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A new study led by Brown University researchers reports thatpercutaneous endoscopic gastric (PEG) feeding tubes, long assumedto help bedridden dementia patients stave off or overcome pressure ulcers , may instead make the horrible sores more likely to develop or notimprove. The analysis of thousands of nursing home patients with advanceddementia appears in the Archives of Internal Medicine. "This study provides new information about the risks of feedingtube insertion in people with advanced cognitive impairment," saidlead author Dr. Joan Teno, a gerontologist and professor of healthservices, policy, and practice in the Public Health Program atBrown. "We see a substantial risk of people developing a stage IIand higher pressure ulcer. We believe these risks should bediscussed with family members before a decision is made to insert afeeding tube in a hospitalized nursing home resident with advancedcognitive impairment." In the new study, Teno and her team asked two basic questions: "Howdoes having a gastric feeding tube affect the chances of preventinga stage II or greater pressure ulcer?" and "Does having a gastricfeeding tube help heal an existing pressure ulcer?" Previous studies, which were much smaller in scope, had producedinconclusive findings. By using a combination of federally gathereddata from nursing homes and Medicare claims, the researchers essentially mimicked a randomizedcontrolled trial through the use of "propensity match cohort"study. Over a particular timeframe, they compared thousands ofpatients with and without ulcers who received a feeding tube tothree times as many statistically similar patients with and withoutulcers who did not get a tube. The risk of feeding tubes What they found was that among patients who did not start with anulcer, 35.6 percent of those with a feeding tube ended up with atleast a stage II ulcer, while only 19.8 percent of patients withouta feeding tube did. After statistical adjustment, they found thatthe chance of getting an ulcer was 2.27 times higher for peoplewith feeding tubes than for those without. The risk of developing amore serious stage IV ulcer was 3.21 times higher for those withfeeding tubes compared to hospitalized nursing home residentswithout a feeding tube. Meanwhile, among patients who already had an ulcer, the researchersfound that 27.1 percent of patients with a feeding tube sawshort-term improvement, but 34.6 percent of those without a feedingtube experienced healing in a comparable timeframe. The adjustedodds of an ulcer getting better for people with a tube were 0.7times as high for people without a tube, meaning their chances forimprovement with a tube were less than for people without a tube. The conventional wisdom among physicians - three-quarters of themaccording to one study - is that if anything, the nutrition delivered by feeding tubes should help patients resist ulcers.Perhaps with the idea of such a benefit in mind, physiciansfrequently don't discuss the risks of feeding tubes with patients'families, Teno has found. The study did not measure how feeding tubes could cause ulcers, butTeno and her co-authors posit that because many patients becomeagitated by having a tube, they are often physically restrained andsedated with drugs. At the same time, feeding tubes can alsoincrease the incidence of diarrhea . These circumstances, she said, may account for the developmentand worsening of pressure ulcers. The new findings should lead doctors and families to ask morequestions about whether feeding tubes are appropriate treatments,compared to careful hand feeding, for patients who have become socognitively impaired that they can no longer eat independently,Teno said. "To me this article is a game changer," Teno said. "It providessolid evidence that there is a risk and that we need to discuss it.I'm hoping that people now can use this study to make betterdecisions in light of a patient's goals and values." Additional References Citations. I am an expert from gpsgprsgsmtracker.com, while we provides the quality product, such as Fleet GPS Systems , Motorcycle GPS Trackers Manufacturer, Real Time GPS Car Tracker,and more.
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