Nutrition Support Team Research Articles

Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait.

Background:Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs).Objective:This study was designed to explore pharmacists’ role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices.Methods:Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists’ demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Results:The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists’ education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists’ communication and conducting TPN-research research.Conclusion:TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.

Influencing the timing of parenteral nutrition initiation in the pediatric intensive care unit.

Background:Lack of benefit and potential harm of early parenteral nutrition (PN) initiation in critically ill children was highlighted in the 2016 published results of a large multicenter, randomized controlled trial.Objectives:The purpose of this project was to implement a process to delay PN initiation for up to five days after admission to our pediatric intensive care unit (PICU).Methods:Patients greater than thirty days of age, admitted to the PICU beginning July 1, 2016 were included in the analysis of the healthcare improvement initiative to decrease early PN initiation. A meeting was held with PICU fellows, attending physicians, dietitians, and pharmacists to reach a consensus to delay initiation of parenteral nutrition until PICU day five. The dietitian, with pharmacist support, reiterated recommendations on rounds and in formal notes.Results:A total of 2333 patients were identified in the pre-intervention group and a total of 2491 patients in the post-intervention group. The percentage of patients receiving PN prior to day five within the PICU was 5.5% in the pre-intervention group versus 3.1% in the delayed PN group (p<0.001). PICU patients receiving PN less than or equal to three days decreased from 2.6% pre-intervention to 1.5% post-intervention (p=0.01). For the subset of patients who were initiated on PN after admission to the PICU, median PICU length of stay was 7 days versus 6 days in the pre-intervention versus post-intervention group (p=0.26).Conclusions:Decrease in PN utilization was seen in the pre and post-intervention groups as assessed by percentage of patients initiated on PN prior to day five of PICU admission. Consensus among practitioners with consistent recommendations from the frontline dietitian and pharmacist, with nutrition support team collaboration, contributed to the evidence based quality initiative results. Delaying PN did not adversely affect length of stay pre versus post-intervention.

PTU-108 Sustainibility of The Impact of Nutrition Support Team (NST) at a District General Hospital-5 Year Results: Abstract PTU-108 Table 1

Introduction Although in 2010 Croydon University Hospital had Parenteral Nutrition (PN) team,it was felt patient care could be improved by broadening the team’s scope and extending its influence. Audit showed that despite Trust policy on PN use, it was non-compliant with NCEPOD recommendations. This was a key driver to form a Nutrition Support Team (NST) in October 2010. Our aims were to reduce inappropriate use of PN and emergency PN, ensure administration through central venous catheters and encourage EN where appropriate. This analysis was to check for sustainability of impact of NST after 5 years. Methods In 2010 NST members included a Chemical Pathologist, Gastroenterologist, Dietitian and Pharmacist. In 2012, a Consultant Biochemist, Dietitian joined the team. Protocols were drawn up, ratified and made available on a NST link on Trust Intranet. Patients requiring PN had to be discussed with NST. Radiology Department was contacted for timely insertion of peripheral inserted central venous catheters (PICC). Medical and nursing staff were trained on care of lines and appropriate use of PN. Results Results are shown in the Table. Use of peripheral cannulae for PN has gone down from 31% in 2009/10 to 4% in 2010/11 to 0% since 2011/12.Cost savings have been made in a number of areas. In 2010/11, savings of £20,671 were made. In 2013,NST advised and implemented a change in supplier of PN bags, resulting in total cost savings of £19,822. The total number of referrals for PN, number of inappropriate referrals, use of emergency PN, number of patients requiring PN for Conclusion Our intervention resulted in safer,coordinated and appropriate delivery of PN which has been sustained over 5 years. The feedback from hospital management,clinical staff has been positive and encouraging. These results may be extrapolated to all hospitals that care for patients requiring parenteral nutrition. Disclosure of Interest None Declared

PTU-102 Critical Care Nutrition in the United Kingdom – A Survey of Current Practice

