AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed ...AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.展开更多
Objective： The aim of this systematic review of randomized controlled trials （RCTs） is to determine the effects of earlyenteral nutrition supplemented with probiotics on clinical outcomes in patients with SHI.Metho...Objective： The aim of this systematic review of randomized controlled trials （RCTs） is to determine the effects of earlyenteral nutrition supplemented with probiotics on clinical outcomes in patients with SHI.Methods and analysis： A systematic search will be carried out in PubMed, Cochrane Central Register of ControlledTrials （CENTRAL）, China National Knowledge Infrastructure （CNKI）, WanFang database, and Chinese BiomedicalLiterature （CBM） in order to identify the randomized controlled trials （RCTs） investigated the potential of early enteralnutrition supplemented with probiotics on patients with severe head injury, as well as we will also manually check thebibliographies of eligible studies and topic-related reviews. We will assign two investigators to independently search allpotential citations, extracted data, and appraised risk of bias accordingly, and then STATA software version 12.0 will beused to statistically analyze all data.Ethics and dissemination： The ethics approval and patient written informed consent will not be required because allanalyses in the present study will be performed based on data from published studies. We will submit our systematicreview to a peer-reviewed scientific journal for publication.展开更多
“Leave Asia”is a systematic and comprehensive social movement in modern Japan,involving national spirit,ideology,culture,politics,and diplomacy.In politics and diplomacy,“Leave Asia”is an aggression and a harm to ...“Leave Asia”is a systematic and comprehensive social movement in modern Japan,involving national spirit,ideology,culture,politics,and diplomacy.In politics and diplomacy,“Leave Asia”is an aggression and a harm to Asia.It is not a self-estrangement from Asia in terms of culture and diplomacy.It is an attempt to get rid of the equal status with Asian compatriots and strive to override other Asian countries.“De-Sinicization”in ideology and culture is the advocacy serving Europeanization and Westernization.The foothold of“Leave Asia”is the strategic choice of diplomacy,the deconstruction of the“tribute system”centered on the Qing Dynasty,and the construction of a new Asian order led by Japan.展开更多
AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on ent...AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition(EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol(pre-intervention) and six months after implementation(post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were preintervention and 51 post-intervention.RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate(pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase(3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showeda non-significant decline in the post-intervention phase(P = 0.24) and the overall volume administered daily was higher in the post-intervention phase(61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions(interruptions for unknown reasons) were lower in the post-intervention phase(pre = 23/124, post = 9/96; P = 0.06).CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.展开更多
基金Supported by the Ministry of Education and Research of Estonia(IUT34-24)
文摘AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.
文摘Objective： The aim of this systematic review of randomized controlled trials （RCTs） is to determine the effects of earlyenteral nutrition supplemented with probiotics on clinical outcomes in patients with SHI.Methods and analysis： A systematic search will be carried out in PubMed, Cochrane Central Register of ControlledTrials （CENTRAL）, China National Knowledge Infrastructure （CNKI）, WanFang database, and Chinese BiomedicalLiterature （CBM） in order to identify the randomized controlled trials （RCTs） investigated the potential of early enteralnutrition supplemented with probiotics on patients with severe head injury, as well as we will also manually check thebibliographies of eligible studies and topic-related reviews. We will assign two investigators to independently search allpotential citations, extracted data, and appraised risk of bias accordingly, and then STATA software version 12.0 will beused to statistically analyze all data.Ethics and dissemination： The ethics approval and patient written informed consent will not be required because allanalyses in the present study will be performed based on data from published studies. We will submit our systematicreview to a peer-reviewed scientific journal for publication.
文摘“Leave Asia”is a systematic and comprehensive social movement in modern Japan,involving national spirit,ideology,culture,politics,and diplomacy.In politics and diplomacy,“Leave Asia”is an aggression and a harm to Asia.It is not a self-estrangement from Asia in terms of culture and diplomacy.It is an attempt to get rid of the equal status with Asian compatriots and strive to override other Asian countries.“De-Sinicization”in ideology and culture is the advocacy serving Europeanization and Westernization.The foothold of“Leave Asia”is the strategic choice of diplomacy,the deconstruction of the“tribute system”centered on the Qing Dynasty,and the construction of a new Asian order led by Japan.
文摘AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition(EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol(pre-intervention) and six months after implementation(post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were preintervention and 51 post-intervention.RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate(pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase(3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showeda non-significant decline in the post-intervention phase(P = 0.24) and the overall volume administered daily was higher in the post-intervention phase(61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions(interruptions for unknown reasons) were lower in the post-intervention phase(pre = 23/124, post = 9/96; P = 0.06).CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.
