• Title/Summary/Keyword: clinical nutrition support

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Development and Application of Telephone Counseling Services for Care of Patients with Colorectal Cancer

  • Lin, Wen-Li;Sun, Jia-Ling;Chang, Shu-Chan;Wu, Pei-Hua;Tsai, Tsung-Chih;Huang, Wen-Tsung;Tsao, Chao-Jung
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.969-973
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    • 2014
  • Background: The number of colorectal cancer (CRC) patients in Taiwan has increased in recent years; therefore, the effective dissemination of information related to symptom care has become especially important. Previous studies indicated that the physical and psychological status of cancer patients can be effectively improved by telephone counseling services (TCS). Thus, determining the most effective means of establishing a TCS to support the clinical practice of oncology has become a crucial goal for nursing. The purposes of this study were to analysis the content of the TCS for CRC and explore stratification of the TCS. Materials and Methods: The study design was retrospective. A total of 850 calls were made to CRC patients in the cancer center of Southern Taiwan during the period of January 2007- December 2011. A structure questionnaire was adopted to analysis satisfaction. Results: Responses provided by the TCS included information regarding nutrition, side effects resulting from chemotherapy and pain. Moreover, 28.7% of CRC patients needed advanced treatment. More than 90% satisfaction with all aspects of the calls was found. Conclusions: The TCS coulkd be shown to provide an effective means by which to expand the reach of nursing care to different times, places and patients, allowing for greater cost efficiency and more rapid service.

Analysis of total mixed ration (TMR) nutrition and metabolic diseases in Korean dairy farm (국내 고능력우 Holsteins 농가의 TMR 영양성분 및 대사성 질병 분석)

  • Kim, SeonHo;Cho, Yong-il
    • Korean Journal of Veterinary Service
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    • v.42 no.2
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    • pp.67-71
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    • 2019
  • A variety of livestock feed resources were used in Korean dairy farm due to a lack of the endemic feed. However, there is inadequate real farm data to support farmers' decisions on the choice of options. The main objective of this study was to evaluate the nutritional value of total mixed ration (TMR) as well as the metabolic diseases status in Korean dairy farms. TMR samples were collected from nine feed companies and eight selected self-formulated by the dairy farms. The nutrient contents were examined by AOAC methods. The frequency of metabolic diseases such as ketosis and hypocalcemia were surveyed. The average moisture content was 36.2% although the min. and max. value were varied from 21.7% and 50.6% among farms. The mean${\pm}$standard deviation of crude fiber (CF), crude ash (CA), ether extract (EE), and crude protein (CP) were $21.4{\pm}2.5$, $4.6{\pm}0.4$, $3.2{\pm}0.5$ and $9.8{\pm}1.7$, respectively. However, the average ADF and NDF was $17.3{\pm}3.7$ and $31.0{\pm}5.7$, respectively. The compositions of TMR were varied significantly among the dairy farms. The frequency of clinical Ketosis (CK), subclinical ketosis (SCK) and hypocalcemia were higher in early lactation period with 4.5%, 11.0% and 3.0%, respectively. Also, the frequency of SCK was higher than CK and hypocalcemia throughout the lactation. Periodic TMR nutrient analysis based on herd production or physiology change would maximize the effects of TMR feeding. Furthermore, the study results would be useful to the farm practitioner and producer for their farm management.

Comparison of Resting Energy Expenditure Using Indirect Calorimetry and Predictive Equations in Trauma Patients: A Pilot Study

  • Ma, Dae Sung;Lee, Gil Jae
    • Journal of Trauma and Injury
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    • v.34 no.1
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    • pp.13-20
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    • 2021
  • Purpose: Nutritional therapy in the intensive care unit is an essential factor for patient progress. The purpose of this study was to compare resting energy expenditure (REE) calculated by prediction equations (PEs) to the REE measured by indirect calorimetry (IC) in trauma patients. Methods: Patients admitted to the trauma intensive care unit who received mechanical ventilation between January and December 2015 were enrolled. REE was measured by IC (CCM Express, MGC Diagnostics) and calculated by the following PEs: Harris-Benedict, Fleisch, Robertson and Reid, Ireton-Jones, and the maximum value (25 kcal/kg/day) of the European Society for Clinical Nutrition and Metabolism (ESPEN). All patients were ventilated at a fraction of inspired oxygen (FiO2) below 60%. Results: Of the 31 patients included in this study, 24 (77.4%) were men and seven (22.6%) were women. The mean age of the patients was 49.7±13.2 years, their mean weight was 68.1±9.6 kg, and their mean Injury Severity Score was 26.1±11.3. The mean respiratory quotient on IC was 0.93±0.19, and their mean FiO2 was 38.72%±6.97%. The mean REE measured by IC was 2,146±444.36 kcal/day, and the mean REE values calculated by the PEs were 1,509.39±205.34 kcal/day by the Harris and Benedict equation, 1,509.39±154.33 kcal/day by the Fleisch equation, and 1,443.39±159.61 kcal/day by the Robertson and Reid equation. The Ireton-Jones equation yielded a higher value (2,278.90±202.35 kcal/day), which was not significantly different from the value measured using IC (p=0.53). The ESPEN maximum value (1,704.03±449.36 kcal/day) was lower, but this difference was likewise not significant (p=0.127). Conclusions: The REE measured by IC was somewhat higher than that calculated using PEs. Further studies are needed to determine the proper nutritional support for trauma patients.

