En el transcurs de l'evolució de la humanitat l'alimentació ha ocupat un lloc predominant. La història de l'alimentació, de fet, ha corregut paral·lela a la història de la humanitat, o, com refereix García Almansa, «la història de l'alimentació és tan antiga com la humanitat mateixa». L'ésser humà constitueix un sistema termodinàmic obert, a través del qual ha d'existir un fluxe ininterromput de matèria i energia per a mantenir la vida. La nutrició és un procés indispensable per a aquest fet. Per mitjà d'ella, l'organisme obté totes les substàncies necessàries per a l'obtenció d'energia adequada per al manteniment de les seves funcions vitals i per al creixement, desenvolupament i recanvi de les seves pròpies estructures Una nutrició correcta és, doncs, una condició indispensable per a mantenir l'estat de salut en l'ésser humà. En l'organisme emmalalteixo la nutrició cobra un especial relleu, considerant-se fins i tot com un tipus de tractament (dietoterapia, terapeutica dietètica, etc.) / En el transcurso de la evolución de la humanidad la alimentación ha ocupado un lugar predominante. La historia de la alimentación, de hecho, ha corrido paralela a la historia de la humnidad, ó, como refiere García Almansa, «la historia de la alimentación es tan antigua como la humanidad misma».El ser humano constituye un sistema termodinámico abierto, a través del cual debe existir un flujo ininterrumpido de materia y energía para mantener la vida. La nutrición es un proceso indispensable para este hecho. Por medio de ella, el organismo obtiene todas las sustancias necesarias para la obtención de energía adecuada para el mantenimiento de sus funciones vitales y para el crecimiento, desarrollo y recambio de sus propias estructurasUna nutrición correcta es, pues, una condición indispensable para mantener el estado de salud en el ser humano. En el organismo enfermo la nutrición cobra un especial relieve, considerándose incluso como un tipo de tratamiento (dietoterapia, terapeútica dietética, etc.)

Syfte: Litteraturöversiktens syfte var att belysa vilken påverkan parenteral nutrition har på livskvaliteten hos palliativa patienter. Metod: Denna studie har genomförts som en litteraturöversikt. Vetenskapliga artiklar har insamlats från databaserna Cinahl, Medline och Pubmed. Totalt fann författarna 12 vetenskapliga artiklar som svarade mot litteraturstudiens syfte. De utvalda artiklarna var både kvantitativa och kvalitativa. Kvalitetsgranskningen utfördes med hjälp av granskningsmallar och artiklarna som lade grunden till resultatet motsvarade medel till hög kvalitet. Resultat: Resultatet visade på att flertalet patienter kände en trygghet och lättnad när den parenterala nutritionen introducerades. Patienterna ansåg att vetskapen att deras nutritionsbehov blev tillfredsställt gjorde att de inte behövde vara rädda för att svälta ihjäl. De upplevde en ökad livskvalitet då de slapp oroa sig för födointaget och orkade medverka mera aktivt i det sociala familjelivet. Flertalet av patienterna uppgav en förbättrad livskvalitet när möjlighet gavs att få parenteral nutrition i hemmet trots att det innebar inskränkningar i familjelivet. De uppgav även en ökad styrka till att hantera bland annat sjukdomssymtom och behandlingsbiverkningar. Den parenterala nutritionen gav i vissa fall problem med biverkningar, men de flesta patienterna skattade ändå livskvaliteten högre av att få näringsdroppet. Resultatet visade även på att om den parenterala nutritionen sattes in i ett tidigt skede kunde en förbättring av nutritionsstatusen ske och patienterna behöll sin kroppsvikt under en något längre tid. Det resulterade i en ökad skattning av livskvaliteten. De sista veckorna i livet hade näringsdroppet ingen mätbar positiv effekt.

