Risco de lesão por pressão em pessoas acamadas assistidas pela estratégia saúde da família / Risk of pressure ulcers in bedridden individuals assisted by the family health strategy / Riesgo de lesiones por presión en personas encamadas atendidas por la estrategia de salud de la familia

Objetivo: Avaliar o risco de Lesão por Pressão em pessoas acamadas assistidas pela Estratégia Saúde da Família. Método: Estudo transversal, com abordagem quantitativa, realizado com 62 pacientes. A coleta de dados sucedeu-se por meio de questionário semiestruturado com dados sociodemográficos, clínicos e a avaliação do risco de Lesão por Pressão por meio da Escala de Braden. Os dados foram analisados pelo softwareestatístico Statistical Package for Social Science, versão 20.0. Resultados: Prevaleceram os pacientes do sexo feminino (61,3 %), cor branca (43,5%), viúvos (35,5%), aposentados (66,1%) e não alfabetizados (62,9%). O principal motivo de estar acamado foi devido a sequelas do Acidente Vascular Encefálico (35,5%). Evidenciou-se prevalência de risco muito alto em 59,7% das pessoas acamadas. Conclusão: O risco para Lesão por Pressão foi elevado, e a identificação dos fatores de risco é necessária e pode contribuir para estratégias preventivas ou redutoras deste agravo. (AU)

Objective: To assess the risk of pressure ulcers in bedridden individuals assisted by the Family Health Strategy. Method: A cross-sectional study employing a quantitative approach was conducted with 62 patients. Data collection was performed through a semi-structured questionnaire, encompassing sociodemographic and clinical data, as well as the assessment of pressure ulcer risk using the Braden Scale. Data were analyzed using the Statistical Package for the Social Sciences software, version 20.0. Results: Female patients (61.3%), Caucasians (43.5%), widows (35.5%), married individuals (66.1%), and those with no formal education (62.9%) predominated. The primary reason for being bedridden was sequelae from a stroke (35.5%). A prevalence of very high risk was observed in 59.7% of bedridden individuals. Conclusion: The risk of pressure ulcers was high, emphasizing the necessity of identifying risk factors to inform preventive or mitigating strategies for this condition. (AU)

Objetivo: Evaluar el riesgo de Úlceras por Presión en personas encamadas atendidas por la Estrategia Salud de la Familia. Método: Se realizó un estudio transversal con enfoque cuantitativo con 62 pacientes. La recolección de datos se realizó a través de un cuestionario semiestructurado con datos sociodemográficos y clínicos, así como la evaluación del riesgo de úlceras por presión utilizando la Escala de Braden. Los datos fueron analizados utilizando el softwareStatistical Package for Social Science, versión 20.0. Resultados: Predominaron pacientes de sexo femenino (61,3%), raza blanca (43,5%), viudas (35,5%), jubiladas (66,1%) y analfabetas (62,9%). El principal motivo de encamación fue por las secuelas de un accidente cerebrovascular (35,5%). Hubo una prevalencia de riesgo muy alta en el 59,7% de las personas encamadas. Conclusión: El riesgo de úlceras por presión fue alto, y la identificación de los factores de riesgo es necesaria y puede contribuir a estrategias preventivas o reductoras de esta condición. (AU)

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis.

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

Inverted U-shaped relationship between Barthel Index Score and falls in Chinese non-bedridden patients: a cross-sectional study.

BACKGROUND: Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments. OBJECTIVES: To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients. METHODS: In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected. RESULTS: A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00-1.04) and 0.97 (95%CI 0.96-0.99), respectively. CONCLUSIONS: Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments.

Humidity-Sensing Mattress for Long-Term Bedridden Patients with Incontinence-Associated Dermatitis.

Designing new medical devices with advanced humidity sensors is of great significance for patients with incontinence-associated dermatitis (IAD). The primary goal of this study is to test the humidity-sensing mattress system for patients with IAD in clinical settings. The design of the mattress is set at 203 cm, with 10 × 3 sensors, dimensions of 19 × 32 cm, and a weighted bearing of 200 kg. The main sensors consist of a humidity-sensing film, a thin-film electrode (6 × 0.1 mm), and a glass substrate (500 nm). The sensitivity of the test mattress system showed that the resistance-humidity sensor was at a temperature of 35 °C (V0 = 30 V, V0 = 350 mV), with slope at 1.13 V/fF, f = 1 MHz, 20-90% RH, and a response time of 20 s at 2 µm. In addition, the humidity sensor reached 90% RH, with a response time of less than 10 s, a magnitude of 107-104 Ω, 1 mol%, CrO1.5, and FO1.5, respectively. This design is not only a simple, low-cost medical sensing device, but also opens a new pathway for developing humidity-sensing mattresses in the field of flexible sensors, wearable medical diagnostic devices, and health detection.

