Integrated protocol for the prevention and treatment of skin ulcers in patients with end-stage renal disease.

Chronic Kidney Disease (CKD) is an escalating global health concern, affecting more than 10 % of the general population worldwide, amounting to over 800 million individuals. One of its major complications for patients is the high prevalence of skin ulcers . This study aims to develop a protocol for ulcer management within the context of a hospital-based dialysis center. The success of this strategy is deeply rooted in the collaboration of a multidisciplinary team, continually enriched by specialist training. The clinical nurse specialist (CNS) in wound care plays a pivotal role in this approach. By employing a systematic methodology, the protocol is tailored to emphasize holistic care for patients diagnosed with end-stage renal disease undergoing hemodialysis. It accentuates the significance of proactive prevention, in-depth patient education, and the immediate identification of early wound signs. The research underscores the necessity to further weave in specialized training for ulcer care, ensuring each hospital visit is maximized for efficiency and effectiveness. Central to this protocol is the understanding that CKD is a growing concern, that the optimal management of ulcers relies heavily on multidisciplinary collaboration, and that an emphasis on prevention, patient education, and timely wound recognition is crucial to enhance patient care and experience.

Malnutrition risk as a negative prognostic factor in COVID-19 patients.

BACKGROUND/OBJECTIVE: SARS CoV-2 infection is a disease, whose prevalence has drastically risen in the past year. The aim of this study is to examine a possible association between the risk of malnutrition, clinical outcomes following hospitalisation and morbidity at discharge. METHODS: This study has analysed the medical records of 652 patients hospitalised at Humanitas Research Hospital (Milan, Italy) between 01/03 and 30/04/2020. The risk of malnutrition was identified with the Malnutrition Universal Screening Tool (MUST). RESULTS: The cohort was composed of 515 patients. The MUST scale is significantly associated to malnutrition evaluating the morbidity at discharge (discharged 0.27 ± 0.68, discharged with problems 0.40 ± 0.93, deceased 0.64 ± 0.93, p < 0.001), and the clinical outcome following hospitalisation (HR 1.25, 95% CI 1.04-1.51, p = 0.019) is maintained even after correction for age, treated hypertension, admission to an intensive care unit and oxygen therapy). A subgroup analysis addressing patients with a BMI ≥30 shows a significant association between comorbidities such as: arterial hypertension (HR 4.95, 95% CI 1.10-22.22, p = 0.037), diabetes (HR 3.37, 95% CI 1.04-10.89, p = 0.043) and renal failure (HR 3.94, 95% CI 1.36-11.36, p = 0.011). CONCLUSIONS: The results of this study suggest that the risk of malnutrition is a noteworthy indicator that impacts both the clinical outcomes and morbidity at discharge.