scholarly journals Do patients undergoing cytoreductive surgery and HIPEC for peritoneal malignancy need parenteral nutrition?

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
David R. Swain ◽  
Allison L. Yates ◽  
Faheez Mohamed ◽  
Sanjeev P. Dayal ◽  
Alexios Tzivanakis ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Cytoreductive Surgery ◽  
Nutritional Assessment ◽  
Primary Tumour ◽  
Arm Circumference ◽  
Significant Difference ◽  
Two Factors ◽  
Crs And Hipec ◽  
Mid Upper Arm Circumference ◽  
Peritoneal Malignancy

AbstractBackgroundTo analyse the duration of parenteral nutrition (PN) in patients treated for peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) over a 2 year period at a single UK National referral centre.MethodsA retrospective analysis of prospective data for all patients (n=321) who underwent CRS and HIPEC for peritoneal malignancy at the Peritoneal Malignancy Institute Basingstoke between April 1, 2013 and March 31, 2015.Duration of PN was compared between primary tumour site (appendix, colorectal, mesothelioma and other); completeness of CRS (complete CRS vs. major tumour debulking) and pre-operative nutritional assessment measures (including Mid Upper Arm Circumference).ResultsThe median duration of PN was 9 days (range 2–87 days). A total of 13 % of patients had PN for less than 7 days and 6 % for 5 days or less. There was no significant difference in duration of PN between the different tumour sites. Two factors that may increase the duration of PN include having major tumour debulking (MTD) and a baseline MUAC<23.5 cm.ConclusionsMost patients who underwent CRS and HIPEC for peritoneal malignancy required PN for more than 7 days with poor pre-operative nutritional status and inability to achieve complete cytoreduction predictors of prolonged PN requirements.

scholarly journals Postoperative paralytic ileus after cytoreductive surgery combined with heated intraperitoneal chemotherapy

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Jesper Nors ◽  
Jonas Amstrup Funder ◽  
David Richard Swain ◽  
Victor Jilbert Verwaal ◽  
Tom Cecil ◽  
...  
Keyword(s):  
Median Time ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Paralytic Ileus ◽  
University Hospital ◽  
Nasojejunal Tube ◽  
Heated Intraperitoneal Chemotherapy ◽  
Duration Of Surgery ◽  
Crs And Hipec ◽  
Peritoneal Malignancy

AbstractBackgroundPatients with peritoneal malignancy treated by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) are prone to develop postoperative paralytic ileus (POI). POI is associated with significant increase in both morbidity and mortality. CRS and HIPEC commonly result in prolonged POI (PPOI). The objective was to clarify the extent of PPOI in patients treated by CRS and HIPEC for peritoneal malignancy.MethodsThis was a prospective multicenter study including patients operated with CRS and HIPEC at the Department of Surgery, Aarhus University Hospital, Denmark and the Peritoneal Malignancy Institute, Basingstoke, United Kingdom. A total of 85 patients were included over 5 months. Patients prospectively reported parameters of postoperative gastrointestinal function in a diary from post-operative day 1 (POD1) until discharge. PPOI was defined as first defecation on POD6 or later.ResultsMedian time to first flatus passage was 4 days (range 1–12). Median time to first defecation was 6 days (1–14). Median time to removal of nasojejunal tube was 4 days (3–13) and 7 days (1–43) for nasogastric tube. Forty-six patients (54%) developed PPOI. Patients with PPOI had longer time to first flatus (p<0.0001) and longer time to removal of nasojejunal tube (p=0.001). Duration of surgery correlated to time to first flatus (p=0.015) and time to removal of nasogastric or nasojejunal tube (p<0.0001) but not to time to first defecation (p=0.321).ConclusionsPostoperative gastrointestinal paralysis remains a common and serious problem in patients treated with CRS and HIPEC.

scholarly journals User-Informed Medical Device Development: A Case Study for Pediatric Malnutrition Assessment

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986157 ◽  
Author(s):  
Kristi Thaete ◽  
Kasey Rowzer ◽  
Karen Stephens ◽  
Susan M. Abdel-Rahman
Keyword(s):  
Nutritional Assessment ◽  
Z Score ◽  
Device Development ◽  
Nutrition Services ◽  
Arm Circumference ◽  
Single Center Study ◽  
Device Use ◽  
And Shifts ◽  
Mid Upper Arm Circumference

Background. Mid-upper arm circumference (MUAC) has been extensively used to classify pediatric malnutrition. Recently, MUAC z score was recommended; however, the logistics of implementation were not addressed. This study examines the usability of a device that provides MUAC and corresponding z score range in a single device. Methods. This was a single-center study of nutrition services providers. The device was applied to children aged 2 months to 18 years admitted as inpatients or seen as outpatients. Surveys incorporated benchmarking questions, assessed the ease with which respondents could perform 6 critical tasks, and provided an open-ended question to elicit feedback. Users were surveyed monthly until saturation was reached. Survey data were analyzed in aggregate and cross-tabulated by the respondents’ experience with the device. Thematic analysis of the open-ended responses followed a structured approach. Results. Sixty device users responded to the survey 280 times. Respondents were female (100%) with a mean age of 45.2 ± 13.2 years and 9.6 ± 8.0 years in practice. Increasing device use was accompanied by significantly shortened measuring times ( P < .001) and shifts in ease of performance for 5 of 6 critical tasks ( P < .05). Open-ended response themes related largely to design and materials. These were used to iteratively refine the device. Conclusions. The active engagement of end users in the real-world testing of our nutritional assessment device allowed us to refine the innovation with special attention paid to the needs of dietitians. The result is a device the majority of dietitians found easy to use, efficient, convenient, and preferable to alternative measurement options.

Use of mid-upper-arm circumference Z scores in nutritional assessment

The Lancet ◽  
1993 ◽  
Vol 341 (8858) ◽  
pp. 1481 ◽  
Author(s):  
Gillian Hall ◽  
Shahriar Chowdhury ◽  
Martin Bloem
Keyword(s):  
Nutritional Assessment ◽  
Upper Arm ◽  
Arm Circumference ◽  
Z Scores ◽  
Mid Upper Arm Circumference

scholarly journals Mid-upper arm circumference measurement for severe malnutrition screening in underfives

2020 ◽  
Vol 60 (1) ◽  
pp. 42-52
Author(s):  
Stephanie Adelia ◽  
Johannes Capistrano Susanto
Keyword(s):  
Screening Method ◽  
Cross Sectional Study ◽  
Severe Malnutrition ◽  
Z Score ◽  
Upper Arm ◽  
Cross Sectional ◽  
Kappa Test ◽  
Arm Circumference ◽  
Significant Difference ◽  
Mid Upper Arm Circumference

Background Severe malnutrition in Indonesia remains abundant. Severe malnutrition has been assessed by several methods, including mid–upper arm circumference (MUAC) and weight-for-height z-score (WHZ). As a screening method, MUAC is expected to be useful for identifying malnutrition in communities. Objective To determine whether MUAC measurements can be used for screening severe malnutrition at the community level in Indonesia. Method A cross-sectional study was conducted in 853 children aged 6 – 59 months who came to an  integrated health service post (Posyandu) in Semarang, Central Java. Anthropometric measurements were performed by cadres and researchers and included MUAC and WHZ. Statistical analysis was done by McNemar test; results with P values >0.05 indicated no significant difference. Sensitivity and specificity were determined by 2 x 2 tables. The MUAC cut-off values were determined by receiver-operating characteristic (ROC) curve. Results Eight hundred fifty-three out of 1,115 children met the inclusion criteria, consisting of 419 (49.1%) boys, with most over the age of 2 years (57.2%). Kappa test revealed good inter-rater reliability in measurements between the cadre and researchers (Kappa=0.726). There were significant differences between MUAC (by cadres) and below red line status as well as WHZ, between MUAC (by researchers) and WHZ, as well as MUAC (by cadre and researchers) with WHZ and height-for-age z-score/HAZ . Sensitivity, specificity, PPV, and NPV of MUAC (by cadre) were 12.5%, 99.9%, 75%, and 97.5%, respectively, while those by the researchers were 16.7%, 99.6%, 57%, and 97.6%, respectively. In this study, MUAC of 14 cm was the best cut-off for severe malnutrition. Conclusion The MUAC measurement of 14 cm can be used for screening severe malnutrition in underfives at community.

