An overview of enteral feeding in the community

2021 ◽  
Vol 26 (1) ◽  
pp. 26-29
Author(s):  
Sarah Jane Palmer
Keyword(s):  
Enteral Feeding ◽  
Healthcare Professionals ◽  
Social Needs ◽  
Care Plan ◽  
Medical Attention ◽  
Community Settings ◽  
Community Based ◽  
Basic Principles ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Enteral feeding in community settings is becoming increasingly common, and this article aims to help nurses and other healthcare professionals to refresh their knowledge of the important concepts in the community-based care of patients receiving enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The article provides an overview on the management and care of the patient, the basic principles surrounding the equipment used, identifying the wider team and essential communication to bear in mind, as well as the importance of tailoring a care plan to the individual's needs, taking into consideration cognition, mental health, social needs and other factors. The article also covers red flags that may be seen in the community after tube insertion that require immediate medical attention.

scholarly journals Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2316
Author(s):  
Shelley Roberts ◽  
Peter Collins ◽  
Megan Rattray
Keyword(s):  
Healthcare Professionals ◽  
Monitoring And Evaluation ◽  
Community Dwelling ◽  
Community Context ◽  
Care Process ◽  
Community Settings ◽  
Community Based ◽  
Comprehensive Overview ◽  
Nutrition Care ◽  
Community Dwelling Older Adults

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

A scoping review of community holistic interventions for older people with multimorbidity

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711509
Author(s):  
Timothy Smith ◽  
Tahera Patel ◽  
Asangaedem Akpan ◽  
Andrew Clegg ◽  
Dame Caroline Watkins ◽  
...  
Keyword(s):  
Older People ◽  
Cochrane Review ◽  
Management Plan ◽  
Social Needs ◽  
Care Plan ◽  
Holistic Care ◽  
Service Usage ◽  
Community Based ◽  
Self Rated Health ◽  
Healthcare Needs

BackgroundIn many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective.AimTo review evidence for community holistic interventions in older people with multimorbidity.MethodThe authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years.ResultsStudies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health (P = 0.023), and Mental Component Summary (P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved (P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year.ConclusionCommunity-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.

scholarly journals Percutaneous Endoscopic Gastrostomy Tube Placement: A Single Center Experience

2019 ◽  
Vol 10 (03) ◽  
pp. 150-154
Author(s):  
Ankur Gupta ◽  
Anil K. Singh ◽  
Deepak Goel ◽  
Akash N. Gaind ◽  
Shireesh Mittal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Enteral Feeding ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Single Center Experience ◽  
Endoscopic Gastrostomy ◽  
Neurologic Disorders ◽  
Swallowing Difficulty ◽  
Procedural Success ◽  
Peg Tube

Abstract Introduction Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the recommended methods for providing enteral feeding in patients with swallowing difficulty and intact gastrointestinal tract. We review our three years of experience pertaining to PEG placement in our hospital. Methods Records of all the patients, who underwent PEG between May 2014 to September 2017, were reviewed and relevant clinical and procedural details were noted. For all the patients, the procedure was conducted under antibiotic prophylaxis, moderate sedation, and local anesthesia. The PEG tube was placed by the “pull up” method. Telephonic follow-up of the patients was carried out after one month of study completion. Results The PEG tube was placed in 73 patients (male 51 [69.9%]; age median [range] 67 [16–91] years). PEG was placed in 42 patients with stroke (57.6%), other neurologic disorders 17 (23.3%), coma due to head injury 5 (6.8%), and terminal malignancy 9 (12.3%). Technical success was achieved in 73 (97%) patients. Eleven procedure-related complications occurred in nine patients (15.5%) including one death due to peritonitis. Of the 57 patients, who could be followed-up after discharge, 41 died of their primary illness after 65 (1–751) days, nine were alive and continuing on PEG tube feed, and in seven PEG was removed because it was not needed. Conclusion PEG is a useful procedure for enteral feeding. Although procedural success is high, it may be accompanied by significant complications.

scholarly journals Percutaneous Endoscopic Gastrostomy Tube Placement in COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Hemant Goyal ◽  
Aman Ali ◽  
Pardeep Bansal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Enteral Feeding ◽  
Multidisciplinary Approach ◽  
Discharge Planning ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
The World ◽  
Gastrostomy Tube Placement ◽  
Peg Tube

Intensive care units (ICU) around the world are overburdened with COVID-19 patients with ventilator-dependent chronic respiratory failure (VDRF). Gastroenterology evaluations are being made to address the provision of chronic enteral feeding with the help of percutaneous endoscopic gastrostomy (PEG) placements in these patients. The placement of the PEG tube along with tracheostomy in patients with COVID-19 and prolonged VDRF may expedite discharge planning and increase the availability of ICU beds for other patients. Herein, we describe a multidisciplinary approach of PEG tube placements for patients with SARS-CoV-2-induced chronic VDRF for continued enteral feeding to avoid complications and decrease the length of stay.

scholarly journals Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement

2019 ◽  
Vol 12 (9) ◽  
pp. e230728
Author(s):  
Peter Cmorej ◽  
Matthew Mayuiers ◽  
Choichi Sugawa
Keyword(s):  
Enteral Feeding ◽  
Gastric Wall ◽  
Feeding Tube ◽  
Wall Defect ◽  
Endoscopic Gastrostomy ◽  
Endoscopic Closure ◽  
Endoscopic Clips ◽  
Adjacent Site ◽  
Peg Tube

A 53-year-old man with dysphagia underwent uneventful placement of a percutaneous endoscopic gastrostomy (PEG) tube for long-term enteral feeding access. 11 hours after the procedure, it was discovered that he had accidentally dislodged the feeding tube. On physical examination, he was found to have a benign abdomen without evidence of peritonitis or sepsis. He was observed overnight with serial abdominal examinations and nasogastric decompression. In the morning, he was taken back to the endoscopy suite where endoscopic clips were employed to close the gastric wall defect and a PEG tube was replaced at an adjacent site. The patient was fed 24 hours thereafter and discharged from the hospital 48 hours after the procedure. Early accidental removal of a PEG tube in patients without sepsis or peritonitis can be safely treated with simultaneous endoscopic closure of the gastrotomy and PEG tube replacement, resulting in earlier enteral feeding and shorter hospital stay.

scholarly journals Discharge Plan to Promote Patient Safety and Shared Decision Making by a Multidisciplinary Team of Healthcare Professionals in a Respiratory Unit

2021 ◽  
Vol 11 (3) ◽  
pp. 590-599
Author(s):  
Daniel A. Nnate ◽  
David Barber ◽  
Ukachukwu O. Abaraogu
Keyword(s):  
Healthcare Professionals ◽  
Health Condition ◽  
Social Needs ◽  
Chronic Obstructive ◽  
Best Interest ◽  
Obstructive Pulmonary Disease ◽  
Discharge Plan ◽  
Health And Social Care ◽  
Multidisciplinary Working ◽  
Prolonged Hospital

Patients with chronic obstructive pulmonary disease (COPD) often require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stays and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organizational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-year-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It also highlights the healthcare decisions made to ensure the patient’s safety at home and further provides a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership, and change management using Havelock’s theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharges could be attributed to bureaucratic organizational workflow which might not be in the patient’s best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient’s health condition in an attempt to remedy the immediate symptoms of COPD.

Treatment of chronic hepatitis C virus infection with crushed ledipasvir/sofosbuvir administered through a percutaneous endoscopic gastrostomy tube in a patient with HIV coinfection

2020 ◽  
Vol 78 (1) ◽  
pp. 36-40
Author(s):  
Vanessa Huffman ◽  
Diana C Andrade ◽  
Elizabeth Sherman ◽  
Jianli Niu ◽  
Paula A Eckardt
Keyword(s):  
Case Report ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Fixed Dose ◽  
Pharmacokinetic Data ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Hiv Coinfection ◽  
Peg Tube

Abstract Purpose Ledipasvir/sofosbuvir is an oral combination therapy containing fixed doses of direct-acting antiviral agents indicated for the treatment of hepatitis C virus (HCV) infection. Currently there are limited data on the clinical efficacy of crushed ledipasvir/sofosbuvir administered via feeding tube. Summary This case report discusses the successful treatment of chronic HCV genotype 1b infection with crushed ledipasvir/sofosbuvir administered through a percutaneous endoscopic gastrostomy (PEG) tube in a patient with human immunodeficiency virus (HIV) coinfection and high-grade sarcoma who had severe swallowing difficulties. The patient received crushed ledipasvir/sofosbuvir daily for a total of 12 weeks. At 12 weeks the patient had achieved a sustained virologic response. Conclusion Currently, ledipasvir/sofosbuvir is available only as a tablet, with limited pharmacokinetic data available to guide clinicians on use of the fixed-dose combination medication in crushed form. This case report highlights our experience treating a patient with HCV/HIV coinfection through administration of crushed ledipasvir/sofosbuvir via PEG tube, which we found to be a safe and effective therapeutic option.

scholarly journals Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110243
Author(s):  
Tyler Lian ◽  
Kate Kutzer ◽  
Diwas Gautam ◽  
Howard Eisenson ◽  
Jane C. Crowder ◽  
...  
Keyword(s):  
Health Center ◽  
Social Services ◽  
Social Needs ◽  
Phone Call ◽  
Community Based ◽  
Factors Associated ◽  
Federally Qualified Health Center ◽  
Or Applications ◽  
Improve Health

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

Grant writing: Moving from generating ideas to applying to grants that matter

2017 ◽  
Vol 52 (3) ◽  
pp. 236-244
Author(s):  
David Nelson ◽  
Leslie Ruffalo
Keyword(s):  
Health Disparities ◽  
Healthcare Professionals ◽  
Behavioral Science ◽  
The United States ◽  
Grant Writing ◽  
Psychosocial Issues ◽  
Health Issues ◽  
Community Settings ◽  
Innovative Strategies ◽  
Fund Research

There is an extraordinary burden placed upon the healthcare system and people as a result of health disparities that exist within the United States. If there is going to be a concerted effort to develop innovative strategies to reduce health disparities, input from the community and behavioral scientists can and should be included in this approach and narrative. Grant writing provides one vehicle to express the narrative and to provide a means to fund research and programs within clinic-based and community settings. This paper describes a four-step inquiry process to guide healthcare professionals with varying degrees of clinical and scholarship interests through the grant writing process. They include: (1) Why write grants (motivations), (2) what is the area of focus? (Interests), (3) whom should be on the project? (partnerships), and (4) what needs to happen next to move the idea forward? (actions) The complexity of psychosocial issues means that behavioral science is well suited to develop both hypotheses-driven and phenomenological research to understand bio-psycho-social health issues. Grant writing does not need to be mysterious or daunting. It can provide a means to an end, not only to fund research but also as a means to an end of health disparities.

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