Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 235
Filtrar
1.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371859

RESUMO

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.


Assuntos
Avaliação Geriátrica/métodos , Desnutrição/terapia , Terapia Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/cirurgia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/complicações , Política Nutricional , Terapia Nutricional/normas , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/normas , Período Pré-Operatório , Melhoria de Qualidade , Resultado do Tratamento
2.
Nutrients ; 13(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34371943

RESUMO

AIM: Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals. METHODS: These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism). RESULTS: Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients. CONCLUSION: These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.


Assuntos
Dieta Saudável/normas , Serviço Hospitalar de Nutrição/normas , Política Nutricional , Terapia Nutricional/normas , Consenso , Técnica Delfos , Comportamento Alimentar , França , Humanos , Pacientes Internados , Refeições , Estado Nutricional , Valor Nutritivo , Formulação de Políticas , Recomendações Nutricionais
3.
Medicine (Baltimore) ; 100(30): e26563, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397687

RESUMO

AIM: This study aimed to assess the outcome of community-based nutritional counseling interventions on eating habits of rural-dwelling children. METHODS: A group-randomized trial design was used in this study. A total of 108 rural-dwelling children from a community in the Enugu North agricultural zone, Enugu State, who participated in the study. The children were randomly assigned to 2 groups: the treatment group (n = 54) and the no-treatment control group (n = 54). The child eating behavior questionnaire was used for data collection. Parents of the participating children within each study group completed the child eating behavior questionnaire at 3 time points. The data collected were analyzed using an independent sample t test at a probability level of .05. RESULT: The outcome of the study showed that the children's eating habits in the treatment group improved positively following the community-based nutritional counseling intervention. The positive gain from exposure to the community-based nutritional counseling intervention program was sustained during follow-up for children in the treatment group compared with the no-treatment group. CONCLUSION: The community-based nutrition counseling intervention carried out among children in rural communities had a positive adjustment in children's eating habits. The intervention requires the constant collaboration of professional childhood educators, caregivers, home economists, school staff, healthcare specialists, families, and the children themselves. Furthermore, there is a need for future long-term evaluations of the effects of community-based nutritional counseling interventions on children's nutrition and eating habits.


Assuntos
Aconselhamento/métodos , Comportamento Alimentar/psicologia , Terapia Nutricional/normas , Adolescente , Criança , Comportamento Infantil/psicologia , Pesquisa Participativa Baseada na Comunidade/métodos , Feminino , Humanos , Masculino , Nigéria , Terapia Nutricional/métodos , Terapia Nutricional/estatística & dados numéricos , Estado Nutricional
5.
Nutrients ; 13(2)2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33671901

RESUMO

Chronic kidney disease (CKD) is an important public health issue with increasing prevalence worldwide. Several clinical practice guidelines have been recently published regarding the nutritional management of CKD patients. The purpose of the present study is to evaluate the quality of the published guidelines and provide recommendation for future updates. PubMed, Scopus and Google Scholar were searched for relevant guidelines and 11 clinical practice guidelines were finally included. Guidelines developed by the American Society for Parenteral and Enteral nutrition (ASPEN), the Dietitians Association of Australia (DAA), the German Society for Nutritional Medicine (DGEM), the European Best Practice Guidelines (EBPG), the European Dialysis and Transplantation Nurses Association-European Renal Care Association (EDTNA-ERCA), the European Society for Clinical Nutrition and Metabolism (ESPEN), the Andalusian Group for Nutrition Reflection and Investigation (GARIN) group, the National Kidney foundation-Kidney Disease Outcomes Quality Initiative (KDOQI), the Italian Society of Nephrology-Association of Dieticians-Italian Association of Hemodialysis, Dialysis and Transplant (SIN-ANDID-ANED), and the Renal Association were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Guidelines by KDOQI, ESPEN, and DAA were of moderate quality and the rest of them were low-quality guidelines. Our study demonstrates gaps related to the development of guidelines and therefore greater emphasis on methodological approaches is recommended. AGREE II tool can be useful to improve quality of guidelines.


