DIFFERENCES IN NUTRITIONAL OUTCOME MEASURES BETWEEN PREADOLESCENTS AND ADOLECENTS WITH ANOREXIA NERVOSA WHO RECEIVED A NASOGASTRIC FEEDING TUBE VERSUS ORAL DIET UPON HOSPITAL ADMISSION by Paige E. Herring Background: Anorexia nervosa (AN) is a disease defined by an extreme weight loss due to an intense fear of gaining weight, and it is the third most chronic disease in adolescent females. Hospitalizations are common among patients with AN due to the major consequences that can arise from this disease. Most of the complications can be resolved with significant weight gain, so hospitals have an implemented feeding protocols to optimize weight gain. Studies have shown that nasogastric (NG) feedings have resulted in a greater weight gain and reduced length of stay without significant side effects. Objective: The purpose of this study is to examine the association between demographic and clinical characteristics and mode of nutrition therapy (oral feeding vs. NG tube feedings) in a population of pre-adolescents and adolescents with a hospital admission diagnosis of AN. The clinical outcome measures are length of stay (LOS), weight gain, and suspected refeeding syndrome. Participants/Setting: The study sample includes 64 patients between the ages 9 and 20 years who have been admitted to Children’s Healthcare of Atlanta between January 1, 2014 and December 31, 2015 for clinical treatment of AN. The demographic, anthropometric, mode of nutrition therapy and clinical characteristics of the patient population were obtained. Statistical Analysis: Frequency statistics were used to describe demographic, anthropometric, mode of nutrition therapy and clinical characteristics of the patient population. A Student’s t-test was used to examine differences in continuous variables by tube feeding status, while a Mann-Whitney U test was used for the non-normally distributed variables. A Chi-square test was used to examine differences in tube feeding status by categorical variables. Results: Data were collected and analyzed for 64 patients, with a mean age of 14.6 + 2.4 years, and the majority of the population being female (93.8%) and Caucasian (92.2%). Approximately half (n=30, 47%) of the population received an NG tube during the admission. Mean discharge BMI was significantly higher in those who received an oral diet vs. NG tube (16.67 vs. 17.08, respectively; p=0.042) while weight change was significantly lower (1.3 kg vs. 2.1 kg, respectively; p=0.012) and LOS shorter (8 days vs. 11 days, respectively; p=0.002) There were no significant differences in other characteristics by mode of nutrition therapy. Conclusion: NG tube feeding is an effective method for feeding hospitalize adolescent patients with AN to yield greater weight gain results. Future studies are necessary to determine the amount of time exclusively on the NG tube, reasons for choosing NG vs. oral feedings, and other variables associated with weight gain and length of stay.

Both intermittent oral gavage tube placement(0G) and indwelling nasogastric tube placement (NG) are acceptable methods for feeding preterm infants. A randomized controlled pilot study was conducted to examine the impact of OG versus NG placement on premature infant feeding transition. Twenty healthy premature infants were enrolled and thirteen completed the study. The results were not statistically significant. Age at last tube feed averaged 35 weeks gestational age (GA) for the intermittent group and 35+4 weeks GA for the indwelling group (p=0.181). Infants in both groups were discharged at an average of 36 weeks GA (p=.836) and averaged suckled volumes at 35 weeks GA was 134.4cc/kg/day for the intermittent group versus 111.8cc/kg/day for the indwelling group (p=0.240). Infant feeding patterns were analyzed descriptively and found to be consistently variable. The lack of consistency in feeding development has implications for feeding plan development and feeding transition care.

Both intermittent oral gavage tube placement(0G) and indwelling nasogastric tube placement (NG) are acceptable methods for feeding preterm infants. A randomized controlled pilot study was conducted to examine the impact of OG versus NG placement on premature infant feeding transition. Twenty healthy premature infants were enrolled and thirteen completed the study. The results were not statistically significant. Age at last tube feed averaged 35 weeks gestational age (GA) for the intermittent group and 35+4 weeks GA for the indwelling group (p=0.181). Infants in both groups were discharged at an average of 36 weeks GA (p=.836) and averaged suckled volumes at 35 weeks GA was 134.4cc/kg/day for the intermittent group versus 111.8cc/kg/day for the indwelling group (p=0.240). Infant feeding patterns were analyzed descriptively and found to be consistently variable. The lack of consistency in feeding development has implications for feeding plan development and feeding transition care.

