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Smith, Margaret Anne. "Home parenteral nutrition in British Columbia." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/26536.
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Parenteral nutrition is a therapy that supplies patients with all their nutritional requirements intravenously, thus eliminating the need for oral alimentation. The therapy was first introduced in the United States to hospitalized patients in the late 1960's. The benefit of long-term parenteral nutrition was soon recognized, and a program for ambulatory or home parenteral nutrition (HPN) was developed. In British Columbia, the first HPN patient was begun on such therapy in 1972. Since then, more than 50 British Columbians have received HPN. In March 1986, there were 24 patients on the program. The average annual cost per patient was $29,278 and the total 1986 operating budget was $702,660, not including costs for equipment or hospital training. Up to now, there has been no analytical assessment of the HPN program in B.C.
This thesis describes the current home parenteral nutrition situation in B.C. and makes recommendations for its improvement. It looks at overall clinical outcomes (both physiological and psychosocial), at the results with different subgroups of the population, and at the cost of the HPN program in B.C., and also considers the potential of this therapy for children.
In Chapter 2, the literature is reviewed and organized to cover a general description of HPN therapy, a summary of the results obtained from a number of academic centers, a review of HPN therapy in childhood and the psychosocial issues of concern to HPN patients.
Chapter 3 provides a detailed description of the current HPN situation in
B.C. The study methodology is described in Chapter 4 and the results in Chapter 5. The study is a descriptive analysis. Due to the lack of any obvious control group, a comparative evaluation per se was not possible. However, a Seattle study by Robb, reported in 1983, does allow for some comparison. The main sources of data were:
1. A Patient Questionnaire: The questionnaire was modelled on that used by the Seattle group. 23 B.C. patients, either on HPN at the time of questioning,
or previously on the therapy, were surveyed. 19 (83%) responded.
2. A Health Professional Questionnaire: This questionnaire was compiled especially for and sent to all known health care workers in B.C. in the HPN field. 19 professionals, including physicians, nurses, pharmacists, dieticians, and administrators, were surveyed. 17 responded for a response rate of 89%.
The patient survey provided basic demographic information, a description of HPN therapy received, as well as data on clinical outcomes, both physiological and psychosocial. Results showed that patient age, length of time on HPN, numbers of hours per week devoted to HPN, occupation and place of residence were the most important variables for predicting patient outcomes. Thus, patients that were older, had been on HPN less than one year, or spent more than 80 hours per week preparing and administering HPN solutions, had more physiological complaints and showed interference with more daily activities and personal relationships. Patients who were employed, rated the HPN experience more positively.
Overall, patients found the HPN experience to be a positive one, although this was not true for a small group of patients. Data also indicated that B.C. patients achieved physiological results similar to the Seattle group, and to other centers reported in the literature, but appeared to have more interference with daily activities and personal relationships than did patients from the Seattle study.
The health professional survey indicated that professionals considered the current situation in B.C. to be good with respect to patient training and the complication rate achieved. However, patient follow-up and the psychosocial support provided to patients were rated only fair to poor. These health care professionals cited problems with the program's organization, the need to standardize service to all patients, and the need to provide patients with pre-mixed solutions.
In conclusion, some recommendations are made for improvement in the B.C. HPN program.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Scales, Denise Lynn. "Hypocaloric parenteral nutrition in stressed obese patients." Connect to resource, 1994. http://rave.ohiolink.edu/etdc/view.cgi?acc%5Fnum=osu1250182003.
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Conocimiento, Dirección de Gestión del. "Journal of Parenteral & Enteral Nutrition (JPEN)." Wiley, 2004. http://hdl.handle.net/10757/655341.
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Minton, Andrew Robert. "Studies on the stability of parenteral nutrition admixtures." Thesis, Cardiff University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422760.
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Hortencio, Taís Daiene Russo 1982. "Nutrição parenteral = complicações metabólicas em pacientes pediátricos e mudanças na prática clínica em pacientes domiciliares no Canadá = Parenteral nutrition: metabolic complication in pediatric patients hospitalized patients and changes in clinical practice in home patients in Canada." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308376.
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Orientadores: Antonio Fernando Ribeiro, José Roberto Negrão NogueiraTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução O desenvolvimento da nutrição parenteral (NP) na década de 1960 e sua subsequente utilização na prática clínica tem tido um enorme impacto sobre os pacientes com numerosas doenças para as quais a nutrição foi impossível por outra via. Mas, esta nova tecnologia tem riscos associados, incluindo o desenvolvimento de distúrbios metabólicos, superalimentação e complicações infecciosas. Método Foram realizados dois estudos. O primeiro estudo teve como objetivo avaliar, em uma coorte histórica de pacientes pediátricos no Brasil que receberam NP individualizada e exclusiva, a prevalência de hipofosfatemia, hipocalemia e hipomagnesemia em até 48 horas antes do início da infusão de NP (P1), do 1° ao 4° dia (P2); 5° ao 7° dia (P3) e, investigar se a infusão de caloria e proteína e também a desnutrição foram relacionadas com esses distúrbios. O segundo estudo foi feito no Canadá. Trata-se de um estudo retrospectivo e multicêntrico, avaliando pacientes sob nutrição parenteral domiciliar (NPD), prospectivamente inseridos no Home Parenteral Nutrition Registry (HPN Registry) nos períodos: 2005-2008 ou 2011-2014. Mudanças na demografia, indicações para NPD, prescrição, avaliação nutricional, acesso vascular e número de infecção de cateter por 1000 dias de cateter foram avaliados. Resultados A desnutrição esteve presente em 32,8% dos 119 pacientes avaliados no primeiro estudo, 66,4% estavam em unidade de terapia intensiva pediátrica (UTI Ped), 13,5% morreram. O período de maior prevalência de distúrbios minerais foi o P1 54 (45,3%), no P2 = 35 (31,8%), no P3 = 4 (3,57%). Hipocalemia esteve relacionada à desnutrição OR 2,79 (95% CI 1,09-7,14) p = 0,045. Nos primeiros sete dias, foram infundidas calorias inferior à quantidade recomendada pelas recomendações atuais em até 84,9% dos pacientes e proteína adequada em até 75,7%. Proteína infundida acima da recomendação nos primeiros quatro dias foi relacionada com hypomagnesaemia OR: 5,66 (IC 95% 1,24 - 25,79) p = 0,033. No estudo canadense, comparando os períodos 2011-2014 com 2005-2008, as indicações para a NPD mudaram significativamente com o aumento da proporção de pacientes com câncer (37,9% versus 16,7%) e diminuição da síndrome do intestino curto (32% versus 65,5%). A taxa de infecção de cateter diminuiu de 1,58 para 0,97 por 1.000 dias de cateter; o uso de cateter tunelizado diminuiu de 64,3% para 38,0% e a proporção de cateteres centrais de inserção periférica (PICC) aumentou de 21,6% para 52,9%. Além disso, houve uma redução no número e dias de internações relacionadas à NPD, e mudanças na prescrição de energia, proteína e oligoelementos. Conclusão Hipofosfatemia, hipocalemia e hipomagnesemia foram eventos frequentes, sendo a individualização ferramenta primordial para gerenciá-los. Pacientes desnutridos tiveram maior chance de desenvolver hipocalemia e os que receberam proteína acima da recomendação tiveram mais chances de desenvolver hipomagnesemia. Os resultados sugerem uma mudança no perfil demográfico e acesso venoso no Canadá, com melhora na infecção de cateter, hospitalizações relacionadas à NPD, e prescrições
Abstract: Introduction: The development of parenteral nutrition (PN) in the 1960s and its subsequent use in clinical practice has had a huge impact on patients with numerous diseases for which nutrition was impossible by other route. But, this new technology has associated risks, including the development of metabolic disorders, overfeeding, and infectious complications. Methods We conducted two studies The first study aims to evaluate in a historical cohort of pediatric patients, the prevalence of hypophosphatemia, hypokalemia and hypomagnesaemia until 48th hours before beginning PN infusion (P1), from 1st¿4th day (P2); 5th¿7th day (P3) of PN infusion and, investigate if malnutrition, calories, and proteins infusion were correlated to these disorders. In Canada, a retrospective study evaluating patients who were prospectively entered in the registry either in 2005¿2008 or in 2011¿2014 was done. Changes in patient demography, indications for Home Parenteral Nutricion (HPN), regimen, nutritional assessment, vascular access, and number of line sepsis per 1000 catheter days were evaluated. Results Malnutrition was present 32.8% of 119 patients participants from the first study, 66.4% were in pediatric intensive care unit (PICU), 13.5% died. The P1 was the period of highest prevalence mineral disorders 54 (45.3%), P2 had 35 (31.8%) and, P3=4 (3.57%). Hypokalemia events were related to malnutrition OR 2.79 (95% CI 1.09-7.14) p = 0.045. In the first seven days, infused calories were below the amount recommended by current guidelines in up to 84.9% of patients and protein infused was adequate in up to 75.7%. Protein infused above recommendation was related to hypomagnesaemia OR: 5,66 (95% CI 1,24 ¿ 25,79) p=0,033. In 2011¿2014 compared with 2005¿2008, indications for HPN changed significantly with an increased proportion of patients with cancer (37.9% versus 16.7%) and decreased short bowel syndrome (32% versus 65.5%). The line sepsis rate decreased from 1.58 to 0.97 per 1,000 catheter days; tunnelled catheters decreased as the most frequently chosen vascular access method from 64.3% to 38.0% and the proportion of peripherally inserted central catheters (PICC) increased from 21.6% to 52.9%. In addition, there was a reduction in number, and days of hospitalizations related to HPN, and changes in the prescription of energy, proteins, and trace elements were noted. Conclusion Hypophosphatemia, hypokalemia and hypomagnesemia were frequent events, being individualization primary tool to manage them. Malnourished patients were more likely to develop hypokalemia, and patients receiving protein above the recommendation were more likely to develop hypomagnesemia. Results suggest a shift in patient demography and line access in Canada, with improvement in line sepsis, hospitalizations and HPN prescriptions
Doutorado
Saude da Criança e do Adolescente
Doutora em Ciências
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Aguzzi, Anna. "Comparison of two nutrient admixtures for total parenteral nutrition." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69695.