Assuntos
Dietética/normas , Terapia Nutricional/normas , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Nutr Clin Pract ; 36(2): 275-281, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33734477

RESUMO

Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.


Assuntos
COVID-19/complicações , Calorimetria Indireta/normas , Cuidados Críticos/normas , Desnutrição/diagnóstico , Avaliação Nutricional , COVID-19/fisiopatologia , Calorimetria Indireta/métodos , Cuidados Críticos/métodos , Resultados de Cuidados Críticos , Estado Terminal/terapia , Metabolismo Energético , Humanos , Unidades de Terapia Intensiva , Desnutrição/prevenção & controle , Desnutrição/virologia , Terapia Nutricional/métodos , Terapia Nutricional/normas , Necessidades Nutricionais , Estado Nutricional , SARS-CoV-2
7.
J Acad Nutr Diet ; 121(5): 979-987, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32411575

RESUMO

Recent evidence examining adults infected with coronavirus disease 2019 (COVID-19) has indicated a significant impact of malnutrition on health outcomes. Individuals who have multiple comorbidities, are older adults, or who are malnourished, are at increased risk of being admitted to the intensive care unit and of mortality from COVID-19 infections. Therefore, nutrition care to identify and address malnutrition is critical in treating and preventing further adverse health outcomes from COVID-19 infection. This document provides guidance and practice considerations for registered dietitian nutritionists providing nutrition care for adults with suspected or confirmed COVID-19 infection in the hospital, outpatient, or home care settings. In addition, this document discusses and provides considerations for registered dietitian nutritionists working with individuals at risk of malnutrition secondary to food insecurity during the COVID-19 pandemic.


Assuntos
COVID-19/complicações , Dietética/métodos , Desnutrição/terapia , Terapia Nutricional/métodos , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Dietética/normas , Feminino , Insegurança Alimentar , Humanos , Masculino , Desnutrição/virologia , Pessoa de Meia-Idade , Terapia Nutricional/normas , SARS-CoV-2
8.
J Acad Nutr Diet ; 121(1): 139-165.e15, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32081589

RESUMO

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline. This publication outlines the Academy's Evidence Analysis Library methods used to complete the systematic review and guideline and examines the recommendations and supporting evidence. A total of 14 recommendations were developed based on evidence from eight conclusions. Using the Nutrition Care Process as a framework for practice, recommendations rated as strong included assessing and monitoring and evaluating body weight and medical nutrition therapy by a registered dietitian nutritionist. Weak recommendations included predicting resting and total energy expenditure. All other recommendations were rated as fair. These included individualizing the calorie prescription and macronutrient composition of the diet; assessing and monitoring and evaluating energy intake, serum 25-hydroxyvitamin D levels, and frequency of exacerbations; and determining need for vitamin D supplementation. Fewer than one-third of the systematic review's conclusions could be used to support the recommendations due to conflicting results or limited or no evidence available. The Evidence Analysis Library 2019 COPD Evidence-Based Nutrition Practice Guideline is a valuable resource for registered dietitian nutritionists and other health care professionals caring for those with COPD.


Assuntos
Prática Clínica Baseada em Evidências/normas , Terapia Nutricional/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Academias e Institutos , Humanos
9.
J Pediatr ; 231: 124-130.e1, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33359473

RESUMO

OBJECTIVE: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD). STUDY DESIGN: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect. RESULTS: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (ß = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (ß = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (ß = 0.04; SE = 0.02; P = .04). CONCLUSIONS: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.


