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Banks MD, Webster J, Bauer J, Dwyer K, Pelecanos A, MacDermott P, Nevin A, Coleman K, Campbell J, Hickling D, Byrnes A, Capra S. Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study. J Wound Care 2023; 32:292-300. [PMID: 37094924 DOI: 10.12968/jowc.2023.32.5.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. METHOD Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. RESULTS Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. CONCLUSION This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.
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Affiliation(s)
- Merrilyn D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Joan Webster
- Centre for Clinical Nursing, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Judy Bauer
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Kathleen Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Anita Pelecanos
- Metro North Hospital and Health Service Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Paula MacDermott
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Amy Nevin
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kerrie Coleman
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Donna Hickling
- Department of Nutrition & Dietetics, The Prince Charles Hospital, Chermside, Australia
| | - Angela Byrnes
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Sandra Capra
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
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Tang S, Ruan Z, Ma A, Wang D, Kou J. Effect of vitamin K on wound healing: A systematic review and meta-analysis based on preclinical studies. Front Pharmacol 2022; 13:1063349. [PMID: 36532748 PMCID: PMC9755209 DOI: 10.3389/fphar.2022.1063349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background: In recent years, many studies have found that vitamin K is beneficial to wound healing. However, some research results seem to be in conflict. The purpose of this study was to evaluate the effect of vitamin K on wound healing.Methods: We systematically and comprehensively searched the PubMed, Web of Science, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), VIP and Wanfang eletronic databases. We applied revman5.3 software to calculate the weighted mean difference (WMD) of 95% confidence interval (CI) of animal and cell groups to evaluate the effect of vitamin K on wound healing. Two researchers independently selected studies and used the Cochrane Collaboration tool to assess the risk of bias in the included studies. The overall quality of evidence was assessed using the Recommendation, Assessment, Development and Evaluation (GRADE) working group approch.Results: Among the 1081 articles searched, 6 articles (16 studies in total) met the inclusion criteria. The results of quantitative analysis showed that vitamin K was beneficial to increase the wound healing rate in animal models [rat model: WMD = 27.45 (95% CI: 13.46, 41.44); p = 0.0001], but the opposite result was obtained in cell experiments [WMD = −33.84 (95% CI: −56.90, −10.79); p = 0.004].Conclusion: This meta-analysis hits that vitamin K could affect the process of wound healing, especially in animal models. While we could not know the clear role at present, which requires larger scale research. In addition, the concentration and safe dose of vitamin K also deserve further study.
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Affiliation(s)
- Saiqing Tang
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhen Ruan
- Xianyang Central Hospital, Xianyang, China
| | - Axue Ma
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Dong Wang
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
- Medical Research and Experiment Center, Shaanxi University of Chinese Medicine, Xianyang, China
- Shaanxi Key Laboratory of Research on TCM Physical Constitution and Disease Prevention and Treatment, Xianyang, China
- *Correspondence: Dong Wang,
| | - Jiushe Kou
- Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
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Efficacy of Nutritional Support Protocol for Patients with Pressure Ulcer: Comparison of Before andAfter the Protocol. Nutrition 2022; 99-100:111638. [DOI: 10.1016/j.nut.2022.111638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
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Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, Coleman K, Campbell J. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial. J Wound Care 2021. [PMID: 32931368 DOI: 10.12968/jowc.2020.29.sup9a.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. METHOD Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. RESULTS The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. CONCLUSION Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible.
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Affiliation(s)
- M D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - L J Ross
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Webster
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - A Mudge
- Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Herston, QLD
| | - M Stankiewicz
- Centre for Research & Education in Nursing, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Coleman
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Campbell
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
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Anthropometric, Biochemical, and Food Consumption Parameters are Associated with Venous Leg Ulcer Area and Duration. Adv Skin Wound Care 2020; 33:476-481. [PMID: 32810060 DOI: 10.1097/01.asw.0000694160.19845.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the dietary habits and anthropometric and biochemical parameters of patients with active venous leg ulcers and to verify the association of these variables with wound duration and area. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study conducted with 33 participants diagnosed with venous leg ulcers in outpatient care. MAIN OUTCOME MEASURES Socioeconomic data, anthropometric parameters, biochemical parameters, food consumption, and wound characteristics were analyzed by an interprofessional team. MAIN RESULTS Participants were an average of 58 ± 13 years, 57.6% women, 84.8% overweight, and had a median wound duration of 10 months (range, 1-192 months) and an average wound area of 5 cm (range, 0.22-61.1 cm). Diets were typically hypocaloric and hypoproteic, with a low amount of vitamin A and magnesium. Wound duration was negatively associated with polyunsaturated fat intake (P = .032), whereas wound area was significantly associated with lipid intake (P = .002) and C-reactive protein (P = .040). CONCLUSIONS Patients with active venous leg ulcers were overweight (leading to systemic inflammation) and had low consumption of calories, protein, and micronutrients that could support cicatrization. Wound area was associated with a high-fat diet, whereas wound duration was negatively associated with polyunsaturated fat intake.
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Barber GA, Weller CD, Gibson SJ. Effects and associations of nutrition in patients with venous leg ulcers: A systematic review. J Adv Nurs 2017; 74:774-787. [PMID: 28985441 DOI: 10.1111/jan.13474] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/04/2023]
Abstract
AIMS To identify the associations and effects of nutritional characteristics and interventions on ulcer outcomes in adult patients with venous leg ulcers. BACKGROUND Venous leg ulcers are the most prevalent type of lower limb ulcer; however, little evidence exists regarding the relationship between nutritional status and ulcer healing. DESIGN A systematic search of English language articles was conducted using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions. DATA SOURCES A search of databases Ovid MEDLINE, EMBASE, Cochrane, CINAHL and Scopus was performed for studies published between January 2004 - May 2017. REVIEW METHODS Quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Assessment tool and the relevant Joanna Briggs Institute quality appraisal checklists. RESULTS Twenty studies met the inclusion criteria. All participants had Clinical Aetiology Anatomy Pathophysiology classification C5 (healed) or C6 (active) ulcers. Studies were conducted in a range of clinical settings with relatively small sample sizes. The majority of patients were overweight or obese. Increased body mass index was associated with delayed wound healing. Vitamin D, folic acid and flavonoids were associated with some beneficial effects on ulcer healing. Dietary intakes of omega-3 fatty acids, vitamin C and zinc were low for some patients. CONCLUSION Current evidence suggests that venous leg ulcer patients are more likely to be overweight or obese. However, evidence for weight management improving wound healing is lacking. Micronutrients, including vitamin D and folic acid, may improve wound healing in at-risk patients.
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Affiliation(s)
- Georgina A Barber
- Faculty Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia.,School of Clinical Sciences, Department Nutrition, Dietetics and Food, Monash University, Melbourne, Vic., Australia
| | - Carolina D Weller
- Faculty Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
| | - Simone J Gibson
- Faculty Medicine, Nursing and Health Sciences, School of Clinical Sciences, Department Nutrition, Dietetics and Food, Monash University, Notting Hill, Vic., Australia
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Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, Coleman K, Campbell J. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial. J Wound Care 2017; 25:384-92. [PMID: 27410392 DOI: 10.12968/jowc.2016.25.7.384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. METHOD Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. RESULTS The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. CONCLUSION Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. DECLARATION OF INTEREST This research was supported by a grant from the Queensland Health, Health Practitioner Research Scheme. The authors have no conflicts of interest to declare.
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Affiliation(s)
- M D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - L J Ross
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Webster
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - A Mudge
- Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Herston, QLD
| | - M Stankiewicz
- Centre for Research & Education in Nursing, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Coleman
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Campbell
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
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