The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD): A Korean Chronic Kidney Disease Cohort

  • Oh, Kook-Hwan;Park, Sue K.;Kim, Jayoun;Ahn, Curie
    • Journal of Preventive Medicine and Public Health
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    • v.55 no.4
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    • pp.313-320
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    • 2022
  • The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) was launched in 2011 with the support of the Korea Disease Control and Prevention Agency. The study was designed with the aim of exploring the various clinical features and characteristics of chronic kidney disease (CKD) in Koreans, and elucidating the risk factors for CKD progression and adverse outcomes of CKD. For the cohort study, nephrologists at 9 tertiary university-affiliated hospitals participated in patient recruitment and follow-up. Biostatisticians and epidemiologists also participated in the basic design and structuring of the study. From 2011 until 2016, the KNOW-CKD Phase I recruited 2238 adult patients with CKD from stages G1 to G5, who were not receiving renal replacement therapy. The KNOW-CKD Phase II recruitment was started in 2019, with an enrollment target of 1500 subjects, focused on diabetic nephropathy and hypertensive kidney diseases in patients with reduced kidney function who are presumed to be at a higher risk of adverse outcomes. As of 2021, the KNOW-CKD investigators have published articles in the fields of socioeconomics, quality of life, nutrition, physical activity, renal progression, cardiovascular disease and outcomes, anemia, mineral bone disease, serum and urine biomarkers, and international and inter-ethnic comparisons. The KNOW-CKD researchers will elaborate a prediction model for various outcomes of CKD such as the development of end-stage kidney disease, major adverse cardiovascular events, and death.

Nutrikinetic study of fermented soybean paste (Cheonggukjang) isoflavones according to the Sasang typology

  • Kim, Min Jung;Lee, Da-Hye;Ahn, Jiyun;Jang, Young-Jin;Ha, Tae-Youl;Do, Eunju;Jung, Chang Hwa
    • Nutrition Research and Practice
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    • v.14 no.2
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    • pp.102-108
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    • 2020
  • BACKGROUND/OBJECTIVES: In Oriental medicine, certain foods may be beneficial or detrimental based on an individual's constitution; however, the scientific basis for this theory is insufficient. The purpose of this study was to investigate the effect of body constitution, based on the Sasang type of Korean traditional medical classification system, on the bioavailability of soy isoflavones of Cheonggukjang, a quick-fermented soybean paste. SUBJECTS/METHODS: A pilot study was conducted on 48 healthy Korean men to evaluate the bioavailability of isoflavone after ingestion of food based on constitution types classified by the Sasang typology. The participants were classified into the Taeeumin (TE; n = 15), Soyangin (SY; n = 15), and Soeumin (SE; n = 18) groups. Each participant ingested 50 g of Cheonggukjang per 60 kg body weight. Thereafter, blood was collected, and the soy isoflavone metabolites were analyzed by ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry. Ntrikinetic analysis of individual isoflavone-derived metabolites was performed. RESULTS: Our nutrikinetic analysis identified 21 metabolites derived from isoflavones in the blood samples from 48 healthy Korean men (age range, 21-29 years). Significant differences were observed in the time to maximum concentration (Tmax) and elimination half-life (t1/2) for nine metabolites among the three groups. The Tmax and t1/2 of the nine metabolites were higher in the SE group than in the other groups. Moreover, the absorption rates, as determined by the area under the plasma-level curve (AUC) values of intact isoflavone, were 5.3 and 9.4 times higher in the TE group than in the SY and SE groups, respectively. Additionally, the highest AUC values for phase I and II metabolites were observed in the TE group. CONCLUSIONS: These findings indicate that isoflavone bioavailability, following Cheonggukjang insgestion, is high in individuals with the TE constitution, and relatively lower in those with the SE and SY constitutions.

