Clinical Nutrition Support Research Articles

Nutrition support pharmacy practices in hospitalized cancer patients admitted to bone marrow transplant units: A 3-year retrospective analysis of clinical nutrition support pharmacists’ interventions

Nutrition support pharmacy practices in hospitalized cancer patients admitted to bone marrow transplant units: A 3-year retrospective analysis of clinical nutrition support pharmacists’ interventions

Virtual Education is the Need of the Hour for the Global Gastroenterology Community: A Survey of Leaders of Professional Gastroenterology Organizations.

Since the onset of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a significant opportunity to leverage virtual platforms for communication and dissemination of knowledge. An online survey was conducted to examine the viewpoints of World Gastroenterology Organization (WGO) leaders concerning the necessity, primary priority areas, and implementation strategies for a virtual global gastroenterology educational program. We conducted a survey of leaders of WGO member societies to assess their opinions on creating opportunities for global education using virtual platforms, identifying practical implementation steps and priority educational areas. Responses were obtained from 57/117 (48.7%) contacted leaders with 56/57 (98.2%) identifying such a need. Five mutually exclusive priority educational topics were proposed in the survey: clinical gastroenterology, endoscopy, nutritional support, research methodology, and professional development. Overall, most participants prioritized clinical gastroenterology (45/57; 78.9%) and endoscopy/hand skills (27/57; 47.3%) as educational topics to be addressed by the virtual global gastroenterology educational program. A majority of WGO member society leaders surveyed favored monthly teaching activities (33/57; 57.8%), ideally carried out between 1500-2100 local time (31/57; 54.3%), ideally with no administrative fees (47/57; 82.4%). This truly global survey of WGO member societies achieved a good response rate and provides important insights into the need for and scope of future virtual education programs under the aegis of the WGO.

Prehab, ERAS, Rehab: A patient care continuum around colo-rectal surgery: Prehabilitation combined with ERAS and rehabilitation to reduce morbidity and hospital stay.

BackgroundPrehabilitation (Prehab) programs aim to optimize patients psycho-physical condition before surgery, to improve post-operative outcomes. Although functional benefits of Prehab are known, the clinical impact does not yet have concrete evidence. The objective of this study is to evaluate the efficacy of Prehab, associated with Enhanced Recovery After Surgery (ERAS) and surgical rehabilitation (Rehab), in frail colorectal oncological patients in terms of morbidity and hospitalization. Patients and methodsThe cohort of patients undergoing Prehab between January 2020 and December 2022 (Prehab group) is compared with the historical cohort of patients operated on in the period 01/2018-12/2019, not undergoing Prehab (no-Prehab group). Prehab scheme: multimodal (physiotherapy, clinical nutrition and psychological support). All patients followed an ERAS path. Only Prehab patients followed a surgical Rehab by a dedicated nurse case-manager. Propensity score matching (PSM) and weighting (PSW) analyses were used for statistical analysis. Primary objectives: complications at 30 days and hospital stay. Secondary objectives: functional outcomes. ResultsIn 3 years of preliminary enrollment, 36 patients completed the program: 22 in person, 16 in tele-prehab. The Prehab group experienced fewer complications than the no-Prehab group (PSM: 31 % vs 53 % p = 0.02; PSW: 31 % vs 51 % p = 0.02), less severe complications (CCI>20 PSM: 17 % vs 33 % p = 0.074; PSW: 17 % vs 53 % 0.026) and shorter hospital stay (4.5 vs 6 days; p = 0.02). Finally, prehabilitated patients improved their preoperative functional capacity and reduced anxiety levels. ConclusionThe strategy of combining Prehab with ERAS and Rehab has positively influenced post-operative clinical outcomes as well as functional parameters in our series.

Nutrition nurses’ status, practices, and routines: an online cross-sectional survey

Objectives: Nutrition is an integral component of care in the intensive care unit. However, no international comparison has been published about the status and practices of nutrition nurses, their legal titles, gained certificates, and routine duties. To describe the working conditions, educational background, nutrition-related practices, challenges, and future development needs of nutrition nurses in Türkiye, the European countries, and the USA. Methods: A cross-sectional design was used. A thirty-three-item online cross-sectional survey was sent to nutrition support nurses in collaboration with national nutrition societies. The data were collected between November 2020 and August 2021. One-way ANOVA and chi-squared test were used to compare the three countries. Results: Eighty-one nurses completed the survey: 44 (54.4%) from Türkiye, 27 (33.3%) from the European countries, and 10 (12.3%) from the USA. All nurses in Türkiye reported having a clinical nutrition support team, while 88.8% in the European countries and 80% of nurses in the USA had this team (p=0.040). Significant differences were found in terms of nurses’ age, length of service, estimated number of ambulant nutritional consultations per week, and time spent on nutritional practices during work (p<0.001). The type of first-line test for nasogastric tube placement was X-ray confirmation (70%) in the US, whereas it is auscultation (77.2%) in Türkiye and pH-testing of gastric aspirate (81.4%) in the European countries (p<0.001). The most frequently reported professional challenge among nurses in Türkiye (66%) and the European countries (22.5%) was having no legal job title. Conclusion: These findings reflect the broader picture of nutrition nurses’ status and point out the need to develop standardized strategies for education and evidence-based nutrition practices. This study has revealed important differences in the roles and responsibilities of nutrition nurses. The study guides the future development needs of nutrition nurses, highlighting the standardized guidelines and protocols for nutrition practices and calling for comprehensive training programs.

Anthropometric parameters as a predictor for abdominal wall thickness in a patient with gastrostomy.

Enteral feeding tubes play essential roles in clinical management and nutritional support. Knowledge of the abdominal wall is beneficial in surgical practice and safe for gastrostomy. Anthropometric parameters are currently used for clinical assessment in many clinical applications. That might be beneficial if we applied anthropometric measurement for thickness prediction of the abdominal wall to the schedule of patients' gastrostomy care. This study aimed to evaluate the anthropometric parameters of abdominal wall thickness (AWT). We conducted a cross-sectional study with anthropometric parameters and CT-measured anterior AWT were assessed and analyzed. The data are collected from January 2020 to March 2021. Arm circumference and body mass index were strongly correlated with AWT at left upper quadrant area and anterior AWT at middle area. The data was created in an TAWT (Thammasat AWT) chart to represent body parameters to AWT. Arm circumference is related to AWT. A TAWT chart is designed to help medical personnel evaluate the thickness of the abdominal wall and could guide estimating the gastrostomy tube length.

Evidence-based practice attitudes and nutrition support guideline knowledge between holders and nonholders of the Certified Nutrition Support Clinician credential.

Clinical practice frequently changes, and professionals should stay abreast of evidence-based practice (EBP) guidelines. Negative attitudes towards EBP are a barrier to guideline adoption. This study explored EBP attitudes and knowledge of a complex nutrition support clinical case scenario of individuals holding or not holding the Certified Nutrition Support Clinician (CNSC) credential. This cross-sectional study used an online survey sent to American Society for Parenteral and Enteral Nutrition (ASPEN) members with and without the CNSC credential and all CNSC credential holders from the National Board of Nutrition Support Certification email list. The survey included the Evidence-Based Practice Attitude Scale Score (EBPAS-15) and eight knowledge questions using a nutrition support case scenario. An independent samples t test compared knowledge and EBPAS-15 total scores and subscores between CNSC holders and nonholders. Pearson correlation determined the correlation between knowledge and EBPAS-15 scores. The response rate was 7.8% (N = 706). CNSC holders (n = 536) had significantly higher mean knowledge scores (4.7 ± 1.6 out of 8) than nonholders (n = 159, 4.1 ± 1.7) (P < 0.001). Total EBPAS-15 scores were not significantly different between CNSC holders (n = 542, 2.9 ± 0.4 out of 4) and nonholders (n = 164, 2.8 ± 0.7) (P = 0.434), and knowledge scores and total EBPAS-15 scores (P = 0.639) or subscores were not significantly correlated. Regardless of holding the CNSC credential, EBPAS-15 scores indicated respondents had positive EBP attitudes. CNSC holders had significantly higher knowledge scores of recent nutrition support EBP guidelines compared with non-CNSC credential holders. Positive EBP attitudes are a precursor to clinical decision-making, but future research should determine the use of guidelines in clinical practice.

