The Refeeding Syndrome revisited: you can only diagnose what you know.

BACKGROUND/OBJECTIVES: The Refeeding Syndrome (RFS) is a serious complication in patients receiving nutrition support after a period of severe malnutrition. We frequently recognize and diagnose the RFS due to increased awareness. Thus, we observe that many physicians do not know the RFS and that it is rarely diagnosed. The aim of the study was to determine whether physicians in Germany know the RFS. SUBJECTS/METHODS: A questionnaire with a case vignette about an older person who developed the RFS after initiation of nutritional therapy was submitted to German physicians and fifth year medical students, who were participants of educational lectures. RESULTS: Of the 281 participants who answered the respective question, 40 participants (14%) correctly diagnosed the RFS of the case vignette and 21 participants (8%) gave nearly correct answers. Indeed, the majority of the participants did not diagnose the RFS. CONCLUSIONS: Although the RFS may lead to fatal complications, it is unknown to the majority of the queried physicians. Therefore, there is a call to implement the RFS in respective curricula and increase systematic education on this topic.

ESPEN Guidelines on Enteral Nutrition: Geriatrics.

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

[The so-called preventive house call. Forestalling nursing home admission]. / Der so genannte präventive Hausbesuch. So verhindern Sie die Pflegeheimeinweisung.

In view of the increasing numbers of elderly citizens in the general population, there is a need to ensure that they receive medical care within a setting of independence preservation and, wherever possible, within the domestic environment. Preventive house calls can contribute greatly to efforts made to achieve this aim. The implementation of this effective instrument should be in the hands of a team of specially trained family doctors, nurses and geriatric care-providers. During a house call, a multidimensional geriatric assessment covering such aspects as mobility, nutritional status, somatosensory status, and domestic and social environment, should be made. Of essential importance is the long-term care of the geriatric patient, which can be realized by the family doctor via repeated house calls. Current cost/benefit analyses clearly favor anchoring the preventive house calls in the public health service.

Do doctors know how much nutrition patients need--a survey from Germany?

For the diagnosis, prevention and therapy of malnutrition, it is important to estimate the energy and fluid requirements of an individual patient. To our knowledge, it is unknown how accurately medical doctors can estimate the energy and fluid requirements of patients in a clinical routine situation. Hence, we conducted the following survey. A written face-to-face survey about the energy and fluid requirements of and tube feeding and fluid recommendations for a typical patient was performed with 179 medical doctors. An estimation error of >15% was defined as relevant. The results revealed substantial variations in estimating the energy and fluid needs of the patient. A total of 25% of the participants underestimated the energy requirements, and 47% of the participants underestimated the fluid requirements. In addition, 68% of the participants recommended a daily dose of tube feeding that was <85% of the reference value. A substantial proportion of medical doctors show a lack of knowledge concerning energy and fluid requirements, which demonstrates a need for better medical education with regard to nutrition.