Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Malnutrition is prevalent in hospitalized elderly people leading to complications including cognitive deficit. However, the relationship between the nutritional status and the preclinical phase of dementia in the elderly is still unclear. The aim of this study was to evaluate the prevalence of malnutrition in older patients with mild cognitive impairment. ⋯ Malnutrition is prevalent in hospitalized elderly patients with cognitive deficit, even in those with mild cognitive impairment. It remains to be demonstrated whether improvement in nutritional status may delay progression to dementia in these patients.
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It was shown that patients in the Netherlands remain exposed to unnecessarily prolonged starvation after abdominal surgery. The present study examined whether a structured collaborative effort would help to implement the early start of oral nutrition after colorectal surgery. ⋯ The present nationwide collaborative effort was successful in implementing a change towards an early start of oral nutrition after abdominal surgery.
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Randomized Controlled Trial
The pattern of amino acid exchange across the brain is unaffected by intravenous glutamine supplementation in head trauma patients.
Exogenous intravenous glutamine supplementation to head trauma patients leaves intracerebral glutamate concentration unaffected. The effect of an exogenous supply upon glutamine and glutamate exchange across the brain has still not been characterised. ⋯ Intravenous glutamine supplementation to head trauma patients was associated with an unaffected amino acid exchange pattern across head and leg, without any measurable uptake of glutamate across the brain. Endogenous glutamine production was in the normal range despite the low plasma glutamine concentration. This pilot study opens the possibility to perform prospective clinical trials in head trauma patients to evaluate the clinical efficacy of exogenous glutamine supplementation.
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Randomized Controlled Trial
Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioid-sparing analgesia versus traditional care after open appendectomy.
Fast track protocols have been successfully used in abdominal surgery but there are no randomized trials on fast track after appendectomy. The aim of this study was to evaluate the safety and feasibility of fast track perioperative care protocol including early feeding with opioid-sparing analgesia after open appendectomy. ⋯ This study indicates that early feeding and opioid-sparing analgesia after open appendectomy is safe and reduces length of hospital stay without deterioration of pain control.
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Consensus regarding definitions of malnutrition and methods to assess nutritional state is lacking. We propose a definition and its operationalization. ⋯ A definition is proposed that reflects the pathophysiology of malnutrition and that, when operationalized, will lead to measures reflecting this pathophysiology. Such an approach may yield comparable and reproducible rates and degrees of malnutrition in populations as well as in individuals.