Octanoic acid-rich enteral nutrition attenuated hypercatabolism through the acylated ghrelin-POMC pathway in endotoxemic rats

ObjectivesMetabolic disorders and no response to intravenous nutrition because of sepsis have been urgent problems for clinical nutrition support. Enteral nutrition (EN) has been an important clinical therapeutic measure in septic patients; however, simple EN has not demonstrated good performance. This study aimed to investigate the effects of different concentrations of octanoic acid (OA)-rich EN on hypercatabolism in endotoxemic rats and test whether OA-rich EN could attenuate hypercatabolism through the acylated ghrelin-proopiomelanocortin (POMC) pathway. MethodsRats were randomly divided into six groups: sham, lipopolysaccharide (LPS), LPS + EN and LPS + EN + OA (0.25, 0.5, and 1 g/kg, respectively) groups to investigate the effects of different concentrations of OA-rich EN on hypercatabolism in endotoxemic rats. The rats were then randomly divided into four groups: sham, LPS, LPS + OA, and LPS + OA + Go-CoA-Tat, to test whether OA-rich EN attenuated hypercatabolism through the acylated ghrelin-POMC pathway. Rats received nutrition support via a gastric tube for 3 d (100 kcal/kg daily). Insulin resistance, muscle protein synthesis and atrophy, inflammatory cytokines, ghrelin in circulation and hypothalamus, ghrelin O-acyltransferase (GOAT), and the adenosine 5′-monophosphate-activated protein kinase (AMPK)-autophagy-POMC pathway were measured. ResultsCompared with simple EN, OA-rich EN promoted the acylation of ghrelin in a dose-dependent manner and attenuated POMC-mediated hypercatabolism in endotoxemic rats. Inhibition of GOAT activity decreased the level of acylated ghrelin and aggravated POMC-mediated hypercatabolism conferred by OA-rich EN. ConclusionsOA-rich EN could increase the level of acylated ghrelin and attenuate hypercatabolism through the acylated ghrelin-POMC pathway compared with simple EN in endotoxemic rats.

An investigation on the nutritional status and support of in-patients with common variable immunodeficiency

The study aimed to reveal for the first time the clinical characteristics, nutritional and metabolic status and support of hospitalized patients with common variant immunodeficiency disease (CVID), and provide reference to improve the long-term nutritional management for such patients. This is a retrospective cross-sectional study. Through searching the electronic medical record system of Peking Union Medical College Hospital, the study included 33 consecutive in-patients with CVID diagnosed in Jan 2016 to Jun 2021, with the male to female ratio of 16∶17. All their medical data, nutritional assessment and intervention retrospectively summarized and analyzed. Data with normal distribution were described using (x¯±s), and analyzed with independent sample t-test. Data with non-normal distribution were compared with non-parametric test. The results showed that the median onset-age of the included patients was 22 (10.0,36.5) years old, and the median duration was 9.0 (2.0,16.0) years. All patients had recurrent infections involving various systems (33/33), with development of autoimmune diseases (8/33) and lymphoproliferative disease or malignancy (9/33) in some cases among them. The nutritional risk screening 2002 (NRS 2002) scores revealed that 85.19% of adults had an NRS 2002≥3 points, and 33.33% of children had a BMI-for-age z score<-2. Weight loss occurred in 66.67% of patients (22/33), while 87.88% (29/33), 69.70% (23/33) and 81.82% (27/33) of patients respectively had anemia, hypoalbuminemia and decreased prealbumin. Among 22 patients with micronutrients status evaluated, 77.27% (17/22), 22.73% (5/22) and 31.82% (7/22) of patients respectively had lowered serum iron, folate deficiency and vitamin B12 insufficiency. Six patients underwent 25-OH-VD3 measurement, and were all testified to have vitamin D deficiency. Among all patients with nutritional risk, 56.00% of them underwent nutritional support: oral nutritional supplements (14 cases), enteral feeding (4 cases) and parenteral nutrition (5 cases). In conclusion, the condition of malnutrition was prevalent in patients with CVID, but was under-recognized and undertreated to some degree.

Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations.

Approximately 30% of all children and neonates admitted to the intensive care unit (ICU) experience acute kidney injury (AKI). Children with AKI are largely poorly fed and experience high rates of malnutrition. Nutrition prescription and provision are exceptionally challenging for critically ill neonates, infants, and children with AKI given the dynamic nature of AKI and its respective treatment modalities. Managing the nutrition prescription of critically ill neonates, infants, and children with AKI requires nutrition support clinicians to have a high-level understanding of the various treatment modalities for AKI, which can affect the patient's protein, fluid, electrolyte, and mineral needs. Accurate and timely nutrition assessment in critically ill neonates and children with AKI can be flawed owing to difficulty obtaining accurate anthropometric parameters. Recently, the Pediatric Renal Nutrition Taskforce introduced clinical practice recommendations for the nutrition management of children with AKI. In this review, we will discuss the practical implications of these recent guidelines and work to bridge the knowledge and practice gaps for pediatric and neonatal nutrition support clinicians providing nutrition therapy for patients with AKI in the ICU. We also appraise special nutrition-related considerations for neonates with AKI given newer available renal replacement treatment modalities.

The Efficacy of Parenteral Nutrition and Enteral Nutrition Supports in Traumatic Brain Injury: A Systemic Review and Network Meta-Analysis.

Enteral nutrition (EN) is often used in patients with traumatic brain injury (TBI), but some studies have shown that EN has its disadvantages. However, it is not clear which nutritional support is appropriate to reduce mortality, improve prognosis, and improve nutritional status in patients with TBI. We performed this Bayesian network meta-analysis to evaluate the improvement of nutritional indicators and the clinical outcomes of patients with TBI. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception until December 2021. All randomized controlled trials (RCTs) which compared the effects of different nutritional supports on clinical outcomes and nutritional indicators in patients with TBI were included. The co-primary outcomes included mortality and the value of serum albumin. The secondary outcomes were nitrogen balance, the length of study (LOS) in the ICU, and feeding-related complications. The network meta-analysis was performed to adjust for indirect comparison and mixed treatment analysis. 7 studies enroll a total of 456 patients who received different nutritional supports including parenteral nutrition (PN), enteral nutrition (EN), and PN + EN. No effects on in-hospital mortality (Median RR = 1.06, 95% Crl = 0.12 to 1.77) and the value of 0-1 days of serum albumin were found between the included regimens. However, the value of 11-13 days of serum albumin of EN was better than that of PN (WMD = -4.95, 95% CI = -7.18 to -2.72, P < 0.0001, I 2 = 0%), and 16-20 days of serum albumin of EN + PN was better than that of EN (WMD = -7.42, 95% CI = -14.51 to -0.34, P=0.04, I 2 = 90%). No effects on the 5-7 day nitrogen balance were found between the included regimens. In addition, the complications including pneumonia and sepsis have no statistical difference between EN and PN. EN was superior to PN in terms of LOS in the ICU and the incidence rate of stress ulcers. Although the difference in indirect comparisons between the included regimens was not statistically significant, the results showed that PN seemed to rank behind other regimens, and the difference between them was extremely small. Available evidence suggests that EN + PN appears to be the most effective strategy for patients with TBI in improving clinical outcomes and nutritional support compared with other nutritional supports. Further trials are required.

