Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52
Asia Pac J Clin Nutr ; 27(3): 728-734, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29737823


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.

Diabetes Mellitus Tipo 2/complicações , Terapia Nutricional , Lesão por Pressão/dietoterapia , Lesão por Pressão/reabilitação , Peso Corporal , Ingestão de Energia , Humanos , Masculino , Desnutrição/complicações , Desnutrição/dietoterapia , Desnutrição/reabilitação , Pessoa de Meia-Idade , Estado Nutricional , Cicatrização
Nutr. hosp ; 34(6): 1305-1310, nov.-dic. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-168968


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)

Humanos , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/dietoterapia , Lesão por Pressão/epidemiologia , Doença Aguda/epidemiologia , Lesão por Pressão/prevenção & controle , Lesão por Pressão/reabilitação , Estudos Retrospectivos , Estudos de Coortes , Doença Aguda/reabilitação , Análise Multivariada , Tempo de Internação , Análise de Dados/métodos
Nurs Older People ; 29(6): 33-39, 2017 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-28664809


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.

Desnutrição/complicações , Recursos Humanos de Enfermagem no Hospital/educação , Terapia Nutricional/normas , Guias de Prática Clínica como Assunto , Lesão por Pressão/dietoterapia , Lesão por Pressão/prevenção & controle , Cicatrização/fisiologia , Educação Continuada em Enfermagem , Humanos , Lesão por Pressão/etiologia , Fatores de Risco , Reino Unido
J Wound Care ; 26(6): 319-323, 2017 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-28598762


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.

Arginina/uso terapêutico , Nutrição Enteral/métodos , Alimentos Formulados , Lesão por Pressão/dietoterapia , Cicatrização , Humanos
Wounds ; 29(2): 56-61, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28272014


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.

Suplementos Nutricionais , Desnutrição/complicações , Lesão por Pressão/dietoterapia , Lesão por Pressão/prevenção & controle , Cicatrização/efeitos dos fármacos , Zinco/farmacologia , Idoso , Envelhecimento/fisiologia , Humanos , Necessidades Nutricionais , Lesão por Pressão/tratamento farmacológico , Lesão por Pressão/fisiopatologia , Oligoelementos/farmacologia , Oligoelementos/uso terapêutico , Cicatrização/fisiologia , Zinco/uso terapêutico
J Wound Care ; 25(7): 384-92, 2016 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-27410392


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.

Cuidados Críticos/métodos , Suplementos Nutricionais , Tempo de Internação/estatística & dados numéricos , Terapia Nutricional/métodos , Lesão por Pressão/dietoterapia , Lesão por Pressão/enfermagem , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Gerokomos (Madr., Ed. impr.) ; 27(1): 27-32, mar. 2016. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-154723


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

Humanos , Suplementos Nutricionais , Cicatrização/fisiologia , Lesão por Pressão/dietoterapia , Úlcera da Perna/dietoterapia , Úlcera Varicosa/dietoterapia , Resultado do Tratamento , Inibidores de Proteases/uso terapêutico
J Wound Care ; 24(10): 478-82, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26488739


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.

Arginina/uso terapêutico , Alimentos Fortificados , Glutamina/uso terapêutico , Falência Renal Crônica/complicações , Lesão por Pressão/dietoterapia , Valeratos/uso terapêutico , Cicatrização , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Humanos , Lesão por Pressão/complicações , Resultado do Tratamento
J Wound Ostomy Continence Nurs ; 41(6): 528-34; quiz E1-2, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25377102


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.

Hospitais , Pacientes Internados/psicologia , Estado Nutricional , Percepção , Lesão por Pressão/dietoterapia , Lesão por Pressão/prevenção & controle , Higiene da Pele/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/complicações , Pesquisa Qualitativa , Higiene da Pele/enfermagem
J Hum Nutr Diet ; 26(5): 452-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23627791


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.

Suplementos Nutricionais , Lesão por Pressão/dietoterapia , Cicatrização/efeitos dos fármacos , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Ácido Ascórbico/administração & dosagem , Doença Crônica , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional/métodos , Estado Nutricional , Lesão por Pressão/patologia , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Zinco/administração & dosagem
Int J Nurs Pract ; 19 Suppl 1: 19-27, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23425376


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.

