[Investigation of the Safety of and Patient Satisfaction with iEat®, the Support Food for the Recovery of Eating Function in Patients with Carcinomatosis - Related Gastrointestinal Passage Disorder].

OBJECTIVE: iEat®, a support food for the recovery of eating function, is food that can be easily masticated with little power and has suitable fluidity for enzyme processing, regardless of its normal appearance. We provided iEat® to 5 patients with carcinomatosis-related gastrointestinal passage disorder who could take fluid foods and investigated the stability of iEat® and patient satisfaction with the food. METHODS: We provided regular diets for lunch on the first and 7th day, and provided iEat® from the 2nd to the 6th day. The stability of iEat(R) was evaluated based on the presence and grade of abdominal pain, diarrhea, sense of abdominal distension, nausea, and vomiting, according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0, JCOG). The patients assessed their satisfaction by using 6 grades of taste, appearance, amount, difficulty of intake, and overall valuation. RESULTS: One patient could not continue the study because of vomiting from overeating of iEat(R). In the other patients, iEat(R) induced approximately the same adverse events as did the regular diets. All of the patients expressed better satisfaction with iEat® than with the regular diets. CONCLUSION: Although patient management for overeating is necessary, iEat® might provide good quality of life in terms of eating satisfaction to the patients with carcinomatosis-related gastrointestinal passage disorder.

[Coordination to assist with hospital-to-home discharge after cerebral hemorrhage--perspectives of a patient's family and nurse].

Discharge support, although provided for a limited time, is of vital importance in the acute phase care period. Such support is necessary to ensure continuity of care and treatment even after being discharged from the hospital. I acquired both the viewpoints of the family and the nurse of a patient who was about to be discharged from the hospital after cerebral hemorrhage. However, the patient's family and I were not able to decide on a home care plan or hospital-to-home transfer ahead of time because of the unstable condition of the patient, limited care power of the family, and varying discharge plans among the family members. I intended to help in the decision-making process, taking into consideration the patient's best interest. I evaluated the viewpoint of the family and was able to understand situations in which a family member, who assumes the role of a primary care giver, would need guidance in providing home care to the patient.

[Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics.

[A regional alliance in nutritional management-ten years of collaboration with an nutrition support team network].

Ten years has passed since we began the nutrition support team(NST)to make a regional alliance between local institutions for construction of the NST network. The network was formed with the following aims: 1) regional joint conferences for learning about nutrition with family doctors, facilities, and hospitals; 2) open general meetings for information about nutrition within the suburbs of our city; 3) preparing and sending an NST manual about parenteral nutrition(PN)and enteral nutrition(EN); and 4) preparation of an NST summary of patient malnutrition to foster mutual understanding. We produced a questionnaire summarizing the completion of nutritional management in patients. The following positive benefits were observed: 1) improved nutritional motivation and technique; 2) reduced nutritional confusion after discharge from our hospital; and 3) lower levels of anxiety in the facilities, the patient, and among the patient's family. In addition, follow-upinquiries allowed us to estimate whether our nutritional strategy was adequate. A more widely open regional alliance is needed in the future to strengthen patient nutrition following hospital discharge.

[Home-based infusion therapy by Broviac catheter after total parenteral nutrition therapy in a patient with a severe skin condition].

In collaboration between the in-hospital nutrition support team and infection control team, we attempted to standardize the management of infusion therapy. We report on a simple and effective at-home infusion therapy, after total parenteral nutrition(TPN)therapy, by using a Broviac catheter in a discharged patient with a severe skin condition. The patient was a man in his 50s who had amyloidosis. Because of dysphagia and complications of the digestive organs, TPN was chosen as the method for nutritional management. At the beginning the patient repeated infection and a trouble of the skin, but the insertion site was managed by the existing standardized manual. However, switching to a Broviac catheter improved the existing disease. Dermatopathy was improved and there was no catheter-related bloodstream infection under the new management method. Furthermore, the patient is now able to feed orally. Patients should be evaluated individually, and for the case that is hard to care with a manual, it is necessary to choose the best possible method.

[A survey on nutritional management planning for patients attending an another institute after discharge].

We sent the reports and plans concerning nutritional management to the 81 facilities, such as a hospital, nursing home, or clinic of home care, and carried out the questionnaire to determine their level of understanding and utilization of the reports. Sixty-nine % understood the purpose of the survey, with 74% noting that the report served as a reference. The purpose of the report was relatively well understood in the hospital or nursing home environments, but was not sufficiently understood in the clinics. In addition, it became clear that several facilities involved with one patient. Therefore, it was necessary to send a report to each facility. The interest in the report concerning nutritional management was very high in a range of various medical workers. Sections such as "matters that require attention, a characteristic in the nourishment management", "dysphagia ", and "a nourishment management method" were considered useful by these workers. The nutritional evaluation of patients discharged may be difficult; therefore, information from reports on nutritional management may help to make a more informed decision on future nutritional management.

[The trend of nutritional management in a survey of nutrient intake, via gastrostomy, in patients following an acute hospital stay].

