Background Tube-feeding or nutritional support is a therapy for people who can’t get enough nutrition by eating or drinking. You may need it if you have difficulty swallowing, loss of appetite, are severely malnourished or have inability to absorb nutrients through your digestive system. There are several diagnoses associated with tube-feeding, depending on the persons diagnose and users state the user can be tied to the tube-feeding equipment from 3 to 18 hours a day. In Sweden there are around 1500-3000 adults in need of tube-feeding outside the hospitals.   Method This report is made by Cindy Sjöblom and is an individual student’s work. The project is her dissertation and final project at the two year Masters program Advanced Product Design at Umeå Institute of Design. The project has been executed during 20 weeks the spring 2015. The project is based on the design process which includes the following phases; Research & Analysing, Ideation & Concept’s and Detailing & Visualization. The Research & Analysis phase has included; Product analysis, user interviews & observations, market outlook, anatomical knowledge, problem listing and opportunity findings. The Ideation & Concept’s phase has included; Inspiration, persona creation, creative workshop, sketching, concepts creation, mock-up building, user testing & feedback. The Detailing & Visualization phase has included; 3D modelling, moodboard creation, sketching, final model building, photo shooting, video recording, documentation, presentation and a poster and exhibition stand at Umeå Institute of Design and at Semcon, Gothenburg. Result Tubie is an ambulatory tube-feeding system to facilitate an active everyday life for people in need of enteral nutrition. Tubie consists out of six parts; A nutrition pump and a wireless charging station, a nutrition bag and an external tubing, a wearable waist band and an application for a smart device to be able to control the pump. Unlike traditional enteral nutritions systems, Tubie is designed with a focus on the users in a home environment and their need for a more active lifestyle and discreet usage in social environments. Tubie is simply discreet due to its wearable features that allows the user to wear it underneath the clothing as well as control the pump via a smart device with an adaptable pre-alarm that sounds like any other text message or ring tone.

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Vitamin K acts a cofactor for the gamma-carboxylation of several proteins in the coagulation cascade. The clinical spectrum of vitamin K deficiency (VKD) can be asymptomatic to a significant bleeding. VKD is classically seen in newborns. However, this can manifest later in patients with risks such as sub-optimal nutrition, fat malabsorption, medications including antibiotics. A 17-year-old male with spinal muscular atrophy (SMA) Type 1, tracheostomy with ventilator dependent, gastrostomy tube feeding was seen by the gastroenterologist following treatment for small intestinal bacterial overgrowth (SIBO). Investigations showed coagulopathy following which he was transferred to the Pediatric ICU. Labs revealed prothrombin time (PT) 114 s [Normal 9.4-12.5 s], INR (International normalized ratio) 12.6 [Normal < 1.1] and partial thromboplastin time (PTT) 90 s [Normal 25.1-36.5 s]. Mixing studies and coagulation assays were consistent with VKD (low Factor VII and Factor IX with normal Factor V). His home blenderized feeding regimen met the caloric requirement but not the adequate intake (AI) values for vitamin K and other minerals. He received intravenous vitamin K (phytonadione) for five consecutive days with resolution of the coagulopathy (PT 13.2 s, PTT 37.1 s, INR 1.2). The patient was discharged on enteral vitamin K and additional supplements following dietary review by a nutritionist. Clinicians should be cognizant of VKD in patients on blenderized tube feeds which may not meet the adequate intake (AI) goals. In patients who are not receiving nutritionally complete formulas or receiving inadequate volumes, it is important to monitor macro and micronutrients.

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Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.

Previous data in our lab demonstrated an inability to induce oral tolerance when using a feeding needle gavage for 14 days. Given that the upper gastrointestinal (GI) tract is the site of antigen introduction, and the interplay between immune cells of the mucosal tissues, we questioned if inflammation in this tissue, induced by physical trauma, would affect oral tolerance induction. We performed studies on Balb/c mice using a needle gavage or syringe feeding method followed by doses of the immunogenic protein ovalbumin (OVA) to induce tolerance. Immunohistochemistry was used to assess inflammation in esophageal tissues and to correlate with an ability or inability to induce tolerance. Non-cellular alterations within the tissue were also assessed using a pathology grading score. Although fluctuations in cell populations were observed in both the syringe and gavage treated mice, the needle gavage caused significant noncellular damage to esophageal mucosal tissue, which is the most likely cause of failed tolerance induction to the OVA. / Department of Biology

Thesis (M.A.)--Catholic Theological Union at Chicago, 1996. / Vita. Includes bibliographical references (leaves 80-85).

