Publications by authors named "Frankenfield D"

Purpose Of Review: To determine from existing literature if achieving energy balance in critically ill patients improves outcome. Only randomized clinical trials were considered. Furthermore, the intent had to be that energy intake of the treatment group would reach 100% of requirement, and that the requirement was measured and not estimated.

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Objectives: Obese patients have an increased risk of developing acute myeloid leukemia (AML), which in turn predisposes to malnutrition. Obesity has been associated with improved survival in critically ill patients (obesity paradox), but this effect seems to disappear when adjusting for malnutrition. How obesity and malnutrition interplay to affect mortality in critically ill patients with AML has not been addressed and was the objective of this study.

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Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline.

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Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals-nurses, physicians, advanced practice providers, pharmacists, and dietitians-identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans.

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Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals-nurses, physicians, advanced practice providers, pharmacists, and dietitians-identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans.

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Background: Predicting resting metabolic rate (RMR) in mechanically ventilated, critically ill patients is an important part of the nutrition care in such patients.

Methods: RMR and associated clinical data from various studies of mechanically ventilated, critically ill patients were combined, and the impact of body size, age, reason for admission, and sedation level were analyzed along with prediction methods of RMR (the American Society for Parenteral and Enteral Nutrition [ASPEN] standards and the Penn State equation).

Results: Among 826 measurements, trauma patients had a higher RMR than surgical and medical patients (2077 ± 290 vs 1987 ± 282 kcal/d; P < .

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Background: Feeding is understood to alter gas exchange and resting metabolic rate (RMR) in critically ill patients, but there are limited data describing such changes.

Methods: A large collection of RMR measurements and energy intake was assembled in mechanically ventilated and critically ill patients. The data were used to explore differences in RMR, respiratory quotient (RQ), and carbon dioxide production (V̇co ) related to feeding state.

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Background: There are many equations used for calculating energy needs of nutrition support patients but few developed specifically for the subset of spontaneously breathing acutely ill patients. The purpose of the current study was to validate existing equations and to start developing new equations for this cohort.

Methods: Acutely ill patients not requiring mechanical ventilation had their resting metabolic rate measured using an indirect calorimeter.

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Purpose: Accurate patient assessment and screening for pressure ulcer (PU) is difficult in the clinical setting, and evaluation of nutritional status is especially problematic. The aim of this retrospective study was to determine the extent to which Braden Scale scores and other nutrition screening parameters (body mass index, poor intake, and weight loss) predict PU development in general and heel and sacral ulcers specifically.

Methods: Records of 230 hospitalized patients who developed PU were compared to a matched control group without PU.

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Background: Critically ill patients with cystic fibrosis may be especially sensitive to the negative consequences of overfeeding and underfeeding, yet there is almost no information available about the energy needs of these patients. The purpose of this study was to characterize the metabolic rate of critically ill adult patients with cystic fibrosis requiring mechanical ventilation.

Methods: This was an observational study in which the resting metabolic rate, oxygen consumption, and carbon dioxide production of adult patients with cystic fibrosis requiring critical care, sedation, and mechanical ventilation were measured with indirect calorimetry.

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When measurement of resting metabolic rate (RMR) by indirect calorimetry is necessary, following evidence-based protocols will ensure the individual has achieved a resting state. The purpose of this project was to update the best practices for measuring RMR by indirect calorimetry in healthy and non-critically ill adults and children found the Evidence Analysis Library of the Academy of Nutrition and Dietetics. The Evidence Analysis process described by the Academy of Nutrition and Dietetics was followed.

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Background: Validation data for currently available indirect calorimeters is limited. The purpose of this investigation was to validate a newer indirect calorimeter system (Vmax Encore) against a criterion device (Deltatrac Metabolic Monitor) in spontaneously breathing mode.

Materials And Methods: An n-of-1 methodology was used in which both indirect calorimeters were employed in the same subject repeatedly until 15 measurement pairs were generated for oxygen consumption (VO2), carbon dioxide production (VCO2), resting metabolic rate (RMR), and respiratory quotient (RQ).

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Background: Indirect calorimetry is an accurate way to measure resting metabolic rate. The Deltatrac Metabolic Monitor is considered a criterion standard but is no longer manufactured. New-generation indirect calorimeters have been introduced, but there are limited published validation data comparing these devices to criterion instruments.

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Objective: The measurement of dead space to tidal volume fraction (Vd/Vt) using various methodologies has been shown to be a reliable predictor of mortality in critically ill patients. In this study, we evaluated the correlation of a validated equation using clinically available information to predict calculation of Vd/Vt with clinically relevant outcome parameters in patients requiring mechanical ventilation.

Methods: Calculations of Vd/Vt were obtained based upon a previously published prediction equation for dead space ventilation fraction: Vd/Vt = 0.

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Background: Barbiturate coma may have a significant effect on metabolic rate, but the phenomenon is not extensively studied. The primary purpose of the current study was to compare the metabolic rate of general critical care patients with those requiring barbiturate coma. A secondary purpose was to evaluate the accuracy of the Penn State prediction equation between these 2 groups of patients.

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Background & Aims: Consensus on the best equation for predicting metabolic rate in healthy people remains elusive. New equations continue to appear. The purpose of the current study was to validate several standard and new metabolic rate equations in obese and non-obese adults.

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Background: Handheld indirect calorimetry has the potential to allow simple and inexpensive measurement of resting metabolic rate in spontaneously breathing people. However, validation work on these devices is contradictory. The purpose of the current study was to determine the bias and level of agreement of oxygen consumption and resting metabolic rate as measured by a handheld indirect calorimeter against a standard open-circuit indirect calorimetry cart.

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Obesity.

World Rev Nutr Diet

April 2015

Obesity has become common in critically ill patients as it is in the population at large. Despite large fuel stores, obese patients can become rapidly malnourished and are subject to the same inflammatory and catabolic responses as their nonobese counterparts. The concepts of early enteral nutrition are therefore equally applicable to the obese patient as to the nonobese patient.

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Background: Although estimation of energy needs by mathematical equation is common in practice, there is relatively little validation data for the equations. This is especially true at the upper and lower extremes of body size. The purpose of the current study was to provide validation data for several common equations in underweight and morbidly obese critically ill patients.

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Background: Indirect calorimetry is the criterion method for assessment of energy expenditure in critically ill patients but is decidedly uncommon. Thus, calculation methods proliferate. Even if indirect calorimetry is available, it usually is not repeated more than weekly on the same patient, creating potential for error.

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Objective: To compare the effect of stroke on the metabolic rate compared with the effect of traumatic brain injury and to determine whether the metabolic rate is predictable in both types of brain injury.

Methods: Indirect calorimetry was conducted prospectively in mechanically ventilated patients within the first 6 d of admission to a critical care unit owing to ischemic stroke, hemorrhagic stroke, isolated traumatic brain injury, or traumatic brain injury with collateral injuries. Clinical data were collected simultaneously and a predicted value of the resting metabolic rate was calculated using the Penn State equation (using body size, body temperature, and minute ventilation).

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Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System.

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Purpose Of Review: The review focuses on current methodology for the most accurate way to determine resting metabolic rate in critically ill patients and to evaluate whether application of any particular method improves clinical outcome.

Recent Findings: Consensus is that indirect calorimetry is the most accurate method for determining resting metabolic rate. Whenever an alternate method of determining energy expenditure is tested (e.

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