Malnutrition and nutritional deprivation are common in hospital patients. Consequent dysfunction is exacerbated in the presence of an inflammatory state and leads to increased morbidity, mortality and treatment cost. This thesis tested the hypothesis that clinical outcome could be improved, and treatment cost reduced, if enteral nutritional (EN) was; a) initiated earlier after the pathological event, and b) when > 50% of a patient's estimated energy and nitrogen requirements were met by EN (ie. aggressive EN). A Preliminary Investigation found that patients starved for &le; 5 days compared to > 5 days, had a lower mortality (p < 0.003) and shorter duration of nasogastric (NG) feeding (p = 0.049). The population studied was heterogenous and no account was taken of disease severity. The hypothesis was therefore re-tested in burned patients, controlling for disease severity. The delay before attempting aggressive EN was associated with major complications excluding (p < 0.001) and including mortality (p = 0.018), length of (hospital) stay (LOS) (p = 0.011), and treatment cost (p < 0.001). Finally, a prospective randomised controlled trial (PRCT) was used to test the hypothesis. A study of patients undergoing major GI surgery failed due to poor recruitment, but useful aspects of this protocol were adapted for a similar trial in head-injured patients. In this group, early aggressive EN was associated with a reduction in infective complications (p = 0.0195), duration of mechanical ventilation (p = 0.019) and treatment cost (p = 0.006). In certain conditions at least, early aggressive EN is associated with improved clinical outcome and reduced treatment cost. Much of this improvement appears to be due to a reduction in infective complications.

No / There are well-recognised complications associated with malposition of nasogastric (NG) tubes. In 2011 the UK National Patient Safety Agency (NPSA) published an alert regarding their insertion and position confirmation. This alert also identified the expected radiology standards for both image acquisition and reporting. This was a retrospective review of referrals over a six-month period within a multi-site NHS Trust. A consecutive sampling approach was used and radiology reports where the text included the terms “NG tube”, “nasogastric” or “feeding” were included. Data were collected from the radiology information system and NG tube visibility and image quality were confirmed by two independent reviewers. 1137 examinations demonstrated an NG tube, of which 68.3% were performed to check tube position. There was statistically significant correlation between lower radiation exposure and non-visualisation (Fishers exact test, p < 0.001). The number of examinations with higher exposure index (EI) in the NG check cohort suggests that the radiographer increased the exposure to improve visualization (x2 = 2.846; 95% CI; p = 0.046), although the utility of this is unproven. Malplaced tubes were demonstrated either in the respiratory tract (1.8%) or proximal gastrointestinal tract (8.6%) as a result of insufficient length introduced. The prompt acquisition and reporting of radiographs is essential to reduce the risk of NG tube complications. Respiratory tract misplacement rates were in line with the published literature, but this study does raise concern regarding the number of tubes located in the proximal GI tract. Radiology's responsibility in accurate and effective reporting of medical interventions is significant.

