Selenium status in patients receiving home parenteral nutrition

Selenium (Se) status was evaluated in patients with intestinal failure requiring home parenteral nutrition (HPN). Ninety-two percent of patients (11 of 12) studied just prior to starting HPN had low serum Se values, and the mean value was 42 ng/ml, significantly less than mean values in disease controls with Crohn's disease not on HPN (76 ng/ml) and healthy controls (88 ng/ml). Eighty-five percent of patients (22 of 26) already on HPN for 2 to 109 months when studied had low serum Se levels (mean 38.4 ng/ml). The mean 24-hr urinary Se values were 3.7 micrograms in patients on HPN who did not have Crohn's disease, 10.9 micrograms in HPN patients with Crohn's, and 17.9 micrograms in healthy controls. In patients with Crohn's disease on HPN, a significant direct correlation existed between serum Se and the activity of whole blood glutathione peroxidase, a selenoprotein ; and a significant inverse correlation was found between serum Se and months of HPN. This study confirms that Se deficiency is very common in patients before starting and during HPN. These data and recent reports of cardiomyopathies associated with Se deficiencies in patients on HPN increase the importance of proper Se replacement and maintenance.     

胃肠外营养支持在癌症病人化疗中应用的评价

目的：观察胃肠外营养支持对化疗药物消化道副反应所致的营养状况下降的影响。方法：选取在第一治疗周期中出现Ⅱ度及Ⅱ度以上消化道副反应的病人为观察对象，在其第二周期配合化疗的同时采用胃肠外营养支持。以第一周期为空白对照，对每个观察对象分别在两个治疗周期进行营养状况评价，评价方法为ＳＧＡ法，统计方法为单向质反应医学序贯试验。结果：当第３３例病人进入观察时，反应曲线与阳性方程一相交。结论：化疗期间合使用胃肠     

A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support

BACKGROUND: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing algorithm in critically ill trauma patients receiving specialized nutrition support. METHODS: Seventy-nine adult trauma patients with hypophosphatemia (serum phosphorus concentration < or = 0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73-0.96 mmol/L (0.32 mmol/kg, low dose), 0.51-0.72 mmol/L (0.64 mmol/kg, moderate dose), and < or = 0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration > or = 4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. RESULTS: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 +/- 20.6 years. Mean Injury Severity Scores and APACHE-II scores were 27.1 +/- 11.6 and 15.2 +/- 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate-dosed group (0.64 +/- 0.06 to 0.77 +/- 0.22 mmol/L, p < .05) and high-dosed group (0.38 +/- 0.06 to 0.93 +/- 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. CONCLUSIONS: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate and severe-dose regimens effectively increase serum phosphorus concentrations.     

肺结核患者的社会支持水平现状调查

目的获取肺结核患者与其陪护人员的社会支持状况进行比较,探讨影响肺结核患者社会支持水平的因素,从而制定适合的护理措施。方法选取2012年10月-2013年3月门诊就医的肺结核患者80例为观察组,陪护人员80名为对照组;门诊肺结核患者及陪护人员的社会支持状况均采用专业评估量表进行测评,比较两组人群的社会支持水平,使用统计软件SPSS 17.0分析。结果社会支持量表总得分观察组患者为(32.56±9.63)分,陪护人员为(40.30±8.91)分,观察组患者比健康人群拥有的社会支持水平低;患者当处于在婚、年龄<60岁的状态时,社会支持水平较高,差异均有统计学意义(P<0.01)。结论临床护理人员需要首先意识到肺结核患者的特点与需求,对于重点人群通过开展系统、全面的健康教育和心理疏导,争取到其家属、朋友、同事等人的社会支持,提高其生活质量。     

超声介入治疗的医院感染危险因素及预防控制措施分析

目的探讨超声介入治疗医院感染的现状,通过对病原菌分布、耐药性及感染发生的危险因素进行分析,以制定相应的干预措施。方法选取经超声介入治疗的1 686例患者临床资料,送检标本采用BACTEC9000培养系统分离培养病原菌,依据K-B琼脂法进行药敏试验,结果判定按照美国临床实验室标准化委员会2005年版标准;采用SPSS13.0软件进行数据处理,分析感染发生的危险因素。结果超声介入治疗患者医院感染率为11.63%;共分离出病原菌204株,其中革兰阳性菌92株占45.10%,革兰阴性菌112株占54.90%;革兰阳性菌对乙酰唑胺和替考拉宁的耐药率较低,均<6.00%,革兰阴性菌对美罗培南和亚胺培南的耐药率较低,均<4.00%;年龄、住院时间、是否进行侵入性治疗、是否合并其他疾病、是否应用抗菌药物是患者发生医院感染危险因素。结论临床应根据发生感染的危险因素,控制感染的发生;当感染发生时,应立即进行细菌培养及药敏试验,根据结果选用耐药率低的抗菌药进行治疗。     