Assessment of nutritional status in preterm newborns admitted to a tertiary neonatal intensive care unit

Introduction: The increase in survival rates of preterm newborns, especially newborns of very low birth weight and extreme low birth weight, has brought challenges to clinical practice: promoting adequate nutritional support to this population, to favor future neuropsychomotor growth and development, since the interaction between nutrition, growth, metabolic and genetic phenomena are determinant in subsequent health and quality of life. Objectives: Evaluate the incidence of extrauterine growth restriction (EUGR) in preterm newborns and describe the evolution of anthropometric parameters during hospitalization in the neonatal unit. Methods: Prospective cohort study included patients with birth weight ≤1500g and/or gestational age ≤32 weeks. Data collection of anthropometric parameters at birth and at hospital discharge, as well as data regarding clinical evolution and nutritional support. Descriptive statistics were used; comparisons of non-parametric data were used by the Mann-Whitney test and comparison of data matched by the Wilcoxon test, with a significance level of 5%. Results: The incidence of EUGR was 60.5%. There was a decrease in the Z score of weight (p&lt;0.0001), length (p&lt;0.0001) and head circumference (p&lt;0.0001), comparing birth and hospital discharge. The evolution of weight was similar to that described in the literature and nutritional management showed late onset of parenteral and enteral nutrition. Patients with complications related to prematurity had a greater difference in Z-score of weight between birth and discharge. Conclusion: EUGR has a high incidence in preterm newborns, as a consequence of the impact of preterm birth, complications related to prematurity and nutritional practices implemented.

Nutritional Support in Patients with Colorectal Cancer: State of Knowledge and Perspectives

Many cancer patients have a nutritional risk. Nutritional support therapy plays an important role in cancer treatment, especially for the patients with digestive system cancer. Nutritional support therapy for tumor patients should be based on the specific saturations. For example, types of tumors, degree of differentiation, and nutritional status of the patients need to be evaluated in detail, and then propose the specific implementation approach. For the colorectal cancer patients with promising treatment prospects, nutritional support should be standardized and make every effort to improve the safety and effectiveness of treatment. This article reviews the research progress on nutritional support therapy for colorectal cancer patients thereby promoting the standardized development of nutritional support therapy and better guiding the clinical nutritional support practice. In addition, this paper discussed the feasibility of a combination of nutritional and exercise interventions to efficiently improve muscle and strength, physical function, nutritional status, fatigue, and quality of life in colorectal cancer patients. Establishing a standard process for nutritional support should become an interdisciplinary task. Standard procedures and quality control should also be specified to ensure the effectiveness of nutritional therapy. The current knowledge, and perspectives of application of nutritional support in patients with colorectal cancer in this paper could provide a good reference for the future research of cancer diagnosis and treatment.

