{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:10:13Z","timestamp":1785391813283,"version":"3.55.0"},"reference-count":69,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T00:00:00Z","timestamp":1586304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T00:00:00Z","timestamp":1586304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Advances in Wound Care"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Significance:<\/jats:title>\n                    <jats:p>A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Advances:<\/jats:title>\n                    <jats:p>A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Critical Issues:<\/jats:title>\n                    <jats:p>\n                      The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle\u2013brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Future Directions:<\/jats:title>\n                    <jats:p>We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/wound.2019.1042","type":"journal-article","created":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T16:36:55Z","timestamp":1571675815000},"page":"332-347","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management"],"prefix":"10.1177","volume":"9","author":[{"given":"Massimo","family":"Rivolo","sequence":"first","affiliation":[{"name":"Independent Tissue Viability Nurse Consultant, Turin, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Dionisi","sequence":"additional","affiliation":[{"name":"AUSL Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diletta","family":"Olivari","sequence":"additional","affiliation":[{"name":"Clinica Medica, Universit\u00e0 Politecnica delle Marche, Ancona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Ciprandi","sequence":"additional","affiliation":[{"name":"Ospedale Pediatrico Bambin Gesu\u2019, Roma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Crucianelli","sequence":"additional","affiliation":[{"name":"Ospedale Pediatrico Bambin Gesu\u2019, Roma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Marcadelli","sequence":"additional","affiliation":[{"name":"AUSL Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Rita","family":"Zortea","sequence":"additional","affiliation":[{"name":"Turriaco GO, Turriaco, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Bellini","sequence":"additional","affiliation":[{"name":"ATS Val Camonica, Sondrio, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Martinato","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera di Padova, Padova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Gabrielli","sequence":"additional","affiliation":[{"name":"Clinica Medica, Universit\u00e0 Politecnica delle Marche, Ancona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pomponio","sequence":"additional","affiliation":[{"name":"Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,4,8]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000292"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afh086"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2012.21.6.261"},{"key":"e_1_3_6_5_2","first-page":"42","article-title":"Practice recommendations for preventing heel pressure ulcers","volume":"54","author":"Fowler E","year":"2008","unstructured":"Fowler E, , Scott-Williams S, , McGuire JB. 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