Introduction Patients in the intensive care unit (ICU) are at high risk of malnutrition. Consensus guidelines recommend a dietitian be part of the ICU team and available within working hours, and hospitals have a nutrition support team (NST) for patients with complex needs. We investigated the provision of nutrition support and patterns of dietetic practice on ICUs in the UK. Methods An online survey was sent to members of the Parenteral and Enteral Nutrition Group and Critical Care Group of the British Dietetic Association (n = 560). Results were analysed in Microsoft® Excel. Results There were 166 responses, 141 from dietitians, an estimated response rate of 30%. 134 (81%) worked in England, 18 in Scotland and 11 in Wales. Most (136, 82%) were from general ICUs, with 30 (18%) from specialist ICUs including 8 cardiac units, 8 neurosciences units, 6 transplant units, 6 HPB/liver units, 4 trauma centres, 3 burns units, 3 intestinal failure units and 1 oncology unit. Only 88 respondents (53%) said their unit had a dedicated ICU dietitian, although 149 (90%) had regular dietitian support. Only 78 respondents (47%) said their unit had dietitian input every weekday. 137 respondents (83%) said their unit had access to an NST but only 103 (62%) stated the NST attended the ICU regularly. 153 respondents (92%) said all patients on parenteral nutrition would receive dietitian input on their unit and 132 (80%) said all those on enteral nutrition would have dietitian input. Only 60 respondents (36%) said all ICU patients would have dietitian input. 107 units (64%) used actual body weight to calculate patient requirements, whilst 48 units (29%) used estimated body weight. 11 units (7%) used ideal body weight. 79% (124/156) of respondents used an equation model to calculate requirements, most commonly the Henry (53%) and Penn State equations (37%). There was significant variation in kcal/kg (range 10–35 kcal/kg, median 20–25 kcal/kg) and nitrogen intake (range 0.05–0.25 gN/kg, median 0.15–0.20 gN/kg) targets between units. 153 (94%) respondents stated their unit used gastric residual volume (GRV) to guide enteral feeding, with GRVs triggering a reduction in feed rate ranging from 200 ml to 500 ml. Specialist supplemental feeds were not commonly used, although 16 (10%) respondents said their unit used glutamine. 126 (79%) respondents said their unit followed NICE guidelines on refeeding syndrome. Conclusion Whilst dietitian and NST input is available on most ICUs, half of units lack a dedicated ICU dietitian, do not have daily dietitian involvement and lack regular NST input. There is significant variation in the methods used to calculate patient requirements, in the use of GRV and of specialist supplementation. National guidance for critical care nutrition may help reduce disparities in dietetic provision. Disclosure of Interest None Declared

PTU-098 Improving PEG Completion Rates: Adoption of an Algorithm to Maximise Success: An 18 Month Single-Centre Review

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is an established technique for nutritional support, with a procedural success rate around 95% in most case series. 1 Failed procedures generally need alternative surgical or radiolofical approaches. In recent years we have adopted an algorithm for maximising PEG placement success rate and have now reviewed our outcomes. Methods Referrals are vetted by the nutrition support team before selection and cases accepted for PEG are listed on a consultant gastroenterologist’s list. The preferred procedural algorithm is: 1 A standard PEG technique is used with finger indentation and a safe-track technique; transillumination not considered necessary. 2 Trochar insertion into the stomach is assisted by counter-traction on the surrounding mucosa with a snare if necessary. 3 If this doesn’t help then the PEG trochar +/- sheath are removed and a long drainage access (kellett) needle is passed to assist gastric puncture. 4 If the PEG is unsuccessful, then a further attempt on another day is considered with another endoscopist if necessary. For this review, the nutrition team, endoscopy and clinical databases were reviewed for all patients accepted for PEG placement for 18 months from July 2014 onwards. Outcome measures included PEG success rates, techniques used, procedural complications and 30 day mortality. Results 154 patients were accepted for first PEG placement. Five patients did not proceed to PEG attempt owing to death or swallowing recovery. In the 149, all patients (100%) achieved successful PEG insertion at first or second attempt. Most cases (140/149, 94%) were done with the standard pull-through technique. In 6 cases (4%) a Kellett needle was used. In 3 cases (2%) a second endoscopy procedure was required for PEG completion: in 2/3 of these cases, initial failure was attributed to inadequate trans-illumination but successful completion was later done by another endoscopist. In the third case the oesophagus could not be intubated due to a large pharyngeal pouch; this was later overcome with the help of an oesophageal guidewire placed under fluoroscopic guidance. There were no identified procedural complications and overall 30 day mortality was 9%. Conclusion The procedural algorithm we have described for PEG placement, which excludes the need for transillumination, includes optional usage of a long drainage access needle and considers a second endoscopy procedure if the first procedure fails, led to a 100% completion rate in this case series. Adoption of this approach may therefore minimise the need for other higher-risk alternatives. Reference 1 Potack JZ, Chokhavatia S. Complications of and controversies associated with PEG: Report of a case and literature review. Medscape J Med 2008; 10 (6):142. Disclosure of Interest None Declared

