Soporte nutricional especializado en un paciente con úlceras por presión: un informe de caso / Specialized nutritional support in a patient with pressure ulcers: a case report

Las úlceras por presión son lesiones de la piel y/o del tejido subyacente. El soporte nutricional adecuado constituye parte del tratamiento de estas lesiones. El objetivo de este reporte es demostrar la eficacia del soporte nutricional como factor coadyuvante en la recuperación de éstas. Paciente masculino de 29 años de edad que ingresó al hospital con diagnóstico de neuroinfección. Durante su estadía desarrolló una úlcera en la región sacra. Fue tratado con nutrición enteral por sonda nasoentérica que incluyó dieta y soporte nutricional hiperproteicos enriquecido con glutamina y arginina; posteriormente se brindó colágeno hidrolizado. A los 36 días tras la aparición de la úlcera, ésta es recuperada. Luego de 4 meses, el paciente fue dado de alta. La intervención nutricional fue crucial en la recuperación de la úlcera. Se enfatiza la necesidad de prevenirlas a través de un monitoreo oportuno y adecuado.

Pressure ulcers are injuries to the skin and / or the underlying tissue. Opportune nutritional support is part of the treatment of these injuries. This report aims to demonstrate the efficacy of nutritional support as a contributing factor in this ulcer recovery. A 29-year-old male patient was admitted to the hospital with a diagnosis of neuroinfection. During his stay, he developed a pressure ulcer in the sacral region. He was treated with enteral nutrition via a nasoenteric tube that included a hyperprotein diet and nutritional support enriched with glutamine and arginine; subsequently, hydrolyzed collagen was provided. Thirty-six days after the development of the pressure ulcer, it has recovered. After four months, the patient was discharged. The nutritional intervention was crucial in the recovery of UPP. The need to prevent this type of ulcers through timely and adequate monitoring is emphasized.

Artigo de revisão terapia nutricional em pacientes críticos com lesão por pressão / Review article nutritional therapy in critically ill patients with pressure injuries

A Nutrição na prevenção e tratamento das lesões por pressão (LPs) é uma das intervenções importantes que incorporam as diretrizes da National Pressure Ulcer Advisory Panel (NPUAP) e da European Pressure Ulcer Advisory Panel (EPUAP). Este estudo tem como objetivo revisar na literatura evidências de terapia nutricional para pacientes críticos com LP. A metodologia se deu por meio de levantamento de dados, a partir das diretrizes pertinentes ao assunto, e artigos científicos obtidos nas bases de dados do National Library of Medicine (PubMed) e Scientific Electronic Library Online (SciELO), nas línguas portuguesa, inglesa ou espanhola. Como resultados, foram incluídos três artigos, porém, apenas um deles realizou a pesquisa em Unidade de Terapia Intensiva (UTI). Concluiu-se que nenhum estudo apresentou evidência de qualidade relacionada à terapia nutricional em pacientes críticos com LPs, bem como não trouxeram associação de benefícios com suplementação de micronutrientes essenciais. (AU)

Putting the 2019 Nutrition Recommendations for Pressure Injury Prevention and Treatment into Practice.

GENERAL PURPOSE: To explore the changes in the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries (CPG) nutrition recommendations and strategies for implementation. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Synthesize the current evidence regarding nutrition approaches to medical conditions, including pressure injury prevention and treatment.2. Summarize the changes and recommendations in the 2019 edition of the CPG. ABSTRACT: Healthy diets provide essential nutrients needed to maintain healthy skin and prevent or manage pressure injuries. The 2019 Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries published by the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance includes specific nutrition recommendations for patients with pressure injuries. The purpose of this CE/CME article is to explore the changes in the nutrition recommendations and strategies for implementation.

Healthy diets provide essential nutrients needed to maintain healthy skin and prevent or manage pressure injuries. The 2019 Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries published by the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance includes specific nutrition recommendations for patients with pressure injuries. The purpose of this CE/CME article is to explore the changes in the nutrition recommendations and strategies for implementation.

