Nutrition and health--enteral nutrition in intensive care patients

Nutritional therapy in the intensive care unit exerts favourable effects on morbidity and mortality. Enteral nutrition is preferable to parenteral nutrition. Only perforation or total obstruction of the gastrointestinal tract, proven mesenteric ischaemia and toxic megacolon are absolute contra-indications to enteral nutrition. Early enteral nutrition is effective in decreasing infectious complications and reducing the length of stay in the hospital. Nutrition that is enriched with specific ingredients in order to modulate the immune response is referred to as immunonutrition. The use of immunonutrition, notably in surgical intensive care patients, has a favourable effect on the incidence of infectious complications, the duration of artificial respiration and the length of hospital stay. The addition of glutamine to parenteral nutrition may reduce mortality compared to standard parenteral nutrition. Implementation of a simple feeding algorithm in the intensive care unit, with special attention for the treatment of delayed gastric emptying, is cost-effective and leads to an improvement in the nutritional parameters.     

营养与艾滋病防治

自1981年全球首次报道艾滋病（AIDS）后,已有2500万人死于AIDS。HIV／AIDS正在成为历史上最具破坏性的流行病之一。根据世界卫生组织（WHO）报告,2005年全球有4030万人感染艾滋病病毒（HIV）,其中2005年新感染病例490万。     

Memisa and home care for AIDS patients in Zambia

Health care in Zambia has since long been receiving support from non-governmental organizations (NGOs) like Memisa. Church organizations bear responsibility for a considerable part of the national health services. During the last 15 years, growing attention has been given to improvement of basic services in the villages and to recruitment and organization of groups in the community active in the field of health care. The combat against AIDS is a major focus. Many NGOs give health education on HIV and AIDS, are coaching HIV-positive individuals and are trying to organize support for AIDS patients and their relatives and relief for women and children after the death of husband or father. The community home care projects established in the urban areas of Copperbelt province in Zambia provide a decent terminal phase for AIDS patients and assist the surviving families in maintaining a certain socioeconomic level of existence.     

Self-care and HIV/AIDS patients: nursing care systematization

This research aimed at systematizing nursing care to HIV/aids patients in view of Orem's Self-care Deficit Nursing Theory, using the convergent-care method and the Self-Care Nursing Process. Subjects were thirteen HIV/AIDS patients attended at a non-governmental organization in Fortaleza/CE, Brazil. We used interview techniques, physical examination, observation and information records, with a structured instrument, addressing requisites related to universal self-care, development and health alterations. Self-care deficits corresponded to nineteen nursing diagnoses, named according to NANDA's Taxonomy II, ten of which were based on the requisites for universal self-care, five on the requisites for self-care related to development and four on the requisites for self-care related to health deviations. In care planning, goals were established and the system and health methods were selected, prioritizing support-education actions in order to engage HIV/aids patients in self-care.     

Expectations of hospitalized patients with HIV/AIDS regarding nursing care

This study aimed at verifying the expectations of patients with HIV serum-positive patients, regarding to nursing care. This is a study with qualitative approach developed in the inpatient unit of a state public hospital in the municipal district of Fortaleza, CE. Data were collected in the period of September to October of 2003 through semi-structured interview, applied to 12 patients, randomly selected among the patients with diagnosis of HIV/AIDS. For data analysis it was used the Collective Subject's Speech (DSC) through emission of central ideas and/or key-expression. It was conclude that the patients expectations are for a more human care, more attention, contact verbal, more affectivity of the nursing team, a qualified and worthy attention. Besides their needs they should be informed daily about the vulnerabilities that they are submitted during the hospitalization.     

