Total nutritional therapy: a nutrition education program for physicians.

OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.

Total nutritional therapy: a nutrition education program for physicians / Tratamiento nutricional total: programa para la educación de los medicos en nutrición

Objective: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. Research Methods & Procedures: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. Results: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. Conclusions: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents (AU)

Objetivo: Casi la mitad de todos los pacientes hospitalizados se encuentran desnutridos y los médicos tienen muy poco conocimiento o apenas utilizan el soporte nutricional. Para corregir este problema, la Federación Latinoamericana de Nutrición Parenteral y Enteral (FELANPE) ideó un curso introductorio de nutrición clínica para médicos de dos días, con el apoyo de los Laboratorios Abbott. El objetivo del tratamiento nutricional total (TNT) es ayudar al médico a aprovechar sus conocimientos de nutrición para incrementar la conciencia sobre malnutrición y aplicación del tratamiento nutricional. Desde 1997, más de 8.000 médicos han completado el curso TNT en 16 países latinoamericanos. Métodos y procedimientos experimentales: Durante 1999 y 2000, 675 participantes respondieron, seis meses después de haber terminado el curso TNT, a una encuesta en la que se pretendía averiguar la repercusión que había tenido el curso en el uso de la evaluación nutricional, los equipos de apoyo nutricional o las consultas sobre nutrición en la práctica clínica y si habían participado en alguna asociación o conferencia de nutrición. Resultados: La mayoría de los médicos que rellenaron la encuesta había aumentado el uso de las herramientas de evaluación nutricional y el tiempo dedicado a este tratamiento; asimismo, había aumentado el número de pacientes que recibieron tratamiento nutricional. Conclusiones: El curso TNT ha resultado un modelo eficiente para la educación de los médicos generales en nutrición clínica. Este curso debería integrarse en la formación de los médicos residentes (AU)

Tratamiento de las estenosis faringeas por la ingestion de causticos. / Treatment of the pharyngeal stenosis caused by caustic ingestion

Este articulo se basa en la revision de los resultados obtenidos en cinco pacientes que ingirieron causticos y que presentaron lesiones faringeas que motivaron tratamiento quirurgico mediante substitucion con tubo esofagico. Se describen diferentes procedimientos que tuvieron como finalidad tratar las lesiones laringofaringeas con la idea de aprovechar funcionalmente el esofago reconstruido

Acalasia del esofago: resultado de su tratamiento quirurgico. / Achalasia of esophagus: result of its surgical treatment

Se efectuo una revision de 76 pacientes de acalasia tratados mediante cardiomiotomia; 30 en el periodo 1975-1980, serie actual, y 46 en el periodo 1963-1973 serie previa.En todos los pacientes excepto en 8, se efectuo un procedimiento antireflujo agregado, siendo en la mayor parte funduplastia posterior. Los resultados comparativos entre las 2 series no tuvieron practicamente diferencias. La valoracion de las series combinadas mostraron fracasos en el 8.9% de los casos y resultados satisfactorios en el 91.1%. Solo 2 pacientes presentaron reflujo gastroesofagico, los cuales formaron parte del grupo en quienes se efectuo Heller sin procedimiento antireflujo. Los resultados evidencian la utilidad de la cardiomiotomia con procedimiento antireflujo agregado

Deteccion gammagrafica de lesiones venosas secundarias a cateterismo para nutricion parenteral total. Estudio prospectivo. / Gammagraphic detection of venous lesions secondary to total parenteral nutritional catheterism. A prospective study

Se efectuo un estudio prospectivo en 25 pacientes que recibieron nutricion parenteral total por via subclavia con el fin de detectar lesion venosa temprana. Se empleo tecnecio 99 con estudios dinamicos de la circulacion venosa a nivel subclavio, con tomas secuenciales en la camara de centelleo. El metodo permitio descubrir tempranamente las lesiones venosas que se observaron en 20 por ciento de los casos y son problablemente secundarias a la presencia del cateter en la luz vascular y reversibles en forma espontanea tras retirar el mismo

Zinc and copper abnormalities in fasting patients undergoing total parenteral nutrition.

Low serum levels of zinc and copper have recently been reported in association with TPN and the fasting state. A prospective study during May 1977 through November 1978 was performed in 28 patients undergoing TPN. Serum and urinary Zn and Cu levels were detected; the patient population was divided in septic and non septic groups and each was subdivided according to plasma administration. In both groups low serum Zn and Cu levels were detected. The urinary losses were greater in the group with sepsis. Three patients had clinical manifestations of Zn deficiency, in two it was reversible with the administration of diet or oral Zn. The third one died of sepsis. The low serum levels found in our patients suggested that plasma administration might be insufficient to cover the daily requirements of such elements. This requirement is augmented by the increased urinary losses seen in septic postoperative stages.

Condiciones actuales de la nutricion artificial en Mexico. / Current conditions of the artificial nutrition in Mexico

Los metodos de nutricion artificial (parenteral y enteral) conocen en la actualidad un auge extraordinario. En nuestro pais, a pesar de algunas carencias en los componentes de los mismos, es posible realizar la mayoria de los mismos

[Parenteral nutrition. Experience of 2 years]. / Nutricón parenteral. Experiencia de dos años.

Total parenteral nutrition is a new method, in our media, that permits the direct administration to the blood stream of all the necesary elements for cellular synthesis. Total parenteral nutrition finds in the field of gastroenterology a wide range of indications to correct and prevent malnutrition in a patient who can not eat. Treatment, by the Department of Hyperalimentation, at the Hospital General del Centro Médico Nacional, during a two years period, of 150 patients, has permitted us to evaluate the results and complications of the method and to insist on the importance of a good nutrition in the overall treatment of a patient with a gastro-intestinal disease.

[Candida infections and their evolution in patients receiving parenteral feeding]. / Infecciones por Cándida y su evolución en pacientes con nutrición parenteral

Parenteral nutrition has completely modified the prognosis in a variety of illnesses of digestive tract. The method is not devoid of complications, and septicemias, particularly those originated by fungii of the Candida species, have been informed to occur with an alarming frequency of up to 23%. The patient on parenteral nutrition is an ideal prey for this kind of infection, but if the technic and the metabolic control are brought down considerably. In 30 patients of the Department of Gastroenterology at the Hospital General, Centro Médico Nacional, Instituto Mexicano del Seguro Social, we have studied the frequency and evolution of Candida infections, detected before or during the treatment with parenteral nutrition to know the influence of the method on this type of host-parasite relationship. In the initial cultures 60% of the patients develop Candida in one or several regions; percentage increased to 63.3% at the end of 15 days and decreased spontaneously to 33% at the end of the treatment on the 30 patients we did not observe a septicemia due to Candida. We conclude that parenteral nutrition, while correcting the nutritional state of the patient, with a good technic, favors the spontaneous withdrawal of the fungii, without the necessary specific treatment.

[Elemental diet and external fistulae of, the digestive system]. / Dieta elemental y fistulas externas del aparato digestivo

An elemental diet is a food which provides the basic needs in calories, proteins, vitamins and minerals with two advantages: it is predigested and leaves minimal or no residue to provide bulk. The care of 20 patients, with an elemental diet, presenting 20 external fistulas (75 per cent with low output and 25 per cent with high output) succeeded to obtain a spontaneous healing in 75 per cent of the cases, and an improvement of the general conditions of 15 per cent of the patients who were operated on because of fistula persistency. The death rate was 10 per cent. We think that the elemental diet is a useful tool in the treatment of external fistulas of patients who have preserved their bowel movements and an output smaller than 500 ml. in 24 hrs.