Nutritional Management Research Articles

Effectiveness of registered dietitian-led management of early nutritional support in the emergency intensive care unit: a retrospective observational study

BackgroundAppropriate nutritional management in critically ill patients positively impacts prognosis. This study evaluated the effectiveness of a dietitian-led early enteral nutrition protocol in an intensive care unit (ICU).MethodsThis retrospective analysis of prospectively collected data included patients who stayed in the emergency ICU (EICU) for at least 5 days between April 2021 and May 2022. Patients were divided into control and early support groups based on the implementation of the early enteral nutrition protocol in November 2021.ResultsThe time to start enteral nutrition after admission was significantly shorter in the early support group (41.9 h) than in the control group (59.8 h). The early support group (n = 58) also had higher nutritional sufficiency rates than the control group (n = 56) and a lower incidence of diarrhea (10% vs. 37.5%).ConclusionsThe dietitian-led early nutritional support system effectively reduced the time to enteral nutrition initiation, improved nutritional sufficiency rates, and decreased the incidence of diarrhea in the EICU.

Enhancing aromatic rice production through agronomic and nutritional management for improved yield and quality

To meet the growing international demand for aromatic rice, this study, conducted at Uttar Banga Krishi Viswavidyalaya in Cooch Behar, West Bengal, aimed to enhance the yield and quality of the ‘Tulaipanji’ rice cultivar through advanced establishment methods and the use of organic nutrients over two years. The research tested three planting techniques: mechanical transplanting, wet direct seeding (using a drum seeder), and traditional methods, alongside four nutrient management strategies: vermicompost, farmyard manure, a mix of both, and conventional fertilizers. Findings revealed that mechanical transplanting significantly increased yield by over 31.98% and 71.05% compared to traditional methods and wet direct seeding, respectively. Using vermicompost alone as a nutrient source not only boosted yields by 21.31% over conventional fertilizers but also enhanced the rice's nutritional value and cooking quality. Moreover, soils treated with vermicompost showed higher dehydrogenase activity, indicating better soil health. Economically, mechanical transplanting with vermicompost was the most beneficial, yielding the highest net returns and benefit–cost ratios in both years studied. This approach presents a viable model for improving the sustainability of aromatic rice production globally, emphasizing the economic and environmental advantages of adopting mechanical planting techniques and organic fertilization methods.

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) therapy decreases lean body mass and appendicular skeletal muscle mass index even until one year after the final treatment in patients with B-cell non-Hodgkin lymphoma

Sarcopenia is an independent prognostic factor for several solid cancers, including B-cell non-Hodgkin lymphoma (B-NHL). However, previous reports have measured the parameters of loss of skeletal muscle as sarcopenia only once before chemotherapy and have predicted poor outcomes. In this study, changes in body composition were measured in patients who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) therapy for B-NHL using the InBody 720 analyzer throughout the therapy. Twenty-seven patients who achieved complete remission and survived for one year after the last cycle were included in the study. Body composition was evaluated immediately before initiation and fourth cycle, and one month and one year after the last cycle. Throughout the follow-up period, the lean body mass index (LBMI) and appendicular skeletal muscle mass index (ASMI) showed significant transient decreases even one year following the last cycle (p < 0.001, p = 0.002, respectively). Body fat index (BFI) and body fat percentage (BF%) decreased until one month after the last cycle; however, they reached levels higher than the baseline levels, +22.1% and +15.9%, respectively, at 1 year from the last cycle. The loss of skeletal muscle mass did not recover even one year after the last cycle. Interventions in nutritional management are needed to prevent sarcopenia in patients treated with R-CHOP therapy.

