1
|
Champagne PT, Tzen YT, Wang J, Bennett B, Van Beest D, Tan WH. Predictors of one year pressure injury outcomes in hospitalized spinal cord injured veterans with one stage 3 or 4 pressure injury. J Spinal Cord Med 2023:1-7. [PMID: 36745095 DOI: 10.1080/10790268.2022.2158290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The purpose of this study is to investigate predictors of pressure injury (PrI) outcomes at one year after discharge for Veterans with spinal cord injury (SCI) hospitalized with a Stage 3 or 4 PrI. DESIGN/SETTING/PARTICIPANTS This is a retrospective medical record review from one VA Health Care System SCI unit. Participants were Veterans with traumatic or non-traumatic SCI admitted with one Stage 3 or 4 pelvic PrI treated medically (e.g. without flap surgery). Logistic models were used to select the significant predictors of PrI healing outcomes. OUTCOME MEASURE One year after discharge wound outcomes (healed vs non-healed) for Veterans with SCI hospitalized with a Stage 3 or 4 PrI. RESULTS A total of 62 hospitalizations were included for analyses resulting in 33 healed and 29 non-healed PrIs. Three significant predictors of non-healed PrI outcomes included use of pressure mapping during hospitalization, greater PrI depth, and usage of alginate dressings. Two significant predictors of healed PrI outcomes included the use of animal-based tissue and hydrocolloid dressings. Area under curve of this logistic regression model was 79.98%. CONCLUSION The clinical decision of having a patient pressure mapped predicts that the PrI may not heal at one year of discharge. Pressure mapping protocol correlated with another variable that could not serve as a predictor by itself, including using powered pressure relief techniques. The three PrI treatment predictors may represent characteristics of the PrI itself, rather than the efficacy of the product. Further investigation on these clinical decision-making factors is warranted to ensure efficient and cost-effective treatment strategies for individuals with SCI hospitalized with PrIs.
Collapse
Affiliation(s)
| | - Yi-Ting Tzen
- Applied Clinical Research, UT Southwestern Medical Center, Dallas, Texas, USA
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
- Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jijia Wang
- Applied Clinical Research, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Bridget Bennett
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
- Spinal Cord Injury, VA North Texas Health Care System, Dallas, Texas, USA
| | - Dominique Van Beest
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
- Spinal Cord Injury, VA North Texas Health Care System, Dallas, Texas, USA
| | - Wei-Han Tan
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
- Spinal Cord Injury, VA North Texas Health Care System, Dallas, Texas, USA
| |
Collapse
|
2
|
Szondi DC, Wong JK, Vardy LA, Cruickshank SM. Arginase Signalling as a Key Player in Chronic Wound Pathophysiology and Healing. Front Mol Biosci 2021; 8:773866. [PMID: 34778380 PMCID: PMC8589187 DOI: 10.3389/fmolb.2021.773866] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
Arginase (ARG) represents an important evolutionarily conserved enzyme that is expressed by multiple cell types in the skin. Arg acts as the mediator of the last step of the urea cycle, thus providing protection against excessive ammonia under homeostatic conditions through the production of L-ornithine and urea. L-ornithine represents the intersection point between the ARG-dependent pathways and the urea cycle, therefore contributing to cell detoxification, proliferation and collagen production. The ARG pathways help balance pro- and anti-inflammatory responses in the context of wound healing. However, local and systemic dysfunctionalities of the ARG pathways have been shown to contribute to the hindrance of the healing process and the occurrence of chronic wounds. This review discusses the functions of ARG in macrophages and fibroblasts while detailing the deleterious implications of a malfunctioning ARG enzyme in chronic skin conditions such as leg ulcers. The review also highlights how ARG links with the microbiota and how this impacts on infected chronic wounds. Lastly, the review depicts chronic wound treatments targeting the ARG pathway, alongside future diagnosis and treatment perspectives.
Collapse
Affiliation(s)
- Denis C Szondi
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jason K Wong
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Manchester Academic Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Leah A Vardy
- Skin Research Institute of Singapore, ASTAR, Singapore, Singapore
| | - Sheena M Cruickshank
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
3
|
Serpa LF, Ortiz MM, Lima AC, Bueno L, Nogueira PC, Ferri C, Santos VLCDG. Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil. Wound Repair Regen 2020; 29:79-86. [PMID: 33047424 DOI: 10.1111/wrr.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/19/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.
Collapse
Affiliation(s)
- Leticia Faria Serpa
- School of Health Sciences Education, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Margarita Maria Ortiz
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anne Chaves Lima
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Línea Bueno
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Cristina Nogueira
- Department of Medical-Surgical Nursing and Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cleusa Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | |
Collapse
|
4
|
Alfonso AR, Kantar RS, Ramly EP, Daar DA, Rifkin WJ, Levine JP, Ceradini DJ. Diabetes is associated with an increased risk of wound complications and readmission in patients with surgically managed pressure ulcers. Wound Repair Regen 2019; 27:249-256. [DOI: 10.1111/wrr.12694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Allyson R. Alfonso
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Rami S. Kantar
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Elie P. Ramly
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - David A. Daar
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | | | - Jamie P. Levine
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Daniel J. Ceradini
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| |
Collapse
|
5
|
Albaugh VL, Mukherjee K, Barbul A. Proline Precursors and Collagen Synthesis: Biochemical Challenges of Nutrient Supplementation and Wound Healing. J Nutr 2017; 147:2011-2017. [PMID: 28978679 PMCID: PMC5657141 DOI: 10.3945/jn.117.256404] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/03/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022] Open
Abstract
Wound healing is a complex process marked by highly coordinated immune fluxes into an area of tissue injury; these are required for re-establishment of normal tissue integrity. Along with this cascade of cellular players, wound healing also requires coordinated flux through a number of biochemical pathways, leading to synthesis of collagen and recycling or removal of damaged tissues. The availability of nutrients, especially amino acids, is critical for wound healing, and enteral supplementation has been intensely studied as a potential mechanism to augment wound healing-either by increasing tensile strength, decreasing healing time, or both. From a practical standpoint, although enteral nutrient supplementation may seem like a reasonable strategy to augment healing, a number of biochemical and physiologic barriers exist that limit this strategy. In this critical review, the physiology of enteral amino acid metabolism and supplementation and challenges therein are discussed in the context of splanchnic physiology and biochemistry. Additionally, a review of studies examining various methods of amino acid supplementation and the associated effects on wound outcomes are discussed.
Collapse
Affiliation(s)
- Vance L Albaugh
- Division of General Surgery, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN; and
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University School of Medicine, Loma Linda, CA
| | - Adrian Barbul
- Division of General Surgery, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN; and
| |
Collapse
|
6
|
|
7
|
Abstract
Clinicians in nearly all practice areas are confronted with the challenges associated with delayed and impaired wound healing. Although nutrition plays a critical role in the healing process, controversy exists regarding the optimal nutrition regimen. This article reviews literature related to nutrition interventions that facilitate wound healing. The limitations of the research that forms the scientific basis of many nutrition recommendations are also examined. The limited availability of rigorously performed clinical studies to develop evidence-based guidelines for nutrition support in wound care emphasizes the need for further research and underscores the importance of individualizing the nutrition care plan for each patient.
