Gastrectomy is the most effective method of treating gastric cancer, but it is commonly associated with weight loss, nutritional deficiencies, and the increased risk of malnutrition due to post-surgery complications, including gastric stasis, dumping syndrome, malabsorption, and maldigestion. Malnutrition is a risk factor for postoperative complications and poor prognosis. To prevent it and guarantee a quick recovery after surgery, continuous and individualized nutrition intervention should be performed both before surgery and postoperatively. The Department of Dietetics at Samsung Medical Center (SMC) performed nutritional status assessment before gastrectomy, initial nutritional assessment within 24 hours of admission, description of therapeutic diet after surgery, nutrition counselling before discharge, and nutritional status assessment and individual nutrition counselling after 1, 3, 6, and 12 months from surgery. This is a case report of a patient who underwent gastrectomy as well as intensive nutrition intervention in SMC.
Purpose: Studies on the efficacy of infliximab (IFX) in a large population of pediatric patients with Crohn's disease (CD) are limited, and prognostic factors are not well-known. The aim of this study was to evaluate outcomes of IFX in pediatric patients with CD and to identify factors associated with poor prognosis. Methods: We retrospectively analyzed medical data of 594 pediatric patients with CD between 1987 and 2013 in a tertiary center. Of these, 156 children treated with IFX were enrolled and were followed up for at least a year with intact data. Outcomes of induction and maintenance, classified as failure or clinical response, were evaluated on the tenth and 54th week of IFX therapy. Results: We treated 156 pediatric patients with CD with IFX, and the median duration of IFX therapy was 47 months. For IFX induction therapy, 134 (85.9%) patients experienced clinical response on the 10th week. Among the 134 patients who showed response to induction, 111 (82.8%) patients maintained the clinical response on the 54th week. In multivariate analysis, low hematocrit (p=0.046) at the time of IFX initiation was associated with the failure of IFX induction. For IFX maintenance therapy, longer duration from the initial diagnosis to IFX therapy (p=0.017) was associated with maintenance failure on the 54th week. Conclusion: We have shown the acceptable outcomes of IFX in a large cohort of pediatric CD patients in Korea. Hematocrit and early introduction of IFX may be prognostic factors for the outcomes of IFX.
The purpose of this study is to introduce the music therapy as one of the 17 kinds of oriental medicine music therapy and investigate the record in the literature. The spleen is an organ that has the function of digestion, absorption, and supply of nutrition. Damp, anxiety, and improper diet can cause deficiency syndrome of the spleen. The symptoms of deficiency of the spleen are poor appetite, abdominal distension, borborygmus, water-grain dysentery, dyspepsia, and lack of strength in limbs. CV12, CV6, S36, B20, B21, and Sp4 are can be used as acupuncture points that are a great help to the patients who suffer from deficiency of the spleen. This study describes the theory of invigorating the spleen music therapy that has a good possibility as a new method of oriental medical treatment and present the acupuncture points that can be used with invigorating the spleen music therapy. The tone of the spleen is Gung(宮) and the sound of the spleen is related to a song. The music therapy of invigorating the spleen includes beating Earth-Gi(地氣) rhythm with Cheonnyeonmanse, stimulating Spleen Meridian and Stomach Meridian with Gayaguem sanjo jungjungmori, and acupuncture with "Le Cygne" of Camille Saint-Saens.
The purpose of this study was to investigate the relationship between changes in the Department of Nutrition and patient satisfaction, following the changes in Food Services Management. Statistical data analyses were completed using the SAS/Win 6.12 program. The results can be summarized as follows. The working environment for dietitians and cooking and meal serving assistants was improved following to a change catering of food service management. The number of dietitians who worked in medical nutritional therapy and food services was increased from one to four, and the number of dietary consultations and meal rounds were increased 2.5-fold and 5-fold, respectively after the change services were implemented. Among the 10 items included in the patient satisfaction questionnaire, "Taste of meals" (p< 0.01) and "Satisfaction of offered menus" (p < 0.01) showed significantly higher scores before the catering. "Kindness of meal sewing assistant" this increase was not statistically significant, showed increased satisfaction after the catering, however.n after the catering, however.
