To examine the nutritional status of newly hospitalized patients with Stage III or Stage IV pressure ulcers.
Descriptive survey.
405 newly admitted hospitalized non-ICU patients were eligible for ...inclusion in the study. Patients included in the study had Stage III or Stage IV pressure ulcers on their trunk, had weight indices available, and had prealbumin levels measured. One hundred and twenty patients were included in the analysis.
Measurements of weight, prealbumin and albumin levels, nutritional intake, type of diet, gender, age, type of pressure ulcer, and type of residence prior to admission.
Analysis of the data revealed that a majority of the patients were elderly, had a Stage III sacral ulcer, were below their usual body weight, had a low prealbumin level, and were not taking in enough nutrition to meet their needs.
The results of this study suggest that a majority of newly hospitalized patients with severe pressure ulcers are malnourished and aggressive nutritional therapy may be warranted.
The effectiveness of cycloserine-cefoxitin-fructose agar (CCFA) and taurocholate-CCFA (TCCFA) in isolating
Clostridium difficile from swabs of the rectum or stools from 184 hospitalized patients who ...were monitored weekly and when they had diarrhea was compared. The number of surveillance time points ranged from two to eight per patient over a period of 4 to 34 days per patient, totalling 621 comparisons of the media.
C. difficile was isolated more frequently by TCCFA than CCFA at seven of eight surveillance points, a significant trend (O'Brien test,
p = 0.002). This difference reached statistical significance at the second surveillance time point when the prevalence of
C. difficile was sufficiently high. At the second surveillance point,
C. difficle was isolated only by TCCFA in 7 of 184 comparisons of the media, only by CCFA in none of the comparisons, and by both media in 19 comparisons (
p = 0.016).
C. difficle was first isolated at an earlier surveillance time point on TCCFA in 11 of 36 patients and on CCFA first only once (
p = 0.005). Use of TCCFA media increased the rapidity and sensitivity of culture for
C. difficle when doing patient surveillance but did not increase sensitivity when diagnosing patients with diarrhea.
Translating a research idea into a well-written grant proposal takes planning and commitment. This Spotlight is the fifth in a series by the members of the Center for Clinical Investigation (CCI) of ...the Wound, Ostomy and Continence Nurses (WOCN) Society. The aim of this series is to facilitate high-quality grant writing and encourage submissions to WOCN's grants program. This article provides guidance on the development of a grant proposal and the revisions necessary to result in a polished final product.
The purpose of this study was to compare the stool consistency categorizations made by 39 adults with fecal incontinence and the percentage of water in their stools determined by lyophilization.
...Subjects collected all stools daily for 8 days during a baseline period and at the end of a fiber treatment period. Stool consistency was recorded as hard and formed, soft but formed, loose and unformed, or liquid. Aliquots of the stools were lyophilized to constant weight.
The main outcome measures were the percentage of stool water among stools in each consistency category and the correlation between subjects' stool consistency categorizations and the percentage of stool water.
The subjects were 8 men and 21 women, ranging in age from 30 to 89 years, who were participating in a study of the effectiveness of dietary fiber for treating fecal incontinence. A total of 1023 stool samples were analyzed. Significant differences in the mean percentage of water were found among the 4 stool consistency categories (hard and formed = 68% +/- 0.9%, soft but formed = 74% +/- 0.3%, loose and unformed = 80% +/- 0.4%, and liquid = 85% +/- 0.3%; P < .001). Ninety-six percent of the stools had a percentage of water within 2 SDs of the mean percentage of water of other stools in their consistency category.
This classification system of stool consistency is a valid and practical measure for clinical studies. It may be useful for clinicians and patients to evaluate outcomes of treatments directed at improving stool consistency.
In our clinical and research experience, persons with fecal incontinence anecdotally report altered diet intake to avoid incontinence. The purpose of this study was to compare the dietary intake of ...39 persons with fecal incontinence living in the community with that of age- and gender-matched control subjects who had normal bowel function. The diets of both groups were compared with recommended dietary allowances (RDAs) for their constituent nutrients.
Subjects prospectively recorded the type, amount, and method of preparing all foods and beverages ingested for 8 consecutive days. Diet records were analyzed using the Nutritionist IV software program.
The main outcome measures were the amounts and percentage of the RDAs of macronutrients and micronutrients in the subjects' diets.
There were no significant differences in the intake of total kilocalories, protein, fat, dietary fiber, caffeine, or lactose by the fecal incontinence and control groups. The fecal incontinence group had a greater intake of carbohydrates, manganese, and vitamin B(1) compared with the control group. Diets of both groups exceeded 100% of the RDA for protein, phosphorus, iron, sodium, potassium, Vitamins B(1), B(2), B(3), B(12), and C and folate. Diets of both groups had less than 50% of the RDA for biotin, chromium, copper, and manganese but did not differ significantly. The percentages of the RDA for calcium and vitamin D were 84% +/- 6% and 56% +/- 8% for the fecal incontinence group and 90 +/- 8 (P =.6) and 69 +/- 11 for the control group (P =.4).
The diets of persons with fecal incontinence were similar to those of control subjects with normal bowel function. Both the fecal incontinence and control groups may improve their nutritional patterns by lowering sodium and protein intake and increasing dietary fiber and monounsaturated fat intake. Calcium and vitamin D supplementation may improve dietary deficiencies and lower disease risks. Including a nutritional assessment and consultation in the care of persons with fecal incontinence to improve their general health and prevent disease is recommended, but consideration must be given to altered diet patterns perceived by the patient to prevent fecal incontinence.
This second of two articles on enteral nutrition discusses the basics of tube feedings, including the types of tubes that are used, when to start a feeding, and some common complications that develop ...in patients--aspiration and diarrhea chief among them.
This first of two articles on enteral nutrition focuses on the formulas that contain special nutrients to enhance immune system function and digestion. We'll review the specific nutrients in enhanced ...formulas, what researchers have found about their effects on the critically ill, and whether they're worth using.
