***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Pressure ulcers are an important source of morbidity and suffering for patients and a formidable burden on caregivers . OBJECTIVES To assess the impact of a feeding formula enriched with fish oil on healing of preexisting pressure ulcers and serum levels of C-reactive protein in critical care patients . METHODS Adult patients with pressure ulcers grade II or higher were r and omly allocated to receive either a formula enriched with fish oil or an isocaloric control formula . Wound healing was assessed by using the Pressure Ulcer Scale for Healing tool on days 7 , 14 , and 28 . Blood levels of C-reactive protein were measured on days 0 , 7 , and 14 . RESULTS Baseline demographics did not differ between the study ( n = 20 ) and the control ( n = 20 ) groups . The mean score on the ulcer healing tool increased significantly ( P = .02 ) from day 0 to day 28 in the control group ( from 9.25 [ SD , 2.12 ] to 10.75 [ SD , 3.41 ] ) compared with the study group ( from 9.10 [ SD , 2.84 ] to 9.40 [ SD , 3.72 ] ) . Mean levels of C-reactive protein decreased significantly ( P= .02 ) from day 0 to day 14 in the study group ( from 191 [ SD , 104.4 ] mg/L to 111.7 [ SD , 97.8 ] mg/L ) compared with the control group ( from 145 [ SD , 90 ] mg/L to 139 [ SD , 62 ] mg/L ) . CONCLUSION Administration of a feeding formula enriched with fish oil was associated with decreased progression of pressure ulcers and a decrease in blood concentrations of C-reactive protein BACKGROUND & AIMS Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting . METHODS Sixteen in patients with a stage 2 , 3 or 4 pressure ulcer r and omised to receive daily a  st and ard hospital diet ; a st and ard diet plus two high-protein/energy supplements ; or a st and ard diet plus two high-protein/energy supplements containing additional arginine ( 9 g ) , vitamin C ( 500 mg ) and zinc ( 30 mg ) . Nutritional status measurements ( dietary , anthropometric and biochemical ) and pressure ulcer size and severity ( by PUSH tool ; Pressure Ulcer Scale for Healing ; 0=completely healed , 17=greatest severity ) were measured weekly for 3 weeks . RESULTS Patients ' age and BMI ranges were 37 - 92 years and 16.4 - 28.1 k g/m2 ) respectively . Baseline PUSH scores were similar between groups ( 8.7+/-0.5 ) . Only patients receiving additional arginine , vitamin C and zinc demonstrated a clinical ly significant improvement in pressure ulcer healing ( 9.4+/-1.2 vs. 2.6+/-0.6 ; baseline and week 3 , respectively ; P<0.01 ) . All patient groups presented with low serum albumin and zinc and elevated C-reactive protein . There were no significant changes in biochemical markers , oral dietary intake or weight in any group . CONCLUSIONS In this small set of patients , supplementary arginine , vitamin C and zinc significantly improved the rate of pressure ulcer healing . The results need to be confirmed in a larger study Measuring progress toward healing is fundamental to the management of pressure ulcers . A method to assess progress of an individual ulcer over time is lacking . Given the limitations of currently available instruments and the need for a precise and practical method of monitoring healing in clinical practice , the National Pressure Ulcer Advisory Panel initiated the development of a new tool for measuring pressure ulcer healing . The key elements in developing an instrument include simplicity of use in clinical setting s , validity for measuring whether ulcers are improving or worsening , and sensitivity to changes in the ulcer between observations . A new tool incorporating surface area , exu date amount , and surface appearance is proposed . Content validity , correlation validity , prospect i ve validity , and sensitivity to change can be met by the proposed Pressure Ulcer Scale for Healing instrument AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women UNLABELLED Bedsores prevention is part of the specific role of the nurse , as defined namely in the order 84 - 869 of the 17 . July 1984 . The analysis of the risk factors for the appearance of bedsores shows that immobilization , reduction of mobility linked to vigilance disorders and the urinary and faecal incontinence are major elements which justify protocol s of well defined local cares . More recently , the role of undernutrition was highlighted but the recommendations lack accuracy . The proteino-energizing undernutrition is frequent among the elderly patients in hospital , reaching 60 % of all the patients in the department of acute affections . The association of a constituted bedsore and of clinical and /or biological scars of protein-energizing undernutrition is demonstrated and justifies a re-feeding of the patients suffering from bedsores . On the other h and , although a bad nutrition state seems to favour the appearance of a bedsore , it is not proved that the nutrition intensification associating the diagnosis of an under-nutrition and the starting of an adapted re-feeding ( with enriched food or assistance ) decreases the actual incidence of the bedsores . A prospect i ve , multicentered , r and omized survey was therefore proposed . Its aim was to study the Influence of Nutrition  in the Bedsores Prevention among the Elderly Patients in hospitals , suffering from acute affections . This research follows upon the preventions audits of bedsores and the nutrition protocol started up in a