Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS2002: Reanalysis of a cohort study.

Objectives: The aim of this study is to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine the number of Nutritional Risk Screening 2002 (NRS2002)-positive patients who do not meet the GLIM, as well as examine whether these patients would benefit from nutritional support therapy.

Methods: A reanalysis of a published prospective observational study was performed. The subjects were rediagnosed per the NRS2002 and GLIM criteria.

Nutrition risk screening in the ICU.

Purpose Of Review: To review recent studies that may help to identify patients in the ICU who benefit from nutrition support.

Recent Findings: One recent controlled trial did not show any clinical benefit of nutrition support among a sample of ICU patients who were hitherto believed to benefit from nutrition support. Several recent observational studies suggest benefit of nutrition support among patients who have a high nutric score, in itself derived from an observational study.

Three Techniques of Contained Morcellation for the Minimally Invasive Gynecologic Surgeon.

Since 1993 (and prior, WISAP® [WISAP Medical Technology GmbH, Brunnthal, Germany] hand morcellators), laparoscopic power morcellation has been an indispensably employed technique for minimally invasive gynecologic surgery, contributing both to laparoscopic myomectomies and hysterectomies. However, the technique was highlighted with concern by the FDA for the given potential to disseminate neoplastic and non-neoplastic cells by morcellating an unexpected uterine sarcoma (Fig. 1).

Closing the Gap: Novel Abdominal Wound Closure Techniques.

Traditionally, surgical procedures within the realm of both general and gynecological surgery employ the use of staples and interrupted sutures that run continuously with knot tying or subcuticular sutures to ensure closure of large wound incisions, subcuticular incisions, and fascial repair. However, these methods may not always be cosmetically favorable and, thus, result in an unpleasant outcome for the patient, adding to their surgery-related stress. It is, therefore, imperative that surgeons and gynecologists are aware of alternative methods of wound closure that are not only cosmetically favorable, but also ensure rapid wound recovery and infection control.

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm.

Objectives: Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search.

Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial.

Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients.

Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU.

Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio.

Purpose Of Review: Malnutrition affects prognosis in many groups of patients. Although screening tools are available to identify adults at risk for poor nutritional status, a need exists to improve the assessment of malnutrition by identifying the loss of functional tissues that can lead to frailty, compromised physical function, and increased risk of morbidity and mortality, particularly among hospitalized and ill patients and older adults. Bioimpedance analysis (BIA) offers a practical approach to identify malnutrition and prognosis by assessing whole-body cell membrane quality and depicting fluid distribution for an individual.

Nutrition support in hospitalised adults at nutritional risk.

Background: The prevalence of disease-related malnutrition in Western European hospitals is estimated to be about 30%. There is no consensus whether poor nutritional status causes poorer clinical outcome or if it is merely associated with it. The intention with all forms of nutrition support is to increase uptake of essential nutrients and improve clinical outcome.

Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: A prospective cohort study with propensity score matching.

Objectives: There is a lack of evidence regarding the economic effects of nutrition support in patients at nutritional risk. The aim of this study was to perform a cost-effectiveness analysis by comparing an adequate nutrition support cohort with a no-support cohort.

Method: A prospective observational study was performed in the surgical and medical gastroenterology wards.

Revisiting the refeeding syndrome: Results of a systematic review.

Objective: Although described >70 y ago, the refeeding syndrome (RFS) remains understudied with lack of standardized definition and treatment recommendations. The aim of this systematic review was to gather evidence regarding standardized definition, incidence rate and time course of occurrence, association with adverse clinical outcomes, risk factors, and therapeutic strategies to prevent or treat this condition.

Methods: We searched MEDLINE and EMBASE for interventional and observational clinical trials focusing on RFS, excluding case reports and reviews.

Biosurgicals and the Minimally Invasive Gynecologic Surgery (MIGS) Surgeon.

Biosurgical materials (biosurgicals) have a wide array of uses for providing hemostasis, including decreasing the risk of postoperative bleeding and, intraoperatively, controling bleeding. These materials are especially useful in situations where electrocautery, sutures, or clips are not feasible. Biosurgicals have long been used in general surgery and surgical subspecialties to provide hemostasis; however, they still are not commonly used during obstetric and gynecologic procedures.