[Risk of cannulation site bleeding during physical therapy mobilization during extracorporeal membrane oxygenation : A retrospective analysis in patients with acute respiratory failure]. / Blutungsrisiko im Kanülenbereich bei physiotherapeutischer Mobilisation unter extrakorporaler Membranoxygenierung : Eine retrospektive Analyse bei Patient*innen mit akutem Lungenversagen.

BACKGROUND: Patients suffering from acute respiratory distress syndrome receive extracorporeal membrane oxygenation (ECMO) as the last possible therapy. At the University Hospital Tübingen, these patients also receive physical therapy during this phase from a specially trained team to counteract physical deconditioning. OBJECTIVES: In this work, the risk of cannula site bleeding during physiotherapy mobilization is investigated and aspects regarding safety are described. METHODS: From 2013 to 2018, 83 patients matching the inclusion criteria were treated at the Anesthesiology Intensive Care Unit at the University Hospital Tübingen. The datasets were retrospectively analyzed by means of a case-control study. For comparison, the patients were divided into a passive and an active group according to the achieved level of mobilization. Bleeding events, ECMO implantation duration, and other aspects were taken into consideration in the analysis. RESULTS AND CONCLUSION: There were two bleeding events in the passive and two bleeding events in the active group, but these were not related to physical therapy mobilization. The ECMO implantation duration varied between 1 and 77 days. Physical therapy mobilization by a specially trained interdisciplinary team did not increase the risk of bleeding at the cannulation site.

Feasibility and early effects of bed-cycling eccentric training: Potential clinical applications.

PURPOSE: This study aimed to evaluate feasibility and early effects of moderate intensity bed-cycling eccentric training on healthy individuals, and establish whether this training modality could be implemented into bedridden patients' routine care. METHODS: Longitudinal study with prepost exercise intervention measurements. The development of a bed-adapted eccentric ergometer allowed to conduct five training sessions during 3 weeks at increasing intensity on 11 healthy individuals. Force-speed relationship, maximal voluntary knee extension force and neural activation of subjects were evaluated before and after the programme. RESULTS: Five training sessions were sufficient to decrease the rate of perceived exertion whereas eccentric power output increased (+40%). After training, maximal voluntary isometric contraction force measured during knee extension had significantly improved in all subjects, with a mean increase of 17%. Maximal cycling power was also significantly higher (+7%) after the training programme. CONCLUSION: Taken together, these results show that moderate load eccentric bed cycling (i) was feasible and efficient, (ii) did not generate excessive individual perception of effort during exercise nor develop major muscular or joint pain after training and (iii) allowed early force and power gains in healthy subjects.

Molecular Epidemiology of Staphylococcus aureus and MRSA in Bedridden Patients and Residents of Long-Term Care Facilities.

At present, multidrug-resistant microorganisms are already responsible for community-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious public health risk worldwide because of the rapid spread and diversification of pandemic clones that are characterized by increasing virulence and antimicrobial resistance. The aim of this study was to identify the prevalence and factors associated with nasal, oral and rectal carriage of S. aureus and MRSA in bedridden patients and residents of long-term care facilities for the elderly (LTCFs) in Botucatu, SP, Brazil. Nasal, oral and rectal swab isolates obtained from 226 LTCF residents or home-bedridden patients between 2017 and 2018 were submitted to susceptibility testing, detection of the mecA gene, SCCmec characterization, and molecular typing by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Logistic regression analysis was used to identify risk factors associated with the presence of S. aureus and MRSA. The prevalence of S. aureus and MRSA was 33.6% (n = 76) and 8% (n = 18), respectively. At the nine LTCFs studied, the prevalence of S. aureus ranged from 16.6% to 85.7% and that of MRSA from 13.3% to 25%. Living in an LTCF, male gender, a history of surgeries, and a high Charlson Comorbidity Index score were risk factors associated with S. aureus carriage, while MRSA carriage was positively associated with male gender. This study showed a high prevalence of S. aureus among elderly residents of small (<15 residents) and medium-sized (15−49 residents) LTCFs and a higher prevalence of MRSA in the oropharynx.

