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This paper aims to summarize researches conducted related to functional textiles for prevention of pressure ulcers and critical analysis of the outcomes to pave path for the future research in this area for benefit of the patients. Pressure ulcers, also known as bed sores, pressure sores and decubitus ulcers, are localized areas of tissue damage that develop due to pressure usually over a bony prominence. A standard hospital mattress has an interface pressure of 100 mmHg which can result in pressure ulcers unless repositioning occurs at regular intervals. Moisture accumulation on the skin is an important physical factor predisposing a patient to the occurrence of pressure ulcers and tissue breakdown. The disability leads to several requirements of functional clothing and textile products. The textiles play a variety of roles in this concern, from simply having good aesthetic appearance to preventing life threatening risks. An ideal support surface prevents pressure ulcers by providing pressure redistribution and maintaining a healthy skin microenvironment. The use of the textiles for the care of elderly disabled and bedridden persons can play an important role, as their quality of life can be improved by making use of functional and good-looking textiles.

This review paper aims to summarize researches conducted related to functional textiles for prevention of pressure ulcers and critical analysis of the outcomes to pave path for the future research in this area for benefit of the patients.

In the past years, there have been several functional textiles developed for the prevention of pressure ulcer. They are designed to maintain proper microclimate around patient skin. Sheepskin is one of the oldest used bed overlays which prevent pressure ulcer but its prolonged use leads to uneasy feeling for the patient. A sensor in bed for pressure detection is one of the good alternatives as it provides proper indication on when to change the position of the patient so that the pressure can be shifted and ulcers is prevented. These sensors are costly and complex to setup so for common man they are not easily available. Multilayer textiles on the other hand are complex to make as the properties are dependent upon the fiber content, yarn structure, fabric structure and technique of layering them together. Spacer fabric provides good air and moisture permeability, but there is a scope to study this type of fabric by varying the fibers type and thickness of the spacer fabric. A bedding material which is not much complex and can be easily purchased and used by common man for in-house usage is the need of the hour.

There is no comprehensive review available regarding research in this area with critical analysis of the outcomes for future study.

Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.

Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.

The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.

Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.

This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.

The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.

The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.

Pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear, and friction. Diagnosis, treatment and care of pressure ulcers involve high costs for sanitary systems. Accurate wound evaluation is a critical task to optimize the efficacy of treatments and health‐care. Clinicians evaluate the pressure ulcers by visual inspection of the damaged tissues, which is an imprecise manner of assessing the wound state. Current computer vision approaches do not offer a global solution to this particular problem. The purpose of this paper is to use a hybrid learning approach based on neural and Bayesian networks to design a computational system to automatic tissue identification in wound images.

A mean shift procedure and a region‐growing strategy are implemented for effective region segmentation. Color and texture features are extracted from these segmented regions. A set of k multi‐layer perceptrons is trained with inputs consisting of color and texture patterns, and outputs consisting of categorical tissue classes determined by clinical experts. This training procedure is driven by a k‐fold cross‐validation method. Finally, a Bayesian committee machine is formed by training a Bayesian network to combine the classifications of the k neural networks (NNs).

The authors outcomes show high efficiency rates from a two‐stage cascade approach to tissue identification. Giving a non‐homogeneous distribution of pattern classes, this hybrid approach has shown an additional advantage of increasing the classification efficiency when classifying patterns with relative low frequencies.

The methodology and results presented in this paper could have important implications to the field of clinical pressure ulcer evaluation and diagnosis.

The novelty associated with this work is the use of a hybrid approach consisting of NNs and Bayesian classifiers which are combined to increase the performance of a pattern recognition task applied to the real clinical problem of tissue detection under non‐controlled illumination conditions.

The purpose of this study is to examine the effect of the use of unit-level functional flexibility on one particular patient outcome, unit-acquired pressure ulcers, and the potential moderating influences of coworker support and workload.

This study uses an archival approach, examining data from 68 hospital units.

The results indicate that a unit's higher use of functionally flexible nurses in one-quarter was associated with a higher number of pressure ulcers among the unit's patients the following quarter. This detrimental effect was significantly diminished when coworker support within the unit was high. Unit-level nurse workload did not have any moderating influence.

One of the scholarly contributions of this study is that it links greater use of functionally flexible employees to a negative patient safety outcome at the unit level. As most of the variables used in the study were archival measures, future research could examine the replicability of these findings using other indicators and measures.

Beyond healthcare settings, the results prompt managers in industries where there has been growing use of functional flexibility (e.g., banking) to think about the associated unintended negative consequences. That said, the results also point to coworker instrumental support as a means by which to mitigate negative outcomes.

Although functional flexibility has been shown to positively correlate with a number of organizational performance indicators, this is one of the very few studies that has examined its negative consequences, particularly on patient safety.