Research Policy of Case Report and Case Series Design

International Journal of Pharmacology and Clinical Sciences,2022,11,2,36-40.DOI:10.5530/ijpcs.2022.11.8Published:June 2022Type:Review ArticleAuthors:Yousef Ahmed Alomi, Amal Hassan Al-Najjar, Esraa S. Altawil, Maha Hussein Almadany, Ghudair Tashan Alanazi, and Abeer Hussin Almasoudi Author(s) affiliations:Yousef Ahmed Alomi*, BSc.Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor, and Data Analyst, Riyadh, SAUDI ARABIA. Amal Hassan Al-Najjar, BSc, MSc,Drug and Poison Information Center, Security Forces Hospitals, Riyadh, SAUDI ARABIA. Esraa S. Altawil, SCCPN, MSc. Pharm,BCCCP, BCNSP, BCPS Consultant Clinical Pharmacist, Critical Care and Nutrition Support, King Saud University Medical City, SAUDI ARABIA. Maha Hussein Almadany, BSc. Pharm. Health Care Quality Management Professional Diploma (HCQM), Pharmacy Quality Department, King Salman bin Abdulaziz Medical City, Al Madina Al Monwarah, SAUDI ARABIA. Ghudair Tashan Alanazi, BSc. Pharm, Pharm.D, MSc. Clin Pharm, Diploma of Epid, Critical Care Clinical Pharmacist, Internal Medicine Clinical Pharmacist, MOH, Hafrbatin, SAUDI ARABIA. Abeer Hussin Almasoudi, BSc.Pharm Director, Administration of Research and Studies, Ministry of Health, Tabuk, SAUDI ARABIA. Abstract:Objectives: This study aims to declare the Research policy of case reports and case series design in pharmacy practice as a new initiative in Saudi Arabia. Methods: This article is a narrative review of pharmacy research. Litterateur looked up specific research policies and procedures in pharmacy practice in databases such as PubMed, Medline, and Google Scholar. The time frame for the search was from the 1960s to October 2021. The terms used are in the English language and encompasses narrative reviews, systemic reviews, meta-analyses, and guidelines. The search term includes all hospital and community pharmacy-related services. Besides, there are national and international guidelines for conducting general research in hospital practice was revised. The pharmacy research committee was formed and consisted of expert members, including clinical pharmacists, pharmacists who specialise in drug information, and clinical research specialists. A member drafted the policy’s guidelines, which were then reviewed and corrected by another member. The research specialist made the third revision. The topic emphasizes the Pharmacy Research policy of case reports and case series design. Results: The Pharmacy Research policy regarding the design of case reports and case series in pharmaceutical care services included several items. This included the advantages and disadvantages of case reports and case series, the steps involved in conducting case report research, and the steps involved in implementing the case series model in pharmacy practice. Conclusion: The case report and case series policy in pharmacy is a new initiative that is part of the pharmacy research services and the pharmacy strategic plan. The case report and case series pharmacy policies help a healthcare organisation address its unique drug related issues. Additionally, the efficacy of the particular drug in treating the particular disease condition. Therefore, in Saudi Arabia, the case report and case series in pharmacy research policy are highly recommended. Keywords:Case report, Case series, Pharmacy, Policy, Research, Saudi ArabiaView:PDF (265.06 KB) PDFClick here to download the PDF file. Images Research Policy of Case Report and Case Series Design

Design and Verification of Human Metabolic Measurement System Based on STM32

A high-precision human metabolic measurement system is designed. The system uses STM32F103 as the main control chip to acquire oxygen, carbon dioxide and flow signals to calculate four quantitative indicators: oxygen consumption(VO2), carbon dioxide production(VCO2), respiratory entropy(RQ) and resting energy metabolism(REE), and finally uses an upper computer to display the calculation results.In this paper, the signal acquisition circuit design was carried out for the oxygen sensor, carbon dioxide sensor and flow sensor, and the validity of the device was verified with the American machine MGCDiagnositcs using Bland-Altman analysis method, and the results showed that the four parameters of VO2,VCO2, RQ and REE of both devices fell in the agreement interval of more than 95%. The device thus provides accurate metabolic measurements and offers an effective tool for the field of general health and clinical nutrition support in China.

P-29: Rapid Progression of Parenteral Nutrition-associated Liver Disease on Liver Biopsies of Pediatric Patients with Short-gut Syndrome: a Case Series