Nutrition support of the pediatric patient with AIDS

Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) is challenging, but it may be one of the most effective therapies. Patients experience numerous complications that compromise nutritional status. Infection, fever, diarrhea, feeding problems, and decreased intake all contribute to malnutrition, which in turn predisposes the patient even more to infection and malabsorption. Nutrition assessment should be done routinely so that new problems may be identified and treated. High-calorie, high-protein feedings, vitamin supplementation, and, when necessary, gavage feedings or parenteral nutrition are recommended to improve nutritional status and prevent further deficits. Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) poses a significant challenge to the health care team. Patients may experience numerous complications that compromise nutritional status. The patient is at high risk for opportunistic infections, especially of the lungs, central nervous system, gastrointestinal (GI) tract, and skin. Such infections are common causes of morbidity and mortality. Impaired nutritional status may further impair the patient's immunocompetence. A study by Kotler and Gaety demonstrated severe progressive malnutrition in adult AIDS patients, with the lowest measures of lean body mass occurring in those patients close to death at the time of the study. While no studies of children with AIDS have been done to date, we have subjectively observed feeding problems, weight loss, and malnutrition in most of the patients we have seen.     

Nutrition assessment, care, and considerations of ventricular assist device patients

A ventricular assist device (VAD) is an implantable mechanical device that is used to partially or completely replace the circulatory function of a failing heart. VADs may serve as a bridge to heart transplantation or as permanent circulatory assistance, also referred to as destination therapy. There is a paucity of information regarding the nutrition complications in VAD patients, and as such, little is presently known of the optimal means of nutrition assessment and management of these complex and often critically ill patients. In this review, a general overview of the VAD, comparisons of nutrition assessment measures, and strategies to meet the nutrition needs of these patients are provided using evidence-based information wherever possible. Because there is a lack of nutrition studies and assessment guidelines specifically for VAD patients, many of the guidelines for care of these patients are currently based on the information available for the care of patients with heart failure. Although the optimal measure to assess nutrition status remains poorly studied, a systematic, thorough nutrition assessment of patients with heart failure and heart transplant candidates prior to VAD placement appears to be important to identify those at nutrition risk and, with appropriate nutrition therapy, decrease their risk for morbidity and mortality. VAD patients with inadequate oral intake may require nutrition support to meet their nutrition needs; however, feeding the hemodynamically compromised patient provides additional challenges.     

人工流产后的营养关怀

女人年过三十之后,常处于这样的境地,工作不容懈怠,生活节调紧凑,而身体呢,却开始了不可遏制的老化进程。不仅如此,经历了婚育的成熟女人还常常会有意外发生,人工流产也好,药物流产也罢,对于已经过了青春年华的她们来说实在是一场无妄之灾,如果没有在这样一场浩劫之后获得周到而合理的关怀,她们怎样来面对今后的风风雨雨,又怎能保持她们的妩媚和青春活力?     

Nutrition care activities and DRGs

The recent passage and implementation of the prospective payment system (PPS) for Medicare inpatient services have had a strong impact on dietitians practicing in southern Florida. Because several local hospitals service regions in which 90% of the population is 65 years old or older, the annual revenues from Medicare have been reduced. The hospitals still have to meet basic overhead costs and profit margins. This has resulted in the elimination of several dietetic positions. Therefore, dietitians need to establish a cost-benefit justification for the nutrition care and support of patients. This study is the initial phase of a plan to define the nutrition care services the dietitian provides and to identify the most frequently occurring diagnosis related grouping (DRG) categories. For 3 weeks, 31 dietitians maintained logs that detailed dietetic intervention and treatment for each of the 3,827 patients seen. The nutrition care activities reported most frequently by dietitians were basic services, hospital visit and reassessment, initial consultation, and screening to rule out malnutrition. The mean time spent in all nutrition care activities ranged from 13 to 33 minutes. The most frequently occurring DRGs were those for diabetes, heart failure, circulatory disorders, specific cerebrovascular accident, and transient ischemic attacks. Overall, the type of nutrition care activities and the time spent in those activities were significantly different among the hospitals studied. The differences reflect the philosophies of each facility. The types of DRG categories observed reflect the age of the population served.     

Patterns of hospital care for patients with HIV infection and AIDS.

OBJECTIVE--The aims were to describe the use of inpatient resources by patients with HIV infection and patients with AIDS; to examine trends in service use over time; and to provide data for planners concerned with service provision for HIV infection. SETTING--An inner London health district reporting 9% of AIDS cases nationally. DESIGN--Data on survival times and inpatient and day care use of resources were derived from existing patient records or collected prospectively between 1983 (when the first case of AIDS was diagnosed in the district) and 31 March 1990. SUBJECTS--A total of 488 HIV positive patients of whom 396 had been diagnosed as having AIDS were studied. MEASUREMENTS AND MAIN RESULTS--Inpatient days consumed per annum; trends in the number of bed days per person year with AIDS; the lifetime inpatient use per AIDS patient; and the influence of survival on service use estimates were determined. Altogether 16.4% of a total 17,785 hospital inpatient days were attributable to HIV positive patients who did not fulfil the criteria for AIDS. For patients with AIDS, there was an initial increase in the intensity of inpatient use in 1987 when a dedicated HIV ward was opened. After 1988, however, inpatient use fell to 30.8 bed days per person year with AIDS. Patients diagnosed after April 1987 had noticeably longer survival times than those diagnosed earlier (a median of 17-18 months compared with a median of 10-11 months). From 214 lifetime service use records, it was estimated that patients with short survival (less than six months) would consume 36 days of inpatient care, while those expected to survive longer would consume approximately twice that number of days, irrespective of how much longer they survived. CONCLUSIONS--The data indicate less intensive use of inpatient care by AIDS patients over time, and hence the apparent ability to manage an increasing AIDS patient workload without a comparable increase in occupied bed days. Increases in the size of that workload and changes in the survival profile of patients, together with a relatively constant rate of service demand by longer survivors, however, will continue to place increasing strains on finite inpatient resources. Further research is needed to establish the extent to which the greater use of outpatient and community services can offset this.     

艾滋病病人营养指导专家共识

<正>序言在HIV感染的全过程中,机体营养状况与免疫功能关系密切且相互影响。从HIV感染到发病期间,由于机体免疫功能受损,易导致营养不良的发生,营养不良又会进一步削弱机体免疫功能,形成恶性循环。良好的营养支持能有效延缓HIV感染者/艾滋病患者疾病进程,提高免疫能力,并降低各类艾滋病相关或非相关疾病的患病率。目前,国内缺乏针对艾滋病营养指导的专家共识,中国营养学会委托北京大学公共卫生学院牵头,联合中国疾病预防控制中心、北京协和医院、中国健康教育中心、解放军总医院第一医学中心、北京佑安医院等单位,按照循证医学原则,选择当前最佳证据,经反复讨论修改,最终形成本共识。证据等级采用世界卫生组织(WHO)指南制定手册证据评价要求和等级评价及结论推荐方法。本共识可供各     

Nutrition and AIDS, 2nd ed.

Objective: To investigate the effect of 5 newly developed maize-based fibers on the activity and composition of the microbiota in the colon. The fibers tested were glucose-based and had variable structures, including 2 resistant starch preparations, soluble corn fiber, pullulan, and soluble fiber dextrin.

Methods: The fibers were predigested, mono- and disaccharides were removed, and the residual polymer was used to assess the production of microbial metabolites and changes in composition of the microbiota using a dynamic, validated, in vitro model of the large intestine.

Results: Microbial metabolite analysis showed an increase in short-chain fatty acids for all fibers, with varying levels of butyrate production for each fiber. The greatest increase of butyrate, both in terms of absolute amounts and as a proportion of total short-chain fatty acids, was observed for pullulan. All fibers also reduced toxic metabolites from protein fermentation compared to the poorly fermentable control (cellulose). Microbial composition was assessed using a micro-array platform. All fibers showed increases of bifidobacteria and some Lactobacillus species, although different species were stimulated by different fibers. Pullulan showed the largest increase of bifidobacteria.

Conclusions: All fibers showed prebiotic activity in terms of increases in growth and/or activity of beneficial microbes. In addition, compared to the control, health-promoting metabolites were produced in higher amounts, while putrefactive metabolites were reduced for all fibers. The importance of the findings lies in the fact that the newly developed, maize-based fibers shift the intestinal environment to a healthier milieu, with increased health-promoting metabolites and health-beneficial microbes.