Wound Management: A Nutritional Formula for Healing Pressure Ulcers

This study investigates the use of a nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers. The researchers conducted a randomized controlled trial with 200 malnourished adults with stage II, III, and IV pressure ulcers. The results suggest that this nutritional intervention, in combination with local wound care, promotes new tissue growth and facilitates faster healing.

Running head: WOUND MANAGEMENT
WOUND MANAGEMENT
Name of the student
Name of the university
Author note:

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PART 1
a. Cereda, E., Klersy, C., Serioli, M., Crespi, A., & D'andrea, F. (2015). A nutritional
formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers:
a randomized trial. Annals of internal medicine, 162(3), 167-174.
Retrieved from:
https://www.researchgate.net/profile/Emanuele_Cereda/publication/271772849_A_Nutrition
al_Formula_Enriched_With_Arginine_Zinc_and_Antioxidants_for_the_Healing_of_Pressure
_Ulcers_A_Randomized_Trial/links/5589bac008ae2affe7152238.pdf
Summary:
The purpose of the study was to assess whether supplements with antioxidants, arginine,
and high protein formula facilitate the faster healing of pressure ulcer. In order to investigate
the hypothesis, the researchers piloted a randomized controlled trial by incorporating 200
malnourished adults with stage II, III and IV pressure ulcer. The researchers conducted the study
within in long term as well as home care services and provided the energy dense protein-rich
energy dense oral formula with zinc, antioxidants and arginine for 8 weeks. The research finds
suggested that this nutrition’s in combination with local wound care promotes new tissue growth
by damaging the affected cells in the wound area.
Rationale:
In order to gain obtain relevant article of wound care management, CINAHL data base was
used. CINAHL is most comprehensive electronic data base which acts a definitive research tool
for nurses and allied health professionals. It provides full text of 768 journals, and index of 5,000

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journals from the field of health professionals. The research is credible since the researchers of
the journal had undertaken randomized control trail which is consider as level one of evidence
(McCusker & Gunaydin, 2015).
b. details
What is the research
problem/s?
Pressure ulcer is a serious damage to skin which may result
in sepsis and death (Edsberg et al., 2016). The incidence of
pressure ulcer was 0.57 per 1,000 patient days (VanGilder et
al., 2017). Hence, it is crucial to design interventions which
can promote faster healing.
What is the research
question?
Is supplementation with arginine, antioxidants and zinc
within a high-protein, high-calorie, formula improves PU
healing in patients?
Is the research important?
Why?
(Word count: 100 words)
Pressure ulcer is serious wound that increase the risk of sepsis
and septic death (Edsberg et al., 2016). While literature
documented researches that management of this type of
wound, evidence to support the faster healing is limited
(Lachenbruch et al., 2016). Hence, few researchers suggested
that nutritional intervention is effective for promoting faster
healing, especially the patients who are malnourished
(Edsberg et al., 2016). Hence, national modification with
traditional wound care management can be effective in

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promoting faster healing.
What methods were used to
conduct the research?
(Word count: 50 words)
In order to investigate the research hypothesis , researchers
undertaken multicentre, randomized, controlled, blinded trial
with 200 adults who were experiencing stage 2, 3 and 4 of
pressure ulcer within the time period of 15 April, 2010 to 5
march 2010. This method aimed to reduce the certain biases
during the period of treating effectiveness of intervention
What type of research is
this? What is the approach
and methodology?
(Word count: 50 words)
The researchers had undertaken multicentre, randomized,
controlled, blinded trial which is a quantitative research. As
discussed by Heale and Twycross, (2015), quantitative study
allows border study with greater number of subject. This
method was considered as gold standard for experimental
research (McCusker & Gunaydin, 2015). The blinded and
prospective approach has been taken for assigning
intervention.

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Who/what was the study
sample?
200 Adult long-term care residents or patients receiving home
care services who are malnourished.
What are the relevant
cultural or ethical issues in
this research?
(Word count: 50 words)
The ethical issue in this case is that patients may refuse to
adhere to treatment, forcing them may breach the autonomy of
patient. Patients can experience side effects because of this
diet which may result in ethical issue (Hollingworth &
Valentine, 2015). The confidentiality of the patients with
pressure ulcer can be an ethical issue.
What are the findings of the The research suggested that modifying nutrition’s with

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research? Are they
important?
(Word count: 100 words)
supplement of arginine, zinc, and antioxidants within a high-
calorie, high-protein formula promote the tissue growth and
increase the amount of immune modulating proteins in
patients, facilitate faster growth. Hence, it can be provided to
the patients with daily care of wound management.
While significant number of health promotional take
traditional approach of wound healing, this research finding
would provide opportunity to integrate the nutritional strategy
for supporting daily care (Edsberg et al., 2016).
Consequently, it will facilitate the immune system of patients
for fighting against the sepsis which is usually observed
because of open wound of pressure ulcer.
What would you do to
improve this research?
(Word count: 50 words)
The researchers showed selection bias by incorporating
patients who are malnourished and living in long term care. In
order to improve this research, patients with normal nutritional
status and not receiving long term care is required to consider
as participant (McCusker & Gunaydin, 2015).