Rehabilitation nutrition in pressure ulcer management with type 2 diabetes: a case report.

BACKGROUND AND OBJECTIVES: Severe infection, inadequate food intake, and pressure ulcers in patients with type 2 diabetes can result in malnutrition. We describe a case in which rehabilitation nutrition was effective for treat-ing a pressure ulcer in a malnourished patient with type 2 diabetes. METHODS AND RESULTS: A 58-year-old man with type 2 diabetes was diagnosed with hidradenitis suppurativa on the left buttock and thigh and a severe pres-sure ulcer on his left kneecap. Malnutrition was related to hypermetabolism caused by chronic hidradenitis suppu-rativa and inadequate protein-energy intake before admission. We initiated a rehabilitation nutrition intervention to improve physical function and to treat a pressure ulcer by prescribing 2,000 kcal/day of food, including 80 g of protein, and physical rehabilitation for 40 minutes/day. The patient showed good progress in terms of his physical function and healing of the pressure ulcer. After prescribing 2,250 kcal/day of food, including 85 g of protein, and physical rehabilitation for 60 minutes/day, HbA1c levels increased to 7.4%. The energy prescription was de-creased to 2,000 kcal/day to improve glycemic levels. Then, the patient's weight decreased and his hand grip strength became weaker. On day 134 and discharge the patient could walk independently with a t-cane and ankle supporter. By day 14 after discharge, the pressure ulcer had epithelialized. CONCLUSION: Rehabilitation nutrition management improved physical function and facilitated pressure ulcer healing in a malnourished patient with type 2 diabetes. Close conjoint management of hyperglycemia was also necessary.

Does the presence of pressure ulcers entail «high risk of negative outcomes» in geriatric rehabilitation? Results from a retrospective cohort study / ¿Son las úlceras por presión al ingreso, un factor predictor negativo de los resultados en unidades de rehabilitación geriátrica? Resultados de un estudio de cohortes retrospectivo

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)

Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)

Importance of nutrition in preventing and treating pressure ulcers.

Pressure ulcers are painful, and affect patients' health, mobility and well-being. They also cost the NHS between £1.4-2.1 billion a year. Although a large proportion of pressure ulcers are avoidable, many still occur and, because pressure ulcer incidence is an indicator of care quality, it can put carers under scrutiny. The National Institute for Health and Care Excellence states that adequate risk assessment of pressure ulcer development, including the role of malnutrition, improves care. Adequate nutrition is vital for the prevention of pressure ulcers and malnutrition can hinder healing when pressure ulcers have developed. The risk of malnutrition should be assessed with a recognised tool, such as the Malnutrition Universal Screening Tool, and appropriate treatment plans should be drawn up for patients identified as being at risk of malnutrition to improve their nutritional state. For example, the dietary intake of people with poor appetite can be supplemented with nutritious snacks between meals. The aims of this article are to help readers understand risk factors for malnutrition and how dietary intake can be manipulated to improve patients' nutritional state. It also aims to highlight how improving nutritional intake helps to prevent pressure ulcers. On completing the article, readers will be able to consider and review their own practice.

Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review.

OBJECTIVE: Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing. METHOD: Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool. RESULTS: There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2-12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses. CONCLUSION: Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.

The Potential Role of Zinc Supplementation on Pressure Injury Healing in Older Adults: A Review of the Literature.

INTRODUCTION: Compromised nutritional status is common among older adults (aged ≥ 65 years) and is a risk factor for pressure injuries (PIs), which may lead to poor clinical outcomes. The aim of this review was to determine whether or not poor PI healing in older adults is a result of suboptimal zinc status. METHODS: A literature search was performed in PubMed from 2001 to 2016 using the key words: "zinc status," "pressure ulcer," "pressure ulcers in older adults," "wound healing," and "zinc sulfate." Inclusion criteria consisted of adequate sample size, nonacute setting, clinical trial or observational study, sound methodology, and generalizable findings for primary and secondary outcomes, which included food intake, oral nutritional supplement (ONS) consumption, risk for malnutrition, nutrient loss from wound exudate, and lab values. RESULTS: Of 41 total studies, 10 satisfied the inclusion criteria and investigated PI in older adults versus nutritional intake. Both standard and specialty ONS interventions, which contain additional fortification, improve outcomes, though findings are inconsistent regarding formulations preferable for the treatment of older adults. Monitoring for nutritional deficiencies, including Zn, is essential for optimal patient outcomes. DISCUSSION: Recently, Zn in combination with ONS containing additional kilocalories, protein, and other trace elements, has been investigated for PIs. Although both standard and specialty ONS interventions improve outcomes, findings are inconsistent regarding preferable formulations for the treatment of older adults. Monitoring for nutritional deficiencies, including Zn, is essential for optimal patient outcomes. Unreliability of biomarkers for frank Zn deficiency make diagnosis uncommon, and oral Zn sulfate administration has not shown significant effects on PI outcomes in the past. CONCLUSION: This population benefits from the clinical application of supplementation with preparations containing Zn, added calories, protein, and other trace elements. This improves outcomes, decreases healing time, and mitigates comorbidities.

Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial.

OBJECTIVE: To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. METHOD: Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. RESULTS: The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. CONCLUSION: Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. DECLARATION OF INTEREST: This research was supported by a grant from the Queensland Health, Health Practitioner Research Scheme. The authors have no conflicts of interest to declare.

Efecto de un suplemento nutricional específico (Balnimax(R)) en la cicatrización de úlceras de la extremidad inferior de etiología venosa y úlceras por presión / Effect of a specific nutritional supplement (Balnimax(R)) on lower extremity ulcers of venous etiology and pressure ulcers

Objetivo: evaluar un suplemento nutricional específico, Balnimax(R) (ácido alfa-lipoico, L-arginina, L-metionina, complejo de vitamina B, vitamina E y selenio) junto con la práctica clínica diaria en la cicatrización de las úlceras por presión y úlceras de etiología venosa. Material y método: se llevó a cabo un estudio multicéntrico, prospectivo, de medidas repetidas en un solo grupo y postautorización en pacientes con úlceras por presión y úlceras de etiología venosa sin signos clínicos de infección local, que fueron tratados durante 8 semanas. Las medidas se registraron al inicio y en las semanas 2, 4, 6 y 8. Los pacientes recibieron una cápsula oral dos veces al día, con las comidas. La medida de resultado principal fue el porcentaje de reducción en el tamaño de la herida. Además, se estudió la cicatrización completa. El tamaño de la muestra se determinó para comparar los resultados frente a un valor de referencia. Se requería un total de 127 pacientes para detectar una diferencia igual o superior al 15% en la reducción del área. Se asumió como porcentaje de reducción de referencia un 57%. Además, se estimó un 10% de pérdidas en el seguimiento. Resultados: Se incluyeron y finalizaron el estudio 112 pacientes con 133 heridas (un 16,0% tuvieron dos o más lesiones), con una media de edad de 74,2 ± 12,0 (mediana: 77, extremos: 35-94). Un 69,8% eran mujeres, la mayoría pacientes ambulatorios (98,4%). En un 9% se utilizaron moduladores de las proteasas y solo en un 27,2% se aplicó un vendaje compresivo multicapa. Un total de 58 (43,6%) úlceras cicatrizaron durante el periodo del estudio. La evolución del tamaño de la herida y su porcentaje de reducción fueron estadísticamente significativos (p ≤ 0,001), disminuyendo a lo largo del tiempo. Hubo diferencias estadísticamente significativas entre los resultados del estudio y el valor de referencia (p ≤ 0,001). Conclusiones: a pesar de las posibles limitaciones metodológicas por ser un estudio en un solo grupo, el complemento estudiado parece tener un efecto sobre la cicatrización. Los resultados son mejores que los publicados previamente con otros suplementos nutricionales o frente a la cura en ambiente húmedo por sí sola

