D R Thomas

..In addition to providing a moist wound environment, it has been theorized that preventing hypothermia in a wound and maintaining a normothermic state might improve wound healing...

..This review focuses on the available tools used in the long-term care setting and provides an overview of their characteristics and performance measures...

..Although body weight is easily measured, the evaluation of unintended weight loss in long-term care facilities is difficult...

..With the availability of recombinant hyaluronidase, subcutaneous infusion of fluids (hypodermoclysis) provides a better opportunity to treat mild to moderate dehydration in the nursing home and at home...

..Failure to distinguish among these causes of skeletal muscle loss often results in frustration over the clinical response to therapeutic interventions...

..General guidelines for the use of orexigenic agents are presented. Although much work remains to be done, anticytokine drugs seem to be a promising avenue for the treatment of involuntary weight loss...

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..The diagnosis is a sentinel event for nursing homes, and often is made at transfer to a hospital...

..Failing compliance with a natural source of essential nutrients, and in populations at high risk of vitamin deficiency, vitamin supplements should be encouraged...

..The low therapeutic success of current treatments and obnoxious side effects, however, limit patient satisfaction and compliance. There is a considerable need for improved therapeutic options to treat this devastating condition...

..To compare the functional status of ambulatory women in four academic nursing homes using standardized rating scales and physical performance measures used in community settings...

..The diagnosis is a sentinel event for nursing homes, and often is made at transfer to a hospital...

..There is increasing concern from these trials that pharmacological supplementation of vitamins may be associated with a higher mortality risk...

..No study has demonstrated that improvement in nutritional status can prevent pressure ulcers. There is at least suggestive evidence that improvement in nutritional status can improve outcome in pressure ulcer healing...

..The accumulating data for the prevention and management of pressure ulcers permits an outline of clinical strategies...

..A more comprehensive understanding of unique individual intrinsic factors may lead to more effective interventions...

..Improved wound healing may require different clinical designs or the use of these factors in a precisely timed sequential administration...

..Dramatic weight loss and hypoalbuminemia often follow acute hospitalization...

..Administration of growth hormone in pharmacologic doses increases muscle mass but not muscle strength. Nutritional therapy is promising, but the effects in clinical trials have been small...

..The association of cytokine-induced inflammatory markers in COPD patients suggests that interventions aimed at controlling cytokine production may be required to reverse the cachexia syndrome and improve functional status...

..Pharmacological stimulants of appetite appear to be a promising intervention for anorexia...

..Simple starvation should respond to voluntary or involuntary hypercaloric feedings. The failure to demonstrate a more positive response may be caused by underlying cachexic states...

..Anemia is associated with a poorer prognosis in diabetic-associated comorbid conditions, but targeted correction of anemia has improved diabetic patients' quality of life...

..CONCLUSIONS: We conclude that peripheral parenteral nutrition can be safely administered in post-acute settings with a low rate of complications...

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..The interaction among these predictors is less well described...

..Treatment principles include assessing the severity of the wound; reducing pressure, friction, and shear forces; optimizing wound care; removing necrotic debris; managing bacterial contamination; and correcting nutritional deficits...

..Aspiration and other early complications are a serious risk and are not diminished by route of feeding. Long-term enteral feeding is associated with a high complication rate, with high mortality, and may not be effective...

..Here, we determined the impact of IRS on functional, biochemical, metabolic, and inflammatory status in a high-risk population: elderly women in nursing homes...

..This study explores physicians' concepts of futility and use of age as a deciding factor in considering medical futility in clinical interventions...

..This article reviews recent evidence relating to the interface between dietary factors and biologic models of atherogenesis. Clinical implications and practical applications are also discussed...

..These studies have not considered the short-term effects of exercise...

..Without a simple tool to evaluate appetite, health care providers often use inaccurate surrogates, such as measurement of energy consumption and nutritional risk, to reflect appetite...

..Numerous diseases can result in cachexia, each by a slightly different mechanism. Both nutritional support and orexigenic agents play a role in the management of cachexia...

..Early screening for anorexia can be undertaken in the physician's office utilizing the Simplified Nutritional Assessment Questionnaire. An algorithmic approach to the office management of weight loss is provided...

..The published data on prevention of pressure ulcers do not support an assumption that all pressure ulcers are preventable. An effective prevention strategy demonstrated to eliminate pressure ulcers across healthcare settings is lacking...

..Although polypharmacy is a problem for older persons, in some cases sildenafil can be used to correct drug-induced impotence...

..Although the goal continues to be prevention, once a pressure ulcer does occur, a systematic and comprehensive approach to assessment and treatment is necessary to reduce healing times...

..The areas discussed are heart failure, vitamin D, falls, new treatments for diabetes mellitus, blood pressure measurement, anemia, clinical nutrition, pressure ulcers, Clostridium difficile, insomnia, and antipsychotic therapy...

..To measure expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in the prostates of men after transurethral resection of the prostate (TURP) following 2 weeks of treatment with finasteride...

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..The editors of JAMDA are committed to assisting authors in developing ideas for manuscripts, structuring the article and providing thoughtful reviewer comment to assist in revising the document...