Obesity in children and adolescents (소아청소년 비만)

  • Seo, Jeong Wan
    • Clinical and Experimental Pediatrics
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    • v.52 no.12
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    • pp.1311-1320
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    • 2009
  • Childhood obesity has rapidly increased in Korea during the past 20-30 years. Approximately 1 of 10 children and adolescents is obese. Appropriate prevention and intervention measures urgently need. Obesity prevention starts early in life, i.e., obesity prevention and education begins during the period of fetal development in utero. Behavioral changes are the most positively reflected during pregnancy. Infants should be fed breast milk, and inculcated with healthy eating and behavioral habits during infancy to ultimately establish a healthy lifestyle in children. For achieving a lifestyle and behavior that successfully allow children to overcome obesity, although individual motivation is important, active support of parents and family members is also imperative. Health care providers should also make an effort to actively prevent obesity and take necessary intervention actions. Although the efforts of individuals, family, and healthy care providers are important to prevent the rapid increase in obesity, primary prevention should be encouraged at a higher level. Schools should specifically aim at improving nutrition and physical activity by allocating times for healthy eating, playing, and physical education. Moreover, local communities should provide support by funding for safe recreational environments, such as playgrounds and walking tracks. Public health strategies in community and national policies, such as city planning, food marketing, and advertisements, are required for primary prevention of obesity.

Clinical Use and Complications of Percutaneous Central Venous Catheterization in Very Low Birth Weight Infants (극소 저출생 체중아에서 경피 중심정맥 도관의 유용성과 합병증)

  • Kim, Hyang;Kim, Sun Hui;Byun, Hyung Suck;Choi, Young Youn
    • Clinical and Experimental Pediatrics
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    • v.48 no.9
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    • pp.953-959
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    • 2005
  • Purpose : The administration of total parenteral nutrition(TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization(PCVC) in very low birth weight infants. Methods : A total of 56 very low birth weight infants below 1,500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group(n=32) included the babies who had undergone PCVC and a control group(n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. Results : There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2,000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1,000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1,000 to 1,500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2,000 g. Conclusion : Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

Elevated Serum Creatine Kinase Level in Rotavirus Gastroenteritis (Rotavirus 위장관염에서 혈청 Creatine Kinase의 증가)

  • Bae, Won Tae;Kim, Jae Hui;Park, Eun Sil;Seo, Ji Hyun;Lim, Jae Young;Park, Chan Hoo;Woo, Hyang Ok;Youn, Hee Shang
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.2
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    • pp.117-121
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    • 2005
  • Purpose: Elevated AST/ALT level in rotavirus gastroenteritis have been reported. We found elevated creatine kinase (CK) in those children. This study was carried out to define the relationship of major clinical presentation, laboratory findings, and level of creatine kinase. Methods: A retrospective analysis was made for thirty patients who were diagnosed rotavirus gastroenteritis from Jan 2001 to Mar 2005 in Department of Pediatrics, Gyeongsang National University Hospital. Serum creatine kinase was checked for the evaluation of high aminotransferase level among the patients. Results: Fourteen patients (8 males, 6 females) with high creatine kinase activity were included in this study. The mean age was $1.46{\pm}1.24year$ of age. The mean level of AST, ALT and CK were $127.5{\pm}136.2IU/L$, $126.1{\pm}154.3IU/L$, and $542.8{\pm}624.6IU/L$, respectively. Electrophoresis of CK isoenzyme was performed in four of them and the results revealed elevated CK-MM fraction (96~100%). Three of them revealed high serum creatine kinase acitivity (>1,000 IU/L) without acute renal failure and other symptom. However, none of them had muscular pain or trauma history. Elevated creatine kinase activity did not correlate with clinical implications (age, sex, vomiting, diarrhea, fever, symptom of URI, degree of dehydration or seizure) or laboratory findings. Conclusion: In this study, we found that serum creatine kinase acitivity also was elevated in infants with rotavirus gastroenteritis. This data support muscular damage due to rotavirus, but could not prove the mechanism of increased serum creatine kinase activity.

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Changes in Life-sustaining Treatment in Terminally Ill Cancer Patients after Signing a Do-Not-Resuscitate Order (심폐소생술금지 동의 전·후 말기암환자의 연명치료 변화)

  • Kim, Hyun A;Park, Jeong Yun
    • Journal of Hospice and Palliative Care
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    • v.20 no.2
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    • pp.93-99
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    • 2017
  • Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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