Hospital Diet Research Articles

Estandardização de dietas hospitalares: diagnóstico e subsídio para a qualidade da atenção

Standardization directly affects the estimated chemical composition of hospital diets and their acceptance. Consequently, patient’s or client’s food consumption and fulfillment of their nutritional needs are influenced by this process. Therefore, the objective of this study was to evaluate the standardization of the production process of diets offered to patients/clients at a public hospital in Belo Horizonte/MG between the years 2010 to 2012. For this purpose, the direct weighing of six types of hospital diets that were prepared was made and the menu types and frequencies were characterized. The macronutrient content and micronutrient content (calcium, iron, sodium, zinc, magnesium, potassium and vitamins A and C) were then calculated. A high repetition rate was observed regarding the combinations of menu preparations implemented, especially in relation to diets for special purposes. There were large disparities in the quantitative measurements and nutritional value of the preparations, in all the diets analyzed, and many of these differences were statistically significant (p<0.05).High coef-ficients of variation regarding portioning (8-30%), macronutrient content (23-115%) and micronutrient content (24-498%) were observed in the six types of diet. Therefore, the results highlighted significant weaknesses in planning menus, the food portions, and hence the nutritional support to their patients / clients by setting up as a non-standard process. The need for progress with a more humanized initiatives view of this service (individualization of care, nutritional and sensory improve-ment of menus; organization of the service, and lifelong learning) was highlighted, as the application of gastronomic tech-niques in planning menus, as well as a continuing education program for the staff of this service, the respective portioning.

Sodium Restriction in Japanese Patients Hospitalized with Acute Decompensated Heart Failure

Backgrounds: Although the salt restriction is nonpharmacologic measures widely used in the treatment of acute decompensated heart failure (ADHF), the benefits of salt restriction in Japanese patients hospitalized with ADHF are unclear. Methods and Results: We studied 114 consecutive patients hospitalized with ADHF between January 2011 and December 2011 retrospectively. Salt restriction (maximum dietary intake, 6 g/d) were carried out in 91 patients: restriction group. Twenty three patients received a standard hospital diet (10 g of dietary intake): control group. The mean age of the patients was 77 years for both groups and the rate of major cardiovascular comorbidities was not different between the groups. At the 2-year follow up, the cumulative incidence of hospitalized for heart failure was not different between the two groups (40% in restriction group v.s. 38% in control group, n.s). In patients O 80 years, the incidence of hyponatremia (Na ! 135 mEq/L), was significantly higher in restriction group than control group (31% v.s. 11%, p50.01). Conclusion: Salt restriction may be unnecessary for aged patients admitted for ADHF.

Licorice-induced Water Retention and Hypokalemia in Elderly Patients

Backgrounds: Although the salt restriction is nonpharmacologic measures widely used in the treatment of acute decompensated heart failure (ADHF), the benefits of salt restriction in Japanese patients hospitalized with ADHF are unclear. Methods and Results: We studied 114 consecutive patients hospitalized with ADHF between January 2011 and December 2011 retrospectively. Salt restriction (maximum dietary intake, 6 g/d) were carried out in 91 patients: restriction group. Twenty three patients received a standard hospital diet (10 g of dietary intake): control group. The mean age of the patients was 77 years for both groups and the rate of major cardiovascular comorbidities was not different between the groups. At the 2-year follow up, the cumulative incidence of hospitalized for heart failure was not different between the two groups (40% in restriction group v.s. 38% in control group, n.s). In patients O 80 years, the incidence of hyponatremia (Na ! 135 mEq/L), was significantly higher in restriction group than control group (31% v.s. 11%, p50.01). Conclusion: Salt restriction may be unnecessary for aged patients admitted for ADHF.

Potential virulence of Klebsiella sp. isolates from enteral diets.

We aimed to evaluate the potential virulence of Klebsiella isolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains of Klebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify the Klebsiella isolates as eight antibiotypes. No production of broad-spectrum β-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.

요양병원 노인환자의 약선음식 제공에 의한 섭취량 증가

This study investigates the effects of serving medicinal food items on the dietary intake of elderly inpatients. A total of 77 elderly inpatients at a long-term senior care hospital in Yeongju participated in this study. Control and medicinal food items were provided for 20 days (March 24 through April 12, 2014, and April 14 through May 3, 2014, respectively). A satisfaction survey was conducted for both control and medicinal food items on the last day of the respective serving period. Data were analyzed by using SPSS (Windows ver. 21.0). The satisfaction level was higher for medicinal food items than for control food items. The leftover rate was higher for control food items than for medicinal food items. The intake of energy, carbohydrates, proteins, fats, vitamin A, thiamin, niacin, potassium, and zinc was higher for medicinal food items than for control food items. These results indicate that the dietary intake of elderly inpatients was higher for medicinal food items than for control food items. This suggests that medicinal food items can help increase the nutrient intake of elderly inpatients and implies that such food items may be more desirable for a long-term senior care hospital diet. A prospective analysis of the long-term control is needed to establish the effects of medicinal food items on elderly patients.

Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later.

Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI). The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87% that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.

Oral Nutrition Supplement Improved Nutritional Status in Malnourished Hip Fracture Patients: A Randomized Controlled Study

Background: Nutritional status has been shown to predict post-surgical recovery and clinical outcomes in orthopedic patients. This study evaluated the effects of an oral nutrition supplement (ONS) in patients undergoing hip fracture surgery. Materials and Methods: In a multicenter, prospective, randomized study (ClincialTrials.gov, registration number NCT01011608), malnourished patients (n=127) who had surgery within 14 Original Research Article Luo et al.; JSRR, 4(6): 480-489, 2015; Article no.JSRR.2015.051 481 days of hip fracture and had screening serum albumin levels ≤ 38 g/L were enrolled. Patients in the ONS group were fed a calorically dense, high protein ONS, providing 798 kcal, 34 g protein/day for 28 days following surgery. Control patients received standard hospital diet only. Weight, nutritional and clinical markers were measured at Baseline, days 14 and 28. Suture status and functional recovery were evaluated on days 14 and 28.Means ± SEM are reported. Results: Baseline characteristics were similar between groups. On day 28, albumin level was improved in the ONS group (4.9±1.4 g/L) compared to the control group (1.2±1.0 g/L, p=0.054). A significant increase in prealbumin was observed in the ONS group (5.0±1.0 mg/dL) vs. control (1.0±1.2 mg/dL, p=0.007). Body weight increased in the ONS group (2.1±0.6 kg) but decreased in the control group (-0.8±0.8 kg; p=0.01). Conclusion: Supplementation of a nutritionally complete, calorically dense, high protein ONS for 28 days significantly improved nutritional status in mild to moderately malnourished patients undergoing hip fracture surgery.

Cooperation between Japanese and Cambodian Dietitians in Setting up a Hospital Diet Management System

Cambodia faces a considerably high percentage of the stunted under 5 (Unicef, 2014). Despite the National Nutrition Strategy Launched by the Ministry of Health in cooperation with development partners, nutrition improvement projects have not always been effective. It is generally said these issues are addressed in many other developing nations, and the literature largely documented that successful nutrition programmes are community-based programmes because of their sustainability and the intensive communications between health workers and beneficiaries. Learning from the past experiences, the Foundation for International Development/Relief organized a project team with a Cambodian dietitian and an experienced Japanese dietitian to implement a hospital diet programme for children from April 2006 to March 2014 in the National Pediatric Hospital (NPH) in Cambodia. The project has two objectives: establishing a hospital diet management system, and developing the capacity of NPH staff. Hospital food menus were created paying particular attention to Cambodian culture, eating habits and accessibility to the ingredients for the purpose of continuous supply. We have also put emphasis on the communication between dietitians and family members of the children to let them understand the importance of a nutritious diet. After 8 y of project implementation, the hospital diet management system was established providing 7 types of menu with nutritious diets. The final evaluation of the project showed that NPH staff have the intention to continue hospital food supply with their acquired knowledge and capacity. In practice, a Cambodian dietitian currently takes the initiative for a continuous nutritional diet in NPH. The key to this success is the collaboration between Japanese dietitians with experience and Cambodian dietitians with knowledge of Cambodian eating habits. Taking our experience into account, it is highly recommended to educate Cambodian dietitians, as they are extremely scarce, and to increase the awareness of health care staff towards the importance of nutrition management.

MEDICAL INTERNS’ AND CLERKSHIP STUDENTS’ VIEWPOINTS ON NUTRITION COURSE IN BIRJAND UNIVERSITY OF MEDICAL SCIENCES

Background and purpose: Nutrition plays a key role in maintaining and promoting health and preventing diseases. In most medical schools, Nutrition education is not sufficient and only 26% of college students have proper nutritional education programs. Physicians should use their knowledge through education and counseling with patients and healthy people to increase people’s level of health. Poor eating habits are considered as a factor of chronic disease. Therefore, the aim of this study was to determine medical interns and clerkship students’ viewpoint about nutrition course at a specific medical school. Methods: This study was descriptive and 87 interns and clerkship students of Birjand University of Medical Sciences participated. The data were collected using a valid and reliable questionnaire based on the existing topics in nutrition, the time allocated, their educational needs as well as the issues that physicians have the greatest exposure to. After completing the questionnaire, all of the data were collected, coded, and analyzed using SPSS software, version 15. The chi-square test was used to compare the views of interns and medical students. Results: Of the participants, 72.4% were female, 27.6% were male, 57.5% were medical students, and 42.5% were interns. According to these students, 51.7% considered one nutrition course in the second semester to be appropriate, and that the topic of improved nutrition in vulnerable groups was more effective during the clinical stage (63.2%). In addition, the need to learn about nutrition in vulnerable groups, foods and nutritious, diseases caused by malnutrition, and food health (66.7%, 57.5%, 54%, and 52.9%, respectively) was considered to be more important. Moreover, 55.2% of the participants considered nutrition in vulnerable groups to be highly relevant, while 51.7% believed that malnutrition-related diseases was more relevant. Most of the students considered the topics of foods and nutrients, food health, nutrition of vulnerable groups, and malnutrition-related diseases with high professional applicability to be highly functional (64.4%, 56.3%, 51.7%, and 50.6%, respectively); and most participants (89.7%) believed that learning about hospital diets was essential. There was a significant difference between men and women in terms of their views on the appropriateness of the topics of the nutrition course with regard to current social problems so that 70.8% of the men believed they fit the current social problems, while 55.5% of the women thought they were inappropriate. Conclusions: Considering the importance of a nutrition course, it is better to provide topics related to the clerkship period, with the applicability of the clinical setting being taught at the same time. Keywords: NUTRITIONAL EDUCATION, MALNUTRITION, MALNUTRITION-RELATED DISEASES

Molecular Characterization of Klebsiella Isolates from Enteral Diets

To evaluate the genotyping of Klebsiella isolates from enteral diets in public hospitals, as high-resolution support within epidemiological surveillance for controlling nosocomial infections. Methods: Klebsiella isolates were obtained from enteral diets at two public hospitals in the state of Minas Gerais, Brazil. These isolates were identified and serotyped. Total DNA of Klebsiella was extracted and subjected to three genotyping methods, to evaluate polymorphism between the strains and genetic diversity. Results: Twenty-one isolates of Klebsiella were obtained from the hospital enteral formulae; fifteen were identified as K. pneumoniae and six as K. oxytoca. The results from random amplified polymorphic DNA (RAPD) and 16S-23S rDNA analysis revealed high polymorphism among the K. pneumoniae isolates and a low level of polymorphism among the K. oxytoca isolates. The 1420 base pairs of DNA fragments generated through amplification of the 16S rDNA region and digestion with eight restriction endonucleases resulted in identical restriction fragment length polymorphism (RFLP) patterns for all isolates. Conclusion: Our data demonstrate that RAPD and 16S-23S rDNA analyses provide more reliable estimates of the genetic diversity among Klebsiella isolates than does amplification of the 16S rDNA gene. Therefore, we recommend that RAPD typing should be the preliminary method for fast and inexpensive investigation and that 16S-23S rDNA typing should be a confirmatory method if needed.

Manger et boire à l’Hôpital royal de l’Île de Mozambique: médecine et changements alimentaires entre la fin du xviiie siècle et le début du xixe siècle

This article analyses the social construction of the hospital diet in Mozambique Island and the process of dietary change induced by the European medical discourse and extended to the East African colonial world, at the end of the Ancien Régime. Mozambique Island, former capital of the Portuguese East Africa colony, was the crossing point of people from various continents, where culinary traditions sometimes mingled together and sometimes coexisted side by side. These foodways were incorporated into the Royal Hospital diet, which combined dishes of Indian, Portuguese, and African origin. Between the late 18th and the early 19th century, the intervention of the European chief-physicians in the hospital diets tended to configure the patients’ food in accordance with the changes taking place in European medical discourse and to exclude certain dishes which had a strong local tradition.

Malnutrition in hospitalized patients receiving nutritionally complete menus: prevalence and outcomes.

The prevalence of malnutrition in hospitals ranges from 20 to 50% and the hospital diet could be a potential risk factor. The aim of the study was to determine the overall and per services prevalence of hospital malnutrition, and assess its impact on clinical outcomes in patients receiving nutritionally complete menus. Cross-sectional study in a university hospital. Nutritional status was assessed using Subjective Global Assessment (SGA), anthropometry, and biochemical parameters. For the assessment of outcomes during hospitalization, length of stay, rate of deaths, and readmissions were collected. 201 patients were evaluated. The median age was 71.59 (IQR 21.43) years old, and 51.20% were women. According to the results obtained by SGA, 37.8% of individuals were well nourished (WN), 50.2% were at nutritional risk (NR), and 11.9% were malnourished (MN). The prevalence of malnourished (NR+MN) was higher in oncology-hematology and medical wards (80.0% and 70.5%) than in surgical ones (52.4%) (p = 0.047). The worse nutritional status was, the longer the length of stay [WN: 8.0 (IQR 8.0) days; NR: 12.0 (IQR 13.5) days; MN: 18.5 (IQR 18.5) days, p < 0.001). The prevalence of malnutrition in the evaluated hospital was very high, being particularly striking in medical services, and doubling length of stay.

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

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

Macronutrients and energy content of oral hospital diet prescribed to chronic kidney disease patients on conservative treatment.

The contribution of diet and treatment planning in the treatment of Chronic Kidney Disease (CKD) has been recognized as having a significant clinical impact if introduced early. determine the levels of carbohydrates, proteins, lipids, energy and energy density (ED) in an oral hospital diet prescribed to CKD patients, and to evaluate the adequacy of this diet with respect to dietary recommendations. Diets were collected in a Brazilian public hospital on two non-consecutive days of six different weeks. The carbohydrate, protein, and lipid (total, saturated, monounsaturated, polyunsaturated, linoleic, linolenic and trans fatty acids) contents were determined in a laboratory. The amount of energy and the ED of the diets were calculated using the correction factor Atware and by dividing the total energy of the diet by weight, respectively. About 14.3% of the diets produced for patients with CKD were analyzed. The average density of the diets was low (0.7 kcal/g). In terms of nutritional adequacy, the average lipid content (15%) and linolenic fatty acid content (0.4%) were below the recommendation, as was energy (23.4 kcal / kg / day). The average carbohydrate content (63.5%) and protein content (1.0 g/kg/day) exceeded the recommendations levels. The oral hospital diet prepared for patients with CKD were considered unbalanced, and an unfavorable clinical treatment for these patients.

The Case of Vegetarian Hospital Diets in Taiwan

The purpose of this study was to understand how vegetarian diets in Taiwanese hospitals are well established and provide suggestion for successful implementation in Korea. Micro-ethnographic case study with in-depth interviews, field observations, and paper reviews were used for this study. Experiences of doctors and nutritionists from Taiwanese hospitals where deliver vegetarian hospital diets were analyzed. This research found out Taiwanese life respect culture has influence on introducing vegetarian diets in hospital, besides most Participants agreed to use vegetarian diets for the medical purpose according to their clinic experiences and research results. Meanwhile there is no restriction to compel patients to keep vegetarian diets. All participants answered food has a large effect on the human body and further study on vegetarian diets’ efficacy is required. The hospital chief’s decision making is crucial to introduce vegetarian diets in hospitals. For the bigger picture, social supports, organizational supports and national policy supports are all important factors for it. The implications and recommendations for Korean hospitals were discussed. The public awareness for vegetarian diet for medical purpose along with research on its efficacy would be needed. In order to make good use of a vegetarian diet for medical purposes, we first need to build a vegetarian-friendly environment, go deep into the study of a diet’s effects using diverse methodologies, and combine the diet with traditional medicine theory. Based on the results of this primary study, more related studies should be carried out in the future.

Comparison of the carbon footprint of different patient diets in a Spanish hospital.

Mitigating climate change requires management strategies to reduce greenhouse gas emissions in any sector, including the health system. Carbon footprint calculations should play a key role in quantifying and communicating these emissions. Food is among the categories with low accuracy because the carbon footprint for food is still under development. We aimed to quantify the carbon footprint of different diets. Average carbon footprint for a normal diet was based on detailed composition data in Juan Ramón Jiménez Hospital (Huelva, Spain). In addition, the carbon footprints of 17 other therapeutic diets were estimated using a streamlined variation of each diet published by Benidorm Clinical Hospital (Spain). The carbon footprint was calculated for 18 hospital diets for a variety of patients. The reference menu corresponds to the normal diet provided to patients who do not have special dietary requirements. This menu has a low carbon footprint of 5.083 CO₂ eq/day. Hospital diets contribute to the carbon footprint of a hospital. The type of diet has a significant impact on the greenhouse gas emissions. A Mediterranean diet is associated with lower environmental impact than diets with more meat, in particular red meat.

Mineral content and adequacy of oral hospital diets offered to chronic kidney disease pre-dialysis patients

Summary Background & aims The diet for patients with Chronic Kidney Disease (CKD) has important clinical impact on the disease progression. This study determined the contents of Ca, P, K, Na, Mg, Fe, Mn, Cu, Zn and Se in an oral hospital diet and a Oral Food Complement (OFC), prepared for CKD patients, with the adequacy quantified with respect to nutritional recommendations. Methods Samples of the diet were collected in a Brazilian public hospital, with mineral determination by ICP-OES. The Dietary Reference Intake and specific nutritional recommendations for CKD patients were used to assess the nutritional adequacy. Results About 14.3% of the diets produced for CKD patients were analyzed. The levels of P, K, Mn and Na were over the recommendation, with Na exceeding the Upper Level. Inadequacy of Ca and Se were observed for all groups and ages. Inadequate values of iron were found for adult women. The combination of OFC with the diet was sufficient to provide adequate values of Fe, however, did not increase Ca and Se contents to adequate levels, and added unnecessary quantities of P, K and Na. Conclusion With the exception of K and P the diets exhibited insufficient mineral contents and toxic levels of Na. Diet menus and OFC compositions need to be changed to meet the nutritional recommendations and support the clinical assistance of CKD patients and also contribute to the nutritional education of this group.

Nutritional interventions for preventing and treating pressure ulcers.

Pressure ulcers affect approximately 10% of people in hospitals and older people are at highest risk. A correlation between inadequate nutritional intake and the development of pressure ulcers has been suggested by several studies, but the results have been inconsistent. To evaluate the effects of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. In March 2014, for this first update, we searched The Cochrane Wounds Group Specialised Trials Register, the Cochrane Central register of Controlled Trials (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library), the Health Technology Assessment Database (HTA) (The Cochrane Library), the Cochrane Methodology Register (The Cochrane Library), NHS Economic Evaluation Database (The Cochrane Library), Ovid Medline, Ovid Embase and EBSCO CINAHL. No date, language or publication status limits were applied. Randomised controlled trials (RCTs) evaluating the effects of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers, which measured the incidence of new ulcers, ulcer healing or changes in pressure ulcer severity. There were no restrictions on types of patient, setting, date, publication status or language. Two review authors independently screened for inclusion, and disagreement was resolved by discussion. Two review authors independently extracted data and assessed quality using the Cochrane Collaboration tool for assessing risk of bias. We included 23 RCTs, many were small (between 9 and 4023 participants, median 88) and at high risk of bias.Eleven trials compared a combination of nutritional supplements, consisting of a minimum of energy and protein in different dosages, for the prevention of pressure ulcers. A meta-analysis of eight trials (6062 participants) that compared the effects of mixed nutritional supplements with standard hospital diet found no clear evidence of an effect of supplementation on pressure ulcer development (pooled RR 0.86; 95% CI 0.73 to 1.00; P value 0.05; I(2) = 13%, random effects). This outcome is at unclear or high risk of bias.Fourteen trials evaluated the effects of nutritional supplements on the healing of existing pressure ulcers: seven trials examined mixed nutritional supplements, three the effects of proteins, two trials examined zinc, and two studies examined ascorbic acid. The included trials were heterogeneous with regard to participants, interventions, comparisons and outcomes and meta-analysis was not appropriate. There was no clear evidence of an improvement in pressure ulcer healing from the nutritional supplements evaluated in any of these individual studies. There is currently no clear evidence of a benefit associated with nutritional interventions for either the prevention or treatment of pressure ulcers. Further trials of high methodological quality are necessary.

Explorations in anatomy: the remains from Royal London Hospital

This paper considers the faunal remains from recent excavations at the Royal London Hospital. The remains date to the beginning of the 19th century and offer an insight into the life of the hospital's patients and practices of the attached medical school. Many of the animal remains consist of partially dissected skeletons, including the unique finds of Hermann's tortoise (Testudo hermanni) and Cercopithecus monkey. The hospital diet and developments in comparative anatomy are discussed by integrating the results with documentary research. They show that zooarchaeological study of later post-medieval material can significantly enhance our understanding of the exploitation of animals in this period

Short hospital stays after laparoscopic gastric surgery under an Enhanced Recovery After Surgery (ERAS) pathway: experience at a single center.

SummaryIntroductionRecently, first reports on benefits from Enhanced Recovery After Surgery (ERAS) pathway in patients undergoing gastric surgery have appeared. It seems that maximal reduction of unfavorable surgery-induced trauma in patients with gastric malignancy via ERAS protocol combined with minimally invasive techniques can improve outcomes.ObjectiveThe aim of this study was to determine the influence of laparoscopic surgery and ERAS protocol in oncological gastric surgery on early outcomes.Materials and methodsProspective analysis involved 28 patients (18 female and 10 male) with gastric malignancy who underwent laparoscopic gastric resection between 2009 and 2013. Gastric tumors (gastrointestinal stromal tumors or adenocarcinoma) were the indication for the surgery. A total of 17 patients underwent laparoscopic local excision, and 11 patients with adenocarcinoma or multiple neuroendocrine tumors underwent laparoscopic D2 total gastrectomy. Perioperative care was based on ERAS principles. Length of hospital stay, postoperative course, perioperative complications, and readmission rates were analyzed.ResultsThere was one conversion in the gastrectomy group. All patients were mobilized on the day of surgery. Oral fluids were introduced on day 0 and were well tolerated. Full hospital diet was started on day 2 in all patients, but was well tolerated in only 18 of them. One postoperative complication requiring reoperation was noted. The length of stay after gastrectomy and gastric wedge resection was 4.6 (2–6) and 3.3 (2–6) days, respectively. No readmissions were noted in the entire group.ConclusionsThe implementation of ERAS protocol to clinical practice in combination with laparoscopy in patients with gastric tumors can result in improved postoperative care quality, shortening of hospital stay, and quicker return to normal activity.