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Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle) 2019; 8:309-322. [PMID: 31832278 PMCID: PMC6906754 DOI: 10.1089/wound.2018.0925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent Advances: Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Critical Issues: Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Future Directions: Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.
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Affiliation(s)
- Sandra W. Citty
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Linda J. Cowan
- Nursing Service and Research, Tampa VA Center of Innovation for Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Zandra Wingfield
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Joyce Stechmiller
- Department of Behavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
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Delaney CL, Smale MK, Miller MD. Nutritional Considerations for Peripheral Arterial Disease: A Narrative Review. Nutrients 2019; 11:E1219. [PMID: 31146408 PMCID: PMC6627356 DOI: 10.3390/nu11061219] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.
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Affiliation(s)
- Christopher L Delaney
- Department of Vascular Surgery, Flinders Medical Centre and Flinders University, Bedford Park 5042, South Australia, Australia.
| | - Matilda K Smale
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia.
| | - Michelle D Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia.
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53
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Zhang H, Wang Y, Sun S, Huang X, Tu G, Wang J, Lin Y, Xia H, Yuan Y, Yao S. Early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e14864. [PMID: 30882688 PMCID: PMC6426535 DOI: 10.1097/md.0000000000014864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Controversy persists about whether early enteral nutrition administration is related to worse prognosis than delayed enteral nutrition for patients with gastrointestinal bleeding. OBJECTIVES To systematically evaluate the effect of early enteral nutrition on the patient with gastrointestinal bleeding through the meta-analysis. METHODS Such electronic databases including PubMed, EMBASE, Cochrane Library, CNKI, and CBM were searched from 1985 to March 2018. Randomized controlled trials that compared early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding were considered eligible. Data extraction and the methodological quality assessment of the included trials were carried out according to the Cochrane Handbook. We calculated the pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval using RevMan5.3. RESULT A total of 5 trials involving 313 patients were included. Compared with delayed enteral nutrition, there was a tendency for a decreased rebleeding rate in the early enteral nutrition group, but the trend was not statistically significant (risk ratio = 0.75, 95% confidential interval: 0.34-1.64, I = 0). As for mortality within 30 days, no significant difference was found between the 2 groups (risk ratio = 0.74, 95% confidential interval: 0.23-2.39, I = 0). In addition, the pooled analysis showed that early enteral nutrition was related to reduced hospitalized days (weighted mean difference = -1.69, 95% confidential interval: -2.15 to -1.23; I = 27%) CONCLUSION:: For patients with gastrointestinal bleeding, early enteral nutrition within 24 hours does not result in the significantly higher risk of rebleeding and mortality compared with delayed enteral nutrition, but decrease hospitalized days. Patients who are at low risk for rebleeding can be fed early and discharged early. However, larger, high-quality randomized controlled trials are needed to verify these findings, and when the gastrointestinal bleeding patient start enteral nutrition is worth studying.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yin Yuan
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
The term malnutrition refers to both undernutrition and overnutrition. In healthcare, it most often refers to undernutrition, in particular disease-related malnutrition, which can be a result or a cause of an illness. The reasons for malnutrition are multifactorial, and its consequences may include an increased risk of pressure ulcers, reduced mobility and psychological effects such as depression. It is essential that nurses prioritise the nutritional care of all patients and identify those at risk of malnutrition using accurate and reliable nutrition screening tools. If there is a risk of malnutrition, further assessment and nutrition action planning can reduce the risk to the patient and improve their nutritional status. This article discusses the effects of disease-related malnutrition and outlines the role of screening tools and assessment in identifying patients who are malnourished or at risk of becoming malnourished. It also describes the nursing care that should be provided to patients with disease-related malnutrition, and emphasises the importance of using a multidisciplinary team approach involving speech and language therapists, dieticians, occupational therapists and physiotherapists.
