Journal of Wound Management

Background Patients’ relatives are members of the care team. Obtaining their cooperation and empowering them by providing education is crucial for pressure ulcer (PU) prevention practices to be successful. Accordingly, innovative educational methods and continuous evaluation are needed.

Aim This study aimed to evaluate the user experiences of patients’ relatives regarding a three dimensional web-based computer game developed for PU prevention training.

Methods The descriptive qualitative study was conducted between November 2021 and February 2022. PreSore: Pressure Ulcer Prevention Game (PPUPG) was developed, and participants (n = 55) were asked to play the game. An interview was performed at the end of the gameplay through the Gaming Experience Interview Questionnaire. Data were analysed using descriptive statistics and qualitative inductive content analysis.

Results The main categories regarding user experience were: learning motivation; responsibility; empathy; authenticity knowledge and learning; awareness; care components; and appropriateness. The most prominent sub-categories were: happy to be informed; desire to care for the virtual patient properly on time; feeling the difficulty of patient care; recognising the patient with PU risk; learning the bedridden patient care; an effective method and enjoyable.

Conclusion The data showed that PPUPG helped to create awareness about a virtual game-based approach for PU training, and users accepted the game as an educational method.

Implications for clinical practice This study lays the groundwork for the future education of individuals and communities through digital platform games about prominent health issues.

Background A good level of knowledge among healthcare professionals in pressure ulcer (PU) management is integral to monitoring the cost-effectiveness of PU responses.

Aim The study aimed to assess the level of nurses’ knowledge about the management of PUs through a standardised Pressure Ulcer Knowledge Test (PUKT) questionnaire at different stages: before and after targeted education.

Design This was a prospective intervention study using the PUKT with pre-test, online education, post-test I, face-to-face education, and post-test II phases.

Settings 117 nurses (pre-test), 106 nurses (post-test I after online education), and 145 nurses (post-test II after face-to-face education) from a Czech university hospital’s Surgical, Internal, and Anaesthesiology Departments. Full stratified sampling was used.

Method Statistical analysis of the data was performed using the Chi-squared test and Fisher’s exact test, a nonparametric Kruskal-Wallis test, and Mann-Whitney rank test at the statistical level <0.05 and multiple linear regression. Statistical Package for Social Sciences (SPSS) version 28.0 software was used for calculations.

Results The pre-test and post-test I score were consistent (74.2% and 74.1%, respectively). Post-test II, after face-to-face education, improved to 93.3%.

Conclusion A sufficient level of knowledge is necessary for the subsequent construction of economic models to generate valid data and implement measures at the national level. Repeated education ensures knowledge retention and quality patient care.

Implications for practice Healthcare facilities can enhance care for PU patients by fostering motivation and effective education strategies.

Background Pressure ulcers (PUs) are high-risk complications of spinal cord injury (SCI) patients. These secondary complications influence the burden of disease, quality of life and cost of the healthcare system. Hence, the prevalence and incidence rates of PUs among patients with SCI are essential information in terms of formulating healthcare strategies and understanding the context of this complication.

Aim The aim of this review was to summarise the evidence regarding the incidence and prevalence of PUs in individuals with SCI.

Methods We followed the PRIOR statement, reporting guidelines for the overviews of reviews of healthcare interventions. This review included research syntheses published within the past 10 years. A systematic search was performed in MEDLINE (Ovid) and Epistemonikos.

Findings We included three research syntheses in the narrative conceptual synthesis. The included reviews reported that the global incidence of PUs was 0.23 (95% CI, 0.20-0.26), and the global pooled magnitude of PUs was 32.36% (95% CI, 28.21-36.51) among SCI patients. SCI-associated PUs are “very prevalent in developing nations”, although reported prevalence and incidence rates vary substantially. All the included studies faced significant heterogeneity in the primary studies.

Conclusions This overview of reviews provides a summary of available research syntheses on the occurrence of PUs among SCI patients.

Implications for clinical practice (I) Recent research syntheses on prevalence and incidence rates of PUs among patients with SCI are desirable, along with proper reporting of this secondary complications. (II) Policymakkers should prioritise the implementation of targeted, context-specific preventive strategies to significantly reduce the burden of PUs in patients with SCI, thereby greatly enhancing the overall quality of healthcare services for this vulnerable population.

In December 2023, EWMA distributed an online survey to its members and to members of co-operating organisations to determine from them the type of wounds they encounter requiring a palliative approach and their priorities for research.

In all 513 people completed the survey, including 333 nurses and 102 doctors.

Respondents had a high level of education in wound management and encountered patients with chronic wounds and non-healable wounds on a daily or weekly basis.

The most frequent wound aetiology requiring a palliative approach was pressure ulcers (n=306) followed by malignant fungating wounds (n=270). The majority of these woulds were described as ulcerated (n=407) followed by fungating (n=211).

A series of free text questions were asked and over 450 responses were provided for each. Pain, odour and exudate management were ranked in the top three concerns for patients, clinicians and for research priority setting. Other factors, such as infection control and patient-centered approaches, ranked highly.

Background Pressure ulcers are a common complication in healthcare, with a global prevalence of approximately 12.8%. Traditional risk assessment methods (Norton, Braden, and Waterlow scales) show limited predictive accuracy (sensitivity 46.8–82.4%, specificity 27.4–67.5%). There is a need to complement them with more objective diagnostic methods such as infrared thermography (IRT).

