The potential for isothermal microcalorimetry to detect venous catheter infection isolates and establish antibiograms.

Objectives: Because bloodstream infection and venous catheter (or cannula) bloodstream infection are associated with high morbidity and cost, early identification and treatment are important. Isothermal microcalorimetry can detect microbial growth using thermal power (heat flow), essentially in real time. The aim of this study was to examine the potential of this technique in clinical practice.

Estimating Total Energy Expenditure to Determine Energy Requirements in Free-Living Children With Stage 3 Chronic Kidney Disease: Can a Structured Approach Help Improve Clinical Care?

Objective: Malnutrition and obesity are complex burdensome challenges in pediatric chronic kidney disease (CKD) management that can adversely affect growth, disease progression, wellbeing, and response to treatment. Total energy expenditure (TEE) and energy requirements in children are essential for growth outcomes but are poorly defined, leaving clinical practice varied and insecure. The aims of this study were to explore a practical approach to guide prescribed nutritional interventions, using measurements of TEE, physical activity energy expenditure (PAEE), and their relationship to kidney function.

An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition.

Objective: Catheter/cannula-bloodstream infection (CBI) has been proposed as a marker of the quality of care provided to patients receiving parenteral nutrition (PN). However, surveillance criteria for CBI are variable, inconsistent, and sometimes confusing and impractical. Surveillance criteria were developed to simply and accurately demonstrate the presence or absence of CBI.

Contribution of intravenous medication to water and sodium intake in upper and lower gastrointestinal surgical patients.

Objectives: The quantitative importance of prescribed intravenous (IV) medication to water and sodium intake in routine clinical practice is undocumented, with uncertain influence on clinical outcomes. The present study aimed to redress this issue in surgical patients with gastrointestinal problems.

Methods: The prescription and administration of IV medication and fluids were retrospectively reviewed for water and sodium over 24-h periods in 86 patients in upper and lower gastrointestinal surgical wards in two teaching hospitals.

Nutritional self-screening in <1 min: Evaluation of a measuring station using sonic measurement of height.

Objective: Since nutritional screening is not routinely and accurately performed by busy care workers, the aim of this study was to evaluate a self-screening electronic measuring station that includes sonic height measurements.

Methods: In all, 114 patients, 18 to 85 y of age and attending gastrointestinal outpatient clinics, followed automatically triggered audio-recorded instructions for weight and height measurements. The patients also provided information about unintentional weight loss to establish malnutrition risk using the Malnutrition Universal Screening Tool (MUST).

'Self-screening' for malnutrition with an electronic version of the Malnutrition Universal Screening Tool ('MUST') in hospital outpatients: concurrent validity, preference and ease of use.

Self-screening using an electronic version of the Malnutrition Universal Screening Tool ('MUST') has been developed but its implementation requires investigation. A total of 100 outpatients (mean age 50 (sd 16) years; 57 % male) self-screened with an electronic version of 'MUST' and were then screened by a healthcare professional (HCP) to assess concurrent validity. Ease of use, time to self-screen and prevalence of malnutrition were also assessed.

Influence of deprivation on health care use, health care costs, and mortality in COPD.

Background And Aim: Deprivation is associated with the incidence of COPD, but its independent impact on clinical outcomes is still relatively unknown. This study aimed to explore the influence of deprivation on health care use, costs, and survival.

Methods: A total of 424 outpatients with COPD were assessed for deprivation across two hospitals.

Defining, Recognizing, and Reporting Malnutrition.

Although malnutrition is a common health and social care problem, there is no universal agreement about its definition, prevalence, or method of identification and report. Fifteen definitions of malnutrition were critically examined to assess their variability. They ranged from descriptions of undernutrition alone to under- and overnutrition, with intakes ranging from dietary protein and energy alone to dietary and nondietary sources of all nutrients and energy.

Cost-effectiveness of oral nutritional supplements in older malnourished care home residents.

Background & Aims: Malnutrition is common in care home residents, but information on the cost-effectiveness of nutritional interventions is lacking. This study, involving a randomised trial in care home residents, aimed to examine whether oral nutritional supplements (ONS) are cost-effective relative to dietary advice.

Methods: An incremental cost-effectiveness analysis was undertaken prospectively in 104 older care home residents (88 ± 8 years) without overt dementia, who were randomised to receive either ONS or dietary advice for 12 weeks.

Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents.

Background & Aims: Few trials have explored the effect of nutrition support on quality of life (QoL). This study examined the effects of oral nutritional supplements (ONS) vs dietary advice on QoL in malnourished care home residents.

Methods: 104 malnourished, care home residents (medium + high risk), identified using the Malnutrition Universal Screening Tool ('MUST'), (mean age 88.

Meta-analysis is not enough: The critical role of pathophysiology in determining optimal care in clinical nutrition.

Evidence based medicine has preferably been based on prospective randomized controlled trials (PRCT's) and subsequent meta-analyses in many fields including nutrition and metabolism. These meta-analyses often yield convincing, contradictory or no proof of effectiveness. Consequently recommendations and guidelines of varying validity and quality have been published, often failing to convince the medical, insurance and government worlds to support nutritional care.