department of geriatrics intern medicine in the Regional Center of Geriatrics of Bordeaux . CONCLUSION Two results must be retained in this nursing survey . It gave the possibility of calling into question the professional experience of the nursing teams which participated to the research and to up date their knowledge in the field of the bedsores prevention . They could thus be acquainted with the existence of the grids which evaluate the risk of bedsore , the dependence or even the nutrition supply and to assess the interest for improving the cares quality . On the other h and , we highlighted the possibility of increasing the energy and protein supply by a distribution of enriched food supplements . Moreover , this action has had a beneficial influence in the bedsores prevention among the old people Pressure sores are a frequent problem , especially in elderly patients . Nutritional status may influence the incidence , progression and severity of pressure sores , data , however , are contradictory ( 1 ) . The purpose of this study was to determine the effect of supplemental feeding on the nutritional status and the development and severity of pressure sores . The effect of supplemental feeding overnight ( tube + ) on patients with a fracture of the hip and a high pressure-sore risk score , was studied in a r and omized clinical trial . The control group ( tube - ) had no supplemental feeding . After informed consent , 140 patients were r and omized , and 129 of these took part in the trial ( 62 tube + , and 67 tube - ) .  Protein and energy intake , haemoglobin , serum albumin , total serum protein and pressure-sore grade were measured at admission and after 1 and 2 weeks . Of the 62 patients r and omized for tube feeding ( tube + ) , only 25 tolerated their tube for more than 1 week and 16 for 2 weeks . Nevertheless , energy and protein intake was significantly higher in the tube + group ( P < 0.001 ) . This , however , did not significantly influence total serum protein , serum albumin and development and severity of pressure sores after 1 and 2 weeks . Comparison of the actually tube fed group ( n=25 at 1 week , n = 16 at 2 weeks ) and the control group showed a 2 - 3 times higher protein and energy intake ( P < 0.0001 ) , and a significantly higher total serum protein and serum albumin after 1 and 2 weeks in the actually tube fed group ( all P < 0.001 ) . Pressure-sore development and severity were not significantly influenced in the actually tube fed group . We conclude that we were not able to show a significant decrease in development and severity of pressure sores , because the nasogastric tube for supplemental feeding was not well tolerated in this patient group . Nevertheless , tube feeding overnight does result in a significant higher protein and energy intake , and has a significant effect on nutritional status in the actually tube-fed group . Other means of supplemental feeding will have to be used in order to answer the question of whether supplemental feeding can decrease development and severity of pressure sores 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation Objectives : To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development . Design : The Prevention and Pressure Ulcer Risk Score Evaluation ( prePURSE ) study is a prospect i ve cohort study in which patients are followed up once a week until pressure ulcer occurrence , discharge from hospital , or length of stay over 12 weeks . Data were collected between January 1999 and June 2000 . Setting : Two large hospitals in the Netherl and s. Participants : Adult patients admitted to the surgical , internal , neurological and geriatric wards for more than 5 days were eligible . A consecutive sample of 1536 patients was visited , 1431 ( 93 % ) of whom agreed to participate . Complete follow up data were available for 1229 ( 80 % ) patients . Main outcome measures : Occurrence of a pressure ulcer grade 2 or worse during admission to hospital . Results : Independent predictors of pressure ulcers were age , weight at admission , abnormal appearance of the skin , friction and shear , and planned surgery in coming week . The area under the curve of the final prediction rule was 0.70 after bootstrapping . At a cut off score of 20 , 42 % of the patient weeks were identified as at risk for pressure ulcer development , thus correctly identifying 70 % of the patient weeks in which a pressure ulcer occurred . Conclusion : A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development and in need of preventive measures Protein energy malnutrition is an important determinant of clinical outcome in older patients after hip fracture , but the effectiveness of nutritional support programs in routine clinical practice is controversial . We performed a prospect i ve , r and omized , controlled clinical trial to determine if nutritional supplementation decreased fracture-related complications in a selection of otherwise healthy patients with hip fractures . Patients were r and omized to intervention or control groups . The control group ( n = 40 ) was given ordinary hospital food and 
    Output:
    
There was no clear evidence of an improvement in pressure ulcer healing from the nutritional supplements evaluated in any of these individual studies .
There is currently no clear evidence of a benefit associated with nutritional interventions for either the prevention or treatment of pressure ulcers .