Repositioning mattress: how a lateral tilt position reshapes the prevention of pressure ulcers in bedridden patients.

Pressure ulcers have been part of tissue damage without effectiveness in medical, surgical, and intensive care units. This study aims to focus on developing lateral tilt positions for effective pressure ulcer relief for bedridden patients. A repositioning mattress was placed in the side-lying left lateral tilt position (15°, 30°, 45°), sheering (0.680, 1.323, 1.870), interface pressure (2.550, 2.290, 2.830), and placed at 1.5 m long piece of polyethylene rubber. The design strength was set at 6000 N and 2100 mm x 1105 mm (σt,0,d = 42, σc,0,d = 34). The design shows the greatest supine position at 30°, 1.323, 2.290, pressure load (Δp0 = 1.125 (1820) ≈ 2050 psi, Δp3000 = 1.125 (620) ≈ 700 psi), tensile stress (σt,0,d (MPa) = 42), compressive stress (σc,0,d (MPa) = 34), and FOS (σt,0,d = 42, σc,0,d = 34). The factor of safety illustrated that the 30° lateral tilt position is more consistent in repositioning for pressure ulcer prevention compared to the supine-to-tilt region. Further, an application of repositioning mattresses was developed to test in bedridden patients with tissue ulcers in nursing homes.

Telenursing: How do caregivers treat and prevent pressure injury in bedridden patients during the COVID-19 pandemic in Thailand? Using an embedded approach.

OBJECTIVE: To evaluate telenursing for caregivers (CGs) to treat and prevent pressure injury (PI) in bedridden patients (BPs) during the COVID-19 pandemic in Thailand. METHODS: Purposive sampling of 70 CGs [intervention group (i-group): n = 35 and control group (c-group): n = 35)] using an embedded approach was conducted from August 2020 to February 2021. The QUAN data were concurrently collected via online semi-structured interviews (OSIs) and video in-depth interviews (VIIs), then analysed using multivariate analysis of variance and thematic analysis. RESULTS: The QUAN data showed that CGs treating and preventing PI in BPs has a significant and positive effect (p < 0.01). The qual data illustrates that telenursing for CGs treating and preventing PI in BPs is associated with training and education, skin cleaning, repositioning, monitoring, and assessment of PI during the COVID-19 pandemic. CONCLUSION AND IMPLICATIONS: Telenursing for CGs treating and preventing PI in BPs is valuable to the professional consultation during the COVID-19 pandemic. Telenursing can reduce the CG burden, instructing them how to visually examine, clean, monitor, and risk assess the skin of BPs to prevent PIs.

The design and application of a foot cleaning device for bedridden patients in ICU / 中国实用护理杂志

Objective:A foot cleaning device for bedridden patients in ICU was made, and its application effects in foot cleaning for bedridden patients in ICU was discussed.Methods:A total of 200 inpatients in the department of ICU from April 2021 to October 2021 were selected as the research objects.According to the random number table, the patients were divided into two groups, including 100 patients in the control group and 100 patients in the experimental group.The patients in the control group used an ordinary foot basin and dipped warm water by a towel for foot wiping and cleaning. The patients in the experimental group used a foot cleaning device for bedridden patients developed and designed by our hospital. Both groups received warm water foot bath for 20 minutes after cleaning. The incidence of adverse events, average foot washing time, total foot washing time, the subjective comfort and satisfaction of the patients and the satisfaction of the operator were observed.Results:The incidence of adverse events during foot cleaning in the experimental group was 2.00%(28/1 400) lower than 4.36%(61/1 400) in the control group, the difference was statistically significant ( χ2=11.88, P<0.05). The foot washing time in the observation group [(27.77 ± 1.34) min] was longer than that in the control group [(24.63 ± 2.36) min], the difference was statistically significant ( t=9.30, P<0.05). The total foot washing time in the observation group [(27.77 ± 1.34) min] was shorter than that in the control group [(49.26 ± 4.71)min], the difference was statistically significant ( t=42.51, P<0.05). The subjective comfort of foot cleaning, the satisfaction of foot cleaning of patients and the satisfaction of foot cleaning operators in the experimental group were 91.00 (91/100) , 97.00% (97/100) , 91.67% (55/60) , while the control group were 75.00% (75/100) 、85.00% (85/100) , 75.00% (45/60) , and the differences between the two groups were statistically significant ( Z=-3.04, -4.82, -2.71, all P<0.05). Conclusions:The self made foot cleaning device for bedridden patients in this study can be used in ICU patients. It can effectively reduce the incidence of adverse events in the process of foot washing and shorten the time of foot washing. It can also improve the comfort and satisfaction of patients, and improve the satisfaction of operators.

