Summary Background A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. Objective ...This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. Methods The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. Results Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. Conclusion An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study)
Background
E-health based patient-reported ...outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors.
Results
Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR= 0.51, 95% CI=(0.27, 0.95),
p
= 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR=1.03, 95% CI=(1.01, 1.06),
p
= 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI=(-3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI=(−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI=(2.27, 4.15),
p
< 0.001). As nutrition status declined, the distress score increased (95%CI=(0.88, 1.68),
p
< 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems.
Conclusion
Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.
Substantial international differences in the prevalence of cancer disease suppose that nutrition may be an important factor in the development of cancer. Many experts believe, that nutritional ...factors may contribute up to 35 % to the development of malignant tumors. Many patients have lost substantial body weight already at the time of the diagnosis of the disease as consequence of undernutrition and malnutrition, respectively. During the course of the disease the nutritional status often is deteriorating further. Caused by both the cancer disease itself and the treatment, loss of appetite, changes in taste, nausea and vomiting may additionally contribute to undernutrition. Undernutrition is a relevant factor for the outcome of the disease and for the tolerance of the treatment as well. Therefore, supporting the heavily impaired patients in nutritional intake is of paramount importance and an urgent task for physicians and nurses. In view of physiology, pathophysiology, genetics and molecular biology, metabolic processes in cancer are highly complex regulated and there is increasing evidence that a diet rich in fat and protein is favourable. This, however, implies a paradigma shift away from the "healthy" balanced diet rich in fruit, vegetable and complex carbohydrates. So far, the evidence based data of this new concept is, however, a controversial issue.
Zusammenfassung
Deutliche internationale Unterschiede in der Häufigkeit von Krebs haben zu der Vermutung geführt, dass die Ernährung ein wichtiger Risikofaktor für die Entstehung von Krebs sein ...könnte. Experten sind der Meinung, dass die Ernährung in 30 – 35 % mitverantwortlich für die Entstehung von bösartigen Tumoren ist. Bereits vor Tumordiagnose haben viele Patienten Gewicht verloren als Folge einer Unter- oder Mangelernährung. Häufig verschlechtert sich der Ernährungszustand während der Erkrankung weiter. Als Folge der Tumorerkrankung sowie therapiebedingt führen Appetitlosigkeit, Geschmacksveränderungen, Übelkeit, Erbrechen zusätzlich zu Mangel- und Unterernährung. Die Mangelernährung hat einen erheblichen Einfluss auf die Prognose der Erkrankung und auch auf die Verträglichkeit der Therapie. Deshalb ist die Unterstützung der stark beeinträchtigten Patienten bei der Nahrungsaufnahme eine wichtige und vordringliche ärztliche und pflegerische Tätigkeit. Die physiologischen, pathophysiologischen, genetischen und molekularbiologischen Stoffwechselprozesse bei Krebs sind hochkomplex reguliert, deuten in ihrer Gesamtheit darauf hin, dass eine fett- und eiweißbasierte Ernährung favorisiert werden sollte, was einem Paradigmenwechsel zur sog. gesunden, ausgewogenen Ernährung mit viel Früchten, Gemüse und komplexen Kohlenhydraten entspricht. Die evidenzbasierte Datenlage wird aber durchaus kontrovers diskutiert.
The purposes of this study were (i) to determine the prevalence of exercise-associated hyponatremia (EAH) in multi-stage ultra-marathoners and (ii) to gain more insight into fluid and electrolyte ...regulation during a multi-stage race. Body mass, sodium concentration (Na⁺), potassium concentration (K⁺), creatinine, urea, specific gravity, and osmolality in urine were measured in 25 male ultra-marathoners in the 'Swiss Jura Marathon' 2008 with 11,000 m gain of altitude over 7 stages covering 350 km, before and after each stage. Haemoglobin, haematocrit, creatinine, urea, Na⁺, K⁺, and osmolality were measured in plasma before stage 1 and after stages 1, 3, 5, and 7. Two athletes (8%) showed plasma Na⁺ <135 mmol/l. Body mass, plasma Na⁺, and plasma K⁺ remained unchanged (p>0.05). Urine specific gravity (p<0.001) and osmolality in both plasma (p<0.01) and urine (p<0.001) were increased and haematocrit (p<0.0001), haemoglobin (p<0.0001) and plasma albumin were decreased (p<0.001). Plasma volume (p<0.01) and plasma urea (p<0.001) were increased. The K⁺/Na⁺ ratio in urine increased >1.0 after each stage and returned to <1.0 the morning of the next stage (p<0.001). To summarize, more sodium than potassium was excreted during rest. The increased urinary sodium losses during rest are compatible with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or the cerebral salt-wasting syndrome (CSWS). Further studies are needed to determine the antidiuretic hormone (ADH) and both the atrial natriuretic peptide (ANP) and the brain natriuretic peptide (BNP) during multi-stage races.
High-altitude pulmonary edema is a life-threatening condition
1
characterized by marked pulmonary vasoconstriction.
2
–
6
Even though the exact underlying mechanisms of high-altitude pulmonary edema ...are incompletely understood, pulmonary hypertension is thought to play an important part.
3
,
7
–
9
On the basis of the hypothesis that in this condition pulmonary arteriolar vasoconstriction is heterogeneous, leading to areas of hypoperfusion and hyperperfusion, a decrease in pulmonary-artery pressure may be beneficial in two ways. A reduction of capillary pressure in overperfused areas may reduce the formation of edema, whereas augmentation of perfusion in previously underperfused areas, where gas exchange is not impaired, may improve . . .
A total knee arthroplasty performed with navigation results in more accurate component positioning with fewer outliers. It is not known whether image-based or image-free-systems are preferable and if ...navigation for only one component leads to equal accuracy in leg alignment than navigation of both components. We evaluated the results of total knee arthroplasties performed with femoral navigation. We studied 90 knees in 88 patients who had conventional total knee arthroplasties, image-based total knee arthroplasties, or total knee arthroplasties with image-free navigation. We compared patients' perioperative times, component alignment accuracy, and short-term outcomes. The total surgical time was longer in the image-based total knee arthroplasty group (109 +/- 7 minutes) compared with the image-free (101 +/- 17 minutes) and conventional total knee arthroplasty groups (87 +/- 20 minutes). The mechanical axis of the leg was within 3 degrees of neutral alignment, although the conventional total knee arthroplasty group showed more (10.6 degrees ) variance than the navigated groups (5.8 degrees and 6.4 degrees , respectively). We found a positive correlation between femoral component malalignment and the total mechanical axis in the conventional group. Our results suggest image-based navigation is not necessary, and image-free femoral navigation may be sufficient for accurate component alignment.
A new internal fixation device was applied to 41 proximal tibial osteotomies to ensure against loss of postoperative correction. An oblique osteotomy was stabilized by two screws and a five-hole ...one-half tubular plate. Thirty-six patients with 41 proximal tibial osteotomies were reviewed for an average roentgenographic follow-up time of 22.6 months (range, six to 48 months) with no loss of correction. In addition, 16 patients with 19 osteotomies and a minimum clinical follow-up time of two years were reviewed using the Hospital for Special Surgery knee scoring system; these early results demonstrated a similar outcome to previously published series. The new fixation device is simple to use, permits early postoperative motion, and maintains the exact correction obtained at the time of surgery.
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