ABSTRACT
In critically ill trauma patients, adequate nutrition is essential for the body's healing process. Currently, there is no clinical standard for initiating feeds after percutaneous endoscopic gastrostomy (PEG) tube placement. We aimed to demonstrate that early enteral nutrition (EN) is as safe as delayed EN in patients who have undergone PEG tube insertion. We conducted a multi-center, retrospective cohort study of 384 patients from the Prisma Health Trauma Registries who received PEGs. Feeding intolerance was defined as high gastric residuals, nausea, emesis, sustained diarrhea, or ileus. The probability that a patient would experience intolerance was 11.7% in those fed within 6 hours, 5.1% among patients fed between 6 and 12 hours, 6.0% among patients fed between 12 and 24 hours, and 7.6% among patients fed after 24 hours, for which no statistically significant difference was detected. These findings support that early EN after PEG placement is safe in critically ill, trauma patients.
Subject(s)
Enteral Nutrition , Gastrostomy , Humans , Infant, Newborn , Retrospective Studies , Critical Illness/therapy , EndoscopyABSTRACT
BACKGROUND: Inadequate delivery of nutrition in critically ill patients has been shown to have adverse outcomes. A surgical trauma intensive care unit provides unique challenges to enteral feeds. Although volume-based feeding protocols, like Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP), have been successfully used in medical intensive care patients, data are sparse on its safety and efficacy in a surgical intensive care unit population. METHODS: A PEP uP protocol was recently initiated at our American College of Surgeons Level 1 verified trauma center. Medical records of 197 patients before this change (pre-PEP uP) were compared with 295 patients after this change (post-PEP uP). RESULTS: The post-PEP uP group met/exceeded energy goals (defined as 80% of target) more often (57.0% compared with 26.9%, P-value < .001), with an adjusted odds ratio (OR) of 4.98 (95% CI 3.49-7.10), and more often met/exceeded protein goals (57.4% compared with 18.6%, P-value < .001), with an adjusted OR of 11.84 (95% CI 7.94-17.64). There was no significant difference in emesis during this time. Additionally, patients in the post-PEP uP arm had less episodes of hyperglycemia (9% compared with 14.4%, P-value < .001). CONCLUSIONS: Volume-based feeding protocols like PEP uP are safe in critically ill trauma patients and are more effective at delivering energy and protein while limiting hyperglycemic episodes when compared with a traditional delivery method.
Subject(s)
Enteral Nutrition , Glycemic Control , Wounds and Injuries/therapy , Critical Care , Critical Illness/therapy , Energy Intake , Humans , Intensive Care Units , NutrientsABSTRACT
BACKGROUND: Glioblastomas (GBMs) are one of the most devastating primary tumors in humans and often results in minimal survival rates. Over the past 2 decades, patients have accessed the internet to obtain information related to their diagnoses. In this study, we aimed to evaluate the accuracy and the reliability of GBM-related YouTube videos. METHODS: In June of 2017, a search was conducted on YouTube using 6 keywords. Videos were sorted using "Relevance-Based Ranking" option, and the first 3 pages for each search were selected for further analysis. Three independent reviewers evaluated the videos using the validated DISCERN Tool. RESULTS: After sorting 23,100 videos, 9 videos were identified and included for analysis. Of the 9 videos analyzed, 88% (8/9) were from hospitals affiliated with prestigious universities across the country. Of the nine videos included in the analysis, two (22%) scored above a 3. There was an average 55% overlap in the videos analyzed by key term and the keyword search of "Malignant Glioma Treatment" had the highest percentage of videos above a score of 3 (66%). CONCLUSION: Many patients with GBM and their families access information on YouTube to familiarize themselves with the epidemiology, survival, and treatment options for this form of tumor. However, the information that is currently available online is not monitored or vetted using an official filtering process prior to its release. Medical institutions must work to produce more peer-reviewed content in order to improve the availability of credible health information on internet platforms.
Subject(s)
Glioblastoma/therapy , Internet , Patient Education as Topic/methods , Reproducibility of Results , Social Media , Humans , Video RecordingABSTRACT
Genetic studies have shown the effects of various photoreceptors on early photomorphogenic processes, defining the precise time course of red (RL), far-red (FrL) and blue light (BL) action. In this study, the effect of green wavebands in conjunction with these responses is examined. Longer-term (end point; 24-96 h) analysis of hypocotyl elongation in enriched green environments shows an increase in growth compared to seedlings under blue, red or both together. The effect was only observed at lower fluence rates (<10 µmol/m² s). Genetic analyses demonstrate that cryptochromes are required for this GL effect, consistent with earlier findings, and that the phy receptors have no influence. However, analysis of early (minutes to hours) stem growth kinetics indicates that GL cannot reverse the cryptochrome-mediated BL effect during early stem growth inhibition, and instead acts additively with BL to drive cryptochrome-mediated inhibition. Green light (GL) treatments antagonize RL and FrL-mediated hypocotyl inhibition. The GL opposition of RL responses persists in phyA, phyB, cry1cry2 and phot2 mutants. The response requires phot1 and NPH3, suggesting that this is not a GL response, but instead a response to extremely low-fluence rate BL. Tests with dim BL (<0.1 µmol/m² s) confirm a previously uncharacterized phot1-dependent promotion of stem growth, opposing the effects of RL. These findings demonstrate how enriched green environments may adjust RL and BL photomorphogenic responses through both the crys and phot1 receptors, and define a new role for phot1 in stem growth promotion.
Subject(s)
Cryptochromes/genetics , Hypocotyl/radiation effects , Light , Mutation , Phototropins/genetics , Arabidopsis/genetics , Arabidopsis/growth & development , Arabidopsis/radiation effects , Arabidopsis Proteins/genetics , Basic-Leucine Zipper Transcription Factors/genetics , Cell Cycle Proteins/genetics , Gene Expression Regulation, Developmental/radiation effects , Gene Expression Regulation, Plant/radiation effects , Hypocotyl/genetics , Hypocotyl/growth & development , Intracellular Signaling Peptides and Proteins/genetics , Kinetics , Membrane Proteins , Nuclear Proteins/genetics , Phosphoproteins/genetics , Phytochrome A/genetics , Phytochrome B/genetics , Plant Stems/genetics , Plant Stems/growth & development , Plant Stems/radiation effects , Protein Serine-Threonine Kinases , Reverse Transcriptase Polymerase Chain Reaction , Seedlings/genetics , Seedlings/growth & development , Seedlings/radiation effects , Time FactorsABSTRACT
Although DES effectively reduces restenosis, a small but significant number of patients suffer complications of in-stent thrombosis. Thus, each patient's health history should be determined before recommending DES. Patients must understand the importance of post-implantation DAT and the need for continued DAT, potentially for life, in order to reduce complications. Current recommendations advocate at least 12 months of uninterrupted clopidogrel and ASA (lifelong ASA if tolerated). With each new generation of stents, patients experience fewer adverse outcomes and improved quality of life. For the present, DES remains a strong therapeutic option for patients with symptomatic CHD.