The pulmonary infection risk factors in long-term bedridden patients: a meta-analysis.

This study aimed to review the pulmonary infection risk factors in long-term bedridden patients. The Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, Wanfang, and the China Biomedical Literature Service System databases were searched to retrieve articles on the clinical risk factors, from database establishment to July 31, 2020. Two researchers independently screened the search results, evaluated the quality of the studies using NOS criteria, and extracted the data. The meta-analysis was performed using RevMan 5.3. A total of 13 articles including 10,182 patients were included. The statistically significant risk factors included age (OR=1.82), diabetes (OR=2.15), hormones (OR=3.14), consciousness disorders (OR=3.83), BMI<18.5 kg/m2 (OR=1.57), antibiotics (OR=2.21), smoking history (OR=1.68), nasal-feeding (OR=4.64), ventilator use (OR=5.95), invasive operations (OR=5.04), hospitalization times (OR=3.16), and stay-in-bed times (OR=2.69). Therefore, according to the OR values, age, a BMI<18.5 kg/m2, and smoking history were low risk-factors (2≥OR>1). Diabetes, antibiotics, and stay-in-bed times were medium risk-factors (3≥OR>2). Hormone levels, consciousness disorders, nasal-feeding, ventilator use, invasive operations, and hospitalization times were high risk-factors (OR>3). In conclusion, the low risk-factors (age, BMI, smoking history), the medium risk-factors (diabetes, antibiotics, stay-in-bed length), and especially the high risk-factors (hormones, consciousness disorders, nasal-feeding, ventilator use, invasive operations, hospitalization times) deserve more attention for preventing pulmonary infections in long-term bedridden patients.

Prognostic Significance of Ultrasound Findings of Acute Acalculous Cholecystitis for Elderly Long-Term Bedridden Patients.

Background: Acute acalculous cholecystitis (AAC) is characterized by the development of cholecystitis in the gallbladder without gallstones or with small gallstones unrelated to inflammatory diseases. This disease is not rare in the elderly bedridden patients with co-morbidities and prone to develop life-threatening gangrene or perforation of gallbladder. Early imaging is essential for detecting and effectively treating AAC. This study aimed to evaluate the use of ultrasound diagnostic criteria for the diagnosis and prognosis of elderly long-term bedridden patients with suspected AAC. Methods: We retrospectively studied 374 elderly bedridden patients with clinical manifestations of AC at the acute stage of the disease. Gallbladder anomalies were found in 92 patients by ultrasound examination, which correlated with the duration time of clinical manifestations, complications, as well as therapeutic prognosis. The major and minor ultrasound criteria of AAC were made according to the Tokyo Guidelines 2018. Ultrasound results were thought to be AAC positive when they met two major criteria or one major and two minor criteria. Results: Forty-three (46.7%) of the 92 patients presented with AAC (+) test results based on the ultrasound criteria, with a higher incidence of complications (27.9%) than AAC (-) patients (0%; P < 0.001). The median length of symptoms (8 vs. 4 days, P < 0.001) and duration of antibiotic therapy (13 vs. 5 days, P < 0.001) were longer in the AAC (+) group. Conclusions: The ultrasound-based AAC (+) group often had a worse prognosis than the AAC (-) group. Therefore, patients from the AAC (+) group should receive a follow-up ultrasound examination to detect disease progression early.

Calidad de atención nutricional desde la percepción del paciente hospitalizado antes y durante la COVID-19 / Quality of nutritional care from the perception of the hospitalized patient before and during covid-19

