To Örebro University

OBJECTIVE: The objective of this scoping review is to map the existing evidence on the epidemiology, care challenges, and impacts of various wound types among individuals living with dementia across different stages of the disease.

INTRODUCTION: Dementia is a growing global health concern, projected to rise significantly as the population ages. This condition not only affects cognitive function but also increases the risk of chronic wounds in part due to impairments in mobility, self-care, and communication. Current wound care guidelines inadequately address the specific needs of individuals with dementia. This scoping review seeks to fill this gap by comprehensively exploring the intersection between dementia and wound care.

INCLUSION CRITERIA: This review will include studies involving adults aged 18 and older diagnosed with dementia or cognitive impairment who are experiencing alterations in skin integrity, such as pressure injuries, venous and arterial ulcers, and diabetic ulcers. Both qualitative and quantitative studies will be considered, as well as studies focusing on the challenges faced by caregivers in managing wounds in this population. Excluded are studies such as editorials and opinion articles.

METHODS: A comprehensive search strategy will be employed across multiple electronic databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and PubMed, as well as grey literature sources like ProQuest Dissertations & Theses Global and OpenGrey. The search will include studies published in English and French without date restrictions. Data will be extracted using a pilot-tested tool and presented in graphical, diagrammatic, and tabular formats. A narrative summary will accompany these visuals, providing context and insights into the data in relation to the review's objectives.

OBJECTIVE: Numerous studies have examined the epidemiology of skin tears; however, inconsistent definitions, classification systems, and data collection methods have highlighted the need for a validated and standardized tool. The primary objective of this study was to validate a data collection tool for skin tears. A secondary aim was to provide a freely accessible tool for health care providers or researchers to collect consistent and reliable data on skin tears. METHODS: The development of the tool was guided by the 2018 International Skin Tear Advisory Panel (ISTAP) Best Practice Recommendations for the prevention, assessment, and management of skin tears in aged skin. Between June and October 2024, a multimethod validation process was undertaken. Content validity ratio and content validity index calculations were used to quantify content validity, supported by qualitative feedback from 15 experts to assess face validity and provide suggestions for refinement. RESULTS: The final tool consists of 22 questions addressing a patient's demographics, clinical features of the skin tear, associated risk factors, and contextual data. The content validity index was calculated at 0.72, indicating an acceptable level of content validity. International experts reached consensus following a 2-round qualitative review, resulting in subsequent adjustments to the tool. CONCLUSIONS: The ISTAP DC-Tool was developed based on evidence-informed recommendations and validated by an international panel of experts. Its implementation will support health care providers and researchers in gathering standardized epidemiological data contributing to clinical practice improvements, quality initiatives, and further research in skin tear prevention and management.

STUDY DESIGN: Guideline adaptation study using the ADAPTE method.

OBJECTIVE: The aim of this study was the development and validation of a Danish clinical practice guideline for PU/PI prevention and treatment for people with SCI through adaptation of existing guidelines.

METHODS: The ADAPTE method is a systematic framework used to adapt existing clinical practice guidelines to a new context, such as a different healthcare setting or population. This method ensures that the adapted guidelines are relevant, evidence-based, and practical for the specific context in which they will be implemented.

SETTING: Relevant stakeholders and treatment units within the Danish healthcare system involved in the rehabilitation, treatment, and care of people with SCI.

RESULTS: The adaptation yielded 22 topics and 121 recommendations, which underwent external review. Stakeholders gave positive feedback and qualified the recommendations. However, they also highlighted challenges in implementation due to the complexity of PU/PI prevention and treatment and organizational issues within the Danish healthcare system.

CONCLUSIONS: This study has resulted in the development of a comprehensive Danish clinical practice guideline tailored specifically for the prevention and treatment of PU/PI among people with SCI within the Danish healthcare system. The external review emphasizes the imperative for continuous research aimed at strengthening evidence-based approaches to both prevention and treatment. Furthermore, it highlights the necessity for systematic dissemination strategies to facilitate the integration of the guideline into clinical practice.

