Enteral Nutrition in Dementia: A Systematic Review

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Joanne Brooke

2015-04-01

Full Text Available The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life.

Management of Hyperglycemia During Enteral and Parenteral Nutrition Therapy

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Umpierrez, Guillermo E.

2013-01-01

Hyperglycemia is a frequent complication of enteral and parenteral nutrition in hospitalized patients. Extensive evidence from observational studies indicates that the development of hyperglycemia during parenteral and enteral nutrition is associated with an increased risk of death and infectious complications. There are no specific guidelines recommending glycemic targets and effective strategies for the management of hyperglycemia during specialized nutritional support. Managing hyperglycemia in these patients should include optimization of carbohydrate content and administration of intravenous or subcutaneous insulin therapy. The administration of continuous insulin infusion and insulin addition to nutrition bag are efficient approaches to control hyperglycemia during parenteral nutrition. Subcutaneous administration of long-acting insulin with scheduled or corrective doses of short-acting insulin is superior to the sliding scale insulin strategy in patients receiving enteral feedings. Randomized controlled studies are needed to evaluate safe and effective therapeutic strategies for the management of hyperglycemia in patients receiving nutritional support. PMID:23065369

Principles of feeding cancer patients via enteral or parenteral nutrition during radiotherapy

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Fietkau, R.

1998-01-01

Background: The nutritional status of cancer patients is frequently impaired already before any therapy starts and may deteriorate even more by radio(chemo)therapy. Methods: This review describes the possibilities and risks of enteral and parenteral nutrition during radiotherapy. The indications of enteral nutrition will be derived from own results. Results: Enteral nutrition is the most preferable way of artificial long-term nutrition. In a prospective non-randomized trial we demonstrated that enteral nutrition via percutaneous endoscopic gastrostomy (PEG) not only improves the anthropometric and biochemical parameters during radio(chemo)therapy but also the quality of life of patients with advanced cancers of the head and neck. Moreover supportive use of megestrolacetate can improve the nutritional status. Parenteral nutrition is only recommended if enteral nutrition is not possible e.g. during radio(chemo)therapy of tumors of the upper gastrointestinal tract. Conclusions: Today adequate nutritional support is feasible during intensive radio(chemo)therapy. (orig.) [de

Early enteral nutrition compared to outcome in critically ill trauma ...

African Journals Online (AJOL)

Objectives: The benefit of an early enteral nutrition start in critical ill patients is widely accepted. However, limited published data focus on trauma patients. This study aimed to investigate the effect of early enteral nutrition initiation on length of stay and mortality in an intensive care unit (ICU), as well as explore if enteral ...

[Biological evaluation of a protein mixture intended for enteral nutrition].

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Meneses, J Olza; Foulquie, J Porres; Valero, G Urbano; de Victoria, E Martínez; Hernández, A Gil

2008-01-01

Enteral nutrition is the best way to feed or supplement the diet when gastrointestinal tract functions of patients are partially or totally preserved. Whenever total enteral nutrition is needed, it represents the only source of nutrients for patients. Thus, it is mandatory to ensure that high biological value proteins are included in enteral formulae. To assess the biological quality of a protein blend constituted by 50% potassium caseinate, 25% whey protein and 25% pea protein intended to be used in enteral nutrition products. Forty Wistar rats (20 male and 20 female), with initial body weight of 51 g, where divided into four groups and feed for 10 days with: casein (Control), experimental protein blend (Experimental), liophylized normo- and hyperproteic enteral nutrition formulae adapted to the animal nutritional requirements (Normoproteic and Hyperproteic). Protein efficiency ratio (PER), apparent digestibility coefficient (ADC), relationship between retained and absorbed nitrogen (R/A) and relationship between retained and consumed nitrogen (R/I) where calculated. Experimental and control groups had similar values for all analysed indices (PER, ADC, R/A and R/I). These indices where also similar between normo and hyperproteic groups, but lower than experimental and control groups, except in PER, where normoproteic group was either similar to control and hiperproteic group. The quality of the protein blend used in this study is high. It is a good protein source to be used in the development of new enteral nutritional products.

Intestine, immunity, and parenteral nutrition in an era of preferred enteral feeding.

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Barrett, Meredith; Demehri, Farokh R; Teitelbaum, Daniel H

2015-09-01

To review the benefits of enteral nutrition in contrast to the inflammatory consequences of administration of parenteral nutrition and enteral deprivation. To present the most recent evidence for the mechanisms of these immunologic changes and discuss potential areas for modification to decrease infectious complications of its administration. There is significant data supporting the early initiation of enteral nutrition in both medical and surgical patients unable to meet their caloric goals via oral intake alone. Despite the preference for enteral nutrition, some patients are unable to utilize their gut for nutritious gain and therefore require parenteral nutrition administration, along with its infectious complications. The mechanisms behind these complications are multifactorial and have yet to be fully elucidated. Recent study utilizing both animal and human models has provided further information regarding parenteral nutrition's deleterious effect on intestinal epithelial barrier function along with the complications associated with enterocyte deprivation. Changes associated with parenteral nutrition administration and enteral deprivation are complex with multiple potential areas for modification to allow for safer administration. Recent discovery of the mechanisms behind these changes present exciting areas for future study as to make parenteral nutrition administration in the enterally deprived patient safer.

[Croatian guidelines for perioperative enteral nutrition of surgical patients].

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Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

2014-01-01

Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

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Abunnaja, Salim; Cuviello, Andrea; Sanchez, Juan A.

2013-01-01

Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7–10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations. PMID:23429491

Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

Directory of Open Access Journals (Sweden)

Juan A. Sanchez

2013-02-01

Full Text Available Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7–10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations.

Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults.

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Vieira, Maricy Machado Cavalca; Santos, Valdirene Francisca Neves; Bottoni, Andrea; Morais, Tania Beninga

2018-02-01

Serious nutritional and contamination risks may be involved in the preparation of blenderized tube-feeding diets and in the handling of commercial diets. Their nutritional and microbiological quality in home settings is unknown. The objective of this study was to assess the nutritional and microbiological quality of commercial enteral and homemade blenderized whole foods diets intended to adult patients in home nutritional therapy. In a cross sectional study, 66 samples of commercial (CD) and noncommercial (NCD) enteral diets were collected at the homes of patients in home enteral nutritional therapy, 33 of each type. Commercial diets were either powder (PCD; n = 13) or liquid (LCD; n = 20). The samples were analyzed in laboratory to assess their nutritional and microbiological quality. Anthropometric data of mid upper arm circumference (MUAC) and triceps skinfold (TST) thickness were obtained from the patients' medical records. NCD presented significantly lower values for protein, fat, fiber, carbohydrate and energy while water content was significantly higher. PCD and LCD did not show any statistically significant differences between them. In the NCD, the values measured for macronutrients and energy corresponded to less than 50% of the prescribed values (except for fat). In CD, protein value was about 20% more than the prescribed value; fat and energy values corresponded to approximately 100% of the prescription, while carbohydrate corresponded to 92%. Regardless the type of the diet, prevalence of undernutrition was high in both groups though patients of the NCD presented a higher percentage. Samples of NCD complied significantly less with the microbiological standards; only 6.0% complied with the standard for coliform bacteria. Escherichia coli was detected in 10, 2, and 2 samples of NCD, PCD and LCD, respectively. Homemade blenderized enteral diets showed low values of energy and macronutrients, delivered less than 50% of the prescribed values and had

Benefits of postpyloric enteral access placement by a nutrition support dietitian.

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Jimenez, L Lee; Ramage, James E

2004-10-01

Although enteral nutrition is considered the preferred strategy for nutrition support, it is often precluded by nasogastric feeding intolerance or the inability to place feeding access into the postpyloric position. In an effort to improve enteral nutrition (EN) outcomes at our institution, the nutrition support dietitian (NSD) began placing postpyloric feeding tubes (PPFT) in intensive care unit patients. Intensive care unit patients who received blind, bedside PPFT placements by the NSD (n = 18) were compared with a concurrent age- and diagnosis-matched control group that received standard nutritional care without NSD intervention (n = 18). Interruption of EN infusion, appropriateness of parenteral nutrition (PN) prescription (based on American Society of Parenteral and Enteral Nutrition guidelines), and incidence of ventilator-associated pneumonia (VAP), as defined by the American College of Chest Physicians practice guidelines, were determined in each group. The NSD was successful in positioning the PPFT at or distal to the third portion of the duodenum in 83% of attempts. The PPFT group demonstrated no interruption of enteral feeding compared with 56% in the control group (p VAP in the PPFT group (6% vs 28%, p = .07). Of the PN initiations in the control group, 88% were deemed to be potentially avoidable; 6 of 8 PNs were initiated because of gastric residuals. Enteral nutrition facilitated by NSD placement of postpyloric feeding access is associated with improved tube feeding tolerance and reduced PN use. Further studies are needed to evaluate a possible effect of postpyloric feeding on the incidence of VAP.

[When enteral nutrition is not possible in intensive care patients: whether to wait or use parenteral nutrition?

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Habes, Q L M; Pickkers, P

2016-01-01

- Overfeeding of critically ill patients is associated with a higher incidence of infections and an increased length of ventilation. However, trophic nutrition or permissive underfeeding appears to have no negative effect on the patient and may even provide a survival benefit.- Initiation of enteral nutrition within 24-48 hours after Intensive Care Unit (ICU) admission may reduce the number of complications and increase the chance of survival.- Total parenteral nutrition is associated with a higher risk of infections than enteral nutrition. This seems to be related to the higher calorie intake with parenteral nutrition rather than the route of administration.- In previously well-nourished patients, in whom enteral nutrition is only partially successful, it is safe to wait for up to 8 days before initiating supplemental parenteral nutrition.- In critically ill children, it is also safe to start supplemental parenteral nutrition at a late (on the 8th day after admission) rather than an early stage (within 24 hours of admission). Late supplemental parenteral nutrition may even result in fewer infectious complications and shorter hospitalisation.

Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit.

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Lewis, Sharon R; Schofield-Robinson, Oliver J; Alderson, Phil; Smith, Andrew F

2018-06-08

Critically ill people are at increased risk of malnutrition. Acute and chronic illness, trauma and inflammation induce stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. In addition, patient management in the intensive care unit (ICU) may also interrupt feeding routines. Methods to deliver nutritional requirements include provision of enteral nutrition (EN), or parenteral nutrition (PN), or a combination of both (EN and PN). However, each method is problematic. This review aimed to determine the route of delivery that optimizes uptake of nutrition. To compare the effects of enteral versus parenteral methods of nutrition, and the effects of enteral versus a combination of enteral and parenteral methods of nutrition, among critically ill adults, in terms of mortality, number of ICU-free days up to day 28, and adverse events. We searched CENTRAL, MEDLINE, and Embase on 3 October 2017. We searched clinical trials registries and grey literature, and handsearched reference lists of included studies and related reviews. We included randomized controlled studies (RCTs) and quasi-randomized studies comparing EN given to adults in the ICU versus PN or versus EN and PN. We included participants that were trauma, emergency, and postsurgical patients in the ICU. Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence with GRADE. We included 25 studies with 8816 participants; 23 studies were RCTs and two were quasi-randomized studies. All included participants were critically ill in the ICU with a wide range of diagnoses; mechanical ventilation status between study participants varied. We identified 11 studies awaiting classification for which we were unable to assess eligibility, and two ongoing studies.Seventeen studies compared EN versus PN, six compared EN versus EN and PN, two were multi-arm studies comparing EN versus PN

Enteral nutrition in the chronic obstructive pulmonary disease (COPD) patient.

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DeBellis, Heather F; Fetterman, James W

2012-12-01

Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient's nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient's dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

Home parenteral nutrition in treatment of severe radiation enteritis

International Nuclear Information System (INIS)

Miller, D.G.; Ivey, M.; Young, J.

1979-01-01

Ten patients with radiation enteritis unresponsive to conventional medical and surgical therapy were put on long-term parenteral nutrition at home. Six of the patients are alive at home; four patients died, two from recurrent cancer. Some of the patients have been able to resume oral intake, but none have been able to discontinue parenteral nutrition. Fistulas healed or had a marked decrease in output. Two patients in our series were given prednisone and sulfasalazine without significant benefit, in contrast to previously reported clinical improvement of radiation enteritis with this therapy

Early enteral nutrition prevents intra-abdominal hypertension and reduces the severity of severe acute pancreatitis compared with delayed enteral nutrition: a prospective pilot study.

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Sun, Jia-Kui; Li, Wei-Qin; Ke, Lu; Tong, Zhi-Hui; Ni, Hai-Bin; Li, Gang; Zhang, Lu-Yao; Nie, Yao; Wang, Xin-Ying; Ye, Xiang-Hong; Li, Ning; Li, Jie-Shou

2013-09-01

To investigate the effects of early enteral nutrition (EEN) on intra-abdominal pressure (IAP) and disease severity in patients with severe acute pancreatitis (SAP). Enteral nutrition (EN) was started within 48 h after admission in the EEN group and from the 8th day in the delayed enteral nutrition (DEN) group. The IAP and intra-abdominal hypertension (IAH) incidence were recorded for 2 weeks. The caloric intake and feeding intolerance (FI) incidence were recorded daily after EN was started. The severity markers and clinical outcome variables were also recorded. Sixty patients were enrolled to this study. No difference about IAP was found. The IAH incidence of the EEN group was significantly lower than that of the DEN group from the 9th day (8/30 versus 18/30; P = 0.009) after admission. The FI incidence of the EEN group was higher than that of the DEN group during the initial 3 days of feeding (25/30 versus 12/30; P = 0.001; 22/30 versus 9/30; P = 0.001; 15/30 versus 4/30; P = 0.002). Patients with an IAP FI incidence than those with an IAP ≥15 mmHg on the 1st day (20/22 versus 17/38; P < 0.001), the 3rd day (11/13 versus 8/47; P < 0.001), and the 7th day (3/5 versus 3/55; P = 0.005) of feeding. The severity markers and clinical outcome variables of the EEN group were significantly improved. Early enteral nutrition did not increase IAP. In contrast, it might prevent the development of IAH. In addition, EEN might be not appropriate during the initial 3-4 days of SAP onset. Moreover, EN might be of benefit to patients with an IAP <15 mmHg. Early enteral nutrition could improve disease severity and clinical outcome, but did not decrease mortality of SAP.

Principles of feeding cancer patients via enteral or parenteral nutrition during radiotherapy

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Fietkau, R. [Strahlentherapeutische Klinik und Poliklinik, Rostock Univ. (Germany)]|[Strahlentherapeutische Klinik und Poliklinik, Erlangen Univ. (Germany)

1998-11-01

Background: The nutritional status of cancer patients is frequently impaired already before any therapy starts and may deteriorate even more by radio(chemo)therapy. Methods: This review describes the possibilities and risks of enteral and parenteral nutrition during radiotherapy. The indications of enteral nutrition will be derived from own results. Results: Enteral nutrition is the most preferable way of artificial long-term nutrition. In a prospective non-randomized trial we demonstrated that enteral nutrition via percutaneous endoscopic gastrostomy (PEG) not only improves the anthropometric and biochemical parameters during radio(chemo)therapy but also the quality of life of patients with advanced cancers of the head and neck. Moreover supportive use of megestrolacetate can improve the nutritional status. Parenteral nutrition is only recommended if enteral nutrition is not possible e.g. during radio(chemo)therapy of tumors of the upper gastrointestinal tract. Conclusions: Today adequate nutritional support is feasible during intensive radio(chemo)therapy. (orig.) [Deutsch] Hintergrund: Der Ernaehrungsstatus von Tumorpatienten ist haeufig bereits vor jeder antitumoroesen Therapie reduziert und kann sich durch die notwendige Radio(chemo)therapie weiter verschlechtern. Methode: Im Rahmen dieses Uebersichtsartikels werden die Moeglichkeiten und Risiken der enteralen und parenteralen Ernaehrung waehrend einer Radiotherapie besprochen. Die Indikationen der enteralen Ernaehrung werden anhand von eigenen Ergebnissen begruendet. Ergebnisse: Die Langzeiternaehrung wird am besten ueber einen enteralen Zugang durchgefuehrt. In einer prospektiven, nichtrandomisierten Studie konnten wir zeigen, dass eine enterale Ernaehrung mittels perkutaner endoskopisch kontrollierter Gastrostomie (PEG) nicht nur die anthropometrischen und biochemischen Parameter waehrend einer Radio(chemo)therapie verbessert, sondern auch die Lebensqualitaet. Eine weitere Moeglichkeit besteht in der

Enteral Nutrition Support to Treat Malnutrition in Inflammatory Bowel Disease

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Altomare, Roberta; Damiano, Giuseppe; Abruzzo, Alida; Palumbo, Vincenzo Davide; Tomasello, Giovanni; Buscemi, Salvatore; Lo Monte, Attilio Ignazio

2015-01-01

Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral nutrition—total parenteral, oral supplementation and enteral tube feeding—in terms of results, patients compliance, risks and and benefits. We also focus on the home entaral nutrition strategy as the future goal for treating IBD while focusing on patient wellness. PMID:25816159

Nutrition and Hyperglycemia Management in the Inpatient Setting (Meals on Demand, Parenteral, or Enteral Nutrition).

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Drincic, Andjela T; Knezevich, Jon T; Akkireddy, Padmaja

2017-08-01

The goal of this paper is to provide the latest evidence and expert recommendations for management of hospitalized patients with diabetes or hyperglycemia receiving enteral (EN), parenteral (PN) nutrition support or, those with unrestricted oral diet, consuming meals on demand. Patients with and without diabetes mellitus commonly develop hyperglycemia while receiving EN or PN support, placing them at increased risk of adverse outcomes, including in-hospital mortality. Very little new evidence is available in the form of randomized controlled trials (RCT) to guide the glycemic management of these patients. Reduction in the dextrose concentration within parenteral nutrition as well as selection of an enteral formula that diminishes the carbohydrate exposure to a patient receiving enteral nutrition are common strategies utilized in practice. No specific insulin regimen has been shown to be superior in the management of patients receiving EN or PN nutrition support. For those receiving oral nutrition, new challenges have been introduced with the most recent practice allowing patients to eat meals on demand, leading to extreme variability in carbohydrate exposure and risk of hypo and hyperglycemia. Synchronization of nutrition delivery with the astute use of intravenous or subcutaneous insulin therapy to match the physiologic action of insulin in patients receiving nutritional support should be implemented to improve glycemic control in hospitalized patients. Further RCTs are needed to evaluate glycemic and other clinical outcomes of patients receiving nutritional support. For patients eating meals on demand, development of hospital guidelines and policies are needed, ensuring optimization and coordination of meal insulin delivery in order to facilitate patient safety.

Parenteral nutrition versus enteral nutrition in severe acute pancreatitis Nutrição parenteral versus enteral em pacientes com pancreatite aguda grave

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Josiel Paiva Vieira

2010-10-01

Full Text Available PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16 and an enteral group (n=15, who met severity criteria for abdominal tomography (Balthazar classes C, D, and E. The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10. Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006. There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.OBJETIVO: Comparar o efeito do suporte nutricional parenteral versus enteral, em pancreatite aguda grave, com relação à eficácia, à segurança, à morbi-mortalidade e ao tempo de internação. MÉTODOS: Foram estudados 31 pacientes distribuídos em grupo parenteral (n=16, no período de 1995 a 1998 e grupo enteral (n=15, no período de 1999 a 2002, que preencheram os critérios de gravidade pela tomografia de abdome (Balthazar C,D,E. Os pacientes foram comparados quanto aos dados demográficos, etiologia, antibioticoprofilaxia, somatostatina, suporte nutricional, complicações e evolução. RESULTADOS

Metodología para la implementación del soporte nutricional enteral personalizado como alternativa de la nutrición enteral domiciliaria Methodology for implementation of personalized enteral nutritional support as an alternative for enteral nutrition at home

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Rafael Jiménez García

2012-09-01

Full Text Available Introducción: la nutrición enteral domiciliaria se realiza en la casa del paciente, y permite que disminuyan los costos hospitalarios como consecuencia de largas estadías para lograr la recuperación o mejorar el estado nutricional y su reingreso al medio familiar. Objetivo: mostrar una metodología para la implementación del soporte nutricional enteral personalizado en el hogar con recursos centralizados, como una alternativa para la nutrición domiciliaria en pediatría. Métodos: a partir del diseño de la metodología para las Unidades de Nutrición Enteral Pediátrica con objetivos de actuación de los Grupos de Apoyo Nutricional Hospitalarios, se diseñó una metodología, que, a través de acciones concretas, logra la integración entre los niveles clínico-facultativos y gerenciales. Resultados: la metodología diseñada está basada en la integración de la atención primaria de salud con la secundaria, en una relación de carácter recíproco (desde y hacia, en la que el control centralizado de los recursos permite, no solo economizarlos, sino, a la vez, su registro para organizar la demanda por la estructura administrativa. El diseño metodológico crea, a su vez, un espacio para las funciones educativas de los padres y el control sistemático del soporte, lo cual, a su vez, le da una connotación preventiva acorde con los objetivos de la medicina comunitaria. Conclusiones: la metodología propuesta por nuestro grupo de trabajo constituye una alternativa en pediatría para el desarrollo de la nutrición enteral domiciliaria, como prestación de los servicios nutricionales, con una mayor integración entre los niveles primario y secundario de salud.Introduction: home enteral nutrition is provided at the patient's house and allows reducing the hospital costs derived from long lengths of stay at hospital to attain the recovery or the improvement of the nutritional status of the patient and his/her return to the family environment

Aspects of enteral nutrition in cancer chemotherapy

NARCIS (Netherlands)

Smit, Jitske Martha

1985-01-01

This thesis deals with several aspects of the influences of intensive cancer chemotherapy on the nutritional status, the metabolism, and the gastrointestinal tract of the host and describes whether these results can be influenced by enteral hyperalimentation, We studied these aspects in patients

Complications relating to enteral and parenteral nutrition in trauma ...

African Journals Online (AJOL)

Objectives: The aim of the study was to compare the incidence of complications in patients receiving enteral and parenteral nutrition (PN), and review how the early initiation of enteral feeding and early achievement of caloric goal would affect the incidence of complications. Design: The design was a retrospective audit of ...

Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives

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Babita Gupta

2012-01-01

Full Text Available Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs. Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials and Methods: Sixty questionnaires were distributed and the results analyzed. A database was prepared and the audit was done. Results: Forty-two (70% questionnaires were filled and returned. A majority (38 of staff nurses expressed awareness of nutrition guidelines. A large number (32 of staff nurses knew about nutrition protocols of the ICU. Almost all (40 opined enteral nutrition to be the preferred route of nutrition unless contraindicated. All staff nurses were of opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay. Everyone opined that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of flatus was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle′s tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle′s tube position. The backrest elevation rate was 100%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle′s tube feed is to be discarded after 6 h. The most preferred (48% method to upgrade their knowledge of enteral nutrition was from the ICU protocol manual. Conclusion: Information generated from this study can be helpful in identifying nutrition practices that are lacking and may be used to review and revise enteral feeding

Osmolality and pH in handmade enteral diets used in domiciliary enteral nutritional therapy

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Gilberto Simeone HENRIQUES

Full Text Available Abstract Patients who need prolonged domiciliary enteral nutritional therapy may benefit from handmade diets. However, the preparation of such diets might cause insecurity with regard to their nutritional composition and physical-chemical properties. Current study analyzes the osmolality and Hydrogen-Ion concentration (pH on handmade enteral diets. To this purpose, six formulas and two juices, prescribed on discharge from hospital, were analyzed physically and chemically. Osmolality and pH were respectively determined by cryoscopy and potentiometry. Most formulations were classified as isosmolar (with less than 400 mOsm/kg solvent, and only one was classified as slightly hyperosmolar, with rates ranging from 356.7 to 403.5 mOsm/kg solvent. On average, the standard formula presented higher osmolality than similar ones prepared for hyperglycemia. Among the juices, only one registered hyperosmolar concentration of 595.54 mOsm/kg solvent. All formulas presented pH rates classified as low acidity, ranging between 6.1 and 6.6, while the two juices had the lowest results, 4.73 and 4.66 each. The blend of ingredients used in handmade formulas and juices studied presented acceptable osmolality and pH rates for a safe administration and absence of gastrointestinal complications. Data showed here are consistent with an appropriate and healthy diet and contributed towards success in domiciliary enteral nutritional therapy.

Patient needs and research priorities in the enteral nutrition market - a quantitative prioritization analysis.

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Weenen, T C; Jentink, A; Pronker, E S; Commandeur, H R; Claassen, E; Boirie, Y; Singer, P

2014-10-01

A quantitative systematic identification and prioritization of unmet needs and research opportunities in relation to enteral nutrition was conducted by means of a tailor-made health research prioritization process. The research objectives were reached by conducting qualitative interviews followed by quantitative questionnaires targeting enteral nutrition key opinion leaders (KOLs). (1) Define disease areas that deserve more research attention; (2) Rank importance of product characteristics of tube feeding (TF) and oral nutritional supplements (ONS); (3) Assess involvement of KOLs in enteral nutrition R&D process. KOLs ranked three product characteristics and three disease areas that deserve additional research attention. From these, overall priority scores were calculated by multiplying ranks for both product characteristics and disease areas. 17 qualitative interviews were conducted and 77 questionnaires (response rate 35%) were completed and returned. (1) Disease areas in ONS and TF with highest priorities are: ONS: general malnutrition & geriatrics, TF: intensive care. (2) TF product characteristics with highest priorities are: composition and clinical evidence from a KOL perspective; tolerance and ease of use from a patient perspective. ONS product characteristics with highest priorities are: composition, clinical evidence and taste from a KOL perspective; taste from a patient perspective. We find a high discrepancy between product characteristic prioritization from a KOL and patient perspective. (3) Although 62% of all KOLs give advice to enteral nutrition companies on patient needs, they under-influence the setting of research priorities by enteral nutrition companies. This study provides a systematic approach to achieve research prioritization in enteral nutrition. In addition to providing new directions for enteral nutrition research and development, this study highlights the relevance of involving KOLs in the identification of research priorities as they

Malnutrition in the critically ill child: the importance of enteral nutrition.

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Prieto, Marta Botrán; Cid, Jesús López-Herce

2011-11-01

Malnutrition affects 50% of hospitalized children and 25-70% of the critically ill children. It increases the incidence of complications and mortality. Malnutrition is associated with an altered metabolism of certain substrates, increased metabolism and catabolism depending on the severity of the lesion, and reduced nutrient delivery. The objective should be to administer individualized nutrition to the critically ill child and to be able to adjust the nutrition continuously according to the metabolic changes and evolving nutritional status. It would appear reasonable to start enteral nutrition within the first 24 to 48 hours after admission, when oral feeding is not possible. Parenteral nutrition should only be used when enteral nutrition is contraindicated or is not tolerated. Energy delivery must be individually adjusted to energy expenditure (40-65 kcal/100 calories metabolized/day) with a protein delivery of 2.5-3 g/kg/day. Frequent monitoring of nutritional and metabolic parameters should be performed.

Clinical and nutritional implications of radiation enteritis

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Beer, W.H.; Fan, A.; Halsted, C.H.

1985-01-01

The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value.

Clinical and nutritional implications of radiation enteritis

International Nuclear Information System (INIS)

Beer, W.H.; Fan, A.; Halsted, C.H.

1985-01-01

The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value

Half-elemental Nutrition Mixtures for Enteral Nutrition of Children in Critical Conditions: Features of Usage and Economic Efficiency

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L. N. Berestennikova

2015-01-01

Full Text Available Enteral (tube nutrition has demonstrated its superiority in comparison with parenteral nutrition for patients with a preserved function of gastrointestinal tract who are in intensive care units, or ICU, and who cannot eat or are not allowed to eat by medical indications. International guidelines recommend enteral injections of mixtures for patients in critical conditions in need of nutritial support. The first twenty-four hour is considered the optimal period for starting nutritional support. It is known that costs of the enteral nutrition are much lower than costs of intravascular supply for patients who are in the ICU. The usage of special-purpose dietary products — half-elemental mixtures with high energy density — is the most physiological for children in ICU from 1 year and for adults in critical conditions.

Standardized Competencies for Parenteral Nutrition Prescribing: The American Society for Parenteral and Enteral Nutrition Model.

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Guenter, Peggi; Boullata, Joseph I; Ayers, Phil; Gervasio, Jane; Malone, Ainsley; Raymond, Erica; Holcombe, Beverly; Kraft, Michael; Sacks, Gordon; Seres, David

2015-08-01

Parenteral nutrition (PN) provision is complex, as it is a high-alert medication and prone to a variety of potential errors. With changes in clinical practice models and recent federal rulings, the number of PN prescribers may be increasing. Safe prescribing of this therapy requires that competency for prescribers from all disciplines be demonstrated using a standardized process. A standardized model for PN prescribing competency is proposed based on a competency framework, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)-published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines. This framework will guide institutions and agencies in developing and maintaining competency for safe PN prescription by their staff. © 2015 American Society for Parenteral and Enteral Nutrition.

High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial.

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van Zanten, Arthur R H; Sztark, François; Kaisers, Udo X; Zielmann, Siegfried; Felbinger, Thomas W; Sablotzki, Armin R; De Waele, Jan J; Timsit, Jean-François; Honing, Marina L H; Keh, Didier; Vincent, Jean-Louis; Zazzo, Jean-Fabien; Fijn, Harvey B M; Petit, Laurent; Preiser, Jean-Charles; van Horssen, Peter J; Hofman, Zandrie

2014-08-06

Enteral administration of immune-modulating nutrients (eg, glutamine, omega-3 fatty acids, selenium, and antioxidants) has been suggested to reduce infections and improve recovery from critical illness. However, controversy exists on the use of immune-modulating enteral nutrition, reflected by lack of consensus in guidelines. To determine whether high-protein enteral nutrition enriched with immune-modulating nutrients (IMHP) reduces the incidence of infections compared with standard high-protein enteral nutrition (HP) in mechanically ventilated critically ill patients. The MetaPlus study, a randomized, double-blind, multicenter trial, was conducted from February 2010 through April 2012 including a 6-month follow-up period in 14 intensive care units (ICUs) in the Netherlands, Germany, France, and Belgium. A total of 301 adult patients who were expected to be ventilated for more than 72 hours and to require enteral nutrition for more than 72 hours were randomized to the IMHP (n = 152) or HP (n = 149) group and included in an intention-to-treat analysis, performed for the total population as well as predefined medical, surgical, and trauma subpopulations. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition, initiated within 48 hours of ICU admission and continued during the ICU stay for a maximum of 28 days. The primary outcome measure was incidence of new infections according to the Centers for Disease Control and Prevention (CDC) definitions. Secondary end points included mortality, Sequential Organ Failure Assessment (SOFA) scores, mechanical ventilation duration, ICU and hospital lengths of stay, and subtypes of infections according CDC definitions. There were no statistically significant differences in incidence of new infections between the groups: 53% (95% CI, 44%-61%) in the IMHP group vs 52% (95% CI, 44%-61%) in the HP group (P = .96). No statistically significant differences were

Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis

OpenAIRE

Cheng, Ying; Zhang, Junfeng; Zhang, Liwei; Wu, Juan; Zhan, Zhen

2018-01-01

Background Nutrition support is a common means for patients with gastric cancer, especially for those undergoing elective surgery. Recently, enteral immunonutrition (EIN) was increasingly found to be more effective than enteral nutrition (EN) in enhancing the host immunity and eventually improving the prognosis of gastric cancer patients undergoing gastrectomy. However, the results reported were not consistent. This meta-analysis aimed to assess the impact of EIN for patients with GC on bioch...

Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials.

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Silva, Camila F A; de Vasconcelos, Simone G; da Silva, Thales A; Silva, Flávia M

2018-01-26

The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy. © 2018 American Society for Parenteral and Enteral Nutrition.

Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients.

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Jukic P, Nikolina; Gagliardi, Cristina; Fagnani, Donata; Venturini, Claudia; Orlandoni, Paolo

2017-08-01

The purpose of this study was to comprehend and describe the views, experiences and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition. The objective was to gather empirical evidence to improve the delivery of Home Enteral Nutrition for old patients taking into account the caregivers' support needs. A qualitative methodology with focus groups as data collection method was used to collect the testimonies of 30 informal and formal caregivers of older patients treated with Home Enteral Nutrition by the Clinical Nutrition Service of INRCA (Ancona) during 2014. Quantitative methodology was used to collect socio-demographic data. Partially modified Silver's "Home Enteral Nutrition Caregiver Task Checklist" was used to identify training needs. The constant comparison method was used to code and categorize data and to develop themes of focus groups. Simple descriptive statistics were used to summarize questionnaires. Five main themes were identified from focus groups: acceptance of the therapy, skill acquisition process, need for psychological and practical support at home from healthcare professionals, lifestyle adaptation, affirmation of life and family. All caregivers testified the initial fear and refusal to manage the nutrition pump and the therapy. They expressed the need to be trained gradually, starting during a patient's hospitalization, and continuing in the community. With reference to their overall QoL, it emerged that informal caregivers suffered mostly from the reduction of their free time while formal caregivers suffered social isolation and psychological burden. For both groups the monthly home visit was the most important element of the HEN service. Informal caregivers highlighted the importance of having their loved ones at home. Unsatisfied training needs were identified by the modified Silver's "Home Enteral Nutrition Caregiver Task Checklist". This qualitative study underlined the challenges and adaptations of

Role of FODMAP content in enteral nutrition-associated diarrhea.

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Halmos, Emma P

2013-12-01

Gastrointestinal symptoms including diarrhea are common complications of enteral nutrition (EN); however, the cause is unclear. Mode of EN delivery that alters digestion and possibly absorption is suggested to contribute to the high incidence of diarrhea; however, enteral formula is frequently blamed. Most research has focused on fiber-supplemented EN, with a meta-analysis showing that fiber reduces the incidence of diarrhea in non-intensive care unit studies. Other hypotheses include formula osmolality and FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) content. FODMAPs are poorly absorbed short-chain carbohydrates that exert an osmotic effect. Dietary FODMAPs have been shown to reduce gastrointestinal symptoms, including diarrhea, in those with irritable bowel syndrome and, given a high-enough dose, will induce a laxative effect in most people. As FODMAPs are commonly added to enteral formula and EN is frequently used as the main source of nutrition, it is reasonable to hypothesize that EN provides more FODMAPs than usual dietary intake and increases risk for developing diarrhea. This hypothesis was assessed through a retrospective study showing that the standard-use enteral formula Isosource 1.5 had a protective effect of developing diarrhea. The only characteristic unique to Isosource 1.5 was the lower FODMAP content as determined through methodologies previously validated for food analysis. Methodologies for application to enteral formulas are currently undergoing formal validation. Once confirmed for application in enteral formula, future directions include FODMAP analysis of specific ingredients to increase understanding of potential problems associated with enteral formula and a randomized, controlled trial investigating the role of formula FODMAP content. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Clinical and nutritional aspects of cystic fibrosis patients assisted by a home enteral nutrition program in Brazil

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Haack, Adriana; Garbi Novaes, Maria Rita

2013-01-01

This study to assessed 47 cystic fibrosis (CF) patients assisted by a program of Home Enteral Nutrition. Anthropometric measurements included weight, height, triceps skinfold thickness, waist circunference and spirometry was also performed. Enzymes, nutritional and fat-soluble vitamin supplementations were recorded. There were no associations with enzymes and vitamin supplements between groups that did or did not have a nutritional deficit. Spirometry of patients without nutritional deficit, ...

Importance of nutritional status in recovery from acute cholecystitis: benefit from enteral nutrition supplementation including medium chain triglycerides.

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Nomura, Yukinobu; Inui, Kazuo; Yoshino, Junji; Wakabayashi, Takao; Okushima, Kazumu; Kobayashi, Takashi; Miyoshi, Hironao; Nakamura, Yuta

2007-09-01

This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum proteinnutrition group (n=71; >5.0 g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0+/-2.2 days) than in the fair nutrition group (27.0+/-8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0+/-7.2 days) than in the fair group (9.4+/-5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1+/-15 days) than in the non-MCT group (35.4+/-12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9+/-7 days) than in the non-MCT group (13.1+/-6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.

Enteral Nutrition for Feeding Severely Underfed Patients with Anorexia Nervosa

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Maria Gabriella Gentile

2012-09-01

Full Text Available Severe undernutrition nearly always leads to marked changes in body spaces (e.g., alterations of intra-extracellular water and in body masses and composition (e.g., overall and compartmental stores of phosphate, potassium, and magnesium. In patients with severe undernutrition it is almost always necessary to use oral nutrition support and/or artificial nutrition, besides ordinary food; enteral nutrition should be a preferred route of feeding if there is a functional accessible gastrointestinal tract. Refeeding of severely malnourished patients represents two very complex and conflicting tasks: (1 to avoid “refeeding syndrome” caused by a too fast correction of malnutrition; (2 to avoid “underfeeding” caused by a too cautious rate of refeeding. The aim of this paper is to discuss the modality of refeeding severely underfed patients and to present our experience with the use of enteral tube feeding for gradual correction of very severe undernutrition whilst avoiding refeeding syndrome, in 10 patients aged 22 ± 11.4 years and with mean initial body mass index (BMI of 11.2 ± 0.7 kg/m2. The mean BMI increased from 11.2 ± 0.7 kg/m2 to 17.3 ± 1.6 kg/m2 and the mean body weight from 27.9 ± 3.3 to 43.0 ± 5.7 kg after 90 days of intensive in-patient treatment (p < 0.0001. Caloric intake levels were established after measuring resting energy expenditure by indirect calorimetry, and nutritional support was performed with enteral feeding. Vitamins, phosphate, and potassium supplements were administered during refeeding. All patients achieved a significant modification of BMI; none developed refeeding syndrome. In conclusion, our findings show that, even in cases of extreme undernutrition, enteral feeding may be a well-tolerated way of feeding.

Nutrition accesses among patients receiving enteral treatment in the home environment.

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Sznajder, Janusz; Ślefarska-Wasilewska, Marta; Wójcik, Piotr

2017-10-31

Enteral feeding in the home environment is connected with creating access to digestive tract, and thanks to that, this kind of treatment is possible. The gold standard in enteral nutrition is PEG, other types of access are: nasogastric tube, gastronomy and jejunostomy. In the article 851 patients who were treated nutritionally in the home environment, in the nutrition clinic, Nutrimed Górny Śląsk, were analyzed. It was described how, in practice, the schedule of nutrition access looks like in the nutrition clinic at a time of qualifying patients to the treatment (PEG 47,35%, gastronomy 18,91%, nasogastric tube 17,39%,jejunostomy 16,33%) and how it changes among patients treated in the nutrition clinic during specific period of time - to the treatment there were qualified patients with at least three-month period of therapy ( second evaluation: PEG 37,01%, gastrostomy 31,13%, nasogastric tube 16,98%, jejunostomy 15,86%). The structure of changes was described, also the routine and the place in what exchanging or changing nutrition access was analyzed. The biggest changes in quantity, among all groups of ill people concerned patients with PEG and gastronomy. In most cases the intervention connected with exchanging access to the digestive tract could be implemented at patient's home.

Minimal Enteral Nutrition to Improve Adaptation After Intestinal Resection in Piglets and Infants

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Aunsholt, Lise; Qvist, Niels; Sangild, Per Torp

2018-01-01

BACKGROUND: Minimal enteral nutrition (MEN) may induce a diet-dependent stimulation of gut adaptation following intestinal resection. Bovine colostrum is rich in growth factors, and we hypothesized that MEN with colostrum would stimulate intestinal adaptation, compared with formula, and would...... be well tolerated in patients with short bowel syndrome. METHODS: In experiment 1, 3-day-old piglets with 50% distal small intestinal resection were fed parenteral nutrition (PN, n = 10) or PN plus MEN given as either colostrum (PN-COL, n = 5) or formula (PN-FORM, n = 9) for 7 days. Intestinal nutrient......, enteral colostrum supplementation was well tolerated, and no infants developed clinical signs of cow's milk allergy. CONCLUSION: Minimal enteral nutrition feeding with bovine colostrum and formula induced similar intestinal adaptation after resection in piglets. Colostrum was well tolerated by newly...

Application of spiral nasointestinal tube in enteral nutrition support for patients with extensive burn

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Lai-Ping Wang

2016-09-01

Full Text Available Objective: To observe the effect of spiral nasointestinal tube on enteral nutrition support in patients with extensive burn. Methods: A total of 60 patients with extensive burn who were admitted in our hospital from January, 2014 to June, 2015 were included in the study and divided into the observation group and the control group with 30 cases in each group according to different catheter indwelling methods. The patients in the observation group were given spiral nasointestinal tube for enteral nutrition support, while the patients in the control group were given routine gastric tube for enteral nutrition support. The nutrition status and the occurrence rate of complications before catheter indwelling, 3, 6, and 10 d after catheter indwelling in the two groups were recorded. Results: The levels of ALB, HB, PA, and Scr 6, 10 d after catheter indwelling in the observation group were significantly higher than those in the control group (P<0.05. The occurrence rate of complications during the treatment period in the observation group was significantly lower than that in the control group (P<0.05. Conclusions: The spiral nasointestinal tube can provide the patients with extensive burn a better effective enteral nutrition support and improve the nutrition support, with a lower occurrence rate of complications, which is beneficial for the patients’ rehabilitation.

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

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2011-01-01

In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness. PMID:22136305

Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice.

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Dupont, B; Dao, T; Joubert, C; Dupont-Lucas, C; Gloro, R; Nguyen-Khac, E; Beaujard, E; Mathurin, P; Vastel, E; Musikas, M; Ollivier, I; Piquet, M-A

2012-05-01

Malnutrition and jaundice are independent prognostic factors in cirrhosis. To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis. The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin ≥51 µmol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan-Meier method and Logrank test. Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P = 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P = 0.99]. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P = 0.59). Enteral nutrition does not improve the survival and hepatic or nutritional parameters of cirrhotic patients with jaundice. © 2012 Blackwell Publishing Ltd.

Regional Comparison of Enteral Nutrition-Related Admission Policies in Skilled Nursing Facilities.

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Burgermaster, Marissa; Slattery, Eoin; Islam, Nafeesa; Ippolito, Paul R; Seres, David S

2016-06-01

Nursing home admission policies are one driver of increased and earlier gastrostomy placement, a procedure that is not always medically or ethically indicated among patients needing short-term nutrition support. This important clinical decision should be based upon patient prognosis, goals, and needs. We compared nursing home enteral nutrition-related admission policies in New York City and other regions of the United States. We also explored motivations for these policies. We conducted a telephone survey with skilled nursing facility administrators in New York City and a random sample of facilities throughout the United States about enteral nutrition-related admission policies. Survey data were matched with publically available data about facility characteristics from the Centers for Medicare and Medicaid Services. The relationship between facility location and admission policies was described with regression models. Reasons for these policies were thematically analyzed. New York City nursing homes were significantly less likely to admit patients with nasogastric feeding tubes than were nursing homes nationwide, after we controlled for facility characteristics (odds ratio = 0.111; 95% CI, 0.032-0.344). Reasons for refusing nasogastric tubes fell into 5 categories: safety, capacity, policy, perception of appropriate level of care, and patient quality of life. Our findings indicate that enteral nutrition-related admission policies vary greatly between nursing homes in New York City and nationwide. Many administrators cited safety and policy as factors guiding their institutional policies and practices, despite a lack of evidence. This gap in research, practice, and policy has implications for quality and cost of care, length of hospital stay, and patient morbidity and mortality. © 2016 American Society for Parenteral and Enteral Nutrition.

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk".

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Oliveira Filho, Ronaldo Sousa; Ribeiro, Lia Mara Kauchi; Caruso, Lucia; Lima, Patricia Azevedo; Damasceno, Náglia Raquel Teixeira; García Soriano, Francisco

2016-09-20

Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. To apply and monitor QINT for critically ill patients at nutritional risk. Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. After three years of research, the percentage of QINT adequacy varied between 55%-77% for ENT and 60%-80% for PNT. The results were only made possible by the efforts of a multidisciplinary team and the continuous re-evaluation of the procedures in order to maintain the nutritional assistance for patients at nutritional risk.

Taurine Concentrations Decrease in Critically Ill Patients With Shock Given Enteral Nutrition

NARCIS (Netherlands)

Vermeulen, Mechteld A. R.; van Stijn, Mireille F. M.; Visser, Marlieke; Lemmens, Stéphanie M. P.; Houdijk, Alexander P. J.; van Leeuwen, Paul A. M.; Oudemans-van Straaten, Heleen M.

2016-01-01

Nutrition studies in the intensive care unit (ICU) have shown that adequate enteral nutrition (EN) support has clinical benefits. However, the course of amino acid concentrations in plasma has never been investigated in patients admitted with shock receiving EN. We hypothesized that plasma

Translational Research in Enteral and Parenteral Nutrition Support for Patients with Severe Head Injury

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Fa-liang LIN

2015-12-01

Full Text Available Abstract Objective: To explore the key points of the translational research in enteral and pareenteral nutrition support for patients with severe head injury (SHI, and to analyze the influence of different nutritional support routes on the prognosis of SHI patients. Methods: Totally 141 patients with severe craniocerebral injury were selected as study subjects, 47 cases for each group, and were given early enteral nutrition (EEN, delayed enteral nutrition (DEN, and parenteral nutrition (PN, respectively. The effect of different nutritional support routes on SHI patients was observed. Results: After 14 d of treatment, Glasgow coma scale (GCS scores of 3 groups were higher than treatment before (P<0.01, and with statistical differences among groups (P<0.05, or P<0.01. The levels of serum albumin, total serum protein and hemoglobin were higher in EEN group than the other groups (P<0.01. The level of serum albumin was lower in PN group than in DEN group (P<0.05. There were statistical differences in the incidence of complications among three groups (χ2=9.2487, P=0.0098. Conclusion: EEN support is more conductive to the improvement of the nutrition status, reduction of the incidence of complications, and promotion of the prognosis of SHI patients than DEN and PN.

Nutritional assessment using stable isotope ratios of carbon and nitrogen in the scalp hair of geriatric patients who received enteral and parenteral nutrition formulas.

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Hayasaka, M; Ogasawara, H; Hotta, Y; Tsukagoshi, K; Kimura, O; Kura, T; Tarumi, T; Muramatsu, H; Endo, T

2017-12-01

The δ 13 C and δ 15 N values in the scalp hair of geriatric patients in Japan who received the enteral or parenteral nutrition formula were measured to assess nutritional status. The relations among δ 13 C, δ 15 N, calorie intake, BMI, albumin concentration, total cholesterol (T-CHO) and geriatric nutritional risk index (GNRI) in the patients were investigated. Furthermore, the enrichment of δ 13 C and δ 15 N from the nutrients to the hair was investigated. The δ 13 C values in the hair of patients who received enteral nutrition decreased with decreases in the calories received, while the δ 15 N values increased, suggesting malnutrition in some patients with a low calorie intake due to a negative nitrogen balance. The distribution of patients with a low calorie intake (below 20 kcal/kg/day) when δ 13 C was plotted against δ 15 N differed from that of control subjects, but the distribution of patients with a high calorie intake (above 20 kcal/kg/day) was similar to that of control subjects. No significant differences were observed in BMI, albumin concentration, T-CHO or GNRI between the low and high calorie groups. The enrichment of δ 13 C and δ 15 N from the enteral nutrients to the hair were inversely correlated with the δ 13 C and δ 15 N in the enteral nutrients. The enrichment levels of δ 13 C and δ 15 N tended to be higher and lower, respectively, in the high calorie group. On the other hand, the δ 13 C and δ 15 N values in the hair of patients who received parenteral nutrition were higher and lower than those in the control subjects and in the patients who received enteral nutrition, respectively, reflecting the higher δ 13 C and lower δ 15 N contents of the parenteral nutrients. The δ 13 C and δ 15 N values in the hair of patients who received enteral nutrition may be effective indicators for evaluating the long-term nutritional status of geriatric patients. A calorie intake of 20 kcal/kg/day may be a cut-off value for malnutrition in

Effectiveness of Enteral Nutritional Therapy in the Healing Process of Pressure Ulcers: A Systematic Review

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Gisely Blanc

2015-02-01

Full Text Available OBJECTIVE To evaluate the effectiveness of enteral nutritional therapy (ENT in the healing process of pressure ulcers (PU in adults and the elderly. METHOD A systematic review whose studies were identified through the databases of Cochrane, MEDLINE/PubMed, SciELO, LILACS, EMBASE, CINAHL, Web of Science, and manual searches. It included randomized clinical trials (RCTs without delimiting the period or language of publication, which addressed adults and elderly patients with pressure ulcers in a comparative treatment of enteral nutritional therapy and placebo or between enteral nutritional therapy with different compositions and dosages. RESULTS We included ten studies that considered different interventions. It resulted in more pressure ulcers healed in the groups that received the intervention. The included studies were heterogeneous with regard to patients, the type of intervention, the sample and the follow-up period, all of which made meta-analysis impossible. CONCLUSION Although the enteral nutritional therapy demonstrates a promotion of pressure ulcer healing, sufficient evidence to confirm the hypothesis was not found.

Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.

Science.gov (United States)

Araújo-Junqueira, L; De-Souza, Daurea A

2012-01-01

Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.

Modulation of intestinal inflammation by minimal enteral nutrition with amniotic fluid in preterm pigs

DEFF Research Database (Denmark)

Østergaard, Mette Viberg; Bering, Stine Brandt; Jensen, Michael Ladegaard

2014-01-01

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder, associated with the difficult transition from parenteral to enteral feeding after preterm birth. We hypothesized that minimal enteral nutrition (MEN) with amniotic fluid (AF), prior to enteral formula feeding, would...... improve resistance to NEC in preterm pigs. Methods: Experiment 1: IEC-6 cells were incubated with porcine (pAF) and human AF (hAF) to test AF-stimulated enterocyte proliferation and migration in vitro. Experiment 2: Cesarean-delivered, preterm pigs were fed parenteral nutrition and MEN with pAF, h...... fed AF as MEN, but NEC incidences were similar (NEC-pAF) or increased (NEC-hAF) compared with controls. Conclusions: Intake of pAF or hAF improved body growth and modulated intestinal inflammatory cytokines during a period of parenteral nutrition, but did not protect against later formula-induced NEC...

[Sensory evaluation of enteral nutritional supplements].

Science.gov (United States)

Granell Vidal, Lina; Sánchez Juan, Carlos; Alfonso García, Antonio

2014-07-01

Enteral nutrition (EN) is indicated in patients who, although they may not eat enough food, maintain a sufficient function to receive, digest and absorb nutrients digestive system. Oral Nutritional Supplements (SON) are nutritionally complete or incomplete formulas (depending on whether or not provide all the nutrients needed to serve as the sole source of nutrients), which supplement inadequate oral diet. This study aims to evaluate the organoleptic characteristics of hyperproteic, normoproteic and fiber-enriched oral SON. SON test, carried out at the Department of Endocrinology and Nutrition Consortium Hospital General Universitario de Valencia from October 2012 to February 2013. 137 SON were evaluated in total, of which 47 were hyperproteic, 46 normoproteic and 44 enriched in fiber. Of the SON evaluated in the group of hyperproteic the following 3 SON obtained the best scores: Fresenius Prot Energy Drink® (21,27, vanilla flavor), Avant Standard Nut® (20.3 , strawberry flavor) and Resource® Protein (20.01, chocolate flavor) In the group of normoproteic SON the 3 best rated were: Ensure Plus® (22.3, banana flavor), Ensure Plus® (21.9, peach flavor) and Fresubin Energy Drink® (21, strawberry flavor) In the group of fiber-enriched the 3 SON most appreciated were: 2 Kcal Fresubin Fibre Drink® (23.78, vanilla flavor), Ensure Plus® TwoCal (22.9, banana flavor) and Fortimel Compact® (21.5, strawberry flavor) The study aims to guide clinicians on what SON may be more acceptable to the patient, so that the SON serve their purpose and restore or improve nutritional status, as the SON intervention is safe and cost - effective, since they improve both the functionality and quality of life. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

[Effects of early enteral nutrition in the treatment of patients with severe burns].

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Wu, Y W; Liu, J; Jin, J; Liu, L J; Wu, Y F

2018-01-20

Objective: To investigate the effects of early enteral nutrition (EEN) in the treatment of patients with severe burns. Methods: Medical records of 52 patients with severe burns hospitalized in the three affiliations of authors from August to September in 2014 were retrospectively analyzed and divided into EEN group ( n =28) and non-early enteral nutrition (NEEN) group ( n =24) according to the initiation time of enteral nutrition. On the basis of routine treatment, enteral nutrition was given to patients in group EEN within post injury day (POD) 3, while enteral nutrition was given to patients in group NEEN after POD 3. The following items were compared between patients of the two groups, such as the ratio of enteral nutrition intake to total energy intake, the ratio of parenteral nutrition intake to total energy intake, the ratio of total energy intake to energy target on POD 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28, the levels of prealbumin, serum creatinine, blood urea nitrogen, total bilirubin, direct bilirubin, and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score on POD 1, 3, 7, 14, and 28, the first operation time, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage, and low blood sugar within POD 28. Data were processed with χ (2)test, t test, Wilcoxon rank sum test, and Bonferroni correction. Results: (1) The ratio of parenteral nutrition intake to total energy intake of patients in group EEN on POD 1 was obviously lower than that in group NEEN ( Z =2.078, P 0.05). On POD 28, the prealbumin level of patients in group EEN was obviously higher than that in group NEEN ( t =3.163, P 0.05). (3) The APACHE Ⅱ scores of patients in group EEN were (22.5±3.1) and (15.6±3.8) points respectively on POD 1 and 3, which were close to (23.6±3.0) and (17.6±4.2) points of patients in group NEEN ( t =1.352, 1.733, P >0.05). The APACHE Ⅱ scores of patients in group EEN on POD 7, 14

[Enteral nutrition: reduction in the contamination risk].

Science.gov (United States)

Montemerlo, H; Menéndez, A M; Marcenac, F; Floridia, J; Esteban, L; Barbaricca, M

1996-01-01

Enteral nutrition is used as a routine therapy in patients with caloric-protein malnutrition, severe dysphagia, major burns, intestinal resection, and enterocutaneous fistulae, as long as a portion of the digestive tract still has an active absorptive function. The administration takes place by means of surgical (ostomies) or non-surgical (nasogastric) tubes. In our country, a significant number of hospitalized patients with various diseases receive this type of nutrition. Given that the colonization of the digestive tract by hospital flora is the first step towards developing intra-hospital infections, the contamination implies serious risks. The objective of this study was to study the most appropriate conditions for the manufacturing, storage and administration of the mixture of nutrients of enteral nutrition, to guarantee nutrition with a lower contamination risk. This study was conducted by the Unit of Nutritional Assistance of the Mater Dei Clinic, by means of bacteriological controls, from January 1991 to December 1992, and in 1993 in which the work systematics were reviewed. The study was prospective, and those solutions whose bacteriological counts were lower than 100.000 colony forming units (CFU), and which showed an absence of enteropathological micro-organisms, were considered acceptable, and those solutions which had a bacteriological count greater than or equal to 100.000 CFU and or the presence of enteropathological micro-organisms, were considered unacceptable. During the first period, "usual working conditions", we analyzed the infra-structure, the personnel, the constituents, and the apparatus used in the manufacturing, for which 36 samples were studied at t0 (moment of preparation). Afterwards, in the second period "special working conditions", we analyzed the manufacturing procedures, the storage and the administration of 103 solutions, corresponding to 36 patients, taking samples at t0 and t24 (after 24 hours of preparing). In the first phase

Early enteral nutrition compared to outcome in critically ill trauma ...

African Journals Online (AJOL)

2014-11-01

Nov 1, 2014 ... 16.4 days, p-value 0.00315) and mortality (9.5 % vs. 20.7 % ..... had a more complicated clinical picture, despite no significant differences in terms ... In other words, an early enteral nutrition start was associated with an almost.

Glutamine-enriched enteral nutrition in very low-birth-weight infants

NARCIS (Netherlands)

van den Berg, Anemone; van Zwol, Annelies; Moll, Henriëtte A.; Fetter, Willem P. F.; van Elburg, Ruurd M.

2007-01-01

Objective: To determine the effect of glutamine-enriched enteral nutrition in very low- birth- weight infants on the incidence of allergic and infectious diseases during the first year of life. Design: Follow- up study. Setting: Tertiary care hospital. Participants: All surviving infants who

Tolerance and efficacy of nasogastric enteral nutrition for severe acute pancreatitis: a metaanalysis

Directory of Open Access Journals (Sweden)

Shu-fen FENG

2013-02-01

Full Text Available Objective 　To evaluate the tolerance and efficacy of nasogastric enteral nutrition (NGEN in the treatment of severe acute pancreatitis (SAP. Methods 　PUBMED, Web of Science and The Cochrane Central Register of Controlled Trials from 1966 to 2011 (up to October and Chinese Journals Full-text Database (CNKI, Database for Chinese Technical Periodicals (VIP and Wanfang Digital Journal Full-text Database from 1978 to 2011 (up to October were retrieved to collect clinical randomized controlled trials of NGEN to compare with nasojejunal enteral nutrition (NJEN in the treatment of SAP. Two reviewers independently screened the literature for eligibility and evaluated the quality with confirmation of cross-check. Different opinions would be decided by the third party. Statistical analysis was performed by meta-analysis using Review Manager 4.2. Results 　Three randomized controlled trails including 159 patients with SAP met the inclusion criteria, involving 82 patients in NGEN group and 77 in NJEN group. There was no significant difference between NGEN and NJEN group in the risk of mortality of SAP (RR=0.69, 95%CI: 0.37-1.29, P=0.25, conversion to surgery (RR=2.09, 95% CI: 0.55-7.92, P=0.28, diarrhea subsequent to enteral nutrition (RR=1.43, 95% CI: 0.59-3.45, P=0.43, rate of tube displacement (RR=0.42, 95%CI: 0.08-2.17, P=0.30 and pain related with enteral nutrition (RR=0.94, 95%CI: 0.32-2.70, P=0.90. While compared with NJEN, the risk of infectious complications was lower than NGEN (RR=0.64, 95%CI: 0.42-0.99, P=0.04. Conclusion 　In enteral nutrition support of SAP, NGEN is comparable to NJEN in efficacy and tolerance, but the former has the lower rate of infectious complications and easier to operate, and there is a tendency of NEGN to replace the latter.

Influence of postoperative enteral nutrition on cellular immunity. A random double-blinded placebo controlled clinical trial

DEFF Research Database (Denmark)

Beier-Holgersen, R; Brandstrup, B

2012-01-01

The aim of this study was to discover if the cellular immunological response is different in patients receiving early postoperative enteral nutrition compared to patients who only receive "water".......The aim of this study was to discover if the cellular immunological response is different in patients receiving early postoperative enteral nutrition compared to patients who only receive "water"....

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score.

Science.gov (United States)

Takehara, Kazuhiro; Sakamoto, Kazuhiro; Takahashi, Rina; Kawai, Masaya; Kawano, Shingo; Munakata, Shinya; Sugimoto, Kiichi; Takahashi, Makoto; Kojima, Yutaka; Fukunaga, Tetsu; Kajiyama, Yoshiaki; Kawasaki, Seiji

2017-01-01

Superior mesenteric artery syndrome (SMAS) is a relatively rare disease that involves bowel obstruction symptoms, such as vomiting and gastric distension, owing to the compression of the third portion of the duodenum from the front by the superior mesenteric artery (SMA) and from the rear by the abdominal aorta and the spine. SMAS is diagnosed on the basis of an upper gastrointestinal examination series indicating the obstruction of the third portion of the duodenum or a computed tomography scan indicating the narrowing of the branch angle between the aorta and the SMA (i.e., the aorta-SMA angle). Here, we report the case of a 78-year-old woman diagnosed with SMAS after a laparoscopic right hemicolectomy for cecal cancer, whose condition was improved by enteral nutritional therapy. We used her controlling nutritional status (CONUT) score as a nutrition assessment and noted the changes in the aorta-SMA angle over the course of the disease. This patient appeared to develop SMAS, on the basis of a worsened CONUT score and a decreased aorta-SMA angle, owing to the inflammation resulting from the intraoperative dissection of the tissues around the SMA and prolonged postoperative fasting. After the initiation of enteral nutritional therapy, the patient exhibited body weight gain and an improved aorta-SMA angle and CONUT score. Hence, assessment of the aorta-SMA angle and CONUT score is an important preoperative consideration.

Clinical use of enteral immune nutrition in patients with acute exacerbation of chronic obstructive pulmonary disease

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Zhi-cheng ZHANG

2015-06-01

Full Text Available Objective　To investigate the use of enteral immune nutrition preparation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD, regard its efficacy in improving nutritional status, and its influence on immunity and the status of acute inflammatory reaction of the patients. Methods　Sixty-two AECOPD patients requiring mechanical ventilation in ICU of our hospital were randomly divided into two groups: immune nutrition group [study group, n=32, receiving Ruineng (a product of Huarui Pharmaceutical Ltd., which contained essential fatty acids, Omega-3 fatty acids, and energy 1.3 kcal/ml] and conventional nutrition group (control group, n=30, receiving the hospital self-made homogenized diet with 1.2 kal/ml. Patients in the two groups took enteral nutrition of equal calorie, and it was given by nasointestinal tube. On the day of admission and the 14th and 18th after admission, venous blood was obtained for the determination of serum albumin, prealbumin, transferrin, C reactive protein (CRP, tumor necrosis factor-α (TNF-α, and interleukin-6 (IL-6. At the same time upper arm muscle circumference (MAMC was measured at the bed side. The 14-day off-respirator rate and mechanical ventilation time within 28 days were compared between the two groups. Results　The 14-day off-respirator rate was higher in study group than in control group (P0.05. Conclusions　Compared with homogenized diet, immune enteral nutrition could better improve the nutritional status and immune function, lower the acute inflammatory response level, increase the success rate of early off-respirator in AECOPD patients, therefore, enteral immune nutrition preparation is a better nutrition support solution for AECOPD. DOI: 10.11855/j.issn.0577-7402.2015.05.17

Nutrition support team management of enterally fed patients in a community hospital is cost-beneficial.

Science.gov (United States)

Hassell, J T; Games, A D; Shaffer, B; Harkins, L E

1994-09-01

To determine whether nutrition support team (NST) management of enterally fed patients is cost-beneficial and to compare primary outcomes of care between team and nonteam management. A quasi-experimental study was conducted over a 7-month period. A 400-bed community hospital. A convenience sample of 136 subjects who had received enteral nutrition support for at least 24 hours. Forty-two patients died; only their mortality data were used. Ninety-six patients completed the study. Outcomes, including cost, for enterally fed patients in two treatment groups--those managed by the nutrition support team and those managed by nonteam staff--were compared. Severity of illness level was determined for patients managed by the nutrition support team and those managed by nonteam staff. For each group, the following measures were adjusted to reflect a significant difference in average severity of illness and then compared: length of hospital stay, readmission rates, and mortality rates. Complication rates between the groups were also compared. The cost benefit was determined based on savings from the reduction in adjusted length of hospital stay. Parametric and nonparametric statistics were used to evaluate outcomes between the two groups. Differences were statistically significant for both severity of illness, which was at a higher level in the nutrition support team group (P group (P team-managed group, there was a 23% reduction in adjusted mortality rate, an 11.6% reduction in the adjusted length of hospital stay, and a 43% reduction in adjusted readmission rate. Cost-benefit analysis revealed that for every $1 invested in nutrition support team management, a benefit of $4.20 was realized. Financial and humanitarian benefits are associated with nutrition support team management of enterally fed hospitalized patients.

Evaluating predictive factors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: A retrospective review

International Nuclear Information System (INIS)

Mangar, Stephen; Slevin, Nicholas; Mais, Kathleen; Sykes, Andrew

2006-01-01

Background and purpose: To identify objective pre-treatment clinical parameters that could be used to predict for patients at high risk of requiring enteral tube feeding prior to head and neck radiotherapy. Patients and methods: A retrospective study was conducted on 160 consecutive patients attending for radiotherapy assessment. Regression analysis was used to determine various pre-treatment nutritional and tumour specific parameters associated with the use of enteral nutrition either before (prophylactic) or during (reactive) radiotherapy (RT). The significant parameters identified were then selected into categorical variables and compared between those who needed reactive enteral nutrition and the remainder of the group who did not. These results were used to generate predictive factors that could be used to identify those at high risk of malnutrition during RT for whom early or prophylactic enteral nutrition should be considered. Results: Fifty patients required enteral feeding of which 60% required this prior to radiotherapy. Multivariate analysis identified the following factors to be significant-body mass index, performance status (PS), advanced stage, pre-treatment weight loss, low serum albumin and protein, age, and smoking. The most significant categorical predictive parameters for reactive enteral feeding were stage 3-4 disease, PS 2-3, and smoking >20/day. The combination of these factors predicted a 75% chance of needing enteral nutrition. Conclusion: Nutritional assessment is important prior to radiotherapy and is multifactorial. Using a combination of relatively simple and objective parameters (performance status, smoking and disease stage) it is possible to identify those at high risk of needing enteral nutrition prior to starting RT

Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer.

Science.gov (United States)

Li, B; Liu, H Y; Guo, S H; Sun, P; Gong, F M; Jia, B Q

2015-06-29

The impact of early enteral nutrition (EEN) on clinical outcomes of gastric cancer patients was investigated. Three hundred pa-tients undergoing gastric cancer surgery from July 2010 to May 2014 were randomly divided into experimental and control groups (n = 150/group). Experimental group patients received enteral nutrition in water during the early postoperative period. Control group patients received conventional perioperative treatment. Patients' clinical outcomes, post-operative immune function, and nutritional statuses were compared, which revealed that the postoperative fever duration (80.2 ± 6.0 vs 88.1 ± 8.1 h, P 0.05]. At postoperative days 3 and 7, the CD3(+), CD4(+), natural killer cell, albumin, and prealbumin levels and CD4(+)/CD8(+) ra-tio were significantly higher in the experimental group than the control group (all P nutritional status and immune function and promote early recovery of intestinal function in patients with gastric cancer.

[Curative effect analysis of bile reinfusion combined with enteral nutrition support before surgery of hilar cholangiocarcinoma].

Science.gov (United States)

Song, P; Mao, L; Bian, X J; Zhou, T; Fan, Y Y; Zhang, J; Xie, M; Qiu, Y D

2018-05-01

Objective: To investigate the clinical effect of bile reinfusion combined with enteral nutrition support before surgery for hilar cholangiocarcinoma. Methods: A retrospective analysis of patients with hilar cholangiocarcinoma who underwent surgical treatment at Nanjing Drum Tower Hospital Hepato-biliary-pancreatic Surgery Department from July 2010 to August 2017 was completed.A total of 52 cases were finally enrolled in our study.All the patients included, on the basis of whether they received preoperative drainage and bile reinfusion, were divided into non-drainage group( n =15) and drainage group( n =37). Differences of clinical indicators, including operation time, intraoperative bleeding and serum liver function index levels at day 1, 3, 7 postoperative, postoperative complications(liver failure, biliary fistula, pleural effusion, peritoneal effusion, abdominal cavity infection, death in hospital), tumor classification, R0 resection, postoperative hospitalization time between the 2 groups were analyzed. At the same time, in the drainage group, patients were divided into non-enteral nutrition subgroup( n =13) and enteral nutrition subgroup( n =24) according to whether they received enteral nutrition before operation. The normal distribution data of the group was statistically analyzed by independent sample t test, the non-normal distribution data of the group was statistically analyzed by rank-sum test. The count data was statistically analyzed by non-calibration and correction of the square test. Results: There was no statistically significant difference in general infomation such as age, gender, and serum liver function between non-drainage group and drainage group( P >0.05). There was no statistically significant difference in general information such as age, gender, and serum liver function between non-enteral nutrition group and enteral nutrition group( P >0.05). The rate of vascular resection and reconstruction(33.3%) and operating time(10.8(2.2)h) in

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score

Directory of Open Access Journals (Sweden)

Kazuhiro Takehara

2017-11-01

Full Text Available Superior mesenteric artery syndrome (SMAS is a relatively rare disease that involves bowel obstruction symptoms, such as vomiting and gastric distension, owing to the compression of the third portion of the duodenum from the front by the superior mesenteric artery (SMA and from the rear by the abdominal aorta and the spine. SMAS is diagnosed on the basis of an upper gastrointestinal examination series indicating the obstruction of the third portion of the duodenum or a computed tomography scan indicating the narrowing of the branch angle between the aorta and the SMA (i.e., the aorta-SMA angle. Here, we report the case of a 78-year-old woman diagnosed with SMAS after a laparoscopic right hemicolectomy for cecal cancer, whose condition was improved by enteral nutritional therapy. We used her controlling nutritional status (CONUT score as a nutrition assessment and noted the changes in the aorta-SMA angle over the course of the disease. This patient appeared to develop SMAS, on the basis of a worsened CONUT score and a decreased aorta-SMA angle, owing to the inflammation resulting from the intraoperative dissection of the tissues around the SMA and prolonged postoperative fasting. After the initiation of enteral nutritional therapy, the patient exhibited body weight gain and an improved aorta-SMA angle and CONUT score. Hence, assessment of the aorta-SMA angle and CONUT score is an important preoperative consideration.

The Comparison of Continuous and Intermittent Enteral Nutrition In Cerebrovascular Patients

Directory of Open Access Journals (Sweden)

Levent Güngör

2011-06-01

Full Text Available OBJECTIVE: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition is compared by means of pulmonary infections and gastrointestinal tolerance, among acute cerebrovascular patients. METHODS: Sixty two acute cerebrovascular patients with dysphagia were included the study. The same volume of nutrition product was infused 4 times daily to 31 patients, and continuously for 24 hours to the remaining 31. After 10 days of follow-up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting and tube occlusion were compared between two groups. RESULTS: Twenty patients developed pneumonia (32% and 8 diarrhea (13%. Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 patients in the intermittent nutrition group (35%, and in 9 patients in the continuous nutrition group (29%. The rate of pulmonary infection was not statistically different between two groups (p>0.05. Diarrhea was observed in 7 intermittently fed patients (23%, while was present only in 1 patient (3% in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, just at the statistical border (p=0.05. None of the patients developed tube occlusion, vomiting and gastric retention. The rate of mortality and the interruption of feeding was not significantly different between two groups (p>0.05. CONCLUSION: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding with respect to continuous enteral nutrition, though the difference is not so conspicuous. The reason may be contamination of the equipments and the feeding solution because of frequent manipulation and

The Comparison of Continuous and Intermittent Enteral Nutrition In Cerebrovascular Patients

Directory of Open Access Journals (Sweden)

Levent Güngör

2011-06-01

Full Text Available OBJECTIVE: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition is compared by means of pulmonary infections and gastrointestinal tolerance, among acute cerebrovascular patients. METHODS: Sixty two acute cerebrovascular patients with dysphagia were included the study. The same volume of nutrition product was infused 4 times daily to 31 patients, and continuously for 24 hours to the remaining 31. After 10 days of follow-up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting and tube occlusion were compared between two groups. RESULTS: Twenty patients developed pneumonia (32% and 8 diarrhea (13%. Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 patients in the intermittent nutrition group (35%, and in 9 patients in the continuous nutrition group (29%. The rate of pulmonary infection was not statistically different between two groups (p>0.05. Diarrhea was observed in 7 intermittently fed patients (23%, while was present only in 1 patient (3% in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, just at the statistical border (p=0.05. None of the patients developed tube occlusion, vomiting and gastric retention. The rate of mortality and the interruption of feeding was not significantly different between two groups (p>0.05. CONCLUSION: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding with respect to continuous enteral nutrition, though the difference is not so conspicuous. The reason may be contamination of the equipments and the feeding solution because of frequent manipulation and

Continuous parenteral and enteral nutrition induces metabolic dysfunction in neonatal pigs

DEFF Research Database (Denmark)

Stoll, Barbara; Puiman, Patrycja Jolanta; Cui, Liwei

2012-01-01

We previously showed that parenteral nutrition (PN) compared with formula feeding results in hepatic insulin resistance and steatosis in neonatal pigs. The current aim was to test whether the route of feeding (intravenous [IV] vs enteral) rather than other feeding modalities (diet, pattern) had...

Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parental nutrition to an enteral feeding program

International Nuclear Information System (INIS)

Szeluga, D.J.

1985-01-01

Allogeneic and autologous bone marrow transplantation (BMT) have been associated with nutritionally-depleting side effects. Total parental nutrition (TPN) has become the standard, but it has not been demonstrated that TPN is the appropriate method of nutritional support. Therefore, in a prospective, randomized clinical trial TPN and enteral feeding were compared for their effectiveness in maintaining the nutritional status of patients through the first 29 post-transplant days. Nutritional assessment included measurement of serum proteins, body weight, anthropometry and isotope dilution analysis of body composition. Total body water (TBW) and extracellular fluid (ECF) were quantified by standard radioisotope dilution techniques using tritiated water and 169 ytterbium-diethylenetriaminepentaacetate, respectively as the tracers. Consenting patients 10-58 years of age were stratified by type of BMT (autologous or allogeneic) and randomized to either TPN plus ad libitum oral feeding or the individualized enteral feeding program (EFP), which included one-on-one counseling, meal-by-meal menu selection, special snacks and tube feeding. There were no differences in the rate of hematologic recovery, incidence of graft-versus-host disease, organ toxicity, length of hospitalization or survival. Therefore, the observed changes in body composition were not clinically significant. Even allowing for increased dietary service, the EFP was only half as expensive as TPN. It was concluded that TPN is not superior to the EFP and therefore, TPN should be reserved for patients who demonstrate intolerance to enteral feeding

Impact of enteral nutrition on postoperative immune function and nutritional status.

Science.gov (United States)

Wang, F; Hou, M X; Wu, X L; Bao, L D; Dong, P D

2015-06-10

We studied the effects of enteral nutrition (EN) support initiated 1 week before surgery on postoperative nutritional status, immune function, and inflammatory response in gastric cancer patients. A total of 200 gastric cancer patients were randomly divided into two groups: EN starting 1 week before surgery (study group) and EN starting early after surgery (control group). The two groups received EN support, following different therapeutic schedules, until the 9th day after operation. In the patients, body weight, skinfold thickness, upper-arm circumference, white blood cell count, albumin, prealbumin, C-reactive protein, peripheral immunoglobulins (IgA, IgG, and IgM), T lymphocyte subsets, interleukin-6, and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery. There was no statistically significant difference in the results of recovery time of passage of gas by anus, abdominal distension, stomachache, blood glucose, hepatic and renal functions, and electrolytes between the two groups of patients (P > 0. 05). Adverse reactions occurred to both groups at 1 and 2 days after operation. Such conditions was improved after the intravenous drip rate was adjusted. The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation (P gastric cancer patients can improve their postoperative nutritional status and immune function, can reduce inflammatory response, and is more conducive to the recovery of patients.

Development and Evaluation of a Home Enteral Nutrition Team

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Sarah Dinenage

2015-03-01

Full Text Available The organisation of services to support the increasing number of people receiving enteral tube feeding (ETF at home varies across regions. There is evidence that multi-disciplinary primary care teams focussed on home enteral nutrition (HEN can provide cost-effective care. This paper describes the development and evaluation of a HEN Team in one UK city. A HEN Team comprising dietetians, nurses and a speech and language therapist was developed with the aim of delivering a quality service for people with gastrostomy tubes living at home. Team objectives were set and an underpinning framework of organisation developed including a care pathway and a schedule of training. Impact on patient outcomes was assessed in a pre-post test evaluation design. Patients and carers reported improved support in managing their ETF. Cost savings were realised through: (1 prevention of hospital admission and related transport for ETF related issues; (2 effective management and reduction of waste of feed and thickener; (3 balloon gastrostomy tube replacement by the HEN Team in the patient’s home, and optimisation of nutritional status. This service evaluation demonstrated that the establishment of a dedicated multi-professional HEN Team focussed on achievement of key objectives improved patient experience and, although calculation of cost savings were estimates, provided evidence of cost-effectiveness.

Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

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Portanova Michel

2010-08-01

Full Text Available Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent total gastrectomy, 9 of them had esophagojejunal fistula (5.2%. In three selected patients a trans-anastomotic naso-enteral feeding tube was placed under fluoroscopic vision when the fistula was clinically detected and a complete polymeric enteral formula was used. Results The complete closing of the esophagojejunal fistula was obtained in day 8, 14 and 25 respectively. Conclusion In some selected cases it is possible to make a successful enteral nutrition using a feeding tube distal to the leak area inserted with the help of fluoroscopic vision. The specialized management of a gastric surgery unit and nutritional therapy unit are highlighted.

Enteral nutrition for preterm infants: by bolus or continuous? An update

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Valentina Bozzetti

2017-06-01

Full Text Available Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants.

[When enteral nutrition is not possible in intensive care patients: whether to wait or use parenteral nutrition?

NARCIS (Netherlands)

Habes, Q.L.M.; Pickkers, P.

2016-01-01

- Overfeeding of critically ill patients is associated with a higher incidence of infections and an increased length of ventilation. However, trophic nutrition or permissive underfeeding appears to have no negative effect on the patient and may even provide a survival benefit.- Initiation of enteral

Serum concentrations of trace elements in patients with Crohn's disease receiving enteral nutrition.

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Johtatsu, Tomoko; Andoh, Akira; Kurihara, Mika; Iwakawa, Hiromi; Tsujikawa, Tomoyuki; Kashiwagi, Atsunori; Fujiyama, Yoshihide; Sasaki, Masaya

2007-11-01

We investigated the trace element status in Crohn's disease (CD) patients receiving enteral nutrition, and evaluated the effects of trace element-rich supplementation. Thirty-one patients with CD were enrolled in this study. All patients were placed on an enteral nutrition regimen with Elental(R) (Ajinomoto pharmaceutical. Ltd., Tokyo, Japan). Serum selenium, zinc and copper concentrations were determined by atomic absorption spectroscopy. Serum selenoprotein P levels were determined by an ELISA system. Average serum levels of albumin, selenium, zinc and copper were 4.1 +/- 0.4 g/dl, 11.2 +/- 2.8 microg/dl, 71.0 +/- 14.8 microg/dl, and 112.0 +/- 25.6 microg/dl, respectively. In 9 patients of 31 CD patients, serum albumin levels were lower than the lower limit of the normal range. Serum selenium, zinc and copper levels were lower than lower limits in 12 patients, 9 patients and 1 patient, respectively. Serum selenium levels significantly correlated with both serum selenoprotein P levels and glutathione peroxidase activity. Supplementation of selenium (100 microg/day) and zinc (10 mg/day) for 2 months significantly improved the trace element status in CD patients. In conclusion, serum selenium and zinc levels are lower in many CD patients on long-term enteral nutrition. In these patients, supplementation of selenium and zinc was effective in improving the trace element status.

A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial.

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Fietkau, Rainer; Lewitzki, Victor; Kuhnt, Thomas; Hölscher, Tobias; Hess, Clemens-F; Berger, Bernhard; Wiegel, Thomas; Rödel, Claus; Niewald, Marcus; Hermann, Robert M; Lubgan, Dorota

2013-09-15

In patients with head and neck and esophageal tumors, nutritional status may deteriorate during concurrent chemoradiotherapy (CRT). The aim of this study was to investigate the influence of enteral nutrition enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on body composition and nutritional and functional status. In a controlled, randomized, prospective, double-blind, multicenter study, 111 patients with head and neck and esophageal cancer undergoing concurrent CRT received either an enteral standard nutrition (control group) or disease-specific enteral nutrition Supportan®-containing EPA+DHA (experimental group) via percutaneous endoscopic gastrostomy. The primary endpoint was the change of body cell mass (BCM) following CRT at weeks 7 and 14 compared with the baseline value. Secondary endpoints were additional parameters of body composition, anthropometric parameters, and nutritional and functional status. The primary endpoint of the study, improvement in BCM, reached borderline statistical significance. Following CRT, patients with experimental nutrition lost only 0.82 ± 0.64 kg of BCM compared with 2.82 ± 0.77 kg in the control group (P = .055). The objectively measured nutritional parameters, such as body weight and fat-free mass, showed a tendency toward improvement, but the differences were not significant. The subjective parameters, in particular the Kondrup score (P = .0165) and the subjective global assessment score (P = .0065) after follow-up improved significantly in the experimental group, compared with the control group. Both enteral regimens were safe and well tolerated. Enteral nutrition with EPA and DHA may be advantageous in patients with head and neck or esophageal cancer by improving parameters of nutritional and functional status during CRT. © 2013 American Cancer Society.

Enteral versus parenteral nutrition in cancer patients: evidences and controversies.

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Cotogni, Paolo

2016-01-01

The debate over the use of enteral nutrition (EN) and parenteral nutrition (PN) is an old but evergreen and hot topic. Since many years, studies comparing EN and PN have been a pivotal 'leitmotif' in the published literature on artificial nutrition (AN). Actually, there is a background misunderstanding in this debate; specifically, that EN and PN are competitors in the choice of the route for delivering nutrition support in cancer patients. Conversely, EN and PN have specific indications and contraindications. This review has the purpose to discuss the indications and complications as well as pros and cons of EN and PN in cancer patients, the crucial role of nutrition support in oncology patients during anticancer treatments and throughout the course of disease, and, finally, the role of AN in advanced cancer patients. In summary, we have no evidence-based data able to definitively indicate the optimal method for delivering AN in cancer patients. EN and PN have to be considered equally effective in maintaining or improving nutritional status in cancer patients. Besides, this review strongly supports the recommendation that a baseline nutritional assessment should be carried out by a healthcare professional expert in AN for all cancer patients at the time of diagnosis or anticancer treatment plan, taking the nutritional status, estimated duration of AN, AN-related potential benefits and possible complications into consideration on an individual basis. Moreover, the patient symptoms, performance status, estimated life expectancy, and mainly, will or preferences have to be evaluated and incorporated into the nutrition support plan before the definitive choice of the route for delivering nutrients is decided. Finally, applying a decision-making process tailored to patient needs-regardless of whether receiving or not anticancer treatment-allows to choose reasonably the optimal nutritional support strategy.

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses.

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Lim, Mei Ling; Yong, Bei Yi Paulynn; Mar, Mei Qi Maggie; Ang, Shin Yuh; Chan, Mei Mei; Lam, Madeleine; Chong, Ngian Choo Janet; Lopez, Violeta

2018-07-01

To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition. © 2018 John Wiley & Sons Ltd.

Beneficial Effects of Early Enteral Nutrition After Major Rectal Surgery: A Possible Role for Conditionally Essential Amino Acids? Results of a Randomized Clinical Trial.

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van Barneveld, Kevin W Y; Smeets, Boudewijn J J; Heesakkers, Fanny F B M; Bosmans, Joanna W A M; Luyer, Misha D; Wasowicz, Dareczka; Bakker, Jaap A; Roos, Arnout N; Rutten, Harm J T; Bouvy, Nicole D; Boelens, Petra G

2016-06-01

To investigate direct postoperative outcome and plasma amino acid concentrations in a study comparing early enteral nutrition versus early parenteral nutrition after major rectal surgery. Previously, it was shown that a low plasma glutamine concentration represents poor prognosis in ICU patients. A preplanned substudy of a previous prospective, randomized, open-label, single-centre study, comparing early enteral nutrition versus early parenteral nutrition in patients at high risk of postoperative ileus after surgery for locally advanced or locally recurrent rectal cancer. Early enteral nutrition reduced postoperative ileus, anastomotic leakage, and hospital stay. Tertiary referral centre for locally advanced and recurrent rectal cancer. A total of 123 patients with locally advanced or recurrent rectal carcinoma requiring major rectal surgery. Patients were randomized (ALEA web-based external randomization) preoperatively into two groups: early enteral nutrition (early enteral nutrition, intervention) by nasojejunal tube (n = 61) or early parenteral nutrition (early parenteral nutrition, control) by jugular vein catheter (n = 62). Eight hours after the surgical procedure artificial nutrition was started in hemodynamically stable patients, stimulating oral intake in both groups. Blood samples were collected to measure plasma glutamine, citrulline, and arginine concentrations using a validated ultra performance liquid chromatography-tandem mass spectrometric method. Baseline concentrations were comparable for both groups. Directly after rectal surgery, a decrease in plasma amino acids was observed. Plasma glutamine concentrations were higher in the parenteral group than in the enteral group on postoperative day 1 (p = 0.027) and day 5 (p = 0.008). Arginine concentrations were also significantly increased in the parenteral group at day 1 (p < 0.001) and day 5 (p = 0.001). Lower plasma glutamine and arginine concentrations were measured in the enteral group, whereas a

Enteral nutritional support management in a university teaching hospital: team vs nonteam.

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Brown, R O; Carlson, S D; Cowan, G S; Powers, D A; Luther, R W

1987-01-01

Current hospital cost containment pressures have prompted a critical evaluation of whether nutritional support teams render more clinically effective and efficient patient care than nonteam management. To address this question with regard to enteral feeding, 102 consecutive hospitalized patients who required enteral nutritional support (ENS) by tube feeding during a 3 1/2-month period were prospectively studied. Fifty patients were managed by a nutritional support team; the other 52 were managed by their primary physicians. Choice of enteral formula, formula modifications, frequency of laboratory tests, and amounts of energy and protein received were recorded daily. In addition, each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. Team-managed (T) and nonteam-managed (NT) patients received ENS for 632 and 398 days, respectively. The average time period for ENS was significantly longer in the team-managed patients (12.6 +/- 12.1 days vs 7.7 +/- 6.2 days, p less than 0.01). Significantly more of the team patients attained 1.2 X basal energy expenditure (BEE) (37 vs 26, p less than 0.05). Total number of abnormalities in each group was similar (T = 398, NT = 390); however, the abnormalities per day were significantly lower in the team group (T = 0.63 vs NT = 0.98, p less than 0.01). Mechanical (T = 0.05 vs NT = 0.11, p less than 0.01), gastrointestinal (T = 0.99 vs NT = 0.14, p less than 0.05), and metabolic (T = 0.49 vs NT = 0.72, p less than 0.01) abnormalities per day all were significantly lower in the team-managed patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of Early Enteral Immunonutrition on Postoperative Immune Function and Rehabilitation of Patients with Gastric Cancer and Nutritional Risk].

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Peng, Chang-Bing; Li, Wen-Zhong; Xu, Rui; Zhuang, Wen

2017-05-01

To investigate the effects of early enteral immunonutrition on postoperative immune function and rehabilitation of gastric cancer patients with nutritional risk. New hospitalized patients with gastric cancer were evaluated the nutrient status based on NRS 2002. The patients who scored between 3 to 5 points were randomized into two groups(30 cases for each group), and those in experimental group were given 7-d early postoperative enteral immune nutrition, those in control group were given normal nutrition. The immune indexes (CD3 + , CD4 + , CD8 + and CD4 + /CD8 + ) and nutritional indexes(transferrin, pre-albumin, albumin) were measured before operation and at the 3 rd and 7 th day postoperatively. In addition, the first flatus time, gastrointestinal adverse reactions and complications, length of hospital stays were compared between the two groups. The level of CD4 + /CD8 + and transferrin, pre-albumin, albumin in experimental group were significantly higher than those in control group at the third and seventh day postoperatively ( P 0.05). Early enteral immunonutrition can effectively promote the recovery of nutritional status and immune function in gastric cancer patients with nutrition risk.

Feeding tube-related complications and problems in patients receiving long-term home enteral nutrition

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Vasileios Alivizatos

2015-04-01

Full Text Available Aim: The aim of this study was to evaluate the long-term complications and problems related to gastrostomy and jejunostomy feeding tubes used for home enteral nutrition support and the effect these have on health care use. Materials and Methods: The medical records of 31 patients having gastrostomy (27 patients and jejunostomy (4 feeding tubes inserted in our Department were retrospectively studied. All were discharged on long-term (>3 months enteral nutrition and followed up at regular intervals by a dedicated nurse. Any problem or complication associated with tube feeding as well as the intervention, if any, that occurred, was recorded. Data were collected and analyzed. Results: All the patients were followed up for a mean of 17.5 months (4-78. The most frequent tube-related complications included inadvertent removal of the tube (broken tube, plugged tube; 45.1%, tube leakage (6.4%, dermatitis of the stoma (6.4%, and diarrhea (6.4%. There were 92 unscheduled health care contacts, with an average rate of such 2.9 contacts over the mean follow-up time of 17.5 months. Conclusion: In patients receiving long-term home enteral nutrition, feeding tube-related complications and problems are frequent and result in significant health care use. Further studies are needed to address their optimal prevention modalities and management.

Diet-Dependent Effects of Minimal Enteral Nutrition on Intestinal Function and Necrotizing Enterocolitis in Preterm Pigs

DEFF Research Database (Denmark)

Cilieborg, Malene Skovsted; Boye, Mette; Thymann, Thomas

2011-01-01

Background: A rapid advance in enteral feeding is associated with necrotizing enterocolitis (NEC) in preterm infants. Therefore, minimal enteral nutrition (MEN) combined with parenteral nutrition (PN) is common clinical practice, but the effects on NEC and intestinal function remain poorly...... characterized. It was hypothesized that a commonly used MEN feeding volume (16-24 mL/kg/d) prevents NEC and improves intestinal structure, function, and microbiology in preterm pigs. Methods: After preterm birth pigs were stratified into 4 nutrition intervention groups that received the following treatments: (1...... later formula-induced gut dysfunction and NEC. However, in CF pigs, intestinal lesions were restricted to the colon, compared with all regions in OF and FF pigs, which indicated proximal protection of colostrum MEN. Bacterial composition was not affected by MEN, diet, or NEC outcomes, but bacterial load...

Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy.

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Zhu, Xin-Hua; Wu, Ya-Fu; Qiu, Yu-Dong; Jiang, Chun-Ping; Ding, Yi-Tao

2013-09-21

To investigate the effect of early enteral nutrition (EEN) combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy (PD). From January 2006, all patients were given EEN combined with parenteral nutrition (PN) (EEN/PN group, n = 107), while patients prior to this date were given total parenteral nutrition (TPN) (TPN group, n = 67). Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery. The assessment of clinical outcome was based on postoperative complications. Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge. Readmission within 30 d after discharge was also recorded. Compared with the TPN group, a significant decrease in prealbumin (PAB) (P = 0.023) was seen in the EEN/PN group. Total bilirubin (TB), direct bilirubin (DB) and lactate dehydrogenase (LDH) were significantly decreased on day 6 in the EEN/PN group (P = 0.006, 0.004 and 0.032, respectively). The rate of grade I complications, grade II complications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased (P = 0.036, 0.028 and 0.021, respectively), and no hospital mortality was observed in our study. Compared with the TPN group (58.2%), the rate of infectious complications in the EEN/PN group (39.3%) was significantly decreased (P = 0.042). Eleven cases of delayed gastric emptying were noted in the TPN group, and 6 cases in the EEN/PN group. The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group (P = 0.031 and P = 0.040, respectively). Early enteral combined with PN can greatly improve liver function, reduce infectious complications and delayed gastric emptying, and shorten postoperative hospital stay in patients undergoing PD.

Early enteral immune nutrition support after radical operation for gastric cancer on promoting the recovery of gastrointestinal function and immune function

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Zhi-Gang Li

2016-05-01

Full Text Available Objective: To analyze the effect of early enteral immune nutrition support after radical operation for gastric cancer on the recovery of gastrointestinal function and immune function. Methods: A total of 106 cases of patients received radical operation for gastric cancer in our hospital were selected as research subjects, and according to different ways of postoperative nutrition intervention, all patients were divided into observation group (n=50 and control group (n=56. Control group received conventional enteral nutrition intervention, observation group received postoperative early enteral immune nutrition support, and then differences in postoperative intestinal mucosa barrier function, gastrointestinal hormone levels, immune function levels and nutrition-related indicator values were compared between two groups. Results: After observation group received enteral immune nutrition intervention, serum DAO, PS and D-lactate levels as well as urine L/M ratio were lower than those of control group; serum GAS, CCK, MTL and SP values of observation group after intervention were higher than those of control group, and GLU, VIP, GIP and SS values were lower than those of control group; CD4, IgG, NK cell, C3, C4, CH50 and S-IgA levels of observation group after intervention were higher than those of control group; serum ALB, PRE, TRF and RBP levels of observation group after intervention were higher than those of control group. Conclusion: Early enteral immune nutrition support after radical operation for gastric cancer is conducive to the recovery of gastrointestinal function and the promotion of immune state, eventually promotes patients’ postoperative overall recovery and has active clinical significance.

Effects of Delayed Enteral Nutrition on Inflammatory Responses and Immune Function Competence in Critically Ill Patients with Prolonged Fasting.

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Xi, Fengchan; Li, Ning; Geng, Yanxia; Gao, Tao; Zhang, Juanjuan; Jun, Tanshan; Lin, Zhiliang; Li, Weiqin; Zhu, Weiming; Yu, Wenkui; Li, Jieshou

2014-05-01

Although different studies suggest that early enteral nutrition (EEN) has benefits in reducing infectious complications, there is no data that addresses whether delayed enteral nutrition (EN) is detrimental and if it may have effects on inflammatory responses and immune function. Forty-five critically ill patients with long fasting were randomly allocated in two groups according to the type of nutritional support. The first group included patients assuming a standard enteral nutrition (EN, n = 22) and the second group assuming a parenteral nutrition (PN, n = 23). The daily nutritional amount was 25 kcal (105 kJ)/kg for all patients. The inflammatory markers white blood cells (WBC), C-reactive protein (CRP), TNF-α, IL-1-β, IL-6, IL-4, IL- 10 and the immune T-lymphocyte sub-populations CD3+, CD4+, CD8+, and HLA-DR+ were evaluated at day 1, and after 2, 3 and 7 days. IL-4, IL-10, CD3+, CD4+, CD8+ and the CD4+/CD8+ ratio were not statistically different between the two groups. WBC and TNF-α in EN patients were higher than those in PN after 3 and 7 days (P fasting increased systemic inflammatory responses, whereas EN could modify immune function, therefore reducing hospital stay and costs.

Early enteral nutrition after total gastrectomy for gastric cancer.

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Chen, Wei; Zhang, Zheng; Xiong, Maoming; Meng, Xiangling; Dai, Fen; Fang, Jun; Wan, Hong; Wang, Miaofeng

2014-01-01

To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition (TPN group) after total gastrectomy for gastric cancer. The nutrition index, liver function, patient generated subjective global assessment (PG-SGA) score, the post-operation complications, the hospital stay and hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of Surgery from May 2011 to May 2013 were analyzed retrospectively. A total of 72 patients including 37 cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN group was significantly lower than the EEN group at 21 days (pnutrition indicators. The incidence of complications in the EEN group and TPN group were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the EEN and in the TPN group were up to 12.2 ± 2.5 d vs 14.9 ± 2.9 d (pgastric cancer.

Nutritional analysis and microbiological evaluation of commercially available enteral diets for cats.

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Prantil, Lori R; Markovich, Jessica E; Heinze, Cailin R; Linder, Deborah E; Tams, Todd R; Freeman, Lisa M

2016-01-01

To determine the prevalence of nutrients less than or greater than accepted standards in commercially available enteral diets for cats, and to identify contamination incidence in enteral diets for cats. Prospective cross-sectional study. University teaching hospital. Seven commercial enteral diets for cats. Labels were evaluated to determine if diets were intended to be nutritionally complete and balanced. One diet under storage techniques partially representative of clinical conditions was sampled on days 0, 1, 3, 5, and 7 of storage for aerobic bacterial culture. All 7 diets were analyzed for key nutrients and results were compared to Association of American Feed Control Officials (AAFCO) Nutrient Profiles for Adult Cats for maintenance and National Research Council recommended allowance (NRC-RA). From label information, 4 diets were classified as complete and balanced and 3 diets were classified as not complete and balanced. All 7 diets had at least 1 nutrient less than the AAFCO minimums and the NRC-RA. The total number of nutrients less than AAFCO minimums ranged from 3 to 9 (median = 4), with iron, potassium, and manganese being the most common. Concentrations of some nutrients were undetectable. None of the samples tested had a positive aerobic culture at baseline (day 0) or on subsequent samples from days 1, 3, 5, and 7 under any storage condition. None of the diets analyzed met all of the minimum nutrient concentrations. While short-term feeding may not be of concern for an individual patient, clinicians should be aware of potential nutritional limitations when feeding enteral diets to ill or injured cats. © Veterinary Emergency and Critical Care Society 2015.

