asistenciales. Los cambios organizativos y funcionales adoptados como medidas de protección no han sido percibidos como motivos  de deshumanización en la atención.  




Objective: To understand how population’s adaptation during de-escalation phase after SARS-CoV-2 pandemic and their demands of pediatric emergency services in Hospital Universitario Valle Hebrón. Methodology: Observational, descriptive and transversal study made at the cited hospital between May and June 2020.  Data were obtained through a self-administered ad hoc questionnaire. The age of the children, priority levels in caregiving, visit’s motive, alternative assistance resources and opinions about protective measures established were gathered. Results: The demands of assistance decreased during May and June 2020 compared with the same months of the previous year (2019). There is a 3.5% increase in level 3 priority attention patients. The main causes of visits were fever and digestive problems. 85% of surveyed patients received medical attention on several occasions during the year. 80% of respondents needed to attend emergency services but they did not go because fear of contagion. 62% prioritized other resources before attending to the hospital. The most used sanitary resource were centers of Primary Care. More than 80% of the respondents did not perceive any dehumanization in their attention and 40% adopted all safety measures.  Discussion: There has been a decrease in Pediatric Emergency assistance during de-escalation period, what has originated an increase in the use of other healthcare resources. Organizational and functional changes adopted as protective measures have not been perceived as reasons for dehumanization in patient’s care.  

Modified telehealth for care of chronic wounds during the Coronavirus disease 2019 pandemic: A rapid literature review of alternative care modalities


Due to the changes in delivering medical care during the Coronavirus disease 2019 (COVID‐19) pandemic, such as the heavy reliance on telehealth, it is worth exploring if this is suitable when treating complex wounds. A literature rapid review was performed to explore the existing evidence around alternative service delivery modalities. While there are organisations that have successful telehealth systems and infrastructure, for services that do not already widely use telehealth it is difficult to implement a standardised system in the current state of emergency. The evidence reviewed demonstrates that telehealth appears to currently have a limited place in chronic wound management; therefore, standardisation on determining suitability in conjunction with evaluation of telehealth during this period is needed to shape implementation of telehealth systems in the future.

Use of a novel silicone‐acrylic drape with negative pressure wound therapy in anatomically challenging wounds


Negative pressure wound therapy (NPWT) utilises a polyurethane drape with acrylic adhesive over foam dressings to create a seal. In anatomically challenging areas, ancillary products are frequently used. Additionally, health care providers are unable to reposition the drape once placed. A novel hybrid drape consisting of polyurethane film with acrylic adhesive and silicone perforated layer has been developed to allow for repositioning after initial placement and easy removal. This six‐patient case series evaluates the use of NPWT with hybrid drape over anatomically challenging wounds. Three males and three females were treated. Dressing changes occurred every 2 to 3 days. Drape application, repositioning, and ability to maintain a seal were evaluated. During application, the drape was repositioned 1 to 2 times without periwound skin irritation in 4/6 wounds. Prior to initial application, ancillary products were applied to help create a seal. However, by the second or third application, ancillary products were no longer used in 4/6 wounds. None of the dressing applications resulted in negative pressure seal leaks. In these patients, health care providers could reposition the hybrid drape after initial placement without periwound skin irritation and successfully create a negative pressure seal without ancillary products in anatomically challenging wound locations.

The use of acellular porcine dermis, hyaluronic acid and polynucleotides in the treatment of cutaneous ulcers: Single blind randomised clinical trial


Reconstruction of chronic ulcers is often hampered by lack of local tissues and poor general conditions. Conservative approaches with debridement and advanced medications, such as polyurethane foam, stand as mainstays. However, the healing process is often slow, thus increasing the risk for infection or other complications. In such cases, porcine dermis (PD) and polynucleotides‐added hyaluronic acid (PAHA) were previously reported to accelerate healing. The aim of the study was to compare the efficacy of PD, PAHA and polyurethane foam in chronic ulcers. Thirty patients were randomly divided into 3 groups: group 1 was treated with advanced medications, group 2 with PD, group 3 with PAHA. Standardised photographs and biopsies were taken before treatment and at 30‐day follow‐up. Photographs were processed to calculate the wound area. Specimens were stained with Haematoxylin/Eosin, Masson trichrome, and immunohistochemically for CD34, alpha‐Smooth Muscle Actin (α‐SMA), Collagen types I and III, Ki67. The re‐epithelialized area was larger in patients treated with PD and PAHA compared with those treated with polyurethane foam (P < .05 and P < .01, respectively). Specimens from patients treated with PD and PAHA showed a higher number of myofibroblasts (α‐SMA+, P < .01), neo‐angiogenesis (CD34+, P < .01), proliferating dermal cells (Ki67+, P < .01), proliferating keratinocytes (Ki67+, P < .01) and collagen type 1 deposition (P < .05). No difference was found between PD and PAHA. PD and PAHA proved to be more effective than polyurethane foam in the treatment of chronic ulcers. These approaches are a versatile and reliable option to address such cases.