Collapse
|
8
|
Cullum N, Buckley H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Goncalves PS, Soares M, Stubbs N. Wounds research for patient benefit: a 5-year programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04130] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | - Richard Morley
- Department of Health Sciences, University of York, York, UK
| | - Susan O’Meara
- Department of Health Sciences, University of York, York, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | | |
Collapse
|
9
|
Gau BR, Chen HY, Hung SY, Yang HM, Yeh JT, Huang CH, Sun JH, Huang YY. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers. J Diabetes Complications 2016; 30:138-42. [PMID: 26490754 DOI: 10.1016/j.jdiacomp.2015.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/31/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to investigate the nutritional status of patients with limb-threatening diabetic foot ulcers (DFUs) and its impact on treatment outcomes. METHODS A total of 478 consecutive patients (mean age, 65.4years) treated for limb-threatening DFUs were enrolled. Nutritional status assessment using the Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) was performed by three qualified dieticians within 48hours of admission. Limb-preservation outcomes were stratified into major lower extremity amputation (LEA) (above the ankle, n=33), minor LEA (distal to ankle, n=117) and no amputation (non-LEA, n=328). RESULTS Most patients were identified as being at risk of malnutrition (70.5%) or malnourished (14.6%) (mean MNA score, 20.6±3.4). MNA scores decreased with increasing severity of LEA (mean, 21.1, 20.0, and 17.9, respectively; P for linear trend <0.001), associated inversely with the tendency to require LEA (P for linear trend was 0.001), and associated independently with both major and minor LEA outcomes (adjusted odds ratio [aOR]=0.80, 95% confidence interval [CI], 0.65-0.99, P=0.042 and aOR=0.89, 95% CI, 0.80-0.99, P=0.032, respectively). The predictive value was sustained in patients younger than age 65years. Though GNRI results had similar associations with outcomes, its predictive value was limited in minor LEA and younger population. CONCLUSIONS Patients' nutritional status was shown to have significant influence on limb-preservation outcomes for limb-threatening DFUs. Nutritional assessment of this patient population using the MNA is recommended.
Collapse
Affiliation(s)
- Bing-Ru Gau
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan; Division of Endocrinology and Metabolism, DaLin Tzu Chi Buddhist Hospital, Tzu Chi University, Taiwan
| | - Hsin-Yun Chen
- Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jiun-Ting Yeh
- Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
| |
Collapse
|
10
|
McInnes E, Jammali‐Blasi A, Bell‐Syer SEM, Dumville JC, Middleton V, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev 2015; 2015:CD001735. [PMID: 26333288 PMCID: PMC7075275 DOI: 10.1002/14651858.cd001735.pub5] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pressure ulcers (i.e. bedsores, pressure sores, pressure injuries, decubitus ulcers) are areas of localised damage to the skin and underlying tissue. They are common in the elderly and immobile, and costly in financial and human terms. Pressure-relieving support surfaces (i.e. beds, mattresses, seat cushions etc) are used to help prevent ulcer development. OBJECTIVES This systematic review seeks to establish:(1) the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared with standard support surfaces, and,(2) their comparative effectiveness in ulcer prevention. SEARCH METHODS In April 2015, for this fourth update we searched The Cochrane Wounds Group Specialised Register (searched 15 April 2015) which includes the results of regular searches of MEDLINE, EMBASE and CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 3). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-randomised trials, published or unpublished, that assessed the effects of any support surface for prevention of pressure ulcers, in any patient group or setting which measured pressure ulcer incidence. Trials reporting only proxy outcomes (e.g. interface pressure) were excluded. Two review authors independently selected trials. DATA COLLECTION AND ANALYSIS Data were extracted by one review author and checked by another. Where appropriate, estimates from similar trials were pooled for meta-analysis. MAIN RESULTS For this fourth update six new trials were included, bringing the total of included trials to 59.Foam alternatives to standard hospital foam mattresses reduce the incidence of pressure ulcers in people at risk (RR 0.40 95% CI 0.21 to 0.74). The relative merits of alternating- and constant low-pressure devices are unclear. One high-quality trial suggested that alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context.Pressure-relieving overlays on the operating table reduce postoperative pressure ulcer incidence, although two trials indicated that foam overlays caused adverse skin changes. Meta-analysis of three trials suggest that Australian standard medical sheepskins prevent pressure ulcers (RR 0.56 95% CI 0.32 to 0.97). AUTHORS' CONCLUSIONS People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure ulcers are unclear, but alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context. Medical grade sheepskins are associated with a decrease in pressure ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre.
Collapse
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
- University of YorkDepartment of Health SciencesArea 2 Seebohm Rowntree BuildingHeslingtonYorkNorth YorkshireUKYO10 5DD
| | - Jo C Dumville
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Victoria Middleton
- 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
| | - Nicky Cullum
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | | |
Collapse
|
11
|
Cereda E, Klersy C, Serioli M, Crespi A, D'Andrea F. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial. Ann Intern Med 2015; 162:167-74. [PMID: 25643304 DOI: 10.7326/m14-0696] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Trials on specific nutritional supplements for the treatment of pressure ulcers (PUs) have been small, inconsistent in their formulations, or unsuccessful in controlling for total supplement calorie or protein content. OBJECTIVE To evaluate whether supplementation with arginine, zinc, and antioxidants within a high-calorie, high-protein formula improves PU healing. DESIGN Multicenter, randomized, controlled, blinded trial. (ClinicalTrials.gov: NCT01107197). SETTING Long-term care and home care services. PATIENTS 200 adult malnourished patients with stage II, III, and IV PUs. INTERVENTIONS An energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants (400 mL/d) or an equal volume of an isocaloric, isonitrogenous formula for 8 weeks. MEASUREMENTS The primary end point was the percentage of change in PU area at 8 weeks. Secondary end points included complete healing, reduction in the PU area of 40% or greater, incidence of wound infections, the total number of dressings at 8 weeks, and the percentage of change in area at 4 weeks. RESULTS Supplementation with the enriched formula (n = 101) resulted in a greater reduction in PU area (mean reduction, 60.9% [95% CI, 54.3% to 67.5%]) than with the control formula (n = 99) (45.2% [CI, 38.4% to 52.0%]) (adjusted mean difference, 18.7% [CI, 5.7% to 31.8%]; P = 0.017). A more frequent reduction in area of 40% or greater at 8 weeks was also seen (odds ratio, 1.98 [CI, 1.12 to 3.48]; P = 0.018). No difference was found in terms of the other secondary end points. LIMITATION Participation was restricted to patients who were malnourished, were able to drink oral supplements, and were living in long-term care institutions or receiving home care services. CONCLUSION Among malnourished patients with PU, 8 weeks of supplementation with an oral nutritional formula enriched with arginine, zinc, and antioxidants improved PU healing. PRIMARY FUNDING SOURCE Azienda Ospedaliera Universitaria Maggiore della Carità.