Transition from parenteral to enteral nutrition induces immediate diet-dependent gut histological and immunological responses in preterm neonates

DEFF Research Database (Denmark)

Siggers, Jayda; Sangild, Per T.; Jensen, Tim Kåre

2011-01-01

bacterial groups (Clostridium, Enterococcus, Streptococcus species) increased with time. We conclude that a switch from parenteral to enteral nutrition rapidly induces diet-dependent histopathological, functional, and proinflammatory insults to the immature intestine. Great care is required when introducing......-six preterm pigs were fed total parenteral nutrition (TPN) for 48 h followed by enteral feeding for 0, 8, 17, or 34 h with either colostrum (Colos, n = 20) or formula (Form, n = 31). Macroscopic NEC lesions were detected in Form pigs throughout the enteral feeding period (20/31, 65%), whereas most Colos pigs...... no histopathological lesions, increased maltase activity, and induced changes in gene expressions related to tissue development. Total bacterial density was high after 2 days of parenteral feeding and was not significantly affected by diet (colostrum, formula) or length of enteral feeding (8–34 h), except that a few...

Enteral Nutrition Support for Abdominal Compartment Syndrome in Morbidly Obese Patient : A Case Report from a Medical Intensive Care Unit (ICU

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Nurul Huda Razalli

2018-01-01

Full Text Available Compartment syndrome occurs when pressure within a closed muscle or bone compartment builds to dangerous levels. This pressure can decrease blood flow to nerve and muscle cells, leading to ischemia and organ dysfunction. Challenges in providing enteral nutrition for abdominal compartment syndrome (ACS patients include the increase risk for developing gastrointestinal symptoms such as diarrhea, constipation and distention. There are limited reports available on the nutritional management of ACS patients in the ICU especially those with morbid obesity condition to guide dietitians in providing nutritional support for these patients.  Here, we report the enteral nutrition management of a mechanically ventilated, morbidly obese patient with ACS in a critical care setting by adopting postpyloric feeding, using prokinetic agents and implementing PO2/FiO2 ratio calculation for prescription of most suitable enteral formula.

Evolução antropométrica e sintomas gastrointestinais em pacientes que receberam suplementos nutricionais ou nutrição enteral Anthropometric evolution and gastrointestinal complaints in oral nutritional supplementation and enteral nutritional therapy

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Juliana Maria Faccioli Sicchieri

2009-01-01

Full Text Available OBJETIVO: Em pacientes hospitalizados, comparar a evolução de variáveis antropométricas e a ocorrência de efeitos adversos relacionados ao consumo de suplementos nutricionais e infusão de nutrição enteral. MÉTODOS: 10 pacientes que recebiam suplementos nutricionais (Grupo SN e 20 em nutrição enteral (Grupo NE, pareados para o gênero, idade (50 ± 21 vs 49 ± 23 anos e afecções de base foram submetidos à avaliação antropométrica ao início e término da terapêutica. Diariamente, foi aplicado um questionário semi-estruturado referente às queixas gastrointestinais. Determinaram-se as diferenças estatísticas obtidas entre o início e o final da terapêutica (teste t para amostras dependentes e entre os grupos de estudo (teste t para amostras independentes. RESULTADOS: A circunferência muscular do braço aumentou nos pacientes do Grupo NE (80 ± 15 vs 85 ± 15% de adequação, p = 0,009 e diminuiu no Grupo SN (96 ± 14 vs 92 ± 14% de adequação, p = 0,04. Náuseas e vômitos foram mais frequentes no Grupo SN (60 vs 10%, p = 0,01 e as queixas relacionadas ao sabor dos produtos ocorreram em 30% dos casos. CONCLUSÃO: Os pacientes que receberam suplementos nutricionais apresentaram maior ocorrência de queixas gastrointestinais e evolução desfavorável dos parâmetros antropométricos. Os dados obtidos no estudo não evidenciam o benefício da suplementação nutricional de rotina em pacientes hospitalizados.OBJECTIVE: To compare the evolution of anthropometric variables and the occurrence of adverse effects related to the ingestion of nutritional food supplements and enteral diet administration in hospitalized patients. METHODS: The study was performed in the Clinical Medicine wards of the Hospital of the School of Medicine of Ribeirão Preto, USP, with 10 patients receiving nutrition supplements, and 20 patients under enteral nutrition therapy, paired by gender, age (50 ± 21 vs 49 ± 23 years and basic afflictions. All

A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region

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Alvin Wong

2018-02-01

Full Text Available Literature regarding the use of home enteral nutrition (HEN and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs, and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r = 0.63, p = 0.021. High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries.

Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial.

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Klek, Stanislaw; Scislo, Lucyna; Walewska, Elzbieta; Choruz, Ryszard; Galas, Aleksander

2017-04-01

The aim of the study was to determine whether the postoperative use of enteral nutrition enriched with arginine, glutamine, and omega-3 fatty acids influences survival in patients diagnosed with stomach cancer. For the purpose of the study, the second wave of the trial performed in 2003 to 2009 was done. Ninety-nine patients who underwent surgery for gastric cancer (27 F, 72 M, mean age: 62.9 y) met the inclusion criteria. Of those, 54 were randomized to standard and 45 to enriched enteral nutrition (EEN). In all patients, short- and long-term (5 y) survival was analyzed. Analysis of the overall survival time did not reveal differences between groups (P = 0.663). Until the end of the third month, however, there were nine deaths in the standard enteral nutrition group and no deaths in the EEN group (16.7% versus 0.0%, P = 0.004). The univariate analyses suggested that the EEN group may have lower risk, especially during the first year after intervention. A significant reduction in the risk of death was seen during the early period after surgery (first 6 mo) in the EEN group in stage IV patients (hazard ratio = 0.25, P = 0.049). The use of enriched enteral diet did not influence, however, the risk of dying when patients were analyzed together. The study does not support the beneficial effect of enriched enteral nutrition in long-term survival; however, the positive impact on the stage IV patients suggests the need for further, more detailed studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

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Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J

2016-03-09

Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p Health-care costs were reduced by 65.6% (p nutritional parameters were improved at one year (albumin: +10.6%, p nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.

[Clinical observation of preoperative administration of enteral nutrition support in gastric cancer patients at risk of malnutrition].

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Chen, Bo; Zhou, Yong; Yang, Ping; Qin, Xian-peng; Li, Ning-ning; He, Dan; Feng, Jin-yan; Yan, Chuan-jing; Wu, Xiao-ting

2013-11-01

To evaluate safety and efficacy of preoperative administration of enteral nutrition support in gastric cancer patients at risk of malnutrition. A single center randomized controlled clinical trial was performed in 60 gastric cancer patients in West China Hospital from May to October 2012. Thirty patients were given enteral nutrition support(Ensure(R)) manufactured by Abbott Laboratories for ten consecutive days before surgical operation in the treatment group, and 30 patients were given an isocaloric and isonitrogenous homogenized diet in the control group for 10 days as well. The laboratory parameters of nutritional status and hepatorenal function were observed and compared between the two groups on admission, preoperative day 1 and postoperative day 3, respectively. Clinical observations, such as nausea and vomiting, were carried out until patients were discharged. Before the intervention, there were no significant differences in the baseline characteristics between the two groups. The levels of serum albumin [(33.9±5.6) g/L vs. (31.0±5.3) g/L, P0.05). Moreover, two patients with nausea and one with vomiting in each group were found. In clinical observation period, no severe treatment-related adverse event were observed. The enteral supplement with Ensure(R) in gastric cancer patients at risk of malnutrition during preoperative period is effective and safe, which is superior to homogenized diet and an appropriate choice for gastric cancer patients with nutritional risk.

Nutritional status and adequacy of enteral nutrition in pediatric cancer patients at a reference center in northeastern Brazil.

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Maciel Barbosa, J; Pedrosa, F; Coelho Cabral, P

2012-01-01

Individualized nutritional support is important to pediatric cancer patients and should be integrated to the overall treatment of these patients. Analyze the nutritional status of cancer patients submitted to enteral nutrition (EN) and assess the adequacy of this form of nutrition. A case series study was carried out at the Pediatric Oncology Unit of the Institute of Integrative Medicine Professor Fernando Figueira (IMIP, Brazil, Recife-PE) between January and December 2009. Clinical and anthropometric data were obtained from medical charts and nutritional follow-up charts. Z scores for height for age, weight for age and body mass index for age indicators (H/A, W/A and BMI/A, respectively) were calculated using the AnthroPlus program. Caloric and protein requirements were calculated based on the recommendations of the Brazilian National Council of Oncologic Nutrition. At the beginning of EN, 32.4% of the sample had short stature and 23.9% were underweight based on the BMI/A indicator. The assessment of EN adequacy demonstrated that 49.3% reached the caloric requirements and 76.1% reached the protein requirements, with maximal intakes of 65.6 Kcal/Kg/day and 1.95 g of protein/kg/day. Malnourished patients had greater mean Z scores for W/A and BMI/A at the end of EN, whereas no significant changes were found among patients with adequate nutritional status and significant reductions in these indicators were found among those with overweight or obesity. The patients either maintained or achieved a significant improvement in nutritional status, which demonstrates the importance of nutritional support and follow up during hospitalization.

Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving.

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Silver, Heidi J; Wellman, Nancy S; Galindo-Ciocon, Daisy; Johnson, Paulette

2004-01-01

We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use. Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit. In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving. Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables. Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03). Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving

Enteral Nutrition in Pancreaticoduodenectomy: A Literature Review

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Salvatore Buscemi

2015-04-01

Full Text Available Pancreaticoduodenectomy (PD is considered the gold standard treatment for periampullory carcinomas. This procedure presents 30%–40% of morbidity. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days, affects the process of healing, the intestinal barrier function and the number of postoperative complications. Few studies focus on the relation between enteral nutrition (EN and postoperative complications. Our aim was to perform a review, including only randomized controlled trial meta-analyses or well-designed studies, of evidence regarding the correlation between EN and main complications and outcomes after pancreaticoduodenectomy, as delayed gastric emptying (DGE, postoperative pancreatic fistula (POPF, postpancreatectomy hemorrhage (PPH, length of stay and infectious complications. Several studies, especially randomized controlled trial have shown that EN does not increase the rate of DGE. EN appeared safe and tolerated for patients after PD, even if it did not reveal any advantages in terms of POPF, PPH, length of stay and infectious complications.

Nutritional support team vs nonteam management of enteral nutritional support in a Veterans Administration Medical Center teaching hospital.

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Powers, D A; Brown, R O; Cowan, G S; Luther, R W; Sutherland, D A; Drexler, P G

1986-01-01

One hundred one patients receiving enteral nutritional support (ENS) by tube feeding during a 5-month period were prospectively studied. Fifty patients were managed by a nutritional support team (T) and 51 patients were managed by the nonteam approach (NT). Demographics, primary diagnosis, chronic diseases, medical service, calculated basal energy expenditure (BEE), duration of ENS, and final patient disposition were recorded. Enteral formula, formula modifications, results of laboratory tests and calories delivered were obtained daily. Results of nitrogen balance studies were obtained when available and each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. No significant difference was found between the team and nonteam managed groups in regard to total feeding days, mean feeding days per patient, total laboratory tests, laboratory tests per patient or laboratory tests per day. Significantly more team patients attained 1.2 times BEE (T = 47, NT = 38, p less than 0.05) for a significantly greater period of time (T = 398 days, NT = 281 days, p less than 0.05). Significantly more team patients achieved a measured positive nitrogen balance than nonteam patients (T = 42, NT = 1, p less than 0.05). Formula modifications to correct nutritional or metabolic aberrations were made in 15 (30%) team patients and five (9.8%) nonteam patients (p less than 0.05). The number of individual abnormalities (pulmonary, mechanical, gastrointestinal, and metabolic), as well as total abnormalities occurring in the team-managed group, was significantly lower than in the nonteam managed group (160 vs 695, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Parenteral lipids and partial enteral nutrition affect hepatic lipid composition but have limited short term effects on formula-induced necrotizing enterocolitis in preterm piglets

DEFF Research Database (Denmark)

Vegge, Andreas; Thymann, Thomas; Lauritzen, Lotte

2015-01-01

Rapid transition from total parenteral nutrition (TPN) to enteral feeding is a risk factor for necrotizing enterocolitis (NEC) in preterm infants. We hypothesized that partial enteral nutrition with colostrum, increased proportion of n-3 polyunsaturated fatty acids (PUFA), or exclusion of lipid...

The potential association of later initiation of oral/enteral nutrition on euthyroid sick syndrome in burn patients.

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Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I

2013-01-01

Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS), and shortens the length of hospital stay (LHS). Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd-5th day) and second sample collection (9th-12th day) after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: 48 h after the injury (Group 3). Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days) was, respectively, in each group, 16.77 ± 4.56, 21.98 ± 4.86, and 26.06 ± 5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61 ± 0.92 days) in Group 3, but there was no group with ESS at the second sample collection (9.89 ± 1.01 days). Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression. Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

[Enteral nutrition in neurological patients: is there enough vitamin D content in commonly used formulas?].

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Botella Romero, F; Alfaro Martínez, J J; Luna López, V; Galicia Martín, I

2012-01-01

Vitamin D deficiency produces inadequate bone mineralization, proximal muscle weakness, abnormal gait and increased risk of falls and fractures. Moreover, in epidemiological studies, has been associated with increased risk of cancer, autoimmune diseases, type 1 and 2 diabetes, rheumatoid arthritis, multiple sclerosis, infectious diseases, cardiovascular diseases and depression. When synthesis through the skin by sun exposure is not possible and the patient can not eat by mouth, as in the advanced stages of various neurological diseases, the supply of vitamin D has to be done by enteral nutrition. The aim of this study is to review the role of vitamin D in a common group of neurological conditions that often require artificial nutrition and analyze whether the vitamin D of different enteral nutrition formulas is adequate to meet the needs of this group of patients. Numerous studies have shown the association between vitamin D deficiency and increased incidence of dementia, stroke and other neurodegenerative diseases. Interventions aimed to increase levels of vit. D and its effects on functional (falls, pain, quality of life) and cardiovascular goals (cardiovascular death, stroke, myocardial infarction, cardiovascular risk factors) have obtained as highlight data a clear reduction of falls and fractures, while the evidence for the other parameters studied is still limited and inconsistent. The content of calcium and vitamin D of enteral formulas is legislated in our country. The total amount of vitamin D for a daily intake of 1,500-2,000 kcal ranges between 300 and 1,600 IU/d (mean ± SD: 32.9 ± 8.5 mg/100 kcal) in the complete formulas for enteral nutrition most commonly used. 50% of the diets studied, for an intake of 2,000 kcal/d, and 90% for an intake of 1,500 kcal/d, provide less than 600 IU/d of vitamin D. Some revised recently guidelines published recommendations of daily intake of vitamin D. The document published by the U.S. Institute of Medicine

Perioperative Alanyl-Glutamine-Supplemented Parenteral Nutrition in Chronic Radiation Enteritis Patients With Surgical Intestinal Obstruction: A Prospective, Randomized, Controlled Study.

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Yao, Danhua; Zheng, Lei; Wang, Jian; Guo, Mingxiao; Yin, Jianyi; Li, Yousheng

2016-04-01

A prospective, randomized, controlled study was performed to evaluate the effects of perioperative alanyl-glutamine-supplemented parenteral nutrition (PN) support on the immunologic function, intestinal permeability, and nutrition status of surgical patients with chronic radiation enteritis (CRE)-induced intestinal obstruction. Patients who received 0.4 g/kg/d alanyl-glutamine and isonitrogenous PN were assigned to an alanyl-glutamine-supplemented PN (Gln-PN) group and a control group, respectively. Serum levels of alanine aminotransferase and glutamine, body fat mass (FM), immunologic function, and intestinal permeability were measured before and after surgery. Serum glutamine levels of the Gln-PN group significantly exceeded that of the control group (P nutrition state and intestinal motility of surgical patients with CRE-induced intestinal obstruction. © 2015 American Society for Parenteral and Enteral Nutrition.

Comparison of the effects of enteral feeding with continuous and intermittent parenteral nutrition on hepatic triglyceride secretion in human beings

International Nuclear Information System (INIS)

Isabel-Martinez, L.; Skinner, C.; Parkin, A.; Hall, R.I.

1989-01-01

Plasma triglyceride turnover was measured during steady-state conditions in 22 postoperative patients. Nine had received nutritional support with an enteral regimen, seven had received an equivalent regimen as continuous parenteral nutrition, and six received the same parenteral regimen as a cyclical infusion. After 5 days of nutritional support, each patient received an intravenous bolus of tritiated glycerol. Plasma radiolabeled triglyceride content was measured during the subsequent 24 hours. The data were analyzed by means of a simple deterministic model of plasma triglyceride kinetics and compared with the results obtained by stochastic analysis. The rates of hepatic triglyceride secretion obtained by deterministic analysis were higher than those obtained by the stochastic approach. However, the mode of delivery of the nutritional regimen did not affect the rate of hepatic triglyceride secretion regardless of the method of analysis. The results suggest that neither complete nutritional bypass of the gastrointestinal tract nor interruption of parenteral nutrition in an attempt to mimic normal eating has any effect on hepatic triglyceride secretion. Any beneficial effect that enteral feeding or cyclical parenteral nutrition may have on liver dysfunction associated with standard parenteral nutrition appears to be unrelated to changes in hepatic triglyceride secretion

The Potential Association of Later Initiation of Oral/Enteral Nutrition on Euthyroid Sick Syndrome in Burn Patients

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Joaquín Pérez-Guisado

2013-01-01

Full Text Available Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS, and shortens the length of hospital stay (LHS. Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd–5th day and second sample collection (9th–12th day after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: 48 h after the injury (Group 3. Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days was, respectively, in each group, 16.77±4.56, 21.98±4.86, and 26.06±5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61±0.92 days in Group 3, but there was no group with ESS at the second sample collection (9.89±1.01 days. Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression. Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

Temporary Rumenostomy for the Treatment of Forestomach Diseases and Enteral Nutrition.

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Callan, Robert J; Applegate, Tanya J

2017-11-01

Temporary rumenostomy is a useful procedure for the treatment, management, and support of patients with forestomach disease of various types. The rumenostomy provides a mechanism for relief of chronic rumen tympany or distention, removal of rumen contents and lavage of the rumen, removal of some rumen foreign bodies, administration of rumen fluid transfaunation, and administration of enteral nutrition or other medications. When the rumenostomy is no longer necessary, it can be allowed to close by second intention or by surgical resection. Copyright © 2017 Elsevier Inc. All rights reserved.

Is Early Enteral Nutrition Better for Postoperative Course in Esophageal Cancer Patients?

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Toshifumi Wakai

2013-09-01

Full Text Available We retrospectively examined esophageal cancer patients who received enteral nutrition (EN to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS, incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01, lesser dose of postoperative albumin infusion (p < 0.01, less use of TPN (p < 0.01, and shorter duration of SIRS (p < 0.01. However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.

Is Early Enteral Nutrition Better for Postoperative Course in Esophageal Cancer Patients?

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Kobayashi, Kazuaki; Koyama, Yu; Kosugi, Shin-ichi; Ishikawa, Takashi; Sakamoto, Kaoru; Ichikawa, Hiroshi; Wakai, Toshifumi

2013-01-01

We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation. PMID:24067386

Delivered volumes of enteral nutrition exceed prescribed volumes.

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Walker, Renee Nichole; Utech, Anne; Velez, Maria Eugenia; Schwartz, Katie

2014-10-01

Enteral nutrition (EN) provisions are typically calculated based on a 24-hour infusion period. However, feedings are often interrupted for daily activities, procedures, or gastrointestinal intolerance. The study's objective was to determine the delivered EN quantities provided to stable hospitalized patients, using cellular time and measured volumes to verify our EN calculation adjustment. A supply of consecutively numbered ready-to-hang (RTH) EN product was delivered to the bedside of 26 inpatients with established EN tolerance at goal rates on various types of nursing units. The dietitian weighed the volume remaining in the infusing product and recorded the measurement time. On the following days, the dietitian continued to weigh the infusing RTH product and the empty RTH bottles saved by nursing. The primary outcome was the difference between the prescribed and delivered EN provisions, which was calculated with a paired t test. Patients received significantly more calories in the delivered enteral feeding (mean [SD], 1678 [385] kcal) than prescribed calories in the EN order (1489 [246 kcal]; t = 3.736, P = .001), adjusting for observed time. No significant differences were found between nursing units, product, and rate. EN delivered may actually exceed ordered amounts by 5%–21% (mean, 12%) with feeding pump inaccuracy as the primary contributing factor. This differs from what others have found. Our findings support using a volume-based ordering system vs a rate-based ordering system for more accurate EN delivery.

Combined enteral feeding and total parenteral nutritional support improves outcome in surgical intensive care unit patients.

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Hsu, Min-Hui; Yu, Ying E; Tsai, Yueh-Miao; Lee, Hui-Chen; Huang, Ying-Che; Hsu, Han-Shui

2012-09-01

For intensive care unit (ICU) patients with gastrointestinal dysfunction and in need of total parenteral nutrition (TPN) support, the benefit of additional enteral feeding is not clear. This study aimed to investigate whether combined TPN with enteral feeding is associated with better outcomes in surgical intensive care unit (SICU) patients. Clinical data of 88 patients in SICU were retrospectively collected. Variables used for analysis included route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, admission diagnosis, surgical procedure, Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbidities, length of hospital stay, postoperative complications, blood glucose values and hospital mortality. Wound dehiscence and central catheter infection were observed more frequently in the group of patients receiving TPN calories less than 90% of total calorie intake (p = 0.004 and 0.043, respectively). APACHE II scores were higher in nonsurvivors than in survivors (p = 0.001). More nonsurvivors received TPN calories exceeding 90% of total calorie intake and were in need of dialysis during ICU admission (p = 0.005 and 0.013, respectively). Multivariate analysis revealed that the percentage of TPN calories over total calories and APACHE II scores were independent predictors of ICU mortality in patients receiving supplementary TPN after surgery. In SICU patients receiving TPN, patients who could be fed enterally more than 10% of total calories had better clinical outcomes than patients receiving less than 10% of total calorie intake from enteral feeding. Enteral feeding should be given whenever possible in severely ill patients. 2012 Published by Elsevier B.V

Gastrointestinal obstruction caused by solidification and coagulation of enteral nutrition: pathogenetic mechanisms and potential risk factors

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Leonello G

2018-04-01

Full Text Available Grazia Leonello,1 Antonio Giacomo Rizzo,1 Viviane Di Dio,2 Antonio Soriano,3 Claudia Previti,3 Grazia Giulia Pantè,3 Claudio Mastrojeni,1 Sebastiano Pantè1 1Department of Human Pathology of Adults and Evolutive Era “Gaetano Barresi”, University of Messina, Messina, Italy; 2Health Research Institute Bonino Pulejo, Piemonte Hospital, Messina, Italy; 3Department of Medical and Surgery Science, University of Messina, Messina, Italy Abstract: Enteral nutrition (EN is preferred in order to provide nutrition and reduce catabolism in critically ill patients. Recent studies suggest that the use of EN is successful and complications are rare. However, an underestimated mechanical complication of tube feedings seen in critically ill patients is the coagulation and solidification of the EN causing gastrointestinal obstruction. This report describes two clinical cases (1.23% of all cases seen at our clinic of obstruction and perforation of the small bowel secondary to the solidification of EN. The understanding and early recognition of this potential complication are essential for the prevention and successful treatment of this condition. Keywords: enteral nutrition, gastrointestinal contents, intestinal obstruction, small-bowel bezoar

Influence of intestinal early enteral nutrition therapy on intestinal barrier function and immune response of patients with radiation enteritis

International Nuclear Information System (INIS)

Liu Guohui; Kang Xin; Chen Gong; Wang Guangyi

2012-01-01

Objective: To investigate the influence of early enteral nutrition therapy on the intestinal barrier function and immune response of the patients with radiation enteritis (ER) so as to find a relatively simple and effective method to treat RE. Methods: Fifty-six patients with radiation enteritis (RE) diagnosed by colonoscopy, X-rays, and pathology were randomly divided into 2 equal groups: experimental group undergoing enteral nutrition therapy, and control group undergoing conventional therapy only. Peripheral blood samples were collected 1, 11, and 21 days after admission. Plasma diamine oxidase (DAO), D-lactic acid, endotoxin, and lactulose/mannitol (L/M) ratio, and levels of IgG, IgM, and IgA, and CD4/CD8 ratio were examined. Five cases from the experimental group and 5 cases from the control group underwent second-time operation because of incomplete intestinal obstruction, intestinal stenosis, or recurrent tumor respectively. The biopsy specimens of the terminal ileum or distal descending colon taken during the first and second operations underwent pathological examination. Peripheral blood samples were collected 1, 11, and 21 days after admission. Plasma diamine oxidase (DAO), D-lactic acid, endotoxin, and lactulose/mannitol (L/M) ratio, and levels of IgG, IgM, and IgA, and CD4/CD8 ratio were examined. Results: There were no significant differences in the intestinal function and blood immunological indices between these 2 groups. The levels of DAO, D-lactic acid, and endotoxin,and the L/M ratio 11 days after admission of the experiment group were all significantly lower than those of the control group (t=2.568, 2.427, 2.143, 2.443, P<0.05), and all those indices 21 days after admission of the experiment group were all much more significantly lower in comparison with the control group (t=6.019, 12.834, 7.837, 7.997, P<0.01). The levels of IgG, IgM, and IgA, and CD4/CD8 ratio 11 days after admission of the experimental group were all significantly higher than

Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).

Science.gov (United States)

Becker, Patricia; Carney, Liesje Nieman; Corkins, Mark R; Monczka, Jessica; Smith, Elizabeth; Smith, Susan E; Spear, Bonnie A; White, Jane V

2015-02-01

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high-quality, cost-effective nutritional care. © 2014 American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics.

[Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: a randomized controlled trial].

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Cai, Jun; Wang, Hua; Zhou, Sheng; Wu, Bin; Song, Hua-Rong; Xuan, Zheng-Rong

2008-01-01

To observe the effect of perioperative application of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation. In this prospective, single-blinded, controlled clinical trial, fifty-nine patients with gastric cancer were randomly divided into three groups: control group (n=20) and two study groups (group A, n=21; group B, n=18). Sjunzi Decoction (100 ml) was administered via nasogastric tube to the patients in the study group B from the second postoperation day to the 9th postoperation day. Patients in the two study groups were given an isocaloric and isonitrogonous enteral diet, which was started on the second day after operation, and continued for eight days. Patients in the control group were given an isocaloric and isonitrogonous parenteral diet for 9 days. All variables of nutritional status such as serum albumin (ALB), prealbumin (PA), transferrin (TRF) and T-cell subsets were measured one day before operation, and one day and 10 days after operation. All the nutritional variables and the levels of CD3(+), CD4(+), CD4(+)/CD8(+) were decreased significantly after operation. Ten days after operation, T-cell subsets and nutritional variables in the two study groups were increased as compare with the control group. The levels of ALB, TRF and T-cell subsets in the study group B were increased significantly as compared with the study group A (Pnutrition assisted with Sijunzi Decoction can positively improve and optimize cellular immune function and nutritional status in the patients with gastric cancer after operation.

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

DEFF Research Database (Denmark)

Bjørnvad, Charlotte R.; Thymann, Thomas; Deutz, Nicolaas E.

2008-01-01

Preterm neonates have an immature gut and metabolism and may benefit from total parenteral nutrition (TPN) before enteral food is introduced. Conversely,delayed enteral feeding may inhibit gut maturation and sensitize to necrotizing enterocolitis (NEC). Intestinal mass and NEC lesions were first...... formula after TPN. Conversely, colostrum milk diets improve gut maturation and NEC resistance in preterm pigs subjected to a few days of TPN after birth....

Successful Treatment of Septic Shock due to Spontaneous Esophageal Perforation 96 Hours after Onset by Drainage and Enteral Nutrition

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Risako Yamashita

2014-12-01

Full Text Available Spontaneous esophageal perforation is relatively uncommon, but carries a high mortality rate if diagnosis or treatment is delayed. We report the case of a 68-year-old man with spontaneous esophageal perforation who was successfully treated over 96 h after onset by thoracic drainage and jejunostomy for enteral nutrition. He vomited after drinking alcohol, soon followed by epigastralgia. Heart failure was suspected on admission to another hospital. Spontaneous esophageal perforation was diagnosed 48 h after admission. Chest tube drainage was performed, but his general condition deteriorated and he was transferred to our hospital. Emergent surgery was performed and esophageal perforation combined with pyothorax and mediastinitis was identified on the left side of the lower esophagus. The left thoracic cavity was rinsed and thoracic drainage was performed. Feeding jejunostomy was performed for postoperative enteral nutrition. Effective drainage and sufficient nutrition management appear extremely valuable in treating spontaneous esophageal perforation.

Nutrient Intake and Contribution of Home Enteral Nutrition to Meeting Nutritional Requirements after Oesophagectomy and Total Gastrectomy

Science.gov (United States)

Baker, Melanie L; Halliday, Vanessa; Robinson, Pauline; Smith, Karen; Bowrey, David J

2017-01-01

Background/Objectives This study evaluated nutrition after oesophago-gastric resection and the influence of home jejunostomy feeding in the six months after surgery. Subjects/Methods Data on nutritional intake and physiologic measures were collected as part of a randomised trial with measurements taken before and up to six months after surgery. Results 41 participants (32 oesophagectomy, 9 total gastrectomy) received home jejunostomy feeding (n=18) or usual care without feeding (n=23). At hospital discharge, oral intakes were adequate for energy and protein in 9% and 6% respectively. By three and six months, these values had increased to 61% & 55%, 94% & 77% respectively. Six participants (26%) who received usual care required rescue feeding. Six weeks after hospital discharge, energy intakes were met in those who received jejunal feeding due to the contribution of enteral nutrition. Jejunal feeding did not affect oral intake, being similar in both groups (fed: 77% estimated need, usual care: 79%). At three months, inadequate micronutrient intakes were seen in over one third. Compared to baseline values, six weeks after surgery, weight loss exceeding 5% was seen in 5/18 (28%) who received feeding, 14/17 (82%) who received usual care and 5/6 (83%) of those who required rescue feeding, p=0.002. Weight loss averaged 4.1% (fed), 10.4% (usual care) and 9.2% (rescue fed), p=0.004. These trends persisted out to six months. Conclusions Supplementary jejunostomy feeding made an important contribution to meeting nutrition after oesophago-gastric resection. Importantly, oral nutritional intake was not compromised dispelling the assertion that jejunal feeding deincentivises patients from eating. PMID:28656968

The enteral probe nutrition with Cosilat in complex therapy of patients with radiotherapeutic late effects of the colon

International Nuclear Information System (INIS)

Sloventantor, V.Yu.; Chmelevskij, Ya.M.; Bradycev, M.S.; Kurpeseva, A.K.; Artamonov, Yu.I.; Kaplan, M.A.; Sokol, N.I.; Vakulovskaja, E.G.

1990-01-01

Results are presented applying an enteral nutrition by means of probes with Cosilat in complex therapy of patients with radiotherapeutic late effects of the colon. This nutrition was prescribed with the intention to gave the colon a functional recovery and to guarantee optimal conditions for repair of radiation injuries. Good results were seen in 27 of 28 patients (96.7%), the situation of one patient (3.3%) continued without any change. Cosilat has a high nutritive value, good organoleptic qualities and is well digested without any complications. (author)

EARLY ENTERAL FEEDING AND DELAYED ENTERAL FEEDING- A COMPARATIVE STUDY

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Alli Muthiah

2017-03-01

Full Text Available BACKGROUND Nutrients form the fuel for the body, which comes in the form of carbohydrates, proteins and lipids. The body is intended to burn fuels in order to perform work. Starvation with malnutrition affects the postoperative patients and patients with acute pancreatitis. There is an increased risk of nosocomial infections and a delay in the wound healing may be noted. They are more prone for respiratory tract infections. Enteral Nutrition (EN delivers nutrition to the body through gastrointestinal tract. This also includes the oral feeding. This study will review the administration, rationale and assess the pros and cons associated with the early initiation of enteral feeding. The aim of this study is to evaluate if early commencement of enteral nutrition compared to traditional management (delayed enteral feeding is associated with fewer complications and improved outcome-  In patients undergoing elective/emergency gastrointestinal surgery.  In patients with acute pancreatitis. It is also used to determine whether a period of starvation (nil by mouth after gastrointestinal surgery or in the early days of acute pancreatitis is beneficial in terms of specific outcomes. MATERIALS AND METHODS A prospective cohort interventional study was conducted using 100 patients from July 2012 to November 2012. Patients satisfying the inclusion and exclusion criteria were included in the study. Patients admitted in my unit for GIT surgeries or acute pancreatitis constituted the test group, while patients admitted in other units for similar disease processes constituted the control group. RESULTS Our study concluded that early enteral feeding resulted in reduced incidence of surgical site infections. When the decreased length of stay, shorter convalescent period and the lesser post-interventional fatigue were taken into account, early enteral feeding has a definite cost benefit.CONCLUSION Early enteral feeding was beneficial associated with fewer

Enteral feeding pumps: efficacy, safety, and patient acceptability

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White H

2014-08-01

Full Text Available Helen White, Linsey King Nutrition and Dietetic Group, School of Health and Wellbeing, Faculty Health and Social Science, Leeds Metropolitan University, Leeds, United Kingdom Abstract: Enteral feeding is a long established practice across pediatric and adult populations, to enhance nutritional intake and prevent malnutrition. Despite recognition of the importance of nutrition within the modern health agenda, evaluation of the efficacy of how such feeds are delivered is more limited. The accuracy, safety, and consistency with which enteral feed pump systems dispense nutritional formulae are important determinants of their use and acceptability. Enteral feed pump safety has received increased interest in recent years as enteral pumps are used across hospital and home settings. Four areas of enteral feed pump safety have emerged: the consistent and accurate delivery of formula; the minimization of errors associated with tube misconnection; the impact of continuous feed delivery itself (via an enteral feed pump; and the chemical composition of the casing used in enteral feed pump manufacture. The daily use of pumps in delivery of enteral feeds in a home setting predominantly falls to the hands of parents and caregivers. Their understanding of the use and function of their pump is necessary to ensure appropriate, safe, and accurate delivery of enteral nutrition; their experience with this is important in informing clinicians and manufacturers of the emerging needs and requirements of this diverse patient population. The review highlights current practice and areas of concern and establishes our current knowledge in this field. Keywords: nutrition, perceptions, experience

Phase Angle and Handgrip Strength Are Sensitive Early Markers of Energy Intake in Hypophagic, Non-Surgical Patients at Nutritional Risk, with Contraindications to Enteral Nutrition

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Riccardo Caccialanza

2015-03-01

Full Text Available The assessment of nutritional intakes during hospitalization is crucial, as it is known that nutritional status tends to worsen during the hospital stay, and this can lead to the negative consequences of malnutrition. International guidelines recommend the use of parenteral nutrition (PN in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition. However, to date, there are no published data regarding either energy intake or objective measurements associated with it in this patient population. The aim of the present exploratory methodological study was to evaluate whether phase angle (PhA and handgrip strength normalized for skeletal muscle mass (HG/SMM are sensitive early markers of energy intake in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition. We evaluated 30 eligible patients, who were treated with personalized dietary modifications and supplemental PN for at least one week during hospitalization. In a liner regression model adjusted for age, gender, basal protein intake and the basal value of each variable, a trend toward improvement of PhA and preservation of HG/SMM was observed in patients satisfying the estimated calorie requirements (N = 20, while a significant deterioration of these parameters occurred in those who were not able to reach the target (N = 10. The mean adjusted difference and 95% CI were +1.4° (0.5–2.3 (p = 0.005 for PhA and +0.23 (0.20–0.43 (p = 0.033 for HG/SMM. A significant correlation between PhA and HG/SMM variations was also observed (r = 0.56 (95% CI, 0.23–0.77; p = 0.0023. PhA and HG/SMM were able to distinguish between hypophagic, non-surgical patients at nutritional risk who satisfied their estimated caloric requirements and those who did not after a one-week personalized nutritional support. Clinical studies are warranted, in order to verify these preliminary observations and to validate the role of Ph

What Is Enteral Nutrition?

Science.gov (United States)

... Solution Center NOVEL Project Parenteral Nutrition Resources Intravenous Lipid Emulsions (ILE) Video Series SmartPN Practice and Research Toolkits Publications & ASPEN Journals Journal of Parenteral and ...

Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes.

Science.gov (United States)

Fan, Mingchao; Wang, Qiaoling; Fang, Wei; Jiang, Yunxia; Li, Liandi; Sun, Peng; Wang, Zhihong

2016-11-20

Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, Pnutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; Pnutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; Pnutritional status, decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.

Enteral Tube Feeding Nutritional Protein Hydrolysate Production Under Different Factors By Enzymatic Hydrolysis

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Nguyen ThiQuynhHoa

2015-01-01

Full Text Available Abstract Hydrolysis of proteins involves the cleavage of peptide bonds to give peptides of varying sizes and amino acid composition. There are a number of types of hydrolysis enzymatic acid or alkali hydrolysis. Chemical hydrolysis is difficult to control and reduces the nutritional quality of products destroying L-form amino acids and producing toxic substances such as lysino-alanine. Enzymatic hydrolysis works without destructing amino acids and by avoiding the extreme temperatures and pH levels required for chemical hydrolysis the nutritional properties of the protein hydrolysates remain largely unaffected. In this research we investigate the fat removal and protein hydrolysis from pork meat to produce the enteral tube feeding nutritional protein hydrolysate for patient. Our results are as follows meat moisture 75.1 protein 22.6 lipid 1.71 ash 0.5 vitamin B1 1.384mg100g n hexantreatment at 80oCin 45 minutes and drying 30 minutes in 90oC.Viscosity of the hydrolysate is very low 2.240 0.092 cPand high degree of hydrolysis 31.390 0.138 . The final protein powder has balance nutritional components and acid amines low microorganisms which are safety for human consumption.

The establishment of enteral nutrition with minimally-invasive interventional procedure under endoscopic or imaging guidance

International Nuclear Information System (INIS)

Li Feng; Cheng Yingsheng

2010-01-01

For patients unable to get the necessary nutrition orally, a variety of techniques,including surgical way, to make gastrostomy with tube placement have been employed. For recent years, gastrostomy and tube placement with the help of endoscopic guidance or percutaneous interventional management has been developed, which is superior to surgical procedure in minimizing injuries, decreasing cost and reducing complications. In certain clinical situations, both endoscopic method and interventional method can be employed. This paper aims to make a comprehensive review of the indications, techniques and skills, advantages and disadvantages of both the endoscopy-guided and the imaging-guided percutaneous gastrojejunostomy for the establishment of enteral nutrition. (authors)

Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice.

Science.gov (United States)

Yang, Shuofei; Wu, Xingjiang; Yu, Wenkui; Li, Jieshou

2014-02-01

Early enteral nutrition (EEN) in critically ill patients is associated with significant benefit as well as elevated risk of complications. Concomitant use of EEN with vasopressors has been associated with nonocclusive bowel necrosis in critically ill patients with hemodynamic instability. The decision when to initiate enteral nutrition in hemodynamically unstable patients that require vasoactive substances remains a clinical dilemma. This review summarizes the effect of EEN and vasoactive agents on gastrointestinal blood flow and perfusion in critically ill patients, based on current evidence. Animal and clinical data involving simultaneous administration of EEN and vasoactive agents for hemodynamic instability are reviewed, and the factors related to the safety and effectiveness of EEN support in this patient population are analyzed. Moreover, practical recommendations are provided. Additional randomized clinical trials are warranted to provide cutting-edge evidence-based guidance about this issue for practitioners of critical care.

Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

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Johan Van Limbergen

2015-01-01

Full Text Available The treatment armamentarium in pediatric Crohn disease (CD is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet], which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario, inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies. Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

Hospital to home paediatric enteral nutrition--parents need support.

LENUS (Irish Health Repository)

Shortall, C

2015-02-01

This study assessed the provision of education and support to parents of children on home enteral nutrition (HEN), current dietetic support available and perceived challenges facing parents and carers. From the 39 responses (13%), 29 (83%, n = 35) parents suggested services for HEN need improvement. 29 (74%, n = 39) parents wanted more structured follow up and 22 (56%) would like one person to co-ordinate HEN, education and discharge. 7 parents (18%) reported a need for further education of health care professionals (HCP). Hospital dietitians were the most common HCPs reported to provide support to patients following discharge. Specialist paediatric HEN dietetic services working in a dedicated HEN team, who would provide accurate training and education and liaise with both parents and community care services post discharge should be in place. This would facilitate transfer to community care, reduce hospital re-admissions, outpatient department attendances and costs.

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition.

Science.gov (United States)

Mehta, Nilesh M; Skillman, Heather E; Irving, Sharon Y; Coss-Bu, Jorge A; Vermilyea, Sarah; Farrington, Elizabeth Anne; McKeever, Liam; Hall, Amber M; Goday, Praveen S; Braunschweig, Carol

2017-07-01

This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and 2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The

Effects of enteral nutritional support on malnourished patients with inflammatory bowel disease by subjective global assessment.

Science.gov (United States)

Sökülmez, Pınar; Demirbağ, Ali Eba; Arslan, Perihan; Dişibeyaz, Selçuk

2014-10-01

To investigate the prevalence of malnutrition in patients with inflammatory bowel disease (IBD) by subjective global assessment (SGA) and the effects of oral nutritional support on the clinical parameters, consumption of energy, macronutrients and fiber intake in the Study and Control groups, prospectively. A total of 38 (28 Male; 10 Female) hospitalized patients with moderate or severe IBD (13 with Crohn's disease (CD); 25 with Ulcerative colitis (UC)) were included. At stage 1, the disease severity, clinical symptoms and, signs, food consumption and nutritional status by using subjective global assessment (SGA) were recorded. At stage 2, the patients were blindly randomized into a Study Group and Controls. In the Study Group, a standard enteral product was added into the regulated hospital diets, but for the Controls, deficits were regulated by only hospital diets for 3 weeks. the independent variables were the group, the disease and its activity, age, Body body mass index (BMI), weight loss history, the hospitalization period; the dependent variables were SGA, bowel movements, change in nutritional status, disease severity, clinical findings, and also consumption of macronutrients. Prevalance of malnutrition (SGA-B or SGA-C) for all the patients was 92.1% at the beginning and 71.1% at the end of study. Improvements in disease activity score for the patients with UC were statistically significant in both the Study Group and the Controls (p=0.006 for the Study Group and p=0.001 for the Controls, respectively). Macronutrients, total and water soluble fiber consumption levels improved, with statistically significant differences for all the groups. The prevalence of malnutrition is a major problem in patients with IBD. Not only the regulation of hospital food, but also enteral nutritional support, improved their levels of malnutrition, as well as their energy, macronutrients, and fiber consumption, and SGA is an easy method for nutritional monitoring.

Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study.

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Bittencourt, Amanda F; Martins, Juliana R; Logullo, Luciana; Shiroma, Glaucia; Horie, Lilian; Ortolani, Maria Claudia; Silva, Maria de Lourdes T; Waitzberg, Dan L

2012-08-01

Digestive complications in enteral nutrition (EN) can negatively affect the nutrition clinical outcome of hospitalized patients. Diarrhea and constipation are intestinal motility disorders associated with pharmacotherapy, hydration, nutrition status, and age. The aim of this study was to analyze the frequency of these intestinal motility disorders in patients receiving EN and assess risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital. The authors performed a sequential and observational study of 110 hospitalized adult patients fed exclusively by EN through a feeding tube. Patients were categorized according to the type of intestinal transit disorder as follows: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula. Patients classified in group C represented 70% of the study population; group D comprised 13%, and group N represented 17%. There was an association between group C and orotracheal intubation as the indication for EN (P constipation (logistic regression analysis: P Constipation is more frequent than diarrhea in patients fed exclusively by EN. Enteral diet with fiber may protect against medication-associated intestinal motility disorders. The addition of prokinetic drugs seems to be useful in preventing constipation.

Current status of parenteral nutrition and enteral nutrition application: an assessment of nutritional prescriptions from 59 hospitals in the People’s Republic of China

Science.gov (United States)

Han, Gang; Yu, Zhenwei; Ma, Ke

2015-01-01

Purpose The aim of the study reported here was to assess the use of parenteral nutrition (PN) and enteral nutrition (EN), and the prevalence of PN and EN formulas, in the People’s Republic of China. Methods Fifty-nine hospitals in the People’s Republic of China participated in a nutrition survey. The resulting information on nutritional support was analyzed. Results We received 379,584 nutritional-support prescriptions over 40 days in 2013. PN provided approximately 63.2% and EN provided approximately 36.8% of nitrogen intake. PN provided 63.5% and EN provided 36.5% of lipid intake. There were obvious differences in nitrogen and lipid intake between PN and EN in different regions, departments, and diseases. The percentage of nourishment provided by PN in different regions was highest in Chengdu, followed by the Beijing, Guangzhou, and Hangzhou areas. The percentage of nourishment provided by PN in different departments was highest in general surgery, followed by gastroenterology and the intensive care unit. The percentage of nourishment provided by PN in different diseases/conditions was highest in acute pancreatitis, followed by cancer, and burns. The main source of nitrogen in PN was balanced amino-acid preparations, and in EN, it was protein. The main source of lipids in PN was long- and medium-chain triglyceride lipid emulsion injection. Conclusion Despite recent improvements in the application of nutritional support in the People’s Republic of China, a much higher percentage of nitrogen and lipids is delivered through PN than through EN. Furthermore, there are marked regional, departmental, and disease-based differences in the selection of PN versus EN. The rationale for use of nutritional support needs to be improved. PMID:25709462

Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients.

Science.gov (United States)

Ding, Dayong; Feng, Ye; Song, Bin; Gao, Shuohui; Zhao, Jisheng

2015-03-01

Effects of preoperative one week enteral nutrition (EN) support on the postoperative nutritional status, immune function and inflammatory response of gastric cancer patients were investigated. 106 cases of gastric cancer patients were randomly divided into preoperative one week EN group (trial group) and early postoperative EN group (control group), which were continuously treated with EN support until the postoperative 9th day according to different treatment protocols. All the patients were checked for their body weight, skinfold thickness, upper arm circumference, white blood cell count (WBC), albumin (ALB), prealbumin (PA), C-reactive protein (CRP), humoral immunity (IgA, IgG), T cell subsets (CD4, CD8 and CD4/CD8), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), etc. on the preoperative and the postoperative 1st and 10th day, respectively. PA and IgG levels of the experimental group were higher than those of the control group on the postoperative 10th day, whereas IL-6 level of the experimental group was lower than that of the control group. EN support for preoperative gastric cancer patients will improve the postoperative nutritional status and immune function, alleviate inflammatory response, and facilitate the recovery of patients.

Diarrhea in enterally fed patients: blame the diet?

Science.gov (United States)

Chang, Sue-Joan; Huang, Hsiu-Hua

2013-09-01

Diarrhea has great impact on enteral nutrition. The purpose of this review is to identify the factors leading to diarrhea during enteral nutrition and to provide the published updates on diarrhea prevention through nutritional intervention. Diarrhea in enteral fed patients is attributed to multiple factors, including medications (major contributor), infections, bacterial contamination, underlying disease, and enteral feeding. Diet management can alleviate diarrhea in enteral feeding. High content of fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAPs) in enteral formula is postulated to induce diarrhea and lower FODMAPs formula may reduce the likelihood of diarrhea in enterally fed patients. Fiber-enriched formula can reduce the incidence of diarrhea and produce short-chain fatty acids for colonocytes. Ingesting prebiotics, nonviable probiotics or probiotic derivatives, and human lactoferrin may provide alternatives for reducing/preventing diarrhea. Enteral feeding is not generally considered the primary cause of diarrhea, which is frequently linked to prescribed medications. When diarrhea is apparent, healthcare members should evaluate the possible risk factors and systematically attempt to eliminate the underlying causes of diarrhea before reducing or suspending enteral feeding. Lower FODMAPs formula, prebiotics, probiotic derivatives, and lactoferrin may be used to manage enteral feeding-related diarrhea.

Parent, patient and health professional perspectives regarding enteral nutrition in paediatric oncology.

