Nutrition Support In Adults Research Articles

A hidden challenge: exploring food refusal in prisons

British Journal of NursingVol. 32, No. 8 CommentA hidden challenge: exploring food refusal in prisonsDonna PhillipsDonna Phillips(E-mail Address: [email protected])Head of Safeguarding, Spectrum Community Health CIC, WakefieldSearch for more papers by this authorDonna PhillipsPublished Online:21 Apr 2023https://doi.org/10.12968/bjon.2023.32.8.S6AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health. Guidelines for the clinical management of people refusing food in immigration removal centres and prisons. London: DH: 2010 Google ScholarHome Office. Detention services order 03/2017. Care and management of detained individuals refusing food and/or fluid. 2022. https://tinyurl.com/yhfua8c5 (accessed 6 April 2023) Google ScholarNational Institute for Health and Care Excellence. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline CG32. 2017 (updated from 2006). https://tinyurl.com/yewcx292 (accessed 6 April 2023) Google ScholarNHS England Health and Justice. Health and justice. 2023. https://www.england.nhs.uk/commissioning/health-just (accessed 3 April 2023) Google Scholar FiguresReferencesRelatedDetails 20 April 2023Volume 32Issue 8ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 21 April 2023 Published in print 20 April 2023 Information© MA Healthcare LimitedPDF download

Managing malnutrition in older people living in residential care

Nursing and Residential CareVol. 24, No. 4 Clinical ReviewManaging malnutrition in older people living in residential careOmorogieva OjoOmorogieva OjoCorrespondence to: Omorogieva Ojo; E-mail Address: [email protected]Senior Lecturer in Primary Care, Faculty of Education and Health, University of Greenwich, Greenwich, London, UKSearch for more papers by this authorOmorogieva OjoPublished Online:2 May 2022https://doi.org/10.12968/nrec.2022.0014AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Dietetic Association. Malnutrition: food fact sheet. 2022. https://www.bda.uk.com/resource/malnutrition.html (accessed 11 March 2022) Google ScholarBrook S. Oral nutritional supplements: an integral part of malnutrition treatment. Br J Community Nurs. 2015; 20(Sup6a):S6–S10. https://doi.org/10.12968/bjcn.2015.20.sup6a.s6 Link, Google ScholarCarlsson M, Haglin L, Rosendahl E, Gustafson Y. Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities. J Nutr Health Aging. 2013;17(2):186–191. https://doi.org/10.1007/s12603-012-0087-z Crossref, Google ScholarCichero JAY. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(54):1–8. https://doi.org/10.1186/1475-2891-12-54 Google ScholarDennis M, Lewis SC, Warlow C et al. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365(9461):755–763. https://doi.org/10.1016/s0140-6736(05)17982-3 Crossref, Google ScholarElia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370–380. https://doi.org/10.1016/j.clnu.2015.05.010 Crossref, Google ScholarForbes C. The ‘Food First’ approach to malnutrition. Nurs Residential Care. 2014;16(8):442–445. https://doi.org/10.12968/nrec.2014.16.8.442 Link, Google ScholarGarcia J, Chambers E. Managing dysphagia through diet modifications. Am J Nurs. 2010;110(11):26–33. https://doi.org/10.1097/01.naj.0000390519.83887.02 Crossref, Google ScholarHampshire Hospital NHS Foundation Trust Prescribing Support Dietitians, North and West Hampshire CCGs. Guide to prescribing thickeners. 2015. https://www.hampshiresouthamptonandisleofwightccg.nhs.uk/ (accessed 18 March 2022) Google ScholarIsenring E, Bauer J, Banks M, Gaskill D. The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care. J Hum Nutr Diet. 2009;22(6):545–550. https://doi.org/10.1111/j.1365-277x.2009.01008.x Crossref, Google ScholarKeller M. Maintaining oral hydration in older adults living in residential aged care facilities. Int J Evid Based Healthc. 2006;4(1):68–73. https://doi.org/10.1111/j.1479-6988.2006.00034.x Google ScholarLearner S, Nazarko L. Tackling malnutrition in care homes. Nurs Residential Care. 2014;16(8):430–431. https://doi.org/10.12968/nrec.2014.16.8.430 Link, Google ScholarLearner S. Dehydration in care homes. Nurs Residential Care. 2015;17(3):126–126. https://doi.org/10.12968/nrec.2015.17.3.126 Link, Google ScholarMerrell J, Philpin S, Warring J et al. Addressing the nutritional needs of older people in residential care homes. Health Soc Care Community. 2012;20(2):208–215. https://doi.org/10.1111/j.1365-2524.2011.01033.x Crossref, Google ScholarNational Institute for Health and Care Excellence. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. 2006. https://www.nice.org.uk/guidance/cg32/chapter/introduction (accessed 18 March 2022) Google ScholarNational Patient Safety Agency. Dysphagia diet food texture descriptors. 2011. http://www.hospitalcaterers.org/media/1160/dysphagia-descriptors.pdf (accessed 21 March 2022) Google ScholarOjo O. The use of oral nutritional supplements in the acute care setting. Br J Nurs. 2016;25(12):664–666. https://doi.org/10.12968/bjon.2016.25.12.664 Link, Google ScholarO'Leary M, Hanson B, Smith CH. Variation of the apparent viscosity of thickened drinks. Int J Lang Commun Disord. 2011;46(1):100824014249025–100824014249029. https://doi.org/10.3109/13682822.2010.484846 Google ScholarParsons EL, Stratton RJ, Cawood AL, Smith TR, Elia M. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr. 2017;36(1):134–142. https://doi.org/10.1016/j.clnu.2016.01.002 Crossref, Google ScholarStatista. Number of people living in care homes in the United Kingdome in 2020, by country. 2022. https://www.statista.com/statistics/1082379/number-of-people-living-in-care-homes-in-the-united-kingdom/ (accessed 11 March 2022) Google ScholarThe British Dietetic Association. National descriptors for texture modification in adults. 2009. https://www.acquiredbraininjury-education.scot.nhs.uk/wp-content/uploads/National-Descriptors-Texture-Modification-Adults-2009.pdf (accessed 21 March 2022) Google ScholarTodorovic V. Evidence-based strategies for the use of oral nutritional supplements. Br J Community Nurs. 2005;10(4):158–164. https://doi.org/10.12968/bjcn.2005.10.4.17954 Link, Google ScholarWoo J, Chi I, Hui E, Chan F, Sham A. Low staffing level is associated with malnutrition in long-term residential care homes. Eur J Clin Nutr. 2005;59(4):474–479. https://doi.org/10.1038/sj.ejcn.1602096 Crossref, Google ScholarWotton K, Crannitch K, Munt R. Prevalence, risk factors and strategies to prevent dehydration in older adults. Contemp Nurse. 2008;31(1):44–56. https://doi.org/10.5172/conu.673.31.1.44 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2022Volume 24Issue 4ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 2 May 2022 Published in print 2 April 2022 Information© MA Healthcare LimitedPDF download