Collapse
Affiliation(s)
- Emanuele Cereda
- From Servizio di Dietetica e Nutrizione Clinica and Servizio di Biometria e Statistica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy, and Struttura Complessa a Direzione Ospedaliera Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria Maggiore della Carità, and Struttura Semplice di Prevenzione e Cura Lesioni Vascolari, Azienda Sanitaria Locale Novara (ASL NO), Novara, Italy
| | - Catherine Klersy
- From Servizio di Dietetica e Nutrizione Clinica and Servizio di Biometria e Statistica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy, and Struttura Complessa a Direzione Ospedaliera Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria Maggiore della Carità, and Struttura Semplice di Prevenzione e Cura Lesioni Vascolari, Azienda Sanitaria Locale Novara (ASL NO), Novara, Italy
| | - Marcella Serioli
- From Servizio di Dietetica e Nutrizione Clinica and Servizio di Biometria e Statistica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy, and Struttura Complessa a Direzione Ospedaliera Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria Maggiore della Carità, and Struttura Semplice di Prevenzione e Cura Lesioni Vascolari, Azienda Sanitaria Locale Novara (ASL NO), Novara, Italy
| | - Aldo Crespi
- From Servizio di Dietetica e Nutrizione Clinica and Servizio di Biometria e Statistica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy, and Struttura Complessa a Direzione Ospedaliera Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria Maggiore della Carità, and Struttura Semplice di Prevenzione e Cura Lesioni Vascolari, Azienda Sanitaria Locale Novara (ASL NO), Novara, Italy
| | - Federico D'Andrea
- From Servizio di Dietetica e Nutrizione Clinica and Servizio di Biometria e Statistica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy, and Struttura Complessa a Direzione Ospedaliera Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria Maggiore della Carità, and Struttura Semplice di Prevenzione e Cura Lesioni Vascolari, Azienda Sanitaria Locale Novara (ASL NO), Novara, Italy
| | | |
Collapse
|
12
|
Dong Y, Hassan WU, Kennedy R, Greiser U, Pandit A, Garcia Y, Wang W. Performance of an in situ formed bioactive hydrogel dressing from a PEG-based hyperbranched multifunctional copolymer. Acta Biomater 2014; 10:2076-85. [PMID: 24389319 DOI: 10.1016/j.actbio.2013.12.045] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/11/2013] [Accepted: 12/17/2013] [Indexed: 01/08/2023]
Abstract
Hydrogel dressings have been widely used for wound management due to their ability to maintain a hydrated wound environment, restore the skin's physical barrier and facilitate regular dressing replacement. However, the therapeutic functions of standard hydrogel dressings are restricted. In this study, an injectable hybrid hydrogel dressing system was prepared from a polyethylene glycol (PEG)-based thermoresponsive hyperbranched multiacrylate functional copolymer and thiol-modified hyaluronic acid in combination with adipose-derived stem cells (ADSCs). The cell viability, proliferation and metabolic activity of the encapsulated ADSCs were studied in vitro, and a rat dorsal full-thickness wound model was used to evaluate this bioactive hydrogel dressing in vivo. It was found that long-term cell viability could be achieved for both in vitro (21days) and in vivo (14days) studies. With ADSCs, this hydrogel system prevented wound contraction and enhanced angiogenesis, showing the potential of this system as a bioactive hydrogel dressing for wound healing.
Collapse
Affiliation(s)
- Yixiao Dong
- The Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Waqar U Hassan
- The Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Robert Kennedy
- The Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Udo Greiser
- The Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Abhay Pandit
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland
| | - Yolanda Garcia
- Anatomy Department, National University of Ireland, Galway, Ireland.
| | - Wenxin Wang
- The Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
| |
Collapse
|
13
|
Aydın G, Mucuk S. The evaluation of daily living activities, pressure sores and risk factors. Rehabil Nurs 2014; 40:84-91. [PMID: 24633702 DOI: 10.1002/rnj.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE This study was conducted to assess daily living activities, pressure sores and risk factors. DESIGN This was a descriptive study. METHODS The study was conducted at a rehabilitation center with 188 individuals participating in the study. Data were collected with a questionnaire form, Activities of Daily Living Scale (ADLS), Instrumental Activities of Daily Living Scale (IADLS) and Braden Risk Assessment Scale (BRAS). FINDINGS Among the participants, 48.9% were dependent according to activities of daily living and 71.8% were dependent on instrumental activities of daily living. It was noted that 4.8% had pressure sores and 38.8% were at high risk. A strong and positive correlation was found among ADLS, IADLS, and BRAS scores (p < .001). Participants who had a low body mass index, had lived at the rehabilitation center for a long time, and were fed on regime 1 or 2, had a higher risk of developing pressure sores (p < .001). CONCLUSION Individuals who were dependent according to ADLS and IADLS were at increased risk for the development of pressure sores. Individuals who are treated at rehabilitation centers should be periodically assessed in terms of risk. Pressure sore development can be prevented with appropriate nursing interventions. CLINICAL RELEVANCE To reduce the risk of developing pressure sores, nurses should describe the individual's degree of dependency according to ADLS and IADLS and initiate preventive nursing care.
Collapse
Affiliation(s)
- Gökçen Aydın
- Department of Surgery Nursing, Health School, Bozok University, Yozgat, Turkey
| | | |
Collapse
|
14
|
|
15
|
Siang Choo T, Hayter M, Watson R. The effectiveness of nutritional intervention(s) and the treatment of pressure ulcers- A systematic literature review. Int J Nurs Pract 2013; 19 Suppl 1:19-27. [DOI: 10.1111/ijn.12019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tze Siang Choo
- Department of Tissue Viability; Leeds Teaching Hospitals; NHS Trust; Leeds General Infirmary; Leeds; UK
| | - Mark Hayter
- Faculty of Health and Social Care; University of Hull; Hull; UK
| | - Roger Watson
- Faculty of Health and Social Care; University of Hull; Hull; UK
| |
Collapse
|
16
|
Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward M, Brown D, Martin R, Crowe T. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. J Wound Care 2012; 21:150-6. [DOI: 10.12968/jowc.2012.21.3.150] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- B. Leigh
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | | | | | - L. Pearce
- Austin Health, Heidelberg, Australia
| | - S. King
- Austin Health, Heidelberg, Australia
| | | | - D. Brown
- Austin Health, Heidelberg, Australia
| | - R. Martin
- Austin Health, Heidelberg, Australia
| | - T.C. Crowe
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| |
Collapse
|
17
|
Preventing pressure ulcers—Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis. Int J Nurs Stud 2012; 49:345-59. [DOI: 10.1016/j.ijnurstu.2011.10.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 11/21/2022]
|
18
|
Wilson R, Lewis SA, Dicianno BE. Targeted preventive care may be needed for adults with congenital spine anomalies. PM R 2012; 3:730-8. [PMID: 21871417 DOI: 10.1016/j.pmrj.2011.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 05/06/2011] [Accepted: 05/18/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare hospitalizations caused by spina bifida-sensitive conditions, ambulatory care-sensitive conditions in adults with spina bifida and in the general population, our aim was to provide information about whether preventive health efforts already underway in the hospitalized general population are adequate for preventive care in spina bifida and congenital spine anomalies. DESIGN Retrospective secondary data analysis. PATIENTS (OR PARTICIPANTS) Records of hospitalized individuals who were 18 years of age and older. METHODS Comparison between individuals hospitalized with spina bifida and the general population using data from the California State Inpatient Database from the Healthcare Cost and Utilization Project for 2004 of adults. MAIN OUTCOME MEASUREMENTS Prevalence of spina bifida-sensitive conditions and ambulatory care-sensitive conditions as reason for hospitalization and 30-day readmission. RESULTS As compared with the general population, persons with spina bifida who were hospitalized in 2004 had a significantly greater number of hospitalizations, number of hospitalizations associated with both spina bifida-sensitive conditions and ambulatory care-sensitive conditions, and number of 30-day readmissions. Stratification by age shows that the admissions for spina bifida sensitive conditions were greater in persons with spina bifida than in the general population for all age groups. In contrast, only in the youngest age group did those with spina bifida experience greater hospitalizations for ambulatory care-sensitive conditions. CONCLUSIONS This study provides further evidence that persons with spina bifida have hospitalizations that are beyond what the general population experiences. These conditions may be potentially preventable with appropriate ambulatory care. This group also had a greater risk for readmission within 30 days of discharge from their last hospitalization. More research is needed on the efficacy of programs aimed at prevention of these conditions.
