YouTube as a Source of Information on Blenderised Tube Feeding Walsh, Anna; Bamkole, Omowunmi; Gerasimidis, Konstantinos
Journal of pediatric gastroenterology and nutrition,
April 2022, 2022-Apr-01, 2022-04-00, 20220401, Letnik:
74, Številka:
4
Journal Article
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ABSTRACT
Blenderised tube feeding (BTF) has become an increasingly popular method of nutrition support for long‐term tube‐fed patients mostly children. This study surveyed perceptions and experiences ...on BTF shared on YouTube. From 71 videos analysed, attitudes towards BTF were mostly positive (91%) and included psychosocial benefits and improvements in gastrointestinal symptoms; no differences between caregivers and healthcare professionals were observed. Very few speakers (8%) felt there was a lack of support regarding use of BTF in schools and from healthcare professionals, because it is not part of the standard clinical management protocols. The most commonly used food items in blends included carrots (n = 16) and chicken (n = 11), and experiences from those who have used BTF included tips on recipes for blends, storing feeds and ensuring nutritional adequacy. Analysis of YouTube content on BTF was considerably positive and suggests that BTF is feasible and safe way to provide nutrition to tube‐fed patients.
Background
Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We ...assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN).
Methods
Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter‐associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan‐Meier graphs to illustrate longevity of CADVT‐free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT.
Results
We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140–7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637–4.696; P = 0.013).
Conclusion
Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days.
•NST positively impacts the quality of care and the NS provided to critically ill surgical patients.•Education and protocol development are keystones of NST implementation.•More studies regarding NST ...implementation and long-term outcomes are needed for further evidence.
Critically ill surgical patients pose one of the greatest challenges in achieving nutritional goals. Several published papers have demonstrated clear benefits when nutrition support (NS) is managed by a multidisciplinary nutrition support team (NST). We hypothesized that implementing a NST in a surgical intensive care unit (ICU) would increase the number of patients achieving their nutritional goals.
Multicenter “BEFORE & AFTER” study. In the BEFORE phase, an audit of the previous state of NS was conducted in three ICUs without a NST.
Implementation of a NST and protocol. In the AFTER phase, a new audit of NS was conducted. Continuous variables (presented as mean ± SD or median Q1–Q3) were tested using the t-test and Mann-Whitney U test. Categorical variables (presented as frequencies and percentages) were assessed using the chi-square test. A binomial logistic regression model was performed, with independent variables introduced using a stepwise forward method. A difference was considered to be significant with a two-sided P-value <0.05. Statistical analysis was conducted using IBM-SPSS 26.
A total of 83 patients were included in the BEFORE phase, and 85 in the AFTER phase. The latter group showed a higher frequency of nutritional risk and malnutrition (SGA B+C odds ratio 2.314, 95% CI 1.164–4.600). Laparoscopy was more frequently utilized as a surgical technique in the AFTER phase. No differences were observed in ICU and hospital LOS or 90 days’ survival rates. Two variables remained independent factors to predict NS achievement: NST implementation (odds ratio 3.582, 95% CI 1.733–7.404), and surgical technique (odds ratio 3.231, 95% CI 1.312–7.959).
NST positively impacts the chance of achieving NS goals in critically ill surgical patients.
Introduction
In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an ...interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations.
Methods
Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee.
Findings/Recommendations
This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%–20% (mild), 20%–30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories.
Conclusions
These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
Background
Malnutrition risk estimates vary greatly, and no robust data on the association between food intake and outcomes exist for hospitals in the United States (U.S.). This study aimed to ...determine the prevalence of malnutrition risk and to evaluate the impact of food intake on mortality using the nutritionDay in the U.S. dataset.
Methods
This study analyzed data from 2009 to 2015 for all adult patients from participating hospitals. Prevalence of malnutrition risk was determined by mapping self‐reported nutritionDay survey questions to the Malnutrition Screening Tool (MST). Fine and Gray competing‐risk analysis with clustering was used to evaluate the impact of nutrition risk and food intake on patients’ 30‐day in‐hospital mortality, while controlling for age, mobility, and other disease‐related factors.
Results
Analysis included data from 9959 adult patients from 601 wards. The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: 1.73, 6.07; P‐value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: 3.03, 11.84; P‐value < 0.0001) for patients eating nothing despite being allowed to eat.
Conclusion
This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.
Over the past few decades, the advancements in home parenteral nutrition (HPN) management mean that patients receiving intravenous nutrition can live independently in the community but so much is ...still left to be desired. Once only a hypothetical concept, the ability to nourish patients while bypassing their digestive tract was brought to reality in the 1960s to turn what was once a terminal illness into a chronic one 1,2. This article is protected by copyright. All rights reserved.