Se determinaron cuantitativamente los marcadores bioquímicos hepáticos: Transaminasa glutámica oxalacética (TGO), Transaminasa glutámico pirúvica (TGP), bilirrubina total (BT), bilirrubina directa (BD) y gamma glutamil transferasa (GGT) para evaluar los efectos de la nutrición parenteral en la función hepática de recién nacidos prematuros mayores de 27 semanas y menores de 37 semanas en la unidad de Neonatología del Hospital Nacional Edgardo Rebagliati Martins. Treinta recién nacidos pre término fueron evaluados antes de iniciar la nutrición parenteral (nivel basal =con NP1), a los 7±2 días de iniciada la nutrición parenteral (con NP2), al momento de la suspensión de la nutrición (sin NP1) y finalmente a los 7±2 días de suspendida la nutrición parenteral (sin NP2). En la evaluación del perfil hepático, se encontró los siguientes valores: TGO=28,63 UI; TGP= 7,37 UI; BT=9,03 UI; BD=0,845 UI; GGT= 110,41 U durante el periodo de administración de NP y los siguientes valores: TGO= 28,73 UI; TGP= 10,53 UI; BT= 6,36 UI; BD= 1,35 UI; GGT= 128,38 UI durante el periodo sin NP. Se encontró diferencias estadísticamente significativas para TGO, TGP y GGT entre los niveles basales versus los niveles a los 7±2días del periodo de administración de NP y diferencias significativas para TGP, BT, entre los niveles basales versus los niveles a los 7±2días del periodo sin NP. Cuando se comparó las medias de los marcadores hepáticos globales (con NP y sin NP) se encontró una diferencia estadísticamente significativa en TGP, BT y BD con una correlación de Pearson significativa sólo en BT y GGT. También se determinó la presencia de peróxidos en mezclas de nutrición parenteral encontrándose: 299,87; 155,11; 212,92 y 284,55 μmoles a las 0, 5,18 y 24 horas de la mezcla respectivamente, en mezclas de NP foto expuestas y 278,01; 142,28; 183,39 y 258,58 μmoles a las 0, 5, 18 y 24 horas respectivamente en mezclas de NP foto protegidas. Se encontraron diferencias estadísticamente significativas de peróxidos globales (NP foto expuesta y NP foto protegida) en los tiempos 0h-5h, 0h-18h, 5h-24h y 18-24h. No se encontraron diferencias estadísticamente significativas de peróxidos entre las mezclas de NP foto expuestas y foto protegidas. / We have done the cuantitative determinations of hepatic markers: Glutamic oxalacetic transaminase (GOT), Glutamic piruvic transaminase (GPT), total bilirrubin (TB), direct bilirrubin (DB) and Gamma glutamiltransferase (GGT) to evaluate the effect of parenteral nutrition in the hepatic function of preterm infants from 27 to 37 weeks in the Neonatology unit of Hospital Nacional Edgardo Rebagliati Martins. Thirty preterm infants were evaluated before parenteral nutrition started (baseline levels), in 7± 2 days from initiation of parenteral nutrition, on the day of suspension of parenteral nutrition 0± 2 days) and finally in the 7± 2 days of suspension of parenteral nutrition. Regarding the hepatic evaluation, we found the following hepatic markers values in the PN administration period: GOT= 23,63 UI; GPT= 7,37 UI; TB= 9,03 UI; DB= 0,845 UI; GGT= 110,41 UI and the following values in the period of absence of parenteral nutrition: GOT= 28,73 UI; GPT= 10,53 UI; TB= 6,36 UI; DB= 1,35 UI; GGT= 128,38 UI. There are significant differences for GOT, GPT and GGT when baseline levels are compared against values from 7±2 days during the PN administration period. There are significant differences for GPT, TB when we compared baseline levels versus levels at 7±2 days during the period of absence of PN. When we compared the different hepatic markers means globally, we found significant difference in GPT, TB, DB, with a Pearson`s correlation only in TB and GGT. We performed an extra research for this study. It was determined the presence of peroxides in parenteral nutrition mixtures. We found the following concentration means for peroxides in the photo exposed PN mixtures: 299,87; 155,11; 212,92; 284,55 μmol at 0,5,18 y 24 hours from the mixture, and the following concentration means for photo protected PN mixtures: 278,01; 142,28; 183,39; 258,58 μmol at 0, 5, 18 y 24 hours respectively. Significant differences regarding global peroxides (PN photo exposed and PN photo protected) were found in 0h-5h, 0h-18h, 5h-24h, 18-24h. We did not find significant differences of peroxides between PN photo exposed and PN photo protected mixtures.

Thesis (M.S.)--University of Missouri-Columbia, 2008. / "May 2008" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Includes bibliographical references.

Administering drug therapy through the intravenous route ensures rapid, and complete, bioavailability, which can be critical in an emergency situation. However, bypassing all of its protective barriers leaves the body vulnerable to harm if the parenteral formulation becomes unstable when mixed with the blood. An example of this formulation instability is the precipitation of poorly water-soluble drugs after mixing with the blood's aqueous environment. This happens when parenteral formulations rely too heavily upon the solution pH, and excipients, to increase the drug solubility. This precipitation in the blood can damage venous cell membranes producing symptoms ranging from mild skin irritation to death. To screen potential drug formulations for problems such as injection site drug precipitation, pharmaceutical companies have traditionally used costly and time consuming animal studies. To reduce the amount of pre-clinical animal studies necessary to find an optimal IV formulation, an in vitro device to detect injection site drug precipitation is introduced. In addition to the device, software that simulates the dilution of a parenteral drug formulation with blood upon administration has been developed and is introduced. Both the device and software were tested on commercially available formulations plus one formulation currently in clinical trials. The results and capabilities of the new device were compared to those obtained using an earlier in vitro device. Finally, a robust model for early screening of injection site precipitation is developed using both the in vitro device and software.

Our objective was to study the effect of GLN supplementation on whole body protein turnover, somatic growth and gastrointestinal tolerance to enteral feeding in neonates following surgical stress. We hypothesized that GLN in total parenteral nutrition (TPN) would (1) favor retention of lean body mass by reducing protein breakdown (PB) during the acute phase after surgery, (2) promote somatic growth, (3) decrease length of time to achieve full feeds. Protein turnover was measured in a double-blind randomized trial involving neonates admitted to the Neonatal Intensive Care Unit after major surgery. L-GLN (n = 6) was added to TPN at a dose of 200 mg/g of protein intake. Controls (n = 7) were isonitrogenous. Isotope studies were performed on Day 4 of TPN. Subjects were given a 4-hour primed constant intravenous infusion of L-[1-13C]-leucine and [15N2]-urea. In the GLN group, a 15% reduction in PB was measured (unpaired t-test, p < 0.05). There was a trend towards improved net protein balance which was statistically different from zero in the GLN group. There were no differences in somatic growth during TPN course and in the length of time to achieve full enteral feeds. Results suggest that early TPN supplemented with GLN has a beneficial sparing effect on protein metabolism in critically ill neonates after major surgical stress.