Collapse
Affiliation(s)
- Richard Wilson
- MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| | | | | |
Collapse
|
19
|
McInnes E, Dumville JC, Jammali-Blasi A, Bell-Syer SE. Support surfaces for treating pressure ulcers. Cochrane Database Syst Rev 2011:CD009490. [PMID: 22161450 DOI: 10.1002/14651858.cd009490] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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. OBJECTIVES To assess the effects of pressure-relieving support surfaces in the treatment of pressure ulcers. SEARCH METHODS We searched: The Cochrane Wounds Group Specialised Register (searched 15 July 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2007 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 14, 2011); Ovid EMBASE (2007 to 2011 Week 27); EBSCO CINAHL (2007 to 14 July 2011). The reference sections of included studies were also searched. SELECTION CRITERIA We included published or unpublished randomised controlled trials (RCTs), that assessed the effects of support surfaces for treating pressure ulcers, in any patient group or setting, that reported an objective measure of wound healing. DATA COLLECTION AND ANALYSIS Data extraction and assessment of risk of bias were performed independently by two review authors. Trials with similar patients, comparisons and outcomes were considered for pooled analysis. Where pooling was inappropriate the results of the trials were reported narratively. Where possible, the risk ratio or mean difference was calculated for the results of individual studies. MAIN RESULTS We identified 18 trials of support surfaces for pressure ulcer treatment, involving 1309 participants with samples sizes that ranged from 14 to 160. Of three trials comparing air-fluidized devices with conventional therapy, two reported significant reductions in pressure ulcer size associated with air-fluidized devices. Due to lack of reported variance data we could not replicate the analyses. In relation to three of the trials that reported significant reductions in pressure ulcer size favouring low air loss devices compared with foam alternatives, we found no significant differences. A small trial found that sheepskin placed under the legs significantly reduced redness and similarly a small subgroup analysis favoured a profiling bed compared with a standard bed in terms of the healing of existing grade 1 pressure ulcers. Poor reporting, clinical heterogeneity, lack of variance data and methodological limitations in the eligible trials meant that no pooled comparisons were undertaken. AUTHORS' CONCLUSIONS There is no conclusive evidence about the superiority of any support surface for the treatment of existing pressure ulcers. Methodological issues included variations in outcomes measured, sample sizes and comparison groups. Many studies had small sample sizes and often there was inadequate description of the intervention, standard care and co-interventions. Individual study results were often inadequately reported, with failure to report variance data common, thus hindering the calculation of mean differences. Some studies did not report P values when reporting on differences in outcomes. In addition, the age of some trials (some being 20 years old), means that other technologies may have superseded those investigated.Further and rigorous studies are required to address these concerns and to improve the evidence base before firm conclusions can be drawn about the most effective support surfaces to treat pressure ulcers.
Collapse
Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute, St Vincent's and Mater Health Sydney ACU, National Centre for Clinical Outcomes Research (NaCCOR), Nursing and Midwifery, Australia, Research Room, Level 5 DeLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, New South Wales, Australia, 2010
| | | | | | | |
Collapse
|
20
|
Leite SN, Jordão Júnior AA, Andrade TAMD, Masson DDS, Frade MAC. Modelos experimentais de desnutrição e sua influência no trofismo cutâneo. An Bras Dermatol 2011; 86:681-8. [DOI: 10.1590/s0365-05962011000400009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 09/13/2010] [Indexed: 05/26/2023] Open
Abstract
FUNDAMENTOS: A pele, para exercer suas funções, necessita de níveis adequados de nutrientes. OBJETIVO: Analisar o trofismo cutâneo de ratos nutridos e desnutridos por meio de dois modelos de desnutrição. MÉTODOS: No Modelo Marasmo, utilizaram-se 60 ratos Wistar em controle dietético, dos quais 30 foram selecionados aleatoriamente para receber metade da dieta diária durante 60 dias. No Modelo Gelatina, empregaram-se 60 ratos, dos quais 30 receberam dieta associada a proteína de baixa qualidade (gelatina) durante 30 dias. Avaliou-se o estado nutricional dos animais por meio da massa corporal, dos sinais clínicos e da dosagem de albumina sérica. Após o período de desnutrição, fez-se a histologia da pele dos animais para análise da espessura da derme e epiderme com o software Leica Application Suite; nas lâminas coradas com tricrômio de Gomori, analisou-se a colagênese com o software ImageJ. RESULTADOS: A massa corporal dos animais desnutridos pelo marasmo e gelatina foi significativamente menor (p<0,0001 e p<0,0001) do que a dos grupos nutridos. Quanto à albumina sérica, não houve diferença entre os grupos nos dois modelos. Em relação à análise histológica da espessura da pele, os desnutridos apresentaram a derme significativamente menos espessa em comparação aos nutridos (p<0,0001 e p<0,0001). No que respeita à colagênese, os grupos desnutridos apresentaram menores percentuais de colágeno em relação aos nutridos (p<0,0005 e p<0,003). CONCLUSÕES: Os animais desnutridos pelos dois modelos apresentaram diminuição na espessura dérmica, confirmada histologicamente pelo menor percentual de colágeno, mostrando a influência negativa da desnutrição no trofismo cutâneo
Collapse
|
21
|
Kim H, Choi-Kwon S. Changes in nutritional status in ICU patients receiving enteral tube feeding: a prospective descriptive study. Intensive Crit Care Nurs 2011; 27:194-201. [PMID: 21680184 DOI: 10.1016/j.iccn.2011.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/20/2011] [Accepted: 05/06/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aimed to assess the changes in nutritional status in Korean ICU patients receiving enteral feeding, and to understand the contribution of baseline nutritional status and energy intake to nutritional changes during the ICU stay. METHODS This was a prospective study of nutritional changes in 48 ICU patients receiving enteral feeding for 7 days. The Subjective Global Assessment scale was used upon admission. In addition, anthropometric measures (triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, body mass index and percent ideal body weight) and biochemical measures (albumin, prealbumin, transferrin, haemoglobin and total lymphocyte count) were evaluated twice, upon admission and 7 days after admission. RESULTS Seventy-five percent of ICU patients were severely malnourished at admission. Although the nutritional status worsened in both the patients with suspected malnourishment and the patients with severe malnutrition at admission, the nutritional status worsened significantly more in the patients with severe malnutrition than in the patients with suspected malnourishment. Moreover, a number of nutritional measures significantly decreased more in underfed patients than in adequately fed patients. The most significant predicting factor for underfeeding was under-prescription. CONCLUSION The ICU patients in our study were severely malnourished at admission, and their nutritional status worsened during their ICU stay even though enteral nutritional support was provided. The changes in nutritional status during the ICU stay were related to the patients' baseline nutritional status and underfeeding during their ICU stay. This study highlights an urgent need to provide adequate nutritional support for ICU patients.
Collapse
Affiliation(s)
- Hyunjung Kim
- University of California San Francisco, School of Nursing, CA, USA
| | | |
Collapse
|
22
|
Perrone F, Paiva AA, Souza LMID, Faria CDS, Paese MCDS, Aguilar-Nascimento JED, Dock-Nascimento DB. Estado nutricional e capacidade funcional na úlcera por pressão em pacientes hospitalizados. REV NUTR 2011. [DOI: 10.1590/s1415-52732011000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Correlacionar a incidência de úlcera por pressão com o estado nutricional e a capacidade funcional de pacientes internados. MÉTODOS: Estudo de corte transversal realizado em dois hospitais, totalizando 130 pacientes (idade mediana = 52 (14-85) anos, 77 (59,2%) homens e 53 (40,8%) mulheres), sendo 72 (55,4%) internados para tratamento clínico, 40 (30,8%) para tratamento cirúrgico e 18 (13,8%) em terapia intensiva. Os pacientes foram avaliados pela avaliação subjetiva global e classificados, de acordo com sua capacidade funcional, em acamados e não acamados. Registrou-se a presença e número de úlceras, e sua gravidade. A classificação das úlceras foi estabelecida como grave, para lesões de 3º e 4º graus, e leve, para os graus 1 e 2. RESULTADOS: A incidência de úlcera por pressão na população estudada foi de 19,2% (n=25). Não houve associação significativa com o sexo, a idade e tipo de tratamento do paciente. Os pacientes acamados apresentaram 7,5 vezes mais chance de apresentar úlceras (19/50; 38,0%) do que os que deambulavam (6/80; 7,5%; OR=7,5; IC95%: 2,7-20,7; p<0,001). A incidência de úlcera nos pacientes gravemente desnutridos (20/49; 40,8%) foi 10 vezes maior que nos pacientes considerados não gravemente desnutridos (5/81; 6,1%; OR=10,4 IC95%: 3,6-30,5; p<0,0001) Pela análise multivariada, tanto a capacidade funcional (acamado, OR=9,2; IC95%: 2,8-30,1; p<0,001) quanto o estado nutricional (desnutrido grave, OR=3,8; IC95%: 1,0-13,9; p=0,04) associaram-se com a úlcera por pressão. CONCLUSÃO: A incidência de úlcera por pressão está diretamente correlacionada com a desnutrição e com a restrição ao leito dos pacientes internados.
Collapse
|
23
|
McInnes E, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev 2011:CD001735. [PMID: 21491384 DOI: 10.1002/14651858.cd001735.pub4] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pressure ulcers (i.e. bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue. They are common in the elderly and immobile, and costly in financial and human terms. Pressure-relieving support surfaces (i.e. beds, mattresses, seat cushions etc) are used to help prevent ulcer development. OBJECTIVES This systematic review seeks to establish: (1) the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared with standard support surfaces, and, (2) their comparative effectiveness in ulcer prevention. SEARCH STRATEGY For this third update we searched: the Cochrane Wounds Group Specialised Register (searched 8 December 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4); Ovid MEDLINE (1950 to November Week 3 2010); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 07, 2010); Ovid EMBASE (1980 to 2010 Week 48); EBSCO CINAHL (1982 to 3 December 2010), and the reference sections of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-randomised studies, published or unpublished, that assessed the effects of any support surface for prevention of pressure ulcers, in any patient group or setting which measured pressure ulcer incidence.Studies reporting only proxy outcomes (e.g. interface pressure) were excluded. Two review authors independently selected studies. DATA COLLECTION AND ANALYSIS Data were extracted by one author and checked by another. Where appropriate, estimates from similar studies were pooled for meta-analysis. MAIN RESULTS One new trial was included, bringing the total of included studies to 53.Foam alternatives to standard hospital foam mattresses reduce the incidence of pressure ulcers in people at risk (RR 0.40 95% CI 0.21 to 0.74). The relative merits of alternating- and constant low-pressure devices are unclear. One high-quality trial suggested that alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context.Pressure-relieving overlays on the operating table reduce postoperative pressure ulcer incidence, although two studies indicated that foam overlays caused adverse skin changes. Meta-analysis of three trials indicated that Australian standard medical sheepskins prevent pressure ulcers (RR 0.56 95% CI 0.32 to 0.97). AUTHORS' CONCLUSIONS People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure ulcers are unclear, but alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context. Medical grade sheepskins are associated with a decrease in pressure ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre.
Collapse
Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute, St Vincent's and Mater Health Sydney ACU, National Centre for Clinical Outcomes Research (NaCCOR), Nursing and Midwifery, Australia, Research Room, Level 5 DeLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, New South Wales, Australia, 2010
| | | | | | | | | |
Collapse
|
24
|
Gyawali S, Solis L, Chong SL, Curtis C, Seres P, Kornelsen I, Thompson R, Mushahwar VK. Intermittent electrical stimulation redistributes pressure and promotes tissue oxygenation in loaded muscles of individuals with spinal cord injury. J Appl Physiol (1985) 2010; 110:246-55. [PMID: 20884840 DOI: 10.1152/japplphysiol.00661.2010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep tissue injury (DTI) is a severe form of pressure ulcer that originates at the bone-muscle interface. It results from mechanical damage and ischemic injury due to unrelieved pressure. Currently, there are no established clinical methods to detect the formation of DTI. Moreover, despite the many recommended methods for preventing pressure ulcers, none so far has significantly reduced the incidence of DTI. The goal of this study was to assess the effectiveness of a new electrical stimulation-based intervention, termed intermittent electrical stimulation (IES), in ameliorating the factors leading to DTI in individuals with compromised mobility and sensation. Specifically, we sought to determine whether IES-induced contractions in the gluteal muscles can 1) reduce pressure in tissue surrounding bony prominences susceptible to the development of DTI and 2) increase oxygenation in deep tissue. Experiments were conducted in individuals with spinal cord injury, and two paradigms of IES were utilized to induce contractions in the gluteus maximus muscles of the seated participants. Changes in surface pressure around the ischial tuberosities were assessed using a pressure-sensing mattress, and changes in deep tissue oxygenation were indirectly assessed using T₂*-weighted magnetic resonance imaging (MRI) techniques. Both IES paradigms significantly reduced pressure around the bony prominences in the buttocks by an average of 10-26% (P < 0.05). Furthermore, both IES paradigms induced significant increases in T₂* signal intensity (SI), indicating significant increases in tissue oxygenation, which were sustained for the duration of each 10-min trial (P < 0.05). Maximal increases in SI ranged from 2-3.3% (arbitrary units). Direct measurements of oxygenation in adult rats revealed that IES produces up to a 100% increase in tissue oxygenation. The results suggest that IES directly targets factors contributing to the development of DTI in people with reduced mobility and sensation and may therefore be an effective method for the prevention of deep pressure ulcers.
Collapse
Affiliation(s)
- Selina Gyawali
- Centre for Neuroscience, Faculty of Medicine and Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Optimal wound healing requires adequate nutrition. Nutrition deficiencies impede the normal processes that allow progression through stages of wound healing. Malnutrition has also been related to decreased wound tensile strength and increased infection rates. Malnourished patients can develop pressure ulcers, infections, and delayed wound healing that result in chronic nonhealing wounds. Chronic wounds are a significant cause of morbidity and mortality for many patients and therefore constitute a serious clinical concern. Because most patients with chronic skin ulcers suffer micronutrient status alterations and malnutrition to some degree, current nutrition therapies are aimed at correcting nutrition deficiencies responsible for delayed wound healing. This review provides current information on nutrition management for simple acute wounds and complex nonhealing wounds and offers some insights into innovative future treatments.
Collapse
Affiliation(s)
- Joyce K Stechmiller
- University of Florida College of Nursing, Health Professions, Nursing and Pharmacy Complex, Office 3222, PO Box 100187, Gainesville, FL 32610-0187, USA.
| |
Collapse
|
26
|
|
27
|
|
28
|
The use of pressure and silicone in hypertrophic scar management in burns patients: a pilot randomized controlled trial. J Burn Care Res 2009; 30:632-42. [PMID: 19506491 DOI: 10.1097/bcr.0b013e3181ac01a3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study investigates whether pressure and silicone therapy used simultaneously are more effective in treating multiple characteristics of hypertrophic scars than pressure alone. A pilot randomized controlled trial was conducted. Twenty-two participants with hypertrophic burn scars were randomized to receive Jobskin pressure garments and Mepiform silicone sheeting or Jobskin pressure garments alone. The Vancouver Scar Scale (VSS) was used to measure multiple scar characteristics at baseline, week 12, and week 24. No statistically significant difference was found in the rate of change of the VSS scores between the pressure therapy (PT) group and the pressure therapy and silicone group at week 12 or week 24; however, the mean scores of both groups reduced over 24 weeks. There were no statistically significant changes in the VSS subscores (scar height, vascularity, pliability, and pigmentation) from baseline to week 12 or week 24. A statistically significant relationship was observed between the VSS score and TBSA burned (<30%) in the PT group at baseline (P<.05), over 12 weeks (P<.05), and over 24 weeks (P<.05). Given the limitations of this study, especially the small sample size, further research is necessary before any firm conclusions can be drawn on this therapy approach. However, this pilot study has discussed the recurring issues in the research regarding these controversial treatments and has yielded potential for further investigation in a fully powered randomized controlled trial.
