scholarly journals Oral nutritional supplements for gastric cancer – the review of current evidence

2021 ◽  
Vol 8 (1) ◽  
pp. 53-61
Author(s):  
A. L. Potapov ◽  
V. E. Khoronenko ◽  
E. V. Gameeva ◽  
Zh. V. Khailova ◽  
A. D. Dorozhkin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Randomized Clinical Trials ◽  
Scientific Information ◽  
Nutritional Supplements ◽  
Current Evidence ◽  
Specific Product ◽  
Current Evidence Base ◽  
Oral Nutritional Supplements

The analysis of the current evidence base concerning the use of oral nutritional supplements (ONS) in gastric cancer (GC) has been made. Databases of scientific information eLIBRARY.ru and PubMed were used. Emphasis is placed on randomized clinical trials and meta‑analyses. The application of ONS is suggested for all patients who undergo to surgical treatment for GC. Its use allows increasing protein and energy consumption, improving the quality of life, some parameters of nutritional status and immunity (albumin, blood lymphocytes etc.). In patients with severe malnutrition (SM) ONS can significantly reduce the incidence of clinically important postoperative complications. The use of this type of medical nutrition in the first 5 days after surgery is safe and does not increase the rate of anastomotic leak. After gastrectomy (GE) its administration reduces the time of recovery of bowel motor function and the duration of hospitalization. After distal GE delay of gastric emptying may occur. In patients with SM, early start of enteral nutrition should be considered. After discharge from the hospital ONS can decelerate the progression of malnutrition, improve the tolerance of adjuvant chemotherapy and improve the quality of life. These effects are most clear after GE and in patients with a high risk of malnutrition (NRS‑2002 ≥ 3). There are no evident advantages of any particular type of ONS in patients with GC. When choosing a specific product, preference should be given to formulas with optimal nitrogen: non‑protein kilocalories ratio, osmolarity closest to physiological and individually selected organoleptic properties. It is recommended that the patient consume at least 200–250 ml of the mixture per day, and in the early postoperative period focus have to be made not on the target volume, but on signs of tolerability.

scholarly journals Design of the DYNAMO study: a multi-center randomized controlled trial to investigate the effect of pre-thickened oral nutritional supplements in nursing home residents with dysphagia and malnutrition (risk)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Viviënne A. L. Huppertz ◽  
Nick van Wijk ◽  
Laura W. J. Baijens ◽  
Lisette C. P. G. M. de Groot ◽  
Ruud J. G. Halfens ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Nutritional Supplements ◽  
Nutritional Intake ◽  
Nutritional Care ◽  
Randomized Controlled ◽  
Oral Nutritional Supplements

Abstract Background Oropharyngeal Dysphagia (OD) and malnutrition are frequently reported conditions in nursing home residents, and are often interrelated. Best care for dysphagic residents with, or at risk of, malnutrition should target adequate nutritional intake and the safety and efficacy of swallowing. The effect of oral nutritional supplements (ONS) suitable for nursing home residents with concurrent OD and malnutrition (risk) on nutritional status has not been investigated before. The current study aims to investigate the effect of daily use of a range of pre-thickened ONS on the body weight of nursing home residents with OD and malnutrition (risk) compared to standard OD and nutritional care. Methods / design The DYNAMO study is a randomized, controlled, multi-center, open label trial with two parallel groups. Study participants will be recruited in nursing homes of several care organizations in the south of the Netherlands. Study duration is 12 weeks. Residents in the control group will receive standard OD and nutritional care, and residents in the test group will receive standard OD and nutritional care with extra daily supplementation of pre-thickened ONS. The main outcome parameter is the difference in body weight change between the control and test groups. An a priori estimation of the required sample size per group (control / test) totals 78. Other outcome parameters are differences in: nutritional intake, health-related quality of life, OD-specific quality of life, activities of daily living, vital signs, and blood nutrient and metabolite levels. Discussion Regular ONS could address the nutritional needs of nursing home residents with malnutrition (risk), but might be too thin and unsafe for residents with OD. Pre-thickened ONS is suitable for residents with OD. It offers the advantage of being a ready-to-use amylase-resistant product available in several consistencies which are able to increase swallowing efficacy and safety. The DYNAMO study is the first to investigate the effects of pre-thickened ONS on nutritional status in nursing home residents with concurrent OD and malnutrition (risk). Trial registration Netherlands Trial Register (NTR): NTR NL7898. Registered 24 July 2019, https://www.trialregister.nl/trial/7898

Effect of oral nutritional supplements with or without nutritional counselling on mortality, treatment tolerance and quality of life in head-and-neck cancer patients receiving (chemo)radiotherapy: a systematic review and meta-analysis

2020 ◽  
pp. 1-18 ◽  
Author(s):  
Arthur T. Mello ◽  
Dayanne S. Borges ◽  
Luana P. de Lima ◽  
Júlia Pessini ◽  
Pedro V. Kammer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Adverse Effects ◽  
Functional Status ◽  
Nutritional Supplements ◽  
Risk Of Bias ◽  
Nutritional Counselling ◽  
Oral Nutritional Supplements ◽  
Treatment Tolerance

Abstract Oral nutritional supplements are widely recommended to head-and-neck cancer patients undergoing anti-cancer treatment; however, their effects on the outcomes of most importance to patients are unclear. This study aimed to systematically review the evidence of effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status, body weight and adverse effects. We searched PubMed, Embase, CENTRAL, LILACS, Web of Science, CINAHL, two trial registry platforms, three sources of grey literature and reference lists of included studies. We assessed the risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We used random-effects models with Hartung–Knapp correction for the meta-analyses. We included fifteen trials, of which five were ongoing or unpublished, providing evidence in four comparisons. We found very low to low certainty evidence for the effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status and adverse effects. When compared with nutritional counselling alone, nutritional counselling plus oral nutritional supplements probably increased body weight slightly. We also found adverse events relating to supplements use such as nausea, vomiting and feeling of fullness. Possible increases in mortality, treatment tolerance and quality of life besides a possible decrease in functional status are worthy of further investigation. Future research could attempt to address the clinical importance of a probable increase in body weight. Possible adverse effects of the use of oral nutritional supplements should not be overlooked.

Exploring the efficacy of housing alternatives for adults with an acquired brain or spinal injury: A systematic review

2019 ◽  
Vol 21 (2) ◽  
pp. 125-153 ◽  
Author(s):  
Courtney J. Wright ◽  
Jacinta Colley ◽  
Elizabeth Kendall
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Residential Care ◽  
Community Integration ◽  
Well Being ◽  
Current Evidence ◽  
Supported Accommodation ◽  
Current Evidence Base ◽  
Cord Injury

AbstractObjective:Housing for people with acquired brain injury (ABI) or spinal cord injury (SCI) remains a significant issue in Australia and internationally. This review examined the current research evidence regarding the efficacy of housing alternatives for adults with ABI or SCI in relation to four principal outcomes of interest: the person’s (1) community integration/participation, (2) independence, (3) psychosocial well-being and (4) quality of life. The review also sought to identify how the reported efficacy of the housing alternatives might be impacted by individual factors.Method:For this systematic review, quantitative empirical, peer-reviewed research published after 1 January 2003 was sought. Ten journal articles met the eligibility criteria. None of the included studies comprised an adult SCI sample.Results:The research identified lower levels of community integration/participation, independence, psychosocial well-being and quality of life for adults (particularly younger adults) with ABI living in ‘structured settings’ (i.e., residential care) compared to those living in ‘home-like’ environments (i.e., private homes) and ‘disability-specific’ settings (i.e., shared supported accommodation, group homes, foster care homes, cluster units).Conclusion:More research is needed to compare ‘home-like’ and ‘disability-specific’ settings, and individual housing models more generally (i.e., living at home with friends vs with family vs living in shared supported accommodation vs living in residential care). This review identified a number of limitations in the current evidence base and several important directions for future research. Policymakers, architects, designers, builders, developers, funding agencies, international researchers as well as people with ABI or SCI and their families may benefit from the findings of this review.

scholarly journals Nonpharmacological Interventions to Improve Depression, Anxiety, and Quality of Life (QoL) in People With Dementia: An Overview of Systematic Reviews

2019 ◽  
Vol 33 (1) ◽  
pp. 28-41 ◽  
Author(s):  
Naoko Kishita ◽  
Tamara Backhouse ◽  
Eneida Mioshi
Keyword(s):  
Quality Of Life ◽  
Systematic Reviews ◽  
Cognitive Stimulation ◽  
Current Evidence ◽  
Future Research ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
People With Dementia ◽  
Current Evidence Base

This overview aimed to systematically synthesize evidence from existing systematic reviews to signpost practitioners to the current evidence base on nonpharmacological interventions to improve depression, anxiety, and quality of life (QoL) in people with dementia and to discuss priorities for future research. The databases MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials were searched in August 2017 with an updated search in January 2019. Fourteen systematic reviews of randomized controlled trials of nonpharmacological interventions were identified. Dementia stage was rated moderate or severe in the majority of the reviews and type of dementia varied. Interventions reported to be effective were cognitive stimulation (QoL: standardized mean difference [SMD] = 0.38), music-based therapeutic interventions (depression: SMD = −0.27, anxiety: SMD = −0.43, QoL: SMD = 0.32), and psychological treatments (mainly cognitive behavior therapy; depression: SMD = −0.22, anxiety: MD = −4.57). Although health-care professionals are recommended to continue using these approaches, future research needs to focus on the type and form of interventions that are most effective for different stages and types of dementia.

scholarly journals Inotropes Are Not Linked to Increased Mortality in Heart Failure

2019 ◽  
Author(s):  
Maya Guglin
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Randomized Clinical Trials ◽  
Advanced Heart Failure ◽  
Current Evidence ◽  
Improve Quality ◽  
Organ Perfusion ◽  
Low Output Syndrome ◽  
Current Guidelines

How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not received inotropes, or received inotropes or placebo. Many physicians would consider this design unethical so the trials would be challenging to implement. But if it is unethical to deny inotropes to this subset of patients, we have to admit that inotropes do not only improve quality of life, but prolong it, or decrease mortality. Otherwise, we consider it unethical to deny the medication which increases mortality. In this review, we analyze the current evidence relating to inotropes and outcomes. We demonstrate that the original trials were performed with agents that are no longer in use, or on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. We conclude that current guidelines for inotropes are misleading in their interpretation of outcomes in patients with advanced heart failure. The guidelines should be revised to adequately reflect the evidence.

511 DO ORAL NUTRITIONAL SUPPLEMENTS IMPROVE QUALITY OF LIFE IN THE FRAIL ELDERLY- A SYSTEMATIC REVIEW

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
C Ryan ◽  
I Hynd
Keyword(s):  
Quality Of Life ◽  
Physical Exercise ◽  
Elderly Patients ◽  
Frail Elderly ◽  
Nursing Home Residents ◽  
Nutritional Supplements ◽  
Elderly Adult ◽  
Oral Nutritional Supplements ◽  
The Impact

Abstract Background Oral nutritional supplements (ONS) are regularly used in older frail adults to help reduced oral intake, recovery from acute illness and weight gain. As, many frailer patients have limited life expectancies the priority for treatment should be improving quality of life (QoL). We set out to find if ONS increase QoL in the frail elderly adult. Method We searched Embase, Medline and OVID databases for using terms for ONS, frail older adults and QoL. The two authors independently reviewed all papers with any dispute was resolved by discussion. Each paper was then reviewed by both authors to extract data and determine bias before collation. Results The search returned 516 papers. Each paper was briefly reviewed to check for relevance leaving 65 papers for detailed review of which 8 papers were included. Two systematic reviews were included. One was unable to draw conclusions from the 3 papers (out of 17) that included QoL as the graded evidence was too poor. The other showed no impact on QoL (in the 2 out of 12 papers that included QoL) in patients post hip fracture receiving ONS. One paper interviewed frail elderly patients about the perceived benefits of their ONS. Nursing home residents perceived that ONS improved their ability to see family which was inferred as improving QoL. Three papers assessed ONS in conjunction with physical exercise. Two showed an improvement in quality of life in the ONS group despite controls also receiving a physical exercise programme. Two papers assessed the impact of ONS on patients discharged from hospital and those chronically unwell- neither showed any difference in QoL. Discussion Quality of life has been a neglected area of study when assessing the impact of ONS on frail elderly patients. When used in conjunction with physical exercise it seems to have a positive effect.

Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10098-10098 ◽  
Author(s):  
Paolo Pedrazzoli ◽  
Emanuele Cereda ◽  
Silvia Cappello ◽  
Sara Colombo ◽  
Catherine Klersy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Systemic Treatment ◽  
Nutritional Supplements ◽  
Calorie Intake ◽  
Nutritional Counseling ◽  
Oral Nutritional Supplements ◽  
Anti Cancer ◽  
Treatment Tolerance

10098 Background: The benefit of systematic use of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT) has not still been properly assessed. Methods: In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02055833; February 2014 - August 2016), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with omega-3 enriched ONS (N = 78) or without ONS (N = 81) from the start of RT and continuing for up to 3 months after its end. The primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, body composition and quality of life (EORTC-QLQ-C30) over the study time points and anti-cancer treatment tolerance. Results: In patients in whom all the variables could be assessed, counseling plus ONS (N = 67) resulted in smaller loss of body weight than nutritional counseling alone (N = 69; mean difference, 1.6 kg [95%CI, 0.5 to 2.7]; P = 0.006). Imputation of missing outcomes provided consistent findings. In the ONS-supplemented group, higher protein-calorie intake and improvement in quality of life over time were also observed (P < 0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR = 0.40 [95%CI, 0.18 to 0.91], P = 0.029). Nine patients reported gastrointestinal intolerance to ONS. Conclusions: In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, weight loss could not be completely prevented, but the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and better anti-cancer treatment tolerance. Clinical trial information: NCT02055833.

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