In our hospital, the nutrition support team(NST)deepened relations with the local medical institution for sequential nutritional management following patient discharge. We began to process additional reports about patient nutritional management that could be passed onto any other institute for subsequent nutritional therapy. Three months following discharge, the main method of nutritional management was examined in 109 patients who were discharged between April 2008 and July 2010 and who were receiving the majority of nutrients via gastrostomy. Ten of these patients could feed orally. We choose the best methods at that time according to the patient condition, the medical treatment environment, and the patients' family. A change in those aspects following discharge will lead to a change in nutritional management methods. Observing the current nutritional therapy methods in patients after discharge is beneficial and allows us to produce a summary of this information to send to the local medical institute and to provide guidelines for the most appropriate procedures for nutritional management via gastrostomy.

[The importance of Dysphagia management during the peri-operative period to home elderly care].

Dysphagia is usually a major problem for the elderly to go home after a surgical treatment for the bone fracture of the thigh bone cervix or trochanter part in the leg. We analyzed each clinical course with regard to a change of the oral intake and the nutritional status, the activity of daily living(ADL)and a nutritional management and the place after the patient was discharged. According to our results, about 20% of the patients among those surgical cases were pointed with dysphagia, and there were many cases that ADL was ultimately gotten worse. We took care of disphagia by doing a best practice of changing in feedings and deglutition function. However, some of the patients with the problem finally moved to another elderly health care institute against their primary wishes to go home. Furthermore, 55% of the disphagia patients became dementia. It seems that dementia might be a high risk factor of disphagia. We should do more better job for managing disphargia during a peri-operative period just after admission.

[A case of severe obese patient complicated with type-2 diabetes--transition from Very Low Calorie Diet(VLCD) therapy to Low Calorie Diet(LCD)therapy].

A 6 0-year-old woman with severe obese and type-2 diabetes was hospitalized due to poorly controlled glycemia by worsening osteoarthritis of both knees. Although a diet therapy(1,200 kcal/day)was initially offered, but the body weight did not decrease. Thus, we changed VLCD therapy to LCD therapy sequentially. The weight loss made her possible not only to walk with a walker but it also improved a glycemic control. Because it was thought to be necessary to reduce her economic burden in order to continue the LCD therapy after was discharged, an inexpensive LCD menu was devised based on meal and auxiliary nutrients including trace elements. To support the LCD therapy at home, it is important to propose a simple and sustainable approach with a consideration of economic aspects as well as home environment.

[The use of total enteral formula with enriched nutrient in home Low Calorie Diet(LCD)therapy based on regular meal].

We made a low calorie diet(LCD)menu which added two commercial supporting nutritional supplements to a meal. Because a conventional formula food is very expensive, the patient was not able to afford it at home. Those supplements are a total enteral formula with enriched nutrient(ACURE EN800)and vitamin-mineral rich drink(V CRESC). The contents of vitamin and mineral in this menu satisfied the dietary reference intakes, though protein was a little low. However, we could keep the price low compared to the formula food. The patient was able to switch over to home LCD therapy with the menu.

[The follow-up study of patients with NST discharge summary for a continuous nutritional management].

The nutritional management of a patient discharged from a primary hospital will not end just there. The nutritional management information issued by the primary hospital is required when a patient moves to a next institute.We,the Nutritional Support Team(NST), make a nutrition summary report in addition to letters written by the doctor and the ward in charge. We investigated a total of 64 patients three months after their discharge, and followed them for a year since April 2008. On some patients, the nutritional care had to be changed in accordance with the facility and the patients' primary disease status.In order for the nutrition management to be continued, a bidirectional communication exchange between the primary hospital and acute phase hospital is essential. In other words, a seamless nutritional management for patients has to be executed. When the disease condition of the patient has changed, the host institution must consult with us about the new nutritional care to the patient. On the other hand, we should keep in touch to reduce a communication distance in the region.

[The management for safety on Home Parenteral Nutrition(HPN)].

Nutrition support team(NST)continuously leads a safe and effective home nutritional management for a reliable operation. With regard to home parenteral nutrition(HPN), we provided some pamphlets on HPN for the patient and family and nurses. The utilization of the pamphlets was two folds: (1) a teaching instruction can be unified for the patient and family and nurses, (2) to eliminate the gap among nurses for instructional procedures.For the individual patient's nutritional status information, we made a nutrition summary for the sake of next institute.So we could follow-up the nutritional status of those discharged patients.It also serves a sort of regional communication system with each institution.Our design of nutrition summary and the problems identified with patients could be good feedback information for analysis.

[Three-case reports--a program of strength training for home health care on frail elderly patients with protein rich supplement just after the training].

We have a program of strength training for home health care with protein rich supplement just after the training on frail elderly patients. Three cases (80-90 years old) received a new good taste protein rich supplement. They were also frail patients after acute clinical treatments, and were able to go home directly against their physical moving problems for daily life. We performed cardio-pulmonary and swallowing function, energy intake, parameters of muscle strength and the status for daily life before and after the training. Practical results were very different among the patients. But, the status for daily life of all was better than before. It was not clear that the new supplement was effective for the parameters of muscle strength, or not. But a trial for programs with thus foods should be an option for promoting to home health care after hospitalization in frail elderly.