ABSTRACT
Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
ABSTRACT
Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
ABSTRACT
This purpose of this study is to help students developing problem-solving skills by using Problem-based Learning (PBL) as a teaching model, combining with the Objective Structured Clinical Examination (OSCE) as a training tool to evaluate students' clinical competencies. Sixty-five college junior students from a therapeutic nutrition course were participated. The topics of PBL included diabetes, kidney disease, cancer, and cardiovascular disease. For each disease, pre- and post-test quiz and after class exam were assessed to evaluate the students' learning effectiveness. Due to the impact of the COVID-19 epidemic, OSCE was performed online. The focus group interview and learning effectiveness questionnaire were conducted by the end of this course for all participants. Moreover, 37 students who attended the dietitian internship filled in the learning effectiveness questionnaire again after the internship. The results indicated that after the PBL, the post quiz score for each disease was increased, and through the online OSCE training, students' abilities to master nutrition education and counseling had been upgraded. Students indicated that both PBL and OSCE training could contributed to the learning effectiveness. The better academic performance students were, the more willing they are to work in nutrition-related fields in the future. For those who finished the dietitian internship agreed that they could understand the work content better in general regional and regional hospitals than in teaching ones. In conclusion, PBL teaching model combined with OSCE training could effectively improve students' learning motivation, learning effectiveness and practical application in a therapeutic nutrition course.Copyright © 2022 Nutrition Society in Taipei. All rights reserved.
ABSTRACT
Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge from ICU [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston (UHBW) had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Spare clinic spaces were used for non COVID ICU patients. Objective(s): To review symptoms reported by patients in the following 3 groups, COVID-19 patients treated in ICU (COVID ICU), COVID-19 patients treated with continuous positive airway pressure ventilation in high dependency areas (COVID CPAP) and non COVID-19 ICU patients (ICU), at 2-3 months post discharge from UHBW. Method(s): Referred patients had an initial phone call at 8 weeks post discharge. The call identified both physical and psychological symptoms. Advice regarding recovery, signposting to resources and onwards referrals to appropriate specialities were provided. If symptoms indicated, patients would then be referred into the multidisciplinary team follow up clinic. Here they met with an intensivist, clinical psychologist, physiotherapist, occupational therapist, speech and language therapist and dietitian. Result(s): As Graph 1 shows all 3 patient groups had a wide variety of ongoing symptoms at 2-3 months post discharge. Fatigue was the most common symptom reported in all 3 groups. Breathlessness was the second most common symptom reported by COVID patients but was less frequently reported in the ICU population who had a variety of non-respiratory related reasons for admission. COVID ICU patients more commonly reported ongoing problems with their swallowing, voice and communication compared to the COVID CPAP group, most probably due to invasive ventilation. Psychological burden post critical illness was high in all 3 groups. More than 20% of all patients scored =10 on a PHQ-9 depression scale showing moderate to severe depression. More than 15% of all patients scored =10 on a GAD-7 showing moderately severe to severe anxiety. COVID ICU group had the highest incidence of post-traumatic stress disorder (PTSD). This may be linked to the higher level of delirium we saw in this group, as a result of change in practice, such as full PPE and absence of visiting during the pandemic. ICU patients presented with a significantly higher percentage of physiotherapy needs. This is likely because patients with the longest and most complex ICU admissions were selected for the clinic. Sleep likely goes under reported in these results as we only began questioning specifically about this later on in the clinic. Conclusion(s): This data goes some way in supporting current literature that the rehabilitation needs of COVID ICU patients equal that of ICU patients (Puthucheary et al 2021). It also shows the need to follow up patients who receive advanced respiratory support outside of the ICU environment, as their symptoms, and therefore rehabilitation needs are very similar to ICU patients at 2-3 months post discharge.
ABSTRACT
Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.
ABSTRACT
Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).