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Part 2;
Comparison between two articles:
Article 1: Cereda, E., Klersy, C., Serioli, M., Crespi, A., & D'andrea, F. (2015). A nutritional
formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a
randomized trial. Annals of internal medicine, 162(3), 167-174.
https://www.researchgate.net/profile/Emanuele_Cereda/publication/271772849_A_Nutrition
al_Formula_Enriched_With_Arginine_Zinc_and_Antioxidants_for_the_Healing_of_Pressure
_Ulcers_A_Randomized_Trial/links/5589bac008ae2affe7152238.pdf
Article 2:
Sugihara, F., Inoue, N., & Venkateswarathirukumara, S. (2018). Ingestion of bioactive collagen
hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled
clinical study. Scientific reports, 8(1), 11403.
Retrieved from: https://www.nature.com/articles/s41598-018-29831-7
Article 1 Article 2
Is the research current? Yes, the research was Yes, this research is more

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published in 2015 current since it was published in
2018
Is the research reliable?
Yes, the research is
reliable since researchers
of the journal had
undertaken randomized
control trail which is
consider as level one of
evidence (McCusker &
Gunaydin, 2015). Here
researchers used
multicentre, randomized,
controlled, blinded trial
(Cereda et al., 2015).
Yes this research is also
reliable since researchers had
undertaken randomized
control trail which is
consider as level one of
evidence (McCusker &
Gunaydin, 2015). Compared
to first article, here
researchers used randomized
double-blind placebo-
controlled clinical study
(Sugihara, Inoue &
Venkateswarathirukumara,
2018).

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Is the research relevant? Yes, research is relevant
to the topic. In this
research, the study
findings suggested that
supplement of arginine,
zinc, and antioxidants
within a high-calorie,
high-protein formula
promote the tissue
growth and increase the
amount of immune
modulating proteins in
patients, facilitating
faster growth (Cereda et
al., 2015).
This research is also relevant.
However, the study finds s
suggested different nutritional
strategy for faster healing. The
researchers suggested that
Ingestion of bioactive collagen
hydrolyses improve the blood
healing. Pro-Hyp and Hyp-Gly
of collagen absorbed into the
blood after the ingestion of it
and act on fibroblasts that are
present in the dermal layer of
the wound.
What are the benefits of
the research?
The benefit of research is
that this intervention can be
Compared to first research, this
research would be beneficial for
the patients who are not
malnourished, rather have

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given to malnourished
patients who are receiving
long term care in order to
enhance the benefit of long
term daily care.
normal nutritional status and
received long term care.
Are there any ethical
considerations? What are
they?
Yes. The research obtained
ethical consent from local
ethics committees. The
ethical considerations include
no patients were forced to
participate in the study and
the identity and personal
information of the patients
remained confidential
(Hollingworth & Valentine,
2015). .
Yes. Compared to first article,
this article also undertaken
similar kinds of ethical
consideration such as patients
were forced to participate in the
study and the identity and
personal information of the
patients remained confidential
(Hollingworth & Valentine,
2015). .

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Are there any risks
associated with the
information?
No. there are risks associated
with the information.
However, efficacy of
intravenous supplement was
not found.
No. there are risks associated
with the information. However,
it is required to check the health
status of the patient before
recommending it.
Is the research relevant to
any other disciplines?
Identify which.
Yes. This research is relevant
to nutritionists since it will
provide them the opportunity
to design accurate nutritional
strategy for supporting
healing (Phillip & Doley
2017).
Yes. This research is also
relevant to nutritionists since it
will provide them the
opportunity to design accurate
nutritional strategy for
supporting healing (Phillip &
Doley 2017). .

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References:
Cereda, E., Klersy, C., Serioli, M., Crespi, A., & D'andrea, F. (2015). A nutritional formula
enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a
randomized trial. Annals of internal medicine, 162(3), 167-174.
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016).
Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised
pressure injury staging system. Journal of Wound, Ostomy, and Continence
Nursing, 43(6), 585.
Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-
based nursing, 18(3), 66-67.
Hollingworth, D., & Valentine, S. (2015). The moderating effect of perceived organizational
ethical context on employees’ ethical issue recognition and ethical judgments. Journal of
business ethics, 128(2), 457-466.
Lachenbruch, C., Ribble, D., Emmons, K., & VanGilder, C. (2016). Pressure Ulcer Risk in the
Incontinent Patient. Journal of Wound, Ostomy and Continence Nursing, 43(3), 235-241.
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), 537-542.

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Phillips, W., & Doley, J. (2017). Granting order-writing privileges to registered dietitian
nutritionists can decrease costs in acute care hospitals. Journal of the Academy of
Nutrition and Dietetics, 117(6), 840-847.
Sugihara, F., Inoue, N., & Venkateswarathirukumara, S. (2018). Ingestion of bioactive collagen
hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-
controlled clinical study. Scientific reports, 8(1), 11403.
VanGilder, C., Lachenbruch, C., Algrim-Boyle, C., & Meyer, S. (2017). The International
Pressure Ulcer Prevalence™ Survey: 2006-2015. Journal of Wound, Ostomy and
Continence Nursing, 44(1), 20-28.