Bakgrund: Enteral nutrition via nasogastrisk sond är en vanlig behandlingsform för kortsiktig nutritionsbehandling då den anses ha förhållandevis lätt inläggning och avlägsnande. Sondinläggning och behandling kan innebära risker som kan leda till aspiration och allvarliga infektioner. Syfte: Syftet var att beskriva vuxna patienters erfarenheter och upplevelser av näringstillförsel via nasogastrisk sond. Metod: En allmän litteraturstudie genomfördes. Nio vetenskapliga artiklar med kvalitativ ansats bearbetades i en innehållsanalys. Resultat: Innehållsanalysen presenterar fyra teman: Erfarenheter och upplevelser av fysiskt obehag, Erfarenheter och upplevelser av ett begränsat liv, Erfarenheter och upplevelser av en förändrad identitet samt Erfarenheter och upplevelser av att hantera vardagen. Deltagare beskrev upplevelser av fysiskt obehag vid insättning av sonden och under själva behandlingen, samt erfarenheter av begränsningar i vardagen och uttryckte även en ovilja att lämna hemmet. Vidare beskrevs upplevelser av en försämrad självbild relaterat till sondens synliga placering samt copingstrategier och behovet av stöd från sjukvårdspersonal och familj. Slutsats: Deltagarna upplevde både positiva och negativa erfarenheter och upplevelser vilket resulterade i motstridiga känslor. Ett individanpassat stöd från sjukvårdpersonal kan ha stor inverkan på deltagarnas välbefinnande och möjlighet till att klara sitt dagliga liv. / Background: Enteral nutrition via nasogastric tube is a common treatment form for short-term nutritional support since intubation and removal are rather simple to perform. Tube intubation and treatment may entail risks of aspiration and serious infections. Aim: The aim was to describe adult patients' experiences of nutritional support via nasogastric tube. Method: A general literature study was implemented. Nine articles with a qualitative approach were analyzed through content analysis. Results: The content analysis present four themes: Experiences of physical discomfort, Experiences of a limited life, Experiences of a changed identity and Experiences of dealing with everyday life. Participants described experiences of physical discomfort during insertion and the treatment itself, and experiences of limitations in their everyday lives and expressed a reluctance to leave their homes. Furthermore, experiences of an impaired self-image related to the tube’s visible location was described as well as coping strategies and a need for support from healthcare personnel and family. Conclusion: Participants described both positive and negative experiences, which resulted in conflicted emotions. Receiving personalized support from healthcare personnel can have a major impact on the participants' well-being and ability to cope with their everyday lives.

The purpose of the study was to identify factors associated with the delay in the initiation of breastfeeding to premature infants before discharge from hospital. The need for this research is evident in the current practice of feeding premature infants after a nasogastric tube is removed. The study sought to provide answers to delayed initiation of breastfeeding to premature infants before discharge from hospital. Fifty members of staff in the Sick Neonate Unit and 50 mothers of premature infants participated in the study. Self-administered data collection instruments were used to collect data from mothers of premature infants and staff of a Sick Neonate Unit in the hospital. The results showed that sociodemographic factors of staff 15 (f=30%) were 31-40 years old, and young nursing staff have decreased knowledge of breastfeeding as compared to senior and older staff members. Maternal demographic factors 36 (f=73.5%) were single and 13 (f=26.5) were married. Married mothers were more likely to breastfeed with the support of the partner than unmarried mothers. Health service factors staff views towards breastfeeding were 11(f=22.0% staff members were neutral about breastfeeding, and Eighteen (f=36.0%) staff members strongly disagreed to other methods of infant feeding. Maternal breastfeeding knowledge was one of the factors under maternal breastfeeding factors because it showed that 48 mothers (f=98.0%) did not have breastfeeding knowledge. Descriptive statistics were used to analyse data. / Health Studies / M.A. (Health Studies)

0BABSTRACT This thesis is focused on enteral nutrition. This issue is an integral part of intensive and resuscitation care, but it is also a part of standard and follow-up care. There are more and more new resources and the products for enteral nutrition are improving. The theoretical part deals with malnutrition, discusses the different components of nutrition. Much of the thesis forms ways of application of nutrition. The issue is a nasogastric tube, a nasojejunal tube, percutaneous endoscopic gastrostomy, percutaneous endoscopic jejunostomy, feeding button or sipping. There are further expanded the introductions, nursing care, indications and contraindications of these options. The following chapters analyse the modes of enteral feeding, advantages and disadvantages of enteral nutrition compared to parenteral. The practical part is focused on research using anonymous questionnaires in the area of enteral nutrition. The survey was conducted in four departments of three teaching hospitals in Prague. It was focused on nurses and paramedics in medical intensive metabolic care units. The survey had 73 respondents. The aim was to identify the mode of feeding that nurses prefer and how they apply it, analyze the extent to which the nurses actively involve themselves in this, how they are oriented in...

Yes / Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals – but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes.