scholarly journals Optimizing foods for special dietary use in Canada: key outcomes and recommendations from a tripartite workshop

2019 ◽  
Vol 44 (11) ◽  
pp. 1258-1265
Author(s):  
Ashleigh K.A. Wiggins ◽  
Andrea Grantham ◽  
G. Harvey Anderson
Keyword(s):  
Tube Feeding ◽  
Infant Food ◽  
Nutritional Recommendations ◽  
Hospital Patients ◽  
Drug Regulations ◽  
Stakeholder Workshop ◽  
Nutritional Needs ◽  
Hospital Stays ◽  
Multi Stakeholder ◽  
Prolonged Hospital

Many health conditions result in unique nutritional requirements (e.g., protein restriction, low energy, fortification) and the need to consume foods in nontraditional formats (e.g., liquid diets, supplements, tube feeding). In Canada, 45% of hospital patients are malnourished upon admission, resulting in prolonged hospital stays, increased health care costs, and higher mortality rates. Fortunately, advances in nutrition and food science enabled the development of products that provide nutritional support for individuals in hospital and at home. In Canada, these products are defined as Foods for Special Dietary Use (FSDUs). Canada’s regulation of FSDUs (Division 24 of the Food and Drug Regulations) is particularly stringent and outdated, which results in products that do not meet current nutritional recommendations or allow application of current technologies, and lack harmonization with other countries. Many of these issues also apply to the Infant Food regulations in Canada. To provide vulnerable populations with optimal nutrition, experts have suggested modernization of Canadian FSDU regulations. A multi-stakeholder workshop established several recommendations and goals toward that end while ensuring the safety of consumers. These include (i) assessing other jurisdictions’ regulations; (ii) tracking products currently on the market; (iii) temporary marketing authorizations to permit products on the market and collect data; (iv) use of incorporation by reference for compositional requirements; (v) support for research of FSDU and nutritional needs of special population; and (vi) better understanding accessibility to these products. Overall, the proposed vision is for a modern, safe, flexible, innovative, and health-driven regulatory framework for FSDU in Canada.

A study on the design of a wardrobe, for patients bed-ridden with cancer, applying the knowledge of anonymous design

Impact ◽  
2020 ◽  
Vol 2020 (7) ◽  
pp. 45-47
Author(s):  
Naoko Fujii
Keyword(s):  
Hospital Stay ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
The Other ◽  
Human Beings ◽  
Prolonged Hospital Stay ◽  
Hospital Patients ◽  
Hospital Gowns ◽  
Hospital Stays ◽  
Prolonged Hospital

The majority of human beings will be admitted to hospital at some point over the course of their lives. For the more fortunate among us, these hospital stays will be brief and will barely register as a significant experience. However, for others, being admitted for weeks or months at a time will be necessary in order to combat and recover from whatever it was that made admittance to hospital necessary. While it is easy to think of many reasons why a prolonged hospital stay might be undesirable, one that may escape our attention is the clothes that are worn by patients during their stay. Once a patient has been assigned a bed, they are often given a gown which they put on without thought and then lie down. The gowns that are given to patients are generally designed with healthcare professionals in mind. For example, in Japan pyjamas and yukata (bathrobes) are used as hospital gowns because they have a front opening that is easy to use during treatment and nursing care. In addition, the other gowns can be opened from the ankle to the crotch using the zip. Dr Naoko Fujii has focused her career on designing clothes for hospital patients and believes that there is a way to satisfy the practical needs of a hospital and the care it gives at the same time as satisfying the requirements of patients. She is now focusing her attention on this challenge.

A study on the design of a wardrobe, for patients bed-ridden with cancer, applying the knowledge of anonymous design

Impact ◽  
2020 ◽  
Vol 2020 (2) ◽  
pp. 33-35
Author(s):  
Naoko Fujii
Keyword(s):  
Hospital Stay ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
The Other ◽  
Human Beings ◽  
Prolonged Hospital Stay ◽  
Hospital Patients ◽  
Hospital Gowns ◽  
Hospital Stays ◽  
Prolonged Hospital