Science.gov (United States)

Cohen, Jennifer; Wakefield, Claire E; Tapsell, Linda C; Walton, Karen; Cohn, Richard J

2017-11-01

Enteral tube feeding (ETF) is an important part of treatment for paediatric cancer patients. Without nutritional therapy, the prevalence of under-nutrition during treatment for childhood cancer may be as high as 50%. To ensure that the appropriate initiation of ETF is optimised, information on the views of key stakeholders regarding ETF is needed. In total, 48 interviews were conducted with parents of paediatric cancer patients (n = 20), patients (n = 10) and members of the paediatric oncology health-care team (n = 18). Semistructured interviews were used to elicit information from participants, and the data were analysed using a content analysis approach. The interviews focused on views regarding: (i) attitude toward, and impact of, ETF; (ii) information and support regarding ETF; and (iii) clinical management of ETF. There was agreement between stakeholders on the impact of ETF on patients, both positive (good nutrition, weight gain and decreased anxiety) and negative (physical appearance, invasive insertion procedure and comfort). There were discordant perceptions regarding the timing and type of information provided on the use of ETF, as well as the decision-making process used. By standardising the information given to parents and enhancing understanding of parent, patient and health-care worker perceptions about ETF, the initiation of tube feeding may be optimised. This may positively impact patient outcomes in the future. © 2017 Dietitians Association of Australia.

A novel protein mixture containing vegetable proteins renders enteral nutrition products non-coagulating after in vitro gastric digestion

NARCIS (Netherlands)

Braak, van den C.C.M.; Klebach, M.; Abrahamse, E.; Minor, M.; Knol, J.; Hofman, Z.; Ludwig, T.

2013-01-01

Background & aims: Non-coagulation of protein from enteral nutrition (EN) in the stomach is considered to improve gastric emptying and may result in reduced upper gastrointestinal complications such as reflux and aspiration pneumonia. For the development of a new EN protein mixture with reduced

Limited effects of preterm birth and the first enteral nutrition on cerebellum morphology and gene expression in piglets

DEFF Research Database (Denmark)

Bergström, Anders; Kaalund, Sanne S.; Skovgaard, Kerstin

2016-01-01

three ages but the proportion of white matter increased postnatally, relative to term pigs. Early initiation of enteral nutrition had limited structural or molecular effects. The Sonic Hedgehog pathway was unaffected by preterm birth. Few differences in expression of the selected genes were found...

Low-FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial.

Science.gov (United States)

Yoon, So Ra; Lee, Jong Hwa; Lee, Jae Hyang; Na, Ga Yoon; Lee, Kyun-Hee; Lee, Yoon-Bok; Jung, Gu-Hun; Kim, Oh Yoen

2015-11-03

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN). In this randomized, multicenter, double-blind, 14-day clinical trial, eligible hospitalized patients receiving EN (n = 100) were randomly assigned to three groups; 84 patients completed the trial (low-FODMAP EN, n = 30; moderate-FODMAP EN, n = 28; high-FODMAP EN, n = 26). Anthropometric and biochemical parameters were measured; stool assessment was performed using the King's Stool Chart and clinical definition. Baseline values were not significantly different among the three groups. After the 14-day intervention, diarrhea significantly improved in the low-FODMAP group than in the moderate- and high-FODMAP groups (P nutritional status and facilitating prompt recovery from illness.

Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy.

Science.gov (United States)

Wang, Junli; Zhao, Jiamin; Zhang, Yanling; Liu, Chong

2018-07-01

Effects of early enteral nutrition (EEN) or total parenteral nutrition (TPN) support on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy were investigated. One hundred and twenty-nine patients with gastric cancer complicated with diabetes mellitus type 2 admitted to the First People's Hospital of Jinan (Jinan, China), from June 2012 to June 2016 were selected into the study. According to different nutrition support pathways, these patients were randomly divided into the EEN group and the TPN group. The improvement of nutritional indexes, postoperative complications, gastrointestinal function recovery and perioperative blood glucose fluctuation were compared between the two groups. On the 4th day after operation, the improvement levels of total bilirubin (TBL), alanine aminotransferase (ALT), aspartate transaminase (AST), total protein (TP), prealbumin (PAB), hemoglobin (HGB) and weight (Wt) in the EEN group were significantly higher than those in the conventional group (P0.05). No patients had complications in the EEN group, while a total of 29 patients in the TPN group suffered adverse reactions, indicating that the incidence rate of complications in the EEN group was significantly lower than that in the TPN group (Pnutrition for patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy, which is worthy of clinical promotion as it maintains good nutritional status, produces few postoperative complications and keeps the blood glucose level stable, by which the postoperative evacuation time is early, the hospitalization time is short and the cost is low.

Nutritive utilization of protein and digestive utilization of fat in two commercial diets designed for clinical enteral nutrition.

Science.gov (United States)

Alférez, M J; Campos, M S; Barrionuevo, M; López-Aliaga, I

1990-01-01

The digestive and metabolic utilization of protein (50% lactoalbumin + 50% casein) and fat (43.0% butter, 29.5% olive oil, 14.7% soy oil, 9.8% MCT and 3.0% lecithin) provided by two commercial diets used in clinical enteral nutrition (normoproteic, 16.1% protein and 20.8% fat, and hyperproteic, 23.1% protein and 14.9% fat), was studied in adult rats (mean body weight 180 g). The diet containing the greater amount of protein improved the digestive utilization of nitrogen, and although nitrogen retention was optimal, it failed to rise further when the dietary protein supply was increased. The digestive utilization of fat in both diets was excellent.

Neutromat-Pfrimmer, a new transporting system for the enteral nutrition therapy of tumor patients before, during and after radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Thiel, H J

1982-03-01

Tumor patients generally suffer from malnutrition which is still aggravated by radiotherapy and its side effects. Therefore the accompanying alimentary guidance and treatment are very important factor. A plan comprising several degrees from dietary guidance, forced oral and enteral nutrition to intravenous hyperalimentation has proved to be practicable. For the ambulatory radiotherapy of our ORL-patients, we have recently been applying a Nutromat-Pfrimmer, a promoter system operating according to the Bakey pump system and serving for continuous or discontinuous enteral nutrition therapy with formula or elementary diets. The authors describe principle and function of the device and present their first experiences. By using early and consequently this device for our irradiated patients, we hope to prevent or heal malnutrition, ameliorate the tolerance of tumor therapy, reduce the incidence of complications, re-establish the immunocompetence, and improve the life quality of the patients.

Impact of Early Enteral Nutrition on Nutritional and Immunological Outcomes of Gastric Cancer Patients Undergoing Gastrostomy: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Nikniaz, Zeinab; Somi, Mohammad Hossein; Nagashi, Shahnaz; Nikniaz, Leila

2017-07-01

The present systematic review and meta-analysis study evaluated the impact of early enteral nutrition (EN) on postoperative nutritional and immunological outcomes of gastric cancer (GC) patients. The databases of PubMed, Embase, Springer, and Cochrane library were searched till September 2016 to identify studies which evaluated the effects of EN compared with parenteral nutrition (PN) on postoperative immunological and nutritional status and hospitalization time in GC patients. Mean difference (MD) or standard mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. The present systematic review and meta-analysis have consisted of seven trials, containing 835 GC patients. According to the result of meta-analysis, compared with PN, EN significantly resulted in more increase in the level of albumin [MD = 2.07 (0.49, 3.64)], prealbumin [MD = 9.41 (049, 33.55)], weight [MD = 1.52 (0.32, 2.72)], CD3+ [SMD = 1.96 (1.50, 2.43)], CD4+ [SMD = 2.45 (1.97, 2.93)], natural killers [MD = 5.80 (3.75, 7.85)], and also a decrease in the hospitalization time [MD=-2.39 (-2.74, -2.03)]. The results demonstrated that early administration of EN is more effective in improving postsurgical nutrition status and immune index in GC patients. So, based on these results, postoperative early administration of EN is recommended for GC patients where possible.

Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

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Cappello Gianfranco

2012-10-01

Full Text Available Abstract Background Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. Methods 19,036 patients (age 44.3 ± 13, M:F = 2:5 with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. Results After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Conclusion Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

Science.gov (United States)

Ross, Vicki M; Guenter, Peggi; Corrigan, Mandy L; Kovacevich, Debra; Winkler, Marion F; Resnick, Helaine E; Norris, Tina L; Robinson, Lawrence; Steiger, Ezra

2016-12-01

Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. Descriptive, χ 2 , and t tests were used to analyze data from the Sustain registry. Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Neutromat-Pfrimmer, a new transporting system for the enteral nutrition therapy of tumor patients before, during and after radiotherapy

International Nuclear Information System (INIS)

Thiel, H.J.

1982-01-01

Tumor patients generally suffer from malnutrition which is still aggravated by radiotherapy and its side effects. Therefore the accompanying alimentary guidance and treatment are very important factor. A plan comprising several degrees from dietary guidance, forced oral and enteral nutrition to intravenous hyperalimentation has proved to be practicable. For the ambulatory radiotherapy of our ORL-patients, we have recently been applying a Nutromat-Pfrimmer, a promoter system operating according to the Bakey pump system and serving for continuous or discontinuous enteral nutrition therapy with formula or elementary diets. The authors describe principle and function of the device and present their first experiences. By using early and consequently this device for our irradiated patients, we hope to prevent or heal malnutrition, ameliorate the tolerance of tumor therapy, reduce the incidence of complications, re-establish the immunocompetence, and improve the life quality of the patients. (orig.) [de

Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease

Directory of Open Access Journals (Sweden)

Tawnya Hansen

2018-04-01

Full Text Available Genetic and environmental factors are thought to profoundly influence the pathophysiology of Crohn’s disease (CD. Changes in dietary and hygiene patterns affect the interactions between the immune system and environment. The gut microbiome is responsible for mediating host immune response with significant dysbiosis observed in individuals with CD. Diet therapy using exclusive enteral nutrition (EEN has been studied as primary therapy for the management of CD. EEN may cultivate the presence of beneficial microbiota, improve bile acid metabolism, and decrease the number of dietary microparticles possibly influencing disease and immune activity. In this review, we will address the current evidence on EEN in the management of adult and pediatric CD. In adults, EEN appears to be moderately beneficial for the induction of remission of CD; however, its use is understudied and underutilized. Stronger evidence is in place to support the use of EEN in pediatric CD with the added benefit of nutrition support and steroid-sparing therapy during the growth phase. Overall, EEN is an established therapy in inducing CD remission in the pediatric population while its role as primary therapy of adult Crohn’s disease remains to be defined.

Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

OpenAIRE

Portanova Michel

2010-01-01

Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

International Nuclear Information System (INIS)

Nijs, Els L. F.; Cahill, Anne Marie

2010-01-01

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis.

Science.gov (United States)

Cheng, Ying; Zhang, Junfeng; Zhang, Liwei; Wu, Juan; Zhan, Zhen

2018-01-16

Nutrition support is a common means for patients with gastric cancer, especially for those undergoing elective surgery. Recently, enteral immunonutrition (EIN) was increasingly found to be more effective than enteral nutrition (EN) in enhancing the host immunity and eventually improving the prognosis of gastric cancer patients undergoing gastrectomy. However, the results reported were not consistent. This meta-analysis aimed to assess the impact of EIN for patients with GC on biochemical, immune indices and clinical outcomes. Four electronical databases (Medline, EMBASE, Scopus and Cochrane library) were used to search articles in peer-reviewed, English-language journals. Mean difference (MD), Relative risk (RR), or standard mean difference (SMD) with 95% confidence interval (CI) were calculated. Heterogeneity was assessed by Cochrane Q and I 2 statistic combined with corresponding P-value. The analysis was carried out with RevMan 5.3. Seven studies involving 583 patients were eligible for the pooled analysis. EIN, when beyond a 7-day time-frame post-operatively (D ≥ 7), increased level of CD4 + (SMD = 0.99; 95% CI, 0.65-1.33; P SMD = 0.34; 95% CI, 0.02-0.67; P = 0.04), the IgM (SMD = 1.15; 95% CI, 0.11-2.20; P = 0.03), the IgG (SMD = 0.98; 95% CI, 0.55-1.42; P SMD = 0.69; 95% CI, 0.32-1.06; P = 0.0003), and the proalbumin (SMD = 0.73; 95% CI, 0.33-1.14; P = 0.0004). However, those increased effects were not obvious within a 7-day time-frame post-operatively (D infection and length of hospitalization (LHS) were not improved no matter what time after surgery. EIN was found to improve the cellular immunity, modulate inflammatory reaction and reduce postoperative complication for GC patients undergoing radical gastrointestinal surgery. Exclusion of grey literature and non-English language studies was the key limitation in this study.

Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis.

Science.gov (United States)

Peng, J; Cai, J; Niu, Z-X; Chen, L-Q

2016-05-01

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support. © 2015 International Society for Diseases of the Esophagus.

The effect of glutamine-enriched enteral nutrition on intestinal permeability in very-low-birth-weight infants : A randomized controlled trial

NARCIS (Netherlands)

van den Berg, Anemone; Fetter, Willem P. F.; Westerbeek, Elisabeth A. M.; van der Vegt, Ina M.; van der Molen, Hilda R. A.; van Elburg, Ruurd M.

2006-01-01

Background: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as

The effect of glutamine-enriched enteral nutrition on intestinal permeability in very-low-birth-weight infants: A randomized controlled trial

NARCIS (Netherlands)

van den Berg, Anemone; Fetter, Willem P. F.; Westerbeek, Elisabeth A. M.; van der Vegt, Ina M.; van der Molen, Hilda R. A.; van Elburg, Ruurd M.

2006-01-01

Background: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as

Enteral nutrition increases interstitial brain glucose levels in poor-grade subarachnoid hemorrhage patients.

Science.gov (United States)

Kofler, Mario; Schiefecker, Alois J; Beer, Ronny; Gaasch, Maxime; Rhomberg, Paul; Stover, John; Pfausler, Bettina; Thomé, Claudius; Schmutzhard, Erich; Helbok, Raimund

2018-03-01

Low brain tissue glucose levels after acute brain injury are associated with poor outcome. Whether enteral nutrition (EN) reliably increases cerebral glucose levels remains unclear. In this retrospective analysis of prospectively collected observational data, we investigate the effect of EN on brain metabolism in 17 poor-grade subarachnoid hemorrhage (SAH) patients undergoing cerebral microdialysis (CMD) monitoring. CMD-values were obtained hourly. A nutritional intervention was defined as the clinical routine administration of EN without supplemental parenteral nutrition. Sixty-three interventions were analyzed. The mean amount of EN per intervention was 472.4 ± 10.7 kcal. CMD-glucose levels significantly increased from 1.59 ± 0.13 mmol/l at baseline to a maximum of 2.03 ± 0.2 mmol/l after 5 h (p  40) and the microdialysis probe location. The increase in CMD-glucose was directly dependent on the magnitude of increase of serum glucose levels (p = 0.007). No change in CMD-lactate, CMD-pyruvate, CMD-LPR, or CMD-glutamate (p > 0.4) was observed. Routine EN also increased CMD-glucose even if baseline concentrations were critically low ( < 0.7 mmol/l, neuroglucopenia; p < 0.001). These results may have treatment implications regarding glucose management of poor-grade aneurysmal SAH patients.

Formulações com alimentos convencionais para nutrição enteral ou oral Formulations for enteral or oral nutrition using conventional foods

Directory of Open Access Journals (Sweden)

Edma M. Araújo

2006-09-01

Full Text Available A nutrição enteral domiciliar é um tratamento econômico e seguro usado na prevenção da desnutrição e manutenção da qualidade de vida. Nesse estudo, foi analisada a formulação FCM (CARVALHO et al. 1992 e foram desenvolvidas formulações (F1 e F2 para obter quantidades e qualidade dos componentes conforme literatura. As fórmulas foram desenvolvidas com alimentos convencionais de baixo custo, factíveis de preparo em domicílio, disponíveis em regiões menos desenvolvidas, onde as dietas industrializadas não são comercializadas. Foram determinadas propriedades como viscosidade, osmolalidade, gotejamento e valor nutricional. As fórmulas F1 e F2 apresentaram menor viscosidade e distribuição calórica (proteína 14%, gordura 33%, carboidrato 53%, fibra alimentar (8,16 g/2 L e densidade calórica (1 kcal/mL melhores que FCM (proteína 19%, gordura 33%, carboidrato 48%, fibra alimentar 4,68 g/2 L e densidade calórica 0,87 kcal. As fórmulas F1 e F2 apresentaram soluções mais fluidas que FCM, gotejamento de 60 80 gotas/minuto. As osmolalidades ficaram isotônicas. A adição de fubá de milho, Soymilk® e Nidex® melhoraram o valor nutritivo e a fluidez de F1 e F2, viabilizando a administração de maior quantidade em menor tempo. As formulações F1 e F2 são opções para uma individualização de dieta enteral normal por gastrostomia em terapia domiciliar.Home enteral nutrition is a safe, economic treatment used in the prevention of malnutrition and in the maintenance of life quality. In this study the formulation FCM (CARVALHO et al., 1992 was analysed, and the formulations F1 and F2 developed, aiming at obtaining the component quantities and qualities cited in the literature. The formulations were developed using low cost conventional foods, easy to prepare domestically and available in less developed regions where industrialised diets are not commercialised. The viscosity, osmolality, dripping properties and nutritive value

Design and development of a manual pump for bolus enteral nutrition.

Science.gov (United States)

Romano-García, Judit; Fernández-Morera, Juan Luis

2018-02-01

Enteral nutrition (EN) is based on administration of liquid solutions into the gastrointestinal tract using a tube. After identifying unsolved practical difficulties in administration of EN using volume syringes, a new device to overcome such technical difficulties was proposed. Specific technologies (CAD, 3D printing) were used in collaboration with the PRODINTEC Foundation (Gijón, Asturias). Clarke Modet, a law firm specialized in intellectual property, provided legal advice on formulas for legal protection of the invention. The resulting device is a manual pump for infusion of EN to patients that solves previously identified problems and is highly functional and compact. It would allow for comfortable and safe administration of solutions. Integration of a bottle into the device itself and pump dimensions facilitate transport and patient mobility. According to the described configuration, this invention has many advantages over the previously known procedures, such as a simpler administration within the field of intermittent EN, improving the standard nutritional support technique, which in this case is use of volume syringes. This would facilitate the work of caregivers while promoting patient self-care and autonomy. The pump was accredited novelty of design, inventive activity and industrial exploitation potential by the European Patent Office (EPO), to which a patent has been requested. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Impact of Type 2 Diabetes Threat Appraisal on Physical Activity and Nutrition Behaviors among Overweight and Obese College Students.

Science.gov (United States)

Amuta, Ann O; Crosslin, Katie; Goodman, Jessica; Barry, Adam E

2016-07-01

We examined the impact of threat appraisal (TA) on Type 2 diabetes (T2D)-related protective behaviors among high-risk college students. Using a Web-based survey, we collected data from 319 overweight or obese undergraduate students attending one of 4 Texas colleges/universities. Hierarchical multiple regression analyses determined the association between the outcome variable, fruits and vegetables (F&V) consumption and physical activity (PA), and TA. Demographic characteristics were entered at step 1, explaining 7% of variance in F&V consumption and 6% in PA. After TA was entered in block 2, the total variance explained changed by only .008% for F&V consumption and .009% for PA. TA did not predict T2D protective behaviors and reduced variability in the model. Being female, as well as having a T2D family history, was significantly associated with increased TA. Results can inform the planning, implementing, and evaluating of health promotion programs.

Differences in outcomes over time with exclusive enteral nutrition compared to steroids in children with mild to moderate Crohn's Disease

DEFF Research Database (Denmark)

Cohen-Dolev, Noa; Sladek, Malgorata; Hussey, Seamus

2018-01-01

Background: Exclusive enteral nutrition (EEN) and corticosteroids (CS) both induce similar rates of remission in mild to moderate pediatric Crohn's disease (CD), but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long term outc...

A qualitative study of the perceived value of membership in The Oley Foundation by home parenteral and enteral nutrition consumers.

Science.gov (United States)

Chopy, Katelyn; Winkler, Marion; Schwartz-Barcott, Donna; Melanson, Kathleen; Greene, Geoffrey

2015-05-01

Support and educational organizations have been shown to improve quality of life of consumers of home nutrition support. One such organization, The Oley Foundation, offers resources for the home parenteral and enteral nutrition (HPEN) consumer. While research has shown proven benefits to HPEN consumers affiliated with The Oley Foundation, no studies have investigated the perceived value of membership to the consumer or the way in which consumers are introduced to the organization. Qualitative methodology was used to gain a deeper understanding of the perceived value of membership in The Oley Foundation. Audiotaped, in-depth, semistructured telephone interviews were conducted to explore participants' experiences with The Oley Foundation and HPEN. Inductive content analysis was used to analyze data and identify themes associated with membership value. The value of The Oley Foundation lies in programs and resources and the competency, inspiration, normalcy, and advocacy gained from membership, helping individuals adjust to life with HPEN dependency. More than half of participants found the organization through self-initiated Internet searches, but all participants clearly expressed the desire "I wish I knew about it sooner." This study identifies the value of membership in The Oley Foundation and the important role the organization has in the lives of HPEN-dependent consumers. Nutrition support clinicians should introduce the organization to patients when the need for HPEN is established and prior to hospital discharge. © 2014 American Society for Parenteral and Enteral Nutrition.

Beneficial effects of enteral nutrition containing with hydrolyzed whey peptide on warm ischemia/reperfusion injury in the rat liver.

Science.gov (United States)

Hanaoka, Jun; Shimada, Mitsuo; Utsunomiya, Toru; Morine, Yuji; Imura, Satoru; Ikemoto, Tetsuya; Mori, Hiroki; Sugimoto, Koji; Saito, Yu; Yamada, Shinichiro; Asanoma, Michihito

2014-01-01

This study examined the efficacy of enteral nutrition containing hydrolyzed whey peptide (HWP) on warm ischemia/reperfusion (I/R) injury in the rat liver. Male Wistar rats were subjected to 30 min of warm hepatic ischemia followed by immediate p.o. intake of enteral nutrition with WHP (HWP group) or 20% glucose solution (control group) (0.025 mL/g). The animals were killed at 6 or 12 h after reperfusion. The serum aspartate aminotransferase (AST) and alanine aminotransferase alt (ALT) levels were measured. The necrotic areas were assessed histologically. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and caspase-3 activation were assessed to evaluate apoptosis. The expressions of hepatic tumor necrosis factor (TNF)-α, interleukin (IL)-6 and nuclear factor (NF)-κB in the liver tissue were assessed by real time reverse transcription polymerase chain reaction. Significant reductions in the serum AST and ALT levels were seen in the HWP group compared with the control group at both 6 and 12 h after reperfusion. The necrotic areas and numbers of TUNEL positive cells were significantly decreased in the HWP group at 6 and 12 h after reperfusion. The caspase-3/7 activities were significantly decreased in HWP group at 6 and 12 h after reperfusion. The mRNA expressions of TNF-α and IL-6 were significantly reduced in the HWP group at 12 h after reperfusion. NF-κB mRNA expression was significantly increased in the HWP group at 6 and 12 h after reperfusion. Enteral nutrition containing HWP ameliorated the hepatic warm I/R injury possibly through the suppression of pro-inflammatory cytokine expressions and the induction of NF-κB in the rat liver. © 2013 The Japan Society of Hepatology.

Psychometric properties of DAPonDEN: definitions, attitudes and practices in relation to diarrhea during enteral nutrition questionnaire.

Science.gov (United States)

Majid, Hazreen A; Bin Sidek, Muhamad Adam; Chinna, Karuthan

2013-01-01

To investigate the psychometric properties of the developed 21 item questionnaire to measure definitions, attitudes and management practices in relation to diarrhea during enteral nutrition (DAPonDEN). Data were analyzed using exploratory factor analysis from a cross sectional study of 102 nurses aged 18 and over, conducted from December 2011 to February 2012 in Malaysia. Face and content validity of DAPonDEN were first evaluated by few expert panels and patients. For this study, adult nurses were recruited from the adult wards. In the final model, three items in DAPonDEN were dropped. In the exploratory factor analysis, five factors were extracted that explained a total of 55% of the variation in the remaining 18 items. The Kaiser-Meyer-Olkin (KMO) value was 0.723. For definition, there were two underlying factors: 'Key items in defining diarrhea' and 'non-key items in defining diarrhea'. For attitude there was a single factor. For practice, there were two underlying factors: 'enteral nutrition (EN) related' and 'awareness related'. The items in each of the underlying dimensions seem to measure the respective concepts for definition, attitude and practices adequately. The 18-items DAPonDEN instrument can be a suitable education tool to be used in relation to diarrhea during EN. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of three different doses of arginine enhanced enteral nutrition on nutritional status and outcomes in well nourished postsurgical cancer patients: a randomized single blinded prospective trial.

Science.gov (United States)

De Luis, D A; Izaola, O; Terroba, M C; Cuellar, L; Ventosa, M; Martin, T

2015-01-01

Patients with head and neck cancer undergoing surgery have a high occurrence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an enhanced enteral formula with three different doses of arginine could improve nutritional variables as well as clinical outcome, depending of arginine dose. A population of 84 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly assigned to three different treatment groups, each one containing at less 28 patients. Group I (28 patients) received an enteral diet supplements with a low physiological dose of arginine (5.7 g per day), group II (28 patients) received an isocaloric, isonitrogenous enteral formula with a medium dose of arginine (12.3 g per day) and group III (28 patients) received an isocaloric, isonitrogenous enteral formula with a high dose of arginine (18.9 g per day). The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034). No differences were detected in postoperative infections complications and diarrhea. Fistula was less frequent in groups II and III than I (10.7% group I vs 3.6% group II vs 3.6% group III: p = 0.033), The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034). Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula to decrease length of hospital stay and fistula wound complications.

Enhanced vaccination effect against influenza by prebiotics in elderly patients receiving enteral nutrition.

Science.gov (United States)

Akatsu, Hiroyasu; Nagafuchi, Shinya; Kurihara, Rina; Okuda, Kenji; Kanesaka, Takeshi; Ogawa, Norihiro; Kanematsu, Takayoshi; Takasugi, Satoshi; Yamaji, Taketo; Takami, Masao; Yamamoto, Takayuki; Ohara, Hirotaka; Maruyama, Mitsuo

2016-02-01

We investigated the effect of prebiotics on the immunological response after influenza vaccination in enterally fed elderly individuals. The intervention group was given an enteral formula containing lactic acid bacteria-fermented milk products. In addition, two different types of other prebiotics, galacto-oligosaccharide and bifidogenic growth stimulator, were also given. The two prebiotics improved intestinal microbiota differently. In a control group, a standard formula without prebiotics was given. An enteral formula with (intervention group [F]) or without (control group [C]) prebiotics was given through percutaneous endoscopic gastrostomy to elderly participants for 10 weeks. Influenza vaccine was inoculated at week 4. Nutritional and biochemical indices, intestinal micro bacteria and immunological indices were analyzed. The Bifidobacterium count in groups F and C at week 0 was 6.4 ± 1.9 and 6.6 ± 3.0 (log10 [count/g feces]), respectively. Although the count in group C decreased at week 10, the count in group F increased. The Bacteroides count in group F increased from 10.7 ± 0.9 to 11.4 ± 0.5, but decreased in group C from 11.2 ± 0.2 to 10.7 ± 0.4. Although the enhanced titers of H1N1, H3N2 and B antigens against the vaccine decreased thereafter in group C, these enhanced titers in group F could be maintained. Our findings suggest that prebiotics affect the intestinal microbiota and might maintain the antibody titers in elderly individuals. © 2015 Japan Geriatrics Society.

Parenteral nutrition in the critically ill.

Science.gov (United States)

Gunst, Jan; Van den Berghe, Greet

2017-04-01

Feeding guidelines have recommended early, full nutritional support in critically ill patients to prevent hypercatabolism and muscle weakness. Early enteral nutrition was suggested to be superior to early parenteral nutrition. When enteral nutrition fails to meet nutritional target, it was recommended to administer supplemental parenteral nutrition, albeit with a varying starting point. Sufficient amounts of amino acids were recommended, with addition of glutamine in subgroups. Recently, several large randomized controlled trials (RCTs) have yielded important new insights. This review summarizes recent evidence with regard to the indication, timing, and dosing of parenteral nutrition in critically ill patients. One large RCT revealed no difference between early enteral nutrition and early parenteral nutrition. Two large multicenter RCTs showed harm by early supplementation of insufficient enteral nutrition with parenteral nutrition, which could be explained by feeding-induced suppression of autophagy. Several RCTs found either no benefit or harm with a higher amino acid or caloric intake, as well as harm by administration of glutamine. Although unanswered questions remain, current evidence supports accepting low macronutrient intake during the acute phase of critical illness and does not support use of early parenteral nutrition. The timing when parenteral nutrition can be initiated safely and effectively is unclear.

Energy expenditure and body composition in children with Crohn's disease: effect of enteral nutrition and treatment with prednisolone

OpenAIRE

Azcue, M; Rashid, M; Griffiths, A; Pencharz, P

1997-01-01

Background—Malnutrition and growth retardation are common complications of Crohn's disease in children. The contribution of resting energy expenditure (REE) to malnutrition is unclear. 
Aims—To characterise the REE and body composition in children with Crohn's disease and compare them with normal controls and patients with anorexia nervosa; to compare the effects of prednisolone and enteral nutrition on energy expenditure and body composition. 
Subjects—Twenty four children wit...

Nutrition in Patients with Head Trauma

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Burcu Totur

2013-01-01

Full Text Available The need of energy increases by 40% in patients with a head trauma, when compared to people who are living a normal life. This ratio reaches to 200% in some cases. It is important to give a nutrition support which can satisfy the energy need resulted from the hypermetabolic and hypercatabolic states and that is enough to help to fix the immunologic state and achieve a better result in healing the injury. When oral nutrition is not possible in the patient with a head trauma, their energy need is satisfied through enteral and parenteral nutrition. Though parenteral nutrition had held an important role in feeding patients with head trauma, enteral nutrition is applied much more widely today. Enteral and parenteral nutrition both has their own advantages and disadvantages. In the clinical and laboratory studies that had been held, it was found that enteral nutrition improved the systemic immunity, decreased the incidence of the major infectious complications, decreased the metabolic response to trauma, protected the intestinal mucosa, and protected the ecologic balance of the microflora. In this article, it is investigated through the importance of the feeding in patients with a head trauma and reasons to chose enteral nutrition

New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition

OpenAIRE

AKBULUT, GAMZE

2011-01-01

Cancer and its treatment result in severe biochemical and physiological alterations associated with a deterioration of quality of life (QoL). Cancer-related malnutrition may evolve into cancer cachexia due to complex interactions between pro-inflammatory cytokines and the host metabolism. Depending on the type of cancer treatment (either curative or palliative), the clinical condition of the patient and nutritional status, adequate and patient-tailored nutritional intervention should be presc...

Effects of Lipid Emulsions in Parenteral Nutrition of Esophageal Cancer Surgical Patients Receiving Enteral Nutrition: A Comparative Analysis

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Wu-Ping Wang

2013-12-01

Full Text Available Background: Olive oil-based lipid emulsion (LE and medium chain triglyceride/long chain triglyceride (MCT/LCT emulsion are both LEs with low ω-6 polyunsaturated fat acids (PUFAs content. However, which one of these LEs is associated with a lower infection risk in patients receiving parenteral nutrition (PN remains unclear. The aim of the study was to compare the effects of the two LEs in PN in esophageal cancer patients undergoing surgery. Methods: Patients with resectable esophageal carcinoma were recruited and allocated randomly to two groups. The test group was given enteral nutrition (EN with PN containing olive oil-based LE after tumor resection for ≥7 days, and the patients in the control group were supported by EN with MCT/LCT emulsion-based PN after surgery for the same time period. Immunological markers and inflammatory indicators were tested and perioperative clinical outcomes were determined. The trial was registered in the Chinese Clinical Trial Register, number ChiCTR-TRC-13003562. 94 Patients were recruited, and grouped (olive oil-based LE, n = 46 and MCT/LCT, n = 48, matched for sex, age, body mass index, histological type, TNM stage, and nutrition risk screening (NRS 2002 score. Results: There were no differences in perioperative fever (>38 °C, infectious complications, length of hospital stay (>14 days, length of critical care stay (>2 days, time for oral food intake, and in-hospital mortality between the two groups. The test group showed a higher increase in IgG level compared with the MCT/LCT group (p = 0.028. There was no difference in other immunological markers and inflammatory indicators between the two groups. Conclusion: PN containing olive oil-based or MCT/LCT LEs had similar effects on perioperative outcome, cell-mediated immune function and inflammatory response in esophageal cancer patients who had undergone surgery and were receiving EN.

Long-term enteral immunonutrition containing lactoferrin in tube-fed bedridden patients: immunological and nutritional status.

Science.gov (United States)

Takeuchi, Yoshiaki; Yamamura, Takuya; Takahashi, Seiichiro; Katayose, Kozo; Kohga, Shin; Takase, Mitsunori; Imawari, Michio

2012-06-01

The aim of this study was to examine the efficacy and safety of a novel immune-enhancing enteral formula, Prem-8, which contains lactoferrin as an immunonutrient. A multicenter, randomized controlled trial was conducted in 5 hospitals in Japan, and 71 tube-fed bedridden patients with serum albumin concentrations between 2.5 and 3.5 g/dL were allocated to Prem-8 (n = 38) or control formula (n = 33) groups for an observation period of 12 weeks. Efficacy was evaluated by comparing immunological (natural killer cell activity, neutrophil-phagocytic activity, neutrophil-sterilizing activity, and C-reactive protein), and nutritional (anthropometric measurements and serum levels of nutritional assessment proteins and total cholesterol) variables. Safety was assessed by comparing the incidence of adverse events. In a secondary analysis, patients were subgrouped according to the amount of protein supplemented (1 g/kg/d) so that immunological and nutritional variables and safety could be further compared. Natural killer activity and neutrophil functions were normal for both groups throughout the study period, without significant between-group differences at any point. Nutritional status was stably maintained in both groups, although the body mass index at 12 weeks was marginally lower in the Prem-8 group than in the control group (p < 0.01). The incidence of adverse events were comparable between both groups, but the incidence of fever in the Prem-8 group (7/14) was significantly lower than in the control group (10/11) in a subgroup of patients whose supplemented protein was less than 1 g/kg/d (p < 0.05). Prem-8 did not demonstrate superiority to the control formula with respect to immunological and nutritional variables, whereas the body mass index of patients in the Prem-8 group marginally decreased. However, Prem-8 had a favorable effect on the incidence of fever in a subgroup of patients with low protein intake.

Pemberian makanan enteral berformulasi bahan pangan lokal terhadap kadar zat besi dan hemoglobin pada tikus putih (Rattus norvegicus

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Dini Ariani

2013-07-01

Full Text Available Background: Enteral nutrition is nutrition used to fulfill the needs of nutrition entirely and as the supplement for malnutrition patient. In a certain condition of a patient, this nutrition is usually given in the form of liquid. Local material foods such as tempeh, rice, mung bean, and ganyong have adequate nutrition, therefore they are suitable for being used as main raw materials in the making of enteral nutrition. Objective: To know the influence of feeding enteral nutrition formulated with local food material toward malnutrition white rats (Rattus norvegicus of which the parameters are iron (Fe, hemoglobin (Hb level and weight. Method: This research used Completely Random Design (CRD. Twenty-seven of malnutrition male white rats were divided into 3 groups of treatment with 9 repetitions for each group of the treatment. Group A was given enteral nutrition diet of formula A (tempeh, rice, and mung bean as the main raw material, group B was given enteral nutrition diet of formula B (tempeh, rice, mung bean, and ganyong as the main raw material, and group C (as the positive control was given commercial enteral nutrition. The daily giving of enteral nutrition is 20 g/day during 30 days. The analysis of Fe and Hb level and the measurement of weight firstly were done before the treatment is given. The next measurement was conducted in 15th day and 31st day. Statistical analysis used ANOVA test dan DMRT of significance 5%. Results: The result showed that the treatment of the enteral nutrition feeding of formula B was more optimal than formula A in terms of the way to increase the level of Hb and Fe. Those two components will give positive effect toward the increasing of the weight of malnutrition white rats (Rattus norvegicus. Conclusion: The enteral nutrition of formula B is more proper to be developed as the main material of making enteral food in order to treat the malnutrition.

Enteral bile acid treatment improves parenteral nutrition-related liver disease and intestinal mucosal atrophy in neonatal pigs

DEFF Research Database (Denmark)

Jain, Ajay Kumar; Stoll, Barbara; Burrin, Douglas G

2012-01-01

Total parenteral nutrition (TPN) is essential for patients with impaired gut function but leads to parenteral nutrition-associated liver disease (PNALD). TPN disrupts the normal enterohepatic circulation of bile acids, and we hypothesized that it would decrease intestinal expression of the newly...... described metabolic hormone fibroblast growth factor-19 (FGF19) and also glucagon-like peptides-1 and -2 (GLP-1 and GLP-2). We tested the effects of restoring bile acids by treating a neonatal piglet PNALD model with chenodeoxycholic acid (CDCA). Neonatal pigs received enteral feeding (EN), TPN, or TPN...... + CDCA for 14 days, and responses were assessed by serum markers, histology, and levels of key regulatory peptides. Cholestasis and steatosis were demonstrated in the TPN group relative to EN controls by elevated levels of serum total and direct bilirubin and also bile acids and liver triglyceride (TG...

Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial

NARCIS (Netherlands)

Peters, Emmeline G.; Smeets, Boudewijn J. J.; Nors, Jesper; Back, Christian M.; Funder, Jonas A.; Sommer, Thorbjørn; Laurberg, Søren; Løve, Uffe S.; Leclercq, Wouter K. G.; Slooter, Gerrit D.; de Vries Reilingh, Tammo S.; Wegdam, Johannes A.; Nieuwenhuijzen, Grard A. P.; Hiligsmann, Mickaël; Buise, Marc P.; Buurman, Willem A.; de Jonge, Wouter J.; Rutten, Harm J. T.; Luyer, Misha D. P.

2018-01-01

Postoperative ileus and anastomotic leakage severely impair recovery after colorectal resection. We investigated the effect of perioperative lipid-enriched enteral nutrition versus standard care on the risk of postoperative ileus, anastomotic leakage, and other clinical outcomes. We did an

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

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Atasever AG

2018-02-01

Full Text Available Ayse Gulsah Atasever,1 Perihan Ergin Ozcan,2 Kamber Kasali,3 Taner Abdullah,4 Gunseli Orhun,2 Evren Senturk5 1Anesthesiology and Intensive Care, Sinop Ayancik State Hospital, Sinop, Turkey; 2Anesthesiology and Intensive Care, Istanbul University Hospital, Istanbul, Turkey; 3Biostatistics, Ataturk University, Erzurum, Turkey; 4Anesthesiology Department, Istanbul University Hospital, Istanbul, Turkey; 5Anesthesiology and Intensive Care, Koc University Hospital, Istanbul, Turkey Background: Gastrointestinal (GI motility disorders in intensive care patients remain relatively unexplored. Nowadays, the frequency, risk factors and complications of GI dysfunction during enteral nutrition (EN become more questionable. Aim: To evaluate the frequency, risk factors and complications of GI dysfunction during EN in the first 2 weeks of the intensive care unit (ICU stay and to identify precautions to prevent the development of GI dysfunction and avoid complications.Methods: In this prospective observational study, we deliberately targeted at-risk patients. A total of 137 patients who received nasogastric tube feeding in an ICU of a tertiary hospital were enrolled.Results: The incidence of GI dysfunction that was found to be 63% which was associated mainly between MDR bacteria positivity and negative fluid balance. Diarrhea was observed in 36 patients (26% and on 147 patient-days (incidence rate, 5.5 per 100 patient-days. The median day of diarrhea onset was 6 days after the initiation of EN. Forty patients (29% presented with constipation (85% during the first week. Fifty patients (36% exhibited upper digestive intolerance on 212 patient-days (incidence rate, 7.9 per 100 patient-days, after a median EN duration of 6 days (range, 2–14 days. Logistic regression analysis revealed MDR bacteria growth in the culture (OR, 1.75; 95% CI, 1.15–2.67; P=0.008 and negative fluid balance (OR, 0.57; 95% CI, 0.34–0.94; P=0.03 as the risk factors for GI dysfunction. We

Effect of minimal enteral feeding on recovery in a methotrexate-induced gastrointestinal mucositis rat model

NARCIS (Netherlands)

Kuiken, Nicoline S. S.; Rings, Edmond H. H. M.; Havinga, Rick; Groen, Albert K.; Tissing, Wim J. E.

Patients suffering from gastrointestinal mucositis often receive parenteral nutrition as nutritional support. However, the absence of enteral nutrition might not be beneficial for the intestine. We aimed to determine the feasibility of minimal enteral feeding (MEF) administration in a methotrexate

[Enteral nutrition in patients with ulcerative and postburn cicatrix strictures of the esophagus and stomach outcome region].

Science.gov (United States)

Abakumov, M M; Kostiuchenko, L N

2009-01-01

Decompensated cicatrices stricture of upper alimentary canal is a complex disease clinically presenting a high mechanical blocking and leads to expressed abnormality of homeostasis, which requires its pathogenetic correction of urgency evidence. The greatest difficulty is correct protein-energy malnutrition and water-electrolyte metabolism. Prior to the imposition of stoma for feeding should begin immediately with standard parenteral nutrition solutions. In a subsequent it is nessesary to resort more physiologecal tube alimentasion. As with esophageal postambustion stricture electrical activity of the stomach inhibiting and in essentially remains small bowel function, preference should be given to ways of enteral threpsology support. This can be used as a balanced composition in breeding (primary breeding should be 1: 2) and special blends for intraintestinal alimentation (close chyme on line carrying the major components). In the case of postambustion struck of outlet termination stomach department when identified violations of the underlying functions of the digestive canal division, rational come to gentle tactics of enteral alimentation using mixtures, completely similar in composition to himus. At stricture janitor ulcer genesis appropriate tactics is enteral correction, similar to that used in the event of postambustion strictures of the zones when bowel function is largely preserved.

Iodine in Enteral and Parenteral Nutrition

NARCIS (Netherlands)

Zimmermann, M.B.; Crill, C.M.

2010-01-01

Iodine deficiency (ID) has multiple adverse effects on growth and development due to inadequate thyroid hormone production. Methods for assessment of iodine nutrition in individuals include the urinary iodine concentration (UI), thyroid size and thyroid function tests. The UI measured in several

The Effectiveness of Community-Based Nutrition Education on the Nutrition Status of Under-five Children in Developing Countries. A Systematic Review.

Science.gov (United States)

Majamanda, J; Maureen, D; Munkhondia, T M; Carrier, J

2014-12-01

This systematic review aimed at examining the best available evidence on the effectiveness of community-based nutrition education in improving the nutrition status of under five children in developing countries. A systematic search of the literature was conducted utilising the following data bases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, and Web of Knowledge. 9 studies were identified for the critical appraisal process. The Joanna Briggs Institute (JBI) critical appraisal check-list for experimental studies was utilised and two reviewers conducted the appraisal process independently. 7 studies were included for this review and data was extracted using the JBI data extraction form for experimental studies. The extracted data was heterogeneous as such narrative synthesis was conducted. The nutritional status of children in all studies improved and this was evidenced by increases in weight, height, mid upper arm circumference and reduced morbidity. Key messages about education were age at introduction of complementary foods, nutrition value on different types of feeds found locally and frequency of feeding the children. However, there were varied results regarding the effects of the intervention on the nutrition status of children. This was attributed by differences in implementers' characteristics, different intervention strategy and intensity, difference in age of the children at enrolment, pre-existing children's growth and nutritional status and follow-up periods. In addition to home visiting, conducting group meetings of care givers and community leaders, providing education twice a week and use of cooking demonstrations have shown that they produce highly significant findings. The evidence from the identified studies suggests that community- based nutrition education improves the nutrition status of under-five children in developing countries.

Effect of Immune-Enhancing Enteral Nutrition Enriched with or without Beta-Glucan on Immunomodulation in Critically Ill Patients

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Jae Gil Lee

2016-06-01

Full Text Available We investigated whether high-protein enteral nutrition with immune-modulating nutrients (IMHP enriched with β-glucan stimulates immune function in critically ill patients. In a randomized double-blind placebo-controlled study, 30 patients consumed one of three types of enteral nutrition: a control or IMHP with and without β-glucan. The IMHP with β-glucan group showed increases in natural killer (NK cell activities relative to the baseline, and greater increases were observed in NK cell activities relative to the control group after adjusting for age and gender. The IMHP groups with and without β-glucan had greater increases in serum prealbumin and decreases in high-sensitivity C-reactive protein (hs-CRP than the control group. The control group had a greater decrease in peripheral blood mononuclear cell (PBMC interleukin (IL-12 production than the IMHP with and without β-glucan groups. In all patients, the change (Δ in hs-CRP was correlated with Δ prealbumin and Δ PBMC IL-12, which were correlated with ΔNK cell activity and Δ prealbumin. This study showed beneficial effects of a combination treatment of β-glucan and IMHP on NK cell activity. Additionally, strong correlations among changes in NK cell activity, PBMC IL-12, and hs-CRP suggested that β-glucan could be an attractive candidate for stimulating protective immunity without enhanced inflammation (ClinicalTrials.gov: NCT02569203.

The effects of conscientiousness on the appraisals of daily stressors.

Science.gov (United States)

Gartland, Nicola; O'Connor, Daryl B; Lawton, Rebecca

2012-02-01

Conscientiousness (C) is positively associated with health and longevity although the mechanisms underlying this relationship are not fully understood. Stress may play a role in explaining the C-longevity relationship. This study investigated whether C predicted the cognitive appraisals of daily stressors/hassles. Participants (N=102) completed measures of C and cognitive appraisal in relation to the most stressful hassle they had experienced in the last 7 days. Correlational analysis revealed that Total C, Order and Industriousness were positively correlated with primary appraisals, and Responsibility was positively correlated with secondary appraisals. The facets of C were then entered into hierarchical regression models, controlling for age and gender. This demonstrated that Order (β=0.27, paccounting for 15.8% of the variance. Responsibility significantly predicted secondary appraisals (β=0.44, paccounting for 16.3% of the variance. These findings indicate that higher Order and Industriousness are related to having a greater stake in daily stressors, whereas higher Responsibility is related to greater confidence in one's ability to deal with daily stressors. These results are the first demonstration that C is related to the appraisals of daily hassles and suggest that C may moderate the experience of stress in daily life. Copyright © 2011 John Wiley & Sons, Ltd.

Parenteral nutrition in the ICU setting: need for a shift in utilization.

Science.gov (United States)

Oshima, Taku; Hiesmayr, Michael; Pichard, Claude

2016-03-01

The difficulties to feed the patients adequately with enteral nutrition alone have drawn the attention of the clinicians toward the use of parenteral nutrition, although recommendations by the recent guidelines are conflicting. This review focuses on the intrinsic role of parenteral nutrition, its new indication, and modalities of use for the critically ill patients. A recent trial demonstrated that selecting either parenteral nutrition or enteral nutrition for early nutrition has no impact on clinical outcomes. However, it must be acknowledged that the risk of relative overfeeding is greater when using parenteral nutrition and the risk of underfeeding is greater when using enteral nutrition because of gastrointestinal intolerance. Both overfeeding and underfeeding in the critically ill patients are associated with deleterious outcomes. Thus, early and adequate feeding according to the specific energy needs can be recommended as the optimal feeding strategy. Parenteral nutrition can be used to substitute or supplement enteral nutrition, if adequately prescribed. Testing for enteral nutrition tolerance during 2-3 days after ICU admission provides the perfect timing to start parenteral nutrition, if needed. In case of absolute contraindication for enteral nutrition, consider starting parenteral nutrition carefully to avoid overfeeding.

Nutritional status and nutritional support before and after pancreatectomy for pancreatic cancer and chronic pancreatitis.

