Jpen Parenter Enter
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Jpen Parenter Enter · Jul 2012
ReviewJonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery.
This lecture reviews the current understanding of how insulin resistance, as a marker of the metabolic stress, is involved in recovery after major surgery. Insulin resistance develops as a graded response related to the magnitude of the operation. It lasts for weeks after medium-size surgery and affects all parts of body metabolism. ⋯ Many of the perioperative treatments in use are outdated, and modern care involves a multimodal approach with several treatments, such as preoperative carbohydrate treatment instead of overnight fasting, continuous epidural anesthesia for postoperative pain care, early feeding, and mobilization, all of which affect insulin by reducing the stress and enhancing recovery. Most of the previous mandatory catabolic responses to surgery can be avoided, resulting in substantially faster recovery and fewer complications. Methods to implement these modern treatments have been developed and used in Europe, resulting in improved care and shorter length of stay.
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This tutorial presents a systematic approach to nutrition assessment based on a modern appreciation for the contributions of inflammation that serve as the foundation for newly proposed consensus definitions for malnutrition syndromes. Practical indicators of malnutrition and inflammation have been selected to guide diagnosis that include medical/surgical history and clinical diagnosis, clinical signs and physical examination, anthropometric data, laboratories, dietary assessment, and functional outcomes. Knowledge of systematic nutrition assessment and appropriate diagnosis of malnutrition will help to guide proper interventions and expected outcomes.
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Jpen Parenter Enter · May 2012
Practice GuidelineConsensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).
The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A. S. P. ⋯ An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.
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Jpen Parenter Enter · May 2012
Comparative StudyBody composition analysis in critically ill survivors: a comparison of bioelectrical impedance spectroscopy devices.
Body composition is commonly altered in response to critical illness and can be estimated at the bedside with bioelectrical impedance spectroscopy (BIS). Different electrode configurations may be used to mitigate assumptions of the technique, but the reliability of tetra-polar and octo-polar arrangements has yet to be established. This study aimed to compare both configurations, in a prospective observational study of 17 critically ill survivors and 12 healthy controls. ⋯ BIS devices should not be used interchangeably in the clinical setting. The reliability of the tetra-polar instrument was good, but daily fluctuations in body weight may have affected the results.
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Parenteral nutrition (PN) is a high-alert medication that contains dozens of active pharmaceutical ingredients. This complex prescription drug preparation is used in a wide variety of clinical settings for patients across the age spectrum. Despite the existence of a number of guidance documents, the drug-use process for PN suffers from lack of standardization for order prescription, order verification and review, PN compounding, labeling, and dispensing. As a result, PN-associated medication errors would not be unexpected but are documented infrequently.