Fundamentos: La pandemia del COVID-19 podría causar un cambio en la valoración de la calidad de atención nutricionaldel paciente hospitalizado. El objetivo principal del estudio fue analizar el impacto de la COVID-19 en la percepción delpaciente hospitalizado sobre la calidad de atención nutricional en un grupo antes y durante la COVID-19. Métodos: Hipotético deductivo, descriptivo comparativo,de diseño transversal; con población muestreada en su totalidad: 80 pacientes (antes) y 84 durante la COVID-19 delHospital Belén de Trujillo. Se aplicó el cuestionario SERVQUAL adaptado por Lora y Rebaza, con 5 dimensiones: Fiabilidad, Capacidad de respuesta, Seguridad, Empatía y Aspectos Tangibles y 22 preguntas. Resultados: La calidad de atención nutricional fue percibida como buena (65%) antes del COVID-19, regular para fiabilidad (42,5%) y bueno para capacidad de respuesta (50%), seguridad (77,5%), empatía (61,3%) y aspectos tangibles (93,8%); y durante la COVID-19, fue regular (64,3%), fiabilidad (41,7%), capacidad de respuesta (59,5%) y seguridad (52,4%); malo (40,5%) para empatía y bueno (53,6%) para aspectos tangibles. Conclusiones: El impacto de la pandemia COVID-19 en la percepción del paciente hospitalizado sobre la calidad de atención nutricional se evidenció con un cambio en la percepción de bueno a regular, así como en todas sus dimensiones. (AU)

Background: The COVID-19 pandemic could cause a change in the assessment of the quality of nutritional care for hospitalized patients. The main objective of the study was to analyzethe impact of COVID-19 on the perception of hospitalized patients on the quality of nutritional care in a group before and during COVID-19. Methods: Hypothetical deductive, descriptive comparative, cross-sectional design; with population sampled in its entirety:80 patients (before) and 84 during COVID-19 at Hospital Belén de Trujillo. The SERVQUAL questionnaire adapted by Lora and Rebaza was applied, with 5 dimensions: Reliability, Responsiveness, Security, Empathy and Tangible Aspects and 22 questions. Results: The quality of nutritional care was perceived asgood (65%) before COVID-19, fair for reliability (42.5%) and good for responsiveness (50%), safety (77.5%), empathy (61.3%) and tangible aspects (93.8%); and during COVID-19,it was regular (64.3%), reliability (41.7%), response capacity (59.5%) and safety (52.4%); bad (40.5%) for empathy and good (53.6%) for tangible aspects. Conclusions: The impact of the COVID-19 pandemic on the perception of hospitalized patients on the quality of nutritional care was evidenced with a change in perception from good to fair, as well as in all its dimensions. (AU)

The effects of total enteral nutrition via nasal feeding and percutaneous radiologic gastrostomy in patients with dysphagia following a cerebral infarction.

OBJECTIVE: To explore the effects of total enteral nutrition (TEN) via nasal feeding and percutaneous radiologic gastrostomy (PRG) on the nutritional status, quality of life, and prognosis in long-term bedridden patients with dysphagia after cerebral infarction. METHODS: One hundred and sixty long-term bedridden patients with dysphagia after cerebral infarction were randomly divided into a control group (CG, n=80) and an observation group (OG, n=80). The CG was administered TEN via nasal feeding, and the OG was administered TEN via PRG. The two groups' results were compared. RESULTS: The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores in the OG were lower than the corresponding scores in the CG at 3 and 6 months after the TEN (P < 0.05). The OG had a higher proportion of high compliance, but a lower proportion of both moderate and low compliance than the CG (P < 0.05). The total incidence of TEN intolerance was 8.75% in the OG, lower than the 20.00% in the CG (P < 0.05). The AST, ALB, ALT, TBIL, Scr, and BUN levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The IgM, IgG, IgA, hemoglobin, total protein, albumin, and transferrin levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The incidence of catheterization complications was 20.00% in the OG, higher than the 8.75% in the CG (P < 0.05). The OG had higher SF-36 scores than the CG at 6 months after the TEN (P < 0.05). CONCLUSION: Both nasal feeding and TEN via PRG can effectively improve patients' nutritional status, enhance their immune function, and improve their liver and renal function, but TEN after PRG is more effective at reducing intolerance and promoting quality of life in long-term bedridden patients with dysphagia after cerebral infarction. However, TEN after PRG will also increase the occurrence of recent complications, complications that should get additional clinical attention.

Stability of Skin Microbiome at Sacral Regions of Healthy Young Adults, Ambulatory Older Adults, and Bedridden Older Patients After 2 Years.

