Heidi Splete

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers used ICD-9 codes to identify cases of sepsis and the sources of the infections. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among the population of patients with diabetes and sepsis, 57% were women, and 64% were white. The average patient age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes, but were significantly less likely to develop acute respiratory failure (see chart) (Crit. Care 2009 Feb. 12 [doi: 10.1186/cc7717]).

No other significant differences appeared in the occurrence of other organ dysfunctions, or in the average total number of organ dysfunctions in the two groups. However, the difference in acute respiratory failure persisted regardless of the source of infection. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

The overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), but fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

The reasons for the distinction in respiratory failure rates between patients with and without diabetes remain uncertain. Theories include the potential blunted inflammatory response to organ dysfunction in people with diabetes, the investigators said, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they may be more alert to signs of infection. Diabetes medications may play a role, too.

“Pharmacological aspects of [diabetes] may also influence the development of organ dysfunction, because many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” the researchers noted.

But more research is needed to show the effects of diabetes medications and other factors on respiratory problems in sepsis patients in order to develop more effective treatments, they added.

The researchers had no financial conflicts to disclose.

Elsevier Global Medical News

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers used ICD-9 codes to identify cases of sepsis and the sources of the infections. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among the population of patients with diabetes and sepsis, 57% were women, and 64% were white. The average patient age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes, but were significantly less likely to develop acute respiratory failure (see chart) (Crit. Care 2009 Feb. 12 [doi: 10.1186/cc7717]).

No other significant differences appeared in the occurrence of other organ dysfunctions, or in the average total number of organ dysfunctions in the two groups. However, the difference in acute respiratory failure persisted regardless of the source of infection. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

The overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), but fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

The reasons for the distinction in respiratory failure rates between patients with and without diabetes remain uncertain. Theories include the potential blunted inflammatory response to organ dysfunction in people with diabetes, the investigators said, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they may be more alert to signs of infection. Diabetes medications may play a role, too.

“Pharmacological aspects of [diabetes] may also influence the development of organ dysfunction, because many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” the researchers noted.

But more research is needed to show the effects of diabetes medications and other factors on respiratory problems in sepsis patients in order to develop more effective treatments, they added.

The researchers had no financial conflicts to disclose.

Elsevier Global Medical News

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers used ICD-9 codes to identify cases of sepsis and the sources of the infections. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among the population of patients with diabetes and sepsis, 57% were women, and 64% were white. The average patient age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes, but were significantly less likely to develop acute respiratory failure (see chart) (Crit. Care 2009 Feb. 12 [doi: 10.1186/cc7717]).

No other significant differences appeared in the occurrence of other organ dysfunctions, or in the average total number of organ dysfunctions in the two groups. However, the difference in acute respiratory failure persisted regardless of the source of infection. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

The overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), but fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

The reasons for the distinction in respiratory failure rates between patients with and without diabetes remain uncertain. Theories include the potential blunted inflammatory response to organ dysfunction in people with diabetes, the investigators said, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they may be more alert to signs of infection. Diabetes medications may play a role, too.

“Pharmacological aspects of [diabetes] may also influence the development of organ dysfunction, because many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” the researchers noted.

But more research is needed to show the effects of diabetes medications and other factors on respiratory problems in sepsis patients in order to develop more effective treatments, they added.

The researchers had no financial conflicts to disclose.

Elsevier Global Medical News

PENTAGON CITY, VA. — Sexual health problems in breast cancer survivors peaked about 12 months after the completion of treatment, and mental health symptoms significantly predicted these problems, according to findings from a study involving 54 female breast cancer survivors.

The findings suggest a need for providers to discuss with breast cancer patients the potential for sexual problems after therapy, and to be alert for mental health symptoms that may increase the risk for these problems, said Beth Fischgrund, a medical student at Northwestern University, Chicago.

To examine which mental health problems were associated with sexual problems and to pinpoint the peak time for these problems, Ms. Fischgrund and her colleagues, surveyed women who had completed breast cancer treatment within 24 months of study enrollment.

After their treatment was finished participants completed two surveys—one at 6–12 months and the other at 18–24 months. Each woman had been in a monogamous relationship since at least a year before her breast cancer diagnosis. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

At the time of the first survey, 40% of the women reported moderate to severe sexual problems, but this number increased to 53% at the time of the second survey. Sexual health was assessed using the Sexual Problems Scale, which measured lack of interest in sex, difficulties with arousal and orgasm, lack of pleasure during sex, and pain during sex. These components were combined to calculate a total sexual score.

The findings suggest that reports of sexual problems peaked at about 12 months post treatment, and decreased by 18–24 months. Mental health symptoms were significant predictors of sexual health problems 6 months later, the researchers said. But there were no significant differences in mental health scores between the two time periods. The strongest predictors of sexual problems were interpersonal difficulties and depression.

When asked why sexual problems didn't emerge immediately after treatment, Ms. Fischgrund suggested that during therapy, women with breast cancer are in “survival mode.” At that time, they likely focus on their treatment and on beating the disease, and they don't focus as much on their sexual relationships, she theorized. The study was supported by the Lynn Sage Cancer Research Foundation. The researchers had no financial conflicts to disclose.

PENTAGON CITY, VA. — Sexual health problems in breast cancer survivors peaked about 12 months after the completion of treatment, and mental health symptoms significantly predicted these problems, according to findings from a study involving 54 female breast cancer survivors.

The findings suggest a need for providers to discuss with breast cancer patients the potential for sexual problems after therapy, and to be alert for mental health symptoms that may increase the risk for these problems, said Beth Fischgrund, a medical student at Northwestern University, Chicago.

To examine which mental health problems were associated with sexual problems and to pinpoint the peak time for these problems, Ms. Fischgrund and her colleagues, surveyed women who had completed breast cancer treatment within 24 months of study enrollment.

After their treatment was finished participants completed two surveys—one at 6–12 months and the other at 18–24 months. Each woman had been in a monogamous relationship since at least a year before her breast cancer diagnosis. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

At the time of the first survey, 40% of the women reported moderate to severe sexual problems, but this number increased to 53% at the time of the second survey. Sexual health was assessed using the Sexual Problems Scale, which measured lack of interest in sex, difficulties with arousal and orgasm, lack of pleasure during sex, and pain during sex. These components were combined to calculate a total sexual score.

The findings suggest that reports of sexual problems peaked at about 12 months post treatment, and decreased by 18–24 months. Mental health symptoms were significant predictors of sexual health problems 6 months later, the researchers said. But there were no significant differences in mental health scores between the two time periods. The strongest predictors of sexual problems were interpersonal difficulties and depression.

When asked why sexual problems didn't emerge immediately after treatment, Ms. Fischgrund suggested that during therapy, women with breast cancer are in “survival mode.” At that time, they likely focus on their treatment and on beating the disease, and they don't focus as much on their sexual relationships, she theorized. The study was supported by the Lynn Sage Cancer Research Foundation. The researchers had no financial conflicts to disclose.

PENTAGON CITY, VA. — Sexual health problems in breast cancer survivors peaked about 12 months after the completion of treatment, and mental health symptoms significantly predicted these problems, according to findings from a study involving 54 female breast cancer survivors.

The findings suggest a need for providers to discuss with breast cancer patients the potential for sexual problems after therapy, and to be alert for mental health symptoms that may increase the risk for these problems, said Beth Fischgrund, a medical student at Northwestern University, Chicago.

To examine which mental health problems were associated with sexual problems and to pinpoint the peak time for these problems, Ms. Fischgrund and her colleagues, surveyed women who had completed breast cancer treatment within 24 months of study enrollment.

After their treatment was finished participants completed two surveys—one at 6–12 months and the other at 18–24 months. Each woman had been in a monogamous relationship since at least a year before her breast cancer diagnosis. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

At the time of the first survey, 40% of the women reported moderate to severe sexual problems, but this number increased to 53% at the time of the second survey. Sexual health was assessed using the Sexual Problems Scale, which measured lack of interest in sex, difficulties with arousal and orgasm, lack of pleasure during sex, and pain during sex. These components were combined to calculate a total sexual score.

The findings suggest that reports of sexual problems peaked at about 12 months post treatment, and decreased by 18–24 months. Mental health symptoms were significant predictors of sexual health problems 6 months later, the researchers said. But there were no significant differences in mental health scores between the two time periods. The strongest predictors of sexual problems were interpersonal difficulties and depression.

When asked why sexual problems didn't emerge immediately after treatment, Ms. Fischgrund suggested that during therapy, women with breast cancer are in “survival mode.” At that time, they likely focus on their treatment and on beating the disease, and they don't focus as much on their sexual relationships, she theorized. The study was supported by the Lynn Sage Cancer Research Foundation. The researchers had no financial conflicts to disclose.

Statins have no impact on the development of dementia or Alzheimer's disease, according to a Cochrane Review of two randomized, controlled trials involving more than 26,000 adults.

Previous studies in animal models have shown that lowering cholesterol slows pathologic signs of Alzheimer's disease (AD), and data from clinical studies in older adults who took statins for vascular disease have suggested that statin users had a reduced risk of developing AD. But the clinical studies in humans were not randomized trials, said Dr. Bernadette McGuinness of Queen's University Belfast, Northern Ireland.

In this review, Dr. McGuinness and her colleagues examined data from two large, randomized controlled trials that included 26,340 adults aged 40-82 years (Cochrane Database Syst. Rev. 2009 April 15; doi: 10.1002/14651858.cd007514

The Medical Research Council/British Heart Foundation Heart Protection Study (HPS) conducted in 2002 was a randomized, placebo-controlled trial of the effect of a daily dose of 40 mg simvastatin vs. placebo on the development of vascular disease in 20,536 high-risk adults, including 5,806 adults aged 70 years and older.

