1
|
Martinuzzi A, Crivelli A, Lopez A, Sgarzini D, Aragon V, Galeano F, Billinger MC, Doeyo M, Matano M, Salomone P, Cabrera D, Fabro AD, Manrique E. Nutritional support team intervention in surgical ICUs and its effect on nutrition delivery and quality in critically ill patients. Nutrition 2024; 125:112501. [PMID: 38905909 DOI: 10.1016/j.nut.2024.112501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/23/2024]
Abstract
RATIONAL Critically ill surgical patients pose one of the greatest challenges in achieving nutritional goals. Several published papers have demonstrated clear benefits when nutrition support (NS) is managed by a multidisciplinary nutrition support team (NST). We hypothesized that implementing a NST in a surgical intensive care unit (ICU) would increase the number of patients achieving their nutritional goals. MATERIAL AND METHOD Multicenter "BEFORE & AFTER" study. In the BEFORE phase, an audit of the previous state of NS was conducted in three ICUs without a NST. INTERVENTION Implementation of a NST and protocol. In the AFTER phase, a new audit of NS was conducted. Continuous variables (presented as mean ± SD or median Q1-Q3) were tested using the t-test and Mann-Whitney U test. Categorical variables (presented as frequencies and percentages) were assessed using the chi-square test. A binomial logistic regression model was performed, with independent variables introduced using a stepwise forward method. A difference was considered to be significant with a two-sided P-value <0.05. Statistical analysis was conducted using IBM-SPSS 26. RESULTS A total of 83 patients were included in the BEFORE phase, and 85 in the AFTER phase. The latter group showed a higher frequency of nutritional risk and malnutrition (SGA B+C odds ratio 2.314, 95% CI 1.164-4.600). Laparoscopy was more frequently utilized as a surgical technique in the AFTER phase. No differences were observed in ICU and hospital LOS or 90 days' survival rates. Two variables remained independent factors to predict NS achievement: NST implementation (odds ratio 3.582, 95% CI 1.733-7.404), and surgical technique (odds ratio 3.231, 95% CI 1.312-7.959). CONCLUSION NST positively impacts the chance of achieving NS goals in critically ill surgical patients.
Collapse
Affiliation(s)
- Andrés Martinuzzi
- Universidad Nacional de La Plata, Critical Care Specialist SATI-UBA (Argentine Society of Critical Care - University of Buenos Aires) and Nutritional Support Expert AANEP (Argentine Association of Enteral and Parenteral Nutrition), Neuquén, Argentina.
| | - Adriana Crivelli
- Nutritional Support Expert AANEP, Nutritional Support Team, San Martin Hospital, La Plata, Argentina
| | - Ariel Lopez
- Sanatorio Guemes, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Darío Sgarzini
- Sanatorio Guemes, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Aragon
- Sanatorio Guemes, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Fátima Galeano
- Sanatorio Guemes, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | | | - Mariana Doeyo
- Hospital Italiano La Plata (HILP), La Plata, Argentina
| | | | - Paula Salomone
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Dafne Cabrera
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | | |
Collapse
|
2
|
Miyabe A, Doi M, Kanoya Y. Development of the ward nurses' discharge-oriented dietary support scale for older adult patients in Japan. Jpn J Nurs Sci 2023; 20:e12541. [PMID: 37280150 DOI: 10.1111/jjns.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
AIM This study aimed to develop a ward nurses' dietary support scale, including physical, psychological, and social background factors in preparation for older adult patients' life after discharge. METHODS We conducted a cross-sectional study using a self-reported questionnaire. Scale items were created based on a conceptual analysis, and refined by a Delphi survey. In total, 696 nurses across 16 acute care hospitals in Japan were eligible to participate. The questionnaire comprised 51 items that used a five-point Likert-type scale. These items were evaluated using exploratory factor analysis. Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients (ICC). Pearson's correlation coefficients were calculated to determine concurrent validity, and construct validity was analyzed using confirmatory factor analysis. RESULTS Altogether, 241 surveys were included in the data analysis; 236 nurses participated in both the test and the retest. The exploratory factor analysis identified 20 items from three factors as follows: "Assessment for healthy eating behavior," "Adjustment of the living environment, including family and caregiver, together with other professions," and "Continual frailty assessment." In the confirmatory factor analysis, the fitness indices supported these results. Cronbach's alpha was 0.932 and ICC was 0.867 for the overall scale. In the concurrent validity, the three factors had a moderate correlation (r = 0.295-0.537, P < .01 and r = 0.254-0.648, P < .01), except for one subscale. CONCLUSIONS We developed a ward nurses' dietary support scale, including physical, psychological, and social background factors in preparation for older adult patients' life after discharge. Its reliability and validity were confirmed.
Collapse
Affiliation(s)
- Akemi Miyabe
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
- Nursing Course, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Mana Doi
- Nursing Course, School of Medicine, Yokohama City University, Kanagawa, Japan
- Division of Nursing, Chiba Faculty of Nursing, Tokyo Healthcare University, Chiba, Japan
| | - Yuka Kanoya
- Nursing Course, School of Medicine, Yokohama City University, Kanagawa, Japan
| |
Collapse
|
3
|
Ajabnoor SM, Zaher S, Malatani R, Jawa H. Exploring the practice of nutritional support during hospitalization across physicians, dietitians, and pharmacists based in Saudi Arabia. Front Nutr 2023; 10:1149727. [PMID: 37293671 PMCID: PMC10244628 DOI: 10.3389/fnut.2023.1149727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Nutritional support has a pivotal role in preventing and treating malnutrition. Recognizing the gaps in nutritional support practice can aid the development of tailored nutritional protocols. Therefore, this study aimed to assess the current practices, attitudes, and perceptions related to nutritional support for hospitalized patients in one of the largest Middle Eastern countries. Methods A cross-sectional study was conducted among different healthcare professionals currently working in hospitals in Saudi Arabia and involved in nutritional support practice. Data were collected using convenient sample via a self-administered web-based questionnaire. Results A total of 114 participants were included in this study. The majority were dietitians (54%), followed by physicians (33%) and pharmacists (12%), and were from the western region (71.9%). Various attitudes in many practices were observed among the participants. Only 44.7% of the participants had a formal nutritional support team. The mean confidence level of all respondents was significantly higher for enteral nutrition practice (7.7 ± 2.3) than for parenteral nutrition practice (6.1 ± 2.5) (p < 0.01). The confidence level for enteral nutrition practice was significantly influenced by nutritional qualification (β = 0.202, p < 0.05), type of healthcare facility (β = 0.210, p < 0.05), profession (β = -0.308, p < 0.01), and years of experience (β = 0.220, p < 0.05). Conclusion This study comprehensively assessed various aspects of nutritional support practice in Saudi Arabia. Healthcare practice of nutritional support should be guided by evidence-based guidelines. Professional qualification and training in nutritional support are essential for promoting practice in hospitals.