Application of individualized nutrition support for adults with Stanford A aortic dissection.

Aortic dissection is a serious aortic pathological changes. Although the surgical technique for aortic dissection continues to improve, postoperative mortality and surgical complications are still high. This study aims to explore the effect of individualized nutritional support for the adult Stanford A aortic dissection. A total of 60 patients with Stanford A aortic dissection, who were treated in the Department of Cardiovascular Surgery at the First Affiliated Hospital of University of Science and Technology of China from January 2019 to February 2020, were selected. The subjects were divided into a control group (n=29) and an observation group (n=31) by random number table method. The control group received routine nutritional support, and the observation group received individualized nutritional support since the 1st day after surgery. The levels of serum nutritional indexes [albumin (Alb), prealbumin (PAB), hemoglobin (Hb), transferrin (TF)], immune function indexes [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)], and inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), procalcitonin (PCT)] on the first day, the 5th day, and the 10th day after surgery were detected by Roche biochemical analyzer, immunoassay analyzer, and microplate reader, respectively. The acute physiology and chronic health evaluation II (APACHEII) was used to evaluate the prognosis on the first day, the 5th day, and the 10th day after surgery, and the incidence of complications was observed in the 2 groups. There were significant differences between the 2 groups in Alb, PAB, Hb, TF, IgG, IgM, IgA, TNF-α, IL-10, and PCT (all P<0.01), and there were also significant differences in the APACHEII, the time factor and the group factor (all P<0.01). On the 5th day and the 10th day after surgery, the levels of Alb, PAB, Hb, TF, IgG, IgM and IgA were higher, and the levels of TNF-α and IL-10 while the scores of PCT and APACHEII were lower in the observation group than those in the control group (all P<0.01). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05). For patients with Stanford A aortic dissection undergoing surgery, the postoperative individualized nutrition support can not only significantly improve nutritional level and immune function, but also effectively reduce levels of postoperative inflammatory factors, which is beneficial to their rapid recovery and has positive clinical significance for reducing postoperative complications and improving prognosis.

