Neurological disorders can change patients’ nutritional status by directly or indirectly affecting dietary intake through mechanisms such as dysphagia, movement disorders, cognitive impairment, and depression. Malnutrition contributes to complications, resulting in delayed rehabilitation and increased morbidity and mortality. It is important to prevent malnutrition in patients with neurological disorders and to improve their nutritional status by identifying nutritional deterioration at an early stage and implementing appropriate nutritional interventions. This review examines the nutritional screening and assessment process in patients with neurological disorders, with a particular focus on stroke patients undergoing rehabilitation. Nutritional assessment, the first step of clinical nutrition management, identifies nutritional problems and their causes, signs, and symptoms through an overall evaluation including anthropometric measurements, dietary assessments, biochemical assessment, nutrition-related physical examinations, and functional assessment data. Based on the assessment, a nutritional intervention plan is established. By synthesizing the assessment results of selected subjective and objective indicators, nutritional screening tools to screen patients at risk of malnutrition and nutritional assessment tools to diagnose malnutrition were developed. It is important to use those tools with a clear understanding of their characteristics and scope.

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.
Delayed Diagnosis ; Gastritis, Atrophic* ; Homocysteine ; Humans ; Methylmalonic Acid ; Nervous System ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency ; Vitamin B 12* ; Vitamins*

PURPOSE: This study was undertaken to assess the feasibility of early feeding in patients that have undergone emergency gastrointestinal (GI) surgery. MATERIALS AND METHODS: The authors retrospectively reviewed 84 patients that underwent emergency bowel resection and/or anastomosis from March 2008 to December 2011. Patients with severe shock, intestinal ischemia, sustained bowel perforation, or short bowel syndrome were excluded. Patients were divided into the early (group E; n=44) or late (group L; n=40) group according to the time of feeding commencement. Early feeding was defined as enteral feeding that started within 48 hours after surgery. Early and late feeding groups were compared with respect to clinical data and surgical outcomes. RESULTS: The most common cause of operation was bowel perforation, and the small bowel was the most commonly involved site. No significant intergroup differences were found for causes, sites, or types of operation. However, length of stay (LOS) in the intensive care unit (1 day vs. 2 days, p=0.038) and LOS in the hospital after surgery were significantly greater (9 days vs. 12 days, p=0.012) in group L than group E; pulmonary complications were also significantly more common (13.6% vs. 47.5%, p=0.001) in group L than group E. CONCLUSION: After emergency GI surgery, early feeding may be feasible in patients without severe shock or bowel anastomosis instability.
Emergencies* ; Emergency Treatment ; Enteral Nutrition ; Gastrointestinal Tract ; Humans ; Intensive Care Units ; Ischemia ; Length of Stay ; Methods ; Retrospective Studies ; Shock ; Short Bowel Syndrome

PURPOSE: The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. MATERIALS AND METHODS: Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. RESULTS: A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (p<0.001). Ten patients (2.3%) were severely malnourished preoperatively, increasing to 115 patients (26.3%) postoperatively. In gastric cancer patients, postoperative severe malnourishment increased significantly (p<0.006). In univariate analysis, old age (>60, p<0.001), male sex (p=0.020), preoperative weight loss (p=0.008), gastric cancer (p<0.001), and open surgery (p<0.001) were indicated as risk factors of postoperative severe malnutrition. In multivariate analysis, old age, preoperative weight loss, gastric cancer, and open surgery remained significant as risk factors of severe malnutrition. CONCLUSION: The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.
Colorectal Neoplasms/surgery ; Gastrointestinal Neoplasms/*surgery ; Humans ; Malnutrition/diagnosis ; *Nutritional Status ; Postoperative Complications ; Risk Factors ; Stomach Neoplasms/surgery