Effect of fermented grain cereal milling by-product on the enhancement of physiological and reproductive parameters of goldfish (Carassius auratus) broodstock

The aim of this work was to assess the effect of feeding goldfish (Carassius auratus) broodstock with diets containing dietary fermented grain cereal milling by-product with Saccharomyces cerevisiae 5, 10, 20 g/Kg diet (FY) (a carbohydrate source) on fish growth, health, maturity, and reproductive performance. The broodstock were divided into four groups: FY0, FY5, FY10, and FY20 diet, and control (FY0) fed a basal diet for 68 days. Growth-related parameters, biochemical composition, and blood biochemical parameters were measured. For maturity progress ovarian histology, gonadotropins and sex steroid hormones (T and E2) were noticed, and to evaluate reproductive performance, fecundity and gonadosomatic index (GSI%) were evaluated. Adding FY to the experimental diets improved broodstock growth and hematological markers. Additionally, it enhanced the ovarian growth (GSI% and fecundity), which augmented significantly (p ≤ 0.05) in FY10 and. FY20 treated sets. Dietary FY significantly increased serum levels of globulin, albumin, total protein, and glucose compared with the control. In addition, gonadotropins and sex hormones were significantly elevated in a dose-dependent mode with increasing FY levels. This study demonstrated positive physiological effects with improving reproductive parameter response after FY dietary addition. The group fed FY20 exhibited the better growth performance than the other treatments. Therefore, nutritional FY management could be employed as a tactical approach to improve reproductive ability and maintain goldfish production.

Smart Nutrient Management in Hydroponics: IoT-Driven Optimization for Enhanced Crop Yield and Resource Efficiency

Hydroponics is a potential option to farming in dirt because it gives you more control over how much water and nutrients are used. However, managing nutrients optimally in hydroponic systems is still a difficult task. This research suggests a smart nutrition management system that uses Internet of Things (IoT) technologies to get the most out of resources and increase food growth. The framework has sensors built in that can check external factors like pH, electrical conductivity, and nutrient amounts in the hydroponic solution in real time. These sensors send constant streams of data, which lets the exact amounts of nutrients be changed to meet the needs of different plants at different times of growth. Machine learning techniques are used to look at monitor data and guess what the best food mixes will be. The system changes with the times by using past data and weather models. This keeps resources from going to waste and increases food yield. The IoT system also allows tracking and control from afar, which makes upkeep and strategic actions easier. Automated alerts let farmers know when conditions aren't as good as they should be, so they can make changes quickly to avoid crop damage or nutrition shortages. Experiments are done in a controlled growing setting to see how well the planned system works. Compared to standard ways, the results show big gains in food growth and resource economy. It can also be scaled up or down, and it can be changed to work with different types of crops and environments.

A critical systematic review on spectral-based soil nutrient prediction using machine learning.

The United Nations (UN) emphasizes the pivotal role of sustainable agriculture in addressing persistent starvation and working towards zero hunger by 2030 through global development. Intensive agricultural practices have adversely impacted soil quality, necessitating soil nutrient analysis for enhancing farm productivity and environmental sustainability. Researchers increasingly turn to Artificial Intelligence (AI) techniques to improve crop yield estimation and optimize soil nutrition management. This study reviews 155 papers published from 2014 to 2024, assessing the use of machine learning (ML) and deep learning (DL) in predicting soil nutrients. It highlights the potential of hyperspectral and multispectral sensors, which enable precise nutrient identification through spectral analysis across multiple bands. The study underscores the importance of feature selection techniques to improve model performance by eliminating redundant spectral bands with weak correlations to targeted nutrients. Additionally, the use of spectral indices, derived from mathematical ratios of spectral bands based on absorption spectra, is examined for its effectiveness in accurately predicting soil nutrient levels. By evaluating various performance measures and datasets related to soil nutrient prediction, this paper offers comprehensive insights into the applicability of AI techniques in optimizing soil nutrition management. The insights gained from this review can inform future research and policy decisions to achieve global development goals and promote environmental sustainability.

Nutritional management of hyperlipaemia in a jenny: a brief report

An adult jenny (5-years-old, non-pregnant) was presented to the Veterinary Teaching Hospital (VTH) of the University of Sassari, with a recent history of appetite loss, extreme underweight condition and reluctance to move. On physical inspection, emaciation [body condition score, BCS: 3/9], muscular waste [muscular condition score, MCS: 1/5], loose/running faeces [faecal score, FS: 2/8], and a general state of mild dehydration were found. Blood analyses outlined a general undernourishment condition [circulating albumins, ALB: 17.6 g/L (21.6–31.6 g/L)] with underlying systemic inflammatory profile and moderate increase in circulating enzymes to explore liver function [aspartate amino-transferase, AST: 657 u/L (279–430 u/L); alanine amino-transferase ALT: 60 u/L (5–14 u/L); gamma-glutamyl-transferase, γ-GT: 87 IU/L (14–69 IU/L); total bilirubin close to the upper limit, TB: 0.20 mg/dL(0.07–0.21 mg/dL)]and hyperlipaemia [TG: 8.70 mmol/L (0.60–2.87 mmol/L)], following fat depots mobilisation, with total cholesterol closed to the lower limit of the physiological range. Hyper-phosphataemia was linked to haemolytic anaemia [P:1.81 mmol/L (0.77–1.39 mmol/L) and red blood cells, RBC: 4.14 1012/L (4.40–7.10 1012)] aligned with the TB to the upper limit. On ultrasound abdominal imaging, enlarged and hyper-echogenic liver was observed. Based on the clinical evaluation, a condition of hepatic lipidosis was diagnosed, requiring dedicated nutritional treatment to solve the extreme emaciation along with the metabolic disorder in support of medical therapy. A two-step feeding protocol was planned to support treatments aiming at immediate re-hydration (Ringer lactate solution 2 ml/kg/8 h). The nutritional objectives were meant at first to restart the voluntary feed intake. Gradual increasing energy provision through a palatable hay-based diet was planned to cover one fourth of daily metabolizable energy requirement calculated on the expected metabolic weight, adjusted according to the daily intake of feed and clinical condition. At the conclusion of this first 7-day phase, circulating blood parameters were closer to the reference values and the BCS moved from 3 to 4 out of 9. Bowel motility was restored, and faecal score improved (4/8). In the second phase, allowance to pasture and a combination diet with compound mixed feed were designed. Within four weeks of starting the nutritional plan, blood parameters were re-established to reference values. The gradual feed provision calculated in this two-phase approach proved successful in support of the overall clinical improvement observed after four weeks of treatment, in a severely undernourished jenny with compromised liver functions.

Nutritional management of muscle mass loss in patients with Post-COVID-19 Syndrome: a scoping review

Post-Covid-19 Syndrome (PCS) is a condition that causes persistent symptoms and impacts nutritional status such as loss of muscle mass. The objective of this study was to review and map scientific evidence on nutritional management in the loss of muscle mass in patients with PCS. The scoping review protocol was prepared following the PRISMA-ScR guidelines. Review articles not written in English or those that included only hospitalized patients and pertained to conditions other than PCS were excluded. Data extraction followed the methodology outlined by the Cochrane Review Group. Of the 81 articles initially identified, only five met the inclusion criteria. The selected studies emphasized the importance of recovering muscle mass, higher protein and caloric intake, and physical strength exercises. Consequently, nutritional interventions aimed at mitigating muscle mass loss should prioritize strategies that increase caloric and protein consumption.

Towards organic farming in roselle (Hibiscus sabdariffa L.) cultivation- feasibility of changing its nutrition management from chemical to bio-organic

The high dependence on chemical fertilizers in the farming systems especially in the arid regions has become a serious challenge that threatens the stability and sustainability of crop production. Therefore, determining alternative nutrition systems based on the organic and biological sources is a critical issue of crops management. The objective of this study is to assess the response of the roselle (Hibiscus sabdariffa L.) to chemical, organic and biological nutrient systems. A two-year field experiment was conducted with a split-plot based on randomized complete blocks design with three replications. The main plots consisted of control (CL), vermicompost (VP), poultry manure (PM), and chemical fertilizer (NPK) (CF), while the sub-plots involved control (AM0), application of Glomus mosseae (AM1), and Rhizophagus intraradices arbuscular mycorrhiza (AM2). The results showed that PM and CF treatments led to the highest increase in fresh calyx yield (58.6%) compared to the control. While PM treatment showed the highest increase in dry calyx yield (23.9%) and seed yield (32.0%). AM inoculation resulted in a 27.3, 26.8, and 22.3% increase in mentioned traits, respectively compared to the control. PM treatment showed the highest values of dry calyx and seed water productivity (13.5 and 15.5 kg m−3, respectively). Also, AM2 treatment showed the highest values for these indices (13.5 and 14.5 kg m−3, respectively). The highest increase in calyx ascorbic acid (20.1%) was obtained from PM treatment, while the highest value of calyx anthocyanin content (0.307 and 0.292 µmol g−1) in the first and the second year was found in PM and CF treatment, respectively. VC treatment resulted in the highest increase in seed oil content (12.8%), while the highest increase in seed protein content (22.8%) belonged to the CF treatment. The average improvements in the calyx ascorbic acid, calyx anthocyanin content, seed oil content, and seed protein content due to AM inoculation were 11.2, 5.0, 9.2, and 7.8%, respectively. According to our findings, the use of mycorrhiza (especially Rhizophagus intraradices) in combination with poultry manure is recommended to achieve proper economic yields and improve water productivity and quality indices of the roselle in order to replace the chemical fertilizers in the cultivation of this plant in the study area.