Introduction: The rate of parenteral nutrition-associated liver disease (PNALD) development in short-bowel syndrome (SBS) children on total parenteral nutrition (TPN) is unknown. We present the first case series of pediatric SBS patients on TPN with rapid progression of their PNALD on liver biopsies (LB) obtained <12 months (m) after TPN initiation. Methods: Charts of 81 children with a history of TPN use at a single institution between 2009-2019 were reviewed for inclusion criteria: 1) SBS diagnosis 2) LB obtained <12 m after TPN initiation and 3) No underlying liver disease. Clinical history, nutritional support, and liver function markers (direct bilirubin [Dbili], aspartate aminotransferase [AST], alanine aminotransferase, international normalized ratio, AST to Platelets Ratio Index, ultrasound elastography and LB) were collected via retrospective chart review approved by our institutional review board. Liver pathology was graded by one pathologist. Results: 10 patients fulfilled criteria; the mean duration on TPN prior to LB was 4m (range 1-10.8m) with half on Intralipid, and the other half on an alternative lipid emulsion. Seventy percent also received enteral feeds. Forty percent patients had elevated Dbili. All LBs showed moderate to marked bile ductular reaction associated with a mixed, portal-predominant inflammatory infiltrate of lymphocytes, neutrophils, and occasional eosinophils of mild to moderate severity. Inflammatory infiltration of interlobular bile ducts was a rare finding in a subset of cases; plasma cells were not a prominent feature. Most samples showed some degree of cholestasis, usually canalicular. Lobular inflammation and hepatocyte necrosis were typically mild and nonzonal/spotty though some showed diffuse ballooning hepatocellular injury. No significant steatosis was observed. Fibrosis on trichrome stain was variable, typically portal-predominant; few cases demonstrated pericellular fibrosis. Based on the LB pathology, 70% had a change in medical care such as changing the lipid emulsion. Conclusion: The progression of PNALD in SBS children on LBs <12 months from TPN initiation was more rapid than previously hypothesized. LBs taken at the time of another surgical procedure may be warranted for SBS pediatric patients on TPN.

Effects of prognostic nutrition index on side effects and prognosis of radiotherapy and chemotherapy after radical gastrectomy.

e16002 Background: To investigate the impact of preoperative prognostic nutritional index (PNI) on the severity of radiotherapy and chemotherapy toxicity and survival prognosis in patients with gastric cancer through retrospective analysis and research in order to guide clinical nutritional support treatment for patients with gastric cancer. Methods: Through a retrospective cohort study，we analyzed the data of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Guizhou Medical University and Guizhou Cancer Hospital from January 2008 to December 2018. According to the cut-off value, the patients were divided into high PNI group (PNI≥47.7) and low PNI group (PNI &lt; 47.7). We Compared the incidences of severe radiotherapy and chemotherapy toxicities and overall survival in high PNI group and low PNI group. and make Analysis of prognostic factors. Results: The low PNI group was more prone to severe radiochemotherapy hematological side effects than the high PNI group, and the postoperative survival time was shorter. Multivariate analysis showed that: TNM stage (P = 0.000) and PNI (P = 0.001) were Independent risk factors in predicting overall survival rate. Conclusions: The preoperative prognostic nutrition index is a useful factor for predicting the incidence of radiotherapy and chemotherapy toxicities in patients after gastric cancer surgery.It is one of the important factors affecting the prognosis of gastric cancer and helps to guide the nutritional support treatment of gastric cancer patients.

The Effect of the Prognostic Nutritional Index on the Toxic Side Effects of Radiochemotherapy and Prognosis After Radical Surgery for Gastric Cancer.

ObjectiveA retrospective analysis was conducted to investigate the effect of the preoperative prognostic nutritional index (PNI) on the severity of toxic side effects of radiochemotherapy and the survival prognosis of patients with gastric cancer to guide the clinical nutritional support for patients with gastric cancer.MethodsData of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of Guizhou Cancer Hospital and the Affiliated Hospital of Guizhou Medical University between January 2008 and December 2018 were analyzed retrospectively. Patients were allocated to the high PNI group (with PNI ≥47.7) and the low PNI group (with PNI <47.7) according to the PNI cutoff value, and the incidence of severe toxic side effects of radiochemotherapy and the overall survival time were compared between the high PNI group and low PNI group. In addition, prognostic factor analysis was performed.ResultsThe severe hematologic side effects of radiochemotherapy and shorter postoperative survival time were more likely to occur in the low PNI group than in the high PNI group. The multifactor analysis showed that TNM stage (p = 0.000) and PNI (p = 0.001) were the independent risk factors for the overall postoperative survival time in patients with gastric cancer.ConclusionPreoperative PNI might predict the severity of hematologic toxic side effects of adjuvant chemotherapy/radiochemotherapy in patients with gastric cancer after surgery. Patients in the low PNI group were more likely to have severe hematologic toxic side effects, and therefore a low PNI might be one of the important factors affecting the prognosis of gastric cancer.

