Nutrition-associated markers and outcomes among patients receiving enteral nutrition after ischemic stroke: a retrospective cohort study
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Stroke
Barthel index
Enteral administration
Nutrition practices for preterm infants during the first few weeks of life can be divided into three phases: the parenteral nutrition (PN), enteral nutrition (EN), and transition (TN) phases; the TN phase includes both PN and EN. Our purpose was to analyze nutrition practices for very preterm infants during the TN phase and their association with the infants' growth during the first 28 days of life.Data from 268 very preterm infants <32 weeks old from six neonatal intensive care units were analyzed retrospectively. The TN phase was defined as enteral feedings of 30-120 ml/kg/d. Postnatal growth failure (PGF) was defined as a 28-day growth velocity <15 g/kg/d. Differences in protein and energy intake between the PGF and non-PGF groups during the TN phase were calculated, and risk factors for PGF were identified using multivariate regression analysis.The total protein (parenteral + enteral) intake during the TN was 3.16 (2.89, 3.47) g/kg/d, which gradually decreased as the enteral feeding volume increased in the TN phase. The total energy (parenteral + enteral) intake during the TN phase was 115.72 (106.98, 122.60) kcal/kg/d. The PGF group had a lower total protein intake (parenteral + enteral) than the non-PGF group had [3.09 (2.85, 3.38) g/kg/d vs. 3.27 (3.06, 3.57) g/kg/d, P = 0.007, respectively]. No significant difference was found in energy intake during the TN phase. The variables associated with PGF included a lower total protein (parenteral + enteral) intake, a smaller day of age at the end of the TN phase, and a higher birth weight z-score.Increasing the total protein intake (parenteral + enteral) during the TN could reduce the incidence of PGF.
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Objective To assess the combined application of staged enteral and parenteral nutrition support in patients with acute pancreatitis. Methods Sixty patients with acute pancreatitis who underwent conservative treatment were divided into total parenteral nutrition and staged parenteral and enteral nutrition. The changes of clinical indicators and clinical outcome were recorded. Results All of the 30 cases in the total parenteral nutrition+enteral nutrition group tolerated the enteral nutrition.One week after nutrition support from parenteral nutrition to enteral nutrition, total protein serum albumin and blood calcium significantly increased (P0.01);ALT and AST significantly decreased (P0.01).The blood glucose was significantly decreased (P0.05).The average hospital stay was shorter in the total parenteral nutrition+enteral nutrition group than in the total parenteral nutrition group(P0.05),and the average charge and total charge were cheaper in the total parenteral nutrition+enteral nutrition group than in the total parenteral nutrition group.Conclusion The results of glucose and nutritional indicators in total parenteral nutrition and enteral nutrition are better than in total parenteral nutrition group.
Enteral administration
Clinical nutrition
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Total Parenteral Nutrition (TPN), which uses intravenous administration of nutrients, minerals and vitamins, is essential in sustaining premature infants until they transition to enteral feeds. There is limited information on metabolomic differences between infants on TPN and enteral feeds. We performed untargeted global metabolomics on urine samples collected between 23-30 days of life from 314 infants born &lt;29 weeks gestational age from the TOLSURF and PROP cohorts. Principal component analysis across all metabolites showed a separation of infants solely on TPN as compared to infants who had transitioned to enteral feeds, indicating global metabolomic differences between infants based on feeding status. Among 913 metabolites that passed quality control filters, 609 varied in abundance between infants on TPN vs enteral feeds at p&lt;0.05. Of these, 88% were in the direction of higher abundance in the urine of infants on enteral feeds. In a subset of infants with longitudinal analysis, both concurrent and delayed changes in metabolite levels were observed with initiation of enteral feeds. Infants on enteral feeds had higher concentrations of essential amino acids, lipids, and vitamins, which are necessary for growth and development, suggesting a nutritional benefit of an enteral feeding regimen.
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Total Parenteral Nutrition (TPN), which uses intravenous administration of nutrients, minerals and vitamins, is essential for sustaining premature infants until they transition to enteral feeds, but there is limited information on metabolomic differences between infants on TPN and enteral feeds. We performed untargeted global metabolomics on urine samples collected between 23–30 days of life from 314 infants born <29 weeks gestational age from the TOLSURF and PROP cohorts. Principal component analysis across all metabolites showed a separation of infants solely on TPN compared to infants who had transitioned to enteral feeds, indicating global metabolomic differences between infants based on feeding status. Among 913 metabolites that passed quality control filters, 609 varied in abundance between infants on TPN vs. enteral feeds at p < 0.05. Of these, 88% were in the direction of higher abundance in the urine of infants on enteral feeds. In a subset of infants in a longitudinal analysis, both concurrent and delayed changes in metabolite levels were observed with the initiation of enteral feeds. These infants had higher concentrations of essential amino acids, lipids, and vitamins, which are necessary for growth and development, suggesting the nutritional benefit of an enteral feeding regimen.
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Barthel index
Stroke
Acute stroke
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Objective: To explore the correlations among the Longshi Scale, the Barthel Index, and the modified Rankin Scale and the differentiate ability of the Longshi Scale and the modified Rankin Scale to Barthel Index scores. Design: Prospective study. Setting: The inpatient rehabilitation units of three teaching hospitals in China. Subjects: A total of 343 stroke inpatients were recruited through convenience sampling. Main measures: Pictorial-based Longshi Scale, Barthel Index, and modified Rankin Scale. Results: The Longshi Scale was highly and moderately correlated with the Barthel Index and modified Rankin Scale, respectively. The median frequency distribution of the Barthel Index was slightly overlapped between Longshi Scale grades 2 and 3 but was considerably overlapped among modified Rankin Scale grades 1, 2, and 3. The Kruskal-Wallis and multiple comparison tests showed that, among the modified Rankin Scale grades, the median Barthel Index scores did not differentiate between grades 1 and 2 ( χ 2 = 20.643, P = 1.000), between grades 1 and 3 ( χ 2 = 60.404, P = 0.070), and between grades 2 and 3 ( χ 2 = 39.760, P = 0.232). Among the Longshi Scale grades, the median Barthel Index scores did not differentiate between grades 2 and 3 ( χ 2 = 48.778, P = 1.000), between grades 3 and 4 ( χ 2 = 57.094, P = 1.000), and between grades 5 and 6 ( χ 2 = 24.709, P = 1.000). Conclusion: Using the Barthel Index as reference, the proposed Longshi Scale has better ability than the modified Rankin Scale in differentiating stroke patients’ disability, especially for those with higher level of activities of daily living.
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To examine the aluminum content of several commercially available enteral nutrition formulas and parenteral solutions.Twelve enteral nutrition formulas and 10 parenteral solutions were commonly used in routine clinical care of patients and obtained from different medical companies in Turkey. The aluminum contents were determined by electrothermal atomic absorption spectrophotometry.We found that aluminum concentration in the enteral nutrition formulas and the parenteral solutions to range from 87.6 to 961.2 ng/mL and 58.4 to 1232.0 ng/mL, respectively.Careful clinical and biochemical monitoring are warranted to determine whether it will be necessary to eliminate aluminum contamination of enteral and parenteral preparations used in patients, particularly infants, with reduced kidney function who may be at risk for aluminum intoxication.
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Background and Purpose— The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index. Methods— We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures. Results— We had full data from 1717 patients. Length of stay was strongly associated with final mRS ( P <0.0001). Each mRS increment from 0 to 1–2 to 3–4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P <0.0005). Ninety-five percent confidence limits for estimated costs (£) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS. Conclusions— Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.
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Stroke
Bonferroni correction
Acute stroke
Repeated measures design
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The aim of the study was to assess early poststroke prognostic factors in patients admitted for postacute phase rehabilitation.A 1-yr multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for postacute rehabilitation. Clinical data were collected in the stroke or acute care units (acute phase), then in rehabilitation units (postacute phase), and, subsequently, after a 6-mo poststroke period (follow-up). Clinical outcome measures were represented using the Barthel Index and the modified Rankin Scale. Univariate and multivariate analyses were performed to identify the most important prognostic index.Modified Rankin Scale score, minor neurologic impairment, and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to Barthel Index (power of prediction = 37%). Similarly, age, premorbid modified Rankin Scale score, and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the modified Rankin Scale (power of prediction = 48%). Barthel Index at admission and certain co-morbidities were also significant prognostic factors correlated with a better outcome.According to the Barthel Index and modified Rankin Scale, early mobilization is an early predictor of favorable outcome.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Incorporate prognostic factors of good clinical outcomes after stroke in developing treatment plans for patients admitted to rehabilitation; (2) Identify acute phase indicators associated with favorable 6-mo outcome after stroke; and (3) Recognize the cut-off for early mobilization linked to better outcome in stroke survivors admitted to rehabilitation.Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Barthel index
Stroke
Acute stroke
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Enteral administration
Malondialdehyde
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