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The goal of Total Parenteral Nutrition (TPN) is to provide protein and non-protein energy in order to promote nitrogen retention and meet energy requirements. Controversy exists on whether glucose or lipid is the optimal source of non-protein energy. A randomized clinical trial was conducted for one week to compare the effects of TPN providing 34% of non-protein energy as lipid (Group 1; n = 7) to those of hypertonic glucose TPN (Group 2; n = 6). Indices of nitrogen retention, metabolic abnormalities, physiologic stress, and fat clearance were measured. The energy and protein intakes of Group 1 exceeded those of Group 2 from days 0 to 7 (p $<$ 0.05). Nitrogen balance improved significantly in both groups (p $<$ 0.005). Group 1 achieved zero nitrogen balance within two days; Group 2 never achieved net positive nitrogen balance. Significant elevations in insulin levels (p $<$ 0.025) were associated with both TPN admixtures. However, between the two groups the changes in nitrogen balance, albumin, glucose, fructosamine, insulin, liver enzymes, bilirubin, cortisol, and free fatty acid levels were not statistically different. It would appear that the lipid-carbohydrate TPN is more beneficial for patients who require TPN for a short period of time, but due to the small sample size and short study period further research is recommended.
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Waara, James H. "Enteral Nutrition versus Total Parenteral Nutrition for Acute Pancreatitis: A Cost-Effectiveness Analysis." The University of Arizona, 2005. http://hdl.handle.net/10150/624775.
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Class of 2005 AbstractObjectives: To develop a decision analytic model to compare the clinical and economic outcomes of enteral nutrition (EN) and total parenteral nutritional (TPN) support in acute pancreatitis patients. Methods: All randomized clinical trials comparing EN and TPN in acute pancreatitis patients published in the medical and pharmacy literature were identified. Six trials were identified by searching MEDLINE, Web of Science, Cochrane Controlled Trials Register, International Pharmaceutical Abstracts, HealthStar, Cumulative Index to Nursing & Allied Health Literature, and citation review of applicable literature. The costs used for the decision tree were from the perspective of a hospital. A literature based decision tree was formed based from these costs and the probabilities of events from the six identified clinical trials. The TreeAge Pro computer program (TreeAge Software, Inc.; Williamstown, MA) was used to conduct the cost effectiveness analysis. Therapeutic success was considered, for the purposes of the trial, as having no complications. Results: EN was associated with a lower risk of infections, a reduced length of hospital stay, and fewer surgical interventions. There was no statistical difference in the risk of mortality, adult respiratory distress syndrome or multiple organ failure between groups treated with EN or TPN. The results found that EN dominated TPN by being both less costly and more effective. The average costs for EN and TPN were $46,345 and $73,878, respectively. The success rates were 0.652 and 0.358 for EN and TPN, respectively. Conclusion: Enteral nutrition was the dominant route of administration for nutritional support, when compared to total parenteral nutrition both clinically and economically for acute pancreatitis patients.
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Bryngelsson, Katrin, and Agneta Ericsson. "Upplevelser av att nutrieras via gastrostomi eller parenteral nutrition." Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-2932.
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Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.
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Klüttgens, Bettina Ursula. "Pan-European investigation of neonatal and paediatric parenteral nutrition." Thesis, University of Bath, 2003. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275829.
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Buskas, Sofia, and Sofia Bengtsson. "Parenteral nutrition i hemmet; upplevelser och inverkan på livskvaliteten." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24460.
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Bakgrund: Parenteral nutrition kan ges vid i stort sett alla tillstånd när magtarmkanalen ej fungerar eller kan utnyttjas tillfredställande. Benigna tarmsjukdomar, t ex Morbus Crohn eller short bowel syndrome av annan anledning är den vanligaste orsaken till HPN (home parenteral nutrition). En europeisk studie från 1997 visar att incidensen för HPN i Danmark är 2,8 patienter/miljoner invånare/år. Vanligen är patienten uppkopplad till HPN-utrustningen 12-14 timmar/dygn. WHO (World Health Organisation) har utarbetat en definition av livskvalitet; ”Quality of life is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” Syfte: Syftet med denna litteraturstudie är att undersöka och beskriva hur patienter med parenteral nutrition i hemmet upplever sin livssituation och behandlingens inverkan på livskvaliteten. Metod: Studien är en litteraturstudie där tio kvantitativa/kvalitativa artiklar valts ut från PubMed och granskats enligt Carlssons & Eimans bedömningsmallar. Resultat: Tre teman framkom; fysiska faktorer, psykiska faktorer och sociala faktorer. Resultatet visar en negativ påverkan på livskvaliteteten i olika aspekter. Dock visar en av studierna att livskvaliteten förbättras efter HPN. Slutsats: I jämförelse med normalbefolkningen och patienter med korttarmssyndrom utan behov av HPN tyder denna litteraturstudie på låg livskvalitet hos patienter med HPN.
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Wahlstedt, Elin. "Home Parenteral Nutrition : Ett begränsat liv med nya möjligheter." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-38995.
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Bakgrund: Home parenteral nutrition används som behandling av patienter med nedsatt näringsupptagsförmåga. I de flesta fall sker denna behandling i hemmet skött av patienten själv, efter undervisning från sjukvården. Problem: Efter hemgång saknas det i många fall uppföljning från sjukvården på patientens kunskap. Som resultat uppfyller inte sjukvården sitt ansvar att bidra till patientens upplevelse av trygghet och kontinuitet i vården. Metod: Allmän litteraturöversikt med 11 artiklar: 6 med kvantitativ ansats, 4 med kvalitativ ansats, samt 1 artikel med mixad metod. Syfte: Syftet är att skapa en översikt av hur det kan vara att leva med HPN ur ett patientperspektiv. Resultat: Begränsningar till följd av infusionen var utmattning, en bristande frihet och sociala begränsningar. Vidare beskrev patienterna emotionella aspekter så som depressiva tendenser, påverkad livskvalitet och slutligen acceptans till följd av HPN. Ångest och oro var vanligt och relaterat till kateterrelaterade komplikationer. Vidare beskrev patienterna relationen till sjukvården som otillräcklig. Slutsats: Patienter är i behov av psykosocialt stöd för att hantera de nya aspekterna av ett liv med HPN. De är i behov av stöd i hemmet för att orka med infusionen. Sjukvården kan erbjuda mer stöd genom uppföljning av patienterna efter hemgång.
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Rahman, Amina. "Parenteral nutrition i hemmet : En litteraturstudie ur ett patientperspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-39026.
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Nilsson-Axelsson, Eva, and Cindy Stenholtz. "Palliativa patienters livskvalitet vid behandling med parenteral nutrition : en litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:du-5570.
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Syfte: Litteraturöversiktens syfte var att belysa vilken påverkan parenteral nutrition har på livskvaliteten hos palliativa patienter. Metod: Denna studie har genomförts som en litteraturöversikt. Vetenskapliga artiklar har insamlats från databaserna Cinahl, Medline och Pubmed. Totalt fann författarna 12 vetenskapliga artiklar som svarade mot litteraturstudiens syfte. De utvalda artiklarna var både kvantitativa och kvalitativa. Kvalitetsgranskningen utfördes med hjälp av granskningsmallar och artiklarna som lade grunden till resultatet motsvarade medel till hög kvalitet. Resultat: Resultatet visade på att flertalet patienter kände en trygghet och lättnad när den parenterala nutritionen introducerades. Patienterna ansåg att vetskapen att deras nutritionsbehov blev tillfredsställt gjorde att de inte behövde vara rädda för att svälta ihjäl. De upplevde en ökad livskvalitet då de slapp oroa sig för födointaget och orkade medverka mera aktivt i det sociala familjelivet. Flertalet av patienterna uppgav en förbättrad livskvalitet när möjlighet gavs att få parenteral nutrition i hemmet trots att det innebar inskränkningar i familjelivet. De uppgav även en ökad styrka till att hantera bland annat sjukdomssymtom och behandlingsbiverkningar. Den parenterala nutritionen gav i vissa fall problem med biverkningar, men de flesta patienterna skattade ändå livskvaliteten högre av att få näringsdroppet. Resultatet visade även på att om den parenterala nutritionen sattes in i ett tidigt skede kunde en förbättring av nutritionsstatusen ske och patienterna behöll sin kroppsvikt under en något längre tid. Det resulterade i en ökad skattning av livskvaliteten. De sista veckorna i livet hade näringsdroppet ingen mätbar positiv effekt.
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Price, Rebecca. "The pharmaceutical implications of drug additions to parenteral nutrition admixtures." Thesis, Cardiff University, 2005. http://orca.cf.ac.uk/55385/.
