WorldWideScience

Sample records for community-based outpatient parenteral

  1. Outpatient parenteral antibiotic therapy in Singapore.

    Science.gov (United States)

    Fisher, D A; Kurup, A; Lye, D; Tambyah, P A; Sulaiman, Z; Poon, E Y H; Lee, W; Kaur, V; Lim, P L

    2006-12-01

    Outpatient parenteral antibiotic therapy (OPAT) remains in its infancy in Singapore, with the first patients enrolled 4 years ago. Singapore's three largest hospitals, with over 3000 inpatient beds, now have designated and approved OPAT services. This study reviews the demographic, clinical and cost data of all patients enrolled in 2005 to facilitate benchmarking between services in Singapore and abroad and also to identify common needs for further development. In 2005, 225 OPAT enrollments in 208 different patients resulted in 4050 days of OPAT care. Orthopaedic diagnoses constituted 40% of admissions. Vancomycin was the most frequently used antibiotic (34%). The re-admission rate was 8.9%, but complications of OPAT care were only occasionally implicated. An estimated $207,200 was saved by patients despite there being significant financial disincentives to subsidised patients. OPAT is a safe, cost-efficient system that is becoming increasingly accepted in Singapore by patients, clinicians and management. Our three services have evolved independently into very similar practices. There is potential for further innovation, including outreach and carer-delivered dosing. However, major financial disincentives require review.

  2. Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity.

    Science.gov (United States)

    Fisher, Dale; Michaels, Jessica; Hase, Ryota; Zhang, Jing; Kataria, Sushila; Sim, Benedict; Tsang, Joseph Kay-Yan; Pollard, James; Chan, Monica; Swaminathan, Subramanian

    2017-04-01

    Healthcare facilities internationally have grown outpatient parenteral antibiotic administration services for the last few decades. The literature contains publications from dozens of countries describing systematized processes with specialist oversight and their levels of service provision and outcomes. Such descriptions are absent in the majority of Asian countries. We sought to elucidate the extent and nature of outpatient parenteral antibiotic therapy (OPAT) in Asia and to consider the ramifications and opportunities for improvement. Utilizing colleagues and their personal networks, we surveyed healthcare facilities across 17 countries in Asia to ascertain the current means (if any) of providing OPAT. In that survey we also sought to explore the capacity and interest of these facilities in developing systematized OPAT services. Responses were received from 171 different healthcare facilities from 17 countries. Most (97/171, 57%) stated that they administer outpatient parenteral antibiotics, but only 5 of 162 facilities (3%) outside of Singapore described comprehensive services with specialist oversight. There is very likely a large unrecognized problem of unchecked outpatient parenteral antibiotic administration in Asia. Developing comprehensive and systematized OPAT in Asia is needed as a priority in an environment in which the infectious diseases community is demanding broad stewardship approaches. There are nonetheless challenges in establishing and sustaining OPAT programmes. Local champions and leverage off identified local incentives and needs are key to regional advancement.

  3. Recommendations for outpatient parenteral antimicrobial therapy in Brazil

    OpenAIRE

    Oliveira, Priscila R.; Carvalho, Vladimir C.; Cimerman,Sergio; Lima,Ana Lucia Munhoz

    2017-01-01

    ABSTRACT A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to determine the recommendations for outpatient parenteral antimicrobial therapy (OPAT) in Brazil. The following aspects are covered in the document: organization of OPAT programs; patient evaluation and eligibility criteria, including clinical and sociocultural factors; diagnosis of eligibility; venous access and antimicrobial infusion devices; protocols for antimicrobial use and monitorin...

  4. Managing an outpatient parenteral antibiotic therapy team: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Halilovic J

    2014-06-01

    Full Text Available Jenana Halilovic,1 Cinda L Christensen,2 Hien H Nguyen31University of the Pacific Thomas J Long School of Pharmacy, Stockton, CA, USA; 2Department of Pharmaceutical Services, University of California, Davis Health System, Sacramento, CA, USA; 3Division of Infectious Diseases, Section of Hospital Medicine, University of California, Davis Health System, Sacramento, CA, USAAbstract: Outpatient parenteral antimicrobial therapy (OPAT programs should strive to deliver safe, cost effective, and high quality care. One of the keys to developing and sustaining a high quality OPAT program is to understand the common challenges or barriers to OPAT delivery. We review the most common challenges to starting and managing an OPAT program and give practical advice on addressing these issues.Keywords: OPAT, quality, safety, program management

  5. Current status in outpatient parenteral antimicrobial therapy: a practical view.

    Science.gov (United States)

    Candel, Francisco Javier; Julián-Jiménez, Agustin; González-Del Castillo, Juan

    2016-04-01

    Outpatient parenteral antimicrobial therapy (OPAT) programs are a current and widely spread trend in clinical practice because of it's a cost-effective option, it's associated with a greater comfort for the patient, a lower risk of nosocomial complications and an important cost saving for the health care system. OPAT is used for treating a wide range of infections, including skin and soft tissue infections, osteoarticular infections, bacteraemia, endocarditis and complex intra-abdominal and urinary tract infections, even in presence of multiresistant microorganisms. Correct choice of antimicrobial agent and adequate patient selection are crucial for reaching therapeutic success and avoiding readmissions, treatment prolongation or treatment-related toxicity. The optimal antimicrobial for OPAT must be highly effective, have a long half-life and an adequate spectrum of action. Ceftriaxone and teicoplanin are currently the most prescribed antibiotics for OPAT, though daptomycin and ertapenem are also on the rise, due to their high efficiency, safety and wide spectrum of action. Antibiotics that are stable at room temperature can be administered through a continuous perfusion, though self-administration is preferable although it requires training of the patient or the caregiver. Factors that are most frequently associated with OPAT failure include advanced age, recent hospitalization and isolation of multiresistant microorganisms.

  6. Utilization of community-based outpatient addiction treatment ...

    African Journals Online (AJOL)

    A field-based follow-up survey was administered to determine abstinence rates among clients who participated in treatment. Factors involved in recovery outcomes are discussed. Utilization of outpatient addictions treatment and retention in services increased over the three-year period, and field-based follow up with clients ...

  7. A Survey on Dementia Training Needs among Staff at Community-Based Outpatient Clinics

    Science.gov (United States)

    Adler, Geri; Lawrence, Briana M.; Ounpraseuth, Songthip T.; Asghar-Ali, Ali Abbas

    2015-01-01

    Dementia is a major public health concern. Educating health-care providers about dementia warning signs, diagnosis, and management is paramount to fostering clinical competence and improving patient outcomes. The objective of this project was to describe and identify educational and training needs of staff at community-based outpatient clinics…

  8. Telephone-Administered Cognitive Behavioral Therapy for Veterans Served by Community-Based Outpatient Clinics

    Science.gov (United States)

    Mohr, David C.; Carmody, Timothy; Erickson, Lauren; Jin, Ling; Leader, Julie

    2011-01-01

    Objective: Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Method: Eighty-five veterans…

  9. Outpatient parenteral antimicrobial therapy for surgery patients: A comparison with previous standard of care

    OpenAIRE

    Anjie Yang; Ron Fung; James Brunton; Linda Dresser

    2013-01-01

    BACKGROUND: Current literature reports that outpatient parenteral antimicrobial therapy (OPAT) programs improve cure rates, and reduce length of hospitalization and costs. OPAT programs are still relatively new in Canada.OBJECTIVE: To evaluate the benefits of an OPAT program initiated at a multispecialty tertiary care facility in Toronto, Ontario, compared with the previous standard of care.METHODS: The present retrospective observational study was conducted using data from a group of surgica...

  10. Ertapenem in outpatient parenteral antimicrobial therapy for complicated urinary tract infections.

    Science.gov (United States)

    Trad, Mohamad-Ali; Zhong, Lihua H; Llorin, Ryan M; Tan, Shire Yang; Chan, Monica; Archuleta, Sophia; Sulaiman, Zuraidah; Tam, Vincent H; Lye, David C; Fisher, Dale A

    2017-02-01

    Ertapenem is a broad-spectrum antibiotic that is increasingly being utilized. Its dosing convenience renders it suitable for outpatient therapy, and its pharmacokinetic characteristics favour its use against complicated urinary tract infections (cUTIs). Despite this, sufficient clinical data are lacking for its use against cUTIs in the outpatient setting. We assessed the microbiological and clinical cure rates associated with ertapenem treatment for cUTIs in two outpatient parenteral antimicrobial therapy (OPAT) departments. We undertook a prospective observational study of adult patients who received ertapenem for cUTIs between August 2010 and August 2014. Data on patient characteristics, clinical progress and microbiological results were collected and analysed. Sixty-one patients were enrolled. The median age was 59 years (range 24, 83) and 61% were male. The most common diagnoses were pyelonephritis (39%) and prostatitis (15%). The most common causative organism was Escherichia coli (67%). Extended-spectrum β-lactamase (ESBL)-producing organisms were detected in 72% of infections. Microbiological cure was achieved in 67% overall, and was less likely in those with Klebsiella pneumoniae infection (OR = 0.21 [95%CI: 0.05 to 0.85] p = 0.029). Clinical cure was observed in 92% of patients. In this study of treating cUTIs with ertapenem, we have demonstrated good clinical outcomes. A lower than expected microbiological cure rate was observed in those with Klebsiella pneumoniae infection.

  11. Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Marie Yan

    2016-01-01

    Full Text Available Outpatient parenteral antimicrobial therapy (OPAT is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%, osteoarticular infections (28%, and bacteremia (21%. The most frequently prescribed antimicrobials were ceftriaxone (21% and cefazolin (20%. Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

  12. PAs in orthopedics in the VHA's community-based outpatient clinics.

    Science.gov (United States)

    Reed, Daniel O; Hooker, Roderick S

    2017-04-01

    In the Veterans Health Administration (VHA) system, most orthopedic care takes place in the VA medical centers (VAMCs). Because most patients receiving orthopedic care were referred by adult medicine providers, more widely deploying physician assistants (PAs) in orthopedic medicine might help offset this workload. An orthopedic medicine demonstration project recruited, trained, and positioned PAs in community-based outpatient clinics (CBOCs) to improve access to care. The project involved surgeons at the Houston VAMC instructing five newly employed PAs in a wide range of orthopedic evaluation and management strategies before their assignment to a CBOC. An administrative assessment compared encounter data pre- and postproject (2012 and 2014) to determine if this strategy modified orthopedic workload and improved patient access to care. By 2014, orthopedic patient visit volume had increased 31%-10% at the VAMC and 21% at the five CBOCs. Overall, the five deployed PAs managed 28% of all orthopedic encounters spread over 1 year and only 3.2% of visits required VAMC referral for further evaluation or treatment. During the project, the total volume of patient visits increased throughout the Houston VAMC region but access to care for this specialty service also increased, with more veteran musculoskeletal care being met at the five CBOCs, off-loading visit demand centrally. The adaptability and flexibility of new roles has been identified as one of the defining characteristics of PAs. That the VHA can take advantage of this role malleability suggests that employing PAs is useful in meeting medical service needs of veterans.

  13. Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

    Directory of Open Access Journals (Sweden)

    Priscila Rosalba Oliveira

    2016-05-01

    Full Text Available Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42. Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies

  14. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    Science.gov (United States)

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  15. A national survey of infectious disease practitioners on their use of outpatient parenteral antimicrobial therapy (OPAT).

    Science.gov (United States)

    Muldoon, Eavan G; Switkowski, Karen; Tice, Alan; Snydman, David R; Allison, Geneve M

    2015-01-01

    The use of outpatient parenteral antimicrobial therapy (OPAT) is standard medical practice; however, significant heterogeneity in practice exists. We hypothesized that formal OPAT programs are associated with increased physician participation in patient safety activities. United States Infectious Disease (ID) physicians were contacted and asked to participate in an electronic survey from April through June 2012. Data were analyzed using SPSS version 20. In all, 3718 physicians were contacted and 316 (8.5%) responded. Respondents practice in 47 states; the majority (79%) practice adult ID, 11% pediatric ID, 10% a combination of the two. Sixty percent reported that ID consultation was not mandatory before OPAT, and 75% of these respondents thought it should be compulsory. The most common indications were osteomyelitis, prosthetic joint infections, and endocarditis, and the most common antibiotics were vancomycin, ceftriaxone, and ertapenem. Most respondents (59%) discharge patients with OPAT weekly, and have a median number of 11 OPAT patients (95% confidence interval (CI) 8.5-13.4). Half of respondents have a formal OPAT program. Fifty-two percent report no systematic method of communication between inpatient and outpatient physicians when patients are discharged with OPAT, 49% have no systematic method of lab tracking, and 34% have no method of ensuring patient adherence to clinic visits. All of these patient safety measures were more likely to be present in practice sites with formal OPAT programs (p < 0.001). Opportunities exist for improving OPAT monitoring and patient safety. Formal OPAT programs provide the framework for safe and effective care and are to be encouraged.

  16. Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain.

    Science.gov (United States)

    González-Ramallo, V J; Mirón-Rubio, M; Mujal, A; Estrada, O; Forné, C; Aragón, B; Rivera, A J

    2017-07-01

    The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  17. Outpatient parenteral antibiotic therapy in a renal transplant population: A single-center experience

    Directory of Open Access Journals (Sweden)

    Jade Harrison

    2015-01-01

    Full Text Available Outpatient parenteral antimicrobial therapy (OPAT is a well-established method in medical specialties. Its use in renal transplant recipients has not been thoroughly explored. No guidelines within this patient subset exist. This study describes OPAT outcomes within a UK teaching hospital renal transplant population. Renal function, mapped by estimated glomerular filtration rate (eGFR, and clinical response to infection were collected retrospectively. A total of 635 antimicrobial episodes were administered to nine renal transplant patients over 12 discrete OPAT courses during the study period. Eleven of 12 OPAT courses (91.67% produced a clinical improvement in infection. One course was terminated due to immunosuppressive-related neutropenia. No patient required admission due to failure of OPAT or adverse events. There was no significant change in graft function throughout the OPAT courses compared with baseline renal function (ANOVA, P = 0.06. One minor line infection was reported. This was treated conservatively and did not interrupt the OPAT. OPAT is safe and clinically effective in our renal transplant recipients with no significant deterioration in eGFR. The incidence of adverse events, specifically line complications, was lower in our population than those reported in the literature. Future work should develop OPAT guidelines designed for transplant recipients to outline the degree of monitoring required.

  18. Small-Town America's Despair: Infected Substance Users Needing Outpatient Parenteral Therapy and Risk Stratification.

    Science.gov (United States)

    Camsari, Ulas M; Libertin, Claudia R

    2017-08-18

    Background  An active intravenous substance use disorder is often the primary cause of infectious diseases in this population of users and creates a barrier to successful parenteral antimicrobial management. The dilemma is compounded by dramatically limited resources in small US towns. Methods This retrospective review from January 2014 through July 2016 aimed to develop a risk stratification approach to aid rural healthcare providers in determining who among patients with addictive disorders could safely be discharged for outpatient antimicrobial therapy with a peripherally inserted central catheter (PICC). Results The high-risk group had a greater likelihood of noncompliance with antimicrobial therapy completion, as well as subsequent illicit drug use during that time frame, compared with the moderate- and low-risk groups. The low-risk group and most of the moderate-risk group could be safely discharged into the community with PICC lines. Conclusions Key in the risk stratification proposal was identifying risk behaviors and determining their degree. Such information provides pivotal delineators in developing risk stratification criteria.

  19. An outcomes analysis of outpatient parenteral antibiotic therapy (OPAT) in a large Asian cohort.

    Science.gov (United States)

    Seetoh, Theresa; Lye, David C; Cook, Alex R; Archuleta, Sophia; Chan, Monica; Sulaiman, Zuraidah; Zhong, Lihua; Llorin, Ryan M; Balm, Michelle; Fisher, Dale

    2013-06-01

    Outpatient parenteral antibiotic therapy (OPAT) facilitates early discharge, easing demands on inpatient resources and allowing patients the opportunity to restore home life. In Singapore, two large hospitals established a common prospective database in 2006. This study presents an analysis of all enrolled cases over 6 years to consider factors potentially causing adverse outcomes. In this prospective observational study, patients' first OPAT episodes, from initiation to completion, re-admission or early cessation, were recorded and analysed using Cox regression to identify factors associated with clinical deterioration leading to unplanned hospital re-admission. Of 2229 first episodes, 1874 (84.1%) completed treatment in OPAT as planned; 201 episodes (9.0%) were complicated by clinical deterioration and re-admitted. Other patients who failed to complete treatment were either re-admitted for elective procedures, experienced adverse drug reactions or peripherally inserted central catheter-related complications, or had other reasons for not completing treatment. Increased risk of clinical deterioration was associated with homecare OPAT (aHR=2.5, 95% CI 1.7-3.8; P70 years (aHR=1.6, 95% CI 1.1-2.2; P=0.008) and non-private care (aHR=1.8, 95% CI 1.0-3.0; P=0.033). Diagnosis and type of antibiotic treatment were not significant risk factors for re-admission. OPAT provides intravenous antibiotics to those who would otherwise remain as hospital inpatients. In this large Asian cohort, clinical factors did not relate to the ability of patients to complete their treatment in OPAT. Criteria identified as significant warrant ongoing consideration as patients are assessed for acceptance into OPAT programmes. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  20. A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis.

    Science.gov (United States)

    Hensey, Conor C; Sett, Arun; Connell, Tom G; Bryant, Penelope A

    2017-09-01

    Despite the benefits of home treatment with outpatient parenteral antimicrobial therapy (OPAT), children with pyelonephritis and meningitis are rarely included. We aimed to compare clinical characteristics and outcomes between hospital and home treatment for these conditions and to identify factors influencing home treatment. Children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013 were identified retrospectively. Patients who received any OPAT (home group) received daily visits via our Hospital-in-the-Home (HITH) program; inpatients (hospital group) received standard care. Clinical and demographic features, length of stay, readmission rate and cost were compared between hospital and home groups. One hundred thirty-nine children with pyelonephritis and 70 with meningitis were identified, of which 127 and 44 were potentially suitable for OPAT, respectively. Of these, 12 (9%) with pyelonephritis received OPAT, contrasting with 29 (66%) with meningitis. Clinical features did not differ between hospital- and home-treated patients for either condition. Patients with meningitis in the hospital group were younger than those transferred to HITH (1 vs. 2 months; P = 0.01). All patients were afebrile before transfer to HITH. Admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002). Unplanned readmission rates were comparable across all groups. Transfer to HITH resulted in a saving of AU$178,180. Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.

  1. Outpatient parenteral antimicrobial therapy for surgery patients: A comparison with previous standard of care.

    Science.gov (United States)

    Yang, Anjie; Fung, Ron; Brunton, James; Dresser, Linda

    2013-01-01

    Current literature reports that outpatient parenteral antimicrobial therapy (OPAT) programs improve cure rates, and reduce length of hospitalization and costs. OPAT programs are still relatively new in Canada. To evaluate the benefits of an OPAT program initiated at a multispecialty tertiary care facility in Toronto, Ontario, compared with the previous standard of care. The present retrospective observational study was conducted using data from a group of surgical patients who were treated for active infections. Between February 1, 2010 and November 30, 2010, a total of 108 surgical patients were enrolled in the OPAT program. Patients were matched 1:1 with historical controls discharged between January 1, 2001 and January 1, 2010 according to age, sex, type of surgery, infection and comorbidities (Charlson Comorbidity Index). Cure rate, 30-day rehospitalization and length of stay were evaluated as primary end points. Of 108 eligible OPAT patients, 21 were matched to the control group using the prespecified criteria. For this cohort, the OPAT program was associated with improved cure rates (OPAT 61.7% versus control 57.1%; P>0.10), reduction in rehospitalization rate (14.3% versus 28.6%; P>0.10) and reduced length of stay (10.7 versus 13.9 days, P>0.10) compared with the control group. For this cohort of surgery patients, the OPAT program demonstrated a trend toward improved outcomes but did not achieve statistical significance. Due to the lack of statistical power, further evaluation is required to determine the full benefit of OPAT to patients and the health care system.

  2. Development of teicoplanin dosage guidelines for patients treated within an outpatient parenteral antibiotic therapy (OPAT) programme.

    Science.gov (United States)

    Lamont, Elspeth; Seaton, R Andrew; Macpherson, Merran; Semple, Lindsay; Bell, Emma; Thomson, Alison H

    2009-07-01

    The long elimination half-life of teicoplanin facilitates outpatient parenteral antibiotic therapy (OPAT) with thrice-weekly dosing. This study aimed to develop teicoplanin dosage guidelines for OPAT use from routine clinical data. Patients received 15-25 mg/kg/day for 3 days, then 15-25 mg/kg thrice weekly. Trough concentrations were measured weekly and doses adjusted to maintain 20-30 or 10-20 mg/L according to clinical condition. Concentration-time data were analysed using the pharmacokinetic package NONMEM and the final model was used to develop new dosage guidelines. Data from 94 and 36 patients were used for model development and validation, respectively. Patient ages ranged from 15 to 94 years, weights from 43 to 146 kg and estimated CL(CR) from 9 to 195 mL/min. Teicoplanin concentrations (n = 670) ranged from 6.7 to 66.9 mg/L and a one-compartment model adequately described the data. The typical estimate of CL was 0.542 L/h and changed by 10.6% for every 10 mL/min difference from a CL(CR) of 66 mL/min. V was 1.62 L/kg. Dosage guidelines based on body weight and CL(CR) can be expected to lead to a significant improvement in the proportion of concentrations in the range 20-30 mg/L. Alternative doses aimed at lower target concentrations have also been developed. New dosage guidelines have been developed to support thrice-weekly administration of teicoplanin in an OPAT setting.

  3. Building the crossroad between inpatient/outpatient rehabilitation and lifelong community-based fitness for people with neurologic disability.

    Science.gov (United States)

    Rimmer, James H; Henley, Kathryn Y

    2013-06-01

    The length of stay in inpatient and outpatient rehabilitation after an injury or illness has declined in recent years, exposing those with newly acquired neurologic disability to a risk of significant postrehabilitation health decline. Following a short stay in outpatient rehabilitation, individuals with neurologic disability have few, if any, options to continue their physical recovery after discharge, thus further increasing their risk for functional decline and secondary conditions. Professionals who work in community-based fitness facilities have the potential to assist therapists in extending the recovery process and preventing this decline. The focus of this article was to address a conceptual framework for better understanding how rehabilitation and health/fitness professionals can work together to help with this growing need. To that end, the antecedents to and effects of postrehabilitation health decline are discussed, followed by the introduction of a theoretical model illustrating a therapist-to-trainer system that facilitates the use of community-based fitness facilities by individuals with neurologic disabilities to continue their recovery postrehabilitation. Finally, a thorough description of an exemplary existing community-based inclusive fitness program is presented, followed by examples of select disability groups using these programs for continued recovery.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A45) for more insights from the authors.

  4. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics

    Directory of Open Access Journals (Sweden)

    Fortney John

    2012-04-01

    Full Text Available Abstract Background Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs. However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI as a strategy to facilitate the adoption of collaborative-care management in CBOCs. Methods This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. Results Adoption: 69.0% (58/84 of primary care providers referred patients to the program. Reach: 9.0% (298/3,296 of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298 of patients, barriers were assessed and addressed for 100% (298/298 of patients, and depression severity was monitored for 100% (298/298 of patients. Less than half (42.5%, 681/1603 of follow-up encounters during the acute

  5. [Decentralized outpatient teams in community-based psychiatric care: comparison of two Bavarian rural catchment areas].

    Science.gov (United States)

    Valdes-Stauber, J; Putzhammer, A; Kilian, R

    2014-05-01

    Psychiatric outpatient clinics (PIAs) are an indispensable care service for crisis intervention and multidisciplinary treatment of people suffering from severe and persistent mental disorders. The decentralization of outpatient clinics can be understood as a further step in the deinstitutionalization process. This cross-sectional study (n=1,663) compared the central outpatient clinic with the decentralized teams for the year 2010 by means of analyses of variance, χ(2)-tests and robust multivariate regression models. The longitudinal assessment (descriptively and by means of Prais-Winsten regression models for time series) was based on all hospitalizations for the two decentralized teams (n = 6,693) according to partial catchment areas for the time period 2002-2010 in order to examine trends after their installation in the year 2007. Decentralized teams were found to be similar with respect to the care profile but cared for relatively more patients suffering from dementia, addictive and mood disorders but not for those suffering from schizophrenia and personality disorders. Decentralized teams showed less outpatient care costs as well as psychopharmacological expenses but a lower contact frequency than the central outpatient clinic. Total expenses for psychiatric care were not significantly different and assessed hospitalization variables (e.g. total number of annual admissions, cumulative length of inpatient-stay and annual hospitalizations per patient) changed slightly 3 years after installation of the decentralized teams. The number of admissions of people suffering from schizophrenia decreased whereas those for mood and stress disorders increased. Decentralized outpatient teams seemed to reach patients in rural regions who previously were not reached by the central outpatient clinic. Economic figures indicate advantages for the installation of such teams because care expenses are not higher than for patients treated in centralized outpatient clinics and

  6. An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.

    LENUS (Irish Health Repository)

    Doran, J-P

    2012-02-01

    INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent\\'s University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.

  7. Self-administered outpatient parenteral antimicrobial therapy: a report of three years experience in the Irish healthcare setting.

    LENUS (Irish Health Repository)

    Kieran, J

    2012-02-01

    Outpatient parenteral antibiotic therapy (OPAT) was first reported in 1972. OPAT programmes are not well established in Ireland, with no reported outcomes in the literature. An OPAT programme was established at St. James Hospital in 2006. Demographics, diagnoses and outcomes of the first 60 courses are reported. A retrospective analysis of prospectively recorded data was performed on patients treated from March 2006 to February 2009. The data was analysed using SPSS v.17. Sixty OPAT courses were administered to 56 patients, 57 percent of which were male. The median age was 50 years, the median inpatient stay was 19 days, the median duration of OPAT was 16 days and 1,289 inpatient bed days were saved. The additional cost per day of OPAT was 167.60 euros. Vancomycin was the most prescribed antimicrobial, administered to 35%. Musculoskeletal infection was the indication for treatment in 50%. Confirmatory microbiological diagnosis was identified in 72%, most frequently due to Staphylococcus aureus (68%). Only minor adverse events were recorded. Clinical cure was achieved in 92.8%. A patient satisfaction survey showed high satisfaction. OPAT is a safe and effective way of providing parenteral antibiotic therapy in the Irish healthcare system. Better integration of funding and the appointment of Infectious Diseases specialists will facilitate its expansion.

  8. [Adherence to and satisfaction with oral outpatient thromboembolism prophylaxis compared to parenteral: SALTO study].

    Science.gov (United States)

    Peidro-Garcés, L; Otero-Fernandez, R; Lozano-Lizarraga, L

    2013-01-01

    Prolongation of drug-based thromboembolism prophylaxis after discharge from hospital is clearly recommended following total hip and knee replacement. The aim of this study was to evaluate and compare adherence to and satisfaction with outpatient thromboembolism prophylaxis (by injection and oral) under routine clinical practice conditions. We analysed two consecutive cohorts of patients (480 and 366, respectively) who had undergone total hip or knee replacement surgery in 120 Spanish hospitals, and were prescribed outpatient thromboembolism prophylaxis, by injection and orally, respectively. Information on adherence to and satisfaction with both treatments, sociodemographic data and treatment compliance was collected using specific questionnaires. The drop-out rate (9.49 vs. 4.14%), general satisfaction (37 vs. 83.38%), and the TSQM satisfaction scale were better in the oral prophylaxis cohort and, although the differences between the two routes of administration were not significant, treatment compliance was also better in the oral cohort (Morisky-Green test: 53.49 vs. 59.05%). Adherence to and satisfaction with the oral thromboembolism prophylaxis were better than for prophylaxis by injection in the context of outpatient prolongation. Nevertheless, suboptimal treatment compliance was found in both cohorts, which could result in lack of efficacy of the prophylaxis. Both patients and doctors have to be made aware of the importance of post-discharge extension of thromboprophylaxis in orthopaedic surgery with high thrombotic risk. Moreover, strategies should be developed to encourage compliance. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  9. Community-Based Appraisal of the Effects of Parenteral Nutrition Versus Enteral Nutrition on the Quality of Care for Patients With Acute Pancreatitis.

    Science.gov (United States)

    Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Fujimori, Kenji

    2011-02-01

    Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in treatment guidelines for acute pancreatitis (AP) as endorsed in randomized studies or meta-analyses. The findings derived from those studies would recognize the criticism of smaller sample sizes or limited patient case-mixes. To determine the generalizability of those findings, community-based appraisal on the advantages of EN over PN is required. Using a Japanese administrative database between 2006 and 2010, we determine whether EN is superior to PN in the real clinical settings. A total of 24,913 patients diagnosed with AP at admission in 1,000 hospitals were identified. Among them, we analyzed 1,803 patients of ≥ 15 years who received EN or PN for AP across 480 hospitals. Among three nutrition categories of PN only, EN only and PN with EN, we examined patient characteristics, comorbidities, complications, AP severity score determined by the Ministry of Health, Labor and Welfare, surgical procedures for the biliary/pancreatic system, use of artificially assisted ventilation and hemodialysis proxy of multiple organ failures and hospital teaching status. To identify the variables associated with PN use, a logistic regression model was used and the propensity score (PS) was calculated to control for the selection bias of patient case-mix preferring PN use. Then, we compared mortality, length of hospital stay (LOS), total charges (TC) and commencement day of oral food intake between EN and PN. A total of 1,191 PN patients, 330 EN patients and 282 mixed EN and PN patients were identified. EN was indicated for patients with mild AP and procedures for the pancreas. PS matching analysis indicated that PN had a higher mortality compared with EN, and PN significantly increased LOS and TC compared with EN. PN deterred the commencement of oral food intake. Community-based study has shown that EN was employed in the less severe case-mixed. Even though considering that selection bias, EN was

  10. A pilot study on community-based outpatient treatment for patients with chronic psychotic disorders in Somalia: Change in symptoms, functioning and co-morbid khat use

    Directory of Open Access Journals (Sweden)

    Odenwald Michael

    2012-07-01

    Full Text Available Abstract Background In Low and Middle Income Countries, mental health services are often poorly developed due to the lack of resources and trained personnel. In order to overcome these challenges, new ways of care have been suggested such as a focus on community-based services. In Somalia, the consumption of the natural stimulant khat is highly prevalent, aggravating mental illness. At the same time, mental health care is largely unavailable to the vast majority of the population. In a pilot project, we tested possibilities for effective measures in community-based out-patient mental health care. Methods Thirty-five male patients with chronic psychotic disorders and their carers were involved in a 10-months follow-up study. All of them abused khat. Seventeen outpatients experiencing acute psychotic episodes were recruited from the community and received an intensive six week home-based treatment package. Additionally eighteen patients with chronic psychotic disorders in remission were recruited either following hospital discharge or from the community. In a second phase of the study, both groups received community-based relapse prevention that differed in the degree of the family’s responsibility for the treatment. The treatment package was comprised of psycho-education, low-dose neuroleptic treatment, monthly home visits and counseling. The Brief Psychiatric Rating Scale (BPRS was applied three times. Additionally, we assessed functioning, khat use and other outcomes. Results Of the 35 patients enrolled in the study, 33 participated in the 10-month follow-up. Outpatients improved significantly in the first six weeks of treatment and did not differ from remitted patients at the start of the second treatment phase. In the preventive treatment phase, we find heterogeneous outcomes that diverge between symptom and functioning domains. With the exception of depressive symptoms, symptoms in all patients tended to worsen. The outpatient group had

  11. Role of outpatient parenteral antibiotic therapy in the treatment of community acquired skin and soft tissue infections in Singapore.

    Science.gov (United States)

    Chan, Monica; Ooi, Chee Kheong; Wong, Joshua; Zhong, Lihua; Lye, David

    2017-07-06

    Treatment of community acquired skin and soft tissue infections (SSTIs) is a common indication for outpatient parenteral antibiotic therapy (OPAT) in USA, UK and Australasia, however data from Asia are lacking. OPAT is well established within the Singapore healthcare since 2002, however, systematic use of OPAT for the treatment of SSTIs remains infrequent. In this report, we describe the treatment and outcome of patients with SSTIs referred directly from Emergency Department (ED) to OPAT for continuation of intravenous (IV) antibiotics in Singapore, thus avoiding potential hospital admission. This is a single center university hospital retrospective study of patients with SSTIs presenting to ED who were assessed to require IV antibiotics and accepted to the OPAT clinic for continuation of IV treatment. Exclusion criteria were: haemodynamic instability, uncontrolled or serious underlying co-morbidities, necessity for inpatient surgical drainage, facial cellulitis and cephalosporin allergy. Patients returned daily to the hospital’s OPAT clinic for administration of IV antibiotics and review, then switched to oral antibiotics on improvement. From 7 February 2012 to 31 July 2015, 120 patients with SSTIs were treated in OPAT. Median age was 56 years and 63% were male. Lower limbs were affected in 91%. Diabetes was present in 20%. Sixty-seven (56%) had been treated with oral antibiotics for a median duration of 3 days prior to OPAT treatment. Common symptoms were erythema (100%), swelling (96%), pain (88%) and fever (55%). Antibiotics administered were IV cefazolin with oral probenecid (71%) or IV ceftriaxone (29%) for median 3 days then oral cloxacillin (85%) for median 7 days. Clinical improvement occurred in 90%. Twelve patients (10%) were hospitalized for worsening cellulitis, with 4 patients requiring surgical drainage of abscess. Microbiological cultures from 2 patients with drained abscess grew methicillin sensitive Staphylococcus aureus (MSSA) and Klebsiella

  12. Resting frontal EEG asymmetry and shyness and sociability in schizophrenia: a pilot study of community-based outpatients.

    Science.gov (United States)

    Jetha, Michelle K; Schmidt, Louis A; Goldberg, Joel O

    2009-01-01

    We conducted a pilot study to examine the relations among the patterns of resting regional electroencephalogram (EEG) alpha activity, trait shyness and sociability, and positive and negative symptoms scores in 20 adults with schizophrenia, attending a community-based treatment and rehabilitation center. As predicted, patients' positive symptoms were related to greater relative resting left frontal EEG activity, replicating earlier work. When only adults with low to no positive symptoms were considered, trait shyness was related to greater relative resting right frontal EEG activity, whereas trait sociability was related to greater relative resting left frontal EEG activity. This finding is similar to what is consistently noted in healthy adults. These pilot data suggest that positive symptoms in patients with schizophrenia may obscure the relations between personality and frontal EEG asymmetry measures observed in healthy adults.

  13. Safe and successful treatment of intravenous drug users with a peripherally inserted central catheter in an outpatient parenteral antibiotic treatment service.

    Science.gov (United States)

    Ho, Jennifer; Archuleta, Sophia; Sulaiman, Zuraidah; Fisher, Dale

    2010-12-01

    The enrollment of intravenous drug users (IVDUs) into an outpatient parenteral antibiotic treatment (OPAT) service using a peripherally inserted central catheter (PICC) is controversial and often avoided. The National University Hospital in Singapore has a policy of permitting OPAT-based treatment of IVDU patients with appropriate medical indications. We report on our experiences. A prospective observational study was conducted on IVDU patients requiring parenteral antibiotics via an OPAT service from January 2005 to December 2009. Clinically appropriate patients were screened using pre-defined criteria and enrolled into our service, where standardized measures were enforced to prevent and detect PICC abuse and optimize treatment. Outcomes measured included mortality, completion of therapy, PICC abuse, and readmission for infective or treatment-related complications during OPAT and a 30 day follow-up period. Twenty-nine IVDU patients received treatment in our OPAT service (total 675 patient-days). The median duration of therapy was 18 days (range 1-85). Infective endocarditis was the primary diagnosis in 42% of cases. Two patients (7%) had recrudescent infection after absconding during their inpatient stay. These two patients subsequently completed treatment in OPAT. There were no deaths or cases of PICC abuse. Five patients (17%) during OPAT and one patient (3%) during the 30-day follow-up period required readmission for infective or treatment-related complications. Appropriately selected, counselled and monitored patients with a history of being an IVDU can be treated safely and successfully via OPAT centres. It is likely that some will respond better to treatment in an outpatient setting.

  14. Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic.

    Science.gov (United States)

    Ekeblad, Annika; Falkenström, Fredrik; Andersson, Gerhard; Vestberg, Robert; Holmqvist, Rolf

    2016-12-01

    Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. Ninety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. IPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity. © 2016 Wiley Periodicals, Inc.

  15. Depressive Symptoms and Associated Clinical Characteristics in Outpatients Seeking Community-based Treatment for Alcohol and Drug Problems

    Science.gov (United States)

    Sanchez, Katherine; Walker, Robrina; Campbell, Aimee N. C.; Greer, Tracy L.; Hu, Mei-Chen; Grannemann, Bruce D.; Nunes, Edward V.; Trivedi, Madhukar H.

    2014-01-01

    Background Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment-seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. Methods Baseline data from a randomized clinical effectiveness trial of a computer-assisted, web-delivered psychosocial intervention were analyzed. Participants (N=507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. Results One-fifth (21%; n=106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and PTSD (42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (p = .001), greater impairment in social adjustment (p problem among substance abusers and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment. PMID:25084694

  16. Parenteral approaches in malabsorption: Home parenteral nutrition

    NARCIS (Netherlands)

    Wanten, G.J.A.

    2016-01-01

    Severe malabsorption of fluids and nutrients leads to intestinal failure (IF) where intravenous supplementation of nutrients and fluids is necessary to maintain health and/or growth. Long-term treatment of IF implies the start of intravenous support in the outpatient setting (home parenteral

  17. Parenteral nutrition

    National Research Council Canada - National Science Library

    Inayet, N; Neild, P

    2015-01-01

    Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility...

  18. Parenteral nutrition.

    Science.gov (United States)

    Inayet, N; Neild, P

    2015-03-01

    Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised.

  19. An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.

    Science.gov (United States)

    Tadesse, Elazar; Worku, Amare; Berhane, Yemane; Ekström, Eva-Charlotte

    2017-10-10

    A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed. © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

  20. [Community-based rehabilitation and outpatient care for patients with acquired brain injury and chronic neurological disability in Germany: continuing support for social participation and re-integration in the neurological care system?].

    Science.gov (United States)

    Reuther, P; Hendrich, A; Kringler, W; Vespo, E

    2012-12-01

    Persons with Disabilities of the United Nations: Goals of rehabilitation have to be more than functional treatment. Activation of the patient and supporting their coping and adaptive processes are necessary to achieve social participation and (re)integration into the community and in occupational life as implied by the standards of our society. Important elements of these are (1) identification of the individual patient and his/her burden during acute phase treatment or early rehabilitation (defined red-flag), (2) an individual clinical reasoning and planning of interventions and help, (3) general acceptance of the defined demands by all "players" in medical and social networks, (4) coordination and supervision of the medical and social interventions and of the assistive processes necessary in the individual environment. What seems to be needed is (5) systematic orientation to the goal of individual social participation at all levels of support, (6) cross linking, cooperation and development of the existing medical and social structures on site, (7) expansion of the legal framework and (7a) especially control of the implementation of the existing rights of social benefits and (7b) surveillance (transparency and quality management not only in the area of caregivers but also for the administration of social insurances!). The recommendations of the authors integrate systematically into the phase model of neurorehabilitation (VDR/BAR) in Germany. The focus of this work is the needs-appropriate programming of phase E, i. e., the transition between inpatient and outpatient care, between the clinical facility-oriented and the community-based (domicile-oriented, occupational-oriented) sectors, between welfare and independency. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Total parenteral nutrition

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000177.htm Total parenteral nutrition To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  2. Total parenteral nutrition - infants

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007239.htm Total parenteral nutrition - infants To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  3. Community-Based Care

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Community-Based Care Basic Facts & Information A variety of ... Adult Day Care Adult day care is a community-based option that has become more common. It ...

  4. Parenteral Nutrition: Amino Acids.

    Science.gov (United States)

    Hoffer, Leonard John

    2017-03-10

    There is growing interest in nutrition therapies that deliver a generous amount of protein, but not a toxic amount of energy, to protein-catabolic critically ill patients. Parenteral amino acids can achieve this goal. This article summarizes the biochemical and nutritional principles that guide parenteral amino acid therapy, explains how parenteral amino acid solutions are formulated, and compares the advantages and disadvantages of different parenteral amino acid products with enterally-delivered whole protein products in the context of protein-catabolic critical illness.

  5. Anemia e insuficiência cardíaca na comunidade: comparação com um ambulatório especializado Anemia e insuficiencia cardiaca en la comunidad: comparación con un consultorio especializado Anemia and heart failure in a community-based cohort: comparison with a specialized outpatient clinic

    Directory of Open Access Journals (Sweden)

    Eduarda Barcellos dos Santos

    2010-01-01

    Full Text Available FUNDAMENTO: A anemia é comum em pacientes com insuficiência cardíaca (IC. Sua prevalência em pacientes com IC na comunidade é desconhecida em nosso meio. OBJETIVO: Avaliar a prevalência e características de pacientes com anemia em uma população não selecionada com IC na comunidade, comparando-a a uma população com IC atendida em um ambulatório especializado. MÉTODOS: Estudo transversal, prospectivo, observacional, realizado de janeiro de 2006 a março de 2007. Os pacientes com IC preenchiam os critérios de Boston, com pontuação >8. Anemia foi definida pelos critérios da Organização Mundial de Saúde, como valores de hemoglobina FUNDAMENTO: La anemia es común en pacientes con insuficiencia cardiaca (IC. Su prevalencia en pacientes con IC en la comunidad es desconocida en nuestro medio. OBJETIVO: Evaluar la prevalencia y características de pacientes con anemia en una población con IC no seleccionada en la comunidad, comparándola a una población con IC atendida en un consultorio especializado. MÉTODOS: Estudio transversal, prospectivo, observacional, realizado de enero de 2006 a marzo de 2007. Los pacientes con IC cumplían los criterios de Boston, con puntuación >8. La anemia fue definida por los criterios de la Organización Mundial de la Salud, como valores de hemoglobina BACKGROUND: Anemia is common in patients with heart failure (HF. Its prevalence in patients with HF from a community-based cohort is unknown in our country. OBJECTIVE: evaluate the prevalence and characteristics of patients with anemia in a non-selected population with HF from a community-based cohort, comparing it with that of a HF population treated at a specialized outpatient clinic. METHODS: This was a transversal, prospective, observational study, carried out from January 2006 to March 2007. The patients with HF met the Boston criteria, with a score > 8. Anemia was defined through the criteria of the World Health Organization as hemoglobin levels

  6. Parenteral Nutrition and Lipids.

    Science.gov (United States)

    Raman, Maitreyi; Almutairdi, Abdulelah; Mulesa, Leanne; Alberda, Cathy; Beattie, Colleen; Gramlich, Leah

    2017-04-14

    Lipids have multiple physiological roles that are biologically vital. Soybean oil lipid emulsions have been the mainstay of parenteral nutrition lipid formulations for decades in North America. Utilizing intravenous lipid emulsions in parenteral nutrition has minimized the dependence on dextrose as a major source of nonprotein calories and prevents the clinical consequences of essential fatty acid deficiency. Emerging literature has indicated that there are benefits to utilizing alternative lipids such as olive/soy-based formulations, and combination lipids such as soy/MCT/olive/fish oil, compared with soybean based lipids, as they have less inflammatory properties, are immune modulating, have higher antioxidant content, decrease risk of cholestasis, and improve clinical outcomes in certain subgroups of patients. The objective of this article is to review the history of IVLE, their composition, the different generations of widely available IVLE, the variables to consider when selecting lipids, and the complications of IVLE and how to minimize them.

  7. [Micronutrients in parenteral nutrition].

    Science.gov (United States)

    García de Lorenzo, A; Alvarez, J; Bermejo, T; Gomis, P; Piñeiro, G

    2009-01-01

    At a multidisciplinary debate, and after reviewing the evidence available as well as experts' opinion, the IV Baxter-SENPE Working Panel established the indications and managemente guidelines for micronutrients (water-soluble and fat-soluble vitamins, and oligoelements or trace elements) in parenteral nutrition. It was concluded about the convenience of daily intake of micronutrients with diferent options regarding deficiente or excessive dosages, administration systems, interactions, monitoring, and cots-effectiveness.

  8. PARENTERAL FEEDING COMPLICATIONS IN PEDIATRICS

    Directory of Open Access Journals (Sweden)

    R. F. Tepaev

    2013-01-01

    Full Text Available The article is dedicated to parenteral feeding – infusion therapy aimed at introducing water, macro- and micronutrients in concordance with body needs. Different parenteral feeding types are described: complete, partial and additional. It shows that balanced parenteral feeding allows providing the child’s body with the sufficient amount of amino acids, carbohydrates, fats and energy required to maintain a baseline energy level and correct a preceding nutritive insufficiency. Protein-energy homeostasis is the basis for vital activity of the body; it determines the inflammatory response activity, immune status adequacy, disease duration and severity and disease prognosis (to a considerable degree. Long-term parenteral feeding is associated with complications of varying severity: from transitory and mild to severe, requiring operative intervention and liver transplantation. The command of modern recommendations allows a practicing doctor to successfully overcome issues associated with long-term parenteral feeding. The article presents modern data on diagnostics, prevention and treatment of parenteral feeding complications.

  9. Standardised parenteral nutrition.

    Science.gov (United States)

    Simmer, Karen; Rakshasbhuvankar, Abhijeet; Deshpande, Girish

    2013-03-28

    Parenteral nutrition (PN) has become an integral part of clinical management of very low birth weight premature neonates. Traditionally different components of PN are prescribed individually considering requirements of an individual neonate (IPN). More recently, standardised PN formulations (SPN) for preterm neonates have been assessed and may have advantages including better provision of nutrients, less prescription and administration errors, decreased risk of infection, and cost savings. The recent introduction of triple-chamber bag that provides total nutrient admixture for neonates may have additional advantage of decreased risk of contamination and ease of administration.

  10. Community-based recreational football

    DEFF Research Database (Denmark)

    Bruun, Ditte Marie; Bjerre, Eik; Krustrup, Peter

    2014-01-01

    is limited and the majority of prostate cancer survivors remain sedentary. Hence, novel approaches to evaluate and promote physical activity are warranted. This paper presents the rationale behind the delivery and evaluation of community-based recreational football offered in existing football clubs under...... the Danish Football Association to promote quality of life and physical activity adherence in prostate cancer survivors. The RE-AIM framework will be applied to evaluate the impact of the intervention including outcomes both at the individual and organizational level. By introducing community-based sport...

  11. Zinc deficiency in a parenteral nutrition-dependent patient during a parenteral trace element product shortage.

    Science.gov (United States)

    Franck, Andrew J

    2014-07-01

    Parenteral nutrition product shortages are common and place vulnerable patients at risk for nutrient deficiencies. This case report describes a parenteral nutrition-dependent patient who was found to have zinc deficiency during a parenteral nutrition product shortage. The management of the patient's zinc deficiency is described. © 2014 American Society for Parenteral and Enteral Nutrition.

  12. Advantages of enteral nutrition over parenteral nutrition

    OpenAIRE

    Seres, David S.; Valcarcel, Monika; Guillaume, Alexandra

    2013-01-01

    It is a strong and commonly held belief among nutrition clinicians that enteral nutrition is preferable to parenteral nutrition. We provide a narrative review of more recent studies and technical reviews comparing enteral nutrition with parenteral nutrition. Despite significant weaknesses in the existing data, current literature continues to support the use of enteral nutrition in patients requiring nutrition support, over parenteral nutrition.

  13. Advantages of enteral nutrition over parenteral nutrition

    Science.gov (United States)

    Valcarcel, Monika; Guillaume, Alexandra

    2013-01-01

    It is a strong and commonly held belief among nutrition clinicians that enteral nutrition is preferable to parenteral nutrition. We provide a narrative review of more recent studies and technical reviews comparing enteral nutrition with parenteral nutrition. Despite significant weaknesses in the existing data, current literature continues to support the use of enteral nutrition in patients requiring nutrition support, over parenteral nutrition. PMID:23503324

  14. Management of perioperative hypertensive urgencies with parenteral medications.

    Science.gov (United States)

    Ahuja, Kartikya; Charap, Mitchell H

    2010-02-01

    Hypertension is the major risk factor for cardiovascular (CV) disease such as myocardial infarction (MI) and stroke. This risk is well known to extend into the perioperative period. Although most perioperative hypertension can be managed with the patient's outpatient regimen, there are situations in which oral medications cannot be administered and parenteral medications become necessary. They include postoperative nil per os status, severe pancreatitis, and mechanical ventilation. This article reviews the management of perioperative hypertensive urgency with parenteral medications. A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search. As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources. When oral therapy cannot be administered, patients with hypertensive urgency can have their blood pressure (BP) reduced with hydralazine, enalaprilat, metoprolol, or labetalol. Due to the scarcity of comparative trials looking at clinically significant outcomes, the medication should be chosen based on comorbidity, efficacy, toxicity, and cost.

  15. Parenteral nutrition in intestinal failure

    Directory of Open Access Journals (Sweden)

    Kurkchubasche AG

    2015-01-01

    Full Text Available Arlet G Kurkchubasche,1 Thomas J Herron,2 Marion F Winkler31Department of Surgery and Pediatrics, 2Department of Surgery, Alpert Medical School of Brown University, 3Department of Surgery/Nutritional Support Service, Rhode Island Hospital, Providence, RI, USAAbstract: Intestinal failure is a consequence of extensive surgical resection resulting in anatomic loss and/or functional impairment in motility or absorptive capacity. The condition is clinically characterized by the inability to maintain fluid, energy, protein, electrolyte, or micronutrient balance when on a conventionally accepted, normal diet. Parenteral nutrition (PN is the cornerstone of management until intestinal adaptation returns the patient to a PN-independent state. Intestinal length, residual anatomic segments and motility determine the need for and duration of parenteral support. The goals of therapy are to provide sufficient nutrients to enable normal growth and development in children, and support a healthy functional status in adults. This review addresses indications for PN, the formulation of the PN solution, patient monitoring, and considerations for prevention of PN-associated complications. With the ultimate goal of achieving enteral autonomy, the important role of diet, pharmacologic interventions, and surgery is discussed.Keywords: intestinal failure, short-bowel syndrome, parenteral nutrition, home nutrition support, intestinal rehabilitation

  16. Parenteral Nutrition in Liver Resection

    Directory of Open Access Journals (Sweden)

    Carlo Chiarla

    2012-01-01

    Full Text Available Albeit a very large number of experiments have assessed the impact of various substrates on liver regeneration after partial hepatectomy, a limited number of clinical studies have evaluated artificial nutrition in liver resection patients. This is a peculiar topic because many patients do not need artificial nutrition, while several patients need it because of malnutrition and/or prolonged inability to feeding caused by complications. The optimal nutritional regimen to support liver regeneration, within other postoperative problems or complications, is not yet exactly defined. This short review addresses relevant aspects and potential developments in the issue of postoperative parenteral nutrition after liver resection.

  17. Immune modulation by parenteral lipid emulsions.

    NARCIS (Netherlands)

    Wanten, G.J.A.; Calder, P.C.

    2007-01-01

    Total parenteral nutrition is the final option for nutritional support of patients with severe intestinal failure. Lipid emulsions constitute the main source of fuel calories and fatty acids (FAs) in parenteral nutrition formulations. However, adverse effects on patient outcomes have been attributed

  18. Pediatric Parenteral Nutrition-Associated Liver Disease.

    Science.gov (United States)

    Israelite, Jill C

    Pediatric parenteral nutrition-associated liver disease (PNALD) is typically defined as a decrease in bile flow that is independent of a mechanical obstruction and of any other underlying liver disease. It is most often seen in pediatric patients receiving parenteral nutrition support. Up to 50% to 66% of children receiving long-term parenteral nutrition are reported to be diagnosed with PNALD. The goal of treatment for PNALD is advancement to full enteral nutrition and elimination of dependence on parenteral nutrition support. Achieving this goal is not always possible, especially in patients with short bowel syndrome. The following review article highlights some of the current treatment strategies focused on prevention or correction of PNALD as noted in current American Society for Parenteral and Enteral Nutrition guidelines.

  19. Gender Responsive Community Based Planning and Budgeting ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Gender Responsive Community Based Planning and Budgeting Tool for Local Governance. During the early 1990s, IDRC supported the development and testing of a reliable and cost-efficient tool for monitoring poverty and facilitating local level budgeting: the community-based (poverty) monitoring system (CBMS).

  20. Community-based Mural: The People's Art.

    Science.gov (United States)

    Chilcoat, George W.

    2000-01-01

    Discusses the history and reasons for community-based mural art in North America. Describes the steps involved in a community-based mural project for students in which they work in groups to develop a mural theme and a sketch of the mural, paint the mural, document the process, and then present the mural to the class. (CMK)

  1. Sustainable Community Based Interventions for Improving ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Sustainable community based interventions for improving environment and health for communities in slums of Banda, Kampala City, Uganda : final technical report (2007-2011). Rapports. Eco-Health project start-up/methodological workshop , Sports View Hotel, Kireka, 11th-13th July 2007 : sustainable community based ...

  2. Blood cultures in ambulatory outpatients

    Directory of Open Access Journals (Sweden)

    Laupland Kevin B

    2005-05-01

    Full Text Available Abstract Background Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients. Methods Blood cultures drawn at community-based collection sites in the Calgary Health Region (population 1 million in 2001 and 2002 were included in this study. These patients were analyzed by linkages to acute care health care databases for utilization of acute care facilities within 2 weeks of blood culture draw. Results 3102 sets of cultures were drawn from 1732 ambulatory outpatients (annual rate = 89.4 per 100,000 population. Significant isolates were identified from 73 (2.4% sets of cultures from 51 patients, including Escherichia coli in 18 (35% and seven (14% each of Staphylococcus aureus and Streptococcus pneumoniae. Compared to patients with negative cultures, those with positive cultures were older (mean 49.6 vs. 40.1 years, p Conclusion Blood cultures drawn in outpatient settings are uncommonly positive, but may define patients for increased intensity of therapy. Strategies to reduce utilization without excluding patients with positive cultures need to be developed for this patient population.

  3. Total parenteral nutrition in cancer patients.

    Science.gov (United States)

    Bozzetti, Federico

    2007-12-01

    To report on how the parenteral nutrition of patients with advanced cancer has evolved and on the current status of research and clinical practice in this field. Clinical research has shown that parenteral nutrition may play a role in incurable cancer if patients are expected to die earlier from starvation than from tumour progression. A benefit was recently observed in hypophagic patients requiring supplemental on-demand home parenteral nutrition. There is some doubt that parenteral nutrition plays a palliative role, and data on quality of life are limited. The regimen of parenteral nutrition should be tailored to the needs of the patient, and recent data indicate a reduction in total energy expenditure and water requirements. There is interest in new lipid emulsions enriched with N-3 polyunsaturated fatty acids, which are well utilized by tumour-bearing individuals and may reduce the catabolic drive of cachectic patients. Future research is addressed at identifying parameters to help in the selection of aphagic/obstructed patients who may benefit from home parenteral nutrition, the early use of supplemental parenteral nutrition in hypophagic patients and developing a better nutritional formulation of lipid emulsions more appropriate for use in advanced cancer patients.

  4. Parenteral nutrition in hospital pharmacies.

    Science.gov (United States)

    Katoue, Maram Gamal; Al-Taweel, Dalal; Matar, Kamal Mohamed; Kombian, Samuel B

    2016-07-11

    Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.

  5. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Science.gov (United States)

    2010-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert of...

  6. Community-based health insurance knowledge, concern ...

    African Journals Online (AJOL)

    Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon. JJN Noubiap, WYA Joko, JMN Obama, JJR Bigna ...

  7. Community Based Networks and 5G

    DEFF Research Database (Denmark)

    Williams, Idongesit

    2016-01-01

    is hinged on a research aimed at understanding how and why Community Based Networks deploy telecom and Broadband infrastructure. The study was a qualitative study carried out inductively using Grounded Theory. Six cases were investigated.Two Community Based Network Mobilization models were identified......The deployment of previous wireless standards has provided more benefits for urban dwellers than rural dwellers. 5G deployment may not be different. This paper identifies that Community Based Networks as carriers that deserve recognition as potential 5G providers may change this. The argument....... The findings indicate that 5G connectivity can be extended to rural areas by these networks, via heterogenous networks. Hence the delivery of 5G data rates delivery via Wireless WAN in rural areas can be achieved by utilizing the causal factors of the identified models for Community Based Networks....

  8. Successful Community-Based Seed Production Strategies

    OpenAIRE

    Anonymous,; Monyo, Emmanuel; Banziger, Marianne

    2004-01-01

    Designed to address the issues that limit the access of small-scale farmers in sub-Saharan Africa to quality, affordable seed of the crops on which they depend for food security and livelihoods, this collection of articles describes successful principles for and experiences in community-based seed production. Among other things, the manuscripts analyze current seed production systems and models; propose ways to design successful community-based seed production schemes; describe proper seed pr...

  9. ESPEN Guidelines on Parenteral Nutrition: gastroenterology

    DEFF Research Database (Denmark)

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

    2009-01-01

    -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....... 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......Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence...

  10. Microwave thawing of frozen parenteral solutions.

    Science.gov (United States)

    Walter, C W; Pauly, J A; Ausman, R K; Kundsin, R B; Holmes, C J

    1983-01-01

    A commercially available microwave oven modified for use at medication stations throughout hospitals allows timely thawing of frozen parenteral solutions. The inherent problems of safety and uniform heating have been overcome, thus making possible the preparation, storage, and distribution of admixtures on a regional basis and ensuring the integrity of the product. Most parenteral medications are not degraded by microwave energy, and thawing by microwave energy permits timely administration and allows coordination of medication for a series of patients.

  11. Manganese in long term paediatric parenteral nutrition.

    OpenAIRE

    Reynolds, A P; Kiely, E; Meadows, N

    1994-01-01

    The current practice of providing manganese supplementation to neonates on long term parenteral nutrition is leading to a high incidence of hypermanganesaemia. Magnetic resonance imaging (MRI) studies in adults on long term manganese parenteral nutrition have shown changes in TI weighted MRI images and similar findings in a neonate receiving trace element supplementation are reported here. Whole blood manganese concentration in the infant was 1740 nmol/l (or 8.3 times upper reference limit). ...

  12. 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.

  13. Parenteral Nutrition and Intestinal Failure

    Science.gov (United States)

    Bielawska, Barbara; Allard, Johane P.

    2017-01-01

    Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes. PMID:28481229

  14. Alteraciones hepáticas inducidas por la nutrición parenteral

    OpenAIRE

    J Salas Salvado; A Recaséns Garica

    1993-01-01

    Liver disorders induced by parenteral nutrition Alteraciones hepáticas inducidas por la nutrición parenteral Liver disorders induced by parenteral nutrition Alteraciones hepáticas inducidas por la nutrición parenteral

  15. Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare.

    Science.gov (United States)

    Korczak, Dieter; Huber, Beate; Steinhauser, Gerlinde; Dietl, Markus

    2010-07-29

    The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in

  16. [Parenteral alimentation in the early postoperative period].

    Science.gov (United States)

    Brisky, T

    1981-01-01

    Parenteral diet is a rather important problem for all of medical science, but especially for intensive care units. During the last few decades, a significant advancement has been made in this field, and there are indications that parenteral diet will be still more adequate, quantitatively and qualitatively, in the future. According to many published papers, patients can now be maintained exclusively on a parenteral diet, as our ward has done in the treatment of a variety of illnesses and diseases. This paper describes all the ingredients necessary for a parenteral diet. Briefly described are the effects on the organism, caloric values, and the ways in which the cells and organs utilize the food (as energy sources). All the preparations that we have used as well as those used by other institutions both foreign and domestic are listed. A full list of the ingredients of the preparations would consume too much space: however, there is a wealth of available literature and brochures for the reader who would like more detailed information. Based on the experience of a great many authors and that of our own institution, guidelines to be followed daily are provided. For such a program to be effectively applied, each member of the team should constantly monitor the parenteral diet, and there should be a frequent exchange of information and experiences. By so doing, still more could be contributed to overcoming this important problem.

  17. Parenteral nutrition: never say never

    Science.gov (United States)

    2015-01-01

    This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due time. Critically ill patients are at risk of energy deficit during their ICU stay, a condition which leads to unfavorable outcomes, due to hypercatabolism secondary to the stress response and the difficulty to optimize feeding. Indirect calorimetry is recommended to define the energy target, since no single predictive equation accurately estimates energy expenditure. Energy metabolism is intimately associated with protein metabolism. Recent evidence calls for adequate protein provision, but there is no accurate method to estimate the protein requirements, and recommendations are probably suboptimal. Enteral nutrition (EN) is the preferred route of feeding, but gastrointestinal intolerance limits its efficacy and PN allows for full coverage of energy needs. Seven recent articles concerning PN for critically ill patients were identified and carefully reviewed for the clinical and scientific relevance of their conclusions. One article addressed the unfavorable effects of early PN, although this result should be more correctly regarded as a consequence of glucose load and hypercaloric feeding. The six other articles were either in favor of PN or concluded that there was no difference in the outcome compared with EN. Hypercaloric feeding was not observed in these studies. Hypocaloric feeding led to unfavorable outcomes. This further demonstrates the beneficial effects of an early and adequate feeding with full EN, or in case of failure of EN with exclusive or supplemental PN. EN is the first choice for critically ill patients, but difficulties providing optimal nutrition through exclusive EN are frequently encountered. In cases of insufficient EN, individualized supplemental PN should be administered to reduce the infection rate and the duration of mechanical ventilation. PN is a safe therapeutic option

  18. Parenteral nutrition: never say never.

    Science.gov (United States)

    Oshima, Taku; Pichard, Claude

    2015-01-01

    This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due time. Critically ill patients are at risk of energy deficit during their ICU stay, a condition which leads to unfavorable outcomes, due to hypercatabolism secondary to the stress response and the difficulty to optimize feeding. Indirect calorimetry is recommended to define the energy target, since no single predictive equation accurately estimates energy expenditure. Energy metabolism is intimately associated with protein metabolism. Recent evidence calls for adequate protein provision, but there is no accurate method to estimate the protein requirements, and recommendations are probably suboptimal. Enteral nutrition (EN) is the preferred route of feeding, but gastrointestinal intolerance limits its efficacy and PN allows for full coverage of energy needs. Seven recent articles concerning PN for critically ill patients were identified and carefully reviewed for the clinical and scientific relevance of their conclusions. One article addressed the unfavorable effects of early PN, although this result should be more correctly regarded as a consequence of glucose load and hypercaloric feeding. The six other articles were either in favor of PN or concluded that there was no difference in the outcome compared with EN. Hypercaloric feeding was not observed in these studies. Hypocaloric feeding led to unfavorable outcomes. This further demonstrates the beneficial effects of an early and adequate feeding with full EN, or in case of failure of EN with exclusive or supplemental PN. EN is the first choice for critically ill patients, but difficulties providing optimal nutrition through exclusive EN are frequently encountered. In cases of insufficient EN, individualized supplemental PN should be administered to reduce the infection rate and the duration of mechanical ventilation. PN is a safe therapeutic option

  19. Total parenteral nutrition - Problems in compatibility and stability

    DEFF Research Database (Denmark)

    Schroder, A.M.

    2008-01-01

    Adding calcium, trace elements and vitamins could turn parenteral nutrition into a dangerous product, which could harm the patient. This article focuses on the major pharmaceutical problems of parenteral. nutrition when adding nutritional compounds Udgivelsesdato: 2008...

  20. Participation in community based natural resource management ...

    African Journals Online (AJOL)

    Participation in community based natural resource management programme and effects on welfare of rural families in Ikwerre, Rivers State, Nigeria. ... and seedlings, fertilizers and reduction in cost of inputs should be taken into cognizance and proper mainstreaming of target beneficiaries of the programme intervention.

  1. Sustainable Community Based Interventions for Improving ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Sustainable Community Based Interventions for Improving Environment and Health in the Banda Slums, Kampala (Uganda). Rapid urbanization is one of the major challenges of the 21st century. About 12 000 people live in Banda parish in eastern Kampala. The area is swampy and prone to episodes of cholera. Incidence ...

  2. Community Based Natural Resource Management in Zimbabwe ...

    African Journals Online (AJOL)

    Interest in Community Based Natural Resources Management (CBNRM) developed as a result of a general despondency with State management of these resources. There is general agreement on the desirability of CNBRM. Numerous programmes and projects currently implemented as CBNRMs bear evidence to this.

  3. participation in community based natural resource management ...

    African Journals Online (AJOL)

    user

    ABSTRACT. The study was on participation in Community Based Natural Resource Management. Programme (CBNRMP) and its socio-economic effect on rural families in Ikwerre. Area, Rivers State Nigeria. A structured questionnaire was administered to 60 beneficiaries of the programme. Data collected were subjected to ...

  4. COMMUNITY BASED ECOTOURISM MANAGEMENT PRACTISE, A ...

    African Journals Online (AJOL)

    larry

    Ecotourism practise is a sustainable management tool targeted at improving livelihood and wellbeing of ... techniques. INTRODUCTION. Community-based natural resource management has been defined as, ―a process by which landholders gain access and use rights to, or ... architects, developers, business people, and.

  5. Shared Reflections through Community-Based Theater.

    Science.gov (United States)

    Salmons-Rue, Janet

    1991-01-01

    Describes the Community-Based Arts Project in central New York State, which offers a course through Cornell University that allows students to explore local history and family traditions through storytelling. The steps of story collecting and sharing are a circular transaction of reflecting, listening, telling, and reflecting with the audience,…

  6. promote Community based research in poor urban

    African Journals Online (AJOL)

    and volunteers. The intervention is being implemented in Ngwenya and Kauma. These are squatter settlements, located in the poorest areas in urban Lilongwe. The ESC action research intervention is informed by both participatory and community-based research approaches and involves the active participation of different.

  7. Future trends in parenteral nutrition.

    Science.gov (United States)

    Wretlind, A

    1975-01-01

    alimentation. The future trend in parenteral nutrition will also be to use this method for exact nutrition balances. In this way it will be possible to determine the endogenous loss via feces, as well as to study the requirements of nutrients in different conditions.

  8. [Domiciliary parenteral antibiotic therapy: a prospective analysis of the last 12 years].

    Science.gov (United States)

    Peláez Cantero, M J; Madrid Rodríguez, A; Urda Cardona, A L; Jurado Ortiz, A

    2014-08-01

    Parenteral antibiotic treatment has been classically developed in hospitals and is considered as a hospital procedure. The development of Hospital at Home Units (HHU) has led to an increase in outpatient parenteral antibiotic therapy (OPAT) in paediatrics patients. The objective of this study is to describe our experience, as an HHU integrated within a Paediatric Department, in home antimicrobial therapy over a period of 12 years. This prospective and descriptive study included every patient with a disease requiring parenteral antimicrobial therapy who was admitted to our HHU from January 2000 to December 2012. During the study there were 163 cases on OPAT. The mean age of the patients was 11.1 years, and the sample group was comprised of 33 males and 22 feamales. The main sources of the treated infections were respiratory tract (76%), catheter-related bloodstream (9.2%), and urinary tract infections (5.5%). Amikacin was the most widely used antibiotic. Almost all treatments (96.6%) were via an intravenous route. Catheter-associated complications were more common than drug-associated complications. Successful at-home treatment was observed in 90.2% of cases. OPAT is a good and safe alternative in many paediatric diseases. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  9. [Parenteral periferic nutrition: non surgical indications].

    Science.gov (United States)

    Ayúcar Ruiz de Galarreta, A; Pita Gutiérrez, F; Mosteiro Pereira, F; Cordero Lorenzana, L; Gómez Canosa, S; Seco Vilariño, C

    2011-01-01

    Peripheral Parenteral Nutrition, defined as a mixture of micronutrients, vitamins and minerals with lower osmolarity of 800 mOsm/L, it avoids the risk of the central catheter. It has traditionally been used in postoperative patients, but really medical conditions can also benefit from it either as complementary, or as the only one source of nutrients, since a high number of patients require less caloric intake than previously believed. Evaluation of the use of peripheral parenteral nutrition in non postoperative hospitalized patients, reasons for its prescription and duration. 368 patients who required peripheral parenteral nutrition were studied by the Nutrition Support Unit for 54 months, in a Tertiary Hospital of 1,560 beds, from all, specialties excluding postoperative patients. The study include the mechanisms that led to its use in all its forms: the only one nutritional support or complementing insufficient Enteral Nutrition or Oral Diet. Oncology and Critical Care were the most prescribed pathologies, followed by Pancreatitis, Inflammatory Bowel Disease and HIV and a miscellany of clinical pathologies. Gastrointestinal pathology (pain, diarrhea or vomiting) was the most frequent cause, both in critically ill as in non-critical patients. Although enteral route is preferred and raised primarily in most patients studied, there are many causes that might impair or nullify it. Peripheral parenteral nutrition is an alternative when caloric intake is impossible or insufficient or refused by the patient, as it minimizes the complications of the central catheter.

  10. [Parenteral nutrition-associated liver disease].

    Science.gov (United States)

    Moreno Villares, J M

    2008-05-01

    Parenteral nutrition associated liver disease (PNALD) is an important problem in patients who require longterm parenteral nutrition as well as in preterm infants. Prevalence varies according to different series. Clinical presentation is different in adults and infants. Although since its first descriptions several hypothesis have been elucidated, the aetiology is not quite clear. It is possible that different factors could be involved. PNALD risk factors can be classified in three groups: 1) those derived from the lack of enteral nutrition stimulus; 2) parenteral nutrition components acting as toxic or the lack of specific nutrients and 3) those due to the underlying disease. If PNALD appears in short-term PN and it presents only as a mild elevation of liver enzymes, there is no need to treat. On the contrary, when direct bilirubin is > 2 mg/dL and lasts longer, there is a need to consider different causes and to minimize risk factors. We review the different approaches to manage PNALD, including optimizing enteral nutrition, modify parenteral solutions, use of specific nutrients -taurine, choline, etc.- or the use of drugs (mainly ursodeoxicolic acid). If liver disease progresses to cirrhosis a liver transplant must be considered.

  11. Pharmaceutical Point of View on Parenteral Nutrition

    Science.gov (United States)

    Stawny, M.; Olijarczyk, R.; Jaroszkiewicz, E.; Jelińska, A.

    2013-01-01

    Parenteral nutrition—a form of administering nutrients, electrolytes, trace elements, vitamins, and water—is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them. PMID:24453847

  12. Pharmaceutical Point of View on Parenteral Nutrition

    Directory of Open Access Journals (Sweden)

    M. Stawny

    2013-01-01

    Full Text Available Parenteral nutrition—a form of administering nutrients, electrolytes, trace elements, vitamins, and water—is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient’s energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them.

  13. Use of parenteral testosterone in hypospadias cases

    Directory of Open Access Journals (Sweden)

    Vikram Satav

    2015-01-01

    Full Text Available Objectives: The aim was to evaluate the effect of parenteral testosterone on penile length, preputial hood, vascularity of dartos pedicle in patients with hypospadias. Materials and Methods: A total of 42 patients with hypospadias were included in this study. Injection aquaviron (oily solution each ml containing testosterone propionate 25 mg was given deep intramuscularly in three doses with an interval of 3 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Preoperatively penile length, transverse preputial width and diameter at the base of the penis were measured. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial width and diameter at the base of penis was 1.01 ± 0.25 cm (P < 0.001, 1.250 ± 0.52 cm and 0.61 ± 0.35 cm, respectively, (P < 0.001. Serum testosterone level after injection was well within normal range for that age. Conclusion: Parenteral testosterone increased phallus size, diameter and prepuce hypertrophy without any adverse effects. However, due to lack of a control group we cannot make any inferences. Controlled studies are required to establish the benefits of parenteral testosterone.

  14. How community based is general practice?

    OpenAIRE

    Bakker, D; Spreeuwenberg, P.

    2006-01-01

    Background: One of the potentially strong points of general-practice-based primary care is that it is accessible within local communities. As the arm of clinical medicine with the broadest reach into the community, primary care clinicians are well-positioned to understand local needs and design programmes that address community health. This paper analyses variations in the degree to which general practices indeed work community based. Geographical factors, patient factors, and practice factor...

  15. [Involuntary outpatient treatment].

    Science.gov (United States)

    Oyffe, Igor; Melamed, Yuval

    2012-03-01

    Much has been written about involuntary outpatient treatment, both in Israel and abroad. Since the amendment of the law in Israel in 1991, there is an option for compulsory outpatient treatment that is Less confining than hospitalization. Research has noted its efficacy in avoiding exacerbation of the mental state, repeat hospitalizations and involvement in dangerous activities among patients with low compliance to treatment. In practice, there is no mechanism for implementation or enforcement. Thus, the main difficulty noted by Spinzy and Krieger, is the lack of tools to supervise involuntary outpatient treatment, thereby making it difficult to implement the law of involuntary outpatient treatment ordered by the regional psychiatrist. In addition, the court interpreted the law in a manner that prevents taking measures against the patient who does not comply with compulsory outpatient treatment unless his condition is so severe that it requires court ordered hospitalization. The issue becomes more problematic with court ordered compulsory outpatient treatment. In the United States there is Assisted Outpatient Treatment (AOT) in 42 states. The criteria include dangerousness to the environment, harm to self, or severe inability to care for one's self. AOT helps prevent hospitalizations and improves the outcome of treatment. According to "Kendra's Law" in the United States, the Court detaiLs the biological and psychosocial treatment programs in the court order recommendations: The recommendations include: create uniformity, determine a mechanism of action, assign skilled manpower to implement compulsory outpatient treatment, establish a plan for compulsory outpatient treatment, and create a legal mechanism to supervise patients in court ordered outpatient treatment. In conclusion, determining a mechanism for intervention, implementation and supervision of compulsory outpatient treatment is first and foremost in the best interest of: the patient, who does not want his

  16. Impact of early parenteral nutrition on metabolism and kidney injury.

    Science.gov (United States)

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

    2013-05-01

    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 unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of parenteral nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early parenteral nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late parenteral nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early parenteral nutrition. In conclusion, early parenteral nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early parenteral nutrition.

  17. MRI in children receiving total parenteral nutrition

    Energy Technology Data Exchange (ETDEWEB)

    Quaghebeur, G. [Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG (United Kingdom)]|[Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Taylor, W.J. [Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Kingsley, D.P.E. [Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Fell, J.M.E. [Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Reynolds, A.P. [Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Milla, P.J. [Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom)

    1996-10-01

    Cranial MRI was obtained in 13 of a group of 57 children receiving long-term parenteral nutrition, who were being investigated for hypermanganasaemia. Increased signal intensity on T1-weighted images has been reported in adult patients on long-term parenteral nutrition and with encephalopathy following chronic manganese exposure in arc welding. It has been postulated that these changes are due to deposition of the paramagnetic trace element manganese. In excess manganese is hepato- and neurotoxic and we present the correlation of whole blood manganese levels with imaging findings. The age range of our patients was 6 months to 10 years, and the duration of therapy 3 months to 10 years. In 7 children we found characteristic increased signal intensity on T1-weighted images, with no abnormality on T2-weighted images. All patients had elevated whole blood manganese levels, suggesting that the basis for this abnormality is indeed deposition of manganese within the tissues. (orig.). With 3 figs.

  18. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    DEFF Research Database (Denmark)

    Estmann, Anne; Qvist, Niels; Husby, Steffen

    2002-01-01

    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...... of Denmark over a period of 11 1/2 years. RESULTS: A total of 21 patients with need for PN for 55 days or more due to gastrointestinal disease were registered with a cumulative hospital stay of 4462 days. The study showed a low incidence of long-term PN due to gastro-intestinal surgical illness...

  19. PARENTERAL NUTRITION IN PEDIATRICS AND PEDIATRIC SURGERY

    OpenAIRE

    R. F. Tepaev; A. E. Aleksandrov; I.V. Kirgizov; Smirnova, T.N.; Rybalko, A. S.

    2012-01-01

    Nutrition plays a key role in the growth and development of children. A present day balanced parenteral nutrition can adequately ensure the child’s organism with amino acids, carbohydrates, fats, and energy needed to maintain a basic energy level, physical activity, height, pre-correction of nutritional deficiency. The child’s body needs sufficient amounts of electrolytes, minerals, microelements and vitamins. Protein and energy homeostasis is the basis of the organism life, which determines ...

  20. [Neonatal parenteral nutrition prescription practices in Portugal].

    Science.gov (United States)

    Neves, A; Pereira-da-Silva, L; Fernandez-Llimos, F

    2014-02-01

    The use of guidelines for neonatal parenteral nutrition (PN) improves its clinical efficiency and the safety of prescription. To evaluate the practices of neonatal parenteral nutrition prescription in Portugal, and the adherence to the National Consensus on neonatal PN (2008). A questionnaire based on a multiple choice response on parenteral nutrition prescription was conducted, and sent to the coordinators of the 50 public and private Portuguese neonatal special care units, 25 being level III and 25 level II. Parenteral nutrition was prescribed in 32 neonatal units, 23 of which (71.9%) responded to the questionnaire. Of the respondents, 19 (82.6%) refer to follow the National Consensus, the remaining following local guidelines; 17 (73.9%) of units referred to using an electronic based system for prescription. In preterm neonates, most mentioned: administering judiciously the fluid intake during the first post-natal week; starting amino acids from the first post-natal day with 1.5-3g/kg/d, increasing up to 3-4g/kg/d; starting lipids from the first three post-natal days with 1g/kg/d, increasing up to 3g/kg/d; administering 40-70mg/kg/d of calcium and of phosphorus with the fixed calcium:phosphorus ratio of 1.7: 1 (mg:mg); and estimating the osmolality of the solutions, and weekly monitoring of serum triglycerides, blood urea, serum phosphorus and liver function. The high response rate is probably representative of the practice of PN prescription in Portugal. Most of the units used the National Consensus on neonatal PN as a reference, thus contributing to better nutritional support for neonates. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. Social capital, community-based governance and resilience in an ...

    African Journals Online (AJOL)

    While the Mozambique government policy promotes community-based fisheries management in artisanal fisheries, we argue that under current conditions of ineffective community-based governance, a strong focus on reconstruction of social capital will be required before a community-based resource management process ...

  2. [Partial parenteral nutrition in severe virus hepatitis].

    Science.gov (United States)

    Kleinberger, G; Schneeweiss, B; Druml, W; Laggner, A; Lenz, K

    1984-03-01

    Patients with severe virus hepatitis and a prothrombin concentration below 25% have a bad prognosis. This is due to direct consequences of hepatic failure and to the rather frequent complications of this disease. The clinical course of such patients is essentially dependent upon the degree of liver regeneration, which again is dependent upon the mass of hepatocytes which are able to regenerate and upon the so called hepatotrophic factors. Patients with severe hepatitis suffer during the first weeks rather frequently from nausea and loss of appetite and for that reason their nutrition is insufficient. In the study recorded here 9 cases were investigated (7 patients with hepatitis B, 2 patients with hepatitis non A non B). The question was asked, if partial parenteral nutrition in addition to a liver diet not containing meat would improve liver function. It could be shown that the prothrombin concentration, which could not be improved by vitamine K1 supplements, was increased during a 7 day parenteral nutrition period from 19,3 +/- 2,9% to 41,5 +/- 8,1% (p less than 0,05), serum albumine and cholinesterase activity improved as well. During the first day of treatment there was a significant fall of ammoniac from 115 +/- 10 mumol to 73 +/- 10 mumol/l (p less than 0,05), at the same time production of urea did not increase. All patients survived. The results show, that parenteral nutrition can improve liver function and decrease the catabolic status of metabolism.

  3. APPLICATION OF PARENTERAL NUTRITION IN PREMATURE INFANTS

    Directory of Open Access Journals (Sweden)

    N. P. Molokanova

    2015-01-01

    Full Text Available Prematurity and, as a result, the expressed morphofunctional immaturity of all body organs and systems makes an essential contribution to morbidity and mortality rates. The efficiency of care for prematurely born children in many respects depends on adequacy of the enteral and parenteral nutrition program. The balanced and correctly organized nutrition is one of the most important components of care for the prematurely born children, which defines both immediate and remote prognosis. The review of literature on parenteral nutrition in prematurely born children is given. The main indications, dosages, beginning time, and strategies for the appointment of «aggressive» nutrition are specified. Main conclusion: it is necessary to use higher doses for parenteral nutrition, and take into account that an early appointment of amino acids and fatty emulsions is important. An early ‘aggressive’ nutrition strategy is well tolerated by preterm infants and provides proper rates of physical development in the postnatal period without adverse outcomes. 

  4. Enteral and parenteral nutrition in acute pancreatitis.

    Science.gov (United States)

    Imrie, Clement W; Carter, C Ross; McKay, Colin J

    2002-06-01

    In the last 5 years naso-enteric feeding has increasingly been used in clinical practice in patients with severe acute pancreatitis. Randomized clinical studies in both mild and severe forms of the disease have demonstrated not only the feasibility but also the safety of this approach. The majority of patients have been fed by variously placed nasojejunal tubes with varied problems in maintaining both location and patency. Most have been surprised to find that it is possible to feed the patients in this way with the potential of improving gut barrier function and immune response, at reduced cost and greater safety than with parenteral nutrition. The current evidence points to nasojejunal feeding being preferable to parenteral feeding, but evidence has yet to be produced to prove beyond reasonable doubt that such feeding is an improvement on conservative management without feeding. Finally, the most recent development has indicated that fine-bore nasogastric feeding may well be a realistic alternative to nasojejunal feeding even in the more severe forms of this disease. A small percentage of patients may still need parenteral nutrition. Copyright 2002 Elsevier Science Ltd.

  5. Enteral fish oil for treatment of parenteral nutrition-associated liver disease in six infants with short-bowel syndrome.

    Science.gov (United States)

    Tillman, Emma M; Crill, Catherine M; Black, Dennis D; Hak, Emily B; Lazar, Linda F; Christensen, Michael L; Huang, Eunice Y; Helms, Richard A

    2011-05-01

    To evaluate the use of enteral fish oil for the treatment of parenteral nutrition-associated liver disease (PNALD). Retrospective case series. Pediatric academic hospital and outpatient clinic. Six parenteral nutrition-dependent infants with short-bowel syndrome and PNALD. The six infants received supplementation with enteral fish oil, and treatment was evaluated over a 12-week period. The PNALD, as reflected by elevated total bilirubin levels, completely reversed in four of the six infants within a mean ± SD of 5 ± 2.6 weeks (range 2-8 wks) after initiation of the enteral fish oil supplementation. In addition, improvement in enteral feedings occurred after starting enteral fish oil therapy. Enteral fish oil may be an effective adjunctive treatment option for infants with PNALD, particularly for those infants with PNALD who are tolerating some amount of enteral nutrition as the result of an adequate amount of small bowel.

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

    Science.gov (United States)

    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.

  7. 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 ...

  8. Outpatient Imaging Efficiency - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - national data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...

  9. Outpatient Imaging Efficiency - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - provider data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...

  10. Outpatient Imaging Efficiency - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - state data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical imaging...

  11. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  12. Amino acid composition in parenteral nutrition: what is the evidence?

    Science.gov (United States)

    Yarandi, Shadi S.; Zhao, Vivian M.; Hebbar, Gautam; Ziegler, Thomas R.

    2011-01-01

    Purpose of review Complete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years. Recent findings Limited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition. Summary Despite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition. PMID:21076291

  13. Micronutrients in parenteral nutrition: boron, silicon, and fluoride.

    Science.gov (United States)

    Nielsen, Forrest H

    2009-11-01

    Boron may be beneficial for bone growth and maintenance, central nervous system function, and the inflammatory response, and silicon may be beneficial for bone maintenance and wound healing. Fluoride is not an essential element but amounts provided by contamination may be beneficial for bone strength. Fluoride toxicity may be a concern in parenteral nutrition. Further studies are warranted to determine whether there are optimal amounts of boron and silicon that should be delivered to typical and special population patients receiving parenteral nutrition. In addition, further studies are needed to determine whether providing the dietary guideline of adequate intake amounts of fluoride parenterally would prevent or treat parenteral nutrition osteopenia.

  14. Community-based natural resource management

    DEFF Research Database (Denmark)

    Treue, Thorsten; Nathan, Iben

    from CBNRM will be useful when designing community-based climate adaptation strategies. Thus, this note is a contribution to an ongoing debate as well as a product of the long-standing experiences of Danida's environmental portfolio. CBNRM is not a stand-alone solution to secure poverty reduction......) and how this concept may be used as a development strategy. CBNRM has the triple objective of poverty reduction, natural resource conservation and good governance. The opportunity and challenge is to pursue these objectives simultaneously, as they are not, by default, mutually supportive. Lessons learnt...... representatives from the public sector (and not only environmental authorities), civil society (women and men), private sector as well as financial institutions. It is envisaged that this work note will be followed by an interdisciplinary workshop in Copenhagen in 2008...

  15. ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients

    DEFF Research Database (Denmark)

    Staun, M.; Pironi, L.; Bozzetti, F.

    2009-01-01

    Home parenteral nutrition (HPN) was introduced as a treatment modality in the early 1970s primarily for the treatment of chronic intestinal failure in patients with benign disease. The relatively low morbidity and mortality associated with HPN has encouraged its widespread use in western countries...

  16. Laboratory Monitoring of Parenteral Direct Thrombin Inhibitors.

    Science.gov (United States)

    Van Cott, Elizabeth M; Roberts, A Joshua; Dager, William E

    2017-04-01

    Argatroban and bivalirudin are parenteral direct inhibitors of the activity of thrombin, but, unlike heparin, can inhibit both soluble as well as clot-bound thrombin. These agents do not require antithrombin as a cofactor for activity. The parenteral direct thrombin inhibitors (DTIs) can be used in a variety of settings, including heparin-induced thrombocytopenia (HIT) or an allergy to heparin, and patients requiring anticoagulation for an invasive cardiovascular intervention. Both agents have a relatively short half-life in patients without organ system failure and are typically administered by continuous infusion. Argatroban is primarily eliminated by the liver, while bivalirudin is removed by a combination of proteolytic cleavage by thrombin and renal clearance mechanisms. Several laboratory tests are available for monitoring the anticoagulant effects of the DTIs: the activated partial thromboplastin time (aPTT) and the activated clotting time (ACT) are the most commonly used assays, but on occasion, the thrombin time may be useful. Other coagulation assays such as the dilute thrombin time (dTT), chromogenic anti-IIa assays, and the ecarin clotting time (ECT) can be used. The intensity of anticoagulation with DTIs depends on the indication for use. For patients with HIT, the target aPTT is 1.5 to 3.0 and 1.5 to 2.5 times the patient's baseline value for argatroban and bivalirudin, respectively. DTI anticoagulation used during percutaneous coronary intervention can be measured using ACT. Both DTIs may cause an elevation in the international normalized ratio depending on their plasma concentration. This article will review the use of parenteral DTIs and related laboratory assays for assessing the anticoagulant effect of these drugs. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Stability of somatostatin in total parenteral nutrition.

    Science.gov (United States)

    Montoro, J B; Galard, R; Catalan, R; Martinez, J; Salvador, P; Sabin, P

    1990-12-14

    The stability of somatostatin, added to a total parenteral nutrition formula, in glass containers and in plastic ethylene vinyl acetate containers was investigated. The somatostatin concentration decreased immediately from 3 micrograms/ml to 0.3-0.6 micrograms/ml after addition to the emulsion. In spite of this rapid decrease, somatostatin concentrations remained stable with values of 0.4-0.7 micrograms/ml during the follow-up period (24 h). These findings could be explained assuming adsorption to the surface of the container.

  18. Parenteral nutrition: indications and safe management.

    Science.gov (United States)

    Wyer, Nicky

    2017-07-01

    The aim of this article is to provide an overview of what parenteral nutrition (PN) is and when its use is required. It will describe the process of nutritional assessment, and considerations when choosing venous access. The different approaches to provision of PN solutions in hospital will be discussed. Catheter-related and metabolic complications can occur during delivery of PN; there will be a discussion of the different types of complications and how these can be avoided or minimised. Finally, the pivotal role of the nurse in the assessment and ongoing care of patients who require PN will be highlighted, including skills required to administer PN safely.

  19. [The behavior of bioelements during long-term parenteral feeding].

    Science.gov (United States)

    Herold, G; Stephan, B; Menzel, T

    1979-04-01

    26 adult patients were investigated for 26--35 postoperative days while being fed parenterally. Serum levels and urine excretion of zinc, magnesium, calcium and phosphate were measured. From the results it can be assumed that only phosphate substitution is necessary during parenteral long-term nutrition.

  20. DESA WISATA SEBAGAI COMMUNITY BASED TOURISM

    Directory of Open Access Journals (Sweden)

    Dhimas Setyo Nugroho

    2017-12-01

    Full Text Available The concept of community-based tourism in the dome house tourism village has succeeded in becoming a tool to trigger the development of the dome house resident and its environment. All of the development can be obviously seen from the economic, social, cultural, environmental and political aspects with a very enthusiastic participation of the resident. The rapid development of the resident and their high participation can emerge a strategy to make the tourist village survive from the tourism industry competition. In this case, the author found that there is a connection between the high level of community participation and the rapid development as the result of it. Therefore, the more the resident willing to participate, the more it will affect the development of the resident and its environment. This research uses qualitative method. The data were obtained by conducting interview, observation, and documentation. After those steps, the data were processed by interactive and SWOT analysis. Then, questionnaire was used to validate the data towards 21 residents.

  1. Risk of Parenteral Nutrition in Neonates—An Overview

    Directory of Open Access Journals (Sweden)

    Maria Martin

    2012-10-01

    Full Text Available Healthcare-associated infections (HAI in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic.

  2. Risk of Parenteral Nutrition in Neonates—An Overview

    Science.gov (United States)

    Zingg, Walter; Tomaske, Maren; Martin, Maria

    2012-01-01

    Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic. PMID:23201767

  3. Community-based knowledge transfer and exchange: Helping community-based organizations link research to action

    Directory of Open Access Journals (Sweden)

    Lavis John N

    2010-04-01

    Full Text Available Abstract Background Community-based organizations (CBOs are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery efforts. CBOs increasingly turn to community-based research (CBR given its participatory focus and emphasis on linking research to action. In order to further facilitate the use of research evidence by CBOs, we have developed a strategy for community-based knowledge transfer and exchange (KTE that helps CBOs more effectively link research evidence to action. We developed the strategy by: outlining the primary characteristics of CBOs and why they are important stakeholders in health systems; describing the concepts and methods for CBR and for KTE; comparing the efforts of CBR to link research evidence to action to those discussed in the KTE literature; and using the comparison to develop a framework for community-based KTE that builds on both the strengths of CBR and existing KTE frameworks. Discussion We find that CBR is particularly effective at fostering a climate for using research evidence and producing research evidence relevant to CBOs through community participation. However, CBOs are not always as engaged in activities to link research evidence to action on a larger scale or to evaluate these efforts. Therefore, our strategy for community-based KTE focuses on: an expanded model of 'linkage and exchange' (i.e., producers and users of researchers engaging in a process of asking and answering questions together; a greater emphasis on both producing and disseminating systematic reviews that address topics of interest to CBOs; developing a large-scale evidence service consisting of both 'push' efforts and efforts to facilitate 'pull' that highlight actionable messages from community relevant systematic reviews in a user-friendly way; and rigorous evaluations of efforts for linking research evidence to action. Summary

  4. Naloxone for opioid overdose prevention: pharmacists' role in community-based practice settings.

    Science.gov (United States)

    Bailey, Abby M; Wermeling, Daniel P

    2014-05-01

    Deaths related to opioid overdose have increased in the past decade. Community-based pharmacy practitioners have worked toward overcoming logistic and cultural barriers to make naloxone distribution for overdose prevention a standard and accepted practice. To describe outpatient naloxone dispensing practices, including methods by which practitioners implement dispensing programs, prescribing patterns that include targeted patient populations, barriers to successful implementation, and methods for patient education. Interviews were conducted with providers to obtain insight into the practice of dispensing naloxone. Practitioners were based in community pharmacies or clinics in large metropolitan cities across the country. It was found that 33% of participating pharmacists practice in a community-pharmacy setting, and 67% practice within an outpatient clinic-based location. Dispensing naloxone begins by identifying patient groups that would benefit from access to the antidote. These include licit users of high-dose prescription opioids (50%) or injection drug users and abusers of prescription medications (83%). Patients were identified through prescription records or provider screening tools. Dispensing naloxone required a provider's prescription in 5 of the 6 locations identified. Only 1 pharmacy was able to exercise pharmacist prescriptive authority within their practice. Outpatient administration of intramuscular and intranasal naloxone represents a means of preventing opioid-related deaths. Pharmacists can play a vital role in contacting providers, provision of products, education of patients and providers, and dissemination of information throughout the community. Preventing opioid overdose-related deaths should become a major focus of the pharmacy profession.

  5. Effectiveness and tolerability of parenteral testosterone undecanoate: a post-marketing surveillance study.

    Science.gov (United States)

    Wolf, Jan; Keipert, Dieter; Motazedi, Heiko; Ernst, Michael; Nettleship, Joanne; Gooren, Louis

    2017-12-01

    This observational post-marketing study of parenteral testosterone undecanoate (TU) in a non-selected population aimed to: examine the effectiveness of TU as treatment of hypogonadism; record adverse drug reactions (ADR) quantitatively particularly regarding polycythemia, prostate safety and cardiovascular-related metabolic risk factors; and verify whether recommended injection intervals apply to routine clinical practice. Eight hundred and seventy subjects from 259 outpatient units scheduled to visit the clinic six times were included. Effectiveness and tolerability of TU administration were assessed on a 4-point scale. Body weight, waist girth, blood pressure, hemoglobin levels, hematocrit, prostate-specific antigen (PSA), and digital rectal prostate examination were assessed. Over 90% of subjects completed the observational duration of 52.8 ± 9.7 weeks (mean ± SD) and 56% judged effectiveness as very good, 30.8% as good. 63.1% judged tolerability as very good, and 24.4% as good. No adverse effects on indicators of cardiovascular risk were observed. Polycythemia occurred in one subject and a supranormal hematocrit in one subject. Four subjects developed supranormal PSA levels. Prostate carcinoma was found in one subject, one subject had recurrence of a previously surgically treated prostate carcinoma, and the other two showed no indication of malignancy. Parenteral TU is safe, effective, and well-tolerated in clinical practice proving a good therapeutic option for hypogonadism.

  6. Tratamento da anemia ferropriva com ferro por via parenteral Iron deficiency anemia treatment with parenteral iron

    Directory of Open Access Journals (Sweden)

    Rodolfo D. Cançado

    2010-06-01

    Full Text Available Embora o ferro por via oral seja considerado a primeira opção de tratamento da deficiência de ferro, em algumas situações específicas, a administração de ferro por via parenteral é uma opção terapêutica que deve ser considerada. Diferentemente do ferro dextran de alto peso molecular utilizado na década de 80 e lembrado como um composto associado ao alto risco de reação anafilática e morte, o desenvolvimento e comercialização de novos compostos com ferro para uso parenteral, sobretudo por via endovenosa - como o ferro sacarato, ferro gluconato e, mais recentemente, a carboximaltose férrica - , tem se tornado cada vez mais uma alternativa terapêutica segura e efetiva, e tem possibilitado ampliar o leque de indicações desta modalidade de tratamento além da nefrologia, como obstetrícia e ginecologia, cirurgia, pediatria, gastroenterologia, hematologia e hemoterapia. Os autores revisam as principais indicações do tratamento com ferro por via parenteral, analisam as principais drogas disponíveis para a correção da anemia ferropriva por via endovenosa e propõem uma estratégia de investigação diagnóstica, tratamento e seguimento laboratorial dos pacientes com indicação desta opção terapêutica.Although oral iron is generally considered the first choice in the treatment of iron deficiency, in some specific situations, parenteral iron administration is a therapeutic option that should be considered. Different to the high-molecular-weight iron dextran utilized in the eighties and remembered as a compound associated with a high risk of anaphylaxis and death, the development and marketing of newer preparations for parenteral, in particular endovenous, administration, such as iron sucrose, ferric gluconate and more recently ferric carboxymaltose, are becoming a more effective and safe therapeutic alternative, that have extended the range of indications beyond nephrology to obstetrics and gynecology, surgery, pediatrics

  7. Nigeria: community-based family planning.

    Science.gov (United States)

    1986-07-01

    Community-based distribution projects are currently operating in 40 countries, including the program in Oyo State in southwest Nigeria. Such programs utilize volunteer community workers to expand the availability and accessibility of primary health care services, family planning information, and nonprescription contraceptives in rural areas. These workers play a vital role in linking the village with government health facilities. Among the responsibilities of community health workers are promotion of food supply and proper nutrition, adequate supply of safe water and sanitation, maternal and child health care (including family planning, immunization, prevention and control of major endemic diseases, treatment of common diseases, and provision of essential drugs). These workers are nominated by traditional village leaders and selected by public health nurses; priority is given to traditional birth attendants. In Oyo State, community workers participate in an extensive 2-phase learning program followed by refresher courses every 6 months. After 2 years of program services in Oyo State, approval of family planning increased from 20% to 50% and the desire to postpone the next pregnancy beyond the period of postpartum abstinence increased from 15% to 34%. Knowledge of a modern family planning method rose from 24% to 45%. Current use of contraception rose from 1.5% to 4.5%. Despite these gains, there has been a persistence of the traditional viewpoint that regards sex as primarily for the purpose of procreation. An additional barrier is the widespread belief among husbands that if women are protected from conceiving, they will engage in extramarital relations. These strong Yoruba cultural beliefs continue to restrict acceptance of family planning and pose a challenge to health workers.

  8. An aggressive parenteral nutrition protocol improves growth in preterm infants.

    Science.gov (United States)

    Törer, Birgin; Hanta, Deniz; Özdemir, Zeliha; Çetinkaya, Bilin; Gülcan, Hande

    2015-01-01

    The objective of this study was to compare postnatal growth and clinical outcomes of preterm infants after an adjustment in amino acid and lipid administration practice. The study was conducted retrospectively in preterm infants with a birth weight parenteral nutrition group). In 2010, amino acid solution was initiated at 3 g/kg/day on the first day of life and advanced 1 g/kg/day to a maximum of 4 g/kg/ day; lipid solution was initiated at 1 g/kg/day on the first day of life and advanced 1 g/kg/day to a maximum of 3 g/kg/day (high-dose parenteral nutrition group). Patient characteristics were similar in the two groups. Infants in the high-dose parenteral nutrition group showed a significant reduction in the time needed to regain birth weight and a significant reduction in the maximum weight loss. Weight, length and head circumference at discharge were significantly higher in the high-dose parenteral nutrition group. The mean duration of parenteral nutrition, mean number of days to reach full enteral feeding and incidence of sepsis and necrotizing enterocolitis were significantly lower in the high-dose parenteral nutrition group. There was no significant difference in the mortality rate between the groups. In conclusion, a more aggressive parenteral nutrition protocol for preterm infants resulted in a more rapid increase in weight, length and head circumference, and decreased incidence of sepsis and necrotizing enterocolitis.

  9. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... “large volume parenteral drug product” means a terminally sterilized aqueous drug product packaged in a...

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

    OpenAIRE

    Druml, W.; Kierdorf, H. P.; Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

    2009-01-01

    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 dial...

  11. Renewal strategy and community based organisations in community ...

    African Journals Online (AJOL)

    Renewal strategy and community based organisations in community development in Nigeria: Some empirical evidence. ... International Journal of Development and Management Review ... the people". Keywords: Renewal strategy, Community development, Community-based organizations, Bottom-up, Top-down, Nigeria ...

  12. Beyond Propietorship: Murphree's Laws on Community-based ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    30 sept. 2009 ... Beyond Propietorship: Murphree's Laws on Community-based Natural Resource Management in Southern Africa. Book cover Beyond Propietorship: Murphree's Laws on Community-based Natural Resource Management in Southern. Directeur(s) : B.B. Mukamuri, J.M. Manjengwa, and S. Anstey. Maison(s) ...

  13. Beyond Propietorship : Murphree's Laws on Community-based ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    30 sept. 2009 ... Beyond Propietorship : Murphree's Laws on Community-based Natural Resource Management in Southern Africa. Couverture du livre Beyond Propietorship : Murphree's Laws on Community-based Natural Resource Management in. Directeur(s) : B.B. Mukamuri, J.M. Manjengwa, et S. Anstey. Maison(s) ...

  14. Community Based Health Insurance Knowledge and Willingness to ...

    African Journals Online (AJOL)

    Introduction: A Community-Based Health Insurance Scheme (CBHI) is any program managed and operated by a community-based organization that provides resource pooling and risk-sharing to cover the costs of health care services. CBHI reduces out of pocket expenditure and is the most appropriate insurance model for ...

  15. Community-based tourism and its potential to improve living ...

    African Journals Online (AJOL)

    Administrator

    Community-based tourism and its potential to improve living conditions among the Hananwa of. Blouberg (Limpopo Province), with particular reference to catering services during winter. ISSN 0378-5254 Tydskrif vir Gesinsekologie en Verbruikerswetenskappe, Vol 35, 2007. Community-based tourism and its potential to.

  16. Tensions, Contradictions and Inconsistencies in Community-Based ...

    African Journals Online (AJOL)

    A community-based rural development programme by Volunteers Efforts for Development Concerns (VEDCO), a local NGO in central Uganda, was used as a case to critically explore the community-based environmental education processes. The programme aimed to empower smallholder farmers economically and ...

  17. Factors Affecting Continuity And Success Of Community-Based ...

    African Journals Online (AJOL)

    Objective: To assess opportunities and threats towards the continuity and success of Community based reproductive health service programme in Northeast Ethiopia. Design: Community based comparative cross sectional study. Setting: Two districts of Amhara region, Ethiopia, classified as strong and weak community ...

  18. Sustainability and factors affecting the success of community-based ...

    African Journals Online (AJOL)

    Various Community-Based Reproductive Health interventions were initiated in many developing countries but their effectiveness has not been evaluated as much as needed. A comparative cross sectional study was carried out in February 2002 among women who participated in community based reproductive health ...

  19. A community-based study of childhood morbidity in

    African Journals Online (AJOL)

    Denmark in urban settings (3). Since 85% of the country's population live in rural areas, information from rural community-based morbidity surveillance is essential for health planners. A one-year community based study of under-fives in rural Butajira in 1991 showed. ARI and acute diarrhea to be the most common diseases ...

  20. Community Based Distributors and Increased Ownership of the ...

    African Journals Online (AJOL)

    Community Based Distributors and Increased Ownership of the Long Lasting Insecticidal Nets in Rural Area of Jos Plateau State. ... those that served as community based distributors (CBDs) who were pregnant women themselves that could read and write and understood English, Hausa and the native language Birom.

  1. Community-based tourism: Origins and present trends | Giampiccoli ...

    African Journals Online (AJOL)

    Community-based tourism: Origins and present trends. ... Understanding the origins of Community Based Tourism helps in mapping its possible trajectories. Past and current trends are important to unlock the possibilities ... from genuine CBT projects. Keywords: Community participation, development, management, tourism.

  2. Ethical and Professional Norms in Community-Based Research

    Science.gov (United States)

    Campano, Gerald; Ghiso, María Paula; Welch, Bethany J.

    2015-01-01

    In this article Gerald Campano, María Paula Ghiso, and Bethany J. Welch explore the role of ethical and professional norms in community-based research, especially in fostering trust within contexts of cultural diversity, systemic inequity, and power asymmetry. The authors present and describe a set of guidelines for community-based research that…

  3. The Paradigm Of Community-Based Participatory Epizootiology: A ...

    African Journals Online (AJOL)

    Community-based participatory approach has been used for decades in rural sociology and the humanities in the design, implementation, monitoring and evaluation of development and intervention projects. Community-based medical and health education paradigm has become the accepted standard for undergraduate ...

  4. Hydrotropic solubilization of nimesulide for parenteral administration.

    Science.gov (United States)

    Agrawal, Shikha; Pancholi, S S; Jain, N K; Agrawal, G P

    2004-04-15

    Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) that exhibits analgesic, antipyretic and anti-inflammatory activities. It is practically insoluble in water. The effect of various hydrotropes such as nicotinamide, sodium ascorbate, sodium benzoate, sodium salicylate and piperazine on the solubility of nimesulide was investigated. The solubility enhancement of nimesulide by the hydrotropes was observed in decreasing order as piperazine > sodium ascorbate > sodium salicylate > sodium benzoate > nicotinamide. In order to elucidate the probable mechanism of solubilization, various solution properties of hydrotropes such as viscosity, specific gravity, surface tension, refractive index, specific conductance of hydrotropic solutions were studied at 25 +/- 2 degrees C on the basis of earlier studies. The hydrotropic solubilization of nimesulide at lower hydrotrope concentration may be attributed to weak ionic interactions while that at higher hydrotrope concentration may be due to molecular aggregation. Parenteral formulations using piperazine as a hydrotrope were developed and studied for physical and chemical stability.

  5. Squalene emulsions for parenteral vaccine and drug delivery.

    Science.gov (United States)

    Fox, Christopher B

    2009-09-01

    Squalene is a linear triterpene that is extensively utilized as a principal component of parenteral emulsions for drug and vaccine delivery. In this review, the chemical structure and sources of squalene are presented. Moreover, the physicochemical and biological properties of squalene-containing emulsions are evaluated in the context of parenteral formulations. Historical and current parenteral emulsion products containing squalene or squalane are discussed. The safety of squalene-based products is also addressed. Finally, analytical techniques for characterization of squalene emulsions are examined.

  6. Squalene Emulsions for Parenteral Vaccine and Drug Delivery

    Directory of Open Access Journals (Sweden)

    Christopher B. Fox

    2009-09-01

    Full Text Available Squalene is a linear triterpene that is extensively utilized as a principal component of parenteral emulsions for drug and vaccine delivery. In this review, the chemical structure and sources of squalene are presented. Moreover, the physicochemical and biological properties of squalene-containing emulsions are evaluated in the context of parenteral formulations. Historical and current parenteral emulsion products containing squalene or squalane are discussed. The safety of squalene-based products is also addressed. Finally, analytica techniques for characterization of squalene emulsions are examined.

  7. Building a community-based culture of evaluation.

    Science.gov (United States)

    Janzen, Rich; Ochocka, Joanna; Turner, Leanne; Cook, Tabitha; Franklin, Michelle; Deichert, Debbie

    2017-12-01

    In this article we argue for a community-based approach as a means of promoting a culture of evaluation. We do this by linking two bodies of knowledge - the 70-year theoretical tradition of community-based research and the trans-discipline of program evaluation - that are seldom intersected within the evaluation capacity building literature. We use the three hallmarks of a community-based research approach (community-determined; equitable participation; action and change) as a conceptual lens to reflect on a case example of an evaluation capacity building program led by the Ontario Brian Institute. This program involved two community-based groups (Epilepsy Southwestern Ontarioand the South West Alzheimer Society Alliance) who were supported by evaluators from the Centre for Community Based Research to conduct their own internal evaluation. The article provides an overview of a community-based research approach and its link to evaluation. It then describes the featured evaluation capacity building initiative, including reflections by the participating organizations themselves. We end by discussing lessons learned and their implications for future evaluation capacity building. Our main argument is that organizations that strive towards a community-based approach to evaluation are well placed to build and sustain a culture of evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Squalene emulsions for parenteral vaccine and drug delivery

    National Research Council Canada - National Science Library

    Fox, Christopher B

    2009-01-01

    .... In this review, the chemical structure and sources of squalene are presented. Moreover, the physicochemical and biological properties of squalene-containing emulsions are evaluated in the context of parenteral formulations...

  9. Parenteral glutamine supplementation in critical illness: a systematic review

    Science.gov (United States)

    2014-01-01

    Introduction The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data. Methods All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers. Results A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD –1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07). Conclusions Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients. PMID:24745648

  10. Prediction of the stability of meclofenoxate injection in parenteral admixtures.

    Science.gov (United States)

    Koshiro, A; Fujita, T

    1981-05-01

    A new method for predicting pharmaceutical stability in parenteral admixtures was studied using meclofenoxate hydrochloride injection as a model preparation. The pH and temperature of clinical parenteral admixtures are not constant, unlike experimental buffer solutions, and it is impossible to predict the accurate degradation ratio by the preceding method described by many authors. This study provides a solution to this problem making possible the accurate prediction of degradation ratios of pharmaceuticals even in such complicated systems.

  11. [Sea-blue histiocyte syndrome associated with home parenteral nutrition].

    Science.gov (United States)

    Egaña, N; Parón, L; Cuerda, C; Bretón, I; Camblor, M; Velasco, C; García-Peris, P

    2009-01-01

    A case of a 55 years-old male with long-term Crohn's disease without response to medical treatment and many intestinal fistula is presented. After the last bowel resection, home parenteral nutrition was started. He presented chronic hepatopathy and pancytopaenia. After 9 months of home parenteral nutrition hepatic function and pancytopaenia began to deteriorate. Bone marrow examination revealed an infiltrate of sea-blue histiocytes. He made unsatisfactory progress and died due to a multiorganic failure.

  12. Parenteral administration medicines: recommendations of preparation, administration and stability

    OpenAIRE

    M. Gaspar Carreño; F. Torrico Martín; L. Novajarque Sala; M. Batista Cruz; P. Ribeiro Gonçalves; B. Porta Oltra; J. C. Sánchez Santos

    2014-01-01

    Objective: To develop recommendations for the preparation of parenteral drugs (MAP), to assess the transferability of their preparation, from nursing units in the hospital ward to the pharmacy service (SF). Method: A table of stabilities of parenteral drugs included in the pharmacotherapeutic guideline was developed using the american and spanish guidelines. Information about MAP was collected (method of preparation, support, maintenance, validity, administration specifications and packaging...

  13. Parenteral omega-3 fatty acids: pouring oil on troubled waters?

    OpenAIRE

    Calder, Philip C.

    2012-01-01

    A meta-analysis of parenteral fish oil in 23 studies in intensive care unit (ICU) and non-ICU patients reported a reduced infection rate (significant in ICU patients) and shorter lengths of ICU and hospital stays (both non-ICU and ICU patients). Parenteral fish oil reduced inflammation and improved oxygenation index and liver function. The findings of the meta-analysis are discussed in this report.

  14. Copper and Zinc Deficiency in a Patient Receiving Long-Term Parenteral Nutrition During a Shortage of Parenteral Trace Element Products.

    Science.gov (United States)

    Palm, Eric; Dotson, Bryan

    2015-11-01

    Drug shortages in the United States, including parenteral nutrition (PN) components, have been common in recent years and can adversely affect patient care. Here we report a case of copper and zinc deficiency in a patient receiving PN during a shortage of parenteral trace element products. The management of the patient's deficiencies, including the use of an imported parenteral multi-trace element product, is described. © 2014 American Society for Parenteral and Enteral Nutrition.

  15. A community-based organization: the Las Mercedes Project.

    Science.gov (United States)

    Murphy, John W

    2012-01-01

    Using the Las Mercedes Project as an example, the aim of this article is to discuss the philosophy and practice of community-based projects. At the core of such projects is a shift in understanding the nature of community. A community, in this case, represents a reality that persons construct that determines the character of rules, norms, and the focus and style of interventions. Additionally, community-based organizations, such as the Las Mercedes Project, are fully participatory, decentered, and carry the imprint of a community's members. Community-based projects, in this regard, improve the likelihood of creating successful interventions.

  16. Establishing a regional, multisite database for quality improvement and service planning in community-based palliative care and hospice.

    Science.gov (United States)

    Bull, Janet; Zafar, S Yousuf; Wheeler, Jane L; Harker, Matthew; Gblokpor, Agbessi; Hanson, Laura; Hulihan, Deirdre; Nugent, Rikki; Morris, John; Abernethy, Amy P

    2010-08-01

    Outpatient palliative care, an evolving delivery model, seeks to improve continuity of care across settings and to increase access to services in hospice and palliative medicine (HPM). It can provide a critical bridge between inpatient palliative care and hospice, filling the gap in community-based supportive care for patients with advanced life-limiting illness. Low capacities for data collection and quantitative research in HPM have impeded assessment of the impact of outpatient palliative care. In North Carolina, a regional database for community-based palliative care has been created through a unique partnership between a HPM organization and academic medical center. This database flexibly uses information technology to collect patient data, entered at the point of care (e.g., home, inpatient hospice, assisted living facility, nursing home). HPM physicians and nurse practitioners collect data; data are transferred to an academic site that assists with analyses and data management. Reports to community-based sites, based on data they provide, create a better understanding of local care quality. The data system was developed and implemented over a 2-year period, starting with one community-based HPM site and expanding to four. Data collection methods were collaboratively created and refined. The database continues to grow. Analyses presented herein examine data from one site and encompass 2572 visits from 970 new patients, characterizing the population, symptom profiles, and change in symptoms after intervention. A collaborative regional approach to HPM data can support evaluation and improvement of palliative care quality at the local, aggregated, and statewide levels.

  17. Enteral or parenteral nimodipine treatment: a comparative pharmacokinetic study.

    Science.gov (United States)

    Scheller, Christian; Wienke, Andreas; Wurm, Franziska; Vogel, Anne-Sophie; Simmermacher, Sebastian; Prell, Julian; Rachinger, Jens; Koman, Gershom; Strauss, Christian; Scheller, Konstanze

    2014-03-01

    BACKGROUND AND STUDY AIMS/OBJECT: Oral nimodipine is recommended to reduce poor outcome related to aneurysmal subarachnoid hemorrhage (SAH). In addition, animal experiments and clinical trails revealed a beneficial effect of enteral and parenteral nimodipine for the regeneration of cranial nerves following skull base, laryngeal, and maxillofacial surgery. Despite these findings there is a lack of pharmacokinetic data in the literature, especially concerning its distribution in nerve tissue. Samples were taken from a consecutive series of 57 patients suffering from skull base lesions and treated with nimodipine prophylaxis from the day before surgery until the seventh postoperative day. Both groups received standard dosages for enteral (n = 25) and parenteral (n = 32) nimodipine . Nimodipine levels were measured in serum, cerebrospinal fluid (CSF), and tissue samples, including vestibular nerves. Nimodipine levels were significantly higher following parenteral as compared with enteral administration for intraoperative serum (p nimodipine was significantly more frequently detected in nerve tissue following parenteral administration (Fisher's exact test, p = 0.015). From a pharmacokinetic point of view, parenteral nimodipine medication leads to higher levels in serum and CSF. Furthermore, traces are more frequently found in nerve tissue following parenteral as compared with enteral nimodipine administration, at least in the early course. Georg Thieme Verlag KG Stuttgart · New York.

  18. Copper Supplementation in Parenteral Nutrition of Cholestatic Infants

    Science.gov (United States)

    Frem, Juliana; Sarson, Yvonne; Sternberg, Tom; Cole, Conrad R.

    2009-01-01

    Background Conventional practice is to reduce or eliminate copper supplementation in the parenteral nutrition of infants with cholestasis due to the increased risk of hepatotoxicity. However, there are reports of copper deficiency in cholestatic infants due to copper reduction in their parenteral nutrition. Objectives 1) To determine the proportion of cholestatic infants who develop elevated serum copper while receiving a non-reduced dose of parenteral copper, 2) To evaluate potential clinical factors that affect serum copper in cholestatic infants, and 3) To evaluate the impact of serum copper on liver disease. Methods This is a retrospective review of 28 cholestatic infants receiving 20 mcg/kg/d of copper via parenteral nutrition. Age-adjusted references were used to determine normality of serum copper levels. Multiple linear regression analyses were performed to determine predictors of serum copper and alanine aminotransferase. Results Serum copper levels were elevated in 2 infants (7%). On average, infants received 80% of their energy intake from parenteral nutrition for 3 months. Intestinal failure was present in 50% of the patients. Birth weight, gestational age and alanine aminotransferase were identified as predictors of serum copper (R2=0.53; p= 0.0001). Serum copper, gestational age and total bilirubin were associated with serum alanine aminotransferase (R2 = 0.43; p = 0.001). Conclusion Supplementation of parenteral copper at 20 mcg/kg/day does not lead to a significant increase in copper toxicity or worsening of liver disease in cholestatic infants. PMID:20400915

  19. Parenteral or enteral nutrition: do you have the choice?

    Science.gov (United States)

    Oshima, Taku; Singer, Pierre; Pichard, Claude

    2016-08-01

    The review focuses on the use of parenteral nutrition and enteral nutrition in critically ill patients to optimize the nutrition care throughout the ICU stay. The key message is: you have the choice! Enteral nutrition has been recommended for critically ill patients, whereas parenteral nutrition has been considered harmful and to be avoided. However, recent studies have challenged this theory. They demonstrated that enteral nutrition is frequently associated with energy and protein undernutrition, whereas parenteral nutrition becomes deleterious only if overfeeding is induced. Measuring energy expenditure by indirect calorimetry, in most cases, enables accurate determination of the energy needs to optimize the prescription of nutrition. Protein targets should also be considered for adequate feeding. Parenteral nutrition can be used as a supplement or as an alternative to enteral nutrition in case of gastrointestinal intolerance, to enable adequate energy, and protein provision. Parenteral nutrition is a powerful tool to optimize nutrition care of critically ill patients to improve clinical outcome, if prescribed according to the individual needs of the patients. After 3-4 days of attempt to feed enterally, enteral nutrition or parenteral nutrition can be used alternatively or combined, as long as the target is reached with special attention to avoid hypercaloric feeding.

  20. Diazepam parenteral no tratamento de epilepsias graves Treatment of severe epilepsies with parenteral diazepam

    Directory of Open Access Journals (Sweden)

    José Geraldo Speciali

    1971-09-01

    Full Text Available As modificações dos quadros clínico e EEG foram estudadas em 9 pacientes com manifestações epilépticas rebeldes às medicações anticonvulsivantes habituais, quando submetidos à administração parenteral diária de diazepam (Valium e após sua interrupção. Houve diminuição do número e da duração das crises, superior a 75%, em três pacientes. Esses resultados são satisfatórios, considerando a gravidade dos quadros epilépticos e foram obtidos em pacientes com predomínio de alterações EEG lentas antes de iniciar o esquema terapêutico. Não se verificaram efeitos colaterais relevantes na época da administração parenteral. Em dois pacientes foi observado o aparecimento de crises tônicas coincidindo com o aumento de elementos EEG paroxísticos rápidos, localizados ou difusos.Changes of the clinical pictures and electroencephalographic patterns were studied in 9 patients suffering from epileptic seizures non responsive to common anticonvulsivants, when submitted to daily parenteral administration of diazepam (Valium and after its interruption. There was decrease of the number and duration of seizures, over to 75%, in 3 patients. These results can be considered as satisfatory, considering the intensity of the seizures. The best results were obtained in those patients which showed predominance of slow waves in the EEGs prior to the begin of the treatment. No side effects were observed during the treatment. Two patients developed tonic seizures coincident with the increasing of fast paroxistic EEG patterns, of localized or diffuse type.

  1. Volume of Home and Community Based Services and...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume of Home- and Community-Based Services and Time to Nursing-Home Placement The purpose of this study was to determine whether the volume of Home and Community...

  2. Tribal Community-Based Social Marketing Training Guide

    Science.gov (United States)

    The Community-Based Social Marketing (CBSM) Training Guide and recycling toolkit provides an overview of how to increase the adoption of sustainable behaviors and recycling practices with a community.

  3. Eradication of vancomycin resistant Enterococcus faecium from a paediatric oncology unit and prevalence of colonization in hospitalized and community-based children.

    Science.gov (United States)

    Nourse, C; Byrne, C; Murphy, H; Kaufmann, M E; Clarke, A; Butler, K

    2000-02-01

    We previously reported an outbreak of vancomycin resistant enterococci (VRE) in a paediatric oncology unit in December 1995 which was associated with widespread environmental contamination of the unit with VRE. We undertook this study to evaluate the effectiveness of the infection control policy instituted subsequent to the outbreak and to investigate the underlying prevalence of VRE colonization in hospitalized, outpatient and community-based children. We sought to establish the molecular similarity of VRE isolates from the study. Stool specimens were obtained from outpatients at risk of VRE, hospital inpatients and from healthy community-based children. VRE colonization was eradicated from the inpatient unit within 11 months, but in outpatients, 16 months after the outbreak, 4 of 137 (2.9 %) attending oncology outpatients, 5 of 65 (7.7%) with cystic fibrosis and 1 of 12 (8.3 %) with liver disease were found to be colonized with VRE. The isolates were all Enterococcus faecium, Van A phenotype except one E. casseliflavus of the Van C phenotype. All were unique in SmaI DNA macrorestriction patterns with the exception of two isolates, which were similar to the original outbreak strain and three further isolates of a single strain but which differed from the outbreak strain. Of 315 hospital inpatients, 2.5 % were colonized with VRE of the Van C resistance phenotype but VRE was not detected in 116 healthy, community-based children. We conclude that effective strategies can successfully control spread of VRE but despite a low prevalence of VRE colonization in hospital patients and in community-based children, outbreaks can occur when infection control practices are not optimal. Continued vigilance to detect VRE and limit spread within hospitals is therefore necessary.

  4. Development of a sustainable community-based dental education program.

    Science.gov (United States)

    Piskorowski, Wilhelm A; Fitzgerald, Mark; Mastey, Jerry; Krell, Rachel E

    2011-08-01

    Increasing the use of community-based programs is an important trend in improving dental education to meet the needs of students and the public. To support this trend, understanding the history of programs that have established successful models for community-based education is valuable for the creation and development of new programs. The community-based education model of the University of Michigan School of Dentistry (UMSOD) offers a useful guide for understanding the essential steps and challenges involved in developing a successful program. Initial steps in program development were as follows: raising funds, selecting an outreach clinical model, and recruiting clinics to become partners. As the program developed, the challenges of creating a sustainable financial model with the highest educational value required the inclusion of new clinical settings and the creation of a unique revenue-sharing model. Since the beginning of the community-based program at UMSOD in 2000, the number of community partners has increased to twenty-seven clinics, and students have treated thousands of patients in need. Fourth-year students now spend a minimum of ten weeks in community-based clinical education. The community-based program at UMSOD demonstrates the value of service-based education and offers a sustainable model for the development of future programs.

  5. Should pediatric parenteral nutrition be individualized?

    Directory of Open Access Journals (Sweden)

    Renata Germano Borges de Oliveira Nascimento Freitas

    2014-12-01

    Full Text Available INTRODUCTION: Parenteral nutrition (PN formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo.METHODS: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO (2006 and WHO (2007. The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL. Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L, sodium (<125mEq/L, magnesium (<1mEq/L, phosphorus (<1.5mEq/L, ionic calcium (<1mmol, and chloride (<90mEq/L, or any value above the references.RESULTS: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations. Most patients were classified as malnourished. It was observed that 74/254 (29.2% of examinations demanded individualized PN for indubitable reasons.CONCLUSION: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters.

  6. Home parenteral nutrition after near total enterectomy.

    Science.gov (United States)

    Nance, M L; Morris, J B; Mullen, J L

    1993-06-01

    Six patients with extreme short bowel syndrome (4.2 +/- 4.9 cm of residual small bowel) were provided home parenteral nutrition (HPN) for 14,397 days. The average age at onset of HPN was 38 years (18-64 years). Patients maintained body weight at 97% of ideal (86-112%) with mean serum albumin of 3.7 +/- 0.6 g/dL (normal 3.5-5.8 g/dL), serum transferrin of 341 +/- 104 mg/dL (normal 200-400 mg/dL), and mean serum pre-albumin of 27.5 +/- 12.6 mg/dL (normal 16.6-43 mg/dL). Hospital admission for HPN-related complications was required 10.3 times/patient for a total of 864 hospital days and was catheter related in 71% of episodes. Catheter sepsis occurred once per 436 catheter days and required catheter removal in only 33% of instances. Five patients were able to resume an oral diet, five had returned to work or school, and three were married with family. HPN allowed return to a quality productive life with acceptable morbidity following catastrophic massive bowel resection.

  7. Pediatric outpatient anesthesia.

    Science.gov (United States)

    Hannallah, R S

    1987-02-01

    Successful anesthetic management of children undergoing outpatient surgery requires that the surgeon and anesthesiologist be actively involved in all aspects of management. Guidelines should be established in consultation with the surgeons, nurses, and administrators to ensure proper selection and preoperative preparation of patients. The psychological evaluation and preparation of children, and the use of pharmacologic premedication when indicated, will ensure a pleasant experience for all involved. The anesthesiologist should choose a specific anesthetic agent and a technique that are appropriate for each individual child. Use of "routine" induction techniques is rarely, if ever, appropriate. Early ambulation and discharge are very desirable in outpatients. Long-acting drugs and techniques that are associated with excessive drowsiness or nausea and vomiting should not be utilized. Special attention must be paid to the analgesic requirements of the child. Regional blocks should be used whenever possible to supplement "light" general anesthesia and to limit the need for narcotics during recovery. Specific criteria for discharge ensure the safety and protection of the child and staff.

  8. Safety of home parenteral nutrition during pregnancy.

    Science.gov (United States)

    Theilla, Miriam; Ławiński, Michał; Cohen, Jonathan; Hadar, Eran; Kagan, Ilya; Perkewick, Marek; Singer, Pierre

    2017-02-01

    Few studies have examined the effect of total parenteral nutrition which is lipid-based given throughout pregnancy to patients unable to obtain adequate nutrition by the oral route. In this study we examined the use of lipid-based home parenteral nutrition (HPN) in 7 pregnant women, commenced either before or during pregnancy, and their intra-pregnant course as well as a 2-year follow-up of their offspring is described. HPN was formulated on an individual basis and protein administered in a dose of 0.8-1.1 g/kg during the three trimesters. Lipid emulsions included long chain triglycerides or olive-oil based formulae and all patients received trace elements. Data were collected during the course of pregnancy and at birth while infants were followed for a period of between 6 months and 2 years using medical records and questionnaires. In total, we studied 9 pregnancies (in 7 women). HPN was administered for a median of 9 months (range 3-9 months). The mean energy provided during the 1st, 2nd and 3rd trimester was 9297 ± 2797 kcal/week, 9148 ± 2629 kcal/week and 8564 ± 4059 kcal/week resp. The mean increase in weight during the pregnancy was 9 ± 5 Kg. The only complications noted during the pregnancy consisted of 3 episodes of catheter-related infections which were successfully treated by antibiotics. The infants were born after a mean of 38.00 ± 1.55 weeks of gestation, with a mean first minute Apgar score of 8.7 ± 1.8 which increased to 9.8 ± 0.4 after 10 min. The mean infant birth weight was 2.45 ± 0.37 kg. No complications were noted at birth apart from one infant who suffered from torticollis which resolved spontaneously. During follow up, a decrease in hemoglobin related to low iron levels was noted in 1 infant, 2 infants were noted to be allergic to pollen and one underwent a scrotal hernia reduction. No developmental problems have been observed, neither physiological nor psychomotor, over the 2-year follow-up period. The authors

  9. Phytosterols, Lipid Administration, and Liver Disease During Parenteral Nutrition.

    Science.gov (United States)

    Zaloga, Gary P

    2015-09-01

    Phytosterols are plant-derived sterols that are structurally and functionally analogous to cholesterol in vertebrate animals. Phytosterols are found in many foods and are part of the normal human diet. However, absorption of phytosterols from the diet is minimal. Most lipid emulsions used for parenteral nutrition are based on vegetable oils. As a result, phytosterol administration occurs during intravenous administration of lipid. Levels of phytosterols in the blood and tissues may reach high levels during parenteral lipid administration and may be toxic to cells. Phytosterols are not fully metabolized by the human body and must be excreted through the hepatobiliary system. Accumulating scientific evidence suggests that administration of high doses of intravenous lipids that are high in phytosterols contributes to the development of parenteral nutrition-associated liver disease. In this review, mechanisms by which lipids and phytosterols may cause cholestasis are discussed. Human studies of the association of phytosterols with liver disease are reviewed. In addition, clinical studies of lipid/phytosterol reduction for reversing and/or preventing parenteral nutrition associated liver disease are discussed. © 2015 American Society for Parenteral and Enteral Nutrition.

  10. Aluminum Content of Neonatal Parenteral Nutrition Solutions.

    Science.gov (United States)

    Huston, Robert K; Heisel, Carl F; Vermillion, Benjamin R; Christensen, J Mark; Minc, Leah

    2017-04-01

    Calcium chloride (CaCl2) has been the only calcium additive available in the United States that has a low aluminum (Al) content. Calcium gluconate in glass vials (CaGluc-Gl) has a high Al content while calcium gluconate in plastic vials (CaGluc-Pl) has a low Al content. The purpose of this study was to measure Al concentrations in neonatal parenteral nutrition (PN) solutions prepared using various calcium additives. Samples of solutions compounded with CaCl2 or CaGluc-Gl and sodium phosphate (NaPhos) as well as CaGluc-Pl and sodium glycerophosphate (NaGP) with and without cysteine were analyzed for Al content. Samples of the cysteine and calcium gluconate additives were also sent for analysis. Solutions containing CaCl2 and CaGlu-Pl had mean Al concentrations of 1.2-2.3 mcg/dL, while those with CaGlu-Gl had mean concentrations of 14.6-15.1 mcg/dL. Solutions made with NaGP were low in Al content. The measured Al content of 2 lots of the cysteine additive were 168 ± 23 mcg/L and 126 ± 5 mcg/L. The Al concentration equalled 2730 ± 20 mcg/L for the CaGlu-Gl additive and 310 ± 80 mcg/L for the CaGlu-Pl additive. The study indicates that solutions containing CaCl2 or CaGluc-Pl and NaPhos or NaGP are low in Al content. Using these options for calcium and phosphate additives can limit aluminum intake from neonatal PN to levels within the Food and Drug Administration guideline of ≤5 mcg/kg/d.

  11. Community based clinical program: the Medunsa physiotherapy students` experience

    Directory of Open Access Journals (Sweden)

    N. P. Taukobong

    2004-02-01

    Full Text Available Backgound: The aim of community based clinical training is tproduce graduates who are responsive to the health needs of their communit It is envisaged that upon completion of training graduates would go back an serve their respective communities following exposure to community need Program evaluation should therefore allow students to express the inadequacie and strengths of the program.Aim: To evaluate the community-based clinical program through student's experiences.Methodology: A qualitative research design was used. End of block students reports for both third (8 and fourth (15 year physiotherapy students (n = 23 were used to collect the data. Responses in the reports were grouped into the following categories for purpose of data analysis: feeling about the block, suggestion/s and supervision.Results: The students described the community based clinical program as an unique learning experience which equipped them with the understanding of life within communities. Sixty five percent (65% expressed satisfaction with the supervision given. The main complaints were amounts of paper work involved and clinical workload.Conclusion: The student's experiences indicated that the community-based clinical program within the MEDUNSA physiotherapy department realizes the goal of community-based clinical training as determined by WHO, except for inclusion of some multi-professional approaches and adaptation of the supervision provided.

  12. Practice of compounding parenteral nutrition in Portugal; comparison with the Spanish guidelines

    National Research Council Canada - National Science Library

    Neves, Andrea; Pereira-da-Silva, Luis; Fernandez-Llimos, Fernando

    2014-01-01

    To evaluate the practices of neonatal parenteral nutrition (PN) compounding in Portugal and the agreement to the recommendations from the Spanish Consensus on Compounding of Parenteral Nutrition Mixtures 2008...

  13. Parenteral glutamine dipeptide supplementation does not ameliorate chemotherapy-induced toxicity

    NARCIS (Netherlands)

    van Zaanen, H. C.; van der Lelie, H.; Timmer, J. G.; Fürst, P.; Sauerwein, H. P.

    1994-01-01

    Glutamine-supplemented total parenteral nutrition (TPN) improved the nitrogen balance in catabolic situations. In animal studies, parenteral glutamine supplementation appeared to maintain gut integrity. This study was performed to evaluate the possible positive effects of glutamine supplementation

  14. Outpatient pulmonary rehabilitation – rehabilitation models and shortcomings in outpatient aftercare

    Directory of Open Access Journals (Sweden)

    Dietl, Markus

    2010-01-01

    Full Text Available Background: The chronic obstructive pulmonary disease (COPD and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives: The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods: Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI. In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results: Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C. The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based, by the length of intervention (from two weeks to 36 months, by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion: Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction

  15. Management of Hyperglycemia During Enteral and Parenteral Nutrition Therapy

    Science.gov (United States)

    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

  16. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

    Directory of Open Access Journals (Sweden)

    Peter Stehle

    2015-01-01

    Full Text Available Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care.

  17. Parenteral nutrition in childhood and consequences for dentition and gingivae.

    Science.gov (United States)

    Olczak-Kowalczyk, D; Danko, M; Banaś, E; Gozdowski, D; Popińska, K; Krasuska-Sławińska, E; Książyk, J

    2017-03-01

    Assessment of dentition in children under parenteral nutrition, risk factors for caries, and dental developmental abnormalities. The study involved 63 patients (aged 2.25-16.6 years), i.e. 32 subjects receiving parenteral nutrition for a mean period of 5.6±2.94 years, and 31 healthy control subjects. Oral hygiene (OHI-S, PL-I), gingival (GI), and dentition status (caries, DMFT/dmft, enamel defects, shape alterations), frequency of oral meals and frequency of cariogenic snacks consumption were evaluated. Medical records provided information on parenteral meals per week, age parenteral nutrition started, birth body mass, Apgar score, weight deficiency, and antibiotic therapy until aged 1 year. The Mann-Whitney test, chi-squared test, and Spearman rank correlation coefficient were used (p≤0.05). Dental developmental abnormalities occurred more often in PN subjects (71.87% vs. 25.80%). The prevalence of caries in PN (56.25% vs. 90.32%) and dmft (2.00±3.30 vs. 4.21±3.33) and DMFT (2.47±4.08 vs. 3.33±3.50) were lower. Positive caries Spearman's rank correlation coefficients: frequency of oral meals and frequency of cariogenic snacks consumption, and GI. Negative correlation coefficients: low birth body mass, antibiotic therapy, and low body mass in the first year of life. Positive dental developmental abnormality Spearman's coefficients: low birth body mass, Apgar score parenteral nutrition duration, low body mass and antibiotic therapy in the first year of life. Beta- lactam, aminoglycoside, glycopeptide and nitroimidazole treatments were related to enamel hypoplasia. Parenteral nutrition in childhood is related to the risk of dental developmental abnormalities, promoted by malnutrition and antibiotic therapy in infancy. Limiting the number of meals and cariogenic snacks, and most probably administration of antibiotics, decreases the risk of caries.

  18. Concentration of selenium in plasma and erythrocytes during total parenteral nutrition in Crohn's disease.

    OpenAIRE

    Jacobson, S; Plantin, L O

    1985-01-01

    Plasma- and erythrocyte-selenium concentrations were determined in five consecutive patients with Crohn's disease given preoperative total parenteral nutrition - nil per os - for a mean period of 34 days per patient. No blood components were administered during the total parenteral nutrition. Before the total parenteral nutrition the plasma-selenium level and, to a less extent, the erythrocyte-selenium levels were below the reference values. After three weeks of total parenteral nutrition bot...

  19. Stage III Community-based Efficacy Trial for Mothering From the Inside Out

    Science.gov (United States)

    2018-01-05

    Addiction; Substance Abuse Drug Chronic; Child Neglect; Child Neglect Emotional; Child Abuse; Parenting; Parent-Child Problem; Parent-Child Relations; Parent / Child Problem; Parenteral Drug Abuse; Parents

  20. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

  1. Standardised neonatal parenteral nutrition formulations - an Australasian group consensus 2012.

    Science.gov (United States)

    Bolisetty, Srinivas; Osborn, David; Sinn, John; Lui, Kei

    2014-02-18

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.

  2. Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition.

    Science.gov (United States)

    Aschner, Judy L; Anderson, Adam; Slaughter, James Christopher; Aschner, Michael; Steele, Steven; Beller, Amy; Mouvery, Amanda; Furlong, Heather M; Maitre, Nathalie L

    2015-12-01

    Manganese, an essential metal for normal growth and development, is neurotoxic on excessive exposure. Standard trace element-supplemented neonatal parenteral nutrition (PN) has a high manganese content and bypasses normal gastrointestinal absorptive control mechanisms, which places infants at risk of manganese neurotoxicity. Magnetic resonance (MR) relaxometry demonstrating short T1 relaxation time (T1R) in the basal ganglia reflects excessive brain manganese accumulation. This study tested the hypothesis that infants with greater parenteral manganese exposure have higher brain manganese accumulation, as measured by MR imaging, than do infants with lower parenteral manganese exposure. Infants exposed to parenteral manganese were enrolled in a prospective cohort study. Infants classified as having high manganese exposure received >75% of their nutrition in the preceding 4 wk as PN. All others were classified as having low exposure. Daily parenteral and enteral manganese intakes were calculated. Whole-blood manganese was measured by high-resolution inductively coupled plasma mass spectrometry. Brain MR relaxometry was interpreted by a masked reviewer. Linear regression models, adjusted for gestational age (GA) at birth, estimated the association of relaxometry indexes with total and parenteral manganese exposures. Seventy-three infants were enrolled. High-quality MR images were available for 58 infants, 39 with high and 19 with low manganese exposure. Four infants with a high exposure had blood manganese concentrations >30 μg/L. After controlling for GA, higher parenteral and total manganese intakes were associated with a lower T1R (P = 0.01) in the globus pallidus and putamen but were not associated with whole-blood manganese (range: 3.6-56.6 μg/L). Elevated conjugated bilirubin magnified the association between parenteral manganese and decreasing T1R. A short T1R for GA identifies infants at risk of increased brain manganese deposition associated with PN

  3. Urea kinetics in neonates receiving total parenteral nutrition.

    OpenAIRE

    Wheeler, R. A.; Griffiths, D M; Jackson, A A

    1993-01-01

    Urea kinetics were measured on 10 occasions in eight neonates who had not received an oral intake from birth and were maintained on total parenteral nutrition. After a prime/intermittent oral dose of 15N15N-urea over 14 hours urine was collected every three to four hours, urea isolated, and kinetics determined from the plateau level of enrichment in urea, measured by isotope ratio mass spectrometry. The total parenteral nutrition provided 393 kJ (94 kcal)/kg/day and 360 mg nitrogen/kg/day. Ur...

  4. Parenteral feeding depletes pulmonary lymphocyte populations

    Science.gov (United States)

    Hermsen, JL; Gomez, FE; Sano, Y; Kang, W; Maeshima, Y; Kudsk, KA

    2009-01-01

    INTRODUCTION Induction of immunity at one mucosal site protects other sites by disseminating sensitized lymphocytes. Parenteral nutrition (PN) reduces gut-associated lymphoid tissue mass and impairs respiratory anti-viral and antibacterial defenses. The effect of PN on lymphocyte mass in the lung is unknown but reduced mucosal lymphocytes were hypothesized to play a role in the reduced IgA-mediated immunity in both gut and lung. Ability to transfer & track cells between mice may allow study of diet induced mucosal immune function. OBJECTIVE 1) Characterize lung T cell populations following PN feeding and 2) study distribution patterns of transferred donor lung T cells in recipient mice. METHODS 1) Cannulated male Balb/c mice were randomized to receive chow or PN × 5 days. Lung lymphocytes were obtained via collagenase digestion and flow cytometric analysis identified total T (CD3+) and B (CD45/B220+) cells. In experiment 2, isolated lung T cells from chow-fed male Balb/c mice were pooled, labeled in vitro with CFSE fluorescent dye and 1.1×108 CFSE+ cells (3.1×106 T cells) transferred into chow-fed Balb/c recipients. Cells recovered from recipient lungs and intestinal lamina propria (LP) were analyzed by flow cytometry to determine CFSE/CD3+ T cells at 1, 2 & 7 days. Experiment 3: cells were transferred into PN-fed recipients. RESULTS Expt 1: PN significantly decreased lung T and B cell populations compared to chow feeding. Expt 2: No mortality occurred after cell transfer. Time-course analysis showed that CFSE+ T cell retention was highest on day 1 in lung and LP and dropped on day 2. Cells were gone by day 7. 98.1% of retained donor lung T cells migrated to recipient lungs and 1.9% to the intestine on day 1. Similar results were seen in a third experiment with transfer of cells to PN-fed recipients. CONCLUSIONS PN reduces pulmonary lymphocyte populations consistent with impaired respiratory immunity. Transferred lung T cells preferentially localize to recipient

  5. Monitoring Outpatient Care

    Science.gov (United States)

    2003-01-01

    Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

  6. Complicaciones hepáticas asociadas al uso de nutrición parenteral Parenteral nutrition-associated liver disease

    OpenAIRE

    J. M. Moreno Villares

    2008-01-01

    La afectación hepática relacionada con la nutrición parenteral (PNALD) es un problema importante especialmente en los pacientes que requieren nutrición parenteral durante un tiempo prolongado y en los recién nacidos prematuros. La prevalencia es muy variable según las series y existen diferencias en la presentación entre los niños y los pacientes adultos. A pesar de haberse propuesto diferentes teorías en relación a la patogénesis del cuadro, su etiología no está bien definida. Es probable qu...

  7. Participation Levels in 25 Community-Based Participatory Research Projects

    Science.gov (United States)

    Spears Johnson, C. R.; Kraemer Diaz, A. E.; Arcury, T. A.

    2016-01-01

    This analysis describes the nature of community participation in National Institutes of Health and Centers for Disease Control and Prevention funded community-based participatory research (CBPR) projects, and explores the scientific and social implications of variation in community participation. We conducted in-depth interviews in 2012 with…

  8. Community-based Natural Resource Management of the Jozani ...

    African Journals Online (AJOL)

    Abstract — Local participation, especially in natural resource management, has been promoted as a key strategy in the quest for sustainable development. Community-based Natural Resource Management (CBNRM) is an approach that has generally been promoted as an institution that genuinely includes and empowers ...

  9. Adaptation and beyond: Lessons from community based adaptation ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    25 avr. 2016 ... It is not just about responding to climate shocks, but is a learning process that empowers communities to solve problems and plan for climate events. ... These briefs resulted from a pilot project carried out as part of the Community Based Adaptation to Climate Change in Africa (CBAA) initiative, with support ...

  10. Community-Based Wildlife Management In Tanzania: The Policy ...

    African Journals Online (AJOL)

    In the 1990s Tanzanians witnessed a rush by government Ministries and Departments to formulate and/or reformulate their policies. One such policy is the Wildlife Policy, formulated by the Wildlife Division in the Ministry of Natural Resources and Tourism. Some policies affect community-based wildlife management (CWM) ...

  11. An Investigation into the Practice of Community Based Education ...

    African Journals Online (AJOL)

    This survey examined the management of Community Based Education (CBE) field activities at Jimma University (JU). The study used both quantitative and qualitative data. Quantitative data were collected from students and academic staff through structured questionnaire. Qualitative data were gathered from top university ...

  12. Community-based survey versus sentinel site sampling in ...

    African Journals Online (AJOL)

    The absence of wasting and the high prevalence of stunting (37,5%) in the community-based sample suggested that the main problem is chronic socioeconomic underdevelopment, rather than a severe or immediate lack of food. The fact that fewer than 20% of households are in any way reliant on domestic production for ...

  13. The effectiveness of Community Based Distribution of Injectable ...

    African Journals Online (AJOL)

    This study reports on findings of a pilot of community-based distribution (CBD) of injectable contraceptives in two local government areas (LGAs) of Gombe State, Nigeria. From August 2009 to January 2010, the project enrolled, trained and equipped community health extension workers (CHEWs) to distribute condoms, oral ...

  14. Exploring the scope of community-based rehabilitation in ensuring ...

    African Journals Online (AJOL)

    Background: Globally, it has been estimated that almost 15% of world's population live with some form of disability, of which the majority are from developing nations. Objectives: To explore the role of community-based rehabilitation (CBR) in the health sector, identify the prevalent challenges, and to suggest measures to ...

  15. Encouraging Use of Community-Based Resources by Bioscience Students

    Science.gov (United States)

    Goulder, Ray; Scott, Graham W.

    2010-01-01

    This communication reports how bioscience students are encouraged to benefit from city and regional community-based resources through use of a guidebook and student-managed learning. Positive outcomes of the module are that bioscience students take their learning experience beyond the classroom, they engage with wider community resources, and they…

  16. Negotiation of values as driver in community-based PD

    DEFF Research Database (Denmark)

    Gronvall, Erik; Malmborg, Lone; Messeter, Jörn

    2016-01-01

    and design things; and different accounts of values in design. Inspired by the concept of design things, and as a consequence of the need for continuous negotiation of values observed in all three cases, we suggest the concept of thinging as fruitful for creating productive agonistic spaces with a stronger...... attention towards the process of negotiating values in community-based PD....

  17. Community Based Forest Management as a Tool for Sustainable ...

    African Journals Online (AJOL)

    Community-Based Forest Management (CBFM) in Cross River State (CRS) was investigated with a view to understanding its efficiency and effectiveness as a tool for sustainable forest management in the State. Four sets of questionnaire were administered to forestry officials; forest edge communities; timber ...

  18. Assessing the contribution of Community-Based Natural Resources ...

    African Journals Online (AJOL)

    This study assessed Community-Based Natural Resources Management Programme (CBNRMP) for environmental sustainability in Ondo State, Nigeria. Data were gathered through a structured interview schedule from 120 rural dwellers participating in CBNRMP. Data collected were described with descriptive statistical ...

  19. Ethics and Community-Based Participatory Research: Commentary on Minkler

    Science.gov (United States)

    Green, Lawrence W.

    2004-01-01

    The author comments on Meredith Minkler's article, "Ethical Challenges for the "Outside" Researcher in Community-Based Participatory Research," Health Education & Behavior 31(6):684-697, 2004 [see EJ824234]. Specifically, this commentary notes along with Minkler that, in relation to the relatively uncharted territory of Community-Based…

  20. The Student Experience of Community-Based Research: An Autoethnography

    Science.gov (United States)

    Ingman, Benjamin C.

    2016-01-01

    This autoethnography provides a description and thematic illustration of the student experience of a community-based research (CBR) course and partnership. Through evaluating personal experiences with CBR, the author identified three qualities of meaningful CBR experiences: trust, indeterminacy, and emotion. These qualities are explored, and…

  1. Community - based management in two biosphere reserves in ...

    African Journals Online (AJOL)

    This article explores the socio - cultural aspects of community - based management of natural resources in Madagascar. The contractual devolution of management rights and responsibilities to local user groups constitutes an important instrument in the country's environmental policy. Its challenges and opportunities

  2. Determinants of diarrhoeal diseases: a community based study in ...

    African Journals Online (AJOL)

    Determinants of diarrhoeal diseases: a community based study in urban south western Ethiopia. ... acute respiratory infecions (ARI) in the previous two weeks were found to be significantly associated with occurrence of diarrhoeal disease; however, only ARI and well water were retained in the logistic regression analysis.

  3. How to move towards community based service delivery?

    NARCIS (Netherlands)

    Meuwissen, L.; Voorham, T.; Bakker, D. de

    2007-01-01

    Aim: Community based primary health care offers in potential the opportunity to tailor health service delivery to the needs and demands of the local population. Up to now, there is no clear cut method to do this. In a pilot benchmark for general practices, data were collected on demand and

  4. Community Based Ecological Monitoring of Non Timber Forest ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Community Based Ecological Monitoring of Non Timber Forest Products in the Nilgiri Biosphere Reserve (India). Securing the livelihoods of forest-dependent peoples necessitates good governance and sustainable management of common-pool resources. The Nilgiri Biosphere Reserve in the Western Ghats of South India ...

  5. Community-based distribution of family planning as perceived by ...

    African Journals Online (AJOL)

    From September 24 through October 4,1997, a cross-sectional survey was conducted to assess the status of Community-based distribution (CBD) of family planning as perceived by reproductive age groups aged 15-49 years and the CBD workers. The study covered 14 German Agency for Technical Co-operation (GTZ) ...

  6. Community Based Health Insurance Schemes and Protection of the ...

    African Journals Online (AJOL)

    The objectives of this study are two folds: firstly to explore the magnitude of catastrophic expenditure, and secondly to determine its contributing factor,s including the protective impact of the voluntary community based health insurance schemes in Tanzania. The study covered 274 respondents. Study findings have shown ...

  7. Implementing and managing community-based education and ...

    African Journals Online (AJOL)

    Community-based education (CBE) and service learning (SL) are teaching approaches used in the Faculty of Health Sciences at the University of the Free State (UFS), Bloemfontein, South Africa to address these challenges. Students have different views with regard to CBE and SL, and by surveying these perceptions ...

  8. The Effectiveness of Community-Based Nutrition Education on the ...

    African Journals Online (AJOL)

    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. Methods : A systematic search of the literature was conducted utilising the following data bases: Cumulative ...

  9. Calibration of Community-based Coral Reef Monitoring Protocols ...

    African Journals Online (AJOL)

    Abstract—Coral reef monitoring (CRM) has been recognised as an important management tool and has consequently been incorporated in Integrated Coastal. Area Management (ICAM) programmes in the Western Indian Ocean (WIO). Community-based coral reef monitoring (CB-CRM), which uses simplified procedures ...

  10. Heterogeneous Community-based mobility model for human opportunistic network

    DEFF Research Database (Denmark)

    Hu, Liang; Dittmann, Lars

    2009-01-01

    a heterogeneous community-based random way-point (HC-RWP) mobility model that captures the four important properties of real human mobility. These properties are based on both intuitive observations of daily human mobility and analysis of empirical mobility traces. By discrete event simulation, we show HC...

  11. Evaluation of School- and Community-Based HIV Prevention ...

    African Journals Online (AJOL)

    The Ministry of Education approved Family Life and HIV Education (FLHE) programme delivered in Junior Secondary Schools and a community-based initiative to raise AIDS Competency of rural communities were evaluated using a clustered randomized control trial and mixed qualitative-quantitative methods. Ten schools ...

  12. Indigenous knowledge in the management of a community-Based ...

    African Journals Online (AJOL)

    Yet, for the many communities involved in the management of forests and other nature reserves, their local knowledges and experiences have been instrumental in the management of their environments and their resources. This paper evaluates the contributions of indigenous knowledge in community-based management ...

  13. Community Based Distribution of Child Spacing Methods at ...

    African Journals Online (AJOL)

    nity through a network of village health volunteers provid- ing information, counselling and community-based distribution (CBD) of oral contraceptives, condoms and spermicides. • Demonstration of a three-tiered child spacing services de- livery model (community, clinic/outreach sites, and hospi- tal) which can be replicated ...

  14. Medical student participation in community-based experiential ...

    African Journals Online (AJOL)

    2010-10-01

    Oct 1, 2010 ... Teaching staff face similar challenges of complexity and uncertainty7 as they attempt to shape the curriculum for a community-based rotation into one that is more appropriate for meeting the demands of the health system.8-10 Medical students at the University of Pretoria participate in a Health and Health ...

  15. From Campuses to Communities: Community-Based Cultism and ...

    African Journals Online (AJOL)

    Due to the criminal activities of the cult groups in the NDR and ineptitude of the police, communities have responded by creating vigilante groups but this has only promoted cycle of violence. The paper recommended that government should tackle community-based cultism and also strengthen the Nigeria Police Force to be ...

  16. Community-based Tourism and Rural Development: The Case of ...

    African Journals Online (AJOL)

    The paper reports an investigation on how community-based tourism can be used as a development strategy for the efficient and sustainable use of tourist resources in seventeen (17) communities within the Hippopotamus (hippo) Sanctuary of the Wa West District of the Upper West Region of Ghana. Specifically, it explores ...

  17. The operational challenges of community-based tourism ventures in ...

    African Journals Online (AJOL)

    Community-based tourism is increasingly being developed and promoted as a means of reducing poverty in developing countries, assisting local communities to meet their needs through the offering of a tourism product. The Swaziland Tourism Authority with the support of the European Union Fund has made significant ...

  18. Community-based tourism research in academic journals: A ...

    African Journals Online (AJOL)

    This article examines the growth of Community-Based Tourism within the broader discipline of tourism. New topics in the field have emerged such as responsible tourism, pro-poor tourism, sports tourism and moral impacts of tourism. This phenomenon also reflects the multidisciplinarity of tourism. In this article, using the ...

  19. A Living Spiral of Understanding: Community-Based Adult Education

    Science.gov (United States)

    Cueva, Melany

    2010-01-01

    What does it mean to provide community-based health education that respects adults of diverse cultures and ways of being in the world? How does one nurture meaningful learning opportunities that awaken possibilities as a catalyst for understanding, conversation, and action? In this article, nurturing place, sharing power, heart listening, talking…

  20. Community-Based Solid Waste Management: A Training Facilitator's Guide.

    Science.gov (United States)

    Peace Corps, Washington, DC. Information Collection and Exchange Div.

    Urban environmental management and environmental health issues are of increasing concern worldwide. The need for urban environmental management work at the local level where the Peace Corps works most effectively is significant, but training materials dedicated specifically to community-based solid waste management work in urban areas are lacking.…

  1. Socio-Cultural Challenges Facing Community- Based Interventions ...

    African Journals Online (AJOL)

    Socio-Cultural Challenges Facing Community- Based Interventions in Providing Care and Support to Children Affected by HIV and AIDS in Lesotho. ... Overstressed and in many cases already overwhelmed, the extended family networks face ever-greater burdens as the number of orphans continues to grow. On the other ...

  2. Community-based agricultural interventions in the context of food ...

    African Journals Online (AJOL)

    2010-09-12

    Sep 12, 2010 ... price and availability being barriers to a healthier diet.22 Rural and urban women in KwaZulu-Natal ..... this input as an important variable, the focus of the Lusikisiki project was on technology transfer, .... the biggest challenges to overcome when implementing community- based gardening activities.54 A ...

  3. Analysis of Community-Based Poverty Reduction Agency and Civil ...

    African Journals Online (AJOL)

    This study analyzed community-Based Poverty Reduction Agency (CPRA) and Civil Resources Development and Documentation Centres (CIRDDC) and highlighted implications for sustainable poverty alleviation in central zone of Ebonyi state, Nigeria. Two hundred and forty randomly selected participants in poverty ...

  4. Risk assessment and model for community-based construction ...

    African Journals Online (AJOL)

    The consequences of not assessing and managing construction risks are that projects may experience time and cost overruns and lead to poor quality structures. It, therefore, becomes necessary to systematically manage uncertainty in community-based construction in order to increase the likelihood of meeting project ...

  5. effectiveness of community based seed multiplication in enhancing

    African Journals Online (AJOL)

    ACSS

    Community Based Seed Multiplication (CBSM) approaches have been used by agricultural research and .... received seed for multiplication and distribution in rural ..... M. NATEEBWA et al. 332 seed production strategies, Mexico. D.F.: CIMMYT. http://ageconsearch.umn.edu/ bitstream/56188/2/seed_production. Manual.pdf.

  6. Exploring the scope of community-based rehabilitation in ensuring ...

    African Journals Online (AJOL)

    tors to empower disabled people/ their family members. /community members regardless of any parameter by creating awareness, eliminating stigma, promoting social inclusion, meeting basic needs and facilitating access to health, education and vocational opportunities.3,6. CBR: Scope and benefits. Community-based ...

  7. Enhancing crop productivity through community-based seed ...

    African Journals Online (AJOL)

    Enhancing crop productivity through community-based seed multiplication system. ... to purchase household items, and part invested in transport businesses and rearing of small ruminants as well as in human capital such as paying children's school fees and family hospital bills and meeting other social responsibilities.

  8. Connect: An Effective Community-Based Youth Suicide Prevention Program

    Science.gov (United States)

    Bean, Gretchen; Baber, Kristine M.

    2011-01-01

    Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in…

  9. A community based study on knowledge, attitude and practice (KAP ...

    African Journals Online (AJOL)

    Background: HIV/AIDS is the major public health problem in our country. Studies need to be conducted to assess the behavioral risk factors of its transmission and prevention. Objectives: To assess knowledge, attitude and practice of HIV/AIDS in the study population. Methods: Community based cross-sectional study was ...

  10. Reflective learning in community-based dental education.

    Science.gov (United States)

    Deogade, Suryakant C; Naitam, Dinesh

    2016-01-01

    Community-based dental education (CBDE) is the implementation of dental education in a specific social context, which shifts a substantial part of dental clinical education from dental teaching institutional clinics to mainly public health settings. Dental students gain additional value from CBDE when they are guided through a reflective process of learning. We propose some key elements to the existing CBDE program that support meaningful personal learning experiences. Dental rotations of 'externships' in community-based clinical settings (CBCS) are year-long community-based placements and have proven to be strong learning environments where students develop good communication skills and better clinical reasoning and management skills. We look at the characteristics of CBDE and how the social and personal context provided in communities enhances dental education. Meaningfulness is created by the authentic context, which develops over a period of time. Structured reflection assignments and methods are suggested as key elements in the existing CBDE program. Strategies to enrich community-based learning experiences for dental students include: Photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. A directed process of reflection is suggested as a way to increase the impact of the community learning experiences. We suggest key elements to the existing CBDE module so that the context-rich environment of CBDE allows for meaningful relations and experiences for dental students and enhanced learning.

  11. The challenge of assessing MTech community-based-visual arts ...

    African Journals Online (AJOL)

    The article explores specific challenges in supervising, accommodating and evaluating diverse candidates who pursue an action-led and community-based research approach rooted within the visual arts. I contend that there is a specific challenge in the field of postgraduate supervision of engaging evaluation strategies.

  12. Local natural and cultural heritage assets and community based ...

    African Journals Online (AJOL)

    The research took the form of case studies at local villages, of which Noqhekwane is the subject of this article. The study revealed that sufficient natural and cultural attractions exist in Noqhekwane, but that the threats identified to both cultural and physical environments are serious. Keywords: Challenges, community based ...

  13. Effectiveness of community based seed multiplication in enhancing ...

    African Journals Online (AJOL)

    Community Based Seed Multiplication (CBSM) approaches have been used by agricultural research and development actors to improve farmers' access to quality seed in many developing countries. CBSM can be private or public driven. However, ways of designing the CBSM for optimum effectiveness under public and ...

  14. Economic performance of community based bean seed production ...

    African Journals Online (AJOL)

    Limited access to seed of improved varieties is an impediment to agricultural productivity in sub-Saharan Africa. Researchers in the national and international agricultural research systems have been piloting a community based seed multiplication and marketing enterprises (CBSME) model, as an alternative to the formal ...

  15. Calibration of Community-based Coral Reef Monitoring Protocols ...

    African Journals Online (AJOL)

    Area Management (ICAM) programmes in the Western Indian Ocean (WIO). Community-based coral reef monitoring (CB-CRM) ..... Hatziolos, M. E. (2007) Coral Reefs. Under Rapid Climate Change and Ocean. Acidification. Science 318: 1737-1742. Horrill, J.C., Kalombo H & Makoloweka. S., (2001). Collaborative Reef and.

  16. Water, sanitation and hygiene in community based care ...

    African Journals Online (AJOL)

    Inadequate access to water influences sanitation and hygiene, and this affects the work of CHW. Government needs to respond promptly to the water and sanitation needs of marginalized communities with limited resources. The findings of the study had implications for policy on WASH and community-based care in low ...

  17. Tensions, Contradictions and Inconsistencies in Community-Based ...

    African Journals Online (AJOL)

    Jenny

    This paper is derived from a PhD study conducted in rural Uganda.The study used Participatory Action. Research (PAR) methodology to explore how educational methods employed in community-based environmental education programmes were empowering communities to respond appropriately to environmental ...

  18. Reflection on an interprofessional community-based participatory ...

    African Journals Online (AJOL)

    Background. A collaborative interprofessional research project that involved community members was beneficial to community development. Objective. To draw upon the experiences of academics relating to their involvement in an interprofessional community-based participatory research (CBPR) project. Methods. A Delphi ...

  19. Capacity of Community-Based Organisations to disseminate ...

    African Journals Online (AJOL)

    Objective: To assess the capacity of established community based organisations (CBOs) to disseminate information on sleeping sickness control. Design: Participatory interview process administered to randomly selected CBOs in a tsetse and trypanosomosis endemic area. Setting: Busia district, Western, Kenya. Results: ...

  20. An Honors Interdisciplinary Community-Based Research Course

    Science.gov (United States)

    Dunbar, David; Terlecki, Melissa; Watterson, Nancy; Ratmansky, Lisa

    2013-01-01

    This article describes how two faculty members at Cabrini College--one from biology and the other from psychology--incorporated interdisciplinary community-based research in an honors course on environmental watershed issues. The course, Environmental Psychology, was team-taught in partnership with a local watershed organization, the Valley Creek…

  1. Immigrant-Host Community Relations in Malawi's Community Based ...

    African Journals Online (AJOL)

    Access to land among land-poor households has always been contentious. In Malawi, the government, aware of this, started Community Based Rural Based Land Development Project. (CBRLDP), financed by the World Bank. The project brought to the fore the latent antagonistic relationship between immigrants and host ...

  2. A case study of Ghana's Community- Based Rural Development ...

    African Journals Online (AJOL)

    This paper argues that the term 'empowerment' is too complex a concept to be simply 'inserted' into development project designs without prior and precise conceptualization. Drawing on qualitative research conducted in 2010/2011 and using Ghana's Community-Based Rural Development Projects (CBRDP) as a case ...

  3. Community based tourism projects as a vehicle for creating ...

    African Journals Online (AJOL)

    Tourism is a modern-day engine for growth and one of the largest industries globally. Being a labour intensive industry with a supply chain that links many sectors, tourism is a priority sector in the national government's planning and policy framework. To understand the impact of community based tourism (CBT) projects in ...

  4. Presbyopic content of a community based Etecare Programme in ...

    African Journals Online (AJOL)

    A community-based eye care programme was carried out in Ikeduru Local Government Area (LGA) of Imo State, Nigeria. This LGA has an estimated population of 150,000. Ocular examinations were carried out on 16,783 (11.19% of total population) mixed population that cut across different ages. The presbyopic content ...

  5. A Community-based feasibility study of National Health Insurance ...

    African Journals Online (AJOL)

    In a community based study at Legon in 1997, a valuation method was used to assess the willingness of students on study leave to pay a percentage premium of their income ... The premium level was found to be influenced positively by financier, sex, age, income, and negatively by health expenditure, but not occupation.

  6. Reducing carbon transaction costs in community-based forest management

    NARCIS (Netherlands)

    Skutsch, Margaret

    2005-01-01

    The article considers the potential for community-based forest management (of existing forests) in developing countries, as a future CDM strategy, to sequester and mitigate carbon and to claim credits in future commitment periods. This kind of forestry is cost-effective, and should bring many more

  7. Reducing carbon transaction costs in community based forest management

    NARCIS (Netherlands)

    Skutsch, Margaret

    The paper considers the potential for community based forest management (of existing forests) in developing countries, as a future CDM strategy, to sequester carbon and claim credits in future commitment periods. This kind of forestry is cost effective, and should bring many more benefits to local

  8. Evaluation of a Community-Based Aging Intervention Program

    Science.gov (United States)

    Hsu, Hui-Chuan; Wang, Chun-Hou; Chen, Yi-Chun; Chang, Ming-Chen; Wang, Jean

    2010-01-01

    This study evaluated the outcome and process of a community-based aging intervention program for the elderly in Taiwan. The program included education on nutrition and dietary behavior and on physical activities. Outcome and process evaluations were conducted. The program may have had some effects on decreasing some dietary behavioral problems and…

  9. Immigrant-Host Community Relations in Malawi's Community Based ...

    African Journals Online (AJOL)

    Access to land among land-poor households has always been contentious. In Malawi, the government, aware of this, started Community Based Rural Based Land Development Project (CBRLDP), financed by the World Bank. The project brought to the fore the latent antagonistic relationship between immigrants and host ...

  10. Out-patient gastroscopy risks

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Clausen, N

    1978-01-01

    Complications in out-patient gastroscopy were evaluated retrospectively in 995 examinations performed in 625 patients. At the examination seven complications were registered in the gastroscopy record. Two complications: perforation of the stomach and cardiac arrhythmia, required hospitalisation...

  11. Tocopherol isoforms in parenteral lipid emulsions and neutrophil activation.

    NARCIS (Netherlands)

    Wanten, G.J.A.; Beunk, J.; Naber, A.H.J.; Swinkels, D.W.

    2002-01-01

    BACKGROUND AND AIMS: Tocopherol is a lipid-soluble anti-oxidant that exists in several isoforms. Patients on total parenteral nutrition depend on lipid emulsions for their tocopherol intake. In the present study, we analysed the content of tocopherol isoforms in various lipid emulsions. We also

  12. Parenteral Lipid Tolerance and Adverse Effects: Fat Chance for Trouble?

    NARCIS (Netherlands)

    Wanten, G.J.A.

    2015-01-01

    Lipid emulsions (LEs) are indispensable sources of fuel calories and (essential) fatty acids (FAs) in modern parenteral nutrition formulations. The use of LE, however, also remains associated with the development of adverse effects. Intolerance for LE mostly becomes apparent upon the development of

  13. [Standard parenteral nutrition preparations in complex clinical situations].

    Science.gov (United States)

    Llop Talaverón, J M; Berlana Martín, D; Badía Tahull, M B; Fort Casamartina, E; Vinent Genestar, J L; Tubau Mola, M; Jódar Massanés, R

    2004-01-01

    Binary and ternary parenteral nutrition preparations may be of limited use in certain cases. The goal of this study is to establish difficult nutritional situations to handle and analyze the type of formula used in these situations. The study included patients treated with parenteral nutrition over 9 months. Three clinically complex situations were defined: long duration, lasting more than 25 days; kidney failure, uraemia > 20 mmol/L or serum creatinine > 200 micromol/L; and liver failure, total bilirubin > 30 mmol/L or ALT > 2 microkat/L and alkaline phosphatase > 3 microkat/L or GGT > 3 microkat/L. Mortality and hypoalbuminaemia (parenteral nutrition were studied. Of these, 283 were included in one or more of the 3 complex clinical situations. All three groups presented higher levels of mortality and hypoalbuminaemia with statistically significant differences when compared to the group in a non-complex clinical situation. The use of individualized formulas was greater in the three groups defined, with statistically significant differences resulting: OR=6.7 (CI 95%; 3.78-11.91) with long duration; OR=3.66 (CI 95%; 2.68-5.68) in kidney failure; and OR=1.5 (CI 95%; 1.01-2.35) in liver failure. Patients in complex clinical situations present greater visceral malnutrition, a worse clinical evolution and, at our hospital, their nutritional treatment by parenteral means is based on a greater use of individualized formulas.

  14. 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 ...

  15. Lipid emulsions in parenteral nutrition: does one size fits all ...

    African Journals Online (AJOL)

    Dietary lipids significantly contribute to preserve the efficiency of human metabolism and restore it during disease. Therefore, in the absence of absolute contraindications, it would not appear reasonable to exclude lipid emulsions when prescribing parenteral nutrition (PN). The metabolic role of lipids has been elucidated, ...

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

    African Journals Online (AJOL)

    2014-11-01

    Nov 1, 2014 ... and infectious complications; and metabolic complications relating to PN, including hepatobiliary complications, i.e. cholestasis. Insulin therapy in patients receiving PN may prevent cholestasis.9. ESPEN suggests the early start of supplementary PN on day 2-3, while the American Society for Parenteral and ...

  17. Gluconeogenesis continues in premature infants receiving total parenteral nutrition

    Science.gov (United States)

    To determine the contribution of total gluconeogenesis, to glucose production in preterm infants receiving total parenteral nutrition (TPN) providing glucose exceeding normal infant glucose turnover rate, eight infants (0.955 +/- 0.066 kg, 26.5 - 0.5 wks, 4-1 d) were studied while receiving routine ...

  18. Assessment of the effects of parenteral quinine on testicular ...

    African Journals Online (AJOL)

    Assessment of the effects of parenteral quinine on testicular histology and sperm parameters in wistar rats. JE Ataman, D Baxter-Grillo, AAA Osinubi. Abstract. Twenty-four week duration experiment was conducted with twenty-one male Wistar rats (200 - 250 g) to investigate the effects of quinine on the testis. The rats were ...

  19. Total parenteral nutrition in a premature rhinoceros calf.

    Science.gov (United States)

    Herrmann, V M; Miller, R E

    1991-10-01

    A female black rhinoceros calf developed significant hypoglycemia (blood glucose, 30 mg/dL) and hypothermia (97 degrees F) within 48 hours of birth and refused to nurse. Normal gestation of the black rhinoceros is 15 months, but elongated hoof slippers and low birth weight (30 kg) suggested prematurity in this calf. Clinical symptoms of neonatal sepsis including lassitude and poor sucking continued in spite of the aggressive use of antibiotics, and the calf required mechanical ventilatory support on day 7. Nutritional support including enteral gavage feedings (Pedialyte/4 ounces of SMA [Wyeth Ayerst] with sucraflox) had been instituted and was supplemented with total parenteral nutrition on day 5. Central venous access was obtained via a jugular cutdown. The total parenteral nutrition included appropriate electrolytes and vitamins for the neonatal calf but did not include trace elements. The use of total parenteral nutrition by our zoos for therapeutic purposes is increasing. Experience with total parenteral nutrition in exotic animals such as the black rhinoceros is limited, yet this may be an important therapeutic modality in these animals, particularly those in danger of extinction.

  20. Oral or Parenteral Paracetamol as a Substitute for Banned Dipyrone ...

    African Journals Online (AJOL)

    In October 2004 there were 103 prescriptions which included Analgin IM (5), ibuprofen (6), oral paracetamol (102). In April 2005, there were 218 prescriptions for antipyretics and non-steroidal anti-inflammatory drugs (NSAIDs) which included piroxicam (11), ibuprofen (9), oral paracetamol (176), parenteral paracetamol (4).

  1. Preoperative total parenteral nutrition (TPN) in severe Crohn's disease

    NARCIS (Netherlands)

    Gouma, D. J.; von Meyenfeldt, M. F.; Rouflart, M.; Soeters, P. B.

    1988-01-01

    This study was performed to evaluate the effect of preoperative total parenteral nutrition (TPN) on the results after surgical treatment of patients with severe Crohn's disease. Of 67 patients admitted with complications of Crohn's disease, 51 had severe active disease and abdominal masses, fistulas

  2. Outpatient management of pulmonary embolism.

    Science.gov (United States)

    Roy, P-M; Moumneh, T; Penaloza, A; Sanchez, O

    2017-07-01

    Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n=3036) or discharged early (n=535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatment may be considered as the first line management for hemodynamically stable PE patients, subject to the respect of simple eligibility criteria and on the condition that a specific procedure for outpatient care is developed in advance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research.

    Science.gov (United States)

    Sheikhattari, Payam; Apata, Jummai; Kamangar, Farin; Schutzman, Christine; O'Keefe, Anne; Buccheri, Jane; Wagner, Fernando A

    2016-12-01

    Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. The intervention consisted of three Phases. Phase I (n = 404) was a clinic-based trial comparing two types of counseling. Phase II (n = 398) and Phase III (n = 163) interventions were conducted in community venues by trained Peer Motivators. Quit rates at 12-week follow-up increased from 9.4 % in Phase I (clinic-based) to an average of 23.7 % in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR 2.6, 95 % CI 1.7-4.2) while controlling for possible confounders. A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.

  4. Lipid emulsions – Guidelines on Parenteral Nutrition, Chapter 6

    Directory of Open Access Journals (Sweden)

    Krohn, K.

    2009-11-01

    Full Text Available The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l. There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.

  5. IODINE CONTENT OF ENTERAL AND PARENTERAL NUTRITION SOLUTIONS.

    Science.gov (United States)

    Willard, Devina L; Young, Lorraine S; He, Xuemei; Braverman, Lewis E; Pearce, Elizabeth N

    2017-07-01

    Iodine is essential for thyroid hormone synthesis, and iodine deficiency may result in thyroid disorders including goiter and hypothyroidism. Patients on long-term enteral nutrition (EN) or parenteral nutrition (PN) may be at risk for micronutrient deficiencies. The recommended daily allowance for iodine intake is 150 μg for nonpregnant adults. However, there is no current consensus among scientific societies regarding the quantity of iodine to be added in adult EN and PN formulations. The objective of this study was to determine the iodine content of U.S. adult enteral and parenteral nutrition solutions. This study also aimed to determine whether adult patients in the United States who are receiving long-term artificial nutrition may be at risk for iodine deficiency. Ten enteral nutrition solutions and 4 parenteral nutrition solutions were evaluated. The iodine contents of these solutions were measured spectrophotometrically and compared to the labeled contents. Measured and labeled EN iodine contents were similar (range 131-176 μg/L and 106-160 μg/L, respectively). In contrast, PN formulas were found to contain small, unlabeled amounts of iodine, averaging 27 μg/L. Typical fluid requirements are 30 to 40 mL/kg/day for adults receiving either total EN (TEN) or total PN (TPN). Adults on long-term TEN likely consume enough servings to meet their daily iodine requirements. However, patients on long-term TPN would require on average 5.6 L PN/day to meet the recommended daily allowance of iodine. This volume of PN is far in excess of typical consumption. Thus, U.S. patients requiring long-term TPN may be at risk for iodine deficiency. EN = enteral nutrition; PN = parenteral nutrition; TEN = total enteral nutrition; TPN = total parenteral nutrition; UIC = urinary iodine concentration.

  6. Treatment of Parenteral Nutrition-Associated Liver Disease: The Role of Lipid Emulsions123

    Science.gov (United States)

    Nandivada, Prathima; Carlson, Sarah J.; Chang, Melissa I.; Cowan, Eileen; Gura, Kathleen M.; Puder, Mark

    2013-01-01

    Parenteral nutrition is a life-saving therapy for infants with intestinal failure. However, long-term parenteral nutrition carries the risk of progressive liver disease. Substantial data has implicated components of parenteral soybean oil in the pathogenesis of parenteral nutrition-associated liver disease (PNALD). Elevated serum concentrations of phytosterols, an abundance of omega-6 polyunsaturated fatty acids, and a relative paucity of α-tocopherol have been associated with the risk of cholestasis and hepatic injury observed in PNALD. Currently available treatment strategies include the reduction of the dose of administered parenteral soybean oil and/or the replacement of parenteral soybean oil with alternative parenteral lipid emulsions. The purpose of this review is to provide an overview of the pathogenetic mechanisms associated with the development of PNALD and the data evaluating currently available treatment strategies. PMID:24228202

  7. Feasibility and efficacy of gentamicin for treating neonatal sepsis in community-based settings: a systematic review.

    Science.gov (United States)

    Jaiswal, Nishant; Singh, Meenu; Kondel, Ritika; Kaur, Navjot; Thumburu, Kiran K; Kumar, Ajay; Kaur, Harpreet; Chadha, Neelima; Gupta, Neeraj; Agarwal, Amit; Malhotra, Samir; Shafiq, Nusrat

    2016-11-01

    Neonatal sepsis is a leading cause of neonatal deaths in developing countries. The current recommended in-hospital treatment is parenteral ampicillin (or penicillin) and gentamicin in young infants for 10- 14 days; however, very few could access and afford. The current review is to evaluate the feasibility of gentamicin in community based settings. Both observational and randomized controlled trials were included. Medline, Embase, Cochrane Central Register of Controlled Trials and Central Trial Register of India were searched until September 2013. We assessed the risk of bias by Cochrane Collaboration's "risk of bias" tool. Two observational studies indicated feasibility ensuring coverage of population, decrease in case fatality rate in the group treated by community health workers. In an RCT, no significant difference was observed in the treatment failure rates [odds ratio (OR)=0.88], and the mortality in the first and second week (OR=1.53; OR=2.24) between gentamicin and ceftriaxone groups. Within the gentamicin group, the combination of penicillin and gentamicin showed a lower rate of treatment failure (OR=0.44) and mortality at second week of life (OR=0.17) as compared to the combination of gentamicin and oral cotrimoxazole. Gentamicin for the treatment of neonatal sepsis is both feasible and effective in community-based settings and can be used as an alternative to the hospitalbased care in resource compromised settings. But there was less evidence in the management of neonatal sepsis in hospitals as was seen in this review in which we included only one RCT and three observational studies.

  8. 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.

  9. Toward an African Community-Based Research (ACBR Methodology

    Directory of Open Access Journals (Sweden)

    John-Okoria Ibhakewanlan

    2015-11-01

    Full Text Available Based on an expressed need in the past few years for an appropriate research methodology for colonized peoples, this article proposes a way of conducting research that is faithful to the essential tenets of the African culture. The article delineates principles of a community-based participatory approach to research in Africa. After first outlining the essential tenets of a community-based research (CBR that are relevant for research projects in Africa, the article argued that the existing CBR lacked a specifically African philosophical basis. It explained the uniqueness of the African philosophy. It then summed up the research principles based on that philosophy. Last, the challenges of conducting such a research study in Africa were outlined. Despite the African emphasis of the overall approach, this proposed methodology may be employed in similar settings where issues such as decolonization are important variables in the research strategy.

  10. The impact of community-based dental education on students.

    Science.gov (United States)

    Strauss, Ronald P; Stein, Margot B; Edwards, Jeffrey; Nies, Kevin C

    2010-10-01

    Community-based dental education (CBDE) shifts a substantial portion of dental clinical education from dental school clinics to mainly public health settings. For dental students to learn effectively in community settings they need preparatory education in cultural awareness, communication skills, and the social and behavioral sciences. The effective integration of CBDE into a dental curriculum requires reflective components, evaluation, and highly organized community-based experiences. This chapter reviews organizational principles and specific strategies to ensure that CBDE is conducted in a fashion that enables student learning and community oral health service. CBDE has substantial potential for affecting the values and behaviors of dental students relative to health care access for underserved populations and for attracting diverse students to dental education. CBDE also provides dentistry with an opportunity to guide dental faculty and student values and orientation towards public service, engagement, ethics, and the health of the public.

  11. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  12. Routine inpatient provider-initiated HIV testing in Malawi, compared with client-initiated community-based testing, identifies younger children at higher risk of early mortality.

    Science.gov (United States)

    Preidis, Geoffrey A; McCollum, Eric D; Kamiyango, William; Garbino, Alejandro; Hosseinipour, Mina C; Kazembe, Peter N; Schutze, Gordon E; Kline, Mark W

    2013-05-01

    To determine how routine inpatient provider-initiated HIV testing differs from traditional community-based client-initiated testing with respect to clinical characteristics of children identified and outcomes of outpatient HIV care. Prospective observational cohort. Routine clinical data were collected from children identified as HIV-infected by either testing modality in Lilongwe, Malawi, in 2008. After 1 year of outpatient HIV care at the Baylor College of Medicine Clinical Center of Excellence, outcomes were assessed. Of 742 newly identified HIV-infected children enrolling into outpatient HIV care, 20.9% were identified by routine inpatient HIV testing. Compared with community-identified children, hospital-identified patients were younger (median 25.0 vs 53.5 months), with more severe disease (22.2% vs 7.8% WHO stage IV). Of 466 children with known outcomes, 15.0% died within the first year of HIV care; median time to death was 15.0 weeks for community-identified children vs 6.0 weeks for hospital-identified children. The strongest predictors of early mortality were severe malnutrition (hazard ratio, 4.3; 95% confidence interval, 2.2-8.3), moderate malnutrition (hazard ratio, 3.2; confidence interval, 1.6-6.6), age mortality. Routine inpatient HIV testing identifies a subset of younger HIV-infected children with more severe, rapidly progressing disease that traditional community-based testing modalities are currently missing.

  13. A Community Based Systems Diagram of Obesity Causes

    OpenAIRE

    Steven Allender; Brynle Owen; Jill Kuhlberg; Janette Lowe; Phoebe Nagorcka-Smith; Jill Whelan; Colin Bell

    2015-01-01

    Introduction Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. Methods Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connec...

  14. Social services delivery through community-based projects

    OpenAIRE

    Dinah McLeod; Maurizia Tovo

    2001-01-01

    The World Bank is financing an increasing number of community-based social services projects. The objective of this paper is to review and categorize the extent, scope and mechanisms of these projects in the current Bank portfolio, and to identify good practices and potential pitfalls. The authors identify 99 projects that finance at least $1.6 billion in social services. While most of the projects surveyed deliver"traditional"services such as nutrition, maternal and child care, and literacy,...

  15. National Intercultural Federation of Community Based Tourism of Ecuador

    OpenAIRE

    Flores, R.

    2004-01-01

    For approximately 20 years, the indigenous nationalities of Ecuador have been searching for new alternatives in order to adapt to the new social and cultural changes in the society and also to face economic problems. For this reason new alternatives of community based tourism have been built according to their own cultural rationalities. The tourism activity has facilitated the possibility to improve the living conditions and create intercultural encounters.

  16. Social networks and community-based natural resource management.

    Science.gov (United States)

    Lauber, T Bruce; Decker, Daniel J; Knuth, Barbara A

    2008-10-01

    We conducted case studies of three successful examples of collaborative, community-based natural resource conservation and development. Our purpose was to: (1) identify the functions served by interactions within the social networks of involved stakeholders; (2) describe key structural properties of these social networks; and (3) determine how these structural properties varied when the networks were serving different functions. The case studies relied on semi-structured, in-depth interviews of 8 to 11 key stakeholders at each site who had played a significant role in the collaborative projects. Interview questions focused on the roles played by key stakeholders and the functions of interactions between them. Interactions allowed the exchange of ideas, provided access to funding, and enabled some stakeholders to influence others. The exchange of ideas involved the largest number of stakeholders, the highest percentage of local stakeholders, and the highest density of interactions. Our findings demonstrated the value of tailoring strategies for involving stakeholders to meet different needs during a collaborative, community-based natural resource management project. Widespread involvement of local stakeholders may be most appropriate when ideas for a project are being developed. During efforts to exert influence to secure project approvals or funding, however, involving specific individuals with political connections or influence on possible sources of funds may be critical. Our findings are consistent with past work that has postulated that social networks may require specific characteristics to meet different needs in community-based environmental management.

  17. Social Networks and Community-Based Natural Resource Management

    Science.gov (United States)

    Lauber, T. Bruce; Decker, Daniel J.; Knuth, Barbara A.

    2008-10-01

    We conducted case studies of three successful examples of collaborative, community-based natural resource conservation and development. Our purpose was to: (1) identify the functions served by interactions within the social networks of involved stakeholders; (2) describe key structural properties of these social networks; and (3) determine how these structural properties varied when the networks were serving different functions. The case studies relied on semi-structured, in-depth interviews of 8 to 11 key stakeholders at each site who had played a significant role in the collaborative projects. Interview questions focused on the roles played by key stakeholders and the functions of interactions between them. Interactions allowed the exchange of ideas, provided access to funding, and enabled some stakeholders to influence others. The exchange of ideas involved the largest number of stakeholders, the highest percentage of local stakeholders, and the highest density of interactions. Our findings demonstrated the value of tailoring strategies for involving stakeholders to meet different needs during a collaborative, community-based natural resource management project. Widespread involvement of local stakeholders may be most appropriate when ideas for a project are being developed. During efforts to exert influence to secure project approvals or funding, however, involving specific individuals with political connections or influence on possible sources of funds may be critical. Our findings are consistent with past work that has postulated that social networks may require specific characteristics to meet different needs in community-based environmental management.

  18. Cost Effective Community Based Dementia Screening: A Markov Model Simulation

    Directory of Open Access Journals (Sweden)

    Erin Saito

    2014-01-01

    Full Text Available Background. Given the dementia epidemic and the increasing cost of healthcare, there is a need to assess the economic benefit of community based dementia screening programs. Materials and Methods. Markov model simulations were generated using data obtained from a community based dementia screening program over a one-year period. The models simulated yearly costs of caring for patients based on clinical transitions beginning in pre dementia and extending for 10 years. Results. A total of 93 individuals (74 female, 19 male were screened for dementia and 12 meeting clinical criteria for either mild cognitive impairment (n=7 or dementia (n=5 were identified. Assuming early therapeutic intervention beginning during the year of dementia detection, Markov model simulations demonstrated 9.8% reduction in cost of dementia care over a ten-year simulation period, primarily through increased duration in mild stages and reduced time in more costly moderate and severe stages. Discussion. Community based dementia screening can reduce healthcare costs associated with caring for demented individuals through earlier detection and treatment, resulting in proportionately reduced time in more costly advanced stages.

  19. Structure and characteristics of community-based multidisciplinary wound care teams in Ontario: an environmental scan.

    Science.gov (United States)

    Abrahamyan, Lusine; Wong, Josephine; Pham, Ba'; Trubiani, Gina; Carcone, Steven; Mitsakakis, Nicholas; Rosen, Laura; Rac, Valeria E; Krahn, Murray

    2015-01-01

    Multidisciplinary team approach is an essential component of evidence-based wound management in the community. The objective of this study was to identify and describe community-based multidisciplinary wound care teams in Ontario. For the study, a working definition of a multidisciplinary wound care team was developed, and a two-phase field evaluation was conducted. In phase I, a systematic survey with three search strategies (environmental scan) was conducted to identify all multidisciplinary wound care teams in Ontario. In phase II, the team leads were surveyed about the service models of the teams. We identified 49 wound care teams in Ontario. The highest ratio of Ontario seniors to wound team within each Ontario health planning region was 82,358:1; the lowest ratio was 14,151:1. Forty-four teams (90%) participated in the survey. The majority of teams existed for at least 5 years, were established as hospital outpatient clinics, and served patients with chronic wounds. Teams were heterogeneous in on-site capacity of specialized diagnostic testing and wound treatment, team size, and patient volume. Seventy-seven percent of teams had members from three or more disciplines. Several teams lacked essential disciplines. More research is needed to identify optimal service models leading to improved patient outcomes. © 2014 by the Wound Healing Society.

  20. Temporal trends in the use of parenteral nutrition in critically ill patients.

    Science.gov (United States)

    Gershengorn, Hayley B; Kahn, Jeremy M; Wunsch, Hannah

    2014-03-01

    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. 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. 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, Pparenteral 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. 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.

  1. Nutrición parenteral precoz en el neonato grave

    Directory of Open Access Journals (Sweden)

    Alina González Mustelier

    2004-06-01

    Full Text Available Se realizó un estudio descriptivo en el Servicio de Terapia Intensiva Neonatal del Hospital Ginecoobstétrico "Ramón González Coro" de Ciudad de La Habana, desde enero del 2000 hasta enero del 2002, con el objetivo de valorar las ventajas del uso de nutrición parenteral (NP precoz en los neonatos críticamente enfermos, durante la primera semana de vida. Se compararon 2 grupos de 23 recién nacidos críticos, uno de ellos recibió alimentación parenteral (grupo I y el otro no (grupo II. Se encontró homogeneidad en ambos grupos en cuanto a peso, edad gestacional, valoración nutricional al nacer, sexo y morbilidad inicial. La nutrición parenteral se caracterizó por su uso precoz (menos de 72 horas, conjuntamente con alimentación enteral mínima. La media del aporte máximo de macronutrientes fue de 16 g/kg/d de dextrosa, 1,2 g/kg/d de lípidos y 2 g/kg/d de proteínas. El desarrollo nutricional fue más favorable en el grupo con NP, porque le disminuyó a la mitad el tanto por ciento de peso perdido en la primera semana de vida, le sostuvo mayor aporte energético durante ese período y recupó 7 días antes su peso del nacimiento en relación con el grupo II. Las complicaciones fueron similares en ambos grupos, para concluir en que estas no estuvieron relacionadas con el uso de NP.A descriptive study was conducted at the Neonatal Intensive Therapy Service of "Ramón Gonzalez Coro" Gynecoobstetric Hospital, in Havana City, from January 2000, to January 2002, aimed at assessing the advantages of the use of early parenteral nutrition in the critically ill neonates during the first week of life. 2 groups of 23 critical newborn infants each were compared. One of them recieved parenteral nutrition (group 1 and the other one did not (group II. Homogeneity was found in both groups as regards weight, gestational age, nutritional assessment at birth and initial morbidity. The parenteral nutrition was characterized by its early use (less than 72

  2. Parenteral nutrition-associated liver disease and lipid emulsions.

    Science.gov (United States)

    Zugasti Murillo, Ana; Petrina Jáuregui, Estrella; Elizondo Armendáriz, Javier

    2015-01-01

    Parenteral nutrition-associated liver disease (PNALD) is a particularly important problem in patients who need this type of nutritional support for a long time. Prevalence of the condition is highly variable depending on the series, and its clinical presentation is different in adults and children. The etiology of PNALD is not well defined, and participation of several factors at the same time has been suggested. When a bilirubin level >2 mg/dl is detected for a long time, other causes of liver disease should be ruled out and risk factors should be minimized. The composition of lipid emulsions used in parenteral nutrition is one of the factors related to PNALD. This article reviews the different types of lipid emulsions and the potential benefits of emulsions enriched with omega-3 fatty acids. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  3. Parenteral trace element provision: recent clinical research and practical conclusions

    Science.gov (United States)

    Stehle, P; Stoffel-Wagner, B; Kuhn, K S

    2016-01-01

    The aim of this systematic review (PubMed, www.ncbi.nlm.nih.gov/pubmed and Cochrane, www.cochrane.org; last entry 31 December 2014) was to present data from recent clinical studies investigating parenteral trace element provision in adult patients and to draw conclusions for clinical practice. Important physiological functions in human metabolism are known for nine trace elements: selenium, zinc, copper, manganese, chromium, iron, molybdenum, iodine and fluoride. Lack of, or an insufficient supply of, these trace elements in nutrition therapy over a prolonged period is associated with trace element deprivation, which may lead to a deterioration of existing clinical symptoms and/or the development of characteristic malnutrition syndromes. Therefore, all parenteral nutrition prescriptions should include a daily dose of trace elements. To avoid trace element deprivation or imbalances, physiological doses are recommended. PMID:27049031

  4. Complications Associated with Parenteral Nutrition in the Neonate

    Science.gov (United States)

    Calkins, Kara L; Venick, Robert S.; Devaskar, Sherin U.

    2017-01-01

    Parenteral nutrition (PN) is essential to the practice of neonatology. While PN is life-sustaining, it associated with a host of complications including parenteral nutrition-associated liver disease (PNALD) and central line-associated bloodstream infections (CLASBIs), which carry a high morbidity and mortality and pose a burden to the healthcare system. Evidence has emerged that the dose and composition of intravenous lipid products can alter the incidence of PNALD and CLASBIs. However, other patient- and PN-related factors, such as prematurity, birth weight, and gastrointestinal anatomy and function, must not be ignored. In order improve neonatal care, future research is still needed to optimize the content of PN and decrease the incidence PNALD and CLASBIs. PMID:24873836

  5. Liver disease due to parenteral and enteral nutrition.

    Science.gov (United States)

    Kwan, V; George, J

    2004-11-01

    Liver disease due to parenteral and enteral nutrition is a well-recognized iatrogenic phenomenon, but its cause and pathogenesis have not been clearly elucidated. Various mechanisms have been postulated, but it is likely that the cause is multifactorial with significant interplay among several factors. A preventive approach to management is ideal but awaits a more complete understanding of the pathophysiology. A variety of management strategies has been proposed in small case series, but level 1 evidence-based guidelines have yet to be established. Although an abundance of both clinical and animal studies exist regarding liver disease associated with parenteral nutrition (PN), there is a paucity of data regarding enteral nutrition (EN)-associated hepatic disease. The latter probably reflects differences in the frequency and severity of PN- versus EN-associated liver disease. This article addresses the two routes of nutritional support individually, with the major focus on PN-associated liver disease.

  6. Parenteral Antibiotics Reduce Bifidobacteria Colonization and Diversity in Neonates

    Directory of Open Access Journals (Sweden)

    Séamus Hussey

    2011-01-01

    Full Text Available We investigated the impact of parenteral antibiotic treatment in the early neonatal period on the evolution of bifidobacteria in the newborn. Nine babies treated with intravenous ampicillin/gentamicin in the first week of life and nine controls (no antibiotic treatment were studied. Denaturing gradient gel electrophoresis was used to investigate the composition of Bifidobacterium in stool samples taken at four and eight weeks. Bifidobacteria were detected in all control infants at both four and eight weeks, while only six of nine antibiotic-treated infants had detectable bifidobacteria at four weeks and eight of nine at eight weeks. Moreover, stool samples of controls showed greater diversity of Bifidobacterium spp. compared with antibiotic-treated infants. In conclusion, short-term parenteral antibiotic treatment of neonates causes a disturbance in the expected colonization pattern of bifidobacteria in the first months of life. Further studies are required to probiotic determine if supplementation is necessary in this patient group.

  7. Splenic siderosis and parenteral iron dextran in maintenance haemodialysis patients.

    OpenAIRE

    Murray, J. A.; Slater, D N; Parsons, M. A.; Fox, M.; Smith, S.; Platts, M. M.

    1984-01-01

    The histological features of 40 spleens surgically removed from maintenance haemodialysis patients are reported. Twenty-four of the 40 (60%) showed massive iron loading and a significant direct correlation was found between iron loading and the amount of intravenous iron dextran administered. Since parenteral iron dextran appears to be a major factor in causing iron overload in haemodialysis patients its use as a method of iron replacement in these patients would appear inappropriate.

  8. Transition from parenteral to oral treprostinil in pulmonary arterial hypertension.

    Science.gov (United States)

    Chakinala, Murali M; Feldman, Jeremy P; Rischard, Franz; Mathier, Michael; Broderick, Meredith; Leedom, Nicole; Laliberte, Kevin; White, R James

    2017-02-01

    Parenteral prostanoids are effective treatment for pulmonary arterial hypertension, but long-term pump infusion systems have significant delivery-related safety and convenience limitations. Subjects with a favorable risk profile transitioned from parenteral to oral treprostinil using a protocol-driven titration during 5 days of inpatient observation. Baseline and Week 24 assessments included 6-minute walk distance, echocardiogram, right heart catheterization, pharmacokinetics, treatment satisfaction and quality of life. Thirty-three subjects (76% female, mean age 50 years) enrolled; 85% were using subcutaneous treprostinil with a median dose of 57 (range 25 to 111) ng/kg/min. Participants were using background, approved non-prostanoid therapy, including 9 on 2 oral therapies; baseline right atrial pressure and cardiac output were in the normal range. All 33 subjects transitioned to oral treprostinil therapy within 4 weeks, but 2 transitioned back to parenteral drug before Week 24. At Week 24, subjects were taking a median total daily dose of 44 (15 to 75) mg, with 25 of 31 using a 3-times-daily regimen at 7- to 9-hour intervals. The 6-minute walk distance was preserved (median +17 m [-98 to 95 m]) at its baseline of 446 m. Hemodynamic variables, including pulmonary vascular resistance, were similar at Week 24 except for mixed venous saturation, which dropped from a median of 71% to 68% (p < 0.001). Overall quality of life and treatment satisfaction measures did not change; however, mood-related symptom and treatment convenience subscores improved. Common adverse effects included headache, nausea, flushing and diarrhea. Lower risk patients managed on parenteral treprostinil may be candidates for transition to a more convenient, oral form of the drug. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Parenteral administration medicines: recommendations of preparation, administration and stability

    Directory of Open Access Journals (Sweden)

    M. Gaspar Carreño

    2014-11-01

    Full Text Available Objective: To develop recommendations for the preparation of parenteral drugs (MAP, to assess the transferability of their preparation, from nursing units in the hospital ward to the pharmacy service (SF. Method: A table of stabilities of parenteral drugs included in the pharmacotherapeutic guideline was developed using the american and spanish guidelines. Information about MAP was collected (method of preparation, support, maintenance, validity, administration specifications and packaging by consulting product technical sheets, pharmaceutical industries, literature review and databases. Results: After reviewing 209 drugs, a list of recommendations was developed. According to the data, MAP will be prepared as follows: 89 drugs will be prepared from SF, 62 drugs at nursing units because of its immediate administration requirement and 58 are already packed for its administration by the industry. Of these 62 drugs prepared a nursing units, 14 of them will be prepared in the following doses by the SF. Therefore, 48 drugs will be prepared at nursing units from the 209 parenteral drugs reviewed. Conclusions: A standardized method of preparation, storage, administration and validity of MAP was established by the SF. The preparation of MAP in the SF extends its shelf life, by considering physicochemical stability, level of risk and product vulnerability to microbiological contamination. The information provided will contribute to a reduction of errors associated with the preparation and administration of MAP.

  10. [Parenteral administration medicines: recommendations of preparation, administration and stability].

    Science.gov (United States)

    Gaspar Carreño, M; Torrico Martín, F; Novajarque Sala, L; Batista Cruz, M; Ribeiro Gonçalves, P; Porta Oltra, B; Sánchez Santos, J C

    2014-11-03

    To develop recommendations for the preparation of parenteral drugs (MAP), to assess the transferability of their preparation, from nursing units in the hospital ward to the pharmacy service (SF). A table of stabilities of parenteral drugs included in the pharmacotherapeutic guideline was developed using the american and spanish guidelines. Information about MAP was collected (method of preparation, support, maintenance, validity, administration specifications and packaging) by consulting product technical sheets, pharmaceutical industries, literature review and databases. After reviewing 209 drugs, a list of recommendations was developed. According to the data, MAP will be prepared as follows: 89 drugs will be prepared from SF, 62 drugs at nursing units because of its immediate administration requirement and 58 are already packed for its administration by the industry. Of these 62 drugs prepared a nursing units, 14 of them will be prepared in the following doses by the SF. Therefore, 48 drugs will be prepared at nursing units from the 209 parenteral drugs reviewed. A standardized method of preparation, storage, administration and validity of MAP was established by the SF. The preparation of MAP in the SF extends its shelf life, by considering physicochemical stability, level of risk and product vulnerability to microbiological contamination. The information provided will contribute to a reduction of errors associated with the preparation and administration of MAP. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  11. Current uses and abuses of total parenteral nutrition.

    Science.gov (United States)

    Archer, S B; Burnett, R J; Fischer, J E

    1996-01-01

    Total parenteral nutrition remains a vital medical intervention, and in our institution it is considered as basic as intravenous fluids, antibiotics, and blood transfusions. As is true of most treatments, there are specific indications as well as associated risks and costs which mandate justification of its use. It is clear that the indications for TPN are diminishing as basic science and clinical studies continue to find increased benefits associated with enteral feeding, and as techniques for initiating enteral nutrition improve. Because of unproven benefits and/or increased complication rates, TPN has lost favor in the treatment of conditions that were previously thought to require parenteral alimentation, such as acute pancreatitis, pediatric and adult burns, critical care, and preoperative use in patients with mild or moderate malnutrition. Despite diminishing indications, TPN continues to generate excitement in some areas as its immunological effects become better defined. The use of TPN in patients with cancer before certain therapies, as well as in the transplant population, remains hopeful. New uses of TPN will result from a better understanding of the cellular and molecular effects of parenteral feeding. In the future, TPN may well be used as a pharmacologic agent rather than as nutritional intervention.

  12. Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies.

    Science.gov (United States)

    Rao, Agam K; Luckman, Emily; Wise, Matthew E; MacCannell, Taranisia; Blythe, David; Lin, Yulin; Xia, Guoliang; Drobeniuc, Jan; Noble-Wang, Judith; Arduino, Matthew J; Thompson, Nicola D; Patel, Priti R; Wilson, Lucy E

    2013-01-01

    In the United States, the prevalence of hepatitis C virus infection among patients treated in hemodialysis facilities is five times higher than among the general population. This study investigated eight new hepatitis C virus infections among patients treated at an outpatient hemodialysis facility. Epidemiologic investigation and viral sequencing demonstrated that transmission likely occurred between patients typically treated during the same or consecutive shifts at the same or a nearby station. Several infection control breaches were observed including lapses involving the preparation, handling, and administration of parenteral medications. Improved infection control education and training for all hemodialysis facility staff is an important component of assuring adherence to appropriate procedures and preventing future outbreaks.

  13. Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study

    Directory of Open Access Journals (Sweden)

    Riess Hanno

    2010-03-01

    Full Text Available Abstract Background Cachexia is a common problem in patients (pts suffering from upper gastrointestinal cancer. In addition, most of these patients suffer from malabsorption and stenosis of the gastrointestinal tract due to their illness. Various methods of supplementary nutrition (enteral, parenteral are practised. In patients with advanced pancreatic cancer (APC, phase angle, determined by bio-electrical impedance analysis (BIA, seems to be a survival predictor. The positive influence of BIA determinate predictors by additional nutrition is currently under discussion. Methods To examine the impact of additional parenteral nutrition (APN we assessed outpatients suffering from APC and progressive cachexia. The assessment based on the BIA method. Assessment parameters were phase angle, ECM/BCM index (ratio of extracellular mass to body cell mass, and BMI (body mass index. Patients suffering from progressive weight loss in spite of additional enteral nutritional support were eligible for the study. Results Median treatment duration in 32 pts was 18 [8-35] weeks. Response evaluation showed a benefit in 27 pts (84% in at least one parameter. 14 pts (43.7% improved or stabilised in all three parameters. The median ECM/BCM index was 1.7 [1.11-3.14] at start of APN and improved down to 1.5 [1.12-3.36] during therapy. The median BMI increased from 19.7 [14.4-25.9] to 20.5 [15.4-25.0]. The median phase angle improved by 10% from 3.6 [2.3-5.1] to 3.9 [2.2-5.1]. Conclusions We demonstrated the positive impact of APN on the assessed parameters, first of all the phase angle, and we observed at least a temporary benefit or stabilisation of the nutritional status in the majority of the investigated patients. Based on these findings we are currently investigating the impact of APN on survival in a larger patient cohort. Trial registration ClinicalTrials.gov Identifier: NCT00919659

  14. Tratamento da endometrite puerperal com antibioticoterapia parenteral exclusiva Treatment of puerperal endometritis using a regimen with exclusive parenteral antibiotics

    Directory of Open Access Journals (Sweden)

    Geraldo Duarte

    2005-08-01

    Full Text Available OBJETIVO: analisar a efetividade e segurança da antibioticoterapia parenteral hospitalar exclusiva para tratamento da endometrite puerperal, em população de baixo nível socioeconômico. MÉTODOS: estudo clínico prospectivo, que avaliou 21 puérperas com diagnóstico de endometrite puerperal, cujas gestações foram resolvidas em hospital universitário por cesárea (52,4% ou parto normal (47,6. A amostra caracterizou-se por baixo nível socioeconômico e de escolaridade. Foram submetidas ao regime de antibioticoterapia parenteral exclusiva, apenas durante o período de internação (grupo ATP-EX. Os resultados foram comparados com aqueles obtidos de série histórica do mesmo serviço (20 casos submetidas a antibioticoterapia parenteral hospitalar, complementada por terapia via oral ambulatorial (grupo ATP+VO. As pacientes foram avaliadas clinicamente em retornos periódicos visando identificar casos de recidivas e complicações infecciosas. RESULTADOS: uma paciente do grupo ATP+VO necessitou de reinternação no 6º dia após a alta por recrudescência da endometrite. Não foi observada nenhuma complicação entre as pacientes do grupo ATP-EX. CONCLUSÃO: para o tratamento de endometrite puerperal, não foi observado benefício adicional com a adição da antibioticoterapia oral complementar após a alta. Os resultados com o uso da antibioticoterapia parenteral exclusiva durante a internação indicam que esse esquema pode ser utilizado com segurança em população de baixo nível socioeconômico.PURPOSE: to analyze the effectiveness and safety of exclusive hospital parenteral antibiotic therapy to treat puerperal endometritis in a population of low socioeconomic level. METHODS: a prospective clinical trial evaluated 21 puerperae with a diagnosis of postpartum endometritis, whose deliveries occurred at a university hospital by cesarean section (52.4% or normal delivery (47.6%. The sample was characterized by low socioeconomic and

  15. Outpatient Surgery In Day Clinics*

    African Journals Online (AJOL)

    1971-12-18

    Dec 18, 1971 ... over-supplied with hospital beds and nursing staff that we can afford such luxuries? Must we insist on ... femoral, inguinal and umbilical), breast segmental excision, fissurotomy or polypectomy, node biopsy, ... neck and many other conditions requiring surgical inter- vention (on outpatients)'. What about our ...

  16. Clostridium difficile Infection in Outpatients

    Centers for Disease Control (CDC) Podcasts

    2011-11-07

    Dr. Jon Mark Hirshon, Associate Professor of Emergency Medicine at the University of Maryland School of Medicine, discusses Clostridium difficile infection in outpatients.  Created: 11/7/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/21/2011.

  17. Elderly alcoholics in outpatient treatment

    DEFF Research Database (Denmark)

    Nielsen, Bent; Nielsen, Anette Søgaard; Lolk, Anette

    2010-01-01

    In Denmark, the treatment of alcoholics is provided by public outpatient alcohol clinics. The purpose of this study was to investigate whether elderly patients differ from younger patients with regards to sociodemographic data, drinking pattern and psychiatric comorbidity which may affect...

  18. Community-based dental education: history, current status, and future.

    Science.gov (United States)

    Formicola, Allan J; Bailit, Howard L

    2012-01-01

    This article examines the history, current status, and future direction of community-based dental education (CBDE). The key issues addressed include the reasons that dentistry developed a different clinical education model than the other health professions; how government programs, private medical foundations, and early adopter schools influenced the development of CBDE; the societal and financial factors that are leading more schools to increase the time that senior dental students spend in community programs; the impact of CBDE on school finances and faculty and student perceptions; and the reasons that CBDE is likely to become a core part of the clinical education of all dental graduates.

  19. Beyond vertical integration--Community based medical education.

    Science.gov (United States)

    Kennedy, Emma Margaret

    2006-11-01

    The term 'vertical integration' is used broadly in medical education, sometimes when discussing community based medical education (CBME). This article examines the relevance of the term 'vertical integration' and provides an alternative perspective on the complexities of facilitating the CBME process. The principles of learner centredness, patient centredness and flexibility are fundamental to learning in the diverse contexts of 'community'. Vertical integration as a structural concept is helpful for academic organisations but has less application to education in the community setting; a different approach illuminates the strengths and challenges of CBME that need consideration by these organisations.

  20. Parenteral opioids for maternal pain relief in labour.

    Science.gov (United States)

    Ullman, Roz; Smith, Lesley A; Burns, Ethel; Mori, Rintaro; Dowswell, Therese

    2010-09-08

    Parenteral opioids are used for pain relief in labour in many countries throughout the world. To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010) and reference lists of retrieved studies. We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with placebo or another opioid. At least two review authors independently assessed study eligibility, collected data and assessed risk of bias. We included 54 studies involving more than 7000 women that compared an opioid with placebo or another opioid administered intramuscularly or intravenously. The 54 studies reported on 27 different comparisons, and for many outcomes only one study contributed data. Overall the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. Parenteral opioids provide some relief from pain in labour but are associated

  1. An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension

    OpenAIRE

    Oudiz, Ronald; Agarwal, Manyoo; Rischard, Franz; De Marco, Teresa

    2016-01-01

    Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids—such as catheter-related infections and intolerable adverse effects—may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients...

  2. The effect of community-based health management on the health of the elderly: a randomized controlled trial from China

    Directory of Open Access Journals (Sweden)

    Chao Jianqian

    2012-12-01

    Full Text Available Abstract Background An aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China. Methods Two thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ2-test, and multiple regression analysis. Results Compared with the control group, the management group demonstrated improvement on the following variables (P Conclusion Community-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health. Trial registration ChiCTR-OCH-11001716

  3. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ... transition models, and lessons learned from participation in the Quality Improvement Organizations' (QIOs... provide a forum for community-based organizations, hospitals, Quality Improvement Organizations[email protected] . SUPPLEMENTARY INFORMATION: I. Background Community-based organizations (CBOs) are...

  4. [Management of parenteral nutrition in intensive care units in Spain].

    Science.gov (United States)

    Vaquerizo Alonso, Clara; Mesejo, Alfonso; Acosta Escribano, José; Ruiz Santana, Sergio

    2013-01-01

    some relevant aspects related to parenteral nutrition in the Spanish ICUs are still unclear. These aspects include: caloric and protein intake, total volume, glycemic control, the type of lipid emulsion used or the comparison of different formulations. Our objective is to know the clinical practice patterns of artificial nutrition therapeutics, particularly of parenteral nutrition in the Spanish ICUs. twelve representative ICU's participated in a nutrition survey from January to March 2012. The survey was divided in two sections: A) Management of artificial nutritional support in critically ill patients and B) Assessment of a new parenteral nutrition formulation adapted to critically ill patients. The following information was collected: percentage of patients receiving artificial nutrition; availability of enteral formulations; types of lipid emulsions; calories, amino acids and lipids supplied; addition of glutamine, vitamins and trace elements; management of volume and hyperglycemia; and comparative data between patients receiving the new formulation vs. standard formulations: glycemic control, assessment of hepatic function and infectious complications as well as the intake of total calories, proteins, volume and insulin supplied. The average number of hospital beds and ICU beds is 780 and 25 respectively; the average number of patients admitted in the ICU is 950 per year. 49% were medical patients, 31% surgical patients and 20% trauma patients. 59.75% of patients required artificial nutrition (AN), of which, 58.7% required enteral nutrition (EN), 16% total parenteral nutrition (TPN); and 25.3% suplementary parenteral nutrition (SPN). When EN was contraindicated, 83.3% of patients were started on early TPN (24 hours) and if EN was not sufficient, 66.7% were started on SPN within 48 hours. Regarding prescribers usual practice, 50% tried to reduce volume of PN and 100% of them had an insulin infusion protocol. 39% of prescribers recommended high-protein, low

  5. Management of intestinal failure in inflammatory bowel disease: Small intestinal transplantation or home parenteral nutrition?

    Science.gov (United States)

    Harrison, Elizabeth; Allan, Philip; Ramu, Amrutha; Vaidya, Anil; Travis, Simon; Lal, Simon

    2014-01-01

    Inflammatory bowel disease and Crohn’s disease in particular, is a common cause of intestinal failure. Current therapeutic options include home parenteral nutrition and intestinal transplantation. For most patients, home intravenous therapy including parenteral nutrition, with a good probability of long-term survival, is the favoured choice. However, in selected patients, with specific features that may shorten survival or complicate home parenteral nutrition, intestinal transplantation presents a viable alternative. We present survival, complications, quality of life and economic considerations that currently influence individualised decision-making between home parenteral nutrition and intestinal transplantation. PMID:24696601

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

    Science.gov (United States)

    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.

  7. Basic Stand Alone Medicare Outpatient Procedures PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Outpatient Procedures Public Use Files (PUF) with information from Medicare outpatient claims. The CMS BSA...

  8. Hospital Outpatient Prospective Payment System (OPPS) Lim...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

  9. How students learn from community-based preceptors.

    Science.gov (United States)

    Epstein, R M; Cole, D R; Gawinski, B A; Piotrowski-Lee, S; Ruddy, N B

    1998-01-01

    To explore how students learn in community-based family physicians' offices from the student's point of view. Each student completing a community-based family medicine clerkship wrote a "critical incident" narrative about an event that was particularly educational. A coding system was developed by a multidisciplinary research team and thematic analysis was conducted. Critical education experiences were brief, problem-focused, had definitive outcomes, were often collaborative, and led to self-reflection. The most commonly identified mode of learning was "active observation." In most of these situations, the student had significant clinical responsibility, but some involved observation of complex tasks beyond the expectations of a medical student. Most (77%) identified their learning needs after having observed a preceptor, rather than prospectively. Collaboration, coaching, advocacy, and exploring affect were means whereby preceptors and students created a learning environment that students felt was safe, allowed them to recognize their own learning needs, and helped them adopt new behaviors. These findings broaden the definition of active learning to include active observation and support learner-centered and relational models of learning. Increasing preceptors' awareness of these modes of student learning will enhance the quality of education in ambulatory settings.

  10. Community-based conservation in a globalized world.

    Science.gov (United States)

    Berkes, Fikret

    2007-09-25

    Communities have an important role to play in biodiversity conservation. However, community-based conservation as a panacea, like government-based conservation as a panacea, ignores the necessity of managing commons at multiple levels, with vertical and horizontal interplay among institutions. The study of conservation in a multilevel world can serve to inform an interdisciplinary science of conservation, consistent with the Convention on Biological Diversity, to establish partnerships and link biological conservation objectives with local development objectives. Improving the integration of conservation and development requires rethinking conservation by using a complexity perspective and the ability to deal with multiple objectives, use of partnerships and deliberative processes, and learning from commons research to develop diagnostic tools. Perceived this way, community-based conservation has a role to play in a broad pluralistic approach to biodiversity protection: it is governance that starts from the ground up and involves networks and linkages across various levels of organization. The shift of attention to processes at multiple levels fundamentally alters the way in which the governance of conservation development may be conceived and developed, using diagnostics within a pluralistic framework rather than a blueprint approach.

  11. Community based rehabilitation: a strategy for peace-building

    Directory of Open Access Journals (Sweden)

    Hodgson Jennifer

    2002-11-01

    Full Text Available Abstract Background Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis. Discussion We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified. Summary During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives.

  12. Community-based oil spill response in Alaska

    Energy Technology Data Exchange (ETDEWEB)

    Banta, J. [Prince William Sound Regional Citizen' s Advisory Council, Anchorage, AK (United States); Munger, M. [Cook Inlet Regional Citizen' s Advisory Council, Kenai, AK (United States)

    2006-07-01

    The Prince William Sound Regional Citizen's Advisory Council and the Cook Inlet Regional Citizen's Advisory Council are independent, non profit organizations formed in 1989 following the Exxon Valdez oil spill to promote the concept of community-based oil spill response (COSR) in their respective regions. COSR involves local citizens in responding to oil spilled in waters they rely upon for income, recreation and subsistence. The 2 advisory councils recently held a Community Oil Spill Response Forum to review the status of existing COSR teams and to share information about past and future COSR-related efforts. The meeting served as an information exchange process about regulatory programs, COSR variations in communities and harbors, training, and personnel issues. Key groups attending the forum were harbor masters, Alaska Department of Environmental Conservation, United States Coast Guard, existing COSR teams, oil response organizations, local community governments, and volunteers from the advisory councils. This paper was based on the notes taken from the forum. It was agreed that the current system is inadequate in its response to small spills that are frequently associated with non-tank vessels. It was suggested that improved capacity for community-based response could address the situation. It was also suggested that work groups should meet on an annual or biannual basis to continue to educate responders and communities about oil spill response. 7 refs.

  13. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Involuntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention.

    Science.gov (United States)

    Swartz, Marvin S; Bhattacharya, Sayanti; Robertson, Allison G; Swanson, Jeffrey W

    2017-02-01

    Involuntary outpatient commitment (OPC)-also referred to as 'assisted outpatient treatment' or 'community treatment orders'-are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal. Relevant publications were identified for review in PubMed, Ovid Medline, PsycINFO, personal communications, and relevant Internet searches of advocacy and policy-related publications. Most research on OPC has focussed on outcomes such as community functioning and hospital recidivism and not on interpersonal violence. As a result, research on violence towards others has been limited but suggests that low-level acts of interpersonal violence such as minor, noninjurious altercations without weapon use and arrests can be reduced by OPC, but there is no evidence that OPC can reduce major acts of violence resulting in injury or weapon use. The impact of OPC on major violence, including mass shootings, is difficult to assess because of their low base rates. Effective implementation of OPC, when combined with intensive community services and applied for an adequate duration to take effect, can improve treatment adherence and related outcomes, but its promise as an effective means to reduce serious acts of violence is unknown.

  15. Fenoldopam: novo antihipertensivo parenteral; alternativa ao nitroprussiato Fenoldopam: nuevo antihipertensivo parenteral; alternativa al nitroprusiato Fenoldopan: a new parenteral anti-hypertensive; an alternative to nitroprusside

    Directory of Open Access Journals (Sweden)

    Daniel Sousa César

    2001-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O fenoldopam é um agonista dopaminérgico seletivo para os receptores dopaminérgicos tipo 1 (DA-1 que causa vasodilatação periférica e o objetivo deste artigo é reunir as informações clínicas sobre este fármaco. CONTEÚDO: Neste artigo foram revisadas as experiências em urgências e emergências hipertensivas, mostrando que o fenoldopam apresenta vantagens sobre o nitroprussiato de sódio (NPS no tratamento das mesmas. Ao contrário do NPS, o fenoldopam causa vasodilatação periférica, ao mesmo tempo que induz diurese e natriurese em pacientes com hipertensão grave sem causar os efeitos deletérios pelo tiocianato. CONCLUSÕES: O fenoldopam parenteral, pelos seus efeitos renais e menor impacto de efeitos colaterais, pode ser considerado uma boa alternativa ao nitroprussiato de sódio no tratamento de emergências hipertensivas.JUSTIFICATIVA Y OBJETIVOS: El fenoldopam es un agonista dopaminérgico selectivo para los receptores dopaminérgicos tipo 1 (DA-1 que causa vasodilatación periférica y el objetivo de este artículo es reunir las informaciones clínicas sobre este fármaco. CONTENIDO: En este articulo fueron revisadas las experiencias en urgencias y emergencias hipertensivas, mostrando que el fenoldopam presenta ventajas sobre el nitroprusiato de sodio (NPS en el tratamiento de las mismas. Al contrario del NPS, el fenoldopam causa vasodilatación periférica, al mismo tiempo que induce diuresis y natriuresis en pacientes con hipertensión grave sin causar los efectos deletérios por el tiocianato. CONCLUSIONES: El fenoldopam parenteral, por sus efectos renales y menor impacto de efectos colaterales, pode ser considerado una buena alternativa al nitroprusiato de sodio en tratamiento de emergencias hipertensivas.Background and Objectives: Fenoldopan is a selective dopaminergic agonist for dopaminergic receptors type 1 (DA-1, which induces peripheral vasodilation. This review aimed at collecting

  16. Long-term outcome of patients with systemic sclerosis requiring home parenteral nutrition.

    Science.gov (United States)

    Harrison, Elizabeth; Herrick, Ariane L; Dibb, Martyn; McLaughlin, John T; Lal, Simon

    2015-10-01

    Patients with systemic sclerosis may develop intestinal failure requiring home parenteral nutrition. However, few outcome data have been reported. This study aimed to review the outcome of patients with systemic sclerosis receiving home parenteral nutrition. Records of all patients with systemic sclerosis who commenced home parenteral nutrition, at a national intestinal failure unit were retrospectively reviewed. Disease characteristics, survival and outcome data were evaluated. Twenty five patients (20% male; median age: 55 years) were included over a 22-year period (37,200 central venous catheter days). All patients had small intestinal involvement. Prior to home parenteral nutrition, 16 failed enteral feeding. Nine patients were trained to self-administer their home parenteral nutrition; carers/relatives were trained for the remainder. Cumulative survivals on home parenteral nutrition at 2, 5 and 10 years were 75%, 37%, and 23%. Sixteen patients died from causes unrelated to home parenteral nutrition. Two patients were weaned off home parenteral nutrition. Seven patients survive on home parenteral nutrition (median: 41 months; range 9-178). Central venous catheter-related complications were low; these included occlusion (0.70 episodes per 1000 central venous catheter days), sepsis (0.19 episodes per 1000 central venous catheter days) and central venous thrombosis (0.11 episodes per 1000 central venous catheter days). This is the longest, largest reported series of patients with systemic sclerosis receiving home parenteral nutrition. It shows that home parenteral nutrition can be used safely and effectively in patients with very severe systemic sclerosis-related gastrointestinal involvement. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  17. Intensive outpatient treatment of elephantiasis.

    Science.gov (United States)

    Pereira De Godoy, J M; Amador Franco Brigidio, P; Buzato, E; Fátima Guerreiro De Godoy, M

    2012-10-01

    The aim of this paper was to report on a novel approach to the intensive outpatient treatment of elephantiasis of an underprivileged population. Prospective, random study, the diagnosis of lymphedema was clinical and the inclusion of patients was by order of arrival in the treatment center where all were invited to participate in the study. Intensive outpatient therapy was performed for 6 to 8 hours daily over a period of four weeks. Eleven legs with grade III elephantiasis of 8 patients were evaluated in a random prospective study. Three patients were men and five were women with ages ranging between 28 and 66 years old. Treatment included mechanical lymph drainage using the RAGodoy® apparatus for a period of 6 to 8 hours daily and the Godoy & Godoy cervical stimulation technique for 20 minutes per day, both associated to the use of a home-made medical compression stocking using a low-stretch cotton-polyester material. Additionally, manual lymph drainage using the Godoy & Godoy technique was performed for one hour. Perimetry was used to compare measurements made before and after treatment, of the three points of the limb with the largest circumferences. The paired t-test was utilized for statistical analysis with an alpha error greater than 5% (P-value treatment program (P-value=0.001). Intensive outpatient treatment is an option for all types of lymphedema with large volumetric reductions being possible in a short period when treating elephantiasis.

  18. Characterizing the Severe Reactions of Parenteral Vitamin K1.

    Science.gov (United States)

    Britt, Rachel B; Brown, Jamie N

    2018-01-01

    Parenteral vitamin K1 (phytonadione) is used for anticoagulant reversal, and a boxed warning exists with intravenous and intramuscular administration due to the possibility of severe reactions, including fatalities. These reactions resemble hypersensitivity or anaphylaxis, including anaphylactoid reaction, and have led to shock and cardiac and/or respiratory arrest. The objective of this review is to summarize the available literature detailing the anaphylactic/anaphylactoid reactions with parenteral vitamin K1 in order to better characterize the reaction and provide a more in-depth understanding of its importance. A comprehensive literature search of MEDLINE (1946 to June 2016) and EMBASE (1947 to June 2016) was conducted using the terms vitamin K1, phytonadione, phytomenadione, vitamin K group, anaphylaxis, polyoxyethylated castor oil, and cremophor. A total of 2 retrospective surveillance studies, 2 retrospective cohort studies, and 17 case reports were identified for inclusion and assessment. Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1. The solubilizer may also increase the risk of adverse reactions, which occurred in patients with and without previous exposure to vitamin K1. Although there are known factors that increase the risk of an adverse drug event occurring, reactions have been reported despite all precautions being properly followed.

  19. Penerapan Corporate Social Responsibility dengan Konsep Community Based Tourism

    Directory of Open Access Journals (Sweden)

    Linda Suriany

    2013-12-01

    Full Text Available Abstract: Business is not only economic institution, but social institution too. As social institution, business has responsibility to help society in solving social problem. This responsibility called Corporate Social Responsibility (CSR. CSR pays attention about social problem and environment, so CSR support continuous development to help government role. Nowadays, our government has national development’s agenda. One of them is tourism sector (Visit Indonesia Year 2008 programmed. But tourism sector has challenge in human resources. In this case, business role in practice CSR is needed to help tourism sector. With CSR activities, the quality of local community will increase to participate in tourism activities. CSR activities include training that based on research. When the quality of local community increase, local community can practice the concept of community based tourism (CBT. In the future, Indonesia has a power to compete with other countries.

  20. The Family Series Workshop: A Community-Based Psychoeducational Intervention

    Science.gov (United States)

    Llanque, Sarah M.; Enriquez, Maithe; Cheng, An-Lin; Doty, Leilani; Brotto, Marco A.; Kelly, Patricia J.; Niedens, Michelle; Caserta, Michael S.; Savage, Lynette M.

    2015-01-01

    This study describes an evaluation of a community-based psychoeducational intervention, called The Family Series Workshop, for caregivers of community-dwelling persons with Alzheimer’s disease or related dementias (ADRD). In a one-group pretest–posttest design, participants (n = 35) attended six weekly sessions. Caregiver stress, coping, and caregiving competence were evaluated along with demographic characteristics of participants. There was a significant improvement found for caregiving competence, and a marginally significant increase in coping with humor. Using regression analysis we also found that coping with humor, along with stress, were significant predictors of caregiving competence. These findings indicate that it is possible to increase caregiving competence utilizing a “grassroots” approach and that it is feasible to hold educational, group discussions on a plethora of challenging caregiving topics. PMID:25609602

  1. Community-based adaptation to climate change: an update

    Energy Technology Data Exchange (ETDEWEB)

    Ayers, Jessica; Huq, Saleemul

    2009-06-15

    Over a billion people - the world's poorest and most bulnerable communities – will bear the brunt of climate change. For them, building local capacity to cope is a vital step towards resilience. Community-based adaptation (CBA) is emerging as a key response to this challenge. Tailored to local cultures and conditions, CBA supports and builds on autonomous adaptations to climate variability, such as the traditional baira or floating gardens of Bangladesh, which help small farmers' crops survive climate-driven floods. Above all, CBA is participatory – a process involving both local stakeholders, and development and disaster risk reduction practitioners. As such, it builds on existing cultural norms while addressing local development issues that contribute to climate vulnerability. CBA is now gaining ground in many regions, and is ripe for the reassessment offered here.

  2. Aluminum toxicity in neonatal parenteral nutrition: what can we do?

    Science.gov (United States)

    Wier, Heather Ann; Kuhn, Robert J

    2012-01-01

    Aluminum toxicity has been described in patients of all ages who are receiving a variety of therapies, including dialysis, phosphate-binding medications, and parenteral nutrition (PN). Neonates are at an increased risk of aluminum toxicity because of anatomic, physiologic, and nutrition-related factors not present in other populations. In 2004, the Food and Drug Administration recommended restricting daily aluminum administration to 5 μg/kg/day and now requires that additives used to compound PN have the maximum aluminum content at expiration listed on the product label. Although the pharmacist can work to decrease aluminum toxicity in this population, it remains difficult to reach this threshold.

  3. Stability and assessment of amino acids in parenteral nutrition solutions.

    Science.gov (United States)

    Unger, Nina; Holzgrabe, Ulrike

    2017-08-02

    Sterile amino acid solutions are applied in medical care as part of Total Parenteral Nutrition systems. Typical formulations consist of variable admixtures of essential and non-essential amino acids together with carbohydrates, electrolytes, vitamins, trace element solutions and lipid emulsions. The complexity of these formulations gives rise to stability and compatibility reflections. This review focuses on amino acid stability in pure amino acid solution and name methods of assessment. Incompatibilities of amino acids with the other ingredients are matter of concern in clinical practice and evaluated for relevance. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Parenteral iron administration in suckling piglets – a review

    Directory of Open Access Journals (Sweden)

    Martin Svoboda

    2017-01-01

    Full Text Available Parenteral iron administration has been a common practice for the prevention of iron deficiency in newborn piglets. The efficacy and safety of this method require reexamination due to the introduction of new genetic lines and management changes in swine production. The aim of this article was to review current knowledge on this method of anaemia prevention in piglets. Iron requirements, iron sources, and the mode of action, dosage, and negative effects of iron dextran injection are discussed. The paper also reviews methods for evaluating the efficacy of iron administration in piglets.

  5. Randomised clinical trial of parenteral selenium supplementation in preterm infants.

    OpenAIRE

    Daniels, L; Gibson, R.; Simmer, K.

    1996-01-01

    AIM: To determine whether selenium supplementation of parenteral nutrition with 3 micrograms/kg/day of selenious acid is safe and effective in improving the selenium status of preterm infants. METHODS: Thirty eight preterm infants with mean (SEM) birthweight of 1171 (38) g and gestational age 29 (0.3) weeks were randomly allocated to a non-supplemented (PN-selenium, n = 19) or supplemented (PN+selenium, n = 19) group. The study began at 2.8 (0.2) (range 1-5) days of age. Term breastfed (n = 2...

  6. Preventing errors in administration of parenteral drugs: the results of a four-year national patient safety program.

    NARCIS (Netherlands)

    Blok, C. de; Schilp, J.; Wagner, C.

    2013-01-01

    Objectives: To evaluate the implementation of a four-year national patient safety program concerning the parenteral drug administration process in the Netherlands. Methods: Structuring the preparation and administration process of parenteral drugs reduces the number of medication errors. A

  7. Seizure precipitants in a community-based epilepsy cohort.

    Science.gov (United States)

    Wassenaar, Merel; Kasteleijn-Nolst Trenité, Dorothée G A; de Haan, Gerrit-Jan; Carpay, Johannes A; Leijten, Frans S S

    2014-04-01

    Epileptic seizures can be provoked by several factors. Better understanding of these factors may improve a patient's sense of control and could reduce seizures. In daily practice, the recognition of seizure precipitants relies heavily on clinical or video-EEG evidence, which can be difficult to obtain. Studies of seizure provocation are largely based on selected hospital-based patient populations, which may lead to biased occurrence estimates. Self-reported seizure precipitants are rarely studied, yet are necessary to understand the experiences of patients and improve epilepsy management. We performed a cross-sectional community-based study of 248 epilepsy patients, selected by pharmacy records of anti-epileptic drug use. Self-reported seizure precipitants and potential associated characteristics were assessed using questionnaires. Almost half of all patients (47 %) reported one or more seizure precipitants, of which stress, sleep deprivation, and flickering lights were the most common. In this community-based setting, light-provoked seizures were especially frequent compared to the literature. Idiopathic generalized epilepsy (IGE), a lower age at seizure onset, and having auras or prodromes were found to be important independent prognostic factors associated with provoked seizures. IGE and a younger age at seizure onset have been linked to provoked seizures in earlier reports. The finding of auras or prodromes as a prognostic factor was unexpected, though case reports have described provoked seizures in patients having auras. Assessment of these factors may facilitate the early recognition of seizure precipitants in daily clinical practice. This is important for the optimization of epilepsy management for a large group of patients, as provoked seizures are expected to occur frequently.

  8. Poaching risks in community-based natural resource management.

    Science.gov (United States)

    Kahler, Jessica S; Roloff, Gary J; Gore, Meredith L

    2013-02-01

    Poaching can disrupt wildlife-management efforts in community-based natural resource management systems. Monitoring, estimating, and acquiring data on poaching is difficult. We used local-stakeholder knowledge and poaching records to rank and map the risk of poaching incidents in 2 areas where natural resources are managed by community members in Caprivi, Namibia. We mapped local stakeholder perceptions of the risk of poaching, risk of wildlife damage to livelihoods, and wildlife distribution and compared these maps with spatially explicit records of poaching events. Recorded poaching events and stakeholder perceptions of where poaching occurred were not spatially correlated. However, the locations of documented poaching events were spatially correlated with areas that stakeholders perceived wildlife as a threat to their livelihoods. This result suggests poaching occurred in response to wildlife damage occurred. Local stakeholders thought that wildlife populations were at high risk of being poached and that poaching occurred where there was abundant wildlife. These findings suggest stakeholders were concerned about wildlife resources in their community and indicate a need for integrated and continued monitoring of poaching activities and further interventions at the wildlife-agricultural interface. Involving stakeholders in the assessment of poaching risks promotes their participation in local conservation efforts, a central tenet of community-based management. We considered stakeholders poaching informants, rather than suspects, and our technique was spatially explicit. Different strategies to reduce poaching are likely needed in different areas. For example, interventions that reduce human-wildlife conflict may be required in residential areas, and increased and targeted patrolling may be required in more remote areas. Stakeholder-generated maps of human-wildlife interactions may be a valuable enforcement and intervention support tool. © 2012 Society for

  9. [CBD: much more than community based distribution of contraceptives].

    Science.gov (United States)

    1984-01-01

    Profamilia in the Dominican Republic began a program called "Popular Promoters" in 1973 in which rural women were referred to family planning clinics, and in 1976 the community-based distribution program was formally begun. Between October 1974-October 1975, Profamilia had gained experience in the distribution of contraceptives in rural areas of the country. At the start, the community program continued promotion of family planning primarily in rural areas while offering contraceptive directly to those seeking them. By 1977, 105 communities and 12 provinces had been added to the program and 6500 women were being served. 14,500 of the 15,200 couples served in 1980 used pills. There were 23,000 users in 1984, 12,000 of whom were new acceptors. Over 34% of Profamilia's 66,000 clients are in the community-based distribution program. The program also maintains a strong educational component which each year offers over 400 talks in its 170 rural and urban communities on themes related to family planning, including health, education, nutrition, and use of available resources. Among early problems of the program were opposition from physicians, difficulty of recruiting volunteers who met the personality and other requirements, myths and incorrect beliefs of the community regarding family planning, the belief among men that contraception would encourage infidelity among women, and official pronatalist policies. The promoters work directly with the 170 distributors and also parrticipate in other community development activities such as the establishment of community organizations. Large families are seen as just 1 of the problems of the communities, most of which are impoverished, lack employment opportunities, and suffer other disadvantages of underdevelopment. Distributors are chosen by communities for leadership and other personality traits. Acceptance of family planning encourages efforts to assume control of other aspects of life.

  10. Variability in ADHD care in community-based pediatrics.

    Science.gov (United States)

    Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua

    2014-12-01

    Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Copyright © 2014 by the American Academy of Pediatrics.

  11. Internet access and empowerment: a community-based health initiative.

    Science.gov (United States)

    Masi, Christopher M; Suarez-Balcazar, Yolanda; Cassey, Margaret Z; Kinney, Leah; Piotrowski, Z Harry

    2003-07-01

    To determine whether access to health information via in-home Internet technology can positively influence empowerment among residents of a low-income urban community. In-home Internet access and training were provided to volunteers, who, along with a comparison group, were interviewed prior to and 1 year after initiation of the program. Community-based participatory research methods were used to design and implement the intervention. A 57-block area on the West Side of Chicago. Twenty-five community residents completed all phases of the technology intervention. Thirty-five randomly selected neighbors of these residents served as the comparison group. Members of the intervention group received Internet access via WebTV, training, technical support, and access to a community specific health-oriented web page during the course of the study. Intervention group members were similar to comparison group members in terms of empowerment at baseline. After receiving Internet access and training, empowerment related to health decision-making improved significantly in the intervention group. Similar changes did not occur in the comparison group. Affinity for and appreciation of information technology also increased in the intervention group but not in the comparison group. As a result, differences in attitudes toward technology increased between the 2 groups over time. Using community-based participatory research methods, we found that Internet access to community-specific and general health information can lead to increased empowerment and appreciation of information technology. These benefits accrued among the intervention group but not among a random group of their neighbors.

  12. Redefining community based on place attachment in a connected world.

    Science.gov (United States)

    Gurney, Georgina G; Blythe, Jessica; Adams, Helen; Adger, W Neil; Curnock, Matthew; Faulkner, Lucy; James, Thomas; Marshall, Nadine A

    2017-09-19

    The concept of community is often used in environmental policy to foster environmental stewardship and public participation, crucial prerequisites of effective management. However, prevailing conceptualizations of community based on residential location or resource use are limited with respect to their utility as surrogates for communities of shared environment-related interests, and because of the localist perspective they entail. Thus, addressing contemporary sustainability challenges, which tend to involve transnational social and environmental interactions, urgently requires additional approaches to conceptualizing community that are compatible with current globalization. We propose a framing for redefining community based on place attachment (i.e., the bonds people form with places) in the context of Australia's Great Barrier Reef, a World Heritage Area threatened by drivers requiring management and political action at scales beyond the local. Using data on place attachment from 5,403 respondents residing locally, nationally, and internationally, we identified four communities that each shared a type of attachment to the reef and that spanned conventional location and use communities. We suggest that as human-environment interactions change with increasing mobility (both corporeal and that mediated by communication and information technology), new types of people-place relations that transcend geographic and social boundaries and do not require ongoing direct experience to form are emerging. We propose that adopting a place attachment framing to community provides a means to capture the neglected nonmaterial bonds people form with the environment, and could be leveraged to foster transnational environmental stewardship, critical to advancing global sustainability in our increasingly connected world.

  13. Systematic Review of Community-Based Childhood Obesity Prevention Studies

    Science.gov (United States)

    Segal, Jodi; Wu, Yang; Wilson, Renee; Wang, Youfa

    2013-01-01

    OBJECTIVE: This study systematically reviewed community-based childhood obesity prevention programs in the United States and high-income countries. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library for relevant English-language studies. Studies were eligible if the intervention was primarily implemented in the community setting; had at least 1 year of follow-up after baseline; and compared results from an intervention to a comparison group. Two independent reviewers conducted title scans and abstract reviews and reviewed the full articles to assess eligibility. Each article received a double review for data abstraction. The second reviewer confirmed the first reviewer’s data abstraction for completeness and accuracy. RESULTS: Nine community-based studies were included; 5 randomized controlled trials and 4 non–randomized controlled trials. One study was conducted only in the community setting, 3 were conducted in the community and school setting, and 5 were conducted in the community setting in combination with at least 1 other setting such as the home. Desirable changes in BMI or BMI z-score were found in 4 of the 9 studies. Two studies reported significant improvements in behavioral outcomes (1 in physical activity and 1 in vegetable intake). CONCLUSIONS: The strength of evidence is moderate that a combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. More research and consistent methods are needed to understand the comparative effectiveness of childhood obesity prevention programs in the community setting. PMID:23753099

  14. Evaluating community-based public health leadership training.

    Science.gov (United States)

    Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

    2011-01-01

    Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

  15. Effects of community-based exercise in children with severe burns: A randomized trial.

    Science.gov (United States)

    Peña, Raquel; Ramirez, Leybi L; Crandall, Craig G; Wolf, Steven E; Herndon, David N; Suman, Oscar E

    2016-02-01

    To counteract long-lasting muscle break down, muscle weakness, and poor physical fitness resulting from severe burns, we recommend a 12-week in-hospital exercise training rehabilitation program. Unfortunately, this in-hospital training program requires time away from home, family, school or work. This study was undertaken to evaluate an alternative exercise rehabilitation strategy involving a 12-week community-based exercise training rehabilitation program (COMBEX) carried out at or near the patient and caretaker's home. Pediatric patients (7-18 years) with ≥ 30% of total body surface area (TBSA) burns were randomized to participate in COMBEX (N=12) or an outpatient exercise program (EX) at the hospital (N=22). Both programs were started after hospital discharge and consisted of 12 weeks of progressive resistive and aerobic exercise. COMBEX was performed in community fitness centers near the patients' home. Endpoints were assessed at discharge (pre-exercise) and after the 12-week program. Primary endpoints were lean body mass (dual energy X-ray absorptiometry), muscle strength (isokinetic dynamometry), and peak aerobic capacity (indirect calorimetry). Demographics, length of hospitalization, and TBSA burned were comparable between groups (P>0.05). Both groups exhibited a significant (P ≤ 0.01 for all) increase (mean ± SEM) in lean muscle mass (EX: 6.9 ± 1.7%; COMBEX: 6.5 ± 1.1%), muscle strength (EX: 67.1 ± 7.0%; COMBEX: 49.9 ± 6.8%), and peak aerobic capacity (EX: 35.5 ± 4.0%; COMBEX: 46.9 ± 7.7%). Furthermore, the magnitude of these increases were not different between groups (P>0.12). Both EX and COMBEX are efficacious in improving lean mass, strength, and cardiopulmonary capacity in severely burned children. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  16. Standardization and Scaling of a Community-Based Palliative Care Model.

    Science.gov (United States)

    Bull, Janet; Kamal, Arif H; Harker, Matthew; Taylor, Donald H; Bonsignore, Lindsay; Morris, John; Massie, Lisa; Singh Bhullar, Parampal; Howell, Mary; Hendrix, Mark; Bennett, Deeana; Abernethy, Amy

    2017-11-01

    Although limited, the descriptions of Community-Based Palliative Care (CBPC) demonstrates variability in team structures, eligibility, and standardization across care settings. In 2014, Four Seasons Compassion for Life, a nonprofit hospice and palliative care (PC) organization in Western North Carolina (WNC), was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing innovative model to implement, evaluate, and demonstrate CBPC in the United States. The objective of this article is to describe the processes and challenges of scaling and standardizing the CBPC model. Four Season's CBPC model serves patients in both inpatient and outpatient settings using an interdisciplinary team to address symptom management, psychosocial/spiritual care, advance care planning, and patient/family education. Medicare beneficiaries who are ≥65 years of age with a life-limiting illness were eligible for the CMMI project. The CBPC model was scaled across numerous counties in WNC and Upstate South Carolina. Over the first two years of the project, scaling occurred into 21 counties with the addition of 2 large hospitals, 52 nursing facilities, and 2 new clinics. To improve efficiency and effectiveness, a PC screening referral guide and a risk stratification approach were developed and implemented. Care processes, including patient referral and initial visit, were mapped. This article describes an interdisciplinary CBPC model in all care settings to individuals with life-limiting illness and offers guidance for risk stratification assessments and mapping care processes that may help PC programs as they develop and work to improve efficiencies.

  17. Hidrotórax secundário à nutrição parenteral: relato de caso Hydrothorax due to parenteral nutrition: a case report

    Directory of Open Access Journals (Sweden)

    José Henrique Silvah

    2011-09-01

    Full Text Available Hidrotórax secundário à infusão de nutrição parenteral é uma condição rara, embora se apresente cada vez mais comum. Neste relato de caso, uma paciente com síndrome do intestino curto desenvolveu instabilidade hemodinâmica e insuficiência respiratória algumas horas após o início da infusão de nutrição parenteral. Ressaltamos também as manobras para evitar e tratar tal complicação.Hydrothorax due to parenteral nutrition infusion is a rare, although increasingly common event. This report shows a short bowel patient who developed hemodynamic instability and respiratory failure few hours after parenteral nutrition infusion's start. We also emphasize the maneuvers to avoid and treat such complication.

  18. [Use of ready-to-use (RTU) products in home-based parenteral nutrition].

    Science.gov (United States)

    Planas, M; Puiggrós, C; Sánchez, J R; Cots, I; Tutusaus, M; Rodríguez, T; Pérez-Portabella, C; Gómez, R

    2006-01-01

    To analyze the real possibility to use ready-to-use multichamber bags for total parenteral nutrition in adult patients on home parenteral nutrition. In June 2005 we studied the adult patients on home parenteral nutrition treatment controlled by the Nutritional Support Unit from an University Hospital. Demographic data, data relating to underlying disease state; infusion regimen and the necessity to modify it; body mass index, fat free mass index, and Karnofsky index evolution, and complications related to parenteral nutrition were assessed. At the time of the study, 8 patients aged 48,9 +/- 17,7 years, were on home parenteral nutrition. The artificial nutrition treatment was administered due to short-bowel syndrome (2); motility disorders (2); suboclusion (2); rapid intestinal transit (1), and malabsorption syndrome (1). With the exception of the patient who started more recently the treatment, all the others needed changes in the parenteral nutrition treatment (number of days for week, or formula modification). In general, both the body mass index and the fat free mass index increased during the treatment. The Karnofsky index was maintained or increased. In relation to catheter-related infection, 4 episodes were observed (0.85/1.000 d of HPN). Due to the effectiveness, safety and the diversity of multichamber bags available for parenteral nutrition, and the few complications observed in the patients studied, although more studied are necessary, our results suggest that we can use this commercial bags for adult patients on home parenteral nutrition.

  19. Hepatic transcriptomic profiles of preterm piglets nourished by enteral and parenteral nutrition

    Science.gov (United States)

    Parenteral nutrition is a life-saving nutritional support for more than half a million premature and hospitalized infants in the U.S. annually. Lipids in parenteral nutrition provide essential fatty acids and are a major source of energy. Intralipid (IL) is the only approved lipid emulsion in the U....

  20. Enteral obeticholic acid prevents hepatic cholestasis in total parenteral nutrition-fed neonatal pigs

    Science.gov (United States)

    Total parenteral nutrition (TPN) is a vital support for neonatal infants with congenital or acquired gastrointestinal (GI) disorders and requiring small bowel resection. An adverse outcome associated with prolonged TPN use is parenteral nutrition associated cholestasis (PNAC). We previously showed t...

  1. Parenteral nutrition facilitates activation of coagulation but not of fibrinolysis during human endotoxemia

    NARCIS (Netherlands)

    van der Poll, T.; Levi, M. [=Marcel M.; Braxton, C. C.; Coyle, S. M.; Roth, M.; ten Cate, J. W.; Lowry, S. F.

    1998-01-01

    Venous thrombosis and bacterial infections are common complications of parenteral nutrition. To test the hypothesis that infection facilitates activation of coagulation during parenteral nutrition, healthy subjects were intravenously injected with endotoxin (2 ng/kg) after they had received either 1

  2. Ceramide in lipid emulsions used in parenteral nutrition: an innocent bystander?

    NARCIS (Netherlands)

    Groener, Johanna E.; Serlie, Mireille J.; Poppema, Aldi; Mirzaian, Mina; Aerts, Johannes M.

    2011-01-01

    Parenteral nutrition-associated liver disease is a prevalent and severe complication of long term parenteral nutrition. We present here for the first time data on the presence of ceramide, a bioactive compound involved in a variety of metabolic processes, in different lipid emulsions used in

  3. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Training for the parenteral administration of unsealed... for the parenteral administration of unsealed byproduct material requiring a written directive. Except as provided in § 35.57, the licensee shall require an authorized user for the parenteral...

  4. Validation of cold chain during distribution of parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Federico Tuan

    2015-09-01

    Full Text Available Objective: this study aims to demonstrate the suitability of the process used to condition the extemporaneous mixtures of parenteral nutrition for distribution, considering the objective of preserving the cold chain during transport until it reaches the patient, necessary to ensure stability, effectiveness and safety of these mixtures. Method: concurrent validation, design and implementation of a protocol for evaluating the process of packaging and distribution of MNPE developed by a pharmaceutical laboratory. Running tests, according to predefined acceptance criteria. It is performed twice, in summer and on routes that require longer transfer time. Evaluation of conservation of temperature by monitoring the internal temperature values of each type of packaging, recorded by data loggers calibrated equipment. Results: the different tests meet the established criteria. The collected data ensure the maintenance of the cold chain for longer than the transfer time to the most distant points. Conclusions: this study establishes the suitability of the processes to maintaining the cold chain for transfer from the laboratory to the patient pharmacist. Whereas the breaking of cold chain can cause changes of compatibility and stability of parenteral nutrition and failures nutritional support, this study contributes to patient safety, one of the relevant dimensions of quality of care the health.

  5. Assessing appropriateness of parenteral nutrition usage in an acute hospital.

    Science.gov (United States)

    Smyth, Niamh D; Neary, Elaine; Power, Siobhan; Feehan, Sinead; Duggan, Sinead N

    2013-04-01

    Although parenteral nutrition (PN) has become an integral component of patient care, the risks and costs associated with this therapy must be weighed against the benefits. The Department of Nutrition and Dietetics at our tertiary referral, university-affiliated hospital has audited the use of enteral nutrition and PN based on criteria devised from guidelines developed by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). We aimed to examine the use of PN over time and in particular to investigate the appropriate and inappropriate use of this feeding method. Each patient referred for PN was assessed by a dietitian and need for PN evaluated. The appropriateness of the PN was categorized according to predefined criteria. A total of 1191 patients had 1409 episodes of PN during the study period. According to the predefined criteria, 82% of PN episodes were considered "appropriate." PN was "appropriate but avoidable" in 13% of cases. In 5% of episodes, the commencement of PN was considered "inappropriate." The use of appropriate PN increased significantly over the study period (P = .018). Most PN episodes were deemed appropriate. We saw 5% inappropriate usage, which is lower than reported in comparable studies. This study underlines the importance of continuous audit and evaluation of practice to maintain appropriate and evidence-based practice in nutrition support.

  6. Impact of early parenteral nutrition on muscle and adipose tissue compartments during critical illness.

    Science.gov (United States)

    Casaer, Michael P; Langouche, Lies; Coudyzer, Walter; Vanbeckevoort, Dirk; De Dobbelaer, Bart; Güiza, Fabian G; Wouters, Pieter J; Mesotten, Dieter; Van den Berghe, Greet

    2013-10-01

    The goal of enhanced nutrition in critically ill patients is to improve outcome by reducing lean tissue wasting. However, such effect has not been proven. This study aimed to assess the effect of early administration of parenteral nutrition on muscle volume and composition by repeated quantitative CT. A preplanned substudy of a randomized controlled trial (Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients [EPaNIC]), which compared early initiation of parenteral nutrition when enteral nutrition was insufficient (early parenteral nutrition) with tolerating a pronounced nutritional deficit for 1 week in ICU (late parenteral nutrition). Late parenteral nutrition prevented infections and accelerated recovery. University hospital. Fifteen EPaNIC study neurosurgical patients requiring prescheduled repeated follow-up CT scans and six healthy volunteers matched for age, gender, and body mass index. Repeated abdominal and femoral quantitative CT images were obtained in a standardized manner on median ICU day 2 (interquartile range, 2-3) and day 9 (interquartile range, 8-10). Intramuscular, subcutaneous, and visceral fat compartments were delineated manually. Muscle and adipose tissue volume and composition were quantified using standard Hounsfield Unit ranges. Critical illness evoked substantial loss of femoral muscle volume in 1 week's time, irrespective of the nutritional regimen. Early parenteral nutrition reduced the quality of the muscle tissue, as reflected by the attenuation, revealing increased intramuscular water/lipid content. Early parenteral nutrition also increased the volume of adipose tissue islets within the femoral muscle compartment. These changes in skeletal muscle quality correlated with caloric intake. In the abdominal muscle compartments, changes were similar, albeit smaller. Femoral and abdominal subcutaneous adipose tissue compartments were unaffected by disease and nutritional strategy. Early parenteral

  7. The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries.

    Science.gov (United States)

    Dylewksi, Maggie L; Baker, Meghan; Prelack, Kathy; Weber, Joan M; Hursey, Derek; Lydon, Martha; Fagan, Shawn P; Sheridan, Robert L

    2013-03-01

    Although enteral nutrition is the ideal mode of nutritional support following burn injury, it is often interrupted during episodes of severe sepsis and hemodynamic instability, leading to significant energy and protein deficits. Parenteral nutrition is not commonly used in burn centers due to concerns that it will lead to hyperglycemia, infection, and increased mortality. However, parenteral nutrition is often utilized in our burn unit when goal rate enteral nutrition is not feasible.To determine the safety and efficacy of a standardized protein-sparing parenteral nutrition protocol in which glucose infusion is limited to 5-7 mg/kg/hour. Retrospective observational study. Pediatric burn hospital. A retrospective medical record review of all children admitted to our hospital with burns ≥ 30% total body surface area was conducted. Only patients admitted within one week of injury and who survived > 24 hours after admission were included in this study. None. Of the 105 patients who met the inclusion criteria, 96 (91%) received parenteral nutrition or a combination of parenteral nutrition and enteral nutrition at some point during their care. Nine patients received only enteral nutrition. Demographic data were similar between groups. Protein intake was significantly higher in the parenteral nutrition group. Incidence of catheter-related blood infections did not differ between groups. Use of parenteral nutrition was not associated with blood or respiratory infections. Overall mortality rate was low (4%), as most patients (96%) achieved wound closure and were discharged home. Judicious use of parenteral nutrition is a safe and effective means of nutritional support when goal enteral nutrition cannot be achieved. A hypocaloric, high-nitrogen parenteral nutrition solution can reduce energy and protein deficits while minimizing complications commonly associated with parenteral nutrition usage.

  8. Misdemeanor Arrestees With Mental Health Needs: Diversion and Outpatient Services as a Recidivism Reduction Strategy.

    Science.gov (United States)

    Alarid, Leanne Fiftal; Rubin, Maureen

    2018-02-01

    Individuals with mental illnesses who are arrested for criminal activity cycle between criminal justice and mental health systems at disproportionately high rates. Studying recidivism of this population has been difficult due to separate system data bases. This study compared recidivism outcomes of 102 adults with mental illness who were arrested for a misdemeanor offense. One group had a diagnosed mental illness ( n = 58) and the other group was diagnosed with co-occurring mental health and substance abuse disorders ( n = 44). As a condition of their personal recognizance bond, both groups voluntarily agreed to stabilize on medication and report to community-based outpatient mental health clinic. Participants in both groups had fewer rearrests and fewer days in jail in the 12 months following discharge from diversion relative to the 12 months prior to diversion participation. Outpatient mental health service utilization following 24 hr in jail seems to be a viable means of reducing recidivism among accused misdemeanant defendants.

  9. Restricted grouper reproductive migrations support community-based management

    KAUST Repository

    Waldie, Peter A.

    2016-03-09

    Conservation commonly requires trade-offs between social and ecological goals. For tropical small-scale fisheries, spatial scales of socially appropriate management are generally small—the median no-take locally managed marine area (LMMA) area throughout the Pacific is less than 1 km2. This is of particular concern for large coral reef fishes, such as many species of grouper, which migrate to aggregations to spawn. Current data suggest that the catchment areas (i.e. total area from which individuals are drawn) of such aggregations are at spatial scales that preclude effective community-based management with no-take LMMAs. We used acoustic telemetry and tag-returns to examine reproductive migrations and catchment areas of the grouper Epinephelus fuscoguttatus at a spawning aggregation in Papua New Guinea. Protection of the resultant catchment area of approximately 16 km2 using a no-take LMMA is socially untenable here and throughout much of the Pacific region. However, we found that spawning migrations were skewed towards shorter distances. Consequently, expanding the current 0.2 km2 no-take LMMA to 1–2 km2 would protect approximately 30–50% of the spawning population throughout the non-spawning season. Contrasting with current knowledge, our results demonstrate that species with moderate reproductive migrations can be managed at scales congruous with spatially restricted management tools.

  10. Unintended Pregnancy in Ethiopia: Community Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Kidest Getu Melese

    2016-01-01

    Full Text Available Introduction. Unintended pregnancy is defined as a pregnancy which is a sum of mistimed pregnancy (pregnancy wanted at a later time and unwanted pregnancy (pregnancy which is not wanted at all. Unintended pregnancy is a global public health problem and its sequels are major causes for maternal and neonatal morbidity and mortality with its effect to maternal metal illness as well. Objective. To determine the prevalence and associated factors of unintended pregnancy in Debre Birhan town, northeast of Ethiopia, in 2014. Method. Community based cross-sectional study and questionnaire developed from Ethiopian demographic health survey 2011. Participants were 690 currently pregnant mothers. Association of unintended pregnancy with factors was measured with bivariate and multivariate logistic regressions. Result. In this study unintended pregnancy is found to be 23.5%. Being formerly married and never married, distance to the nearest health facility >80 minutes, gravidity >5, 1-2 parity, and partner disagreement on desired number of children are the variables significantly associated with unintended pregnancy. Conclusion. Significant proportion of unintended pregnancy is found in the study area. To minimize unintended pregnancy concerned bodies should work on the identified factors, so we can minimize maternal and neonatal morbidity and mortality and keep the health of the family specifically and country in general.

  11. Community-based livestock breeding programmes: essentials and examples.

    Science.gov (United States)

    Mueller, J P; Rischkowsky, B; Haile, A; Philipsson, J; Mwai, O; Besbes, B; Valle Zárate, A; Tibbo, M; Mirkena, T; Duguma, G; Sölkner, J; Wurzinger, M

    2015-04-01

    Breeding programmes described as community-based (CBBP) typically relate to low-input systems with farmers having a common interest to improve and share their genetic resources. CBBPs are more frequent with keepers of small ruminants, in particular smallholders of local breeds, than with cattle, pigs or chickens with which farmers may have easier access to alternative programmes. Constraints that limit the adoption of conventional breeding technologies in low-input systems cover a range of organizational and technical aspects. The analysis of 8 CBBPs located in countries of Latin-America, Africa and Asia highlights the importance of bottom-up approaches and involvement of local institutions in the planning and implementation stages. The analysis also reveals a high dependence of these programmes on organizational, technical and financial support. Completely self-sustained CBBPs seem to be difficult to realize. There is a need to implement and document formal socio-economic evaluations of CBBPs to provide governments and other development agencies with the information necessary for creating sustainable CBBPs at larger scales. © 2015 Blackwell Verlag GmbH.

  12. Potential for Integrating Community-Based Monitoring into REDD+

    Directory of Open Access Journals (Sweden)

    Arturo Balderas Torres

    2014-07-01

    Full Text Available Countries at the United Nations Framework on the Convention on Climate Change (UNFCCC have decided to engage local communities and indigenous groups into the activities for the monitoring, reporting and verification (MRV of the program to reduce emissions from deforestation and forest degradation and increase carbon removals (REDD+. Previous research and projects have shown that communities can produce reliable data on forest area and carbon estimates through field measurements. The objective of this article is to describe the framework that is being created for REDD+ under the UNFCCC to identify the potential inclusion of local information produced through community-based monitoring (CBM into monitoring systems for REDD+. National systems could use different sources of information from CBM: first, local information can be produced as part of public programs by increasing sample size of national or regional inventories; second, government can collect information to produce carbon estimates from on-going management practices implemented at local level driven by access to local direct benefits (e.g., forest management plans, watershed conservation; third, national data systems could include information from projects participating in carbon markets and other certification schemes; and finally information will be produced as part of the activities associated to the implementation of social and environmental safeguards. Locally generated data on carbon and areas under different forms of management can be dovetailed into national systems and be used to describe management practices, complement existing information or replace Tier 1/2 values with more detailed local data produced by CBM.

  13. Comprendiendo el community-based tourism desde la comunidad

    Directory of Open Access Journals (Sweden)

    Esteban Ruiz

    2008-01-01

    Full Text Available El creciente impulso del Community-based tourism (CBT como vía para un turismo sostenible y estrategia para el desarrollo social nos obliga a profundizar en su comprensión. En este artículo proponemos como táctica teórico-metodológica la focalización analítica en la comunidad. El referente empírico de la investigación es el turismo comunitario (TC en Ecuador, donde se han seleccionado cinco comunidades para llevar a cabo un estudio etnográfico en profundidad. Como conclusión planteamos un marco comprensivo del TC que tiene tres pilares básicos: la centralidad analítica de las comunidades, la consideración del TC como `traducción´ antes que como `adaptación´ al mercado, y el carácter fortalecedor —antes que debilitador— del TC para las comunidades. De aquí se derivan una serie de indicadores cualitativos que sirven para encarar, desde el punto de vista teórico, la comprensión general del CBT y asimismo son útiles para la evaluación de la sostenibilidad de proyectos y experiencias de CBT

  14. Community Health Workers Support Community-based Participatory Research Ethics:

    Science.gov (United States)

    Smith, Selina A.; Blumenthal, Daniel S.

    2013-01-01

    Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. We conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalizing the ethical principles of CBPR. PMID:23124502

  15. Towards organizing health knowledge on community-based health services.

    Science.gov (United States)

    Akbari, Mohammad; Hu, Xia; Nie, Liqiang; Chua, Tat-Seng

    2016-12-01

    Online community-based health services accumulate a huge amount of unstructured health question answering (QA) records at a continuously increasing pace. The ability to organize these health QA records has been found to be effective for data access. The existing approaches for organizing information are often not applicable to health domain due to its domain nature as characterized by complex relation among entities, large vocabulary gap, and heterogeneity of users. To tackle these challenges, we propose a top-down organization scheme, which can automatically assign the unstructured health-related records into a hierarchy with prior domain knowledge. Besides automatic hierarchy prototype generation, it also enables each data instance to be associated with multiple leaf nodes and profiles each node with terminologies. Based on this scheme, we design a hierarchy-based health information retrieval system. Experiments on a real-world dataset demonstrate the effectiveness of our scheme in organizing health QA into a topic hierarchy and retrieving health QA records from the topic hierarchy.

  16. A Community Based Systems Diagram of Obesity Causes.

    Science.gov (United States)

    Allender, Steven; Owen, Brynle; Kuhlberg, Jill; Lowe, Janette; Nagorcka-Smith, Phoebe; Whelan, Jill; Bell, Colin

    2015-01-01

    Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session. The process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity. This causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems.

  17. Community-based research as a mechanism to reduce ...

    Science.gov (United States)

    Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural impacts. As a result, both quantity and quality of culturally important subsistence resources are diminished, contributing to poor nutrition and obesity, and overall reductions in quality of life and life expectancy. Climate change is adding to these impacts on Native American communities (Wildcat 2013), variably causing drought, increased flooding and forced relocation (Maldonado et al. 2013), affecting Tribal water resources (Cozzetto et al. 2013), traditional foods (Lynn et al. 2013; Gautam et al. 2013), forests and forest resources (Voggesser et al. 2013) and Tribal health (Donatuto et al 2014; Doyle et al. 2013). This article will highlight several extramural research projects supported by the United States Environmental Protection Agency (USEPA) Science to Achieve Results (STAR) Tribal environmental research grants as a mechanism to address the environmental health inequities and disparities faced by Tribal communities (USEPA, 2014a, www.epa.gov/ncer/tribalresearch). The Tribal Research portfolio has focused on addressing tribal environmental health risks through community based participatory research. Specifically, the STA

  18. Partnership readiness for community-based participatory research.

    Science.gov (United States)

    Andrews, Jeannette O; Newman, Susan D; Meadows, Otha; Cox, Melissa J; Bunting, Shelia

    2012-08-01

    The use of a dyadic lens to assess and leverage academic and community partners' readiness to conduct community-based participatory research (CBPR) has not been systematically investigated. With a lack of readiness to conduct CBPR, the partnership and its products are vulnerable. The purpose of this qualitative study was to explore the dimensions and key indicators necessary for academic and community partnership readiness to conduct CBPR. Key informant interviews and focus groups (n = 36 participants) were conducted with academic and community participants who had experiences with CBPR partnerships. A 'framework analysis' approach was used to analyze the data and generate a new model, CBPR Partnership Readiness Model. Antecedents of CBPR partnership readiness are a catalyst and mutual interest. The major dimensions of the CBPR Partnership Readiness Model are (i) goodness of fit, (ii) capacity, and (iii) operations. Preferred outcomes are sustainable partnership and product, mutual growth, policy and social and health impact on the community. CBPR partnership readiness is an iterative and dynamic process, partnership and issue specific, influenced by a range of environmental and contextual factors, amenable to change and essential for sustainability and promotion of health and social change in the community.

  19. A Community Based Systems Diagram of Obesity Causes.

    Directory of Open Access Journals (Sweden)

    Steven Allender

    Full Text Available Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity.Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12 built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session.The process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity.This causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems.

  20. Evaluation of a Telerehabilitation System for Community-Based Rehabilitation

    Directory of Open Access Journals (Sweden)

    Jamie L Schutte

    2012-06-01

    Full Text Available The use of web-based portals, while increasing in popularity in the fields of medicine and research, are rarely reported on in community-based rehabilitation programs.  A program within the Pennsylvania Office of Vocational Rehabilitation’s Hiram G. Andrews Center, the Cognitive Skills Enhancement Program (CSEP, sought to enhance organization of program and participant information and communication between part- and full-time employees, supervisors and consultants. A telerehab system was developed consisting of (1 a web-based portal to support a variety of clinical activities and (2 the Versatile Integrated System for Telerehabilitation (VISyTER video-conferencing system to support the collaboration and delivery of rehabilitation services remotely.  This descriptive evaluation examines the usability of the telerehab system incorporating both the portal and VISyTER. Telerehab system users include CSEP staff members from three geographical locations and employed by two institutions. The IBM After-Scenario Questionnaire (ASQ and Post-Study System Usability Questionnaire (PSSUQ, the Telehealth Usability Questionnaire (TUQ, and two demographic surveys were administered to gather both objective and subjective information. Results showed generally high levels of usability.  Users commented that the telerehabilitation system improved communication, increased access to information, improved speed of completing tasks, and had an appealing interface. Areas where users would like to see improvements, including ease of accessing/editing documents and searching for information, are discussed.         

  1. Potential usefulness of olive oil-based lipid emulsions in selected situations of home parenteral nutrition-associated liver disease.

    Science.gov (United States)

    Reimund, Jean-Marie; Arondel, Yves; Joly, Francisca; Messing, Bernard; Duclos, Bernard; Baumann, Rene

    2004-12-01

    Long-term (i.e. home) parenteral nutrition has been advocated to be responsible for several metabolic complications among which hepatic disorders have long been the most relevant in view of patients' prognosis. The increased knowledge of the pathophysiologic factors associated to parenteral nutrition-related liver disease as well as the regular improvement of the components and the techniques used for parenteral nutrition leaded progressively to a better prevention of these side effects. This case report focuses on the potential interest of olive oil-based lipid emulsions in home parenteral nutrition patients, in selected situations of home parenteral nutrition-associated metabolic liver disease.

  2. Outpatient management of pediatric burns.

    Science.gov (United States)

    Kassira, Wrood; Namias, Nicholas

    2008-07-01

    The leading etiologies of pediatric burns are scald, thermal, and electrical injuries. The initial management of burns involves assessment of burn depth and total body surface area (TBSA) affected, a history, and physical examination. Calculation of percent of TBSA affected is an important determinant of the necessity for hospitalization versus outpatient management. Only second- and third-degree burns are included in the calculation. The criteria for outpatient management vary based on the center experience and resources. One such set of criteria in an experienced burn center includes burn affecting less than 15% TBSA, therefore not requiring fluid resuscitation; the ability to take in oral fluids, excluding serious perioral burns; no airway involvement or aspiration of hot liquid; no abuse; and dependable family able to transport the patient for clinic appointments. Once the child is ready to reenter school, the physician must discuss with the family and school staff any needs and expectations for the child, including wound care. Social reintegration can be difficult. Educating the teachers and staff of the child's appearance may help prepare the students.

  3. Perceptions of Social Support from Pregnant and Parenting Teens Using Community-Based Doulas

    OpenAIRE

    Breedlove, Ginger

    2005-01-01

    Few studies have examined community-based doula care during the childbearing period. This descriptive study was designed to explore and describe the perceptions of disadvantaged pregnant and parenting teens (N = 24) who received support from culturally matched, community-based doulas. Their reported perceptions included enhanced knowledge about childbearing, support during childbirth, self-care, and early attachment to the newborn. Participants concurred that the community-based doula interve...

  4. Community-based prevalence of undiagnosed mycobacterial diseases in the Afar Region, north-east Ethiopia

    OpenAIRE

    Legesse, Mengistu; Mamo, Gezahegne; Ameni, Gobena; Medhin, Girmay; Bjune, Gunnar; Abebe, Fekadu

    2013-01-01

    Background: Information on the community-based prevalence of tuberculosis (TB) in different settings is vital for planning, execution and evaluation of strategies to control the disease. Objective: To assess community-based prevalence of undetected active pulmonary TB (PTB) in pastoralists of the Amibara District. Methods: Between March and April 2010, a community-based cross-sectional survey of undiagnosed active PTB was conducted in the pastoralists of the Amibara District of the Afar...

  5. [Intestinal transplant in patients with parenteral nutrition at home].

    Science.gov (United States)

    de Cos, A I; Gómez Candela, C; Vázquez, C; López Santamaría, M; Vicente, E

    2003-01-01

    Failure of the intestine, whether due to functional or anatomical reasons, constrains Parenteral Nutrition Therapy in children or adults who, as a result of intestinal resections, alterations in motility, diseases of the microvilli or other reasons, present insufficient intestine to cover their needs in terms of nutrients and fluids. Nonetheless, the maintenance of support with parenteral nutrition at home in subjects with irreversible intestinal failure is not without life-threatening complications: liver disease, recurrent sepsis and loss of central routes recommend the assessment of the indication of intestinal transplant in this group of patients. The incidence of morbidity and mortality after intestinal transplant is greater than in other transplants (kidney, liver), but the long-term survival is around 50-60%. In Spain, 7 transplants (6 children and 1 adult) have been performed so far: 3 of intestine alone, 3 of liver plus intestine and 1 mutivisceral transplant. In 4 cases, the indication for transplant was due to terminal liver disease, with the remainder being due to the loss of venous access, intractable diarrhoea and intra-abdominal desmoid tumour, respectively. Except for one girl who presented severe rejection of the graft, the rest achieved digestive autonomy. One boy has presented lymphocyte neoplasia (PTLD) after 2 years and another died after the transplant as a result of a routine liver biopsy (with functioning grafts). Of the 38 patients assessed for transplant, 18 were considered as candidates and of these, three youthful candidates for hepato-intestinal transplant (with short intestine syndrome) have died while on the waiting list and a fourth in the operating theatre prior to an attempted multivisceral transplant. Intestinal transplants must not be considered as the last desperate therapeutic option in patients with permanent intestinal failure. The type of graft, clinical expertise and the use of new inducers (Sirulimos) all contribute to the

  6. 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.

  7. Parenteral nutrition in patients with inborn errors of metabolism - a therapeutic problem.

    Science.gov (United States)

    Kaluzny, L; Szczepanik, M; Siwinska-Mrozek, Z; Borkowska-Klos, M; Cichy, W; Walkowiak, J

    2014-06-01

    Parenteral nutrition is now a standard part of supportive treatment in pediatric departments. We describe four cases in which parenteral nutrition was extremely difficult due to coincidence with inborn errors of metabolism. The first two cases was fatty acid beta-oxidation disorders associated with necrotizing enterocolitis and congenital heart disease. Thus, limitations of intravenous lipid intake made it difficult to maintain a good nutritional status. The third case was phenylketonuria associated with a facial region tumour (rhabdomyosarcoma), in which parenteral nutrition was complicated because of a high phenylalanine content in the amino acid formulas for parenteral nutrition. The fourth patient was a child with late-diagnosed tyrosinemia type 1, complicated with encephalopathy - during intensive care treatment the patient needed nutritional support, including parenteral nutrition - we observed amino acid formula problems similar to those in the phenylketonuria patient. Parenteral nutrition in children with inborn errors of metabolism is a rare, but very important therapeutic problem. Total parenteral nutrition formulas are not prepared for this group of diseases.

  8. Pathological gamblers: inpatients' versus outpatients' characteristics.

    Science.gov (United States)

    Ladouceur, Robert; Sylvain, Caroline; Sévigny, Serge; Poirier, Lynda; Brisson, Laurent; Dias, Carlos; Dufour, Claudie; Pilote, Pierrette

    2006-12-01

    Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.

  9. 75 FR 17938 - Advisory Committee on Interdisciplinary, Community-Based Linkages; Notice for Request for...

    Science.gov (United States)

    2010-04-08

    ..., and Behavioral and Mental Health Professionals; Graduate Psychology Education; and Preventive and... interdisciplinary, community-based training grant programs; expertise in the field; and personal desire in...

  10. Parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

    Science.gov (United States)

    Bizari, Letícia; da Silva Santos, Andressa Feijó; Foss, Norma Tiraboschi; Marchini, Júlio Sérgio; Suen, Vivian Marques Miguel

    2016-07-01

    Short bowel syndrome is a severe malabsorption disorder, and prolonged parenteral nutrition is essential for survival in some cases. Among the undesirable effects of long-term parenteral nutrition is an increase in proinflammatory cytokines. The aim of the present study was to measure the serum levels of interleukin-6, interleukin-10, tumor necrosis factor alpha, and transforming growth factor beta, in patients with short bowel syndrome on cyclic parenteral nutrition and patients who had previously received but no longer require parenteral nutrition. The study was cross-sectional and observational. Three groups were studied as follows: Parenteral nutrition group, 9 patients with short bowel syndrome that receive cyclic parenteral nutrition; Oral nutrition group, 10 patients with the same syndrome who had been weaned off parenteral nutrition for at least 1 year prior to the study; Control group, 13 healthy adults, matched for age and sex to parenteral and oral groups. The following data were collected: age, tobacco use, drug therapies, dietary intake, body weight, height, blood collection. All interleukins were significantly higher in the parenteral group compared with the control group as follows: interleukin-6: 22 ± 19 vs 1.5 ± 1.4 pg/mL, P= .0002; transforming growth factor β: 854 ± 204 vs 607 ± 280 pg/mL, P= .04; interleukin-10: 8 ± 37 vs 0.6 ± 4, P= .03; tumor necrosis factor α: 20 ± 8 vs 8 ± 4 pg/mL, Pparenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR)

    OpenAIRE

    Seyednezami Nasrin; Nabipour Iraj; Pazoki Raha; Imami Seyed

    2007-01-01

    Abstract Background Cardiovascular disease remains the leading killer of women in most developed areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) ...

  12. Commercial premixed parenteral nutrition: Is it right for your institution?

    Science.gov (United States)

    Miller, Sarah J

    2009-01-01

    Two-compartment premixed parenteral nutrition (PN) products are heavily promoted in the United States. These products may present safety advantages over PN solutions mixed by a local pharmacy, although clinical data to support this assertion are scarce. Multicompartment products can be labor-saving for pharmacy and therefore may be cost-effective for some institutions. Before adopting such products for use, an institution must determine that standardized PN solutions are acceptable for many or most of their patients compared with customized PN compounded specifically for individual patients. A larger selection of premixed products is available in Europe and some other parts of the world compared with the United States. Availability of a broader selection of products in the United States, including 3-compartment bags and a wider range of macronutrient concentrations and volumes, may make the use of such products more desirable in the future.

  13. Appropriateness of Parenteral Nutrition Usage in Cancer Patients.

    Science.gov (United States)

    Feng, Yu-Lin; Lee, Chun-Sung; Chiu, Chong-Chi; Chao, Chien-Ming; Lai, Chih-Cheng

    2015-01-01

    This study is to investigate the indication appropriateness of parenteral nutrition (PN) administration in cancer patients. Between December 2013 and August 2014, all cancer patients who received PN (including total PN and Kabiven) in a regional hospital of Southern Taiwan were included in this retrospective study. A total of 107 cancer patients received PN. Among them, colorectal cancer was the most common type of cancer (n = 45, 42.1%), followed by gastric cancer, head and neck cancer, and esophageal cancer. After evaluation of the appropriateness of PN administration, 88 (82.2%) PN episodes were considered appropriate and unavoidable, 4 (3.7%) as appropriate and avoidable but 15 (14.1%) as inappropriate. In conclusion, PN could be inappropriately used by some oncologic physicians. Physicians and nutrition support team specialists should carefully evaluate the indication of PN administration for cancer patients to obey the generally acknowledged usage rule.

  14. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure

    DEFF Research Database (Denmark)

    Brandt, Christopher Filtenborg; Tribler, Siri; Hvistendahl, Mark

    2018-01-01

    characteristics were extracted from the Copenhagen IF database. The incidences were given per 1000 central venous catheter (CVC) days. RESULTS: The 1715 CRCs occurred in 70% of the 508 patients with IF (56% of the 2191 CVCs). The incidence of catheter-related bloodstream infections (CRBSIs) was 1.43. Higher age......BACKGROUND/AIMS: Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution......, HPN administration by community home nurses, and prior CRBSIs significantly raised the hazard for CRBSIs. In the 1970s, catheters were generally replaced following CRBSIs, whereas catheter salvage was the norm in the 2000s. The incidences of mechanical complications, tunnel infections, and catheter...

  15. [Hypersensibility reaction to parenteral nutrition approach; a case report].

    Science.gov (United States)

    Sanchez Acera, Elián; Arenas Villafranca, Jose Javier; Abilés, Jimena; Faus Felipe, Vicente

    2014-03-01

    Parenteral nutrition (PN) is essential in the treatment of many hospitalized patients. However, administration of PN is not without potential complications and patients are exposed to related possible adverse reactions such as hypersensitivity. For that reason and because of the complexity of this treatment, PNs are considered by the ISMP (Institute for Safe Medication Practice) a high risk medication. Following is introduced the case of an oncologic patient with severe malnutrition, who after receiving PN for several days, developed a hypersensitivity reaction that could have being associated with intravenous mixture administration. Our aim is to analize the difficulties related with pre-surgery nutrition and to clarify the main possible causes of the reaction. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  16. Accidental intracranial infusion of parenteral nutrition in a preterm neonate.

    Science.gov (United States)

    Ahmadian, Amir; Manwaring, Jotham; Truong, Devon; McCarthy, Jeane; Rodriguez, Luis F; Carey, Carolyn M; Tuite, Gerald F

    2015-10-01

    Vascular access in the neonate can be challenging, especially in preterm infants. When other access is not available, superficial scalp veins can be safely used for vascular access. However, rare and potentially catastrophic complications can occur due to unique features of the neonatal skull and soft-tissue anatomy. The authors report a rare complication of vascular access in a preterm infant, which led to the direct infusion of parenteral nutrition into the intracranial space. The child had an excellent outcome after open drainage and irrigation of bilateral intracranial spaces and the spinal thecal sac. Relevant anatomy is illustrated, and an outcome-based literature review is presented on this rarely reported condition. Surgical and conservative management strategies are discussed, along with clinical and radiographic follow-up. Drainage and irrigation is advocated in patients with mass effect, viscous effusions, or declining neurological examination findings.

  17. Trace Elements in Parenteral Nutrition: Considerations for the Prescribing Clinician

    Science.gov (United States)

    Jin, Jennifer; Mulesa, Leanne; Carrilero Rouillet, Mariana

    2017-01-01

    Trace elements (TEs) are an essential component of parenteral nutrition (PN). Over the last few decades, there has been increased experience with PN, and with this knowledge more information about the management of trace elements has become available. There is increasing awareness of the effects of deficiencies and toxicities of certain trace elements. Despite this heightened awareness, much is still unknown in terms of trace element monitoring, the accuracy of different assays, and current TE contamination of solutions. The supplementation of TEs is a complex and important part of the PN prescription. Understanding the role of different disease states and the need for reduced or increased doses is essential. Given the heterogeneity of the PN patients, supplementation should be individualized. PMID:28452962

  18. Mortality of Parkinson's disease by Hoehn-Yahr stage from community-based and clinic series [Keelung Community-based Integrated Screening (KCIS) no. 17)].

    Science.gov (United States)

    Liou, Horng-Huei; Wu, Chia-Yun; Chiu, Yueh-Hsia; Yen, Amy Ming-Fang; Chen, Rong-Chi; Chen, Ta-Fu; Chen, Chih-Chuan; Hwang, Yuarn-Chung; Wen, Ying-Rong; Chen, Tony Hsiu-Hsi

    2009-08-01

    We aimed to quantify the mortality reduction by which the early detection of Parkinson's disease (PD) within a community-based study could reduce the number of advanced cases. Data used in this study were derived from two community-based surveys and from a clinical series of PD cases identified from a medical centre. The cumulative survival by Hoehn-Yahr (H-Y) scale was estimated and the mortality reduction derived from a community-based survey was predicted. A total of 117 PD patients were detected through two community-based approaches. By comparing the H-Y stage distribution of screen-detected cases with those from the clinical series, a 22.5% excess in the number of early PD (H-Y stage I and stage II) were identified with screening. The risk ratios of being H-Y stage III or severe for community-based detected cases versus clinical series were 0.49 (95% confidence interval: 0.30-0.78). The total death rate adjusted by H-Y stage distribution was 21% and 28% for cases from community and clinical series, respectively. The present study revealed that early detection of PD through a community-based survey may reduce 51% incidence of stage III or more severe PD at diagnosis, leading to a 25% reduction in mortality.

  19. Safety of parenteral nutrition in newborns: Results from a nationwide prospective cohort study.

    Science.gov (United States)

    Lapillonne, Alexandre; Berleur, Marie-Pierre; Brasseur, Yvette; Calvez, Sophie

    2017-02-08

    Limited or delayed availability of parenteral nutrition (PN) solutions, as well as difficulties in ordering are often identified as reasons for non-compliance with international guidelines in newborns. This study aims at assessing the modality of use and safety of premixed standardized PN solutions in a nationwide prospective cohort of newborns treated in clinical practice. Two premixed fixed formulations with respective osmolarity of 715 and 790 mOsm/L specifically designed for neonates were made available throughout the country for clinical use from birth onwards. Descriptive data and modality of use were prospectively collected in a case report form, whereas all related and unrelated adverse events were recorded on a separate adverse event form. A total of 14,167 infants were prospectively included and 16,640 parenteral nutrition periods were analyzed. Mean age was 33 weeks of gestation, and mean weight was 2086 g. The majority of infants (81%) started the parenteral nutrition the first day of life or the day after. The route of parenteral nutrition delivery was peripheral in 47% of the parenteral nutrition periods. During the whole study, a total of 72 adverse events occurring in 68 infants were reported. Of these adverse events, 59 (0.37% of the nutrition periods), among which 19 serious adverse events, were reported as related to the parenteral nutrition solutions. The events related to parenteral nutrition solutions were general disorders and administration site conditions (n = 42 including 9 cases of cutaneous necrosis), and nutrition and metabolism disorders (n = 17). There was no case of thrombophlebitis. Six of the 19 serious events related to the parenteral nutrition solutions (32%) were due to the misuse of the infusion bag. These data support the concept that ready-to-use parenteral nutrition formulations can safely provide parenteral nutrition from birth onwards. They further support that parenteral solutions with an osmolarity up to 800

  20. Treatment of end stage chronic intestinal pseudo-obstruction by subtotal enterectomy and home parenteral nutrition.

    Science.gov (United States)

    Mughal, M M; Irving, M H

    1988-11-01

    Three cases are described of end stage chronic intestinal pseudo-obstruction successfully treated by subtotal enterectomy and home parenteral nutrition (HPN). In all three patients prior use of drugs to stimulate gastrointestinal motility, antibiotics to suppress bacterial overgrowth and surgical bypass of dilated bowel had failed to alleviate the symptoms of chronic intestinal obstruction. Similarly parenteral nutrition combined with restriction of oral intake, although improving nutrition did not relieve symptoms. The treatment of end stage chronic pseudo-obstruction should relieve intestinal obstruction and correct nutritional deficiency. In our experience this is best achieved by subtotal enterectomy, restoration of continuity by end-to-end anastomosis and total parenteral nutrition.

  1. Assessment of Cu-Zn EDTA Parenteral Toxicity in Calves.

    Science.gov (United States)

    Fazzio, Luis Emilio; Rosa, Diana Esther; Picco, Sebastian Julio; Mattioli, Guillermo Alberto

    2017-10-01

    Copper (Cu) parenteral administration is used in a beef cow-calf operations to prevent or correct Cu deficiency in bovines. At present, Zinc (Zn) salts have been incorporated to complement Cu antioxidant effect. A risk of hepatotoxicity generated by overdose is a negative consequence of injectable Cu application. Cu-Zn EDTA appears as an alternative; however, data about its toxicity is unknown. The aim of this study was to assess toxicity risk of different doses of Cu-Zn EDTA in calves. Thirty two Aberdeen Angus calves of 162 (±20) kg BW were assigned to 4 groups (n = 8), homogeneous in weight, sex, and age. Cu-Zn EDTA was administrated in doses of 0.3 mg/kg BW (group 1X); 0.6 mg/kg BW (group 2X); 0.9 mg/kg BW (group 3X) and sterile saline solution (control group-with no treatment). Clinical and blood parameters in animals were monitored during 28 days. In groups' control, 1X and 2X there were no alterations in the assessed parameters. In group 3X, one of the animals showed depression, permanent decubitus, and muscular twitching; that animal had to be killed in extremis for humanitarian reasons. Necropsy and Cu tissue concentration findings confirmed intoxication in the clinically affected animal. The rest of the animals in group 3X showed only a temporary increase in liver enzymes. The results indicate that a dose of 0.9 mg/kg BW of Cu as Cu-Zn EDTA is potentially hepatotoxic, this dose is similar to other soluble salts of parenteral administration.

  2. [Hypocaloric peripheral parenteral nutrition in postoperative patients (Proyecto Europan)].

    Science.gov (United States)

    Jiménez Jiménez, F J; Ortiz Leyba, C

    1992-01-01

    Hypocaloric peripheral parenteral nutrition (HPPN) appears to be indicated in patients with moderate malnutrition subjected to a short period of fasting following surgery. Our objective is to determine whether or not the intake of hypocaloric parenteral solutions containing aminoacid is useful in postsurgical patients, by means of a study of different nutritional evaluation parameters. A study was performed on 35 postsurgical patients who fulfilled at least 2 of the following criteria indicating malnutrition: 1) albumin levels less than 3 g/dl; 2) prealbumin levels less than 21 mg/; 3) body weight less than 95% of ideal weight. The patients were divided into 3 groups: Group I consisted of 15 patients treated with conventional fluid therapy, Group II consisted of 10 patients treated with nutritional support based on glucose and aminoacid and Group III was comprised of 10 patients also treated with a nutritional therapy based on glycerol and aminoacid. The most significant data included a rapid recovery of short term proteins (prealbumin and retinol-binding protein) and a less negative nitrogen balance 5 days afterwards in both the glucose and glycerol groups, both of which were statistically significant. With regard to complications studied, there was a greater incidence of suture dehiscence in the control group than in the groups under treatment (13.3% compared to 50%). Our conclusion is that HPPN is a valid nutritional support measure in postsurgical patients in certain clinical situations and circumstances, although further controlled, randomized studies should be considered, during both the pre and post operative periods of these patients in order to clearly indicate how and when nutritional therapy should be applied.

  3. Performance Stability of Silicone Oxide-Coated Plastic Parenteral Vials.

    Science.gov (United States)

    Weikart, Christopher M; Pantano, Carlo G; Shallenberger, Jeff R

    2017-01-01

    A new packaging system was developed for parenteral pharmaceuticals that combines the best attributes of plastic and glass without their respective drawbacks. This technological advancement is based on the synergy between high-precision injection-molded plastics and plasma coating technology. The result is a shatter-resistant, optically clear, low-particulate, and chemically durable packaging system. The demand for this product is driven by the expanding market, regulatory constraints, and product recalls for injectable drugs and biologics packaged in traditional glass materials. It is shown that this new packaging system meets or exceeds the important performance characteristics of glass, especially in eliminating the glass delamination and breakage that has been observed in many products. The new packaging system is an engineered, multilayer, glass-coated plastic composite that provides a chemically stable contact surface and oxygen barrier performance that exceeds a 2 year shelf life requirement. Evaluation of the coating system characteristics and performance stability to chemical, temperature, and mechanical extremes are reported herein.LAY ABSTRACT: A new packaging system for parenteral pharmaceuticals was developed that combines the best attributes of plastic and glass without their respective drawbacks. This technological advancement is based on the synergy between high-precision injection-molded plastics and plasma coating technology. The result is a shatter-resistant, optically clear, low-particulate, and chemically durable packaging system. It is shown that this new packaging system meets or exceeds the important performance characteristics of glass, especially in eliminating the glass delamination and breakage that has been observed in many products. The new packaging system is an engineered, multilayer, glass-coated plastic composite that provides a chemically stable contact surface and oxygen barrier performance that exceeds a 2 year shelf life

  4. Amino acids – Guidelines on Parenteral Nutrition, Chapter 4

    Directory of Open Access Journals (Sweden)

    Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

    2009-11-01

    Full Text Available Protein catabolism should be reduced and protein synthesis promoted with parenteral nutrion (PN. Amino acid (AA solutions should always be infused with PN. Standard AA solutions are generally used, whereas specially adapted AA solutions may be required in certain conditions such as severe disorders of AA utilisation or in inborn errors of AA metabolism. An AA intake of 0.8 g/kg/day is generally recommended for adult patients with a normal metabolism, which may be increased to 1.2–1.5 g/kg/day, or to 2.0 or 2.5 g/kg/day in exceptional cases. Sufficient non-nitrogen energy sources should be added in order to assure adequate utilisation of AA. A nitrogen calorie ratio of 1:130 to 1:170 (g N/kcal or 1:21 to 1:27 (g AA/kcal is recommended under normal metabolic conditions. In critically ill patients glutamine should be administered parenterally if indicated in the form of peptides, for example 0.3–0.4 g glutamine dipeptide/kg body weight/day (=0.2–0.26 g glutamine/kg body weight/day. No recommendation can be made for glutamine supplementation in PN for patients with acute pancreatitis or after bone marrow transplantation (BMT, and in newborns. The application of arginine is currently not warranted as a supplement in PN in adults. N-acetyl AA are only of limited use as alternative AA sources. There is currently no indication for use of AA solutions with an increased content of glycine, branched-chain AAs (BCAA and ornithine-α-ketoglutarate (OKG in all patients receiving PN. AA solutions with an increased proportion of BCAA are recommended in the treatment of hepatic encephalopathy (III–IV.

  5. On the relative safety of parenteral iron formulations.

    Science.gov (United States)

    Chertow, Glenn M; Mason, Phillip D; Vaage-Nilsen, Odd; Ahlmén, Jarl

    2004-06-01

    Intravenous iron is usually required to optimize the correction of anaemia in persons with advanced chronic kidney disease and end-stage renal disease. Randomized clinical trials may have insufficient power to detect differences in the safety profiles of specific formulations. We obtained data from the US Food and Drug Administration on reported adverse drug events (ADEs) related to the provision of three formulations of intravenous iron during 1998-2000. We estimated the relative risks [odds ratios (OR)] of ADEs associated with the use of higher molecular weight iron dextran and sodium ferric gluconate complex compared with lower molecular weight iron dextran using 2 x 2 tables. The total number of reported parenteral iron-related ADEs was 1981 among approximately 21,060,000 doses administered, yielding a rate of 9.4 x 10(-5), or approximately 94 per million. Total major ADEs were significantly increased among recipients of higher molecular weight iron dextran (OR 5.5, 95% CI 4.9-6.0) and sodium ferric gluconate complex (OR 6.2, 95% CI 5.4-7.2) compared with recipients of lower molecular weight iron dextran. We observed significantly higher rates of life-threatening ADEs, including death, anaphylactoid reaction, cardiac arrest and respiratory depression among users of higher molecular weight compared with lower molecular weight iron dextran. There was insufficient power to detect differences in life-threatening ADEs when comparing lower molecular weight iron dextran with sodium ferric gluconate complex. Parenteral iron-related ADEs are rare. Using observational data, overall and most specific ADE rates were significantly higher among recipients of higher molecular weight iron dextran and sodium ferric gluconate complex than among recipients of lower molecular weight iron dextran. These data may help to guide clinical practice, as head-to-head clinical trials comparing different formulations of intravenous iron have not been conducted.

  6. Tuberculosis and parenteral viral hepatitides: incidence of mixed forms

    Directory of Open Access Journals (Sweden)

    A. A. Asratyan

    2014-01-01

    Full Text Available Objective: to estimate the frequency of parenteral viral hepatitides (HB and HC (PVH in patients with tuberculosis in Moscow in relation to data on their incidence in the aggregate population of the capital.Materials and methods. The authors analyzed the incidence of (acute, chronic HB and HC (carriage and tuberculosis in Moscow in 2009. A total of 24,220 cards for infectious patients (No. 089/y and federal statistical follow-up forms (No. 2 were first processed to compare and search for personal data among the patients with tuberculosis and all forms of PVH and to establish the evidence of PVH and tuberculosis comorbidity.Results. The infection of tuberculosis patients with parenteral hepatitis B and C viruses was ascertained to be 5.5 to 284.9 times higher (in relation to the form of a hepatitis course than that in the aggregation population of Moscow, which suggests that PVH is of high significance for the tuberculosis patients and that it is necessary to improve a PVH prevention program among this cohort patients. Analysis of the sex-age structure shows that male tuberculosis patients in the 20-39-year-old group should be considered to be a special risk group that should attract special attention when implementing preventive measures. The tuberculosis mortality rate among mixed infected patients was 1.8-fold higher than among those who had PVH-uncomplicated tuberculosis.Conclusion. The results of the investigations are suggestive of the evidence of PVH and tuberculosis comorbidity. The mixed forms of these infections in different combinations have been established to be accompanied by their severer clinical course and high death rates. 

  7. Implementing community-based education: essential elements and recommendations.

    Science.gov (United States)

    Osborn, L M

    1996-12-01

    Two elements are essential for implementing community-based educational programs: a vision of how community experiences fit into the training of the health professionals of the future and a local environment that will support innovation, change, and growth. Change cannot occur unless very basic assumptions regarding medical education are challenged. What is "quality education"? Can programs oriented toward tertiary and specialty care adequately provide the training that should be the core of a 3-year general training program? Do schools and programs select and train physicians to function within the microcosm of the academic center, or do they prepare physicians to manage the country's health care needs? National consensus has had little influence over local environments. Each medical school, training program, and teaching facility must reexamine its values and its culture. Each must have a vision of the physicians of the future and a commitment to train them appropriately. The role of vision and culture in creating successful programs has been clearly described. Several key elements have been found to be consistent with success, the first being vision. Four basic principles will bring the vision to fruition: (1) preserving core values while still stimulating progress; (2) emphasizing the process by which programs are created, implemented, and changed rather than the product; (3) avoiding the "tyranny of the or," learning to be inclusive with a broad vision rather than limited to an "either-or" approach; and (4) aligning the process, management, and values in working toward envisioned progress for the future. Effective leadership is essential for a group or organization to accomplish its mission, as is an organizational structure that aligns responsibility, authority, resources, and accountability.

  8. Pattern of blindness in a community based hospital of Nepal.

    Science.gov (United States)

    Sharma, R; Marasini, S; Nepal, B P

    2013-01-01

    Because of the availability of modern health facilities and moderately easy access to health services in the last 25 years, the blindness due to cataract and trachoma is expected to decline in Nepal. So it is felt that the causes of blindness need to be revised. To regroup the disease pattern leading to permanent blindness in patients attending a suburban multidisciplinary community-based hospital of Nepal. A cross-sectional, descriptive study was conducted in patients attending Dhulikhel hospital over a period of 12 months, from March 2010. Only the patients with best corrected visual acuity of less than 3/60 were enrolled in the study. A detailed ocular examination was carried out. A total of 76 eyes of 58 patients were analyzed. Of all, 32 were male (55.2 %). The mean age of the patients was 43.03 ± 22.98, with a range of 7 years to 84 years. Retinal diseases had the higher prevalence (23, 39.7 %) followed by amblyopia (10, 17.2 %) and corneal diseases (9, 15.51 %). Anisometropic amblyopia (3.94 %) was the commonest type of amblyopia. Retinitis pigmentosa (9.21 %) and age-related macular degeneration (7.89 %) were common retinal diseases whereas anterior staphyloma (5.26 %) and leucoma (3.94 %) were common corneal diseases. Other important and rare causes of blindness included ethambutol-induced optic neuropathy and vitelliform dystrophy. Periodic collection of statistics on the relative frequency of the causes of blindness is important in socioeconomically developing nations like Nepal. This helps to revise the pattern of blinding diseases so that priorities can be redefined. © NEPjOPH.

  9. Introduction to multi-level community based culturally situated interventions.

    Science.gov (United States)

    Schensul, Jean J; Trickett, Edison

    2009-06-01

    This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of "level" in intervention science, and advocating for "multi-level" approaches to social/behavioral change. They presented examples of ways in which interventions targeted social "levels" either simultaneously or sequentially by working together with communities across levels, and drawing on and co-constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level-specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection.

  10. Team sponsors in community-based health leadership programs.

    Science.gov (United States)

    Patterson, Tracy Enright; Dinkin, Donna R; Champion, Heather

    2017-05-02

    Purpose The purpose of this article is to share the lessons learned about the role of team sponsors in action-learning teams as part of community-based health leadership development programs. Design/methodology/approach This case study uses program survey results from fellow participants, action learning coaches and team sponsors to understand the value of sponsors to the teams, the roles they most often filled and the challenges they faced as team sponsors. Findings The extent to which the sponsors were perceived as having contributed to the work of the action learning teams varied greatly from team to team. Most sponsors agreed that they were well informed about their role. The roles sponsors most frequently played were to provide the teams with input and support, serve as a liaison to the community and serve as a sounding board, motivator and cheerleader. The most common challenges or barriers team sponsors faced in this role were keeping engaged in the process, adjusting to the role and feeling disconnected from the program. Practical implications This work provides insights for program developers and community foundations who are interested in building the capacity for health leadership by linking community sponsors with emerging leaders engaged in an action learning experience. Originality/value This work begins to fill a gap in the literature. The role of team sponsors has been studied for single organization work teams but there is a void of understanding about the role of sponsors with multi-organizational teams working to improve health while also learning about leadership.

  11. Agent Community based Peer-to-Peer Information Retrieval

    Science.gov (United States)

    Mine, Tsunenori; Matsuno, Daisuke; Amamiya, Makoto

    This paper proposes an agent community based information retrieval method, which uses agent communities to manage and look up information related to users. An agent works as a delegate of its user and searches for information that the user wants by communicating with other agents. The communication between agents is carried out in a peer-to-peer computing architecture. In order to retrieve information related to a user query, an agent uses two histories : a query/retrieved document history(Q/RDH) and a query/sender agent history(Q/SAH). The former is a list of pairs of a query and retrieved documents, where the queries were sent by the agent itself. The latter is a list of pairs of a query and sender agents and shows ``who sent what query to the agent''. This is useful to find a new information source. Making use of the Q/SAH is expected to cause a collaborative filtering effect, which gradually creates virtual agent communities, where agents with the same interests stay together. Our hypothesis is that a virtual agent community reduces communication loads to perform a search. As an agent receives more queries, then more links to new knowledge are achieved. From this behavior, a ``give and take''(or positive feedback) effect for agents seems to emerge. We implemented this method with Multi-Agents Kodama which has been developed in our laboratory, and conducted preliminary experiments to test the hypothesis. The empirical results showed that the method was much more efficient than a naive method employing 'broadcast' techniques only to look up a target agent.

  12. [Efficiency of a pharmaceutical care program for long-acting parenteral antipsychotics in the health area of Santiago de Compostela].

    Science.gov (United States)

    Vázquez-Mourelle, Raquel; Parrondo, Carmen Durán; López-Pardo Pardo, Estrella; Carracedo-Martínez, Eduardo

    2016-01-01

    In the healthcare area of Santiago de Compostela (Spain), the therapeutic subgroup "other antipsychotics" represented the fifth largest outpatient expenditure in 2013. More than half of this expenditure corresponded to long-acting parenteral forms of paliperidone and risperidone. Over a 12-month period, the implementation of a pharmaceutical care program based on process management and coordination of actions between health professionals in both levels of care represented savings of € 636,391.01 for the organization and a direct saving of € 16,767.36 and 9,008 trips to the pharmacy for patients. This study shows the efficiency of the program, which was facilitated by its situation in an area of integrated management and the use the unified medical records and electronic prescription, elements that will enable the future implementation of similar programmes. The new registries and healthcare interventions will allow reliable evaluation of their effectiveness in terms of treatment adherence, relapses and hospitalisations. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  13. Involuntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention

    Science.gov (United States)

    Bhattacharya, Sayanti; Robertson, Allison G.; Swanson, Jeffrey W.

    2016-01-01

    Objective: Involuntary outpatient commitment (OPC)—also referred to as ‘assisted outpatient treatment’ or ‘community treatment orders’—are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal. Method: Relevant publications were identified for review in PubMed, Ovid Medline, PsycINFO, personal communications, and relevant Internet searches of advocacy and policy-related publications. Results: Most research on OPC has focussed on outcomes such as community functioning and hospital recidivism and not on interpersonal violence. As a result, research on violence towards others has been limited but suggests that low-level acts of interpersonal violence such as minor, noninjurious altercations without weapon use and arrests can be reduced by OPC, but there is no evidence that OPC can reduce major acts of violence resulting in injury or weapon use. The impact of OPC on major violence, including mass shootings, is difficult to assess because of their low base rates. Conclusions: Effective implementation of OPC, when combined with intensive community services and applied for an adequate duration to take effect, can improve treatment adherence and related outcomes, but its promise as an effective means to reduce serious acts of violence is unknown. PMID:27777274

  14. Outpatient treatment for acute uncomplicated diverticulitis

    NARCIS (Netherlands)

    Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.

    2013-01-01

    Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment

  15. Predictors of readmission after outpatient plastic surgery.

    Science.gov (United States)

    Mioton, Lauren M; Buck, Donald W; Rambachan, Aksharananda; Ver Halen, Jon; Dumanian, Gregory A; Kim, John Y S

    2014-01-01

    Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery. The 2011 National Surgical Quality Improvement Program database was reviewed for all outpatient procedures. Unplanned readmission rates were calculated for all 10 tracked surgical specialties (i.e., general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery. A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94 percent) compared with other specialties. Seventy-five patients were readmitted with a complication. Multivariate regression analysis revealed obesity (body mass index ≥ 30), wound infection within 30 days of the index surgery, and American Society of Anesthesiologists class 3 or 4 physical status as significant predictors for unplanned readmission. Unplanned readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the index operation, and American Society of Anesthesiologists class 3 or 4 physical status are independent predictors of readmission. As procedures continue to transition into outpatient settings and the drive to improve patient care persists, these findings will serve to optimize outpatient surgery use.

  16. Fostering Sociopolitical Consciousness with Minoritized Youth: Insights from Community-Based Arts Programs

    Science.gov (United States)

    Ngo, Bic; Lewis, Cynthia; Maloney Leaf, Betsy

    2017-01-01

    In this chapter, we review the literature on community-based arts programs serving minoritized youth to identify the conditions and practices for fostering sociopolitical consciousness. Community-based arts programs have the capacity to promote teaching and learning practices in ways that engage youth in the use of academic skills to pursue…

  17. Identity and Agonism: Tim Miller, Cornerstone, and the Politics of Community-Based Theatre.

    Science.gov (United States)

    Fletcher, John

    2003-01-01

    Contends that community-based theatre (CBT) can productively redefine the parameters of what "political performance" can mean. Draws on the work of community-based performance artist Tim Miller and on the author's experience as a dramaturg to suggest that artists and scholars must develop a revised idea of what constitutes activist democratic…

  18. Lifeline Work: Community-Based Adult Learning and Learners' Personal Progression

    Science.gov (United States)

    Macintyre, Janis

    2012-01-01

    This paper explores learner progression for participants in community-based adult learning (CBAL) provision in Scotland. It focuses on learners' perceptions of progression drawn from analysis of life history interviews carried out with ten adults who had participated in community-based adult learning. The analysis of data was undertaken in three…

  19. Performing Environmental Change: MED Theatre and the Changing Face of Community-Based Performance Research

    Science.gov (United States)

    Schaefer, Kerrie

    2012-01-01

    This article examines a programme of work produced by community-based theatre company, Manaton and East Dartmoor (MED) Theatre, addressing issues of climate change as they impact on life in rural Devon, UK. After some discussion of MED Theatre's constitution as a community-based company and the group's long-term engagement with the place, history,…

  20. Exploring Partnership Functioning within a Community-Based Participatory Intervention to Improve Disaster Resilience

    Science.gov (United States)

    Gagnon, Elizabeth; O'Sullivan, Tracey; Lane, Daniel E.; Paré, Nicole

    2016-01-01

    Disasters happen worldwide, and it is necessary to engage emergency management agencies, health and social services, and community-based organizations in collaborative management activities to enhance community resilience. Community-based participatory research (CBPR) has been widely accepted in public health research as an approach to develop…

  1. The Culture of Experiential Community Based Learning: Developing Cultural Awareness in Pre-Service Teachers

    Science.gov (United States)

    Droppert, Alida J.

    2013-01-01

    This paper describes the culture of experiential community based learning at Central College, a rural liberal arts college in Midwestern, USA. Pre-service teachers use experiential community based learning to reflect on their personal growth in understanding the needs of diverse learners. Reflections demonstrate how the program contributes to the…

  2. Ethical and Epistemic Dilemmas in Knowledge Production: Addressing Their Intersection in Collaborative, Community-Based Research

    Science.gov (United States)

    Glass, Ronald David; Newman, Anne

    2015-01-01

    Collaborative community-based research can bring a range of benefits to universities, communities, and the public more broadly. A distinct virtue of collaborative community-based research is that it makes the ethical-epistemic intersections and challenges in research a focal point of its methodology. This makes collaborative community-based…

  3. Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management

    NARCIS (Netherlands)

    Zwerink, Marlies; Effing, Tanja; Kerstjens, Huib A. M.; van der Valk, Paul; Brusse-Keizer, Marjolein; van der Palen, Job

    2016-01-01

    Introduction: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. Methods:

  4. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model

    Science.gov (United States)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

  5. Phylodynamic and Phylogeographic Patterns of the HIV Type 1 Subtype F1 Parenteral Epidemic in Romania

    Science.gov (United States)

    Hué, Stéphane; Buckton, Andrew J.; Myers, Richard E.; Duiculescu, Dan; Ene, Luminita; Oprea, Cristiana; Tardei, Gratiela; Rugina, Sorin; Mardarescu, Mariana; Floch, Corinne; Notheis, Gundula; Zöhrer, Bettina; Cane, Patricia A.; Pillay, Deenan

    2012-01-01

    Abstract In the late 1980s an HIV-1 epidemic emerged in Romania that was dominated by subtype F1. The main route of infection is believed to be parenteral transmission in children. We sequenced partial pol coding regions of 70 subtype F1 samples from children and adolescents from the PENTA-EPPICC network of which 67 were from Romania. Phylogenetic reconstruction using the sequences and other publically available global subtype F sequences showed that 79% of Romanian F1 sequences formed a statistically robust monophyletic cluster. The monophyletic cluster was epidemiologically linked to parenteral transmission in children. Coalescent-based analysis dated the origins of the parenteral epidemic to 1983 [1981–1987; 95% HPD]. The analysis also shows that the epidemic's effective population size has remained fairly constant since the early 1990s suggesting limited onward spread of the virus within the population. Furthermore, phylogeographic analysis suggests that the root location of the parenteral epidemic was Bucharest. PMID:22251065

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

    Directory of Open Access Journals (Sweden)

    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

  7. Reversal of parenteral nutrition-associated liver disease with a fish oil-based lipid emulsion (Omegaven) in an adult dependent on home parenteral nutrition.

    Science.gov (United States)

    Burns, David L; Gill, Brian M

    2013-03-01

    Patients with intestinal failure and short bowel syndrome usually require chronic parenteral nutrition (PN). PN is associated with risks, including infections, vascular thrombosis, and liver disease. PN-associated liver disease (PNALD) can progress from steatosis to chronic hepatitis and ultimately to cirrhosis. The etiology of PNALD is not completely understood. Therapies for PNALD include carbohydrate or lipid calorie reduction, antibiotics, or the use of ursodeoxycholic acid. When these efforts fail, therapeutic options are limited and liver transplantation may be required. The transition from a soybean- to a fish oil-based lipid formulation, such as the ω-3 parenteral lipid formulation (Omegaven), has shown a dramatic reversal of PNALD within the pediatric population. This is the first report of a PN-dependent adult in the United States complicated by PNALD and hepatic failure who had improvement of liver disease with an ω-3 fish oil-based parenteral formulation.

  8. [Isoforms A and B of lysosomal N-acetyl-beta-D-hexosaminidase in serum and urine of parenterally fed patients].

    Science.gov (United States)

    Raczkowska, Katarzyna; Zalewska-Szajda, Beata; Chojnowska, Sylwia; Kepka, Alina; Raczkowski, Krzysztof; Waszkiewicz, Napoleon; Siedlecka-Czykier, Edyta; Dadan, Jacek; Snarska, Jadwiga; Zwierz, Krzysztof; Ładny, Jerzy Robert; Szajda, Sławomir Dariusz

    2013-05-01

    Parenteral nutrition entails numerous metabolic complications resulting from food bypass of the gastrointestinal tract. Up to now have not been established all complications of parenteral nutrition, despite intensive research and clinical observations. Knowledge of the biochemical changes resulting from parenteral nutrition is essential to effective prevention, early detection and effective treatment of the metabolic disorders induced by parenteral nutrition. The aim of the study was to evaluate the catabolism of glycoconjugates of parenterally fed patients, reflected by the activity of N-acetyl-beta-D-hexosaminidase (HEX): HEX A and HEX B isoenzymes in serum and urine. Samples of blood and urine were collected from 23 patients: before intravenous alimentation, at start, as well as of fifth and tenth day of parenteral nutrition. The activity of HEX A and HEX B in serum and urine was determined by the colorimetric method of Zwierz et al. as modified by Marciniak et al. The activity of urinary HEXA and HEX B has been calculated per 1 mg of creatinine. The activity of serum HEXA significantly decreased at fifth day, in comparison to the activity before parenteral alimentation, and significantly increased at tenth day of parenteral nutrition. The activity of HEX B in serum increased significantly at fifth and tenth day of the parenteral nutrition. Parenteral nutrition alter the catabolism of glycoconjugates, reflected by significant changes in serum HEX A and HEX B activities. Urine was the not appropriate material to evaluate the catabolism of glycoconjugates in view of HEX A and HEX B activities.

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

    Science.gov (United States)

    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

  10. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

    Science.gov (United States)

    2010-01-01

    Objectives To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. Methods The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. Results There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. Conclusions There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly

  11. ROLE OF PARENTERAL NUTRITION IN ONCOLOGIC PATIENTS WITH INTESTINAL OCCLUSION AND PERITONEAL CARCINOMATOSIS.

    Science.gov (United States)

    Aría Guerra, Eva; Cortés-Salgado, Alfonso; Mateo-Lobo, Raquel; Nattero, Lía; Riveiro, Javier; Vega-Piñero, Belén; Valbuena, Beatriz; Carabaña, Fátima; Carrero, Carmen; Grande, Enrique; Carrato, Alfredo; Botella-Carretero, José Ignacio

    2015-09-01

    the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis. 55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed. 69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  12. Evaluation of Parenteral Opioid Analgesics Utilization in Patients Hospitalized in a Referral Teaching Hospital

    OpenAIRE

    Rasool Soltani; Hossein Vatanpour; Fatemeh Shafiee; Niloofar Sadeghian

    2016-01-01

    Background: Opioid drugs are the most effective drugs for the treatment of moderate to severe pain. Rates of opioid use are influenced by a variety of factors. The aim of this study was to determine the pattern of use of parenteral opioid drugs in hospitalized patients in a referral teaching hospital. Methods: In a retrospective study, required data were extracted from medical records of adult patients who had received any parenteral opioid analgesic in the 6-month period from March 2013 to S...

  13. Does long term parenteral nutrition in children have an impact on malocclusion? Preliminary report.

    Science.gov (United States)

    Olczak-Kowalczyk, Dorota; Krasuska-Sławińska, Ewa; Danko, Mikołaj; Popińska, Katarzyna; Banaś, Elżbieta; Gozdowski, Dariusz; Książyk, Janusz; Zadurska, Małgorzata

    2014-01-01

    To evaluate the impact of long-term partial parenteral nutrition and its complications on malocclusion in children and adolescents. The assessment involved 61 patients (2.25 to16 years of age) without a masticatory parafunction - i.e. 31 subjects receiving parenteral nutrition for a mean period of 5.71±2.87 years, and 30 healthy control subjects. The medical records provided information on the delivery (full-term, preterm), birth body mass, Apgar score, weight deficiency at the age of 1 year; the patient assessment included the current body mass, the number of enteral meals per day and parenteral meals per week, occlusion (acc.to Orlik-Grzybowska's parameters). The statistical analysis was performed by using the chi-square test, Spearman's correlation analysis; the statistical significance was p<0.05. Premature infants with low birth body mass (38.7%), Apgar score below 7 (25.8%), underweight in the first year of life (74.2%) and on examination day (58.1%) were only part of the test group. Mean number of eaten meals: 4.63±1.88 in parenteral nutrition patients, 6.26±1.39 in healthy individuals in the control group. Malocclusions were significantly more frequent in the children receiving parenteral nutrition (38.71%: the most frequent defects included crossbite (19.31%), open bite malocclusion (12.9%), crowding of teeth (9.67%), than in the control group (13.3%: crossbite (3.3%), open bite malocclusion (3.3), crowding of teeth (3.3%). A correlation was statistically proved between the malocclusion and parenteral nutrition, the number of parenteral feeding sessions per week, the current low body mass. Long-term parenteral nutrition, a decreased number of oral meals and a coexistent low body mass at the developmental age may contribute to the development of malocclusion.

  14. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

    Directory of Open Access Journals (Sweden)

    Abd Arwa Y

    2010-12-01

    Full Text Available Abstract Objectives To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. Methods The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010 for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. Results There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. Conclusions There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This

  15. Treatment of end stage chronic intestinal pseudo-obstruction by subtotal enterectomy and home parenteral nutrition.

    OpenAIRE

    Mughal, M M; Irving, M H

    1988-01-01

    Three cases are described of end stage chronic intestinal pseudo-obstruction successfully treated by subtotal enterectomy and home parenteral nutrition (HPN). In all three patients prior use of drugs to stimulate gastrointestinal motility, antibiotics to suppress bacterial overgrowth and surgical bypass of dilated bowel had failed to alleviate the symptoms of chronic intestinal obstruction. Similarly parenteral nutrition combined with restriction of oral intake, although improving nutrition d...

  16. An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension.

    Science.gov (United States)

    Oudiz, Ronald; Agarwal, Manyoo; Rischard, Franz; De Marco, Teresa

    2016-12-01

    Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids-such as catheter-related infections and intolerable adverse effects-may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients transitioning from parenteral prostanoids to inhaled trepostinil. Rigid inclusion criteria were used, including parenteral prostanoid dose < 30 ng/kg/min, New York Heart Association functional class (FC) < 3, and pulmonary vascular resistance (PVR) < 6 Wood units. Of the 9 patients meeting initial inclusion criteria, 3 were excluded. In the remaining patients, the parenteral prostanoid was reduced and the inhaled prostanoid was increased over 24-36 hours with continuous hemodynamic monitoring. Exercise capacity and FC were measured at baseline and weeks 1, 4, and 12. All patients were successfully weaned from parenteral prostanoids. An acute PVR decrease was seen with most inhaled prostanoid doses, but PVR varied throughout the transition. Patients tolerated inhaled prostanoids for 9-12 breaths 4 times a day with no treatment-limiting adverse events. At week 12, FC was unchanged, and all patients continued to receive inhaled prostanoids without serious adverse events or additional PAH therapy. In 5 of 6 patients, 6-minute walk distance and peak [Formula: see text] were within 10% of baseline. Using a strict transition protocol and rigid patient selection criteria, the parenteral prostanoid to inhaled prostanoid transition appeared safe and well tolerated and did not result in clinical deterioration over 12 weeks. Hemodynamic variability noted acutely during transition in our study did not adversely affect successful transition. (Trial registration: Clinical

  17. An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension

    Science.gov (United States)

    Agarwal, Manyoo; Rischard, Franz; De Marco, Teresa

    2016-01-01

    Abstract Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids—such as catheter-related infections and intolerable adverse effects—may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients transitioning from parenteral prostanoids to inhaled trepostinil. Rigid inclusion criteria were used, including parenteral prostanoid dose < 30 ng/kg/min, New York Heart Association functional class (FC) < 3, and pulmonary vascular resistance (PVR) < 6 Wood units. Of the 9 patients meeting initial inclusion criteria, 3 were excluded. In the remaining patients, the parenteral prostanoid was reduced and the inhaled prostanoid was increased over 24–36 hours with continuous hemodynamic monitoring. Exercise capacity and FC were measured at baseline and weeks 1, 4, and 12. All patients were successfully weaned from parenteral prostanoids. An acute PVR decrease was seen with most inhaled prostanoid doses, but PVR varied throughout the transition. Patients tolerated inhaled prostanoids for 9–12 breaths 4 times a day with no treatment-limiting adverse events. At week 12, FC was unchanged, and all patients continued to receive inhaled prostanoids without serious adverse events or additional PAH therapy. In 5 of 6 patients, 6-minute walk distance and peak V˙O2 were within 10% of baseline. Using a strict transition protocol and rigid patient selection criteria, the parenteral prostanoid to inhaled prostanoid transition appeared safe and well tolerated and did not result in clinical deterioration over 12 weeks. Hemodynamic variability noted acutely during transition in our study did not adversely affect successful transition. (Trial registration: Clinical

  18. Enteral and parenteral nutrition in patients with enteric fistulas and short bowel syndrome.

    Science.gov (United States)

    Rombeau, J L; Rolandelli, R H

    1987-06-01

    Significant advances in the use of enteral and parenteral nutrition in patients with either enteric fistulas or short bowel syndrome include increased usage of enteral nutrition because of its trophic effects on the gut and increased usage of both enteral and parenteral nutrition in the home setting. Current investigations are directed toward identifying gut-specific fuels and dietary and pharmacologic enhancement of nutrient utilization.

  19. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients.

    Science.gov (United States)

    Salih, Muhannad R M; Bahari, Mohd Baidi; Abd, Arwa Y

    2010-12-31

    To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations

  20. Quality assessment of total parenteral nutrition admixtures by the use of fractional factorial design

    Directory of Open Access Journals (Sweden)

    Mirković Dušica

    2013-01-01

    Full Text Available Background/Aim. Parenteral nutrition as a specific aspect of providing nutritients still remains a permanent topic of both theoretical and experimental research. Total parenteral nutrition (TPN admixtures have complex contents making difficult to maintain their stability. The most critical parameter is the diameter of a lipid droplet, i.e. droplet size distribution. It is recommended that droplet size should not be more than 5

  1. Potential of polymeric particles as future vaccine delivery systems/adjuvants for parenteral and non-parenteral immunization against tuberculosis: A systematic review

    Directory of Open Access Journals (Sweden)

    Farzad Khademi

    2018-02-01

    Full Text Available Objective(s: Production of effective tuberculosis (TB vaccine is necessity. However, the development of new subunit vaccines is faced with concerns about their weak immunogenicity. To overcome such problems, polymers-based vaccine delivery systems have been proposed to be used via various routes. The purpose of this study was to determine the potential of polymeric particles as future vaccine delivery systems/adjuvants for parenteral and non-parenteral immunization against TB. Materials and Methods: PubMed, Scopus, Science-Direct, and the ISI web of knowledge databases were searched for related keywords. A total of 420 articles, written up to June 25, 2016, were collected on the potential of polymeric particles as TB vaccine delivery systems after parenteral and non-parenteral immunization. Thirty-one relevant articles were selected by applying inclusion and exclusion criteria. Results: It was shown that the immunogenicity of TB vaccines had been improved by using biodegradable and non-biodegradable synthetic polymers as well as natural polymers and they are better able to enhance the humoral and cellular immune responses, compared to TB vaccines alone. The present study revealed that various polymeric particles, after M. tuberculosis challenge in animal models, provide long-lasting protection against TB. PLGA (poly (lactide-co-glycolide and chitosan polymers were widely used as TB vaccine delivery systems/adjuvants. Conclusion: It seems that PLGA and chitosan polymers are well-suited particles for the parenteral and non-parenteral administration of TB vaccines, respectively. Non-biodegradable synthetic polymers in comparison with biodegradable synthetic and natural polymers have been used less frequently. Therefore, further study on this category of polymers is required.

  2. Trasplante intestinal en el paciente con nutrición parenteral domiciliaria Intestinal transplant in patients with parenteral nutrition at home

    OpenAIRE

    A. I. de Cos; C. Gómez Candela; Vázquez, C.; M. López Santamaría; E. Vicente

    2003-01-01

    El fracaso intestinal, bien sea por causa anatómica o funcional, condiciona el tratamiento con nutrición parenteral en niños o adultos que, como resultado de resecciones intestinales, alteración de la motilidad, enfermedad de microvellosidades u otras causas, presentan un intestino insuficiente para proveer sus necesidades en nutrientes y fluidos. Sin embargo, en sujetos con fallo intestinal irreversible el mantenimiento del soporte con nutrición parenteral domiciliaria no esta exento de comp...

  3. Evaluation of parenteral nutrition use in patients undergoing major upper gastro-intestinal surgery.

    Science.gov (United States)

    Deleenheer, Barbara; Declercq, Peter; Van Veer, Hans; Nafteux, Philippe; Spriet, Isabel

    2015-08-01

    After major upper gastro-intestinal surgery, enteral feeding is often hampered. There is still no consensus on which route of nutrition is preferable in patients undergoing this type of surgery. Current ESPEN guidelines recommend parenteral nutrition in undernourished patients, if caloric requirements cannot be met orally/enterally within 7 days and enteral nutrition is contraindicated. The current practice of systematic parenteral nutrition at the thoracic surgery ward of the University Hospitals Leuven was evaluated based on the ESPEN guidelines. This prospective observational study included patients undergoing upper gastro-intestinal surgery and receiving postoperative parenteral nutrition. Parenteral nutrition use was considered appropriate when patients were undernourished and unable to obtain adequate caloric requirements by oral or enteral feeding within 7 days. Twenty-five out of 35 patients were nutritionally at risk. In 9 of 25 patients, the indication for parenteral nutrition was considered justified. As the intestinal tract below the anastomosis site remains accessible in the total studied population, enteral nutrition might be an option. Unfortunately, an appropriate jejunostomy tube was not available at our institution. In accordance to the ESPEN guidelines, enteral nutrition can replace parenteral nutrition in most thoracic surgery patients, but only if an appropriate enteral access is available.

  4. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome

    Science.gov (United States)

    Hyeda, Adriano; da Costa, Élide Sbardellotto Mariano

    2017-01-01

    ABSTRACT Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died. PMID:28767918

  5. Is parenteral nutrition really that risky in the intensive care unit?

    Science.gov (United States)

    Griffiths, Richard D

    2004-03-01

    Although enteral nutrition is now the mainstay of nutrition delivery within intensive care, there is a blind faith in its benefits and a disregard of its risks. This has led to the belief that parenteral nutrition is no longer required as it is fraught with risks to the patient. This review attempts to dispel these myths and compares and contrasts the risks of enteral nutrition with those of parenteral nutrition in the critically ill. A greater appreciation of the failings and risks associated with the delivery of enteral nutrition combined with improvements in the formulation and use of parenteral nutrition help explain why parenteral nutrition is not as risky as some have believed. Recent evidence has suggested that enteral nutrition in a few selected circumstances may even carry a higher mortality risk. Real outcome benefits have been described with the new glutamine-containing parenteral nutrition formulations. Parenteral nutrition remains a valuable yet challenging weapon in our therapeutic armoury in the presence of gastrointestinal feed intolerance or failure. However, it should be used wisely and not indiscriminately because the majority of intensive care unit patients with a fully functional gastrointestinal tract may be fed safely with enteral nutrition.

  6. Outcomes of outpatient management of pediatric burns.

    Science.gov (United States)

    Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J

    2014-01-01

    The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.

  7. Eating disorders: a hidden phenomenon in outpatient mental health?

    Science.gov (United States)

    Fursland, Anthea; Watson, Hunna J

    2014-05-01

    Eating disorders are common but underdiagnosed illnesses. Help-seeking for co-occurring issues, such as anxiety and depression, are common. To identify the prevalence of eating problems, using the SCOFF, and eating disorders when screening positive on the SCOFF (i.e., ≥2), among patients seeking help for anxiety and depression at a community-based mental health service. Patients (N = 260) consecutively referred and assessed for anxiety and depression treatment were administered the SCOFF screening questionnaire and a semi-structured standardized diagnostic interview during routine intake. 18.5% (48/260) scored ≥2 on the SCOFF, indicating eating problems. Of these, 41% (19/48) met criteria for an eating disorder. Thus, overall, 7.3% (19/260) of the sample met criteria for a DSM-IV eating disorder. Those scoring ≥2 on the SCOFF were more likely to: be female (p = 0.001), younger (p = 0.003), and have a history of self-harm (p eating disorders are a hidden phenomenon in general outpatient mental health. By using a standardized diagnostic interview to establish diagnosis rather than self- or staff-report, the study builds on limited previous findings. The naturalistic study setting shows that screening for eating disorders can be easily built into routine intake practice, and successfully identifies treatment need. Copyright © 2013 Wiley Periodicals, Inc.

  8. Developing a community-based flood resilience measurement standard

    Science.gov (United States)

    Keating, Adriana; Szoenyi, Michael; Chaplowe, Scott; McQuistan, Colin; Campbell, Karen

    2015-04-01

    Given the increased attention to resilience-strengthening in international humanitarian and development work, there has been concurrent interest in its measurement and the overall accountability of "resilience strengthening" initiatives. The literature is reaching beyond the polemic of defining resilience to its measurement. Similarly, donors are increasingly expecting organizations to go beyond claiming resilience programing to measuring and showing it. However, key questions must be asked, in particular "Resilience of whom and to what?". There is no one-size-fits-all solution. The approach to measuring resilience is dependent on the audience and the purpose of the measurement exercise. Deriving a resilience measurement system needs to be based on the question it seeks to answer and needs to be specific. This session highlights key lessons from the Zurich Flood Resilience Alliance approach to develop a flood resilience measurement standard to measure and assess the impact of community based flood resilience interventions, and to inform decision-making to enhance the effectiveness of these interventions. We draw on experience in methodology development to-date, together with lessons from application in two case study sites in Latin America. Attention will be given to the use of a consistent measurement methodology for community resilience to floods over time and place; challenges to measuring a complex and dynamic phenomenon such as community resilience; methodological implications of measuring community resilience versus impact on and contribution to this goal; and using measurement and tools such as cost-benefit analysis to prioritize and inform strategic decision making for resilience interventions. The measurement tool follows the five categories of the Sustainable Livelihoods Framework and the 4Rs of complex adaptive systems - robustness, rapidity, redundancy and resourcefulness -5C-4R. A recent white paper by the Zurich Flood Resilience Alliance traces the

  9. Observational study of outpatients with schizophrenia in the Middle ...

    African Journals Online (AJOL)

    Observational study of outpatients with schizophrenia in the Middle East and Africa — 3- and 6-month efficacy and safety results. The Intercontinental Schizophrenia Outpatient Health Outcomes Study.

  10. CLINICAL STATISTICAL STUDIES ON HEMATURIA IN OUTPATIENTS

    OpenAIRE

    青木, 正治; 熊本, 悦明

    1982-01-01

    Clinical statistical studies on hematuria were performed in outpatients who were seen at our Department, during the 7-year period from 1974 through 1980. Of the 11,574 outpatients studied, the total number of outpatients with hematuria 1,705; macroscopic hematuria was found in 446 cases (3.9%) and microscopic hematuria was in 1,259 cases (10.9%). The most frequent cause of macroscopic hematuria was malignant urinary tumors and that of microscopic hematuria was urinary tract infections. Macros...

  11. Place-power-prognosis: Community-based conservation, partnerships, and ecotourism enterprises in Namibia

    Directory of Open Access Journals (Sweden)

    Arthur Frederick Hoole

    2009-08-01

    Full Text Available Namibia’s community-based natural resource management program (CBRNM and communal conservancies have gained international acclaim for rural poverty alleviation and wildlife conservation on the commons. Community-based ecotourism enterprise development has played a central role in the generation of community revenues, employment and additional benefits. The place of community-based ecotourism enterprises in the evolution of Namibia’s conservancies is examined. A participatory rural appraisal (PRA approach was conducted in Namibia as part of recent doctoral research in 2006 and 2007, featuring participant observation, semi-structured key informant interviews and structured communal villager interviews. Findings demonstrate some tangible successes of community-based ecotourism enterprise development, as well as emerging issues in related benefits distribution and power brokering. The case of the Torra Conservancy is profiled as a leading model for success in partnerships between conservancies, as community-based conservation institutions, and tourism enterprises. The experience of Ehi-rovipuka Conservancy is also detailed, to illuminate challenges and prospects for replicating the Torra model. Power relationships between and among private enterprise, community, and the state are elucidated. Ecotourism enterprise development can contribute successfully to community-based conservation. But, issues of power sharing, governance and competition necessitate the further evolution of commons institutions to capture future, sustainable benefits from community-based conservation premised on wildlife and related ecotourism development.

  12. Engaging and sustaining adolescents in community-based participatory research: structuring a youth-friendly community-based participatory research environment.

    Science.gov (United States)

    LoIacono Merves, Marni; Rodgers, Caryn R R; Silver, Ellen Johnson; Sclafane, Jamie Heather; Bauman, Laurie J

    2015-01-01

    Community-Based Participatory Research partnerships typically do not include adolescents as full community partners. However, partnering with adolescents can enhance the success and sustainability of adolescent health interventions. We partnered with adolescents to address health disparities in a low-income urban community. In partnering with youth, it is important to consider their developmental stage and needs to better engage and sustain their involvement. We also learned the value of a Youth Development framework and intentionally structuring a youth-friendly Community-Based Participatory Research environment. Finally, we will raise some ethical responsibilities to consider when working with youth partners.

  13. Prediction of parenteral nutrition osmolarity by digital refractometry.

    Science.gov (United States)

    Chang, Wei-Kuo; Yeh, Ming-Kung

    2011-05-01

    Infusion of high-osmolarity parenteral nutrition (PN) formulations into a peripheral vein will damage the vessel. In this study, the authors developed a refractometric method to predict PN formulation osmolarity for patients receiving PN. Nutrients in PN formulations were prepared for Brix value and osmolality measurement. Brix value and osmolality measurement of the dextrose, amino acids, and electrolytes were used to evaluate the limiting factor of PN osmolarity prediction. A best-fit equation was generated to predict PN osmolarity (mOsm/L): 81.05 × Brix value--116.33 (R(2) > 0.99). To validate the PN osmolarity prediction by these 4 equations, a total of 500 PN admixtures were tested. The authors found strong linear relationships between the Brix values and the osmolality measurement of dextrose (R(2) = 0.97), amino acids (R(2) = 0.99), and electrolytes (R(2) > 0.96). When PN-measured osmolality was between 600 and 900 mOsm/kg, approximately 43%, 29%, 43%, and 0% of the predicted osmolarity obtained by equations 1, 2, 3, and 4 were outside the acceptable 90% to 110% confidence interval range, respectively. When measured osmolality was between 900 and 1,500 mOsm/kg, 31%, 100%, 85%, and 15% of the predicted osmolarity by equations 1, 2, 3, and 4 were outside the acceptable 90% to 110% confidence interval range, respectively. The refractive method permits accurate PN osmolarity prediction and reasonable quality assurance before PN formulation administration.

  14. Standardised versus Individualised Parenteral Nutrition. Further Food for Thought

    LENUS (Irish Health Repository)

    McCarthy, R

    2016-04-01

    Parenteral Nutrition may be prescribed as a standard PN (SPN) formulation or as an individualised PN (IPN) formulation. SPN may have advantages in terms of rapid availability, less prescription errors, decreased risk of infection and cost savings but IPN, specifically tailored to an infant’s needs, may achieve better outcomes in terms of nutrient intake and weight gain. The aim of our study was to determine if VLBW infants in our NICU benefited from receiving IPN over currently available SPN solutions. Our findings were that VLBW infants prescribed IPN received significantly more amino acid (28%), glucose (6%), energy (11%) and calcium (8%) from the aqueous phase of PN than had they received a similar volume of SPN. The benefits were seen over all the days for which PN was administered. In conclusion, IPN was found to offer significant benefits to our VLBW infants. Modifications to currently available SPN would result in better SPN formulations. Our study also supported the recent recommendation to reduce the calcium:phosphate ratio in PN solutions to avoid early hypophosphataemia

  15. Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia.

    Science.gov (United States)

    Ramanathan, Subramaniam; Kumar, Praveen; Mishra, Kirtisudha; Dutta, Ashok Kumar

    2016-01-01

    To compare the risk of hyponatremia between hypotonic and isotonic parenteral maintenance solutions (PMS) administered to children with very severe pneumonia, admitted in the general pediatric ward. A randomized controlled open label trial was conducted in the pediatrics department of a tertiary care medical college hospital including euvolemic children 2 mo to 5 y of age, fulfilling the WHO clinical definition of very severe pneumonia and requiring PMS. They were randomized to receive either isotonic PMS (0.9% saline in 5% dextrose and potassium chloride 20 meq/L) or hypotonic PMS (0.18% saline in 5% dextrose and potassium chloride 20 meq/L) at standard rates for next 24 h. A total of 119 children were randomized (59: Isotonic; 60: Hypototonic PMS). Nine (15%) children in the isotonic PMS group and 29 (48%) in the hypotonic PMS group developed hyponatremia during the study period, (p hypotonic group compared to the isotonic group (p < 0.001 each at 6, 12 and 24 h). The difference in mean change in serum sodium from baseline was also significant at 12 and 24 h (5.4 and 5.8 meq/L respectively; p < 0.001 each). This study demonstrates the rationality of the use of isotonic PMS in children with respiratory infections, a condition regularly encountered by most pediatricians.

  16. Carbohydrates – Guidelines on Parenteral Nutrition, Chapter 5

    Science.gov (United States)

    Bolder, U.; Ebener, C.; Hauner, H.; Jauch, K. W.; Kreymann, G.; Ockenga, J.; Traeger, K.

    2009-01-01

    The main role of carbohydrates in the human body is to provide energy. Carbohydrates should always be infused with PN (parenteral nutrition) in combination with amino acids and lipid emulsions to improve nitrogen balance. Glucose should be provided as a standard carbohydrate for PN, whereas the use of xylite is not generally recommended. Fructose solutions should not be used for PN. Approximately 60% of non-protein energy should be supplied as glucose with an intake of 3.0–3.5 g/kg body weight/day (2.1–2.4 mg/kg body weight/min). In patients with a high risk of hyperglycaemia (critically ill, diabetes, sepsis, or steroid therapy) an lower initial carbohydrate infusion rate of 1–2 g/kg body weight/day is recommended to achieve normoglycaemia. One should aim at reaching a blood glucose level of 80–110 mg/dL, and at least a glucose level <145 mg/dL should be achieved to reduce morbidity and mortality. Hyperglycaemia may require addition of an insulin infusion or a reduction (2.0–3.0 g/kg body weight/day) or even a temporary interruption of glucose infusion. Close monitoring of blood glucose levels is highly important. PMID:20049080

  17. Carbohydrates – Guidelines on Parenteral Nutrition, Chapter 5

    Directory of Open Access Journals (Sweden)

    Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

    2009-11-01

    Full Text Available The main role of carbohydrates in the human body is to provide energy. Carbohydrates should always be infused with PN (parenteral nutrition in combination with amino acids and lipid emulsions to improve nitrogen balance. Glucose should be provided as a standard carbohydrate for PN, whereas the use of xylite is not generally recommended. Fructose solutions should not be used for PN. Approximately 60% of non-protein energy should be supplied as glucose with an intake of 3.0–3.5 g/kg body weight/day (2.1–2.4 mg/kg body weight/min. In patients with a high risk of hyperglycaemia (critically ill, diabetes, sepsis, or steroid therapy an lower initial carbohydrate infusion rate of 1–2 g/kg body weight/day is recommended to achieve normoglycaemia. One should aim at reaching a blood glucose level of 80–110 mg/dL, and at least a glucose level <145 mg/dL should be achieved to reduce morbidity and mortality. Hyperglycaemia may require addition of an insulin infusion or a reduction (2.0–3.0 g/kg body weight/day or even a temporary interruption of glucose infusion. Close monitoring of blood glucose levels is highly important.

  18. Telemedicine Support Groups for Home Parenteral Nutrition Users.

    Science.gov (United States)

    Nelson, Eve-Lynn; Yadrich, Donna Macan; Thompson, Noreen; Wright, Shawna; Stone, Kathaleen; Adams, Natasia; Werkowitch, Marilyn; Smith, Carol E

    2017-12-01

    Patients receiving home parenteral nutrition (HPN), a life-sustaining intravenous (IV) infusion that provides nourishment and hydration to patients with short gut or inflammatory bowel diseases, are often isolated and not in visual contact with peers or health providers. One completed clinical trial (Clinical Trials.gov NCT0190028) and 1 ongoing clinical trial (Clinical Trials.gov NCT02987569) are evaluating a mobile videoconferencing-delivered support group intervention for patients on HPN and their caregivers. This home-based telemedicine intervention uses encrypted tablet-based videoconferencing to connect multiple families in real time. The twice-daily IV regimen is challenging for patients who may experience infusion catheter-related bloodstream infections, difficulties with fatigue, loss of sleep, depressive disorders, and worry over the potential life-threatening side effects and the expenses of this therapy. Using secure telemedicine, the facilitated support group intervention aims to enhance HPN home care, daily functioning, and quality of life. The authors provide the rationale for the telemedicine approach with HPN users and caregivers. They provide "how-to" information about the content and process of the facilitated support group sessions via secure videoconferencing. They share lessons learned from the ongoing evaluation of the telemedicine approach.

  19. Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

    Directory of Open Access Journals (Sweden)

    Fusch, C.

    2009-11-01

    Full Text Available There are special challenges in implementing parenteral nutrition (PN in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated. Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.

  20. ANTIBACTERIAL THERAPY IN OUTPATIENT TREATMENT OF RESPIRATORY TRACT INFECTIONS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    V. N. Turchina

    2014-01-01

    Full Text Available The study was aimed at analyzing prescriptions of antibacterial drugs for outpatient treatment of respiratory tract infections in children. Patients and methods. The study involved patients with acute respiratory tract infections: 158 children were undergoing outpatient treatment, whereas 30 children were being treated at the polyclinic day hospital. The children aged from 3 months to 15 years. Acute rhinopharyngitis, acute laryngitis, acute bronchitis, tonsillitis and pneumonia were registered in 66.5, 2.6, 18.1, 11.7 and 1.1% of cases. We appraised indications for antibacterial therapy, prescription terms, therapy duration and choice of an antibacterial drug. Results. Antibacterial therapy prescription was found unreasonable in 44.0% of acute rhinopharyngitis cases, 41.1% of acute bronchitis cases and 60.0% of acute laryngitis cases. In the first day of diagnosis establishment, antibiotics were prescribed in 63.8 and 100% of cases at pediatric divisions and day hospitals, respectively. The unreasonable antibiotic prescription rate in infants was 66.7% - significantly higher than in 1-7-year-old children (p < 0.05. The most frequently (66.4% prescribed class of antibacterial drugs at pediatric divisions was penicillins (amoxicillin, amoxicillin clavulanate; at day hospitals, they were prescribed in 23.3% of cases (p < 0.01. Use of cephalosporin antibiotics as the initial therapy was significantly higher at day hospitals than at pediatric divisions (P < 0.01; the drug was administered parenterally in 90% of cases. Antibiotic prescription courses did not exceed 5 days in most cases (60.1%. Conclusions. We revealed high rate of unreasonable antibiotic use for outpatient treatment of acute rhinopharyngitis, laryngitis and acute bronchitis, especially at day hospitals and in infants. 

  1. Community-based arts initiatives: exploring the science of the arts.

    Science.gov (United States)

    Stein, Catherine H; Faigin, David A

    2015-03-01

    In this introduction to the special issue, we describe some of the rewards and challenges of community-based arts initiatives for our discipline. We explore the inherent tensions between art and science that are reflected in community-based arts activities. We pose larger questions about researching community-based arts activities and defining the arts as a means of promoting social change. The diversity of populations, settings, and issues represented by the papers in the special issue are described and a common set of values, methods of inquiry and action are discussed.

  2. Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment approaches for haematological malignancies

    NARCIS (Netherlands)

    Iestra, J. A.; Fibbe, W. E.; Zwinderman, A. H.; Romijn, J. A.; Kromhout, D.

    1999-01-01

    Patients receiving intensive cytotoxic therapy are traditionally supported with parenteral nutrition (PN), although it is unclear whether all patients benefit from PN. This study aimed to identify regimen-associated differences in PN requirements, to reveal discrepancies between the number of PN

  3. Vitamin E in new Generation Lipid Emulsions Protects Against Parenteral Nutrition-Associated Liver disease in Parenteral Nutrition-Fed Preterm Pigs

    DEFF Research Database (Denmark)

    Kenneth, Ng; Stoll, Barbara; Chacko, Shaji

    2016-01-01

    Introduction: Parenteral nutrition (PN) in preterm infants leads to PN-associated liver disease (PNALD). PNALD has been linked to serum accumulation of phytosterols that are abundant in plant oil but absent in fish oil emulsions. Hypothesis: Whether modifying the phytosterol and vitamin E composi...

  4. Vitamin E in new-generation lipid emulsions protects against parenteral nutrition-associated liver disease in parenteral nutrition-fed preterm pigs

    Science.gov (United States)

    Parenteral nutrition (PN) in preterm infants leads to PN-associated liver disease (PNALD). PNALD has been linked to serum accumulation of phytosterols that are abundant in plant oil but absent in fish oil emulsions. Whether modifying the phytosterol and vitamin E composition of soy and fish oil lipi...

  5. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  6. The intercontinental schizophrenia outpatient health outcomes (IC ...

    African Journals Online (AJOL)

    The intercontinental schizophrenia outpatient health outcomes (IC-SOHO) study: baseline clinical and functional characteristics and antipsychotic use patterns in the North Africa and Middle Eastern (AMEA) region: original article.

  7. Neuroprotective efficacy of prophylactic enteral and parenteral nimodipine treatment in vestibular schwannoma surgery: a comparative study.

    Science.gov (United States)

    Scheller, Christian; Wienke, Andreas; Wurm, Franziska; Simmermacher, Sebastian; Rampp, Stefan; Prell, Julian; Rachinger, Jens; Scheller, Konstanze; Koman, Gershom; Strauss, Christian; Herzfeld, Eva

    2014-07-01

    BACKGROUND AND STUDY AIMS/OBJECT: Oral nimodipine improves neurologic outcome after aneurysmal subarachnoid hemorrhage. In addition, the neuroprotective efficacy of nimodipine has been revealed following skull base, laryngeal, and maxillofacial surgery. Pharmacokinetic investigations showed nimodipine to reach higher serum levels following parenteral versus enteral administration. Furthermore, a correlation between nimodipine levels in serum, cerebrospinal fluid, and nerve tissue could be quantified. These observations raise the question whether the proven neuroprotective effect of nimodipine is related to its serum level. A consecutive series of 37 patients with vestibular schwannoma treated with nimodipine from the day before surgery until the seventh postoperative day was analyzed retrospectively. Both groups received standard dosages for enteral (n = 17) and parenteral (n = 20) nimodipine medication. Nimodipine levels were measured in pre- and postoperative serum and cerebrospinal fluid samples. Cochlear and facial nerve functions were documented before surgery, in the early postoperative course, and 1 year after surgery. Facial nerve outcome was significantly better in the group with parenteral nimodipine medication (p = 0.038). Logistical regression analysis revealed a seven times smaller risk for a deterioration of facial nerve function in the group with parenteral treatment. There was no difference in hearing preservation between both groups despite tumor size tending to be larger in the parenteral group. Intraoperative (p = 0.004), postoperative (p = 0.001), and serum and cerebrospinal fluid (p = 0.024) nimodipine levels were significantly higher following parenteral administration as compared with enteral administration. Both groups were comparable regarding tumor size and extent of resection. These results support a dependency of nimodipine's neuroprotective efficacy on its serum levels. Parenteral nimodipine treatment produces higher serum levels and

  8. Parenteral Opioid Analgesics Utilization Pattern in Amir-al-Momenin Hospital, Zabol-IRAN

    Directory of Open Access Journals (Sweden)

    Hossein Vatanpour

    2016-08-01

    Full Text Available Opioids are the most available medicines to get rid of any general severe pain and avoiding of any deleterious sequential that can worsen patient outcomes. Rational prescription of opioid analgesics with respect to the possibility of abuse is a big concern in the medical care costs. Zabol, where is located in eastern part of Iran and has common border with Afghanistanhas the most opioid traffic in the region. In this study the rational prescription of parenteral opioid in Amir-al-Momenin general hospital was investigated. A retrospective drug utilization review was performed on 509 in-patients who received parenteral opioids including Morphine, Pethidin, Pentazocin, Fentanyl, Alfentanil, Sufentanil and Methadone from March 21sttoSeptember 23rd, 2011. Multivariate conditional regression modeling was used to determine independent predictors for daily parenteral opioid consumption. Total daily parenteral opioid consumption was 38.63 DDDs/100bed-days for Morphine, Pethidine and Pentazocin and 84564.78 PFEQs/100bed-days for Fentanyl, Alfentanil and Sufentanil and 766 mg for Methadone. Pethidine was the most frequently prescribed parenteral opioid. Most patients who were prescribed by the intramuscular routes, ordered PRN. Daily parenteral opioid consumption was the highest in the emergency ward whereas it was considered as the lowest in the intensive care unit[ICU]. According to our findings, total daily parenteral opioid consumption was almost high in Amir-al-Momenin Hospital. Unlike to some relevant factors that can effect on the consumption of analgesic opioids like gender, age, drug-drug interaction and etc, we found no rational prescription and consumption in the mentioned hospital.

  9. Parenteral Nutrition with Oliclinomel N8-800 in Patients with Hypercatabolism during Extended Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    V. A. Zyryanov

    2014-01-01

    Full Text Available Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs. Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group (n=20 was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml.Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen.Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of

  10. Evaluating the real-world effectiveness of cognitive-behavior therapy efficacy research on eating disorders: a case study from a community-based clinical setting.

    Science.gov (United States)

    Lowe, Michael R; Bunnell, Douglas W; Neeren, Amy M; Chernyak, Yelena; Greberman, Laurel

    2011-01-01

    There is a growing consensus that there is a need to test the real-world effectiveness of eating disorder therapies that show promise in efficacy research. This article provides a narrative account of an NIMH-funded study that attempted to apply efficacy findings from CBT research to an Intensive Outpatient Program (IOP) at the largest community-based eating disorder program in the United States. We describe the study as originally envisioned as well as the various challenges that the researchers and the IOP staff encountered in implementing this study. The different training, assumptions, and "ways of knowing" of the research team and the treatment staff in regard to the nature of eating disorders and their treatment created multiple challenges for both groups during the study period. We describe valuable lessons learned about how to-and how not to-implement effectiveness designs in clinical settings that are relatively unfamiliar with empirically-based research findings. It is hoped that our experience in attempting to apply efficacy-based research findings on eating disorders treatment in a community-based clinical setting will prove helpful to other researchers and service providers engaging in such translational research. Copyright © 2010 Wiley Periodicals, Inc.

  11. Outpatient treatment for acute uncomplicated diverticulitis.

    Science.gov (United States)

    Ünlü, Çagdas; Gunadi, Patrick M; Gerhards, Michael F; Boermeester, Marja A; Vrouenraets, Bart C

    2013-09-01

    Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment of acute uncomplicated diverticulitis is feasible and safe, and which patients could benefit from outpatient care. A retrospective cohort study was carried out in two teaching hospitals using hospital registry codes for diverticulitis. All patients diagnosed with acute uncomplicated diverticulitis between January 2004 and January 2012, confirmed by imaging or colonoscopy, were included. Exclusion criteria were patients with recurrent diverticulitis, complicated diverticulitis (Hinchey stages 2, 3, and 4), and right-sided diverticulitis. Inpatient care was compared with outpatient care. Primary outcome was admission for outpatient care and the complication rate in both groups. Multivariate analysis was carried out to identify potential factors for inpatient care. Of 627 patients with diverticulitis, a total of 312 consecutive patients were identified with primary uncomplicated diverticulitis of the sigmoid colon; 194 patients had been treated as inpatients and 118 patients primarily as outpatients. In this last group, 91.5% had been treated successfully without diverticulitis-related complications or the need for hospital admission during a mean follow-up period of 48 months. Despite inherent patient selection in a retrospective cohort, ambulatory treatment of patients presenting with uncomplicated acute diverticulitis seems feasible and safe. In mildly ill and younger patients, hospital admission can be avoided.

  12. Performance Status, Prognostic Scoring, and Parenteral Nutrition Requirements Predict Survival in Patients with Advanced Cancer Receiving Home Parenteral Nutrition.

    Science.gov (United States)

    Keane, Niamh; Fragkos, Konstantinos C; Patel, Pinal S; Bertsch, Friderike; Mehta, Shameer J; Di Caro, Simona; Rahman, Farooq

    2018-01-01

    We describe a cohort of Home Parenteral Nutrition (HPN) patients with advanced cancer in order to identify factors affecting prognosis. Demographic, anthropometric, biochemical and medical factors, Karnofsky Performance Status (KPS), Glasgow Prognostic Score (GPS), and PN requirements were recorded. Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression, and correlation analyses. In total, 107 HPN patients (68 women, 39 men, mean age 57 yr) with advanced cancer were identified. The main indications for HPN were bowel obstruction (74.3%) and high output ostomies (14.3%). Cancer cachexia was present in 87.1% of patients. The hazard ratio (HR) for upper gastrointestinal and "other" cancers vs. gynaecological malignancy was 1.75 (p = 0.077) and 2.11 (p = 0.05), respectively. KPS score, GPS, PN volume, and PN potassium levels significantly predicted survival (HRKPS ≥50 vs 0.05). Most patients passed away in their homes or hospice (77.9%). Performance status, prognostic scoring, and PN requirements may predict survival in patients with advanced cancer receiving HPN.

  13. Improving outcomes for persons with aphasia in advanced community-based treatment programs

    National Research Council Canada - National Science Library

    Aftonomos, L B; Appelbaum, J S; Steele, R D

    1999-01-01

    .... We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer...

  14. A peer evaluation of the community-based education programme for ...

    African Journals Online (AJOL)

    A peer evaluation of the community-based education programme for medical students at the University of Zimbabwe College of Health Sciences: A southern African Medical Education Partnership Initiative (MEPI) collaboration.

  15. Severe skull base osteomyelitis caused by Pseudomonas aeruginosa with successful outcome after prolonged outpatient therapy with continuous infusion of ceftazidime and oral ciprofloxacin: a case report.

    Science.gov (United States)

    Conde-Díaz, Cristina; Llenas-García, Jara; Parra Grande, Mónica; Terol Esclapez, Gertrudis; Masiá, Mar; Gutiérrez, Félix

    2017-02-21

    Skull base osteomyelitis is an uncommon disease that usually complicates a malignant external otitis with temporal bone involvement. It affects predominantly diabetic and immunocompromised males and has a high mortality rate. Pseudomonas aeruginosa is the most common causative organism. Currently, there is no consensus about the best therapeutic option. Here we describe a case of severe skull base osteomyelitis caused by Pseudomonas aeruginosa with progressive palsy of cranial nerves that was successfully managed with prolonged outpatient continuous infusion of ceftazidime plus oral ciprofloxacin. A 69-year-old Caucasian man presented with dysphagia, headache, and weight loss. He complained of left earache and purulent otorrhea. Over the following weeks he developed progressive palsy of IX, X, VI, and XII cranial nerves and papilledema. A petrous bone computed tomography scan showed a mass in the left jugular foramen with a strong lytic component that expanded to the cavum. A biopsy was then performed and microbiological cultures grew Pseudomonas aeruginosa. After 6 weeks of parenteral antibiotic treatment, our patient was discharged and treatment was continued with a domiciliary continuous infusion of a beta-lactam through a peripherally inserted central catheter, along with an oral fluoroquinolone for 10 months. Both radiological and clinical responses were excellent. Skull base osteomyelitis is a life-threating condition; clinical suspicion and correct microbiological identification are key to achieve an accurate and timely diagnosis. Due to the poor outcome of Pseudomonas aeruginosa skull base osteomyelitis, prolonged outpatient parenteral antibiotic therapy administered by continuous infusion could be a valuable option for these patients.

  16. Community-based organizations in the health sector: A scoping review

    Directory of Open Access Journals (Sweden)

    Wilson Michael G

    2012-11-01

    Full Text Available Abstract Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues, we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry. We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff, the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks. Given the range of terms used to

  17. Community-Based Social Enterprise: Svanholm as a case-study

    OpenAIRE

    Rasmussen, Asger Nørregård; Nieminen, Elli Emilia; Tadeo, Eileen Ruth; Rich-Byberg, Isak Phakiso

    2015-01-01

    This project seeks to explore the antagonism between neo-liberal economical forces and community based social movements that seek to oppose them. This is a qualitative case study, the case being the intentional community Svanholm, which is based in Denmark. Our problem formulation investigates how the community members of Svanholm position themselves in relation to the dichotomy between being a social movement and a community-based social enterprise. The data is collected by interviewing two ...

  18. Community-based research decision-making: Experiences and factors affecting participation

    OpenAIRE

    Vivien Runnels; Caroline Andrew

    2013-01-01

    From the post World War II period through to the present, scientific research and policy has increasingly reflected acceptance and implementation of a view that public interests are better served through public participation. Built on principles of democratic participation, community-based research (CBR) can produce new knowledge through the integration of knowledge of community members’ lived experience with the scientific and technical knowledge of academics. Although community-based resear...

  19. Embracing a competency-based specialty curriculum for community-based nursing roles.

    Science.gov (United States)

    Levin, Pamela F; Swider, Susan M; Breakwell, Susan; Cowell, Julia M; Reising, Virginia

    2013-01-01

    The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community-based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross-mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community-based specialties and (b) ensure the appropriateness of a Quad Council-based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross-mapping process, including validation with practice leaders. Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council-based curriculum is appropriate to prepare graduates in community-based specialties when attention to the specialty-specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community-based specialties. © 2013 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  2. O significado da nutrição parenteral para o cliente no contexto hospitalar

    Directory of Open Access Journals (Sweden)

    Consuelo Helena Aires de Freitas Lopes

    1996-06-01

    Full Text Available A necessidade de compreender o significado da nutrição parenteral para o cliente no contexto hospitalar surgiu das nossas inquietações diante do cuidado de enfermagem. Realizaram-se observações participantes, entrevistas e anotações de campo junto a sete clientes hospitalizados, que se encontravam sob nutrição parenteral. O sentido das investigações foi centrado na indagação: como você está se sentindo com a nutrição parenteral? Os dados foram analisados numa abordagem interacionista, mostrando as dificuldades enfrentadas pelos clientes na assistência hospitalar, como percebiam eles a nutrição parenteral e que significados eram atribuídos a essa terapêutica. O estudo revelou os sentimentos, comportamentos e atitudes relacionados aos aspectos biológico, emocional e sócio-cultural do cliente, ligados à nutrição parenteral, demonstrando, também as limitações impostas ao cliente sob esse tratamento, bem como as dificuldades na assistência de enfermagem.

  3. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

    Directory of Open Access Journals (Sweden)

    Jin-Cheng Yang

    2015-01-01

    Full Text Available Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%, rectal carcinoma (17.3%, colon carcinoma (CC, 14.7%, gastric carcinoma (29.8%, pancreatic carcinoma (11.5%, and duodenal carcinoma (DC, 4.8%. The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG

  4. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition.

    Science.gov (United States)

    Yang, Jin-Cheng; Dai, Yuan-Yuan; Wang, Li-Ming; Xie, Yi-Bin; Zhou, Hai-Yan; Li, Guo-Hui

    2015-08-05

    Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The ClinicalTrials.gov ID is NCT02024321.

  5. [National Registry of Home Parenteral Nutrition of the year 2001].

    Science.gov (United States)

    Planas, M; Castellà, M; Moreno, J M; Pita, A M; Pedrón, C; Gómez Candela, C; Gómez Enterría, P; de la Cuerda, C; Pérez de la Cruz, A; Forga, M T; Martí, E; Garde, C; Carrera, J A; García Luna, P P; Ordóñez, J; Bonada, A; Pares, R M; Rodríguez, A

    2004-01-01

    We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 +/- 4.9 years for patients or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 +/- 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0.19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

  6. [Nutritional support with parenteral nutrition. Course and associated complications].

    Science.gov (United States)

    Herranz Antolín, Sandra; Álvarez De Frutos, Visitación; Blasco Guerrero, Marta; García Martínez, Maria del Carmen; Gimeno Fernández, Maria del Carmen

    2013-01-01

    Parenteral nutrition (PN) is an integral part of medical management of patients who do not have a functioning or accessible gastrointestinal tract. This paper discusses the clinical characteristics of patients receiving PN in a 420-bed hospital from 2009 to 2011. In addition, nutritional parameters were assessed at the start and end of PN and associated complications were analyzed. retrospective, observational study of PN episodes in adults conducted at the Nutrition Unit of Hospital Universitario de Guadalajara. Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC). There were 312 episodes of PN. The immediate indication was postoperative ileus in 53.8% of the episodes. There was a statistically significant improvement in all analytical parameters assessed (albumin, prealbumin, retinol binding protein, transferrin, cholesterol, and lymphocytes). Caloric provision (kcal per kg) was 25.1±6.6. No metabolic complication occurred in 16.3% of the episodes, and hyperglycemia was the most common complication (79.8%). There were 10 cases of phlebitis (32.2%) and 30 episodes of BAC (8.7%). Bacteriemia rate was 8.1 per 1000 days of PN. Although PN is an effective nutritional support technique, it is associated with complications of varying severity. Use of PN should therefore comply with the instructions accepted in the main clinical practice guidelines and requires careful monitoring by experienced professionals. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  7. [Efficacy of parenteral glutamine in patients undergoing bone marrow transplantation].

    Science.gov (United States)

    Oliva García, J G; Pereyra-García Castro, F; Suárez Llanos, J P; Ríos Rull, P; Breña Atienza, J; Palacio Abizanda, J E

    2012-01-01

    Autologous bone marrow transplant (ABMT) represents a high metabolic stress. Glutamine has proven to be effective in severe catabolic states, although there are controversial studies. To assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on the occurrence of mucositis and mean hospital stay in patients submitted to ABMT. Retrospective study of patients submitted to ABMT between 2006 and 2009. In 2008, one vial of L-alanyl-L-glutamine (20 g) was added by protocol to the PN formulations of these patients. Thirteen clinical charts since that date (glutamine group) and 13 previous charts (control group) were randomly selected (n = 26). We compared the degree of mucositis and hospital stay in both groups. In the subgroup of glutamine-treated patients, we compare the glutamine dose in the patients developing some degree of mucositis with that of those not having this complication. Mean hospital stay: 27.8 ± 7.4 days (control group) vs. 20.3 ± 5.3 days (glutamine group) (p = 0.01). The severity of mucositis was lower in the glutaminetreated group (p = 0.02). The weight-adjusted dose of L-alanyl-L-glutamine in the patients not developing mucositis was higher than in the other ones (0.32 vs. 0.24 g/kg/day; p = 0.02). Glutamine supplementation reduces the degree of mucositis and hospital stay in patients submitted to autologous bone marrow transplantation. The degree of mucositis is lower in the subgroup of patients receiving higher doses of glutamine.

  8. 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 B12 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.

  9. [Suppression of cycling activity in sheep using parenteral progestagen treatment].

    Science.gov (United States)

    Janett, F; Camponovo, L; Lanker, U; Hässig, M; Thun, R

    2004-03-01

    The objective of this study was to evaluate the effect of two synthetic progestagen preparations Chlormadinone acetate (CAP, Chronosyn, Veterinaria AG Zürich) and Medroxyprogesterone acetate (MPA, Nadigest, G Streuli & Co. Uznach) on cycling activity and fertility in sheep. A flock of 28 non pregnant white alpine sheep was randomly divided into three groups, A (n = 10), B (n = 9) and C (n = 9). During a period of 4 weeks the cycling activity was confirmed by blood progesterone analysis. Thereafter, the animals of group A were treated with 50 mg CAP, those of group B with 140 mg MPA and those of group C with physiological saline solution. All injections were given intramuscularly. Suppression of endogenous progesterone secretion lasted from 28 to 49 days (mean = 39 days) in group A and from 42 to 70 days (mean = 50 days) in group B. The synchronization effect of both preparations was unsatisfactory as the occurrence of first estrus was distributed over a period of 3 weeks in group A and 4 weeks in group B. These findings could also be confirmed by the lambing period which lasted 52 days in group A and 36 days in group B. Control animals lambed within 9 days due to the synchronizing effect of the ram. The first fertile estrus was observed 36 days (group A) and 45 days (group B) after the treatment. In group A all 10 animals and in groups B and C 8 of 9 ewes each became pregnant. Parenteral progestagen application with CAP and MPA is a simple, safe and reversible method of estrus suppression in the sheep. The minimal suppressive duration of 4 (CAP) and 5 weeks (MPA) is not sufficient when a period of 3 months (alpine pasture period) is desired.

  10. Management of parenteral nutrition in critically ill patients.

    Science.gov (United States)

    Cotogni, Paolo

    2017-02-04

    Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting "near zero" catheter-related bloodstream infections. Adopting all these strategies, the goal of "near zero" PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

  11. Growth of microorganisms in total parenteral nutrition solutions without lipid.

    Science.gov (United States)

    Kuwahara, Takashi; Kaneda, Shinya; Shimono, Kazuyuki; Inoue, Yoshifumi

    2010-01-22

    To identify the microorganisms that can grow rapidly in total parenteral nutrition (TPN) solutions, we investigated the growth of the major causes of catheter-related blood stream infection (Staphylococcus aureus, Serratia marcescens, Bacillus cereus, and Candida albicans) in TPN solutions without lipid. Experiment 1: A commercial TPN solution without lipid containing multivitamins (pH5.6) was used. A specific number of each test microorganism was added to each 10 mL of the TPN solution and incubated at room temperature. An aliquot of test solution was sampled and inoculated to SCD agar plates at 0, 24, and 48 hrs after the addition of the microorganisms. The number of microorganisms was counted as colony forming units. Experiment 2: The other 2 commercial TPN solutions without lipid (pH5.5) were supplemented with multivitamins. The pH values of the solutions were adjusted to about 6.0, 6.5, or 7.0 using 0.5 mol/L NaOH. The addition of microorganisms, incubation, and counting were performed in the same manner. Experiment 1: S. aureus, S. marcescens, and B. cereus did not increase in the TPN solution without lipid containing multivitamins (pH5.6), but C. albicans increased rapidly. Experiment 2: The 3 bacterial species did not increase even at pH6.0, but increased at pH6.5 and increased rapidly at pH7.0 in both TPN solutions. C. albicans increased similarly at any pH. These results suggest that bacterial species cannot grow in TPN solutions without lipid due to the acidity (pH5.6 or lower), but Candida species can grow regardless of the acidity.

  12. Growth of microorganisms in total parenteral nutrition solutions containing lipid.

    Science.gov (United States)

    Kuwahara, Takashi; Shimono, Kazuyuki; Kaneda, Shinya; Tamura, Takumi; Ichihara, Masao; Nakashima, Yoshifumi

    2010-05-18

    To identify the microorganisms that can grow rapidly in total parenteral nutrition (TPN) solutions, we investigated the growth of the major causes of catheter-related blood stream infection (Staphylococcus aureus, Serratia marcescens, Bacillus cereus, and Candida albicans) in TPN solutions containing lipid. The pH value of a TPN solution containing lipid (pH 6.0, containing 20 ppm of NaHSO(3)) was adjusted by the addition of HCl to 5.7, 5.4, or 4.9. The pH value of another TPN solution (pH5.5, containing 400 ppm of NaHSO(3)) was adjusted by the addition of NaOH to 5.9, 6.3, or 6.8. A specific number of each microorganism was added to 10 mL of each test solution and incubated at room temperature. The number of microorganisms was counted as colony forming units at 0, 24, and 48 hrs later. C albicans increased similarly at any pH values in the TPN solution. The bacterial species also increased rapidly at pH6.0 in the solution containing 20 ppm of NaHSO(3), but growth was suppressed as the pH value was reduced, with growth halted at pH4.9. However, these bacterial species did not increase, even at pH5.9, in the other solution containing 400 ppm of NaHSO(3). These results suggest that Candida species can grow rapidly in almost all TPN solutions regardless of the acidity, lipid, and NaHSO(3); also, some bacterial species may grow in TPN solutions containing lipid unless the pH value is 5.0 or less. Therefore, each TPN solution should be examined whether or not the bacterial species can proliferate.

  13. 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.

  14. 45 CFR 2517.300 - Who may participate in a community-based service-learning program?

    Science.gov (United States)

    2010-10-01

    ... (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE COMMUNITY-BASED SERVICE-LEARNING PROGRAMS Eligibility To Participate § 2517.300 Who may participate in a community-based service-learning program... 45 Public Welfare 4 2010-10-01 2010-10-01 false Who may participate in a community-based service...

  15. 45 CFR 2517.600 - How are funds for community-based service-learning programs distributed?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false How are funds for community-based service-learning... (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE COMMUNITY-BASED SERVICE-LEARNING PROGRAMS Distribution of Funds § 2517.600 How are funds for community-based service-learning programs distributed? All...

  16. 34 CFR 426.23 - What selection criteria does the Secretary use for the Community-Based Organization Projects?

    Science.gov (United States)

    2010-07-01

    ... Community-Based Organization Projects? 426.23 Section 426.23 Education Regulations of the Offices of the... the Secretary use for the Community-Based Organization Projects? The Secretary uses the following criteria to evaluate an application for a community-based organization project: (a) Program factors. (10...

  17. 34 CFR 380.5 - What activities may the Secretary fund under community-based supported employment projects?

    Science.gov (United States)

    2010-07-01

    ... the Secretary fund under community-based supported employment projects? (a) Authorized activities. The following activities are authorized under community-based projects: (1) Job search assistance. (2) Job... Community-Based Supported Employment projects for the provision of extended supported employment services...

  18. Clinical efficacy and safety of multidrug therapy including thrice weekly intravenous amikacin administration for Mycobacterium abscessus pulmonary disease in outpatient settings: a case series.

    Science.gov (United States)

    Namkoong, Ho; Morimoto, Kozo; Nishimura, Tomoyasu; Tanaka, Hiromu; Sugiura, Hiroaki; Yamada, Yoshitake; Kurosaki, Atsuko; Asakura, Takanori; Suzuki, Shoji; Fujiwara, Hiroshi; Yagi, Kazuma; Ishii, Makoto; Tasaka, Sadatomo; Betsuyaku, Tomoko; Hoshino, Yoshihiko; Kurashima, Atsuyuki; Hasegawa, Naoki

    2016-08-09

    Mycobacterium abscessus (M. abscessus) pulmonary disease is a refractory chronic infectious disease. Options for treating M. abscessus pulmonary disease are limited, especially in outpatient settings. Among parenteral antibiotics against M. abscessus, intravenous amikacin (AMK) is expected to be an effective outpatient antimicrobial therapy. This study evaluated the clinical efficacy and safety of intravenous AMK therapy in outpatients with M. abscessus pulmonary disease. This retrospective chart review of cases of M. abscessus pulmonary disease evaluated patient background data, AMK dosage and duration, sputum conversion, clinical symptoms radiological findings, and adverse events. M. massiliense was excluded on the basis of multiplex PCR assay. Thirteen patients (2 men and 11 women) with M. abscessus pulmonary disease were enrolled at 2 hospitals. The median age at the initiation of intravenous AMK treatment was 65 years (range: 50-86 years). Patients received a median AMK dose of 12.5 mg/kg (range: 8.3-16.2 mg/kg) for a median duration of 4 months (range: 3-9 months). The addition of intravenous AMK led to sputum conversion in 10 of 13 patients, and 8 patients continued to have negative sputum status 1 year after treatment. Approximately half of the patients showed improvement on chest high-resolution computed tomography. There were no severe adverse events such as ototoxicity, vestibular toxicity, and renal toxicity. Thrice weekly intravenous AMK administration in outpatient settings is effective and safe for patients with M. abscessus pulmonary disease.

  19. Ascorbylperoxide from parenteral nutrition induces an increase of redox potential of glutathione and loss of alveoli in newborn guinea pig lungs

    Directory of Open Access Journals (Sweden)

    Wesam Elremaly

    2014-01-01

    Conclusion: Results suggest that ascorbylperoxide, generated in parenteral nutrition, is involved in the development of bronchopulmonary dysplasia, independently of the increase of the redox potential. This study underlines the importance of developing a safer formulation of parenteral nutrition.

  20. Dry influenza vaccines: towards a stable, effective and convenient alternative to conventional parenteral influenza vaccination.

    Science.gov (United States)

    Tomar, Jasmine; Born, Philip A; Frijlink, Henderik W; Hinrichs, Wouter L J

    2016-11-01

    Cold-chain requirements, limited stockpiling potential and the lack of potent immune responses are major challenges of parenterally formulated influenza vaccines. Decreased cold chain dependence and stockpiling can be achieved if vaccines are formulated in a dry state using suitable excipients and drying technologies. Furthermore, having the vaccine in a dry state enables the development of non-parenteral patient friendly dosage forms: microneedles for transdermal administration, tablets for oral administration, and powders for epidermal, nasal or pulmonary administration. Moreover, these administration routes have the potential to elicit an improved immune response. This review highlights the rationale for the development of dried influenza vaccines, as well as processes used for the drying and stabilization of influenza vaccines; it also compares the immunogenicity of dried influenza vaccines administered via non-invasive routes with that of parenterally administered influenza vaccines. Finally, it discusses unmet needs, challenges and future developments in the field of dried influenza vaccines.

  1. [Bone loss and oral health status in patients on home parenteral nutrition].

    Science.gov (United States)

    von Wowern, S N; Klausen, B; Møller, E H

    1997-08-11

    The mandible and forearm bone mineral content and dental and periodental state were studied in 15 patients, aged 26 to 65 years, on home parenteral nutrition due to short bowel syndrome and compared to the findings in a normal population. The bone mineral content was measured by dual-photon absorptiometry. All patients were on free oral intake as a supplement to the parenteral nutrition. Forty-seven percent of the patients showed mandibular osteoporosis. Thirty-three percent had osteoporosis in the forearm and also radiographic signs of osteoporotic fractures of the columna. The dental and periodental state did not differ from that of the normal Danish population of the same age. Thus, patients on home parenteral nutrition due to short bowel syndrome seem to have a high risk of developing systemic osteoporosis, including the jaws, but apparently do not have a higher risk for deterioration of the dental or periodental state.

  2. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome.

    Science.gov (United States)

    Hyeda, Adriano; Costa, Élide Sbardellotto Mariano da

    2017-01-01

    To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died. Realizar uma análise econômica de custos da terapia nutricional enteral e parenteral, conforme o tipo de doença e o desfecho (sobreviventes versus óbitos). Estudo transversal, observacional, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares de uma operadora de saúde da Região Sul do Brasil. Foram analisadas 301 contas hospitalares de usuários que utilizaram dieta enteral e parenteral. O custo total com dieta foi de 35,4% do custo total das contas hospitalares. A modalidade enteral representou 59,8% do custo total em dieta. Os maiores custos com dieta

  3. Methylprednisolone sodium succinate in pediatric parenteral nutrition: influence of vehicle injection.

    Science.gov (United States)

    Gellis, Christophe; Sautou-Miranda, Valérie; Jarrige, Jean-François; Grand-Boyer, Anne; Bleyzac, Nathalie; Chopineau, Jean

    2004-08-01

    Many drugs can be administered in parenteral nutrient mixtures, but no work on the delivery of corticoids by such means is reported. We studied the influence of pediatric parenteral nutrient mixtures on the kinetic parameters of the corticoid methylprednisolone injected in an intravenous bolus in rabbits as its sodium succinate ester. Four groups of six male New Zealand rabbits were used. After extraction, the plasma drug concentrations were measured by high performance liquid chromatography. The distribution volume of the ester and the clearance rates of the two entities (ester and methylprednisolone) were lowered in the presence of a lipid emulsion. The description of these pharmacokinetic parameters provides a basis for a preclinical study of 24h administration of methylprednisolone in a parenteral nutrient mixture. Copyright 2003 Elsevier Ltd.

  4. Outpatient oral rehydration in the United States.

    Science.gov (United States)

    Listernick, R; Zieserl, E; Davis, A T

    1986-03-01

    Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. Thirteen of 15 patients were successfully rehydrated orally as outpatients; two patients, who were subsequently discovered to have urinary tract infections, required hospitalization due to persistent vomiting. Orally rehydrated outpatients spent a mean of 10.7 hours in the holding room, as compared with intravenously rehydrated inpatients, who were hospitalized for a mean of 103.2 hours. Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy (+272.78 vs +2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.

  5. [Infection control in the outpatient setting].

    Science.gov (United States)

    Sansoni, Diana; D'Angelo, Tonino; Passamonti, Mauro; Tarulli, Sabrina; Olori, Maria Patrizia; Viviani, Giancarlo

    2007-01-01

    Data regarding the observance of infection control practices in ambulatory healthcare settings is scarce. This type of data is important since the health care system has evolved in such a way that hospital stays are now briefer and there is an increased provision of healthcare in outpatient settings, such as day surgery, day hospital and ambulatory care services. Studies have shown that transmission of infectious diseases in outpatient health care settings is often associated with lack of, or insufficient adherence to, evidence-based preventive measures. Outpatients have less risk factors for nosocomial infections than inpatients, nevertheless, some high risk settings include physicians' waiting rooms (airborne and droplet transmission) and outpatient settings in which invasive procedures are performed. Preventive strategies consist in verifying the adherence to infection control guidelines (this should be done by specifically trained personnel), developing disinfection and sterilization protocols for medical devices (that are comparable to those used in hospitals), training of healthcare personnel, and development of efficacy-based infection control protocols for outpatient settings.

  6. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation

    DEFF Research Database (Denmark)

    Pironi, Loris; Joly, Francisca; Forbes, Alastair

    2011-01-01

    The indications for intestinal transplantation (ITx) are still debated. Knowing survival rates and causes of death on home parenteral nutrition (HPN) will improve decisions.......The indications for intestinal transplantation (ITx) are still debated. Knowing survival rates and causes of death on home parenteral nutrition (HPN) will improve decisions....

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

    Science.gov (United States)

    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 des...

  8. 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...

  9. Developing a vision and strategic action plan for future community-based residency training.

    Science.gov (United States)

    Skelton, Jann B; Owen, James A

    2016-01-01

    The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met. National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process. The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided. The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to

  10. Serum levels of nimodipine in enteral and parenteral administration in patients with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Abboud, Tammam; Andresen, Hilke; Koeppen, Johannes; Czorlich, Patrick; Duehrsen, Lasse; Stenzig, Justus; Westphal, Manfred; Regelsberger, Jan

    2015-05-01

    The aim of this study was to evaluate serum nimodipine concentrations in patients with aneurysmal subarachnoid hemorrhage (SAH) after parenteral therapy and a following course of enteral administration. SAH patients were treated with intravenous nimodipine (2 mg/h) during the 1st week after hemorrhage, and on day 8, we switched over to enteral administration (60 mg/4 h), either orally or by gavage. Serum nimodipine concentrations were measured on days 3, 5, 8, 9 and 12. Area under the curve (AUC) was calculated during parenteral and enteral therapy. The data of 15 patients were analyzed retrospectively. In this study, 157 blood samples were obtained. In seven samples, during the administration by gavage to two patients with high-grade SAH, the serum nimodipine concentrations were negligible. The AUC values during parenteral administration (median 149.3 ng-h/ml) were significantly higher than during oral administration on days 9 (median 92.1 ng-h/ml) and 12 (median 44.1 ng-h/ml) in seven patients (p = 0.030 and p = 0.016, respectively). The AUC values during parenteral administration were significantly higher than during administration by gavage on day 9 in eight patients (median 87.9 and 34 ng-h/ml, respectively, p = 0.001). The AUC values during enteral administration were higher in patients who received nimodine orally than in those who received it by gavage (median 52.3 and 23.1 ng-h/ml, respectively, p = 0.006). Enteral administration of nimodipine showed lower bioavailability during the 2nd week after SAH compared to parenteral application during the 1st week. Negligible serum concentrations were even expected when nimodipine was given by gavage in patients with high-grade SAH, thus suggesting that parenteral administration may be the better route in these patients.

  11. Quality of Life and Nutrition Condition of Patients Improve Under Home Parenteral Nutrition: An Exploratory Study.

    Science.gov (United States)

    Girke, Jutta; Seipt, Claudia; Markowski, Andrea; Luettig, Birgit; Schettler, Anika; Momma, Michael; Schneider, Andrea S

    2016-10-01

    Patients with end-stage cancer and advanced chronic bowel disease are often malnourished, which has a negative effect on patients' outcome, well-being, and activity. It is inconclusive whether these patients benefit from home parenteral nutrition. This prospective exploratory study investigates its influence on nutrition state, muscle strength, mobility, and quality of life. Patients ≥18 years old with an indication for home parenteral nutrition were included and followed for 2-24 months. Nutrition parameters, activity, and quality of life were assessed. Forty-eight patients participated (mean age 11.5 years), and 85% were severely malnourished (subjective global assessment score, class C). Four weeks after parenteral nutrition, patients with tumors demonstrated a deterioration in phase angle (from 3.9 to 3.4) and extracellular mass:body cell mass ratio (from 1.6 to 2.1), while patients with bowel disease improved (from 3.4 to 4.0 and 2.1 to 1.6, respectively); grip strength remained constant in both groups (difference: 1.11 and -2.11, respectively). Activity improved in patients with bowel disease but stayed the same in the tumor group (P = .02 and P = .33, respectively). When the groups were pooled, emotional and social functioning domain scores (P quality of life improved (P = .02) 4 weeks after home parenteral nutrition. Both groups seem to benefit from home parenteral nutrition without harmful side effects. If the indication is determined early, the patients' disease course could perhaps be improved. © 2016 American Society for Parenteral and Enteral Nutrition.

  12. Evaluation of Bacillus oleronius as a Biological Indicator for Terminal Sterilization of Large-Volume Parenterals.

    Science.gov (United States)

    Izumi, Masamitsu; Fujifuru, Masato; Okada, Aki; Takai, Katsuya; Takahashi, Kazuhiro; Udagawa, Takeshi; Miyake, Makoto; Naruyama, Shintaro; Tokuda, Hiroshi; Nishioka, Goro; Yoden, Hikaru; Aoki, Mitsuo

    2016-01-01

    In the production of large-volume parenterals in Japan, equipment and devices such as tanks, pipework, and filters used in production processes are exhaustively cleaned and sterilized, and the cleanliness of water for injection, drug materials, packaging materials, and manufacturing areas is well controlled. In this environment, the bioburden is relatively low, and less heat resistant compared with microorganisms frequently used as biological indicators such as Geobacillus stearothermophilus (ATCC 7953) and Bacillus subtilis 5230 (ATCC 35021). Consequently, the majority of large-volume parenteral solutions in Japan are manufactured under low-heat sterilization conditions of F0 Sterile Pharmaceutical Products Produced by Terminal Sterilization" (guidance in Japan, issued in 2012). In this study, we investigated whether B. oleronius is an appropriate biological indicator of the efficacy of low-heat, moist-heat sterilization of large-volume parenterals. Specifically, we investigated the spore-forming ability of this microorganism in various cultivation media and measured the D-values and z-values as parameters of heat resistance. The D-values and z-values changed depending on the constituents of large-volume parenteral products. Also, the spores from B. oleronius showed a moist-heat resistance that was similar to or greater than many of the spore-forming organisms isolated from Japanese parenteral manufacturing processes. Taken together, these results indicate that B. oleronius is suitable as a biological indicator for sterility assurance of large-volume parenteral solutions subjected to low-heat, moist-heat terminal sterilization. © PDA, Inc. 2016.

  13. Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

    Science.gov (United States)

    2013-01-01

    Background Pediatric osteomyelitis is a bacterial infection of bones requiring prolonged antibiotic treatment using parenteral followed by enteral agents. Major complications of pediatric osteomyelitis include transition to chronic osteomyelitis, formation of subperiosteal abscesses, extension of infection into the joint, and permanent bony deformity or limb shortening. Historically, osteomyelitis has been treated with long durations of antibiotics to avoid these complications. However, with improvements in management and antibiotic treatment, standard of care is moving towards short durations of intravenous antibiotics prior to enteral antibiotics. Methods/Design The authors will perform a systematic review based on PRISMA guidelines in order to evaluate the literature, looking for evidence to support the optimal duration of parenteral and enteral therapy. The main goals are to see if literature supports shorter durations of either parenteral antibiotics and/or enteral antibiotics. Multiple databases will be investigated using a thorough search strategy. Databases include Medline, Cochrane, EMBASE, SCOPUS, Dissertation Abstracts, CINAHL, Web of Science, African Index Medicus and LILACS. Search stream will include medical subject heading for pediatric patients with osteomyelitis and antibiotic therapy. We will search for published or unpublished randomized and quasi-randomized controlled trials. Two authors will independently select articles, extract data and assess risk of bias by standard Cochrane methodologies. We will analyze comparisons between dichotomous outcomes using risk ratios and continuous outcomes using mean differences. 95% confidence intervals will be computed. Discussion One of the major dilemmas of management of this disease is the duration of parenteral therapy. Long parenteral therapy has increased risk of serious complications and the necessity for long therapy has been called into question. Our study aims to review the currently available

  14. 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.

  15. Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

    Science.gov (United States)

    2014-01-01

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors. PMID:24548745

  16. Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition12

    Science.gov (United States)

    Aschner, Judy L; Anderson, Adam; Slaughter, James Christopher; Aschner, Michael; Steele, Steven; Beller, Amy; Mouvery, Amanda; Furlong, Heather M; Maitre, Nathalie L

    2015-01-01

    Background: Manganese, an essential metal for normal growth and development, is neurotoxic on excessive exposure. Standard trace element–supplemented neonatal parenteral nutrition (PN) has a high manganese content and bypasses normal gastrointestinal absorptive control mechanisms, which places infants at risk of manganese neurotoxicity. Magnetic resonance (MR) relaxometry demonstrating short T1 relaxation time (T1R) in the basal ganglia reflects excessive brain manganese accumulation. Objective: This study tested the hypothesis that infants with greater parenteral manganese exposure have higher brain manganese accumulation, as measured by MR imaging, than do infants with lower parenteral manganese exposure. Design: Infants exposed to parenteral manganese were enrolled in a prospective cohort study. Infants classified as having high manganese exposure received >75% of their nutrition in the preceding 4 wk as PN. All others were classified as having low exposure. Daily parenteral and enteral manganese intakes were calculated. Whole-blood manganese was measured by high-resolution inductively coupled plasma mass spectrometry. Brain MR relaxometry was interpreted by a masked reviewer. Linear regression models, adjusted for gestational age (GA) at birth, estimated the association of relaxometry indexes with total and parenteral manganese exposures. Results: Seventy-three infants were enrolled. High-quality MR images were available for 58 infants, 39 with high and 19 with low manganese exposure. Four infants with a high exposure had blood manganese concentrations >30 μg/L. After controlling for GA, higher parenteral and total manganese intakes were associated with a lower T1R (P = 0.01) in the globus pallidus and putamen but were not associated with whole-blood manganese (range: 3.6–56.6 μg/L). Elevated conjugated bilirubin magnified the association between parenteral manganese and decreasing T1R. Conclusion: A short T1R for GA identifies infants at risk of

  17. Dexamethasone for pain after outpatient shoulder surgery

    DEFF Research Database (Denmark)

    Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld

    2014-01-01

    Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double......-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....

  18. Screening for mental disorders in cardiology outpatients

    DEFF Research Database (Denmark)

    Birket-Smith, M.; Rasmussen, A.

    2008-01-01

    The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86...... were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic......, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment Udgivelsesdato: 2008...

  19. [Parenteral nutrition at home: NADYA register for the year 2000].

    Science.gov (United States)

    Planas, M; Castellá, M; León, M; Pita, A M; García Peris, P; Gómez Enterría, P; Gómez Candela, C; Forga, M; Martí Bonmatí, E; Pérez de la Cruz, A; Salas, J; Ordóñez, J; Rodríguez Pozo, A; Camarero, E; Carrera, J A

    2003-01-01

    We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. Fourteen hospitals participated, and 67 patients were enrolled. Middle age was 5 +/- 4 years for patients or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn's disease (2.9%), and other. The mean time on HPN was 7.5 +/- 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0.12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0.3 hospitalizations/100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 patients/10(6) habitants, 2000: 1.9 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to

  20. Intestinal immune function is unaffected by parenteral nutrition in man.

    Science.gov (United States)

    Buchman, A L; Mestecky, J; Moukarzel, A; Ament, M E

    1995-12-01

    Animal studies have demonstrated intestinal immunoglobulin production is decreased when luminal nutrition is withheld and nutrition is provided solely on the basis of total parenteral nutrition (TPN). Eight normal volunteers were hospitalized in the Clinical Research Center for three weeks. The subjects received TPN as an exclusive means of nutritional support for 14 days followed by 5 days of enteral feeding with either standard or a glutamine- and arginine-supplemented formula in which the protein source was primarily free amino acids and peptides. Endoscopic jejunal biopsies obtained before and after TPN and following enteral refeeding were evaluated by immunofluorescence for the number of IgA, IgM and IgG-producing cells; T and B cells as well as intraepithelial and lamina propria lymphocytes were also counted. Serum immunoglobulins and the molecular forms of serum IgA were determined at the same intervals. The number of intestinal IgA-, IgM- and IgG-producing cells was unaffected by TPN (676 +/- 58 vs. 643 +/- 38, 101 +/- 14 vs. 98 +/- 18, 10 +/- 1 vs. 11 +/- 2 per low power field). The total number of intestinal lymphocytes, and CD3+ lymphocytes in the intraepithelial area was unaffected by TPN (10.4 +/- 0.4 vs. 10.2 +/- 1.3, 7.3 +/- 0.8 vs. 8.6 +/- 1.6 per 100 epithelial cells). Similarly, the total number of lymphocytes and CD3+ lymphocytes in the intestinal lamina propria was unaffected by TPN (4.4 +/- 0.2 vs. 6.2 +/- 0.8, 3.3 +/- 0.7 vs. 4.5 +/- 0.8). A small, but statistically significant increase in serum IgA and IgM was seen with TPN 314 +/- 11 vs. 342 +/- 16 mg/dL and 154 +/- 25 vs. 226 +/- 47 mg/dL, although IgG remained unchanged (1262 +/- 69 vs. 1207 +/- 57 mg/dL). The proportion of polymeric and monomeric serum IgA remained unchanged after TPN (19.2 vs. 22.1% polymeric). The use of TPN is not associated with intestinal immune dysfunction in man. A small, but statistically significant increase in serum IgM, and a borderline statistically