Nurses are research leaders in skin and wound care


The World Health Assembly declared 2020, the International Year of the Nurse and the Midwife. Recent editorials and commentaries support the leading role of nurses and midwives as frontline caregivers emphasizing the need to invest in the nursing workforce worldwide to meet global health needs. Today nurses are also leaders in research and one example is skin and wound care. In order to reflect on the contribution of nurses as researchers we conducted a systematic review of published articles in five international leading wound care journals in the years 1998, 2008 and 2018. We aimed to determine the type of research publication and percentage of nurses as first, second or senior authors. The place in the authorship was selected as indicative of leadership as it implies responsibility and accountability for the published work. Across the years 1998, 2008 and 2018, 988 articles were published. The overall proportion of nurse‐led articles was 29% (n = 286). The total numbers of articles increased over time and so too did the nurse‐led contributions. Nurse‐led research was strongest in the design categories 'cohort studies' (46%, n = 44), 'systematic reviews' (46%, n = 19), and 'critically appraised literature and evidence‐based guidelines' (47%, n = 55).Results of this review indicate that, in addition to the crucial clinical roles, nurses also have a substantial impact on academia and development of the evidence base to guide clinical practice. Our results suggest that nurse led contributions were particularly strong in research summarizing research to guide skin and wound care practice.

Rationale for participation in venous leg ulcer clinical research: Patient interview study


Recruitment to wound care clinical trials is challenging and a better understanding of patient decisions to participate has the potential to influence recruitment success. We conducted 31 semi‐structured telephone interviews of patients who participated in the Aspirin in Venous Leg Ulcer (ASPiVLU) randomised controlled trail (RCT) or ASPiVLU cohort study. Data were coded and analysed using thematic analysis. We identified four key themes: (a) “I participated to help others”; (b) “I participated in research to thank those who cared for me”; (c) “I participated to receive better care”; and (d) “I participated to have a say on what works.” These themes became basic elements for the Rationale for Research Participation Framework that we have developed to improve the participant recruitment process for clinical trials in wound care.

A collaborative approach in patient education for diabetes foot and wound care: A pragmatic randomised controlled trial


Foot care education is an important strategy in reducing lower limb complications. There is evidence that contemporary communication approaches can improve patient education outcomes. To inform the potential of such methods in diabetic foot education, we trialled a collaborative approach in patient education counselling in a podiatry clinic. We conducted a single‐blind pragmatic randomised controlled trial on 52 diabetes patients who had an active foot ulcer. Participants were randomised to either collaborative education or traditional didactic education. Outcomes on knowledge and self‐care behaviours were collected via a pre and post study questionnaire (max score: 75). The study ended at 12 weeks or when the wound healed prior. 42 (80.7%) participants completed the study. The collaborative patient education group had a significant increase in score post‐study (38.8 ± 8.5) compared to pre‐study (32.8 ± 6.9; P < .001). The control group had no significant increase in score post study. The difference in scores between groups had a moderate effect size (d = 0.54). The use of a collaborative approach in patient education was able to produce significantly greater increase in knowledge retention and self‐care behaviours, without the need for additional consultation time in a podiatry clinic.

Can an early mobilisation programme prevent hospital‐acquired pressure injures in an intensive care unit?: A systematic review and meta‐analysis


A systematic review and meta‐analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital‐acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital‐acquired pressure injuries (five quasi‐experimental and two random comparative). The five quasi‐experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I 2), and the odds ratio was 0.97 (95% CI: 0.49‐1.91) with a non‐significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.

Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review


Chronic wounds are defined as “hard‐to‐heal” wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form biofilms, leading to the release of planktonic bacteria, which causes persistent infections locally or remotely. Therefore, infection control and removal of the biofilm in chronic wounds are essential. Recently, ultrasonic debridement was introduced as a new method to reduce infection and promote the healing of chronic wounds. This scoping review aimed to evaluate the effectiveness of ultrasonic debridement on the changes in bacteria and biofilms, and consequently the wound healing rate of chronic wounds. A total of 1021 articles were identified through the database search, and nine papers were eligible for inclusion. Findings suggest that non‐contact devices are useful for wound healing as they reduce the inflammatory response, although the bacterial load is not significantly changed. Ultrasonic debridement devices that require direct contact with the wound promote wound healing through reduction of biofilm or bacterial load. The optimum settings for ultrasonic debridement using a non‐contact device are relatively consistent, but the settings for devices that require direct contact are diverse. Further studies on ultrasonic debridement in chronic wounds are required.