Objective: To evaluate a specific oral nutritional supplement, Balnimax(R) (alfa-lipoic acid, L-arginine, L-methionine, vitamin B complex, vitamin E and selenium) along with daily clinical practice on the healing of pressure and venous leg ulcers. Method: a multicentre, prospective, single-group, repeated measures and post-authorization study was carried out with pressure and venous leg ulcers’ patients without signs of local infection, to be treated for up to 8 weeks. Measures were recorded at baseline, 2, 4, 6 and 8 weeks. The patients received a tablet orally twice daily with meals. The primary outcome variable was the percentage of wound size reduction. We also analysed the complete healing. The sample size calculation was determined to compare the results against a reference value. 127 subjects would be required to detect a difference equal to or above 15%. It was assumed that the percentage of wound reduction was 57%. We estimated a loss rate of up to 10%. Results: 112 patients with 133 wounds were included and finished the study (16.0% had 2 or more wounds), with a mean age of 74.2±12.0 (median: 77, extremes: 35-94). 69.8% were women, most of them ambulatory patients (98.4%). In 9% proteases modulators were used and in only 27.2% was applied a multilayer compression therapy. 58 (43.6%) ulcers healed during the study period. The evolution of wound size and percentage reduction was, statistically significant (p ≤ 0.001), decreasing over time period. It was a statistical significant difference (p ≤ 0.001) between the results and the reference value. Conclusions: Despite the possible methodological flaws due to a single-group study, the supplement studied seems to be an effect over healing. The results are better than previous published with other nutritional supplements or with moist wound healing only

Treatment of pressure ulcers in patients with declining renal function using arginine, glutamine and ß-hydroxy-ß-methylbutyrate.

The aim of this study is to examine the efficacy on healing pressure ulcers (PU) of using a supplement combination containing arginine, glutamine and ß-hydroxy-ß-methylbutyrate, which was given to two elderly patients with renal dysfunction. The PU was surgically opened, decompressed and treated by drugs. A half quantity of the defined dose of the supplement combination, with an enteral nutrition product, was administered to the patients twice a day. This combination improved the PUs, with no effect on renal function. This novel finding may provide a nutritional rationale of arginine, glutamine and ß-hydroxy-ß-methylbutyrate for PUs associated with renal dysfunction.

Patient perceptions of the role of nutrition for pressure ulcer prevention in hospital: an interpretive study.

PURPOSE: The aims of this study were to explore (a) patients' perceptions of the role of nutrition in pressure ulcer prevention; and (b) patients' experiences with dieticians in the hospital setting. DESIGN: Interpretive qualitative study. SUBJECTS AND SETTING: The sample comprised 13 females and 7 males. Their mean age was 61.3 ± 12.6 years (mean ± SD), and their average hospital length of stay was 7.4 ± 13.0 days. The research setting was a public health hospital in Australia. METHODS: In this interpretive study, adult medical patients at risk of pressure ulcers due to restricted mobility participated in a 20 to 30 minute interview using a semi-structured interview guide. Interview questions were grouped into 2 domains; perceptions on the role of nutrition for pressure ulcer prevention; and experiences with dieticians. Recorded interviews were transcribed and analyzed using content analysis. RESULTS: Within the first domain, 'patient knowledge of nutrition in pressure ulcer prevention,' there were varying patient understandings of the role of nutrition for prevention of pressure ulcers. This is reflected in 5 themes: (1) recognizing the role of diet in pressure ulcer prevention; (2) promoting skin health with good nutrition; (3) understanding the relationship between nutrition and health; (4) lacking insight into the role of nutrition in pressure ulcer prevention; and (5) acknowledging other risk factors for pressure ulcers. Within the second domain, patients described their experiences with and perceptions on dieticians. Two themes emerged, which expressed differing opinions around the role and reputation of dieticians; they were receptive of dietician input; and displaying ambivalence towards dieticians' advice. CONCLUSIONS: Hospital patients at risk for pressure ulcer development have variable knowledge of the preventive role of nutrition. Patients had differing perceptions of the importance and value of information provided by dieticians.