The majority of human beings will be admitted to hospital at some point over the course of their lives. For the more fortunate among us, these hospital stays will be brief and will barely register as a significant experience. However, for others, being admitted for weeks or months at a time will be necessary in order to combat and recover from whatever it was that made admittance to hospital necessary. While it is easy to think of many reasons why a prolonged hospital stay might be undesirable, one that may escape our attention is the clothes that are worn by patients during their stay. Once a patient has been assigned a bed, they are often given a gown which they put on without thought and then lie down. The gowns that are given to patients are generally designed with healthcare professionals in mind. For example, in Japan pyjamas and yukata (bathrobes) are used as hospital gowns because they have a front opening that is easy to use during treatment and nursing care. In addition, the other gowns can be opened from the ankle to the crotch using the zip. Dr Naoko Fujii has focused her career on designing clothes for hospital patients and believes that there is a way to satisfy the practical needs of a hospital and the care it gives at the same time as satisfying the requirements of patients. She is now focusing her attention on this challenge.

scholarly journals Malnutrizione associata a patologie, una problematica da risolvere

2002 ◽  
Vol 3 (3) ◽  
pp. 147-160
Author(s):  
Mario Eandi ◽  
Lorenzo Pradelli ◽  
Augusta Palmo
Keyword(s):  
Clinical Outcomes ◽  
Health Professionals ◽  
Tube Feeding ◽  
General Medicine ◽  
Cost Benefit ◽  
Industrialized Countries ◽  
Nutritional Interventions ◽  
Hospital Stays ◽  
Prolonged Hospital ◽  
The Cost

Disease-related malnutrition, the most frequent cause of undernourishment in industrialized countries, appears to be highly prevalent among western patient populations, interesting up to 60% of the hospitalized and almost one fifth of the persons attending to the general medicine service. There are several reasons for this high prevalence, among which pathology-related causes, inadequate presentation of the meals in hospitals and institutions, and low recognition of nutritional problems by health professionals. Several studies have shown that undernourished patients have higher morbidity and mortality rates than the general population and suffer of more and more severe complications, leading to prolonged hospital stays and worse clinical outcomes. This determines a much higher Health costs, estimated in an English study as a yearly additional burden of over 7 billion £ for the National Heath Service. Nutritional interventions, such as the administration of oral supplements or enteral tube feeding, are capable to increase body mass index (BMI), that is considered the most reliable indicator of the nutritional status, muscle strength and overall psycho-physical performance, determining an improved quality of life and a reduced need for medical assistance. These functional improvements go alongside with better clinical outcomes, as shown by a reduced mortality rate, shorter hospital stays and lower incidence of complications observed after supplementation. Studies that have analyzed the economical impact of nutritional supplementation in terms of cost-benefit have shown that the cost of enteral nutritional interventions is almost negligible when compared to the associated savings in the production of the health service, mainly determined by lower hospitalization rates, shorter hospital stays, reduced costs for the treatment of complications and for the consultation of specialists. Greater awareness of the health professionals and more encouraging health policies toward nutritional interventions are required to reduce the clinical and economical impact of this unnecessarily wide-spread condition.

scholarly journals State-of-the-art colorectal disease: postoperative ileus

2021 ◽  
Author(s):  
Nils P. Sommer ◽  
Reiner Schneider ◽  
Sven Wehner ◽  
Jörg C. Kalff ◽  
Tim O. Vilz
Keyword(s):  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Treatment Strategies ◽  
Colorectal Disease ◽  
Opioid Receptor Antagonists ◽  
Hospital Stays ◽  
Definition Of ◽  
Meta Analyses ◽  
Epidural Catheters ◽  
Prolonged Hospital

Abstract Purpose Postoperative Ileus (POI) remains an important complication for patients after abdominal surgery with an incidence of 10–27% representing an everyday issue for abdominal surgeons. It accounts for patients’ discomfort, increased morbidity, prolonged hospital stays, and a high economic burden. This review outlines the current understanding of POI pathophysiology and focuses on preventive treatments that have proven to be effective or at least show promising effects. Methods Pathophysiology and recommendations for POI treatment are summarized on the basis of a selective literature review. Results While a lot of therapies have been researched over the past decades, many of them failed to prove successful in meta-analyses. To date, there is no evidence-based treatment once POI has manifested. In the era of enhanced recovery after surgery or fast track regimes, a few approaches show a beneficial effect in preventing POI: multimodal, opioid-sparing analgesia with placement of epidural catheters or transverse abdominis plane block; μ-opioid-receptor antagonists; and goal-directed fluid therapy and in general the use of minimally invasive surgery. Conclusion The results of different studies are often contradictory, as a concise definition of POI and reliable surrogate endpoints are still absent. These will be needed to advance POI research and provide clinicians with consistent data to improve the treatment strategies.

scholarly journals Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?

2016 ◽  
Vol 124 (6) ◽  
pp. 1794-1804 ◽  
Author(s):  
Suzanne M. Michalak ◽  
John D. Rolston ◽  
Michael T. Lawton
Keyword(s):  
Improve Patient Care ◽  
Vital Role ◽  
Team Members ◽  
Operating Team ◽  
Technical Errors ◽  
Resident Surgeon ◽  
Hospital Stays ◽  
Using Data ◽  
Prolonged Hospital ◽  
Communication Errors

OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0.001 and p = 0.028, respectively). CONCLUSIONS This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder—the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays.

scholarly journals Managing Eating Disorders in Elderly with Dementia and the Ethical Considerations for Tube Feeding

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Quality Of Life ◽  
Eating Disorders ◽  
Management Strategies ◽  
Tube Feeding ◽  
The Elderly ◽  
Feeding Tube ◽  
Medical Complications ◽  
Ethical Considerations ◽  
Nutritional Needs

As dementia progresses, the elderly with dementia often have difficulties finishing their meals and weight loss is a common feature at this stage of their dementia journey. Eating disorders cause tremendous caregiver stress and burden. In considering provision of best care for this group of elderly, the hospital is probably not the best place and yet, they are frequently brought in to the hospital to seek help for fever, pneumonia, dislodged feeding tube, medical complications arising from poor feeding and dehydration. It is important to understand the aetiology of poor feeding among this group of patients and advise the patients and their family on the appropriate management strategies to improve the intake of food and to maximize their quality of life. At this stage of dementia, focusing on means to ensure nutritional needs are met may end up causing further harm and distress.

scholarly journals Characterisation of Plasmids in Multidrug Resistant Uropathogenic Gram-negative Bacterial Isolates

2021 ◽  
Author(s):  
Manish Ranjan ◽  
Mahadevan Kumar ◽  
Sourav Sen ◽  
Parijat Das ◽  
Kunal Kanti Lahiri
Keyword(s):  
Acquired Resistance ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Bacterial Isolates ◽  
Cross Sectional ◽  
Gram Negative ◽  
Hospital Stays ◽  
Tract Infections ◽  
Almost All ◽  
Prolonged Hospital

Introduction: Urinary Tract Infections (UTI) are one of the commonest conditions for which people seek medical care with an estimated 150 million episodes per annum worldwide. An unprecedented upsurge in the rate of development of antimicrobial resistance has reduced the therapeutic options leading to increased morbidity, prolonged hospital stays, development of complications. Majority of these infections are attributable to Gram negative bacteria which have now acquired resistance to almost all classes of antibiotics. Aim: To analyse the plasmid-mediated drug resistance and characterise the major plasmid families that are in circulation. Materials and Methods: A cross-sectional study comprising of a total of 95 non consecutive multidrug-resistant gram-negative bacterial isolates were subjected to Plasmid based replicon typing from January 2017 to June 2018. The 18 major replicons were divided in five multiplex and three uniplex Polymerase Chain Reaction (PCR) formats and the samples were subjected for plasmid characterisation and further sequencing of the plasmid Deoxyribonucleic Acid (DNA). The data obtained was analysed by Microsoft Excel software. Results: Escherichia coli, accounted for maximum n=51 (53.7%), Klebsiella pneumoniae n=19 (20%), Citrobacter sp n=11 (11.6%), miscellaneous gram negative n=14 (14.7%) The isolates exhibited a high degree of resistance to almost all tested antibiotics, sparing a few like Fosfomycin, Chloramphenicol, Imipenem, Amikacin. A total of 154 different plasmid families were detected from the 95 isolates. FIB replicon (24%), FIA (21%), F, W (20%), FIC, B/O (14%), Y (12%), I1 replicon (10.5%) were the major plasmid families detected in the present study. Conclusion: Many isolates exhibited the presence of more than one Incompatibility (Inc.) group plasmids, conferring multidrug resistance to the isolates. The study highlights the need for further research to study the association between plasmid families and their respective antibiotic resistance profiles for a given geographical niche and the need to devise further methods to target these epidemic plasmids.

Feeding the feeble

2021 ◽  
pp. 265-272
Author(s):  
Michael Obladen
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Tube Feeding ◽  
Theoretical Knowledge ◽  
Air Inlet ◽  
Nasogastric Tubes ◽  
Nutritional Needs ◽  
The 1960S

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

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