GP patient databases show that malnutrition is under-reported and under-treated in patients with chronic disease

Disease-related malnutrition is a significant, common and costly problem [1,2], with the majority of those affected living in the community (93%) [1] and under the care of their GP. Patients with chronic disease are particularly vulnerable to the effects of malnutrition and it is recommended that they are routinely screened, and if found to be at risk of malnutrition, appropriately managed (including the use of nutrition support [3]). There is limited recent data available in the literature on the prevalence of malnutrition in patients with chronic diseases and the extent to which the identification and management of malnutrition is undertaken and documented by GPs in such patients. The appropriate use of nutrition support in malnourished patients is also unclear. This study aimed to investigate the recorded prevalence of malnutrition and the use of nutrition support (oral nutritional supplements (ONS) and tube feeds) in community-based malnourished adults with chronic diseases (cancer, COPD, dementia/Alzheimer's and stroke) in the UK. Data was collected from GP databases within the period April 2014–March 2015 using electronic longitudinal patient data (IMS Information Solutions UK Ltd), from 1,150,744 adults aged 19+ years (76% 19–65 years, 24% 65+ years) registered with UK GP practices. Patients with a read code for stroke, COPD, dementia/Alzheimer's or cancer, were identified as malnourished if they had a BMI of <18.5 kg/m2 and/or a read code for malnutrition recorded in the GP database. Prescriptions of nutrition support (all available ONS and tube feeds) were also assessed. Overall, 43.5% (501,098) of patients had a BMI recorded, 2.9% (33,877) were identified as malnourished and 0.9% (10,507) were receiving nutrition support. The documented prevalence of malnutrition in patients with chronic disease ranged from 7%-15%, and of these, 18%-34% were prescribed nutrition support (see Table 1).Table 1Malnutrition prevalence and use of medical nutrition by chronic disease.Chronic Disease (n)Number (%) of malnourished patientsNumber (%) of malnourished patients who had a prescription for nutrition supportCancer (11,262)904 (8%)270 (30%)COPD (29,047)3001 (10%)537 (18%)Dementia/Alzheimer's (14,339)2161 (15%)741 (34%)Stroke (41,540)3108 (7%)627 (20%) Open table in a new tab This is the largest survey of GP records to assess recording of malnutrition and prescription of ONS and other enteral nutrition support in adults with chronic conditions in the UK. Malnutrition was common in the chronic conditions, but overall prevalence was lower than previously reported in GP practices [4], possibly due to under-reporting by GPs, lack of screening for malnutrition, or the malnutrition criteria used (i.e. lower BMI cut off). The data in the GP database also suggests under-treatment of patients with malnutrition as more than two thirds did not receive a prescription for nutrition support, although the use of other dietary strategies/dietetic intervention could not be assessed. Further research is required to more clearly elucidate the prevalence, detection and management of malnourished patients with chronic diseases in GP practice, in the UK.

Managing dysphagia in patients with neurological conditions

British Journal of Neuroscience NursingVol. 13, No. 3 CommentManaging dysphagia in patients with neurological conditionsRosie ThompsonRosie ThompsonSearch for more papers by this authorRosie ThompsonPublished Online:14 Jul 2017https://doi.org/10.12968/bjnn.2017.13.3.106AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Fletcher J (2015) Dealing with dysphagia, a multi-disciplinary approach. Nursing and Residential Care 17(8): 430-432. https://doi.org/10.12968/nrec.2015.17.8.430 Google ScholarHeadway (2010) Dysphagia after brain injury. https://tinyurl.com/y8qwu3df (accessed 21 June 2017) Google ScholarLancaster J (2015) Dysphagia: its nature, assessment and management. Br J Community Nurs Suppl Nutrition: S28-32. https://doi.org/http://dx.doi.org/10.12968/bjcn.2015.20.Sup6a.S28 Link, Google ScholarMarsh S, Ross N, Pittard A (2011) Neuromuscular disorders and anaesthesia. Part 1: generic anaesthetic management. Contin Educ Anaesth Crit Care Pain 11(4): 115-8. doi: https://doi.org/https://doi.org/10.1093/bjaceaccp/mkr020 Crossref, Google ScholarMalhi H (2016) Dysphagia: warning signs and management. Br J Nurs 25(10): 546–9. https://doi.org/http://dx.doi.org/10.12968/bjon.2016.25.10.546 Link, Google ScholarMiles A, McFarlane M, Kainth P, Parmar P (2014) Interdisciplinary management of dysphagia. Nursing and Residential Care. 16(10): 561-7. https://doi.org/https://doi.org/10.12968/nrec.2014.16.10.561 Link, Google ScholarMyatt R (2015) Nursing care of patients with a temporary tracheostomy. Nurs Stand 29(26): 42–9. https://doi.org/https://doi.org/10.7748/ns.29.26.42.e9742 Crossref, Google ScholarNational Institute for Health and Care Excellence (2006) Nutrition Support for Adults: Oral nutrition support, enteral tube feeding, and parenteral nutrition [CG32] https://tinyurl.com/kz8nu6h (accessed 21 June 2017) Google ScholarNational Patient Safety Agency (2011) Dysphagia Diet Food Texture Descriptors. https://tinyurl.com/l4o2say (accessed 21 June 2017) Google ScholarNational Tracheostomy Safety Project (2013) NTSP Manual. https://tinyurl.com/y7qy8jzg (accessed 21 June 2017) Google ScholarNutrition and Diet Resources (2014) Easier Swallowing: Fluid Thickening Guide. Nutrition and Diet Resources, Glasgow Google ScholarRoyal College of Physicians and British Society of Rehabilitation Medicine (2003) Rehabilitation following acquired brain injury: national clinical guidelines. RCP BSRM, London Google ScholarRoyal College of Physicians, British Society of Gastroenterology (2010) Oral Feeding Difficulties and Dilemmas: A Guide to Practical Care, Particularly Towards the End of Life. Royal College of Physicians, London Google ScholarRoyal College of Speech and Language Therapists (2013) RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Dysphagia. RCSLT, London. http://tinyurl.com/ybdlszy3 (accessed 21 June 2017) Google ScholarRoyal College of Speech and Language Therapists (2014) Position paper. Speech and language therapy in adult critical care. http://tinyurl.com/y7lu853l (accessed 21 June 2017) Google ScholarScottish Intercollegiate Guidelines Network (2010) Management of Patients with Stroke: Identification and Management of Dysphagia. A National Clinical Guideline. https://tinyurl.com/y86mfoso (accessed 21 June 2017) Google ScholarSmithard DG (2015) Dysphagia: prevalence, management and the community nurse. Community Pract 88(10): 32–5 Google ScholarTanton M (2010) Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 106(15): 18–20 Google Scholar FiguresReferencesRelatedDetails 2 June 2017Volume 13Issue 3ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 14 July 2017 Published in print 2 June 2017 Information© MA Healthcare LimitedPDF download

Do Patients With a Baseline Clinical Condition Warranting the Cautious Use of Parenteral Nutrition Develop Subsequent Metabolic Complications?

The American Society for Parenteral and Enteral Nutrition Adult Nutrition Support Core Curriculum describes clinical conditions that warrant cautious use of parenteral nutrition (CCWCPN). The Core Curriculum authors acknowledge there is no evidence for specific criteria suggested for the clinical conditions. Consequently, the purpose of this study was to determine the impact of a baseline CCWCPN on the development of subsequent metabolic complications in patients receiving parenteral nutrition (PN). Adult patients initiated on PN from May 2014 to July 2015 at Cooper University Hospital were included in this retrospective study. The impact of a CCWCPN on the development of the following was determined: acid-base disturbances, hepatobiliary complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome. Three hundred forty-one patients were included (mean age, 61.7 years; mean duration of PN, 8.5 days; central PN, 97%). Metabolic complications occurred more frequently in patients with a baseline CCWCPN than without these conditions (77% vs 53%, P = .001). Subgroup analyses for the development of metabolic complications in patients with or without each individual baseline CCWCPN yielded the following statistically significant results: hypernatremia (93% vs 57%, P = .007) and hyperchloremia (86% vs 57%, P = .033). Hospitalized adult patients with a baseline CCWCPN were more likely to develop a metabolic complication when receiving PN. Baseline hypernatremia and hyperchloremia were associated with the development of metabolic complications. Baseline CCWCPN should be recognized upon initiation of PN; practitioners should closely monitor patients to minimize subsequent metabolic complications.

Dietitians on the stroke unit

British Journal of Healthcare AssistantsVol. 10, No. 5 ClinicalDietitians on the stroke unitPaul Carr, Sian Martin, Patricia LalorPaul CarrSearch for more papers by this author, Sian MartinSearch for more papers by this author, Patricia LalorSearch for more papers by this authorPaul Carr; Sian Martin; Patricia LalorPublished Online:23 May 2016https://doi.org/10.12968/bjha.2016.10.5.224AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Carr P (2016) Stroke and stroke rehabilitation 4: speech and language therapy. British Journal of Healthcare Assistants 10(4): 164–6 Google ScholarNational Institute for Health and Care Excellence (NICE) (2006) Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. www.nice.org.uk/guidance/cg32 (accessed 12 April 2016) Google Scholar FiguresReferencesRelatedDetails 2 May 2016Volume 10Issue 5ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 23 May 2016 Published in print 2 May 2016 Information© MA Healthcare LimitedPDF download

Clinical Ethics and Nutrition Support Practice: Implications for Practice Change and Curriculum Development