Background
Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary ...counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition.
Methods
We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta‐analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence.
Results
Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30‐day mortality (RR = 1.24; 0.60–2.55; I2 = 45%; P = 0.56; moderate certainty), slightly reduces 6‐month mortality (RR = 0.83; 0.69–1.00; I2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73–0.98; I2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66–1.03; I2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: −0.75 days; −1.66‐0.17; I2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty).
Conclusions
There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.
Background
Clinical practice frequently changes, and professionals should stay abreast of evidence‐based practice (EBP) guidelines. Negative attitudes towards EBP are a barrier to guideline adoption. ...This study explored EBP attitudes and knowledge of a complex nutrition support clinical case scenario of individuals holding or not holding the Certified Nutrition Support Clinician (CNSC) credential.
Methods
This cross‐sectional study used an online survey sent to American Society for Parenteral and Enteral Nutrition (ASPEN) members with and without the CNSC credential and all CNSC credential holders from the National Board of Nutrition Support Certification email list. The survey included the Evidence‐Based Practice Attitude Scale Score (EBPAS‐15) and eight knowledge questions using a nutrition support case scenario. An independent samples t test compared knowledge and EBPAS‐15 total scores and subscores between CNSC holders and nonholders. Pearson correlation determined the correlation between knowledge and EBPAS‐15 scores.
Results
The response rate was 7.8% (N = 706). CNSC holders (n = 536) had significantly higher mean knowledge scores (4.7 ± 1.6 out of 8) than nonholders (n = 159, 4.1 ± 1.7) (P < 0.001). Total EBPAS‐15 scores were not significantly different between CNSC holders (n = 542, 2.9 ± 0.4 out of 4) and nonholders (n = 164, 2.8 ± 0.7) (P = 0.434), and knowledge scores and total EBPAS‐15 scores (P = 0.639) or subscores were not significantly correlated.
Conclusions
Regardless of holding the CNSC credential, EBPAS‐15 scores indicated respondents had positive EBP attitudes. CNSC holders had significantly higher knowledge scores of recent nutrition support EBP guidelines compared with non–CNSC credential holders. Positive EBP attitudes are a precursor to clinical decision‐making, but future research should determine the use of guidelines in clinical practice.
ABSTRACT
Introduction:
Recently, significant interest from families and healthcare providers has arisen to use blenderized tube feedings (BTF). Although many institutions are providing this ...nutritional option, literature documenting outcomes and safety is lacking.
Methods:
A retrospective chart review was performed on pediatric patients receiving BTF at Rutgers‐Robert Wood Johnson University Hospital between January 2013 and April 2017. Demographic data and dietary information before and after BTF were collected. Reasons for diet initiation, symptoms, and anthropometrics were recorded. Adverse events and outcomes were assessed through physician documentation and relevant medication changes.
Results:
Thirty‐five patients (24 boys) received BTF. Age at initiation of BTF ranged from 1 to 19 years (mean 8.3 +/− 5.8 SD years). Length of follow‐up ranged from 1 to 45 months (mean 15 +/− 12.2 months). The most common reason for starting BTF was gastroesophageal reflux disease (GERD) (N = 32). Almost all patients were on medications for GERD, constipation, or gastrointestinal dysmotility before starting BTF (N = 33). Majority of patients had improvement in relevant symptoms (N = 20); 13 of 33 patients on gastrointestinal medications were able to wean or stop medication(s). BMI z scores did not differ before and after BTF initiation (P = 0.558). No serious life‐threatening adverse events were found.
Conclusions:
Our data suggest that BTF is a safe dietary intervention that may improve gastrointestinal symptoms in pediatric patients. Further prospective studies are needed to compare safety and efficacy of BTF and commercial formulas in pediatric patients.
ESPEN guideline on home enteral nutrition Bischoff, Stephan C.; Austin, Peter; Boeykens, Kurt ...
Clinical nutrition (Edinburgh, Scotland),
January 2020, 2020-01-00, 20200101, Letnik:
39, Številka:
1
Journal Article
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This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers about the indications and contraindications for HEN, and its ...implementation and monitoring. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. This guideline will also inform interested patients requiring HEN. The guideline is based on current evidence and expert opinion and consists of 61 recommendations that address the indications for HEN, relevant access devices and their use, the products recommended, the monitoring and criteria for termination of HEN, and the structural requirements needed to perform HEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.
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