Pressure ulcers are a significant problem in health care, due to high costs and large impact on patients' life. In general, pressure ulcers develop as tissue viability decreases due to prolonged mechanical loading. The relation between load and tissue viability is highly influenced by individual characteristics. It is proposed that measurements of skin blood flow regulation could provide good assessment of the risk for pressure ulcer development, as skin blood flow is essential for tissue viability. . Therefore, the aim of this systematic review is to gain insight in the relation between mechanical load and the response of the skin and underlying tissue to this loading measured in-vivo with non-invasive techniques. A systematic literature search was performed to identify articles analysing the relation between mechanical load (pressure and/or shear) and tissue viability measured in-vivo. Two independent reviewers scored the methodological quality of the 22 included studies. Methodological information as well as tissue viability parameters during load application and after load removal were extracted from the included articles and used in a meta-analysis. Pressure results in a decrease in skin blood flow parameters, compared to baseline; showing a larger decrease with higher magnitudes of load. The steepness of the decrease is mostly dependent on the anatomical location. After load removal the magnitude of the post-reactive hyperaemic peak is related to the magnitude of pressure. Lastly, shear in addition to pressure, shows an additional negative effect, but the effect is less apparent than pressure on skin viability.

Fetal acidemia, caused by impaired gas exchange between the fetus and the mother, is a leading cause of stillbirth and neurologic complications. Early prediction is therefore essential to guide timely clinical intervention. Several strategies rely on cardiotocography (CTG), which combines fetal heart rate (fHR) with uterine contractions and has led to development of clinical guidelines for CTG interpretation and the introduction of different fHR features. Additionally, ST event analysis, investigating changes in the ST segments of the fetal electrocardiogram (fECG), has been proposed as a complementary tool. This narrative review adopts a systematic approach, with comprehensive searches in Embase and PubMed to ensure full coverage of the available literature, and summarizes findings from 30 studies. Clinical guidelines for CTG interpretation frequently lead to intermediate risk level annotations, leaving the final decision regarding fetal management to clinical experience. In contrast, various fHR features can successfully discriminate between fetuses developing acidemia and healthy controls. Evidence regarding the added value of ST events derived from the scalp electrode remains conflicting, due to concerns about invasiveness. Recent studies on machine learning models highlight their ability to integrate multiple fHR features and improve predictive performance, suggesting a promising direction for enhancing acidemia prediction during labor.

While exercise therapy generally yields positive outcomes in patients with hip or knee osteoarthritis (HOA or KOA), individual results vary. Expectations may influence treatment results, but research on this topic is scarce. Therefore, this study aimed to describe methods to assess pre-treatment expectations of patients with HOA or KOA with respect to exercise therapy. Scoping review, with the Pubmed, Embase, CINAHL and Cochrane databases searched for original clinical studies of any design reporting a method or instrument to assess expectations of exercise therapy in patients with HOA or KOA. Data extraction from selected studies concerned study characteristics and the method or instrument used, as well as their content, categorized into expectations of structure, process or outcomes of exercise therapy treatment. Twenty-nine studies met the inclusion criteria. Twenty-three different methods used to address expectations were identified, 3 of which had a qualitative nature (interviews) and 20 concerned questionnaires. There was a large variation in number of items and measurement scales in the identified methods. Nine methods addressed expectations of outcomes of treatment, 7 addressed both outcomes and the process/structure of treatment. One instrument was found to measure willingness to receive exercise rather than expectations. For the remaining 6 instruments no content nor aspects measured were reported. In the literature, apart from interviews, mainly quantitative methods have been used to measure expectations with regard to exercise therapy in patients with HOA or KOA. Most of their content concerned the outcomes of care, rather than its structure and/or process.