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Katz, Roni. "Protein metabolism in septic patients ungergoing [sic] total parenteral nutrition /." Bern : [s.n.], 1989. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Isaksson, Annelie, and Olsson Adeline Mutiara. "Ett annat sätt att äta : Att leva med parenteral nutrition." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-43315.
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Bakgrund: Vid problem att nutriera sig självständigt kan kraftig viktnedgång förekomma och upplevas skrämmande för familjen. Erbjudande om parenteral nutrition tas då ofta emot med glädje av patienter och anhöriga. Vid vård i hemmet måste vårdpersonal, anhöriga och patienten samverka för att vården ska bli optimal där familjens gensvar kan vara avgörande för patientens följsamhet. Sjuksköterskors ansvar för patienters vård är stort vilket kan upplevas utmanande, betungande och samtidigt tillfredställande då möjlighet att kunna förlänga patienters liv och förbättra livskvaliteten finns. Dock saknar sjuksköterskor kunskap om patienters erfarenheter vilket kan skapa otrygghet hos båda parter och leda till att patienters behov av omvårdnad inte tillfredsställs. Syfte: Att beskriva patienters erfarenheter av att leva med parenteral nutrition i hemmet. Metod: Allmän litteraturöversikt användes där tre kvantitativa och åtta kvalitativa artiklar har analyserats samt en med mixad metod. Resultat: Fem teman synliggjordes i examensarbetets resultat; Förmågan att kunna hantera en förändrad livssituation, Betydelsen av stöd och utbildning, Att ha livskvalitet, Att ha förmåga att äta och Att vara begränsad. Slutsats: Att erhålla parenteral nutrition i hemmet förändrar patienters liv. Patienter beskriver förbättrad livskvalitet samtidigt som vården innebär begränsningar. Vårdens stöd beskrivs som bristfälligt. Genom att utforska patienters erfarenheter utifrån patientperspektivet kan mer optimal vård utformas.Background: Having problems with nutrition can lead to heavy weight loss and can be frightening by the family. If offered parenteral nutrition as a form of nutritional treatment, it is often welcomed by patients and relatives. In homecare, healthcare staff, relatives and the patient need to cooperate in order to ensure that the healthcare becomes optimal and the family's response can be decisive for the patient's compliance. Nurses’ responsibility for the patient's care is great, which can be experienced as challenging, burdensome and at the same time satisfactorily with the opportunity to extend patient's lives and improve quality of life. However, nurses’ lack of knowledge of the patient's experience, can create insecurity in both of them and lead to that patients need for nursing is not satisfied. Aim: To describe patients' experiences of living with home parenteral nutrition. Method: General literature review were used. Three quantitative and eight qualitative articles have been analyzed and one article using mixed method. Results: Five themes were discovered in the result: Ability to manage an altered life situation, the need of support and education, to have quality of life, to be able to eat and to be limited. Conclusion: Receiving home parenteral nutrition changes the patients. Patients describe that the quality of life improves while the care entails limitations. Access to healthcare support is described as inadequate. By exploring the patient's experience based on the patient perspective a more optimal care can be designed.
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Oskarsson, Amanda, and Johanna Frännfors. "Enteral och parenteral nutrition : En allmän litteraturöversikt ur ett patientperspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-39889.
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Isaksson, Lina, and Emmie Rask. "Patienters påverkan av enteral och parenteral nutrition : Ur ett patientperspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-41214.
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Dodington, Sean Rhys. "Nutritional abnormalities in patients receiving long-term home parenteral nutrition." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/111542/.
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The last two decades have seen an increased drive to administer parenteral nutrition (PN) to patients in their home environments, thereby reducing associated hospital costs and improving patient quality of life. The occurrence of deranged nutritional biochemistry results has baffled PN experts for years because PN additives are marketed for the general needs of patients and PN is tailored to each patient’s requirements (both formulation and regimen). This thesis documents the investigations into HPN population characteristics, the extent of nutritional abnormalities (deficiencies and excesses) in a cohort of LT PN patients in Wales. Both cross-sectional and longitudinal retrospective study designs were employed alongside small-scale laboratory efforts to investigate stability of vitamin D in PN additives using High Performance Liquid Chromatography (HPLC). Characteristics of the HPN population in Wales were shown to be variable in terms of PN requirements for a predominantly female sample population (2:1); in whom 78.6% of patients received PN for indications relating to short bowel syndrome (SBS). A database analysis of micronutrient test results revealed a high prevalence of deficiencies of vitamin D and selenium, as well as excesses of manganese and water-soluble vitamins; which can lead to clinically relevant effects in patients. The sample population was shown to have impaired bone health since first receiving PN; respective sites of the femoral neck and total hip presented 58% and 60.8% of patients had osteopenia, while 28% and 19.6% had osteoporosis. Evidence in the literature links these clinical outcomes of metabolic bone disease (MBD) to patients’ inadequate vitamin D status. A final study exploring the adequacy of the trace element (TE) preparation Additrace®, found it lacking in selenium and excessive in manganese for the general requirements of the PN population. Clinician-directed supplementation of PN outside of Additrace® was associated with better micronutrient status in patients and more test results within range.
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Wheeler, Michael Brent. "The effect of total parenteral nutrition on pancreatic and gastric endocrine secretion." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/29449.
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Total parenteral nutrition (TPN) provides an experimental situation where adequate nutrition is provided intravenously, bypassing the gastrointestinal tract. Under these conditions the importance of orally ingested nutrients in the control of gastric and pancreatic endocrine secretion can be assessed. The objectives of this thesis were two-fold. First, to examine the effects of TPN on the enteroinsular axis component of insulin secretion. Second, to study the importance of orally ingested nutrients in the regulation of gastric hormone secretion using the TPN rat model.
In order to carry out these objectives, techniques for TPN and enteral feeding (TEN) of the rat were first developed. A dietary regimen for use in TPN and TEN rats was formulated from commercially-available, human TPN components. Under most circumstances, the TPN/TEN regimen met or exceeded the nutritional requirements for growing rats, as determined by the National Research Council (1978). Hematological analysis revealed few side effects of — intravenous or intragastric feeding. Parenterally and enterally-fed animals demonstrated comparable weight gain to that of a control group (ORAL) fed a rat chow (#5012, Ralston Purina) diet ad libitum. In addition, both TPN and TEN animals appeared healthy after the 7-day infusion period. These studies indicated that the infusion formulation was suitable for chronic intravenous and intragastric feeding.
In the first series of experiments, the effects of TPN and TEN on the hormonal component of the enteroinsular axis were studied. TPN animals exhibited hyperinsulinemia and mild hyperglycemia. Conversely, TEN animals exhibited normal plasma glucose and immunoreactive insulin (IRI) concentrations. These data suggested that enterally delivered nutrients were assimilated with greater efficiency than intravenously administered nutrients. It was hypothesized that gut factors normally released by oral food intake facilitated the disposal of nutrients by hepatic and/or peripheral tissues.
During the infusion period, TPN animals exhibited chronically depressed circulating IR-gastric inhibitory polypeptide (GIP) levels, in contrast to TEN animals where IR-GIP was elevated. Seven days of TPN or TEN resulted in no change in fasting plasma IRI or IR-GIP levels. However, an exaggerated insulin response to an oral glucose challenge (OGC) occurred after TPN, while the glucose response was reduced. The insulin response from the perfused pancreata of TPN animals to a GIP gradient was 20% and 40% greater than from ORAL and TEN pancreata respectively. Shorter periods of TPN (3 and 5-day periods) indicated that the hypersensitivity of the pancreas to GIP was a progressive condition, increasing with longer periods of infusion. Immunocytochemical and morphometric analysis revealed no differences in the jejunal GLP-cell population after chronic (7-day) intravenous or intragastric feeding. In addition, these routes of feeding had no effect on pancreatic islet area or endocrine cell composition of the islets. Based on these results, it was hypothesized that the increased B-cell sensitivity to GIP may have been causally related to the exposure of the pancreas to chronically low plasma GIP levels during the infusion period.
To further test this hypothesis, chronically depressed plasma GIP levels, observed during TPN, were elevated by exogenous GIP infusion to levels seen in TEN rats. Chronic GIP —treatment in TPN animals (TPN-GIP) resulted in normalization of the insulin response to an OGC and in the in vitro insulin response of the isolated pancreas to GIP. These data were taken as further evidence that B-cell sensitivity to GIP was affected by ambient plasma GIP levels, and it was hypothesized that changes in sensitivity may be mediated by alteration at the receptor or post-receptor level.
The effect of TPN on nutrient and neuronally mediated insulin release was also investigated. During TPN, metabolites and neuronal elements provided the main stimulus for insulin release, since hormonal components of the enteroinsular axis remained inactive. The present experiments indicated that the B-cell was hypersensitive to glucose, vagal stimulation and the cholinergic agonist methacholine, but normally sensitive to vasoactive intestinal polypeptide (VIP) and the insulinotropic amino acid arginine. These results indicated that TPN was associated with an increased B-cell sensitivity to specific hormonal, nutritive and neuronal stimuli. It was hypothesized that an increased B-cell sensitivity to these specific stimuli contributed to hyperinsulinemia observed in TPN animals during the infusion period, and to the exaggerated insulin response observed after an oral glucose challenge.
