Enteral Tube Feeding Research Articles

Assessing the Rate of inappropriately Crushed Medications in Skilled Nursing Facilities.

Purpose: Evaluate the impact of senior care pharmacists' medication management when a Do Not Crush (DNC) list is used to identify patients inappropriately receiving crushed medications. Methods: Participating senior care pharmacists retrospectively assessed skilled nursing residents with active medications on the DNC list for study inclusion. Study outcomes included assessing prevalence of residents with the inability to receive medications whole orally yet receiving DNC medication(s). Additional outcomes included prevalence rate of patients receiving DNC medications who also have enteral feeding tubing, nothing by mouth orders (NPO), or inability/unwillingness to swallow medications whole. Results: A total of 1,070 skilled nursing patients were reviewed with 778 meeting inclusion criteria. Of those 778 patients, approximately 27% were receiving inappropriately crushed medications. Of those patients, 90% warranted pharmacist intervention associated with a total of 473 medications. Females represented 67% of the patient population, and 90% of patients were 65 years of age or older. The average number of DNC medications was three per patient. The reasons for crushing medications varied. Four patients were classified as NPO, 13 had enteral feeding tubes, 130 patients could not physically swallow medications due to dysphagia, and 122 refused to receive medications whole. Conclusion: Senior care pharmacists can play an integral role in ensuring patients receive medications in accordance with manufacturer guidelines, safe medication practices, and use of alternative formulations as appropriate. The rate of inappropriately crushed medications administered in skilled nursing facilities is high at 27% in the present study. This rate could be further confounded because of the possibility of medications being crushed despite the fact that there is not an indication to do so in the patient chart.

Exploring Dietitians' Experience of Blended Tube Feed in Paediatric Inpatient Settings: National Cross-Sectional Survey, United Kingdom.

Enteral tube feeding is used for children who are unable to meet their nutritional requirements orally. Gastrointestinal symptoms are some complications that can occur in enteral tube-fed patients. Blended tube feeds (BTFs) for children who are gastrotomy tube-fed have significantly increased in the last decade. BTF refers to homemade food that has been liquidised for enteral tube feeds. An increasing amount of evidence suggests that children on BTF have improved feed tolerance. It is unknown whether children admitted to a hospital established on a BTF can continue a BTF due to the potential barriers such as catering processes, staffing hours (limited to syringe bolus feeding) and food safety concerns. This national cross-sectional survey aimed to explore the use of BTF in a paediatric hospital setting. This was a prospective, cross-sectional, practice-based survey of registered paediatric dietitians who work in an inpatient care setting to explore the use of BTF. The final survey consisted of 13 questions and took dietitians approximately 15 min to complete. The questions focused on the dietitian's experience, knowledge and confidence in children on a BTF. Across the United Kingdom, 51 hospitals completed the survey. Of these, 16 of 19 were specialist children's hospitals (79% response rate) and 35 of 89 were general paediatric hospitals (39% response rate). All responders were paediatric dietitians. 49 of 51 (96%) dietitians knew of the British Dietetic Association (BDA) Practice Toolkit for Blended diets. Dietitians were asked to estimate on average per month how many children were admitted on a BTF; 41% (21 of 51) of dietitians reported that on average there are one to five children admitted on a BTF. There was no significant difference in the number of children admitted on a BTF between a specialist and a general children's hospital (χ2 statistic = 4.96, p value < 0.08). The number of dietitians who had clinical guidelines to support children admitted on a BTF was 49% (25 of 51). Specialist children's hospitals were more likely to have a clinical guideline compared with a general hospital (χ2 statistic = 6.348, p value = 0.01). However, only 18 of 51 (35%) dietitians reported being confident or very confident to review a child on a BTF. The most common perceived benefit was that parents/carers could incorporate family foods into their child's diet. 26% reported that a varied diet was beneficial in relation to the gut microbiome. If a BTF was contraindicated for children admitted to a hospital (immunocompromised, post-pyloric feeding or intensive care), 49 of 51 (96%) dietitians reported they would use an enteral formula with food-derived ingredients (Compleat paediatric-Nestle Health Science) as an alternative to a BTF. BTF continues to grow in popularity. Our survey reported that children on BTF are frequently admitted to the hospital. There is growing evidence to support BTF in relation to family psychosocial health and feed tolerance. Dietitians must keep abreast of this fast-evolving area practice to ensure that they are the experts in BTF. When a BTF is contraindicated, an enteral formula with food-derived ingredients is a suitable alternative. Issues such as microbial contamination, nutritional composition, and adequacy of diluted BTF need further exploration.