Science.gov (United States)

Karagianni, Vasiliki Th; Papalois, Apostolos E; Triantafillidis, John K

2012-12-01

Cachexia, malnutrition, significant weight loss, and reduction in food intake due to anorexia represent the most important pathophysiological consequences of pancreatic cancer. Pathophysiological consequences result also from pancreatectomy, the type and severity of which differ significantly and depend on the type of the operation performed. Nutritional intervention, either parenteral or enteral, needs to be seen as a method of support in pancreatic cancer patients aiming at the maintenance of the nutritional and functional status and the prevention or attenuation of cachexia. Oral nutrition could reduce complications while restoring quality of life. Enteral nutrition in the post-operative period could also reduce infective complications. The evidence for immune-enhanced feed in patients undergoing pancreaticoduodenectomy for pancreatic cancer is supported by the available clinical data. Nutritional support during the post-operative period on a cyclical basis is preferred because it is associated with low incidence of gastric stasis. Postoperative total parenteral nutrition is indicated only to those patients who are unable to be fed orally or enterally. Thus nutritional deficiency is a relatively widesoread and constant finding suggesting that we must optimise the nutritional status both before and after surgery.

The postoperative clinical outcomes and safety of early enteral nutrition in operated gastric cancer patients.

Science.gov (United States)

Li, Bing; Liu, Hong-Yi; Guo, Shao-Hua; Sun, Peng; Gong, Fang-Ming; Jia, Bao-Qing

2015-01-01

This study investigated the impact of early enteral nutrition (EEN) on the clinical outcomes of gastric cancer patients after radical gastrectomy. Four hundred gastric cancer patients undergoing radical gastrectomy of any extend with D2 nodal dissection were randomly divided into an experimental and a control group with 200 cases in each group. Patients in the control group received postoperative parenteral nutrition (PN), while patients in the experimental group received postoperative EEN. After treatment, the clinical outcomes, postoperative immune function, and nutritional status of the two groups were evaluated. The postoperative fever time, intestinal function recovery time, anal exhaust time, and the length of hospital stay for patients in the experimental group were significantly shorter than those of the control group. We did not find significant differences in anastomotic leak, postoperative ileus and regurgitation between the two groups. The activities of multiple immune cell types, including CD3⁺, CD4⁺, CD4⁺/CD8⁺, and natural killer (NK) cells, were significantly lower in both groups on postoperative day 1 when compared with the preoperative levels (p0.05). After treatment, levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, and NK cells in the experimental group patients were 35.6 ± 4.2, 42.2 ± 3.0, 1.7 ± 0.3, and 27.3 ± 5.3%, respectively, on postoperative day 7, which were similar to the preoperative levels. The immune cell levels from the control group patients remained significantly lower when compared with preoperative values; in addition, these values were also significantly lower when compared with the EEN patients (pgastric cancer patients undergoing radical gastrectomy, the clinical outcome, immune function and nutritional status after EEN were significantly improved. These data suggest the widespread use of EEN in clinical practice.

Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy.

Science.gov (United States)

Liu, Hua; Ling, Wei; Shen, Zhi Yong; Jin, Xin; Cao, Hui

2012-08-01

To determine whether immune-enhanced enteral nutrition (EN) was effective on nutritional status, immune function, surgical outcomes and days of hospitalization after total gastrectomy for patients with advanced gastric cancer (AGC). From August 2005 to May 2011, 78 patients with AGC who underwent a total gastrectomy were enrolled and divided randomly into three groups: immune-enhanced EN (EN + glutamine [Gln]) group, standard EN group and control group. Serum parameters including total protein, albumin, proalbumin and transferrin were examined on preoperative day 1, postoperative day 2 and day 12. Levels of immunoglobulin M (IgM), immunoglobulin G (IgG), natural killer (NK) cells, CD4⁺ and CD8⁺ T cells were also compared. The formulas were tolerated well in all the patients except 5 with mild complications. The EN + Gln and EN groups showed a faster onset of flatus and shorter hospitalization duration than the control group. On postoperative day 12, serum total protein, albumin, proalbumin and transferrin levels of the EN + Gln and EN groups were significantly higher than those of the control group (P nutritional status and immune function for the patients with AGC after total gastrectomy. © 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study).

Science.gov (United States)

Nishioka, Shinta; Okamoto, Takatsugu; Takayama, Masako; Urushihara, Maki; Watanabe, Misuzu; Kiriya, Yumiko; Shintani, Keiko; Nakagomi, Hiromi; Kageyama, Noriko

2017-08-01

Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change. Severe malnutrition risk independently

Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy.

Science.gov (United States)

Fini, Nicola; Georgoulopoulou, Eleni; Vinceti, Marco; Monelli, Marco; Pinelli, Giovanni; Vacondio, Paolo; Giovannini, Michele; Dallari, Rossano; Marudi, Andrea; Mandrioli, Jessica

2014-10-01

We performed a population-based study to assess amyotrophic lateral sclerosis (ALS) survival after noninvasive ventilation (NIV), invasive ventilation (IV), and enteral nutrition (EN). We included patients diagnosed from 2000 to 2009 in Modena, where a prospective registry and a Motor Neuron Diseases Centre have been active since 2000. Of the 193 incident cases, 47.7% received NIV, 24.3% received tracheostomy, and 49.2% received EN. A total of 10.4% of the patients refused NIV, 31.6% refused IV, and 8.7% refused EN. The median survival times after NIV, IV, and EN were 15, 19, and 9 months, respectively. Of the tracheostomized patients, 79.7% were discharged from the hospital; 73.0% were discharged to home. The median survival times for tracheostomized patients who were cared for at home and in nursing homes were 43 and 2 months, respectively. The multivariate analysis demonstrated that the place of discharge was the only independent prognostic factor after IV (PNIV, IV, EN, and influence postprocedure survival. These data may be useful in defining health plans regarding advanced ALS care and in patient counseling. © 2014 Wiley Periodicals, Inc.

Optimizing Perioperative Nutrition in Pediatric Populations.

Science.gov (United States)

Canada, Nicki L; Mullins, Lucille; Pearo, Brittany; Spoede, Elizabeth

2016-02-01

Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period. © 2015 American Society for Parenteral and Enteral Nutrition.

Implementation of enteral feeding protocol in an intensive care unit

DEFF Research Database (Denmark)

Padar, Martin; Uusvel, Gerli; Starkopf, Liis

2017-01-01

AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients. METHODS: An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013......, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population...... the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher...

Compliance with nutrition support guidelines in acutely burned patients.

Science.gov (United States)

Holt, Brennen; Graves, Caran; Faraklas, Iris; Cochran, Amalia

2012-08-01

Adequate and timely provision of nutritional support is a crucial component of care of the critically ill burn patient. The goal of this study was to assess a single center's consistency with Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition (SCCM/ASPEN) guidelines for nutritional support in critically ill patients. Acutely burned patients >45kg in weight admitted to a regional burn center during a two-year period and who required 5 or more days of full enteral nutritional support were eligible for inclusion in this retrospective review. Specific outcomes evaluated include time from admission to feeding tube placement and enteral feeding initiation and percent of nutritional goal received within the first week of hospital stay. Descriptive statistics were used for all analyses. IRB approval was obtained. Thirty-seven patients were included in this retrospective review. Median age of patients was 44.9 years (IQR: 24.2-55.1), and median burn injury size was 30% (IQR: 19-47). Median time to feeding tube placement was 31.1h post admission (IQR: 23.6-50.2h), while median time to initiation of EN was 47.9h post admission (IQR: 32.4-59.9h). The median time required for patients to reach 60% of caloric goal was 3 days post-admission (IQR: 3-4.5). The median time for initiation of enteral nutrition was within the SCCM/ASPEN guidelines for initial nutrition in the critically ill patient. This project identified a 16h time lag between placement of enteral access and initiation of enteral nutrition. Development of a protocol for feeding tube placement and enteral nutrition management may optimize early nutritional support in the acutely injured burn patient. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice.

Science.gov (United States)

Le Palma, Krisha; Pavlick, Elisha Rampolla; Copelovitch, Lawrence

2018-04-01

Current treatment options for chronic hyperkalemia in children with chronic kidney disease include dietary restrictions or enteral sodium polystyrene sulfonate (SPS); however, dietary restrictions may compromise adequate nutrition and enteral SPS may be limited by palatability, adverse effects and feeding tube obstruction. A potentially safer alternative is to pretreat enteral nutrition (EN) with SPS prior to consumption. The purpose of this study was to evaluate the efficacy and safety of pretreating EN with SPS in pediatric patients with hyperkalemia. We performed a retrospective cohort study between September 2012 and May 2016 at the Children's Hospital of Philadelphia. In all, 14 patients (age range 0.5-53.2 months) who received 19 courses of SPS pretreatment of EN were evaluated. Serum electrolytes were evaluated at baseline and within 1 week of initiating therapy. The primary endpoint was mean change in potassium at 7 days. Secondary endpoints included the mean change in serum sodium, chloride, bicarbonate, calcium, phosphorous and magnesium, as well as the percentage of patients who developed electrolyte abnormalities within the first week of treatment. Serum potassium levels decreased from 6.0 to 4.4 mmol/L (P < 0.001) and serum sodium levels increased from 135.8 to 141.3 mmol/L (P = 0.008) 1 week after initiating SPS pretreatment. No significant differences in mean serum calcium or magnesium levels were noted. Nevertheless, more than half of the courses resulted in at least one electrolyte abnormality, with hypokalemia (31.6%), hypernatremia (26.3%) and hypocalcemia (21.1%) occurring most frequently. Pretreatment of EN with SPS is an effective method for treating chronic hyperkalemia in pediatric patients; however, close monitoring of electrolytes is warranted.

[Effects of modified bazhen decoction in assistant with enteral nutrition on the growth hormone, the nutritional state, and the immune function in patients with gastric cancer after operation].

Science.gov (United States)

Wang, Hong-xing; Li, Jian-ping

2011-10-01

To observe the effects of modified Bazhen Decoction (BZD) in assistant with enteral nutrition (EN) on the growth hormone, the nutritional state, and the immune function in patients with gastric cancer after operation. The prospective, random, single-blinded, controlled clinical trial was adopted. 88 patients receiving gastric cancer operation were randomly assigned to the parenteral nutrition group (Group A, 27 cases), the EN group (Group B, 30 cases), and the comprehensive group (Group C, BZD in assistant with EN, 31 cases). Isocaloric and isonitrogenous parenteral nutritional support was given to patients in Group A from the operation day to the ninth day. Isocaloric and isonitrogenous EN was given to patients in Group B and C from the second day of operation till the ninth day. 100 mL BZD was nasal fed to patients in Group C during the second day to the ninth day after operation. The levels of the growth hormone, immune indices such as IgA, IgG, CD4+, CD8+, and CD4+/CD8+, etc., and nutritional indices such as serum albumin, prealbumin, transferrin, etc. were detected in the three groups one day before operation, on the 1st day after operation, and on the tenth day after operation. The levels of IgA, IgG, CD4+, and CD4+/CD8+, serum albumin, prealbumin, transferrin decreased more than before operation in the three groups, with statistical difference (Pnutrition state and the immune function.

Pediatric parenteral nutrition: clinical practice guidelines from the Spanish Society of Parenteral and Enteral Nutrition (SENPE), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Hospital Pharmacy (SEFH)

Science.gov (United States)

Pedrón Giner, Consuelo; Cuervas-Mons Vendrell, Margarita; Galera Martínez, Rafael; Gómez López, Lilianne; Gomis Muñoz, Pilar; Irastorza Terradillos, Iñaki; Martínez Costa, Cecilia; Moreno Villares, José Manuel; Pérez-Portabella Maristany, Cleofé; Pozas Del Río, M ª Teresa; Redecillas Ferreiro, Susana E; Prieto Bozano, Gerardo; Grupo de Estandarización de la Senpe, Senpe

2017-06-05

Introduction:Parenteral nutrition (PN) in childhood is a treatment whose characteristics are highly variable depending on the age and pathology of the patient. Material and methods: The Standardization and Protocols Group of the Spanish Society for Parenteral and Enteral Nutrition (SENPE) is an interdisciplinary group formed by members of the SENPE, the Spanish Society of Gastroenterology, Hepatology and Pediatric Nutrition (SEGHNP) and the Spanish Society of Hospital Pharmacy (SEFH) that intends to update this issue. For this, a detailed review of the literature has been carried out, looking for the evidences that allow us to elaborate a Clinical Practice Guide following the criteria of the Oxford Center for Evidence-Based Medicine. Results: This manuscript summarizes the recommendations regarding indications, access routes, requirements, modifi cations in special situations, components of the mixtures, prescription and standardization, preparation, administration, monitoring, complications and home NP. The complete document is published as a monographic number. Conclusions: This guide is intended to support the prescription of pediatric PN. It provides the basis for rational decisions in the context of the existing evidence. No guidelines can take into account all of the often compelling individual clinical circumstances.

Infection control in enteral feed and feeding systems in the community

OpenAIRE

Ojo, Omorogieva; Bowden, Julie

2013-01-01

This article examines the infection risk to adult patients receiving home enteral nutrition (HEN) and strategies for its prevention and management. Enteral nutrition was historically associated with acute care settings owing to its invasive nature. The changing landscape of community care means that it is now likely to be administered in the patient’s home or in other community settings such as nursing homes. HEN is associated with two main routes of infection risks: the risk of gastrointesti...

Nutritional support for critically ill children.

Science.gov (United States)

Joffe, Ari; Anton, Natalie; Lequier, Laurance; Vandermeer, Ben; Tjosvold, Lisa; Larsen, Bodil; Hartling, Lisa

2016-05-27

Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children. This is an update of a review that was originally published in 2009. . The objective of this review was to assess the impact of enteral and parenteral nutrition given in the first week of illness on clinically important outcomes in critically ill children. There were two primary hypotheses:1. the mortality rate of critically ill children fed enterally or parenterally is different to that of children who are given no nutrition;2. the mortality rate of critically ill children fed enterally is different to that of children fed parenterally.We planned to conduct subgroup analyses, pending available data, to examine whether the treatment effect was altered by:a. age (infants less than one year versus children greater than or equal to one year old);b. type of patient (medical, where purpose of admission to intensive care unit (ICU) is for medical illness (without surgical intervention immediately prior to admission), versus surgical, where purpose of admission to ICU is for postoperative care or care after trauma).We also proposed the following secondary hypotheses (a priori), pending other clinical trials becoming available, to examine nutrition more distinctly:3. the mortality rate is different in children who are given enteral nutrition alone versus enteral and parenteral combined;4. the mortality rate is different in children who are given both enteral feeds and parenteral nutrition versus no nutrition. In this updated review we searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 2); Ovid MEDLINE (1966 to February 2016); Ovid EMBASE (1988 to February 2016); OVID Evidence-Based Medicine Reviews; ISI Web of Science - Science Citation Index Expanded (1965 to February 2016); Web

Nutrición enteral total vs. nutrición parenteral total en pacientes con pancreatitis aguda grave Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis

Directory of Open Access Journals (Sweden)

M. Casas

2007-05-01

Full Text Available Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET frente a nutrición parenteral total (NPT en pacientes con pancreatitis aguda grave (PAG. Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11 recibió NPT y el grupo II (n = 12 NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6, las proteínas viscerales (pre-albúmina, albúmina, la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones, las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT.Objective: to compare the efficacy of early total enteral nutrition (TEN vs. total parenteral nutrition (TPN in patients with severe acute pancreatitis (SAP. Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I or TEN (group II. SAP was defined applying APACHE II score, C-reactive protein (CRP measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6, visceral proteins (pre-albumin, albumin, complications (systemic inflammatory response syndrome, multiorgan failure, infections, surgical interventions, length of hospital stay and mortality were

Should early enteral nutrition be used in the trauma intensive care ...

African Journals Online (AJOL)

Critical illness, sepsis, surgery, multi-organ failure and haemo- dynamic instability are conditions that are associated with feeding inadequacies and nutritional challenges. Conversely, meeting nutritional requirements and providing optimal nutrition are associated with an improved outcome. Since these facts have been.

Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings

Science.gov (United States)

Smith, Avery L.; Santa Ana, Carol A.; Fordtran, John S.; Guileyardo, Joseph M.

2018-01-01

ABSTRACT It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions. PMID:29904295

Surgery and transplantation – Guidelines on Parenteral Nutrition, Chapter 18

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Holland-Cunz, S.

2009-11-01

Full Text Available In surgery, indications for artificial nutrition comprise prevention and treatment of catabolism and malnutrition. Thus in general, food intake should not be interrupted postoperatively and the re-establishing of oral (e.g. after anastomosis of the colon and rectum, kidney transplantation or enteral food intake (e.g. after an anastomosis in the upper gastrointestinal tract, liver transplantation is recommended within 24 h post surgery. To avoid increased mortality an indication for an immediate postoperatively artificial nutrition (enteral or parenteral nutrition (PN also exists in patients with no signs of malnutrition, but who will not receive oral food intake for more than 7 days perioperatively or whose oral food intake does not meet their needs (e.g. less than 60–80% for more than 14 days. In cases of absolute contraindication for enteral nutrition, there is an indication for total PN (TPN such as in chronic intestinal obstruction with a relevant passage obstruction e.g. a peritoneal carcinoma. If energy and nutrient requirements cannot be met by oral and enteral intake alone, a combination of enteral and parenteral nutrition is indicated. Delaying surgery for a systematic nutrition therapy (enteral and parenteral is only indicated if severe malnutrition is present. Preoperative nutrition therapy should preferably be conducted prior to hospital admission to lower the risk of nosocomial infections. The recommendations of early postoperative re-establishing oral feeding, generally apply also to paediatric patients. Standardised operative procedures should be established in order to guarantee an effective nutrition therapy.

Adequação calórico-proteica da terapia nutricional enteral em pacientes cirúrgicos Protein-calorie adequacy of enteral nutrition therapy in surgical patients

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Marília Freire Isidro

2012-10-01

Full Text Available OBJETIVO: Avaliar a adequação calórico-proteica da terapia nutricional enteral (TNE empregada em pacientes cirúrgicos. MÉTODOS: Estudo prospectivo, realizado em pacientes cirúrgicos que receberam TNE de março a outubro de 2011. Os pacientes foram avaliados antropometricamente e pela avaliação subjetiva global (ASG. Os valores de calorias e proteínas prescritos e administrados e as causas de interrupção da dieta foram registrados diariamente. O valor de 90% foi utilizado como referencial de adequação. A diferença entre o prescrito e o administrado foi verificada pelo teste t de Student. RESULTADOS: Uma amostra de 32 pacientes, com idade de 55,8 ± 14,9 anos, apresentou 40,6 a 71,9% de desnutrição dependendo da ferramenta utilizada. A neoplasia gástrica e as gastrectomias foram o diagnóstico e as cirurgias mais frequentes. Dos pacientes, 50% conseguiram atingir suas necessidades calórico-proteicas. A adequação da dieta recebida em relação à prescrita foi de 88,9 ± 12,1% e de 87,9 ± 12,2% para calorias e proteínas, respectivamente, com um déficit significativo (p OBJECTIVE: To evaluate the protein-calorie adequacy of enteral nutrition therapy (ENT in surgical patients. METHODS: A prospective study was performed in surgical patients who received ENT from March to October 2011. Patients were evaluated anthropometrically and by subjective global assessment (SGA. The amount of calories and protein prescribed and administered were recorded daily, as well as the causes of discontinuation of the diet. A 90% value was used as the adequacy reference. The difference between the prescribed and administered amount was verified by Student's t-test. RESULTS: A sample of 32 patients, aged 55.8 ± 14.9 years, showed a malnutrition rate of 40.6% to 71.9%, depending on the assessment tool used. Gastric cancer and gastrectomy were the most common diagnosis and surgery, respectively. Of the patients, 50% were able to meet their caloric and

Nutrition for the pediatric surgical patient: approach in the peri-operative period

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Falcão Mário Cícero

2002-01-01

Full Text Available Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): neurocritical patient].

Science.gov (United States)

Acosta Escribano, J; Herrero Meseguer, I; Conejero García-Quijada, R

2011-11-01

Neurocritical patients require specialized nutritional support due to their intense catabolism and prolonged fasting. The preferred route of nutrient administration is the gastrointestinal route, especially the gastric route. Alternatives are the transpyloric route or mixed enteral-parenteral nutrition if an effective nutritional volume of more than 60% cannot be obtained. Total calore intake ranges from 20-30 kcal/kg/day, depending on the period of the clinical course, with protein intake higher than 20% of total calories (hyperproteic diet). Nutritional support should be initiated early. The incidence of gastrointestinal complications is generally higher to other critically-ill patients, the most frequent complication being an increase in gastric residual volume. As in other critically-ill patients, glycemia should be closely monitored and maintained below 150 mg/dL. Copyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.

Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Elke, Gunnar; van Zanten, Arthur R H; Lemieux, Margot; McCall, Michele; Jeejeebhoy, Khursheed N; Kott, Matthias; Jiang, Xuran; Day, Andrew G; Heyland, Daren K

2016-04-29

Enteral nutrition (EN) is recommended as the preferred route for early nutrition therapy in critically ill adults over parenteral nutrition (PN). A recent large randomized controlled trial (RCT) showed no outcome differences between the two routes. The objective of this systematic review was to evaluate the effect of the route of nutrition (EN versus PN) on clinical outcomes of critically ill patients. An electronic search from 1980 to 2016 was performed identifying relevant RCTs. Individual trial data were abstracted and methodological quality of included trials scored independently by two reviewers. The primary outcome was overall mortality and secondary outcomes included infectious complications, length of stay (LOS) and mechanical ventilation. Subgroup analyses were performed to examine the treatment effect by dissimilar caloric intakes, year of publication and trial methodology. We performed a test of asymmetry to assess for the presence of publication bias. A total of 18 RCTs studying 3347 patients met inclusion criteria. Median methodological score was 7 (range, 2-12). No effect on overall mortality was found (1.04, 95 % CI 0.82, 1.33, P = 0.75, heterogeneity I(2) = 11 %). EN compared to PN was associated with a significant reduction in infectious complications (RR 0.64, 95 % CI 0.48, 0.87, P = 0.004, I(2) = 47 %). This was more pronounced in the subgroup of RCTs where the PN group received significantly more calories (RR 0.55, 95 % CI 0.37, 0.82, P = 0.003, I(2) = 0 %), while no effect was seen in trials where EN and PN groups had a similar caloric intake (RR 0.94, 95 % CI 0.80, 1.10, P = 0.44, I(2) = 0 %; test for subgroup differences, P = 0.003). Year of publication and methodological quality did not influence these findings; however, a publication bias may be present as the test of asymmetry was significant (P = 0.003). EN was associated with significant reduction in ICU LOS (weighted mean difference [WMD] -0.80, 95 % CI -1.23, -0.37, P = 0.0003, I(2

The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients.

Science.gov (United States)

Atasever, Ayse Gulsah; Ozcan, Perihan Ergin; Kasali, Kamber; Abdullah, Taner; Orhun, Gunseli; Senturk, Evren

2018-01-01

Gastrointestinal (GI) motility disorders in intensive care patients remain relatively unexplored. Nowadays, the frequency, risk factors and complications of GI dysfunction during enteral nutrition (EN) become more questionable. To evaluate the frequency, risk factors and complications of GI dysfunction during EN in the first 2 weeks of the intensive care unit (ICU) stay and to identify precautions to prevent the development of GI dysfunction and avoid complications. In this prospective observational study, we deliberately targeted at-risk patients. A total of 137 patients who received nasogastric tube feeding in an ICU of a tertiary hospital were enrolled. The incidence of GI dysfunction that was found to be 63% which was associated mainly between MDR bacteria positivity and negative fluid balance. Diarrhea was observed in 36 patients (26%) and on 147 patient-days (incidence rate, 5.5 per 100 patient-days). The median day of diarrhea onset was 6 days after the initiation of EN. Forty patients (29%) presented with constipation (85% during the first week). Fifty patients (36%) exhibited upper digestive intolerance on 212 patient-days (incidence rate, 7.9 per 100 patient-days), after a median EN duration of 6 days (range, 2-14 days). Logistic regression analysis revealed MDR bacteria growth in the culture (OR, 1.75; 95% CI, 1.15-2.67; P =0.008) and negative fluid balance (OR, 0.57; 95% CI, 0.34-0.94; P =0.03) as the risk factors for GI dysfunction. We also showed that GI dysfunction was associated with high SOFA score, hypoalbuminemia, catecholamine use, and prolonged length of stay (LOS). GI dysfunction, on the other hand, can cause some complications including inadequate nutrition, and newly developed decubitus ulcers. GI dysfunction should be considered a clinical predictor of inadequate nutrition and prolonged LOS. In addition, the most dramatic risk for GI dysfunction was observed in patients with MDR bacteria growth in the culture and patients in negative fluid

A critical look at medical nutrition terminology and definitions,

NARCIS (Netherlands)

Claassen, E.; Weenen, T.C.; Commandeur, H

2014-01-01

A plethora of terms and definitions for medical nutrition has resulted in an ambiguity in the way "medical nutrition" is termed and defined across various societal levels. The terms medical nutrition, clinical nutrition, enteral nutrition, parenteral nutrition, oral nutritional supplements, medical

The Challenges of Home Enteral Tube Feeding: A Global Perspective

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Omorogieva Ojo

2015-04-01

Full Text Available The aim of this review is to provide a global perspective of Home Enteral Tube Feeding (HETF and to outline some of the challenges of home enteral nutrition (HEN provisions. It is well established that the number of patients on HETF is on the increase worldwide due to advances in technology, development of percutaneous endoscopic gastrostomy techniques, and the shift in care provisions from acute to community settings. While the significance of home enteral nutrition in meeting the nutritional requirements of patients with poor swallowing reflexes and those with poor nutritional status is not in doubt, differences exist in terms of funding, standards, management approaches and the level of infrastructural development across the world. Strategies for alleviating some of the challenges militating against the effective delivery of HETF including the development of national and international standards, guidelines and policies for HETF, increased awareness and funding by government at all levels were discussed. Others, including development of HEN services, which should create the enabling environment for multidisciplinary team work, clinical audit and research, recruitment and retention of specialist staff, and improvement in patient outcomes have been outlined. However, more research is required to fully establish the cost effectiveness of the HEN service especially in developing countries and to compare the organization of HEN service between developing and developed countries.

Nutrition quality control in the prescription and administration of parenteral nutrition therapy for hospitalized patients.

Science.gov (United States)

Shiroma, Glaucia Midori; Horie, Lilian Mika; Castro, Melina Gouveia; Martins, Juliana R; Bittencourt, Amanda F; Logullo, Luciana; Teixeira da Silva, Maria de Lourdes; Waitzberg, Dan L

2015-06-01

Nutrition quality control in parenteral nutrition therapy (PNT) allows the identification of inadequate processes in parenteral nutrition (PN). The objective of this study was to assess the quality of PNT at a hospital with an established nutrition support team (NST). This observational, longitudinal, analytical, and prospective study examined 100 hospitalized PNT adult patients under the care of an NST for 21 days or until death/hospital discharge. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2007 guidelines for PNT prescription were followed. PNT indications were not in accordance with the A.S.P.E.N. 2007 guidelines in 15 patients. Among the remaining 85 patients, 48 (56.5%) did not receive adequate PNT (≥80% of the total volume prescribed). Non-NST medical orders, progression to and from enteral nutrition, changes in the central venous catheter, unknown causes, and operational errors (eg, medical prescription loss, PN nondelivery, pharmacy delays, inadequate PN bag temperature) were associated with PNT inadequacy (P nutrition therapy related to estimated energy expenditure and protein requirements and glycemia levels reached the expected targets; however, the central venous catheter infection rate was higher than 6 per 1000 catheters/d and did not meet the expected targets. Despite an established NST, there was a moderate level of PNT inadequacy in indications, administration, and monitoring. It is important to establish periodic meetings among different health professionals who prescribe and deliver PNT to define responsibilities and protocols. © 2015 American Society for Parenteral and Enteral Nutrition.

Effects of a diabetes-specific enteral nutrition on nutritional and immune status of diabetic, obese, and endotoxemic rats: interest of a graded arginine supply.

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Breuillard, Charlotte; Darquy, Sylviane; Curis, Emmanuel; Neveux, Nathalie; Garnier, Jean-Pierre; Cynober, Luc; De Bandt, Jean-Pascal

2012-08-01

Obese and type 2 diabetic patients present metabolic disturbance-related alterations in nonspecific immunity, to which the decrease in their plasma arginine contributes. Although diabetes-specific formulas have been developed, they have never been tested in the context of an acute infectious situation as can be seen in intensive care unit patients. Our aim was to investigate the effects of a diabetes-specific diet enriched or not with arginine in a model of infectious stress in a diabetes and obesity situation. As a large intake of arginine may be deleterious, this amino acid was given in graded fashion. Randomized, controlled experimental study. University research laboratory. Zucker diabetic fatty rats. Gastrostomized Zucker diabetic fatty rats were submitted to intraperitoneal lipopolysaccharide administration and fed for 7 days with either a diabetes-specific enteral nutrition without (G group, n=7) or with graded arginine supply (1-5 g/kg/day) (GA group, n=7) or a standard enteral nutrition (HP group, n=10). Survival rate was better in G and GA groups than in the HP group. On day 7, plasma insulin to glucose ratio tended to be lower in the same G and GA groups. Macrophage tumor necrosis factor-α (G: 5.0±1.1 ng/2×10⁶ cells·hr⁻¹; GA: 3.7±0.8 ng/2×10⁶ cells·hr⁻¹; and HP: 1.7±0.6 ng/2×10⁶ cells·hr⁻¹; p1.1 ng/2×10⁶ cells·hr⁻¹; GA: 5.1±1.0 ng/2×10⁶ cells·hr⁻¹; and HP: 1.0±0.5 nmol/2×10⁶ cells·hr⁻¹; pdiabetic obese and endotoxemic rats, a diabetes-specific formula leads to a lower mortality, a decreased insulin resistance, and an improvement in peritoneal macrophage function. Arginine supplementation has no additional effect. These data support the use of such disease-specific diets in critically ill diabetic and obese patients.

Home enteral nutrition recipients: patient perspectives on training, complications and satisfaction

LENUS (Irish Health Repository)

Boland, Karen

2016-10-01

The equitable provision of home enteral nutrition (HEN) in the community can have a transformative effect on patient experience and family life for adults and children alike. While optimising quality of life in HEN patients can be challenging, the initiation of HEN positively impacts this measure of healthcare provision.1 Quality of life scores have been shown to improve in the weeks after hospital discharge, and HEN is physically well tolerated. However, it may be associated with psychological distress, and sometimes reluctance among HEN patients to leave their homes.2 Globally, HEN can attenuate cumulative projected patient care costs through a reduction in hospital admission and complications including hospital acquired infections.3 In an era where the cost of disease related malnutrition and associated prolonged hospital stay is being tackled in our healthcare systems, the role of HEN is set to expand. This is a treatment which has clear clinical and social benefits, and may restore some independence to patients and their families. Rather than the indications for HEN being focused on specific diagnoses, the provision of months of quality life at home for patients is adequate justification for its prescription.4 Previously, a review of HEN service provision in 39 cases demonstrated that patients want structured follow-up after hospital discharge, and in particular, would like one point of contact for HEN education and discharge.5 Management structures, funding challenges and the need for further education, particularly within the primary care setting may limit optimal use of HEN. The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) aims to develop a national guideline document, drawing on international best practice, forming a template and standards for local policy development in the area of HEN service provision, training and follow-up. The first step in guideline development was to investigate patient experience for adults and children alike. Care

What Is Nutrition Support Therapy?

Science.gov (United States)

... Sponsored CE Programs Calendar of Events What Is Nutrition Support Therapy All people need food to live. ... patient populations from pediatrics to geriatrics. Key Terms: Nutrition Support Therapy The provision of enteral or parenteral ...

Inflammatory bowel diseases: principles of nutritional therapy

Directory of Open Access Journals (Sweden)

Campos Fábio Guilherme

2002-01-01

Full Text Available Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants still need further evaluation through prospective and randomized trials.

Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness.

Science.gov (United States)

Gungabissoon, Usha; Hacquoil, Kimberley; Bains, Chanchal; Irizarry, Michael; Dukes, George; Williamson, Russell; Deane, Adam M; Heyland, Daren K

2015-05-01

We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes. We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator-free days (VFDs), ICU stay, and 60-day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted. Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant. Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes. © 2014 American Society for Parenteral and Enteral Nutrition.

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

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Paul M

2017-03-01

Full Text Available Melanie Paul, Melanie Baker, Robert N Williams, David J Bowrey Department of Surgery, Leicester Royal Infirmary, Leicester, UK Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990–2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction and feed (diarrhea, distention problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%–1%, principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%–75% (median 46%, dysphagia 11%–38% (median 27%, early satiety 40%–90

Influence of early enteral nutrition on nutritional status, immunity and body composition in postoperative elderly gastric cancer patients%早期肠内营养对老年胃癌术后患者营养免疫及人体成分的影响

Institute of Scientific and Technical Information of China (English)

王凤; 王庆华; 陈强谱

2011-01-01

目的 探讨早期肠内营养(EEN)对老年胃癌患者术后营养、免疫和人体成分的影响.方法 将360例老年胃癌患者分为EEN组和肠外营养(PN)组各180例.EEN组术后20～24 h开始行EEN；PN组术后1d经周围静脉或中心静脉开始PN.术前、术后1d、7d检测营养指标、免疫和人体成分指标测量.结果 两组患者术后营养、免疫指标及人体成分指标值均有降低,但EEN组术后下降程度显著小于PN组(均P＜0.05),并发症发生率低于PN组.结论 老年胃癌患者术后EEN支持能有效改善营养状况、免疫功能和人体成分的变化,减少术后并发症的发生,有利于促进患者康复.%Objective To study the effect of early enteral nutrition on nutritional status, immunity and body composition in elderly patients with gastric cancer after operations. Methods A total of 360 patients with gastric cancer after operation were equally randomized into two groups receiving either parenteral nutrition (PN group) on the first postoperative day or early enteral nutrition (EN group) in 20-hour to 24-hour postoperative period. The parameters of nutritional status, immunity and body composition were measured before operation and on the first and seventh postoperative days. Results The values of parameters of nutritional status, immunity and body composition decreased after operation in both groups, with the fluctuations of parameters in the EN group being smaller than the PN group (P<0. 05 for all). The incidence of complications in the EN group was lower than the PN group. Conclusion Early enteral nutrition can improve nutritional status, immune function and body composition in elderly patients with gastric cancer after operations, reduce complications, and promote patients recovery.

Nutrition in acute pancreatitis: a critical review

NARCIS (Netherlands)

Lodewijkx, Piet J.; Besselink, Marc G.; Witteman, Ben J.; Schepers, Nicolien J.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Bakker, Olaf J.

Severe acute pancreatitis poses unique nutritional challenges. The optimal nutritional support in patients with severe acute pancreatitis has been a subject of debate for decades. This review provides a critical review of the available literature. According to current literature, enteral nutrition

Hepatology – Guidelines on Parenteral Nutrition, Chapter 16

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Plauth, M.

2009-11-01

Full Text Available Parenteral nutrition (PN is indicated in alcoholic steatohepatitis (ASH and in cirrhotic patients with moderate or severe malnutrition. PN should be started immediately when sufficientl oral or enteral feeding is not possible. ASH and cirrhosis patients who can be sufficiently fed either orally or enterally, but who have to abstain from food over a period of more than 12 hours (including nocturnal fasting should receive basal glucose infusion (2–3 g/kg/d. Total PN is required if such fasting periods last longer than 72 h. PN in patients with higher-grade hepatic encephalopathy (HE; particularly in HE IV° with malfunction of swallowing and cough reflexes, and unprotected airways. Cirrhotic patients or patients after liver transplantation should receive early postoperative PN after surgery if they cannot be sufficiently rally or enterally nourished. No recommendation can be made on donor or organ conditioning by parenteral administration of glutamine and arginine, aiming at minimising ischemia/reperfusion damage. In acute liver failure artificial nutrition should be considered irrespective of the nutritional state and should be commenced when oral nutrition cannot be restarted within 5 to 7 days. Whenever feasible, enteral nutrition should be administered via a nasoduodenal feeding tube.

Timing of the initiation of parenteral nutrition in critically ill children.

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Jimenez, Lissette; Mehta, Nilesh M; Duggan, Christopher P

2017-05-01

To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. Nutritional management remains an important aspect of care among the critically ill, with enteral nutrition generally preferred. However, inability to advance enteral feeds to caloric goals and contraindications to enteral nutrition often leads to reliance on parenteral nutrition. The timing of parenteral nutrition initiation is varied among critically ill children, and derives from an assessment of nutritional status, energy requirements, and physiologic differences between adults and children, including higher nutrient needs and lower body reserves. A recent randomized control study among critically ill children suggests improved clinical outcomes with avoiding initiation of parenteral nutrition on day 1 of admission to the pediatric ICU. Although there is no consensus on the optimal timing of parenteral nutrition initiation among critically ill children, recent literature does not support the immediate initiation of parenteral nutrition on pediatric ICU admission. A common theme in the reviewed literature highlights the importance of accurate assessment of nutritional status and energy expenditure in deciding when to initiate parenteral nutrition. As with all medical interventions, the initiation of parenteral nutrition should be considered in light of the known benefits of judiciously provided nutritional support with the known risks of artificial, parenteral feeding.

Early versus late enteral nutrition in intensive care units. Analysis of results

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Sara Bermejo de las Heras

2017-08-01

Full Text Available Introduction: Malnutrition is particularly prevalent in Intensive Care Units (ICU and associated with poor clinical outcomes. Enteral nutrition (EN has multiple benefits in critically ill patients, particularly when started early at the ICU. A series of studies corroborate this fact; however, other studies present conflicting results. Objective: To assess the clinical results of ICU patients receiving EN, according to EN starting time (early versus late. Patients and method: Basic variables were recorded in all ICU patients who received NE along the study period, as well as time from ICU admission to the start of EN, ICU length of stay, characteristic gastrointestinal complications of EN (gastric residue, constipation, diarrhea, vomiting, regurgitation, abdominal distension and bronchoaspiration and mortality. Results: There was a significant association between early EN and mortality reduction. However, there were no differences in ICU length of stay according to EN starting time. The most frequent complications in the sample were high gastric residue (17.9%, abdominal distension (22.5% and constipation (42.2%. However, no significant differences were observed as a function of the EN starting time. Discussion: Our results, although discrepant at times, do not contradict with those of other studies. EN has shown to be effective as a therapeutic strategy. Therefore, it is recommended the early start of EN in the ICU.

[Audit of artificial nutrition in an intensive care unit].

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Blesa Malpica, A L; Salaverría Garzón, I; Prado López, L M; Simón García, M J; Reta Pérez, O; Ramos Polo, J

2001-01-01

To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a second stage and after introducing the modifications considered appropriate in the protocol, to verify its implementation and compare both series. REFERENCE POPULATION: All patients with artificial nutrition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial preparations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, including propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not considered to be AN. The period of observation was two months in both cases. The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being collected for patients with AN during a similar period. The study of the first series revealed the provisions of energy and nitrogen were below theoretical levels (both in the corrected Harris-Benedict test and at the fixed prescription of 25 kcal/kg). In the second series, there was greater agreement between the theoretical values and the amounts actually received. The deviation in energy and nitrogen was significantly less in the second series. And although the total nitrogen load per patient did not reveal any differences, there were discrepancies in the daily provision per patient. On most days, the diet provided covered over 75% of the energy requirements. With parenteral nutrition on its own or in combination with enteral nutrition, the requirements of energy and nitrogen were exceeded. There were no differences between the two series. The type of provision was enteral on 55% of the days and parenteral on 18%. There was no difference in the type of provision between the two series, although there was a difference in the type

Nurses' Competency and Challenges in Enteral feeding in the ...

African Journals Online (AJOL)

Studies have emphasised the role of nurses in nutritional support. .... Ethical consideration. The study was ... Mann-Whitney U test was applied to make associations ..... based guidelines and critical care nurses knowledge of enteral feeding.

The Effect of Emodin-Assisted Early Enteral Nutrition on Severe Acute Pancreatitis and Secondary Hepatic Injury

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Gang Wang

2007-01-01

Full Text Available Severe acute pancreatitis (SAP characterized by atrocious progression and numerous complications often leads to a high mortality rate due to hypermetabolism, systemic inflammatory response syndrome (SIRS, and multiple organs dysfunction syndrome (MODS. Studies have revealed that both early enteral nutrition (EEN and emodin are potent agents in the management of SAP. However, whether the combined strategy is rational and more effective than either one alone remains unknown. In this regard, Wistar rats were treated with emodin-assisted EEN (EAEEN through enteral nutrient tubes after induction of SAP by retrograde infusion of 5.0% sodium taurocholate into the common pancreatic duct. Serum levels of amylase, tumor necrosis factor-alpha (TNF-α, angiotensin II (AngII, maleic dialdehyde (MDA, glutamic pyruvic transaminase (ALT, glutamic oxaloacetic transaminase (AST and C-reactive protein (CRP, intestinal secretory IgA (SIgA, pancreatic and hepatic myeloperoxidase (MPO activity as well as plasma levels of D-lactate and endotoxin were measured. In addition, pathologic alterations of pancreas and liver were observed microscopically. We found that EAEEN could significantly ameliorate these parameters and prevent pancreas and liver from serious damage. In conclusion, Our results indicated that EAEEN could exert beneficial effects on experimental SAP and obviously abate the severity of secondary hepatic injury. The combined strategy was safe and more effective than either one alone in the acute stage of SAP. This study also provided an experimental base for the clinical treatment of SAP patients with EAEEN.

Reconciling divergent results of the latest parenteral nutrition studies in the ICU.

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Singer, Pierre; Pichard, Claude

2013-03-01

Recent studies on the optimal modalities to feed patients during the ICU stay show divergent results. The level and the timing of energy provision is a critical issue, associated with the clinical outcome. These results questioned the clinical relevance of the recent guidelines issued by American, Canadian and European academic societies. Four recent prospective randomized studies enrolled critically ill patients who received various nutritional regimens and tested the effect of nutritional support on outcome. The Tight Calorie balance Control Study (TICACOS) targeted on calorie administration according to measured energy expenditure and found increased ICU morbidity but improved hospital mortality. The large EpaNIC study compared 'early' with 'late' (parenteral nutrition) nutrition, mostly in patients after cardiac surgery, and found an increased morbidity associated with early parenteral nutrition. The supplemental parenteral nutrition (SPN) study randomized the patients after 3 days and targeted the calories administered by parenteral nutrition as a complement to unsuccessful enteral nutrition using indirect calorimetry. The SPN resulted in less nosocomial infections and shorter duration of mechanical ventilation. Finally, a recent Australian study enrolled patients unable to be early fed enterally to receive, or not, parenteral nutrition targeted at 1500 kcal. No complications were noted in the parenteral nutrition group. Lessons from all these studies are summarized and should help in designing better studies and guidelines. The critical analysis of recent prospective studies comparing various levels of calorie administration, enteral versus parenteral nutrition and enteral versus SPN confirms the recommendations to avoid underfeeding and overfeeding. Parenteral nutrition, required if enteral feeding is failing, and if adjusted up to a measured optimal level, may improve outcome. More studies on the optimal level of energy and protein administration to

Nutrition and Imagenology

International Nuclear Information System (INIS)

Rodriguez Allende, Miguel Angel

2003-01-01

In this article we present the close, although little explored, relationship between Nutrition and Imagenology, relying mainly on an important number of images which will allow us to explain all the ways an Imagenology can influence upon the nutritional support of a patient.We primarily emphasize the diagnostic aspects of non-operated patients, as well as of those who have undergone surgical treatment, by showing both normality and the resulting surgical complications. We finally describe several interventionist Imagenology techniques used to achieve an adequate enteral nutrition

Severe Hypothyroidism From Iodine Deficiency Associated With Parenteral Nutrition.

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Golekoh, Marjorie C; Cole, Conrad R; Jones, Nana-Hawa Yayah

2016-11-01

Parenteral nutrition is crucial for supply of nutrients in children who cannot tolerate a full enteral diet. In the United States, it is not standard of care to give iodine to children dependent on parenteral nutrition, hence iodine is not routinely included in the micronutrient package. Herein, we present a case of a boy with hypothyroidism secondary to iodine deficiency after prolonged exclusive use of parenteral nutrition. Our case highlights the importance of screening for iodine deficiency and administering timely iodine supplementation in these at-risk children to prevent iatrogenic hypothyroidism. © 2015 American Society for Parenteral and Enteral Nutrition.

Brief Parenteral Nutrition Accelerates Weight Gain, Head Growth Even in Healthy VLBWs

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Morisaki, Naho; Belfort, Mandy B.; McCormick, Marie C.; Mori, Rintaro; Noma, Hisashi; Kusuda, Satoshi; Fujimura, Masanori

2014-01-01

Introduction Whether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate. Methods We studied 4005 hospitalized VLBW, very preterm (23–32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003–2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates. Discussion Even in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants. PMID:24586323

Positive emotion, appraisal, and the role of appraisal overlap in positive emotion co-occurrence.

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Tong, Eddie M W; Jia, Lile

2017-02-01

Appraisal research has traditionally focused on negative emotions but has not addressed issues concerning the relationships between several positive emotions and appraisals in daily life and the extent to which co-occurrence of positive emotions can be explained by overlap in appraisals. Driven by a priori hypotheses on appraisal-emotion relationships, this study investigated 12 positive emotions and 13 appraisal dimensions using Ecological Momentary Assessment. The results provide strong evidence that positive emotions and appraisals correlate significantly in daily life. Importantly, we found that the positive emotions' overlap on theoretically relevant, as compared to irrelevant, appraisals was stronger and more predictive of their co-occurrence. Furthermore, appraisal overlap on theoretically relevant appraisals predicted the co-occurrence of positive emotions even when the appraisal of pleasantness was excluded, indicating that positive emotions do not co-occur just by virtue of their shared valence. Our findings affirmed and refined the appraisal profiles of positive emotions and underscore the importance of appraisals in accounting for the commonality and differences among positive emotions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Nutrition in Patients with Gastric Cancer: An Update.

Science.gov (United States)

Rosania, Rosa; Chiapponi, Costanza; Malfertheiner, Peter; Venerito, Marino

2016-05-01

Nutritional management of patients with gastric cancer (GC) represents a challenge. This review provides an overview of the present evidence on nutritional support in patients with GC undergoing surgery as well as in those with advanced disease. For patients undergoing surgery, the preoperative nutritional condition directly affects postoperative prognosis, overall survival and disease-specific survival. Perioperative nutritional support enriched with immune-stimulating nutrients reduces overall complications and hospital stay but not mortality after major elective gastrointestinal surgery. Early enteral nutrition after surgery improves early and long-term postoperative nutritional status and reduces the length of hospitalization as well. Vitamin B12 and iron deficiency are common metabolic sequelae after gastrectomy and warrant appropriate replacement. In malnourished patients with advanced GC, short-term home complementary parenteral nutrition improves the quality of life, nutritional status and functional status. Total home parenteral nutrition represents the only modality of caloric intake for patients with advanced GC who are unable to take oral or enteral nutrition. Early evaluations of nutritional status and nutritional support represent key aspects in the management of GC patients with both operable and advanced disease.

Estudo comparativo da adequação das prescrições e ofertas protéicas a pacientes em uso de terapia nutricional enteral = Comparative study on the adequacy of protein prescription and supply to patients undergoing enteral nutritional therapy

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Vanessa Taís Nozaki

2008-07-01

Full Text Available O objetivo desse estudo foi de avaliar as prescrições e ofertas protéicas a pacientes em uso de terapia nutricional enteral em dois hospitais da região metropolitana de Maringá, Estado do Paraná. Como metodologia utilizou-se os valores prescritos e o consumo de proteínas pelos pacientes foram obtidos dos prontuários médicos e comparados com as recomendações de consumo diário de proteínas por quilo de peso corporal para cada patologia. Os principais resultados dessa pesquisa foram que apenas 11,43% das dietas prescritas no Hospital A e 22,22% das dietas prescritas no Hospital B estavam corretas com relação à quantidade recomendada de proteínas. Nos dois hospitais, apenas 11% dos pacientes ingeriram a quantidade diária recomendada de proteínas. Pode-se concluir que a terapia nutricional enteral inadequada foi encontrado nos dois hospitais. Este estudodemonstrou a necessidade de melhoras nos serviços de nutrição enteral. Isto pode ser conseguido adotando-se procedimentos de padronização e avaliação regulares dos pacientes.The aim of this study was to evaluate protein prescription and supply to patients undergoing enteral nutritional therapy at two general hospitals in Maringá, Paraná State, Brazil. How methodology used isthe prescribed protein values and protein intake of each patient were obtained from medical records, and compared with the recommended daily protein intake per kilogram of body weight for each pathology. The main results of this survey were that only 11.43% of theprescribed diets in Hospital A and 22.22% of the prescribed diets in Hospital B were correct with respect to recommended protein amounts. In both hospitals, only 11% of all patients ingested the daily recommended amount of protein. It was concluded inadequate enteralnutritional therapy was found in both hospitals. The study demonstrates a need for improvement in enteral nutrition practices. This can be accomplished through the adoption of

The effects of implementing a nutritional support algorithm in critically ill medical patients.