Total parenteral nutrition also provided an experimental situation in which to study the importance of gastric nutrients in the regulation of Gl-hormone secretion. TPN resulted in a rapid and progressive depletion of circulating gastrin levels. G-cell secretory activity in vivo under basal and stimulatory conditions was also reduced by TPN. This condition persisted in vitro in the isolated stomach. The antral G-cell population was shown to decrease progressively with longer TPN periods, but G-cell hypoplasia and reductions in antral gastrin content were less dramatic than reductions in G-cell secretory activity. It was hypothesized that reductions in G-cell secretory activity were in part causally related to antral G-cell hypoplasia. The present data further suggested, however, that mechanisms which control synthesis and/or secretion within G-cells may have also been impaired, since various stimulants of gastrin release could not reverse gastrin hyposecretion observed during basal periods. Gastrin hyposecretion also could not be reversed by chronic bombesin administration, but was reversed by a 6-day period of oral — refeeding, indicating that the presence of nutrients in the gastric lumen was the primary regulator of tissue gastrin levels and G-cell secretory activity. The gastric D-cell was much less affected by the absence of nutrients in the gastric lumen than was the G-cell, and antral somatostatin hypersecretion may have contributed to G-cell hyposecretion.
The experiments presented in this thesis indicated that total parenteral nutrition had marked effects on both B- and G-cell secretory activity. These studies clearly demonstrated the importance of enteral feeding in the maintenance of normal pancreatic and gastrointestinal endocrine secretion.Medicine, Faculty of
Cellular and Physiological Sciences, Department of
Graduate
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Lowrey, Olga, Laura Thaler, Kathryn Matthias, and Carol Rollins. "Evaluation of the Occurrence of Hypermanganesemia in Patients on Long-Term Parenteral Nutrition." The University of Arizona, 2013. http://hdl.handle.net/10150/614251.
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Class of 2013 AbstractSpecific Aims: Trace elements such as manganese are added into parenteral nutrition formulations to prevent or treat trace elements deficiencies. Excessive amounts of certain trace elements added to parenteral nutritional formulations can cause potential adverse effects. The purpose of this study was to evaluate whole-blood manganese concentrations obtained in patients prescribed parenteral nutrition for more than 30 days. The manganese concentrations obtained were evaluated based on the duration and amount of manganese prescribed in the parenteral nutritional formulations.. Methods: In this IRB approved project, adult patients prescribed parenteral nutrition for at least 30 consecutive days at an academic medical center or through the outpatient healthcare system between January 2007 and December 2011 were evaluated. Subjects were excluded if no manganese concentrations were obtained while parenteral nutrition was prescribed. Manganese concentrations were grouped by duration that trace elements were added to parenteral nutrition formulations as < 30 days, 30-90 days, 90-365 days, and >365 days. A fifth group of manganese concentrations were evaluated if they were obtained when manganese was not added to the parenteral nutritional formulation for at least 90 days. Data collected included demographic information, reason for initiation and discontinuation of parenteral nutrition, reason for long-term parenteral nutrition, duration of parenteral nutrition, duration and timing of other nutrient sources, amount prescribed and timing of trace elements, trace element concentrations, and documentation of potential manganese toxicity in medical records. A normal manganese concentration was defined as 4.2 to 16.5 mcg/L. Main Results: A total of 27 subjects who were prescribed long-term parenteral nutrition were evaluated. Subjects had a median age of 54 years and range of 18 to 71 years. The majority of subjects (53%) were initially prescribed parenteral nutrition for enteric fistula or malabsorption issues while 27% of subjects were classified as have short gut. A total of 41 manganese concentrations were reported with a median value of 20.1 mcg/L and range of 9.1 to 49.9 mcg/L. The percentage of abnormally high manganese concentrations was 0% at 0-30 days, 63% at 30-90 days, 83% at 90-365 days, and 100% at >365 days of parenteral nutrition with manganese added through a multitrace element solution. In subjects who had received parenteral nutrition for at least 90 days without manganese, abnormal manganese concentrations reported rate was 28%. The rate of abnormal manganese concentrations was significant different between 0-30 days compared to 90-365 days (p = 0.015) and > 365 days (p =0.09) of multi-trace element added to parenteral nutrition. The median number of days between the initial day of parenteral nutition and day managanese concentration checked was 131 days and ranged from 0 to 849 days. Conclusion: The majority of commercially available trace element solutions contain approximately 500% per mL of the recommended daily supplementation amount. In 27 subjects who received long-term parenteral nutrition, the risk of hypermanganesemia was significantly associated with durations of parenteral nutrition that contained multi-trace element solutions for more than 90 days.
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Mattson, Christine. "Outcomes of dietitian involvement with leukemia patients receiving total parenteral nutrition." Online version, 2002. http://www.uwstout.edu/lib/thesis/2002/2002mattsonc.pdf.
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Fan, Bo-Guang. "Effects of total parenteral nutrition on the exocrine and endocrine pancreas an experimental study /." Lund : Lund University, 1997. http://catalog.hathitrust.org/api/volumes/oclc/68945114.html.
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Azevedo, Silvana de Oliveira. "Enfermagem em suporte nutricional: pesquisa qualitativa." Universidade Federal Fluminense, 2008. https://app.uff.br/riuff/handle/1/1419.
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Universidade Federal Fluminense
Mestrado Profissional em Enfermagem Assistencial
Nas metas do suporte nutricional, incluindo a identificação dos pacientes candidatos à prática de uma avaliação nutricional, destaca-se a capacidade de dirigir a terapêutica e conseqüentemente ministrar suporte que seja seguro e eficiente. Para isso, é importante que haja uma equipe interdisciplinar interagindo, cada qual com suas funções e responsabilidades. Suporte Nutricional tem como definição o conjunto de procedimentos terapêuticos para a manutenção ou recuperação do estado nutricional podendo ser através de uma Nutrição Oral Especializada (NOE), Nutrição Enteral (NE) ou Nutrição Parenteral (NP). Em unidades de internação de um hospital público de grande porte, observa-se a precariedade do planejamento do cuidado de enfermagem ao cliente que faz uso do Suporte Nutricional. Uma situação constante que se encontra na assistência a esses clientes é a suspensão do tratamento devido a diversos fatores, os quais ocorrem muitas vezes por falta de avaliação e desconhecimento do enfermeiro e da equipe de enfermagem em relação à terapêutica nutricional. O presente estudo tem como objeto o planejamento do cuidado de enfermagem ao cliente hospitalizado em Suporte Nutricional e objetiva: descrever o planejamento da assistência ao cliente em suporte nutricional realizado pelo enfermeiro, identificar as dificuldades enfrentadas pelo enfermeiro ao cuidado a clientes em suporte nutricional, e criar modelo de planejamento da assistência ao cliente em terapia nutricional com base em procedimentos operacionais padrão (POP). O estudo de abordagem qualitativa do tipo exploratório foi desenvolvido em treze unidades de internação do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense que possuem clientes em suporte nutricional, tendo como sujeitos vinte e cinco enfermeiros. A coleta de dados se deu a partir de observação participante e entrevista semi-estruturada, utilizando-se como técnica de análise, a análise de conteúdo. Os resultados apontam para uma assistência ao cliente em suporte nutricional restrita a uma ação mecânica, sem instrumentos administrativos (normas e rotinas) que favoreçam uma assistência planejada, bem como o registro do processo de cuidar deste cliente. A nutrição, tanto enteral como parenteral, se mostrou como um cuidado pouco valorizado pelos profissionais em detrimento dos demais procedimentos inerentes ao cuidar. No sentido de uma prática e cuidado ao cliente em suporte nutricional mais segura e com qualidade, criaram-se os Procedimentos Operacionais Padrão (POP), com base nos resultados desta pesquisa, relacionados à Terapia Nutricional Enteral e Parenteral. Os POPs objetivam uma normalização de condutas e a disseminação de boas práticas nas unidades de internação para uma assistência de enfermagem efetiva. A atenção à nutrição do cliente hospitalizado deve ser um fator a ser observado na instituição estudada, uma vez que a eficácia da terapia nutricional também depende das ações do enfermeiro e de sua equipe. Por ser uma atividade especializada e sujeita a complicações e riscos em todas as etapas de sua implementação, faz-se necessário o preparo tanto da instituição quanto dos profissionais para a terapêutica nutricional de qualidade
In the matter of nutricional support, including the identification of patients who are candidates to a nutricional assessment practice, is distinguished by the capacity to direct therapeutic and offers a safe and efficient support . In order for this to happen, it is important that a interdisciplinar team work together with functions and responsibilities of their own. Nutricional support has as definition a set of therapeutic procedures that maintain or recover the nutricional state that can be through an Specialty Oral Nutrition (SON), Enteral Nutrition (EN) or Parenteral Nutrition (PN). In inpatient units of a great public hospital, its common to observe precarious planning of nurse care developed to patients that use Nutricional Support. Different factors are associated to the treatment suspension of these patients, most of the times due to the lack of evaluation and knowledge expected from the nurse and its team according to therapeutic nutrition. The present study presents the planning of nurse care to the patient hospitalized in Nutricional Support and aims to: describe the planning care of the patient in nutricional support realized by the nurse, identify difficulties of the nurse when caring with patients in nutricional support and also create a model of care planning to the patient in nutricional therapy according to standard of operational procedures (SOP). The study of qualitative exploratory approach, was developed in thirteen inpatient units of the University Hospital Antonio Pedro, located in the state of Rio de Janeiro of the Fluminense Federal University. The subjects weretwenty and five nurses. staff . The data was collected from Participant observation and semistructured interviews. The content analysis was used for data analysis . The results points to an patient care in nutricional support restricted to mechanic action, without administrative instruments (norms and routines) that favor a planning care, as well as the care process of this patient. The nutrition, enteral or parenteral, was figured as a not valued care procedure among the professionals comparing to other extant procudures. The results of this research related to the Enteral and Parenteral Nutricional Therapy, Standard of Operacional Procedure were created in order to afford a safe and efficient practice and patient care in nutricional support. These SOPs lens to a conduct normalization and the dissemination of good practice in the inpatient units for an effective nursing care. The nutrition of a hospitalized patient must be considered in the studied institution, once the effectiveness of nutricional therapy depends on nurse and its team actions. For being such a specialized activity makes it vulnerable to complications and risks in all stages of its implementation, so it´s necessary to prepare not only the institution but also the professionals for a quality in therapeutic nutricional
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Novak, Ana. "Effects of lipid emulsions on parenteral nutrition associated liver dysfunction (PNALD)." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667607.
