Nutrition Support Team Research Articles

SUN-PO209: How Nutrition Support Teams Deal with Ethical Issues?

SUN-PO209: How Nutrition Support Teams Deal with Ethical Issues?

Impact of edema on length of calf circumference in older adults.

Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. This retrospective cross-sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1-2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6-2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1-2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5-2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema-related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%-38.7% for men. Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993-998.

Creation of a Virtual Nutrition Support Team to Improve Quality of Care for Patients Receiving Parenteral Nutrition in a Multisite Healthcare System.

Parenteral nutrition (PN) is a complicated therapy in which having specially trained clinicians can provide benefit, but it can be difficult to provide this level of expertise to all patients requiring PN. Creation of a virtual nutrition support team (NST) model allows patients across multiple hospitals to receive care from NST clinicians using remote conferencing technology on a daily basis. This study reviewed retrospective data from before and after implementation of the virtual model to assess quality indicators. The NST was developed including a team of dietitians and pharmacists with a physician medical director. Practice guidelines were developed to provide consistent methods for ordering and monitoring patients receiving PN. Patient charts in both the preintervention and postintervention groups were reviewed for indication for PN, duration of therapy, blood glucose levels, and demographic data. A greater proportion of patients in the postintervention period had appropriate orders (97.2%) compared with patients in the preintervention period (58.9%) (P<0.001). A greater proportion of patients in the postintervention period had blood glucose levels within the range 65-180mg/dL (83.5%) compared with patients in the preintervention period (62.2%) (P<0.001). A virtual team model was applied to remotely manage patients receiving PN in a large healthcare system. This resulted in optimized care of patients by reducing inappropriately prescribed therapy and improving blood glucose control.

Effect of whole-course nutrition management on patients with esophageal cancer undergoing concurrent chemoradiotherapy: A randomized control trial.

Malnutrition is the most common complication of patients with esophageal cancer and can lead to poor prognosis and death. Good nutritional status has been shown to help improve patient outcomes and reduce complications. In the absence of specific evidence on the effect of nutrition in patients with esophageal cancer, the purpose of this study was to investigate the effect of whole-course nutrition management on the prognosis and complications of chemoradiotherapy in patients with esophageal cancer through a randomized controlled trial. A total of 96 patients with esophageal cancer treated with concurrent chemoradiation were randomized to an intervention group (treated with whole-course nutrition management from the Nutrition Support Team) and a control group (treated with the general nutritional method) for approximately 6 wk. Dietary surveys and body measurements were conducted at baseline and every day thereafter. Patient-generated Subjective Global Assessment score, blood index, quality of life, and psychological condition were assessed at baseline and every week before discharge. Complications (e.g., radiation esophagitis, myelosuppression, and skin symptoms), completion rates of therapy, short-term efficacy evaluation, as well as clinical outcomes were measured. A total of 85 patients completed the study (intervention group = 45; control group = 40). There were significant differences in the changes of serum albumin and total protein between the two groups throughout the trial (P < 0.05). Complications (e.g., radioactive esophagitis, skin symptom of complications) and quality of life were statistically different before and after the intervention (P < 0.05). The difference in the change of other indicators was not statistically significant. Whole-course nutrition management can improve the nutritional status of patients with esophageal cancer treated with concurrent chemoradiotherapy, reduce the severity of radiation esophagitis and radiation skin reactions, improve the quality of life, and relieve depressive symptoms.

Investigation on the utilization of parenteral nutrition preparations in 12 Hospitals of Jiangsu

