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In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time. [ABSTRACT FROM AUTHOR]

ABSTRACT: Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off‐loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web‐based nominal group voting process was successful in engaging expert decision‐making and has wide‐reaching international appeal in facilitating cost‐effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research. [ABSTRACT FROM AUTHOR]

Objective: To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals’ recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care. Review methods: The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health‐care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible. Results: A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies – seven quantitative, eight qualitative and three opinion papers – met the inclusion criteria and were appraised. The importance of sexuality to well‐being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health‐care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings. Conclusions: Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health‐care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment. [ABSTRACT FROM AUTHOR]

Background The Prevocational General Practice Placement programme ( PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy. Methods All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure ( PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations. Results In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales. Discussion This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community. [ABSTRACT FROM AUTHOR]

Introduction and aim The Australian general practitioner ( GP) teaching workforce will need to expand in order to provide for the increasing number of medical students and doctors-in-training. Understanding factors that motivate GPs to become involved in teaching in their clinical practice environments is important for developing recruitment and retention strategies. Method Thirty-one semi-structured interviews were conducted with a cross section of GP teachers and were subjected to thematic analysis. Themes were identified and further classified as motivations and prerequisites for teaching. Results The desire to update clinical knowledge was the most frequently mentioned motivation for teaching, and was described as a strategy for GP teachers to preserve clinical competence through the opportunity to learn new aspects of medicine from junior colleagues. Other motivations included personal fulfillment and enjoyment of teaching, the opportunity to pass on general practice skills and knowledge, promoting general practice as a career, and fulfilling a sense of responsibility to the profession and community. Peers, students and patients also influenced the decision to teach. Most GPs identified that time, workload, availability of space and adequate financial remuneration were prerequisites for teaching. Practice owners also often determined the GP teachers' capacity to teach. Discussion To increase the recruitment and retention of GP teachers, it is recommended that teaching organisations give more recognition to teaching as a clinical professional development activity, place more emphasis on GPs' personal enjoyment, professional responsibility and pride in teaching, and increase engagement with practice owners. [ABSTRACT FROM AUTHOR]

This article reports on a systematic review of the strategies, practices, and organizational characteristics that promote constructive staff–family relationships in the care of older adults in the health care setting. Research evidence points to the need to address power and control issues, communication, and collaborative approaches to care. Interventions designed to promote family–staff relationships are more likely to achieve maximum benefit when implemented with accompanying information sharing, education, and managerial support. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30:385–398, 2007. [ABSTRACT FROM AUTHOR]