Clinical ethics awareness involving nutrition support has increased during the past 4 decades because of media attention and public discussion of several landmark cases, including Karen Ann Quinlan, Nancy Beth Cruzan, and Theresa Marie Schiavo, and the results of subsequent court decisions. 1 Schwartz D.B. Ethical considerations in the critically ill patient. in: Cresci G. Nutritional Therapy for the Critically Ill Patient: A Guide to Practice. 2nd ed. Taylor & Francis, Boca Raton, FL2015: 635-652 Crossref Google Scholar Yet decisions to start or stop nutrition support for specific individuals remain challenging. Withholding or withdrawing nutrition support is appropriate if the risks and burdens outweigh the potential benefits as perceived by the informed individual, family, or surrogate decision maker. Despite advancements in the field of nutrition support practice, a practice gap remains between appropriate use of nutrition support and other advanced life-sustaining treatments, such as mechanical ventilation and cardiopulmonary resuscitation, based on the individual’s wishes. 2 Geppert C.M.A. Barrocas A. Schwartz D.B. Ethics and law. in: Mueller C. McClave S.A. Schwartz D.B. Kovacevich D. Miller S.J. The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 2nd ed. American Society for Parenteral and Enteral Nutrition, Springfield, MD2012: 656-676 Google Scholar , 3 Raijmakers N.J.H. van Zuylen L. Costantini M. et al. on behalf of OPCARE9Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects. Ann Oncol. 2011; 22: 1478-1486 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar , 4 Teno J.M. Gozalo P.L. Bynum J.P.W. et al. Change in end-of-life care for beneficiaries. JAMA. 2013; 309: 470-477 Crossref PubMed Scopus (753) Google Scholar , 5 Schwartz D.B. Barrocas A. Wesley J.R. et al. A.S.P.E.N. Special report: Gastrostomy tube placement in patients with advanced dementia or near end of life. Nutr Clinc Pract. 2014; 29: 829-840 Crossref PubMed Scopus (35) Google Scholar , 6 Institute of Medicine. Dying in America Improving Quality and Honoring Individual Preferences Near the End of Life, Key Findings and Recommendations. https://iom.nationalacademies.org/∼/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.pdf. Published 2014. Accessed October 26, 2015. Google Scholar

Enteral tube feeding: reducing the risk of malnutrition

Nursing and Residential CareVol. 17, No. 8 EditorialEnteral tube feeding: reducing the risk of malnutritionCharlotte BirdCharlotte BirdSearch for more papers by this authorCharlotte BirdPublished Online:13 Jul 2015https://doi.org/10.12968/nrec.2015.17.8.458AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Howard P (2009) Basics in clinical nutrition: administration of enteral tube feeds. European e-Journal of Clinical Nutrition and Metabolism 4(4): 170–1. doi: https://doi.org/http://dx.doi.org/10.1016/j.eclnm.2009.05.004 Crossref, Google ScholarLloyd, D, Powell-Tuck J (2004) Artificial Nutrition: Principles and Practice of Enteral Feeding. Clin Colon Rectal Sur 17(2): 107–18 Crossref, Google ScholarMalhi H, Thompson R (2014) PEG tubes: dealing with complications. Nurs Times 110(45): 18–21 Google ScholarMedlin S (2012) Recent developments in enteral feeding for adults: an update. Br J Nurs 21 (18): 1064–7 Link, Google ScholarNational Patient Safety Agency (2005) Reducing harm caused by the misplacement of nasogastric feeding tubes. http://bit.ly/1NIiUSR (accessed 6 July 2015) Google ScholarNational Patient Safety Agency (2010) Early detection of complications after gastrostomy. http://bit.ly/1H4vveg (accessed 6 July 2015) Google ScholarNational Patient Safety Agency (2011) Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants. http://bit.ly/1KGboKK (accessed 6 July 2015) Google ScholarNational Institute for Health and Care Excellence (2006) Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. http://bit.ly/1QlnzA1 (accessed 6 July 2015) Google ScholarPearce C, Duncan H (2002) Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jeunostomy: indications and limitations. Postgrad Med J 78(918): 198–204 Crossref, Google ScholarStroud M, Duncan H, Nightingale J (2003) Guidelines for enteral feeding in adult hospital patients. GUT 52(7): 1136 Google ScholarUVA Health System (2015) Tube Feeding Routes of Delivery and Selection of Continuous vs. Intermittent Feedings. http://bit.ly/1KGci9Z (accessed 6 July 2015) Google Scholar FiguresReferencesRelatedDetails 2 August 2015Volume 17Issue 8ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 13 July 2015 Published in print 2 August 2015 Information© MA Healthcare LimitedPDF download

