A diet enriched in eicosapentanoic acid, gamma-linolenic acid and antioxidants in the prevention of new pressure ulcer formation in critically ill patients with acute lung injury: A randomized, prospective, controlled study.

BACKGROUND & AIMS: Pressure ulcers are a significant burden in the ICU. Many factors have found to be associated with pressure ulcers including malnutrition. While it has been recognized that high protein diets decrease the incidence of pressure ulcers, the role of lipids as well as vitamins and antioxidants remains unclear. The aim of this study was to evaluate the preventive and healing effects of an enteral diet enriched in eicosapentanoic acid (EPA) and gamma-linolenic acid (GLA) and vitamins (vitamins A, C and E) on pressure ulcers. METHODS: One hundred patients with acute lung injury were included in a larger study evaluating the effects of lipids and vitamins on respiratory function. A secondary end point, occurrence and healing of pressure ulcers was included. A diet enriched in lipids (EPA, GLA) and vitamins (vitamins A, C and E) was compared with a diet similar in macronutrient composition. The occurrence and healing of pressure ulcers was evaluated according to the National Pressure Ulcer Panel. Nutritional assessment included calorie intake, resting energy expenditure, levels of serum prealbumin, albumin, vitamins A and E, zinc and copper. C-reactive protein and procalcitonin were also measured. RESULTS: Patient's age, severity of disease and gender distribution were similar in the two groups. The study group had a higher body mass index. At baseline, the pressure ulcer score was similar in the two groups A significantly lower rate of occurrence of new pressure ulcers was observed in the study group compared to the control group (p<0.05). No difference was observed in the healing of existing pressure ulcers in the study as opposed to the control group. There was no significant difference in the nutritional parameters between the two groups. CONCLUSIONS: A diet enriched with EPA, GLA and vitamins A, C and E is associated with a significantly lower occurrence of new pressure ulcers in critically ill patients with acute lung injury.

WITHDRAWN: A diet enriched in eicosapentanoic acid, gamma-linolenic acid and antioxidants in the prevention of new pressure ulcer formation in critically ill patients with lung injury: A randomized, prospective, controlled study.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Clin. Nutr., doi:10.1016/j.clnu.2007.06.015. The duplicate article has therefore been withdrawn.

The involvement of glucocorticoids and interleukin-1 in the regulation of brain prostaglandin production in response to surgical stress.

BACKGROUND: This study examined the role of glucocorticoids (GC) and interleukin-1 (IL-1) in regulating the production of brain prostaglandin E(2) (PGE(2)) in response to surgical stress. METHODS: Surgical stress was induced in rats by laparotomy or exploration of the carotid. PGE(2) ex vivo production was measured in the frontal cortex or central amygdala of adrenalectomized rats, or of rats treated with either the GC type II receptor blocker (RU38486) or synthetic GC (dexamethasone). IL-1 involvement in mediating PGE(2) response to surgical stress was examined in IL-1 receptor type I deficient (IL-1rKO) mice. RESULTS: Surgical stress elevated serum corticosterone and increased PGE(2) production by the frontal cortex and the central amygdala. A more pronounced PGE(2) response was found in adrenalectomized rats and in rats treated with RU38486, whereas administration of dexamethasone inhibited stress-induced PGE(2) production. IL-1rKO mice exhibited lower PGE(2) production in the frontal cortex under basal condition and failed to increase PGE(2) production in response to surgical stress. CONCLUSIONS: Surgical stress-induced production of brain PGE(2) is specifically regulated by GC via the mediation of type II corticosteroid receptors. Normal IL-1 signaling is required for the production of brain PGE(2) under basal conditions and in response to surgical stress.

Effects of surgical stress on brain prostaglandin E2 production and on the pituitary-adrenal axis: attenuation by preemptive analgesia and by central amygdala lesion.

Surgical stress is the combined result of tissue injury, anesthesia, and postoperative pain. It is characterized by elevated levels of adrenocorticotropin (ACTH), corticosterone (CS), and elevated levels of prostaglandin E2 (PGE2) in the periphery and in the spinal cord. The present study examined the effects of perioperative pain management in rats undergoing laparotomy on serum levels of ACTH, CS, and on the production of PGE2 in several brain regions, including the amygdala. The amygdala is known to modulate the pituitary-adrenal axis response to stress. We, therefore, also examined the effects of bilateral lesions in the central amygdala (CeA) on laparotomy-induced activation of the pituitary-adrenal axis in rats. In the first experiment, rats either underwent laparotomy or were not operated upon. Half the rats received preemptive analgesia extended postoperatively, the other received saline. ACTH, CS serum levels, and ex vivo brain production of PGE2 were determined. In the second experiment, rats underwent bilateral lesions of the CeA. Ten days later, rats underwent laparotomy, and ACTH and CS serum levels were determined. Laparotomy significantly increased amygdala PGE2 production, and CS and ACTH serum levels. This elevation was markedly attenuated by perioperative analgesia. Bilateral CeA lesions also attenuated the pituitary-adrenal response to surgical stress. The present findings suggest that the amygdala plays a regulatory role in mediating the neuroendocrine response to surgical stress. Effective perioperative analgesia attenuated the surgery-induced activation of pituitary-adrenal axis and PGE2 elevation. The diminished elevation of PGE2 may suggest a mechanism by which pain relief mitigates pituitary-adrenal axis activation.