Vitamin E status in patients on parenteral nutrition receiving Intralipid

Low vitamin E levels have been found to be a frequent side effect in patients on total parenteral nutrition (TPN). In the present study, the vitamin E content of fat emulsions (Intralipid) was measured and the influence of the intravenously administered lipid emulsion on plasma vitamin E levels was investigated. The majority of vitamin E was provided in the beta + gamma-tocopherol fractions (68.7% of total tocopherol). Vitamin E levels in patients were significantly lower (p less than 0.05) as compared to age- and sex-matched normal controls. Although sufficient amounts of vitamin E (16.9 +/- 0.8 IU daily) were infused, according to RDA requirements, E-plasma levels decreased even further during the course of TPN. It was concluded that high amounts of biologically less active tocopherol isomers are not sufficient to maintain vitamin E plasma levels. Supplemental sources of alpha-tocopherol are needed and more attention should be paid to the different tocopherol isomers in the quantitation of the daily allowances of vitamin E.     

Essential fatty acid status in adult patients receiving soybean-base formula

Essential fatty acid (EFA) status was assessed in 48 normal Thai adults and 6 patients who required tube feeding ro 2-4 wk with commercial soybean-base formula (Sobel, Mead Johnson). Each 1000 kcal of this formula provided 40.2 g protein, 32.8 g fat, 136 g carbohydrate, 13.9 g linoleic acid, 2.9 g linolenic acid, and 0 g arachidonic acid. The linoleic acid status in these patients before receiving soybean-base formula was inadequate, as evidenced by the significantly lower serum 18:2-W6 percentage but higher serum 16:1-W7 and 18:1-W9 percentages than those in normal adults. These changes were reversed while receiving soybean-base formula. A significant positive correlation between linoleic acid intake and its serum level was demonstrated. There was a significant decrease in serum 20:4-W6 percentage while receiving soybean-base formula. This could be related to the absence of this EFA in the formula and suppression of biotransformation of 18:2-W6 to 20:4-W6 in the presence of a significant amount of 18:3-W3. None of the patients had 20:3-W9 in the serum or developed scaly dermatitis throughout the study.     

A narrative review of healthcare financing and reimbursement of nutritional support for patients in Singapore

AimsNutritional support is used frequently in Singapore’s healthcare settings, but limited research has been published on how it is financed. This paper aims to provide a narrative review on the financing of nutritional support in Singapore for acute care, step-down care, intermediate and long-term care (ILTC), community and home settings.MethodsA structured search strategy was applied to available electronic databases using selected search terms, with additional reports and grey literature identified using iterative searches.ResultsA limited number of publications were found via electronic databases. The majority of publications were from governmental reports/ press releases, and healthcare organizations’ websites. While funds are available via MediSave, MediShield Life, MediFund, and various other schemes, they may not be sufficient for individuals on long-term nutritional support.ConclusionsMore funding sources for nutritional support are urgently required for patients in ILTC. Means-testing mechanism and targeting may need to improve to ensure access to financial assistance for nutritional support and prevent poorer outcomes and higher medical costs. Medical providers, dietitians, pharmacists and social workers play a role in determining need, prescribing and accessing nutritional support for optimal care of individuals in hospitals and ILTC. Future policies will need to address the issues of access to nutritional support in the elderly and low-income populations.     

The health status of diabetic patients receiving orthotic therapy

Diabetes has a major impact on the quality of life and those with related foot ulcers are among those most affected. The main aim of the study, which was carried out over an 18-month time period, was to compare the self-reported health status of a group of diabetic patients receiving orthotic therapy with that of other groups who did not receive the therapy. A sample of 280 was recruited from patients with type I and type II diabetes. The study group comprised four groups of patients: those receiving orthotic therapy (insoles) for pedal complications as a result of their diabetes; those with diabetes mellitus, without complications of the disease affecting their foot; those with unilateral lower limb amputation and those with active ulceration who had not been prescribed footwear. The specialised orthotic intervention resulted in statistically significant improvements in health status (p < 0.05), (measured using the SF-36) both physically and mentally, for patients with at-risk feet and should become an integral part of the treatment regime for diabetics with at-risk feet.     

Variations in fertility by marital status and marriage order

Analysis of data from the June 1985 Current Population Survey reveals that although marriage continues to be an important setting for childbearing, the strength of this relationship varies considerably by the mother's race, education and age at first birth. The largest proportion of white births occurs during first marriages, with the next largest group made up of premarital births; that pattern is reversed for black births. The proportion of births occurring during second marriages is twice as high among whites as among blacks; however, intermarital childbearing is more common among blacks than among whites. For both races, the number and proportion of all births that occurred in second marriages increased between 1973-1974 and 1983-1984; in the latter period, women who were in their second marriage had about 300,000 births a year. About half of all nonmarital births in 1983-1984--370,000 births a year--were of birth order two or higher.     

