Healing pressure ulcers/injuries: Efficacy and cost effectiveness of nutrition interventions in the treatment of pressure ulcer/injuries

Patients will be randomized to one of the following groups: a. Standard nutritional care by clinical team that may or may not include dietetic intervention, high protein/energy diet and/or nutritional supplement. b. intensive individualised nutritional intervention provided by an associate investigator site dietitian aimed to meet estimated nutritional requirements of patients on a daily basis, which will likely include a high protein/energy diet and supplements (but not including wound healing supplements). Estimated nutritional requirements will be determined at 1.2g protein/kg and 30 KCal/kg per day. Patient will be reviewed by a dietitian for appox 20-30 minutes 3-4 times per week to assess intake and modify nutritional care plan if required. c. standard care as described above, plus the provision of a nutritional supplements developed specifically to enhance wound healing ie complete oral liquid nutritional formulas enriched with Arginine, Vitamin C and Zinc. Supplements will be prescribed based on manufacturers recommendations ie 2 or 3 200-250ml tetrapaks daily. Patients will be given a choice of two different brands of supplements based on their preferences. Supplement A contains per 200ml bottle: 20g protein (of which arginine is 3.0g), 250 KCal, 9 mg Zinc, 250 mg Vitamin C Recommended dose is 3 200ml bottles per day. Supplement B contains per 250ml tetrapak: 21 g protein (of which arginine is 4.5g), 250 KCal, 15 mg Zinc, 250 mg Vitamin C. Recommended dose is 2 250 ml tetrapaks per day. Duration of interventions will be for the duration of patient hospital stay. Compliance with interventions will be monitored through data collection of food and fluid (including supplement) intake.