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Prescribing adult intravenous nutrition
No full textPatients who are unable to achieve an adequate nutritional intake via their gut are at risk of malnutrition and its many associated problems. They may, therefore, require feeding directly into a vein. Prescribing Adult Intravenous Nutrition is an introductory text offering the healthcare professional involved in nutritional support a practical guide to the broad principles and practice of adult intravenous nutrition.Prescribing Adult Intravenous Nutrition describes:
why nutritional care is so important
what should be given
what can go wrong
how to deal with any intravenous feeding problems
how to organise aspects of nutritional care.
Numerous illustrations and case studies help to illustrate the principles discussed.
Contents:
1. The Importance of Nutritional Support: 2. Oral and Enteral Tube Support: 3. Intravenous Support: 4. Clinical Assessment: 5. Pharmaceutical Review: 6. Decisions on Intravenous Nutrition: 7. Fluid and Macronutrients: 8. Electrolytes: 9. Micronutrients: 10. Prescribing for Patients with Specific Problems: 11. Regimen Choice: 12. Potential Complications: 13. Monitoring: 14. Organising Nutrition Support: 15. Technical Services: 16. On the Ward: Appendix 1 Stability: Appendix 2 Salts and Pharmaceutical Calculations: Appendix 3 Micronutrient Preparations: Appendix 4 High Sodium Drinks and Feeds for Short Bowel Syndrome
Nutrition in acute care
No full textMalnutrition is common in hospitalised patients but is underrecognised and undertreated. It increases mortality and complications, and delays recovery from illness during and after hospital stay. The doctor therefore has the responsibility of ensuring that malnutrition is recognised and treated appropriately. Since hospital stays are often short, there is a need to ensure continuity of care so that treatment
that begins in hospital is continued in the community.
Hospital physicians have the opportunity to diagnose obesity related problems, which may go unrecognised. The most obvious example is type 2 diabetes but sleep apnoea,1 which is linked to loud snoring and disrupted sleep, can present as tiredness, headaches, depression,
loss of energy and even loss of memory. It commonly occurs in overweight individuals, especially those with large neck size (neck adipose tissue deposition) and responds to weight loss, although in severe cases continuous positive airway pressure may be needed.
The management of obesity takes place predominantly in the community; hence the discussion that follows focuses mainly on the problem of malnutrition.<br/
100 years since Scott reached the Pole: a century of learning about the physiological demands of Antarctica
No full textThe 1910–1913 Terra Nova Expedition to the Antarctic, led by Captain Robert Falcon Scott, was a venture of science and discovery. It is also a well-known story of heroism and tragedy since his quest to reach the South Pole and conduct research en route, while successful was also fateful. Although Scott and his four companions hauled their sledges to the Pole, they died on their return journey either directly or indirectly from the extreme physiological stresses they experienced. One hundred years on, our understanding of such stresses caused by Antarctic extremes and how the body reacts to severe exercise, malnutrition, hypothermia, high altitude, and sleep deprivation has greatly advanced. On the centenary of Scott's expedition to the bottom of the Earth, there is still controversy surrounding whether the deaths of those five men could have, or should have, been avoided. This paper reviews present-day knowledge related to the physiology of sustained man-hauling in Antarctica and contrasts this with the comparative ignorance about these issues around the turn of the 20th century. It closes by considering whether, with modern understanding about the effects of such a scenario on the human condition, Scott could have prepared and managed his team differently and so survived the epic 1,600-mile journey. The conclusion is that by carrying rations with a different composition of macromolecules, enabling greater calorific intake at similar overall weight, Scott might have secured the lives of some of the party, and it is also possible that enhanced levels of vitamin C in his rations, albeit difficult to achieve in 1911, could have significantly improved their survival chances. Nevertheless, even with today's knowledge, a repeat attempt at his expedition would by no means be bound to succee
The financial cost of managing patients with type 2 intestinal failure: experience from a regional centre
No full textCould Scott have survived with today's physiological knowledge?
No full textIn 1911, members of a British expedition walked across the Antarctic to the South Pole, but in the punishingly hostile environment, retracing their steps back to the edge of the continent proved fatal. Over the last 100 years, knowledge about human physiology has greatly increased and, on the centenary of this most extreme of all journeys, this essay explores the true extent of the physiological stress experienced by the men involved and whether their fate was inevitabl
Malnutrition and nutrition support in patients with liver disease
No full textLiver disease, especially alcohol related, is increasingly common and is often accompanied by malnutrition as a result of reduced intake, absorption, processing and storage of nutrients. An increase or alteration in metabolic demands also occurs and some patients have high nutrient losses. Malnutrition in all forms of liver disease is associated with higher rates of mortality and morbidity but it is often under recognised and under treated despite the fact that appropriate treatment can improve outcomes. In this review, the causes, consequences and assessment of nutritional status in patients with liver disease are examined, and an approach to best treatment is proposed.</p
‘Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill elderly
Get PDFMalnutrition and its impact on clinical outcome may be underestimated in hospitalised elderly as many screening procedures require measurements of weight and height that cannot often be undertaken in sick elderly patients. The 'Malnutrition Universal Screening Tool' ('MUST') has been developed to screen all adults, even if weight and/or height cannot be measured, enabling more complete information on malnutrition prevalence and its impact on clinical outcome to be obtained. In the present study, 150 consecutively admitted elderly patients (age 85 (sd 5·5) years) were recruited prospectively, screened with `MUST' and clinical outcome recorded. Although only 56?% of patients could be weighed, all (n 150) could be screened with 'MUST'; 58?% were at malnutrition risk and these individuals had greater mortality (in-hospital and post-discharge, P<0·01) and longer hospital stays (P=0·02) than those at low risk. Both 'MUST' categorisation and component scores (BMI, weight loss, acute disease) were significantly related to mortality (P<0·03). Those patients with no measured or recalled weight ('MUST' subjective criteria used) had a greater risk of malnutrition (P=0·01) and a poorer clinical outcome (P<0·002) than those who could be weighed and, within both groups, clinical outcome was worse in those at risk of malnutrition. The present study suggests that 'MUST' predicts clinical outcome in hospitalised elderly, in whom malnutrition is common (58?%). In those who cannot be weighed, a higher prevalence of malnutrition and associated poorer clinical outcome supports the importance of routine screening with a tool, like 'MUST', that can be used to screen all patients
Malnutrition is dangerous: The importance of effective nutritional screening and nutritional care
No full textIn July 2010, the Government published the White Paper Equity and Excellence: Liberating the NHS, which places a strong emphasis on patient safety, sets the long-term vision for the NHS and describes a coherent framework of reform to deliver health care amongst the best in the world. Good nutritional care is a prerequisite of safe care and hence fundamental to the achievement of this vision, especially for vulnerable individuals. This article outlines the prevalence and costs associated with malnutrition* and the impact of malnutrition on patient safety within the context of the current NHS reforms. It concludes with guidance for clinicians and senior managers which, where fully implemented, will facilitate good nutritional care and ensure compliance to nutritional guidelines, standards and legislation including the regulations relating to nutrition as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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