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 com- munity 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 qual- ity 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 signifi- cant heterogeneity is detected. Where statistical pooling is not possible, findings will be reported narratively. The Grading of Recommendations As- sessment, 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.

Background Re-ulceration is common after healing of a diabetic foot ulcer (DFU) and patient education alone has not significantly reduced this risk. People living with diabetes and a DFU in remission often suffer from comorbidities and other diabetes-related complications. We wished to gain insights into these people’s experiences of living with feet in remission in order to understand how they prevent re-ulceration themselves.

Objective To explore experiences of people with diabetes regarding keeping feet in remission after healing of DFU.

Methods A qualitative explorative study was performed. A total of 49 people took part in participant-driven group sessions inspired by problem-based learning. The sessions were recorded and analysed by content analysis.

Results The overarching theme – feelings of frustration when losing self-determination in the footsteps of diabetes – was substantiated by four categories: 1) deeper insights of the need of prevention; 2) vulnerability to external factors; 3) reminders of daily limitations; and 4) recurring dependence on others.

Conclusion People living with diabetes and feet in remission expressed feelings of frustration. They experienced loss of self-determination in their lives and should be offered various educational interventions to adapt to daily challenges. Nurses in diabetes have an essential role in meeting these people’s complex and individual needs throughout life.

Implications for clinical practice Registered nurses should take patients’ feelings of frustrations into consideration when performing nursing interventions and educational activities for patients, next of kin and healthcare providers.

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 Chronic wounds secondary to conditions, including venous insufficiency, diabetes or unrelieved friction/shear, are a significant burden to patients and healthcare systems. Biofilms are estimated to occupy 60–78% of these wounds. However, they are difficult to detect macroscopically and have no definitive clinical markers. Clinicians are thus advised to assume biofilm presence in all stalled wounds. Incorrect diagnosis of biofilm presence may result in sub-optimal care provision and inadvertent, inappropriate administration of medical interventions.

Hypothesis/aim To achieve clinical consensus on which signs, symptoms and/or biomarkers (items) currently reported in the literature are most likely to indicate presence of biofilm in chronic wounds.

Methods design, sample, data collection, data analysis An international steering committee of researchers and wound clinicians convened to develop this protocol for a 2-round electronic Delphi process that will recruit ≥30 active clinicians with ≥3 years’ clinical experience, ≥50% of which must be in wound care. Participants will rate items on a 9-point Likert scale. Consensus to include items requires ≥70% of participants rating 7–9 and ≤15% rating 1–3.

Conclusions The integrity of research findings depends on methodological rigour. Concerns exist regarding the consistency of methods in Delphi studies. Given these concerns, we decided that a review of Delphi methodological dilemmas by a group of experienced clinicians and researchers would be the most appropriate means to optimise the methods for this particular project.

Implications for clinical practice Findings will consolidate current clinical opinion on what signifies biofilm in chronic wounds. Delphi methodology should be standardised to develop its rigour.

Background Diabetic foot ulcers (DFU) are complex, multifactorial and often complicated by delayed, impaired and uncoordinated wound healing. DFU are associated with devastating outcomes including infection, amputation and premature death.

Aim The aim of this narrative literature review is to obtain a broad perspective on the pathophysiological mechanisms that contribute to delayed and impaired healing in the diabetic foot.

Methods We undertook a review of the literature to critique and synthesise the evidence for pathophysiological factors that contribute to delayed and impaired healing in the diabetic foot.

Findings It is evident from the literature that molecular mechanisms that give rise to impaired inflammation will impact upon healing, whilst physical parameters such as tissue hypoxia, pressure foot-loading, wound PH, temperature and biofilm can all contribute to delayed healing in the diabetic foot.

Conclusions An understanding of the pathophysiology of impaired healing and a focus on controlling these disturbances can facilitate successful healing. To enhance the management of foot disease in diabetic patients, primary care professionals must be made aware of the significance of early referral to a specialised unit. When DFU do not heal adequately after 4 weeks of standard treatment, the underlying pathology should be re-evaluated, and the need for advanced therapy should be considered.

Implications for clinical practice It is important that clinicians involved in treating DFU have an understanding of the pathophysiological mechanisms that cause delayed and impaired healing in the diabetic foot. When a DFU fails to respond to standard care within a 4-week period, the pathophysiology of the wound should be re-evaluated and advanced therapies should be considered.