Nutrition support during acute pancreatitis

Studies have shown that protein catabolism increases by 80% and energy expenditure by 20% in acute pancreatitis, indicating that nutritional requirements are elevated. Other studies have associated the resolution of negative nitrogen balance by nutrition support with improved outcome. Consequently, the need for effective nutrition is one cornerstone of management of acute pancreatitis. Concerns that feeding may exacerbate the disease process by stimulating the synthesis of proteolytic enzymes in the acinar cell and perpetuating autolysis has led to the widespread use of total parenteral nutrition (TPN) and bowel rest. Unfortunately, the use of TPN in clinical practice has been associated with major metabolic and infective complications, possibly because 1). patients with acute pancreatitis are intolerant of glucose due to coexistent pancreatic endocrine dysfunction and 2). the disease causes immune suppression. This has led to the search for alternatives. Based on physiologic studies, infusion of nutrients into the distal jejunum bypasses the stimulatory effect of feeding on pancreatic secretion. Many controlled trials have compared TPN with jejunal feeding. No study has shown that jejunal feeding exacerbates the disease. Further, jejunal feeding is associated with fewer infectious and metabolic complications. These observations and the fact that enteral feeding is one-tenth the cost of TPN has resulted in the general acceptance of jejunal feeding as the preferred mode for maintaining nutrition in patients with acute pancreatitis.     

重症急性胰腺炎的营养支持治疗

目的：探讨营养支持在重症急性胰腺炎病人治疗中的价值及特点。方法;通过对１７例重症急性胰腺炎营养支持治疗,观察其应用的必要性。采取低热量,高氮量的营养配方,糖脂比例为１：１,热氮比４１８．４（ｋＪ）：１（ｇ）。全肠外营养全部自中心静脉供给。分阶段逐渐由ＴＰＮ过渡到全肠内营养或口服饮食。     

重症急性胰腺炎的营养支持效果评价

目的:探讨不同营养支持方式对重症急性胰腺炎(SAP)病人的l临床应用效果.方法:对38例收住于SICU的SAP病人营养支持实施情况、EN相关性并发症及感染进行观察.17例病人在PN过程中加入EN(EN PN组),21例单纯应用PN(PN组),定期检测血清蛋白质,并进行统计学分析.结果:营养支持中PN应用总时间为(25.58±3.84)天,17例病人于发病后(17.00±3.35)天开始应用EN,(17.58±5.42)天达到最大喂养量;5例病人应用EN后肠功能明显恢复.EN 2周后感染性并发症明显降低;两组血清蛋白质轻度升高,PN7天、EN 14天血清前清蛋白升高(P＜0.05).结论:SAP早期应以PN为主,肠功能允许时,PN EN是较好的营养支持方式,肠道喂养有助于降低SAP病人的全身性感染.     

乌司他丁治疗急性胰腺炎的系统评价

目的评价乌司他丁治疗急性胰腺炎的有效性与安全性。方法利用RewMan4.2软件,对乌司他丁治疗急性胰腺炎的随机对照试验(RCT)进行Meta分析。结果共纳入16篇RCT,Meta分析结果显示,乌司他丁组的治疗有效率明显高于常规组(P0.00001);乌司他丁组的血淀粉酶恢复正常时间、腹痛及腹部压痛消失时间、平均住院时间明显短于常规组(P0.00001);乌司他丁治疗重症急性胰腺炎的并发症发生率明显降低(P=0.006);6个试验记录乌司他丁治疗后未发现有不良反应,2个试验记录有1例病人出现不良反应;没有试验记录乌司他丁治疗后有病死情况。结论乌司他丁在改善急性胰腺炎近期临床疗效指标方面优于常规治疗,但远期疗效尚待研究评价。     

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty‐six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well‐being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well‐designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.     

Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature

Background  

Cannabis intoxication is related to a number of physical and mental health risks with ensuing social costs. However, little attention has been given to the investigation of possible pharmacological interactions in this condition.     

Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature

Background

Medical cannabis dispensaries following the social or hybrid model offer supplementary holistic services in addition to dispensing medical cannabis. Historically, alternative physical health services have been the norm for these dispensaries, including services such as yoga, acupuncture, or chiropractor visits. A clinical service dearth remains for medical cannabis patients seeking substance use, misuse, dependence, and mental health services. This study examined patient desires for various clinical services and level of willingness to participate in specific clinical services.

Methods

Anonymous survey data (N = 303) were collected at Harborside Health Center (HHC), a medical cannabis dispensary in Oakland, CA. The sample was 70% male, 48% Caucasian and 21% African American. The mean male age was 38 years old and female mean age was 30. Sixty two percent of the male participants and 44% of the female participants are single. Sixteen percent of the population reported having a domestic partner. Forty six percent of the participants are employed full time, 41% have completed at least some college, and 49% make less than $40,000 a year.

Results

A significant portion of the sample, 62%, indicated a desire to participate in free clinical services at HHC, 34% would like more information about substances and use, and 41% want to learn more about reducing harms from substance use. About one quarter of the participants marked "would" or "likely would" participate in individual services such as consultation. Approximately 20% indicated "would" or "likely would" participate in psycho-educational forums, harm reduction information sharing sessions, online support groups, and coping, life, and social skills group. There was little interest in traditional NA/AA 12-step groups or adapted 12-step groups.

Conclusions

Desired clinical services can be qualified as a combination of harm reduction, educational, skills-based, peer support and therapeutic individual and group services. Results suggest that medical cannabis patients seek more information about various substances, including cannabis. Dispensaries can help to decrease gaps in substance education and clinical services and fulfill unmet clinical desires. More research is necessary in additional medical cannabis dispensaries in different geographic settings with different service delivery models.     

Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature

Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.     

Pay-for-performance in disease management: a systematic review of the literature

Background

There is a lack of acceptable, reliable, and valid survey instruments to measure conceptual research utilization (CRU). In this study, we investigated the psychometric properties of a newly developed scale (the CRU Scale).

Methods

We used the Standards for Educational and Psychological Testing as a validation framework to assess four sources of validity evidence: content, response processes, internal structure, and relations to other variables. A panel of nine international research utilization experts performed a formal content validity assessment. To determine response process validity, we conducted a series of one-on-one scale administration sessions with 10 healthcare aides. Internal structure and relations to other variables validity was examined using CRU Scale response data from a sample of 707 healthcare aides working in 30 urban Canadian nursing homes. Principal components analysis and confirmatory factor analyses were conducted to determine internal structure. Relations to other variables were examined using: (1) bivariate correlations; (2) change in mean values of CRU with increasing levels of other kinds of research utilization; and (3) multivariate linear regression.

Results

Content validity index scores for the five items ranged from 0.55 to 1.00. The principal components analysis predicted a 5-item 1-factor model. This was inconsistent with the findings from the confirmatory factor analysis, which showed best fit for a 4-item 1-factor model. Bivariate associations between CRU and other kinds of research utilization were statistically significant (p < 0.01) for the latent CRU scale score and all five CRU items. The CRU scale score was also shown to be significant predictor of overall research utilization in multivariate linear regression.

Conclusions

The CRU scale showed acceptable initial psychometric properties with respect to responses from healthcare aides in nursing homes. Based on our validity, reliability, and acceptability analyses, we recommend using a reduced (four-item) version of the CRU scale to yield sound assessments of CRU by healthcare aides. Refinement to the wording of one item is also needed. Planned future research will include: latent scale scoring, identification of variables that predict and are outcomes to conceptual research use, and longitudinal work to determine CRU Scale sensitivity to change.     

Knowledge management in health: a systematic literature review

Knowledge has been used as a resource for intelligent and effective action planning in organizations. Interest in research on knowledge management processes has intensified in different areas. A systematic literature review was accomplished, based on the question: what are the contributions of Brazilian and international journal publications on knowledge management in health? The sample totaled 32 items that complied with the inclusion criteria. The results showed that 78% of journals that published on the theme are international, 77% of researchers work in higher education and 65% have a Ph.D. The texts gave rise to five thematic categories, mainly: development of knowledge management systems in health (37.5%), discussion of knowledge management application in health (28.1%) and nurses' function in knowledge management (18.7%).     