Assuntos
Cardiopatias Congênitas/cirurgia , Terapia Nutricional/normas , Assistência Perioperatória/normas , Ganho de Peso , Perda de Peso , Procedimentos Clínicos , Feminino , Cardiopatias Congênitas/fisiopatologia , Hospitalização , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Modelos Logísticos , Masculino , Terapia Nutricional/métodos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento
10.
Nutrients ; 12(12)2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33322627

RESUMO

Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer care settings in North America, Europe and Australia between 2016 and 2018. Adherence criteria were derived from relevant EBG recommendations with pooled results for participating centres reported according to the Nutrition Care Model at either system or patient levels. Adherence to EBG recommendations was: good (≥80%) for performing baseline nutrition screening and assessment, perioperative nutrition assessment and nutrition prescription for energy and protein targets; moderate (≥60 to 80%) for utilizing validated screening and assessment tools and pre-radiotherapy dietitian consultation; and poor (60%) for initiating post-operative nutrition support within 24 h and also dietetic consultation weekly during radiotherapy and fortnightly for 6 weeks post-radiotherapy. In conclusion, gaps in evidence-based cancer nutrition care remain; however, this may be improved by filling known evidence gaps through high-quality research with a concurrent evolution of EBGs to also encompass practical implementation guidance. These should aim to support multidisciplinary cancer clinicians to close evidence-practice gaps throughout the patient care trajectory with clearly defined roles and responsibilities that also address patient-reported concerns.


Assuntos
Neoplasias Esofágicas/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/terapia , Desnutrição/prevenção & controle , Terapia Nutricional/normas , Austrália , Neoplasias Esofágicas/complicações , Europa (Continente) , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/complicações , Implementação de Plano de Saúde , Humanos , Desnutrição/etiologia , Auditoria Médica , América do Norte , Avaliação Nutricional , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Pesquisa Médica Translacional
11.
J Acad Nutr Diet ; 120(12): 2061-2075.e57, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33222885

RESUMO

Intellectual and developmental disabilities (IDD) encompass both intellectual disabilities (ID) and developmental disabilities (DD). In 2016, 7.37 million people in the United States and 200 million worldwide were identified with an ID or DD. Approximately 1 in 6 (17.8%) children have been identified with a DD in the United States, which is up from 16.2% in 2009-2011. Globally, 52.9 million children from birth to 5 years of age have been identified with a DD. Registered dietitian nutritionists (RDNs) have an important role in the treatment of this population, as optimizing nutrition status improves cognition and quality of life. The Behavioral Health Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Intellectual and Developmental Disabilities for 3 levels of practice-competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for care of individuals with an ID or DD. The SOPP describes 6 domains that focus on professionalism. Indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with an ID or DD. The SOP and SOPP are intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.


Assuntos
Competência Clínica/normas , Deficiências do Desenvolvimento/terapia , Dietética/normas , Serviços de Saúde para Pessoas com Deficiência/normas , Deficiência Intelectual/terapia , Academias e Institutos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Terapia Nutricional/normas , Estados Unidos
12.
Nutrients ; 12(11)2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105731

RESUMO

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/reabilitação , Desnutrição/terapia , Política Nutricional , Terapia Nutricional/normas , Pneumonia Viral/reabilitação , Adulto , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/virologia , Pandemias , Alta do Paciente , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Medição de Risco , SARS-CoV-2
13.
Nutr Hosp ; 37(5): 984-998, 2020 Oct 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32960639

RESUMO

Introduction: Introduction: in SARS-CoV-2-infected patients nutritional requirements are increased. These patients present symptoms that make food intake and nutrient absorption difficult, therefore involving nutritional risk. On the other hand, acute respiratory complications require prolonged ICU stays, and this predisposes to increased malnutrition and loss of skeletal muscle mass and function, which can lead to poor quality of life, disability and morbidity long after discharge. For this reason, the world's leading nutrition societies and associations believe that nutritional therapy should be considered a part of the basic treatment of patients with COVID-19. Methods: we have reviewed and compared 9 expert recommendations (ER) published by nutrition societies and associations from China, Spain, Brazil, Europe, Colombia, Australia, America, and the United Kingdom, in relation to critical and non-critical hospitalized patients due to the COVID-19 pandemic. Conclusions: the 9 ERs reviewed agree on the importance of nutritional management in critical and non-critical hospitalized patients with COVID-19, as well as on the early detection of nutritional risk, the intervention, and subsequent follow-up. Even so, each published document has its own particularities and puts a special stress on some specific aspect.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pacientes Internados , Desnutrição , Terapia Nutricional/normas , Necessidades Nutricionais , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Austrália , Brasil , COVID-19 , China , Colômbia , Infecções por Coronavirus/terapia , Europa (Continente) , Humanos , Desnutrição/diagnóstico , Desnutrição/dietoterapia , Terapia Nutricional/métodos , Pandemias , Pneumonia Viral/terapia , SARS-CoV-2
14.
Am J Kidney Dis ; 76(3 Suppl 1): S1-S107, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32829751

RESUMO

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.


Assuntos
Terapia Nutricional/normas , Insuficiência Renal Crônica/terapia , Dieta com Restrição de Proteínas , Gorduras na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Eletrólitos/administração & dosagem , Ingestão de Energia , Medicina Baseada em Evidências , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Micronutrientes/administração & dosagem , Avaliação Nutricional , Apoio Nutricional/métodos , Insuficiência Renal Crônica/dietoterapia , Vitaminas/administração & dosagem
15.
Aust J Gen Pract ; 49(8): 513-518, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32738865

RESUMO

BACKGROUND AND OBJECTIVES: Exercise and healthy eating patterns are effective in improving health-related quality of life for patients with cancer. However, little is known about general practitioners' (GPs') views and experiences regarding providing exercise and nutrition recommendations to their patients with cancer. The aim of this study was to 1) report GPs' experiences of providing nutrition and exercise advice to their patients and 2) identify perceived barriers and enablers to implementation of exercise and nutrition advice throughout the cancer journey from the GP perspective. METHOD: Twenty-three semi-structured interviews were conducted, and transcripts coded by two independent researchers. A thematic analysis was performed to derive main themes. RESULTS: Four main themes were identified: the importance of exercise and nutrition recommendations for patients with cancer, the influence of the patient agenda, the influence of additional training or personal interest of the GP, and limitations of the primary care setting. DISCUSSION: Increased communication between primary and tertiary care, availability of resources, professional development opportunities and access to allied health services is needed to further support GPs to deliver exercise and nutrition information to their patients with cancer. This study provides evidence of GPs' desire to be involved in supporting the healthy exercise and nutrition habits of their patients with cancer and presents avenues for future research and resource development.


Assuntos
Terapia por Exercício/normas , Clínicos Gerais/psicologia , Neoplasias/terapia , Terapia Nutricional/normas , Adulto , Atitude do Pessoal de Saúde , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Terapia Nutricional/métodos , Terapia Nutricional/psicologia , Pesquisa Qualitativa , Vitória
16.
Crit Care ; 24(1): 499, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787899

RESUMO

The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Contemporary observational studies have exposed the pervasive undernutrition of critically ill patients and its association with adverse clinical outcomes. The intuitive hypothesis is that optimization of nutrition delivery should improve ICU clinical outcomes. It is therefore surprising that multiple large randomized controlled trials have failed to demonstrate the clinical benefit of restoring or maximizing nutrient intake. This may be in part due to the absence of biological markers that identify patients who are most likely to benefit from nutrition interventions and that monitor the effects of nutrition support. Here, we discuss the need for practical risk stratification tools in critical care nutrition, a proposed rationale for targeted biomarker development, and potential approaches that can be adopted for biomarker identification and validation in the field.


Assuntos
Biomarcadores/análise , Terapia Nutricional/normas , Albuminas/análise , Biomarcadores/sangue , Composição Corporal/fisiologia , Índice de Massa Corporal , Proteína C-Reativa/análise , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Nutrição Enteral/normas , Humanos , Resistência à Insulina/fisiologia , Interleucina-6/análise , Interleucina-6/sangue , Nitrogênio/análise , Nitrogênio/sangue , Terapia Nutricional/efeitos adversos , Terapia Nutricional/métodos , Apoio Nutricional/efeitos adversos , Apoio Nutricional/métodos , Apoio Nutricional/normas , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Nutrição Parenteral/normas , Proteínas/análise
17.
Curr Opin Clin Nutr Metab Care ; 23(4): 288-293, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32487876

RESUMO

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.


Assuntos
Infecções por Coronavirus , Transtornos Nutricionais , Terapia Nutricional/normas , Fenômenos Fisiológicos da Nutrição , Pandemias , Pneumonia Viral , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Transtornos Nutricionais/epidemiologia , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Terapia Nutricional/métodos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Fatores de Risco
18.
Nutrients ; 12(5)2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32438607

RESUMO

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence-practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre-post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Neoplasias de Cabeça e Pescoço/terapia , Desnutrição/terapia , Terapia Nutricional/métodos , Assistência Centrada no Paciente/métodos , Idoso , Auditoria Clínica , Análise Custo-Benefício , Dietética/economia , Dietética/métodos , Dietética/normas , Prática Clínica Baseada em Evidências/economia , Prática Clínica Baseada em Evidências/normas , Estudos de Viabilidade , Feminino , Grupos Focais , Fidelidade a Diretrizes , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/economia , Implementação de Plano de Saúde , Humanos , Masculino , Desnutrição/economia , Desnutrição/etiologia , Pessoa de Meia-Idade , Avaliação Nutricional , Terapia Nutricional/economia , Terapia Nutricional/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/normas , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/normas , Projetos Piloto , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estudos Retrospectivos
19.
J Acad Nutr Diet ; 120(6): 1068-1073, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446565

RESUMO

The Academy of Nutrition and Dietetics (Academy) develops and maintains foundational documents that apply to all registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs): Scope of Practice for the RDN and NDTR; Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs and NDTRs; and the Academy and the Commission on Dietetic Registration Code of Ethics for the Nutrition and Dietetics Profession. The Quality Management Committee of the Academy has developed resources that assist RDNs and NDTRs in understanding how to work to the fullest extent of their individual scope of practice to increase professional satisfaction, achieve future employment and position goals, and provide safe and reliable services. These resources are the definition of terms list, practice tips and case studies, and scope of practice decision algorithm, which build on Academy foundational documents. They support quality practice by answering questions such as "how can I become more autonomous in my practice" and "how can I use telehealth technology in my practice?" The foundational Academy documents and practice application resources assist all RDNs and NDTRs in recognizing their individual competence and practicing within their scope of practice.


Assuntos
Academias e Institutos , Dietética/normas , Competência Clínica/normas , Códigos de Ética , Humanos , Terapia Nutricional/normas , Nutricionistas/normas , Padrão de Cuidado/normas
20.
Curr Obes Rep ; 9(3): 326-338, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32451780

RESUMO

PURPOSE OF REVIEW: Bariatric surgery is the most effective treatment for severe and complex obesity; however, the risk of developing nutrient deficiencies varies based upon the type of surgery, degree of malabsorption, and level of nutrition intervention. There are numerous factors that can impact the nutrition status of a patient during their pre- and postoperative journey. We review the critical components and considerations needed in order to provide optimal nutrition care for patients with bariatric surgery. RECENT FINDINGS: A dietitian, specializing in bariatric surgery, is the best equipped healthcare provider to prepare and support patients in achieving and maintaining optimal nutrition status. We present best practices for both the pre- and postoperative nutrition-related phases of a patient's journey. The dietitian specialist is integral in the assessment and ongoing nutrition care of patients with bariatric surgery. Further consideration should be given to enable access for lifelong follow-up and monitoring.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Desnutrição/terapia , Terapia Nutricional/métodos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/terapia , Humanos , Desnutrição/etiologia , Terapia Nutricional/normas , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...