AIMS: The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.

DESIGN: A co-design development process was conducted.

METHODS: This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.

RESULTS: A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.

CONCLUSION: The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come.

IMPLICATIONS FOR THE PROFESSION: This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.

IMPACT: What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses.

REPORTING METHOD: The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

BACKGROUND & AIMS: In ventilated critically ill patients, both overfeeding and underfeeding can be harmful. Determining energy expenditure is challenging due to various factors. Accurate estimation of nutritional requirements is essential for optimal care. This study compared resting energy expenditure in patients on full-dose high protein-to-energy tube feeding, using indirect calorimetry (IC) and the Roza & Shizgal (R&S) formula. It also examined the effects of sex, age, BMI, primary diagnoses, and non-intentional energy intake, and assessed adherence to European Society for Clinical Nutrition and Metabolism guidelines on protein intake.

METHODS: A retrospective cohort study included 178 ventilated ICU patients who received ≥7 days of full-dose high-protein enteral tube feeding between June 2019 and December 2022. IC was compared to the R&S formula, and 24-hour nutritional intake data, including non-intentional sources, were analysed. Multivariate regression identified predictors of energy expenditure differences.

RESULTS: A significant difference of -146.64 kcal (SD = 276.38) was found between measured and estimated resting energy expenditure, with severe or morbid obesity and COVID-19 pneumonia as significant predictors. This difference increased when non-intentional energy intake in the preceding 24 hours was considered (M = -514.51; SD = 326.37). When excluding non-intentional energy intake, patients achieved the ESPEN daily protein target of ≥1.3 g/kg actual or adjusted body weight/day, with averages of 1.3 to 1.5 g/kg using both indirect calorimetry and the Roza & Shizgal formula.

CONCLUSION: The Roza & Shizgal formula for estimating resting energy expenditure can overestimate or underestimate, so caution is needed, especially in severely to morbidly obese patients. Monitoring energy intake is important, particularly in tube feeding. Protein targets per international guidelines are generally met, except in patients with high non-intentional energy intake.

OBJECTIVES: This study aimed to assess and analyze nurses' knowledge regarding Skin Tears (STs).

METHODS: An observational, exploratory, and cross-sectional study was conducted across four hospitals in São Paulo, Brazil, encompassing diverse settings: two public hospitals (one affiliated with a university and the other serving state public service professionals) and two private hospitals (one specializing in highly complex cases and the other a general hospital). Data collection involved two instruments: one for sample characterization and another, the OASES instrument, which was translated and content-validated for use in Brazilian Portuguese, to assess nurses' knowledge on STs. Data were analyzed using measures of central tendency and variability.

RESULTS: The study included 179 nurses, with an average score of 10.83 (SD = 3.32). Higher knowledge levels were observed in nurses who had received training on STs (p = 0.003) and those who participated in scientific activities (p < 0.001).

CONCLUSIONS: Nurses across the four hospitals in São Paulo demonstrated a level of knowledge about STs that was slightly higher compared to international benchmarks in similar studies.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a common skin problem in adults with urinary incontinence, faecal incontinence, or both. Prevention involves skin care interventions such as skin cleansing and the application of skin protectants/barriers (leave-on products).

OBJECTIVES: To assess the effects of skin care cleansers, leave-on products, and procedures for preventing incontinence-associated dermatitis in adults.

SEARCH METHODS: On 29 April 2024, we searched the Cochrane Incontinence Specialised Register - which includes searches of CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, and WHO ICTRP - and hand-searched journals and conference proceedings. We searched reference lists of included studies to identify additional studies.

SELECTION CRITERIA: We selected randomised controlled trials (RCTs) and quasi-RCTs conducted in any healthcare setting and involving participants aged over 18 years without IAD at baseline. We included trials comparing the effectiveness of skin cleansing interventions and leave-on products or combinations of interventions/leave-on products.