Effect of Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding

Abstract Background Early enteral nutrition is the standard of care in critically ill patients receiving invasive mechanical ventilation. However, numerous studies have shown that early enteral nutrition is frequently not used. The main reason for nonuse is gastrointestinal intolerance to enteral nutrition which has been ascribed to gastroparesis with increased gastric volume, gastroesophageal reflux, and regurgitation or vomiting carrying a risk of aspiration and ventilator-associated pneumonia. Aim of the Work To test the hypothesis that the risk of ventilator-associated pneumonia is not increased when residual gastric volume is not monitored compared with routine residual gastric volume monitoring in patients receiving invasive mechanical ventilation and early enteral nutrition. Furthermore residual gastric volume monitoring may be associated with decreased calorie delivery and therefore, with underfeeding and increased morbidity. Patients and Methods This is a Prospective cohort study that was conducted at Ain Shams University Hospitals&amp; Rashid General hospital for 6 months on critically ill patients admitted to ICU with mechanical ventilation. Sample sizes of 215 in each group totaling 430 in the study achieve 80% power to detect a non-inferiority margin difference between the group proportions of -0.0800. The reference group proportion is 0.158. The treatment group proportion is assumed to be 0.078 under the null hypothesis of inferiority. Results There was no significant difference between groups regard BMI (is calculated as weight in kilograms divided by height in meters squared), SAPS II or SOFA regard sex distribution the majority were male in both groups with no significant difference and also DM and HTN distributed with no significant difference between groups. Considering cause of admission and risk factors distribution between studied groups, in our study there is no significant difference or association between the two groups and the majority admission causes of both groups were respiratory and cancer. No significant difference between groups regard hospital stay or ICU days but MV days were significantly shorter in intervention group. In our study, Ventilator-Associated Pneumonia was significantly associated with control group as 47.4% had pneumonia while only 11.2% in intervention group had it. In the present study, cumulative calories deficit was significantly lower in intervention group, Intolerance and Prokinetic TTT were significantly associated with control group. Conclusion The current study supports the hypothesis that a protocol of enteral nutrition management without residual gastric volume monitoring is not inferior to a similar protocol including residual gastric volume monitoring in terms of protection against VAP. Residual gastric volume monitoring leads to unnecessary interruptions of enteral nutrition delivery with subsequent inadequate feeding and should be removed from the standard care of critically ill patients receiving invasive mechanical ventilation and early enteral nutrition.

Current practices in the nutrition management of people with amyotrophic lateral sclerosis (ALS): a survey of U.S. ALS care teams

Objective To assess current practices of U.S. professionals providing outpatient ALS nutrition care. Methods A cross-sectional survey assessing nutrition care practices was distributed in February/March 2023 through electronic mailing lists of relevant professional organizations. Results Of the 87 professionals completing the survey, 85.1% were registered dietitians and 50.6% had five or fewer years of experience in ALS care. Many (44.2%) professionals reported receiving no training on the nutrition care of people with ALS (PALS), and 40.2% reported having no other ALS dietitians in their close network. Methods utilized to estimate calorie and protein requirements in PALS varied widely. Although 95.4% of respondents reported that their clinic’s dietitian participates in feeding tube discussions, many practitioners may be waiting until ALS symptoms negatively impact PALS’ breathing, eating, swallowing, or weight to begin discussing feeding tubes. Additionally, few professionals reported institutional practices conducive for refeeding syndrome prevention or monitoring. Conclusions Many professionals providing outpatient nutrition care to PALS possess limited experience, received insufficient training, and are not connected to other ALS dietitians. Specific nutrition care practices, including nutrient need estimation, vary widely among health professionals. Practices surrounding feeding tube discussions and refeeding syndrome may be suboptimal at many institutions. These findings highlight the need for initiatives that educate and connect practitioners providing nutrition care to PALS.