社区老年人多病共存与死亡关系的队列研究

  目的  了解北京市18～79岁居民不良睡眠状况与慢性病共病患病的关系,为慢性病共病的预防控制提供参考依据。  方法  于2017年8 — 12月采用多阶段分层整群随机抽样方法在北京市16个区抽取13 240名18～79岁常住居民进行问卷调查、体格检查和实验室检测;采用复杂抽样加权方法估计居民不良睡眠率和慢性病共病患病率,并应用多因素非条件logistic回归模型分析打鼾/窒息、中间觉醒 ≥ 2次、早醒、入睡困难、服用安眠药5种不良睡眠状况与慢性病共病患病的关系。  结果  北京市13 240名18～79岁居民中,自述30 d内每周 ≥ 3 d出现打鼾/窒息3413人（25.8 %）、入睡困难2536人（19.2 %）、中间觉醒 ≥ 2次3103人（23.4 %）、早醒2671人（20.2 %）、服用安眠药367人（2.8 %）,有 ≥ 1种不良睡眠状况者6490人,复杂抽样加权后不良睡眠率为52.1 %;慢性病共病患病者4 980例,复杂抽样加权后慢性病共病患病率为41.7 %;在调整了性别、年龄、文化程度、婚姻状况、居住地、是否现在吸烟、近7 d是否饮酒、是否身体活动不足、是否主动体检和是否健康体重等混杂因素后,多因素非条件logistic回归分析结果显示,打鼾/窒息（OR = 1.955,95 % CI = 1.731～2.208）、中间觉醒 ≥ 2次（OR = 1.914,95 % CI = 1.591～2.202）、早醒（OR = 1.802,95 % CI = 1.534～2.117）、入睡困难（OR = 1.625,95 % CI = 1.380～1.913）、服用安眠药（OR = 2.617,95 % CI = 1.907～3.592）这5种不良睡眠状况均与北京市18～79岁居民慢性病共病的风险有关。  结论  北京市18～79岁居民不良睡眠和慢性病共病患病状况均较为严重,且多种不良睡眠状况均与慢性病共病患病有关,应在治疗已有疾病的同时关注患者的睡眠问题。     

Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: a systematic review

BACKGROUND & AIMS: There is increasing evidence that tight glucose control may reduce infectious complications and mortality in surgical critically ill patients. However, data regarding the influence of artificial nutrition on glycemic homeostasis are limited. Our aim was to review all randomized controlled trials on enteral versus parenteral nutrition in acute pancreatitis to determine whether the route of feeding can affect the glucose control in the setting of this disease. METHODS: Relevant literature cited in three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and Medline) were systematically reviewed. A meta-analysis was carried out using a random-effects model. RESULTS: Thirteen randomized controlled trials on enteral versus parenteral nutrition in acute pancreatitis were identified. Seven studies were excluded from analysis, leaving 6 trials in which a total of 264 non-diabetic patients with acute pancreatitis were treated. Intake of nutrients did not differ among enterally and parenterally fed patients in 5 of 6 randomized controlled trials. Enteral nutrition reduced the risk of hyperglycemia (relative risk 0.53; 95% confidence interval 0.29-0.98; p = 0.04) and insulin requirement (relative risk 0.41; 95% confidence interval 0.24-0.70; p = 0.001). CONCLUSIONS: Enteral nutrition, when compared with parenteral nutrition, is associated with better blood glucose control in patients with acute pancreatitis.     

Nutritional support in acute pancreatitis

PURPOSE OF REVIEW: This review explores the role of enteral and parenteral nutrition in severe acute pancreatitis and discusses the potential benefits of glutamine, omega-3 fatty acids, arginine and selenium together with probiotics and prebiotics in these patients. In addition, the method of refeeding during the convalescent period is also examined. RECENT FINDINGS: A complex picture is emerging in which enteral nutritional support may be important early in the course of the disease with parenteral nutrition being used more as a backup and possibly only after the systemic inflammatory response has peaked. Nasogastric feeding, sometimes supplemented by parenteral nutrition, is as efficacious as nasojejunal feeding. An individualized approach, in which strategies of nutritional support are tailored to patient response, is gaining currency. Data regarding specialized formulae are mixed but the use of prebiotics is showing promise and is worthy of further exploration. In the convalescent period, preliminary data also indicate that the risk of pain developing is no greater if a light diet is instituted rather than clear fluids. SUMMARY: Nutritional support in acute pancreatitis remains challenging and controversial with a number of different and unexpected approaches, including the use of nasogastric feeding and dual enteral and parenteral nutrition support, being adopted in recent clinical trials.     

Nutrition support of intractable diarrhea. A case report and literature review

Intractable diarrhea is an important cause of severe malnutrition and growth failure during infancy. Early recognition and intervention under the direction of the nutritional support team facilitates successful recovery from the disease.     

Oka株水痘减毒疫苗免疫水痘发病的现场观察

  目的  对2004年2月 — 2021年11月国内外水痘疫苗不同免疫策略经济学研究进行质量评价,为我国水痘疫苗免疫策略和免疫规划决策提供参考。   方法  以“水痘疫苗”、“经济学评价”、“成本”、“成本效果”、“成本效用”、“成本效益”、“varicella vaccine”、“economic evaluation”、“cost”、“cost-benefit”、“cost-effect”、“cost-utility” 为检索主题,检索3个中文数据库和6个英文数据库,对检索出的文献进行2次筛选,参照世界卫生组织《免疫规划项目的经济学评价标准指南》提取纳入文献中的相关信息,采用卫生经济研究质量评价工具（quality of health economic studies,QHES）对2004年2月 — 2021年11月国内外水痘疫苗不同免疫策略经济学研究进行质量评价,并综合分析评价结果。   结果  共纳入13篇文献,其中中文文献4篇、英文文献9篇。分析结果显示,与不接种水痘疫苗相比,接种1剂次或2剂次水痘疫苗普遍具有成本效益;接种2剂次与1剂次相比,成本效益尚待进一步研究,但随着时间推移,2剂次接种的成本效益正逐渐提高。   结论  应进一步开展2剂次与1剂次水痘疫苗免疫策略成本效益的对比研究。我国应基于国内数据,开展水痘疫苗不同免疫策略经济学研究,从而采用成本效益佳的水痘疫苗免疫策略。     

Treatment of postherpetic neuralgia: a systematic review of the literature

OBJECTIVES: We wanted to determine whether any treatment had been shown to reduce pain or disability from postherpetic neuralgia (PHN), a common sequela of herpes zoster in elderly patients. STUDY DESIGN: We undertook a systematic review of English-language randomized controlled trials (RCTs) of treatments of PHN with evaluation periods longer than 24 hours. DATA SOURCES: We systematically searched MEDLINE, Current Contents, and the Cochrane Library. We also searched reference lists of identified trials and reviews and contacted content experts. OUTCOMES MEASURED: Two reviewers independently evaluated RCTs for methodologic quality and data extraction. Outcomes of primary focus were pain and quality of life. RESULTS: Twenty-seven RCTs met inclusion criteria and were reviewed. Six trials of tricyclic antidepressants found evidence for clinically meaningful effects over 6 weeks. All other treatments were evaluated in no more than 2 trials meeting our inclusion criteria. Topical capsaicin 0.075%, gabapentin, and controlled-release oxycodone were shown to be effective, but the clinically meaningful benefit is difficult to quantify. Intrathecal methylprednisolone and possibly bupivacaine sympathetic blocks are helpful in refractory cases. Other treatments evaluated, including topical lidocaine, had no evidence or inconsistent evidence of benefit. CONCLUSIONS: No single best treatment for PHN is known. Tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN; however, long-term, clinically meaningful benefits are uncertain and side effects are common. Patients with PHN refractory to these therapies may benefit from intrathecal methylprednisolone. Little evidence is available regarding treatment of PHN of less than 6 months' duration.