Statement of Problem In the past few years, there has been increased interest in the intravenous administration of antibiotics in the home. The catalyst for this interest has been the need to contain costs and decrease surgical waiting lists in hospitals. However, the scientific evidence for cost containment for home parenteral programs is scant, conflicting and confusing. This study is the first to undertake an economic model based on a cost-benefit framework encompassing both direct and the often-ignored indirect costs. It also examines patient self-administered home parenteral antibiotic therapy (HPAT) within an economic, clinical and humanistic outcomes (ECHO) structure as a source of model inputs. The modelling approach overcomes the analytical and statistical difficulties associated with these early discharge programs due to the small and diverse nature of the populations. Methods and Procedures This study uses data from the Alternate Site Infusion Service (ASIS) at Princess Alexandra Hospital, Brisbane, Australia to populate some fields in the economic model. This service is based on the patient self-administration model and provides early hospital discharge to medically stable patients who require medium to long-term intravenous antibiotics for the treatment of infectious disease. The economic model is described as a probabilistic, second-order, Monte Carlo simulation based on cost-benefit design and constructed from realistic incremental differences in costs and benefits. The multi-dimensional probabilistic sensitivity analysis is used to account for uncertainty present in some of the model inputs. Risk analysis software known as “@Risk” Version 4.5.5 Professional is used to construct the simulation model. The cost and benefit framework, and ultimately inputs, are constructed from primary data emanating from the databases of the ASIS unit, Princess Alexandra Hospital in Brisbane for the period 2001 to 2002, secondary data based on literature reviews, and expert opinion. Societal perspective is chosen to encompass areas such as loss or gain of productivity and carer burden. Clinical outcome is investigated by examining the ASIS database regarding the treatment outcome of HPAT patients. The incidence and mortality rates of nosocomial intravascular bacteraemia (NIB) for hospital and HPAT patients are based on the literature review and included as inputs in the model. Carer burden is determined by the identified carers of ASIS patients with the completion of the mailed Caregiving Distress Scale (CDS) and the Impact of Caring Scale (ICS) instruments. A labour questionnaire was designed to collect data on paid employment, students returning to education and individuals returning to normal daily activities (including forgone leisure activities). The Australian Bureau of Statistics’ (ABS) Australian Standard Classification of Occupations (ASCO) and the ABS gender-specific average weekly wages for nine major work groups are used to estimate productivity of patients and their carers. The value of a hospital bed day was modelled to estimate the value of hospitalisation at the end of a hospital length of stay to avoid using an average bed day cost. The change in the utilisation of nursing, medical and pharmacy human resources due to HPAT is also modelled to avoid using average estimates. A sensitivity analysis is conducted on the value of a hospital bed day to measure the impact on the net benefit. Results The @Risk economic model was undertaken with 10,000 iterations to capture the variability of the net benefit. The value of a hospital bed day appears to have the greatest impact on the net benefit of ASIS with the probability of NIB and incidence of death from NIB in hospital also contributing. The correlation of CDS and the ICS demonstrates a linear relationship, and a total of 93% of carers indicate that they would repeat their participation as a carer. However, most relationships between variables are not statistically significant, or clinically unimportant. Carer burden is suggested to be low in home parenteral antibiotic patients despite the ASIS unit adopting the patient self-administered form of service delivery. However, the number of patients identifying a carer is low and, therefore, there is difficulty in the collection of a suitable sized data set. HPAT failed in 10% of home patients and was fairly comparable with other studies based on the patient self-administered model of service delivery. A total of 58% of HPAT patients (total patients = 123 and 3,939 bed days) returned to work or normal activities with an estimated productivity gain of $190,045 for the economic model of 3,964 bed days. Lost productivity for carers emanating from the survey research was estimated to be $118,121 for the economic model of 3,964 bed days. A mean cost difference of $19,584 between the hospital and home NIB, based on literature probability rates, was estimated indicating a benefit to the HPAT with regard to NIB. Overall, the @Risk model for the ASIS patients representing 3,964 bed days calculated a mean net benefit of $2,450,163 for the HPAT program. A 50% reduction in a hospital bed day value to $253 still resulted in a mean net benefit of $1,447,273 – and a zero net benefit resulted when the value of a hospital bed day reached $112. This suggests that the HPAT program, based on a patient self-administered model of service delivery, represents a viable option for healthcare delivery.

Thesis (M.A.)--Mahidol University, 1982.

Title from title page of PDF (University of Missouri--St. Louis, viewed March 22, 2010). Includes bibliographical references.

Thesis (M.S.)--Duquesne University, 2009. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 82-90) and index.