Early goal-directed nutrition in ICU patients (EAT-ICU): protocol for a randomised trial.

Introduction: Extensive weight loss has been docu-mented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein-energy nutrition based on measured requirements on short-term clinical outcomes and long-term physical quality of life in ICU patients.

Methods: The EAT-ICU trial is a single-centre, randomised, parallel-group trial with concealed allocation and blinded outcome assessment.

Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard.

Background And Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable.

Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery.

Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines.

Objective: Despite the high prevalence of malnutrition in the general inpatient population, there is a lack of knowledge in regard to detecting disease-related malnutrition and implementing nutritional support. Our aim was to suggest practical procedures for screening and treating malnourished or at-risk patients hospitalized in medical wards, thereby fostering a straightforward implementation of nutritional therapy independent of the underlying disease and comorbidities.

Methods: A working group of experts in clinical nutrition selected and analyzed published disease-specific European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines relevant for our aim.

Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber-enriched tube feed in hospitalized patients initiated on tube nutrition: Randomized controlled trial.

Background & Aims: During the first days of tube feeding (TF) gastrointestinal (GI) complications are common and administration of sufficient nutrition is a challenge. Not all standard nutritionally complete formulas contain dietary fiber, fish oil or carotenoids, key dietary nutrients for health and wellbeing. The aim of this study was to investigate the effects of a fiber, fish oil and carotenoid enriched TF formula on diarrhea, constipation and nutrient bioavailability.

An Update on the Use of Barbed Suture in Minimally Invasive Gynecological Surgery (MIGS).

The use of barbed suture has enabled general and minimally invasive gynecological surgery (MIGS) surgeons to close surgical wounds more efficiently with minimal complications. This article reviews developments in barbed (knotless) sutures and related devices.

Now You See It: Using Angled Laparoscopes in Minimally Invasive Gynecologic Surgery.

As minimally invasive gynecologic surgery (MIGS) becomes more complex, and cases more difficult, surgeons must adapt to the challenges not only by using innovative equipment but also using the lessons learned from other disciplines. Many years after general surgeons learned the "art of laparoscopy," it is clear that general surgeons in the United States-and those around the world-have surpassed the "masters of laparoscopy" (gynecologists) with their use of new techniques and new equipment. Surgeons are using less traumatic graspers and perform a higher percentage of surgeries laparoscopically than gynecologic surgeons.

Laparoscopic Morcellation and Tissue Spillage Containment Using the LI Endofield™ Bag.

There are many times during laparoscopic surgery that a surgeon, whether gynecologist or general surgeon, must work in an environment where spillage of tissue or organ contents should be avoided. In gynecologic surgery, this involves management of ovarian cysts as well as containment of tissue fragments during morcellation of uteri or fibroids. Unfortunately, many laparoscopic containment bags on the market today are not large enough to remain open on their own during the entire procedure.

The New HARMONIC ACE®+7 Shears: A Game Changer in Ultrasonic Hemostasis.

The latest version of HARMONIC®, the HARMONIC ACE®+7 Shears by Ethicon US, LLC, is now commercially available. While earlier models also had easy-to-use handles and a fine, non-stick tip, the HARMONIC ACE®+7 Shears adds a new hemostasis feature. The "7" in HARMONIC ACE®+7 stands for the device's ability to coagulate and divide 7-mm vessels.

Nutritional-risk scoring systems in the intensive care unit.

Purpose Of Review: There is a need to develop a screening tool to assist clinical staff in deciding whether or not a patient in the ICU should be given nutrition support. The purpose of this review is to analyze the recent randomized trials in this context.

Recent Findings: Five trials describe the effect of early supplemental parenteral nutrition.

Nutritional intake and status in persons with alcohol dependency: data from an outpatient treatment programme.

Purpose: Malnutrition increases the risk of developing alcohol-related complications. The aim of this study was to describe nutrient intake, nutritional status and nutrition-related complications in a Danish population of outpatients with alcohol dependency.

Methods: This was a cross-sectional study with a 6-month follow-up enrolling persons with alcohol dependency (n = 80) admitted to a hospital-based outpatient clinic.