The effectiveness of a specialised oral nutrition supplement on outcomes in patients with chronic wounds: a pragmatic randomised study.

BACKGROUND: Nutrition supplements enriched with immune function enhancing nutrients have been developed to aid wound-healing, although evidence regarding their effectiveness is limited and systematic reviews have lead to inconsistent recommendations. The present pragmatic, randomised, prospective open trial evaluated a wound-specific oral nutrition supplement enriched with arginine, vitamin C and zinc compared to a standard supplement with respect to outcomes in patients with chronic wounds in an acute care setting. METHODS: Twenty-four patients [11 males and 13 females; mean (SD) age: 67.8 (22.3) years] with chronic wounds (14 diabetic or venous ulcers; 10 pressure ulcers or chronic surgical wounds) were randomised to receive either a wound-specific supplement (n = 12) or standard supplement (n = 12) for 4 weeks, with ongoing best wound and nutrition care for an additional 4 weeks. At baseline, and at 4 and 8 weeks, the rate of wound-healing, nutritional status, protein and energy intake, quality of life and product satisfaction were measured. Linear mixed effects modelling with random intercepts and slopes were fitted to determine whether the wound-specific nutritional supplement had any effect. RESULTS: There was a significant improvement in wound-healing in patients receiving the standard nutrition supplement compared to a wound-specific supplement (P = 0.044), although there was no effect on nutritional status, dietary intake, quality of life and patient satisfaction. CONCLUSIONS: The results of the present study indicate that a standard oral nutrition supplement may be more effective at wound-healing than a specialised wound supplement in this clinical setting.

The effectiveness of nutritional intervention(s) and the treatment of pressure ulcers--a systematic literature review.

This review aims to evaluate the effectiveness of nutritional intervention in the treatment of pressure ulcers. Four databases were searched systematically using the keywords formulated and papers were selected according to inclusion and exclusion criteria. The literature search period included articles published from 1 January 2000 to 30 December 2011 (inclusive). Six papers on randomized controlled trials were retrieved. All six trials showed positive outcomes in pressure ulcer healing with nutritional interventions. Secondary outcomes such as lower number of dressings required, less time spent on dressing changes and lower occurrence of infections were reported. The main results emerged from this study generally supported the use of nutritional interventions in the treatment of pressure ulcers. Various methodological issues associated with these trials were highlighted. The implications for clinical practice need to bear in mind both the methodological problems raised and limitations of this review.

Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria / Relationship between nutritional status and the risk of having pressure ulcers in patients included in a home care program

Objetivos: Se evaluó el grado de relación entre estado nutricional y riesgo de presentar úlceras por presión (UPP) en pacientes de atención domiciliaria (ATDOM). Secundariamente, se valoró la relación entre el grado de deterioro cognitivo, dependencia física, patologías de base y estado nutricional. Ámbito: Pacientes de atención domiciliaria (ATDOM) en atención primaria.Pacientes100 pacientes ATDOM. Variables principales: Edad, sexo, cuidador, enfermedades, IMC, hemoglobina, hematocrito, linfocito S, albúmina, colesterol, Barthel, Pfeiffer, valoración nutricional (MNA) y Braden. Resultados: Un 14% de los pacientes ATDOM presentaron malnutrición y un 46% riesgo de desnutrición. El incremento del grado de dependencia y el deterioro cognitivo aumentó (p<0,001) el riesgo UPP. Además, el estado nutricional afectó al riesgo de UPP (p<0,001) con una OR 3,73 superior en aquellos pacientes malnutridos. Valores de albúmina de 3,76±0,05g/dL y de colesterol de 176,43±6,38 se relacionaron con un mayor riesgo de ulceración. En cuanto al estado nutricional existió una relación significativa (p<0,01) con el grado de dependencia. En pacientes malnutridos los niveles de albúmina disminuyeron a 3,46±0,098, con medias de colesterol de 154,95mg/dL±11,41. Finalmente, IMC menores se relacionaron significativamente con malnutrición. Conclusiones: El presente estudio demuestra que el 14% de pacientes ATDOM presentaron malnutrición y un 46% riesgo de desnutrición. La malnutrición, el grado de dependencia física, el deterioro cognitivo severo y los parámetros sanguíneos básicos se relacionan significativamente con un aumento del riesgo de ulceración, justificando la necesidad de llevar a cabo medidas de corrección y mejoría personalizada en los pacientes ATDOM(AU)

Objective: The objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underlying diseases and the nutritional status. Scope: Patients in home care program in Primary Health Care.Patients100 home care patients. Main variables: age, sex, caregiver, illness, BMI, haemoglobin, haematocrit, lymphocyte count, albumin, cholesterol, Barthel index, Pfeiffer, nutritional assessment (MNA) and Braden scale. Results: Fourteen percent of the ATDOM patients had malnutrition and 46% a high risk of malnutrition. The degree of dependency, and the level of cognitive impairment increased (P<001) the risk of pressure ulcers. Furthermore, the nutritional status affected the risk of pressure ulcers (P<001) with OR 3.73 higher in malnourished patients. Values of 3.76±0.05g/dL albumin and cholesterol of 176.43±6.38 were associated with an increased risk of ulceration. There was a significant relationship between nutritional status (P<01) and the degree of dependence. In malnourished patients albumin levels decreased to 3.46±0.098, with averages of 11.41±154.95mg/dL cholesterol. Finally, a lower BMI was significantly related to malnutrition. Conclusions: The present study demonstrates that 14% of the ATDOM patients showed malnutrition, and 46% a high risk of malnutrition. Malnutrition, the degree of physical dependence and severity of cognitive impairment is associated with an increased risk of ulceration, which justify the need for carrying out some personalised measurements on ATDOM patients(AU)

Cost-effectiveness of nutritional intervention on healing of pressure ulcers.

BACKGROUND & AIMS: Pressure ulcers not only affect quality of life among the elderly, but also bring a large economic burden. There is limited evidence available for the effectiveness of nutritional interventions for treatment of pressure ulcers. In Japan, recently, a 60-patient randomized controlled trial of nutritional intervention on pressure ulcers demonstrated improvement in healing of pressure ulcers, compared with conventional management. To evaluate value for money of nutritional intervention on healing of pressure ulcers, cost-effective analysis was carried out using these trial results. METHODS: The analysis was carried out from a societal perspective. As effectiveness measures, pressure ulcer days (PUDs) and quality-adjusted life years (QALYs) were estimated. Prevalence of pressure ulcers was estimated by the Kaplan-Meier method. Utility score for pressure ulcers is derived from a cross-sectional survey among health professionals related to pressure ulcers. Costs (e.g., nutritional interventions and management of pressure ulcers) were estimated from trial data during observation and follow-up. Stochastic and qualitative sensitivity analyses were performed to examine the robustness of results. RESULTS: For observation (12 weeks) and follow-up (12-week observation plus 4-week follow-up), nutritional intervention reduced PUDs by 9.6 and 16.2 per person, and gained 0.226 × 10(-2) QALYs and 0.382 × 10(-2) QALYs per person, respectively. In addition, costs were reduced by $542 and $881 per person, respectively. This means nutritional intervention is dominant (cost savings and greater effectiveness). The sensitivity analyses showed the robustness of these results. CONCLUSION: Economic evaluation of nutritional intervention on healing pressure ulcers from a small randomized controlled trial showed that this intervention is cost saving with health improvement. Further studies are required to determine whether this is a cost-effective intervention for widespread use.