Malnutrition rates for critically ill patients being admitted to the intensive care unit (ICU) are reported to range from 38% to 78%. Malnutrition in the ICU is associated with increased mortality, ...morbidity, length of hospital admission, and ICU readmission rates. The high volume of ICU admissions means that efficient screening processes to identify patients at nutritional or malnutrition risk are imperative to appropriately prioritise nutrition intervention. As the proportion of noninvasively mechanically ventilated patients in the ICU increases, the feasibility of using nutrition risk screening tools in this population needs to be established.
The aim of this study was to compare the feasibility of using the Malnutrition Universal Screening Tool (MUST) with the modified NUtriTion Risk In the Critically ill (mNUTRIC) score for identifying patients at nutritional or malnutrition risk in this population.
A single-centre, prospective, descriptive, feasibility study was conducted. The MUST and mNUTRIC tool were completed within 24 h of ICU admission in a convenience sample of noninvasively mechanically ventilated adult patients (≥18 years) by a trained allied health assistant. The number (n) of eligible patients screened, time to complete screening (minutes), and barriers to completion were documented. Data are presented as mean (standard deviation), and the independent samples t-test was used for comparisons between tools.
Twenty patients were included (60% men; aged 65.3 13.9 years). Screening using the MUST took a significantly shorter time to complete than screening using the mNUTRIC tool (8.1 2.8 vs 22.1 5.6 minutes; p = 0.001). Barriers to completion included obtaining accurate weight history for the MUST and time taken for collection of information and overall training requirements to perform mNUTRIC.
The MUST took less time and had fewer barriers to completion than mNUTRIC. The MUST may be the more feasible nutrition risk screening tool for use in noninvasively mechanically ventilated critically ill adults.
This study assessed the responsiveness and convergent validity of two preference-based measures; the newly developed cancer-specific EORTC Quality of Life Utility Measure-Core 10 dimensions ...(QLU-C10D) relative to the generic three-level version of the EuroQol 5 dimensions (EQ-5D-3L) in evaluating short-term health related quality of life (HRQoL) outcomes after esophagectomy. Data from 164 respondents (mean age: 63 years, 81% male) were analysed. HRQoL significantly reduced on both measures with large effect sizes (> 0.80), and a greater mean difference (0.29 compared to 0.16) on QLU-C10D. Both measures had ceiling effects (> 15%) on all dimensions at baseline. Following esophagectomy, ceiling effects were observed with self-care (86%), mobility (67%), anxiety/depression (55%) and pain/discomfort (19%) dimensions on EQ-5D-3L. For QLU-C10D ceiling effects were observed with emotional function (53%), physical function (16%), nausea (35%), sleep (31%), bowel problems (21%) and pain (20%). A strong correlation (r = 0.71) was observed between EQ-5D-3L anxiety and QLU-C10D emotional function dimensions. Good agreement (3.7% observations outside the limits of agreement) was observed between the utility scores. The QLU-C10D is comparable to the more widely applied generic EQ-5D-3L, however, QLU-C10D was more sensitive to short-term utility changes following esophagectomy. Cognisant of requirements by policy makers to apply generic utility measures in cost effectiveness studies, the disease-specific QLU-C10D should be used alongside the generic measures like EQ-5D-3L.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Severe mucositis: how can nutrition help? Keefe, Dorothy M; Rassias, Georgina; OʼNeil, Lisa ...
Current opinion in clinical nutrition and metabolic care,
2007-September, 2007-Sep, 2007-09-00, Letnik:
10, Številka:
5
Journal Article
Recenzirano
PURPOSE OF REVIEWTo review the recent evidence on the effect of nutrition on the incidence and severity of mucositis following anticancer treatment.
RECENT FINDINGSThere have been many recent ...publications on mucositis and on nutrition in cancer, but very few on nutrition and mucositis in cancer. It is difficult to establish a definite link between nutritional status, nutritional interventions and mucositis. Malnutrition is probably a risk factor for mucositis, however, and some of the interventions that improve nutrition in cancer patients and reduce the risk of cancer in the general population work via mechanisms that might positively affect the development and course of mucositis. Whilst it can be tempting to extrapolate these findings to suggest that nutritional support can reduce the incidence and severity of mucositis, this would be premature.
SUMMARYThere may well be a link between nutritional status, nutritional supplementation, anticancer treatment and mucositis, but it is not yet proven; and mechanism-based, prospective, randomized studies are required to answer the question. This is likely to be an area of increased study in the future.
The effects of different macronutrients on appetite and pyloric motility and the impact of short-term dietary glucose supplementation on these responses were evaluated. Ten males (aged 19-38 yr) ...received isocaloric (2.9 kcal/min) intraduodenal infusions of glucose and lipid while antropyloroduodenal motility and appetite were assessed by manometry and visual analog scales, respectively. Effects of each intraduodenal nutrient on appetite and motility were evaluated before and after 7 days of dietary supplementation with glucose (400 g daily). Initially, both nutrients caused a similar rise in pyloric tone, but intraduodenal lipid was a more potent stimulus of phasic pyloric motility ( P = 0.05) and suppressed appetite more ( P = 0.013) than intraduodenal glucose. After dietary glucose supplementation, the increase in pyloric tone during intraduodenal glucose was attenuated. Although intraduodenal lipid remained a more potent stimulant of phasic pyloric motility ( P = 0.016), it no longer decreased appetite. We conclude that in healthy young males 1) intraduodenal infusion of lipid is a more potent stimulus of phasic pyloric motility and suppresses appetite more than intraduodenal glucose and 2) dietary glucose supplementation alters both the appetite suppressant effect of intraduodenal lipid and the pyloric motor response to intraduodenal glucose infusion.
The effects of different macronutrients on appetite and pyloric motility and theimpact of short-term dietary glucose supplementation on these responses were evaluated. Ten males (aged 19-38 yr) ...received isocaloric (2.9 kcal/min) intraduodenal infusions of glucose and lipid while antropyloroduodenal motility and appetite were assessed by manometry and visual analog scales, respectively.
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