Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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The perioperative management of patients undergoing abdominal surgery has been based on traditional concepts and often not supported by scientific evidence. Recently there have been several scientific studies showing that some traditional procedures for the perioperative management of patients as preoperative fasting, bowel preparation, use of naso-gastric tubes, placement of intra-abdominal drainage, postoperative fasting etc. They are unnecessary and sometimes counterproductive. ⋯ In all these specialties has unanimously showing improved postoperative recovery with ERAS application protocols. The purpose of this paper is twofold. On the one hand examine the scientific evidence that exists today on the most important elements of an ERAS program and present preliminary results of the implementation of a program ERAS in our hospital.
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Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease which has no cure, so the treatment will be symptomatic in a Multidisciplinary Unit. It is composed of professionals, experts in patient care, with an interdisciplinary vision in order to act in a coordinated manner depending on the different situations which may arise over the course of the disease. There are several studies showing improved survival in patients treated within the framework of a multidisciplinary team compared to treatment by isolated specialties. An ALS Multidisciplinary Unit was created in 2004 in the University Hospital of Bellvitge (HUB). It is composed of a neurologist, pulmonologist, nutritionist, endocrinologist, rehabilitation, physical therapist, psychologist, social worker, nurse manager, speech therapist and an administrative worker. To assess the impact of the multidisciplinary care of our program 418 patients diagnosed with ALS were evaluated, 84 patients who had been treated by general neurology and 334 who had been treated under a model of multidisciplinary care. Patients who were treated in the unit of multidisciplinary care had a median survival of 1246 days (IC 1109-1382), 104 days above the median 1148 days of those followed by a general neurology consultation (CI 998-1297). This difference was statistically significant (log-rank 10,8; p= 0.008). This benefit was independent of having received treatment with riluzole, non-invasive mechanical ventilation or percutaneous gastrostomy. Nutritional assessment was performed on the first visit and all subsequent controls. It is important to do anthropometric measurements and detect unintentional weight loss and its possible precipitating causes in order to establish the appropriate nutritional treatment. The exploration of dysphagia allows a determination of the appropriate dietary advice, the introduction of thickeners to adjust the texture of food or nutritional supplementation with high-calorie formulas to prevent or correct weight loss. If these measures are not sufficient or there is the risk of failure of respiratory function, early gastrostomy placement will be indicated. The analysis of 140 ALS patients (92 controls and 48 with radiologic percutaneous gastrostomy) showed no difference in mean survival time between groups (32 vs 33.9 months, log Rank 1.86 p=0.39). Any patient had major complications. Despite not find changes in survival, the use of gastrostomy should be understood as a treatment to improve the quality of life and well-being of the patient. Psychosocial support of the person and the family environment is essential to integrate all the changes and situations that arise in the course of the disease. This should start from diagnosis as early intervention contributes to improved training, preventing situations of deterioration and helping coping with the dependency process. It is also possible to use technology and social media to complement the classic care model. In the case of the HUB ALS Multidisciplinary Unit, affected individuals and their families have the resources of the Aula Paciente and ALS blog, created with the objective of providing opportunities for dialogue between patients, families and caregivers. The satisfaction degree of the patients with the care provided by the ALS Multidisciplinary Unit on service accessibility, information received and the quality of care was assessed globally as good in 52.8% or very good in 29, 2% of patients. ⋯ Attention for the ALS affected person must be considered within the framework of a multidisciplinary team made up of all the professionals who go to intervene throughout the disease process in order to provide increased survival with the best care and quality of life.
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The Cuban Study of Hospital Malnutrition, as conducted during 1999 - 2001 with 1,905 patients assisted in 12 hospitals from 6 provinces of the country, revealed a hospital malnutrition rate of 41.2%. Having elapsed a decade after the first edition of the enquiry, update of this estimate is mandatory. ⋯ Having elapsed 10 years after the first edition of the ELAN CUBA Study, modest advances are seen in the identification and treatment of malnutrition in Cuban hospitals. It is perceived that formation and insertion of nutritionists verticalized in hospital care has contributed to the observed change. In addition, the activity of the Cuban Society of Clinical Nutrition and Metabolism in the advancement of the disciplines of nutritional therapy, artificial nutrition and metabolism might have served for a better recognition of the health problem posed by hospital malnutrition.
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The food environment can have an important influence on the availability of and access to food, which plays a significant role in the health of individuals. The goal of this study was to compare the consumption of fruits, legumes and vegetables (FLV) by adults and the availability of food stores in the context of socioeconomic and geographic space connected to basic health units in a Brazilian capital city. ⋯ The highest concentration of food stores, regardless of supply quality, was observed in geographic areas with higher purchasing power and in those where there was a greater concentration of other types of businesses and services, a different pattern from that found in other countries.
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Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians. ⋯ There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.