scholarly journals Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors

2019 ◽  
Vol 110 (5) ◽  
pp. 430-442 ◽  
Author(s):  
Erin Laing ◽  
Nicole Kiss ◽  
Michael Michael ◽  
Meinir Krishnasamy
Keyword(s):  
Clinical Practice ◽  
Neuroendocrine Tumors ◽  
Dietary Habits ◽  
Somatostatin Analogs ◽  
The United States ◽  
The Body ◽  
Care Needs ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Vitamin Deficiencies ◽  
The Impact

Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40–90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.

Impact of Peritoneal Dialysis Dose Guidelines on Clinical Outcomes

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 95-98 ◽  
Author(s):  
David N. Churchill
Keyword(s):  
Clinical Trials ◽  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
Adverse Effects ◽  
Randomized Clinical Trials ◽  
Intervention Group ◽  
The United States ◽  
Dialysis Dose ◽  
Middle Molecules ◽  
The Impact

The objective was to review the rationale for the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommendations for adequacy of peritoneal dialysis and to evaluate the impact of these recommendations on clinical practice and patient survival. The K/DOQI recommendations were based on large observational studies; the target weekly Kt/V value of 2.0 assumed equivalence of peritoneal and renal clearances. This assumption is no longer considered correct. The impact on clinical practice was evaluated by an examination of temporal trends before and after publication of the guidelines in 1997. In the United States and The Netherlands, there had been a trend toward increased delivered total Kt/V prior to 1997, and there was no acceleration in this trend after 1997. Two randomized clinical trials have implemented these guidelines with increased peritoneal Kt/V (or creatinine clearance) used to achieve the K/DOQI target in the intervention group. This was not associated with improved survival, compared to a lower Kt/V, in either of the randomized clinical trials. Among the explanations for the failure to improve outcome are potential adverse effects of increasing the dialysis dose. These include increased intraperitoneal pressure associated with increased exchange volume, failure to increase clearance of middle molecules, and increased exposure to glucose. Strategies that increase peritoneal clearance without exposure to these potential adverse effects include more-frequent exchanges rather than increased exchange volume, and decreased exposure to glucose and glucose degradation products. Pending such studies, current K/DOQI guidelines should be updated in a timely manner.

scholarly journals Longitudinal impact of Welsh clinical leadership fellowship

2020 ◽  
Vol 33 (1) ◽  
pp. 1-11
Author(s):  
Suzanne Phillips ◽  
Alison Bullock
Keyword(s):  
Clinical Practice ◽  
Medical Training ◽  
Healthcare Delivery ◽  
The Body ◽  
Longitudinal Impact ◽  
Structured Interviews ◽  
Clinical Leadership ◽  
Content Type ◽  
Training Programmes ◽  
The Impact

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications Small participant numbers limit generalisability. Practical implications The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

scholarly journals Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Vladimir Neychev ◽  
Electron Kebebew
Keyword(s):  
Neuroendocrine Tumors ◽  
Tryptophan Hydroxylase ◽  
Management Strategies ◽  
Somatostatin Analogs ◽  
Treatment Strategies ◽  
Peptide Receptor Radionuclide Therapy ◽  
Phase Iii ◽  
Management Options ◽  
Intermediate Grade ◽  
Gastroenteropancreatic Neuroendocrine Tumors

Our understanding of the biology, genetics, and natural history of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas has improved considerably in the last several decades and the spectrum of available therapeutic options is rapidly expanding. The management of patients with metastatic low or intermediate grade NETs has been revolutionized by the development of new treatment strategies such as molecular targeting therapies with everolimus and sunitinib, somatostatin analogs, tryptophan hydroxylase inhibitors, and peptide receptor radionuclide therapy that can be used alone or as a multimodal approach with or without surgery. To further define and clarify the utility, appropriateness, and the sequence of the growing list of available therapies for this patient population will require more high level evidence; however, data from well-designed randomized phase III clinical trials is rapidly accumulating that will further stimulate development of new management strategies. It is therefore important to thoroughly review emerging evidence and report major findings in frequent updates, which will expand our knowledge and contribute to a better understanding, characterization, and management of advanced NETs.

scholarly journals Alternative Treatments for Minor GI Ailments

2019 ◽  
Vol 10 (3) ◽  
pp. 2
Author(s):  
AK Mohiuddin
Keyword(s):  
Dietary Habits ◽  
Herbal Medicines ◽  
Well Being ◽  
The United States ◽  
Lymphoid Organ ◽  
The Body ◽  
Gastrointestinal Disorders ◽  
Daily Routine ◽  
Gi Tract ◽  
Herbal Products

About 80% of the population worldwide use a variety of traditional medicine, including herbal medicines, for the diagnosis, prevention and treatment of illnesses, and for the improvement of general well-being. Total consumer spending on herbal dietary supplements in the United States reached an estimated $8.085 billion in 2017. In addition, the 8.5% increase in total sales from 2016 is the strongest growth for these products in more than 15 years. The main reason to use herbal products in these countries is the assumption of a better tolerability compared to synthetic drugs. Whereas in developing countries herbal medicines are mostly the only available and   affordable treatment option. Surveys from industrialized countries reveal as main health areas in which herbal products are used for upper airway diseases including cough and common cold; other leading causes are gastrointestinal, nervous and urinary complaints up to painful conditions such as rheumatic diseases, joint pain and stiffness. Gastrointestinal disorders are the most widespread problems in health care. Many factors may upset the GI tract and its motility (or ability to keep moving), including: eating a diet low in fiber; lack of motion or sedentary lifestyle; frequent traveling or changes in daily routine; having excessive dairy products; anxiety and depression; resisting the urge to have a bowel movement habitually or due to pain of hemorrhoids; misuse of laxatives (stool softeners) that, over time, weaken the bowel muscles; calcium or aluminum antacids, antidepressants, iron pills, narcotics; pregnancy. About 30% to 40% of adults claim to have frequent indigestion, and over 50 million visits are made annually to ambulatory care facilities for symptoms related to the digestive system. Over ten million endoscopies and surgical procedures involving the GI tract are performed each year. Community-based studies from around the world demonstrate that 10% to 46% of all children meet the criteria for RAP. Gastrointestinal disorders such as chronic or acute diarrhea, malabsorption, abdominal pain, and inflammatory bowel diseases can indicate immune deficiency, present in 5% to 50% of patients with primary immunodeficiencies. The gastrointestinal tract is the largest lymphoid organ in the body, so it is not surprising that intestinal diseases are common among immunodeficient patients. Gastroenterologists therefore must be able to diagnose and treat patients with primary immunodeficiency. Further, pathogens do influence the gut function. On the other hand, dietary habits and specific food types can play a significant role in the onset, treatment, and prevention of many GI disorders. Many of these can be prevented or minimized by maintaining a healthy lifestyle, and practicing good bowel habits.   Article Type: Review

scholarly journals Impact of the grasping test on women’s cardiovascular systems, and the possibility of replacing the orthostatic tolerance test with it

2014 ◽  
Vol 27 (4) ◽  
pp. 217-219
Author(s):  
Karolina Zaluska ◽  
Tomasz Sawicki ◽  
Bartlomiej Kulesza ◽  
Adam Nogalski
Keyword(s):  
Clinical Practice ◽  
Cardiovascular System ◽  
Tolerance Test ◽  
Female Students ◽  
Physiological Parameters ◽  
The Body ◽  
Orthostatic Tolerance ◽  
Heart Rates ◽  
Blood Pressures ◽  
The Impact

Abstract The aim of this study was to test the impact of the Grasping Test (GT) on the female cardiovascular system and to ascertain the possibility of using this to replace the Orthostatic Tolerance Test (OT). In this study, 15 volunteer female students were examined, and their physiological parameters - their systolic (SBP) and diastolic blood pressures (DBP), and their heart rates (HR) - were compared. We found that the Orthostatic Tolerance Test (changing the position of the body from recumbent to upright) and the Grasping Test induced meaningful but similar changes in the functioning of the women’s cardiovascular system. The results confirm that there were significant similarities between the cardiovascular system measurements as produced through the Orthostatic Tolerance Test and the Grasping Test. The possibility of introducing the procedure into clinical practice is a crucial factor for continuing our research in the wider population.

scholarly journals Polyunsaturated fatty acid arachidonic acid increases the virulence of gut pathogen, Yersinia enterocolitica

2021 ◽  
Author(s):  
Denise Chac ◽  
Kelly Crebs ◽  
Cara Yee ◽  
R. William DePaolo
Keyword(s):  
Arachidonic Acid ◽  
Yersinia Enterocolitica ◽  
Dietary Habits ◽  
The United States ◽  
Dietary Factors ◽  
Health Concern ◽  
Enteric Infection ◽  
Peptide Mass ◽  
Food Borne ◽  
The Impact

ABSTRACTFood-borne illnesses are a major health concern worldwide. While 1 in 6 individuals are infected in the United States yearly, there is little research into which dietary factors can alter the risk of infection. Despite evidence suggesting a correlation between obesity and enteric infection, the few reported studies focus on the role of dietary factors and the impact on host tissues and susceptibility. The direct impact of dietary constituents on the virulence of a pathogen has largely been ignored. One component of the Western diet that has been correlated with increasing inflammatory diseases is increased consumption of omega-6 polyunsaturated fatty acids such as arachidonic acid. Here, we show that arachidonic acid directly alters the pathogenicity of the food-borne pathogen Yersinia enterocolitica. Using in vitro cellular adherence assays, proteomic peptide mass fingerprint profiles and in vivo mouse models, we show that arachidonic acid can alter the pathogenesis of Y. enterocolitica by increasing proliferation and intracellular invasion. These findings have major implications in more than food safety, potentially revealing how current dietary habits may increase the virulence of food-borne pathogens.

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