Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Comparative Study
Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support.
Malnutrition is a common problem in hospitalized patients. Early assessment of nutritional status may help in identifying patients for whom nutritional interventions are needed. The purpose of this study was to assess and compare the nutritional status of mechanically ventilated critically ill patients who were receiving nutritional support. ⋯ Subjects in the combined group showed a significant increase in prealbumin and the Maastricht Index levels after 14 days. Patients in all three groups were malnourished when admitted to the ICU. Patients showed a slightly improvement of nutritional status after receiving nutritional support for 14 days.
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Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. ⋯ The MNA was found to be well-suited for the preoperative assessment during anaesthesia consultation because it required no biological marker. It showed that approximately one-third of all the examined patients, and half of the ASA 3-4 patients, were not well-nourished. The ASA score could not predict poor nutritional status. The results suggested that nutritional assessment should be routinely performed in ASA 3-4 patients over 60 years of age.
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Comparative Study
A comparative study of polyurethane and silicone cuffed-catheters in long-term home total parenteral nutrition patients.
The purpose of this study was to report our compared experience of long-term complications with polyurethane (LeaderCuff) and silicone (Lifevac) tunnelled, cuffed catheters in home adult TPN patients. ⋯ Both Lifevac and LeaderCuff catheters enable safe, long-term, venous access and prevent, in most cases, inadvertent catheter dislodgement. There is little evidence, from our study, to support the hypothesis that polyurethane catheters offer more security than silicone catheters in home TPN adult patients.
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Specific nutrition standards are now developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in order to improve the nutritional status in hospitalized patients. We investigated the use of clinical nutrition in Danish hospitals and compared it with the standards of JCAHO by doing a questionnaire-based investigation among doctors and nurses randomly selected in 40 hospitals including internal medicine, gastroenterology, oncology, orthopedic departments and intensive care units (ICU). Overall, 857 (43.4%) responded to the questionnaire (doctors: 395, nurses: 462). ⋯ Seventy-six percent found that nutritional assessment should be performed during hospital stays, but only 23% monitored the nutritional status. Sixty-eight percent stated that responsibility should be assigned to one or more persons, but this was the case in only 20%The use of clinical nutrition in Danish hospitals did not fulfill the standards for nutrition support according to the criteria established by JCAHO. Special efforts should be aimed at education, specific screening tools and introduction of guidelines in clinical nutrition.
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Randomized Controlled Trial Clinical Trial
Preoperative oral carbohydrates and postoperative insulin resistance.
Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance. Presently, we investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative insulin sensitivity. ⋯ Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast.