Impact of nurse practitioner navigation on access to care for patients with refractory gastroesophageal reflux disease.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common digestive complaint that can negatively affect patients' quality of life and have serious complications if inadequately treated. LOCAL PROBLEM: Facilitating prompt and efficient access to digestive care is imperative especially given the current burden of gastrointestinal diseases such as GERD. METHODS: A clinical team conducted a quality improvement study in which a nurse practitioner (NP) navigator performed a preconsultation chart review for patients with refractory GERD referred to an Esophagus Center between August and December 2018. INTERVENTIONS: Based on preconsultation chart review, the NP navigator arranged for diagnostic testing and follow-up. Days from consultation to testing completion and establishment of plan were tracked and compared with historic controls. The NP navigator documented time spent for chart review and care coordination. RESULTS: The median number of days from consultation to testing completion for patients who underwent NP navigation and required diagnostic testing (n = 26) was 33.5 as compared with 64.5 for historic controls who required testing but received usual care (n = 28) (p = .005). The median number of days from consultation to establishment of a management plan was 52 for patients who underwent NP navigation as compared with 97 for historic controls who did not (p = .005). The mean amount of time spent by the NP navigator for chart review and care coordination was 17.5 min (n = 30). CONCLUSIONS: Incorporation of NP navigators into gastroenterology practices offers a potential solution for timelier patient care delivery.

Caregiver Burden in Gastroparesis and GERD: Correlation with Disease Severity, Healthcare Utilization and Work Productivity.

BACKGROUND: Caregiver burden can be significant in chronic gastrointestinal diseases. No studies have been performed to evaluate caregiver burden in gastroparesis or gastroesophageal reflux disease (GERD). AIMS: (1) Assess the caregiver burden in gastroparesis and GERD patients and healthy volunteers (HVs); (2) correlate the caregiver burden of these patients to the severity of patients' symptoms, healthcare utilization, and work productivity of the patients and the caregivers. METHODS: Patients with gastroparesis and GERD, seen between June 2018 and November 2018, completed Patient Assessment of Gastrointestinal Symptoms, Work Productivity and Activity Impairment (WPAI) and healthcare utilization questionnaires. The caregivers of these patients completed Zarit Burden Interview (ZBI) and WPAI questionnaire. HVs and their potential caregivers also completed these questionnaires. RESULTS: Forty-seven patients (gastroparesis = 31, GERD = 17), 12 HVs, and their caregivers completed questionnaires. Caregivers of gastroparesis patients reported high burden on ZBI (27.7 ± 2.9), greater than the caregivers of GERD (14.9 ± 2.5) and HVs (5.5 ± 1.6, p < 0.01). Among all patients, the caregiver burden had a strong correlation with patients' Gastroparesis Cardinal Symptom Index (GCSI) total score (rs = 0.63, p < 0.01) and moderate correlations with the number of patients' physician office visits (rs = 0.46, p < 0.01) and the number of work hours missed by caregivers due to patients' symptoms (rs = 0.36, p = 0.04). Using multivariable regression, both presence of gastroparesis and other comorbidities significantly predicted caregiver burden, F(2, 33) = 15.94, p < 0.0001, R2 = 0.491. CONCLUSIONS: Caregivers of gastroparesis patients have high caregiver burden that strongly correlates with patients' GCSI total score. Interventions to reduce symptom severity of Gp patients may reduce the caregiver burden.

Gord.

Essential facts Bringing up food after eating is a normal process that can occur in healthy infants, children and young people. Gastro-oesophageal reflux (GOR) is most common in babies, affecting four in ten infants. Gastro-oesophageal reflux disease (GORD) is reflux that is so severe medical treatment is required. Differentiating between GOR and GORD is difficult because the terms are often used interchangeably.