PWE-421 Knowledge of refeeding syndrome amongst foundation year doctors

Introduction Refeeding syndrome (RS) is a potentially fatal condition and our trust has local guidelines in place to monitor for RS. Junior doctors on the wards are often the ones who are most responsible for the day-to-day care of patients and thus, they should be aware of the risk factors, monitoring and treatment of RS. We aimed to assess the knowledge of RS amongst Foundation Year 1 (F1) and Year 2 (F2) doctors in our trust. Method We conducted a paper questionnaire survey which was distributed to F1s and F2s over a time period from October 2014 to December 2014. The contents of the survey were based off the 2006 NICE guidelines ‘Nutrition support in adults’1and our trust’s local guidelines. Results The response rate was 56% (55/99). All respondents were aware of RS. 49% were able to list 2 risk factors for RS. 69% were aware of which electrolytes that were of importance in the monitoring of RS and 91% would monitor the electrolytes daily until stable. Only 40% were aware of the importance of supplementary vitamins such as thiamine, vitamin B co-strong and multivitamin in patients at risk of RS. 7% were able to list 3 clinical complications of RS. Only 26% were aware of our trust’s guidelines on RS. Conclusion Our survey showed that whilst junior doctors were aware of RS, the knowledge of management of RS in clinical practice has to be improved upon. Further education is needed and junior doctors should be aware of the availability of national and local trust guidelines which are valuable resources. Disclosure of interest None Declared. Reference NICE CG32 Guidelines: Nutrition support in adults. (http://www.nice.org.uk/guidance/cg32/)

PTH-241 ‘it made a big difference’-investigation of the patient experience of a community dietetic domiciliary service for patients at risk of malnutrition

<h3>Introduction</h3> Early identification of patients at risk of malnutrition and onward referral to dietetic service is advocated in best practice guidelines.¹Patients who are housebound are not able to attend dietitian clinic appointments require a domiciliary community dietetic service (CNDS). Data is lacking in relation to the patients’ experience of this type of service in the Irish setting. <h3>Aim</h3> To investigate patient experience and satisfaction with CNDS domiciliary service for patients at risk of malnutrition in 4 midlands counties in the Republic of Ireland (ROI). <h3>Method</h3> A random sample of patients who were actively receiving a domiciliary service from the CNDS were contacted and invited to be interviewed by an independent dietitian researcher at their home. A semi-structured interview-assisted questionnaire was used. The interview was audio-recorded and later transcribed for content analysis. <h3>Results</h3> Out of 20 patients contacted by the researcher, 12 participants (4 male, 8 female) were available to take part in the study. In 2/10 cases carers were interviewed as a proxy for patients who had advanced dementia. Average age of patients was 79 years (Range 62–94 years). All participants (n = 12) could recall the last visit they had received from the community dietitian (CD). All (n = 12) were satisfied with the service provided and many commented that a domiciliary visit made them feel supported. The majority of patients (10/12) felt they needed a domiciliary service. Most (10/12) participants could recall advice given by the CD however only half of those surveyed felt they were coping better with their diet (including supplement usage) after receiving the advice. <i>“I’ve become more aware what I should and should not do’. </i>Seven out of 12 participants felt the CNDS service had improved their overall quality of life such as improved health, energy, and appetite. <h3>Conclusion</h3> The finding that all patients receiving a domiciliary service from the CNDS are satisfied with the service and assessment carried out by the dietitan is encouraging. However the results suggest that many patients requiring a domically CNDS service still struggle to cope with dietary changes to improve nutritional intake despite receiving dietary advice and prescribed oral nutritional supplements. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Nutrition support in adults: oral nutritional support, enteral tube feeding, and parenteral nutrition (2006). London, National Institute for Health and Clinical Excellence (NICE)

PTH-209 Patient experiences of parenteral nutrition in an acute teaching hospital: Abstract PTH-209 Table 1

Introduction There is a lack of research investigating the experience of patients with intestinal failure (IF) who require parenteral nutrition (PN) in acute care. The NCEPOD national audit (Stewart et al. 2010) demonstrated high levels of complications in patients receiving PN. Furthermore, gastrointestinal symptoms caused by IF require complex regimens of medication and the modification or restriction of fluid and diet. It is recommended that all acute hospitals should have a nutrition team (NICE 2006), however nutrition teams need to better understand how to best support patients receiving PN in hospital. The aim of this study was to explore the patient experiences of receiving PN in the acute healthcare setting. Method Descriptive phenomenology was the chosen methodology. Purposive sampling was used to recruit ten participants who had received PN for >7 days in an acute teaching hospital. In-depth interviews were conducted, which were audio-recorded. The interviews were transcribed verbatim and qualitatively analysed, guided by Colaizzi’s (1978) approach. Results PN was universally considered positive by patients. It was ‘life saving’ and they felt it unlikely that they would have survived the hospital admission without it. Three core themes and seven subthemes were identified: Conclusion Patients who require PN wish to be heard and be involved in decisions about their nutritional care; however healthcare professionals in acute care frequently fail to operate in a patient centred manner. This is particularly evident when several clinical teams are involved and when enteral nutrition is being introduced. When conflicting nutritional advice is given to patients it affects their trust and confidence in the clinical teams. The patient experience whilst on PN could be improved by nutrition teams having greater autonomy regarding the provision of nutritional advice and by providing more support to patients on dealing with the altered relationship with eating. Disclosure of interest None Declared. References Colaizzi, P. (1978) Psychological Research as a Phenomenologist Views it. In Existential Phenomenological Alternatives for Psychology . Ed. by Valle, R. and King, M. New York, NY: Oxford University Press, 48–71 NICE (2006) Nutrition Support in Adults: Oral Nutrition Support , Enteral Tube Feeding and Parenteral Nutrition : NICE Stewart JAD, Mason DG, Smith N, Protopapa K, Mason M. A Mixed Bag . An Enquiry into the Care of Hospital Patients Receiving Parenteral Nutrition: NCEPOD, 2010