Collapse
|
29
|
Meaume S, Kerihuel JC, Constans T, Teot L, Lerebours E, Kern J, Bourdel Marchasson I. Efficacy and safety of ornithine alpha-ketoglutarate in heel pressure ulcers in elderly patients: results of a randomized controlled trial. J Nutr Health Aging 2009; 13:623-30. [PMID: 19621198 DOI: 10.1007/s12603-009-0173-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pressure ulcers affect predominantly the elderly and nutritional status is a known risk factor. Guidelines on pressure ulcers provide recommendation on nutritional management. Ornithine alpha-ketoglutarate (OKG) is an adjuvant treatment in undernourished elderly patients or in patients with hypercatabolism states. It is a precursor of different amino-acids which play a role in the process of healing. The objective of the study is to determine the efficacy of OKG on pressure ulcer area reduction after six weeks of treatment. DESIGN Multi-centre, international, randomized, comparative, double blind, parallel groups, placebo-controlled study. PARTICIPANTS 160 patients (ITT population) aged over 60 years with a heel pressure ulcer at stage II or III. INTERVENTION Patients received OKG (n=85) or placebo (n=75) once a day for 6 weeks. MEASUREMENTS Ulcer area was measured each week, using a tracer. The primary endpoint was the percentage reduction of the surface at the final visit: [(Wound areatn - Wound areat0)/ (Wound areat0)]. RESULTS At inclusion, ulcer area distribution deviated from normal distribution (median ulcer area OKG 6.6 cm(2), placebo 3.9 cm2, p=0.044, Mann-Whitney test). As healing is strongly related to baseline ulcer area, the abnormal distribution was a major bias. Therefore it was decided to perform the analysis on 2 sub-groups of patients according to the mean ulcer area, i.e. above or below 8 cm2. The mean wound area reduction for baseline area 8 cm2 no between group differences on either parameter was detected. When closure rate is considered, a significant difference in favor of OKG group is observed (- 0.07 cm2/day in the OKG group and - 0.04 cm2/day in the placebo groups respectively p=0.007, Mann-Whitney test). Thirty serious adverse events were reported in 28 patients (15 allocated to OKG and 13 to placebo). None of them was considered treatment related. CONCLUSION This clinical trial supports a potential benefit of OKG 10g daily in the subgroup of patients with pressure ulcers
Collapse
Affiliation(s)
- S Meaume
- Department of Gerontology, Charles Foix Hospital, Ivry-sur-Seine, Paris
| | | | | | | | | | | | | |
Collapse
|
30
|
Lobo A. Factores de riesgo en el desarrollo de úlceras de presión y sus implicaciones en la calidad de vida. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2008. [DOI: 10.1590/1809-9823.2008.11039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumen En la vejez la incidencia de úlceras de presión (UPs) aumenta muy debido al aumento considerable del número de factores de riesgo. Entender su etiología es esencial para su prevención. En este contexto surge este estudio, debido a la necesidad de los autores identificaren que factores están implicados y son determinantes en el desarrollo de la úlcera de presión. También se analizó el efecto de las UPs en la percepción de la calidad de vida (CV). Objetivos: Determinar la contribución específica de cada factor de la escala de Braden en la predicción del desarrollo de UPs; explorar la hipótesis de que la ausencia de úlcera de presión se asocia a una mejor percepción de la CV e identificar que factores y condiciones están presentes en los ancianos con UPs. Material y Métodos: Estudio descriptivo, con una muestra aleatoria simple, constituída por 40 ancianos (12 con y 28 sin UPs) institucionalizados, para compararse la percepción de la calidad de vida y de los factores de riesgo. Se midieron: las medidas antropométricas, composición corporal, análisis sanguíneos, percepción de la calidad de vida y escala de Braden. Para el análisis estadístico se estableció la correlación existente entre las distintas variables con un nivel de significación (intervalo de confianza [1] del 95%) p < 0,05. Resultados: Una persona enferma con alteraciones en la nutrición tiene cerca de 4.5 veces más probabilidad de tener UPs y la presencia de alteraciones en la movilidad aumenta esta probabilidad en cerca de tres veces más. De las condiciones analizadas de la salud, se destacan las alteraciones hematológicas, designadamente la glucosa y el albumen. Al nivel de la composición corporal, el estado de hidratación es lo que tiene más significado estadístico. En lo general, la CV de estos ancianos es baja, siendo mayor en las mujeres (25.6±11) y en el grupo de los ancianos sin UPs (27±10). Conclusión: Una escala simplificada de tres factores (movilidad, nutrición y actividad) se asocia más al riesgo del desarrollo de UPs que la clásica escala de Braden.
Collapse
|
31
|
Sayar S, Turgut S, Doğan H, Ekici A, Yurtsever S, Demirkan F, Doruk N, Taşdelen B. Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. J Clin Nurs 2008; 18:765-74. [PMID: 19077014 DOI: 10.1111/j.1365-2702.2008.02598.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine incidence of pressure ulcers in patients at risk according to the Waterlow scale in intensive care units and to evaluate the effects of risk factors in critically ill patients. BACKGROUND Pressure ulcers continue to be an important health problem that increases the risk of illness and death, extends patients' length of hospital stay and increases healthcare expenses. DESIGN The study was conducted as a descriptive and prospective study. METHOD The sample consisted of 140 patients. Data were collected using a data collection form, the skin assessment instrument and the Waterlow scale. RESULTS The incidence of pressure ulcers in intensive care unit patients was found to be 14.3%. The majority of pressure ulcers (74%) were grade I. The mean length of time for pressure ulcer development was found to be 10.4 (SD 1.85) days. A statistically significant difference was found in the patients for pressure ulcer development according to their level of consciousness, activity, cooperation, length of stay, Waterlow scale score and C-reactive protein level. In the multiple stepwise logistic regression analysis, the most influential factors for pressure ulcer development were determined to be length of stay and activity level. CONCLUSIONS Extra care needs to be taken to prevent pressure ulcer development in intensive care unit patients who have an extended length of stay, are dependent for activities, have high Waterlow scores, are unconscious and are not cooperative. RELEVANCE TO CLINICAL PRACTICE This study determined the incidence of and factors that can affect the development of pressure ulcers in intensive care unit patients who are in a high risk group for the development of pressure ulcers and presented the importance of having Turkish nurses implement interventions directed at these factors.
