Background Frailty is a geriatric syndrome associated with limited function, reduced quality of life and premature death. Chronic conditions, such as diabetes and vascular disease leading to chronic ulceration, may increase the risk of frailty. If chronic wounds are a strong predictor of frailty, researchers and practitioners should proactively and effectively manage both the wound and the potential underlying frailty issues. However, there is a paucity of research evidence in this area.

Aim We aim to identify the prevalence of frailty and pre-frailty in older adults with chronic leg ulcers and/or diabetes, and investigate the associations between having diabetes and chronic leg ulcers and being pre-frail or frail.

Design Descriptive and cross sectional study protocol.

Data collection Frailty and pre-frailty status will be identified using two separate tools: the Groningen Frailty Indicator (self-reported) for multidimensional frailty screening, and the five criteria of the Physical Frailty Phenotype for physical frailty assessment.

Sample Patients aged ≥65 years with chronic leg ulcers and/or diabetes will be recruited from two hospitals in the west of Ireland.

Data analysis Associations between the frailty and pre-frailty prevalence and wound aetiology and duration, age, gender and co-comorbidities will be explored using descriptive and comparative analyses.

Background Pressure injuries are a common healthcare problem and are associated with impaired quality of life.

Objective To investigate the impact of pressure injuries on the quality of life of adults aged 18 years and older.

Design Systematic review.

Eligibility criteria Both quantitative and qualitative studies that report on quality of life in adults with a pressure injury from acute care, rehabilitation, long-term care and community settings will be included.

Methods Studies conducted between January 2009 and July 2022 and found in the Ovid Medline, Ovid Embase, CINAHL EBSCO, Scopus and Central Register of Controlled Trials databases will be identified. Two independent review authors will perform the study selection and data extraction. Methodological quality will be appraised using the Critical Appraisal Skills Programme checklists. A thematic synthesis will be used to analyse qualitative evidence. A meta-analysis will be conducted for quantitative data if no significant heterogeneity is detected. Where statistical pooling is not possible, findings will be reported narratively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) tools will be used to determine confidence levels of findings from quantitative and qualitative studies.

Aim The research objective was to explore how a digital wound management checklist (Wound Navigator) affects clinical decision-making. The aim was to understand how physicians view the use of digital checklists in a clinical setting.

Methods The research was conducted as a qualitative case study with a usability testing approach. Nine test subjects were given seven fictional patient cases, which included picture(s) of the wound with some medical history and details of the wound. The results were analysed according to the usability domains effectiveness, efficiency and engagement.

Results With the digital wound management checklist, all test subjects were able to work through patient cases and receive a valid conclusion and recommendations for follow-up procedures. The majority of the test subjects found that it helped in selecting follow-up procedures. Several test subjects reported that the digital wound management checklist brought structure to the patient assessment and commented on its clear user interface. Improvements pointed out by the test subjects included decreasing the number of mouse clicks. Test subjects reported that they could use the digital wound management checklist in clinical work to assist in patient assessment, especially with more complex cases.

Conclusions and implications for clinical practice The digital wound management checklist provides structure to the patient assessment and can either enforce or broaden the clinical decision-making process; thus, it can be useful, especially when assessing more complex cases or when the physician is inexperienced. End-users declared the digital wound management checklist was a tool they would use in their work.

Introduction A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence-based. There are many wound care-related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being used to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice.

Methods We critically reflected on data from an evaluation study using a systems thinking approach and informed by implementation and safety science using the wider literature and our expertise to generate a guideline-implementation theory.

Discussion Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, which we called ‘liminal spaces’. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice.

Conclusion Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, and these have their own characteristics. This theory provides a framework that can be used to underpin guidelines’ strategies for embedding skin and wound care guidelines into policy and clinical practice to improve patient care.

Background Diabetic foot and lower limb complications affect 40–60 million people globally. A rapid method is needed to understand the bioburden and type of infecting bacteria on diabetic foot ulcers.

Aim To compare the accuracy and efficacy of a novel multispectral imaging device, against the standard culture method and correlate bacterial bioburden levels with metagenome sequencing.