PTH-226 Prevalence of malnutrition in medical and surgical gastrointestinal outpatient clinics

<h3>Introduction</h3> UK NICE guidelines, state that patients attending an outpatient clinic for the first time, should be screened for malnutrition.¹30% of inpatients are malnourished or at risk of malnutrition,²however the prevalence of malnutrition in outpatients, especially those with gastro-intestinal (GI) illnesses has not been assessed. Therefore, we aimed to determine the prevalence of malnutrition in the outpatient department (OPD) using body mass index (BMI) and% weight loss (%WL) and to assess the physicians’/surgeons’ response malnutrition being detected. <h3>Method</h3> The BMI and the WL were determined for every patient for a 2 week period and the results put in the notes immediately before the clinician’s entry. The BMI and WL were scored as in the Malnutrition Universal Screening Tool (MUST). The demographic data, underlying disease and action taken were recorded. Data were statistically analysed using the chi-square test. <h3>Results</h3> 605 patients (316 females) of mean age 54 years were included. 150 (25%) were new patients, 223 (37%) had previous abdominal surgery, 208 (34%) had inflammatory bowel disease, 73 (12%) had anorectal issues, 54 (9%) upper GI symptoms or conditions, 44 (7%) cancer and 33 (6%) had liver disease. 214 patients (35%) had co-morbidities: 107 (18%) cardiovascular, 91 (15%) endocrine, 45 (7%) musculoskeletal or connective tissue disorders, 38 (6%) respiratory, 21 (4%) non GI malignancies,19 (3%) neurological and 10 (2%) psychiatric co-morbidities. 519 participants (86%) had a normal BMI and%WL. 86 (14%) had a BMI &lt;20 kg/m² or had 5% WL. 61 (10%) were in MUST “medium risk” and 25 (4%) were in MUST “high risk” of malnutrition. 15 (60%) of the “high risk” patients were under the care or referred to a dietitian compared to 19 (28%) of “medium risk” patients. The prevalence of malnutrition was independent of sex, age, history of previous surgery and co-morbidity. There was no difference in the prevalence of malnutrition between new and follow up patients. Malnourished patients with IBD (38, 18%) vs. non-IBD (48, 12%) and patients with cancer (11, 25%) vs. non cancer (75, 13%) were more likely to be malmourished (p &lt; 0.05). <h3>Conclusion</h3> The risk of malnutrition in our outpatient department is 14%. IBD and cancer patients have a higher prevalence. Most patients with malnutrition (52, 61%) are not being seen by a dietitian. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> NICE, <i>Quality standard for nutrition support in adults.</i>2012 Vera Todorovic CR, Marinos Elia, <i>The MUST explanatory booklet. A guide to the Malnutrition Universal Screening Tool (MUST) for adults</i>

Series 4.4. Measuring height and weight

British Journal of Healthcare AssistantsVol. 9, No. 3 ClinicalSeries 4.4. Measuring height and weightMenna Lloyd JonesMenna Lloyd JonesSearch for more papers by this authorMenna Lloyd JonesPublished Online:12 Mar 2015https://doi.org/10.12968/bjha.2015.9.3.122AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Association of Parenteral and Enteral Nutrition (BAPEN) (2014) 10 key characteristics of good nutritional care in hospitals. http://tinyurl.com/27wr3mn (accessed 19 February 2015) Google ScholarDepartment of Health (DH), Age UK (2014) The Hospital Food Standards Panel's Report On Standards Of Food And Drink In NHS Hospitals. http://tinyurl.com/keqqev7 (accessed 19 February 2015) Google ScholarDougherty L, Lister S, eds (2012) Royal Marsden Hospital Manual Of Clinical Procedures. Student edn, 8th edn. Wiley-Blackwell, London Google ScholarNational Institute for Health and Care Excellence (NICE) (2006) NICE Guidelines [CG32]: Nutrition Support In Adults: Oral Nutrition Support, Enteral Tube Feeding And Parenteral Nutrition. www.nice.org.uk/guidance/cg032 (accessed 19 February 2015) Google Scholar FiguresReferencesRelatedDetails 2 March 2015Volume 9Issue 3ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 12 March 2015 Published in print 2 March 2015 Information© MA Healthcare LimitedPDF download

Phosphorus and calcium: a review for the adult nutrition support clinician.