PTH-135 A Dedicated PEG Service Can Improve Mortality and Clinical Outcome

Introduction The BSG guidelines 1 recommend that every endoscopy unit in an acute hospital setting should provide a basic percutaneous endoscopic gastrostomy (PEG) service, which is a part of the nutritional support team. The service should provide a framework for patient selection, pre-assessment and post-procedural care as well as working closely with the community-based services. Our trust recently appointed an accredited therapeutic endoscopist and gastroenterology nurse practitioner to run this service. Methods Retrospective analysis of all PEG insertions performed from Jan 2014 to Nov 2015 over a 23 month period. We looked at early-term (four weeks) and late term (eight weeks) mortality after PEG insertion. Results All patients were referred via a revised pathway proforma and examined by the team before the procedure to assess suitability. Further help and advice is offered to the community team upon discharge. 71 patients were referred for PEG insertion during the period of study. 29 (41%) were male, with a mean age 68 (range 29–87 years), 42 (59%) were female, with a mean age 69 (range 18–93 years). Indications for referrals included: 37 (52%) stroke related dysphagia, 15 (21%) head and neck cancers, 6 (8.5%) Huntington’s disease, 4 (5.6%) traumatic head injury, 3 (4.2%) learning disability, 2 (2.8%) cerebral palsy, 2 (2.8%) multiple sclerosis, 1 (1.4%) supranuclear palsy, 1 (1.4%) mitochondrial myopathy, 1 (1.4%) syringomyelia, 1 (1.4%) parkinsonism, 1 (1.4%) Korsakoff’s psychosis, and 1 (1.4%) myoclonic epilepsy with ragged-red fibres (MERRF) syrdrome. Patients with a formal diagnosis of dementia were not selected to undergo PEG insertion during this period. No short-term complications were reported post-insertion. Early-term mortality was 12.7% and late-term rose to 22.5%. Previous departmental audit in 2014 revealed early-term mortality of 20% and late-term mortality of 28%. Conclusion Meta-analysis has reported a 19% 30 day mortality following PEG insertion . 3 We have shown that in our centre, both early and late-term mortality has improved due to careful patient selection and a dedicated PEG service. Adherence to the BSG guidelines on PEG service has had a direct impact on improving mortality and clinical outcome. References 1 Westaby D, Young A, O’Toole P, Smith G, Sanders DS. The provision of a percutaneously placed enteral tube feeding service. Gut . 2010; 59 :1592–1605. doi:10.1136/gut.2009.204982 2 Johnston S, Tham T, Mason M. Death after PEG: results of the national confidential enquiry into patient outcome and death. Gastrointestinal Endoscopy 2008; 68 :223–7. 3 Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000; 55 :M735–9. Disclosure of Interest None Declared

Economic Evaluation of Home Total Parenteral Nutrition

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.

ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient.

The value of nutrition therapy for the adult hospitalized patient is derived from the outcome benefits achieved by the delivery of early enteral feeding. Nutritional assessment should identify those patients at high nutritional risk, determined by both disease severity and nutritional status. For such patients if they are unable to maintain volitional intake, enteral access should be attained and enteral nutrition (EN) initiated within 24-48 h of admission. Orogastric or nasogastric feeding is most appropriate when starting EN, switching to post-pyloric or deep jejunal feeding only in those patients who are intolerant of gastric feeds or at high risk for aspiration. Percutaneous access should be used for those patients anticipated to require EN for >4 weeks. Patients receiving EN should be monitored for risk of aspiration, tolerance, and adequacy of feeding (determined by percent of goal calories and protein delivered). Intentional permissive underfeeding (and even trophic feeding) is appropriate temporarily for certain subsets of hospitalized patients. Although a standard polymeric formula should be used routinely in most patients, an immune-modulating formula (with arginine and fish oil) should be reserved for patients who have had major surgery in a surgical ICU setting. Adequacy of nutrition therapy is enhanced by establishing nurse-driven enteral feeding protocols, increasing delivery by volume-based or top-down feeding strategies, minimizing interruptions, and eliminating the practice of gastric residual volumes. Parenteral nutrition should be used in patients at high nutritional risk when EN is not feasible or after the first week of hospitalization if EN is not sufficient. Because of their knowledge base and skill set, the gastroenterologist endoscopist is an asset to the Nutrition Support Team and should participate in providing optimal nutrition therapy to the hospitalized adult patient.

Improving growth in preterm infants during initial hospital stay: principles into practice

Despite recent innovations in nutritional care, postnatal growth failure between birth and hospital discharge remains a significant problem in preterm infants. Whether or not it is entirely preventable is unclear....

État nutritionnel en unité de surveillance continue pédiatrique : évaluation à l’admission, en cours de séjour et à distance

Malnutrition, known as a cause of morbidity, has not been studied in children admitted to pediatric intermediate care units. This study aimed to describe the association between patients' nutritional status and the relative severity of illness that characterizes this population. In this prospective longitudinal study, a dedicated nutrition support team assessed the nutritional status of all children, aged 5 days to 18 years, admitted to our university pediatric intermediate care unit (Hôpital Femme-Mère-Enfants, Lyon, France) over one year (2012-2013). Weight, height, body mass index, weight-for-age ratio, height-for-age ratio, and the analysis of growth curves were collected at admission. We monitored patients' weight, which allowed us to detect malnutrition occurrence during the stay, and its progression up to 3 months after discharge. A total of 459 patients were enrolled. Based on the analysis integrating all nutritional indices and the progression of growth curves, malnutrition at admission was detected in 23.8% of children (20.5% and 6.8% suffered from acute and chronic malnutrition, respectively). Based only on the body mass index, malnutrition was detected in 15.5% of children. Chronic disease appeared as a risk factor for malnutrition at admission (P=0.0001) and young age for acute malnutrition (P=0.04). The incidence of acquired malnutrition during the stay (in children with a length of stay > 5 days) was up to 26%, and dyspnea was the only risk factor identified. This population recovered with a normal nutritional status late (66% after 2 months and 16% after 3 months). The prevalence of malnutrition is high in our pediatric intermediate care unit. The occurrence of acquired malnutrition during the stay is frequent. All children should benefit from systematic nutritional assessment at admission as well as careful monitoring during the stay and after discharge, to adapt early and individualized nutritional support.

The nutritional intake of elderly patients with dysphagia admitted to the internal medical department of the emergency hospital was analyzed. The Fujishima dysphagia scale after care and treatment by the Nutrition Support Team was assessed.

The Nutrition Support Team (NST) assessed the severity of dysphagia in elderly patients admitted to the internal medical department, and the appropriate nutritional treatment was determined. Patients were treated with either oral nutrition (enteral nutrition, EN) or artificial alimentation (parenteral nutrition, PN). The goal of this study was to analyze whether or not the route of nutrition affected the patient discharge rates. We divided 290 elderly inpatients with dysphagia into 2 groups, the pneumonia group (200 patients) and the non-pneumonia group (90 patients). The NST estimated the swallowing function using the Fujishima dysphagia scale. Monitoring was continued until the NST care and treatment had been finalized. We further divided the pneumonia patients into two subgroups: those with a Fujishima dysphagia scale score ≤3 or ≥4 at the beginning of NST intervention. The changes in the swallowing function were analyzed.The swallowing function in the patients with a score ≥4 was significantly improved compared with that in the patients with a score ≤3. This difference, however, was not observed in the non-pneumonia group. In both the pneumonia and non-pneumonia groups, the ratio of patients discharged on oral nutrition was one-third, and the ratio of death in hospital was one-quarter, the remaining patients required artificial alimentation. Among elderly patients admitted to the internal medical department of the emergency hospital with dysphagia, one-third left the hospital with oral nutritional intake, one-quarter died in hospital, and the remaining required artificial alimentation.

A Nursing Survey on Nutritional Care Practices in French-Speaking Pediatric Intensive Care Units: NutriRéa-Ped 2014.

Malnutrition in critically ill children contributes to morbidity and mortality. The French-speaking pediatric intensive care nutrition group (NutriSIP) aims to promote optimal nutrition through education and research. The NutriSIP-designed NutriRéa-Ped study included a cross-sectional survey. This 62-item survey was sent to the nursing teams of all of the French-speaking pediatric intensive care units (PICUs) to evaluate nurses' nutrition knowledge and practices. One nurse per PICU was asked to answer and describe the practices of their team. Of 44 PICUs, 40 responded in Algeria, Belgium, Canada, France, Lebanon, Luxemburg, and Switzerland. The majority considered nutrition as a priority care but only 12 of the 40 (30%) had a nutrition support team, 26 of the 40 (65%) had written nutrition protocols, and 19 of 39 (49%) nursing teams felt confident with the nutrition goals. Nursing staff generally did not know how to determine nutritional requirements or to interpret malnutrition indices. They were also unaware of reduced preoperative fasting times and fast-track concepts. In 17 of 35 (49%) PICUs, the target start time for enteral feeding was within the first 24 hours; however, frequent interruptions occurred because of neuromuscular blockade, fasting for extubation or surgery, and high gastric residual volumes. Combined pediatric neonatal intensive care units were less likely to perform systematic nutritional assessment and to start enteral nutrition rapidly. We found a large variation in nursing practices around nutrition, exacerbated by the lack of nutritional guidelines but also because of the inadequate nursing knowledge around nutritional factors. These findings encourage the NutriSIP to improve nutrition through focused education programs and research.

Parenteral Nutrition in Hospitalized Children

Objective: Parenteral Nutrition (PN) is prescribed to children with a non functioning gut or to those who fail to meet their nutritional requirements enterally. Complications should be balanced against the benefit for the patient. The aim of this study was to establish if the indications for PN prescribing in a tertiary referral children’s hospital were appropriate. Study Design: Children and newborns (infants <4 weeks of age) receiving inpatient PN between October 2013 and March 2014 were enrolled and data was collected prospectively. The appropriate indications for the use of PN were based on the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Results: 303 children (67 newborns) were enrolled. Patients were referred from different departments across the hospital. The median duration of PN was 18 days (1-160). PN was mainly prescribed to critically ill children on intensive care (66/303), those ungergoing surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (newborns 64/67, 95.5%; children 214/236, 90.8%). The use of PN was considered inappropriate in 12/303 patients and in 13/303 it was not possible to reach a conclusion. Conclusion: Although the indications for inpatient PN in children is mostly justified, there is still a proportion of patients receiving intravenous nutrition unnecessarily highlighting the need for more PN training and better access to nutritional support teams.

Medical Professionals’ Cooperative Structure and its Developmental Requirements for a Community Nutrition Support Team

Medical Professionals’ Cooperative Structure and its Developmental Requirements for a Community Nutrition Support Team

Pharmaceutical approach in our nutrition support team for the drug interaction between Warfarin and total parenteral nutrition kit containing vitamin K.

Pharmaceutical approach in our nutrition support team for the drug interaction between Warfarin and total parenteral nutrition kit containing vitamin K.

Implementation and effect of home enteral nutrition in outpatients with Crohn's disease

Objective To guide the implementation of home enteral nutrition(EN) for outpatients with Crohn's disease, and to observe its effect. Methods In this observational study, 26 patients at active period of Crohn's disease were collected between April 2014 and June 2015 in the clinic of Clinical Nutrition Center of Nanjing General Hospital of Nanjing Military Command. Home EN combined with medication was administered. The nutritional status, Crohn's Disease Activity Index (CDAI), and quality of life before and after EN were compared. Results After home EN therapy, body mass index (BMI) of the patients increased from (17.7±2.1) kg/m2 to (19.8 ±2.0)kg/m2 (P<0.001), proportion of lymphocytes from (0.216±0.066) to (0.305±0.106) (P=0.007), albumin level from (40.3±5.9)g/L to (43.7±5.4)g/L (P=0.038), prealbumin from (233.1±71.5)mg/L to (306.0±72.1)mg/L (P=0.009), and transferrin from (2.7±0.6)g/L to (3.1±0.7)g/L (P=0.038). In the indicators reflecting the activity of Crohn's disease, CDAI declined from 197.0±55.8 to 113.2±33.4 (P<0.001)after EN, C-reactive protein from 28.50(18.00-32.80) mg/L to 2.00 (0.58-6.33) mg/L (P<0.001), erythrocyte sedimentation rate from (29.6±9.9)mm/h to (9.4±7.6)mm/h (P<0.001). The patient's disease activity scores and inflammatory reaction indexes all reached the normal levels after EN, show that the patients were in remission stage. In inflammatory bowel disease quality of life score, the score of intestinal symptoms rose from 41.2±13.3 to 57.0±9.6(P< 0.001), the score of systemic symptom from 20.7±5.5 to 28.9±4.2(P<0.001), emotional ability from 43.6±16.1 to 61.0±15.9(P=0.002), and social ability from 20.6±4.9 to 28.4±5.6(P<0.001), all showing statistical significance. Conclusions Standardized home enteral nutrition in patients at active period of Crohn's disease, when implemented under professional guidance of nutritional support team and well followed up, may improve nutritional status, induce remission, and improved quality of life. Key words: Home enteral nutrition; Outpatient service; Crohn's disease; Implementation; Effects

当院 NSTが介入した下痢症例に関する検討～電解質異常に着目して～

当院 NSTが介入した下痢症例に関する検討～電解質異常に着目して～

Report on the first year of applying initial assessment of nutritional status in hospital inpatients

Abstract Introduction. Since 2012, Polish hospitals are recommended to implement the assessment of the nutritional status and appoint nutrition support teams. Aim. To evaluate the application of initial assessment of inpatients’ nutritional status in the first year of its implementation in clinical practice. Material and methods. A retrospective analysis of medical documentation of patients admitted to hospital in the year 2012 was conducted. The research sample included one in ten medical records. Results. A total of 433 medical records was analyzed. In 5.3% medical records a lack of duly completed Subjective Global Assessment questionnaires was revealed. In 81.8% cases a calculated Body Mass Index (BMI) was not found. No instances of renewed calculation of BMI were recorded. In 49.7% cases no information on diet recommended to the inpatient was found. With the exception of the internal medicine ward, in 87% of the cases the diets were not recommended in writing by a physician or included in the medical orders documentation. The inpatients classified as undernourished were usually recommended a diet containing 2000 kcal + additional 300 kcal as second breakfast and afternoon snack. Information on cooperation with the nutrition support team and on inpatient’s nutrition was not included in the nursing documentation. Conclusions. During the first year when the obligatory patient nutritional status assessment was introduced in Polish hospitals, the awareness of its significance, nutritional therapy planning and monitoring of the results were insufficient. The assessment of nutritional status seems to be another dead letter in patient medical documentation.

An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy.

Background:The prevalence of malnutrition is very high in patients with cancer. The purpose of this study was to investigate whether or not a nutrition support team (NST) could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT).Methods:Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group. The nutritional statuses of 25 patients in the NST group were managed by the NST. The other 25 patients in the control group underwent the supervision of radiotherapy practitioners. At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay (LOS) and the in-patient cost were also compared between these two groups.Results:At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB), transferrin, and ALB parameters (P = 0.001, 0.000, and 0.000, respectively). The complication incidences, including bone marrow suppression (20% vs. 48%, P = 0.037) and complications related infections (12% vs. 44%, P = 0.012), in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs. 76%, P = 0.103). Furthermore, the average LOS was decreased by 4.5 days (P = 0.001) and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times (P > 0.05) in the NST group.Conclusions:A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.

Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.