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Michele Nicolo MS RD CNSC Christopher Still DO Mustafa Huseini MD Sarah Dayton RD Gordon L. Jensen MD PhD 《JPEN. Journal of parenteral and enteral nutrition》2014,38(8):954-959
Background: The feasibility of accessing data in hospitalized patients to support a malnutrition diagnosis using the new Academy of Nutrition and Dietetics–American Society for Parenteral and Enteral Nutrition (AND‐A.S.P.E.N.) consensus recommended clinical characteristics of malnutrition is largely unknown. We sought to characterize baseline practice to guide the development of appropriate interventions for implementation of the recommended approach. Materials and Methods: A cross‐sectional survey was conducted of 262 consecutive adults who were referred for dietitian or nutrition support team assessments at 2 tertiary teaching hospitals in Pennsylvania. The availability of data to support the proposed AND‐A.S.P.E.N. approach and the resulting malnutrition diagnoses were examined. Results: Mean ± SD age was 58.2 ± 17.1 years, and half were female. Food intake history was available for 76%, weight history for 67%, and physical examination for loss of fat and muscle mass for 94% and for edema for 84%. Hand‐grip strength was not available. The prevalence of malnutrition among the patients referred for nutrition assessment was 6.7% moderate, 7.6% severe with acute illness; 12.2% moderate, 11% severe with chronic illness; and 0.8% moderate, 0.4% severe with social circumstances. Decline in typical food intake and weight loss were the most commonly used clinical characteristics. Conclusion: Data could generally be accessed to support the AND‐A.S.P.E.N. consensus clinical characteristics for malnutrition diagnosis, but further testing in multiple care settings is needed before these observations may be generalized. Training in assessment methods and dissemination of the necessary tools will be necessary for full implementation. 相似文献
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Mark R. Corkins MD CNSC FAAP Peggi Guenter PhD RN Rose Ann DiMaria‐Ghalili PhD RN CNSC Gordon L. Jensen MD PhD Ainsley Malone MS RD CNSC Sarah Miller PharmD MS BCNSP Vihas Patel MD FACS CNSC Steve Plogsted PharmD BCNSP CNSC Helaine E. Resnick PhD MPH 《JPEN. Journal of parenteral and enteral nutrition》2014,38(2):186-195
Malnutrition is common among hospitalized patients in the United States, and its coded prevalence is increasing. Malnutrition is known to be associated with increased morbidity, mortality and healthcare costs. Although national data indicate that the number of malnutrition diagnoses among hospital discharges has been steadily rising, an in‐depth examination of the demographic and clinical characteristics of these patients has not been conducted. We examined data from the 2010 Healthcare Cost and Utilization Project (HCUP), the most recent nationally‐representative data describing U.S. hospital discharges. Using ICD‐9 codes, we constructed a composite variable indicating a diagnosis of malnutrition. Based on our definition, 3.2% of all U.S. hospital discharges in 2010 had this diagnosis. Relative to patients without a malnutrition diagnosis, those with the diagnosis were older, had longer lengths of stay and incurred higher costs. These patients were more likely to have 27 of 29 comorbidities assessed in HCUP. Finally, discharge to home care was twice as common among malnourished patients, and a discharge of death was more than 5 times as common among patients with a malnutrition diagnosis. Taken together, these nationally representative, cross‐sectional data indicate that hospitalized patients discharged with a diagnosis of malnutrition are older and sicker and their inpatient care is more expensive than their counterparts without this diagnosis. 相似文献
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Paul W. Wales MD Nancy Allen MLS RD CNSC Patricia Worthington MSN RN Donald George MD Charlene Compher PhD RD CNSC LDN FADA FASPEN Daniel Teitelbaum MD 《JPEN. Journal of parenteral and enteral nutrition》2014,38(5):538-557
Background: Children with severe intestinal failure and prolonged dependence on parenteral nutrition are susceptible to the development of parenteral nutrition–associated liver disease (PNALD). The purpose of this clinical guideline is to develop recommendations for the care of children with PN‐dependent intestinal failure that have the potential to prevent PNALD or improve its treatment. Method: A systematic review of the best available evidence to answer a series of questions regarding clinical management of children with intestinal failure receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. Questions: (1) Is ethanol lock effective in preventing bloodstream infection and catheter removal in children at risk of PNALD? (2) What fat emulsion strategies can be used in pediatric patients with intestinal failure to reduce the risk of or treat PNALD? (3) Can enteral ursodeoxycholic acid improve the treatment of PNALD in pediatric patients with intestinal failure? (4) Are PNALD outcomes improved when patients are managed by a multidisciplinary intestinal rehabilitation team? 相似文献
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Use of Temporary Enteral Access Devices in Hospitalized Neonatal and Pediatric Patients in the United States 下载免费PDF全文
Beth Lyman MSN RN CNSC Carol Kemper PhD RN CPHQ LaDonna Northington DNS RN Jane Anne Yaworski MSN RN Kerry Wilder BSN RN MBA Candice Moore BSN RN CPN Lori A. Duesing MSN RN CPNP‐AC Sharon Irving PhD RN 《JPEN. Journal of parenteral and enteral nutrition》2016,40(4):574-580
Background: Temporary enteral access devices (EADs), such as nasogastric (NG), orogastric (OG), and postpyloric (PP), are used in pediatric and neonatal patients to administer nutrition, fluids, and medications. While the use of these temporary EADs is common in pediatric care, it is not known how often these devices are used, what inpatient locations have the highest usage, what size tube is used for a given weight or age of patient, and how placement is verified per hospital policy. Materials and Methods: This was a multicenter 1‐day prevalence study. Participating hospitals counted the number of NG, OG, and PP tubes present in their pediatric and neonatal inpatient population. Additional data collected included age, weight and location of the patient, type of hospital, census for that day, and the method(s) used to verify initial tube placement. Results: Of the 63 participating hospitals, there was an overall prevalence of 1991 temporary EADs in a total pediatric and neonatal inpatient census of 8333 children (24% prevalence). There were 1316 NG (66%), 414 were OG (21%), and 261 PP (17%) EADs. The neonatal intensive care unit (NICU) had the highest prevalence (61%), followed by a medical/surgical unit (21%) and pediatric intensive care unit (18%). Verification of EAD placement was reported to be aspiration from the tube (n = 21), auscultation (n = 18), measurement (n = 8), pH (n = 10), and X‐ray (n = 6). Conclusion: The use of temporary EADs is common in pediatric care. There is wide variation in how placement of these tubes is verified. 相似文献
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Characteristics of a Cohort of Home Parenteral Nutrition Patients at the Time of Enrollment in the Sustain Registry 下载免费PDF全文
Marion F. Winkler PhD RD LDN CNSC FASPEN Rose Ann DiMaria‐Ghalili PhD RN CNSC FASPEN Peggi Guenter PhD RN FAAN Helaine E. Resnick PhD MPH Lawrence Robinson BS PharmD MS Beth Lyman RN MSN CNSC Carol Ireton‐Jones PhD RD LDN FASPEN Lillian Harvey Banchik MD FACS CNSC Ezra Steiger MD FACS FASPEN AGAF 《JPEN. Journal of parenteral and enteral nutrition》2016,40(8):1140-1149
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Charlene Compher PhD RD CNSC LDN FASPEN Stanley J. Dudrick MD John R. Wesley MD FACS FAAP FASPEN Ainsley Malone MS RD LD CNSC FAND FASPEN Gordon S. Sacks PharmD BCNSP FCCP M. Molly McMahon MD Marion F. Winkler PhD RD LDN CNSC FASPEN Kris M. Mogensen MS RD LDN CNSC Arlet Kurkchubasche MD Meghan A. Arnold MD Hua Yang MD PhD Allison B. Blackmer PharmD BCPS Carol Braunschweig PhD RD Theresa Han‐Markey MS RD M. Luisa Partipilo PharmD BCNSP Mary Beth Harris MPH RD CSP CNSC Deb Kovacevich MPH BSN RN Bonnie Peters RN Alexis Cantwell Mary Ann Fithian 《JPEN. Journal of parenteral and enteral nutrition》2016,40(8):1079-1086