The nutritional status of patients receiving home enteral feeding

19 patients receiving home enteral nutrition (HEN) were nutritionally assessed, using anthropometry and blood analysis. Blood was taken for measurement of serum albumin, magnesium, zinc, copper, selenium and vitamins A and E. 8 patients had anthropometric evidence of protein and energy depletion, of whom 6 were severely depleted. 15 patients had biochemical evidence of trace element or vitamin depletion of whom 6 had multiple (>/= 3) depletion. Depletion occurred in all diagnostic categories, even in patients with normal anthropometric measurements, and was independent of duration, volume or method of feeding. We conclude that patients receiving HEN may be at risk of protein energy malnutrition and of developing vitamin or trace element deficiency states regardless of diagnosis, anthropometric measurements or duration of feeding. Therefore close nutritional monitoring of such patients is essential, and it is recommended that patients on HEN are supervised by clinicians with an appropriate interest.     

Direct healthcare costs of osteoporosis-related fractures in managed care patients receiving pharmacological osteoporosis therapy

Background

Osteoporosis is a common condition and the economic burden of osteoporosis-related fractures is significant. While studies have reported the incremental or attributable costs of osteoporosis-related fracture, data on the economic impact of osteoporosis-related fractures in commercial health plan populations are limited.

Objective

To estimate the direct costs of osteoporosis-related fractures among pharmacologically treated patients in a large, commercially insured population between 2005 and 2008.

Methods

In this retrospective cohort study, patients were identified from a large, commercially insured population with integrated pharmacy and medical claims. Inclusion criteria were age 45?C64 years; one or more osteoporosis medication claim(s) with first (index) claim between 1 January 2005 and 30 April 2008; and continuous insurance coverage for ??12 months pre-index and ??6 months post-index. Patients with pre-index Paget??s disease or malignant neoplasm; skilled nursing facility stay; combination therapy at index; or fracture ??6 months post-index were excluded. A generalized linear model compared differences in 6-month pre-/post-event costs for patients with and without fracture. Propensity score weighting was used to ensure comparability of fracture and non-fracture patients. Generalized estimating equations accounted for repeated measures.

Results

The study included 49 680 patients (2613 with fracture) with a mean (SD) age of 56.4 (4.7) years; 95.9% were female. Mean differences between pre- and post-event direct costs were $US14049 (95% CI 7670, 20 428) for patients with vertebral fractures, $US16 663 (95% CI 11690, 21636) for patients with hip fractures, and $US7582 (95% CI 6532, 8632) for patients with other fractures. After adjusting for covariates, osteoporosis-related fractures were associated with an additional $US9996 (95% CI 8838, 11154; p< 0.0001) in direct costs per patient across all fracture types during the 6 months following fracture.

Conclusion

Patients with osteoporosis-related fractures were found to incur nearly $US10 000 in estimated additional direct healthcare costs in the 6 months post-fracture, compared with patients with no fracture. Reduced fracture risk may lower associated direct healthcare costs.     

Vitamin status of pediatric patients receiving long-term peritoneal dialysis

The oral vitamin intakes and concentrations of vitamins in blood of eight children on long-term peritoneal dialysis and six control children were measured. All patients received a daily supplement containing water-soluble vitamins. Serum concentrations of vitamin A, vitamin B-12, ascorbic acid, and folic acid and dialysate concentrations of ascorbic acid were determined. Thiamin and riboflavin were assessed by measuring erythrocyte enzyme activities. Vitamin B-6 was measured as plasma pyridoxal phosphate. Dietary vitamin intake was determined with weighed 3-d food records. The dialysis patients had significantly greater stores of vitamin A, thiamin, riboflavin, pyridoxal phosphate, and folic acid than did the control population (P less than or equal to 0.01). The patients' combined dietary and supplemental intake of all vitamins except ascorbic acid was also significantly greater than the intake of the control group (P less than 0.01). Vitamin supplementation is associated with normal or greater-than-normal values of water-soluble vitamins in pediatric patients receiving long-term peritoneal dialysis.     

应用NRS2002标准对手术病人营养状况和营养支持的调查

目的:应用NRS2002标准对手术病人开展术前营养筛查,以了解该组病人的营养状况,同时进行围手术期营养支持和临床结局调查.方法:收治入院择期手术的127例普通外科、胸外科、妇科和骨科病人参与调查,采用2006年中国肠外肠内营养分会颁布的NRS2002评判标准;同时对病人围手术期营养支持方式、能量、营养素供给和术后并发症、住院时间和药物费用进行调查.结果:需要营养支持的病人占总调查人数的30.7%,其中普通外科占28.3%,高于胸外科(2.4%)、妇科(0%)和骨科(0%).老年人、恶性肿瘤、腹部大手术病人比例较高,分别为18.1%、19.7%和18.1%,与其他病人比较有显著性差异.7.6%的超重病人术前需制订营养支持计划.围手术期实际开展营养支持者与NRS2002评判结果有较大的差异(P＜0.05).正确实施营养支持者占19.7%,误用营养支持者占11.8%,未用营养支持者占11.0%.营养支持方式单一,以PN支持为主,实施营养支持病人的药物治疗费用、住院时间和术后感染并发症高于未实施的病人.结论:手术病人具有较高的营养不良风险,适宜采用NRS2002这样一个简便、易操作的工具对所有的病人进行营养筛查,并制订出合理的营养支持计划,以减少医疗资源的浪费和感染并发症的发生率.