Intervenciones de enfermería para el cuidado del paciente pediátrico con enfermedad del reflujo gastroesofágico / Interventions of infirmary for the care of pediatric patient with disease of gastroesophageal reflux

Antecedentes: Hemos creado la guía de práctica clínica de las intervenciones de enfermería para el cuidado del paciente pediátrico con enfermedad de reflujo gastroesofágico.Métodos: Esta guía de intervención de la práctica clínica de Enfermería forma parte de los guías que integran el Catálogo General de la Práctica Clínica, la cual se instrumentó a través del programa de acción específico: Guías de desarrollo de la práctica clínica, de acuerdo con las estrategias y líneas de acción que considera el Programa Nacional de Salud. 2013-2018 Esta guía de práctica clínica guiará al profesional de la salud para que otorgue cuidados especiales a este tipo de pacientes, al mismo tiempo que se basa en el conocimiento actualizado y estandarizado que fundamenta la evidencia y la toma de decisiones que favorecen la calidad de vida del paciente con la enfermedad de reflujo gastroesofágico, disminuyendo así las complicaciones y la mortalidad súbita. Y al mismo tiempo aumentar la eficiencia del proceso de atención en la enfermería propiciando un cuidado seguro y libre de riesgos.Resultados: Se favorecerá la mejora de la eficiencia, seguridad y calidad de la atención que contribuye, por la presente, para el bienestar de la gente y de las comunidades, que es el objetivo central y la razón de ser de los servicios de salud.Conclusión: el propósito de este catálogo es establecer un estandar nacional para orientar las decisiones clínicas de guía basadas en las recomendaciones sufridas en la mejor evidencia disponible y que tiene las intervenciones dirigidas a la identificación oportuna de los signos y síntomas y complicaciones, así como intervenciones de colaboración para el tratamiento y medidas de seguridad.

Background: We created the guide of clinical practice of interventions of infirmary for the care of pediatric patient with disease of gastroesophageal reflux. Methods: This guide of clinical practice intervention of infirmary forms a part of the guides who integrate the Guides' Main Catalogue of Clinical Practice, which is orchestrated across the Specific Program of Action: Guides' Development of Clinical Practice, according to the strategies and lines of action that considers 2013-2018 National Health program. This guide of clinical practice will guide the professional of health provider to taken care this type of patients, rely on updated and standardized knowledge based on the evidence and to take decisions that affect favorably the quality of life of the patient with gastroesophageal reflux disease as well as to diminish complications, sudden mortality, increase the efficiency of the process of care in infirmary and to propitiate a sure and free care of risks.Results: it will favor the improvement of the efficiency, safety and quality of the care contributing, hereby, to the wellbeing of the people and of the communities, which it is the central aim and the reason to be of health services. Conclusion: the purpose of this catalog is to establish national modal to orientate the guide clinical decisions based on recommendations sustained in the best available evidence and having interventions directed to the opportune identification of signs and symptoms and complications as well as collaborative interventions for the treatment and safety measures.

Antecedentes: Criamos o guia da prática clínica de intervenções de enfermaria para o atendimento de pacientes pediátricos com a doença do refluxo gastroesofágico.Métodos: Este guia de intervenção prática clínica da enfermaria faz parte dos guias que integram 'principal Catalogue of Clinical Practice, que é orquestrada em todo o programa de acção específicos: Guias' as Guias de Desenvolvimento da prática clínica, de acordo com as estratégias e linhas de ação que considera 2013-2018 programa Nacional de Saúde. Este guia da prática clínica vai orientar o profissional de prestador de cuidados este tipo de pacientes, dependem de conhecimento atualizado e padronizado com base nas provas e tomar decisões que afectam favoravelmente a qualidade de vida do paciente com doença do refluxo gastroesofágico, bem de modo a diminuir as complicações, a mortalidade súbita, aumentar a eficiência do processo de atendimento em enfermaria e propiciar um atendimento seguro e livre de riscos. Resultado: ele vai favorecer a melhoria da eficiência, segurança e qualidade do contribuinte cuidado, por este meio, para o bem-estar das pessoas e das comunidades, que é o objetivo central e a razão de ser dos serviços de saúde.Conclusão: o objectivo deste catálogo é estabelecer modal nacional para orientar as decisões clínicas de orientação com base nas recomendações sustentadas na melhor evidência disponível e com intervenções dirigidas à identificação oportuna de sinais e sintomas e complicações, bem como intervenções de colaboração para o tratamento e medidas de segurança.

Managing gastroesophageal reflux symptoms in the very low-birth-weight infant postdischarge.

Gastroesophageal reflux and gastroesophageal reflux disease symptoms are common challenges for very low-birth-weight infants (<1500 g). These symptoms frequently result in feeding difficulties and family stress. Management of symptoms across healthcare disciplines may not be based on current evidence, and inconsistency can result in confusion for families and delayed interventions. The feeding relationship between infant and caregivers may be impaired when symptoms are persistent and poorly managed. An algorithm for managing gastroesophageal reflux-like symptoms in very low-birth-weight infants (from hospital discharge to 12 months corrected age) was developed through the formation of a multidisciplinary community of practice and critical appraisal of the literature. A case study demonstrates how the algorithm results in a consistent approach for identifying symptoms, applying appropriate management strategies, and facilitating appropriate timing of medical consultation. Application to managing gastroesophageal reflux symptoms in the neonatal intensive care unit will be briefly addressed.

Enfermedades esofágicas: enfermedad por reflujo gastroesofágico, Barrett, acalasia y esofagitis eosinofílica / Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis

En la Digestive Disease Week 2014 se han presentado importantes novedades en patología esofágica. A destacar, respecto de la enfermedad por reflujo gastroesofágico, la utilidad de la impedanciometría para el diagnóstico de la enfermedad por reflujo, o la eficacia de los inhibidores de la bomba de protones para el tratamiento del dolor torácico no coronario. Respecto del esófago de Barrett, que su prevalencia es idéntica en pacientes con y sin síntomas de reflujo, que el < 1 cm probablemente no precisa seguimiento y que en pacientes de edad y con Barrett largo, la endoscopia inicial pasa por alto hasta un 2% de lesiones significativas. Respecto de la acalasia, la miotomía quirúrgica no es superior a la dilatación endoscópica y podría ser menos efectiva que la miotomía endoscópica peroral (POEM). Respecto de la esofagitis eosinofílica, es importante tomar biopsias sistemáticamente en pacientes con disfagia, para no pasar por alto casos de esofagitis eosinofílica y que, en esta patología, la dilatación endoscópica rutinaria no solamente no parece útil para mejorar el curso de la enfermedad, sino que incluso podría empeorar la respuesta al tratamiento médico

At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment

[Calories, proteins - what does the intensive care patient need?]. / Kalorien, Proteine - was braucht der Intensivpatient?

It is increasingly recognized that the nutrition of critically ill patients is a highly complex activity with many unanswered questions. Much research has been performed showing that early enteral nutrition helps to avoid complications. In addition, it has already been shown that the calorie goal as the sole diet goal rather plays a minor role, if one pays attention to sufficient supply of proteins. The diet of the different patient groups with their very individual physiological conditions and their very different diseases are another difficile question in nutritional therapy. The question about the best access path currently appears clearly to be the way of enteral nutrition. Although there seems to be no clear advantage to the gastric or jejunal route, the gastric tube is apparently used more often in clinical practice due to the ease of placement. Reflux control is also currently controversially discussed. To assess the intestinal transport capacity, control of reflux is inevitable, but the amount of reflux that should be considered as cut-off criteria is still unclear. The field of immunonutrition or the substitution of selenium, glutamine, and other substances requires further research. The goal of this article is to provide the reader with a review of the current literature concerning nutritional needs of intensive care patients.

Factors relating to quality of life after esophagectomy for cancer patients in Taiwan.

BACKGROUND: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries. OBJECTIVE: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan. METHODS: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery. RESULTS: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL. CONCLUSIONS: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Jejunostomy enteral feeding in children: outcome and safety.

BACKGROUND: The aim of this study was to report on the clinical outcome and safety of jejunostomy tube feeding used in our clinical setting for more than 14 years. MATERIAL AND METHODS: A retrospective study of all children who underwent a surgical catheter jejunostomy placement between July 1996 and March 2010 was conducted. Data were collected regarding the outcome and complications. RESULTS: Thirty-three children (14 girls) were included. The median age at the time of primary surgery was 1.43 years (range, 0.15-17.7 years), and the median time of follow-up was 2.34 years (range, 0.27-12.6 years). Seventeen children were severely neurologically impaired (NI). Surgical insertion of a jejunostomy tube was performed due to 1 or more of the following indications: gastroesophageal reflux disease (GERD), failure to thrive, recurrent pneumonia, esophageal disease, or oral feeding difficulties. The effect of the indications showed a reduction in GERD and pneumonia. Feeding difficulties also decreased. Weaning was possible in 12 of 16 children without NI but in only 2 of 17 with NI. Major complications requiring surgical reoperation affected 8 children. No mortality was related to the jejunostomy feeding catheter. CONCLUSION: In selected cases, surgically placed jejunostomy tubes for feeding in children is an effective and safe method to overcome GERD, feeding difficulties, or recurrent pneumonia without major surgery.

Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women.

AIMS AND OBJECTIVES: To determine the incidence of pregnancy-related physical symptoms in healthy pregnant women and their management strategies. BACKGROUND: In normal progression of pregnancy, many symptoms were experienced. Pregnancy-related physical symptoms may have a negative effect on pregnant women's quality of life. However, pregnant women avoid taking medications from the fear that the medication they use may have a harmful effect on the foetus. Therefore, they practise nonpharmacological methods to help them manage their pregnancy-related physical symptoms. DESIGN: This study used a comparative and descriptive design. METHODS: The study population comprised of pregnant women who were visiting for routine check-up and/or examination in the obstetrics gynaecology outpatient clinics of three hospitals in Erzurum, Turkey. The data were collected via a questionnaire including socio-demographic items and questions to identify the pregnancy-related physical symptoms that they experienced and their management strategies. RESULTS: The top three most reported complaints were nausea-vomiting (87·8%), fatigue (77·9%) and breast pain-tenderness (76·2%) during the first trimester, whereas polyuria (79·9%, 88·4%), fatigue (75·6%, 88·4%) and heart burn (71·3%, 81·8%) during the second and third trimesters. Depending on the symptoms, the pregnant women either did nothing or took correct, incorrect or empirical actions to manage their problems. Data revealed that the major source of knowledge was based on their previous experience and that of close relatives. As their education level increased, the percentage of women taking scientifically proven action to correct the problem increased. CONCLUSIONS: Various physical symptoms were experienced by women in each trimester of pregnancy. The majority of the women did not do anything to alleviate their physical symptoms. RELEVANCE TO CLINICAL PRACTICE: Midwives and nurses should question the strategies used by pregnant women. In this way, the inappropriate and incorrect practices can be determined, and education on the appropriate practices can be provided.

Evidence-based recommendations for GERD treatment.

Gastroesophageal reflux disease (GERD) is a common presentation in primary care. New research findings have implications for the diagnosis and management of GERD. The purpose of this article is to synthesize current research related to the diagnosis and management of GERD in adults and to make practice recommendations.

Gastroesophageal reflux in critically ill patients.

Gastroesophageal reflux (GER) is a common occurrence in critically ill, mechanically ventilated patients. Reflux can lead to pulmonary aspiration of gastric contents and subsequent pneumonia. Several characteristics of patients, interventions provided in the intensive care unit setting, and factors associated with feeding increase a patient's risk for reflux. Critical care nurses and clinical nurse specialists can identify patients at highest risk for GER by utilizing the patient's history, reviewing the medications, and assessing the current status to provide interventions to reduce the risk of GER and its sequelae of aspiration pneumonia. This article reviews the physiology of GER, risk factors, and interventions to decrease GER in the critically ill patient.

Positioning after feedings: what is the evidence to reduce feeding intolerances?

Nursing's goal is to be the least invasive as the patient's condition allows. As a NICU nurse, each feeding for our patients is a priority for them to grow and develop with the idea to speed discharge to home. When infants develop reflux or have increased gastric aspirates, we are concerned that their weight will taper and their length of stay will increase. Positioning provides nurses with a noninvasive option to care for these patients. The that the right-side position is best for infants to enhance digestion stems from theories of anatomy and physics. Research strengthens this supposition for those infants needing help with decreased gastric motility. Other research supports the left lateral and prone positions for those patients with GER. In practice, a patient does not necessarily have one or the other and in fact may have both GER and slowed gastric motility at any given time. The literature supports the right lateral position for enhancing gastric emptying or motility and left lateral position for GER in the uncomplicated patient with one gastrointestinal concern. The knowledge the research provides is encouraging to provide a solution, but it does not clarify the true issues of a complex patient who can have decreased gastric motility needing the right lateral position and also suffer from symptoms of GER requiring the left lateral position (see Table). For those more complicated infants, the solution might best be choosing the prone position. The prone position should not be forgotten as the findings of many studies, although not often the first choice (best results) showed it to be consistently the second best for digestive problems. In any case, the dominant positions appear to be the right or left lateral side with the prone position considered a reasonable compromise. Further research is needed to provide a clear choice for correct positioning in the NICU population. The reality for nurses is that neonatal patients are often fed every 3 hours and their lives depend on each feeding to provide nutrients for growth. It is ideal for these patients to receive every prescribed feeding and be comfortably placed in a variety of positions. Nurses' assumption that the right lateral position is best is considered, in most cases, to be a true statement for those infants with increased gastric aspirates. For those patients with GER, the left lateral position is more highly preferred. It is important for nurses to be aware of the literature but also guide their practice based on the patient assessment and presentation of symptoms. Future knowledge may provide nurses with the data needed to perfect positioning methods for infants with feeding intolerances.

A review of nonsurgical treatment for the symptom of irritability in infants with GERD.

PURPOSE: The purpose of this review was to assess effectiveness of nonsurgical treatment on irritable behavior of infants with gastroesophageal reflux disease. DESIGN AND METHODS: A systematic literature review was conducted. RESULTS: Research targeted treatment for irritability in infants with gastroesophageal reflux disease. All interventions including placebo were similar in reducing irritability. Which specific intervention is best for which infant is not yet known. Minor adverse effects that could increase discomfort in infants were found with pharmacologic treatments. PRACTICE IMPLICATIONS: Knowledge of the effects of treatment on irritability and regurgitation can assist the nurse to work with other care providers in deciding how best to treat an individual infant.

Strategies used by Jordanian women to alleviate heartburn during pregnancy.

OBJECTIVE: to explore the strategies used by Jordanian women to manage heartburn during pregnancy. DESIGN: an exploratory descriptive study. PARTICIPANTS AND SETTING: 235 Jordanian women from the three regions of Jordan, aged between 18 and 54 years, who were pregnant at the time of the study or had previously had at least one full-term pregnancy. FINDINGS: a number of strategies were used by Jordanian women in the sample for the alleviation of heartburn of pregnancy, including non-pharmacological strategies such as diet and lifestyle changes, pharmacological treatments such as antacids, and the use of home remedies such as drinking cold milk, 'baking powder' in liquid form or herbs, eating cucumber, lintel seeds, or dry tea leaves. Women aged 40 years and older, who had lower income, and were not employed were more likely to use home remedies to manage heartburn in pregnancy than the other groups. Overall, women rated their chosen strategy as useful. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: heartburn can be very uncomfortable and can affect food intake and appetite, daily routine and even sleep. Heartburn during pregnancy is at risk for being poorly managed given that birth is the cure. As a health-care provider, it is important to prepare women and their families to manage heartburn during pregnancy effectively. Midwives should encourage women to seek help from care providers when they need it, and continue to assess heartburn and the strategies used to manage symptoms during pregnancy.

Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care.

BACKGROUND: Up to 50% of patients with gastro-oesophageal reflux disease (GORD) have persistent symptoms despite taking proton pump inhibitors (PPIs) regularly. Lifestyle advice is available to patients, but no previous UK study has tested a behavioural change intervention to help patients self-manage their symptoms. AIM: To determine whether a primary care, nurse-led intervention to address behaviours that promote GORD symptoms results in symptom improvement, an increased sense of control, and a reduced requirement for prescribed medication. DESIGN OF STUDY: A group intervention focusing on diet and stress was delivered to patients with reflux symptoms, recruited in rural general practices. SETTING: General practice in England. METHOD: Forty-two subjects (male 19, female 23) aged 31-86 years took part. Pre- and post-intervention data were gathered using the Brief Illness Perception Questionnaire (BIPQ), the GORD Impact Scale (GIS), and the Hospital Anxiety and Depression Scale (HAD). RESULTS: There was a significant improvement (BIPQ P<0.001, GIS P = 0.008) 3 months after the intervention. There was no reduction in PPI use or change in HAD score. The greatest improvements were demonstrated in domains measuring the patient's sense of control, perception of symptoms, and understanding of reflux. Patients reported benefits including understanding relevant anatomy and physiology, learning behavioural techniques to change eating patterns and manage stress, identifying actual and potential triggers, and developing and executing action plans. CONCLUSION: An education programme for GORD enhances self-management, brings perceived symptom improvement, and promotes a sense of control at 3 months. This type of behavioural intervention, alongside medical management, could improve symptom control for reflux patients with refractory symptoms and should be the subject of a controlled trial.