Nutritional Support for ICU Patients Receiving Extracorporeal Membrane Oxygenation Therapy: A Meta-Analysis

Abstract Background ECMO constitutes a mechanical technique that provides extracorporeal gas exchange or/and circulatory support for patients with refractory life-threatening pulmonary or/ and cardiac failure. There is infrequent evidence regarding the optimal nutritional management and related clinical outcomes for adult critically-ill patients receiving ECMO. Objective This study was conducted to evaluate the effect of nutritional intervention on clinical outcomes in adult critically ill patients receiving Extracorporeal Membrane Oxygenation Therapy. Methodology Advanced search was conducted in Medline, PubMed, google scholar and the Egyptian Knowledge Bank for cohort studies that were published in English until September 2020. Inclusion Criteria cohort studies which assess nutrition support in adult critically-ill patients receiving ECMO therapy, and include at least one of these outcomes a) 28-day mortality, b) length of ICU stay, C) duration of mechanical ventilation and d) incidence of infection. Exclusion Criteria duplicate reports, Abstracts, case reports, case series, review articles, editorials and clinical guidelines. In addition, studies with unavailable full text or studies with different outcomes were excluded. Results 7 studies with a total number of 2358 patients were included in the meta-analysis. Estimates and their 95% confidence intervals (CI) were calculated, then pooled for analysis. Nutrition support in adult critically ill patients receiving ECMO was significantly related to 28-day mortality ( 95% CI 0.428 = 0.329–0.527; p &amp;lt; 0.001), increased ICU length of stay ( 95% CI 29.512 (22.930–36.095), and P value &amp;lt; 0.001), duration of mechanical ventilation (95% CI 17.985 = 4.682–31.288; p &amp;lt; 0.008) and incidence of infection ( 95% CI 0.105 ( 0.066 – 0.144), and P value &amp;lt; 0.001). Conclusion The study indicates positive association between effective nutrition support and clinical outcomes for adult critically-ill patients receiving ECMO therapy.

Workshop write up: nurse-led nutrition clinics

Veterinary nurses have a key role to play in the management of nutrition. In this workshop session, Laura Hughes looked at how to set up a nurse-led clinic, the key parameters to check and how to manage difficult conversations with owners. This article provides a brief overview of the main topics discussed in the workshop.

Malnutrition management in children with chronic kidney disease.

Chronic kidney disease (CKD) encompasses diverse conditions such as congenital anomalies, glomerulonephritis, and hereditary nephropathies, necessitating individualized nutritional interventions. Early detection is pivotal due to the heightened risk of adverse outcomes, including compromised growth and increased healthcare costs. The nutritional assessment in pediatric CKD employs a comprehensive, multidisciplinary approach, considering disease-specific factors, growth metrics, and dietary habits. The prevalence of malnutrition, as identified through diverse tools and guidelines, underscores the necessity for regular and vigilant monitoring. Nutritional management strategies seek equilibrium in calorie intake, protein requirements, and electrolyte considerations. Maintaining a well-balanced nutritional intake is crucial for preventing systemic complications and preserving the remaining kidney function. The nuanced landscape of enteral nutrition, inclusive of gastrostomy placement, warrants consideration in scenarios requiring prolonged support, with an emphasis on minimizing risks for optimized outcomes. In conclusion, the ongoing challenge of managing nutrition in pediatric CKD necessitates continuous assessment and adaptation. This review underscores the significance of tailored dietary approaches, not only to foster growth and prevent complications but also to enhance the overall quality of life for children grappling with CKD.

Nutritional Assessment of Protein and Sodium Contents in Commercial Senior-Friendly Foods.

