of the skin) that overlie bony protuberances such as those in or around the hip, shoulder, greater trochanter of the femur, iliac crest, lumbar region, or scapular region. IF tumors differ from pressure ulcers in that they typically do not have extensive ulcerations of the skin and on histopathological microscopic analysis lack evidence of acute inflammation as determined by the presence of various types of white blood cells. These tumors are commonly treated by surgical removal. Prevention In the United Kingdom, the Royal College of Nursing has published guidelines in Pressure Ulcer Risk Assessment and Prevention that call for identifying people at risk and taking preventive action; the UK National Standards for Care Homes to do so as well. Recent efforts in the United States and South Korea have sought to automate risk assessment and classification by training machine learning models on electronic health records. Internationally, the NPIAP, EPUAP and Pan Pacific Pressure Injury Alliance, together with wound organizations from 15 countries around the world, published updated the international evidence-based clinical practice guideline in 2019. The 2019 guideline was developed by an international team of over 180 clinical specialists and updates the 2009 EPUAP/NPUAP clinical guideline and the 2014 NPUAP/EPUAP/PPPIA clinical guideline. The guideline includes recommendations on strategies to treat pressure ulcers, including the use of bed rest, pressure redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation). Reliable scientific evidence to support the use of many of these interventions, though, is lacking. More research is needed to assess how to best support the treatment of pressure ulcers, for example by repositioning. Also, the benefit of using systemic or topical antibiotics in the management of pressure ulcer is still unclear. Recently, the NPIAP President and Past-President, William Padula and Joyce Black, collaborated on the development of the Standardized Pressure Injury Prevention Protocol (SPIPP) Checklist in order to create a derivative of the International Guideline that was easy to follow and actionable at the bedside to facilitate consistent implementation of pressure injury prevention. In 2022, United States Congress passed legislation updating the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015 () to establish the SPIPP Checklist as law that United States Department of Veterans Affairs (VA) facilities should adhere to in order to keep patients safe from harm. It is important to understand that before turning and repositioning occur,