Lesão por Pressão/dietoterapia , Idoso , Idoso de 80 Anos ou mais , Bandagens , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização
Aten. prim. (Barc., Ed. impr.) ; 44(10): 586-594, oct. 2012. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-106616


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)

Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Estado Nutricional/fisiologia , Lesão por Pressão/complicações , Lesão por Pressão/dietoterapia , Lesão por Pressão/diagnóstico , Antropometria/métodos , Fatores de Risco , Desnutrição/complicações , Desnutrição/dietoterapia , Lesão por Pressão/prevenção & controle , Serviços de Assistência Domiciliar/tendências , Nutrição Parenteral no Domicílio/métodos , Estudos Transversais/métodos , Estudos Transversais , Repertório de Barthel , Modelos Logísticos
Clin Nutr ; 31(6): 868-74, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22626888


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.

Dietoterapia/economia , Lesão por Pressão/dietoterapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Japão , Masculino , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
Mundo saúde (Impr.) ; 35(4): 448-453, 2011.
Artigo em Português | LILACS | ID: lil-619124


O objetivo deste trabalho foi avaliar o estado nutricional e a ingestão alimentar de pacientes amputados com úlceras de pressão (UP) atendidos no ambulatório de um Centro Hospitalar de Reabilitação em Curitiba por meio de um estudo retrospectivo. Os critérios de inclusão foram: idade acima de 18 anos, via de alimentação exclusivamente oral, diagnóstico médico de amputação, úlcera de pressão como problema associado e número de consultas com Nutricionista (no mínimo 3). Foram selecionadas para análise as fichasde cinco pacientes. O estudo mostrou que a maioria dos pacientes foi diagnosticada com sobrepeso e que a ingestão de proteínas energiae micronutrientes essenciais para cicatrização de UP (vitaminas A, C e E, cobre e zinco) foram insuficientes. Após a terapia nutricional,todos apresentaram melhoras no processo de cicatrização. Ainda faltam estudos que comprovem uma eficácia na suplementação de nutrientes em pacientes com esse diagnóstico, porém todos concordam que uma melhora no estado nutricional favorece a cura e prevenção de UP quando ainda existem outros fatores associados.

The aim of this work was to evaluate the nutritional status and food consumption patterns of patients amputated due topressure ulcers (PU) assisted in the clinic of a Hospital Rehabilitation Center in Curitiba by means of a retrospective study. Inclusion criteria were: age above 18 years, exclusively oral feeding, amputated, pressure ulcer as associated problem and at least 3 consultationswith a Nutritionist. The medical history of five patients was selected for analysis. The study has showed that most patients were diagnosedwith overweight and that the essential protein ingestion, energy and micronutrients for cicatrization of PU (vitamins C and E, copper and zinc) were insufficient. After the proposed nutritional therapy, all patients presented improvements in the cicatrization process. Stillthere is a lack of studies that prove the effectiveness of nutrients supplementation in patients with this diagnosis, although all agree thatan improvement in the nutritional status contributes to cure and prevention of PU in cases in which here are other associated factors.

La meta de este trabajo fue evaluar el estado nutricional y los patrones del consumo de alimentos de pacientes amputados debido a úlceras de presión (UP) ayudados en la clínica de un centro de rehabilitación hospitalario en Curitiba por medio de un estudioretrospectivo. Los criterios de inclusión fueran: tener más de 18 años, utilizar exclusivamente alimentación oral, ser amputado, tener úlcera de presión como problema asociado y por lo menos 3 consultas con un nutricionista. El historial médico de cinco pacientes fueseleccionado para el análisis. El estudio ha demostrado que la mayoría de los pacientes ha sido diagnosticada con exceso de peso y que laingestión de proteínas, la energía y los microalimentos esenciales para la cicatrización de UP (vitaminas C y E, cobre y cinc) eran escasos.Después de la terapia alimenticia propuesta, todos los pacientes presentaron mejorías en el proceso de cicatrización. Hay una carenciade estudios que prueben la eficacia de la suplementación nutricional en pacientes con esta diagnosis, aunque todos convengan que una mejoría en el estado alimenticio contribuye a la curación y a la prevención de la UP en los casos que presentan otros factores asociados.

