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Cárdenas D, Davisson Correia MIT, Hardy G, Ochoa JB, Barrocas A, Hankard R, Hannequart I, Schneider S, Bermúdez C, Papapietro K, Pounds T, Cuerda C, Ungpinitpong W, Toit A, Barazzoni R. Nutritional care is a human right: Translating principles to clinical practice. Nutr Clin Pract 2022; 37:743-751. [DOI: 10.1002/ncp.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diana Cárdenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism El Bosque University Bogotá Colombia
| | | | - Gil Hardy
- Ipanema Research Trust Auckland New Zealand
| | - Juan B. Ochoa
- Critical Care Medicine Hunterdon Medical Center Hunterdon New Jersey USA
| | | | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food University of Tours Tours France
| | | | - Stéphane Schneider
- Nutrition Support Unit, Gastroenterology and Nutrition Department Archet University Hospital Nice France
| | - Charles Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country Bogotá Colombia
| | - Karin Papapietro
- Nutrition Unit Hospital Clínico de la Universidad de Chile Santiago Chile
| | - Teresa Pounds
- Department of Pharmacy Wellstar Atlanta Medical Center Atlanta Georgia USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina Universidad Complutense Madrid Spain
| | | | | | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste Ospedale di Cattinara Trieste Italy
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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Thurston MM, Liao TV, Lim T, Pounds T, Moye‐Dickerson PM. Utilization of a multidisciplinary team to reduce the rate of hospital readmissions in high‐risk heart failure patients at a community teaching hospital: The pharmacist's role in transitions of care. J Am Coll Clin Pharm 2019. [DOI: 10.1002/jac5.1072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maria M. Thurston
- Department of Pharmacy Practice, College of Pharmacy Mercer University Atlanta Georgia
| | - Tze‐chun Vivian Liao
- Department of Pharmacy Practice, College of Pharmacy Mercer University Atlanta Georgia
| | - Tanna Lim
- Department of Internal Medicine WellStar Atlanta Medical Center Atlanta Georgia
| | - Teresa Pounds
- Department of Clinical Pharmacy WellStar Atlanta Medical Center Atlanta Georgia
| | - Pamela M. Moye‐Dickerson
- Department of Pharmacy Practice, College of Pharmacy Mercer University Atlanta Georgia
- Department of Clinical Pharmacy WellStar Atlanta Medical Center Atlanta Georgia
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Moye PM, Chu PS, Pounds T, Thurston MM. Impact of a pharmacy team–led intervention program on the readmission rate of elderly patients with heart failure. Am J Health Syst Pharm 2018; 75:183-190. [DOI: 10.2146/ajhp170256] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose
The results of a study to determine whether pharmacy team–led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported.
Methods
A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013–June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014–October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students.
Results
Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85).
Conclusion
In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team–led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.
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Affiliation(s)
- Pamela M. Moye
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA
- Wellstar Atlanta Medical Center, Atlanta, GA
| | | | | | - Maria Miller Thurston
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA
- Wellstar Atlanta Medical Center, Atlanta, GA
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Osburne RC, Cook CB, Stockton L, Baird M, Harmon V, Keddo A, Pounds T, Lowey L, Reid J, McGowan KA, Davidson PC. Improving Hyperglycemia Management in the Intensive Care Unit. Diabetes Educ 2016; 32:394-403. [PMID: 16772655 DOI: 10.1177/0145721706288072] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose The purpose of this study was to assess the feasibility of a nurse-driven effort to improve hyperglycemia management in the intensive care unit (ICU) setting. Methods The setting was the ICU of a large urban hospital. The program was composed of 3 components: nurses as leaders, a clinical pathway to identify patients in need of hyperglycemia therapy, and implementation of a redesigned insulin infusion algorithm (the Columnar Insulin Dosing Chart). Time to reach a target glucose range of 80 to 110 mg/dL (4.4-6.1 mmol/L) was evaluated. Results One hundred sixteen ICU nurses were trained in the project. The Columnar Insulin Dosing Chart was applied to 20 patients. The average time required to reach the target blood glucose range was 12.8 hours. Below-target blood glucose levels were 6.9% of all blood glucose levels recorded, but only 0.9% were below 60 mg/dL (3.3 mmol/L). There was no sustained hypoglycemia, and no persistent clinical findings attributable to hypoglycemia were noted. Barriers to implementing the project included an increased nursing workload, the need for more finger-stick blood glucose monitors, and the need to acquire new finger-lancing devices that allowed for shallower skin puncture and increased patient comfort. Conclusions Tighter glycemic control goals can be attained in a busy ICU by a nurse-led team using a pathway for identifying and treating hyperglycemia, clear decision support tools, and adequate nurse education. The novel chart based insulin infusion algorithm chosen as the standard for this pilot was an effective tool for reducing the blood glucose to target range with no clinically significant hypoglycemia.
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Affiliation(s)
- Robert C Osburne
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | | | | | | | - Valerie Harmon
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Annie Keddo
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Teresa Pounds
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Linda Lowey
- The Atlanta Medical Center, Atlanta, Georgia (Dr Osburne, Ms Harmon, Ms Keddo, Dr Pounds, Ms Lowey)
| | - Joyce Reid
- Georgia Hospital Association, Marietta (Ms Reid, Ms McGowan)
| | | | - Paul C Davidson
- Atlanta Diabetes Associates, Atlanta, Georgia (Dr Davidson), for the Georgia Hospital Association Diabetes Special Interest Group
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Bach Q, Lovett A, Pounds T, Moye P. Pharmacy Practice Model Initiative: Case Studies in Health-System Pharmacy. app 2014. [DOI: 10.13189/app.2014.020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pounds T, Lovett A, Eng S, Iqbal K, Orija I, Chmielewski J. Evaluation of Efficacy and Safety of Premixed Parenteral Nutrition versus Customized Parenteral Nutrition in a Large Teaching Hospital. app 2013. [DOI: 10.13189/app.2013.010204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Walker ML, Owen PS, Sampson C, Marshall J, Pounds T, Henderson VJ. Incidence and Outcomes of Critical Illness-Related Corticosteroid Insufficiency in Trauma Patients. Am Surg 2011. [DOI: 10.1177/000313481107700517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline Cortisol levels (mean 56 ± 84 vs 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.
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Affiliation(s)
- Mark L. Walker
- Department of Surgery, Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia
| | - Phillip S. Owen
- Department of Pharmacy Practice, Mercer College of Pharmacy and Health Sciences, Department of Pharmacy, Atlanta Medical Center, Atlanta, Georgia
| | - Candace Sampson
- Department of Pharmacy Practice, Hampton University, Hampton, Virginia
| | - Janene Marshall
- Department of Pharmacy Practice, Chicago State University College of Pharmacy, Chicago, Illinois
| | - Teresa Pounds
- Clinical Pharmacy Services, Department of Pharmacy, Atlanta Medical Center, Mercer College of Pharmacy and Health Sciences, Atlanta, Georgia
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Walker ML, Owen PS, Sampson C, Marshall J, Pounds T, Henderson VJ. Incidence and outcomes of critical illness-related corticosteroid insufficiency in trauma patients. Am Surg 2011; 77:579-585. [PMID: 21679591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline cortisol levels (mean 56 ± 84 vs. 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs. 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.
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Affiliation(s)
- Mark L Walker
- Department of Surgery, Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia, USA.
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