Science.gov (United States)

Sungur, Gonul; Sahin, Habibe; Tasci, Sultan

2015-08-01

To determine the effect of the enteral nutrition algorithm on nutritional support in critically ill medical patients. The quasi-experimental study was conducted at a medical Intensive Care Unit of a university hospital in central Anatolia region in Turkey from June to December 2008. The patients were divided into two equal groups: the historical group was fed in routine clinical applications, while the study group was fed according to the enteral nutritional algorithm. Prior to collecting data, nurses were trained interactively about enteral nutrition and the nutritional support algorithm. The nutrition of the study group was directed by the nurses. Data were recorded during 3 days of care. SPSS 22 was used for statistical analysis. The 40 patients in the study were divided into two equal groups of 20(50%) each. The energy intake of study group was 62% of the prescribed energy requirement on the 1st, 68.5% on the 2nd and 63% on the 3rd day, whereas in the historical group 38%, 56.5% and 60% of the prescribed energy requirement were met. The consumed energy of the historical group on the 1st 2nd and 3rd day was significantly different (p=0.020). In the study group, serum total protein and albumin levels decreased significantly (pgroup, any of the serum parameters did not change. Enteral nutrition-induced complications, duration of stay in intensive care unit were not significantly different between the groups (p>0.05). The use of standard algorithms for enteral nutrition may be an effective way to meet the nutritional requirements of patients.

[A 5-year interval report on study of burn metabolism and nutrition].

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Wang, S L

1992-12-01

This paper introduces the essential experiences concerning studies of burn metabolism and nutrition in our institute in the past five years. 1. Three new and practical animal models were developed for studying gastro-enteral nutrition in burns. 2. With indirect calorimetry, resting energy expenditure (REE) of 92 burn adult patients were measured and analyzed, and on the basis of which a new formula for calculating nutritional supplement in Chinese burn adults was proposed: kcal/day = 1,000 x M2 (body surface area) + 25 x % TBSA (total burn surface area). 3. Through experimental and clinical studies, it was found that antiouperoxide agents (such as SOD, CAT), tolbutamide, glutamine and Chinese herb decoction Sizunzituang all exhibited modulating effects on postburn metabolism and nutrition, e.g. decreasing catabolism, reducing negative nitrogen balance, stimulating secretion of insulin, enhancing tissue utilization of glucose, maintaining the mass of enteral mucosa and improving functions of viscerae. 4. A new less irritating, simple and easy-to-introduce nasal-enteral nutrition tube was devised, which could pass through the pylorus easily into the duodenum usually within 6hrs without using a stylet. It would be useful in the early postburn enteral nutrition supplementation.

Sobrevida e complicações em idosos com doenças neurológicas em nutrição enteral Occurrence of complications and survival rates in elderly with neurological disorders undergoing enteral nutrition therapy

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Aline Stangherlin Martins

2012-12-01

Full Text Available OBJETIVO: Avaliar a sobrevida e complicações de pacientes idosos com doenças neurológicas em uso de nutrição enteral (NE. MÉTODOS: Avaliaram-se pacientes acima de 60 anos acompanhados pelo serviço de atenção domiciliar de um plano de saúde de Belo Horizonte, MG, Brasil. A avaliação ocorreu no domicílio após a alta hospitalar com NE, após três e seis meses e ao término do estudo. Foram realizadas avaliação nutricional, coleta de dados em prontuários e entrevistas com familiares ou cuidadores. RESULTADOS: Foram avaliados 79 pacientes, idade 82,9 ± 10,4 anos, 49,4% com demência e 50,6% com outros diagnósticos neurológicos, 100% com elevado grau de dependência avaliada pelo índice de Katz. A maioria dos pacientes (91,2% apresentou complicações (pneumonia, perda da sonda, diarreia, constipação, vômito, extravasamento periostomia, obstrução da sonda, refluxo e miíase. Pneumonia foi a mais frequente, ocorrendo em 55,9%. A mortalidade foi de 15,2% aos três meses, 22,8% aos 6 meses e 43% ao término do estudo. A mediana de sobrevida após iniciada a NE foi de 364 dias. Não se observaram diferenças entre mortalidade e diagnóstico neurológico, vias de acesso de NE e complicações. A sobrevida foi menor em pacientes com estado nutricional inadequado e albumina OBJECTIVE: To evaluate the occurrence of complications, as well as the survival rates, in elderly people having neurological diseases and undergoing enteral nutrition therapy (ENT. METHODS: Patients aged over 60 years, assisted by a home medical service from a healthcare plan in the city of Belo Horizonte, MG, Brazil, were thoroughly evaluated. The mentioned evaluation occurred at their homes after hospital discharge with enteral nutrition (EN after a three-month period, a six-month period, and at the end of the study. A nutritional assessment was performed along with data collection performed on the patients' electronic medical records, and interviews

Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials.

Science.gov (United States)

Koretz, Ronald L; Avenell, Alison; Lipman, Timothy O; Braunschweig, Carol L; Milne, Anne C

2007-02-01

Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. The objective was to assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available RCTs. We conducted a systematic review. RCTs comparing EN or VNS with untreated controls, or comparing EN with PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least three RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B, respectively, indicated the presence of strong or weak (low-quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. RCTs could include either hospitalized or nonhospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. The RCT had to compare recipients of either EN or VNS with controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. These were mortality, morbidity (disease specific), duration of hospitalization, cost, or interventional complications. SUMMARY OF GRADING: A: No indication was identified. B: EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low-quality trials found a significant difference in

Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go.

Science.gov (United States)

Yang, Min; Chen, Pei-Yu; Gong, Si-Tang; Lyman, Beth; Geng, Lan-Lan; Liu, Li-Ying; Liang, Cui-Ping; Xu, Zhao-Hui; Li, Hui-Wen; Fang, Tie-Fu; Li, Ding-You

2014-11-01

A standard nutrition screening and enteral nutrition (EN) protocol was implemented in January 2012 in a tertiary children's center in China. The aims of the present study were to evaluate the cost-effectiveness of a standard EN protocol in hospitalized patients. A retrospective chart review was performed in the gastroenterology inpatient unit. We included all inpatient children requiring EN from January 1, 2010, to December 31, 2013, with common gastrointestinal (GI) diseases. Children from January 1, 2012, to December 31, 2013, served as the standard EN treatment group, and those from January 1, 2010, to December 31, 2011, were the control EN group. Pertinent patient information was collected. We also analyzed the length of hospital stay, cost of care, and in-hospital infection rates. The standard EN treatment group received more nasojejunal tube feedings. There was a tendency for the standard EN treatment group to receive more elemental and hydrolyzed protein formulas. Implementation of a standard EN protocol significantly reduced the time to initiate EN (32.38 ± 24.50 hours vs 18.76 ± 13.53 hours; P = .011) and the time to reach a targeted calorie goal (7.42 ± 3.98 days vs 5.06 ± 3.55 days; P = .023); length of hospital stay was shortened by 3.2 days after implementation of the standard EN protocol but did not reach statistical significance. However, the shortened length of hospital stay contributed to a significant reduction in the total cost of hospital care (13,164.12 ± 6722.95 Chinese yuan [CNY] vs 9814.96 ± 4592.91 CNY; P common GI diseases. © 2014 American Society for Parenteral and Enteral Nutrition.

Intensive medicine - Guidelines on Parenteral Nutrition, Chapter 14.

Science.gov (United States)

Kreymann, G; Adolph, M; Druml, W; Jauch, K W

2009-11-18

In intensive care patients parenteral nutrition (PN) should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of <5 days, do not require full PN but should be given at least a basal supply of glucose. Critically ill patients should be nourished parenterally from the beginning of intensive care if they are unlikely to be adequately nourished orally or enterally even after 5-7 days. Critically ill and malnourished patients should, in addition to a possible partial enteral nutrition, be nourished parenterally. Energy supply should not be constant, but should be adapted to the stage, the disease has reached. Hyperalimentation should be avoided at an acute stage of disease in any case. Critically ill patients should be given, as PN, a mixture consisting of amino acids (between 0.8 and 1.5 g/kg/day), carbohydrates (around 60% of the non-protein energy) and fat (around 40% of the non-protein energy) as well as electrolytes and micronutrients.

Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake.

Science.gov (United States)

Sabatino, Alice; Regolisti, Giuseppe; Gandolfini, Ilaria; Delsante, Marco; Fani, Filippo; Gregorini, Maria Cristina; Fiaccadori, Enrico

2017-12-01

The clinical data available on dietary requirements of patients with chronic kidney disease (CKD) not on dialysis are limited and largely inconclusive in terms of the renal, cardiovascular and nutritional outcomes achievable through dietary modifications. Restriction of protein intake during the early stages of CKD may in fact slow its progression, but at the same time this approach may also lead to protein-energy wasting, if energy intake is not adequate and properly monitored. Unfortunately, compliance to dietary recommendations is traditionally low in this patient population. A switch from saturated to mono- and polyunsaturated fats is generally recognized as advantageous for cardiac health; however, the benefits in term of renal function are largely unknown. Similarly, the association between dietary fiber intake and kidney disease is largely unknown. In fact, while there is evidence on the positive health effects of dietary fibers in the general population, nutritional guidelines for CKD lack formal recommendations concerning fiber intake. This paper reviews data and evidence from clinical trials and meta-analyses on renal and cardiovascular outcomes related to modifications in protein, fat and fiber intake. Suggestions for maintaining nutritional status through patient-oriented dietary patterns and enteral supplementation in CKD patients on conservative therapy are also presented.

The spectrum of radiation enteritis: surgical considerations

International Nuclear Information System (INIS)

Haddad, G.K.; Grodsinsky, C.; Allen, H.

1983-01-01

Radiation therapy, often used to treat gynecologic and urologic pelvic malignancies, has varying, adverse effects on the bowel. Radiation enteritis may occur from one month to 20 years after irradiation, and disabling symptoms may require surgery in 10 to 20 per cent of patients. From our experience with 20 patients who required surgery for radiation enteritis and who were followed for up to 20 years, we were able to identify three clinical groups. Patients in the first group need only medical treatment for their symptoms, and observation, whereas patients in the second group may present with acute, debilitating, life-threatening symptoms that may require emergency surgery. Patients in the third group have a long-standing history of intermittent bowel obstruction and/or enteric fistulas that are best treated with adequate nutritional support followed by timely surgical intervention

An evaluation of the Cortrak Enteral access system in our intensive care.

LENUS (Irish Health Repository)

Dolan, A M

2012-05-01

Appropriate nutrition is considered a cornerstone of Intensive care; however its successful initiation is frequently impeded by decreased gastric emptying secondary to opiates, sepsis, or ileus. The presence of a postpyloric tube will guarantee delivery of calories while reducing the incidence of reflux and aspiration. Enteral nutrition is approximately 100 fold cheaper than parenteral nutrition. A nasojejunal tube may be placed blindly (success 15%), by direct vision with a gastroscope, or under fluoroscopic guidance in the X-ray department. This study examines the use of the Cortrak Enteral access system (CEAS) in placement of nasojejunal tubes, a method facilitated by the use of an electromagnet. A retrospective review was conducted to evaluate the effectiveness of the CEAS for establishing nasojejunal feeding in the Intensive Care Unit (ICU) between January and December 2010. Our results found that the CEAS was successful in positioning a nasojejunal tube in ten out of twelve patients (83% success rate). Successful placement was confirmed by portable abdominal \\/ chest x-ray. Placement took an average of 30 minutes, and prokinetic agents were used to facilitate two placements. The duration of successful enteral nutrition varied from 2 to 15 days post placement. The CEAS is a simple bedside tool for placing postpyloric tubes. While there is a learning curve associated with its use, it may confer significant benefits to individual patients and also to those responsible for ever shrinking budgets.

Protocol for Appraisal of Petroleum Producing Properties on Native American Tribal Lands

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-04-27

Petroleum is currently produced on Native American Tribal Lands and has been produced on some of these lands for approximately 100 years. As these properties are abandoned at a production level that is considered the economic limit by the operator, Native American Tribes are considering this an opportunity to assume operator status to keep the properties producing. In addition to operating properties as they are abandoned, Native American Tribes also are assuming liabilities of the former operator(s) and ownership of equipment left upon abandonment. Often, operators are assumed by Native American Tribes without consideration of the liabilities left by the former operators. The purpose of this report is to provide protocols for the appraisal of petroleum producing properties and analysis of the petroleum resource to be produced after assuming operations. The appraisal protocols provide a spreadsheet for analysis of the producing property and a checklist of items to bring along before entering the property for onsite appraisal of the property. The report will provide examples of some environmental flags that may indicate potential liabilities remaining on the property left unaddressed by previous operators. It provides a starting point for appraisal and analysis of a property with a basis to make the decision to assume operations or to pursue remediation and/or closure of the liabilities of previous operators.

Introducing enteral feeding induces intestinal subclinical inflammation and respective chromatin changes in preterm pigs

DEFF Research Database (Denmark)

Willems, Rhea; Krych, Lukasz; Rybicki, Verena

2015-01-01

AIM: To analyze how enteral food introduction affects intestinal gene regulation and chromatin structure in preterm pigs. MATERIALS & METHODS: Preterm pigs were fed parenteral nutrition plus/minus slowly increasing volumes of enteral nutrition. Intestinal gene-expression and chromatin structure......; no significant differences for colostrum) with corresponding decondensed chromatin configurations. On histology this correlated with mild mucosal lesions, particularly in formula-fed pigs. In CaCo-2 cells, histone hyperacetylation led to a marked increase in TLR4 mRNA and increased IL8 expression upon...... stimulation with lipopolysaccharide (median: 7.0; interquartile range: 5.63-8.85) compared with naive cells (median 4.2; interquartile range: 2.45-6.33; p = 0.03). CONCLUSION: Enteral feeding, particular with formula, induces subclinical inflammation in the premature intestine and more open chromatin...

Impact of enteral supplements enriched with omega-3 fatty acids and/or omega-6 fatty acids, arginine and ribonucleic acid compounds on leptin levels and nutritional status in active Crohn's disease treated with prednisolone

DEFF Research Database (Denmark)

Nielsen, Aneta Aleksandra; Nielsen, Jens Nederby; Grønbaek, Henning

2007-01-01

BACKGROUND: Patients with Crohn's disease (CD) often develop malnutrition due to disease activity. We aimed to assess the effect of two different enteral supplements of Impact(R) Powder (IP; Novartis, Switzerland) on leptin levels and nutritional status in active CD patients during prednisolone...... treatment and tapering. METHODS: Thirty-one CD patients were randomized to IP Extra (group 1) or IP Standard (group 2). Leptin levels, nutritional, clinical and biochemical markers were studied at inclusion, after 5 and after 9 weeks of the study. RESULTS: Leptin levels, body mass index (BMI) and total...... to improve nutritional status in CD patients....

12 CFR 564.5 - Appraiser independence.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraiser independence. 564.5 Section 564.5 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.5 Appraiser independence. (a) Staff appraisers. If an appraisal is prepared by a staff appraiser, that appraiser must be...

Impacto da adequação da oferta energética sobre a mortalidade em pacientes de UTI recebendo nutrição enteral Impact of the adequacy of energy intake on intensive care unit mortality in patients receiving enteral nutrition

Directory of Open Access Journals (Sweden)

Natália Sanchez Oliveira

2011-06-01

.OBJECTIVE: To investigate the relationship between adequacy of energy intake and intensive care unit mortality in patients receiving exclusive enteral nutrition therapy. METHODS: Observational and prospective study conducted during 2008 and 2009. Patients above 18 years with exclusive enteral nutrition therapy for at least 72 hours were included. The adequacy of energy intake was estimated by the administered/prescribed ratio. Non-conditional logistic regression was used to assess the relationship between predictive variables (adequacy of energy intake, APACHE II, gender, age, and intensive care unit length of stay and intensive care unit mortality. RESULTS: Sixty-three patients (mean 58 years, 27% mortality were included, 47.6% of whom received more than 90% of the energy prescribed (mean adequacy 88.2%. Mean energy balance was -190 kcal/day. Significant associations between death in the intensive care unit and the variables age and intensive care unit length of stay were observed, after removing the variables adequacy of energy intake, APACHE II, gender and age during the modeling process. CONCLUSION: In our study, adequacy of energy intake did not affect intensive care unit mortality. Carefully followed enteral nutrition protocols, resulting in an administered/prescribed ratio above 70%, are apparently not sufficient to impact the mortality rates in the intensive care unit. Therefore, it may not be necessary to achieve 100% of the targeted energy, considering the high frequency of enteral feeding interruptions due to gastrointestinal intolerance and fasting for tests and procedures. Additional research is needed to identify the optimal energy intake for improved outcomes and reduced costs.

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

Science.gov (United States)

Mogre, Victor; Scherpbier, Albert J J A; Stevens, Fred; Aryee, Paul; Cherry, Mary Gemma; Dornan, Tim

2016-01-01

Objective To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve

Influence of enteric bacteria and parasite infection and nutritional ...

African Journals Online (AJOL)

While nutritional, microbiological and immunological factors have been implicated in childhood diarrhoea in many countries, there is limited aetiological information in Morogoro Region of Tanzania. A case-control study was conducted to establish whether diarrhoea in 6-60 months old children admitted at a Regional ...

Treatment of radiation enteritis: a comparison study

International Nuclear Information System (INIS)

Loiudice, T.A.; Lang, J.A.

1983-01-01

Twenty-four patients with severe radiation injury to the small bowel seen over a 4-year period were randomized to four treatment groups: 1) methylprednisolone 80 mg intravenously plus Vivonex-HN, 2 L/day po, 2) methylprednisolone 80 mg intravenously plus total parenteral nutrition, 2.5 L/day, 3) total parenteral nutrition, 2.5 L/day, and 4) Vivonex-HN, 2 L/day po. Patients received nothing by mouth except water in groups II and III, and only Vivonex-HN in groups I and IV. Patients were treated for 8-wk periods. Improvement was gauged by overall nutritional assessment measurements, nitrogen balance data and by radiological and clinical parameters. No significant difference between groups I, II, III, and IV could be found for age, sex, mean radiation dosage, time of onset after radiation therapy, or initial nutritional assessment data. Differences statistically could be found between groups II and III and I and IV regarding nutritional assessment data, nitrogen balance, radiographic and clinical parameters after therapy, with marked improvement noted in groups II and III. We conclude that a treatment regimen consisting of total parenteral nutrition and bowel rest is beneficial in the treatment of radiation enteritis. Methylprednisolone appears to enhance this effect and indeed, may be responsible for a longer lasting response

Test Takers' Performance Appraisals, Appraisal Calibration, and Cognitive and Metacognitive Strategy Use

Science.gov (United States)

Phakiti, Aek

2016-01-01

The current study explores the nature and relationships among test takers' performance appraisals, appraisal calibration, and reported cognitive and metacognitive strategy use in a language test situation. Performance appraisals are executive processes of strategic competence for judging test performance (e.g., evaluating the correctness or…

La nutrición enteral precoz en el enfermo grave Early enteral nutrition in the critically-ill patient

OpenAIRE

B. García Vila; T. Grau

2005-01-01

La nutrición enteral se ha demostrado como un método eficaz y seguro de nutrir a los enfermos graves ingresados en una Unidad de Cuidados Intensivos. Aunque se desconoce cuánto tiempo puede estar un enfermo grave sin nutrición, el catabolismo acelerado y el ayuno pueden ser deletéreos en el enfermo grave y la recomendación más frecuente es la de empezar la nutrición artificial cuando se prevea un período de ayuno superior a los siete días. Las ventajas de la nutrición enteral sobre la nutrici...

Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding: The ASPEN Model.

Science.gov (United States)

Boullata, Joseph I; Holcombe, Beverly; Sacks, Gordon; Gervasio, Jane; Adams, Stephen C; Christensen, Michael; Durfee, Sharon; Ayers, Phil; Marshall, Neil; Guenter, Peggi

2016-08-01

Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN. An American Society for Parenteral and Enteral Nutrition (ASPEN) standardized model for PN order review and PN preparation competencies is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines, and is intended for institutions and agencies to use with their staff. © 2016 American Society for Parenteral and Enteral Nutrition.

12 CFR 564.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraisals required; transactions requiring a State certified or licensed appraiser. 564.3 Section 564.3 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.3 Appraisals required; transactions requiring a State...

Home parenteral nutrition in management of patients with severe radiation enteritis

International Nuclear Information System (INIS)

Lavery, I.C.; Steiger, E.; Fazio, V.W.

1980-01-01

Five patients who would have been unable to survive because of intestinal complications of radiation therapy were able to lead an otherwise normal life with the use of parenteral nutrition administered at home. One patient died of recurrent carcinoma of the cervix after 14 months. Another patient died as the result of a totally avoidable pharmaceutical error after 2 1/2 years. The remaining three are still disease free without morbidity relating to the parenteral nutrition

A transatlantic survey of nutrition practice in acute pancreatitis.

LENUS (Irish Health Repository)

Duggan, SN

2012-08-01

Many guidelines exist for the nutritional management of acute pancreatitis; however, little is known regarding current practice. We aimed to investigate feeding practices, including the use of parenteral\\/enteral nutrition.

Intensive medicine – Guidelines on Parenteral Nutrition, Chapter 14

Directory of Open Access Journals (Sweden)

Kreymann, G.

2009-11-01

Full Text Available In intensive care patients parenteral nutrition (PN should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of <5 days, do not require full PN but should be given at least a basal supply of glucose. Critically ill patients should be nourished parenterally from the beginning of intensive care if they are unlikely to be adequately nourished orally or enterally even after 5–7 days. Critically ill and malnourished patients should, in addition to a possible partial enteral nutrition, be nourished parenterally. Energy supply should not be constant, but should be adapted to the stage, the disease has reached. Hyperalimentation should be avoided at an acute stage of disease in any case. Critically ill patients should be given, as PN, a mixture consisting of amino acids (between 0.8 and 1.5 g/kg/day, carbohydrates (around 60% of the non-protein energy and fat (around 40% of the non-protein energy as well as electrolytes and micronutrients.

Appraisal Report

DEFF Research Database (Denmark)

Schleimann, Finn; Enemark, Ulrika; Vagnby, Bo Hellisen

Appraisal of continued support to Ghana's health sector for a third phase covering 2003 - 2007. Funding recommended with DKK 340 million over five years.......Appraisal of continued support to Ghana's health sector for a third phase covering 2003 - 2007. Funding recommended with DKK 340 million over five years....

胃癌术后肠内营养支持对患者人体成分及能量代谢变化的影响%Patients with gastric cancer postoperative enteral nutrition support on body composition and the change of energy metabolism

Institute of Scientific and Technical Information of China (English)

李雪娇; 黄迎春; 彭南海; 刘思彤

2015-01-01

Objective: To investigate the effect of enteral nutrition support on the changes of body element and energy metabolism in patients with gastric cancer after operation.Methods:Prospective selected from 182 cases of postoperative patients with gastric cancer, including 140 patients accept enteral nutrition and related nursing care before discharge and 42 patients who did not receive enteral nutrition support from February 2013 to July 2015. Two groups of patients atfer surgery followed up by the nutritional support of nursing team, and use the human body composition analyzer and indirect energy metabolism instrument measuring body composition, observed and compared patients after accept nutrition support their muscle, body fat, protein, weight, BMI changes. Results:Atfer 3 months of enteral nutrition support, treatment group to check the patients’ weight, BMI, skeletal muscle, protein, body cell mass (BCM), intracellular water (ICW) is significantly higher than before enteral nutrition therapy, patients with edema degree reduced, the difference was statistically significant (P0.05); 140 cases receiving enteral nutrition support after gastric cancer patients with no after nutritional support treatment of 42 cases of postoperative gastric cancer patients compared, its weight, skeletal muscle, protein, around the upper arm (AC), upper arm around fat-free (AMC) significantly less high nutritional support group, the difference was statistically significant (P0.05).Conclusion: Atfer 3 months of enteral nutrition support, postoperative gastric cancer patients of energy metabolism and body composition than before treatment signiifcantly were improved.%目的：了解肠内营养支持治疗对胃癌术后患者人体成份变化及能量代谢的影响。方法：前瞻性选取2013年2月至2015年7月南京军区南京总医院收治的182例胃癌术后患者，其中140例患者于出院前开始对其实施肠内营养及相关护理，42�

Parenteral nutrition in malnourished patients

International Nuclear Information System (INIS)

Lichvarova, I.

2011-01-01

Parenteral nutrition became a routine therapeutic option in malnourished patients, if conventional nutritional enteral support is not effective. Cachexia and malnutrition prolong the wound healing, contribute to immunosuppression, increase morbidity and the cost of treatment. Using of a malnutrition protocol as a screening tool is necessary to sort out malnourished patients. Parenteral nutrition is therefore an important part of the multimodal therapy and from the medical and the ethical point of view is a great mistake not to feed a patient. (author)

Nutritional requirements of the critically ill patient.

Science.gov (United States)

Chan, Daniel L

2004-02-01

The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.

Parenteral and Early Enteral Feeding in Patients with Colonic Tumor

Directory of Open Access Journals (Sweden)

O. A. Malkov

2008-01-01

Full Text Available Objective: to provide evidence whether it is expedient to use an early enteral feeding protocol in patients with colonic malignancies in the postoperative period to prevent and to correct hemodynamic disorders, oxygen imbalance, and malnutrition. Subjects and methods. A hundred patients (61 males and 39 females aged 66.2±5.0 years, who had Stages 2—3 colonic malignancies, were examined. Two algorithms of postoperative management were analyzed using the traditional diet and early enteral feeding. Results. The early enteral feeding protocol improves central hemodynamics and oxygen and nutritional status, prevents moderate protein-energy deficiency in the early postoperative period and reduces the number of complications and fatal outcomes in patients with colonic malignancies. Key words: malignancies, malnutrition, hemo-dynamics, oxygen status, enteral feeding.

Influence of G308A polymorphism of tumor necrosis factor-alpha gene on inflammatory markers in postsurgical head and neck cancer patients with early enteral nutrition.

Science.gov (United States)

de Luis, Daniel Antonio; Sagrado, Manue Gonzalez; Vallejo, Luis Angel; Carcedo, Luis María Gil; Izaola, Olatz; Cuellar, Luis; Terroba, María Concepción; Aller, Rocío

2007-01-01

Although immune dysfunction in patients with cancer could be multifactorial, the immune system may be modulated by nutritional substrates and genetic background. Our study evaluated the effect of G308A polymorphism of the tumor necrosis factor-alpha (TNF-alpha) gene on inflammatory markers in patients after surgery for head and neck cancer who received early enteral nutrition. A population of 60 patients with oral and laryngeal cancer was enrolled. At surgery patients were treated with a hyperproteic enteral diet. Perioperatively and on postoperative day 6 the following parameters were evaluated: serum values of prealbumin, transferrin, total number of lymphocytes, interleukin-6, TNF-alpha, and C-reactive protein. In addition, genotyping of G308A gene polymorphism was assessed. Patients' mean age was 61.1 +/- 14.6 y (four women, 56 men) with a body mass index of 25.4 +/- 5.2 kg/m(2) and a previous weight loss of 0.35 +/- 0.2 kg. Forty patients (37 men, 3 women; 66.6%) had the genotype G308/G308 (wild group) and 20 patients (19 men, 1 woman; 23.4%) had the genotype G308/A308 (mutant group). A significant increase in prealbumin and transferrin levels was detected in both groups. C-reactive protein decreased in both groups (wild group: 105.1 +/- 60 versus 53.8 +/- 62.3 mg/dL, P < 0.05; mutant group: 99.5 +/- 46 versus 43.9 +/- 51.9 mg/dL, P < 0.05). Interleukin-6 decreased in both groups (wild group: 20.1 +/- 22 versus 6.2 +/- 4.1 pg/mL, P < 0.05; mutant group: 22.3 +/- 38 versus 9.2 +/- 7.4 pg/mL, P = NS). Lymphocytes increased in both groups (wild group: 1102 +/- 468 versus 1600 +/- 537 10(3)/mL, P = NS; mutant group: 1441 +/- 739 10(3)/mL versus 1669 +/- 614 10(6)/mL, P = NS). TNF-alpha showed no changes. The G308A polymorphism of the TNF-alpha gene did not affect levels of inflammatory markers in patients after surgery for head and neck cancer who were treated with early enteral nutrition.

Continuous elemental enteral alimentation in children with Crohn's disease and growth failure.

Science.gov (United States)

Morin, C L; Roulet, M; Roy, C C; Weber, A

1980-12-01

Four children aged (11.7-13.5 yr) with protracted growth retardation related to Crohn's disease, received a 6-wk period of continuous elemental enteral alimentation with no other form of treatment. Despite drug therapy the yearly height and weight gain velocities of these children (1.7 +/- 0.3 cm and -0.8 +/- 1.4 kg, respectively) had been abnormal during the previous 2 yr. All patients experienced a complete remission of symptoms, improved nutritional status, and significant height (1.8 +/- 0.3 cm) and weight (3.8 +/- 0.5 kg) gains during the 67 wk of treatment. After cessation of elemental enteral alimentation, 3 of the 4 patients continued to grow, and over a period of 4.5 mo from the beginning of this form of nutritional therapy, they gained an average of 5.0 +/- 1.6 kg and 3.5 +/- 0.3 cm. The disease became active thereafter, and the 3 children resumed their previously abnormal growth patterns during the ensuing year. The 4th patient had surgery 2 mo after elemental enteral alimentation and experienced a subsequent second spurt of growth and pubertal changes. This study suggests that a relatively short course of elemental enteral alimentation leads to a temporary resumption of growth in children with severe growth failure and Crohn's disease. The possibility that repeated courses of elemental enteral alimentation might be beneficial needs to be explored.

Nutrition support in hospitalised adults at nutritional risk.

Science.gov (United States)

Feinberg, Joshua; Nielsen, Emil Eik; Korang, Steven Kwasi; Halberg Engell, Kirstine; Nielsen, Marie Skøtt; Zhang, Kang; Didriksen, Maria; Lund, Lisbeth; Lindahl, Niklas; Hallum, Sara; Liang, Ning; Xiong, Wenjing; Yang, Xuemei; Brunsgaard, Pernille; Garioud, Alexandre; Safi, Sanam; Lindschou, Jane; Kondrup, Jens; Gluud, Christian; Jakobsen, Janus C

2017-05-19

trials accounted for one-third of all included participants. The included participants were heterogenous with regard to disease (20 different medical specialties). The experimental interventions were parenteral nutrition (86 trials); enteral nutrition (tube-feeding) (80 trials); oral nutrition support (55 trials); mixed experimental intervention (12 trials); general nutrition support (9 trials); and fortified food (2 trials). The control interventions were treatment as usual (122 trials); no intervention (107 trials); and placebo (15 trials). In 204/244 trials, the intervention lasted three days or more.We found no evidence of a difference between nutrition support and control for short-term mortality (end of intervention). The absolute risk was 8.3% across the control groups compared with 7.8% (7.1% to 8.5%) in the intervention groups, based on the risk ratio (RR) of 0.94 (95% confidence interval (CI) 0.86 to 1.03, P = 0.16, 21,758 participants, 114 trials, low quality of evidence). We found no evidence of a difference between nutrition support and control for long-term mortality (maximum follow-up). The absolute risk was 13.2% in the control group compared with 12.2% (11.6% to 13%) following nutritional interventions based on a RR of 0.93 (95% CI 0.88 to 0.99, P = 0.03, 23,170 participants, 127 trials, low quality of evidence). Trial Sequential Analysis showed we only had enough information to assess a risk ratio reduction of approximately 10% or more. A risk ratio reduction of 10% or more could be rejected.We found no evidence of a difference between nutrition support and control for short-term serious adverse events. The absolute risk was 9.9% in the control groups versus 9.2% (8.5% to 10%), with nutrition based on the RR of 0.93 (95% CI 0.86 to 1.01, P = 0.07, 22,087 participants, 123 trials, low quality of evidence). At long-term follow-up, the reduction in the risk of serious adverse events was 1.5%, from 15.2% in control groups to 13.8% (12.9% to 14.7%) following

Adult classical homocystinuria requiring parenteral nutrition: Pitfalls and management.

Science.gov (United States)

Tran, Christel; Bonafé, Luisa; Nuoffer, Jean-Marc; Rieger, Julie; Berger, Mette M

2017-07-25

Homocystinuria due to cystathionine beta synthase (CBS) deficiency presents with a wide clinical spectrum. Treatment by the enteral route aims at reducing homocysteine levels by using vitamin B6, possibly methionine-restricted diet, betaine and/or folate and vitamin B 12 supplementation. Currently no nutritional guidelines exist regarding parenteral nutrition (PN) under acute conditions. Exhaustive literature search was performed, in order to identify the relevant studies describing the pathogenesis and nutritional intervention of adult classical homocystinuria requiring PN. Description of an illustrative case of an adult female with CBS deficiency and intestinal perforation, who required total PN due to contraindication to enteral nutrition. Nutritional management of decompensated classical homocystinuria is complex and currently no recommendation exists regarding PN composition. Amino acid profile and monitoring of total homocysteine concentration are the main tools enabling a precise assessment of the severity of metabolic alterations. In case of contraindication to enteral nutrition, compounded PN will be required, as described in this paper, to ensure adequate low amounts of methionine and others essential amino acids and avoid potentially fatal toxic hypermethioninemia. By reviewing the literature and reporting successful nutritional management of a decompensated CBS deficiency using tailored PN with limited methionine intake and n-3 PUFA addition, we would like to underscore the fact that standard PN solutions are not adapted for CBS deficient critical ill patients: new solutions are required. High methionine levels (>800 μmol/L) being potentially neurotoxic, there is an urgent need to improve our knowledge of acute nutritional therapy. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study.

Science.gov (United States)

Terzi, Nicolas; Darmon, Michael; Reignier, Jean; Ruckly, Stéphane; Garrouste-Orgeas, Maïté; Lautrette, Alexandre; Azoulay, Elie; Mourvillier, Bruno; Argaud, Laurent; Papazian, Laurent; Gainnier, Marc; Goldgran-Toledano, Dan; Jamali, Samir; Dumenil, Anne-Sylvie; Schwebel, Carole; Timsit, Jean-François

2017-11-29

Patients starting noninvasive ventilation (NIV) to treat acute respiratory failure are often unable to eat and therefore remain in the fasting state or receive nutritional support. Maintaining a good nutritional status has been reported to improve patient outcomes. In the present study, our primary objective was to describe the nutritional management of patients starting first-line NIV, and our secondary objectives were to assess potential associations between nutritional management and outcomes. Observational retrospective cohort study of a prospective database fed by 20 French intensive care units. Adult medical patients receiving NIV for more than 2 consecutive days were included and divided into four groups on the basis of nutritional support received during the first 2 days of NIV: no nutrition, enteral nutrition, parenteral nutrition only, and oral nutrition only. Of the 16,594 patients admitted during the study period, 1075 met the inclusion criteria; of these, 622 (57.9%) received no nutrition, 28 (2.6%) received enteral nutrition, 74 (6.9%) received parenteral nutrition only, and 351 (32.7%) received oral nutrition only. After adjustment for confounders, enteral nutrition (vs. no nutrition) was associated with higher 28-day mortality (adjusted HR, 2.3; 95% CI, 1.2-4.4) and invasive mechanical ventilation needs (adjusted HR, 2.1; 95% CI, 1.1-4.2), as well as with fewer ventilator-free days by day 28 (adjusted relative risk, 0.7; 95% CI, 0.5-0.9). Nearly three-fifths of patients receiving NIV fasted for the first 2 days. Lack of feeding or underfeeding was not associated with mortality. The optimal route of nutrition for these patients needs to be investigated.

A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study.

Science.gov (United States)

Bowrey, David J; Baker, Melanie; Halliday, Vanessa; Thomas, Anne L; Pulikottil-Jacob, Ruth; Smith, Karen; Morris, Tom; Ring, Arne

2015-11-21

Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients. The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre randomised controlled trial to evaluate routine home enteral nutrition in these patients. Patients undergoing oesophagectomy or total gastrectomy were randomised to either six weeks of home feeding through a jejunostomy (intervention), or treatment as usual (control). Intervention comprised overnight feeding, providing 50 % of energy and protein requirements, in addition to usual oral intake. Primary outcome measures were recruitment and retention rates at six weeks and six months. Nutritional intake, nutritional parameters, quality of life and healthcare costs were also collected. Interviews were conducted with a sample of participants, to ascertain patient and carer experiences. Fifty-four of 112 (48 %) eligible patients participated in the study over the 20 months. Study retention at six weeks was 41/54 patients (76 %) and at six months was 36/54 (67 %). At six weeks, participants in the control group had lost on average 3.9 kg more than participants in the intervention group (95 % confidence interval [CI] 1.6 to 6.2). These differences remained evident at three months (mean difference 2.5 kg, 95 % CI -0.5 to 5.6) and at six months (mean difference 2.5 kg, 95 % CI -1.2 to 6.1). The mean values observed in the intervention group for mid arm circumference, mid arm muscle circumference, triceps skin fold thickness and right hand grip strength were greater than for the control group at all post hospital discharge time points. The economic evaluation suggested that it was feasible to collect resource use and EQ-5D data for a full cost-effectiveness analysis. Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial: 1) a positive experience, 2) the reasons for taking

Parenteral Nutrition Basics for the Clinician Caring for the Adult Patient.

Science.gov (United States)

Derenski, Karrie; Catlin, Jennifer; Allen, Livia

2016-10-01

Parenteral nutrition (PN) is a life-sustaining therapy providing nutrients to individuals with impaired intestinal tract function and enteral access challenges. It is one of the most complex prescriptions written routinely in the hospital and home care settings. This article is to aid the nutrition support clinician in the safe provision of PN, including selecting appropriate patients for PN, vascular access, development of a PN admixture, appropriate therapy monitoring, recognition of preparation options, and awareness of preparation and stability concerns. © 2016 American Society for Parenteral and Enteral Nutrition.

Gastroenterology – Guidelines on Parenteral Nutrition, Chapter 15

Directory of Open Access Journals (Sweden)

Schulz, R. J.

2009-11-01

Full Text Available In patients with Crohn's disease and ulcerative colitis parenteral nutrition (PN is indicated when enteral nutrition is not possible or should be avoided for medical reasons. In Crohn's patients PN is indicated when there are signs/symptoms of ileus or subileus in the small intestine, scars or intestinal fistulae. PN requires no specific compounding for chronic inflammatory bowel diseases. In both diseases it should be composed of 55–60% carbohydrates, 25–30% lipids and 10–15% amino acids. PN helps in the correction of malnutrition, particularly the intake of energy, minerals, trace elements, deficiency of calcium, vitamin D, folic acid, vitamin B12, and zinc. Enteral nutrition is clearly superior to PN in severe, acute pancreatitis. An intolerance to enteral nutrition results in an indication for total PN in complications such as pseudocysts, intestinal and pancreatic fistulae, and pancreatic abscesses or pancreatic ascites. If enteral nutrition is not possible, PN is recommended, at the earliest, 5 days after admission to the hospital. TPN should not be routinely administered in mild acute pancreatitis or nil by moth status <7 days, due to high costs and an increased risk of infection. The energy requirements are between 25 and 35 kcal/kg body weight/day. A standard solution including lipids (monitoring triglyceride levels! can be administered in acute pancreatitis. Glucose (max. 4–5 g/kg body weight/day and amino acids (about 1.2–1.5 g/kg body weight/day should be administered and the additional enrichment of TPN with glutamine should be considered in severe, progressive forms of pancreatitis.

Nutritional support for liver disease.

Science.gov (United States)

Koretz, Ronald L; Avenell, Alison; Lipman, Timothy O

2012-05-16

Weight loss and muscle wasting are commonly found in patients with end-stage liver disease. Since there is an association between malnutrition and poor clinical outcome, such patients (or those at risk of becoming malnourished) are often given parenteral nutrition, enteral nutrition, or oral nutritional supplements. These interventions have costs and adverse effects, so it is important to prove that their use results in improved morbidity or mortality, or both. To assess the beneficial and harmful effects of parenteral nutrition, enteral nutrition, and oral nutritional supplements on the mortality and morbidity of patients with underlying liver disease. The following computerised databases were searched: the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, and Science Citation Index Expanded (January 2012). In addition, reference lists of identified trials and review articles and Clinicaltrials.gov were searched. Trials identified in a previous systematic handsearch of Index Medicus were also considered. Handsearches of a number of medical journals, including abstracts from annual meetings, were done. Experts in the field and manufacturers of nutrient formulations were contacted for potential references. Randomised clinical trials (parallel or cross-over design) comparing groups of patients with any underlying liver disease who received, or did not receive, enteral or parenteral nutrition or oral nutritional supplements were identified without restriction on date, language, or publication status. Six categories of trials were separately considered: medical or surgical patients receiving parenteral nutrition, enteral nutrition, or supplements. The following data were sought in each report: date of publication; geographical location; inclusion and exclusion criteria; the type of nutritional support and constitution of the nutrient formulation; duration of

Parenteral nutrition in the elderly cancer patient.

Science.gov (United States)

Orrevall, Ylva

2015-04-01

Parenteral nutrition may be considered when oral intake and/or enteral nutrition are not sufficient to maintain nutritional status and the patient is likely to die sooner from starvation than from the cancer. A detailed assessment should be made prior to the decision about whether parenteral nutrition should be started. A follow up plan should be documented with objective and patient centred treatment goals as well as specific time points for evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

Setting priorities for research in medical nutrition education: an international approach.

Science.gov (United States)

Ball, Lauren; Barnes, Katelyn; Laur, Celia; Crowley, Jennifer; Ray, Sumantra

2016-12-14

To identify the research priorities for medical nutrition education worldwide. A 5-step stakeholder engagement process based on methodological guidelines for identifying research priorities in health. 277 individuals were identified as representatives for 30 different stakeholder organisations across 86 countries. The stakeholder organisations represented the views of medical educators, medical students, doctors, patients and researchers in medical education. Each stakeholder representative was asked to provide up to three research questions that should be deemed as a priority for medical nutrition education. Research questions were critically appraised for answerability, sustainability, effectiveness, potential for translation and potential to impact on disease burden. A blinded scoring system was used to rank the appraised questions, with higher scores indicating higher priority (range of scores possible 36-108). 37 submissions were received, of which 25 were unique research questions. Submitted questions received a range of scores from 62 to 106 points. The highest scoring questions focused on (1) increasing the confidence of medical students and doctors in providing nutrition care to patients, (2) clarifying the essential nutrition skills doctors should acquire, (3) understanding the effectiveness of doctors at influencing dietary behaviours and (4) improving medical students' attitudes towards the importance of nutrition. These research questions can be used to ensure future projects in medical nutrition education directly align with the needs and preferences of research stakeholders. Funders should consider these priorities in their commissioning of research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

No Gut No Gain! Enteral Bile Acid Treatment Preserves Gut Growth but Not Parenteral Nutrition-Associated Liver Injury in a Novel Extensive Short Bowel Animal Model.

Science.gov (United States)

Villalona, Gustavo; Price, Amber; Blomenkamp, Keith; Manithody, Chandrashekhara; Saxena, Saurabh; Ratchford, Thomas; Westrich, Matthew; Kakarla, Vindhya; Pochampally, Shruthika; Phillips, William; Heafner, Nicole; Korremla, Niraja; Greenspon, Jose; Guzman, Miguel A; Kumar Jain, Ajay

2018-04-27

Parenteral nutrition (PN) provides nutrition intravenously; however, this life-saving therapy is associated with significant liver disease. Recent evidence indicates improvement in PN-associated injury in animals with intact gut treated with enteral bile acid (BA), chenodeoxycholic acid (CDCA), and a gut farnesoid X receptor (FXR) agonist, which drives the gut-liver cross talk (GLCT). We hypothesized that similar improvement could be translated in animals with short bowel syndrome (SBS). Using piglets, we developed a novel 90% gut-resected SBS model. Fifteen SBS piglets receiving PN were given CDCA or control (vehicle control) for 2 weeks. Tissue and serum were analyzed posteuthanasia. CDCA increased gut FXR (quantitative polymerase chain reaction; P = .008), but not downstream FXR targets. No difference in gut fibroblast growth factor 19 (FGF19; P = .28) or hepatic FXR (P = .75), FGF19 (P = .86), FGFR4 (P = .53), or Cholesterol 7 α-hydroxylase (P = .61) was noted. PN resulted in cholestasis; however, no improvement was noted with CDCA. Hepatic fibrosis or immunostaining for Ki67, CD3, or Cytokeratin 7 was not different with CDCA. PN resulted in gut atrophy. CDCA preserved (P = .04 vs control) gut mass and villous/crypt ratio. The median (interquartile range) for gut mass for control was 0.28 (0.17-0.34) and for CDCA was 0.33 (0.26-0.46). We note that, unlike in animals with intact gut, in an SBS animal model there is inadequate CDCA-induced activation of gut-derived signaling to cause liver improvement. Thus, it appears that activation of GLCT is critically dependent on the presence of adequate gut. This is clinically relevant because it suggests that BA therapy may not be as effective for patients with SBS. © 2018 American Society for Parenteral and Enteral Nutrition.

Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database.

Science.gov (United States)

Elke, Gunnar; Wang, Miao; Weiler, Norbert; Day, Andrew G; Heyland, Daren K

2014-02-10

Current international sepsis guidelines recommend low-dose enteral nutrition (EN) for the first week. This contradicts other nutrition guidelines for heterogenous groups of ICU patients. Data on the optimal dose of EN in septic patients are lacking. Our aim was to evaluate the effect of energy and protein amount given by EN on clinical outcomes in a large cohort of critically ill septic patients. We conducted a secondary analysis of pooled data collected prospectively from international nutrition studies. Eligible patients had a diagnosis of sepsis and/or pneumonia and were admitted to the ICU for ≥3 days, mechanically ventilated within 48 hours of ICU admission and only receiving EN. Patients receiving parenteral nutrition were excluded. Data were collected from ICU admission up to a maximum of 12 days. Regression models were used to examine the impact of calorie and protein intake on 60-day mortality and ventilator-free days. Of the 13,630 patients included in the dataset, 2,270 met the study inclusion criteria. Patients received a mean amount of 1,057 kcal/d (14.5 kcal/kg/day) and 49 g protein/day (0.7 g/kg/d) by EN alone. Patients were mechanically ventilated for a median of 8.4 days and 60-day mortality was 30.5%. An increase of 1,000 kcal was associated with reduced 60-day mortality (odds ratio (OR) 0.61; 95% confidence interval (CI) 0.48 to 0.77, P <0.001) and more ventilator-free days (2.81 days, 95% CI 0.53 to 5.08, P = 0.02) as was an increase of 30 g protein per day (OR 0.76; 95% CI 0.65 to 0.87, P <0.001 and 1.92 days, 95% CI 0.58 to 3.27, P = 0.005, respectively). In critically ill septic patients, a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome.

The Role of Nutrition in Periodontal Health: An Update

Directory of Open Access Journals (Sweden)

Shariq Najeeb

2016-08-01

Full Text Available Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed.

Interdependency of EGF and GLP-2 Signaling in Attenuating Mucosal Atrophy in a Mouse Model of Parenteral Nutrition

DEFF Research Database (Denmark)

Feng, Yongjia; Demehri, Farok R; Xiao, Weidong

2017-01-01

BACKGROUND & AIMS: Total parenteral nutrition (TPN), a crucial treatment for patients who cannot receive enteral nutrition, is associated with mucosal atrophy, barrier dysfunction, and infectious complications. Glucagon-like peptide-2 (GLP-2) and epidermal growth factor (EGF) improve intestinal...... deprived of enteral nutrition. METHODS: Adult C57BL/6J, IEC-Egfr(knock out (KO)) and IEC-pik3r1(KO) mice receiving TPN or enteral nutrition were treated with EGF or GLP-2 alone or in combination with reciprocal receptor inhibitors, GLP-2(3-33) or gefitinib. Jejunum was collected and mucosal atrophy and IEC...