Cognitive decline was assessed via a questionnaire completed in person at the clinic or by phone. No significant differences appeared between the treatment and placebo groups in the overall percentages of patients who met criteria for cognitive impairment at the start of the study (23.7% vs. 24.2%). And 31 individuals in each group developed dementia during a 5-year follow-up period (Lancet 2002;360:7-22).

In another 2002 study, the Prospective Study of Pravastatin in the Elderly at Risk (known as the PROSPER trial), 5,804 adults aged 70-82 years were randomized to receive a daily dose of 40 mg pravastatin or a placebo. All the study participants had risk factors for vascular disease or a history of vascular disease. The cognitive function of the participants was assessed using neuropsychologic tests and the Mini-Mental State Examination. During a 3-year follow-up period, pravastatin had no significant impact on cognitive function (Lancet 2002;360:1623-30).

“The two trials identified were large scale and included patients at high risk of vascular disease,” noted the researchers, who had no relevant conflicts of interest to disclose. “The fact that they had similar findings was reassuring.”

Statins have no impact on the development of dementia or Alzheimer's disease, according to a Cochrane Review of two randomized, controlled trials involving more than 26,000 adults.

Previous studies in animal models have shown that lowering cholesterol slows pathologic signs of Alzheimer's disease (AD), and data from clinical studies in older adults who took statins for vascular disease have suggested that statin users had a reduced risk of developing AD. But the clinical studies in humans were not randomized trials, said Dr. Bernadette McGuinness of Queen's University Belfast, Northern Ireland.

In this review, Dr. McGuinness and her colleagues examined data from two large, randomized controlled trials that included 26,340 adults aged 40-82 years (Cochrane Database Syst. Rev. 2009 April 15; doi: 10.1002/14651858.cd007514

The Medical Research Council/British Heart Foundation Heart Protection Study (HPS) conducted in 2002 was a randomized, placebo-controlled trial of the effect of a daily dose of 40 mg simvastatin vs. placebo on the development of vascular disease in 20,536 high-risk adults, including 5,806 adults aged 70 years and older.

Cognitive decline was assessed via a questionnaire completed in person at the clinic or by phone. No significant differences appeared between the treatment and placebo groups in the overall percentages of patients who met criteria for cognitive impairment at the start of the study (23.7% vs. 24.2%). And 31 individuals in each group developed dementia during a 5-year follow-up period (Lancet 2002;360:7-22).

In another 2002 study, the Prospective Study of Pravastatin in the Elderly at Risk (known as the PROSPER trial), 5,804 adults aged 70-82 years were randomized to receive a daily dose of 40 mg pravastatin or a placebo. All the study participants had risk factors for vascular disease or a history of vascular disease. The cognitive function of the participants was assessed using neuropsychologic tests and the Mini-Mental State Examination. During a 3-year follow-up period, pravastatin had no significant impact on cognitive function (Lancet 2002;360:1623-30).

“The two trials identified were large scale and included patients at high risk of vascular disease,” noted the researchers, who had no relevant conflicts of interest to disclose. “The fact that they had similar findings was reassuring.”

Statins have no impact on the development of dementia or Alzheimer's disease, according to a Cochrane Review of two randomized, controlled trials involving more than 26,000 adults.

Previous studies in animal models have shown that lowering cholesterol slows pathologic signs of Alzheimer's disease (AD), and data from clinical studies in older adults who took statins for vascular disease have suggested that statin users had a reduced risk of developing AD. But the clinical studies in humans were not randomized trials, said Dr. Bernadette McGuinness of Queen's University Belfast, Northern Ireland.

In this review, Dr. McGuinness and her colleagues examined data from two large, randomized controlled trials that included 26,340 adults aged 40-82 years (Cochrane Database Syst. Rev. 2009 April 15; doi: 10.1002/14651858.cd007514

The Medical Research Council/British Heart Foundation Heart Protection Study (HPS) conducted in 2002 was a randomized, placebo-controlled trial of the effect of a daily dose of 40 mg simvastatin vs. placebo on the development of vascular disease in 20,536 high-risk adults, including 5,806 adults aged 70 years and older.

Cognitive decline was assessed via a questionnaire completed in person at the clinic or by phone. No significant differences appeared between the treatment and placebo groups in the overall percentages of patients who met criteria for cognitive impairment at the start of the study (23.7% vs. 24.2%). And 31 individuals in each group developed dementia during a 5-year follow-up period (Lancet 2002;360:7-22).

In another 2002 study, the Prospective Study of Pravastatin in the Elderly at Risk (known as the PROSPER trial), 5,804 adults aged 70-82 years were randomized to receive a daily dose of 40 mg pravastatin or a placebo. All the study participants had risk factors for vascular disease or a history of vascular disease. The cognitive function of the participants was assessed using neuropsychologic tests and the Mini-Mental State Examination. During a 3-year follow-up period, pravastatin had no significant impact on cognitive function (Lancet 2002;360:1623-30).

“The two trials identified were large scale and included patients at high risk of vascular disease,” noted the researchers, who had no relevant conflicts of interest to disclose. “The fact that they had similar findings was reassuring.”

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.