scholarly journals Do we need a 6D’s Framework of Nutritional Stewardship in critical care?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Dafne Pisani ◽  
Paolo Navalesi ◽  
Silvia De Rosa
Keyword(s):  
Critically Ill ◽  
Cost Effective ◽  
Clinical Nutrition ◽  
Artificial Nutrition ◽  
Nutrition Guidelines ◽  
Stewardship Program ◽  
Regulatory Guidelines ◽  
Individualized Approach ◽  
National Programs ◽  
Improve Patient

AbstractRecent European Society for Clinical Nutrition and Metabolism (ESPEN) guideline on clinical nutrition in the intensive care unit had as ultimate goal the achievement of optimal nutritional support for critically ill patients and to illuminate the gaps in knowledge in order to provide priorities for future clinical research. Although malnutrition is a vital part of the treatment of patients with critical illness and injury, nutrition in the critically ill is not one size fits all. Both clinical nutrition guidelines and ICU experts have recognized the need for a new, individualized approach to nutrition. Nutrition stewardship, analog to antimicrobial and fluid stewardship, could be defined as the “ongoing effort by a healthcare institution to optimise artificial nutrition use in order to improve patient outcomes, ensure cost effective therapy and reduce adverse sequelae.” A robust nutrition stewardship program could gain reputation if the concept will spread to various national programs and regulatory guidelines released in the recent past.

scholarly journals Challenges for Evaluation of the Safety of Engineered Nanomaterials

2021 ◽  
Vol 43 (1) ◽  
pp. 4-7
Author(s):  
Linda J. Johnston ◽  
Norma Gonzalez-Rojano ◽  
Kevin J. Wilkinson ◽  
Baoshan Xing
Keyword(s):  
Rapid Development ◽  
Sustainable Use ◽  
Cost Effective ◽  
Engineered Nanomaterials ◽  
Full Potential ◽  
Effective Strategies ◽  
Toxicological Studies ◽  
Regulatory Guidelines ◽  
Significant Effort ◽  
Safe By Design

Abstract Nanotechnology has developed rapidly in the last two decades with significant effort focused on the development of nano-enabled materials with new or improved properties that offer solutions for current world challenges. The commercialization of products containing engineered nanomaterials (ENM) has progressed much more rapidly than the development of practical approaches to ensure their safe and sustainable use. The lack of adequate detection and characterization techniques and reproducible and validated methods for toxicological studies have been identified as major limitations. The rapid development of ENM of increasing complexity and diversity and concerns over the adequacy of existing regulations also contribute to safety concerns with these materials. The full potential of nanotechnology can only be realized when feasible, cost-effective strategies to ensure a safe-by-design approach, effective risk assessment approaches and appropriate regulatory guidelines are in place.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

Physiological Rationale and Current Evidence for Therapeutic Positioning of Critically Ill Patients

2009 ◽  
Vol 20 (3) ◽  
pp. 228-240
Author(s):  
Karen L. Johnson ◽  
Tim Meyenburg
Keyword(s):  
Critically Ill ◽  
Patient Outcomes ◽  
Critically Ill Patients ◽  
Bed Rest ◽  
Current Evidence ◽  
Kinetic Therapy ◽  
Bed Elevation ◽  
Continuous Lateral Rotation ◽  
Head Of Bed Elevation ◽  
Improve Patient

Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. This article reviews therapeutic positions including stationary positions (supine, semirecumbent with head of bed elevation, lateral, and prone) and active repositioning (manual, continuous lateral rotation, and kinetic therapy). The physiological rationale and current evidence for each position are described. Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.

Parenteral nutrition in the ICU

2016 ◽  
Author(s):  
Jonathan Cohen ◽  
Shaul Lev
Keyword(s):  
Animal Models ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Glutamine Supplementation ◽  
Artificial Nutrition ◽  
Omega 3 ◽  
Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

Critical-care medicine and the acute-care laboratory

1990 ◽  
Vol 36 (8) ◽  
pp. 1552-1556 ◽  
Author(s):  
J R Hall
Keyword(s):  
Critical Care ◽  
Data Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ex Vivo ◽  
Hospital Costs ◽  
Cost Effective ◽  
Critical Care Medicine ◽  
Time Utilization

Abstract Critical-care medicine today is practiced by anesthesiologists, internists, pediatricians, and surgeons. Outcome from today's management of critically ill patients is very good, yet associated costs are very high. Over one-half of the hospital costs of critically ill patients emanates from the intensive-care unit (ICU), although the ICU stay accounts for less than 20% of their time in the hospital. Outside of the operating room, the ICU is the most expensive location for patient care in the hospital, and laboratory tests are the most expensive single item. Plans for cost containment should incorporate the following: more effective data management, education of practitioners about appropriateness and costs of tests, conversion from laboratory measurements to appropriate in vivo and ex vivo measurements, and real-time utilization assessment. To provide high-quality, cost-effective critical care in the future, laboratorians and clinicians must work together today to meet the challenges of technology, data management, and staff education.

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