DATA COLLECTION AND ANALYSIS: Three review authors independently screened the titles, abstracts, and full-text articles. Four review authors independently extracted data and assessed risk of bias. Data from studies not published in English were translated and extracted by volunteers from Cochrane Engage and the review authors' networks. Primary outcomes were: number of participants with IAD and adverse effects related to the intervention (pain, skin rash, itching, and other serious adverse effects). Secondary outcomes were: number of participants satisfied with skin care products or procedures, adherence to the protocol throughout the intervention, and quality of life (condition-specific or generic). We used GRADE to assess the certainty of the evidence.

MAIN RESULTS: We included 15 trials with 1020 participants in a qualitative synthesis (41 participants from nursing homes; 65 from both care homes and hospital, and 914 from hospital settings). Participants had urinary incontinence, faecal incontinence, or both. Thirteen trials had small sample sizes and two trials had 180 and 174 participants. Six trials assessed outcomes in the short term (≤ 7 days), four in the medium term (8 days-1 month), and one in the long term (> 1 month-3 months). In the remaining studies, the timing of assessment was unclear. The overall risk of bias in the included studies was high. Substantial heterogeneity (in study populations, skin care products, skin care procedures, outcomes, and measurement tools) precluded meta-analysis. Three trials compared skin cleansing interventions, and five trials compared leave-on products or a combination of leave-on products. Seven trials compared a combination of skin cleansers and leave-on products.

Number of participants with incontinence-associated dermatitis

Three trials compared a skin cleanser with soap and water. One provided evidence that using a foam cleanser might be more effective than soap and water for preventing IAD (RR 0.35, 95% CI 0.14 to 0.85; 65 participants; very low-certainty evidence), while another found little or no difference in effectiveness between a disposable washcloth containing 3% dimethicone and soap and water (RR 0.14, 95% CI 0.01 to 2.28; 12 participants; very low-certainty evidence). The third trial reported lower erythema scores with a no-rinse skin cleanser compared with soap and water, but we were unable to analyse these data. In trials evaluating combinations of skin cleansers and leave-on products versus skin cleansing alone, one suggested the combined treatment may be more effective for preventing IAD (RR 0.03, 95% CI 0.00 to 0.53; 180 participants; very low certainty of evidence), and the other showed little to no difference between interventions (RR 0.71, 95% CI 0.14 to 3.68; 31 participants; very low-certainty evidence). Two studies showed little to no difference between a combination of leave-on products versus a single product (RR 0.85, 95% CI 0.36 to 2.02; 74 participants; very low-certainty evidence); (RR 0.25, 95% CI 0.03 to 1.86; 20 participants; very low-certainty evidence). In general, we cannot draw meaningful conclusions about the effectiveness of the tested interventions in preventing IAD because of the very low certainty of the evidence for all comparisons.

ADVERSE EFFECTS: pain

One trial found that fewer people using a combination of skin cleansing and a leave-on product experienced pain compared with those receiving cleansing without a leave-on product (RR 0.33, 95% CI 0.09 to 1.19; 180 participants; low-certainty evidence), and one trial found that fewer people using a no-rinse skin cleanser plus a skin cream developed pain compared with those using soap and water followed by a lotion (RR 0.58, 95% CI 0.19 to 1.74; 31 participants; low-certainty evidence). However, our analyses of these two comparisons suggest there may be little to no difference between the tested interventions in terms of associated pain.

ADVERSE EFFECTS: itching

One trial found that skin cleansing and a leave-on product may be less frequently associated with itching compared with a conventional skin care regimen with no leave-on product (RR 0.04, 95% CI 0.01 to 0.29; 180 participants; low-certainty evidence).

AUTHORS' CONCLUSIONS: We found limited evidence, of low and very low certainty, on the effectiveness of interventions for preventing IAD in adults. Consequently, it is unclear whether any skin cleanser or leave-on product, used alone or in combination, performs better than any other. There is some very uncertain evidence that using a skin cleanser may be better at preventing IAD than soap and water, and that using a combination of a skin cleanser with a leave-on product may be better at preventing IAD than using a skin cleanser alone. There is a need for high-quality confirmatory trials using standardised, comparable prevention regimens in different settings/regions.