Objective To investigate the use of parenteral nutrition preparations in Jiangsu Province, and to provide reference for the standardized management of parenteral nutrition preparations. Methods 720 cases using parenteral nutrition preparations from January 2017 to June 2017 in the department of general surgery of 12 hospitals in Jiangsu province were selected. The rate of nutritional risk screening, the indications of parenteral nutrition, the way of infusion, the rationality and economy of the prescriptions were retrospectively evaluated. The calorie, amino acid content, non-protein calorie/nitrogen ratio, glycolipid ratio and cation concentration of the patients received total parenteral nutrition were calculated. Results The total costs of parenteral nutrition preparations of 720 cases were 1.614 1 millions, and 346 cases did not have the indications for parenteral nutrition. The results of prescription comment showed that only 16 patients were screened for nutritional risk by Nutritional Risk Screening 2002 tool at admission. 544 cases were intravenous dripped with amino acid and fat emulsion from peripheral vein. In the 176 total parenteral nutrition prescriptions, there were 39 non-protein calorie/nitrogen ratio cases, 15 glycolipid ratio cases, 69 cation concentration cases, 61 calorie cases and 32 amino acid content cases failing to comply with the recommendation of the guidelines. Only 31 total parenteral nutrition prescriptions were completely reasonable. Conclusion The costs of parenteral nutrition preparations used in hospitals of Jiangsu are high but the rate of rationality is low. Nutrition support team should be established to regulate the use of parenteral nutrition preparations and save medical resources. Key words: Parenteral nutrition; Nutritional Risk Screening 2002; Nutritional risk screening; Nutrition support team

The Present and Future of Nutrition Support Team

The Present and Future of Nutrition Support Team

A Retrospective Look at TPN with Pancreatitis: Do Recommendations Match Guidelines? (P12-036-19)

ObjectivesThe objective of this project was to assess if best practice guidelines for the use of total parenteral nutrition (TPN) in pancreatitis are being followed at a university teaching hospital. MethodsThis retrospective study was an exploratory analysis of de-identified data pulled from a university teaching hospital clinical data repository and electronic medical records for patients who had a diagnosis of pancreatitis between the years of 2014 and 2018. Variables of interest included diagnosis, reason for initiating TPN, diet order, past medical history, age, gender, and race. Feeding modalities were compared to best practice guidelines for nutrition support initiation in pancreatitis provided by the American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN), American Pancreatic Association and the International Association of Pancreatology (IAP/APA), Best Practice in Surgery group at the University of Toronto, and the American College of Gastroenterology (ACG). ResultsA total of 57 patients were admitted between 2014 and 2018 with the diagnosis of pancreatitis. Chart reviews of each patient were assessed for an initial nutrition regimen of either enteral nutrition (EN) or TPN. Of the 57 patients started on nutrition support, 12 patients (21%) received a trial of EN prior to starting TPN. After exclusion of eight patients who had a diagnosis of either ileus, small bowel obstruction (SBO) or bowel perforation, there were 37 (65%) patients who were started on TPN initially without an EN trial. ConclusionsDespite best practice guidelines from multiple groups advocating for EN over TPN, it was found that TPN appears to be a first line feeding strategy in the majority of patients admitted with or who developed pancreatitis at this hospital. Development of an interdisciplinary nutrition support team at this hospital is recommended to facilitate adherence to best practices regarding treatment of patients with pancreatitis. Funding SourcesNot Applicable.

Hastanede Yatan ve Beslenme Destek Ekibine Danışılan Hastalarda Malnütrisyon Durumu ve Hedeflenen Beslenme Desteği Etkinliğinin Değerlendirilmesi