Social support as experienced by Chinese and Israeli husbands of women with breast cancer: a comparative study.

The purpose of this research was to compare the experience of social support of Israeli and Chinese husbands of women with breast cancer. Social support was examined from three different sources: wives, friends and family, and the healthcare team. This study is part of a larger descriptive comparative study investigating the husbands' adjustment to their wives' diagnosis of cancer. A convenience sample of 50 husbands from each cultural framework was selected. Support from family and friends and the healthcare team was measured by items from the Social Support Questionnaire (SSQ), the Psychosocial Adjustment to Illness Scales (PAIS) and questions developed by the authors. Israeli husbands reported significantly higher levels of support in all three areas. Chinese husbands were significantly more interested in joining a support group. The results of this study show that culture has an impact on spousal responses to their wives' illness. In developing appropriate breast cancer nursing, nurses need to practice sensitivity and awareness of the cultural differences in order to provide culturally sensitive family oriented nursing care. This study is an ongoing effort of collaboration between nursing professionals from the far east and the middle east.

Patients voice issues of dress and address.

Establishing a positive patient care environment is one of the most basic concepts of health care professional practice. Dress and personal address are aspects of this environment that are influenced by culture and express mutual respect within the patient-provider relationship. The Patient Sensitivity Questionnaire was administered to determine how 76 Israeli inpatients perceived forms of address and dress in their health care environment. Patients preferred that their health care providers wear formal dress and be addressed by their formal titles. Respondents did not object to being addressed by their first names. Based on these results, it would seem that this Israeli sample preferred to retain the traditional provider-patient environment.

Psychoneuroimmunology in critically ill patients.

Psychoneuroimmunology is the study of the interactions among behavior, neural, and endocrine functions and the immune system. The purpose of this review is to briefly summarize the evidence concerning interactions among behavior, the neuroendocrine system, and the immune system, and to show how this evidence relates to critical care patients. It has been shown that the immune function of many patients in the intensive care unit is suppressed as a result of trauma, sepsis, or profound physiologic and psychological stress. Three of the most common stressors among patients in the intensive care unit are pain, sleep deprivation, and fear or anxiety. Findings have shown each of these stressors to be associated with decreased immune functioning. Nurses have an important responsibility to protect their patients from infection and promote their ability to heal. Several actions are suggested that can help the nurse achieve these goals. It is hoped that nurses would keep these interactions in mind while caring for their patients in the intensive care unit.

A review of nursing research on blood pressure.

PURPOSE: To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research. ORGANIZING CONSTRUCT: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement. METHODS: This 10-year literature review 1990-1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article. FINDINGS: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurements of BP under multiple conditions increased, but measurement within conditions did not. CONCLUSIONS: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.

International trauma care: a comparison between Jerusalem, Israel, and Fairfax County, Virginia, USA.

BACKGROUND: Trauma is viewed by many as a global problem. The phenomenon of similar outcomes within differing healthcare delivery systems can illuminate the strengths and weaknesses of various trauma systems as well as the effects of these characteristics on patient outcome. OBJECTIVES: To compare and contrast demographic and injury characteristics as well as patient outcomes of two urban/suburban trauma centers, one in Israel and the other in the United States. METHODS: Study data were obtained from the trauma registries of two trauma centers. Demographic variables, injury characteristics and outcomes were compared statistically between registries. RESULTS: Significant differences between the registries were found in demographic variables (age), injury characteristics (Injury Severity Score and mechanism of injury), and outcome (mortality and length of stay). Age and Injury Severity Score were found to be significant predictors of outcome in both registries. The Glasgow Coma Score was found to contribute to patient outcomes more than the ISS. Differences were found in the relative impact of injury and demographic factors on outcomes between the registries. After including the influence of these factors on patient outcomes, significant differences still remained between the outcomes of the trauma centers. CONCLUSIONS: Despite possible explanations for these differences, true comparisons between centers are problematic.