This issue of Advances features three important articles from lead authors in Switzerland, the US, and Canada in the fields of nursing, physiotherapy, and medicine, representing the journal's international and interprofessional focus. These articles describe video education patient storytelling methods; how to perform comprehensive wheelchair assessments; and lessons learned from pressure injuries (PIs) associated with COVID-19 infections, especially with prone positioning.

In the study by RN Corinne Brunner and interprofessional colleagues from Zurich, the authors integrated storytelling videos into parent education for children aged 0 to 5 years with uncontrolled atopic dermatitis. The main defect in persons with atopy is skin barrier function. Atopic dermatitis appears after 2 weeks of age with a genetic susceptibility that is likely stimulated by environmental conditions. To reduce parents' fears regarding use of topical corticosteroids, the authors performed a randomized controlled trial using educational storytelling videos prior to pediatric dermatologic consultation. The six videos were short, only 3 to 6 minutes in length, and showed scenarios of families like the clinic parent population. Using validated tools, the authors demonstrated a significant reduction in worries or beliefs about topical steroid use among parents who watched the videos. All patients had a pediatric dermatologic consultation, and this did not change the attitudes of the control group. The children's quality of life and their atopic eczema severity did not vary between the groups, indicating the multicomponent management needs of this young atopic dermatitis population. Innovative patient education tools and video storytelling should be encouraged for other skin and wound conditions.

Dr Stephen Sprigle's US-based physiotherapy expertise is highlighted in our continuing education article this month. He explores connections between the biomechanics of posture and numerous wheelchair characteristics, highlighting the complexity of seating assessments and the need to examine several aspects of wheelchairs to ensure proper fit. For example, providers should consider the patient's posture and relate it ergonomically to the pelvis and backrest; note that leaning on the backrest will tend to push the patient out of the chair; recognize that a slouched, kyphotic posture may require a seating correction; routinely palpate the coccyx in relation to the seat cushion; and confirm that the wheelchair components are appropriate (eg, seat width, depth, and height). This article identifies several additional needs for seating assessments to enhance comfort and prevent PIs. Remember, a cushion alone can not prevent a PI from a poorly fitted wheelchair!

The third article investigated the relationship between COVID-19 and hospital-acquired PIs. Canadian authors Bourkas et al identified 489 potential articles and extracted 19 publications that met the inclusion criteria. The narrative synthesis identified a strong association between hospital-acquired PIs and men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. The authors utilized a model from Dr Amit Gefen1 to explain some of the issues with prone positioning. These patients were in a prone position to maximize lung function and the tissue deformation from the positive airway pressure mechanical loading caused a loss of homeostasis and cell damage. In the model, Gefen describes the progression of cell death through a build up of interstitial pressure that is complicated by a loss of cytoskeletal integrity and increased permeability, culminating in occluded small blood vessels. This leads to hypoxia and low pH, linked to an accumulation of lactic acid.

In the early days of the pandemic, comorbidities associated with COVID-19 infections and prone positioning increased PI risk. There was a high incidence of hospital-acquired PIs, often related to respiratory devices, especially ventilator-related breathing devices. However, we now have improved knowledge of treatments for acute COVID-19 complications and strategies to protect patients' skin from respiratory devices. Professional organizations, including the National Pressure Injury Advisory Panel, contributed practice tips on how to protect most prone patients from PI.

R. Gary Sibbald, MD, MEd, FRCPC, FAAD, JM

Elizabeth A. Ayello, PhD, MS, RN, CWON, FAAN

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