Aim A review of potential applications of infrared thermography in the early diagnosis and monitoring of pressure ulcers.

Methods A selective search of PubMed, Scopus, and Web of Science databases was conducted, focusing mainly on English and Polish articles from 2015 to 2025, using the terms “thermography”, “infrared imaging”, “pressure ulcers”, “diagnosis” and “wound monitoring.”

Findings IRT enables non-invasive assessment of skin temperature distribution, detecting functional changes before visible symptoms appear. Temperature drops (ΔT ≤ -0.1°C) in at-risk areas predict pressure ulcer development more accurately than traditional scales. Hypothermic areas of non-blanching erythema are 31.8 times more likely to undergo necrosis. IRT also identifies deep tissue damage, predicts undermining, and assesses healing potential. AI algorithms enhance the diagnostic accuracy of IRT (overall accuracy ~84.6%).

Conclusions IRT is a valuable complement to traditional pressure ulcer assessment methods, allowing early detection of subcutaneous changes regardless of skin color.

Implications for clinical practice Implementation of IRT is recommended upon admission of high-risk patients, interpreting temperature differences relative to adjacent skin areas, and immediate intervention upon detection of thermal anomalies.

Background Pressure injuries are localised tissue defects that occur due to increased pressure on the skin that causes ischemic damage.These injuries are more frequently seen in patients who are immobile, elderly, malnourished, or have a history of intensive care unit stays. The management of pressure injuries consists of conservative treatment, including wound care and ultimately, surgical closure of the wound.

Aim The aim of this study is to compare the long-term clinical outcomes of patients who underwent surgery for pressure injuries in our chronic wound clinic and to develop an algorithm for flap selection, highlighting the most appropriate options for approaching pressure injuries.

Methods Our study includes 97 patients are people with grade 3 and 4 pressure injuries, who were followed up between January 2017 and December 2024. The patients were classified and followed up based on factors such as the location of tissue defects, length of hospital stay, type of surgery performed, presence of bacterial growth in cultures, use of NPWT, comorbidities, wound size, and the success of the surgical treatment.

Results Cases reconstructed with flaps had 30.6% detachtment rates and were observed at the same time as cases with skin grafts who showed an 86.5% viability rate. Average hospital stay for patients with skin graft was avarage of 11.3 days, and for patients reconstructed with flaps 37.1 days.

Conclusion Pressure injuries require different approaches from other chronic wounds. Treatment should be tailored according to patient and surgeons should take every possible outcome into consideration.

Implication for clinical practice Reconstruction with flaps, even with high complication rates, should be first line of choice and skin grafting should be limited with patients who are immobile and have superficial skin defects.

Introduction Chronic wounds are difficult-to-heal lesions that generate high healthcare costs and significantly affect patients’ quality of life. Current visual assessment is limited, as it does not allow detecting subclinical alterations or deepening tissue assessment. Ultrasound, a non-invasive technique, provides accurate information in real time, improving diagnosis and early interventions.

Hypothesis/aim The main objective was to review the current knowledge on using ultrasound for complex chronic wound assessment, diagnosis, prevention, treatment and progression by nurses.

Material and methods Research articles published over 16 years (2008–2024) were collected. After screening, 31 articles were analysed for assessment. Data sources: Scielo, PUBMED, The Cochrane Library, Scopus and Cinahl were used.

Main results The studies identify ultrasound as useful for the diagnosis and follow-up of chronic wounds. Applications were found in different types of wounds, highlighting pressure ulcers. Lack of realisation by nurses is identified.

Discussion and conclusions Ultrasound is a promising tool for assessment and diagnosis in the management of chronic wounds, promoting evidence-based care.

Implications for clinical practice Ultrasound is a promising tool for evaluating and monitoring chronic wounds, providing objective data and improving management, although it remains an underexplored area. Its use can enhance the role of advanced nursing practice.

Introduction The aim of this retrospective, real world, cohort analysis is to report the clinical and economic outcomes of an Integrated Care Bundle (ICB) that used a 3-layer silicone adhesive foam dressing for exudate management across multiple chronic wound types within a community setting in Canada.

Methods Analysis of the safety and effectiveness of the introduction of wound centered ICBs, adopted to improve the management of chronic wounds, from March 2016 to December 2018. Outcomes were compared between patients who received a 3-layer silicone foam adhesive dressing alongside an ICB and those that did not, as part of their care.

Results Patients who received care with an ICB and the dressing (n=6612) experienced improved clinical outcomes, compared with those who did not (n=2242). Including faster time to healing (12.7 vs 25.4 weeks, respectively) and longer time between dressings changes (3.5 vs 1.8 days, respectively). There were reduced number of nursing visits in the ICB cohort which led directly to reduced resource costs, compared to the patients in the non-ICB cohort (CAD$1736 vs $6488, respectively).

Conclusions This real-world cohort analysis demonstrated the adoption of an ICB that included treatment with a three -layer silicone adhesive foam dressing improved clinical outcomes, reducing chronic wound healing times and the frequency of wound dressing changes.

Implications for clinical practice Delivering wound care as part of an Integrated Care Bundle may improve health and economic outcomes for patients with chronic wounds.