The purpose of this study was to evaluate the nutritional adequacy of senior-friendly foods sold in Korea, focusing on protein and sodium. This study examined the nutritional content of 170 products with nutritional labels that were sold in online stores in Korea and categorized the products into 93 staple foods (cooked rice, porridge, and mousse) and 77 side-dish and snack foods (braized·steam·roast products, broth, sauces, and snacks). Then, the adequacy of the nutritional content of these foods, focusing on protein and sodium, was evaluated according to product type. The 93 staple products and 77 side-dish products had average serving sizes of 163.27 g and 127.92 g, prices of $3.25 and $2.72, and energy contents of 295.25 kcal and 141.95 kcal, respectively. For staple foods, the energy content was significantly greater in cooked rice, but the protein content and index of nutrition quality (INQ) were significantly greater in mousse. There were no significant differences in sodium content or contribution to adequate intake (AI) by product type, but the sodium INQ was significantly greater in the mousse and porridge. For side-dish foods and snack products, the protein content, contribution to the recommended intake, and INQ were all significantly greater for the braized·steam·roast products. Sauces and braized·steam·roast products were significantly higher in sodium content and contribution to the AI, while broth was significantly higher in sodium INQ. These findings can be used to guide proper product selection and nutritional management that considers the health characteristics of health-vulnerable and elderly people.

Traditional Persian Medicine and Autophagy: Integrating Ancient Health Principles with Modern Cellular Mechanisms

Autophagy, a cellular process responsible for maintaining cellular homeostasis through the degradation and recycling of intracellular components, has a complex relationship with various human diseases, including cancer, neurodegenerative disorders, and infections. Traditional Persian Medicine (TPM), with a 10,000-year history, emphasizes health preservation through six essential principles: physical activity, nutrition, sleep, psychological well-being, air quality, and the excretion of body waste. This review examines the intersection of these principles with autophagy, highlighting the potential of TPM in modern health practices. Recent studies have shown that physical activity induces autophagy, aiding in the prevention and treatment of diseases such as Alzheimer's and diabetes. Nutritional management, another key TPM principle, influences autophagy through practices like intermittent fasting, which can improve insulin sensitivity and prolong life. Sleep, critical for bodily functions and waste disposal, affects autophagy, with disruptions linked to conditions like sleep apnea and cardiovascular diseases. Excretion and retention of necessary materials are crucial for health, with autophagy playing a role in managing obesity, renal function, and gastrointestinal health. Clean air is essential for well-being, and studies indicate that air pollution can stimulate autophagy, potentially leading to liver steatosis. Psychological states also significantly impact autophagy, with stress and emotional well-being influencing cellular processes. This review suggests that the non-pharmacologic modulators of autophagy inherent in TPM's six essential principles could precede pharmaceutical interventions due to their simplicity, safety, and affordability. Health authorities are encouraged to consider these principles in policies for disease treatment and health improvement, leveraging the potential of autophagy modulation for better health outcomes.

Nutritional management for acute liver failure.

Acute liver failure (ALF) induces increased energy expenditure and disrupts the metabolism of essential nutrients. Hepatic encephalopathy is a complication of ALF with a poor prognosis and mainly involves the metabolic disturbance of amino acids in its pathogenesis. In this review, we discuss the nutritional management for ALF in consideration of the pathophysiology of ALF with respect to the impairment of hepatocyte function. It is known that enteral nutrition is recommended for patients with ALF, while parenteral nutrition is recommended for patients who cannot tolerate enteral nutrition. As ALF leads to a hypermetabolic state, the energy intake is recommended to cover 1.3 times the resting energy expenditure. Because of the high risk of hypoglycemia associated with disturbances in glucose metabolism, substantial glucose intake is recommended. Along with the deterioration of glucose metabolism, protein metabolism is also disrupted. As patients with ALF have increased systemic protein catabolism together with decreased protein synthesis, appropriate amounts of amino acids or protein under monitoring serum ammonia levels are recommended. In conclusion, nutritional management based on the understanding of nutritional pathophysiology is a pivotal therapeutic approach for patients with ALF. The approach should be individualized in the acute phase, the recovery phase, and the pretransplant phase.

Break-Up With Salt (BUWS), Community-Based Nutrition Education Supporting Hypertension Prevention and Management

Break-Up With Salt (BUWS), Community-Based Nutrition Education Supporting Hypertension Prevention and Management

Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor.

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement.

Facilitators & Barriers to Implementing E-STAR, a Team Nutrition School Nutrition Manager Training and Professional Development Program

Facilitators & Barriers to Implementing E-STAR, a Team Nutrition School Nutrition Manager Training and Professional Development Program