Zena Moore, RGN, MSc, FFNMRCSI, Health Research Board of Ireland, Clinical Nursing and Midwifery Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland.
Seamus Cowman, PhD, MSc, FFNMRCSI, P.G Cert Ed (Adults), Dip N (London), RNT, RGN, RPN, Professor and Head of Department, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.

Pressure ulcers are common, costly, and adversely affect quality of life. Nutritional status is one risk factor that predisposes individuals to the development of a pressure ulcer. The impact of nutritional supplementation is reflected in the reduced incidence of pressure ulcers; however, the evidence is limited. The precise role of nutritional supplementation in pressure ulcer healing is less clear, yet a trend towards healing has been suggested. Patients should have their nutritional status monitored carefully. If difficulties arise, these should be detected early, and if it is not possible to increase the intake of normal food and fluids, then advice should be sought from the dietitian.
Key words: pressure ulcers, risk, prevention, treatment, nutrition.

Heather H. Keller, RD, PhD, Associate Professor, Dept. Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.

Although the prevalence of malnutrition and, specifically, undernutrition are unknown among Canadian seniors, nutritional risk has been identified as a common problem. As nutritional risk can lead to malnutrition and all of its sequelae, efforts are needed to identify nutrition problems early in their course to improve the quality of life of seniors. The following article provides a variety of approaches for identifying nutritional problems, from simple indicators to a simplified and standardized nutritional assessment. Suggestions also are provided on how the practitioner can seek assistance with intervening and helping the senior to overcome these problems.
Key words: nutrition, older adults, screening, intervention, risk, weight.

Demosthenes B. Panagiotakos, PhD, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
Christos E. Pitsavo, MD, PhD, FESC, FACC, First Cardiology Clinic, School of Medicine, University of Athens, Greece.

The beneficial effect of the Mediterranean diet on human health has been advocated since the Renaissance. There are now several scientific evidences that relate this traditional dietary pattern with the incidence of coronary heart disease, various types of cancer and other diseases. However, only in the past few years have several observational and clinical studies suggested mechanisms by which this traditional diet may affect coronary risk. This review underlines the importance of the Mediterranean dietary pattern in the primary prevention of coronary heart disease.
Key words: Mediterranean diet, risk, coronary heart disease.

A recent paper suggests that lung-volume--reduction surgery, believed to be a potentially valuable treatment for advanced emphysema, may be dangerous for some patients. The operation involves the resection of 20-35% of the emphysematous lung, by means of either a median sternotomy or video-assisted thorascopy. Generally, lung function, exercise capacity and quality of life improve after surgery, but results have been shown to vary.

The National Emphysema Treatment Trial is a randomized, multicentre trial comparing lung-volume--reduction surgery with medical treatment. The study found that, for patients with emphysema who have a low forced expiratory volume in one second (FEV1) and either a homogeneous emphysema or a very low carbon dioxide diffusing capacity, the 30-day mortality rate after surgery was 16%. This mortality rate was in comparison to a rate of 0% among 70 medically treated patients.

The main goal of the trial is to compare survival rates and exercise capacity two years after lung-volume--reduction surgery with the results obtained after medical treatment. Another important goal of the trial is to identify selection criteria for the surgery. As a result of the findings of this study, the National Emphysema Treatment Trial has now modified its protocol to exclude this particular group of patients.

Source

1. National Emphysema Treatment Trial Research Group. Patients at high risk of death after lung-volume--reduction surgery. New England Journal of Medicine. From the website http://content.nejm.org/, to be published in the October 11 issue.

Shabbir M.H. Alibhai, MD, MSc, FRCP(C)
Staff Physician, University Health Network,
Instructor, University of Toronto,
Toronto, ON.

The last few decades have seen major advances in the surgical management of numerous illnesses. As the proportion of the elderly in the general population continues to increase, the prevalence of many chronic conditions also increases. Given the number of available surgical therapeutic options to cure or palliate these chronic conditions, more and more elderly patients are undergoing surgery. Conventional wisdom suggests that, compared to younger or middle-aged patients, older individuals have a higher risk of perioperative and postoperative complications, including death. This increased risk has been attributed to aging itself. This article will examine this relationship in greater detail.

Dozens of studies have suggested that advanced age leads to an increased risk of experiencing surgical complications. This includes an increased risk of postoperative complications such as deep venous thrombosis, infections (including wound, urinary tract, and lung), delirium and mortality.¹ In preoperative assessment clinics, internists and anesthetists utilize risk indices or algorithms to determine an individual patient's surgical risk and potentially modifiable risk factors.