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Parenteral nutrition-associated liver dysfunction (PNALD) is one of the most severe long-term parenteral nutrition complications, which was attributed to the phytosterols, found in vegetable oil based lipid emulsions (LE). On the other hand, among various options for its prevention, addition of antioxidant α-tocopherol, has been investigated.
The main objective of this thesis is to determine the content of phytosterols present in LE for parenteral nutrition and assess their clinical effect on patients receiving this therapy.
Firstly, a simple analytical method for simultaneous determination of phytosterols, cholesterol, squalene and tocopherols was developed and validated for analyses of LE available on the Spanish pharmaceutical market. The obtained results demonstrated a significant variation of all analysed fractions between various providers and different batches.
The use of LEs was investigated in a survey, performed among various hospitals in Catalonia. The results showed the extended use of third generation of LE, based on the combination of vegetable oils and fish oil, in doses recommended by manufacturers.
Lastly, a clinical trial was conducted on hospitalised adult patients at the Bellvitge University Hospital in order to evaluate changes of biochemical parameters after administration of LEs. The obtained results showed that the use of LE, based on vegetable oils, is associated to alterations of the hepatic function as from seven days of its administration.
The study concludes that monitoring the concentrations of phytosterol fractions and hepatic function is essential and that the use of fish oil based LE is more effective in the PNALD preventive than reducing the dose of vegetable oil LE. The addition of α-tocopherol as excipient would also be adequate due to its hepatoprotective effect.La disfunción hepática asociada a la nutrición parenteral (DHANP) es una de las complicaciones más graves de la nutrición parenteral de larga duración, atribuida a los fitoesteroles, que se encuentran en las emulsiones lipídicas (EL) de origen vegetal. Por otro lado, entre las diversas opciones para su prevención, se ha investigado la adición de α-tocoferol como antioxidante. El objetivo principal de esta tesis es determinar el contenido de fitoesteroles presentes en las EL utilizadas en nutrición parenteral y evaluar su efecto clínico en pacientes que reciben esta terapia. Primero, se desarrolló y validó un método analítico simple para la determinación simultánea de fitoesteroles, colesterol, escualeno y tocoferoles para el análisis de las EL disponibles en el mercado farmacéutico español. Los resultados obtenidos en las EL demostraron una variación significativa de todas las fracciones analizadas entre las diferentes marcas comerciales y diferentes lotes. El uso de las EL se investigó en un estudio de utilización en varios hospitales de Cataluña. Los resultados mostraron el uso extendido de EL de tercera generación, basadas en la combinación de aceites de patrón vegetal y de pescado, en dosis recomendadas por los fabricantes. Finalmente, se realizó un ensayo clínico en pacientes adultos hospitalizados en el Hospital Universitario de Bellvitge para evaluar los cambios de los parámetros bioquímicos después de la administración de EL. Los resultados obtenidos mostraron que el uso de EL, de patrón vegetal, se asocia a alteraciones de la función hepática a partir de los siete días de su administración. El estudio concluye que la monitorización de las concentraciones de las fracciones de fitoesteroles y los parámetros de la función hepática es esencial y que el uso de EL de patrón de aceite de pescado es más eficaz en la prevención de DHANP que el reducir la dosis de las EL de patrón vegetal. La adición de α-tocoferol como excipiente también seria adecuada por su efecto hepatoprotector.
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Chen, Cathy Zi-Li. "Threonine requirement and kinetics in neonatal piglets receiving total parenteral nutrition." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0015/MQ27487.pdf.
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Said, Siti Norlina Md. "Problems associated with the provision of micronutrients to parenteral nutrition patients." Thesis, Cardiff University, 2006. http://orca.cf.ac.uk/55626/.
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Parenteral Nutrition PN provides nutrition to patients through the intravenous route, and is comprised of carbohydrates, fats, proteins, vitamins, trace elements, electrolytes and fluids. The vitamins are a major limiting factor in the shelf life determination of a PN formulation and are generally added just before administration. This thesis reports on some stability studies of a multivitamin infusion for the possible development of a minibag which may be stored before administration to PN patients. The physicochemical stability of the water-soluble vitamins contained in Solivito N Adult Injection Fresenius Kabi, the fat-soluble vitamins contained in Vitlipid N Adult Injection Fresenius Kabi and the combined admixture of the water-soluble and fat-soluble vitamins, prepared in 100 ml 0.9 sodium chloride in Freeflex Fresenius Kabi minibags was investigated. Physical tests include nephelometry, pH, dissolved oxygen, microscopy and particle size determination by laser diffraction, while the chemical tests used validated stability indicating reversed phase HPLC methods. The vitamins investigated were pyridoxine, nicotinamide, thiamine, folic acid, riboflavin sodium phosphate, Vitamin A and Vitamin E. The water-soluble vitamins and the fat-soluble vitamins were found to be stable, with more than 90 remaining, at 4 °C for 168 hours. For samples stored at 25 °C, they remained stable for 168 hours only if light-protected. During simulated clinical conditions, the water-soluble and fat-soluble vitamins, and the combined vitamin admixture were found to be stable for up to 30 days storage at 4 °C, and remained stable for a further 24 hours at 25 °C if light protected. The light protective effects of different coloured plastic covers to be used during delivery of the vitamin minibags were also investigated. The stability data showed promising results with the vitamins in the minibag remaining stable when assessed under simulated clinical conditions and these longer shelf-life vitamin minibags would benefit PN patients in the hospital and home settings.
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Goon, Anne Frances. "The use of hypocaloric parenteral nutrition in acutely ill obese patients." Connect to resource, 1992. http://rave.ohiolink.edu/etdc/view.cgi?acc%5Fnum=osu1250181324.
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Sjögren, Alice, and Julia Salatino. "Parenteral nutrition : Patienters upplevelser av att få näringstillförsel parenteralt i hemmet." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-43456.
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Bakgrund: Parenteral nutrition (PN) kan vara väsentligt för överlevnaden för patienter som inte kan tillfredsställa närings- och vätskebehovet. Att inte kunna äta och dricka kan leda till känslor av utanförskap och försämrad livskvalitet. Närstående och vårdpersonal kan se positiva aspekter av PN, såsom ökad energi. De kan även se negativa aspekter, såsom minskat välmående. Metod: Allmän litteraturöversikt. Tio artiklar, varav fyra med kvantitativ ansats och sex med kvalitativ ansats, analyserades. Syftet: Syftet är att skapa en översikt av patienters upplevelse av att leva med parenteral nutrition i hemmet. Resultat: Analysen resulterade i tre teman och sex subteman; Upplevelsen av att vara begränsad (Att känna sig begränsad och Att anpassa sig till nya matvanor), Att uppleva parenteral nutrition som trygghet (Att känna trygghet och Att ha behov av stöd) och Strävan efter att ha ett normalt liv (Att anpassa sig till en ny vardag och Att vara självständig). Slutsats: Patienter kan uppleva PN som en stor trygghet, då det kan uppfylla deras närings- och vätskebehov trots att de inte kan inta föda oralt och upplevs vara avgörande för deras överlevnad. Patienter strävar efter normalitet i livet trots PN, men kan känna sig begränsade av det. Stödet från närstående och sjukvården har visat ha stor betydelse för patienter med PN.
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Emery, Sophie. "Development of analytical methods for the stability assessment of parenteral nutrition." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/112136/.
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Parenteral nutrition (PN) provides intravenous nutritional support to patients with reduced gastrointestinal function. A PN bag comprises the basic building blocks of the food groups: lipids, glucose, amino acids, vitamins, electrolytes and trace elements. Recently there has been an increase in demand for extended storage periods for PN bags, to ease management of an increasing home care market. Prior to a PN formulation being deemed safe for a patient, a laboratory simulation is carried out on the proposed admixture under the requested storage and administration conditions. Currently only the physical stability is assessed; physical testing provides no information on the quantity of each component remaining in the bag after storage. Consequently, there is a need for assessing the chemical stability of PN to indicate the quantity of each component that remains in the PN bag. A commonly used amino acid product, Aminoven® 25, contains 16 amino acids; this work aimed to develop a HPLC assay capable of quantifying the amino acids in an aqueous PN bag containing Aminoven® 25. Fluorescence detection was used as it is a highly selective method of detection, which was preferable due to the number of components in PN. To detect the amino acids, as they don’t naturally fluoresce, derivatization was carried out using ortho-phthalaldehyde to form a fluorescing derivative. The developed assay resulted in validation of thirteen of the amino acids in Aminoven® 25. In addition, the method was shown to be unaffected by the iv presence of aqueous PN components, so this method is suitable for quantifying thirteen amino acids in aqueous PN containing Aminoven® 25. This assay can be used for assessing the stability during stability testing and confirming the quantity of amino acids after compounding for quality control release.
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Conocimiento, Dirección de Gestión del. "Guía de acceso para Journal of Parenteral & Enteral Nutrition (JPEN)." Wiley, 2021. http://hdl.handle.net/10757/655341.
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Napoleon, Betty J. "Home Parenteral Nutrition and the Individual and Family Self-Management Theory." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1428088584.
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Ly, Eric T., Scott N. Mirgeler, Carol J. Rollins, and Kathryn R. Matthias. "Development of a Standardized Parenteral Nutrition Protocol for the Obese Population." The University of Arizona, 2016. http://hdl.handle.net/10150/614001.
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Class of 2016 AbstractObjectives: To determine if obese patients receiving parenteral nutrition (PN) require an increased amount of potassium, magnesium, and phosphorus electrolyte provisions compared to non-obese patients. Methods: The project design was an institutional review board-approved, retrospective, descriptive chart review. Electronic medical records and physical parenteral nutrition order cards were accessed to identify patients who met the inclusion and exclusion criteria of the study. The total amounts of potassium, phosphorous, and magnesium received by patients over the initial seven days of PN therapy were calculated. The Chi-squared and independent t-tests were utilized to evaluate the statistical significance for all nominal and interval data respectively. Results: 112 samples met the inclusion criteria of the study. There were 75 samples in the non-obese group (mean age=55.1 years, mean BMI=22 kg/m2, 53% female), and 37 samples in the obese group (mean age=57.1 years, mean BMI=33.8 kg/m2, 51% female). The daily average and seven-day totals of potassium, magnesium, and phosphorus did not significantly differ between the non-obese and obese groups (average daily potassium (P=0.6224), weekly total potassium (P=0.7551), average daily magnesium (P=0.8068), weekly total magnesium (P=0.3863), average daily phosphorus (P=0.9698), weekly total phosphorus (P=0.0603)). Conclusions: Potassium, magnesium, and phosphorus electrolyte provisions administered through PN over a week appear to be similar for both non-obese and obese patients. Our study results indicate that the same standard set for dosing initial PN electrolyte provisions in a non-obese patient may be applied to dosing similar provisions for an obese patient.
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Wong, Christina S. C. "Experiences of adult patients living with home parenteral nutrition : a grounded theory study : a qualitative research into the experiences of home parenteral nutrition : discovery of patients' perspectives." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/14744.
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Introduction Patients with intestinal failure (IF) develop problems of malabsorption and malnutrition associated with short bowel syndrome (SBS). Home parenteral nutrition (HPN) became available to treat these patients since the 1970s. There is a paucity of qualitative research on patients’ experiences in the UK. The study aim was to generate theory that explains the experiences of adults living with HPN and complex medication regimens. Method The grounded theory methodology was used to explore the experiences and to generate theory about this health intervention. Twelve participants were interviewed. The interviews were recorded and transcribed verbatim. The joint process of data collection and analysis followed the principles of constant comparative approach. Results The core categories of stoma care and HPN treatment were supported by the subcategories of maintaining stoma output, access to toilets, maintaining HPN infusion routine, access to technical help to set up HPN infusion, and general health changes. Strategy used to manage living with loss was demonstrated by the subcategory of maintaining daily activities and social interactions. Discussion The theory of living with loss suggests that patients with a stoma receiving HPN experience the sense of loss at home and in social situations. Opportunities for professional practice development are detailed along with implications for future research. Conclusions The findings resonate with the Kubler-Ross Model of the five stages of grief (Kubler-Ross, 1970). The theory of living with loss was generated by the use of the grounded theory methodology. This study identified opportunities for changes and improvement in clinical practice.
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Nordqvist, Maria, and Marielle Misiak. "Patienters upplevelse av att leva med artificiell nutrition." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-43264.
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Bakgrund: Näring och vätska är grundbehov för människor och när behovet inte kan tillgodoses, finns det möjlighet att ge näring med hjälp av artificiell nutrition. Sjuksköterskor upplever kunskapsbrist inom ämnet och önskar utbildning. Förändring som sker i samband med behandling av artificiell nutrition påverkar även de närståendes livskvalitet och sjuksköterskors roll är att fungera som en länk mellan patienter och närstående. Problem: Sjuksköterskor har ansvar att framföra nödvändig information om artificiell nutrition till patienter. Forskning visar att sjuksköterskor saknar kunskap om artificiell nutrition. Genom att sjuksköterskor får kunskap om patienters upplevelse av att leva med artificiell nutrition, kan sjuksköterskors omvårdnadsarbete förbättras. Syfte: Att beskriva patienters upplevelse av att leva med artificiell nutrition. Metod: En systematisk litteraturstudie med beskrivande syntes, där tio stycken vetenskapliga artiklar har analyserats. Resultat: Patienternas upplevelse av att leva med artificiell nutrition påverkade patienternas liv, behandlingen gav trygghetskänsla men innebar samtidigt begränsningar i det dagliga livet och kroppslig påverkan. Patienterna behövde kunskap för att kunna hantera och acceptera livssituationen. Slutsats: Artificiell nutrition förändrade patienters liv och patienter behövde lära sig hantera den nya livssituationen. Att få tillgång till patienters upplevelse av att leva med artificiell nutrition kan öka sjuksköterskors kunskap och ge förhoppning att tillfredsställa patienters omvårdnadsbehov.
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Khan, Khurshid. "Fuel utilisation in the human forearm tissues with emphasis on glutamine metabolism." Thesis, University of Cambridge, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282012.
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Nolin, France. "Parenteral glutamine supplementation in neonates following surgical stress." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31281.
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Our objective was to study the effect of GLN supplementation on whole body protein turnover, somatic growth and gastrointestinal tolerance to enteral feeding in neonates following surgical stress. We hypothesized that GLN in total parenteral nutrition (TPN) would (1) favor retention of lean body mass by reducing protein breakdown (PB) during the acute phase after surgery, (2) promote somatic growth, (3) decrease length of time to achieve full feeds. Protein turnover was measured in a double-blind randomized trial involving neonates admitted to the Neonatal Intensive Care Unit after major surgery. L-GLN (n = 6) was added to TPN at a dose of 200 mg/g of protein intake. Controls (n = 7) were isonitrogenous. Isotope studies were performed on Day 4 of TPN. Subjects were given a 4-hour primed constant intravenous infusion of L-[1-13C]-leucine and [15N2]-urea. In the GLN group, a 15% reduction in PB was measured (unpaired t-test, p < 0.05). There was a trend towards improved net protein balance which was statistically different from zero in the GLN group. There were no differences in somatic growth during TPN course and in the length of time to achieve full enteral feeds. Results suggest that early TPN supplemented with GLN has a beneficial sparing effect on protein metabolism in critically ill neonates after major surgical stress.
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Gibbons, Emma Catherine. "A study of the stability of ascorbic acid in parenteral nutrition mixtures." Thesis, University of Derby, 2000. http://hdl.handle.net/10545/323647.
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Parenteral nutrition (PN) is a method of feeding those incapable of absorbing nutrients from the gastrointestinal tract. All required nutrients are combined in one "big bag". Consequently, many chemical interactions are possible between components. Ascorbic acid (AA) is ubiquitous to both animal and plant kingdoms. Although its biochemistry is not fully understood, dietary deficiency is detrimental to well being, with the most extreme condition being scurvy. AA is water-soluble and frequent intake is therefore required to maintain nutritional status. AA is possibly the most reactive additive in PN mixtures, readily reacting with dissolved oxygen, initially producing dehydroascorbic acid (OHAA). OHAA retains the biological activity of AA. It was the purpose of this study to further knowledge regarding stability of AA and OHAA in PN mixtures, informing pharmaceutical practice to improve safety and efficacy of PN. A stability-indicating HPLC method was optimised for the study of AA and OHAA in PN mixtures. A study of the kinetics of OHAA degradation was undertaken to provide data that could be used to predict OHAA stability. Results obtained indicated a first order reaction. In direct contrast to AA degradation, trace elements did not catalyse OHAA degradation. A further product of AA degradation is oxalic acid (OA) which is potentially toxic. A HPLC method for the determination of OA in PN mixtures was developed and validated, although minimum quantification limits were relatively high (~10J.Lg/ml).The method was used to assess OA appearance in stored PN mixtures, with results indicating that concentrations remained below 10J.Lg/ml even after 35 days storage. The final aspect of this research was to investigate the most likely components of a PN mixture which may "protect" AA from oxidation. a-tocopherol photo-oxidises and therefore may compete with AA for oxygen. As light catalyses the reaction it is possible oxygen reacts more rapidly with a-tocopherol compared with AA. Results indicated 0.- Tocopherol did not oxidise in preference to AA and therefore offered no "protection". Cysteine is a reducing agent included in some amino acid preparations. The average dissolved oxygen content of standard adult PN mixtures was determined, from which the amount of cysteine required to react with dissolved oxygen was calculated. AA instability in PN mixtures was compared with and without cysteine. Results indicated that adding cysteine to PN mixtures 24 hours before addition of AA, resulted in retention of >95% AA. Results obtained from this study have furthered knowledge of the AA degradation profile, its kinetics and the potential influence of other components in PN mixtures. In particular potential strategies for minimising AA degradation are identified therefore ensuring patients receive quantities approaching those prescribed.
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Falegård, Johansson Mikaela, and Sara Skansgård. "Sjuksköterskors erfarenheter av parenteral nutrition för patienter i livets slutskede : En litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:du-20854.
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Bakgrund: Tidigare forskning har visat att parenteral nutrition ges till patienter som befinner sig i livets slutskede även om den medicinska nyttan är oklar. Syfte: Att genom en vetenskaplig litteraturöversikt beskriva sjuksköterskors erfarenheter av vad som är betydelsefullt i arbetet med parenteral nutrition för patienter i livets slutskede. Metod: Examensarbetet är utformat som en litteraturöversikt. Tretton artiklar med kvalitativ och kvantitativ design valdes ut. Artiklarna söktes på databaserna CINAHL och Pubmed Resultat: Delaktighet i vårdteam var av stor betydelse, ett fungerade samarbete där sjuksköterskan ville och fick möjlighet att arbeta som omvårdnadsansvarig upplevdes av sjuksköterskan resultera i god personcentrerad vård. Erfarenhet och egna känslor spelar en betydande roll i hur mycket sjuksköterskan vågar och vill vara delaktig i beslut angående PN i livets slutskede, och vilken relation som skapas med patientens närstående. Slutsats: Ökad kunskap om parenteral nutrition i livets slutskede och personcentrerad vård behövs för att sjuksköterskorna ska våga vara aktivt delaktig och stärka patienten i livets slutskede.Background: Previous research shows that parenteral nutrition is administered to patients who are at the end of life, even though the medical benefit is unclear. Aim: Through a scientific literature review describe nurses' experiences of what is important in the work of parenteral nutrition for patients in the end of life. Method: A literature review, based on 13 articles with both qualitative and quantitative design. The articles were searched on databases CINAHL and PubMed Result: Participation in care team was of great importance, a working partnership where the nurse wanted and had the opportunity to work as a care manager experienced by nurse’s result in good person-centered care. Experience and own emotions play a significant role in how much the nurse dare and want to be involved in decisions regarding PN at the end of life , and the relationship that is created with the patient's relatives. Conclusion: Increased knowledge of parenteral nutrition in palliative care and person-centered care needed for nurses to dare to be actively involved and to strengthen the patient in the final stages of life.
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Cosslett, Allan George. "Studies on the stability of lipid emulsions in total parenteral nutrition admixtures." Thesis, Cardiff University, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422763.
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Fält, Kristina, and Jennifer Brown. "Att behandlas med parenteral nutrition i hemmet : En litteraturstudie ur ett patientperspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-43020.
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Background: The treatment with parenteral nutrition is used when the nutritional needs can’t be satisfied by enteral nutrition. To eat and drink can be valuable activities that fulfills biological, social, psychological and culturally needs. Problem: Previous research shows that home parenteral nutrition has an impact on life, both for the patient and their family. Nurses experience a lack of knowledge in caring of patients with home parenteral nutrition. Aim: The aim of this study was to describe patients’ experiences of being treated with home parenteral nutrition. Method: A systematic literature study with a descriptive synthesis. Ten qualitative studies were analyzed. Result: Two themes and five subthemes were identified. The themes that were identified were “Possibilities with home parenteral nutrition” and “Difficulties with home parenteral nutrition”. Conclusion: The result shows that being treated with HPN changes the patients’ life in several ways. It gave an opportunity to life and could increase quality of life, even though it came with some restrictions.Bakgrund: Behandling med parenteral nutrition används då näringsbehovet inte kan tillgodoses genom enteral näringstillförsel. Att äta och dricka kan vara en betydelsefull aktivitet som tillmötesgår biologiska, sociala, psykologiska och kulturella behov. Problem: Tidigare forskning visar att parenteral nutrition i hemmet kan ha stor påverkan på patienterna och deras familjer i vardagen. Sjuksköterskorna upplever en kunskapsbrist i vårdandet av patienter med parenteral nutrition i hemmet. Syfte: Syftet var att beskriva patienters upplevelser av att behandlas med parenteral nutrition i hemmet. Metod: En systematisk litteraturstudie med beskrivande syntes. Tio vårdvetenskapliga artiklar analyserades. Resultat: Två teman och fem subteman identifierades. De teman som identifierades var ”Möjligheter med parenteral nutrition i hemmet” och ”Hinder med parenteral nutrition i hemmet”. Slutsats: Det framkom att behandlingen med parenteral nutrition i hemmet förändrade livet på flera sätt. Det gav en möjlighet till liv och kunde ge en förbättrad livskvalitet, dock innefattade behandlingen även en del begränsningar.
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Naghibi, Mani. "Home parenteral nutrition therapy for patients with incurable malignancy and intestinal failure." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/415379/.
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In the UK, the prevalence of home parenteral nutrition (HPN) for patients with incurable palliative malignancy has historically been lower than countries with comparable health economies, but there is evidence to suggest a significant increase in the prevalence within the UK. Despite this increase, there has been lack of clarity regarding patient survival and quality of life, optimisation of patient selection and associated health economics. This thesis examined the complex issues involved in the use of HPN for Intestinal Failure in the palliative phase of malignancy deriving information from: a systematic review of the existing medical literature on these topics; novel data generated through meta-analysis of survival data; a national questionnaire of clinician’s attitudes to PN use in this context; analysis of a retrospective case series from University Hospital Southampton; identification of patient factors which effect survival; validation of newly developed survival prognostic tools; and a health economic assessment of this therapy. Meta-analysis of survival data for palliative malignancy patients treated with HPN showed that survival was short, 55% and 74% mortality at 3- and 6-months respectively, with only 2% of patients alive at one year. There were insufficient and poor quality data on quality of life (QoL), although the available data indicate a probable positive impact of HPN treatment in this highly symptomatic patient group. The attitudes of UK based IF clinicians are increasingly positive towards HPN therapy for palliative malignancy, with an emphasis of treatment for improving QoL. Patient performance status at commencement of HPN is the best predictor of survival. Newly developed survival prognostication tools lack sensitivity and specificity. The cost of HPN treatment in the palliative malignancy patient group is high, with low cost effectiveness (£176,587 per quality adjusted life year), although comparable to HPN treatment for non-malignancy patients. The cost effectiveness dramatically improves when patient selection favours better performance status with consequent longer survival, at a higher QoL. The results presented in this thesis provide clinically relevant information that can help with informed decision making by clinicians and patients when considering commencing HPN therapy during the palliative phase of malignant disease. This thesis also presents the first health economic assessment of this treatment, which can aid commissionaires when planning funding of services to meet the increasing demands for this treatment.
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Olne, Karin, and Anna Jemsby. "Undersökning av följsamhet till lokal riktlinje om enteral och parenteral nutrition hos intensivvårdspatienter - en journalgranskning." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-27588.
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En svårt sjuk patient som vårdas på en intensivvårdsavdelning, med svikt i ett eller flera organsystem, löper betydande risk att drabbas av malnutrition med ökad risk för infektioner och längre vårdtider. När en väl utarbetad riktlinje inom nutrition följs ökar patientens möjligheter att nå upp till sitt kalorimål med minskad malnutrition och förkortade vårdtider som följd. Syftet med studien var att undersöka följsamheten till en befintlig riktlinje om nutrition på en intensivvårdsavdelning i västra Sverige med hjälp av journalgranskning. Ett konsekutivt urval gjordes och 31 uppfyllde inklusionskriterierna. Journalerna granskades enligt deskriptiv analys. Resultatet visade en varierande följsamhet till riktlinjen med högst följsamhet mot slutet av vårdtiden och lägst följsamhet i början av vårdtiden. Med hjälp av resultatet i denna studie kan följsamheten till riktlinjen förbättras och på så sätt kan bedömning och behandling av nutrition för intensivvårdspatienten optimeras.A critically ill patient within the intensive care unit, with failure in one or more organ systems, has an increased risk of malnutrition with infections and extended hospital stay as a result. When a wellestablished guideline of nutrition is used, the patients possibility of reaching the caloric goal increases which lead to decreased malnutrition and shortened hospital stay. The aim of the study was to investigate the compliance of an enteral and parenteral guideline in an intensive care unit in a hospital in the west of Sweden with a review of medical records. A consecutive sample was made and 31 patients met the criteria. The medical records were reviewed according to descriptive analysis. The results showed a varying compliance to the guideline, with the highest compliance in the end of hospital stay and the lowest compliance in the beginning of hospital stay. Using the results in this study, the compliance of the nutritional guideline can be improved, and nutritional assessment and treatment for the intensive care patient can be optimized.
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Hjulström, Ida, and John Otterstadh. "När vardagen förändras : Patienters upplevelser av sin livssituation i samband med parenteral nutritionsbehandling i hemmet." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-42628.
