Nutrition Support Team Research Articles

フットケアにおけるNST (栄養サポートチーム ; Nutrition Support Team) の役割

フットケアにおけるNST (栄養サポートチーム ; Nutrition Support Team) の役割

The Gaps between Nutrition Support Guidelines and the Applications of Parenteral Nutrition

Objective/Aim/HypothesisThe literature suggests that gaps exist between nutrition support guidelines and the actual process of ordering/prescription, compounding and administration. The purpose is to describe the gaps, to summarize the reasons, and to present possible solutions to improve parenteral nutrition (PN) safety.Methods/Design/ApproachThis is a pilot study and provides the rationale for the data collection project. Ten articles were reviewed (n=10). Several key words, such as quality, parenteral nutrition, energy intake and quality assurance, were used in searching in the database of ASN, ASPEN, CIHANL, and PubMed. Study outcomes were provided according to the current categories of PN safety: Ordering/prescription, compounding and administration.Results and/or Implications30% of the articles indicate inadequate PN administration, 70% of articles display noncompliance with nutritional support guidelines, 20% of articles inform inappropriate PN. In this literature review, the gaps mainly occur in ordering/prescription (n=7) and administration (n=8).Conclusion(s)Drug shortages, lack of Nutrition Support Team in the facility, insufficient communication between medical care team members, and insufficient education among medical care team were listed as source of the conditions. Possible suggestions were included to establish the Nutrition Support Team, to increase communication between healthcare team members, and periodical training sessions.Support or Funding InformationNone

Sa1988 - Impact and Outcomes of Nutritional Support Team Intervention in Patients with Gastrointestinal Disease in the Intensive Care Unit

Sa1988 - Impact and Outcomes of Nutritional Support Team Intervention in Patients with Gastrointestinal Disease in the Intensive Care Unit

Nutritional Support Team Intervention for Patients with Mandibular Fracture Treated by Intermaxillary Fixation

The objective of this study was to investigate the effectiveness of nutrition support teams (NSTs) for oral injuries in patients with mandible fracture treated by intermaxillary fixation (IMF). The participants included 25 patients who were treated for mandibular fracture by IMF with NST intervention, who were used as the primary study group, and 25 patients treated without NST intervention, who were used prospectively as a control group. Decrease of body weight of these groups was compared. During the NST intervention, the patients in the study group were encouraged to freely engage in mild exercise. In the primary study group, nutrition sufficiency ratios, body weight, serum markers (albumin Alb, hemoglobin Hb, C-reactive protein CRP), grip strength and body composition parameters (triceps skinfold thickness, mid-arm muscle circumference, body fat, subcutaneous fat, skeletal muscle) were then measured. The study group was then subdivided into two groups based on whether their grip strength increased or decreased during the NST intervention, and the data were compared between sub-groups. The body weight loss (kg and %) of patients with NST intervention was significantly lower than that of patients without NST intervention. In the primary study group, significant decrease of Alb and CRP, and significant increase of energy sufficiency was found. The body weight loss was significantly higher during the NST waiting period than during the weekly NST active period. Furthermore, the body weight loss of patients with increased grip strength was significantly lower than that of patients with decreased grip strength.

Importance of Pharmaceutical Training and Clinical Research at Medical Facilities.

To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

Validation of the method of evaluation of the official Japanese report of the Nutrition Support Team (NST) with respect to the outcome of the NST in an acute hospital

Validation of the method of evaluation of the official Japanese report of the Nutrition Support Team (NST) with respect to the outcome of the NST in an acute hospital

Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson’s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side–to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.

Management of parenteral nutrition in critically ill patients.

Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel “myths” about PN-related complications and show how prevention and monitoring are able to reach the goal of “near zero” PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting “near zero” catheter-related bloodstream infections. Adopting all these strategies, the goal of “near zero” PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

A case of collagenous colitis with watery diarrhea improved by ending lansoprazole administration after nutrition support team intervention

A case of collagenous colitis with watery diarrhea improved by ending lansoprazole administration after nutrition support team intervention

Analysis of Compliance with Plan of Nutritional Support Team in Intensive Care Unit

To improve the nutritional state of patients, cooperation between medical and nutritional support teams is needed. The present study analyzed compliance with the plan of the nutritional support team.

Protected time for nutrition support teams: What are the benefits?

Nutrition support teams (NSTs) are important and unique entities in acute care hospitals. Despite their utility, NSTs are lacking in the majority of hospitals worldwide and where they exist, most members only spend a fraction of their time working within that role. We aim to evaluate the effect of protected time on NST performance by assessing the influence of structure and process in NST activities. All large public hospitals (>250 beds) in the Brazilian Federal District were evaluated with a structured questionnaire designed to assess NST performance. The questionnaire was adapted to include the Donabedian quality processes comprising 54 questions split amongst 6 domains; mainly structure and processes. The percentage of questionnaire compliance (NST outcome) was utilized to assess differences regarding structure and process. Hospitals with protected time to NST activities (Group I) were compared to hospitals without NSTs protected times (Group II). Seven hospitals were assessed. Group I, n=3, showed a significantly higher performance outcome than Group II, n=4 (77.9×60.3; P=0.004), and only Group I's score achieved the benchmark for quality standards (75% compliance). Significant differences between groups were also found in structure (P=0.017) and process (P=0.014). This study indicates that protected time for NST activities is paramount to increase NST performance and could positively influence Donabedian quality indicators. Our results highlight the importance of NSTs in large hospitals and is an advocate for public policies requiring dedicated time for NST work. Only a larger study can confirm our findings.

