Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

{\it Helicobacter pylori\/}: An infectious consideration when screening patients with complaints of dyspepsia

Historically, abdominal complaints have been generally dealt with palliatively. Seldom were underlying causes given consideration. However, in 1982 (Warren & Marshall, 1983), the identification of the bacterial agent Helicobacter pylori (known hereafter in this paper as H. pylori) as a potential link between gastrointestinal complaints such as gastric and duodenal ulcers, Crohn's Disease, and some forms of gastric cancer has given rise for concern. In 1994, the National Institute for Health recommended that patients with complaints of dyspepsia be studied for the occurrence of H. pylori. This study proposes to study the occurrence of H. pylori in patients who complain with dyspepsia with a relatively non invasive screening technique to be done in an office setting. The study findings were considered signifcant if p $\le$.05. This study indicated that 49% of patients with complaints of dyspepsia were postive for H. pylori infection with p =.000. ^

Systematic Monitoring of Wound Healing Using a Hand-held Near-Infrared Optical Scanner

According to the American Podiatric Medical Association, about 15 percent of the patients with diabetes would develop a diabetic foot ulcer. Furthermore, foot ulcerations leads to 85 percent of the diabetes-related amputations. Foot ulcers are caused due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities and the duration of the diabetes. To date, the wounds are inspected visually to monitor the wound healing, without any objective imaging approach to look before the wound’s surface. Herein, a non-contact, portable handheld optical device was developed at the Optical Imaging Laboratory as an objective approach to monitor wound healing in foot ulcer. This near-infrared optical technology is non-radiative, safe and fast in imaging large wounds on patients. The FIU IRB-approved study will involve subjects that have been diagnosed with diabetes by a physician and who have developed foot ulcers. Currently, in-vivo imaging studies are carried out every week on diabetic patients with foot ulcers at two clinical sites in Miami. Near-infrared images of the wound are captured on subjects every week and the data is processed using customdeveloped Matlab-based image processing tools. The optical contrast of the wound to its peripheries and the wound size are analyzed and compared from the NIR and white light images during the weekly systematic imaging of wound healing.