Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study

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.

273 ‘HOME ON TIME’: MULTIDISCIPLINARY INTERVENTION REDUCES LENGTH OF STAY AND DELAYS IN CARE TRANSFERS ON AN ACUTE GERIATRIC MEDICINE WARD

Background

Unnecessarily prolonged hospital admission can have a profound effect on a frail, older person’s confidence, mood, functional status and cognition.This study examined whether a structured multidisciplinary intervention, embedded within an acute geriatric medicine ward, could reduce unnecessary days in hospital for acutely unwell older patients.

Methods

The study site is a 28-bed acute geriatric medicine ward in a large urban teaching hospital; data was collected from 1/1/22 to 11/4/22. Patients aged ≥70 years and admitted to the ward were randomly allocated to the Home On Time (HOT) Pathway (n=50) or usual care (n=100). All patients were cared for by a specialist geriatric team. The HOT Pathway involved daily multidisciplinary team (physiotherapy, nursing, occupational therapy, social work and medical) huddles focusing on enhanced communication, early discharge planning and identification of barriers to discharge home. Huddles typically lasted for <15 minutes.

Results

Almost two-thirds (92/150) of the study sample (mean age 83 years, 60% female) were discharged directly from the ward while one-fifth (29/150) were transferred for rehabilitation and one-tenth ultimately to long term care (16/150). The average acute ward Length-of-Stay (LOS) for HOT pathway patients was 10.4 days, compared to 14.4 days for usual care. The average LOS for HOT pathway patients discharged directly home (i.e. not via rehabilitation or to long-term care) was 8.0 days, compared to 10.2 days for usual care. One-fifth (10/50) of HOT pathway patients were discharged home within 48 hours of admission compared to one tenth (10/100) of usual care patients.

Conclusion

A structured, multidisciplinary intervention focusing on enhanced communication and early discharge planning within a geriatric medicine ward can reduce length of inpatient stay, delays in transitions of care and increase the rate of discharge home within 48 hours, potentially averting complications related to prolonged hospital admission.

In-situ technical study of modern paintings - Part 2: Imaging and spectroscopic analysis of zinc white in paintings from 1889 to 1940 by Alessandro Milesi (1856-1945)

We present a multi-analytical in situ non-invasive study of a series of emblematic paintings by Alessandro Milesi (1856-1945) from the collection of the International Gallery of Modern Art Ca' Pesaro in Venice. Eight paintings dated from 1897 to 1910 were studied with imaging and spectroscopic techniques. White pigments were characterized by a combination of X-ray fluorescence spectroscopy which traced the presence of zinc-based pigments in Milesi's paintings, Raman Spectroscopy, Laser Induced Fluorescence (LIF) Spectroscopy and Time-resolved Luminescence Imaging. Time-resolved analysis of luminescence emissions revealed the nanosecond emission from organic compounds and the slower emission from the luminescent inorganic pigment Zinc Oxide that varied between 1.1 and 1.6 microseconds. In this work, data regarding the distribution of luminescent pigments was acquired with a time-gated imaging detector. Furthermore, differences in emission decay kinetics recorded from different paintings can be ascribed to different paint formulations or origins of the Zinc white in paint.

In-situ technical study of modern paintings part 1: The evolution of artistic materials and painting techniques in ten paintings from 1889 to 1940 by Alessandro Milesi (1856-1945)

A complementary multi-analytical in-situ approach has been adopted for the investigation of a corpus of ten paintings dating from 1889 and 1940 by the Venetian painter Alessandro Milesi (1856-1945), from the collection of the International Gallery of Modern Art Ca' Pesaro in Venice. Analyses were performed in situ with digital imaging, elemental and spectroscopic analysis. The analysis of pigments and binding media and their possible deterioration patterns were studied with a combination of X-Ray Fluorescence (XRF) Spectroscopy, External Reflection- Fourier Transform Infrared Spectroscopy (ER-FTIR) and Raman Spectroscopy. These analytical methods provide information regarding the evolution of the artist's palette and the painting techniques adopted in painting. Data suggest the widespread detection of zinc carboxylates, with implications for conservation and display.

