Nestle Nutrition workshop series. Clinical & performance programme最新文献

Brief history of parenteral and enteral nutrition in the hospital in the USA. 美国医院的肠外和肠内营养简史

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235675

Bruce R Bistrian

{"title":"Brief history of parenteral and enteral nutrition in the hospital in the USA.","authors":"Bruce R Bistrian","doi":"10.1159/000235675","DOIUrl":"https://doi.org/10.1159/000235675","url":null,"abstract":"The meteoric rise in parenteral and enteral nutrition was largely a consequence of the development of total parenteral nutrition and chemically defined diets in the late 1960s and early 1970s and the recognition of the extensive prevalence of protein calorie malnutrition associated with disease in this same period. The establishment of Nutrition Support Services (NSS) using the novel, multidisciplinary model of physician, clinical nurse specialist, pharmacist, and dietitian, which, at its peak in the 1990s, approached 550 well-established services in about 10% of the US acute care hospitals, also fostered growth. The American Society of Parenteral and Enteral Nutrition, a multidisciplinary society reflecting the interaction of these specialties, was established in 1976 and grew from less than 1,000 members to nearly 8,000 by 1990. Several developments in the 1990s initially slowed and then stopped this growth. A system of payments, called diagnosis-related groups, put extreme cost constraints on hospital finances which often limited financial support for NSS teams, particularly the physician and nurse specialist members. Furthermore, as the concern for the nutritional status of patients spread to other specialties, critical care physicians, trauma surgeons, gastroenterologists, endocrinologists, and nephrologists often took responsibility for nutrition support in their area of expertise with a dwindling of the model of an internist or general surgeon with special skills in nutrition support playing the key MD role across the specialties. Nutrition support of the hospitalized patient has dramatically improved in the US over the past 35 years, but the loss of major benefits possible and unacceptable risks of invasive nutritional support if not delivered when appropriate, delivered without monitoring by nutrition experts, or employed where inappropriate or ineffective will require continued attention by medical authorities, hospitals, funding agencies, and industry in the future.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"12 ","pages":"127-136"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28460206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Malnutrition in North America: where have we been? Where are we going? 北美的营养不良:我们都到哪里了?我们要去哪里?

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235665

Gordon L Jensen

{"title":"Malnutrition in North America: where have we been? Where are we going?","authors":"Gordon L Jensen","doi":"10.1159/000235665","DOIUrl":"https://doi.org/10.1159/000235665","url":null,"abstract":"Malnutrition was first highlighted as a prevalent concern in hospital care more than 30 years ago. In response the nutrition support field grew precipitously but changes in the healthcare environment have culminated in a period of accountability and consolidation in nutrition support practice over the past decade. Evolving regulatory environment and reimbursement policies have had a profound impact upon nutrition support and these trends are likely to continue. Both undernutrition and overnutrition (obesity) remain prevalent concerns in North America. In particular the growing prevalence of overweight/obesity will have far-reaching implications for nutrition support practitioners and will require the development, testing, and validation of new standards of assessment, intervention, and monitoring. Adoption of common language and definitions by practitioners will facilitate standardized interventions, outcome measures, and high quality research. The future remains bright with tailored nutrition interventions poised to become a part of the individual medical treatment plan for specific patient conditions and genotypes. Future research priorities should include studies of nutritional modulation of inflammatory conditions with specific nutrients and functional foods and the testing of individualized nutritional interventions tailored to gene polymorphisms.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"12 ","pages":"15-28"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28088089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enteral nutrition reimbursement - the rationale for the policy: the US perspective. 肠内营养补偿-政策的基本原理:美国的观点。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235668

Alan K Parver, Sarah E Mutinsky

引用次数: 12

Food modification versus oral liquid nutrition supplementation. 食品改性与口服液营养补充。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235670

Heidi J Silver

引用次数: 3

Innovative models for clinical nutrition and financing. 临床营养和融资的创新模式。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235673

Jan Van Emelen

引用次数: 1

What went right? The story of US Medicare Medical Nutrition Therapy. 什么是对的?美国医疗保险医疗营养疗法的故事。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235676

Stephanie Patrick

引用次数: 4

Enteral nutrition reimbursement - the rationale for the policy: the German perspective. 肠内营养补偿-政策的基本原理:德国人的观点。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235669

Norbert Pahne

引用次数: 3

Cost-effectiveness analysis and health policy. 成本效益分析和卫生政策。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235671

David J Torgerson

引用次数: 5

Implementing nutritional standards: the Scottish experience. 实施营养标准:苏格兰的经验。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235672

Alastair W McKinlay

{"title":"Implementing nutritional standards: the Scottish experience.","authors":"Alastair W McKinlay","doi":"10.1159/000235672","DOIUrl":"https://doi.org/10.1159/000235672","url":null,"abstract":"In the United Kingdom, 5% of the population are underweight or have features of malnutrition. The prevalence of malnutrition rises with age and is more common in the north of England than in the south, but comparable data are not available for Scotland. In 2003, the National Health Service Quality Improvement Scotland (NHS QIS) developed a standard for food, fluid and nutritional care in hospitals (FFNCH). In 2006, a peer review of Scottish health boards was published. The reviewers reported that all Scottish health boards had started to implement the standards, but not across all clinical areas. Every health board had set up a nutritional care group to oversee and advise on the implementation of the standards, but none had produced a financial framework to support the work of the groups. Most health boards had not fully developed a policy or strategic plan to improve nutritional care as required, and there was a shortage of specialist nutrition nurses and clinical and nutrition support teams to supervise the treatment of patients with complex nutritional needs. The Scottish experience emphasizes the size of the task that health services face to bring about change.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"12 ","pages":"105-111"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28460203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The need for consistent criteria for identifying malnutrition. 确定营养不良的一致标准的必要性。

Nestle Nutrition workshop series. Clinical & performance programme Pub Date : 2009-01-01 Epub Date: 2009-08-20 DOI: 10.1159/000235667

L John Hoffer

{"title":"The need for consistent criteria for identifying malnutrition.","authors":"L John Hoffer","doi":"10.1159/000235667","DOIUrl":"https://doi.org/10.1159/000235667","url":null,"abstract":"The lack of consistent criteria for diagnosing malnutrition and protein-energy malnutrition (PEM) creates problems in educating medical students and physicians, setting the parameters for observational and controlled clinical trials, and formulating clinical guidelines. There is no validated formal definition of malnutrition (or PEM), and the tools that have been developed to screen for it, or diagnose it, vary in their agreement. I make the following suggestions. First, avoid unqualified use of the term 'malnutrition', as it is ambiguous. Second, carefully distinguish between screening and diagnosis, which have different aims and implications. Third, consider the notion that in medicine the diagnosis of PEM is reached by 'narrative-interpretive' reasoning, which regards the disease as a pathophysiological entity in a specific clinical context. I recommend that the concept of PEM as a disease (not a score) be imbedded in teaching and the practice of medicine, and in the design of clinical trials and the setting of guidelines. Fourth, disagreements in screening-derived risk scores and uncertainty in diagnosis are difficult to avoid, but only in the grey zone. It would be prudent, at least until the greater medical world considers the nutritional paradigm plausible enough to invest in it, to enroll only patients who have unambiguously diagnosed PEM in prospective trials with hard clinical endpoints.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"12 ","pages":"41-52"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000235667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28088092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10