Malnutrition in patients with advanced head and neck cancer: Exploring the Global Leadership Initiative on Malnutrition (GLIM) criteria, energy balance and health-related quality of life.

Head and neck cancer (HNC) involves several tumor locations, the most common of which are the oropharynx and oral cavity. Patients with HNC are at high risk of developing malnutrition. Together with treatment, the tumor location contributes to difficulties in eating and swallowing, which can lead to a negative energy balance and weight loss. This study aimed to examine malnutrition via the Global Leadership Initiative on Malnutrition (GLIM) criteria, explore the different combinations of the GLIM criteria, study changes in body energy content and evaluate health-related quality of life (HRQoL) in patients with locally advanced HNC. Malnutrition was diagnosed via the GLIM criteria. Body weight, muscle mass, body fat, C-reactive protein (CRP) levels, energy intake, use of enteral feeding tubes or parenteral nutrition were assessed, and HRQoL scales from the European Organization for Research and Treatment of Cancer (EORTC), including the Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Quality of Life Questionnaire-Head and Neck 35 (QLQ-HN35), and the M.D. Anderson Dysphagia Inventory (MDADI) were completed at baseline, 6 weeks and at 3, 6 and 12 months after the start of treatment. Body composition was measured via dual-energy X-ray absorptiometry, and body energy content was calculated. Eighty patients were included. The prevalence of malnutrition varied over time and peaked at the end of treatment at 71%, and at this time, the most common combination of the GLIM criteria was weight loss + reduced food intake + inflammation (31%), followed by weight loss + reduced muscle mass + reduced food intake + inflammation (20%). At the end of treatment patients were in a negative energy balance, and compared to baseline, body weight, body fat, and muscle mass had decreased with 6.0% (p<0.0001), 5.9% (p<0.0001), and 8.0% (p<0.0001) respectively. At the 3-month follow-up, the reduction in muscle mass had ceased, despite a negative energy balance, and patients started to regain muscle mass. At 12 months body weight had decreased with 7.4% (p<0.0001), body fat with 18.9% (p<0.0001), and muscle mass with 2.4% (p<0.0001) compared to baseline. Patients with malnutrition reported significantly worse HRQoL on a majority of the 16 quality of life scales at all time points, except at the end of treatment, when no significant differences were found between malnourished and nonmalnourished patients. Patients with advanced HNC receiving combined treatment experience major nutritional problems, and malnutrition is common at the end of treatment. Inflammation-driven muscle depletion during treatment is challenging, but it seems possible to recover muscle mass after treatment. Patients with malnutrition reported worse HRQoL at all time points, except at the end of treatment, when all patients' quality of life was very negatively affected.

Best Evidence Summary of Home Enteral Tube Feeding Care Management in the Elderly.

To evaluate and summarize the best evidence of home enteral tube feeding (HETF) care management in the elderly to provide an evidence-based basis for caregivers to implement care interventions. Evidence on HETF care management in the elderly was retrieved from Chinese and international databases, guidelines, and websites of professional associations, including systematic reviews and expert consensuses, using the keywords of home enteral nutrition, home tube feeding, old, elder, home care, etc. The literature considered in this study was published from April 2019 to April 2024. Two trained researchers independently evaluated the quality of the included literature, graded the literature using the JBI evidence pre-grading system, classified and summarized the extracted evidence. A total of 15 articles were included, including 1 clinical decision, 1 guideline, 3 best evidence summaries, 4 systematic reviews, 2 randomized controlled trials, and 4 quasi-experimental studies. 18 pieces of the best evidence were summarized in 3 aspects, including the NST administration, education of caregivers, and selection of nutrition formulas. This study comprehensively summarized the best evidence of home enteral tube feeding care management in the elderly and provided a scientific basis for caregivers to implement care interventions. In home care settings, using evidence-based practices requires developing a comprehensive care management system based on the trinity of hospital, community and home, in order to reduce the incidence of HETF-related complications, improve the quality of life of the elderly with HETF, and provide a practical reference for NST members and caregivers.

Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study.

Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet. In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record. Critical weight loss (defined as >5% from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8% during radiotherapy, and an additional 2.1% at follow-up (n=48). A nasogastric feeding tube was used by 42% at the end of radiotherapy, and 29% at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27kcal/kg body weight, 7.8 vs 4.4% weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92% of the patients were malnourished at the end of treatment and 71% at follow-up (p<0.001). Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.

Nutritional interventions in randomised clinical trials for people with incurable solid cancer: A systematic review.

Malnutrition is highly prevalent in those with cancer and more so in those with incurable cancer. In incurable cancer, it is widely agreed that optimal nutritional care has the potential to positively impact patient and caregiver distress and oncological outcomes. The aim of this systematic review was to describe the diversity and frequency of nutritional interventions, whether given in isolation or as part of a multimodal intervention in those with incurable cancer, in randomised controlled trials. The secondary aims were to describe adherence and their efficacy. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following databases were searched electronically: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Central Register of Controlled Trials (CENTRAL) with the time frame from January 2000 to 7th September 2023. Eligible studies included adult patients (≥18 years) diagnosed with incurable solid cancer with a sample size ≥40. Studies were to be primary research and delivered for at least 14 days to allow for efficacy. They were to include a nutritional intervention encompassing at least one of the following: dietary counselling, oral nutritional supplements (ONS), enteral tube feeding and/or parenteral nutrition (PN), given in isolation or as part of a multi-modal intervention. Studies were excluded if the population contained patients who had completed curative treatment or are being treated with curative intent, haematological cancers, or if they examined the effects of micronutrients, proteins, amino acids or fatty acids given in isolation. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomised trials (RoB2). A balloon plot was produced to present the results in addition to a table with a narrative summary of the primary outcomes. A total of 7968 studies were identified, of which 18 met the eligibility criteria. This included 2720 study participants. The included studies comprised: multimodal interventions (n=7), dietary counselling (n=2), nutritional supplementation with or without dietary counselling (n=7) and PN (n=2). Primary outcomes included quality of life (QoL), body composition and nutritional status. For QoL, this was reported in 15 studies, 4 studies showed a significant improvement. Body composition was evaluated in 15 studies, 5 of which showed a significant improvement in body weight and two in fat-free mass (FFM). Nutritional status was reported in 6 studies with one showing a significant difference in Patient-Generated Subjective Global Assessment (PG-SGA) score. The risk of bias was deemed 'low' in 6 studies, with 'some concerns' in 10 studies and a 'high risk' in 2 studies. There was heterogeneity between the studies. This systematic review has highlighted some positive findings in regard to QoL, body weight and nutritional intake. Optimum nutritional intervention was not identified. Future studies should evaluate the effectiveness of earlier nutritional interventions at the point of diagnosis, including regular reviews and the impact this has on nutritional outcomes, QoL and overall survival (OS).

Using Tap Water for Enteral Tube Flushes.

Enteral feeding tubes, used in patients who require enteral nutrition or medication, require flushing between medications and feedings to maintain patency. Various types of water can be used to flush enteral feeding tubes, which raises the question of which type of water is best supported by evidence. The aims of this quality improvement project were to examine the evidence on the use of tap water instead of sterile water for enteral tube flushes and to implement the use of tap water as a safe, cost-effective alternative to sterile water at a multisite oncology institution. A systematic literature search of electronic databases including Scopus, PubMed, CINAHL, Google Scholar, Embase, and JBI was conducted to review current evidence and professional organization recommendations on the use of sterile water versus tap water in enteral feeding tubes. The oncology institution's policies were reviewed, and nurses were surveyed on the type of water they used for enteral tube flushes. After the literature search and nurse survey results concurred that tap water was as effective as sterile water, the institution's nursing practice policy was updated to state that tap water should be used for enteral tube flushes, and that the use of sterile water for this purpose should be reserved for cases when there are concerns about tap water safety. This policy change was projected to incur annual sterile water cost savings of $15,930 to $19,872. The implementation of a policy recommending the use of tap water for enteral tube flushes standardized clinical practice and decreased institutional costs while maintaining patient safety.

Attitudes of health and social care professionals towards the use of blended diets for enteral tube feeding for children and young people.

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants' care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data:• Change from medicalised enteral tube feeding practice.• Individual, person-centred approach.• Open support networks and responsibility.Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.

Possibility of enteral tube feeding in severe surgical pathology

Objective. To study the possibility of using new GASTROAXILIUM mixtures in complex therapy of patients with severe surgical abdominal pathology. Materials and methods. The study of characteristics of the developed mixtures was carried out by standard and non-standard methods in an accredited laboratory. Clinical studies were conducted in accordance with the Procedure for conducting studies of the effectiveness of specialized dietary therapeutic and dietary preventive food products. Statistical processing was carried out using analysis of variance. Results. GASTROAXILIUM, specialized food product for tube feeding developed by the specialists of the Research and Production Center for Healthy Nutrition Technologies of Saratov State Medical University named after V.I. Razumovsky, differs from foreign ones in its technological solutions. In the main group a statistically significant reduction in the duration of postoperative intestinal paresis was noted, both in planned and emergency surgeries, in contrast to the comparison group. Conclusions. We consider that the results of the use of daily nutritional complex of oligomeric dry mixtures for enteral nutrition GASTROAXILIUM are in agreement with the literature data, they will successfully complement the scientific data on the necessity for nutritional support and will play an important role in improving the quality of treatment of patients with severe postoperative abdominal pathologies.

Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders.

Few studies have examined pediatric hospital utilization across the spectrum of eating disorder (ED) diagnoses among hospitalized patients. We describe sociodemographic and clinical characteristics, hospital utilization, and enteral tube feeding and examine factors associated with hospital utilization among patients with EDs. Using data from the Pediatric Health Information System, we included patients aged 4 to 20 years with primary ED diagnoses hospitalized from 2018 to 2022. We examined sociodemographic factors, length of stay, costs, and enteral tube feeding by ED diagnosis. Adjusted regression models compared hospital utilization by diagnosis, adjusting for sociodemographic and clinical factors. Among N = 10 279 hospitalizations from 49 hospitals, anorexia nervosa (AN) was most common (70.9%), followed by avoidant restrictive food intake disorder (ARFID) (15.6%). Mean age was 15.1 years (SD = 2.5), and most were female (86.6%), of white non-Hispanic race (70.9%), with private insurance (70.1%), with 63.9% occurring after the coronavirus disease 2019 pandemic onset. Median (interquartile range) length of stay was 8.0 days (7.0), and hospital costs were $18 099 ($15 592). A total of 18.8% received enteral tube feeding, with significant hospital variation. In adjusted models, compared with AN, ARFID, binge disorders, and unspecified feeding and ED had shorter stays, whereas hospital costs were lower for binge disorders, and enteral feeding was more likely for ARFID. Our findings indicate long and costly hospitalizations, especially for AN, with implications for hospital and treatment capacity, highlighting the need for earlier diagnosis and treatment to prevent the need for hospitalization.

Investigating Inappropriate Discontinuations of Enteral Nutrition Related to Gastric Residual Volume in Critically Ill Patients: A Retrospective Observational Descriptive Study

Background: Gastric residual volume (GRV) is measured by nurses in clinical practice as a simple method to assess gastrointestinal intolerance. Nutrition therapy guidelines recommend avoiding enteral tube feeding (ETF) discontinuation if GRV is &lt; 500 mL. Aim: This study aimed to clarify the status of inappropriate ETF discontinuation related to GRV in critically ill patients. Methods: Patients who were ventilated for more than 48 hours in the intensive care unit of a university hospital in 2021 were retrospectively surveyed, and data were collected up to 2 weeks after admission. ETF discontinuation data were collected and categorized as planned or unplanned. The reasons for unplanned discontinuation were further categorized into high GRV, symptoms, and conditions. The reasons and the amount of GRV were analyzed descriptively. Inappropriate ETF discontinuation related to GRV was defined as ETF discontinuation for a GRV of &lt; 500 mL. Results: ETF was discontinued in 10% (270 events / 2,600 orders) of critically ill patients. Unplanned discontinuations accounted for 37% (99/270) of discontinuations, with GRV being the most common reason (43%), followed by nausea and vomiting (8%), and hemodynamic instability (8%). Conclusions: Thirty-seven percent of ETF discontinuations in critically ill patients were unplanned, and 42% of these were inappropriate ETF discontinuations related to GRV. Research results and guideline recommendations need to be disseminated clearly to make more healthcare providers aware of the GRV criteria for discontinuing ETFs.

Dietetic attitudes and practice towards bolus feeding

Bolus feeding is the administration of feed to a patient as a series of smaller volumes of enteral nutrition given at regular intervals via an enteral feeding tube.(1) It is currently estimated that approximately 2,000 people are receiving home enteral tube feeding (HETF) in Ireland.(2) However, there is limited evidence surrounding the use of bolus feeding in enterally fed patients.The aim of this study is to investigate Irish dietitians’ attitudes and usage of bolus feeding in their adult patients.Survey Monkey was used to create an eighteen-question survey which was distributed by the ‘Irish Nutrition and Dietetic Institute’ in their online newsletter and the ‘Irish Nutrition Jobs’ Facebook page. Descriptive statistics were performed using IBM SPSS® v27 to determine percentages. Dietitians that worked with adult patients and reccommended bolus feeding to patients were eligible to take part in the survey.Out of 100 respondents, 74 dietitians fit the eligibility criteria for data analysis. Of the 74 participants recommending bolus feeding in adult patients, they primarily worked in hospitals (64%, n = 47) and in the community (35%, n = 26) with 20% (n = 15) specialising in oncology. Just over half (58%, n = 43) of dietitians agreed that the number of patients being bolus fed has increased over the last 5 years with 26% (n = 19) reporting that more than half of their enterally fed patient case load receive bolus tube feeding. The majority of dietitians (99%, n = 73), routinely use the syringing method when administering a bolus feed.Dietitians commonly recommend bolus feeding in oncology patients (65%, n = 48), those with neurodisability (46%, n = 34) and in adults with gastrointestinal diseases (19%, n = 14). When choosing to administer a bolus feed, 53% (n = 39) of dietitians aim for 400kcal per feed, with 200ml ONS being the most popular bolus feed format (62%, n = 46). Almost all dietitians (96%, n = 71), decide to use bolus feeding with their patients as it suits their lifestyles as well as 81% (n = 60) reporting that it is favoured for its convenience.Many of the dietitians (61%, n = 45) are of the opinion that feeds designed in a format for bolus feeding would improve patient experience. To further improve their training, dietitians reported there is a need for additional practice guidelines (47%, n = 35) and practical workshops (46%, n = 34) on bolus feeding.This study found that dietitians are recommending bolus feeding for patients more often in the last 5 years (2019-2024). Participants reported that bolus feeding suits patients’ lifestyles as it’s convenient and it suits their social circumstances. There is a need for a specific format for bolus feeding products as well as specific bolus feeds to improve patient experience. Dietitians agree that additional resources such as practical workshops and guidelines are needed to further support them with bolus feeding.

Crushed posaconazole delayed-release tablets for antifungal prophylaxis and treatment in children.

Therapeutic drug monitoring (TDM) is recommended for posaconazole to achieve target concentrations of ≥0.7 mg/L and ≥1.0 mg/L for prophylaxis and treatment of invasive fungal infection (IFI), respectively. However, target attainment is challenging with the oral suspension, particularly in children. Here, we describe our experience using crushed delayed-release tablet (DRT) in a paediatric cohort, with a focus on TDM. We undertook a retrospective audit of crushed posaconazole DRT administration via enteral feeding tubes (EFTs) for patients aged ≤18 years over 18 months at The Royal Children's Hospital Melbourne who had at least one trough concentration measured at steady state. Details of patient demographics, posaconazole dosing, monitoring and adverse effects were recorded. Twelve patients with a median age of 9 years (range 2 to 14) received posaconazole DRT via EFT for prophylaxis (n = 8) or treatment (n = 4). All children achieved target concentration, with a median dose of 7 mg/kg/day (range 5 to 11) for prophylaxis and 13 mg/kg/day (range 9 to 20) for treatment. The median time to reach therapeutic levels was 7 days (range 5 to 14) for prophylaxis and 20 days (range 15 to 35) for treatment. One child had blockage of their EFT, which was attributed to posaconazole. No other adverse effects were observed. Crushed posaconazole DRT administered via EFT may be used as a method of attaining therapeutic posaconazole concentrations in children for antifungal prophylaxis and treatment.

Enteric Tube Placement and Management: Tips for Interventional Radiologists

AbstractThere is a significant risk of malnutrition and aspiration among hospitalized patients, particularly the elderly, patients with head and neck malignancy, and those with a chronic debilitating disease. Enteral feeding is preferred over parenteral feeding for patients with functional gastrointestinal tracts but who have impaired swallowing due to its cost-effectiveness, lesser complications, and theoretical benefits such as preserving mucosal architecture and gut-associated lymphoid tissue. While nasogastric and nasojejunal tubes address short-term feeding needs, long-term enteral feeding tubes are crucial for patients requiring nutritional support beyond 4 weeks. Enteric tube placement can be performed surgically, endoscopically, or radiologically, with radiologically inserted gastrostomy emerging as a safe and effective method. This review article discusses various interventional radiological techniques for enteral feeding, including percutaneous gastrostomy, gastrojejunostomy, jejunostomy tube placement, and gastrointestinal tract decompression procedures like cecostomy. It covers procedural considerations, patient selection criteria, technical aspects, and outcomes, drawing on current evidence and clinical experience. The review also addresses emerging trends, advancements, and future directions in interventional radiology for enteral feeding and gastrointestinal tract decompression, aiming to contribute to the ongoing evolution of clinical practice and patient care. Key recommendations from international guidelines are summarized, emphasizing individualized risk assessment for optimal enteral feeding strategies.

Safety in geriatric patients as a determining factor in the pharmaceutical drug development

The elderly are seen as a distinct population in which medications should be used with extreme caution. Age-related physiological characteristics of the body affect the safety profile of drugs and may increase the risk of adverse reactions. Pharmaceutical drug development in geriatrics is designed to consider said characteristics of patients in this category. Objectives of the study: to highlight the features of pharmacokinetics and pharmacodynamics of drugs in the geriatric population in the context of age-related, physiological, and pathophysiological changes in individuals of this group and related approaches to minimizing the risks of pharmacotherapy at the stage of pharmaceutical drug development. Materials and methods are analysis of publications from the PubMed database using such approaches as system analysis, generalization, and systemic approach, as well as a bibliographic method based on the processing of sources of information on the features of pharmacokinetics and pharmacodynamics of drugs in geriatrics, as well as the use of drugs in this group of patients and the development of geriatric dosage forms. The article discusses an impact of such factors as the features of pharmacokinetics and pharmacodynamics of drugs, concomitant diseases and polypharmacy, and decrease in compliance (adherence to treatment) on the safety of pharmacotherapy in patients of the geriatric population. Also, considering the above factors, approaches to the pharmaceutical drug development in geriatrics and the management of patients of this group are highlighted. Attention is paid to the provisions of the draft reflection paper of the European Medicines Agency on the pharmaceutical development of medicines for use in the older population, namely, recommendations on the tablet breaking, administration of drugs through enteral feeding tubes, and temporary storage of medicines outside the original packaging. The advantages of using multi-particulate dosage forms, fixed-dose combinations, and orodispersible dosage forms are summarized. Pharmacokinetics and pharmacodynamics of drugs in geriatric patients have their peculiarities due to age-related, physiological, and pathophysiological factors in this category of patients. This should be considered in pharmaceutical drug development. The use of fixed-dose combinations and multi-particulate dosage forms, as well as adherence to good pharmacotherapy practices in geriatrics, are designed to ensure the safety of pharmacotherapy and improve compliance in elderly patients. It is expedient to further establish regulatory guidelines and recommendations in pharmaceutical geriatric drug development and conduct clinical research on drugs for use in this population.

Efficacy and Safety of Orogastric vs. Nasogastric Tube Feeding in Preterm Infants: A Systematic Review and Meta-Analysis.

Enteral nutrition can be delivered to the stomach using nasogastric or orogastric tubes, with each route having advantages and disadvantages. This meta-analysis aimed to compare the effects of these methods on growth, development, and the incidence of adverse outcomes. This analysis included studies that enrolled preterm infants who received nasogastric or orogastric tube feeding. We searched databases including PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Only randomized controlled trials were selected. We used version 2 of the Cochrane tool to assess the risk of bias in randomized trials and Review Manager 5.4 software to perform the meta-analysis. Six studies involving 265 preterm infants were included. The meta-analysis showed that orogastric tube feeding took significantly longer to establish full enteral tube feeding compared to nasogastric tube feeding (MD = 1.62, 95% confidence interval [CI]: 0.99-2.26, Z = 5.02, p < 0.01). However, no significant difference was observed between the two groups regarding time to regain birth weight (MD = -0.38, 95% CI: -2.2-1.44, Z = 5.02, p = 0.68). Data on adverse events were insufficient to perform a combined analysis. Preterm infants fed via nasogastric tubes took less time to reach full enteral feeding than those fed via orogastric tubes. Further research is required to evaluate the effect of feeding routes on adverse outcomes.

Blended diets for children and young people: applying the evidence to nursing practice.

Enteral tube feeding is commonly used for children and young people with complex health and care needs. Blended diets are becoming more widely used and there is increasing evidence to show the benefits of a blended diet for children, young people and their families. This article aims to collate recent evidence on blended diets and describe the implications for nursing practice. Studies exploring blended diets have identified benefits such as improved gastrointestinal symptoms, positive engagement with families around food and mealtimes and the normalisation of enteral tube feeding. Research has also explored the nutritional and microbial content of food blends as well as the viscosity and risk of tube blockage. These are key considerations when supporting families to make informed decisions and use blended diets safely. Nurses play an important role in supporting the safe and effective use of blended diets as part of a wider multidisciplinary team. It is necessary that they have an understanding of the evidence underpinning nursing practice in this area.

17 Caregiver experiences with enteral feeding transitions

Abstract Background Children with medical complexity (CMC) are an expanding group within paediatrics due to advances in medical care, often including a dependence on medical technology. Issues such as oromotor swallowing dysfunction and feeding difficulties are common in this population. As a result, many CMC require the use of enteral tubes for feeding. While evidence does support improved nutritional status with the use of enteral feeding tubes, there is limited literature discussing how these interventions impact other patient centered outcomes, such as quality of life for the child, changes in parental caregiving, and logistical implications for the family. A comprehensive understanding of the positive and negative outcomes associated with selection and transition between different feeding tube options is needed. Objectives To describe and explore the caregiver and patient experience with different feeding tubes, with a focus on the experience of transitioning between different enteral feeding modalities. Design/Methods We conducted semi-structured interviews with 16 participants, including both caregivers and two patients. Reflexive thematic analysis was utilized to identify preliminary themes from interviews. Themes were further refined by the study team. Results The themes identified through interviews included: A) the pros and cons with each type of enteral feeding modality, B) the emotional impacts on patients and caregivers, C) logistical impacts on day-to-day life for families, and D) the experience of transitioning between feeding tubes. Globally, participants spoke positively about their transition from nasogastric feeding to either gastrostomy or gastrojejunal feeding tubes. Caregivers also felt that they were integral to the decision-making process, though some felt in hindsight the transition process was too slow. Conclusion This study highlights both the complexity and heterogeneity of the caregiver experience with different feeding tubes. It found that most families consistently viewed their transitions with enteral feeding tubes positively, as this was seen as a significant milestone in helping their child both nutritionally and with their quality of life. Finally, further research could be done to explore experiences with gastrojejunal and jejunal feeding, as this patient population is not well elucidated within the literature.

Bacterial contamination of hospital-prepared enteral tube feeding formulas in Kerman, Iran

Background: Blenderized feedings continue to be used in most parts of Iran, mostly due to economic and cultural reasons. The most important problem of this kind of food is bacterial contamination. Materials and Methods: 54 samples were taken at the first and the last time of their giving to patients from blenderized food. Furthermore, 10 samples were collected from the commercial brand Fresubin® in the same way. Samples were brought to the laboratory and analyzed for the presence of some microbial pathogens. Results: Citrobacter diversus, Enterobacter cloacae, E.coli, Klebsiella pneumonia, Proteus sp, Klebsiella oxytoca, Hafnia alvei, Serratia sp, Shigella sonnei were identified from blenderized feeding. The mean bacterial contamination of 54 samples that were collected from 3 intensive care units was 5/5×106 CFU/ml. Bacterial contamination of commercial food was obtained less than 1 organism/ml. According to these results, there are significant differences between these foods. Commercial foods are the best choice for feeding patients in the hospital. Conclusion: The results indicated that a majority of the blenderized enteral tube feedings in those hospitals are not safe. In comparison to the standard limits, these enteral tube feedings are highly contaminated and pose a substantial risk of developing a foodborne disease or nosocomial infection.

Oropharyngeal dysphagia impact of pneumonia risk in neurological patients receiving enteral tube feeding: Insights from a gastroenterologist.

Oropharyngeal dysphagia is prevalent among neurological patients, often necessitating enteral tube feeding with a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). These patients are at significant risk of developing aspiration pneumonia. This study aimed to assess the impact of oropharyngeal dysphagia on pneumonia risk requiring hospitalization in neurological patients on long-term enteral tube feeding. This retrospective observational study was conducted between 2015 and 2022. It included neurological patients who underwent upper gastrointestinal endoscopy combined with a Modified Flexible Endoscopic Evaluation of Swallowing (mFEES) for suspect dysphagia, characterized by difficulty or discomfort in swallowing. Participants were either orally fed or had been on long-term enteral tube feeding via NGT or PEG. A 2-year follow-up was conducted to monitor pneumonia cases requiring hospitalization. Multivariate analyses were conducted to identify risk factors for pneumonia requiring hospitalization. A total of 226 orally fed and 152 enteral tube-fed patients were enrolled. Multivariate analyses showed a significantly increased risk of pneumonia in patients with a history of pneumonia and those receiving enteral tube feeding. Subgroup analysis indicated a significantly lower risk of pneumonia among enteral tube-fed patients with oropharyngeal dysphagia who PEG-fed patients compared to NGT-fed patients (adjusted HR: 0.21, 95% CI: 0.10-0.44, p < 0.001). The cumulative incidence of pneumonia requiring hospitalization was significantly lower in the PEG group than in the NGT group (p < 0.001). mFEES could be a screening tool for oropharyngeal dysphagia. PEG is preferred over NGT for long-term enteral feeding, as it significantly reduces the risk of pneumonia requiring hospitalization, especially in patients with oropharyngeal dysphagia.