Phosphorus (P) and calcium (Ca) serve vital roles in the human body and are essential components of nutrition support therapy. Regulation of P and regulation of Ca in the body are closely interrelated, and P and Ca homeostasis can be affected by several factors, including disease states, clinical condition, severity of illness, and medications. Nutrition support clinicians must understand these factors to prevent and treat P and Ca disorders in patients receiving nutrition support therapy. This review provides an overview of P and Ca for the adult nutrition support clinician, with some emphasis on the hospitalized inpatient.

PTH-021 Nutrition Assessment In The Acute Medical Unit

IntroductionMalnutrition can increase hospital mortality rates, worsen clinical outcomes and increase the length of hospital stays. Those at particular risk include patients with cancer, gastrointestinal and neurological disease. We wanted...

PTU-001 Refeeding Syndrome: is our Knowledge Deficient?: Abstract PTU-001 Table

<h3>Introduction</h3> The 2006 NICE guidelines on “Nutrition support in adults” recommend screening and identification of patients at risk of refeeding syndrome (RS). Despite the implementation of local hospital policies, RS still occurs. This may, in part, be due to a lack of awareness amongst clinicians responsible for at risk patients. We aimed to assess the knowledge and awareness of RS amongst medical doctors in our Trust. <h3>Methods</h3> We conducted a questionnaire survey of doctors’ practises between April and August 2008. In total 68 doctors, working in medical specialities, from FY1 to Consultants, were surveyed. <h3>Results</h3> The overall response rate was 40 (59%). Only 10% were unaware of RS (all FY doctors). However, only 35% were aware of the importance of correcting electrolyte imbalance when commencing enteral feeding. 30% would not monitor electrolytes daily with 25% of the respondents unaware of the important electrolytes to monitor. Although 90% of respondents recognised thiamine as important supplementation, only 20% indicated they would prescribe this to all at risk patients. Only 58% stated they would provide Vitamin B Co-strong and only 63% multivitamins or trace element supplements. <h3>Conclusion</h3> RS is potentially fatal. It is essential that clinicians are aware and able to identify at risk patients. This survey highlights that, although many clinicians are familiar with RS and its effects, there is a lack of awareness regarding the NICE guidelines and practise aimed at its prevention in those patients at high risk. Most strikingly, 65% of the doctors surveyed did not consider starting enteral feed prior to or alongside correcting any electrolyte imbalances. Delaying the onset of enteral feed may put patients at greater risk of malnutrition. Further education and training about RS are necessary for all grades, particularly junior doctors. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> Mehanna HM, Moledina J, Travis J, Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 2008; 336:1495–1498 NICE guidelines for nutritional support in adults. http://www.nice.org.uk/cg32

PWE-181 The Development and Evolution of Nutrition Service Provision in the North East: 2003–2012

IntroductionMalnutrition is well recognised as a treatable cause and result of ill-health. The recognition and management of malnutrition hinges upon the quality of organisation of nutrition services as well as...

CPC-011 An Audit of the Adult Nutrition Support Team in the Management of Refeeding Risks in a UK Teaching Hospital

BackgroundIn June 2010 a report, ‘A Mixed Bag – An enquiry into the care of hospital patients receiving parenteral nutrition’, was published by the National Confidential Enquiry into Patient Outcome...

Development of an Adult and Pediatric Nutrition Support Emphasis at the UVA Health System: Implementation and Outcomes

Beginning in the 2009-2010 internship program year, the University of Virginia Health System Dietetic Internship Program established an “adult and pediatric nutrition support” emphasis for the purpose of: a) attracting students interested in the specialty areas of nutrition support and/or pediatrics, and b) to establish a unique niche and strengthen the focus of our clinical program. Factors contributing to this decision included the Health System’s already strong clinical nutrition program with established nutrition support expertise, including surgery and medicine nutrition support teams and a strong inpatient and rehabilitative pediatric nutrition program. Also, most dietitians were certified nutrition support clinicians with many years of clinical, research and publishing experience. The program was structured to include: two weeks of general inpatient pediatrics and pediatric intensive care, three weeks specialty pediatrics including newborn intensive care, inborn errors of metabolism, pediatric rehabilitative nutrition and children’s fitness clinic. Interns also spend fiveweeks in adult nutrition support, which includes surgery and medicine nutrition support teams and transplant nutrition. Interns then select an additional week of “nutrition support specialization” in their area of preference. The transition to the adult and pediatric nutrition support emphasis has resulted in improved program evaluation scores as interns entering the program are typically those that purposely select and thrive in the clinical and nutrition support setting. In addition, since this change in program emphasis, five of our program’s graduates (25%) obtained positions just upon graduation at pediatric or children’s hospitals including the care of specialty pediatrics and nutrition support patients.