Amaç: Hastanede yatan ve beslenme desteği (BD) tedavisi alan hastalarda yetersiz beslenme, malnütrisyona bağlı komplikasyon riskini arttırmaktadır. Bu çalışmada hastanede yatan ve BD alan hastalarda, malnütrisyon durumu ve BD tedavisinin etkinliğinin ölçülmesi amaçlanmıştır.Bireyler ve Yöntem: Bu çalışmaya hastanede yatan, BD gereksinmesi nedeni ile beslenme destek ekibine danışılan ve izlenen 100 yetişkin (≥18 yaş) hasta dahil edilmiştir. Hastalarda malnütrisyon durumu Nütrisyonel Risk Değerlendirme Skoru-2002 (NRS-2002) ile değerlendirilmiştir. Beslenme destek tedavisi alan hastaların hedeflenen günlük enerji ve protein gereksinmelerine ulaşma süreleri günlük vizitler ile değerlendirilmiştir. Hastalar taburcu oluncaya kadar veya hastanede ölüm görülünceye kadar izlenmiştir. Hastaların ilk değerlendirmede ve izlem süresi sonunda haftalık olarak bazı biyokimyasal parametreleri değerlendirilmiştir. Hastaların klinik sonuçları, hastanede yatış süreleri ve mortalite görülme sıklığı kayıt edilmiştir.Bulgular: Hastanede BD ekibine danışılan hastalarda, NRS-2002 skoruna göre nütrisyonel risk altında olan hastaların sıklığı %75’tir. Hastalarda hedeflenen protein ve enerji gereksinmelerine ulaşma süresi sırasıyla ortalama 21.15±18.15 gün ve 19.56±17.14 gün’dür. İzlenen hastalarda mortalite görülme sıklığı %59’dur. Beslenme desteği tedavisine rağmen tüm hastaların BD tedavisi aldıkları son haftada serum protein değerleri (total protein ve albümin) düşmüştür (p&lt;0.005). Serum albümin düzeyleri ve hastanede yatış süresi arasında pozitif yönde bir ilişki bulunmuştur. Düşük serum protein değerleri mortaliteyi olumsuz yönde etkilemiştir (p&lt;0.01). NRS-2002 skoru ile belirlenen nütrisyonel risk mortaliteyi ve hastanede yatış süresini etkilememiştir (p&gt;0.05).Sonuç: Bu çalışmada, BD ekibine danışılan hastaların klinik durumunun, BD tedavisinin etkinliğini değiştirdiğini ve bu nedenle hedeflenen BD tedavisine ulaşma süresinin çok geç olduğu düşünülmektedir. Klinikte BD tedavisi alan hastaların izlemleri düzenli olarak yapılmalı ve hedef stratejiler oluşturularak izlem süreçlerinin iyileştirilmesi gerekmektedir.

Bibliometric analysis of home enteral nutrition in China

Objective To analyze the current status of studies related to home enteral nutrition (HEN) in China, and provide scientific basis for the research and management of HEN in China. Methods We searched CNKI and WanFang Data since it built to January 1st, 2018. The included studies were screened and categorized by publication information, study type, subjects of the study, topic, interventions and outcomes. Descriptive analysis was conducted after extraction of information. Results A total of 153 studies were included, of which 37 were observational studies, 102 were experimental studies, 12 were case report, and 2 were exploring articles. Since 2012, the number of studies has been increasing. Most of the subjects were elderly people who were diagnosed with diseases of digestive system, head and neck tumors and diseases of nervous system. These studies were featured as small sample size and short intervention time, follow-ups by telephone and home visit, less than 1/4 providing professional nutrition support team, and outcomes mainly as complication, nutritional biochemical indices, anthropometric indices and prognosis. Conclusion HEN in China is still in its infancy. The number of relative studies is still small and quality of literatures is very low, but it has been increasing. At present, there are some problems in the implementation of HEN in China, such as lack of standardized management model and professional team, short-term intervention, and single follow-up mode. The elderly and patients with digestive disease, head and neck tumors and nervous disease are the key subjects; more professional nutrition support team and scientific management model should be established in the future. Key words: Home enteral nutrition; Bibliometric analysis

Navigating the Challenges of Home Parenteral Nutrition.

Providing parenteral nutrition at home has significant challenges for both patients and providers alike. Some of these challenges are systemic and are secondary to the way the healthcare system is designed to deliver care. Others are more practical and require educating patients and their families to ensure success at home. Overall, the nutrition support team was designed to help deal with these challenges in an effective way. The changing realities of the modern health system are challenging the nutrition support team to adapt to new obstacles. Providing patients with the tools to succeed at home requires a significant amount of time and investment but will pay dividends in the future as patients thrive for years to come.

Percutaneous endoscopic gastrostomy (PEG) service provision in south-east kent hospitals

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report 2004 into PEG recommendations included an in-depth assessment of the patients for PEG insertion and that all patients in whom PEG feeding is proposed should be reviewed by a multidisciplinary team3. The provision of a percutaneous enteral tube feeding service should be within the remit of the hospital nutrition support team (NST)1. This designated team should provide a framework for patient selection, pre-assessment and post-procedural care.

The composition of nutrition support teams in the UK

The composition of nutrition support teams in the UK

Nutrition in the real world – patient outcomes from a multidisciplinary nutrition clinic in a large district general hospital (non-intestinal failure) setting in the UK

NICE guidelines1 recommend that all acute trusts should have multidisciplinary nutrition support teams and that patients receiving nutritional support in the community should be monitored by healthcare professionals with relevant skills and training. We are a large district general hospital offering multiple tertiary services but not home parenteral nutrition (HPN). In 2014 we set up a multidisciplinary nutrition clinic led by a consultant gastroenterologist and senior dietician in order to improve the management of out-patients with complex nutritional needs. We retrospectively reviewed case-notes of all patients referred to this clinic over its first three years (January.2014 – January 2017) to ascertain referral patterns and outcome.

The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2).

To characterize the practices of nutritional support in Latin American and Spanish PICUs. Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. PICUs of participant hospitals. Critically ill children between 1 month and 18 years old. None. Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%. Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.

Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals.

BackgroundThe purpose of this study was to identify risk factors for intensive nutritional intervention outcomes in elderly undernourished patients to help reduce the number of patients with prolonged hospital stay or without recuperation of previous activities of daily living and quality of life.MethodsIn total, 230 patients who received interventions from a nutrition support team (NST) between January 2016 and July 2018 were included. Patients were classified into two groups based on NST intervention outcomes: patients with improved nutritional status were included in the successful group, whereas those whose nutritional status did not improve, as defined by progressive illness or death, were classified into the non-successful group. We assessed patient characteristics, laboratory data, and nutrition support methods.ResultsOur multivariate Cox proportional hazard analysis showed that: 1) The presence of peripheral parenteral nutrition (hazard ratio (HR): 1.80; 95% confidence interval (CI): 1.13 - 2.88) was identified as an independent risk factor for NST intervention outcomes; 2) The energy fill rate to total energy expenditure was < 66.0% (HR: 1.61; 95% CI: 0.98 - 2.66); and 3) A geriatric nutritional risk index score < 70.0 (HR: 1.54; 95% CI: 0.92 - 2.56) tended to be negatively associated with NST intervention outcomes.ConclusionsIn addition to the nutrition therapy provided by a traditional NST, patients with the risk factors require nutritional intervention. Elderly individuals should also receive nutrition care because they have been recuperating at their home or in long-term care facilities, to prevent experiencing adverse conditions.

Association of tongue pressure and number of residual teeth with nutritional assessment values in patients working with a nutrition support team

Association of tongue pressure and number of residual teeth with nutritional assessment values in patients working with a nutrition support team

Nutrition Support Team in the acute phase

Nutrition Support Team in the acute phase

Outcomes and prognoses of nutritionally depleted cases that calorie intake is deficient after nutrition support team intervention

Outcomes and prognoses of nutritionally depleted cases that calorie intake is deficient after nutrition support team intervention

Nurseʼs Expectation of Dental Hygienists in “Community Nutrition Support Team”

Nurseʼs Expectation of Dental Hygienists in “Community Nutrition Support Team”

Association between indication for therapy by nutrition support team and nutritional status.

The nutrition support team is a multidisciplinary team composed of medical doctors, registered nurses, pharmacists, and nutritionists, who evaluate the nutritional status of patients. The objective of this study was to determine the relationship between indications for nutrition support team therapy and the nutritional status of patients hospitalized in local major hospitals.Patients who were referred to a nutrition support team from January to December 2016 were enrolled. Patients were classified into 4 age groups, and the weight categories were determined using body mass index (BMI). Four of 6 indications were used for referral to a nutrition support team. The required calories were estimated, and the nutritional status was classified into malnutrition or eutrophia, based on the estimation.The proportion of elderly patients (37.0%) was higher than that of younger ones (28.3%). Patients with higher BMI had a relatively lower proportion of malnutrition. Patients receiving enteral nutrition had greater risk of malnutrition (adjusted odds ratio [aOR] = 3.77, 95% confidence interval [CI] = 2.71–5.24). Patients receiving parenteral nutrition (aOR = 0.38, 95% CI = 0.30–0.47) and treated in the intensive care unit (aOR = 0.70, 95% CI = 0.54–0.91) had lower risk of malnutrition. Patients with >3 indications for nutrition support team therapy had a lower risk of malnutrition than those with only 1 indication (aOR = 0.54, 95% CI = 0.37–0.77).Parenteral nutrition was the most common indication for referral to nutrition support team therapy; however, enteral nutrition had the poorest nutritional status. Patients receiving enteral nutrition who are referred to a nutrition support team need an intensive nutrition support strategy.