Journal of human nutrition and dietetics : the official journal of the British Dietetic Association
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It has been consistently observed that a significant proportion of hospital inpatients are malnourished and many actually develop malnutrition in hospital. The NHS provides over 300 million meals each year at a cost of pound 500 million, yet there is relatively little research evaluating how well different catering systems provide for the needs of hospital inpatients. ⋯ Patient intakes did not meet their estimated requirements. The patients in this study were eating well and not at nutritional risk, thus patients with a poor appetite will be even less likely to meet their nutritional requirements. Steamplicity meals result in a lower energy intake than meals from a bulk cook-chill system, but similar protein intakes.
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Malnutrition has serious consequences for recovery and increases the risk of complications in hospital patients. Fractured neck of femur (NOF) patients may be particularly at risk because of their old age and frail state of health. We conducted an observational study to evaluate the nutritional state and the nutritional support, which was provided to this group during their stay in hospital. ⋯ This group of patients with fractured NOF is likely to be malnourished on admission and to show a rapid deterioration in its nutrition status during admission. Energy needs were not met in up to 50% of patients. These results reinforce the need to screen, supplement and monitor fractured NOF patients.
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In critically ill patients enteral nutrition (EN) is frequently associated with underfeeding and intolerance, whilst parenteral nutrition (PN) has been associated with a greater risk of infectious complications and overfeeding. ⋯ Overall patients received approximately 81% and 76% of prescribed energy and protein intakes respectively. Underfeeding occurred on 50.3% of days. Reasons for patients failing to achieve adequate intakes included, fasting for airway management procedures (21%) and gastrointestinal intolerance (14%). Overfeeding, although less common (18.6% of days), was more likely to occur in patients with a tracheostomy requiring prolonged mechanical ventilation (>16 days). The combination of oral and nasogastric feeding or use of nutrient-dense feeds were most frequently associated with overfeeding. Discussion The overall adequacy of nutritional intakes in the present study was similar to those reported elsewhere. However, the incidence of overfeeding was greater than anticipated and occurred in patients already experiencing delayed weaning from mechanical ventilation.
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Head and neck cancer patients being treated with radiotherapy are at an increased risk of malnutrition due to the severe side-effects, e.g. mucositis, odynophagia and xerostomia, impacting on the ability to eat and drink. Effective dietetic management involves identifying those patients malnourished or at risk of becoming so and incorporating nutritional intervention into their treatment plan. The use of gastrostomy tubes in this patient group has been shown to be acceptable. By placing them prophylactically, the aim is to prevent a disruption to treatment and avoid an unnecessary admission for feeding. This audit was carried out to determine whether the implementation of locally produced nutritional guidelines improved the dietetic management of this patient group. ⋯ Implementation of the guidelines led to an improvement in the nutritional management of this patient group. Implementation may be more likely if a dietitian is present at the combined head and neck clinic.