The effect of preventive use of hydrolyzed protein formula milk on gastrointestinal diseases and physical development of premature infants: A protocol for systematic review and meta-analysis.

Background:Because of the controversy in clinical nutritional support therapy of hydrolyzed protein formula milk and standard preterm infant formula (SPIF) in premature infants. In this study, the effectiveness and safety of preventive use of hydrolyzed protein formula milk in reducing gastrointestinal diseases and promoting physical development of premature infants are scientifically evaluated by systematic evaluation. To help find the suitable nutritional support for premature infants.Methods:To search the database of Chinese and English by computer: SinoMed, CNKI, WanFang Data, VIP, PubMed, EMbase and The Cochrane Library, and to collect randomized controlled trials on the application of hydrolyzed protein formula milk in nutritional support treatment of premature infants compared with SPIF. The retrieval time limit is from the establishment of each database to September 1, 2020. Two authors independently completed the paper search, and sorting out the main outcome indicator and secondary outcome indicator in the selected literature, and the data are statistically analyzed by Review Manager software (RevManV.5.3.0) and STATA 13.0.Results:This study will provide a high-quality evidence on the effects of hydrolyzed protein formula milk on gastrointestinal diseases and physical development of premature infants.Conclusion:At present, the clinicians are controversial about the safety and effectiveness of hydrolyzed protein formula milk and SPIF in the nutritional support therapy of premature infants. This study will compare the effectiveness and safety of these 2 nutritional support methods, and make a comprehensive analysis of the influence of hydrolyzed protein formula milk on gastrointestinal diseases and physical development of premature infants, and finally give a positive conclusion.OSF registration number:DOI 10.17605/OSF.IO/UQD92

Hotspot issues and countermeasures in nutritional support treatment for critically ill surgical patients

Nutritional therapy is one of the most important treatment measures for surgical critically ill patients, and it is also a difficult point in clinical nutritional support practice. In recent years, nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice. Many large-scale, multi-center clinical studies have been completed worldwide. Consensus has been formed on many hot issues and relevant guidelines have been issued. Based on the latest evidence-based medicine achievements, the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years. Key words: Critical illness; Surgery; Nutritional support; Parenteral nutrition; Enteral nutrition

Role of the Nutrition Support Clinician on a Hospital Bioethics Committee.

Hospital bioethics committees comprise a diverse group of healthcare professionals to deal with ethical issues within the institution that arise during patient care. The nutrition support clinicians (NSCs) have an important role on a bioethics committee because of their knowledge and expertise of different nutrition routes and the benefits vs burdens and risks of these modalities, both enteral and parenteral nutrition. Ethics expertise is built on an understanding of ethical principles, when applied in clinical ethics, using critical thinking to prevent ethical dilemmas and to assist in healthcare decision making with a focus on patient-centered care. The NSCs have the opportunity to address ethics during direct patient care with their participation in the intensive care unit interprofessional rounds, family meetings, and surrogate meetings. Evident in ethical dilemmas is often the lack of advance care planning by patients and their family members concerning healthcare wishes for when the individual is unable to communicate their preferences for life-sustaining therapies, including nutrition support. NSCs, as hospital bioethics committee members, are able to support the initiative of National Healthcare Decisions Day to help educate other healthcare clinicians and the public about the importance of advance care planning with communication of healthcare wishes and completion of an advance directive. Components addressed in the article are incorporated into a comprehensive ethics case study, highlighting the role of NSCs.