Effects of intervention by a nutrition support team on serum albumin level in diabetic patients

Effects of intervention by a nutrition support team on serum albumin level in diabetic patients

SUN-P015: Impact of Nutrition Support Team on Postoperative Nutritional Status and Clinical Outcome in Pediatric Patients with Congenital Gastrointestinal Anomalies

SUN-P015: Impact of Nutrition Support Team on Postoperative Nutritional Status and Clinical Outcome in Pediatric Patients with Congenital Gastrointestinal Anomalies

An Institutional Change in Continuous Renal Replacement Therapy: Nutrition Support Team Resolves Resultant Severe Hypophosphatemia.

Critically ill patients with acute kidney injury may require parenteral nutrition (PN) and continuous renal replacement therapy (CRRT). Introduction of a phosphate-free premixed renal replacement fluid without system-wide education in May 2011 resulted in increased incidence of hypophosphatemia, necessitating change in practice. Changes included (1) maximizing phosphate in PN, (2) modifying the CRRT order set, and (3) developing a CRRT competency evaluation for nutrition support team members. This study evaluates the effect of these changes on the incidence of hypophosphatemia. Phosphate levels and predicated probability of hypophosphatemia were evaluated for patients receiving PN and CRRT over 3 time periods: prior to implementing the changes (preimplementation), during change implementation (intermediate), and following implementation (postimplementation). Hypophosphatemia was defined as a serum phosphate level <2.5 mg/dL. Generalized linear mixed models were applied for statistical analysis. The retrospective study includes 336 measures from 49 patients. Patients in the intermediate and postimplementation periods were not significantly different from each other and had significantly higher mean phosphate levels than patients in the preimplementation period (P < .0001). They were also less likely to develop hypophosphatemia compared with preimplementation patients (intermediate: odds ratio [OR], 0.07; 95% confidence interval [CI], 0.03-0.18, P < .0001; postimplementation: OR, 0.09; 95% CI, 0.03-0.27, P < .0001). Modifications in phosphate dosing together with CRRT education reduced the incidence of hypophosphatemia in PN patients receiving CRRT. Communication of significant changes in clinical care should be shared with all services prior to implementation. Communication and planning between services caring for complex patients are necessary to prevent systems-based problems.

Effects of Compliance with the Nutrition Support Team in Critically Ill Pediatric Patients

This study performed a comparative evaluation of nutritional condition’s improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients.

Survey on the State of Nutrition Support Team (NST) Activity: Comparison of the Questionnaire Survey 2016 vs. 2005 and the State of NST Activity since the Introduction of the Medical Insurance Fee

Survey on the State of Nutrition Support Team (NST) Activity: Comparison of the Questionnaire Survey 2016 vs. 2005 and the State of NST Activity since the Introduction of the Medical Insurance Fee Ji-Yoon Cho, Jung-Tae Kim, Seoung-Lan Kim, Korean Society for Parenteral and Enteral Nutrition Working Group, Nutrition Support Pharmacy Committee of Korean Society of Health-System Pharmacists Department of Pharmacy, Daegu Fatima Hospital, Daegu, Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Department of Pharmacy, Asan Medical Center, Seoul, Korea

Characteristics and Clinical Course of Patients Who Received Enteral or Parenteral Nutrition in Tertiary Referral Hospitals in Korea

The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea.

The Effects of Early Enteral Nutrition in Patients: A Role of Nutrition Support Team

The Effects of Early Enteral Nutrition in Patients: A Role of Nutrition Support Team

The science and art of pediatric critical care nutrition.

Nutritional status and nutrient delivery during critical illness impact clinical outcomes. We have reviewed recent studies that may guide best practices regarding nutrition therapy in critically ill children. Malnutrition is prevalent in the pediatric ICU population, and is associated with worse outcomes. Nutrition support teams, dedicated dietitians, and educational programs facilitate surveillance for existing malnutrition and nutrition risk, but specific tools for the pediatric ICU population are lacking. Estimation of macronutrient requirements is often inaccurate; novel strategies to accurately determine energy expenditure are being explored. Indirect calorimetry remains the reference method for measuring energy expenditure. Enteral nutrition is the preferred route for nutrition in patients with a functioning gut. Early enteral nutrition and delivery of adequate macronutrients, particularly protein, have been associated with improved clinical outcomes. Delivery of enteral nutrition is often interrupted because of fasting around procedures and perceived intolerance. Objective measures for detection and management of intolerance to nutrient intake are required. In low-risk patients who are able to tolerate enteral nutrition, supplemental parenteral nutrition may be delayed during the first week of critical illness. Systematic research and consensus-based practices are expected to promote optimal nutritional practices in critically ill children with the potential to improve clinical outcomes.

Parenteral nutrition in hospital pharmacies.

Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.