A comparison of a home parenteral nutrition service with the current European (ESPEN) guidelines on chronic intestinal failure in adults.

BACKGROUND & AIMS: Comprehensive evidenced based guidelines on appropriate and safe provision of home parenteral nutrition (HPN) have been developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) in 2016 and 2020. These guidelines provide clinical standards of care against which the current practice of HPN services can be audited. The aim of this study was to audit a single center's current practice against 183 recommendations on supporting patients on HPN. The objective was to measure compliance and identify areas for quality improvement. METHODS: A retrospective audit of the HPN service received by patients from January 2019-May 2021 was conducted. The ESPEN guidelines were used as a benchmark to measure compliance of healthcare practice. Compliance was evaluated for the 13 subject areas included in the 2016 guideline and the 6 subject areas included in the 2020 guideline. Compliance was calculated as the percentage of criteria fully met for each subject area and an overall compliance rate with each guideline. RESULTS: Overall, compliance with the recommendations from 2016 was 80% and compliance with the recommendations from 2020 was 65%. Within the 2020 guideline there were 24 recommendations where noncompliance was found, 15 of these were due to the absence of a nutrition support team and dedicated intestinal failure unit. CONCLUSION: This audit and evaluation of current practice has identified areas of good evidence-based healthcare practice providing HPN. However, the absence of funding of a nutrition support team to provide a service to patients on HPN was identified as a major barrier to compliance with ESPEN recommendations in this study.

The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: Sarcopenia is defined as a progressive loss of skeletal muscle mass, strength and physical performance. Myosteatosis is an increase of intra- and intermuscular fat and can be measured radiologically by muscle attenuation. The study aim was to perform a systematic review and meta-analysis on the prognostic potential of sarcopenia and low muscle attenuation in relation to 3-year survival rates (3YSR) and 5YSR in epithelial ovarian cancer (EOC). METHODS: A systematic literature search was conducted using the databases Ovid Medline, EMBASE, and Scopus, using PRISMA guidelines, from inception to 10th of May 2019. Studies evaluated the prognostic potential of sarcopenia and low muscle attenuation on 3YSR and 5YSR in EOC. Quality assessment of included studies was performed using the Methodological Index for Non-Randomised Studies criteria. RESULTS: A comprehensive search of databases resulted in the identification of 2194 studies, resulting in 1695 citations meeting the inclusion criteria. Six studies were included for systematic review. Sarcopenia was not significantly associated with improved 3YSR (OR 1.7, 95% CI 0.8-3.5, p = 0.15) or 5YSR (OR 1.8, 95% CI 1.0-3.2, p = 0.07) in meta-analysis. Normal muscle attenuation was associated with a favourable 3YSR (OR 3.0, 95% CI 2.0-4.5, p < 0.001) and 5YSR (OR 2.3, 95% CI 1.6-3.4, p < 0.001) compared to low muscle attenuation. CONCLUSION: Our meta-analysis indicated normal muscle attenuation was significantly associated with improved 3YSR and 5YSR in patients with EOC. Sarcopenia was not significantly associated with 3YSR or 5YSR in patients with EOC.

Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance.

OBJECTIVE: Optimize patient access to mealtime assistance, decrease missed meal incidence, risk of malnutrition, reduce food waste and staff rework. DESIGN: Lean Six Sigma methodology informed a pre/post intervention design. SETTING: 31 bed ward including Specialist Geriatric services and Acute Stroke Unit within an Irish University teaching hospital. PARTICIPANTS: Clinical and non-clinical staff including catering, nursing, speech and language therapy, dietetics and nutrition; patients, relatives. INTERVENTIONS: An interdisciplinary team used the structured Define/Measure/Analyse/Improve/Control (DMAIC) framework to introduce visual aids and materials to improve the access of patients to assistance at mealtimes. MAIN OUTCOME MEASURES: Pre and post outcomes measures were taken for the number and cost of uneaten meals, rework for staff, staff and patient satisfaction, patient outcomes. RESULTS: Following a 1-month pilot of a co-designed process for ensuring access to assistance at mealtimes, average wasted meals due to staff not being available to assist patients requiring mealtime assistance went from 3 per day to 0 corresponding to an average reduction of 0.43 kg per participating patient in food waste per day. Patients receiving assistance did not require additional oral therapeutic nutritional supplements, evidenced no new incidences of aspiration pneumonia or swallowing difficulties and were discharged without requirement for ongoing Dietetics and Nutrition support. Following a 6 month Control period comprising repeated PDCA cycles, the initiative was incrementally introduced to a further 10 wards/units, with positive feedback from patients and staff alike. CONCLUSION: The co-designed new process highlights the importance of staff and patient collaboration, inclusion and participation in designing quality improvement projects.

Effectiveness of Nursing Education to Prevent Inpatient Suicide.

BACKGROUND: Inpatient suicide is recognized by The Joint Commission as a preventable sentinel event associated with inadequate patient and environmental assessments. Strategies are needed to meet this Joint Commission requirement. METHOD: Community hospital nurses were provided with classes to increase knowledge of inpatient suicide, patient assessments, and appropriate care. Independent pre- and postclass assessments were performed to measure nurses' confidence when talking to patients about suicidal thoughts and to assess nursing knowledge of actions to take when an at-risk patient is identified. RESULTS: Education significantly increased nurses' confidence talking to patients about three of four confidence measures and increased their knowledge of actions to take when suicidal thoughts are identified. Confidence was lower in nurses with more experience; therefore, experience does not appear to increase confidence, and education is needed. CONCLUSION: This study demonstrated that a focused in-service education program can increase nurses' confidence to dialogue with patients about suicidal thoughts and nurses' knowledge of actions to prevent inpatient suicide. J Contin Educ Nurs. 2017;48(9):413-419.

Poly(9,9-dialkyl-3,6-dibenzosilole)--a high energy gap host for phosphorescent light emitting devices.

The preparation of the 3,6-disubstituted dibenzosilole monomers , and by two different routes is described; Suzuki copolymerisation afforded poly(9,9-dioctyl-3,6-dibenzosilole) which has a sufficiently high triplet energy (2.55 eV) to function as a host for green electrophosphorescent emitters.

Poly(2,7-dibenzosilole): a blue light emitting polymer.

2,7-Disubstituted dibenzosilole monomers have been prepared by the selective trans-lithiation of 4,4'-dibromo-2,2'-diiodobiphenyl followed by silylation with dichlorodihexylsilane. Suzuki copolymerization of dibromo and bis(boronate) monomers afforded poly(9,9-dihexyl-2,7-dibenzosilole) which showed better efficiency than the corresponding polyfluorene in a single layer light emitting device. Preliminary studies demonstrated this to be a promising blue light emitting polymer.