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The inconsistency of diagnostic criteria for malnutrition has confused clinicians since the 1980s. After the implementation of disease diagnosis related group payment (DRG) in China's public hospitals, the diagnosis of malnutrition and the correct documentation of nutrition-related diagnosis on the front sheet of medical records are related to the correct classification of the disease group and the medical insurance payment. Therefore, the reliable diagnostic criteria for malnutrition, especially disease-related malnutrition, is urgently needed in clinical practice. In September 2018, The global leadership Iinitiative on malnutrition (GLIM) diagnostic criteria consensus was launched. GLIM aimed to provide the explicit and unified diagnostic criteria for malnutrition in adult hospitalized patients. However, GLIM criteria was based on the voting by nutritional experts and was merely a consensus in nature. The clinical validity of GLIM criteria needs prospective verification, i.e., to demonstrate that patients with malnutrition as per GLIM criteria could have improved clinical outcomes with reasonable nutritional interventions. In November 2020, the article titled Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002 was published on the journal Nutrition. It was the first study comparing nutritional risk screening 2002 (NRS 2002) and GLIM malnutrition diagnostic criteria among Chinese patients for the indication of nutritional support therapy. The clinical effectiveness of the two tools was retrospectively verified as well. Here we discussed the key points of this retrospective study, including the critical research methods, to inform the currently ongoing prospective validation of the GLIM malnutrition diagnostic criteria (the item of reduced muscle mass not included).
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Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.
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Objective@#To explore the effect of early enteral nutrition(EEN) and parenteral nutrition(PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery.@*Methods@#A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups.@*Results@#The incidence of nutrition-related complications was 10 cases (15.38%) and 4 cases (6.15%)in EEN group and PN group, that was not statistically different (P=0.157). The incidence of infection-related complications was 3 cases (4.61%) and 5 cases (7.69%) in EEN group and PN group, that was not statistically different (P=0.715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13)in EEN group and PN group, that was not statistically different (P=0.233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours(range, 60-86) and 96 hours(range, 86-120) in PN group, that was statistically different(P=0.001, P=0.034).@*Conclusion@#Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.
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Objective To explore the clinical effect of applying standard process management in early enteral nutrition support for elderly patients with gastric cancer after operation. Methods A total of142 elderly patients with gastric cancer in our hospital were randomly divided into control group ( n=71) treated with the traditional nursing of enteral nutrition and intervention group ( n=71) adopting the standardized process man-agement, and then enteral nutrition tolerance, complications, nutritional status and recovery of gastrointestinal function were compared between the two groups. Results There was no significant difference in age, sex and preoperative nutritional condition and operation situation between the two groups ( P>0. 05) . The incidence of nutritional intolerance and the cost of nutritional support were lower than those in the control group ( P<0. 05) . The completion rate of enteral nutrition target in the intervention group was significantly higher than that in the control group ( P<0. 05) . The anal exsufflation time and defecation time of patients in the intervention group were shorter than those in the control group ( P<0. 05) . There was no significant difference in pulmonary infec-tion, incision infection and postoperative hospital stay between the two groups ( P>0. 05 ) . Conclusions Standardized process management of early enteral nutrition after operation could significantly improve the toler-ance of enteral nutrition, meanwhile, it has positive significance in promoting rapid recovery of elderly patients with gastric cancer.
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Objective To explore the effect of early enteral nutrition (EEN) and parenteral nutrition (PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery. Methods A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen. The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups. Results The incidence of nutrition-related complications was 10 cases (15. 38％) and 4 cases (6. 15％) in EEN group and PN group, that was not statistically different (P = 0. 157). The incidence of infection-related complications was 3 cases (4. 61％) and 5 cases (7. 69％) in EEN group and PN group, that was not statistically different (P = 0. 715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13) in EEN group and PN group, that was not statistically different (P = 0. 233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours (range, 60-86) and 96 hours (range, 86-120) in PN group, that was statistically different (P=0. 001, P=0. 034). Conclusion Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.
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Objective To investigate the prevalence of nutritional risk and undernutrition of geriatric patients with hip fracture in the department of orthopaedics and analyze the relationship between nutritional risk scores and clinical outcomes.Methods In this prospective cohort study,the baseline demographic data of 235 elderly patients with hip fracture in the department of orthopaedics of Ningbo First Hospital were consecutively recorded from November 2013 to December 2015.The prevalence of nutritional risk and undernutrition,infectious complications,and length of hospital stay were also recorded.The infectious complications and length of hospital stay in patients in different age groups(60-69 years,70-79 years,and ≥80 years)and those with different nutritional risks(<3 points,3-4 points,and ≥5 points)were analyzed.Results All patients without PN EN support during hospitalized durations.The incidence of nutritional risk was 62.98％in 235 elderly patients with hip fracture,twenty patients were undernutritioned by multi-item standard based on Nutritional Risk Screening 2002 nutrition disorder score,and 15 patients were undernutritioned by one-item standard with body mass index.Hip arthroplasty patients had significantly higher nutritional risk than those who had undergone internal fixation(74.04％vs.54.20％,P=0.002).Patients with comorbidities had significantly higher nutritional risk than patients without comorbidities(71.56％vs.55.56％,P=0.011).There were significant differences in infectious complications(2.30％vs.3.91％vs.50.00％)and length of hospital stay[(6.35±0.87)d vs.(8.12±1.13)d vs.(10.85±1.52)d,(8.66±2.06)d vs.(10.45±2.43)d vs.(13.25 ±3.65)d] among patients with different nutritional risks(<3 points,3-4 points,and ≥5 points)(P=0.000).Conclusions Elderly patients with hip fracture has relatatively high nutritional risk.These patients tend to have more complications and longer hospital stay.
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Objective To investigate the quality of nursing care after the application of tracer methodology in patients undergoing chemoradiotherapy with peripherally inserted central catheters (PICC),evaluate the nurses' adherence to the procedural protocol of PICC,and calculate the number of infectious complications related with the placement.Methods We compared the nurses' adherence to the procedural protocol and the number of infectious complications before (April 2014 to June 2015) and after (July 2015 to October 2016) the tracer methodology was applied at the Chemoradiotherapy Center of Ningbo First Hospital in July 2015.Results After the tracer methodology was introduced to the care of patients with PICC,the nurses had better adherence to the procedural protocol,as shown in the rise of quality control score from (94.00± 3.35) to (97.87± 1.42).The incidence of infectious complications dropped significantly (all P＜0.001).Conclusion The clinical application of tracer methodology can improve the quality of nursing for patients with PICC,reduce the incidence of PICC-related infectious complications,and promote patient safety.
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Objective To investigate compliance of breast cancer patients with postoperative peripherally inserted central catheter (PICC) in terms of upper limb motion, to formulate practical plan of upper limb motion, and to improve the compliance in the patients with PICC catheter.Methods A total of 75 patients after breast cancer operation with PICC for chemotherapy were selected from Department of Thyroid and Breast Surgery for upper limb activity instructions.Plan-Do-Check-Act method was used to evaluate the feasibility and effectiveness.Two cycles were performed in two weeks.Patients' compliance was assessed by the inquiry method.Results After practicing and refining nursing process, perfecting the risk assessment table, adjusting the education time, etc., the cognition and acceptance of the significance of upper limb motion were improved in the patients.The compliance of the patients to the upper limb motion instructions was satisfactory.Conclusions The upper limb motion scheme in this study was modified and perfected through application, research, and practice.This scheme could enhance the compliance of patients in terms of upper limb motion.