http://archinte.jamanetwork.com/ en-us Sat, 01 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:52:04 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1151405 Mon, 14 May 2012 00:00:00 GMT Christmas C, Finucane TE. <span class="paragraphSection">“Malnutrition” is frequently cited when patients with pressure sores do poorly, and “adequate” nutrient intake (or input) is part of most guidelines on pressure sore management. This may be misleading, however. Although not conclusive, available evidence consistently suggests that nutrition support—parenterally, with oral supplements, or via enteral tube feeding—does not improve pressure sore outcomes. The Cochrane review of enteral tube feeding in older people with dementia concluded that data were limited and that “there was no evidence of benefit in terms of nutritional status or the prevalence of pressure ulcers.”</span> 172 9 701 703 10.1001/archinternmed.2012.1207 http://archinte.jamanetwork.com/article.aspx?articleID=1151405 http://archinte.jamanetwork.com/article.aspx?articleID=1151419 Mon, 14 May 2012 00:00:00 GMT Teno JM, Gozalo P, Mitchell SL, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>The evidence regarding the use of feeding tubes in persons with advanced dementia to prevent or heal pressure ulcers is conflicting. Using national data, we set out to determine whether percutaneous endoscopic gastrostomy (PEG) tubes prevent or help heal pressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI).<div class="boxTitle">Methods</div>A propensity-matched cohort study of NH residents with ACI and recent need for assistance in eating was conducted by matching each NH resident who had a feeding tube inserted during a hospitalization to 3 without a PEG tube inserted. Using the Minimum Data Set (MDS), we examined 2 outcomes: first, whether residents without a pressure ulcer developed a stage 2 or higher pressure ulcer (n = 1124 with PEG insertion); and second, whether NH residents with a pressure ulcer (n = 461) experienced improvement of the pressure ulcer by their first posthospitalization MDS assessment (mean [SD] time between evaluations, 24.6 [32.7] days).<div class="boxTitle">Results</div>Matched residents with and without a PEG insertion showed comparable sociodemographic characteristic, rates of feeding tube risk factors, and mortality. Adjusted for risk factors, hospitalized NH residents receiving a PEG tube were 2.27 times more likely to develop a new pressure ulcer (95% CI, 1.95-2.65). Conversely, those with a pressure ulcer were less likely to have the ulcer heal when they had a PEG tube inserted (OR 0.70 [95% CI, 0.55-0.89]).<div class="boxTitle">Conclusions</div>Feeding tubes are not associated with prevention or improved healing of a pressure ulcer. Rather, our findings suggest that the use of PEG tube is associated with increased risk of pressure ulcers among NH residents with ACI.</span> 172 9 697 701 10.1001/archinternmed.2012.1200 http://archinte.jamanetwork.com/article.aspx?articleID=1151419