ABSTRACT
Background: The COVID-19 pandemic continues to pose challenges for healthcare systems across the world. Many patients infected with the virus, whether mild or severe, have nutritional complications ranging from poor appetite to the need for nutrition support. Limited research has shown that nutritional status plays a significant role in disease outcomes for COVID-19 patients. Although the American Society for Parenteral and Enteral Nutrition set guidelines for the nutritional management of COVID-19 patients, to date there are few major studies investigating the association between nutritional risk and outcomes in these patients. Thus, the purpose of this study is to assess the association between nutritional status and outcomes in hospitalized patients with COVID-19 and to identify the most common feeding practices among these patients. Method(s): A descriptive research design was used. Researchers reviewed the medical records of a random sample of 300 adult patients diagnosed with COVID-19 admitted to an academic metropolitan healthcare system between March 2020 to March 2021. Nutritional status was obtained from the admission screening and assessment documentation by a clinical dietitian (RD). Patients were then stratified based on admission nutritional status as malnourished or not. Differences in hospital length of stay (LOS), ICU LOS, ventilator dependence (in hours), and mortality were compared between groups using Mann-Whitney U, independent t-test, and chi-square tests. Result(s): Malnourished patients had a longer median (IQR) length of stay compared to non-malnourished patients (8 days (3,16) vs 4 days (3,8), p = 0.001). More patients who were malnourished expired (10/43, 23.3%) compared to patients who were not malnourished (17/ 257, 6.6%) (p = 0.002). No significant differences were observed in ICU length of stay or hours on a ventilator between groups. Most patients in the study were fed orally (87.3%), while 12.7% were fed enterally, and none of the patients were fed through use of parenteral nutrition. Conclusion(s): Results suggest that malnourished patients with COVID-19 experienced several worse outcomes compared to patients with COVID-19 who were not malnourished during hospitalization. Other known factors that influence outcomes of patients with COVID-19 were not considered in this descriptive study. Subsequent analysis to account for race, obesity, and other comorbidities is needed.
ABSTRACT
Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .
ABSTRACT
Background: Providing care for patients with Diabetes in Pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care, or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Method(s): A qualitative study using semi-structured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing DiP care;the need for flexibility in scheduling and the ability to individualise the way care is provided;challenges to adapting to new technology. Result(s): Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the limited current infrastructure and patient resources. Conclusion(s): Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporating teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.
ABSTRACT
Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Background: Filter paper (FP) or dried blood spot testing is the preferred method of monitoring blood levels of phenylalanine and tyrosine for patients diagnosed with phenylketonuria (PKU) in the state of Georgia. This cost effective and convenient at-home approach simplifies the nutritional assessment and management of patients with PKU and lessens the burden on patients and caretakers. Emory and a local specialty laboratory had a long-standing contract for FP testing, which included patient insurance and grant billing. When this laboratory abruptly ended FP testing in September 2020, an emergent alternative plan became essential to prevent potential disruptions in patient care while working on a sustainable solution for PKU monitoring, especially given the ongoing COVID-19 pandemic. Method(s): Emory's in-house laboratory was not contracted with outside laboratories to process FP testing and bill insurance. To mitigate any delays in FP testing, the MNT4P program conducted a vendor search and selected ARUP Laboratories to perform PKU FP testing. Eligible patients included those referred, enrolled, and consented to the MNT4P program. To streamline the FP submission process, customized FP cards and business reply envelopes were developed and distributed in collaboration with PerkinElmer, Emory Mail Services and the United States Postal Service. Patient outreach efforts were facilitated through email campaigns, MNT4P website updates, and in collaboration with Georgia PKU Connect. Result(s): 95 patients were referred to MNT4P program for FP paper monitoring. During the 4-month period, a total of 239 FPs were collected from patients with PKU and processed with corresponding results reported to Emory Clinic, allowing registered dietitians to continue nutrition management without disruption. Once the patient-centered business prototype was established, FP testing was successfully transferred from the MNT4P program to Emory's inhouse laboratory. FP testing is now a part of Emory's test catalog, and results are available to providers through electronic health records. Conclusion(s): The MNT4P program successfully worked with Emory's in-house laboratory to develop a sustainable solution for FP monitoring. It prevented interruption in long-term follow up of patients with PKU. MNT4P continues to be the payor of FP tests for uninsured and underinsured patients.Copyright © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Introduction: Due to the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the humoral immune system, gastrointestinal, and metabolic activities, malnutrition in COVID-19 is inevitable. This study aimed to assess the prevalence, identify COVID-19 patients at risk of malnutrition, and determine the nutritional risk profile of COVID-19 patients and the need for ongoing nutritional support after ICU stay. Method(s): A monocentric observational study based on data collected from 200 COVID-19 patients at hospital discharge in Dubai, UAE. Male and female residents and citizens (>= 18 years) who tested positive for COVID-19 upon ICU admission and who were ready for discharge were included. The 'MUST' malnutrition screening was performed to identify patients at high risk of malnutrition who required ONS and other treatments. Result(s): The present study included two hundred patients where male participants constituted 68% compared to females (32%). The included population was neither acutely ill nor had nutritional intake for more than 5 days. 45% of COVID-19 patients experienced a reduced dietary intake at hospital, and 58% lost weight during ICU/hospital stays. About 25% received enteral nutrition in the ICU, whereas (2%) required ongoing homecare nutritional support after hospital discharge. Almost 80% were advised to follow up with a dietitian and 96% were provided additional dietary counseling. Regarding the COVID-19 patients' post-ICU stay nutritional support, the adjusted odds ratio of follow-up consultation with dietitian significantly decreased by 66% among patients aged from 18 to 49 years, compared to older patients (ORa = 0.34, 95% CI 0.12-0.86, p = 0.032). Conclusion(s): Close assessment, evaluation, and monitoring of malnutrition are critical in severely ill COVID-19 patients post-ICU. ONS is highly recommended for high-risk patients to provide support against muscle loss during ICU stay and improve the recovery of the patients at discharge.
ABSTRACT
Background: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by variants in the PAH gene which encodes for phenylalanine hydroxylase (PAH). PKU, left untreated, can cause intellectual disability, psychiatric symptoms, and behavioral abnormalities. Lifelong management of PKU is challenging, and many adult patients become lost to follow-up, despite recommendations for lifelong management. Method(s): The PKU clinic team is a multidisciplinary team consisting of an APN Director, physician, dieticians, diet tech, genetic counselor, registered nurse, and social worker. After establishing formal guidelines, algorithms were created to determine thresholds for initiating patient outreach based on both age and type of PKU treatment. EMRbased data collection is used to track adherence to both clinic visits and consistent submission of Phe levels. Data was collected and analyzed for roughly 250 PKU patients. Baseline levels for adherence to clinic visits and filter card submission were collected at time of implementation. Data was then reviewed after 18 months, and has been further analyzed for a second 18 months (which correlates with the start of the COVID-19 pandemic) Results: Overall baseline adherence across the population for annual clinic visitswas 72% (144/200). Clinic visit adherence increased to 88% at 18 months, and then was similar at 86% through COVID-19 pandemic. In the adult population, 54% (57/106) were adherent at baseline with clinic follow-up. With implementation compliance increased to 80% initially and was then reported to be 74% during the pandemic. Baseline for all PKU patients showed 81% (161/200) filter card submission within the last 12 months. Submission increased to 91% after 18 months of overdue outreach, and as of October 2021, 85% of all patients had submitted a filter card within the last calendar year. Adult patients specifically showed an increase, with 53% at baseline to 69% after implementation. Conclusion(s): Implementation of an overdue outreach program is successful in re-engaging patients with the PKU clinic and improving adherence to treatment recommendations. We have seen increased patient adherence across all domains and have maintained this improved adherence despite the global COVID-19 pandemic.Copyright © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
The proceedings contain 63 papers. The topics discussed include: doxorubicin cardiotoxicity in human organotypic cardiac slices is modulated by P38 MAPK inhibition in a sex- and isoform-specific manner;validation of a modified response evaluation criteria in solid tumors after stereotactic ablative radiosurgery for lung cancer;safer use of aspirin in older adults, need for a consensus;efficacy of facemasks in prevention of COVID-19: a systematic review;practice patterns of rapid influenza diagnostic test;equity and inclusion in patient centered outcomes research: lessons from the adaptable study at Montefiore site;a solution to decrease potentially inappropriate medications (PIM) use during hospitalization;predictors of misperceptions, risk perceptions, and personal risk perceptions about COVID-19 by country, education and income;cognitive function and the consumption of probiotic foods in older adults: an NHANES study;and registered dietitian nutritionist care impacts nutrition-related outcomes for patients with cancer in the outpatient setting.
ABSTRACT
BACKGROUND AND AIMS: Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. METHODS: A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. RESULTS: One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. CONCLUSION: Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.
ABSTRACT
Purpose: Self-reported coronavirus 2019 (COVID-19) pandemic effects on dietetic job search, employment, and practice of recent graduates were explored within a national workforce survey.Methods: Graduates (2015-2020) who were registered/licensed dietitians or eligible to write the Canadian Dietetic Registration Exam were recruited through dietetic programmes, Dietitians of Canada's communication channels, and social media. The online survey, available in English and French from August through October 2020, included questions about pandemic experiences. Descriptive statistics and thematic analysis were applied to closed and open-ended responses, respectively.Results: Thirty-four percent of survey respondents (n = 524) indicated pandemic effects on job search and described delayed entry into dietetics, fewer job opportunities, and challenges including restricted work between sites. The pandemic affected employment for 44% of respondents; of these, 45% indicated working from home, 45% provided virtual counselling, 7% were redeployed within dietetics, 14% provided nondietetic COVID-19 support, and 6% were furloughed or laid off. Changed work hours, predominantly reduced, were identified by 29%. Changes in pay, identified by 12%, included loss (e.g., raises deferred) or gain (e.g., pandemic pay). Fear of infection and stress about careers and finances were expressed.Conclusion: The COVID-19 pandemic profoundly affected both acquiring positions and employment in 2020 for recent dietetic graduates.
ABSTRACT
The COVID-19 pandemic presented clinical and logistical challenges in the delivery of adequate nutrition in the critical care setting. The use of neuromuscular-blocking drugs, presence of maxilla-facial oedema, strict infection control procedures, and patients placed in a prone position complicated feeding tube placement. We audited the outcomes of dietitian-led naso-jejunal tube (NJT) insertions using the IRIS (Kangaroo, USA) device, before and during the COVID-19 pandemic. NJT placement was successful in 78% of all cases (n = 50), and 87% of COVID-19 cases. Anaesthetic support was only required in COVID-19 patients (53%). NJT placement using IRIS was more difficult but achievable in patients with COVID-19.Copyright © The Intensive Care Society 2023.