Humanos , Amputação/reabilitação , Dietoterapia , Avaliação Nutricional , Lesão por Pressão/dietoterapia
Adv Skin Wound Care ; 23(12): 560-72; quiz 573-4, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21084879


PURPOSE: To enhance the clinician's competence in using nutrition as an integral part of wound healing. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Analyze the effects of specific nutritional deficiencies and patient parameters on wound healing capabilities. 2. Accurately interpret laboratory values related to nutritional status. 3. Apply evidence-based nutrition guidelines for improved wound healing.

Estado Nutricional , Lesão por Pressão/enfermagem , Cicatrização , Ferimentos e Lesões/enfermagem , Antropometria , Doença Crônica , Pé Diabético/enfermagem , Pé Diabético/patologia , Pé Diabético/reabilitação , Humanos , Programas de Rastreamento , Inquéritos Nutricionais , Lesão por Pressão/dietoterapia , Lesão por Pressão/reabilitação , Ferimentos e Lesões/patologia , Ferimentos e Lesões/reabilitação
Nutrition ; 26(9): 867-72, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20598855


OBJECTIVE: We investigated the potential of a high-protein, arginine- and micronutrient-enriched oral nutritional supplement (ONS) to improve healing of pressure ulcers in non-malnourished patients who would usually not be considered for extra nutritional support. METHODS: Forty-three non-malnourished subjects with stage III or IV pressure ulcers were included in a multicountry, randomized, controlled, double-blind, parallel group trial. They were offered 200 mL of the specific ONS or a non-caloric control product three times per day, in addition to their regular diet and standard wound care, for a maximum of 8 wk. Results were compared with repeated-measures mixed models (RMMM), analysis of variance, or Fisher's exact tests for categorical parameters. RESULTS: Supplementation with the specific ONS accelerated pressure ulcer healing, indicated by a significantly different decrease in ulcer size compared with the control, over the period of 8 wk (P

Arginina/uso terapêutico , Proteínas na Dieta/administração & dosagem , Micronutrientes/uso terapêutico , Lesão por Pressão/dietoterapia , Pele/patologia , Cicatrização , Idoso , Análise de Variância , Ácido Ascórbico/sangue , Bandagens , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Masculino , Modelos Estatísticos , Estado Nutricional , Lesão por Pressão/patologia , Valores de Referência , Índice de Gravidade de Doença
J Wound Care ; 19(7): 311-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20616774


OBJECTIVE: To determine whether or not the use of an arginine-containing nutritional supplement could result in significantly shorter pressure ulcer (PU) healing times in people with spinal cord injuries living in the community, compared with a comparative historical control group. METHOD: Eighteen spinal-cord-injured patients (all part of a hospital spinal outreach service) received 9 g of a commercial powdered arginine supplement per day until full PU healing occurred. Healing rates were compared against 17 historical control patients (as assessed by medical history audit). RESULTS: Baseline characteristics (age, gender, injury level and time) were similar between groups. Mean ulcer healing times were 10.5 +/- 1.3 weeks versus 21 +/- 3.7 weeks (p<0.05) in the intervention and control groups respectively. Comparison of healing rates in the intervention group against expected healing rates derived from the medical literature showed that intervention patients had a significantly shorter mean healing time (category 2 PU: 5.5+/-1.3 weeks versus 13.4 weeks; category 3 PU: 12.5 +/- 1.9 weeks versus 18.2 weeks; category 4 PU: 14.4 +/- 4.8 weeks versus 22.1 weeks). A diagnosis of diabetes did not significantly alter healing rates in either group. CONCLUSION: Results from this observational study show a promising benefit of arginine supplementation on PU healing for individuals with spinal cord injury living in the community.

Arginina/uso terapêutico , Suplementos Nutricionais , Lesão por Pressão/dietoterapia , Traumatismos da Medula Espinal/complicações , Cicatrização/efeitos dos fármacos , Administração Oral , Arginina/farmacologia , Suplementos Nutricionais/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Lesão por Pressão/diagnóstico , Lesão por Pressão/etiologia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Vitória