OBJECTIVE: The sacral skin of bedridden older patients often develops a dysbiotic condition. To clarify whether the condition changes or is sustained over time, we analyzed the skin microbiome and the skin physiological functions of the sacral skin in patients who completed our 2017 study. METHODS: In 2019, we collected the microbiome on the sacral region and measured sacral skin hydration, pH, and transepidermal water loss from 7 healthy young adults, 10 ambulatory older adults, and 8 bedridden older patients, all of whom had been recruited for the 2017 study. For microbiome analysis, 16S ribosomal RNA-based metagenomic analysis was used. RESULTS: No significant differences in the microbial compositions or any alpha diversity metrics were found in the bedridden older patients between the 2017 and 2019 studies; the higher gut-related bacteria were still observed on the sacral skin of the bedridden older patients even after 2 years. Only skin pH showed a significant decrease, approaching normal skin condition, in the bedridden older patients over 2 years. CONCLUSION: This study indicated that gut-related bacteria stably resided in the sacral skin in bedridden patients, even if the patient had tried to restore skin physiological functions using daily skin care. We propose the importance of skin care that focuses more on bacterial decontamination for the sacral region of bedridden older patients, in order to decrease the chances of skin/wound infection and inflammation.

Effects of Nutritional Treatment on the Frequency of Pneumonia in Bedridden Patients Receiving Oral Care.

Objective Pneumonia develops in bedridden patients, even in those receiving oral care, and malnutrition is associated with the development of pneumonia. We examined the effects of nutritional treatment on the prevention of pneumonia. Patients and Methods We retrospectively examined the effects of nutritional treatment on the prevention of pneumonia by analyzing the records of bedridden patients (n=68; mean age: 68.0 years) who stayed in a hospital for 2 years or longer. Results Among the analyzed patients, pneumonia developed in 52 (76%) patients, and the mean frequency of pneumonia was 1.6 times per year during the first year of stay. In a multivariate analysis, the serum albumin level at admission in the pneumonia group was lower than that in the non-pneumonia group. The frequency of pneumonia during the second year of stay was lower than that during the first year of stay. Serum levels of albumin and total protein (TP) at one year after admission were higher than those at admission in all analyzed patients, and in all patients (n=52) and elderly (≥65 years) patients (n=31) in the pneumonia group. The proportions of patients with hypoalbuminemia (<3.5 g/dL) and hypoproteinemia (<6.5 g/dL) at one year after admission were lower than those at admission. The increases in the proportions of patients presenting a reduced frequency of pneumonia were correlated with increases in the proportions of patients presenting increased levels of albumin and/or TP. Conclusion Nutritional treatment may reduce the frequency of pneumonia by improving malnutrition in bedridden patients receiving oral care.

Effects of a Synbiotic Formula on Functional Bowel Disorders and Gut Microbiota Profile during Long-Term Home Enteral Nutrition (LTHEN): A Pilot Study.

Long-term enteral nutrition (LTEN) can induce gut microbiota (GM) dysbiosis and gastrointestinal related symptoms, such as constipation or diarrhoea. To date, the treatment of constipation is based on the use of laxatives and prebiotics. Only recently have probiotics and synbiotics been considered, the latter modulating the GM and regulating intestinal functions. This randomized open-label intervention study evaluated the effects of synbiotic treatment on the GM profile, its functional activity and on intestinal functions in long-term home EN (LTHEN) patients. Twenty LTHEN patients were recruited to take enteral formula plus one sachet/day of synbiotic (intervention group, IG) or enteral formula (control group, CG) for four months and evaluated for constipation, stool consistency, and GM and metabolite profiles. In IG patients, statistically significant reduction of constipation and increase of stool consistency were observed after four months (T1), compared to CG subjects. GM ecology analyses revealed a decrease in the microbial diversity of both IC and CG groups. Biodiversity increased at T1 for 5/11 IG patients and Methanobrevibacter was identified as the biomarker correlated to the richness increase. Moreover, the increase of short chain fatty acids and the reduction of harmful molecules have been correlated to synbiotic administration. Synbiotics improve constipation symptoms and influences Methanobrevibacter growth in LTHEN patients.

Incidence and Related Factors for Hospital-Acquired Pneumonia Among Older Bedridden Patients in China: A Hospital-Based Multicenter Registry Data Based Study.