ABSTRACT
Nutrition plays a critical role in preventing, managing, and treating noncommunicable diseases;thus it is essential physicians be able to appropriately refer to and collaborate with interprofessional (IP) care team members, like registered dietitian nutritionists (RDNs). This study evaluated the effectiveness of the Nutrition Clinical Experience (NCE) to increase first-year medical students' (M1s′) understanding of RDNs' roles on the IP healthcare team, common reasons to consult a RDN, and interventions RDNs implement. M1s participated in a 1.5 or 2-h IP clinical observation experience with an outpatient or inpatient RDN. Due to the COVID-19 pandemic, virtual, in-person, and hybrid experiences were offered. Before the experience, students were provided a handout with an overview of a RDN's role, description of medical nutrition therapy, and example cases. During the NCE students shadowed a RDN as they conducted outpatient encounters or inpatient rounds, and were encouraged to discuss real or sample patient cases. Students and RDNs answered post-experience 5-point Likert surveys and free-response questions to evaluate experience effectiveness. Of responding students, 96% agreed or strongly agreed the experience helped them learn about RDNs' roles and 99% agreed or strongly agreed they were more likely to involve a RDN in patient care following the experience. Additionally, after the experience, 78% of participating students identified at least one common reason to consult a RDN and 70% described at least three interventions that RDNs implement. All responding RDNs agreed or strongly agreed the experience is valuable to students and 85% agreed or strongly agreed the NCE allowed them to communicate their roles to students. The ability to deliver the experience virtually makes it a useful curricular program for schools without on-site RDNs to engage preclinical students in IP experiences. This report includes materials required for the experience. © 2023 Elsevier Inc.
ABSTRACT
Introduction: Patients who have had a stroke or transient ischaemic attack (TIA) are at high risk of recurrent events. Around 90% of strokes are associated with ten modifiable risk factors. The prevalence of modifiable risk factors is high, with 89% of stroke clinic patients at Guy's and St. Thomas' Hospital having at least one. This study aimed to explore the patient experience of a novel virtual dietetic secondary prevention service, between November and December 2020, developed in response to the COVID-19 pandemic. Method(s): A questionnaire was developed to explore patients' experience of receiving virtual consultation with the Specialist Stroke Dietitian for the secondary stroke or TIA prevention. The questionnaire, informed by a literature review, was piloted with dietitians and patients. The Questionnaire was used to develop a topic guide for structured in-depth telephone interviews. Patients (n=8) who completed a telephone consultation with the Stroke Dietitian were invited to participate in a structured telephone interview with the researcher. The Framework method was used for thematic analysis. Result(s): Six patients aged 30-69 years discussed their experience of secondary prevention dietetic consultations. Thematic analysis suggests that new knowledge obtained, nutrition education provided, and the Dietitian's interpersonal communication style were key factors that improved confidence, facilitated behaviour change and contributed to a positive patient experience. Participants expressed a preference for telephone appointments rather than face-to-face or video. Conclusion(s): Exploration of patient experience is central to the design of novel clinical services. Our pilot questionnaire can be modified for use in future stroke service development.
ABSTRACT
Introduction: Dietary supplement use is continuously increasing in the world and it seems to be more common among women. Data on supplement habits of women in Turkey are still limited. The purpose of this study is to determine dietary supplement use and to evaluate associated factors in Turkish women in the pre-COVID-19 period. Methodology: A total of 727 Turkish women (33.4[10.3] years;25.9[4.57] kg/m2;162.9[6.81] cm) participated in this cross-sectional study. After piloting, the participants completed a six-part questionnaire form that was administered either face-to-face or over the phone by a trained dietitian. The questionnaire intended to collect data about demographic characteristics, use of dietary supplements and factors influencing supplement choices such as eating habits, physical activity and lifestyle habits. Result(s): A total of 307 participants (42.2%) used at least one dietary supplement within the previous year. The most commonly used was iron (30.6%) followed by vitamin D (30.6%), vitamin B12 (26.7%), multivitamins (18.2%), and calcium (11.4%). Supplement use decreased with higher physical activity (p=0.002). Furthermore, it was significantly higher among women who consume meals at regular times (p=0.001) and those that avoid fast food consumption (p=0.014). However, the use of dietary supplements was not associated with lower BMI, older age or higher academic level (p>0.05). Conclusion(s): More than 40% of women were reported using dietary supplements. The use of supplements was not associated with lower BMI, higher physical activity, older age, higher academic level smoking or drinking. Turkish women seem to show a different consumer profile from typical dietary supplement users.Copyright © 2022 Asociacion Espanola de Dietistas-Nutricionistas. All rights reserved.