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Affiliation(s)
- Hardip Malhi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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55
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Armstrong E, Jamieson R, Porter J. Food cooking methods contribute to the reduced vitamin C content of foods prepared in hospitals and care facilities: a systematic review. Int J Food Sci Technol 2018. [DOI: 10.1111/ijfs.13979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Emma Armstrong
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
| | - Rachel Jamieson
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
| | - Judi Porter
- Clinical Dietitian; Eastern Health; Box Hill Vic. 3128 Australia
- Department of Nutrition; Dietetics & Food, Monash University; Ferntree Gully road Notting Hill Vic. 3168 Australia
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56
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Eglseer D, Hödl M, Lohrmann C. Nutritional management of older hospitalised patients with pressure injuries. Int Wound J 2018; 16:226-232. [PMID: 30440105 PMCID: PMC7379703 DOI: 10.1111/iwj.13016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 12/14/2022] Open
Abstract
This cross-sectional, multicentre study was conducted in hospitals to investigate nutritional interventions conducted in patients aged 70 years or older with (risk of) pressure injuries. A total of 1412 patients from 33 hospitals with 208 wards participated in the study. A standardised questionnaire was used to collect demographic data and data on care dependency, malnutrition risk, risk for/prevalence of pressure injuries, and nutritional interventions. Data analyses were conducted by using descriptive statistics, chi-square tests, or independent t-tests. According to the Braden Scale, 678 (48.0%) of the patients were at risk of developing pressure injuries, and 71 patients (5.0%) had at least one pressure injury (assessed by skin inspection). The most frequently conducted nutritional interventions in patients with pressure injuries were providing support during mealtimes (50.7%), food specifically desired by the patient (40.8%), and conducting a malnutrition screening (39.4%). One quarter of the patients with pressure injuries were referred to a dietitian. The provision of an energy-enriched/protein-enriched diet (18.3%), energy-enriched/protein-enriched snacks (12.7%), or oral nutritional supplements (8.5%) was rare. Nutritional care in older patients with risk of pressure injuries is suboptimal. Health care professionals need to raise awareness regarding the importance of nutrition in the management of patients with pressure injuries.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Manuela Hödl
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Trinks A, Hägglin C, Nordvall D, Rothenberg E, Wijk H. The impact of a national quality register in the analysis of risks and adverse events among older adults in nursing homes and hospital wards—a Swedish Senior Alert survey. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40886-018-0077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
BACKGROUND Pressure ulcers are treated by reducing pressure on the areas of damaged skin. Special support surfaces (including beds, mattresses and cushions) designed to redistribute pressure, are widely used as treatments. The relative effects of different support surfaces are unclear. This is an update of an existing review. OBJECTIVES To assess the effects of pressure-relieving support surfaces in the treatment of pressure ulcers. SEARCH METHODS In September 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included published or unpublished randomised controlled trials (RCTs), that assessed the effects of support surfaces for treating pressure ulcers, in any participant group or setting. DATA COLLECTION AND ANALYSIS Data extraction, assessment of 'Risk of bias' and GRADE assessments were performed independently by two review authors. Trials with similar participants, comparisons and outcomes were considered for meta-analysis. Where meta-analysis was inappropriate, we reported the results of the trials narratively. Where possible, we planned to report data as either risk ratio or mean difference as appropriate. MAIN RESULTS For this update we identified one new trial of support surfaces for pressure ulcer treatment, bringing the total to 19 trials involving 3241 participants. Most trials were small, with sample sizes ranging from 20 to 1971, and were generally at high or unclear risk of bias. PRIMARY OUTCOME healing of existing pressure ulcersLow-tech constant pressure support surfacesIt is uncertain whether profiling beds increase the proportion of pressure ulcer which heal compared with standard hospital beds as the evidence is of very low certainty: (RR 3.96, 95% CI 1.28 to 12.24), downgraded for serious risk of bias, serious imprecision and indirectness (1 study; 70 participants).There is currently no clear difference in ulcer healing between water-filled support surfaces and foam replacement mattresses: (RR 0.93, 95% CI 0.63 to 1.37); low-certainty evidence downgraded for serious risk of bias and serious imprecision (1 study; 120 participants).Further analysis could not be performed for polyester overlays versus gel overlays (1 study; 72 participants), non-powered mattresses versus low-air-loss mattresses (1 study; 20 participants) or standard hospital mattresses with sheepskin overlays versus standard hospital mattresses (1 study; 36 participants).High-tech pressure support surfacesIt is currently unclear whether high-tech pressure support surfaces (such as low-air-loss beds, air suspension beds, and alternating pressure surfaces) improve the healing of pressure ulcers (14 studies; 2923 participants) or which intervention may be more effective. The certainty of the evidence is generally low, downgraded mostly for risk of bias, indirectness and imprecision.Secondary outcomesNo analyses were undertaken with respect to secondary outcomes including participant comfort and surface reliability and acceptability as reporting of these within the included trials was very limited.Overall, the evidence is of low to very low certainty and was primarily downgraded due to risk of bias and imprecision with some indirectness. AUTHORS' CONCLUSIONS Based on the current evidence, it is unclear whether any particular type of low- or high-tech support surface is more effective at healing pressure ulcers than standard support surfaces.
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Affiliation(s)
- Elizabeth McInnes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityNursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU)Executive Suite, Level 5 DeLacy BuildingSt Vincent's Hospital, 390 Victoria RoadDarlinghurstNew South WalesAustralia2010
| | - Asmara Jammali‐Blasi
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityNursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU)Executive Suite, Level 5 DeLacy BuildingSt Vincent's Hospital, 390 Victoria RoadDarlinghurstNew South WalesAustralia2010
| | - Sally EM Bell‐Syer
- CochraneCochrane Editorial UnitSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vannessa Leung
- Sydney Eye HospitalKensingtonSydneyNSWAustralia2052
- The University of SydneyReserve RoadSydneyNSWAustralia2065
- The University of New South WalesReserve RoadSydneyNSWAustralia2065
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59
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Wong A, Goh G, Banks MD, Bauer JD. Economic Evaluation of Nutrition Support in the Prevention and Treatment of Pressure Ulcers in Acute and Chronic Care Settings: A Systematic Review. JPEN J Parenter Enteral Nutr 2018; 43:376-400. [PMID: 30207386 DOI: 10.1002/jpen.1431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/13/2018] [Accepted: 07/11/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent developments in nutrition intervention indicated clinical effectiveness for pressure ulcer (PU) prevention and treatment, but it is important to assess whether they are cost-effective. The aims of this systematic review are to determine the cost-effectiveness and clinical outcomes of nutrition support in PU prevention and treatment. METHODS A systematic search of randomized controlled trials, observational studies, and statistical models that investigated cost-effectiveness and economic outcomes for prevention and/or treatment of PUs were performed using standard literature and electronic databases. RESULTS Fourteen studies met the inclusion criteria, which included 3 randomized controlled trials with their companion economic evaluations, 4 model-based, 2 cohort, 1 pre and post, and 1 prospective controlled trial. Risk of bias assessment for all of the uncontrolled or observational trials revealed high or serious risk of bias. Interventions that incorporated specialized nursing care appeared to be more effective in prevention and treatment of PUs, compared with single intervention studies. There is a trend of improved PU healing when additional energy/protein are provided. PU prevention ($250-$9,800) was less expensive than treatment ($2,500-$16,000). Nutrition intervention for PU prevention was cost-effective in 87.0%-99.99% of the simulation models. CONCLUSIONS There is potential cost-saving and/or cost-effectiveness of nutrition support in the long term, as predicted by the model-based PU prevention studies in the review. Prevention of PU also appears to be more cost-effective than treatment. A multidisciplinary approach to managing PU is more likely to be cost-effective.
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Affiliation(s)
- Alvin Wong
- Dietetic and Food Services, Changi General Hospital, Singapore 529889, Singapore.,School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Queensland, Australia
| | - Geraldine Goh
- Health Services Research, Changi General Hospital, Singapore 529889, Singapore
| | - Merrilyn D Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Queensland, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Queensland, Australia
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60
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Otero TMN, Canales C, Yeh DD, Elsayes A, Belcher DM, Quraishi SA. Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients. Nutr Clin Pract 2018; 34:142-147. [PMID: 30101993 DOI: 10.1002/ncp.10184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients. METHODS We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit. RESULTS A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL. CONCLUSION In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.
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Affiliation(s)
- Tiffany M N Otero
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts.,Department of Medicine, Carney Hospital, Boston, Massachusetts
| | - Cecilia Canales
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, University of California, Irvine, California
| | - D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Ali Elsayes
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Donna M Belcher
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Najafi E, Ahmadi M, Mohammadi M, Beigmohammadi MT, Heidary Z, Vatanara A, Khalili H. Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial. J Wound Care 2018; 27:495-502. [DOI: 10.12968/jowc.2018.27.8.495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elham Najafi
- Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Motahareh Ahmadi
- Clinical Pharmacist, Department of Clinical Pharmacy, Homozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Mostafa Mohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Heidary
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Vatanara
- Faculty Member, Department of Pharmaceutical Sciences, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Older adults are particularly vulnerable to compromised nutritional status. With advancing age, the consumption of a high-quality, nutritionally dense diet is increasingly essential to optimize health and well-being. Proportionally, macronutrient needs for older adults are similar to younger adults, however overall calorie requirements tend to decline with age. Unique factors influencing food intake should be considered and individualized guidance should be designed to help overcome medical, physical, and social barriers to a healthy diet. The goal for nutrition intervention should ultimately be to promote health and quality of life across the continuum of the aging process.
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Affiliation(s)
- Melissa Bernstein
- Department of Nutrition, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
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Durrant LA, Taylor J, Thompson H, Usher K, Jackson D. Health literacy in pressure injury: Findings from a mixed-methods study of community-based patients and carers. Nurs Health Sci 2018; 21:37-43. [DOI: 10.1111/nhs.12429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa A. Durrant
- Oxford Institute for Nursing, Midwifery and Allied Health Research; The Colonnade, Oxford Brookes University; Oxford UK
| | - James Taylor
- Oxford Institute for Nursing, Midwifery and Allied Health Research; The Colonnade, Oxford Brookes University; Oxford UK
| | - Helen Thompson
- Oxford Institute for Nursing, Midwifery and Allied Health Research; The Colonnade, Oxford Brookes University; Oxford UK
| | - Kim Usher
- Oxford Institute for Nursing, Midwifery and Allied Health Research; The Colonnade, Oxford Brookes University; Oxford UK
- School of Health, University of New England; Armidale, NSW Australia
| | - Debra Jackson
- Oxford Institute for Nursing, Midwifery and Allied Health Research; The Colonnade, Oxford Brookes University; Oxford UK
- Oxford University Hospitals National Health Service Foundation Trust; Oxford UK
- Oxford Health National Health Service Foundation Trust; Oxford UK
- Faculty of Health, University of Technology; Sydney, 15 Broadway, Ultimo NSW 2007 Australia
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64
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Qin Z, Wang Y, Zhao W, Zhang Y, Tian Y, Sun S, Li X. Pressure ulcer healing promoted by adequate protein intake in rats. Exp Ther Med 2018; 15:4173-4178. [PMID: 29731816 PMCID: PMC5921074 DOI: 10.3892/etm.2018.5934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/13/2017] [Indexed: 12/02/2022] Open
Abstract
The effect of protein intake on rat pressure ulcer healing was evaluated. One hundred rats were numbered according to body weight and then they were randomly divided into 4 groups (n=25) using the random number table. After rat models of stage II pressure ulcer were established, they were fed with feed containing different protein levels (10, 15, 20 and 25%). Healing time, pressure ulcer area, body weight, albumin (ALB) and hemoglobin (Hb) levels among groups were compared. Hematoxylin and eosin (H&E) staining was also performed to observe pressure ulcer tissue structure. In the healing process of pressure ulcer, rats with 20% protein intake had the shortest healing time and the smallest pressure ulcer area. Body weight, ALB and Hb levels were much closer to the normal level. H&E staining result also suggested that the pressure ulcer healing degree of rats with 20% protein intake was much better than the others. Adequate protein intake is therefore conducive to pressure ulcer healing, while excessive or insufficient protein intake has negative impact on healing.
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Affiliation(s)
- Zhanfen Qin
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yao Wang
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Wei Zhao
- The Second General Surgery Department, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yanan Zhang
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yiqing Tian
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Sujuan Sun
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Xian Li
- Department of Nursing, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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65
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Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings. J Acad Nutr Diet 2018; 118:724-735. [DOI: 10.1016/j.jand.2018.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 01/04/2023]
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66
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Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure Ulcer and Nutrition. Indian J Crit Care Med 2018; 22:283-289. [PMID: 29743767 PMCID: PMC5930532 DOI: 10.4103/ijccm.ijccm_277_17] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pressure ulcers can diminish global life quality, contribute to rapid mortality in some patients and pose a significant cost to health-care organizations. Accordingly, their prevention and management are highly important. Nutritional deprivation and insufficient dietary intake are the key risk factors for the development of pressure ulcers and impaired wound healing. Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength. No laboratory test can exactly define an individual's nutritional status. Although serum albumin, prealbumin, transferrin, and retinol-binding protein as well as anthropometric measures such as height, weight, and body mass index and the other laboratory values may be suitable to establish the overall prognosis, still they might not well represent the nutritional status. Although the ideal nutrient intake to encourage wound healing is unknown, increased needs for energy, protein, zinc, and Vitamins A, C, and E and also amino acids such as arginine and glutamine have been documented. Hydration plays a vital role in the preservation and repair of skin integrity. Dehydration disturbs cell metabolism and wound healing. Adequate fluid intake is necessary to support the blood flow to wounded tissues and to prevent additional breakdown of the skin. The main aim of the present article is to review the current evidence related to hydration and nutrition for bedsore prevention and management in adults.
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Affiliation(s)
- Seied Hadi Saghaleini
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kasra Dehghan
- Department of Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Kamran Shadvar
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Ostadi
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Koivunen M, Hjerppe A, Luotola E, Kauko T, Asikainen P. Risks and prevalence of pressure ulcers among patients in an acute hospital in Finland. J Wound Care 2018; 27:S4-S10. [DOI: 10.12968/jowc.2018.27.sup2.s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marita Koivunen
- Nursing Director, Adjunct Professor, Department of Nursing Science, University of Turku, Satakunta Hospital District
| | - Anna Hjerppe
- Chief Physician, Clinical Teacher, Department of Dermatology, Satakunta Hospital District, and Department of Medicine, University of Turku
| | - Eija Luotola
- Authorised Wound Care Nurse, Satakunta Hospital District
| | - Tommi Kauko
- Biostatistician, Satakunta Hospital District
| | - Paula Asikainen
- Administrative Nursing Director, Adjunct Professor, Department of Biostatistics, University of Turku, and School of Health Sciences, University of Tampere, Satakunta Hospital District
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王 华, 戴 世, 卢 铨, 叶 林, 李 华, 宋 希, 洪 涛, 沙 卫. [Effect of different time windows and interventions on skin pressure ulcers and ischemia-reperfusion injury in rats]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1688-1694. [PMID: 29292267 PMCID: PMC6744022 DOI: 10.3969/j.issn.1673-4254.2017.12.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To observe the effect of different time windows and interventions on skin pressure ulcers and ischemia-reperfusion (I/R) injury in rats. METHODS Sixty?eight SD rats were randomly divided into blank control group (n=4) and model group (n=64). The rats in the model group were randomly divided into group A (n=32) without intervention and group B (n=32) with post?conditioning. The degree of skin compression, neutrophil infiltration and serum levels of free radicals were observed in the rats after compression for 2, 4, 6, and 8 h (8 rats at each time point). RESULTS A significant difference was found in the severity of skin damage among the control group, group A, and group B (P=0.001), and the injury was milder in group B than in group A. Severe skin lesions occurred in 2 rats after skin compression for 6 h, as compared with 6 after compression for 8 h (P=0.043), but in none of the rats after compression for 2 or 4. Seventeen rats in group B and 15 in group A showed grade 1 neutrophil infiltration in the skin lesions, and 8 rats in group B and 10 in group A showed grade II neutrophil infiltration (P=0.002). Neutrophil infiltration was the mildest in rats with a 2?h compression, and exacerbated progressively and significantly as the compression time extended (P=0.027). With the prolongation of the intervention time, the rats in both groups A and B showed decreased SOD and increased MDA and NO levels, and overall the I/R injury was milder in 2? and 4?h compression groups than in 6? and 8?h compression groups. The level of serum SOD was significantly higher and MDA and NO levels were significantly higher in group B than in group A (P<0.05). CONCLUSION Ischemic post?conditioning can relieve I/R injury in acute pressure ulcer in rats. The effective time window for intervention is within 6 h of ischemia, and the effect of ischemic post-conditioning is optimal within 2 h. Ischemic post?conditioning can alleviate free radical injury and inflammation caused by I/R injury.
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Affiliation(s)
- 华军 王
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 世学 戴
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 铨 卢
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 林昌 叶
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 华 李
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 希 宋
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 涛 洪
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 卫红 沙
- />广东省医学科学院//广东省人民医院消化内科,广东 广州 510080Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Haughey L, Barbul A. Nutrition and Lower Extremity Ulcers: Causality and/or Treatment. INT J LOW EXTR WOUND 2017; 16:238-243. [DOI: 10.1177/1534734617737639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between malnutrition, impaired wound healing, and the presence of chronic wounds has been recognized for a long time. It is widely believed that the lack of adequate nutrition increases the risk of developing wounds which have a great likelihood of progressing to chronicity due to lack of appropriate healing responses. This risk is particularly high in the aging population. For the individual patient, as well as patient populations, the diagnosis of malnutrition has been in dispute; further, there is lack of agreement of when and how to intervene nutritionally in those with wounds or healing deficits. This article examines the relationship of nutritional status with the presence and clinical evolution of leg ulcers in humans, focusing on diabetic and venous leg ulcers; we will further review the effect of nutritional therapy on the outcome of these ulcers.
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Affiliation(s)
| | - Adrian Barbul
- Tennessee Valley VA Hospital, Nashville, TN, USA
- Vanderbilt University School of Medicine, Nashville, TN, Vanderbilt University School of Medicine, Nashville, TN, USA
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Evidence-Based Interventions for Diabetic Heel Ulcers. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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71
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Oliveira KDLD, Haack A, Fortes RC. Nutritional therapy in the treatment of pressure injuries: a systematic review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.160195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract Objective: to review literature on the use of nutritional therapy in the treatment of pressure injuries. Methods: a systematic review of the PubMed, Lilacs and Scielo databases was performed, with studies in the English and Portuguese languages published in the last five years selected. Result: three articles that investigated the use of different doses of arginine, a mixture of amino acids and nutritional supplements enriched with arginine, zinc and antioxidants were analyzed. The studies found that there was a reduction in the area of wounds in the intervention groups, although the difference in size was not significant in all the articles. Conclusion: nutritional intervention should be considered an integral part of the treatment of pressure injuries. The use of certain nutrients may positively affect the healing process of such injuries. Due to the heterogeneity of the methodologies used, the small sample size and the range of intervention times and nutrients used, more scientifically rigorous studies are recommended to create an evidence based nutritional intervention model for the treatment of pressure injuries.
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Phillips SM. Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults. Front Nutr 2017; 4:13. [PMID: 28534027 PMCID: PMC5420553 DOI: 10.3389/fnut.2017.00013] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 12/21/2022] Open
Abstract
Protein needs for otherwise healthy individuals older than 19 years are defined by the recommended dietary allowance (RDA) at 0.80 g protein/kg/day. There is no recommendation in the current RDA for subpopulations of older adults or people in various pathological situations. Despite the lack of a separate recommendation, there exists a growing body of evidence that is strongly suggestive of an increased need and/or benefit for protein in older persons. That is, intakes beyond the RDA are, in older persons, associated with benefits. In addition, a number of catabolic states including critical illness also result in a sharp elevation in the needs for protein and amino acids. An underappreciated issue in protein nutrition is the impact of protein quality on clinically relevant outcomes. The introduction of a new protein scoring system-the digestible indispensable amino acid score (DIAAS)-for protein quality has raised a forgotten awareness of protein quality. The DIAAS, which replaces the protein digestibility-corrected amino acid score (PDCAAS), is based on ileal digestibility of protein and a different test protein than PDCAAS and has values greater than 1.0. The aim of this article is a brief review and summary recommendations for protein nutrition and protein requirements in populations who would benefit from more protein than the RDA. The emphasis of the review is on muscle protein turnover, and there is a discussion of the impact of protein quality, particularly as it applies to commercially available protein sources. The evidence for more optimal protein intakes is considered in light of the potential health risks of consumption of protein at levels greater than the RDA.
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Neyens J, Cereda E, Meijer E, Lindholm C, Schols J. Arginine-enriched oral nutritional supplementation in the treatment of pressure ulcers: A literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.wndm.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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74
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The Effectiveness of the Braden Scale as a Tool for Identifying Nutrition Risk. J Acad Nutr Diet 2017; 118:385-391. [PMID: 28094227 DOI: 10.1016/j.jand.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 11/23/2022]
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Cereda E, Neyens JCL, Caccialanza R, Rondanelli M, Schols JMGA. Efficacy of a Disease-Specific Nutritional Support for Pressure Ulcer Healing: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2017; 21:655-661. [PMID: 28537329 DOI: 10.1007/s12603-016-0822-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this systematic review was to summarize the evidence on the efficacy of high-calorie, high-protein nutritional formula enriched with arginine, zinc, and antioxidants (disease-specific support) in patients with pressure ulcers (PUs). METHODS Randomized controlled trials in English published from January 1997 until October 2015 were searched for in electronic databases (EMBASE, Medline, PubMed, and CINAHL). Studies comparing a disease-specific nutritional support (oral supplements or tube feeding) to a control nutritional intervention enabling the satisfaction of energy requirements regardless of the use of high-calorie formula or placebo or no support for at least 4 weeks were considered eligible. Study outcomes were the percentage of change in PU area, complete healing and reduction in the PU area ≥40% at 8 weeks, and the percentage of change in area at 4 weeks. RESULTS A total of 3 studies could be included in the meta-analysis. Compared with control interventions, formulas enriched with arginine, zinc and antioxidants resulted in significantly higher reduction in ulcer area (-15.7% [95%CI, -29.9, -1.5]; P=0.030; I2=58.6%) and a higher proportion of participants having a 40% or greater reduction in PU size (OR=1.72 [95%CI, 1.04, 2.84]; P=0.033; I2=0.0%) at 8 weeks. A nearly significant difference in complete healing at 8 weeks (OR=1.72 [95%CI, 0.86, 3.45]; P=0.127; I2=0.0%) and the percentage of change in the area at 4 weeks (-7.1% [95%CI, -17.4, 3.3]; P=0.180; I2=0.0%) was also observed. CONCLUSIONS This systematic review shows that the use of formulas enriched with arginine, zinc and antioxidants as oral supplements and tube feeds for at least 8 weeks are associated with improved PU healing compared with standard formulas.
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Affiliation(s)
- E Cereda
- Emanuele Cereda MD, PhD, Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy, Tel.: +39 0382 501615 ; Fax: + 39 0382 502801, E-mail:
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Marcus B. Treatment of large, complex, non-healing wounds with cryopreserved amniotic suspension allograft: a case series. J Wound Care 2016; 25:S18-S24. [DOI: 10.12968/jowc.2016.25.sup10.s18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- B. Marcus
- North Fulton Hospital Hyperbaric and Wound Care Center, 517 Johnson Ferry Road, NE, Atlanta, GA 30328
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Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility. Open Access Maced J Med Sci 2016; 4:423-427. [PMID: 27703567 PMCID: PMC5042627 DOI: 10.3889/oamjms.2016.094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.
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Affiliation(s)
- Lenche Neloska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Katerina Damevska
- University Clinic of Dermatology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Andjelka Nikolchev
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Lidija Pavleska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | | | - Milenko Kostov
- University Clinic of Neurosurgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Lindholm C, Searle R. Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J 2016; 13 Suppl 2:5-15. [PMID: 27460943 PMCID: PMC7949725 DOI: 10.1111/iwj.12623] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Treatment of wounds of different aetiologies constitutes a major part of the total health care budget. It is estimated that 1·5-2 million people in Europe suffer from acute or chronic wounds. These wounds are managed both in hospitals and in community care. The patients suffering from these wounds report physical, mental and social consequences of their wounds and the care of them. It is often believed that the use of wound dressings per se is the major cost driver in wound management, whereas in fact, nursing time and hospital costs are together responsible for around 80-85% of the total cost. Healing time, frequency of dressing change and complications are three important cost drivers. However, with the use of modern, advanced technology for more rapid wound healing, all these cost drivers can be substantially reduced. A basic understanding of the terminology and principles of Health Economics in relation to wound management might therefore be of interest.
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81
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Clinical insights: Understanding the link between nutrition and pressure ulcer prevention. Geriatr Nurs 2015; 36:477-81. [DOI: 10.1016/j.gerinurse.2015.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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82
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Kennerly S, Boss L, Yap TL, Batchelor-Murphy M, Horn SD, Barrett R, Bergstrom N. Utility of Braden Scale Nutrition Subscale Ratings as an Indicator of Dietary Intake and Weight Outcomes among Nursing Home Residents at Risk for Pressure Ulcers. Healthcare (Basel) 2015; 3:879-97. [PMID: 27417802 PMCID: PMC4934619 DOI: 10.3390/healthcare3040879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/23/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022] Open
Abstract
The Braden Scale for Pressure Sore Risk(©) is a screening tool to determine overall risk of pressure ulcer development and estimate severity of specific risk factors for individual residents. Nurses often use the Braden nutrition subscale to screen nursing home (NH) residents for nutritional risk, and then recommend a more comprehensive nutritional assessment as indicated. Secondary data analysis from the Turn for Ulcer ReductioN (TURN) study's investigation of U.S. and Canadian NH residents (n = 690) considered at moderate or high pressure ulcer (PrU) risk was used to evaluate the subscale's utility for identifying nutritional intake risk factors. Associations were examined between Braden Nutritional Risk subscale screening, dietary intake (mean % meal intake and by meal timing, mean number of protein servings, protein sources, % intake of supplements and snacks), weight outcomes, and new PrU incidence. Of moderate and high PrU risk residents, 61.9% and 59.2% ate a mean meal % of <75. Fewer than 18% overall ate <50% of meals or refused meals. No significant differences were observed in weight differences by nutrition subscale risk or in mean number protein servings per meal (1.4 (SD = 0.58) versus 1.3 (SD = 0.53)) for moderate versus high PrU risk residents. The nutrition subscale approximates subsequent estimated dietary intake and can provide insight into meal intake patterns for those at either moderate or high PrU risk. Findings support the Braden Scale's use as a preliminary screening method to identify focused areas for potential intervention.
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Affiliation(s)
- Susan Kennerly
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
| | - Lisa Boss
- School of Nursing, UT Health Houston, Houston, TX 77030, USA.
| | - Tracey L Yap
- School of Nursing, Duke University, Durham, NC 27710, USA.
| | | | - Susan D Horn
- School of Medicine, University of Utah, Salt Lake City, UT 84108, USA.
| | - Ryan Barrett
- International Severity Information Systems and the Institute for Clinical Outcomes Research, Salt Lake City, UT 84102, USA.
| | - Nancy Bergstrom
- School of Nursing, UT Health Houston, Houston, TX 77030, USA.
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Response to “Clinical Order Sets. Adv Skin Wound Care 2015; 28:297. [DOI: 10.1097/01.asw.0000466479.00585.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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