Routine laboratory parameters to support decision on parenteral nutrition in palliative care.

Introduction: Parenteral nutrition (PN) is widely used in palliative care (PC), but there is limited evidence to support its use at the end of life (EOL). This aim of this was to investigate the relationship between routine laboratory parameters and survival in patients receiving PN, and to develop a decision tree model to support clinicians decide whether to start or forgo PN. Methods: The laboratory parameters of 113 patients with advanced diseases who were admitted to a specialized palliative care unit (PCU) were analyzed at two points in time: T0 = before PN, T1 = two weeks after initiation of PN. Univariate Mann-Whitney U-tests and multivariate linear regression models, as well as a decision tree analysis were computed; all in relation to survival time. Results: The final regression model was significant with p = 0.001 (adjusted R2 = 0.15) and included two predictors for survival time after PN initiation: the CRP/albumin ratio and urea at T1 (ps = 0.019). Decision tree analysis revealed three important predictors for classification of survival time after PN initiation: CRP, urea, and LDH (all at T0). Discussion: The decision tree model may help to identify patients likely to benefit from PN, thus supporting the clinical decision whether or not to start PN.

Intervention with dietary fiber to treat constipation and reduce laxative use in residents of nursing homes.

BACKGROUND: Residents of nursing homes have lost their independence. Recent studies reported that nutritional problems arise in nursing homes. These problems are correlated with changed eating habits and geriatric constipation which is predominantly treated with laxatives. These interventions are not always without risk since frequent usage of laxatives may be accompanied by several side effects. Dietary fibers also affect stool weight and transit time. Therefore, oat-bran effectiveness in reducing the need for bowel medication was examined. AIM: To develop diets with the addition of oat bran for reduction of laxatives and to improve the inhabitants' well-being in a long-term-care facility. METHODS: A controlled blind parallel intervention trial among 30 frail inhabitants of a geriatric ward aged 57-100 years with laxative use. An intervention and a control group were formed. 15 of them received oat bran for 12 weeks (fiber group) mixed up in the daily common diet of the ward and 15 served as control (control group). Laxative use, body weight and the observations concerning the eating habits of the elderly were documented. RESULTS: A cake with the required dietary fibers and the complaisant acceptance of the seniors was developed. Laxatives were successfully discontinued by 59% (p < 0.001) in the fiber group. Body weight remained constant in the fiber group and decreased in the control group (p < 0.005). CONCLUSION: Fiber supplementation in the form of a cake allows discontinuation of laxatives and increases the seniors' well-being in a nursing home.