Basal metabolic rate in children with chronic kidney disease and healthy control children.

Background: Meeting energy requirements of children with chronic kidney disease (CKD) is paramount to optimising growth and clinical outcome, but little information on this subject has been published. In this study, we examined basal metabolic rate (BMR; a component of energy expenditure) with the aim to determine whether it is related to kidney function independently of weight, height and lean body mass (LBM).

Methods: Twenty children with CKD and 20 healthy age- and gender-matched control children were studied on one occasion.

Imposed rate and extent of weight loss in obese men and adaptive changes in resting and total energy expenditure.

Objectives: Weight loss (WL) is associated with a decrease in total and resting energy expenditure (EE). We aimed to investigate whether (1) diets with different rate and extent of WL determined different changes in total and resting EE and if (2) they influenced the level of adaptive thermogenesis, defined as the decline in total or resting EE not accounted by changes in body composition.

Methods: Three groups of six, obese men participated in a total fast for 6 days to achieve a 5% WL and a very low calorie (VLCD, 2.

Which screening method is appropriate for older cancer patients at risk for malnutrition?

The risk for malnutrition increases with age and presence of cancer, and it is particularly common in older cancer patients. A range of simple and validated nutrition screening tools can be used to identify malnutrition risk in cancer patients (e.g.

Clinical and economic outcomes of nutrition interventions across the continuum of care.

Optimal nutrition across the continuum of care plays a key role in the short- and long-term clinical and economic outcomes of patients. Worldwide, an estimated one-quarter to one-half of patients admitted to hospitals each year are malnourished. Malnutrition can increase healthcare costs by delaying patient recovery and rehabilitation and increasing the risk of medical complications.

Can trained volunteers make a difference at mealtimes for older people in hospital? A qualitative study of the views and experience of nurses, patients, relatives and volunteers in the Southampton Mealtime Assistance Study.

Background: Malnutrition is common amongst hospitalised older patients and associated with increased morbidity and mortality. Poor dietary intake results from factors including acute illness and cognitive impairment but additionally patients may have difficulty managing at mealtimes. Use of volunteers to help at mealtimes is rarely evaluated.

Factors Influencing Escherichia coli and Enterococcus durans Growth in Parenteral Nutrition With and Without Lipid Emulsion to Inform Maximum Duration of Infusion Policy Decisions.

Background: Recommendations effectively restrict the infusion duration of lipid-containing parenteral nutrition (PN) from a single bag, purportedly because it encourages growth of potential microbial contaminants more than lipid-free PN. Since other variables, including osmolarity, may independently affect microbial growth, this study examined variables affecting growth of Escherichia coli and Enterococcus durans in PN infusates.

Materials And Methods: Growth of E coli and E durans was assessed in quadruplicate in 12 different PN infusates, with and without lipid, in varying glucose concentrations.

The feasibility and acceptability of training volunteer mealtime assistants to help older acute hospital inpatients: the Southampton Mealtime Assistance Study.

Aims And Objectives: To determine the feasibility and acceptability of using trained volunteers as mealtime assistants for older hospital inpatients.

Background: Poor nutrition among hospitalised older patients is common in many countries and associated with poor outcomes. Competing time pressures on nursing staff may make it difficult to prioritise mealtime assistance especially on wards where many patients need help.

Obesity: a window of opportunity to intervene? Characteristics and management of morbidly obese adult inpatients in three trusts in Southern England.

Obesity affects 22% of men and 24% of women over the age of 16 years in the general population of the UK and is associated with multiple comorbidities. Little is known about the magnitude of the obesity problem among hospitalised adults and, although significant focus has been given to the identification and treatment of the malnourished inpatient, it is not known to what extent obese inpatients are equally -targeted. National guidelines for consideration of bariatric surgery exist, but it is not known to what extent potentially eligible individuals are referred.

Factors influencing Candida albicans growth in parenteral nutrition with and without lipid emulsion: using an established framework to inform maximum duration of infusion policy decisions.

Background & Aims: Because lipid putatively encourages contaminant growth it has been proposed that infusion of lipid-containing parenteral nutrition (PN) bags should be restricted to 24 h (48 h or longer if lipid free). This study aimed to examine this proposal by identifying factors affecting Candida albicans growth in PN.

Methods: C.

A comparison of the surface contaminants of handwritten recycled and printed electronic parenteral nutrition prescriptions and their transfer to bag surfaces during delivery to hospital wards.

Background: Handwritten recycled paper prescription for parenteral nutrition (PN) may become a concentrated source of viable contaminants, including pathogens. This study examined the effect of using fresh printouts of electronic prescriptions on these contaminants.

Materials And Methods: Cellulose sponge stick swabs with neutralizing buffer were used to sample the surfaces of PN prescriptions (n = 32 handwritten recycled; n = 32 printed electronic) on arrival to the pharmacy or following printing and PN prescriptions and bags packaged together during delivery (n = 38 handwritten recycled; n = 34 printed electronic) on arrival to hospital wards.