[Treating the somatic complications of anorexia]. / Traiter les complications somatiques de l'anorexie.

Anorexia can cause serious somatic complications, linked to undernutrition or associated pathological behaviours. The care pathway drawn up by a multi-discipline team is a real therapeutic challenge. Oral nutritional supplements, enteral nutrition and parenteral nutrition are three possible forms of nutritional assistance.

[Between intent and inability-management of malnutrition on medical wards of a centre hospital in Switzerland: patients' experience and perceptions]. / Wollen und nicht können. Malnutritionsmanagement in medizinischen Kliniken eines schweizerischen Zentrumsspitals: Erleben und Sichtweisen von Patient(inn)en.

BACKGROUND: Malnutrition is a common phenomenon in acute care institutions accounting for many negative health consequences for the patient. In many hospitals, therefore, malnutrition risk screening and nutrition management programs were established; however, programs were commonly developed without integrating the patients' perspective. It is unknown if the program covers the patients' needs and if the interventions are worthwhile. AIM: Because patient experience is known solely from everyday conversations, the aim of the study was to explore affected patients' experience regarding nutrition management. METHOD: The study has a qualitative, inductive approach. From September 2011 till May 2012, seven women and one man were interviewed. To analyse the guided interviews, content analysis was used. RESULTS: The analysis shows that patients find themselves between 'to want but not be able to eat'. Patients at risk encounter barriers due to their physical condition, such as swallowing- and chewing pain, nausea and dysgeusia and barriers associated with the system when ordering meals, such as fixed mealtimes, a limited variety of the menu and non-tasting supplements. To overcome these barriers patients are left to develop self-management strategies and to be in charge of their nutrition. CONCLUSIONS: Therefore, targeted training for caregivers is a key, enabling them to support patients individually in their nutrition management. At the same time, institutional barriers must be removed.

Improving Nutrition in Mechanically Ventilated Patients.

BACKGROUND: Although proper diet has been found to play an important role in patient outcomes, studies have shown that intensive care unit patients often receive inadequate nutrition. Moreover, it has been found that critically ill patients who are mechanically ventilated regularly receive even less nutrition. Inadequate nutrition has been associated with impaired immune response, increased susceptibility to infection, poor wound healing, and neuromuscular impairment. These factors lead to prolonged dependence on ventilators, protracted length of stay, and increased morbidity and mortality. This study investigates the use of an enteral nutrition (EN) protocol and its ability to prompt earlier initiation of feedings and more complete nutrition in mechanically ventilated patients to minimize such complications. METHODS: In a sample of 51 mechanically ventilated patients admitted to an intensive care unit, percentage of prescribed calories received and percentage of feedings initiated with 24-48 hours of intubation were calculated before and after the initiation of an EN protocol. RESULTS: In the postintervention group (n = 18), 83.3% received EN with the first 24-48 hours after intubation, compared with 54.5% in the preintervention group (n = 33). In the postintervention group, 77.8% received at least 60% of their prescribed feeding goal compared with 63.6% of the preintervention group. CONCLUSION: Findings show that the use of an EN protocol when caring for mechanically ventilated patients leads to earlier initiation of feedings as well as more complete nutrition.

Weight reduction after severe brain injury: a challenge during the rehabilitation course.

BACKGROUND: There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations in patients with ABI at a subacute inpatient rehabilitation hospital. METHOD: This is a descriptive cohort study. Ninety-eight patients were admitted in a 3-month period, of whom n = 76 met inclusion criteria. The Malnutrition Universal Screening Tool was used for categorizing patients according to risk of malnutrition. RESULTS: Patients had experienced weight loss of 5.59% ± 5.89% (p < .001) at admission at the rehabilitation hospital, and patients with traumatic brain injury had experienced a greater weight loss than patients with stroke (p < .01). Thirty percent of patients were at high risk for malnutrition, and 52% of these patients received enteral or parenteral nutrition at admission at the rehabilitation hospital. No association was found between risk of malnutrition and severity of injury, complications, functional outcome, or length of stay. CONCLUSION: RESULTS underline the importance that nurses, especially in acute care, adhere to clinical guidelines to minimize weight loss. Special attention should be on patients with traumatic brain injury. Weight gain in the following course of rehabilitation may facilitate positive rehabilitation outcomes.

[Comparison of the nutritional status of residents in shared-housing arrangements and nursing homes: a secondary data analysis]. / Vergleich der Ernährungssituation von Bewohnern ambulant betreuter Wohngemeinschaften und einer stationären Pflegeeinrichtung: Eine Sekundärdatenanalyse.

Malnutrition and weight loss are special challenges in the care of older people particularly with dementia. In Germany, shared-housing arrangements (SHA) for older care-dependent people evolved in the last years. SHA are an alternative to traditional nursing homes. Despite of the increase of SHA in number it remains unclear if this setting is especially beneficial in terms of (mal-)nutrition. Therefore the nutritional status of older people with and without dementia living in SHA and traditional nursing homes will be compared. From 2010 to 2011 data was collected in various SHA in Berlin and in a nursing home in Schkeuditz/Saxony using standardized face-to-face interviews with nurses. In addition to socio-demographic data the nutritional status using the Mini Nutritional Assessment (MNA) and the cognitive capacities usingthe Mini Mental State Examination (MMSE) were examined. In the secondary data analysis, data from 129 residents (60 residents from 29 SHA and 69 from a nursing home) were included in the analysis. The residents of both settings were mostly female (76.7%) and on average 80.4 years old and with a moderate to severe cognitive decline (MMSE: 13.2). The average MNA score of residents from both settings is 19.7, indicating a risk for malnutrition. Residents of SHA have a significantly higher (and therefore better) MNA score (21.2) on average than residents in the nursing home (18.3; t-Test p<0.001). The present study shows that residents in SHA show a better nutritional status than residents in the nursing home even when taking into account differences concerning age, gender, care dependency, a medical diagnosis of dementia and the MMSE. Further studies should evaluate the concept of food intake in both settings and evaluate differences.

[Calories, proteins - what does the intensive care patient need?]. / Kalorien, Proteine - was braucht der Intensivpatient?

It is increasingly recognized that the nutrition of critically ill patients is a highly complex activity with many unanswered questions. Much research has been performed showing that early enteral nutrition helps to avoid complications. In addition, it has already been shown that the calorie goal as the sole diet goal rather plays a minor role, if one pays attention to sufficient supply of proteins. The diet of the different patient groups with their very individual physiological conditions and their very different diseases are another difficile question in nutritional therapy. The question about the best access path currently appears clearly to be the way of enteral nutrition. Although there seems to be no clear advantage to the gastric or jejunal route, the gastric tube is apparently used more often in clinical practice due to the ease of placement. Reflux control is also currently controversially discussed. To assess the intestinal transport capacity, control of reflux is inevitable, but the amount of reflux that should be considered as cut-off criteria is still unclear. The field of immunonutrition or the substitution of selenium, glutamine, and other substances requires further research. The goal of this article is to provide the reader with a review of the current literature concerning nutritional needs of intensive care patients.

Improving protein and vitamin D status of obese patients participating in physical rehabilitation.

PURPOSE: Sarcopenia and vitamin D deficiency increase risk of disability outcomes associated with a million hip and knee replacements annually. The purpose of the present study was to identify protein and vitamin D inadequacy in arthroplasty patients, and observe the effect of supplementation on metabolic markers on protein and vitamin D status. METHODS: One hundred and eighty obese arthroplasty patients admitted for inpatient rehabilitation, positive for protein and vitamin D insufficiency, received supplemental protein and vitamin D. RESULTS AND CONCLUSION: Following supplementation, normalization of protein and vitamin D status was achieved. Nutrient supplementation during physical rehabilitation provided an efficient and effective means to reverse nutrient deficiency in an obese, orthopedic population. CLINICAL RELEVANCE: Inpatient physical rehabilitation is an opportune environment for nurses to provide education and intervention of nutrient supplementation, which may lessen consequences of sarcopenic obesity and related frailty disorders.