Collapse
Affiliation(s)
- Serap Sayar
- Mersin Universitesi Tip Fakültesi Araştirma Hastanesi, Yara Bakim Unitesi, Zeytinlibahçe Sk Eski Otogar Yani, Mersin, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Escarres en gériatrie : place de la prise en charge nutritionnelle. Presse Med 2008; 37:1150-7. [DOI: 10.1016/j.lpm.2007.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/03/2007] [Accepted: 11/16/2007] [Indexed: 11/20/2022] Open
|
34
|
Cereda E, Pusani C, Limonta D, Vanotti A. The Association of Geriatric Nutritional Risk Index and Total Lymphocyte Count with Short-Term Nutrition-Related Complications in Institutionalised Elderly. J Am Coll Nutr 2008; 27:406-13. [DOI: 10.1080/07315724.2008.10719718] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
35
|
Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol 2008; 58:185-206. [PMID: 18222318 DOI: 10.1016/j.jaad.2007.08.048] [Citation(s) in RCA: 366] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 08/17/2007] [Accepted: 08/17/2007] [Indexed: 11/20/2022]
Abstract
UNLABELLED Chronic wounds are a major healthcare problem costing the United States billions of dollars a year. The American Academy of Dermatology has underscored the significance of wound care in dermatological practice. It is critical for all dermatologists to understand the elements of diagnosis and therapy. We emphasize major aspects of diagnosis and present a simple classification of wound dressings with guidelines for usage and relative cost data. LEARNING OBJECTIVE After completing this learning activity, participants should be able to diagnose common types of chronic wounds, formulate a therapeutic plan, and describe the major classes of topical therapies and dressings for the chronic wound.
Collapse
Affiliation(s)
- Margaret A Fonder
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | |
Collapse
|
36
|
Myers WT, Leong M, Phillips LG. Optimizing the patient for surgical treatment of the wound. Clin Plast Surg 2007; 34:607-20. [PMID: 17967617 DOI: 10.1016/j.cps.2007.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Plastic surgeons are consulted often to close wounds that fail or are difficult to heal. Optimizing the patient's medical condition before surgical closure of a wound can mean the difference between a successful outcome and an undesirable one. It is imperative that plastic surgeons have an extensive knowledge of the modifiable risk factors affecting the wound-healing process and their subsequent complications. This knowledge allows the surgeon to tailor the treatment options and intervene when appropriate to optimize outcomes for successful surgical closure of a wound. Whether the impairments to wound healing and closure are local or systemic, they must be addressed appropriately.
Collapse
Affiliation(s)
- Wesley T Myers
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | | | | |
Collapse
|
37
|
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.
Collapse
Affiliation(s)
- Susanne Hengstermann
- Research Group on Geriatrics, Evangelisches Geriatriezentrum Berlin, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | |
Collapse
|
38
|
PITT S, MAY K, COLMAN P, WRAIGHT P. Deficiencies in nutritional intake in patients admitted with diabetes-related foot complications. Nutr Diet 2007. [DOI: 10.1111/j.1747-0080.2007.00096.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
Jones KR, Fennie K. Factors Influencing Pressure Ulcer Healing in Adults Over 50: An Exploratory Study. J Am Med Dir Assoc 2007; 8:378-87. [PMID: 17619036 DOI: 10.1016/j.jamda.2007.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/15/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine which demographic, clinical, and treatment factors influenced chronic pressure ulcer healing, and to identify the implications for pressure ulcer care being delivered in skilled nursing facilities. DESIGN A multisite retrospective chart review was conducted using a structured data abstraction form and protocol. SETTING Data collection took place in 3 geographically disperse areas of the country, with subjects having received wound care in hospitals, clinics, nursing homes, and home care. PARTICIPANTS Subjects whose charts were reviewed were 50 years of age or older, had at least 1 diagnosed chronic pressure ulcer, and had 3 to 6 months of data available for abstraction. Stage I ulcers were excluded from the analysis. MEASURES The structured data collection form included demographics, clinical variables, wound characteristics, and outcomes. The variables ulcer size, exudate type and amount, and necrotic tissue type were combined into a single wound severity score. RESULTS Bivariate analyses showed that insurance type, secondary diagnoses of cardiovascular disease and pulmonary disease, initial ulcer size and stage, dressing type changes, use of topical antiseptics, type of debridement, category of dressing, use of hydrocolloid or wet-to-dry dressings, antibiotic administration, and appropriateness of selected dressing and management of necrosis were all significantly associated with healing within 6 months. Logistic regression models identified the following as the most significant predictors of healing: Medicaid, secondary diagnosis of cardiovascular disease, dressing type changed, topical antiseptics, antibiotic administration, pressure relief device, lack of exudate management dressing for moderate or large exudate wound, and lack of debridement of wounds with yellow slough, all decreased the odds of healing; use of exudate management dressings on wounds with no documented exudate increased the odds of healing. CONCLUSION Pressure ulcer healing rates overall could be improved if clinicians better matched the characteristics of the wound with the decision to debride and the selection of the optimal dressing. Healing within nursing homes might be improved with less use of enzymatic debridement and antibiotics and more frequent application of hydrocolloid dressings.
Collapse
Affiliation(s)
- Katherine R Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 48106-4904, USA.
| | | |
Collapse
|
40
|
Affiliation(s)
- David R Thomas
- Saint Louis University Medical Center, Saint Louis, MO 63104, USA.
| |
Collapse
|
41
|
Thomas DR. The New F-tag 314: Prevention and Management of Pressure Ulcers. J Am Med Dir Assoc 2006; 7:523-31. [DOI: 10.1016/j.jamda.2006.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/08/2006] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
|
42
|
Debats IBJG, Booi D, Deutz NEP, Buurman WA, Boeckx WD, van der Hulst RRWJ. Infected Chronic Wounds Show Different Local and Systemic Arginine Conversion Compared With Acute Wounds. J Surg Res 2006; 134:205-14. [PMID: 16631201 DOI: 10.1016/j.jss.2006.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 01/30/2006] [Accepted: 03/07/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Several experimental studies have shown the importance of arginine in wound healing. However, little is known about its role in human wound healing. In this study, we investigated arginine metabolism in impaired wound healing. MATERIALS AND METHODS Twenty patients with chronic wounds and 10 patients with acute wounds were included in a prospective study. Amino acids, nitrate/nitrite, and arginase concentrations were determined in plasma and wound fluid using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Chronic wounds were divided into two groups: noninfected chronic wounds (n = 11) and infected chronic wounds (n = 9), based on quantitative bacterial analysis of wound fluid samples. RESULTS Plasma arginine levels, next to total plasma amino acid levels, were significantly decreased in patients with infected chronic wounds compared with patients having acute or noninfected wounds. Citrulline and ornithine levels were significantly increased in infected chronic wounds and related to decreased nitrate/nitrite levels, whereas wound fluid arginine levels were similar in all groups. In addition, wound fluid arginase levels of infected chronic wounds were significantly enhanced. CONCLUSIONS This study demonstrates that patients with infected chronic wounds have decreased plasma arginine levels and suggests enhanced arginine conversion in the wound. In contrast to noninfected chronic wounds, arginine seems to be mainly metabolized by arginase in infected chronic wounds. In conclusion, our hypothesis is that impaired wound healing is related to an altered arginine usage.
Collapse
Affiliation(s)
- Iris B J G Debats
- Department of Plastic and Reconstructive Surgery, Maastricht Academic Hospital, Maastricht, The Netherlands
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
In order to better understand aspects related to the nutritional assessment of patients in risk for pressure ulcers, we reviewed the national and international literature indexed on Medline and LILACS bibliographic databases, from 1987 to 2001. The aim of this research was to investigate the knowledge production on pressure ulcers and nutritional status, as well as to learn about the authors and the publication focus. We concluded that patients in risk for pressure ulcers can be early identified based on nutritional assessment, including biochemical data, anthropometric evaluation, clinical data, diet history and energetic consumption. The alterations are frequent in elderly patients, hospitalized patients, patients with a chronic disease such as a vascular cerebral accident, cancer and spinal cord injury.
Collapse
Affiliation(s)
- Lillian Dias Castilho
- Bolsista do Programa Especial de Treinamento - PET-Capes, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo.
| | | |
Collapse
|
44
|
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.
Collapse
Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis University Health Sciences Center, St Louis, MO 63104, USA.
| |
Collapse
|
45
|
Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, Elia M. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev 2005; 4:422-50. [PMID: 16081325 DOI: 10.1016/j.arr.2005.03.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 03/07/2005] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND There have been few systematic reviews and no meta-analyses of the clinical benefits of nutritional support in patients with, or at risk of developing, pressure ulcers. Therefore, this systematic review and meta-analysis was undertaken to address the impact of enteral nutritional support on pressure ulcer incidence and healing and a range of other clinically relevant outcome measures in this group. METHODS Fifteen studies (including eight randomised controlled trials (RCTs)) of oral nutritional supplements (ONS) or enteral tube feeding (ETF), identified using electronic databases (including Pub Med and Cochrane) and bibliography searches, were included in the systematic review. Outcomes including pressure ulcer incidence, pressure ulcer healing, quality of life, complications, mortality, anthropometry and dietary intake were recorded, with the aim of comparing nutritional support versus routine care (e.g. usual diet and pressure ulcer care) and nutritional formulas of different composition. Of these 15 studies, 5 RCTs comparing ONS (4 RCTs) and ETF (1 RCT) with routine care could be included in a meta-analysis of pressure ulcer incidence. RESULTS Meta-analysis showed that ONS (250-500 kcal, 2-26 weeks) were associated with a significantly lower incidence of pressure ulcer development in at-risk patients compared to routine care (odds ratio 0.75, 95% CI 0.62-0.89, 4 RCTs, n=1224, elderly, post-surgical, chronically hospitalised patients). Similar results were obtained when a combined meta-analysis of ONS (4 RCT) and ETF (1 RCT) trials was performed (OR 0.74, 95% CI 0.62-0.88, 5 RCTs, n=1325). Individual studies showed a trend towards improved healing of existing pressure ulcers with disease-specific (including high protein) versus standard formulas, although robust RCTs are required to confirm this. Although some studies indicate that total nutritional intake is improved, data on other outcome measures (quality of life) are lacking. CONCLUSIONS This systematic review shows enteral nutritional support, particularly high protein ONS, can significantly reduce the risk of developing pressure ulcers (by 25%). Although studies suggest ONS and ETF may improve healing of PU, further research to confirm this trend is required.
Collapse
Affiliation(s)
- Rebecca J Stratton
- Institute of Human Nutrition, University of Southampton, MP 113 F Level, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | | | | | | | | | | | | |
Collapse
|
46
|
Collins CE, Kershaw J, Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: a randomized trial. Nutrition 2005; 21:147-55. [PMID: 15723742 DOI: 10.1016/j.nut.2004.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Revised: 03/14/2003] [Accepted: 05/12/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective was to determine whether provision of oral nutritional supplements, delivered by community nurses, could improve nutritional status and wound healing in home-nursed elderly. METHODS This was a double-blind, randomized trial in 50 elderly patients referred for wound management. Patients received 237 mL/d of 4 or 8 kJ/mL of an oral nutritional supplement for 4 wk. Nutritional status was measured with the Subjective Global Assessment and the Mini-Mental State Examination questionnaire to determine cognitive function and wound characteristics to assess healing. Differences between variables were examined with the Mann-Whitney or Student's t test for comparing two groups, one-way analysis of variance when there was more than two groups, and chi-square analysis for comparing two categorical variables. Associations between variables were examined with Pearson's correlation and regression analysis. RESULTS At baseline, 34% subjects were moderately malnourished and 8% were severely malnourished. In both groups, there was significantly greater improvement in Mini-Mental State Examination scores at week 4 (95% confidence interval -2.0 to -0.001, P = 0.04) and a greater decrease in the wound effusion score (95% confidence interval -2.0 to 0.0, P = 0.045). Median length of stay did not differ between groups (P > 0.05). CONCLUSIONS Malnutrition is common in elderly patients who are nursed at home for wound management. Provision of energy- and protein-dense oral supplements by community nurses is effective in improving some indices of wound healing and cognitive function in this group. Although further study is needed to determine the effect on length of stay, the nutritional needs of this vulnerable group should not be overlooked.
Collapse
Affiliation(s)
- Clare E Collins
- School of Health Sciences, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia.
| | | | | |
Collapse
|
47
|
Carasa M, Polycarpe M. Caring for the chronically critically ill patient: establishing a wound- healing program in a respiratory care unit. Am J Surg 2004; 188:18-21. [PMID: 15223497 DOI: 10.1016/s0002-9610(03)00286-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chronically critically ill patients may recover from their acute catastrophic illness but still require intensive nursing care. In the Respiratory Care Unit (RCU) at Mount Sinai Hospital, nurse practitioners, working with nurses and physicians, act as coordinators of care for these patients. This interdisciplinary collaboration is the basis of the RCU wound healing program and has brought about desirable patient outcomes.
Collapse
Affiliation(s)
- Miriam Carasa
- Respiratory Care Unit, Mount Sinai Hospital, One Gustave Levy Place, New York, New York 10029, USA.
| | | |
Collapse
|
48
|
Abstract
Nutrition and metabolic support of acutely and chronically ill patients is an emerging branch of medicine that has direct applicability to wound healing. The occurrence of pressure ulcers is associated with malnutrition, as well as specific micronutrient deficiencies. A comprehensive approach is reviewed that involves nutritional assessment, selection of an appropriate route for nutrition support (enteral versus parenteral), prioritizing nitrogen retention over energy balance in stressed patients, micronutrient management, and incorporation of specialized nutritional pharmacologic interventions.
Collapse
Affiliation(s)
- Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, New York, USA.
| |
Collapse
|
49
|
Wildish DE. An evidence-based approach for dietitian prescription of multiple vitamins with minerals. ACTA ACUST UNITED AC 2004; 104:779-86. [PMID: 15127064 DOI: 10.1016/j.jada.2004.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dietitians working in hospitals are routinely involved in assessing energy and macronutrient (ie, protein, fat, carbohydrate) requirements of patients. However, complete nutritional therapy requires a comprehensive review of vitamin and mineral requirements. Scientific evidence for vitamin and mineral supplementation is primarily based on healthy, free-living people. This raises clinical challenges for dietitians working with patients whose vitamin and mineral requirements are impacted by various diseases, conditions, and medical treatment. Dietitians are the best-positioned health professionals to lead an evidence-based approach toward recommending vitamin and mineral supplements. The dietitians at the Toronto Rehabilitation Institute were authorized through a medical directive to prescribe multiple vitamins with minerals and to discontinue orders for unnecessary vitamin supplements. This is an ongoing, advanced practice initiative that focuses on the clinical efficacy for and safety of supplementation with multiple vitamins with minerals. It involves assessing the strength of evidence as it emerges in the literature, determining its relevance to specific patient populations in the practice setting and re-evaluating clinical practices for potential applications. When dietitians assume advanced practice initiatives, they are better equipped to deliver high-quality patient care. Simultaneously, state-of-the-art dietetic practice heightens dietitian recognition as a valuable member of the health care team.
Collapse
Affiliation(s)
- Deborah E Wildish
- Nutrition Services, University Centre, Toronto Rehabilitation Institute, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2.
| |
Collapse
|
50
|
Thomas DR. Are All Pressure Ulcers Avoidable? J Am Med Dir Assoc 2003. [DOI: 10.1016/s1525-8610(04)70305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|