Objective: To identify the incidence and related factors for hospital-acquired pneumonia (HAP) among older bedridden patients in China. Study design and setting: This multicenter registry data-based study conducted between November 2015 and March 2016 surveyed 7,324 older bedridden patients from 25 hospitals in China (six tertiary, 12 non-tertiary, and seven community hospitals). The occurrence of HAP among all participants was monitored by trained investigators. Demographics, hospitalization information and comorbidity differences were compared between patients with and without HAP. A multilevel regression analysis was used to explore the factors associated with HAP. Results: Among 7,324 older bedridden patients, 566 patients were diagnosed with HAP. The incidence of HAP in this study was 13.9 per 1,000 person-days. There were statistical differences in gender, age, length of bedridden days, BMI, smoking, department, undergoing general anesthesia surgery, ventilator application, Charlson comorbity index (CCI) score, disturbance of consciousness, tranquilizer use, glucocorticosteroid use, and antibiotic use between patients with HAP and patients without HAP (all p < 0.05). Multilevel regression analysis found no significant variance for HAP at the hospital level (0.332, t = 1.875, p > 0.05). There were significant differences for the occurrence of HAP among different departments (0.553, t = 4.320, p < 0.01). The incidence density of HAP was highest in the ICU (30.1‰) among the selected departments, followed by the departments of neurosurgery (18.7‰) and neurology medicine (16.6‰). Individual patient-level factors, including older age, disturbance of consciousness, total CCI score, ICU admission, and glucocorticoid and antibiotic use, were found to be associated with the occurrence of HAP (all p < 0.05). Conclusion: A relatively high incidence density of HAP among older bedridden patients was identified, as well as several factors associated with HAP among the population. This suggests that attention should be paid to the effective management of these related factors of older bedridden patients to reduce the occurrence of HAP.

Effect of integrated nursing care mode on lower extremity deep venous thrombosis in bedridden patients / 中国实用护理杂志

Objective@#To explore the influence of integrated nursing care mode on the incidence of deep vein thrombosis in lower extremities in bedridden patients.@*Methods@#82 cases of chronic bed rest patients in our hospital were selected as clinical subjects. The time of admission was from December 2016 to December 2017. The patients were divided into control group (routine nursing, 41 cases) and observation group (medical nursing integrated nursing, 41 cases). To compare the influence of nursing intervention on the incidence of deep venous thrombosis of the lower extremities.@*Results@#After treatment, the incidence of deep vein thrombosis in the control group was 24.39% (10/41), and that in the observation group was 4.88% (2/41). The difference was statistically significant (χ2=6.248, P<0.05). The prevention disease score and nursing satisfaction score of the observation group were (35.01±4.21) points and (87.02±5.22) points, and the control group were (28.65±5.87) points and (68.75±4.64) points. The difference was statistically significant (t=5.638, 16.750, P<0.01). The DD dimer, aPTT and PT of the observation group were (448.82±56.27) ug/L, (29.75±2.01) s, (12.88±0.65) s, and the control group were (610.32±72.88) ug/L, (26.81±1.98) s, (10.54±0.59) s. The differences were statistically significant (t=11.231, 6.672, 17.068, P<0.05).@*Conclusion@#For the patients in bed, the effect of nursing intervention is obvious, which can effectively reduce the incidence of deep venous thrombosis and improve the blood coagulation function of the patients.

Effect of integrated nursing care mode on lower extremity deep venous thrombosis in bedridden patients / 中国实用护理杂志

Objective To explore the influence of integrated nursing care mode on the incidence of deep vein thrombosis in lower extremities in bedridden patients. Methods 82 cases of chronic bed rest patients in our hospital were selected as clinical subjects. The time of admission was from December 2016 to December 2017. The patients were divided into control group (routine nursing, 41 cases) and observation group (medical nursing integrated nursing, 41 cases). To compare the influence of nursing intervention on the incidence of deep venous thrombosis of the lower extremities. Results After treatment, the incidence of deep vein thrombosis in the control group was 24.39% (10/41), and that in the observation group was 4.88% (2/41). The difference was statistically significant (χ2=6.248, P<0.05). The prevention disease score and nursing satisfaction score of the observation group were (35.01±4.21) points and (87.02 ± 5.22) points, and the control group were (28.65 ± 5.87) points and (68.75 ± 4.64) points. The difference was statistically significant (t=5.638, 16.750, P<0.01). The DD dimer, aPTT and PT of the observation group were (448.82±56.27) ug/L, (29.75±2.01) s, (12.88±0.65) s, and the control group were (610.32 ± 72.88) ug/L, (26.81 ± 1.98) s, (10.54 ± 0.59) s. The differences were statistically significant (t=11.231, 6.672, 17.068, P<0.05). Conclusion For the patients in bed, the effect of nursing intervention is obvious, which can effectively reduce the incidence of deep venous thrombosis and improve the blood coagulation function of the patients.