This research aims to focus on developing a customized support surface using additive manufacturing (AM) for effective pressure relief for patients who are in bed or wheelchair suffering from pressure ulcers (PU).

A novel customized support surface is developed using AM technology incorporated with magnetic levitation and ball and socket mechanisms. Magnetic levitation provides cushioning effect for the developed cushion to users who are sitting in a wheelchair and increases the rate of healing. The ball and socket mechanism provides the user body's self-adaptive mechanism and reduces shear and friction forces between the surfaces of the additive manufactured cushion and the human buttocks.

From the results of ISO 16480-6 biomechanical standardized tests, the additive manufactured support surface performed better than, or on par with, the most widely available commercial cushions. It is evident that the developed cushion’s peak pressure values are lower when compared with other cushions. The overall efficiency of the developed cushion was qualitatively reported; 67% of people felt it was excellent and 22% of people responded as good and 11% were satisfactory. Henceforth, the overall effectiveness of the developed support surface provides a better experience to the end-user in the view of PU reduction.

A developed additive manufactured customized support surface will be an alternative approach for the reduction of PU, and it overcomes the drawbacks faced by the currently available cushions.

This paper aims to explore the content of Safeguarding Adult Reviews (SARs) from older adult care homes to understand how safety is understood and might be measured in practice.

SARs relevant to older adult care homes from 2015 onwards were identified via the Social Care Institute of Excellence SARs library. Using thematic analysis, initial inductive coding was mapped to a health-derived safety framework, the Safety Measurement and Monitoring Framework (SMMF).

The content of the SARs reflected the dimensions of the SMMF but gaining a deeper understanding of safety in older adult care homes requires additional understanding of how this unique context interacts with these dimensions to create and prevent risks and harms. This review identified the importance of external factors in care home safety.

This study provides an insight into the scope of safety issues within care homes using the SARs content, and in doing so improves understanding of how it might be measured. The measurement of safety in care homes needs to acknowledge that there are factors external to care homes that a home may have little knowledge of and no ability to control.

Real-time monitoring of wound or injured tissues is critical for speedy recovery, and the onset of a cascade of biochemical reactions provides potential biomarkers that facilitate the process of wound monitoring, e.g. pH, temperature, moisture level, bacterial load, cytokines, interleukins, etc. Among all the biomarkers, pH has been known to have a profound impact on the wound healing process, and is used to determine the incidence of bacterial infection of the wound (persistently elevated alkaline pH), proteolytic activity at the site of injury, take rate in skin grafting, wound healing stage and preparation for wound debridement.

This review highlights the significance of pH in determination of clinical parameters and for selection of an appropriate treatment regime, and it presents an in-depth analysis of the designs and fabrication methods that use integrated pH sensors, which have been reported to date for the real-time monitoring of wound healing.

For an expedited wound healing process, the significance of pH mandated the need of an integrated sensor system that would facilitate real-time monitoring of healing wounds and obviate the requirement of redressing or complicated testing procedures, which are both labor-intensive and painful for the patient. The review also discussed different types of sensor systems which were developed using hydrogel as a pH-responsive system coupled with voltammetry, potentiometry, impedimetric and flex-circuit inductive transducer systems. All of the mentioned devices have considerable potential for clinical applications, and there is need of in vivo testing to validate their efficiency and sensitivity under practical scenarios.

This manuscript is an original review of literature, and permission has been granted to use the figures from previously published papers.

Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems.

Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews’ observations and recommendations. The main circumstances, recommendations and common themes were identified.

The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual’s circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults’ lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially.

The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives

This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals.

The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults’ health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.

Reports on a study that focuses on the specific roles of the nurse within the interdisciplinary team as an example of how nursing contributes to developing clinical effectiveness in wound healing. The multidisciplinary team approach used here builds on recommendations by Edmonds as the most effective method of delivering care to patients with diabetic foot ulceration. In particular, monitors the evolution of the service provided and patient outcomes by measuring the number of ulcers treated, the level of service provided, record keeping and patient outcome. The contribution of the wound care nurse includes the assessment of the status and progress of ulcers presented at the clinic. Argues that, as research in wound care has evolved, so the contribution of the nurse has grown (in line with NHS recommendations) with a broader range of wound features assessed and documented. In evaluating improvements in recording information, three indicators were used. Ulcer size and type were recorded in 1993 on 2.2 per cent and 17.8 per cent of occasions respectively. By 1999 these had progressed to being recorded on 100 per cent of occasions. Assessments of ulcer edge also showed an improvement, being recorded on 11.1 per cent of occasions in 1993 and 50.6 per cent of occasions in 1999. The detail of record keeping allowed the data collection.