Method A clinical study was conducted on diabetic foot ulcer patients. Wounds, post-debridement, were imaged using the multispectral imaging device and the report, containing spatially mapped regions of bacterial burden along with their bacterial gram type, was compared with the culture sensitivity report. Additionally, metagenome sequencing was done on a subset of the patient samples.

Results A total of 157 patients were imaged, and 177 deep tissue biopsies were taken from colour-coded regions (Gram Positive/Gram Negative infected) identified by the machine learning algorithm. The class-averaged accuracy of the device was found to be 90.4% for gram-positive, -negative, polymicrobial and for no bacterial burden. A total of 26 biopsies were also sent for 16S rRNA sequencing. Of these, cultures were positive in 17 and correlated with the species identified through 16S rRNA results in 16 cases. In five cases where there was no growth in culture, the multispectral imaging device could still detect the presence of bacteria as confirmed by 16S rRNA results (using 50 reads as a cut-off) and thus be used as an adjunct for monitoring wounds’ bacterial burden over time.

Conclusions The novel multispectral imaging device can be used to effectively understand the bioburden in a wound of clinical significance and the gram type of infecting bacteria.

Implications for clinical practice The autofluorescence imaging device can assist doctors in evaluating wounds’ bacterial burden level, spatial bioburden extent and the gram type of bacteria present, thus aiding in effective debridement and proper wound-management protocols.

Purpose Almost 95% of patients undergoing radiotherapy treatments will develop a form of radiodermatitis. Despite this prevalence, treatment recommendations lack consensus, and clinical practices differ. The purpose of this scoping review is to examine the literature for radiodermatitis treatment options occurring in persons with head and neck, as well as breast, cancer and to report the pain felt by these populations after receiving radiotherapy.

Methods A scoping review based on the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA_Sc-R) checklist was performed. To identify the sources of evidence, the MEDLINE, CINAHL, Cochrane, LiSSA and Google Scholar databases were searched. All available articles published in the French and English languages were included.

Results Two hundred fifty-five studies met the inclusion criteria. The included studies demonstrated heterogeneous results, owing to significant variations in the interventions, the controls and the assessment tools. The quality of the evidence was found to be low and at high risk for biases.

Conclusion This scoping review provides a broad overview of the available data and highlights the paucity of high-quality evidence to guide therapeutic interventions for the optimal management of radiodermatitis. Since radiodermatitis is a common injury of radiotherapy for breast cancer and head and neck cancer, more research is needed to guide the prevention and treatment of radiodermatitis for patients suffering from this complication.

‘Dermatoporosis’ is a term proposed 15 years ago to describe an extreme cutaneous insufficiency/fragility syndrome beyond cosmetic aspects. Individuals suffering from this condition are usually elderly, with a history of chronic sun exposure and/or chronic topical or systemic corticosteroid use. The preliminary clinical aspect is skin atrophy, which may be complicated by skin tears and deep dissecting haematoma, a severe complication of dermatoporosis that requires immediate medical attention. We reviewed the literature on dermatoporosis in the PubMed and CINAHL databases from 2006 to 2022 and present here the current knowledge about this emerging skin condition with potential molecular mechanisms and novel therapeutic targets.

Background Dermatoporosis is a particular form of skin atrophy/fragility proposed for the first time in 2007. It has a clear link not only to skin tears, but also to deep dissecting haematomas and pressure ulcers in older adults.

Aim To review the literature published on the subject since its first description.

Method A literature search between 2006 and May 2022 using the keyword ‘dermatoporosis’ was performed on PubMed and CINAHL databases.

Findings A total of 46 papers were identified in the initial search. They describe different aspects of dermatoporosis. From an epidemiological perspective, some papers report its prevalence to be around 30% among elderly hospitalised subjects. Beyond the usual clinical features of dermatoporosis (purpura, pseudoscars, skin tears and deep dissecting haematomas), some papers statistically link dermatoporosis to osteoporosis and pressure ulcers. Other studies describe the histological aspects and molecular mechanisms of dermatoporosis.    

Implications for clinical practice These observations should help clinicians to identify patients at risk of developing  dermatoporosis and allow them to benefit from global prevention. For those patients already showing the clinical complications of dermatoporosis, an understanding of the underlying process should lead to a better patient care.