Impact of Early Parenteral Nutrition on Metabolism and Kidney Injury

OpenAIRE

Gunst, Jan; Vanhorebeek, Ilse; Casaer, Michaël P.; Hermans, Greet; Wouters, Pieter J.; Dubois, Jasperina; Claes, Kathleen; Schetz, Miet; Van den Berghe, Greet

2013-01-01

A poor nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early parenteral nutrition to supplement insufficient enteral nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding parenteral nutrition for 1 week. Whether early versus late parenteral nutrition impacts the incidence and recovery of AKI is ...

Pilot study using wheat bran to mitigate malnutrition and enteric pathogens

Science.gov (United States)

In 2015, 4.9 million children under the age of five died from infectious, neonatal, or nutritional conditions. Malnourished children have an increased susceptibility to enteric pathogens and diarrhea, which flush commensal bacteria from the intestines. Commensal bacteria in the intestines regulate n...

[Nutritional support in sepsis].

Science.gov (United States)

Ortiz Leyba, C; López Martínez, J; Blesa Malpica, A L

2005-06-01

Although it is considered that metabolic and nutritional support must be part of the management of septic patients, it has not been conclusively shown that nutritional support will improve survival or complications from sepsis. Specific data on this issue are scarce since there are few studies that have investigated specialized nutritional support in septic patients. Thus, most of the recommendations are based on outcomes obtained in severely ill patients with different pathologies. It is assumed that nutritional support should be carried out through the enteral route whenever possible, as in other critically ill patients. The energetic waste in these patients is highly variable, although in general terms the hypermetabolic situation may be classified as moderate. An adjustment factor of 1.25-1.30 is recommended for the Harris-Benedict's equation to calculate the caloric intake. Septic patients should receive a hyperproteic intake. The amount of glucose administered should not exceed 70% of non-protein calories, and lipids intake should not exceed 40%. With regards to micronutrients, it is recommended to increase the supply of those with antioxidant properties (vitamin E, carotenes, vitamin C, selenium). There are data to consider that the use of diets enriched with pharmaco-nutrients (both with parenteral and enteral routes) may be beneficial in septic patients, although there is some controversy when interpreting the outcomes.

Uranium-mill appraisal program

International Nuclear Information System (INIS)

Everett, R.J.; Cain, C.L.

1982-08-01

The results of special team appraisals at NRC-licensed uranium mills in the period May to November 1981 are reported. Since the Three Mile Island accident, NRC management has instituted a program of special team appraisals of radiation protection programs at certain NRC-licensed facilities. These appraisals were designed to identify weaknesses and strengths in NRC-licensed programs, including those areas not covered by explicit regulatory requirements. The regulatory requirements related to occupational radiation protection and environmental monitoring at uranium mills have been extensively upgraded in the past few years. In addition, there was some NRC staff concern with respect to the effectiveness of NRC licensing and inspection programs. In response to this concern and to changes in mill requirements, the NRC staff recommended that team appraisals be conducted at mills to determine the adequacy of mill programs, the effectiveness of the new requirements, and mill management implementation of programs and requirements. This report describes the appraisal scope and methodology as well as summary findings and conclusions. Significant weaknesses identified during the mill appraisals are discussed as well as recommendations for improvements in uranium mill programs and mill licensing and inspection

76 FR 72306 - Federal Housing Administration (FHA) Appraiser Roster: Appraiser Qualifications for Placement on...

Science.gov (United States)

2011-11-23

... disciplinary action in any state in which the appraiser is certified; * * * * * (c) * * * (1) Appraisers subject to state disciplinary action. An appraiser whose state certification in any state has been revoked, suspended, or surrendered as a result of a state disciplinary action is automatically suspended from the...

An appraisal profile of nostalgia.

Science.gov (United States)

van Tilburg, Wijnand A P; Bruder, Martin; Wildschut, Tim; Sedikides, Constantine; Göritz, Anja S

2018-03-05

The authors aimed to (a) identify the cognitive appraisals underlying nostalgia and (b) compare nostalgia with other emotions in terms of its appraisal profile. In Study 1, participants (N = 1,125) generated narratives. Next, they reported the level of nostalgia and 31 other emotions that these narratives elicited. Subsequently, participants evaluated the narrative events on several cognitive appraisals. Events that elicited nostalgia were pleasant, involved an irretrievable loss, felt psychologically distant, and were unique-an appraisal profile that differed from all other emotions. In Study 2 (N = 1,261), the authors experimentally varied these appraisals in a vignette paradigm and measured anticipated nostalgia and 10 other emotions. Participants anticipated most nostalgia when events were pleasant, involved irretrievable loss, were distant, and were unique-a profile shared only with longing. In Study 3 (N = 994), the authors used a guided autobiographical recall procedure in which they manipulated appraisals and measured the resultant emotions. Corroborating Studies 1-2, nostalgia was most intense for events that were pleasant, irretrievably lost, temporally distant, and unique. This appraisal profile was not shared by other emotions. The findings delineate the distinguishing cognitive appraisal profile of nostalgia. Nostalgia occupies a special place in the pantheon of emotions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Antimicrobial and nutritional interventions in early life

DEFF Research Database (Denmark)

Jensen, Michael Ladegaard

Necrotizing enterocolitis (NEC) is the most common gastrointestinal disorder in premature newborn infants, yet there is still no well-established prevention strategy or treatment for this disease. The pathogenesis of NEC remains to be fully elucidated; however, prematurity, enteral nutrition...... with regard to challenge dose and supportive nutrition was done and presented in Paper IV....

Nutritional condition of fish larvae in South African estuaries: an ...

African Journals Online (AJOL)

Nutritional condition of fish larvae in South African estuaries: an appraisal of three biochemical methods. D Costalago, N Strydom, C Frost. Abstract. Estuaries are exposed to a number of threats and many South African estuarine systems are functionally and structurally altered. The extent to which fish are affected by these ...

How to locate and appraise qualitative research in complementary and alternative medicine.

Science.gov (United States)

Franzel, Brigitte; Schwiegershausen, Martina; Heusser, Peter; Berger, Bettina

2013-06-03

The aim of this publication is to present a case study of how to locate and appraise qualitative studies for the conduct of a meta-ethnography in the field of complementary and alternative medicine (CAM). CAM is commonly associated with individualized medicine. However, one established scientific approach to the individual, qualitative research, thus far has been explicitly used very rarely. This article demonstrates a case example of how qualitative research in the field of CAM studies was identified and critically appraised. Several search terms and techniques were tested for the identification and appraisal of qualitative CAM research in the conduct of a meta-ethnography. Sixty-seven electronic databases were searched for the identification of qualitative CAM trials, including CAM databases, nursing, nutrition, psychological, social, medical databases, the Cochrane Library and DIMDI. 9578 citations were screened, 223 articles met the pre-specified inclusion criteria, 63 full text publications were reviewed, 38 articles were appraised qualitatively and 30 articles were included. The search began with PubMed, yielding 87% of the included publications of all databases with few additional relevant findings in the specific databases. CINHAL and DIMDI also revealed a high number of precise hits. Although CAMbase and CAM-QUEST® focus on CAM research only, almost no hits of qualitative trials were found there. Searching with broad text terms was the most effective search strategy in all databases. This publication presents a case study on how to locate and appraise qualitative studies in the field of CAM. The example shows that the literature search for qualitative studies in the field of CAM is most effective when the search is begun in PubMed followed by CINHAL or DIMDI using broad text terms. Exclusive CAM databases delivered no additional findings to locate qualitative CAM studies.

How to locate and appraise qualitative research in complementary and alternative medicine

Science.gov (United States)

2013-01-01

Background The aim of this publication is to present a case study of how to locate and appraise qualitative studies for the conduct of a meta-ethnography in the field of complementary and alternative medicine (CAM). CAM is commonly associated with individualized medicine. However, one established scientific approach to the individual, qualitative research, thus far has been explicitly used very rarely. This article demonstrates a case example of how qualitative research in the field of CAM studies was identified and critically appraised. Methods Several search terms and techniques were tested for the identification and appraisal of qualitative CAM research in the conduct of a meta-ethnography. Sixty-seven electronic databases were searched for the identification of qualitative CAM trials, including CAM databases, nursing, nutrition, psychological, social, medical databases, the Cochrane Library and DIMDI. Results 9578 citations were screened, 223 articles met the pre-specified inclusion criteria, 63 full text publications were reviewed, 38 articles were appraised qualitatively and 30 articles were included. The search began with PubMed, yielding 87% of the included publications of all databases with few additional relevant findings in the specific databases. CINHAL and DIMDI also revealed a high number of precise hits. Although CAMbase and CAM-QUEST® focus on CAM research only, almost no hits of qualitative trials were found there. Searching with broad text terms was the most effective search strategy in all databases. Conclusions This publication presents a case study on how to locate and appraise qualitative studies in the field of CAM. The example shows that the literature search for qualitative studies in the field of CAM is most effective when the search is begun in PubMed followed by CINHAL or DIMDI using broad text terms. Exclusive CAM databases delivered no additional findings to locate qualitative CAM studies. PMID:23731997

African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa.

Science.gov (United States)

Holdsworth, Michelle; Kruger, Annamarie; Nago, Eunice; Lachat, Carl; Mamiro, Peter; Smit, Karlien; Garimoi-Orach, Chris; Kameli, Yves; Roberfroid, Dominique; Kolsteren, Patrick

2015-09-01

Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective

7 CFR 4279.144 - Appraisals.

Science.gov (United States)

2010-01-01

... value of the collateral. All real property appraisals associated with Agency guaranteed loanmaking and... appraise the property in question. All appraisals will include consideration of the potential effects from... value of the collateral. For additional guidance and information concerning the completion of real...

Nutrition in paediatric Crohn's disease

African Journals Online (AJOL)

Keywords: Crohn's disease; linear growth; Tumour Necrosis Factor-α; nutritional support; enteral ... hormone (GH) stimulation, is the key mediator of GH effects at the ... deficit documented in children with CD seems to be directly linked to.

Case Study: Nutrition in the ICU and multi-organ failure

African Journals Online (AJOL)

ml/kg was suggested, divided between maintenance fluids and enteral feeds. Supply ... 8.5 mmol/L. The nurse feels that she is tolerating her enteral feeding but during .... balances are very frequent during severe critical illness despite nutrition ...

Nutritional Care in Iranian Intensive Care Units

Science.gov (United States)

2018-01-01

Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary. PMID:29713622

Glutamine-enriched enteral diet increases splanchnic blood flow in the rat

NARCIS (Netherlands)

Houdijk, A. P.; van Leeuwen, P. A.; Boermeester, M. A.; van Lambalgen, T.; Teerlink, T.; FLINKERBUSCH, E. L.; Sauerwein, H. P.; Wesdorp, R. I.

1994-01-01

The hemodynamic consequences of glutamine (Gln)-enriched nutrition have not been investigated. This study investigates the effects of a Gln-enriched enteral diet on organ blood flows and systemic hemodynamics. Male Fischer 344 rats (n = 24) were randomized to a group that received a 12.5% (wt/wt)

Parenteral nutrition in patients with renal failure – Guidelines on Parenteral Nutrition, Chapter 17

Directory of Open Access Journals (Sweden)

Druml, W.

2009-11-01

Full Text Available Partial EN (enteral nutrition should always be aimed for in patients with renal failure that require nutritional support. Nevertheless PN (parenteral nutrition may be necessary in renal failure in patient groups with acute or chronic renal failure (ARF or CRF and additional acute diseases but without extracorporeal renal replacement therapy, or in patients with ARF or CRF with additional acute diseases on extracorporeal renal replacement therapy, haemodialysis therapy (HD, peritoneal dialysis (PD or continuous renal replacement therapy (CRRT, or in patients on HD therapy with intradialytic PN. Patients with renal failure who show marked metabolic derangements and changes in nutritional requirements require the use of specifically adapted nutrient solutions. The substrate requirements of acutely ill, non-hypercatabolic patients with CRF correspond to those of patients with ARF who are not receiving any renal replacement patients therapy (utilisation of the administered nutrients has to be monitored carefully. In ARF patients and acutely ill CRF patients on renal replacement therapy, substrate requirements depend on disease severity, type and extent/frequency of extracorporeal renal replacement therapy, nutritional status, underlying disease and complications occurring during the course of the disease. Patients under HD have a higher risk of developing malnutrition. Intradialytic PN (IDPN should be used if causes of malnutrition cannot be eliminated and other interventions fail. IDPN should only be carried out when modifiable causes of malnutrition are excluded and enhanced oral (like i.e. additional energy drinks or enteral supply is unsuccessful or cannot be carried out.

What are the factors that influence the attainment of satisfactory energy intake in pediatric intensive care unit patients receiving enteral or parenteral nutrition?

Science.gov (United States)

de Menezes, Fernanda Souza; Leite, Heitor Pons; Nogueira, Paulo Cesar Koch

2013-01-01

Children admitted to the intensive care unit (ICU) are at risk of inadequate energy intake. Although studies have identified factors contributing to an inadequate energy supply in critically ill children, they did not take into consideration the length of time during which patients received their estimated energy requirements after having achieved a satisfactory energy intake. This study aimed to identify factors associated with the non-attainment of estimated energy requirements and consider the time this energy intake is maintained. This was a prospective study involving 207 children hospitalized in the ICU who were receiving enteral and/or parenteral nutrition. The outcome variable studied was whether 90% of the estimated basal metabolic rate was maintained for at least half of the ICU stay (satisfactory energy intake). The exposure variables for outcome were gender, age, diagnosis, use of vasopressors, malnutrition, route of nutritional support, and Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction scores. Satisfactory energy intake was attained by 20.8% of the patients, within a mean time of 5.07 ± 2.48 d. In a multivariable analysis, a diagnosis of heart disease (odds ratio 3.62, 95% confidence interval 1.03-12.68, P = 0.045) increased the risk of insufficient energy intake, whereas malnutrition (odds ratio 0.43, 95% confidence interval 0.20-0.92, P = 0.030) and the use of parenteral nutrition (odds ratio 0.34, 95% confidence interval 0.15-0.77, P = 0.001) were protective factors against this outcome. A satisfactory energy intake was reached by a small proportion of patients during their ICU stay. Heart disease was an independent risk factor for the non-attainment of satisfactory energy intake, whereas malnutrition and the use of parenteral nutrition were protective factors against this outcome. Copyright © 2013 Elsevier Inc. All rights reserved.

Development and validation of a specific questionnaire to assess health-related quality of life in patients with home enteral nutrition: NutriQoL® development

Directory of Open Access Journals (Sweden)

Cuerda MC

2016-11-01

Full Text Available Maria Cristina Cuerda,1 Antonio Apezetxea,2 Lourdes Carrillo,3 Felipe Casanueva,4 Federico Cuesta,5 Jose Antonio Irles,6 Maria Nuria Virgili,7 Miquel Layola,8 Luis Lizan9 1Hospital General Universitario Gregorio Marañon, Madrid, 2Organización Sanitaria Integrada Bilbao Basurto, Bilbao, 3Centro de Salud Victoria de Acentejo, Santa Cruz, 4Hospital Universitario de Santiago de Compostela, Santiago, 5Hospital Clínico San Carlos, Madrid, 6Hospital Universitario Nuestra Señora de Valme, Seville, 7Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, 8Nestlé Health Science, Barcelona, 9Outcomes’10, Universitat Jaume 1, Castellon, Spain Introduction: Home enteral nutrition (HEN is indicated in patients with a functional gastrointestinal tract but who are unable to meet their nutritional requirements with normally consumed foodstuffs. HEN allows patients to remain in their social and family environment, thus reducing complications and costs associated with hospital admission, while increasing health-related quality of life (HRQoL. HRQoL in patients with HEN is mainly evaluated by generic instruments, which are not sensitive enough to identify certain specific patient-related outcomes of HEN. Objective: To develop a specific instrument to measure HRQoL in patients receiving HEN whose results allow interpretation regardless of the underlying disease and nutritional support administration route: the NutriQoL® questionnaire. Materials and methods: The development of the NutriQoL entailed a literature review, focus groups with experts, semistructured interviews with patients, an assessment of face validity and feasibility, and Rasch analysis conducted on data from a sample of 141 patients and 24 caregivers. Results: Of the 52 items initially proposed on the basis of the literature review, expert focus group, and semi-structured interviews with patients and caregivers, 17 items were finally selected through the development process to make

Nutrition in Heart Failure

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Reci Meseri

2013-10-01

Full Text Available Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilemma. Since one of the main reasons of heart failure is cardiovascular diseases, in first phase, the patient may be obese. In the later phases, cachexia may show up. It was shown that cachexia is associated with mortality. Within this period, patients should not be over-fed and the patient should pass from catabolic state to anabolic state slowly. If the gastrointestinal track is functional oral/enteral feeding must be preferred. Multi vitamin and mineral supportsmay be beneficial, which may replace the increased loss, increase anti-inflammatory response and be anti-oxidants. Large, controlled and well-designed studies must be conducted in order to evaluate the benefits of nutritional practices such as nutritional assessment, enteral feeding and nutrient supports in heart failure patients.

Nutritional intervention for amyotrophic lateral sclerosis.

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Morassutti, I; Giometto, M; Baruffi, C; Marcon, M L; Michieletto, S; Giometto, B; Spinella, N; Paccagnella, A

2012-09-01

The aim of the study was to assess the consequences of early and systematic nutritional intervention on the clinical conditions of amyotrophic lateral sclerosis (ALS) patients and on the opportunity to maintain a good nutritional status for as long as possible. Thirty-three subjects with ALS. Protocol Group: 12 subjects (9 M and 3 F) monitored according to a precise nutritional intervention protocol. 21 subjects (10 M and 11 F) monitored before applying the protocol. Data recorded at the time of initial assessment were compared and expressed as the mean ± standard deviation for the Protocol Group vs. the BMI (kg/m2) 23.6 ± 4.1 vs. 21.6 ± 3.5; weight loss as a percentage of usual weight 6.6 ± 7.9 vs. 16.3 ± 8.8 (P=0.003). At six months: weight loss as a percentage of usual weight 4.9 ± 6.2 vs. 16.9 ± 10.2 (P=0.002). At 12 months: weight loss as a percentage of usual weight 7.3 ± 7.1 vs. 17.5 ± 11.1 (P=0.03). At the first follow-up visit, fewer patients in the Protocol Group were receiving enteral nutrition (25%) than patients in the CONTROL GROUP (60%). At six-month follow-up visit: 30% vs. 68%. Standard enteral nutrition formulas were used. One year after initial assessment, the mortality rate was 17% for the Protocol Group, whereas it was 24% at six months and 33% after one year for the CONTROL GROUP. If patients are treated before any significant weight loss occurs, early and specific nutritional intervention allows good nutritional status to be maintained for a longer period; if artificial nutrition is required, standard diets are able to ensure adequate clinical results.

Nutritional Interventions in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: A Narrative Review

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Maurizio Bossola

2015-01-01

Full Text Available The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC and oral nutritional supplements (ONS should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started, prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.

Nutritional Therapy in Liver Transplantation

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Ahmed Hammad

2017-10-01

Full Text Available Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.

32 CFR 644.44 - Fee appraisals.

Science.gov (United States)

2010-07-01

... HANDBOOK Appraisal § 644.44 Fee appraisals. (a) Definitions and procedures. (1) The complete and.... The keynote of this approach lies in the sound development of a proper rate. The appraiser must have a...

Early goal-directed nutrition versus standard of care in adult intensive care patients

DEFF Research Database (Denmark)

Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

2017-01-01

Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we...... estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7......, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline...

Nutrition in peri-operative esophageal cancer management.

Science.gov (United States)

Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

2017-07-01

Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

Conducting effective performance appraisals.

Science.gov (United States)

2001-01-01

According to experts, performance appraisals rate just below firing someone as the least favorite thing managers do. Many factors contribute to this view--one is that current systems do a poor job of evaluating performance and in fact often impede both evaluation and performance. When used as part of an ongoing supportive process of goal setting and feedback, performance appraisals can enhance performance and morale. One alternative to traditional employee evaluation methods is full-circle or 360-degree feedback. Contained in this issue are practical suggestions for preparing employees for performance appraisals which, when followed daily, encourage employees to put their best feet forward as part of their regular routine. Also included is a template specific to assessing the performance of clinical laboratory technologists . Additionally, numerous resources are provided to help you refine appraisal systems to fit your needs. Full-circle feedback is proving to be a boon to managers. It relieves them from being the exclusive "heavies" in evaluating performance, integrates appraisal input from several sources, and incorporates increasing employee skills, competencies, and satisfaction, thus improving productivity of people and processes. And aren't integration and continuous improvement what the laboratory is all about?

Enteral Feeding in Abdominal Compartment Syndrome

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Ye. V Grigoryev

2009-01-01

Full Text Available Objective: to substantiate the choice of a gastrointestinal tract (GIT function support regimen as a mode for correction of the abdominal compartment syndrome (ACS. Subjects and methods. Forty-three patients with different causes of inadequate GIT function of various origin and ACS (disseminated peritonitis (45%, pancreatitis (24%, and severe concomitant injury (31% were examined. Group 1 (control received complete parenteral nutritional feeding (n=23; APACHE II scores, 21±4; calculated probability of fatal outcome, 33.5%. In Group II (study, complete parenteral feeding in the first 24 hours after stabilization was supplemented with GIT function support with Pepsisorb (Nutricia in doses of 500, 1000, and 1500 ml on days 1, 2, and 3, respectively (n=20; APACHE II scores, 20±6; calculated probability of fatal outcome, 37.1%. During early enteral nutritional support, the SOFA score was significantly less than that in Group 1 on days 2—3; the oxygenation index significantly increased on day 3; the value of intra-abdominal hypertension decreased to the control values. The positive effect of the GIT function support regimen on regression of the multiple organ dysfunction syndrome (MODS was confirmed by the lowered levels of biological markers (von Willebrand factor (WF and endothelin-1 as markers of endothelial damage of MODS. Correlation analysis showed a direct correlation between the markers of endothelial damage and the SOFA scores (r=0.34; p=0.05 for WF and r=0.49;p=0.03 for endothelin. Conclusion. The GIT function support regimen via early enteral alimentation with Peptisorb, which was initiated in the first 24 hours after admission, is able to level off the manifestations of the early stages of the abdominal compartment syndrome, with the acceptable values of oxygen balance and water-electrolyte and osmotic homeostasis being achieved. Key words: abdominal compartment syndrome, nutritional support, biological markers, oxygenation index

Fodder shrubs and fatty acids: strategies to reduce enteric methane production in cattle.

Directory of Open Access Journals (Sweden)

Juan Leonardo Cardona-Iglesias

2016-12-01

Full Text Available The aim of this study was to analyze the use of fodder shrubs and polyunsaturated fatty acids as a nutritional strategy to mitigate enteric methane production in cattle. Special emphasis was made on the use of Tithonia diversifolia (Hemsl. A. Gray (Mexican sun ower, as a species with antimethanogenic potential. Bibliographic information for this review was obtained between July and September 2015 by using key words. Methane is a powerful greenhouse gas (GHG, the increase of its atmospheric concentration is caused mainly by emissions from agriculture and industry, but it is also estimated that a proportion of methane is emitted by ruminants as a product of enteric and anaerobic fermentation of diet. This causes an environmental and productive problem in livestock production systems worldwide. Although there is controversy about the real contribution of methane by ruminants and its impact on environmental issues, the amount of emissions should try to be reduced.This document emphasizes the search for nutritional strategies such as supplementation with forage shrubs and sources of polyunsaturated fatty acids, which have shown potential to maintain animal production ef ciency and decrease enteric methane synthesis.

ESPEN Guidelines on Parenteral Nutrition: gastroenterology

DEFF Research Database (Denmark)

A., Van Gossum; Cabre, E.; Hebuterne, X.

2009-01-01

. There is a lack of data supporting specific nutrients in these conditions. Parenteral nutrition is mandatory in case of intestinal failure, at least in the acute period. In patients with short bowel, specific attention should be paid to water and electrolyte supplementation. Currently, the use of growth hormone......-based recommendations for the indications, application and type of parenteral formula to be used in acute and chronic phases of illness. Parenteral nutrition is not recommended as a primary treatment in CD and UC. The use of parenteral nutrition is however reliable when oral/enteral feeding is not possible...

Irritable bowel syndrome: contemporary nutrition management strategies.

Science.gov (United States)

Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

2014-09-01

Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

Glutamine granule-supplemented enteral nutrition maintains immunological function in severely burned patients.

Science.gov (United States)

Peng, Xi; Yan, Hong; You, Zhongyi; Wang, Pei; Wang, Shiliang

2006-08-01

Glutamine is an important energy source for immune cells. It is a necessary nutrient for cell proliferation, and serves as specific fuel for lymphocytes, macrophages, and enterocytes when it is present in appropriate concentrations. The purpose of this clinical study was to observe the effects of enteral nutrition supplemented with glutamine granules on immunologic function in severely burned patients. Forty-eight severely burned patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trail. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, Gln and B group patents were given glutamine granules or placebo (glycine) at 0.5 g/kgd for 14 days with oral feeding or tube feeding, respectively. The plasma level of glutamine and several indices of immunologic function including lymphocyte transformation ratio, neutrophil phagocytosis index (NPI), CD4/CD8 ratio, the content of immunoglobulin, complement C3, C4 and IL-2 levels were determined. Moreover, wound healing rate of burn area was observed and then hospital stay was recorded. The results showed significantly reduced plasma glutamine and damaged immunological function after severe burn Indices of cellular immunity function were remarkably decreased from normal controls. After taking glutamine granules for 14 days, plasma glutamine concentration was significantly higher in Gln group than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P0.05). In addition, wound healing was better and hospital stay days were reduced in Gln group (46.59+/-12.98 days versus 55.68+/-17.36 days, Pburn; supplemented glutamine granules with oral feeding or tube feeding abate the degree of immunosuppression, improve immunological function

Application Effect of Home Enteral Nutrition for Advanced Gastric Cancer%家庭肠内营养应用于胃癌晚期患者中的效果

Institute of Scientific and Technical Information of China (English)

明军; 徐克强; 袁友强

2015-01-01

目的 探讨家庭肠内应用对胃癌晚期患者营养状态以及生活质量的效果. 方法 选取96例晚期胃癌患者作为研究对象,其中46例患者采用家庭肠内营养支持为EN组,另50例患者进行院内肠外营养支持为PN组,比较两组患者营养支持前后营养状态的变化以及营养支持6个月后患者生活质量的变化. 结果 两组患者经营养支持治疗后其血液成分和机体组成成分均与营养支持前存在明显差异(P0.05),但EN组患者的体重、BMI以及脂肪群均明显高于PN组患者(P0.05),but the body weight,BMI and fat mass of patients in EN group were significantly higher than those of the PN group( P<0.05) ,and the KPS,OLI and func-tional scores of EORTC QLQ C30EN of EN group were significantly higher than those of the PN group,while the single score of EORTC QLQ C30 was significantly lower than that of the PN group(P<0.05),the differences were statistically significant.Con-clusion Home enteral nutrition can effectively improve the nutritional status of advanced gastric cancer,and compared with par-enteral nutrition,it has better effect in improving quality of life of patients,it is worthy of application in advanced gastric cancer patients.

Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases

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Heitor Pons Leite

Full Text Available OBJECTIVE: To report on acquired experience of metabolic support for children with acute neurological diseases, emphasizing enteral tube feeding usage and metabolic assessment, and also to recommend policies aimed towards improving its implementation. DESIGN: Retrospective analysis. SETTING: Pediatric Intensive Care Unit of Hospital do Servidor Público Estadual de São Paulo. SUBJECTS: 44 patients consecutively admitted to the Pediatric ICU over a period of 3 years who were given nutrition and metabolic support for at least 72 hours. Head trauma, CNS infections and craniotomy post-operative period following tumor exeresis were the main diagnoses. MEASUREMENTS: Records of protein-energy intake, nutrient supply route, nitrogen balance and length of therapy. RESULTS: From a total of 527 days of therapy, single parenteral nutrition was utilized for 34.3% and single enteral tube feeding for 79.1% of that period. 61.4% of the children were fed exclusively via enteral tube feeding, 9.1% via parenteral and 39.5 % by both routes. The enteral tube feeding was introduced upon admission and transpyloric placement was successful in 90% of the cases. Feeding was started 48 hours after ICU admission. The caloric goal was achieved on the 7th day after admission, and thereafter parenteral nutrition was interrupted. The maximum energy supply was 104.2 ± 23.15 kcal/kg. The median length of therapy was 11 days (range 4-38. None of the patients on tube feeding developed GI tract bleeding, pneumonia or bronchoaspiration episodes and, of the 4 patients who were given exclusive TPN, 2 developed peptic ulcer. The initial urinary urea nitrogen was 7.11 g/m2 and at discharge 6.44 g/m2. The protein supply increased from 1.49 g/kg to 3.65 g/kg (p< 0.01. The nitrogen balance increased from -7.05 to 2.2 g (p< 0.01. CONCLUSIONS: Children with acute neurological diseases are hypercatabolic and have high urinary nitrogen losses. The initial negative nitrogen balance can be

[Effect of nutritional support on survival in patients with amyotrophic lateral sclerosis].

Science.gov (United States)

López Gómez, J J; Ballesteros Pomar, Ma D; Vázquez Sánchez, F; Vidal Casariego, A; Calleja Fernández, A; Cano Rodríguez, I

2011-01-01

Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

The use of specialised enteral formulae for patients with diabetes ...

African Journals Online (AJOL)

The majority of enteral nutrition products for diabetes mellitus have a carbohydrate content of 30–45% and fat between 40–49%, mainly monounsaturated fat, with a mix of soluble and insoluble fibre (total of 14–24 g/l). Does this have short- and long-term benefits and which component(s) is/are crucial for the outcome or is it ...

12 CFR 564.4 - Minimum appraisal standards.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Minimum appraisal standards. 564.4 Section 564.4 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.4 Minimum appraisal standards. For federally related transactions, all appraisals shall, at a minimum: (a...

Protein energy wasting in chronic kidney disease: An update with focus on nutritional interventions to improve outcomes

Directory of Open Access Journals (Sweden)

Yashpal P Jadeja

2012-01-01

Full Text Available Protein-energy wasting (PEW is common in patients with chronic kidney disease (CKD. PEW is one of the strongest predictors of mortality in patients with CKD. The International Society of Renal Nutrition and Metabolism (ISRNM expert panel has defined PEW as a, "state of decreased body stores of protein and energy fuels (body protein and fat masses". The ISRNM panel has also proposed diagnostic criteria of PEW with four categories. Cachexia is a severe form of PEW. The proposed causes of PEW are multi-factorial and include nutritional and non-nutritional mechanisms. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus and in children with CKD, in addition to dialysis patients. Features of ideal dietary supplement have also been discussed. Dietary interventions such as enteral feeding with high-protein meals or supplements might improve the nutritional status and outcomes in dialysis patients.

The Power of Developmental Performance Appraisal

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Nasser Salim Alghanabousi

2013-02-01

Full Text Available Development of employee performance is a must that any organization should take into account to be a successful in achieving its goals. However, the tools of developing that performance are varying based on the type of the organization and the nature of the work performed. Performance appraisal is one of the effective tools that help the organization to measure the accomplishment of its goals, if implemented effectively. In education, it became evident that performance appraisal of educators is an essential element of the development of any educational institution. To make the performance appraisal fruitful, the development element should be dominant in the sense that other elements of the appraisal should serve the broad aim of the appraisal process. Therefore, a well-designed and comprehensive system is needed to cover all the aspects of appraisal process that include of the goals, criteria, instruments, and continuous support.

The evidence for the use of nutritional support in liver disease.

Science.gov (United States)

Koretz, Ronald L

2014-03-01

Although there is a well established association between malnutrition and poorer clinical outcomes in patients with liver disease, that fact alone does not prove that improving the malnutrition will improve outcome. The best way to determine if nutritional interventions are effective is to compare them to untreated control groups in well designed and executed randomized clinical trials. A recent systematic review assessed 37 trials that compared parenteral nutrition, enteral nutrition, or nutritional supplements to no nutritional therapy in patients with a variety of liver diseases. Since the publication of that review, an additional three trials have become available. Whereas all but one of the trials did have methodologic shortcomings that may have allowed the introduction of bias (which usually results in an overestimation of benefit), the trials failed to show much, if any, benefit. In fact, the single trial at low risk of bias found that more deaths occurred in the recipients of the supplements. Although malnutrition may be associated with a poor outcome, the current best evidence indicates that the provision of adjunctive nutritional support (parenteral or enteral nutrition, or nutritional supplements) to patients with a variety of liver diseases (alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, liver surgery, liver transplantation, obstructive jaundice, hepatitis C antiviral treatment) does not improve clinical outcomes.

A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy

Directory of Open Access Journals (Sweden)

E Jeffery

2012-01-01

Full Text Available Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects which lead to weight loss. Nutrition intervention in the form of counselling or oral nutrition support (ONS is frequently needed for these patients. For some patients, tube feeding is required to minimise weight loss during treatment.MethodData was collected on 48 patients who received radiotherapy to the head and neck region over a nine-month period (June 2009–March 2010. Retrospective data collection was commenced in July 2010. Each patient’s Diet Therapy Department record was reviewed. Main outcome measures were: 1 type of nutrition support; 2 percentage weight change during treatment; and 3 Patient-Generated Subjective Global Assessment Global (PG-SGA rating.ResultsOn initial assessment 28 (77.8% patients were classified as well nourished using the PG-SGA. Mean weight loss during radiotherapy was 5.74%. Risk factors for the need for ONS and enteral nutrition support (ENS were older age, presence of nutrition impact symptoms, high-risk tumour sites, advanced disease and chemotherapy. No significant difference was shown in weight loss between ONS and ENS groups.ConclusionThis study identified the need for early dietetic intervention for high nutritional risk groups of head and neck cancer patients to prevent significant weight loss. Pre-treatment nutritional status did not influence weight loss during treatment. ONS alone cannot prevent significant weight loss in patients with multiple nutrition impact symptoms. Early enteral feeding should be considered in this group of patients.

Nutritional assistance to patients during radiotherapy

International Nuclear Information System (INIS)

Dias, Maria C.G.; Nadalin, Wladimir; Baxter, Yara C.; Faintuch, Joel; Waitzberg, Dan L.; Maculevicius, Janete

1996-01-01

With the aim of assessing the possible benefits of nutritional therapy , 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 ± 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100% and a lymphocyte count diminished along this period (1933 ± 1033 vs 1265 ± 688, p.0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases initially, significantly improved to just 40% inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21% of the patients, taste changes in 79%, xerostomy in 81%, anorexia in 66% and odinophagia in 59%. In the individuals selected for enteral feeding, side effects were represented by technical problems (20%) and gastrointestinal disorders (13%). All patients completed the nutritional support program and there was no mortality in this series. It is conclude that: early nutritional support during radiotherapy was able to maintain or improve the nutritional status; tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; reduction of total lymphocytes could not be prevented by the mentioned therapy; complications of enteral alimentation were mild and affected a small proportion of the population; troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of the food; the compliance of the therapeutic plan was excellent and can be attributed to the efforts of the

[Nutrition therapy of cancer patients].

Science.gov (United States)

Lövey, József

2017-09-20

The majority of cancer patients becomes malnourished during the course of their disease. Malnutrition deteriorates the efficiency of all kinds of oncologic interventions. As a consequence of it, treatment-related toxicity increases, hospital stay is lengthened, chances of cure and survival as well as the quality of life of the patients worsen. Nutritional status therefore influences all aspects of outcome of oncology care. In spite of this the use of nutritional therapy varies across health care providers but its application is far from being sufficient during active oncology interventions as well as rehabilitation and supportive care. It threatens not only the outcome and quality of life of cancer patients but also the success of oncologic treatments which often demand high input of human and financial resources. Meanwhile application of nutritional therapy is legally regulated in Hungary and a very recent update of the European guideline on cancer patient nutrition published in 2017 is available. Moreover, cost effectiveness of nutritional therapy has been proven in a number of studies. In this review we present the basics of nutritional therapy including nutritional screening and evaluation, nutritional plan, the role of nutrition support teams, oral, enteral and parenteral nutrition, the use of different drugs and special nutrients and the follow-up of the patients.

Essential amino acid enriched high-protein enteral nutrition modulates insulin-like growth factor-1 system function in a rat model of trauma-hemorrhagic shock.

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Xianfeng Xia

Full Text Available Nutrition support for critically ill patients supplemented with additional modular protein may promote skeletal muscle protein anabolism in addition to counteracting acute nitrogen loss. The present study was designed to investigate whether the essential amino acid (EAA enriched high-protein enteral nutrition (EN modulates the insulin-like growth factor-1 (IGF-1 system and activates the mammalian target of rapamycin (mTOR anabolic signaling pathway in a trauma-hemorrhagic shock (T-HS rat model.Male Sprague-Dawley rats (n = 90, 278.18 ± 0.94 g were randomly assigned to 5 groups: (1 normal control, (2 pair-fed, (3 T-HS, (4 T-HS and standard EN, and (5 T-HS and EAA enriched high-protein EN. Six animals from each group were harvested on days 2, 4, and 6 for serum, gastrocnemius, soleus, and extensor digitorum longus sample collection. T-HS significantly reduced muscle mass. Nutrition support maintained muscle mass, especially the EAA enriched high-protein EN. Meanwhile, a pronounced derangement in IGF-1-IGFBPs axis as well as impaired mTOR transduction was observed in the T-HS group. Compared with animals receiving standard EN, those receiving EAA enriched high-protein EN presented 18% higher serum free IGF-1 levels following 3 days of nutrition support and 22% higher after 5 days. These changes were consistent with the concomitant elevation in serum insulin and reduction in corticosterone levels. In addition, phosphorylations of downstream anabolic signaling effectors - including protein kinase B, mTOR, and ribosomal protein S6 kinase1 - increased significantly in rats receiving EAA enriched high-protein EN.Our findings firstly demonstrate the beneficial effect of EAA enriched high-protein EN on the metabolic modulation of skeletal muscle protein anabolism by regulating the IGF-1 system and downstream anabolic signaling transduction.

Nutrition pathways in consequence modeling

International Nuclear Information System (INIS)

Tveten, U.

1982-01-01

During 1979-1980 calculations of risk from waste transportation by truck (fire following collision) and fire in temporary storage for waste were performed. A modified version of the consequence model of WASH-1400 (CRAC) was used. Two exposure pathways dominated the results: external exposure from material on the ground and exposure via nutrition. Many of the parameters entering into the nutrition calculations will depend upon local conditions, like soil composition, crop yield, etc. It was decided to collect detailed comments upon the CRAC nutritions model and parameter values from radioecologists in the four Nordic countries. Four alternate sets of parameter values were derived from these comments, and new risk calculations were performed

Physician Appraisals: Key Challenges

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Klich Jacek

2017-06-01

Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

Highlights of the 2012 research workshop: Using nutrigenomics and metabolomics in clinical nutrition research

Science.gov (United States)

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Research Workshop, "Using Nutrigenomics and Metabolomics in Clinical Nutrition Research," was held on January 21, 2012, in Orlando, Florida. The conference brought together experts in human nutrition who use nutrigenomic and meta...

Invited review: Enteric methane in dairy cattle production: quantifying the opportunities and impact of reducing emissions.

Science.gov (United States)

Knapp, J R; Laur, G L; Vadas, P A; Weiss, W P; Tricarico, J M

2014-01-01

Many opportunities exist to reduce enteric methane (CH4) and other greenhouse gas (GHG) emissions per unit of product from ruminant livestock. Research over the past century in genetics, animal health, microbiology, nutrition, and physiology has led to improvements in dairy production where intensively managed farms have GHG emissions as low as 1 kg of CO2 equivalents (CO2e)/kg of energy-corrected milk (ECM), compared with >7 kg of CO2 e/kg of ECM in extensive systems. The objectives of this review are to evaluate options that have been demonstrated to mitigate enteric CH4 emissions per unit of ECM (CH4/ECM) from dairy cattle on a quantitative basis and in a sustained manner and to integrate approaches in genetics, feeding and nutrition, physiology, and health to emphasize why herd productivity, not individual animal productivity, is important to environmental sustainability. A nutrition model based on carbohydrate digestion was used to evaluate the effect of feeding and nutrition strategies on CH4/ECM, and a meta-analysis was conducted to quantify the effects of lipid supplementation on CH4/ECM. A second model combining herd structure dynamics and production level was used to estimate the effect of genetic and management strategies that increase milk yield and reduce culling on CH4/ECM. Some of these approaches discussed require further research, but many could be implemented now. Past efforts in CH4 mitigation have largely focused on identifying and evaluating CH4 mitigation approaches based on nutrition, feeding, and modifications of rumen function. Nutrition and feeding approaches may be able to reduce CH4/ECM by 2.5 to 15%, whereas rumen modifiers have had very little success in terms of sustained CH4 reductions without compromising milk production. More significant reductions of 15 to 30% CH4/ECM can be achieved by combinations of genetic and management approaches, including improvements in heat abatement, disease and fertility management, performance

9 CFR 52.3 - Appraisal of swine.

Science.gov (United States)

2010-01-01

... an APHIS employee alone. (b) The appraisal of swine will be based on the fair market value as determined by the meat or breeding value of the animals. Animals may be appraised in groups, provided that where appraisal is by the head, each animal in the group is the same value per head, and where appraisal...

Weight loss and body composition changes following three sequential cycles of ketogenic enteral nutrition

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Gianfranco Cappello

2012-01-01

Full Text Available Background: Ketogenic enteral nutrition (KEN is a modification of the protein sparing modified fast in which a protein solution is introduced with a continuous infusion through a nasogastric tube over 10-days cycles. The aim of the study was to perform a retrospective analysis of the safety, compliance, weight loss and body composition changes after 3 sequential 10-days cycles of KEN therapy. Materials and Methods: From a large number of patients who underwent KEN therapy in our department over a 5-year period, we selected 188 patients who participated in 3 KEN cycles with 10-13 days of break between them. Before and after the treatment cycles, body composition was analyzed by bioelectric impedance; a final assessment was made 10 days after the end of last cycle. During each rest period all the patients were on a low-carbohydrate, normal caloric diet. Results: Most patients (97% successfully tolerated the nasogastric treatment and lost an average of 14.4 kg of body weight, 10.6 kg of fat mass and 3.4 kg of body cell mass. Adverse effects were recorded as mild gastric hypersecretion (2% and constipation (5%. Patients continued to lose fat during the 10-day follow up period after the end of each KEN Cycle. This effect may be explained by abnormality of water distribution during the rapid weight loss inducing the observed change in fat mass. Conclusion: Ten-days KEN treatment cycles can induce rapid weight loss and reduction of fat mass in obese patients. Furthermore, preservation of lean mass can be achieved by infusing 1.9 g of protein/kg of BCM.

Nutritional therapy in cirrhosis or alcoholic hepatitis

DEFF Research Database (Denmark)

Dam Fialla, Annette; Israelsen, Mads; Hamberg, Ole

2015-01-01

BACKGROUND & AIMS: Patients with cirrhosis and alcoholic hepatitis are often malnourished and have a superimposed stress metabolism, which increases nutritional demands. We performed a systematic review on the effects of nutritional therapy vs. no intervention for patients with cirrhosis...... or alcoholic hepatitis. METHODS: We included trials on nutritional therapy designed to fulfil at least 75% of daily nutritional demand. Authors extracted data in an independent manner. Random-effects and fixed-effect meta-analyses were performed and the results expressed as risk ratios (RR) with 95% confidence...... with 329 allocated to enteral (nine trials) or intravenous (four trials) nutrition and 334 controls. All trials were classed as having a high risk of bias. Random-effects meta-analysis showed that nutritional therapy reduced mortality 0.80 (95% CI, 0.64 to 0.99). The result was not confirmed in sequential...

Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate).

Science.gov (United States)

León-Sanz, Miguel; García-Luna, Pedro P; Sanz-París, Alejandro; Gómez-Candela, Carmen; Casimiro, César; Chamorro, José; Pereira-Cunill, José L; Martin-Palmero, Angeles; Trallero, Roser; Martínez, José; Ordóñez, Francisco Javier; García-Peris, Pilar; Camarero, Emma; Gómez-Enterría, Pilar; Cabrerizo, Lucio; Perez-de-la-Cruz, Antonio; Sánchez, Carmen; García-de-Lorenzo, Abelardo; Rodríguez, Nelly; Usán, Luis

2005-01-01

Type 2 diabetic patients may need enteral nutrition support as part of their treatment. The objective was to compare glycemic and lipid control in hospitalized patients with type 2 diabetes requiring feeding via nasogastric tube using enteral feedings with either a highcarbohydrate or a high-monounsaturated-fat content. This trial included type 2 diabetes patients admitted to the hospital for neurologic disorders or head and neck cancer surgery who received either a low-carbohydrate-high-mono-unsaturated-fat (Glucerna) or a high-carbohydrate diet (Precitene Diabet). Glycemic and lipid control was determined weekly. Safety and gastrointestinal tolerance were also assessed. A total of 104 patients were randomized and 63 were evaluable according to preestablished protocol criteria. Median duration of therapy was 13 days in both groups. Mean glucose was significantly increased at 7 days of treatment (p = .006) in the Precitene arm, with no significant variations in the Glucerna arm. Mean weekly blood triglycerides levels in the Precitene arm were increased without reaching statistical significance, whereas patients in the Glucerna arm showed a stable trend. Patients in the Precitene arm showed a significantly higher incidence of diarrhea than patients in Glucerna arm (p = .008), whereas the incidence of nausea was smaller in the Precitene arm than in the Glucerna arm (p = .03). An enteral formula with lower carbohydrate and higher monounsaturated fat (Glucerna) has a neutral effect on glycemic control and lipid metabolism in type 2 diabetic patients compared with a high-carbohydrate and a lower-fat formula (Precitene Diabet).

Effect of the early postoperative enteral nutrition on nutrition status and body composition in gastric cancer after gas trectomy%早期经鼻肠管持续滴注肠内营养对胃癌术后近期营养状态及机体组成的影响

Institute of Scientific and Technical Information of China (English)

周龙翔; 杨喆; 赵登秋

2012-01-01

Objective To investigate the effect of the early postoperative enteral nutrition on nutrition status and body composition in patients with gastric cancer after gastrectomy. Methods Thirty one patients with gastric cancer were divided into two group: treatment group which received early enteral nutrition( n = 16 ), and control group which received parenteral nutrition( n = 15 ). The patients in treatment groups received enteral nutrition as follows: peptisorb liquid ( Nutricia ) 500 ml on postoperative day 1st, 1000 ml on postoperative day 2nd and 1500 ml from postoperative day 3rd to day 10th. The patients in control group received parenteral nutrition as follows: TPN from postoperative day 1st to day 3rd, PN added with independent eating from postoperative day 4th to day 7th and independent eating after 7 days. The level of Alb,pre Alb and body compositions were detected 10 days after operation. Results The nutritive index in each group were decreased compared with pre-operation status, the differences between the two groups were not statistical significant P >0. 05 ). The body weight and FFM in the control group were decreased more obvious( P 0.05 ). Conclusion The early postoperative enteral nutrition improved the nutritional status and the composition of the body.%目的 探讨早期鼻饲肠内营养对胃癌术后近期营养状态及机体组成的影响.方法 选择择期手术胃窦癌患者31例,手术方式均为远端根治性胃大部分切除(毕II式吻合,无远处转移及种植),随机分为治疗组(16例)和对照组(15例).治疗组于术后24 h后开始经鼻饲空肠营养(百普力),第1天输注500 ml,第2天开始加至1000 ml,第3天1500 ml,连续使用至术后第10天.对照组术后3 d完全周围静脉营养(热量25 kcal·kg-1·d-1,糖脂比6∶4,氮热比1∶120).术后第4天予以半量静脉营养,不足部分依靠患者自主进食,术后第7天,停用营养支持,完全依赖自主进食.分别于术前、术后第10�

Parenteral Nutrition-Associated Liver Disease: The Role of the Gut Microbiota.

Science.gov (United States)

Cahova, Monika; Bratova, Miriam; Wohl, Petr

2017-09-07

Parenteral nutrition (PN) provides life-saving nutritional support in situations where caloric supply via the enteral route cannot cover the necessary needs of the organism. However, it does have serious adverse effects, including parenteral nutrition-associated liver disease (PNALD). The development of liver injury associated with PN is multifactorial, including non-specific intestine inflammation, compromised intestinal permeability, and barrier function associated with increased bacterial translocation, primary and secondary cholangitis, cholelithiasis, short bowel syndrome, disturbance of hepatobiliary circulation, lack of enteral nutrition, shortage of some nutrients (proteins, essential fatty acids, choline, glycine, taurine, carnitine, etc.), and toxicity of components within the nutrition mixture itself (glucose, phytosterols, manganese, aluminium, etc.). Recently, an increasing number of studies have provided evidence that some of these factors are directly or indirectly associated with microbial dysbiosis in the intestine. In this review, we focus on PN-induced changes in the taxonomic and functional composition of the microbiome. We also discuss immune cell and microbial crosstalk during parenteral nutrition, and the implications for the onset and progression of PNALD. Finally, we provide an overview of recent advances in the therapeutic utilisation of pro- and prebiotics for the mitigation of PN-associated liver complications.

Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study

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Huang Hsiu-Hua

2012-05-01

Full Text Available Abstract Background Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. Methods One hundred and eight critically ill patients were grouped as “less severe” and “more severe” for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding, length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB, and 24-h urinary urea nitrogen data were collected over 21 days. Results There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036 and prealbumin (p = 0.014 but worsened NB (p = 0.01, more feeding complications (p = 0.005, and prolonged ICU stays (p = 0.005 compared to their late feeding counterparts. Conclusions There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality

Continuous elemental enteral alimentation in the treatment of children and adolescents with Crohn's disease.

Science.gov (United States)

Morin, C L; Roulet, M; Roy, C C; Weber, A; Lapointe, N

1982-01-01

Ten pediatric patients, aged 8.5-19 years, with active symptomatic Crohn's disease, received a three-week period of continuous elemental enteral alimentation with no other form of treatment. All patients in this study were selected according to the following criteria, which were applied consecutively: (1) newly diagnosed patients with no previous treatment for Crohn's disease, (2) disease activity index over 200, and (3) no complication requiring surgery. All patients experienced a clinical remission and improved their immunologic and nutritional status during the elemental enteral alimentation. The mean disease activity index for the whole group was 307.0 +/- 23.6 (range: 203 to 413) before and 69.2 +/- 11.4 (range: 15 to 114) after the feeding period. Significant increases in body weight, triceps skinfold, mid-arm circumference, serum transferrin and mean percentage of T lymphocytes were also observed. Following cessation of enteral alimentation, a small declining dose of prednisone was used during a one-year follow-up period. Eight of the ten patients were still in clinical remission three months after the feeding period and their nutritional status had continued to improve during that period of time.

Terms, concepts and definitions in clinical artificial nutrition. The ConT-SEEN Project.

Science.gov (United States)

Del Olmo García, María Dolores; Ocón Bretón, Julia; Álvarez Hernández, Julia; Ballesteros Pomar, María Dolores; Botella Romero, Francisco; Bretón Lesmes, Irene; de Luis Román, Daniel; Luengo Pérez, Luis Miguel; Martínez Olmos, Miguel Ángel; Olveira Fuster, Gabriel

2018-01-01

Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Etiopathogenesis of cataract: An appraisal

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Varun B Gupta

2014-01-01

Full Text Available Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc., traumatic, complicated (inflammatory and degenerative diseases of eye, metabolic (diabetes, galactosemia etc., toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc. are implicated as significant risk factors in the development of cataract.

Energy intake and sources of nutritional support in patients with head and neck cancer--a randomised longitudinal study.

Science.gov (United States)

Silander, E; Jacobsson, I; Bertéus-Forslund, H; Hammerlid, E

2013-01-01

Malnutrition decreases the cancer patient's ability to manage treatment, affects quality of life and survival, and is common among head and neck (HN) cancer patients due to the tumour location and the treatment received. In this study, advanced HN cancer patients were included and followed during 2 years in order to measure their energy intake, choice of energy sources and to assess problems with dysphagia. The main purpose was to explore when and for how long the patients had dysphagia and lost weight due to insufficient intake and if having a PEG (percutaneous endoscopic gastrostomy) in place for enteral nutrition made a difference. One hundred thirty-four patients were included and randomised to either a prophylactic PEG for early enteral feeding or nutritional care according to clinical praxis. At seven time points weight, dysphagia and energy intake (assessed as oral, nutritional supplements, enteral and parenteral) were measured. Both groups lost weight the first six months due to insufficient energy intake and used enteral nutrition as their main intake source; no significant differences between groups were found. Problems with dysphagia were vast during the 6 months. At the 6-, 12- and 24-month follow-ups both groups reached estimated energy requirements and weight loss ceased. Oral intake was the major energy source after 1 year. HN cancer patients need nutritional support and enteral feeding for a long time period during and after treatment due to insufficient energy intake. A prophylactic PEG did not significantly improve the enteral intake probably due to treatment side effects.

Fibras solúveis e insolúveis de verduras, tubérculos e canela para uso em nutrição clínica Soluble and insoluble fibres of vegetables, tubers and cinnamon for use in enteral nutrition

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Edma Maria de Araújo

2009-06-01

Full Text Available Dietas enterais com alimentos convencionais são usadas para obter individualização e menor custo. No entanto, para melhorar o teor de fibras alimentares, o valor nutritivo e a confiabilidade, mais estudos são necessários. A proposta desse estudo foi estudar fontes de fibra alimentar de abóbora, agrião, canela em pó, couve-flor, inhame e tomate, para uso em nutrição enteral ou suplemento nutricional oral. Esses alimentos foram escolhidos por conter fibras alimentares e outros elementos considerados funcionais (isotiocianatos, indóis, licopeno, carotenoides, clorofila. Foram formuladas preparações com os alimentos em solução de água e adicionadas a uma formulação enteral domiciliar. Foram determinadas fibras solúvel e insolúvel, a composição centesimal dos alimentos e a atividade de água das formulações. Os alimentos foram acrescentados à formulação enteral domiciliar em quantidades de 100 g/2000 kcal/2 L e à água 150 g/2000kcal/2 L. Essas quantidades equivalem a duas porções diárias de cada alimento. A maior quantidade de fibra alimentar (base úmida foi de canela (50,11%, sendo o teor dos outros alimentos: abóbora 1,76%; agrião 0,85%; couve-flor 1,51%; inhame 1,56%; e tomate 1,00%. Os valores de atividades de água ficaram entre 0,988 e 0,999, indicando que as dietas são suscetíveis à contaminação microbiana, sendo mais seguro consumir essas dietas imediatamente após o preparo.Enteral diets containing conventional foods are used to reduce costs and obtain individualization. However, more studies are required to improve their dietary fibre content, the nutritive value, and reliability. This study proposed to study the dietary fibres of different vegetables and spices such as pumpkin, watercress, powdered cinnamon, cauliflower, yam, and tomato for use in enteral nutrition or in oral nutritional supplements. These foods were chosen since they contain dietary fibres and other elements considered to be

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome.

Science.gov (United States)

Sparks, Eric A; Khan, Faraz A; Fisher, Jeremy G; Fullerton, Brenna S; Hall, Amber; Raphael, Bram P; Duggan, Christopher; Modi, Biren P; Jaksic, Tom

2016-01-01

Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC. Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient. Median age at PN onset was 0 weeks [IQR 0-0]. Median residual small bowel length was 33.5 cm [IQR 20-70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2-38.4]months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Fig. 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Fig. 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (pChildren with SBS because of NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support. Copyright © 2016 Elsevier Inc. All rights reserved.

Using functional analysis in archival appraisal a practical and effective alternative to traditional appraisal methodologies

CERN Document Server

Robyns, Marcus C

2014-01-01

In an age of scarcity and the challenge of electronic records, can archivists and records managers continue to rely upon traditional methodology essentially unchanged since the early 1950s? Using Functional Analysis in Archival Appraisal: A Practical and Effective Alternative to Traditional Appraisal Methodologies shows how archivists in other countries are already using functional analysis, which offers a better, more effective, and imminently more practical alternative to traditional appraisal methodologies that rely upon an analysis of the records themselves.

Social appraisal influences recognition of emotions.

Science.gov (United States)

Mumenthaler, Christian; Sander, David

2012-06-01

The notion of social appraisal emphasizes the importance of a social dimension in appraisal theories of emotion by proposing that the way an individual appraises an event is influenced by the way other individuals appraise and feel about the same event. This study directly tested this proposal by asking participants to recognize dynamic facial expressions of emotion (fear, happiness, or anger in Experiment 1; fear, happiness, anger, or neutral in Experiment 2) in a target face presented at the center of a screen while a contextual face, which appeared simultaneously in the periphery of the screen, expressed an emotion (fear, happiness, anger) or not (neutral) and either looked at the target face or not. We manipulated gaze direction to be able to distinguish between a mere contextual effect (gaze away from both the target face and the participant) and a specific social appraisal effect (gaze toward the target face). Results of both experiments provided evidence for a social appraisal effect in emotion recognition, which differed from the mere effect of contextual information: Whereas facial expressions were identical in both conditions, the direction of the gaze of the contextual face influenced emotion recognition. Social appraisal facilitated the recognition of anger, happiness, and fear when the contextual face expressed the same emotion. This facilitation was stronger than the mere contextual effect. Social appraisal also allowed better recognition of fear when the contextual face expressed anger and better recognition of anger when the contextual face expressed fear. 2012 APA, all rights reserved

9 CFR 50.9 - Appraisals.

Science.gov (United States)

2010-01-01

... part must be appraised at their fair market value by an appraiser selected by APHIS. APHIS may decline... veterinarian in charge may grant a reasonable time for the presentation of their registration papers. [67 FR...

Identification of quality indicators for the nutritional management of adult hospitalized patients by a modified Delphi process.

Science.gov (United States)

Verbanck, L; De Waele, J; Duysburgh, I; Van Looy, L; Ysebaert, D; Merckx, L; Ferdinande, P

2015-01-01

The aim of this study was to identify quality indicators (QI) that measure or evaluate the quality of nutritional management of the adult hospitalized patient irrespective of the primary disease or surgical condition. During a modified Delphi procedure consisting of three rounds a 48 member expert panel selected quality indicators applicable to the subject focusing on validity and feasibility from a list of 89 candidate indicators, retrieved from the literature and completed by expert opinion. The following top ten of QIs were selected (weight between brackets): (1) Priority use of enteral route in the absence of contra indications (.95); (2) Patients with malnutrition (risk) receive a nutrition care plan or Nutritional Support (NS) (.935); (3) The hospital has a formulary on enteral formulas, parenteral nutrition (PN) solutions and nutritional supplements (.93); (4) The hospital has a designated nutrition support service (or team) (.922); (5) The hospital has written policies and procedures for the provision of nutrition support therapy (.9); (6) In hospitalized patients on PN the plasma triglycerides are checked weekly (.894); (7) Presence of a protocol for enteral drug administration through a feeding tube (.885); (8) Frequency of periodic reassessment of patients on NS (.883); (9) Enteral and PN orders are regularly revised and adjusted (daily/weekly/twice a week)(.88); (10) There is a hospital wide consensus on the screening method(s) for malnutrition (.88). Using a three round modified Delphi approach a list of ten best scoring QIs for the management of the adult hospitalized patient was established.

[Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report].

Science.gov (United States)

Camblor-Álvarez, Miguel; Ocón-Bretón, María Julia; Luengo-Pérez, Luis Miguel; Viruzuela, Juan Antonio; Sendrós-Maroño, María José; Cervera-Peris, Mercedes; Grande, Enrique; Álvarez-Hernández, Julia; Jiménez-Fonseca, Paula

2018-01-10

Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel's criteria, could generate greater controversy or doubt. Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer Patients.

FEATURES OF INTENSIVE NUTRITIONAL SUPPORT OF PREMATURE INFANTS IN INTENSIVE CARE UNIT (PART 1

Directory of Open Access Journals (Sweden)

K.V. Romanenko

2011-01-01

Full Text Available The article presents the modern approaches to preterm infants feeding, principles of parenteral and enteral nutrition. The importance of adequate control of deficit status in preterm infants at different periods of developmental care is marked. Arguments for using the enriched milk or specialized formulas for prematurity during the in-clinic and out-clinic periods of care are provided.Key words: premature infants, enteral nutrition, formulas for premature infants, breast milk, breast milk enriches.

Core Data Necessary for Reporting Clinical Trials on Nutrition in Infancy

NARCIS (Netherlands)

Koletzko, Berthold; Fewtrell, Mary; Gibson, Robert; van Goudoever, Johannes B.; Hernell, Olle; Shamir, Raanan; Szajewska, Hania

2015-01-01

This paper presents an updated and revised summary of the 'core data set' that has been proposed to be recorded and reported in all clinical trials on infant nutrition by the recently formed Consensus Group on Outcome Measures Made in Paediatric Enteral Nutrition Clinical Trials (COMMENT). This core

Nutritional modulation of the gut microbiota and immune system in preterm neonates susceptible to necrotizing enterocolitis

DEFF Research Database (Denmark)

Siggers, Richard H.; Siggers, Jayda; Thymann, Thomas

2011-01-01

on the nutritional, microbial and immunological interactions during the early feeding-induced mucosal dysfunction and later NEC development. We show that introduction of suboptimal enteral formula diets, coupled with parenteral nutrition, predispose to disease, while advancing amounts of mother's milk from birth...... (particularly colostrum) protects against disease. Hence, the transition from parenteral to enteral nutrition shortly after birth plays a pivotal role to secure gut growth, digestive maturation and an appropriate response to bacterial colonization in the sensitive gut of preterm neonates.......The gastrointestinal inflammatory disorder, necrotizing enterocolitis (NEC), is among the most serious diseases for preterm neonates. Nutritional, microbiological and immunological dysfunctions all play a role in disease progression but the relationship among these determinants is not understood...

Enteric glia.

Science.gov (United States)

Rühl, A; Nasser, Y; Sharkey, K A

2004-04-01

The enteric nervous system is composed of both enteric neurones and enteric glia. Enteric glial cells were first described by Dogiel and are now known to outnumber neurones approximately 4 : 1. In the past, these cells were assumed to subserve a largely supportive role; however, recent evidence indicates that enteric glial cells may play a more active role in the control of gut function. In transgenic mouse models, where enteric glial cells are selectively ablated, the loss of glia results in intestinal inflammation and disruption of the epithelial barrier. Enteric glia are activated specifically by inflammatory insults and may contribute actively to inflammatory pathology via antigen presentation and cytokine synthesis. Enteric glia also express receptors for neurotransmitters and so may serve as intermediaries in enteric neurotransmission. Thus, enteric glia may serve as a link between the nervous and immune systems of the gut and may also have an important role in maintaining the integrity of the mucosal barrier and in other aspects of intestinal homeostasis.

Early and intensive nutritional strategy combining parenteral and enteral feeding promotes neurodevelopment and growth at 18months of corrected age and 3years of age in extremely low birth weight infants.

Science.gov (United States)

Ohnishi, Satoshi; Ichiba, Hiroyuki; Tanaka, Yuko; Harada, Sayaka; Matsumura, Hisako; Kan, Ayako; Asada, Yuki; Shintaku, Haruo

2016-09-01

To evaluate whether aggressive nutrition can improve long-term neurodevelopmental outcomes and growth in extremely low birth weight (ELBW) infants born appropriate for gestational age (AGA). This single-center cohort study included 137 ELBW AGA infants born in two epochs. The first group received standard nutrition (SN; n=79) consisting of amino acids started at 0.5g/kg/day on Day 4 of life and increased to 1.0g/kg/day. The second aggressive nutrition (AN) group received amino acids started at 1.5-2.0g/kg/day within 24h of life and increased to 3.5g/kg/day. Parenteral and enteral feedings were combined in both groups. Neurodevelopmental outcomes by the Kyoto Scale of Psychological Development and growth were followed up to 18months of corrected age or 3years of age and compared by univariate and multivariate analyses. Baseline characteristics were similar between the two groups. At 3years of age, AN children had a significantly greater mean value of head circumference, but not length or weight, than SN children (49.1 vs 48.0cm, p=0.014). The cognitive-adaptive (C-A) score in the AN group was also significantly higher than that in the SN group (98.3 vs 91.9 at 18months, p=0.039 and 89.5 vs 83.1 at 3years, p=0.047). AN infants born ≥26weeks of gestation were less likely to develop borderline disability in C-A, language-social and overall developmental scores compared to gestational age-matched SN infants. Parenteral and enteral AN after birth improved the long-term cognitive neurodevelopment in ELBW AGA infants, especially in those born ≥26weeks of gestational age, however results need to be confirmed in a larger, multi-site randomized trial. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Improvement in Parenteral Nutrition-Associated Cholestasis With the Use of Omegaven in an Infant With Short Bowel Syndrome.

Science.gov (United States)

Strang, Brian J; Reddix, Bruce A; Wolk, Robert A

2016-10-01

Parenteral nutrition-associated cholestasis (PNAC) and liver disease have been associated with soybean oil-based intravenous fat emulsions (IVFEs). The benefit of fish oil-based IVFEs in the reversal of parenteral nutrition (PN)-associated liver damage includes allowing for longer PN duration without immediate need for bowel or liver transplantation. The present case involves an infant born with short bowel syndrome (SBS) requiring long-term PN with development of PNAC and subsequent administration of a fish oil-based IVFE. An infant born with SBS was initiated on PN and enteral feeds. After failed enteral progression, bowel lengthening by serial transverse enteroplasty (STEP) resulted in postoperative ileus with delayed enteral feeding for 4 weeks. The administration of long-term PN led to development of PNAC, resulting in initiation of a fish oil-based IVFE. After 4 months, the cholestasis had resolved. Despite the STEP, at 16 months, the child required bowel tapering due to inability to advance enteral feeding. Fish oil-based IVFE was effectively used to reverse PNAC in a child with SBS. Despite early STEP, the patient was not able to tolerate enteral feedings and required bowel tapering. This case illustrates that early surgical intervention did not allow for improved feed tolerance. This resulted in a significant period without enteral nutrition, leading to development of cholestasis. The use of fish oil-based IVFE may permit a longer duration of PN administration without the development of cholestasis or liver disease, allowing for longer time for bowel adaptation prior to the need for surgical intervention. © 2016 American Society for Parenteral and Enteral Nutrition.

Assessment of nutritional status in cancer patients in Osijek health area center.

Science.gov (United States)

Ebling, Barbara; Brumnić, Vesna; Rendić-Miocević, Zrinka; Gmajnić, Rudika; Pribić, Sanda; Juretić, Antonio; Ebling, Zdravko; Muha, Ivana

2014-03-01

The aim of this research was to perform the nutritional screening and clinical assessment of malnutrition and of cachexia as well as the need for enteral nutritional support. We used an international questionnaire for nutrition screening and clinical assessment of malnutrition. 103 cancer patients participated in the research. The results indicate that 80patients (78%) have recently unintentionally lost weight in the last six months. Of those 80 patients 12 (15%) have lost more than 15 kilograms. Three patients (3%) suffer from hunger because of their inability to eat. Presence of multiple (3 or more) symptoms (nausea, vomiting, diarrhea or anorexia) was reported by 11 patients (11%). Severe work dysfunction was found in 28 patients (27%). 14 patients (14%) experience significant loss of musculature (musculus quadriceps femoris, musculus deltoideus). The obtained results indicate that 15patients (14%) are severely, and 39 patients (38%) are moderately undernourished. This survey confirmed the significance of nutritional screening in cancer patients, as it detected 30 patients (29%) who required introduction of enteral nutrition.

Appraisal of family doctors: an evaluation study.

NARCIS (Netherlands)

Lewis, M.I.; Elwyn, G.; Wood, F.

2003-01-01

BACKGROUND: Appraisal has evolved to become a key component of workforce management. However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes. AIMS: To evaluate the

Nutritional support as an adjunct to radiation therapy

International Nuclear Information System (INIS)

Donaldson, S.S.

1984-01-01

Patients with malignancies which are treated with therapeutic radiation are at risk for nutritional problems, both from their underlying malignancy as well as from their treatment. These effects may be acute or chronic and relate to the site of the tumor and regions irradiated. There is a large experience with nutritional intervention in irradiated patients, including oral feedings and enteral and parenteral nutritional support. The indications for the specific administration of nutritional support during radiotherapy depend on the nutritional status of the patient and the area irradiated, as well as the individual prognosis. Patients who are malnourished at the time of treatment are most likely to profit from nutritional intervention. To date, prospective randomized trials of nutritional support in patients undergoing radiotherapy fail to show a benefit of routine adjuvant nutritional intervention in terms of improved response and tolerance to treatment, improved local control or survival rates, or reduction of complications from therapy

Managing hyperglycaemia in patients with diabetes on enteral nutrition: the role of a specialized diabetes team.

Science.gov (United States)

Wong, V W; Manoharan, M; Mak, M

2014-12-01

Hyperglycaemia is commonly observed in patients with diabetes mellitus (DM) while receiving enteral nutrition (EN) in hospital, and hyperglycaemia has been shown to be associated with poor clinical outcomes. The aim of this study was to assess the glycaemic status of patients with DM who received EN during hospital admission and evaluate the impact of intervention by a specialist diabetes team (SDT) on glycaemic control and clinical outcomes of these patients. A retrospective review of patients with DM who required EN during hospital admission was conducted. We compared patient characteristics, glycaemic profile and clinical outcomes between patients who were managed by SDT and those who were managed by the admitting team. Seventy-four patients with DM on EN were included in this study, of whom 27 were managed by SDT while on EN. Compared with patients managed by the admitting team, those who were reviewed by SDT had better glycaemic control during the period of EN as well as during the 24 h after EN was ceased. These patients also had shorter length-of-stay in hospital and lower in-patient mortality. Our findings confirmed that there was a role for SDT in managing patients with DM who received EN during their hospital admission. These patients had improved glycaemic control while receiving EN and had better clinical outcomes. Further prospective studies will be required to validate the findings of this study.

Lysine requirement of the enterally fed term infant in the first month of life

NARCIS (Netherlands)

Huang, L.; Hogewind-Schoonenboom, J.E.; de Groof, F.; Twisk, J.W.R.; Voortman, G.J.; Dorst, K.; Schierbeek, H.; Boehm, G.; Huang, Y.; Chen, C.; van Goudoever, J.B.

2011-01-01

Background: Infant nutrition has a major impact on child growth and functional development. Low and high intakes of protein or amino acids could have a detrimental effect. Objective: The objective of the study was to determine the lysine requirement of enterally fed term neonates by using the

A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition programs

NARCIS (Netherlands)

Dongen, J.M. van; Proper, K.I.; Wier, M.F. van; Beek, A.J. van der; Bongers, P.M.; Mechelen, W. van; Tulder, M.W. van

2012-01-01

Objective The aim of this study was to appraise and summarize the evidence on the cost-effectiveness of worksite physical activity and/or nutrition programs. Methods We searched EMBASE, MEDLINE, SportDiscus, PsycInfo, NIOSHTIC-2, NHSEED, HTA, and Econlit for studies published up to 14 January 2011.

Preventing hospital malnutrition: a survey on nutritional policies in an Italian University Hospital.

Science.gov (United States)

Annetta, M G; Pittiruti, M; De Rosa, S; Franchi, P; Pintaudi, G; Caricato, A; Antonelli, M

2015-11-01

A proper strategy for fighting hospital malnutrition should include nutritional screening of all hospitalized patients, adequate utilization of the Hospital facilities - such as Clinical Nutrition Services or Nutrition Teams - and an adequate algorithm for the adoption of proper nutrition support (oral, enteral or parenteral) with proper timing. The main aim of the present study was to investigate the current policies of different non-intensive wards of our institution (a 1100 beds University Hospital) in terms of prevention of hospital malnutrition. We conducted a one-day survey to verify the current policies of nutritional screening and the indication to nutritional support in adult patients, interviewing nurses and physicians of our non-intensive hospital wards. A total of 29 wards were considered, which sum up to 755 hospitalized patients. We found that nutritional screening at admission is routinely assessed only in 41% of wards and that oral nutrient intake is controlled regularly only in 72%. Indication to clinical nutrition support and specifically to artificial nutrition is not consistent with the current international guidelines. Only 14% of patients were receiving artificial nutrition at the moment of the survey and the majority of them were given parenteral nutrition rather than enteral feeding. Our survey confirmed that in large hospitals the main barriers to the fight against hospital malnutrition are the lack of knowledge and/or commitment by nurses and physicians as well as the lack of well-defined hospital policies on early nutritional screening, surveillance of nutritional status and indication to nutrition support.

Estudo de fibras alimentares em frutas e hortaliças para uso em nutrição enteral ou oral Study of dietary fibre in fruits and vegetables for use in oral or enteral diets

Directory of Open Access Journals (Sweden)

Edma Maria de Araújo

2010-03-01

Full Text Available Dietas enterais com alimentos convencionais são usadas em nutrição domiciliar para fornecer macronutrientes, obter dietas individualizadas e de menor custo. O objetivo deste trabalho foi estudar frutas e hortaliças (alface, berinjela, cenoura, chicória, goiaba e tamarindo como fontes de fibras alimentares solúveis e insolúveis para serem usadas em nutrição enteral ou suplemento nutricional oral. As hortaliças e frutas foram adicionadas a uma formulação enteral domiciliar e também preparadas em solução com água. Foram determinadas a composição centesimal, as fibras solúveis e insolúveis dos alimentos, a atividade de água e o pH das formulações. Foram realizados testes de gotejamento das formulações com os alimentos experimentais. A melhor proporção de alimento/dieta enteral domiciliar foi de 100 g/2 L para dieta enteral e de 150 g/2 L para suplemento nutricional oral (ingestão por boca. As quantidades de cada alimento adicionadas à formulação enteral equivalem a duas porções (100 g diárias de cada alimento para 2 L e 2000 kcal. A maior contribuição para aumentar a quantidade de fibras foi da goiaba e a menor, da berinjela. Os valores de atividade de água ficaram entre 0,95 e 1,00, indicando que as dietas são susceptíveis à contaminação microbiana. Nessas condições, devem ser consumidas imediatamente após o preparo.Enteral diets based on conventional foods are used in domestic nutritional therapy to provide macronutrients, obtain individualised diets and to lower costs. Eggplant, carrot, chicory, lettuce, guava and tamarind were studied as sources of soluble and insoluble fibers for use in enteral diets or as oral nutritional supplements, added to a domestic enteral formulation and also prepared in aqueous solution. The following physical-chemical characteristics were determined: soluble and insoluble fibers, proximate composition, pH and water activity. Drip tests were carried out with the formulas

A psychometric appraisal of the DREEM

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Hammond Sean M

2012-01-01

Full Text Available Abstract Background The quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM. Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device. Methods 239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed. Results Whilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89, subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Fleming's indices shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question. Conclusions There has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the

A psychometric appraisal of the DREEM

LENUS (Irish Health Repository)

Hammond, Sean M

2012-01-12

Abstract Background The quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM). Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device. Methods 239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed. Results Whilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89), subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Fleming\\'s indices) shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question. Conclusions There has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the device in future

HOW APPRAISERS DEVELOP FAIR VALUE

Directory of Open Access Journals (Sweden)

MIROSLAV ŠKODA

2012-01-01

Full Text Available Management is responsible for its own financial decisions. If we take into account, that fair value concept was shown in financial crisis as something that does not work anymore in this way; there is a big need to develop it for the future. Non-professional readers of financial statements believe, however, that company financials are the work of the public accounting firm that had signed the audit certificate. The main reason for bringing this point up is that when companies disclose Fair Value (FV information in their financial statements, they are taking responsibility for the values disclosed. Management may often be encouraged to utilize the services of an outside professional, but at the end of the day, the outside appraiser is a hired gun. Although the appraiser has to take responsibility for his own work, hiring the appraiser does not absolve management of its ultimate responsibility. The obverse of this is also true. Management does not have to hire the appraiser to develop any fair value disclosures made in the financial statements. Developing FV information is not recommended as a do-it yourself undertaking, there is nothing in Generally Accepted Accounting Principles (GAAP or Securities Exchange Commission (SEC regulations, however, that requires an outside appraiser.

Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

Science.gov (United States)

Brennan, Ann-Marie; Fenton, Sarah; Murphy, Brendan P.

2018-01-01

The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase. PMID:29393903

Temporal Trends in the Use of Parenteral Nutrition in Critically Ill Patients

Science.gov (United States)

Kahn, Jeremy M.; Wunsch, Hannah

2014-01-01

Background: Clinical practice guidelines recommend enteral over parenteral nutrition in critical illness and do not recommend early initiation. Few data are available on parenteral nutrition use or timing of initiation in the ICU or how this use may have changed over time. Methods: We used the Project IMPACT database to evaluate temporal trends in parenteral nutrition use (total and partial parenteral nutrition and lipid supplementation) and timing of initiation in adult ICU admissions from 2001 to 2008. We used χ2 tests and analysis of variance to examine characteristics of patients receiving parenteral nutrition and multilevel multivariate logistic regression models to assess parenteral nutrition use over time, in all patients and in specific subgroups. Results: Of 337,442 patients, 20,913 (6.2%) received parenteral nutrition. Adjusting for patient characteristics, the use of parenteral nutrition decreased modestly over time (adjusted probability, 7.2% in 2001-2002 vs 5.5% in 2007-2008, P nutrition use increased simultaneously (adjusted probability, 11.5% in 2001-2002 vs 15.3% in 2007-2008, P parenteral nutrition declined most rapidly in emergent surgical patients, patients with moderate illness severity, patients in the surgical ICU, and patients admitted to an academic facility (P ≤ .01 for all interactions with year). When used, parenteral nutrition was initiated a median of 2 days (interquartile range, 1-3), after ICU admission and > 90% of patients had parenteral nutrition initiated within 7 days; timing of initiation of parenteral nutrition did not change from 2001 to 2008. Conclusions: Use of parenteral nutrition in US ICUs declined from 2001 through 2008 in all patients and in all examined subgroups, with the majority of parenteral nutrition initiated within the first 7 days in ICU; enteral nutrition use coincidently increased over the same time period. PMID:24233390

Parenteral nutrition in malnourished patients; Parenteralna vyziva u malnutricnych pacientov

Energy Technology Data Exchange (ETDEWEB)

Lichvarova, I. [OAIM, Narodny onkologicky ustav, Bratislava (Slovakia)

2011-07-01

Parenteral nutrition became a routine therapeutic option in malnourished patients, if conventional nutritional enteral support is not effective. Cachexia and malnutrition prolong the wound healing, contribute to immunosuppression, increase morbidity and the cost of treatment. Using of a malnutrition protocol as a screening tool is necessary to sort out malnourished patients. Parenteral nutrition is therefore an important part of the multimodal therapy and from the medical and the ethical point of view is a great mistake not to feed a patient. (author)

Analysis of Appraising Agricultural Intangible Asset Value by Cost Method

OpenAIRE

Li, Xiao-Juan

2010-01-01

On the basis of describing the connotation of agricultural intangible asset and cost method, the technical ideas of appraising by cost method are introduced. The article analyzes the advantages (simple appraisal principle and easy to understand and grasp; overall consideration of various factors related to appraisal result value) and disadvantages (high appraisal cost; difficult to appraise and grasp various appraisal factors) of appraising by cost method. The article also summarizes the prec...

The appraisal rationalisation of real estate expertise

Directory of Open Access Journals (Sweden)

Marina Ciuna

2013-12-01

Full Text Available The Italian appraisal practice is characterized by valuations developed in subjective opinions formulated by the valuers, according to the experience and the competence rather than on the survey of the market data of comparable properties. This practice makes up for the lack of information on the real estate market and to the consequent absence of systematic collections of market data. This tradition is in the cadastral appraisal for the rural (1886 and urban properties (1939. The assessed income is appraised for a representative property and wide to all the other properties with arbitrary scores (pure number. The assessed value is derived from the income with fixed multipliers. The reform of the cadastral appraisals (2013 provides the employment of predetermined statistic functions rather than the automated valuation models applied in the mass appraisal. There are therefore ample spaces to rationalize the Italian valuations. For the market appraisal the process of rationalization is based on the comparison between the expertise and the market comparison approach. For the cadastral appraisal the process of rationalization is based on the statistic application to the fixed functions with the survey of a sample of market prices and the ratios study according to the valuation standards.

How Should an Effective Performance Appraisal Be: EFL Teachers’ Perspective

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Holi Ibrahim Holi Ali

2012-11-01

Full Text Available This study is set to examine EFL teachers’ perceptions, views about what makes an effective performance appraisal system by adopting a quantitative survey design for data collection. A total number of 45 college instructors in the Sultanate of Oman responded to survey on: how is an effective performance appraisal perceived by EFL teachers? How do teachers perceive their participation in developing the appraisal system? And how might the present performance appraisal practices be improved? The result reveals that staff participation in developing performance appraisal system and goals, feedback confidentiality, quality appraiser, quality of place and time of appraisal, appraiser-appraisee relationships, and developmental nature of performance appraisal would help in making effective appraisal and the overall PA effectiveness depends mostly on these factors. The result has a significant implication for improving the process of teacher performance appraisal in Oman and enriches the body knowledge of PA in general. The study puts forwards suggestions and recommendations for improving PA practices and exercises in EFL contexts.

The merits of measuring challenge and hindrance appraisals.

Science.gov (United States)

Searle, Ben J; Auton, Jaime C

2015-01-01

The challenge-hindrance framework has shown that challenge stressors (work characteristics associated with potential personal gain) tend to have positive outcomes, whereas hindrance stressors (those which obstruct goals) have negative outcomes. However, typical research methods assume that stressors allocated to these categories are appraised consistently by different people and across different situations. We validate new measures of challenge and hindrance appraisals and demonstrate their utility in stress research. We used a cross-sectional survey of American employees (Study 1, n = 333), a diary survey of Australian employees (Study 2, n = 241), and a survey of Australian college students whose performance was evaluated independently (Study 3, n = 350). Even after accounting for the effects of stressors, challenge and hindrance appraisals consistently explained unique variance in affective states, with indications that stressors have indirect effects via appraisals. Such effects were seen within- as well as between-participants (Study 2). Appraisals also had expected associations with specific coping behaviors (Study 1), while challenge appraisal was associated with task performance (Study 3). The scales of challenge and hindrance appraisals were psychometrically sound across multiple contexts. RESULTS highlight the merit of considering appraisal in stress research.

Optimizing Nutrition in Preterm Low Birth Weight Infants—Consensus Summary

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R. Kishore Kumar

2017-05-01

Full Text Available Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW infants. The following were the primary recommendations of the panel: (1 enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2 early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3 routine use of nasogastric tubes is not advisable; (4 preterm infants can be fed while on ventilator or continuous positive airway pressure; (5 routine evaluation of gastric residuals and abdominal girth should be avoided; (6 expressed breast milk (EBM is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7 EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8 standard fortification is effective and safe but does not fulfill the high protein needs; (9 use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10 optimizing weight gain in preterm infants prevents long-term cardiovascular complications

Appraisal patterns of envy and related emotions.

Science.gov (United States)

van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

2012-06-01

Envy is a frustrating emotion that arises from upward social comparison. Two studies investigated the appraisals that distinguish benign envy (aimed at improving one's own situation) from malicious envy (aimed at pulling down the superior other). Study 1 found that appraisals of deservingness and control potential differentiated both types of envy. We manipulated these appraisals in Study 2 and found that while both did not influence the intensity of envy, they did determine the type of envy that resulted. The more a situation was appraised as undeserved, the more participants experienced malicious envy. Benign envy was experienced more when the situation was not undeserved, and the most when the situation was appraised as both deserved and controllable. The current research also clarifies how the types of envy differ from the related emotions admiration and resentment.

Current practices in economic appraisal

NARCIS (Netherlands)

Mossink, J.C.M.

2000-01-01

By means of economic appraisal, the costs and the benefits of health, environment and safety management can be made clear, both at the national level and at the company level. As such it is a tool in advocating good practices. This paper explores the possibilities of economic appraisal for policy

The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review.

Science.gov (United States)

Gray, Selena; Carmichael, Laurence; Barton, Hugh; Mytton, Julie; Lease, Helen; Joynt, Jennifer

2011-11-24

Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries.The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes), lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury) more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Research is needed to assess (i) the degree to which statutory plan appraisal processes (SA in the UK) incorporate health; (ii) whether recommendations arising from health

The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

Directory of Open Access Journals (Sweden)

Gray Selena

2011-11-01

Full Text Available Abstract Background Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. Methods A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. Results A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries. The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes, lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Conclusion Research is needed to assess (i the degree to which statutory plan appraisal processes (SA in the UK

Appraisal of Transport Projects

DEFF Research Database (Denmark)

Jensen, Anders Vestergaard

and robustness measures have been elaborated, which examine the subjective part of the MCDA (in form of criteria weights) and its role in decision support making. For this purpose both deterministic and stochastic sensitivity analyses have been developed. In addition, the focus has been formulating a framework...... into account the interests and preferences of different stakeholders. These various interests and preferences have been revealed by the use of decision conferencing, which engage the stakeholders and provide a common platform for understanding the decision problem. Leading up to this framework, this thesis has......, as robustness of a recommended solution is major concern in the final steps of decision making. As mentioned, the appraisal of transport projects is a complex issues involving conflict of various interests and this calls for new approaches to the practice of appraisal. The presented appraisal framework...

Enteric Diseases of Poultry with Special Attention to Clostridium perfringens

Directory of Open Access Journals (Sweden)

Hafez Mohamed Hafez

2011-06-01

Full Text Available The enteric heath of growing poultry is imperative to success of the production. The basic role of poultry production is turning feed stuffs into meat. Any changes in this turning process, due to mechanical, chemical or biological disturbance of digestive system (enteric disorders is mostly accompanied with high economic losses due to poor performance, increased mortality rates and increased medication costs. The severity of clinical signs and course of the disorders are influenced several factors such as management, nutrition and the involved agent(s. Several pathogens (viruses, bacteria and parasites are incriminated as possible cause of enteric disorders either alone (mono-causal, in synergy with other micro-organisms (multi-causal, or with non-infectious causes such as feed and /or management related factors. In addition, excessive levels of mycotoxins and biogenic amines in feed lead to enteric disorders. Also factors such as high stocking density, poor litter conditions, poor hygiene and high ammonia level and other stressful situation may reduce the resistance of the birds and increases their susceptibility to infections. Under field conditions, however, under filed conditions it is difficult to determine whether the true cause of enteric disorders, is of infectious or non-infectious origin. In recent years and since the ban of use of antimicrobial growth promoters in several countries the incidence of intestinal disorders especially those caused by clostridial infection was drastically increased. The present review described in general the several factors involved in enteric disorders and summarized the available literatures about Clostridium perfringens infection in poultry.

APPRAISAL ANALYSIS IN FREEDOM WRITERS MOVIE

Directory of Open Access Journals (Sweden)

Nani Hidayati

2017-02-01

Full Text Available This study attempts to find out conveyed messages in the movie from the realization of the appraisal and narrative structure as well as to describe the use of the Appraisal System to express LaGravenese's (a Attitudes, (bEngagement & (c Graduation towards the main characters in Freedom Writers movie screenplay. Using both quantitative and qualitative descriptive approach for discourse appraisal system analysis, the result of this study reveals several messages of tolerance, earning respect and trust, honor diversity, and striving for success and trust from the realization of Appraisal and Narrative Structure either in the dialogues or monologues of Freedom Writers’ characters. The result from the Appraisal Devices realizing (a Attitudes reveals that LaGravenese likes to express characters’ negative emotion explicitly than implicitly. He likes to express characters’ negative capability than other kinds of Judgments. He appreciates the characters using more Negative Value which denotes that in his opinion, they see each other negatively. (bEngagement used in the screenplay describes that he emphasizes more on characters’ denial towards each other’s opinion and existence with the use of more Disclaim Heterogloss in the screenplay. (cGraduation used in the screenplay describes that the use of more Sharpening Focus indicates he emphasizes on characters’ category boundary more than scaling of intensity. Keywords: Appraisal Devices, Attitude, Engagement, and Graduation.

Quality Appraisal of Single-Subject Experimental Designs: An Overview and Comparison of Different Appraisal Tools

Science.gov (United States)

Wendt, Oliver; Miller, Bridget

2012-01-01

Critical appraisal of the research literature is an essential step in informing and implementing evidence-based practice. Quality appraisal tools that assess the methodological quality of experimental studies provide a means to identify the most rigorous research suitable for evidence-based decision-making. In single-subject experimental research,…

Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics.

Science.gov (United States)

Hiller, Lynn D; Shaw, Robert F; Fabri, Peter J

2017-11-01

Previous studies have demonstrated an association between malnutrition and poor outcomes. The primary objective of this study was to explore the difference in the composite end point of readmission rate or mortality rate between hospitalized veterans with and without malnutrition. This was a retrospective chart review comparing veterans with malnutrition based on a modified version of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus characteristics that used 5 of the 6 clinical characteristics to a matched control group of nonmalnourished veterans based on age, admitting service, and date of admission who were admitted between August 1, 2012, and December 1, 2014. Data were extracted from the medical record. Multivariate analysis was used to identify predictors of outcomes. In total, 404 patients were included in the final analysis. All end points were found to be statistically significant. The malnourished group was more likely to meet the composite end point (odds ratio [OR], 5.3), more likely to be readmitted within 30 days (OR, 3.4), more likely to die within 90 days of discharge (OR, 5.5), and more likely to have a length of stay >7 days (OR, 4.3) compared with the nonmalnourished group. Length of stay was significantly longer in the malnourished group, 9.80 (11.5) vs 4.38 (4.5) days. Malnutrition was an independent risk factor for readmission within 30 days or death within 90 days of discharge. Malnourished patients had higher rates of readmission, higher mortality rates, and longer lengths of stay and were more likely to be discharged to nursing homes.

Supplemental parenteral nutrition in critically ill patients: a study protocol for a phase II randomised controlled trial.

Science.gov (United States)

Ridley, Emma J; Davies, Andrew R; Parke, Rachael; Bailey, Michael; McArthur, Colin; Gillanders, Lyn; Cooper, David J; McGuinness, Shay

2015-12-24

Nutrition is one of the fundamentals of care provided to critically ill adults. The volume of enteral nutrition received, however, is often much less than prescribed due to multiple functional and process issues. To deliver the prescribed volume and correct the energy deficit associated with enteral nutrition alone, parenteral nutrition can be used in combination (termed "supplemental parenteral nutrition"), but benefits of this method have not been firmly established. A multi-centre, randomised, clinical trial is currently underway to determine if prescribed energy requirements can be provided to critically ill patients by using a supplemental parenteral nutrition strategy in the critically ill. This prospective, multi-centre, randomised, stratified, parallel-group, controlled, phase II trial aims to determine whether a supplemental parenteral nutrition strategy will reliably and safely increase energy intake when compared to usual care. The study will be conducted for 100 critically ill adults with at least one organ system failure and evidence of insufficient enteral intake from six intensive care units in Australia and New Zealand. Enrolled patients will be allocated to either a supplemental parenteral nutrition strategy for 7 days post randomisation or to usual care with enteral nutrition. The primary outcome will be the average energy amount delivered from nutrition therapy over the first 7 days of the study period. Secondary outcomes include protein delivery for 7 days post randomisation; total energy and protein delivery, antibiotic use and organ failure rates (up to 28 days); duration of ventilation, length of intensive care unit and hospital stay. At both intensive care unit and hospital discharge strength and health-related quality of life assessments will be undertaken. Study participants will be followed up for health-related quality of life, resource utilisation and survival at 90 and 180 days post randomisation (unless death occurs first). This trial

The Good Appraisal Toolkit for Primary Care Chambers Ruth et al The Good Appraisal Toolkit for Primary Care 189pp Radcliffe Publishing 9781857756029 1857756029.

Science.gov (United States)

2005-03-02

The principles and frameworks demonstrated in this book could be used in many other healthcare settings. The text is divided neatly into nine chapters and addresses practical issues such as being an effective appraiser, developing and demonstrating competence, linking appraisal with career development, and evaluation of the appraisal process. The comprehensive approach to all aspects of appraisal makes this a must-have book for all health professionals and managers undertaking appraisals. It should also appeal to clinical governance leads and individuals being appraised. There are excellent tips on how to prepare for appraisals and how to link this with reflection, lifelong learning, career direction, and so on. The book is well referenced and contains an appendix with useful examples for the appraiser.

Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness

Science.gov (United States)

Markowitz, Fred E.; Angell, Beth; Greenberg, Jan S.

2011-01-01

Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers' stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes…

Nutrition of preterm infants in relation to bronchopulmonary dysplasia

Directory of Open Access Journals (Sweden)

Tschirch Edda

2011-02-01

Full Text Available Background The pathogenesis of bronchopulmonary dysplasia (BPD is multifactorial. In addition to prenatal inflammation, postnatal malnutrition also affects lung development. Methods A retrospective study was performed to analyse during the first two weeks of life the total, enteral and parenteral nutrition of premature infants ( Results Ninety-five premature infants were analysed: 26 with BPD (27 ± 1 weeks and 69 without BPD (28 ± 1 weeks. There was no statistical significant difference in the total intake of fluids, calories, glucose or protein and weight gain per day in both groups. The risk of developing BPD was slightly increased in infants with cumulative caloric intake below the minimal requirement of 1230 kcal/kg and a cumulative protein intake below 43.5 g/kg. Furthermore, the risk of developing BPD was significantly higher when infants had a cumulative fluid intake above the recommended 1840 ml/kg. In infants who developed BPD, the enteral nutrition was significantly lower than in non-BPD infants [456 ml/kg (IQR 744, 235 vs. 685 (IQR 987, 511]. Infants who did not develop BPD reached 50% of total enteral feeding significantly faster [9.6 days vs. 11.5]. Conclusions Preterm infants developing BPD received less enteral feeding, even though it was well compensated by the parenteral nutrient supply. Data suggest that a critical minimal amount of enteral feeding is required to prevent development of BPD; however, a large prospective clinical study is needed to prove this assumption.

The appraisal of clinical guidelines in dentistry.

Science.gov (United States)

Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco

2009-01-01

To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

The System of Employee Appraisal in a Company

OpenAIRE

Vaverová, Lucie

2011-01-01

This bachelor study called "The System of Employee Appraisal in a Company" deals with a general subscription of a personal process "Employee appraisal". It describes the principles of the system of employee appraisal and also covers the conditions necessary for its efficiency and operation. The bachelor study is focused on the system of employee appraisal centrally implemented in company ČEZ, a. s. This system is analyzed and compared with generally stated theoretical principles. The study in...

Research report appraisal: how much understanding is enough?

Science.gov (United States)

Lipscomb, Martin

2014-07-01

When appraising research papers, how much understanding is enough? More specifically, in deciding whether research results can inform practice, do appraisers need to substantively understand how findings are derived or is it sufficient simply to grasp that suitable analytic techniques were chosen and used by researchers? The degree or depth of understanding that research appraisers need to attain before findings can legitimately/sensibly inform practice is underexplored. In this paper it is argued that, where knowledge/justified beliefs derived from research evidence prompt actions that materially affect patient care, appraisers have an epistemic duty to demand high (maximal) rather than low (minimal) levels of understanding regards finding derivation (i.e. appraisers have a duty to seek a superior epistemic situation). If this argument holds assumptions about appraiser competence/ability and the feasibility of current UK conceptions of evidence based practice are destabilized. © 2014 John Wiley & Sons Ltd.

Fecal energy losses in enterally fed intensive care patients: An explorative study using bomb calorimetry

NARCIS (Netherlands)

Strack van Schijndel, R.J.M.; Wierdsma, N.J.; van Heijningen, E.M.B.; Weijs, P.J.M.; de Groot, S.D.W.; Girbes, A.R.J.

2006-01-01

Background & Aims: Early enteral nutrition and tailored supply of nutrients have become standard in most of the intensive care units (ICU). So far little attention has been given to losses of energy in the stools. The purpose of this explorative study was to evaluate the energy losses of patients

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments.

Science.gov (United States)

Langer, Astrid

2012-08-16

Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies