Multidisciplinary Nutrition Team Research Articles

Nutritional, Metabolic, and Inflammatory Alterations in Children with Chylous Effusion in the Postoperative Period of Cardiac Surgery: A Descriptive Cohort

Objective: The occurrence of chylous effusion in children undergoing cardiac surgery is progressively increasing due to technical advances that have led to a rise in the number of surgeries. In this context, the objective was to describe the clinical profile of a cohort of patients at the time of chylous effusion diagnosis. Methods: A retrospective cohort analysis was conducted between January 2011 and July 2023, involving 23 patients, aged 0 to 18 years, treated at a quaternary university hospital in southeastern Brazil. Data were obtained from the follow-up records of the Multidisciplinary Nutritional Therapy Team (MNTT) for patients who received nutritional support after developing chylous effusion in the postoperative period of cardiac surgery. Results: The younger population predominated (median age of 6 months), with a high prevalence of malnutrition (60.9%). At the time of chylous effusion diagnosis, 83% had lymphopenia, and 74% had hypoalbuminemia. The longer the time elapsed after surgery for the onset of chylous effusion, the lower the HDL cholesterol, the lower the albumin levels, the greater the surgical complexity, the younger the patient, and the lower their weight. Hypocalcemia occurred in nearly half of the sample and hypophosphatemia in 26% of the analyzed cases. Conclusions: There was a notable presence of lymphopenia, hypoalbuminemia, and low HDL cholesterol, as well as a high incidence of mineral imbalances, particularly hypocalcemia and hypophosphatemia, which, if untreated, may lead to unfavorable outcomes. Therefore, clinical and laboratory monitoring of children in the postoperative period of cardiac surgery is important and can aid in the early diagnosis of chylous effusion and, consequently, in the timely initiation of treatment.

The impact of a nutrition course on self-epistemic authority, professional meaning as mediating factors on professional identity among nursing students

BackgroundThe professional competence of nursing personnel is integral to the efficacy of nursing procedures. Educational endeavors, especially those encompassing professional training programs, are critical in fostering a professional identity among nurses. The role of nurses within a multi-disciplinary nutrition team has the potential to enhance professional identity and improve the quality of care provided.ObjectiveThis study aimed to explore the potential impact of knowledge acquisition and practical nutrition education on the development of professional identity among nursing school students. Furthermore, we hypothesize that professional autonomy and self-epistemic authority mediated the relationship between a sense of meaning, professional mission, and professional identity.DesignA cross-sectional survey compared nursing students who had completed a practical nutrition course with those who had not. The study measured professional identity, professional autonomy, self-epistemic authority, and sense of meaning. Data collection was conducted using validated questionnaires, with questions tailored to suit the study demographic. Mediation analysis was conducted on the combined sample of both groups.ParticipantsThe study included 98 nursing students, divided into a study group (57 students who completed a nutrition course) and a control group (41 students who did not complete the course).ResultsSignificant differences were found between the groups in measures of professional identity (t = 3.42, p < .001), professional autonomy (t = 2.93, p < .005), and self-epistemic authority (t = 2.78, p < .007). There was no significant difference in the sense of meaning (t = 1.45, p = .150). Mediation analysis on the combined sample revealed that self-epistemic authority mediated the relationship between professional meaning and professional identity, while professional autonomy did not.ConclusionThe findings suggest that practical nutrition education enhances nursing students’ professional identity, autonomy, and self-epistemic authority. Future studies should include larger and more diverse samples to further explore these relationships.

Are Guideline Recommendations on Supportive Nutrition and Exercise Therapy for Cancer Patients Implemented in Clinical Routine? A National Survey with Real-Life Data.

Malnutrition and cancer cachexia are highly prevalent comorbidities of cancer, limiting patients' quality of life and being relevant to prognosis. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. However, there is little current epidemiological evidence on the implementation of these guideline recommendations in clinical routine. To close this data gap, a national survey in Germany using an online questionnaire was conducted. There were 261 of a total of 5074 contacted hospitals and medical offices who participated in the survey (5.1% response rate). The data indicated that nutrition and exercise therapy for cancer patients is so far inadequately implemented, with 59% of the respondents reporting nutrition therapy as an integral part of oncological treatment, 66.7% having a nutrition specialist/team, and 65.1% routinely conducting a screening for nutritional status. Only half of the participants stated that there are defined goals in nutrition therapy. The majority of respondents (85.8%) generally recommend exercise therapy, but only a few of them provide specific offers at their own institution (19.6%) or at cooperation partners (31.7%). In order to implement the recommended combined nutrition and exercise therapy as part of regular care, there is a need for nationwide availability of multidisciplinary nutrition teams and targeted offers of individualized exercise therapy. Health policy support would be important to create the structural, financial, and staff conditions for appropriate guideline implementation in order to achieve the optimal treatment of cancer patients.

Posicionamento BRASPEN sobre o uso de micronutrientes via parenteral em adultos

Introduction: micronutrients (vitamins and oligoelements) are essential components in human nutrition. Usually, they are obtained through a varied and balanced diet. However, when patients are stricken with some diseases, it is often necessary to utilize alternative feeding methods, which can interfere in micronutrient availability and acquisition. The objective of this work is to promote the rational use of micronutrients in parenteral nutrition to doctors and other staff in the multidisciplinary nutritional therapy team (MNTT). Methods: the text reflects a compilation of the current guidelines and literature by experienced healthcare workers in adult parenteral nutrition therapy (PNT). Results: in cases of severe illness, the micronutrient concentration deficiency must be corrected in order to improve clinical results. The correction is necessary due to the negative effects micronutrient deficiency have on antioxidant defense mechanisms, metabolic and general immunologic pathways. Final considerations: the present document has the intention of contributing the rational use of micronutrients as a daily integrant of the safe and responsible supply of nutrients in parenteral nutrition.

Evaluation of a Europe-wide Survey on Paediatric Nutrition Training.

Commissioned by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), we investigated how European physicians training in these fields are educated in nutrition. A survey on time spent in nutrition training, composition of multidisciplinary nutrition teams, and topics covered during training enrolled 50 participants. A median of 20% of training time was spent on nutrition training during fellowship. Fourteen (28%) had regular nutrition teaching. Thirty-four (68%) were part of a multidisciplinary nutrition team. Twelve (24%) used the ESPGHAN syllabus. Most frequent topics during nutrition training were diagnosis/investigation of failure to thrive, indications/contraindications for enteral feeds, and benefits/risks of enteral/parenteral nutrition. Twenty-seven (54%) had taken a formal nutrition course. Nutrition training in Europe varies and the ESPGHAN training syllabus is not yet implemented Europe-wide. ESPGHAN nutrition summer schools, and Web-based learning may provide appropriate training. We suggest that all patients necessitating nutritional care be treated by multidisciplinary nutrition teams.

Multidisciplinary nutritional therapy team: The importance of continous education

Multidisciplinary nutritional therapy team: The importance of continous education

A profile of elderly whit dysphagia accompanied by multidisciplinary nutritional therapy team

A profile of elderly whit dysphagia accompanied by multidisciplinary nutritional therapy team

Is the topic of malnutrition in older adults addressed in the European nursing curricula? A MaNuEL study

BackgroundThe lack of sufficient knowledge of health care professionals is one main barrier to implementing adequate nutritional interventions. Until now, it is not known to which extent European nurses are exposed to the topic of malnutrition in older adults during their education. ObjectiveTo determine whether formal nursing degree programs in Europe address the topic of nutrition and, specifically, malnutrition in older adults. DesignA cross-sectional study was conducted using an online-survey. ParticipantsThe online-survey link was e-mailed to 926 nursing education institutions in 31 European countries. MethodsThis study was conducted as part of the Healthy Diet for Healthy Life Joint Programming Initiative, Malnutrition in the Elderly Knowledge Hub (MaNuEL) project. Descriptive analyses were performed using SPSS. Associations were calculated using the chi-square tests and Fisher's exact test. ResultsThe response rate of our survey was 14.2% (131 institutions). Of these, 113 (86.3%) addressed the topic of nutrition in their educational programs, and 73.7% addressed the topic of malnutrition in older adults. Malnutrition screening (70.8%), causes (67.2%) and consequences (68.7%) of malnutrition were frequently-addressed topics of content. Topics that were rarely addressed included nutritional support in intensive care units (ICU) (23.7%), cooperation in multidisciplinary nutrition teams (28.2%), dietary counselling (32.1%) and the responsibilities of various professions in nutritional support (35.1%). The topic of malnutrition in older adults is taught by nurses in 52.7%, by dietitians in 23.7%, by nutritional scientists in 18.3%, and physicians in 19.8% of the institutions. ConclusionsThe topics of malnutrition and malnutrition screening are currently not included in the content of nutrition courses taught at nearly 30% of the European educational institutions for nurses. Nursing educators urgently need to improve curriculum content with respect to the topic of malnutrition in older adults to enable nurses to provide high-quality nutritional care of older persons.

The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit.

The aim of this study was to evaluate nutritional care and outcomes in a medical intensive care unit (ICU) following multidisciplinary nutritional team (MNT) involvement. The authors retrospectively reviewed the data of all patients admitted to a medical ICU from April to October 2013 (pre-MNT period) and from April to October 2014 (post-MNT period). In total, 140 patients were included and allocated to the pre-MNT group (n=70) or the post-MNT group (n=70). The post-MNT group was more likely to use enteral nutrition (61.4 vs 37.1%, P=0.002). In terms of total calories and protein provided, the number of nutritional goal-achieved days during stays in ICU was significantly greater in the post-MNT group than in the pre-MNT group (63.7% vs 47.6%, P<0.05 and 44.3% vs 29.9%, respectively, P<0.05). The MNT activities resulted in significant improvements in terms of nutritional provision and adequacy in a medical ICU.

Impact of a multidisciplinary rehabilitation nutrition team on evaluating sarcopenia, cachexia and practice of rehabilitation nutrition

To determine whether the presence of a multidisciplinary rehabilitation nutrition team affects sarcopenia and cachexia evaluation and practice of rehabilitation nutrition. A cross-sectional study using online questionnaire among members of the Japanese Association of Rehabilitation Nutrition (JARN) was conducted. Questions were related to sarcopenia and cachexia evaluation and practice of rehabilitation nutrition. 677 (14.7%) questionnaires were analysed. 44.5% reported that their institution employed a rehabilitation nutrition team, 20.2% conducted rehabilitation nutrition rounds and 26.1% conducted rehabilitation nutrition meetings. A total of 51.7%, 69.7%, 69.0% and 17.8% measured muscle mass, muscle strength, physical function and cachexia, respectively. For those with a rehabilitation nutrition team, 63.5%, 80.7%, 82.4% and 22.9% measured muscle mass, muscle strength, physical function and cachexia, respectively, whereas 46.7%, 78.0% and 78.1% of the respondents reported implementation of nutrition planning strategies in consideration of energy accumulation, rehabilitation training in consideration of nutritional status and use of dietary supplements, respectively. Multivariate logistic regression analysis showed that the use of a rehabilitation nutrition team independently affected sarcopenia evaluation and practice of rehabilitation nutrition but not cachexia evaluation. The presence of a multidisciplinary rehabilitation nutrition team increased the frequency of sarcopenia evaluation and practice of rehabilitation nutrition. J. Med. Invest. 64: 140-145, February, 2017.

Study of possible beneficial effect of crocin in an animal model of diabetes

s / Clinical Nutrition ESPEN 13 (2016) e55ee74 e65 Materials and methods: 107 patients diagnosed with cancer and treated in an oncology centre of excellence who have been referred to the community nursing home-care service. A pilot cross-sectional quantitative study, based on convenience sampling. The screening tool used to determine malnutrition was the ESPEN Nutrition Day questionnaire for oncological patients in greek language, as translated and validated by GrESPEN. Results: On average, a weight loss of 8 kilograms over the last year was noted for male patients, contrary to women, for whom no change was noted. In 76% of cases the weight loss was unintentional and 13% of the sample population has already lost more than 20% body weight. Minimum BMI was 19.8 with a good correlation to cancer stage. Risk factors for malnutrition identified included taste distortion, anorexia and constipation. None of the individuals at risk had been referred for nutrition counseling/support before the study. Conclusions: The community nurses should promote cancer patients’ education on nutritional status screening within the context of multidisciplinary nutrition teams. STUDY OF POSSIBLE BENEFICIAL EFFECT OF CROCIN IN AN ANIMAL MODEL OF DIABETES Konstantinos Feidantsis , Nantia Apostolidou , Eleftheria Galatou , Antigone Lazou . 1 Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, GR 54124, Greece; Alexander Technological Educational Institution of Thessaloniki, Department of Nutrition and Dietetics, Thessaloniki, Greece Introduction: Diabetes mellitus is a metabolic disease whose worldwide incidence is high (4-5%). The connection between diabetes with poor metabolic control and the high mortality due to cardiovascular disease, hyperlipidemia, nephropathies and neuropathies are very well established. Several recent studies demonstrate the protective effect of a wide variety of antioxidants to tissue damage as in the case of myocardial infarction. The extract of the plant Crocus sativus L. (commonly known as saffron) contains compounds, such as crocin, picrocrocin and safranal. Among the pharmacologically active ingredients, crocin is the most important and abundant antioxidant, has antitumor, antioxidant, anti-hyperlipidemic properties and is known to strengthen memory. Aim: The purpose of this study is the possible improvement of heart, liver and kidney function of diabetic rats after oral administration of crocin (10 and 20 mg / kg body weight) for 2 weeks and identification of the underlying molecular mechanisms that contribute to the improvement of cardiac, hepatic and renal function of the animals. Materials and methods: Specifically levels of biochemical indicators such as glucose, triglycerides, urea, total cholesterol, HDL and LDL and levels of enzymes SGOT, SGPT and GGT were detected in animal blood plasma. Results: a The study was carried out as part of a nutritional educational program that is performed from Aegean University (Responsible Prof.: Lecturer PD 407 Koutelidakis A.) in collaboration with 301 ARMY DEPOT (Responsible from 301 Depot: C. Z. Titakis, PhD candidate, Dept of Chemical Engineering, National Technical University of Athens) Figure 1. Glucose, triglycerides, urea, total cholesterol, HDL and LDL levels in control, diabetic and diabetic rats after the oral administration of crocin (10 and 20 mg/kg body weight). Values are means ± SD; n1⁄45 preparations from different animals. *P 0,05). Conclusion: The implementation of a nutrition education program with aim to improve dietary habits, may lead to improved work efficiency and promoting the health of workers. DEVELOPMENT AND VALIDATION OF A MODEL THAT ESTIMATES BODY FAT PERCENTAGE BASED ON SIMPLE ANTHROPOMETRIC MEASUREMENTS Vladlena Khudokonenko , Spyridon Kanellakis , Efstathios Skoufas , Eftychia Apostolidou , Loukia Gerakiti , Maria Andrioti , Christianna Georgopoulou , Georgia Ziogou , Theodora Makridi , Yannis Manios . Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; Department of Nutrition and Dietetics, T.E.I. of Thessaly, Karditsa, Greece; Department of Nutrition and Dietetics, T.E.I. of Crete, Sitia, Greece

Psychometric testing of the "Graz Malnutrition Screening Tool" (GMS) - Validity, Reliability, Sensitivity &amp; Specificity

Background Despite high prevalence rates of malnutrition in hospitals, awareness of medical and nursing staff is still rather low [1]. The implementation of valid malnutrition screening tools within preexisting electronic data source systems seems mandatory. Hospitals are in need of an easy to handle, valid and reliable malnutrition screening tool with high sensitivity and specificity for all kind of adult patient groups. The GMS was developed by a multidisciplinary nutrition team of the University Hospital Graz (Austria). It is primarily based on the ESPEN recommendations [2] and consists of five items shown in table 1. To individualize for special needs of older patients, age was introduced as independent risk factor.

Retrospective audit of parenteral nutrition use in a tertiary oncology and haematology centre prior to the launch of the multidisciplinary nutrition team

Retrospective audit of parenteral nutrition use in a tertiary oncology and haematology centre prior to the launch of the multidisciplinary nutrition team

PTH-214 An audit reviewing the impact of a nutrition multi-disciplinary team on wastage of adult parenteral nutrition bags

Introduction At our hospital prior to April 2014, patients commenced on parenteral nutrition (PN) were reviewed on a daily basis by the chemical pathology registrar and once weekly on a multi-disciplinary nutrition team (MDT) ward round. PN was prescribed and manufactured in advance where possible to help facilitate the work flow within the pharmacy aseptic unit. In April the nutrition MDT recruited a nutrition clinical nurse specialist (CNS) and introduced twice weekly consultant led MDT ward rounds. In addition, daily reviews of all PN patients are done by the CNS and a pharmacist with the registrar, for daily prescriptions. The aim of this audit was to assess the impact of the enhanced nutrition support MDT on: (1) the percentage of PN bags used for the intended patients, (2) the projected annual financial cost of wasted PN, (3) the percentage of PN bags that have been reallocated where cold chain storage is assured, (4) the cost saving incurred as a result of reallocating wasted PN bags. Method Prospective data was collected on adult PN bags over a three month period between October – December 2014. All PN bags ordered from an external provider and standard PN bags from the aseptic pharmacy department were included. Any PN bags from other hospitals and home PN bags were excluded. Information captured included: total number of adult PN bags, type of PN bag, reasons for wastage or return, why bag could not be reallocated, number of bags reallocated and the cost of the PN bag. The price for each PN bag was calculated based on the cost breakdown from the monthly PbR PN reporting for aseptic services. Results were compared to data collected during a previous audit undertaken between April–July 2014. Results 627 PN bags were ordered during the audit period. Out of which 91% (n = 568/627) were used for intended patient (an increase of 1%); the financial cost of wasted PN was £6,217 per annum (a decrease of 62%); 69% (n = 41/59) were reallocated (increase of 5%); and the cost saving was £8,926 per annum (an increase of 37%). Conclusion The inclusion of a CNS and a pharmacist to the daily ward rounds as well as daily prescribing of adult PN bags significantly improved the utilisation of PN bags appropriately and minimised waste. A system to highlight which PN bags are available for reallocation should be introduced locally to avoid available bags not being utilised. Disclosure of interest None Declared.

PTH-206 Audit on appropriateness intravenous fluid therapy in tpn patients

Introduction In hospitalised patients, fluid resuscitation is the second commonest intervention after oxygen administration. The situation becomes complex when fluids are prescribed to patients on parenteral nutrition (TPN), as TPN contributes to their fluid requirements. Excess IV fluids can cause complications such as fluid overload in sick patients with multiple co-morbidities. Method The aim of the study was to assess the appropriateness of additional IV fluid therapy in patients receiving TPN at our hospital. We prospectively reviewed patients receiving TPN for 3 months from October to December 2014. We used dietitian’s charts, medical notes and drug charts to gather data, which included indications, amount and type of additional fluids given and fluid balance. We also noted whether there were any complications such as fluid overload. The data included patient gender, age and whether a medical or surgical team looked after them. Additional fluids were described as appropriate if given for renal impairment or to match the fluid balance e.g. insensible or extra losses. Results A total of thirty patients were given TPN during the three months. Age range was 35–90 with an average age of 58. There were equal number of male and female patients. 22 (73%) patients were managed on surgical wards, the remainder on medical wards. 26 (86%) patients were prescribed additional IV fluids during their admission. Indications for fluids were not documented in 24/26 (92%). 15 patients were in a positive fluid balance of at least 2 litres over an average duration of 3 days. Of these, 10 patients had renal impairment, which subsequently improved. 4 patients had IV fluids prescribed to compensate for fluid losses e.g. from a high stoma output. 14/26 (53%) fluid prescriptions were appropriate. The choice of fluids was variable as most patients had a mixture of fluids, approximately 50% given at least one litre dextrose as fluids. All of the fluid prescriptions were made by the house officers. Two patients developed fluid overload requiring diuretics. There were 2 deaths unrelated to fluid management but secondary to the underlying conditions. Conclusion The results demonstrate that additional IV fluid prescription was often poorly managed. The indication for fluids was not documented in most cases and the choice and volume of fluids were often inappropriate. This is particularly relevant in TPN patients as more dextrose can increase the caloric burden. We propose that a multidisciplinary nutrition team should take the lead in advising about fluid management as well as TPN and only experienced practitioners should prescribe fluids in these scenarios. Juniors prescribing additional fluids should be supervised or advised. Disclosure of interest None Declared.

Parenteral Nutrition Utilization After Implementation of Multidisciplinary Nutrition Support Team Oversight: A Prospective Cohort Study.

Multidisciplinary nutrition teams can help guide the use of parenteral nutrition (PN), thereby reducing infectious risk, morbidity, and associated costs. Starting in 2007 at Harborview Medical Center, weekly multidisciplinary meetings were established to review all patients receiving PN. This study reports on observed changes in utilization from 2005-2010. All patients who received PN from 2005-2010 were followed prospectively. Clinical data and PN utilization data were recorded. Patients were grouped into cohorts based on exposure to weekly multidisciplinary nutrition team meetings (from 2005-2007 and from 2008-2010). Patients were also stratified by location, primary service, and ultimate disposition. In total, 794 patients were included. After initiation of multidisciplinary nutrition meetings, the rate of patients who started PN decreased by 27% (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63-0.84). A reduction in the number of patients receiving PN was observed in both the intensive care unit (ICU) and on the acute care floor (RR, 0.64; 95% CI, 0.53-0.77 and RR, 0.80; 95% CI, 0.64-0.99, respectively). The rate of patients with short-duration PN use (PN duration of <5 days) declined by 30% in the ICU (RR, 0.70; 95% CI, 0.51-0.97) and by 27% on acute care floors (RR, 0.73; 95% CI, 0.51-1.03). Weekly multidisciplinary review of patients receiving PN was associated with reductions in the number of patients started on PN, total days that patients received PN, and number of patients who had short-duration (<5 days) PN use.

Surveillance of Clostridium difficile infections in a long-term care psychogeriatric facility: outbreak analysis and policy improvement.

BackgroundFollowing an exceptionally high Clostridium difficile infections (CDI) incidence (Spring 2011) in a psychogeriatric long-term care facility, a bidirectional study (2009–2012) was initiated to identify determinants (retrospectively) and to assess intervention measures taken (prospectively).MethodsFor every CDI patient (de novo cases, relapses, and recurrences), a control patient (patient in the opposite room) was selected and risk factor analysis performed. Following the epidemic peak a more stringent hygienic protocol and surveillance program were implemented, as well as uniform guidelines for metronidazole and vancomycin prescription.ResultsThe nutritional state (total protein/prealbumine) significantly differed between the CDI group (poorer nutritional state at admission) and the control group, and also antibiotic use (general) could be confirmed as a risk factor. A multi-disciplinary nutritional team has been established in order to improve the nutritional balance of our patients.ConclusionsAside from stringent hygiene and antibiotic prescription stewardship, malnutrition of patients is a factor to be taken into account to contain a CDI outbreak in a long term care facility (LTCF).

G183(P) Learning together study days: cross specialty education to improve children and young people’s health

Aims The UK is lagging behind the majority of Europe in children and young people’s health outcomes. 1 One possible hypothesis for this is the lack of integration between primary, secondary and tertiary care. The World Health Organisation supports effective inter-professional education as it enables effective and collaborative practice. 2 There is published evidence that inter-professional learning can lead to better patient care and safety, reduced mortality rates and better use of specialist health resources. 3–5 Methods Following focus group work and a pilot study day, the authors created three study days: Child and Adolescent Mental Health, Public Health and Adolescent Sexual Health. These are areas where good care crosses traditional medical specialties and health care professions. Royal College curricula were analysed to define learning outcomes. The study days were advertised to paediatric, GP and relevent specialty trainees as well as other children’s and young people’s health professionals. Each day featured a mix of lecture and small group case based learning. Results The three days were attended by 163 trainees (85 paediatric, 52 GP, 26 other). We received pre and post course online feedback from 85 (53%) and 104 (64%) trainees respectively. Across the three days the proportion of delegates who strongly agreed with the statement ‘My learning is enhanced when I learn with health care professionals from different specialties’ increased from 40.7 to 60.2% (Tables 1 and 2). Conclusions This series demonstrates that it is both desirable and feasible to offer cross specialty inter-professional education in Children and Young People’s health and that it not only increases confidence and knowledge in the individual subject areas but also improves the delegates’ own perceptions of learning in the wider cross specialty team. References Wolfe I, Thompson M, Gill P, et al . Health services for children in Western Europe. Lancet 2013; 381 (9873):1224–1234 WHO Framework for Action on Interprofessional Education {$} Collaborative Practice 2010 Simmonds S, Coid J, Joseph P, et al . Community mental health team management in severe mental illness: a systematic review. Br J Psychiatry 2001; 178 :497–502 Naylor CJ, Griffiths RD, Fernandez RS. Does a multidisciplinary total parenteral nutrition team improve outcomes? A systematic review. J Parenter Enteral Nutr . 2004; 28 :251–258 Holland R, Battersby J, Harvey I, et al . Systematic review of multidisciplinary interventions in heart failure. Heart 2005; 91 :899–906

When is feeding via a percutaneous endoscopic gastrostomy indicated?

This review addresses current controversies regarding appropriate indications for percutaneous endoscopic gastrostomy (PEG) insertion. We address specific indications, namely, dementia, stroke, aspiration, motor neurone disease/amyotrophic lateral sclerosis, and head and neck cancer. We recommend practical strategies for improving patient selection. There is now a general consensus in the United States that PEG feeding does not benefit patients with advanced dementia. 'Early' PEG insertion following stroke is similarly of no benefit. It is currently unclear whether patients with amyotrophic lateral sclerosis and head and neck tumors should have PEG or radiologically inserted gastrostomy. Decisions relating to PEG insertion remain difficult. The gastroenterologist, working as a member of a multidisciplinary nutrition team, needs to take a lead role in this regard, rather than functioning as a technician.

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals) and private sectors (two hospitals) were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment. Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels. A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.