PURPOSE: The aim of this study was to investigate nutritional support status and effects of nutrition consultation in critically ill surgical patients. METHODS: The medical records of 76 patients, admitted between June 1 and November 30, 2013, were reviewed retrospectively. Patients were divided into 2 groups: the nutrition consultation group (n=17) and the no consultation group (n=59). Patients were also divided into 3 groups: the enteral nutrition (EN) group (n=8), the parenteral nutrition (PN) group (n=25), and the enteral and parenteral mixed nutrition (ENPN) group. Total delivered/required caloric ratio and serum albumin, serum total protein, hemoglobin and other biochemical variables were compared in each group. RESULTS: Mean daily required and delivered caloric/protein amount were EN group 60.0%, PN group 64.6%, and ENPN group 86.9%. ENPN group showed statistically significant difference when compared with EN group, PN group (P=0.005). When the proportion of patients who were fed more than 75% of the daily required calories was calculated, EN, PN, and ENPN showed 37.5%, 25.0% and 81.8%, respectively. ENPN group were significantly more supplied (P=0.007). Although neither the nutrition consultation group nor the non-consultation group received more than 80% of the daily required calories, the nutrition consultation group received 73% of the daily required calories whereas the no consultation group only received 46% (P=0.007). The total delivered/required protein ratio was approximately 69% of the nutrition consultation group and approximately 42% of the no consultation group (P=0.006). CONCLUSION: The results of providing nutritional consultation to intensive care unit patients showed an increase in the nutrition support. Nutrition education, continuous monitoring and management for nutritional support by systemic administration of a nutritional support team should be considered in order to achieve effective clinical outcomes in critically ill surgical patients.
Critical Illness* ; Education ; Enteral Nutrition ; Humans ; Intensive Care Units ; Medical Records ; Nutritional Status* ; Nutritional Support ; Parenteral Nutrition ; Retrospective Studies ; Serum Albumin

The first permanent molars play a key role in maxillofacial development and occlusion. The purpose of this study is to investigate the characteristics and development stages of first molars with delayed eruption, and to evaluate their associations with congenital missing teeth. Eight-year-old patients who had delayed eruption in their first molars were classified into 75 patients with physical barriers and 77 patients without physical barriers. The development stages of the first and second molars in the delayed area were analyzed using Nolla method from the panoramic radiographs. The relationship between congenital missing teeth and delayed area was also investigated. Delayed eruption of first molars were more common in the maxilla alone. With the presence of physical barriers, male patients showed higher frequency in unilateral cases, while female patients had higher bilateral cases when there was no physical barrier. Delayed development of first molars were observed in delayed eruption area. In the absence of physical barriers, adjacent second molars were also developed slowly and the incidence of congenital missing teeth was high in delayed area. If first molars with delayed eruption are observed, clinical and radiographical follow-ups are necessary for the evaluation of their developmental stages and congenital missing teeth.

Forty-two percent of the patients with renal failure that requires continuous renal replacement therapy (CRRT) have been reported to have severe malnutrition, and preexisting malnutrition is a statistically significant and independent predictor of negative hospital outcomes. We performed this study to evaluate the appropriateness of the calorie and protein provided for the critically ill patients who require CRRT. One hundred forty-nine patients who received CRRT were enrolled. The demographic data, the length of the ICU stay and the mortality were recorded. The calorie/protein intake and the blood urea nitrogen (BUN), albumin and creatinine levels were used as nutritional parameters. The mean daily calorie intake during CRRT was 16.1+/-7.4 kcal/kg, which was 64% of the recommended intake. Only 10% of the patients received the recommended caloric intake and the ratio of the enteral and parenteral calories was 26%/74%. The mean protein intake was 0.58+/-0.34 g/kg, which was 38% of the recommended intake. The calorie and protein intakes at the termination of CRRT were significantly increased compared to the initial day of treatment, but they stayed under the recommended intake. The BUN, creatinine and albumin levels were significantly increased in the survival group (odds ratio for albumin: 2.73; creatinine: 2.43). A strategy to increase the nutrition provision is needed to improve the nutritional statuses and clinical outcomes of the critically ill patients who require CRRT.
Blood Urea Nitrogen ; Creatinine ; Critical Illness ; Energy Intake ; Humans ; Critical Care ; Intensive Care Units ; Malnutrition ; Nutritional Status ; Renal Insufficiency ; Renal Replacement Therapy

BACKGROUND: With increasing use of medical radiologic procedures, wearing proper protector should be emphasized to reduce occupational radiation exposures. This research describes the rates of lead apron wearing for radiation protection and assessed occupational factors related to wearing rates for various types of healthcare professionals. METHODS: We conducted a self-administered questionnaire survey through a website, on-site visits, fax, and mail. Of the 13,489 participants, 8858 workers who could not completely separate themselves from radiological procedure areas. Their general characteristics (sex and age), work history (job title, duration of employment, and hospital type), and practices (frequency of radiation procedures, ability to completely separate from radiation, and frequency of wearing protective lead aprons) were examined. RESULTS: The mean rate of lead apron wearing during radiologic procedures was 48.0 %. The rate was different according to sex (male: 52.9 %, female: 39.6 %), hospital type (general hospital: 63.0 %, hospital: 51.3 %, clinic: 35.6 %, dental hospital/clinic: 13.3 %, public health center: 22.8 %), and job title (radiologic technologist: 50.3 %, doctor: 70.3 %, dentist/dental hygienist: 15.0 %, nurse/nursing assistant: 64.5 %) (p < 0.001). By logistic regression analysis stratified by job title, use of lead aprons by radiologic technologists and nurses/nursing assistants was associated with hospital type and exposure frequency score. For doctors, apron wearing was associated with employment duration. For dentists/dental hygienists, apron wearing was associated with the exposure frequency score. CONCLUSIONS: To improve working environments for healthcare professionals exposed to radiation, it is necessary to consider related factors, such as job title, duration of employment, and hospital type, when utilizing a planning and management system to prevent radiation-related health problems.
Delivery of Health Care* ; Employment ; Female ; Humans ; Logistic Models ; Postal Service ; Public Health ; Radiation Protection

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 +/- 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9 +/- 7.1. The subjects received 2.3 +/- 1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: < 140 mg/dl vs > or = 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P = 0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.
APACHE ; Blood Glucose ; Critical Illness ; Diabetes Mellitus ; Glucose ; Humans ; Hyperglycemia ; Intensive Care Units ; Length of Stay ; Linear Models ; Nutritional Status ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Retrospective Studies

PURPOSE: To determine the prevalence of malnutrition in hospitalized elderly Korean patients using Mini Nutritional Assessment-Short Form (MNA-SF) in Korea. METHODS: A cross-sectional, multi-center study was performed. We enrolled 300 patients aged > or =65 years from 10 hospitals. We collected subjects' general characteristics, including age, sex, height, weight, and diagnosis. Patients' nutritional status was assessed using MNA-SF within 48 hours since hospital admission. RESULTS: The subjects were 74.2+/-6.3 years old, and 155 patients were male (51.7%). Cancer was the most common diagnosis (26.3%), followed by musculoskeletal (11.3%), neuromuscular (10.3%), pulmonary (9.0%), and cardiovascular disease (8.7%). The length of hospital stay was 8.7+/-5.9 days. According to MNA-SF, 99 patients (33.0%) were at risk of malnutrition, and 51 patients (17.0%) were malnourished. MNA-SF score showed negative correlations with age (r=-0.259, P<0.001) and hospital stay (r=-0.168, P=0.006). Patients in the malnourished or at risk of malnutrition groups were more likely to be admitted to and stayed longer in the intensive care unit (ICU) than those of normal nutritional status (8.7% vs. 17.3%, P=0.026; 1.6+/-1.0 days vs. 3.7+/-3.2 days, P=0.033). The patients who were malnourished or at risk of malnutrition were hospitalized significantly longer than those of normal nutritional status (9.8+/-6.2 vs. 7.7.+/-5.4 days, P=0.004). After adjusting for age and ICU admission, nutritional status by MNA-SF was the only risk factor for prolonged hospitalization (beta=1.384, P=0.005). CONCLUSION: About half of hospitalized elderly patients were at risk of malnutrition or malnutrition status at admission, and nutritional status was the only risk factor for longer hospital stay. Thus, more attention should be paid to the nutritional care of elderly patients to improve clinical outcomes.
Aged* ; Cardiovascular Diseases ; Diagnosis ; Hospitalization ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Malnutrition* ; Nutritional Status ; Prevalence* ; Risk Factors