Collapse
Affiliation(s)
- Sarah M. Ajabnoor
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Zaher
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Rania Malatani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani Jawa
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Barrocas A, Schwartz DB, Bistrian BR, Guenter P, Mueller C, Chernoff R, Hasse JM. Nutrition support teams: Institution, evolution, and innovation. Nutr Clin Pract 2023; 38:10-26. [PMID: 36440741 DOI: 10.1002/ncp.10931] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
The historical institution, evolution, and innovations of nutrition support teams (NSTs) over the past six decades are presented. Focused aspects of the transition to transdisciplinary and patient-centered care, NST membership, leadership, and the future of NSTs are further discussed. NSTs were instituted to address the need for the safe implementation and management of parenteral nutrition, developed in the late 1960s, which requires the expertise of individuals working collaboratively in a multidisciplinary fashion. In 1976, the American Society for Parenteral and Enteral Nutrition (ASPEN) was established using the multidisciplinary model. In 1983, the United States established the inpatient prospective payment system with associated diagnosis-related groupings, which altered the provision of nutrition support in hospitals with funded NSTs. The number of funded NSTs has waxed and waned since; yet hospitals and healthcare have adapted, as additional education and experience grew, primarily through ASPEN's efforts. Nutrition support was not administered in some instances by the "core of four" (physician, nurse, dietitian, pharmacist). The functions may be carried out by a member of the core of four not associated with the parent discipline, in accordance with licensure/privileging. This cross-functioning has evolved into the adaptation of the concept of transdisciplinarity, emphasizing function over form, supported and enhanced by "top-of-license" practice. In some institutions, nutrition support has been incorporated into other healthcare teams. Future innovations will assist NSTs in providing the right nutrition support for the right patient in the right way at the right time, recognizing that nutrition care is a human right.
Collapse
Affiliation(s)
- Albert Barrocas
- Department of Surgery, Tulane University School of Medicine, Atlanta, Georgia, USA
| | - Denise Baird Schwartz
- Bioethics Committee, Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Bruce R Bistrian
- Division of Clinical Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (ASPEN), Moses Lake, Washington, USA
| | - Charles Mueller
- Department of Nutrition and Food Studies, New York University/Steinhardt, New York, New York, USA
| | - Ronni Chernoff
- Donald Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jeanette M Hasse
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| |
Collapse
|
5
|
Mao Y, Wu J, Liu G, Yu Y, Chen B, Liu J, Wang J, Yu P, Zhang C, Wu J. Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022). Aging Med (Milton) 2022; 5:191-203. [PMID: 36247340 PMCID: PMC9549312 DOI: 10.1002/agm2.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.
Collapse
Affiliation(s)
- Yongjun Mao
- Department of Geriatric Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jianqing Wu
- Department of GeriatricsJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Gongxiang Liu
- Center of Gerontology and GeriatricsWest China HospitalSichuan UniversityChina National Clinical Research Center for Geriatric MedicineChengduChina
| | - Yao Yu
- Department of Geriatric Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Bo Chen
- Department of GeriatricsJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jia Liu
- Department of Geriatric Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jianye Wang
- Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Pulin Yu
- Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Cuntai Zhang
- Institute of Aging, Department of Geriatrics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jinhui Wu
- Center of Gerontology and GeriatricsWest China HospitalSichuan UniversityChina National Clinical Research Center for Geriatric MedicineChengduChina
| | | |
Collapse
|
6
|
Malhi H, Dera M, Fletcher J. Exploring the role of the nutrition nurse specialist in an intestinal failure tertiary referral centre. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S12. [PMID: 35404659 DOI: 10.12968/bjon.2022.31.7.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The role of the nutrition nurse specialist (NNS) is diverse and is usually integral to a wider, multidisciplinary nutrition support team (NST). Practice frameworks have been developed to identify competencies within the NNS role. A mind-mapping technique was used with the NNS team and the wider NST to explore the role of the NNS in the authors' intestinal failure tertiary referral centre. The results of this were further compared with the published competency frameworks. The mind maps from the NNS team and NST demonstrated commonality. It was encouraging to see that colleagues seem to have a similar understanding of the NNS role and contribution to the wider service. Published competency frameworks did not entirely reflect the expanded scope of practice that is undertaken within this particular team. It is important for clinical nurse specialist teams to evaluate their role and service provision and to compare this against published competency frameworks.
Collapse
Affiliation(s)
- Hardip Malhi
- Nutrition Nurse, Queen Elizabeth Hospital Birmingham
| | | | - Jane Fletcher
- Nutrition Nurse, Queen Elizabeth Hospital Birmingham/School of Nursing, University of Birmingham
| |
Collapse
|
7
|
Salman G, Boullata JI, Sacks GS, Tellez‐Corrales E. Call to action: The need for enhanced nutrition support education and training in pharmacy schools and postgraduate programs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Genene Salman
- Department of Pharmacy Practice Marshall B. Ketchum University, College of Pharmacy Fullerton California USA
| | - Joseph I. Boullata
- Hospital of the University of Pennsylvania Clinical Nutrition Support Services Philadelphia Pennsylvania USA
| | - Gordon S. Sacks
- Fresenius Kabi USA, LLC Medical Affairs for Parenteral Nutrition Market Unit Lake Zurich Illinois USA
| | - Eglis Tellez‐Corrales
- Department of Pharmacy Practice Marshall B. Ketchum University, College of Pharmacy Fullerton California USA
| |
Collapse
|
8
|
Lyu Y, Chen G, Shen L, Liu Y, Gao F, He X, Crilly J. Knowledge, attitudes, clinical practice and perceived barriers with nutrition support among physicians and nurses in the emergency department: A national cross-sectional survey. Int Emerg Nurs 2021; 55:100973. [PMID: 33618221 DOI: 10.1016/j.ienj.2021.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/11/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the current status of knowledge, attitudes, clinical practice and barriers in nutrition support amongst physicians and nurses working in Chinese Emergency Departments (EDs), and the relationship between their demographic characteristics and knowledge and attitudes regarding nutrition support. METHODS A 34 item survey was developed, validated and distributed nationally to ED physicians and nurses from 1st April to 1st May 2018. RESULTS A total of 1234 respondents completed and returned the survey. Knowledge of nutrition support was moderate (mean: 6.70/10) and differed significantly based on demographic characteristics (e.g. age, staff type). Attitudes was very positive (4.15/5), more so among nurses compared to physicians. Only few (5.6%) respondents reportedly assessed nutritional condition for all patients. The most common barriers to optimize nutrition support were being too busy, lack of standardized protocol specific to ED, and lack of teamwork and coordination. CONCLUSION In a subset of physicians and nurses working in Chinese EDs, limited knowledge but positive attitudes toward nutrition support was evident. Recommendations to optimize evidence-based nutritional support practice in the ED include initiating, implementing and sustaining training regarding nutrition support, establishing, implementing and evaluating a standardized protocol, and enhancing interdisciplinary coordination.
Collapse
Affiliation(s)
- Yang Lyu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, PR China.
| | - Gang Chen
- Department of Pharmacy, Beijing Chao-Yang Hospital, Beijing, PR China
| | - Luhui Shen
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, PR China
| | - Yingqing Liu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, PR China
| | - Fengli Gao
- Department of Nursing, Beijing Chao-Yang Hospital, Beijing, PR China
| | - Xinhua He
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, PR China.
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Queensland, Australia; School of Nursing and Midwifery, Menzies Health Institute, Queensland, Australia
| |
Collapse
|
9
|
Kim SH, Bu SY. Effect of the Timing of Nutritional Support Team Intervention on Nutritional Status on Patients Receiving Enteral Nutrition. Clin Nutr Res 2021; 10:1-13. [PMID: 33564648 PMCID: PMC7850813 DOI: 10.7762/cnr.2021.10.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Many hospitalized patients usually have a high risk of malnutrition, which delays the therapy process and can lead to severe complications. Despite of the potential benefits, the effects of timely intervention by nutrition support team (NST) on the nutritional status of admitted patients are not well established. This study aimed to compare the nutritional status between patients with early and delayed NST supports and to assess the effect of the timing of NST support initiation on the nutritional status of enteral nutrition patients. In a simple comparison between the two groups, the early NST intervention group had shorter hospital stays and fewer tube feeding periods than the delayed NST intervention group. The increase in the amount of energy intake from first to last NST intervention was 182.3 kcal in patients in the early NST intervention group, higher than that in patients in the delayed intervention group (p = 0.042). The extent of reduction in serum albumin and hemoglobin levels between the initial and last NST intervention tended to be lower in the early NST intervention group than in the delayed NST intervention group. The mean odds ratio for the patients who were severely malnourished in the early NST intervention group was 0.142 (95% confidence interval, 0.045–0.450) after adjusting for hospital stay and age. The results of this study indicate that early NST intervention can improve patients' overall nutritional status.
Collapse
Affiliation(s)
- Su Hyun Kim
- Department of Food and Nutrition, Daegu University, Gyeongsan 38453, Korea.,Dietary Team, Daegu Fatima Hospital, Daegu 41199, Korea
| | - So Young Bu
- Department of Food and Nutrition, Daegu University, Gyeongsan 38453, Korea
| |
Collapse
|
10
|
[Pillars for excellence in nutrition support units. Regulation]. NUTR HOSP 2021; 38:8-14. [PMID: 33525887 DOI: 10.20960/nh.03555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Nutritional assessment and treatment, necessary for the prevention and treatment of disease-related malnutrition, should be carried out by a multidisciplinary team where each member has well-defined skills and functions, and mechanisms are established to allow adequate coordination, both in the inpatient and outpatient settings. In Spain, the development and implementation of these teams or units dedicated to clinical nutrition has been very important: today they are present in most hospitals. This paper reviews the characteristics of clinical nutrition units, the functions of their team members, and the regulatory framework in our country.
Collapse
|
11
|
Rosas-Flota X, Castillo-Martínez L, Reyes-Ramírez AL, Martínez-Soto Holguín MC, Serralde-Zúñiga AE. Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey. Clin Nutr ESPEN 2020; 40:187-192. [PMID: 33183535 DOI: 10.1016/j.clnesp.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Intestinal Failure (IF) is a complex disease with huge impacts on our society due to complications. Therefore, in a developing country like Mexico without specialized IF clinics, health care professionals must provide evidence-based interventions for the IF patient. This study aims to achieve consensus on how to adapt the existing guidelines for IF to the local practices considering the available resources and local practices. METHODS A three-round modified Delphi process was used to build consensus on the most important interventions for our IF patients. For each round, data was collected and consensus was defined as ≥80% of agreement for each item. Descriptive statistics were used to determine whether a consensus was achieved. RESULTS Ten content experts completed the three-round modified Delphi survey. Consensus was achieved for 98% of the items related to the hospitalized patient, ambulatory care management, and drug therapy. Some of these items are not included in the ESPEN guidelines for IF, but we considered that they are relevant in our clinical practice, like the calculation of fluids for patients with very low body weight, screening for refeeding syndrome and the use of some conventional drugs to promote intestinal rehabilitation. CONCLUSIONS Using a three-round modified Delphi process, consensus was achieved for nearly all items. This represents a starting point for the improvement of our local practices towards this complex disease, leading to better outcomes and the implementation of evidence-based protocolized interventions which can have an important impact due to the lack of access to some of the most novel pharmacological therapies like the glucagon-like-peptide (GLP-2) analog.
Collapse
Affiliation(s)
- Ximena Rosas-Flota
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Universidad Nacional Autónoma de México, Facultad de Medicina, Div. Estudios de Posgrado, Mexico.
| | - Lilia Castillo-Martínez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ana L Reyes-Ramírez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| |
Collapse
|
12
|
Palmer LB, Limketkai BN. Modern Challenges to Gastrointestinal Nutrition Physicians and the Nutrition Support Team: Cautionary Tales and Call to Action. Nutr Clin Pract 2020; 35:855-859. [PMID: 32786094 DOI: 10.1002/ncp.10552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The current climate of healthcare economics in the United States has imposed unprecedented market stressors on health institutions traditionally providing tertiary care to those with the most challenging healthcare needs. In such a stressed financial atmosphere, administrators look to streamline costs and cut margins as tightly as possible. This often results in restructuring, consolidating, or closing service lines that are perceived as unprofitable or unsupportable. Nutrition support often falls into this category because of few sources of direct revenue-generating activities and poor reimbursement from third-party payers. This article discusses the challenges to modern nutrition support teams, particularly those with gastroenterologists as physician leaders, and delineates market forces that need shifting to continue to make this a viable part of the healthcare system.
Collapse
Affiliation(s)
- Lena B Palmer
- Director of Clinical Nutrition, Department of Medicine, Division of Gastroenterology, Southeast Louisiana Veterans Affairs Health Care System, New Orleans, Louisiana, USA
| | - Berkeley N Limketkai
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
13
|
Zarei-Shargh P, Yuzbashian E, Mehdizadeh-Hakkak A, Khorasanchi Z, Norouzy A, Khademi G, Imani B. Impact of Nutrition Support Team on Postoperative Nutritional Status and Outcome of Patients with Congenital Gastrointestinal Anomalies. Middle East J Dig Dis 2020; 12:116-122. [PMID: 32626565 PMCID: PMC7320989 DOI: 10.34172/mejdd.2020.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome. METHODS A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs. RESULTS Median weight gain and the amount of calorie delivered during NICU stay in subjects of NSTsupported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant. CONCLUSION NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.
Collapse
Affiliation(s)
- Parisa Zarei-Shargh
- Department of Nutrition, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Emad Yuzbashian
- Student Research Committee, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atieh Mehdizadeh-Hakkak
- Student Research Committee, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Khorasanchi
- Student Research Committee, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- Biochemistry and Nutrition Research Center and Department of Nutrition, Mashhad University of Medical Sciences, Mashad, Iran
| | - Gholamreza Khademi
- Department of Pediatrics, Mashhad University of Medical Science, Mashhad, Iran
| | - Bahareh Imani
- Department of Pediatrics, Mashhad University of Medical Science, Mashhad, Iran
| |
Collapse
|
14
|
Barrocas A. Demonstrating the Value of the Nutrition Support Team to the C-Suite in a Value-Based Environment: Rise or Demise of Nutrition Support Teams? Nutr Clin Pract 2020; 34:806-821. [PMID: 31697446 DOI: 10.1002/ncp.10432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Nutrition support teams (NSTs) in the United States have had to justify their existence since their inception in the 1970s. Concomitant with those efforts, changes in healthcare financing have challenged hospital administrators to adapt their reimbursement strategies and methods. NSTs, if they are to survive and/or thrive, must be aware of the convulsive currents of change faced by those who determine which programs move downstream and which find their demise on the banks of the stream. This review provides a historical perspective of both the US healthcare financing system and the NST experiences of nutrition clinicians over the past 4 decades. Focused discussions of 5 teams are provided from individual members of those varied NSTs. Additional recommendations from the administrative side of the equation are presented by 3 administrators. Whether NSTs will "rise or demise" depends on many factors. Understanding what those who control the purse strings are seeking in terms of salutary cost and quality outcomes in the current value-based system will facilitate the NST's communication with them. The demonstration of the NST's value is more likely to succeed when bolstered by current evidence-based data as applied to the specific institution. These efforts can be carried out by a formal NST in larger or academic institutions or a "virtual" team with a single individual coordinating the services in a transdisciplinary fashion, employing the acronym ACT (accountability, communication, [transdisciplinary] teamwork).
Collapse
Affiliation(s)
- Albert Barrocas
- WellStar Atlanta Medical Center, Atlanta, Georgia, USA.,Tulane School of Medicine, New Orleans, Louisiana, USA.,ALMA, LLC, Atlanta, Georgia, USA
| |
Collapse
|
15
|
Mistiaen P, Van den Heede K. Nutrition Support Teams: A Systematic Review. JPEN J Parenter Enteral Nutr 2020; 44:1004-1020. [PMID: 32181928 DOI: 10.1002/jpen.1811] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition. METHODS Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses. RESULTS The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use. CONCLUSION Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.
Collapse
|
16
|
Reber E, Strahm R, Bally L, Schuetz P, Stanga Z. Efficacy and Efficiency of Nutritional Support Teams. J Clin Med 2019; 8:jcm8091281. [PMID: 31443543 PMCID: PMC6780521 DOI: 10.3390/jcm8091281] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023] Open
Abstract
Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients’ quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient’s individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.
Collapse
Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
| | - Rachel Strahm
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Philipp Schuetz
- Department of Medical University, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
- Department for Clinical Research, Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| |
Collapse
|
17
|
Meyer M, Hartwell J, Beatty A, Cattell T. Creation of a Virtual Nutrition Support Team to Improve Quality of Care for Patients Receiving Parenteral Nutrition in a Multisite Healthcare System. Nutr Clin Pract 2019; 34:881-886. [PMID: 31342581 DOI: 10.1002/ncp.10375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Parenteral nutrition (PN) is a complicated therapy in which having specially trained clinicians can provide benefit, but it can be difficult to provide this level of expertise to all patients requiring PN. Creation of a virtual nutrition support team (NST) model allows patients across multiple hospitals to receive care from NST clinicians using remote conferencing technology on a daily basis. This study reviewed retrospective data from before and after implementation of the virtual model to assess quality indicators. METHODS The NST was developed including a team of dietitians and pharmacists with a physician medical director. Practice guidelines were developed to provide consistent methods for ordering and monitoring patients receiving PN. Patient charts in both the preintervention and postintervention groups were reviewed for indication for PN, duration of therapy, blood glucose levels, and demographic data. RESULTS A greater proportion of patients in the postintervention period had appropriate orders (97.2%) compared with patients in the preintervention period (58.9%) (P < 0.001). A greater proportion of patients in the postintervention period had blood glucose levels within the range 65-180 mg/dL (83.5%) compared with patients in the preintervention period (62.2%) (P < 0.001). CONCLUSION A virtual team model was applied to remotely manage patients receiving PN in a large healthcare system. This resulted in optimized care of patients by reducing inappropriately prescribed therapy and improving blood glucose control.
Collapse
Affiliation(s)
- Michelle Meyer
- Grant Medical Center, OhioHealth Columbus, Columbus, Ohio, USA
| | - Jennifer Hartwell
- Grant Medical Center, Indiana University School of Medicine/Methodist Hospital, OhioHealth Columbus, Indianapolis, Indiana, USA
| | - Amy Beatty
- OhioHealth Columbus, Columbus, Ohio, USA
| | - Theresa Cattell
- Riverside Methodist Hospital, OhioHealth Columbus, Columbus, Ohio, USA
| |
Collapse
|
18
|
Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Holcombe B. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 2018; 33:906-920. [DOI: 10.1002/ncp.10204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Andrew Ukleja
- Beth Israel Deaconess Medical Center; Division of Gastroenterology; Boston Massachusetts USA
| | - Karen Gilbert
- Thomas Jefferson University Hospital; Philadelphia Pennsylvania USA
| | - Kris M. Mogensen
- Department of Nutrition; Brigham and Women's Hospital; Boston Massachusetts USA
| | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center; Houston Texas USA
| | | | - Joe Ybarra
- Medical City McKinney; McKinney Texas USA
| | - Beverly Holcombe
- American Society for Parenteral and Enteral Nutrition; Silver Spring Maryland USA
| | | |
Collapse
|
19
|
Boeykens K, Van Hecke A. Advanced practice nursing: Nutrition Nurse Specialist role and function. Clin Nutr ESPEN 2018; 26:72-76. [DOI: 10.1016/j.clnesp.2018.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/08/2018] [Accepted: 04/20/2018] [Indexed: 01/10/2023]
|
20
|
Lopes MCBR, Ceniccola GD, Araújo WMC, Akutsu R. Nutrition support team activities can improve enteral nutrition administration in intensive care units. Nutrition 2018; 57:275-281. [PMID: 30219684 DOI: 10.1016/j.nut.2018.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/26/2018] [Accepted: 04/08/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of the nutritional support team (NST) activities on the quality of enteral nutrition administration in intensive care units. METHODS An observational, analytical, and cross-sectional study was performed in nine hospitals in the Brazilian Federal District through the administration of two questionnaires. One questionnaire focused on the activities of the NST and the other on the quality of enteral nutrition administration in intensive care units. RESULTS There was a strong correlation between the scores of the two questionnaires, which was confirmed by a linear regression model (R2 = 0.623; P = 0.007). The results suggest that high scores in the NST activities questionnaire predict a better performance in enteral nutrition administration. The sections of the NST activity questionnaire that most strongly affected enteral nutrition administration were the protocols (r = 0.895; P < 0.01), quality control (r = 0.779; P < 0.05), and continuing education (r = 0.753; P < 0.05). CONCLUSIONS The NST has the potential to positively influence enteral nutrition management in intensive care units and investments could be directed to the areas of continuing education, protocols, and quality control to maximize the effect of NST in intensive care units.
Collapse
Affiliation(s)
- Martina Celi Bandeira Rufino Lopes
- Universidade de Brasília, Departamento de Nutrição. Campus Universitário Darcy Ribeiro, Brasília, Brasil; Hospital Regional de Ceilândia, Brasil.
| | - Guilherme Duprat Ceniccola
- Hospital de Base do Distrito Federal, Residência multiprofissional em terapia intensive, SMHS - Área Especial, Brasília, Brasil
| | - Wilma Maria Coelho Araújo
- Universidade de Brasília, Departamento de Nutrição. Campus Universitário Darcy Ribeiro, Brasília, Brasil
| | - Rita Akutsu
- Universidade de Brasília, Departamento de Nutrição. Campus Universitário Darcy Ribeiro, Brasília, Brasil
| |
Collapse
|
21
|
Braun K, Utech A, Velez ME, Walker R. Parenteral Nutrition Electrolyte Abnormalities and Associated Factors Before and After Nutrition Support Team Initiation. JPEN J Parenter Enteral Nutr 2018; 42:387-392. [PMID: 29443393 DOI: 10.1177/0148607116673186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/02/2016] [Indexed: 10/13/2023]
Abstract
BACKGROUND Studied since the 1940s, refeeding syndrome still has no universal definition, thus making comparison of studies difficult. Negative outcomes (eg, metabolic abnormalities) may occur with the use of specialized nutrition, such as parenteral nutrition (PN). Less than half of medical institutions have a nutrition support team (NST) managing PN. Interdisciplinary team management of PN may reduce negative outcomes of PN. The objective of this study was to show the value of the NST by measuring differences in PN variables, especially electrolyte abnormalities (EAs), before and after NST initiation at a large medical center and to identify factors associated with EAs among adult subjects receiving PN. MATERIALS AND METHODS During this retrospective study, computerized medical charts (N = 735) from 2007-2010 were reviewed for electrolyte changes (particularly potassium, magnesium, and phosphorus) the first 3 days following PN initiation in hospitalized adults. Changes in EAs with other variables were compared before and after NST implementation. Equivalent samples sizes were collected to better evaluate the impact of the team. RESULTS Following the implementation of the NST, fewer EAs were seen in PN patients (53%; χ2 = 10.906, P = .004); significantly less potassium, phosphorus, and magnesium intravenous piggyback supplementation (88.8% vs 94%; χ2 = 5.05, P = .026) was used; and mortality within 30 days of PN cessation was significantly less (12.7% vs 10.6%, P = .012). CONCLUSION Our study complements existing research, finding that an NST was associated with a decreased occurrence of EAs and mortality in the hospitalized adult receiving PN.
Collapse
Affiliation(s)
- Katie Braun
- Michael E. DeBakey Medical Center, Houston, Texas, USA
| | - Anne Utech
- Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Maria Eugenia Velez
- Michael E. DeBakey Medical Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Renee Walker
- Michael E. DeBakey Medical Center, Houston, Texas, USA
| |
Collapse
|
22
|
Mehta Y, Sunavala JD, Zirpe K, Tyagi N, Garg S, Sinha S, Shankar B, Chakravarti S, Sivakumar MN, Sahu S, Rangappa P, Banerjee T, Joshi A, Kadhe G. Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2018; 22:263-273. [PMID: 29743765 PMCID: PMC5930530 DOI: 10.4103/ijccm.ijccm_3_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Aim: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Methods: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.
Collapse
Affiliation(s)
- Yatin Mehta
- Department of Critical Care, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - J D Sunavala
- Department of Critical Care Medicine, Jaslok Hospital, Mumbai, India
| | - Kapil Zirpe
- Department of Critical Care Medicine, Intensive Care and Neurotrauma - Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Niraj Tyagi
- Department of Intensive Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Sunil Garg
- Department of Critical Care Medicine, Max Hospital, New Delhi, India
| | - Saswati Sinha
- Department of Critical Care Medicine, AMRI Hospitals, Kolkata, West Bengal, India
| | | | - Sanghamitra Chakravarti
- Department of Nutrition and Dietetics, Medica Superspeciality Hospital, Kolkata, West Bengal, India
| | - M N Sivakumar
- Department of Critical Care Medicine, KMCH, Coimbatore, Tamil Nadu, India
| | - Sambit Sahu
- Department of Critical care Medicine, KIMS Hospital, Hyderabad, Telangana, India
| | - Pradeep Rangappa
- Department of Intensive Care Medicine, Columbia Asia Hospitals, Bengaluru, Karnataka, India
| | - Tanmay Banerjee
- Department of Intensive Care Medicine, Medica Institute of Critical Care, Medica Super speciality Hospital, Kolkata, West Bengal, India
| | - Anshu Joshi
- Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, India
| | - Ganesh Kadhe
- Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, India
| |
Collapse
|
23
|
Safarian M, Taghipour A, Norouzy A, Mozhdehifard M, Pouryazdanpanah M. Development and validation of a questionnaire to evaluate the state of Iranian hospital nutrition support. Electron Physician 2017; 9:6043-6049. [PMID: 29560158 PMCID: PMC5843432 DOI: 10.19082/6043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022] Open
Abstract
Background Recently, nutrition support was implemented as a part of clinical services in hospitals. The implementation of nutrition support needs to be assessed for its improvement. Objective This study aimed to develop and validate a questionnaire to assess the state of nutrition support in Iranian hospitals. Methods A mixed method approach was used in this study. This study was performed in training hospitals of Iran in 2016. In the development stage, pre-determined keywords were searched on international electronic databases. Additionally, semi-structural interviews were performed with 13 key informants based on purposive sampling. Themes were extracted from articles and interviews by thematic analysis. A primary questionnaire was generated based on extracted themes. In the validating stage, the content validity ratio (CVR) and content validity index (CVI) were used. The reliability of the questionnaire was also computed through a pilot study using Cronbach’s alpha test. SPSS version 16.0 was used for data analysis. Results Based on 16 items elicited from the content analysis, 110 questions were generated, out of which, 65 questions were selected. Then, 55 questions showing acceptable CVI and CVR were chosen for the pilot study. The Cronbach’s alpha coefficient of the questionnaire was found to be 0.80. This value remained stable for each item, even after an item was deleted. Conclusion For the first time, a validated questionnaire for the assessment of the state of nutrition support in hospitals was developed in a methodological approach process with high validity and reliability indexes which intended to be comprehensive based on the mixed method approach.
Collapse
Affiliation(s)
- Mohammad Safarian
- MD., Ph.D. of Clinical Nutrition, Associate Professor, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- MD., Ph.D. of Epidemiology, Associate Professor, Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- MD., Ph.D. of Clinical Nutrition, Associate Professor, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Mozhdehifard
- DDS., Ph.D. Candidate in health policy, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Pouryazdanpanah
- MD-Ph.D. Candidate in Nutrition, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
24
|
Park YE, Park SJ, Park Y, Cheon JH, Kim TI, Kim WH. Impact and outcomes of nutritional support team intervention in patients with gastrointestinal disease in the intensive care unit. Medicine (Baltimore) 2017; 96:e8776. [PMID: 29245235 PMCID: PMC5728850 DOI: 10.1097/md.0000000000008776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nutritional support has become an important intervention for critically ill patients. Many studies have reported on the effects of nutritional support for the patients within the intensive care unit (ICU); however, no studies have specifically assessed patients with gastrointestinal diseases who may have difficulty absorbing enteral nutrition (EN) in the ICU.Sixty-two patients with gastrointestinal disease were admitted to the ICU between August 2014 and August 2016 at a single tertiary university hospital. We analyzed 2 different patient groups in a retrospective cohort study: those who received nutritional support team (NST) intervention and those who did not.Forty-four (71.0%) patients received nutritional support in ICU and 18 (29.0%) did not. Variables including male sex, high albumin or prealbumin level at the time of ICU admission, and short transition period into EN showed statistically significant association with lower mortality on the univariate analysis (all P < .05). Multivariate analysis revealed that longer length of hospital stay (P = .013; hazard ratio [HR], 0.972; 95% confidence interval [CI], 0.951-0.994), shorter transition into EN (P = .014; HR, 1.040; 95% CI, 1.008-1.072), higher prealbumin level (P = .049; HR, 0.988; 95% CI, 0.976-1.000), and NST intervention (P = .022; HR, 0.356; 95% CI, 0.147-0.862) were independent prognostic factors for lower mortality.In conclusion, NST intervention related to early initiated EN, and high prealbumin levels are beneficial to decrease mortality in the acutely ill patients with GI disease.
Collapse
Affiliation(s)
| | - Soo Jung Park
- Department of Internal Medicine
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yehyun Park
- Department of Internal Medicine
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hee Cheon
- Department of Internal Medicine
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Il Kim
- Department of Internal Medicine
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Internal Medicine
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
25
|
Affiliation(s)
- Christopher P Duggan
- From the Center for Advanced Intestinal Rehabilitation (C.P.D., T.J.), Division of Gastroenterology, Hepatology, and Nutrition (C.P.D.), and the Department of Surgery (T.J.), Boston Children's Hospital and Harvard Medical School, Boston
| | - Tom Jaksic
- From the Center for Advanced Intestinal Rehabilitation (C.P.D., T.J.), Division of Gastroenterology, Hepatology, and Nutrition (C.P.D.), and the Department of Surgery (T.J.), Boston Children's Hospital and Harvard Medical School, Boston
| |
Collapse
|
26
|
Arenas Moya D, Plascencia Gaitán A, Ornelas Camacho D, Arenas Márquez H. Hospital Malnutrition Related to Fasting and Underfeeding: Is It an Ethical Issue? Nutr Clin Pract 2017; 31:316-24. [PMID: 27208012 DOI: 10.1177/0884533616644182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospital malnutrition is a relevant clinical issue present in about 50% of patients that is associated with increased morbidity, mortality, and cost of care. Because of the relation of malnutrition with chronic and acute inflammatory processes secondary to disease, nutrition therapy is considered an important medical treatment. However, there is little discussion about the impact of another critical issue related to hospital malnutrition, that is, lack of appropriate food or nutrition therapy given to the patients. Unnecessary fasting practices and the use of inappropriate nutrition prescriptions result in underfeeding that can be a related or direct cause of hospital malnutrition, independent of disease or inflammatory state. Suboptimal prescription of oral, enteral, and parenteral nutrition should be analyzed and discussed from an ethical perspective since this practice has the potential to harm patients. In addition, absence or inadequate provision of nutrition may present barriers for improved patient outcomes and could be prevented by simply recognizing lack of knowledge, skills, or experience in nutrition and entrusting nutrition prescription to interdisciplinary teams with clinicians well prepared in nutrition sciences. This article reviews potential barriers to the prevention or treatment of hospital malnutrition and proposes specific actions that can help clinicians to overcome and implement optimal nutrition not just as medical therapy but also as a basic comfort care that may help patients nutritionally, clinically, physically, and emotionally.
Collapse
|
27
|
Ceniccola GD, Araújo WM, de Brito-Ashurst I, Abreu HB, Akutsu RDC. Protected time for nutrition support teams: What are the benefits? Clin Nutr ESPEN 2016; 16:36-41. [DOI: 10.1016/j.clnesp.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/10/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
|
28
|
Chang DK, Song GA. [Understanding Nutritional Support in Digestive Diseases]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:333-5. [PMID: 26087686 DOI: 10.4166/kjg.2015.65.6.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The prevalence of hospital malnutrition is still high in patients with digestive diseases, especially for those suffering from cancer and bowel diseases which cause malabsorption. It is well known that malnutrition is associated with delayed wound healing, impaired immunity, infection, increased complication, and poor convalenscence. Recently, nutrition screening and assessment by nutrition support team has become essential for nutrition management, and gastroenterologists comprise a dominant member of the nutrition support team. In critically ill patients and older people with chronic disease, nutritional support with enteral feeding and early feeding contributes to recovery and rehabilitation of patients. Securing enteral feeding routes, such as feeding tube insertion and placement of percutaneous endoscopic gastrostomy/jejunostomy, is an essential part of nutrition care that should be accomplished by gastroenterologists without much difficulty. It will also be necessary to recommend nutrition care as one of the clinical routines in gastrointestinal clinical practices. Therefore, education on nutrition care is strongly required as a part of gastroenterologist's training.
Collapse
Affiliation(s)
- Dong Kyung Chang
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geun Am Song
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan , Korea
| |
Collapse
|
29
|
Park YH, Park SJ. [Organization and the Role of Nutirition Support Team]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:342-5. [PMID: 26087688 DOI: 10.4166/kjg.2015.65.6.342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
With the development of specialized nutrition therapy and the need for interdisciplinary approach, nutrition support teams (NSTs) were created to optimize effectiveness and safety of nutritional therapy. NSTs are interdisciplinary support teams with specialty training in nutrition that are typically comprised of physicians, dietitians, nurses, pharmacists, and others. Their role includes nutrition screening, assessment, determination of nutrition needs, recommendations for appropriate nutrition therapy, management of nutrition support therapy, and monitoring. Studies have demonstrated significant improvements in patient nutrition status and improved clinical outcomes as well as reductions in costs when patients were appropriately managed by NSTs. Organization and the role of NSTs are discussed in this review.
Collapse
Affiliation(s)
- Ye Hyun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
30
|
Karim SA, Ibrahim B, Tangiisuran B, Davies JG. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. JPEN J Parenter Enteral Nutr 2015; 39:482-488. [PMID: 24590009 DOI: 10.1177/0148607114525209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/02/2014] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. METHODS A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. RESULT Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the "average" score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. CONCLUSION Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.
Collapse
Affiliation(s)
- Sarah A Karim
- Pharmacy Department, Penang General Hospital, Pulau Pinang, Malaysia
| | - Baharudin Ibrahim
- Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia
| | - Balamurugan Tangiisuran
- Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia
| | - J Graham Davies
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| |
Collapse
|
31
|
Shiroma GM, Horie LM, Castro MG, Martins JR, Bittencourt AF, Logullo L, Teixeira da Silva MDL, Waitzberg DL. Nutrition Quality Control in the Prescription and Administration of Parenteral Nutrition Therapy for Hospitalized Patients. Nutr Clin Pract 2015; 30:406-13. [DOI: 10.1177/0884533614567540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Dan L. Waitzberg
- GANEP, Hospital Beneficência Portuguesa, São Paulo, Brazil
- Gastroenterology Department, School of Medicine of University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
32
|
Composition of personalized and standard nutritional mixtures in patients on home parenteral nutrition. Eur J Clin Nutr 2014; 68:433-6. [DOI: 10.1038/ejcn.2014.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/20/2013] [Accepted: 01/01/2014] [Indexed: 11/08/2022]
|
33
|
Quality control of parenteral nutrition in hospitalized patients. Nutrition 2014; 30:165-8. [DOI: 10.1016/j.nut.2013.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022]
|
34
|
Matarese LE, Jeppesen PB, O’Keefe SJD. Short Bowel Syndrome in Adults. JPEN J Parenter Enteral Nutr 2014; 38:60S-64S. [DOI: 10.1177/0148607113518946] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Laura E. Matarese
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, East Carolina University, Greenville, North Carolina, USA
| | - Palle B. Jeppesen
- Department of Medical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Stephen J. D. O’Keefe
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
35
|
|
36
|
Santarpia L, Pagano MC, Pasanisi F, Contaldo F. Home artificial nutrition: an update seven years after the regional regulation. Clin Nutr 2013; 33:872-8. [PMID: 24182767 DOI: 10.1016/j.clnu.2013.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 08/10/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Home Artificial Nutrition (HAN) is a well established extra-hospital therapy, contributing to decreased health care costs, by reducing the number and length of hospitalizations. The knowledge of the epidemiology of HAN helps plan health-care funding and in analyze the factors that can improve HAN service. SUBJECTS AND METHODS An update on the prevalence of Home Artificial Nutrition (HAN) in the Campania region (Southern Italy) and patients clinical characteristics has been regularly carried out in the past seven years after a specific regional regulation issued in 2005. RESULTS Total number of patients on HAN has increased from 355 in April 2005 to 1165 in April 2012 (+228.2%); in particular, patients on Home Parenteral Nutrition (HPN) increased from 156 in April 2005 to 306 in April 2012 (+96.2%) and patients on Home Enteral Nutrition (HEN) from 199 to 838 (+321.1%) respectively. HEN/HPN ratio in adults has changed from 1.3/1 in April 2005 to 2.7/1 in April 2012, gradually nearing the expected national mean ratio of 5/1 as observed in the 2005 national survey. CONCLUSIONS The specific regional regulation in Campania has contributed to increase the prescription of HAN and to ameliorate its indications; in particular, through the years, HEN is gradually nearing national standards.
Collapse
Affiliation(s)
- Lidia Santarpia
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
| | - Maria Carmen Pagano
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Fabrizio Pasanisi
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Franco Contaldo
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| |
Collapse
|
37
|
Guenter P. Nutrition support clinicians: needed now more than ever. Nutr Clin Pract 2013; 28:541-2. [PMID: 23969267 DOI: 10.1177/0884533613499376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peggi Guenter
- Peggi Guenter, American Society for Parenteral and Enteral Nutrition, 8601 Fenton Ave. Suite 412, Silver Spring, MD 20910, USA.
| |
Collapse
|
38
|
Hamilton C, Boyce VJ. Addressing Malnutrition in Hospitalized Adults. JPEN J Parenter Enteral Nutr 2013; 37:808-15. [DOI: 10.1177/0148607113497224] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
39
|
Rosen BS, Maddox PJ, Ray N. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition. JPEN J Parenter Enteral Nutr 2013; 37:796-801. [PMID: 23765065 DOI: 10.1177/0148607113492337] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.
Collapse
Affiliation(s)
- Barry S Rosen
- Departments of Surgery and Hospital Administration, Advocate Good Shepherd Hospital, Barrington, Illinois
| | | | | |
Collapse
|
40
|
Corkins MR, Griggs KC, Groh-Wargo S, Han-Markey TL, Helms RA, Muir LV, Szeszycki EE. Standards for Nutrition Support. Nutr Clin Pract 2013; 28:263-76. [DOI: 10.1177/0884533613475822] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mark R. Corkins
- University of Tennessee Memphis Children’s Medical Center, Tennessee
| | | | - Sharon Groh-Wargo
- University of Tennessee Memphis Children’s Medical Center, Tennessee
| | | | - Richard A. Helms
- University of Tennessee Memphis Children’s Medical Center, Tennessee
| | - Linda V. Muir
- University of Tennessee Memphis Children’s Medical Center, Tennessee
| | | | | |
Collapse
|
41
|
Abstract
BACKGROUND/OBJECTIVES The practice of home enteral nutrition (HEN) represents a relevant aspect of the clinical management of both malnourished children and well-nourished children unable to be fed using an oral diet. The aim of this study was to estimate in an Italian paediatric population over a 14-year period (1996-2009), the clinical relevance and results over time of HEN activity. SUBJECTS/METHODS HEN-computerized database and medical/dietetic charts were evaluated for patients aged at start of HEN <18 years and HEN duration >1 month. RESULTS During the study period, we recorded 757 HEN programs. HEN began at a median age of 2 years for a median duration of 8.1 months. The complication rate was 14.8%. In the second period of the survey (2003-2009), the main changes concerned the underlying diseases requiring HEN, choice of formula feeding and access route. In 2009, the estimated overall prevalence of HEN was 3.47 and the incidence 2.45 per 100 000 inhabitants from 0 to 18 years of age. CONCLUSIONS The epidemiological data of this study demonstrate that HEN concerns a growing number of Italian children and families. Some aspects of HEN clinical management should be modified to reach the recommended standards.
Collapse
|
42
|
Mascarenhas MR, August DA, DeLegge MH, Gramlich L, Iyer K, Patel V, Schattner MA. Standards of Practice for Nutrition Support Physicians. Nutr Clin Pract 2012; 27:295-9. [DOI: 10.1177/0884533612438286] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - David A. August
- The Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Mark H. DeLegge
- Baxter Healthcare Corporation, Deerfield, Illinois, and Medical University of South Carolina, Charleston, South Carolina
| | - Leah Gramlich
- University of Alberta, Royal Alexandra Hospital, Edmonton, Canada
| | - Kishore Iyer
- Mount Sinai School of Medicine, New York, New York
| | - Vihas Patel
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | |
Collapse
|
43
|
Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Ukleja A, Freeman KL, Gilbert K, Kochevar M, Kraft MD, Russell MK, Shuster MH. Standards for nutrition support: adult hospitalized patients. Nutr Clin Pract 2011; 25:403-14. [PMID: 20702847 DOI: 10.1177/0884533610374200] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
45
|
McClave SA, Mechanick JI, Bistrian B, Graham T, Hegazi R, Jensen GL, Kushner RF, Merritt R. What is the Significance of a Physician Shortage in Nutrition Medicine? JPEN J Parenter Enteral Nutr 2010; 34:7S-20S. [DOI: 10.1177/0148607110375429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen A. McClave
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | | | | | - Toby Graham
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Robert F. Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | |
Collapse
|