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The 2021 Update on Pressure Injuries: A Review of the Literature. Adv Skin Wound Care 2022; 35:422-428. [PMID: 35856612 DOI: 10.1097/01.asw.0000834588.32255.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To provide a review of the recent literature on the epidemiology and treatment of pressure injuries (PIs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify risk factors for developing PIs.2. Differentiate factors that could affect the healing of PIs.3. Select strategies that have an impact on the development of PIs. ABSTRACT Keeping up with the literature on pressure injuries is always a challenge for busy clinicians. In this article, the authors summarize six important articles published in 2021. Articles cover a range of topics including epidemiology, treatment, precision medicine, nurse staffing, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information is intended to help clinicians incorporate new data into their clinical practice.
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Abed Elahad J, McCarthy MW, Goverman J, Kaafarani HMA. An Overview of Sacral Decubitus Ulcer. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0152-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iizaka S, Kaitani T, Nakagami G, Sugama J, Sanada H. Clinical validity of the estimated energy requirement and the average protein requirement for nutritional status change and wound healing in older patients with pressure ulcers: A multicenter prospective cohort study. Geriatr Gerontol Int 2014; 15:1201-9. [DOI: 10.1111/ggi.12420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Junko Sugama
- Division of Health Sciences; Graduate School of Medical Science, Kanazawa University; Ishikawa Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Iizaka S, Koyanagi H, Sasaki S, Sekine R, Konya C, Sugama J, Sanada H. Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients. J Wound Care 2014; 23:198-200, 202-6. [PMID: 24762383 DOI: 10.12968/jowc.2014.23.4.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting. METHOD The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated. RESULTS Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127). CONCLUSION Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.
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Affiliation(s)
- S Iizaka
- RN, PHN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan
| | - H Koyanagi
- RN, MHS, University of Tokyo Hospital, Tokyo, Japan
| | - S Sasaki
- RN, University of Tokyo Hospital, Tokyo, Japan
| | - R Sekine
- RD, University of Tokyo Hospital, Tokyo, Japan
| | - C Konya
- RN, PhD, School of Nursing, Kanazawa Medical University, Ishikawa, Japan
| | - J Sugama
- RN, PhD, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - H Sanada
- RN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan
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Iizaka S, Sanada H, Matsui Y, Furue M, Tachibana T, Nakayama T, Sugama J, Furuta K, Tachi M, Tokunaga K, Miyachi Y. Serum albumin level is a limited nutritional marker for predicting wound healing in patients with pressure ulcer: two multicenter prospective cohort studies. Clin Nutr 2011; 30:738-45. [PMID: 21802178 DOI: 10.1016/j.clnu.2011.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS We aimed to investigate the predictive validity of serum albumin for pressure ulcer healing, according to patient condition and wound characteristics. METHODS This study was a secondary analysis of pooled data from two multicentre cohort studies undertaken in 2005 and 2007. All adult patients with pressure ulcer were included and were tracked until wound healing or discharge from care. Baseline serum albumin data were obtained from medical charts. RESULTS A total of 2530 patients were analyzed. By multivariate Cox proportional hazards analysis, higher serum albumin level was associated with wound healing of only superficial pressure ulcers for patients in acute/postoperative conditions (hazard ratio 1.29, 95% confidence interval 1.13-1.46) and the cutoff point was 24/25 g/L. However, the addition of serum albumin level to other factors resulted in little increase in the ability to predict wound healing as measured by the overall C-statistics. For patients in chronic/palliative conditions, serum albumin level as the continuous variable was not significantly associated with ulcer healing. CONCLUSIONS The addition of serum albumin marker may not have much advantage to predict pressure ulcer healing although its level can be associated with ulcer healing, depending on patient condition and wound depth.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Faculty of Medicine Bldg. No. 5-308, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr 2010; 29:47-53. [DOI: 10.1016/j.clnu.2009.05.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 04/03/2009] [Accepted: 05/31/2009] [Indexed: 11/22/2022]
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Terekeci H, Kucukardali Y, Top C, Onem Y, Celik S, Oktenli C. Risk assessment study of the pressure ulcers in intensive care unit patients. Eur J Intern Med 2009; 20:394-7. [PMID: 19524181 DOI: 10.1016/j.ejim.2008.11.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 10/21/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
Abstract
In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p<0.05), Norton score: 8.4+/-4.7 and 13.9+/-4.6 (p<0.05), albumin 2.7+/-0.7 g/dl and 3.2+/-0.8 g/dl (p<0.05). MAP and hemoglobin levels were not different (p>0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p<0.05), Norton score: 7.1 and 14.4 (p<0.05), albumin 2.2 g/dl and 3.0 g/dl (p<0.05). MAP 55.15+/-24.10 mm Hg and 79.76+/-18.12 mm Hg (p<0.05), APACHE-II score 22.3+/-4.2 and 18.2+/-6.2 (p<0.05). Hospitalization period: 18.3+/-10.3 days and 6.6+/-4.3 days (p<0.05) respectively. BMI and hemoglobin levels were not different (p>0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (p<0.05). Results of this study show us the PU incidence of ICU patients may be low if we perform PU screening all patients at the admission and put into practice NPUAP strictly. Age, low Norton score, hospitalization period, high APACHE-II score, hypotension, malnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.
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Affiliation(s)
- Hakan Terekeci
- Department of Internal Medicine, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey
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Decubiti Prevention and Treatment. Tech Orthop 2008. [DOI: 10.1097/00013611-200409000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hengstermann S, Fischer A, Steinhagen-Thiessen E, Schulz RJ. Nutrition status and pressure ulcer: what we need for nutrition screening. JPEN J Parenter Enteral Nutr 2007; 31:288-94. [PMID: 17595437 DOI: 10.1177/0148607107031004288] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pressure ulcers (PU) and malnutrition exist in elderly hospitalized patients as a significant and costly problem. The aim of the study was to compare different screening tools to assess nutrition status and to verify them for usage in clinical routine. METHODS Nutrition status (body mass index [BMI], Mini Nutritional Assessment [MNA], weight loss) was determined in 484 (326 female/158 male) multimorbid elderly patients with mean age of 79.6 +/- 7.6 (80.9 +/- 7.4 female/76.9 +/- 7.4 male) years. Bioelectrical impedance analysis (BIA; Nutrigard 2,000-M) was used for evaluation of body composition. Activities of daily living (ADL) were measured with the Barthel Index. PUs were divided into stages I-IV (European Pressure Ulcer Advisory Panel [EPUAP]) and were assessed by the Norton scale. RESULTS The prevalence of PU was 16.7%, with a median Norton scale of 20 (range, 17-24). According to MNA, 39.5% of the PU patients were malnourished, and 2.5% were well nourished. By contrast, 16.6% of the non-PU patients were malnourished, and 23.6% were well nourished. BMI decreased significantly in PU patients (p < .008). BIA resulted in no significant resistance and reactance but in a significant reduction of phase angle in PU. According to a significantly reduced body cell mass and lean body mass in PU patients, the ADL decreased in these patients, too. Furthermore, we analyzed a significant effect of age, ADL, MNA, BMI, phase angle, and body cell mass on the Norton scale. CONCLUSIONS The MNA as a screening and assessment tool is easy to use to determine the nutrition status in multimorbid geriatric patients with PU. Further studies are needed to show an improved outcome of PU healing if evaluation of nutrition status is part of routine clinical practice in multimorbid elderly risk patients within the first day after admission.
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Affiliation(s)
- Susanne Hengstermann
- Research Group on Geriatrics, Evangelisches Geriatriezentrum Berlin, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Suwa T, Kinoshita S, Fukao A, Murakami N. [Care team for bed sores]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2007; 96:1758-64. [PMID: 17802733 DOI: 10.2169/naika.96.1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Abstract
Pressure ulcers are complex chronic wounds for which no gold standard for prevention or treatment has yet been established. Several attempts at developing guidelines has been undertaken by different organizations. Pressure ulcers are devastating comorbidities for patients and difficult to prevent or manage. Whether or not pressure ulcers are preventable remains controversial. The strategy for prevention includes recognizing the risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and prolonged sitting, and preserving the integrity of the skin. The principles of treatment of pressure ulcers include assessing severity, reducing pressure, friction and shear forces, optimizing local wound care, removing necrotic debris, managing bacterial contamination, and correcting nutritional deficits.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis University Health Sciences Center, St Louis, MO 63104, USA.
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Gengenbacher M, Stähelin HB, Scholer A, Seiler WO. Low biochemical nutritional parameters in acutely ill hospitalized elderly patients with and without stage III to IV pressure ulcers. Aging Clin Exp Res 2002; 14:420-3. [PMID: 12602578 DOI: 10.1007/bf03324471] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Pressure ulcers are associated with impaired nutritional status in acutely ill elderly patients. The objective of this study was to establish whether a difference exists between biochemical nutritional parameters in acutely ill elderly with stage III to IV pressure ulcers and a group of acutely ill elderly with no pressure ulcers. METHODS In a retrospective study we compared 8 biochemical nutritional markers in a group of 22 acutely ill elderly patients consecutively admitted to the geriatric ward who had stage III to IV pressure ulcers (PU group) in addition to their acute illness with a control group of 40 acutely ill elderly patients with no pressure ulcers (NPU group). RESULTS The PU group compared with the NPU group had significantly lower (p < 0.0001) values of albumin, transferrin, hemoglobin, cholesterol, iron, and zinc (p < 0.0059). Total lymphocyte count was slightly, but not significantly lower in the PU group. In contrast, C-Reactive Protein levels were significantly higher (p < 0.0001) in the PU group compared with the NPU group, indicating a more severe illness in the presence of additional pressure ulcers. CONCLUSIONS In this study, serum levels of biochemical nutritional parameters in acutely ill elderly patients with stage III to IV pressure ulcers are lower than those of acutely ill elderly subjects with no pressure ulcers, indicating a worse nutritional status of the PU patients. These findings, while not documenting a causal relationship, suggest the need for routine nutritional assessment and support in older patients, especially those with pressure ulcers.
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Affiliation(s)
- Michael Gengenbacher
- Geriatric University Clinic, Clinical Chemical Laboratory, Kantonsspital, Basel, Switzerland
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Berlowitz DR, Brandeis GH, Morris JN, Ash AS, Anderson JJ, Kader B, Moskowitz MA. Deriving a risk-adjustment model for pressure ulcer development using the Minimum Data Set. J Am Geriatr Soc 2001; 49:866-71. [PMID: 11527476 DOI: 10.1046/j.1532-5415.2001.49175.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To use the Minimum Data Set (MDS) to derive a risk-adjustment model for pressure ulcer development that may be used in assessing the quality of nursing home care. DESIGN Perspective observational study using MDS data from 1997. SETTING A large, for-profit, nursing home chain. PARTICIPANTS Our unit of analysis was 39,649 observations made on 14,607 nursing home residents who were without a stage 2 or larger pressure ulcer on an index assessment. MEASUREMENTS Pressure ulcer status was determined at an outcome assessment approximately 90 days after an index assessment. Potential predictors of pressure ulcer development were examined for bivariate associations, contributing to the development of a multivariate logistic regression model. RESULTS A stage 2 or larger pressure ulcer developed in 2.3% of the observations. Seventeen resident characteristics were found to be associated with pressure ulcer development. These included dependence in mobility and transferring, diabetes mellitus, peripheral vascular disease, urinary incontinence, lower body mass index, and end-stage disease. A risk-adjustment model based on these characteristics was well calibrated and able to discriminate among residents with different levels of risk for ulcer development (model c-statistic = 0.73). CONCLUSION A clinically credible risk-adjustment model with good performance properties can be developed using the MDS. This model may be useful in profiling nursing homes on their rate of pressure ulcer development.
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Affiliation(s)
- D R Berlowitz
- Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts, USA
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Abstract
Pressure ulcers and malnutrition frequently co-exist in frail patients. Nutritional parameters have been correlated with development and with healing in chronic pressure ulcers, leading to suggestions that improving nutritional status can prevent or treat pressure ulcers. Despite a strong association, a causal relationship of poor nutritional status to development of pressure ulcers has not been established. Support for a causal relationship would include evidence that nutritional interventions improve general nutritional status, acute wound healing, or chronic wound healing. The data suggesting that nutritional intervention can improve clinical outcome are limited. No study has demonstrated that improvement in nutritional status can prevent pressure ulcers. There is at least suggestive evidence that improvement in nutritional status can improve outcome in pressure ulcer healing.
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Affiliation(s)
- D R Thomas
- St. Louis Health Sciences Center, Veterans Administration, Division of Geriatric Medicine, St. Louis, Missouri 63104, USA.
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Anthony D, Reynolds T, Russell L. An investigation into the use of serum albumin in pressure sore prediction. J Adv Nurs 2000; 32:359-65. [PMID: 10964183 DOI: 10.1046/j.1365-2648.2000.01484.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To ascertain the relevance of serum albumin and serum sodium as predictors of pressure sores in addition to the Waterlow score. DESIGN Observational study of patients at risk of developing decubitus ulcers. SETTING Staffordshire, in the midlands of the United Kingdom. PARTICIPANTS 773 elderly hospital in-patients of a district general hospital. MEASUREMENTS Waterlow scores and serum albumin and sodium. Development of a pressure sore. RESULTS Logistic regression analysis of serum albumin, serum sodium and the Waterlow score showed the Waterlow score and serum albumin were significant predictors of pressure sores. CONCLUSIONS Serum albumin may, in this patient group (in-patients over 64 years of age), be a useful predictor of pressure sore occurrence, though further work is needed to establish whether this is the case. Risk assessment of pressure sores can possibly be improved by adding serum albumin to one of the pre-existing tools such as the Waterlow score.
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Affiliation(s)
- D Anthony
- The Mary Seacole Research Centre, School of Nursing and Midwifery, De Montfort University, Leicester, England
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Abstract
Among the many risk factors for pressure ulcers, malnutrition is potentially reversible. This article examines the relationship of malnutrition to the prevention and healing of pressure ulcers. Evidence for nutrition in preventing and healing pressure ulcers is presented. Specific nutrients, including some amino acids, vitamins, and minerals, have been evaluated for their effects on wound healing.
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Affiliation(s)
- D R Thomas
- Center for Aging, Division of Gerontology and Geriatric Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA
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