Thesis (M.A.)--Catholic Theological Union at Chicago, 1996. / Vita. Includes bibliographical references (leaves 80-85).

Thesis (M.A.)--Catholic Theological Union at Chicago, 1996. / Vita. Includes bibliographical references (leaves 80-85).

Orientador: Antonio Fernando Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T00:03:41Z (GMT). No. of bitstreams: 1 Nogueira_RobertoJoseNegrao_D.pdf: 1229933 bytes, checksum: affc50589086791ae8d3862bcf6b885e (MD5) Previous issue date: 2011 / Resumo: As Fendas Orofaciais Típicas (FOT), compõe um grupo que inclui as fendas labiais, labiopalatais e palatais, acometem 1 em cada 650 a 1000 recém-nascidos em todo o mundo. Os indivíduos com FOT sejam estes sindrômicos ou não sindrômicos, padecem, com frequência, de desordens nutricionais múltiplas, com destaque para as dificuldades alimentares nos seis primeiros meses de vida. Com o objetivo de contribuir para a melhoria da assistência aos afetados, o presente estudo foi dividido em quatro fases de análise e uma proposta. As fases de análise são: a) caracterização do estado nutricional de um grupo de indivíduos com FOT; b) avaliação inicial e intervenção nutricional com abordagem multiprofissional padronizada, ambas em atendimento ambulatorial; c) análise de dados nutricionais de estudo multicêntrico brasileiro; d) avaliação de conhecimento sobre FOT e nutrição aplicada aos alunos do último ano de graduação em áreas da saúde da Faculdade de Ciências Médicas da Unicamp. O presente trabalho mostra que cerca da metade dos pacientes chega desnutrida para consulta especializada e, ainda, que há impacto positivo no ganho de peso quando orientações nutricionais e fonoaudiológicas são realizadas. Apesar de notar-se uma melhoria na assistência a este grupo de indivíduos, ela ainda é precária no nosso país. Sobretudo, as cirurgias necessárias são frequentemente postergadas devido a diversos problemas estruturais, com destaque para a nutrição inadequada. O trabalho revela também que os estudantes de cursos da área de saúde que terão contato com estes pacientes não conhecem o assunto. Finalizando, baseados nestes achados e na revisão de literatura, elaborou-se material educacional e algoritmo de avaliação e condução de aspectos nutricionais, voltados para o profissional da saúde / Abstract: The "Typical Orofacial Clefts" (TOC) represents a group of congenital defects composed by cleft lip with or without cleft palate and isolated cleft palate. They affect about 1:650-1000 newborns in the entire world. Multiple nutritional diseases, specially feeding disorders from newborn until six month of life, are often detected. The main aim of the study is to contribute for the assistance of these children. Five independent chapters built up a picture of some relevant aspects in this theme. Firstly, it was performed a cross sectional investigation of anthropometric parameters of TOC individuals without syndrome. After that, it was designed a longitudinal study using nutritional intervention. A multicentre study characterized nutritional records in children from seven different centers by parents' interview. In the chapter four it was performed an evaluation of nutritional knowledge of health professional students from the last year of graduation of Unicamp (dentist, nurse, physician and speech therapy). These studies showed that a half of the patients were in malnutrition state and nutritional counseling was effective to improve it. Despite of the health care for clefts individuals already structured in Brazil, it should be improved. Surgical delays related to health structure problems and inadequate nutrition care, as well. In order to improve the health care, the last chapter is a nutritional guide and algorithm for nutritional approach for cleft babies to health care professionals / Doutorado / Pediatria / Doutor em Saude da Criança e do Adolescente