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Attitudes of Medical Staff and Factors Related to Nutritional Support for Patient Care in a University Hospital.

Hwee Soo JEONG ; Chen Hsuen TEONG ; You Jung CHOI ; Woo Jeng KIM ; Ah Ran LEE

Journal of Clinical Nutrition.2014;6(1):37-41. doi:10.15747/jcn.2014.6.1.37

PURPOSE: Knowledge of nutritional support and attitudes of medical staff both affect patient care. We identified attitudes regarding nutritional support among medical staff as well as changes in attitudes when a nutritional support team is present. METHODS: Data were collected from 172 medical staff members who served at a university hospital located in Gyeongju by self-administered questionnaire from June 12~August 30, 2013. The questionnaire inquired about importance of nutritional support, self-confidence about nutritional support, consideration of nutritional support for patient care, consideration of nutritional support when a nutritional support team is present, and nutritional knowledge training during the past year. RESULTS: A total of 169 subjects (98.3%) thought that nutritional support is important for patient care. Only 19 subjects (11.0%) were highly self-confident about nutritional support. In total, 147 subjects (85.5%) considered nutritional support for some or all patients, whereas 169 (98.3%) considered nutritional support for patient care when a nutritional support team is present. Thirty-eight subjects (22.1%) received nutritional knowledge training during the past year. High self-confidence for nutritional support was related to nutritional knowledge training and service part. Positive changes regarding nutritional support when a nutritional support team is present were associated with nutritional knowledge training and high self-confidence for nutritional support. CONCLUSION: No differences in nutritional support attitudes for patient care were observed among the medical staff. Nutritional knowledge training and service part affected self-confidence of nutritional support and induced positive changes in attitudes for nutritional support.
Gyeongsangbuk-do ; Humans ; Inpatients ; Medical Staff* ; Nutritional Status ; Nutritional Support* ; Patient Care* ; Surveys and Questionnaires

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Validation of Geriatric Nutritional Risk Index and Percent Weight Loss as a Predictor of Post-operative Complications after Gastrectomy in Elderly Patients.

Kyung Eun LEE ; Young Gil SON ; Seung Wan RYU

Journal of Clinical Nutrition.2014;6(1):30-36. doi:10.15747/jcn.2014.6.1.30

PURPOSE: Gastric cancer surgery is expected to increase in frequency in elderly patients aged over 65 years. The aim of this study was to validate the Geriatric Nutritional Risk Index (GNRI) and percent weight loss as a predictor of post-operative complications after gastrectomy in elderly patients. METHODS: We retrospectively collected data on elderly patients (over 65 years) who underwent gastrectomy for gastric cancer at Keimyung University Dongsan Medical Center between January 2010 and December 2012. Data included patientsocharacteristics (body mass index [BMI], underlying disease, body weight loss during 3 months before gastrectomy, American Society of Anesthesiologists [ASA] score, and stage of disease), operative characteristics (operation method, operation time, and blood loss during operation), GNRI, and post-operative complications after gastrectomy. RESULTS: A total of 321 patients were included. The patients'mean age was 72.4+/-4.7 years, and 49.5% of patients were rated as being at risk by the GNRI. There were no differences in post-operative complications by GNRI, age, sex, ASA score, BMI, serum albumin, co-morbidity, stage of disease, surgical approach, type of surgery, extent of lymph node dissection, operation time, or blood loss during surgery. However, percent weight loss during 3 months was correlated independently with post-operative complications (P<0.001). In logistic regression analysis, a 1% increase in percent weight loss was associated with a 1.102 times increase in the incidence of postoperative complications (P=0.012, 95% confidence interval 1.021~1.189). CONCLUSION: The percent weight loss during 3 months before gastrectomy could help predict post-operative complications in elderly patients.
Aged* ; Body Weight ; Gastrectomy* ; Humans ; Incidence ; Logistic Models ; Lymph Node Excision ; Malnutrition ; Postoperative Complications ; Retrospective Studies ; Serum Albumin ; Stomach Neoplasms ; Weight Loss*

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Prevalence of Malnutrition in Hospitalized Elderly Korean Patients Based on Mini Nutritional Assessment-Short Form.

Hosun LEE ; Ju Hee KANG ; Eunmee KIM ; Won Gyoung KIM

Journal of Clinical Nutrition.2014;6(1):24-29. doi:10.15747/jcn.2014.6.1.24

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

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Nutrition Support for Pediatric Short Bowel Syndrome.

Ji Young SONG ; Hyun Young KIM

Journal of Clinical Nutrition.2014;6(1):19-23. doi:10.15747/jcn.2014.6.1.19

Short bowel syndrome (SBS) develops in infants and children with inadequate small intestine for digestion and absorption of enteral nutrients for normal growth and development. This can lead to malabsorption of macronutrients or micronutrients, electrolyte imbalance, dehydration, malnutrition, and growth failure. The goals of nutrition support in pediatric SBS are to promote intestinal adaptation, avoid complications associated with intestinal resection and parenteral nutrition (PN), and, ultimately, maintain normal growth. In the initial phase of SBS, PN support is important in order to meet energy requirements and for avoidance of electrolyte imbalance or dehydration. Enteral nutrition should be initiated as soon as possible after bowel resection in order to promote intestinal adaptation. In order to stimulate oral motor activity and to avoid feeding aversion behavior, tolerable volumes of bottle-feeding or solid food should be accepted. In addition, feeding volume might be gradually increased in small amounts with monitoring of stool quantity and consistency. Because not all enterally administered calories are absorbed, PN should not be decreased isocalorically against enteral nutrition. In order to enhance bowel adaptation by maximizing nutrient delivery, it is necessary to determine the potential advantages of administration mode, continuous vs. bolus feeding, and what formula should be considered, polymeric vs. monomeric or oligomeric formula. Optimal enteral feeding regimen for pediatric SBS is still being debated, how to feed or what to feed, therefore, nutritional management of SBS should be adjusted according to the patient's medical condition.
Absorption ; Child ; Dehydration ; Digestion ; Enteral Nutrition ; Growth and Development ; Humans ; Infant ; Intestine, Small ; Malnutrition ; Micronutrients ; Motor Activity ; Nutritional Support ; Parenteral Nutrition ; Polymers ; Short Bowel Syndrome*

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Drug-nutrient Interactions in Elderly Patients.

Juhyun RHO

Journal of Clinical Nutrition.2014;6(1):11-18. doi:10.15747/jcn.2014.6.1.11

Physiological changes associated with aging affect the absorption, distribution, metabolism, and excretion of drugs and thus therapeutic outcomes. These changes may be further amplified by interactions with nutrients. The purpose of this review was to summarize drug-nutrient interactions found in elderly patients. Mechanisms of the interactions can be categorized as ex vivo bio-inactivations, interactions in absorption and elimination phases, and physiological interactions. The goal of enteral nutrition (EN) is to maximize the therapeutic response of medication without adversely affecting EN tolerance. Therefore, to ensure safety, consistent monitoring is necessary for enteral feeding of patients receiving medication via an enteral tube. Elderly patients receiving parenteral nutrition (PN) are often treated concomitantly with medication via the parenteral route. The stability and compatibility of PN formulations infused with other additives, including medication, may be influenced. Limitation of the number of prescriptions to essential medications only during the minimum period along with periodic re-evaluations of the treatment are thus necessary to minimize undesirable drug-nutrient interactions in elderly patients.
Absorption ; Aged* ; Aging ; Enteral Nutrition ; Food-Drug Interactions ; Humans ; Metabolism ; Nutritional Support ; Parenteral Nutrition ; Prescriptions

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Effect of Fish Oil-based Intravenous Fat Emulsion with Parenteral Nutrition in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.

Ji Hyeong CHOE ; Young Joo LEE ; Hye Jung BAE ; Sun Hoi JUNG ; Hyeon Joo HAHN ; Yungil KOH

Journal of Clinical Nutrition.2016;8(1):29-35. doi:10.15747/jcn.2016.8.1.29

PURPOSE: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients' immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records. RESULTS: The patients' characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs. -1.08%, P=0.245). CONCLUSION: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.
Adult ; Body Mass Index ; Demography ; Electronic Health Records ; Fatty Acids ; Fever ; Fish Oils ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Length of Stay ; Mortality ; Parenteral Nutrition* ; Retrospective Studies ; Sepsis ; Weight Gain ; Weight Loss

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Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients.

Won Bae CHANG ; Kyuwhan JUNG ; Sang Hoon AHN ; Heung Gwon OH ; Mi Ok YOON

Journal of Clinical Nutrition.2016;8(1):24-28. doi:10.15747/jcn.2016.8.1.24

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.
Adult* ; Anesthesia ; Anesthesia, General ; Dyspnea ; Fasting ; Herniorrhaphy ; Hoarseness ; Humans ; Hunger ; Nausea ; Pilot Projects* ; Thirst ; Vomiting ; Water

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Economic Evaluation of Home Total Parenteral Nutrition.

Ja Kyung MIN

Journal of Clinical Nutrition.2016;8(1):19-23. doi:10.15747/jcn.2016.8.1.19

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.
Chronic Disease ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Korea ; Organization and Administration ; Parenteral Nutrition, Home Total* ; Quality-Adjusted Life Years

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Nutritional Supports in Patients with Inflammatory Bowel Disease.

Bong Hyeon KYE

Journal of Clinical Nutrition.2016;8(1):11-18. doi:10.15747/jcn.2016.8.1.11

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, particularly Crohn's disease (CD) have impaired linear growth. Nutritional support is important in patients with IBD and nutritional problems. Enteral nutrition (EN) can reduce CD activity and maintain remission in both adults and children. Given that the ultimate goal in the treatment of CD is mucosal healing, this advantage of EN over corticosteroid treatment is valuable in therapeutic decision-making. EN is indicated in active CD, in cases of steroid intolerance, in patient's refusal of steroids, in combination with steroids in undernourished individuals, and in patients with inflammatory stenosis of the small intestine. EN should be the first choice compared to total parenteral nutrition. However, EN does not have a primary therapeutic role in ulcerative colitis. In conclusion, it appears that the role of nutrition as supportive care in patients with IBD should not be underestimated. The aim of this comprehensive review is to provide the reader with an update on the role of nutritional support in IBD patients.
Adult ; Child ; Colitis, Ulcerative ; Constriction, Pathologic ; Crohn Disease ; Disulfiram ; Enteral Nutrition ; Humans ; Inflammatory Bowel Diseases* ; Intestine, Small ; Nutritional Support* ; Parenteral Nutrition, Total ; Steroids ; Thinness

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Nutritional Screening Tool for In-Hospital Patients.

Eunmi SEOL ; Dal Lae JU ; Hyuk Joon LEE

Journal of Clinical Nutrition.2016;8(1):2-10. doi:10.15747/jcn.2016.8.1.2

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient's medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.
Appetite ; Enteral Nutrition ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; Malnutrition ; Mass Screening* ; Medical Records ; Nursing ; Nutrition Assessment ; Nutritional Status ; Nutritional Support ; Prevalence ; Weight Loss ; Wound Healing

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