Public Release: 

News from Annals of Internal Medicine tip sheet, Feb. 3, 2015

American College of Physicians

1. Oral supplements help to heal bed sores in malnourished patients

An oral supplement containing arginine, zinc, and antioxidants improves healing of mild to severe pressure ulcers in malnourished patients, according to an article published in Annals of Internal Medicine. Pressure ulcers, or bed sores, can cause serious illness or death and healing them presents a challenge. Researchers conducted a randomized trial of 200 adult malnourished patients with mild to severe pressure ulcers to evaluate whether an oral nutritional supplement could improve healing. Patients were randomly assigned to receive either an energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants (n = 101) or an equal volume of control formula for 8 weeks. All of the patients in both groups received wound care based on an evidence-based guideline. At the end of the trial period, patients in the enriched formula group experienced improved wound healing. The authors conclude that nutritional intervention should be considered an integral part of pressure ulcer care. Note: The URL will be live when the embargo lifts. For a PDF please contact Megan Hanks at mhanks@acponline.org or 215-351-2656. For an interview, please contact the lead author, Emanuele Cereda MD, PhD, directly at E.Cereda@smatteo.pv.it.

2. Survey suggests shortcomings in end-of-life care

A survey of dying patients and their proxies suggests that pain and other alarming symptoms in the last year of life have increased from 1998 to 2010. The study is being published in Annals of Internal Medicine. Research has shown a high prevalence for troubling symptoms, such as pain, shortness of breath, and depression among dying patients. While a 1997 report by the Institute of Medicine emphasized the need for better care at the end of life, whether symptom management for dying patients has improved since then is not known. Researchers used data from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of community-dwelling adults aged 51 and older, and proxy interviews to evaluate changes in pain intensity and symptom prevalence during the last year of life. Participants were interviewed about their symptoms every two years from 1998 to 2010. After each participant's death, a proxy most familiar with the patient was interviewed. Responses showed that pain and other alarming symptoms in the last year of life remained common throughout the study timeframe, suggesting persisting shortcomings in end-of-life care. Note: The URL will be live when the embargo lifts. For a PDF, please contact Megan Hanks mhanks@acponline.org or 215-351-2656. To speak with the lead author, please contact Ken Schwartz at ken.schwartz@altarum.org or 571-733-5709.

3. ACIP Releases its Recommended Adult Immunization Schedule for 2015

Older adults should have two vaccinations to protect against pneumococcal infection All adults aged 65 and over should now have the 13-valent pneumococcal conjugate vaccine (PCV13) in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) to protect against pneumococcal infection, according to the 2015 Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for adults being published in Annals of Internal Medicine. Despite extensive and targeted recommendations for use of the PCV13 and PPSV23, pneumococcal infection continues to be a major cause of morbidity, including bacteremia, meningitis, and pneumonia, among older adults. Expanding use of PCV13 to all adults along with use of PPSV23 should serve as added protection against pneumococcal infection. This is the only major change from the 2014 schedule. The complete schedule, including footnote changes, is being simultaneously published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention (CDC) web site at http://www.cdc.gov/vaccines.

The Center for Disease Control and Prevention's ACIP is comprised of the American College of Physicians and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDC's Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients.

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Note: URLs will be live when the embargo lifts. For a PDF, please contact Megan Hanks mhanks@acponline.org or 215-351-2656. For questions about the new immunization schedule, please contact Dr. Sandra Fryhofer directly at sandra@drsandrafryhofer.com.

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