Feasibility and Acceptability of Implementing Indirect Calorimetry Into Routine Clinical Care of Patients With Spinal Cord Injury

Background: In the absence of reliable predictive equations, indirect calorimetry (IC) remains the gold standard for assessing energy requirements after spinal cord injury (SCI), but it is typically confined to a research setting. The purpose of this study is to assess the feasibility and acceptability of implementing IC into routine clinical care in an Australian SCI rehabilitation facility. Methods: Bedside IC (canopy hood) was performed, and patients completed an IC acceptability questionnaire (open-ended; yes/no; 5-point Likert scale). Fasted resting energy expenditure (REE) steady-state criteria were applied to assess data quality, and adherence to a test ≥20 minutes was recorded. Staff were surveyed to assess impact of IC on usual care. Results: Of 35 eligible patients, 9 declined (7 reported claustrophobia). One patient could not be tested before discharge and 25 underwent IC (84% male, injury level C2-L2, AIS A-D). Anxiety prevented one patient from completing IC, while another failed to fast. The remaining 23 patients achieved a steady-state REE (≥5 consecutive minutes with ≤10% coefficient of variation for VO₂ and VCO₂). Test-retest (n = 5) showed <10% variation in REE. Patients deemed the procedure acceptable, with 88% reporting a willingness to repeat IC. Eighty percent of patients and 90% of staff agreed it was acceptable for IC to be integrated into usual care. Conclusion: This study found that IC is a feasible and acceptable addition to the routine clinical care of patients recovering from SCI and may serve to improve accuracy of nutrition interventions for this patient population.

Characterization of fresh and aged natural ingredients used in historical ointments by molecular spectroscopic techniques: IR, Raman and fluorescence

Natural organic materials used to prepare pharmaceutical mixtures including ointments and balsams have been characterized by a combined non-destructive spectroscopic analytical approach. Three classes of materials which include vegetable oils (olive, almond and palm tree), gums (Arabic and Tragacanth) and beeswax are considered in this study according to their widespread use reported in ancient recipes. Micro-FTIR, micro-Raman and fluorescence spectroscopies have been applied to fresh and mildly thermally aged samples. Vibrational characterization of these organic compounds is reported together with tabulated frequencies, highlighting all spectral features and changes in spectra which occur following artificial aging. Synchronous fluorescence spectroscopy has been shown to be particularly useful for the assessment of changes in oils after aging; spectral difference between Tragacanth and Arabic gum could be due to variations in origin and processing of raw materials. Analysis of these materials using non-destructive spectroscopic techniques provided important analytical information which could be used to guide further study.

Analysis of natural and artificial ultramarine blue pigments using laser induced breakdown and pulsed Raman spectroscopy, statistical analysis and light microscopy

Pulsed laser induced breakdown spectroscopy (LIBS) and Raman spectroscopy were performed using a novel laboratory setup employing the same Nd:YAG laser emission at 532 nm for the analysis of five commercially available pigments collectively known as "ultramarine blue", a sodium silicate material of either mineral origin or an artificially produced glass. LIBS and Raman spectroscopy have provided information regarding the elemental and molecular composition of the samples; additionally, an analytical protocol for the differentiation between natural (lapis lazuli) and artificial ultramarine blue pigments is proposed. In particular LIBS analysis has allowed the discrimination between pigments on the basis of peaks ascribed to calcium. The presence of calcite in the natural blue pigments has been confirmed following Raman spectroscopy in specific areas of the samples, and micro-Raman and optical microscopy have further corroborated the presence of calcite inclusions in the samples of natural origin. Finally multivariate analysis of Laser induced breakdown spectra using principal component analysis (PCA) further enhanced the differentiation between natural and artificial ultramarine blue pigments.

A new compact instrument for Raman, laser-induced breakdown, and laser-induced fluorescence spectroscopy of works of art and their constituent materials

A small, potentially transportable prototype instrument capable of carrying out Raman, laser-induced breakdown (LIB), and laser-induced fluorescence (LIF) spectroscopy using a single pulsed laser source was developed for the analysis of cultural heritage objects. The purpose of this instrumentation is to perform fast and reliable analysis of surfaces with minimum damage to an object. For this purpose, a compact (51 x 203 x 76 mm) nanosecond Q-switched neodymium doped yttrium aluminum garnet laser (8 ns, 20 Hz, 0.01-115 mJ/pulse) was used as an irradiation source. The use of a nanosecond-gated detector sensitive between 180 and 900 nm allows the acquisition of elemental emissions in LIB spectroscopy and can also be employed for both LIF and time-resolved Raman spectroscopy. In this work, attention is focused on the description of the instrument and its optical components, and two examples of applications for the analysis of pigments and binding media used in works of art are presented.

Paraneoplastic syndrome in vaginal melanoma: a case report and review of the literature

The authors of this article present a case of a woman diagnosed with a vaginal melanoma who developed paraneoplastic syndrome (PNS) soon after diagnosis. A review of the literature regarding PNSs in gynecological malignancies is also described in this article. To our knowledge, this is the first reported case of paraneoplastic cerebellar degeneration with opsoclonus myoclonus secondary to a vaginal melanoma. In addition, our patient had an unusually acute progression to pancerebellar symptoms over the course of 3 weeks. Her paraneoplastic symptoms improved significantly after partial resection of the melanoma.