scholarly journals Predictors of the risk of malnutrition among children under the age of 5 years in Somalia

2015 ◽  
Vol 18 (17) ◽  
pp. 3125-3133 ◽  
Author(s):  
Damaris K Kinyoki ◽  
James A Berkley ◽  
Grainne M Moloney ◽  
Ngianga-Bakwin Kandala ◽  
Abdisalan M Noor
Keyword(s):  
Vegetation Index ◽  
Nutritional Assessment ◽  
Cluster Sampling ◽  
Close Monitoring ◽  
Upper Arm ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
Enhanced Vegetation Index ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6–59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions.DesignCross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6–59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data.SettingThe study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia.SubjectsChildren between the ages of 6 and 59 months in Somalia.ResultsThe estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6–59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively.ConclusionsInfection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.

Malnutrition is an independent predictor of 1-year mortality following acute illness

2007 ◽  
Vol 98 (2) ◽  
pp. 332-336 ◽  
Author(s):  
Salah Gariballa ◽  
Sarah Forster
Keyword(s):  
Nutritional Status ◽  
Nutritional Assessment ◽  
Hazard Analysis ◽  
Prognostic Indicators ◽  
Significant Deterioration ◽  
Baseline Serum ◽  
Hazard Ratios ◽  
Arm Circumference ◽  
Hospitalised Patients ◽  
Mid Upper Arm Circumference

Four hundred and forty-five randomly selected hospitalised patients had their nutritional status assessed from anthropometric, haematological and biochemical data. Nutritional status was compared between survivors and non-survivors at baseline, 6 weeks and 6 months. Using Cox's proportional hazard analysis, we measured the association between nutritional assessment variables and 1-year mortality after adjusting for disability, chronic illness, medications, smoking and tissue inflammation. Nutritional status was significantly worse amongst non-survivors compared with survivors, and non-survivors showed marked and significant deterioration in all measures of nutritional status compared with survivors. After adjusting for poor prognostic indicators the hazard ratios of death in the fourth, third and second quarters of both baseline serum albumin and mid-upper arm circumference distributions relative to the first were 0·68, 0·77 and 0·58 (trend P = 0·013) and 0·61, 1·0 and 0·87 (trend P = 0·005) respectively. Intervention studies are needed to determine whether the relationship between malnutrition and the poor outcome highlighted by the present study is causal or a mere association.

scholarly journals Maternal Nutrition Status Associated with Pregnancy-Related Adverse Outcomes

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2398
Author(s):  
Maria J Miele ◽  
Renato T Souza ◽  
Iracema M Calderon ◽  
Francisco E Feitosa ◽  
Debora F Leite ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Maternal Nutrition ◽  
Adverse Outcomes ◽  
Nutrition Status ◽  
Obese Women ◽  
Nulliparous Women ◽  
Arm Circumference ◽  
Significant Difference ◽  
Outpatient Practice ◽  
Mid Upper Arm Circumference

Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.

scholarly journals Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Synchronous Peritoneal Metastases: Multicenter Study of ‘Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O.’

2021 ◽  
Author(s):  
Luigi Marano ◽  
◽  
Daniele Marrelli ◽  
Paolo Sammartino ◽  
Daniele Biacchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Neoadjuvant Treatment ◽  
Term Survival ◽  
Peritoneal Surface ◽  
Significant Difference ◽  
Crs And Hipec ◽  
Peritoneal Surface Malignancies

Abstract Background The development of multimodality treatment, including cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC), has led to promising results in selected patients with peritoneal disease of gastric origin. The aim of this study was to investigate the short- and long-term outcomes of CRS/HIPEC in the treatment of synchronous peritoneal metastasis in gastric cancer. Methods The Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O. retrospective registry included patients with synchronous peritoneal malignancy from gastric cancer submitted to gastrectomy with CRS and HIPEC between 2005 and 2018 from 11 high-volume, specialized centers. Results A total of 91 patients with a median age of 58 years (range 26–75) were enrolled. The median overall survival (OS) time for the whole group of patients was 20.2 months (95% confidence interval [CI] 11.8–28.5] and the median recurrence-free survival (RFS) was 7.3 months (95% CI 4–10.6). The completeness of cytoreduction score (CCS) of 0 and Peritoneal Cancer Index (PCI) score of ≤ 6 groups showed a significantly better long-term survival (median OS 40.7 and 44.3 months, respectively) compared with the incomplete resected groups (median OS 10.7 months, p = 0.003) and PCI score of > 6 group (median OS 13.4 months, p = 0.005). A significant difference was observed in the survival rate according to neoadjuvant treatment (untreated patients: 10.7 months, 95% CI 5.1–16.2; treated patients: 35.3 months, 95% CI 2.8–67.8; p = 0.022). Conclusions In referral centers, CRS and HIPEC after neoadjuvant treatment significantly improved survival in selected patients. Patients with a PCI score ≤ 6, complete cytoreduction, negative nodal involvements, and negative cytology had encouraging results, showing a clinically meaningful survival.

scholarly journals Pregnancy Readiness in Married Female Adolescents from Different Ethnic Groups in Probolinggo District, Indonesia

2020 ◽  
Author(s):  
Sri Sumarmi ◽  
Agung Dwi Laksono
Keyword(s):  
Ethnic Groups ◽  
Binary Logistic Regression ◽  
Final Analysis ◽  
Female Adolescents ◽  
Arm Circumference ◽  
Significant Difference ◽  
Independent Variable ◽  
Education And Employment ◽  
Mid Upper Arm Circumference ◽  
Married Female

Abstract Background: Physical readiness for pregnancy potentially affects the new born’s health status. The study aims to analyze pregnancy readiness in married female adolescents.Methods: Data were collected in Probolinggo District, Indonesia from 2012-2014. This study involved 760 married female adolescents (< 20 years old) as the analysis units. There are 2 major ethnic groups in Probolinggo District (Javanese and Madurese), as well as a small number of other ethnic groups. The study’s dependent variable was pregnancy readiness, while its independent variable was ethnicity. In addition, other independent variables were also analyzed, for example, marital status, age, education, and employment. The final analysis was done using a binary logistic regression. Pregnancy readiness variable was seen from other sub-variables, such as anemia status, body weight, stature, nutritional status, and mid-upper-arm circumference. Results: Married female adolescents mostly suffered from anemia. The respondents mostly had normal anthropometry. Regarding pregancy readiness variable, married female adolescents from all ethnicities married female adolescentswere not ready to get pregnant. Madurese married female adolescents were 0.563 times readier to get pregnant compared to Javanese married female adolescents (OR 0.563; 95% CI 0.369-0.857). There was no significant difference between Madurese ethnic adolescents and the Java-Madurese ones and others. Moreover, there was no significant difference between educational levels and the respondents’ readiness for pregnancy. Conclusions: There were partial differences in readiness for pregancy in married female adolescents from different ethnic groupsmarried female adolescents. Madurese married female adolescents had a lower possibility of prenancy readiness than Javanese ones.

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