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Bakgrund: Behandling med parenteral nutrition innebär att näringsbehovet tillgodoses utan förtäring av föda. Behandlingen ses av anhöriga som livsavgörande och av sjuksköterskor som avancerad och resurskrävande. Syfte: Att beskriva patienters upplevelser av sin livssituation i samband med parenteral nutritionsbehandling i hemmet. Metod: En systematisk litteraturstudie med kvalitativ ansats och beskrivande syntes, där tio artiklar analyserades. Resultat: Analysen resulterade i två teman och fem subteman. De teman som framkom i resultatet var Att uppleva förändringar i vardagen och Att hantera den nya vardagen. Patienterna upplevde fysiska och sociala begränsningar samt att de var i behov av stöd från anhöriga och sjukvården. De upplevde även en oro och rädsla för komplikationer. Trots detta var patienterna tacksamma till behandlingen då den medförde en större frihet och kontroll. Slutsats: Behandling med parenteral nutrition i hemmet medför förändringar i det dagliga livet. Det innebär både möjligheter och begränsningar där patienterna uttrycker ökat behov av stöd inom flera områden. Därmed är det av betydelse för sjuksköterskor att skapa en ökad förståelse om hur patienterna upplever sin livssituation för att kunna erbjuda god omvårdnad.Background: Treatment with parenteral nutrition means that the nutritional need is satisfied without eating. The treatment is viewed upon by relatives as life-saving and by nurses as advanced and demanding. Aim: To describe patients ́ experiences of their life situation in association with home parenteral nutrition. Method: A qualitative systematic literature study with descriptive approach, where ten articles were analyzed. Results: The analysis resulted in two themes and five subthemes. The themes that emerged was To experience changes in the daily life and To handle the new daily life. The patients experienced that they were physically and socially restricted and in need of support from relatives and healthcare. They also experienced anxiety and fear of complications. The patients were grateful despite all of this because the treatment offered them more freedom and control. Conclusion: Treatment with home parenteral nutrition resulted in changes in their everyday life. This brings possibilities and restrictions where the patients expressed an increase of support in many different areas. It is therefore important for nurses to increase their knowledge of how the patients perceive their life situation to be able to offer better care.
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Jensen, Emma. "Artificiell Nutrition i hemmet." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-36105.
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Bakgrund: Patienter som vårdas med enteral eller parenteral nutrition har blivit mer förekommande i vården. Att sjuksköterskan hade hög kompetens gällande artificiell nutrition, kunde vara avgörande för hur patienterna kunde själva hantera problem som uppstod i samband med infusionen i hemmet. Syfte: är att beskriva patienters upplevelse av sitt dagliga liv med enteral eller parenteral nutrition i hemmet. Metod. Allmän litteraturöversikt med beskrivande design. Tio artiklar med kvalitativa och kvantitativa ansatser har inkluderats. Resultat: Social isolering, tidskrävande, biverkningar och nedsatta funktioner är upplevelser som kopplas ihop med att ha artificiell nutrition i hemmet. Välbefinnande är något som kan upplevas om patienterna får hjälp att hantera dom negativa aspekterna med artificiell nutrition. Slutsats: Genom att belysa patienternas upplevelser av att leva med artificiell nutrition i hemmet kan sjuksköterskorna lindra lidande och främja hälsa.
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Baxter, Janet P. "The development of a quality of life questionnaire for adult patients receiving home parenteral nutrition." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2008. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=25929.
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Freitas, Renata Germano Borges de Oliveira Nascimento 1989. "Avaliação do estado nutricional, do perfil inflamatório e da prescrição de nutrição parenteral de pacientes em um hospital terciário." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309384.
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Orientador: Gabriel HesselDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O objetivo geral do estudo foi avaliar o estado nutricional e suas relações com a atividade inflamatória e a prescrição da nutrição parenteral (NP) de pacientes internados em um hospital terciário em uso de NP. Métodos: A pesquisa foi longitudinal e desenvolvida em 3 capítulos. A coleta de dados foi realizada durante as primeiras 72 horas, no 7º e 14º dia de uso da NP entre os adultos (2 primeiros capítulos). Entre os pacientes pediátricos, foram computados os dados de 24 horas anteriores às individualizações da NP (capítulo 3). Os exames laboratoriais realizados foram: albumina, proteína C reativa (PCR), pré-albumina, colesterol total, HDL, triglicerídeos (TGL) e creatinina, glutationa peroxidase (GPx), sódio, potássio, cálcio iônico, cloreto, magnésio e fósforo inorgânico. A avaliação da gravidade foi determinada pelo cálculo do escore de Acute Physiologic and Chronic Health Evaluation (APACHE II) e Sequential Organ Failure Assessment (SOFA). Com os dados do peso e da altura, foi calculado o Índice de Massa Corporal (IMC) e com a circunferência braquial (CB) e a prega cutânea tricipital (PCT), foram calculados as medidas derivadas: circunferência muscular do braço (CMB), área muscular braquial corrigida (AMBc) e área adiposa braquial (AAB). A prescrição energética dos pacientes foi realizada de acordo com a ESPEN (2009), e ASPEN (2002) para adultos e segundo a ASPEN (2010) e a ESPGHAN (2005) para os pediátricos. Foi comparada a recomendação calórica das fórmulas Harris Benedict (HB) e ESPEN 2009. Resultados: Entres os 88 pacientes avaliados, apesar da maioria ter sido classificada como normoponderal pelo IMC (55,36%), a depleção de massa magra foi predominante segundo AMBc (93,33%) e CMB (62,5%). Os níveis da PCR estavam elevados e albumina, pré-albumina e GPx, baixos. Ao longo do estudo a pré-albumina aumentou (p=0.0261). Houve diferença entre as fórmulas (25kcal/kg/dia) e HB (p?0,0001). Entre os 53 pacientes da unidade de terapia intensiva (UTI), 20 (37,74%) foram a óbito. Foi encontrada diferença significativa do SOFA com o desfecho e uma tendência inversamente proporcional do IMC com o óbito. Foi encontrada correlação negativa e forte entre o SOFA e a pré-albumina (r = -0.64; p = 0.05). Com relação aos 12 pacientes pediátricos (49 individualizações), a maioria foi classificada com desnutrição. Observou-se que 74/254 (29,2%) dos exames bioquímicos demandaram NP individualizada por motivos indubitáveis. Conclusões: O IMC parece estar relacionado com a inflamação. Os valores baixos de pré-albumina e albumina indicam desnutrição e/ou processo inflamatório. A aplicação da fórmula (25kcal/kg/dia), já padronizada, contribuiu com a melhora do estado nutricional, evidenciado pelos valores de pré-albumina. Entre os pacientes da UTI, o SOFA foi um bom instrumento para avaliação prognóstica. A albumina foi um marcador para desnutrição. É possível que o IMC seja um parâmetro para avaliação prognóstica do paciente. Entre os pediátricos, o estado nutricional dos pacientes foi considerado crítico, na maioria dos casos. Desta forma, a individualização realizada no início da NP para a adequação energética proteica é essencial. Além disto, a NP individualizada foi indispensável em, no mínimo, 29,2% das NP, para correção das alterações dos exames bioquímicos
Abstract: This study aimed to evaluate the nutritional state and its relationships with inflammatory activity and parenteral nutrition (PN) prescription of patients using PN hospitalized in a tertiary hospital. Methods: The research was longitudinal and developed in three chapters. The data collection was performed during the first 72 hours, on the 7th and 14th days using PN in adults (two first chapters). The data from pediatric patients were computed 24 hours before PN individualizations (chapter 3). The following laboratory examinations were performed: albumin, reactive C-protein (RCP), prealbumin, total cholesterol, HDL, triglycerides (TGL) and creatinine, glutathione peroxidase (GPx), sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus. The evaluation of severity was determined by the calculation of the score of Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA). The body mass index (BMI) was calculated using weight and height, and using brachial circumference (BC) and triceps skinfold thickeness (TST), the following derived measurements were calculated: mid arm muscle circumference (MAMC), corrected arm muscle area (CAMA) and arm fat area (AFA). The energy requirement of patients was performed according to the ESPEN (2009) and ASPEN (2002) for adults, and the ASPEN (2010) and ESPGHAN (2005) for pediatric patients. The calorie recommendation of the formulas Harris Benedict (HB) and ESPEN 2009 were compared. Results: Among the 88 evaluated patients, although most of them has been classified as normoponderal by the BMI (55.36%), malnutrition was prevalent according to AMBc (93.33%) and CMB (62.5%). While the PCR levels were elevated, albumin, prealbumin and GPx levels were low. During the study, prealbumin increased (p=0.0261). There was difference between the formulas (25kcal/kg/day) and HB (p?0.0001). Amont the 53 patients in the intensive therapy unit (ITU), 20 (37.74%) died. It was found a significant difference of SOFA with outcome, and a inversely proportional trend of BMI with death. There was a negative and strong correlation between SOFA and prealbumin (r = -0.64; p = 0.05). Most of the 12 pediatric patients (49 individualizations) were classified as having malnutrition. It was observed that 74/254 (29.2%) of biochemical examinations demanded individualized PN due to indubitable reasons. Conclusions: BMI seems to be related to inflammation. The low values of prealbumin and albumin indicate malnutrition and/or inflammatory process. The application of the already standardized formula (25kcal/kg/day) contributed to an improvement in the nutritional state, evidenced by prealbumin values. SOFA was a good instrument for prognostic evaluation in patients in the ITU. Albumin was a marker of malnutrition. It is possible that the BMI is a parameter for prognostic evaluation of patients. The nutritional state of most pediatric patients was considered critical. Thus, the individualization performed in the beginning of the PN for energy protein adequacy is essential. In addition, the individualized PN was indispensable in at least 29.2% of PN, for correction of alterations of biochemical examinations
Mestrado
Saude da Criança e do Adolescente
Mestra em Ciências
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Chan, Kwong-leung. "Management of intestinal failure - parenteral nutrition, experimental small bowel transplantation and preservation injury of small bowel allograft." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22237586.
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Svanfeldt, Monika. "Perioperative nutrition and insulin resistance /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-637-9/.
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Drozdowski, Laurie. "Effects of short chain fatty acids and total parenteral nutrition on intestinal gene expression." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0005/MQ59798.pdf.
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