This book is the first of a new series which will present the proceedings of the newly established Nestlé Nutrition Workshop Series: Clinical & Performance Programme aimed at adult nutrition. Undernutrition is a common phenomenon in elderly people, and malnutrition reaches significant levels in those being in hospital, nursing homes or home care programs. Consequences of malnutrition often go unrecognised owing to the lack of specific validated instruments to assess nutritional status in frail elderly persons. The Mini Nutritional Assessment (MNA) provides a single, rapid assessment of nutritional status in the elderly of different degrees of independence, allowing the prevalence of protein-energy malnutrition to be determined and to evaluate the efficacy of nutritional intervention and strategies. Easy, quick and economical to perform, it enables staff to check the nutritional status of elderly people when they enter hospitals or institutions and to monitor changes occurring during their stay. Moreover, the MNA is predictive of the cost of care and length of stay in hospital. This publication will be of immense assistance to heads of geriatric teaching units, teachers in nutrition, clinicians general practitioners and dieticians, enabling them to better detect, recognise and start treatment of malnutrition in the elderly.
Parenteral nutrition in general is required if nutritional needs cannot be met by oral or enteral feeding. In the paediatric patient, its initiation depends both on individual circumstances and the age and size of the infant or child. This compact reference work on parenteral nutrition in children is based on the 'Guidelines for Paediatric Parenteral Nutrition' that have been developed jointly by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), in collaboration with the European Society for Paediatric Research (ESPR).These guidelines were based on systematic literature reviews as well as a formal consensus process of a multidisciplinary panel of professionals. However, as a result of the scarcity of good quality clinical trials in children, many of the recommendations were extrapolated from adult studies and based on expert opinion. A detailed analysis of the available data was performed, and for each statement, the level of evidence and grade of recommendation was assessed. This reference guide has been conceived as an aid for the treating physician to assist him in the decision process, thus being a valuable companion in clinical practice.
"This important publication is the final report of the most recent expert group meeting, the Joint FAO/WHO/UNU Expert Consulation on Human Energy Requirements, convened in October 2001 at FAO headquarters in Rome, Italy ... FAO publishes this report on behalf of the three United Nations (UN agencies (FAO/WHO/UNU that organised the consultation" -- Foreword.
This guideline provides updated global, evidence-informed recommendations on the intake of free sugars to reduce the risk of NCDs in adults and children, with a particular focus on the prevention and control of unhealthy weight gain and dental caries. The recommendations in this guideline can be used by policy-makers and programme managers to assess current intake levels of free sugars in their countries relative to a benchmark. They can also be used to develop measures to decrease intake of free sugars, where necessary, through a range of public health interventions. Examples of such interventions and measures that are already being implemented by countries include food and nutrition labelling, consumer education, regulation of marketing of food and non-alcoholic beverages that are high in free sugars, and fiscal policies targeting foods and beverages that are high in free sugars. This guideline should be used in conjunction with other nutrient guidelines and dietary goals, in particular those related to fats and fatty acids (including saturated fatty acids and trans-fatty acids), to guide development of effective public health nutrition policies and programmes to promote a healthy diet.
Guide for nutrition professionals to implement the four steps of the Nutrition Care Process: assessment, diagnosis, intervention, and monitoring and evaluation.
This edition of the Manual of Neonatal Care has been completely updated and extensively revised to reflect the changes in fetal, perinatal, and neonatal care that have occurred since the sixth edition. This portable text covers current and practical approaches to evaluation and management of conditions encountered in the fetus and the newborn, as practiced in high volume clinical services that include contemporary prenatal and postnatal care of infants with routine, as well as complex medical and surgical problems. Written by expert authors from the Harvard Program in Neonatology and other major neonatology programs across the United States, the manual’s outline format gives readers rapid access to large amounts of valuable information quickly. The Children’s Hospital Boston Neonatology Program at Harvard has grown to include 57 attending neonatologists and 18 fellows who care for more than 28,000 newborns delivered annually. The book also includes the popular appendices on topics such as common NICU medication guidelines, the effects of maternal drugs on the fetus, and the use of maternal medications during lactation. Plus, there are intubation/sedation guidelines and a guide to neonatal resuscitation on the inside covers that provide crucial information in a quick and easy format.
The essentials of teaching carbohydrate counting are presented in this revised and much expanded edition. This resource provides clear and practical approaches that will allow you to help your patients achieve glycemic control with Basic or Advanced Carbohydrate Counting. Includes: reasons for teaching carbohydrate counting, which type, and to whom; complete information on both Basic and Advanced Carbohydrate Counting; skills and readiness checklists for patients; case studies; and much more!
Central venous catheters (CVC) are vital for patients receiving chemotherapy not compatible with peripheral infusion. Thousands of centrally and peripherally inserted central venous catheters are inserted into patients with cancer each year. All types of intravascular catheters are associated with complications. These complications may be divided into infectious, thrombotic, mechanical and occlusive events. All of these events have the potential to harm patients and cause additional expense for the health-care system. Furthermore, the above-mentioned complications are largely avoidable through proper patient selection, insertion technique, hygiene precautions and catheter maintenance. Catheter-related infections and deep venous thrombosis are the two most common and feared CVC related complications. Infection in a catheter can cause lifethreatening bacteraemia, and thrombosis can lead to pulmonary embolisation, post-thrombotic syndrome and stenosis of the vessel affected. Many studies describing methods to minimise infectious complications associated with central venous catheters have been carried out. These methods appear to have been implemented in most modern advanced healthcare facilities resulting in a continual decrease in catheter-related infections over the last two decades. New implantation techniques, fewer infections and better catheter materials are likely to have contributed to the reduction in the incidence of catheter-related deep venous thrombosis (CR-DVT). Peripherally inserted central venous catheters (PICC) and subcutaneously implanted vascular access ports (PORT) are two very commonly used catheter devices for delivery of chemotherapy. International guidelines are unclear as to which device to choose due to the paucity of controlled trials. The aim of this thesis was to study complications related to central venous access devices used over long periods of time, usually for the delivery of chemotherapy. Vascular access in cancer patients – clinical implications We prospectively studied PORT complications (Study 1) over a six-month follow- up period. In Study 2, we assessed the number of common CVC-related micro- organisms that are transferred across PORT membrane contaminated by a controlled suspension of micro-organisms when a non-coring access needle is inserted using two different techniques. In the largest randomised controlled trial published on this topic (Study 3), we compared PICC with PORT regarding CRDVT and other catheter-related complications. The economic implications of using PICC or PORT were assessed from health-care system´s perspective (Study 4), using data on adverse events and clinical factors (implantation, treatments and dwell-time) from Study 3. Chemotherapy against various forms of cancer is very common. Implantation of PORT is one of the ten most common surgical procedures in Sweden according to the Swedish Perioperative Register. Hence, the topic in this thesis may be clinically relevant to many patients and their health care providers. We found that the incidence of catheter-related blood stream infection was very low in the cohorts studied. In general, PICCs are associated with significantly more CR-DVTs and adverse events than PORTs. The cost to the health-care system when using PICC is higher than for PORT when complications are included. Given the choice, patients about to commence chemotherapy appear to prefer PORT to PICC. PORT implantation is more painful than PICC insertion, but PICC appears to influence activities of daily life more than PORT.