Kim, Hye-Jin;NamGung, Sin-A;Hong, Jeong-Im;Mok, Hee-Jung
Journal of the Korean Dietetic Association
/
v.17
no.2
/
pp.206-215
/
2011
Currently, metabolic surgery (Laparoscopic Roux-en-Y gastric bypass, LRYGB) has an important role and should be recommended as an intervention in the management of obese patients with type 2 diabetes mellitus (T2DM). A successful outcome of surgery requires medical nutrition therapy. Therefore, we performed a retrospective study on 25 patients with T2DM who underwent LRYGB at Yeouido St. Mary's Hospital from October 2008 to May 2010. The patients were followed up for an average of 6 months after surgery (range: 2~19 months). Diabetes was resolved in 80% of the patients. Percentage of excess weight loss was (%EWL) was 56.2%. After surgery, fasting blood sugar (FBS) and HbA1c were significantly reduced (123 mg/dl, A1c 6.7%, P<0.001) and triglyceride was also significantly reduced to 107.6 mg/dl (P<0.05). As diets of the patients progressed from liquid to soft to regular diet, energy, carbohydrates, and fat intakes increased significantly (P<0.001). But protein intake did not change significantly. Nutrient intake of the patients after the surgery was significantly lower than the recommended diet for the non-surgery group. Patients experienced side-effects related to the diets after surgery, including hair-loss (76%), smelly gas (52%), vomiting (48%), etc. A significantly positive correlation was observed between vomiting and FBS (P<0.001). There was a significant relationship between side effects and the amount of nutrient intakes. Therefore, guide patients to a diet progression with treatment to minimize side effects, especially vomiting. And monitor their dietary life to be healthy and not to regain weight until remission of T2DM.
The purpose of this study was to investigate the effects of the nutrition therapy and drug(simvastatin) treatment on the levels of blood lipids for the hyperlipidemic patients according to genetic polymorphism of apo CIII. Subjects of the study consisted of 43(male: 9, female: 34 )hyperlipidemic patients registered to Kyung Hee Medical Center, Intakes of nutrients for the subjects were determined by 24-hr recall method through a personal interviews. The subjects were instructed to take the hypolipidemic and hypocholesterolemic diets. Compliance was monitored through food records, personal interview, and body-weight measurements. The patients changed their basal diet containing 40. 1g fat(182.7mg cholesterol./day) to a diet containing 30.7g fat(139.2mg cholesterol/day) after 12 weeks of nutrition therapy. The distribution of genotypes for apo CIII by Msp I was 32.5% of TT, 50.0% of TC, and 17.5% of CC. aT the beginning of the study, the level of blood triglyceride was the highest for patients with TT and TC. Following the nutrition therapy, patients with CC exhibited the largest drop of blood triglyceride. Following simvastatin treatment with nutrition therapy, blood LDL-cholesterol decreased in most of the patiens with TT. Meanwhile the distribution of genotypes for apo CII by the Fok I was 10.0% of TT, 47.5% of TC, and 42.5% of CC. The level of blood triglyceride was the highest for patients with CC. Following the nutrition therapy, patients with TC exhibited a significant drop for the blood triglyceride. Following simvastatin treatment with nutrition therapy the level of blood LDL-cholesterol decreased in most of the patients with CC. We concluded that dietary habits and food have been changed by nutrition therapy. And blood lipid levels have been decreased by the restriction of intakes of energy, fat and cholesterol. There was variation in the levels of blood lipids according to apo CII polymorphisms. The level of blood lipids responded to nutrition therapy and drug treatment in different was according to genetic polymorphisms. Accordingly, the choice of individualized therapy based on the patient\\`s genetic polymorphism is very important for effective therapy(Korean J Nutrition 33(8) : 813-823, 2000)
The purpose of this study was to investigate the compliance and need for diet therapy among diabetics and their caregivers. A total of 625 respondents participated in this survey. Appropriate management for long-term blood glucose control and difficult-to-manage cases appeared to be diet therapy, physical activity, medical treatment and folk remedies, in that order. The most important educational avenues for diet therapy were books, magazines and TV, Most respondents were educated in diet therapy within a year after diagnosis and had practiced diet therapy for over four years. The most common diet therapy Practices were food selection and Quantity control. Of the specific problems in practicing diet therapy, time and labor, taste, and meal planning appeared to be equally difficult factors. The prevailing diet therapy skills were controlling food amounts at breakfast and supper, and selecting food for lunch and refreshments. Respondents practicing both skills were about 20% of the participants; this shows the need to improve the current situation. The nutrients most frequently considered in diet therapy practice were simple sugars (sugar and sweet goods) , total fats and cholesterol. Since the perception of the role of dietary fiber among respondents was very low, nutrition education about the importance of dietary fiber and food sources of dietary fiber was needed. Diabetics seemed to be concerned about diabetic menus. Three difficult problems in planning diabetic menus were daily menu planning, patient's preferences, and the calculation of calories. As a means of nutrition counseling, they preferred interviews. The higher the educational status and the lower the age, the higher the preference was for internet or PC counseling. Therefore, it is necessary to develop nutrition educational programs so that diabetics can obtain practical knowledge of diet therapy. Furthermore, it is also necessary to develop additional means of informing diabetics about menu planning, while still considering Korean dietary behavior.
The purpose of this study was to analyze the importance-performance of clinical nutrition management in convalescent hospitals. The research was carried out based on questionnaires administered from March to April, 2015 to 73 dietitians at 40 convalescent hospitals in the Gyeongnam area. There was a statistically significant difference between the mean scores for importance (4.01/5.00) and performance (2.95/5.00) of clinical nutrition management. The importance and performance grid analysis showed that participation in a nutritional management committee, administration of patients using a cooperation program among hospital departments, cooperation with a medical team on patient's nutrition status, nutrition initial assessment, nutrition care process for patients showing malnutrition, nutrition care process for tube feeding patients, management of a therapeutic diet, meal management using dietary slip instructions including a therapeutic diet, and explication of a therapeutic diet for patients scored high regarding importance and performance (doing great area). Medical records on patient's nutrition management, and nutrition counseling for requested patient scored low regarding the importance and high regarding performance (overdone area). Participation in medical rounds, personal nutrition education for patients, group nutrition education for patients, nutrition education for medical teams, development of a menu for therapeutic diet and standardized recipes, and provision of information on diet therapy for patients after discharge scored low regarding importance and performance (low priority area). Accreditation of convalescent hospitals and interest of medical professionals in clinical nutrition management were effective variables for the importance-performance gap of clinical nutrition management. In conclusion, the accreditation process and positive awareness of medical professionals with regard to clinical nutrition management had positive effects on reduction of the importance-performance gap in clinical nutrition management at convalescent hospitals. The strength of clinical nutrition management in the accreditation and development of an education program for increasing medical team or administrator interest in clinical nutrition management could lead to improvement of clinical nutrition management for elderly patients in convalescent hospitals.
This study was carried out to investigate the relationship between diabetic control and related factors of the practice of diet therapy which affects mostly diabetic patients’ dietary compliance. A questionnaire survey was conducted on 128 diabetic patients who had visited Internal medicine endocrinology clinic at University Medical Center of Daegu area. The questionnaires including clinical characteristics, meal regularity and food intake which shows dietary compliance, intrinsic barriers to the practice of diet therapy and knowledge of diet therapy were asked and analyzed. The factor which affects HbA1c was intrinsic barriers and HbA1c became higher as the level of intrinsic barriers was increasing. The education on diet therapy had no influence on the intrinsic barriers, but the level of knowledge on diet therapy was shown higher in the educated patients. The above results suggest that the practice of diet therapy should be leaded to develop behavioral aspects through resonable motivation on dietary compliance along with removing intrinsic barriers rather than simply providing information.
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