Background: Nutritional imbalance is a serious problem in developing countries, especially for the older population, which makes simple and rapid instruments for nutritional evaluation very necessary in order to have a detailed picture of the undernutrition epidemiology in those places. Objective: This work aimed to evaluate the nutritional status of elderly institutionalized patients by use of the Mini-Nutritional Assessment (MNA) test and compare the MNA scores with some hematological variables. Methods: We performed a cross-sectional study in elderly institutionalized patients (153) of all nursing homes in the Brazilian city of Uberlândia, using the MNA questionnaire and quantitative analysis of erythrocytes, hematocrit, hemoglobin, serum iron and transferrin. The subjects were classified by gender, nutritional state and age range. The nutritional categories were compared by analysis of variance and the dependence between the considered variables was tested with the Spearman correlation analysis. Results: 60% of the subjects were female. The average age was 74.6 ± 9.5 and 78.5 ± 9.5 years for male and female individuals, respectively. 18.3% of the patients presented undernutrition, 45.7% presented risk of undernutrition, and 36.0% were well nourished. These three nutritional categories showed statistically significant differences among the MNA scores, age and all the hematological parameters, for the sum of both genders, but not for the age, iron and transferrin values of the male individuals and hematocrit and hemoglobin values of the female patients. Significant differences between genders were not observed only for the MNA and transferrin values. MNA values presented positive correlations with erythrocytes, hematocrit, hemoglobin, and serum iron levels, and also a negative correlation with age, which was attributed to a worsening of the nutritional state with age. Conclusion: Based on the MNA, 64% of the elderly institutionalized patients of Uberlândia presented risk of undernutrition and undernutrition, and their nutritional state is aggravating with the age increase, which is consistent with the age-dependent decrease observed in some hematological variables. Since the low MNA scores were not necessarily associated to subnormal mean values of the hematological variables, we can conclude that the low MNA values are predicting situations that still did not manifest pathologically in those variables.
Objective: Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). Protocol: A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. Outcomes: Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. Discussion: To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.
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