No description available.

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke, craniocerebral trauma, critical-illness-polyneuropathy. The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinikum in Bad König. There were observed 58 patients (33 men and 25 women) during 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition and nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein and albumin in serum. These data are divided by sex, age and type of disease. Based on the results, it was found that although patients due to uniform tube feeding do not have sufficient protein intake, serum total protein and albumin levels increased. This can be caused by eating a uniform diet that contains good quality protein in patients, which suffered from hypoalbunemia at the outset of observation, also by reducing the effect of stress reactions with gradual improvement of the state and...

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating. Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project. Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating. Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience.

With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

The purpose of this study was to ascertain the number of registered dietitians in Tennessee who perceive they are practicing at advanced levels versus those making recommendations only. Job satisfaction according to order writing privileges was also assessed. A five question survey was sent to hospitals meeting selection criteria. Thirty-three surveys (89%) were returned. Eighty-nine percent of dietitians with order writing privileges considered themselves to be advanced level practitioners compared to 60% in the group of dietitians who did not have order writing privileges. Dietitians with order writing privileges indicated greater job satisfaction compared to dietitians that did not have that privilege. Greater job satisfaction was reported with advanced level skills which included order writing privileges. This study may show the need for dietitians to pursue advanced level skills in order to be challenged by their work, which may improve job satisfaction, and advancement in the field of nutritional care.

No description available.

As sondas de alimentação constituem uma via alternativa para a administração de medicamentos em pacientes cuja situação clínica impede a utilização da via oral. É sabido que a utilização de medicamentos nesses pacientes requer cuidados especiais, tanto na seleção da forma farmacêutica quanto no preparo e na administração dos mesmos. Para se conhecer as características dos pacientes internados usando sondas de nutrição enteral (SNE) no Hospital de Clínicas de Porto Alegre, bem como os medicamentos prescritos e utilizados via SNE, foram analisados 315 prontuários médicos na primeira etapa do estudo. A maioria dos pacientes era formada por adultos (51%) do sexo masculino (59%), com diagnóstico de câncer (32%) ou doença neurológica (21%). A média de uso da SNE foi de 15 dias. Noventa e cinco por cento dos pacientes utilizaram algum fármaco na forma farmacêutica sólida, principalmente comprimidos (72%), cápsulas (12%) e drágeas (9%). A taxa de troca de sonda correspondeu a 32%. Na segunda etapa do estudo, auxiliares de enfermagem foram observados em suas rotinas de trabalho no hospital, visando analisar o processo de preparo e administração dos medicamentos aos pacientes. Foi observado que esses profissionais não utilizavam técnicas adequadas nos momentos de preparo dos medicamentos e administração dos mesmos aos pacientes com SNE. A alta incidência do uso de formas farmacêuticas sólidas, o número de medicamentos prescritos, os dias de uso da sonda e a diversidade de métodos de trabalho utilizados no momento da derivação, diluição e administração dos medicamentos pelos auxiliares de enfermagem mostram que, apesar da ampla informação disponível na literatura sobre o uso de medicamentos em pacientes com SNE, a prática clínica está sendo realizada de modo inconsistente em relação aos dados disponíveis, trazendo assim dificuldades para o tratamento dos pacientes. / The tube feeding constitutes an alternative way for patients with a clinic situation that the oral way is hindered. It is known that these patients require particular methods in the drug utilization process, even in the selection of the pharmaceutical form of the medicine as in the preparation and administration of these drugs. To understand the patient characteristics using enteral tube feeding (ETF) in the Hospital de Clínicas de Porto Alegre as well as the drugs prescribed by ETF way, the medical records of 315 interned patients were analyzed in the first stage of the research. The majority of patients was adults (51%) of male gender (59%) with cancer (32%) or neurological disease (21%) diagnostic. The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The average of ETF changing was 32%. In the second stage of this research, nurse assistants were observed in their routine of working in the hospital to analyze the process of preparation and administration of the drugs to patients with ETF. It was observed that the nurses assistant neither use proper techniques in the moment of the drugs preparation nor in the administration of these drugs to patients with ETF. The high incidence of using solid pharmaceutical forms; the number of drugs prescribed, the using days of ETF and the diversity of working methods used in the derivation, dilution and administration moment by the nurse assistants showed that despite good amount of information in the literature about the administration of drugs in patients using ETF, the clinical practice is being carried out in a way that is inconsistent with the data available, causing difficulties for the patient treatment.

As sondas de alimentação constituem uma via alternativa para a administração de medicamentos em pacientes cuja situação clínica impede a utilização da via oral. É sabido que a utilização de medicamentos nesses pacientes requer cuidados especiais, tanto na seleção da forma farmacêutica quanto no preparo e na administração dos mesmos. Para se conhecer as características dos pacientes internados usando sondas de nutrição enteral (SNE) no Hospital de Clínicas de Porto Alegre, bem como os medicamentos prescritos e utilizados via SNE, foram analisados 315 prontuários médicos na primeira etapa do estudo. A maioria dos pacientes era formada por adultos (51%) do sexo masculino (59%), com diagnóstico de câncer (32%) ou doença neurológica (21%). A média de uso da SNE foi de 15 dias. Noventa e cinco por cento dos pacientes utilizaram algum fármaco na forma farmacêutica sólida, principalmente comprimidos (72%), cápsulas (12%) e drágeas (9%). A taxa de troca de sonda correspondeu a 32%. Na segunda etapa do estudo, auxiliares de enfermagem foram observados em suas rotinas de trabalho no hospital, visando analisar o processo de preparo e administração dos medicamentos aos pacientes. Foi observado que esses profissionais não utilizavam técnicas adequadas nos momentos de preparo dos medicamentos e administração dos mesmos aos pacientes com SNE. A alta incidência do uso de formas farmacêuticas sólidas, o número de medicamentos prescritos, os dias de uso da sonda e a diversidade de métodos de trabalho utilizados no momento da derivação, diluição e administração dos medicamentos pelos auxiliares de enfermagem mostram que, apesar da ampla informação disponível na literatura sobre o uso de medicamentos em pacientes com SNE, a prática clínica está sendo realizada de modo inconsistente em relação aos dados disponíveis, trazendo assim dificuldades para o tratamento dos pacientes. / The tube feeding constitutes an alternative way for patients with a clinic situation that the oral way is hindered. It is known that these patients require particular methods in the drug utilization process, even in the selection of the pharmaceutical form of the medicine as in the preparation and administration of these drugs. To understand the patient characteristics using enteral tube feeding (ETF) in the Hospital de Clínicas de Porto Alegre as well as the drugs prescribed by ETF way, the medical records of 315 interned patients were analyzed in the first stage of the research. The majority of patients was adults (51%) of male gender (59%) with cancer (32%) or neurological disease (21%) diagnostic. The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The average of ETF changing was 32%. In the second stage of this research, nurse assistants were observed in their routine of working in the hospital to analyze the process of preparation and administration of the drugs to patients with ETF. It was observed that the nurses assistant neither use proper techniques in the moment of the drugs preparation nor in the administration of these drugs to patients with ETF. The high incidence of using solid pharmaceutical forms; the number of drugs prescribed, the using days of ETF and the diversity of working methods used in the derivation, dilution and administration moment by the nurse assistants showed that despite good amount of information in the literature about the administration of drugs in patients using ETF, the clinical practice is being carried out in a way that is inconsistent with the data available, causing difficulties for the patient treatment.