Tesis: "Enteral feeding"

1

Lee, Cheuk-hung, and 李卓雄. "Microbial contamination of enteral feeds." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31245596.

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李潔怡 and Kit-yue Samson Lee. "Evaluation of enteral feeding support in mechanically ventilated, critically-ill patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41710757.

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3

Lee, Kit-yue Samson. "Evaluation of enteral feeding support in mechanically ventilated, critically-ill patients." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41710757.

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4

Chhetri, Suresh Kumar. "Outcomes of enteral feeding in motor neurone disease." Thesis, University of Central Lancashire, 2015. http://clok.uclan.ac.uk/12862/.

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Motor Neurone Disease (MND) is a fatal neurodegenerative disease of unknown aetiology characterised by the degeneration of motor neurones leading to progressive wasting and weakness of the bulbar, limb and respiratory muscles. Symptomatic treatment remains the cornerstone of management. Malnutrition is a common occurrence and an independent risk factor for worse prognosis. Clinical guidelines recommend enteral feeding when there is deterioration in nutritional status and/or dysphagia. However, it remains unclear whether enteral feeding offers any survival advantage. Moreover, the impact of enteral feeding on patients’ quality of life remains unknown. This study was undertaken to assess the impact of enteral feeding on survival and quality of life of patients with MND and describe the clinico-demographic characteristics of MND in Lancashire and South Cumbria in North West England. The study has both retrospective and prospective arms. The retrospective study was undertaken by reviewing the Preston MND database and case notes to examine the demographic, clinical and survival characteristics of MND in Lancashire and South Cumbria. The prospective study was undertaken over a period of three years to explore the perspectives of 21 patients with enteral feeding and its impact on their quality of life. The overall crude incidence of MND was 3.15 per 100,000. The mean age of onset was 67.28 (S.D. 11.06; range 22.78-93.06) years. Median overall illness duration was 1.98 (range 1.18-3.05) years. The presentation was limb onset in 62.1% cases and bulbar onset in 37.9% cases. A total of 91 (26.8%) patients received enteral feeding of which 67.0% were bulbar onset. Enteral feeding was not associated with a statistically significant survival advantage (χ2 (1) = 1.73, p = 0.19). iii Enteral feeding was associated with improved quality of life, despite the attendant inconveniences. Enteral feeding was perceived as being essential to survival by some participants while others reported a sense of relief and security that their nutritional needs were met. The body mass index stabilised following enteral feeding. A key finding, relevant for clinical practice, is that most study subjects acknowledged the importance of enteral feeding and a vast majority did not wish for the feeding tube to be removed, indicating a positive attitude towards enteral feeding. In conclusion, this study demonstrates a positive impact of enteral feeding on quality of life but not on survival. The lack of survival advantage should however, not dissuade clinicians from offering enteral feeding to patients with MND who manifest dysphagia and/or malnutrition. Even if enteral feeding does not add months to life, this study provides preliminary evidence that that it helps to add life to months.

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5

Singh, Rashmi Roshan. "Enteral feeding methods and surgical complications in children." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10057352/.

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Background: In the unwell child who is unable to feed orally, various methods for enteral feeding having been advocated. The ideal method for a particular child has to be tailored according to his/her anatomy, physiology and requirements. The impact of complex medical background on outcomes and complications following a surgical procedure in children remains largely unrecognized. Aims: 1. To determine whether percutaneous endoscopic gastrostomy (PEG) is superior to radiologically inserted gastrostomy (RIG) 2. To determine outcomes following surgical jejunostomy (SJ) or radiologically inserted gastro-jejunal (RGJ) tube 3. To study complications after surgery and determine its effect Methods: A double-blinded randomised controlled trial was conducted in children needing gastric feeding, who received either a PEG or RIG. They were followed up for up to 3 years to record any complication. Retrospective reviews of buried bumpers (a specific complication of gastrostomy), and the nutritional outcomes following jejunostomy placement (SJ or RGJ) was carried out. Available scoring systems for post-operative complications were reviewed and initial development of a new paediatric complexity scoring system was performed. Results: In the trial 198 children were randomised (100 PEG and 98 RIG). They were followed up to a median of 1 year (6 weeks to 3 years). There was no difference between total number of complications or the rate of complications, following PEG or RIG. Both SJ and RGJ are able to maintain and improve growth in a carefully selected group of children. There is a need for validation of a developed paediatric complexity scoring system. Conclusions: PEG and RIG have equivalent rates of complications. SJ and RGJ cannot be compared as they are used for patients at different stages in a spectrum of malnutrition. Impact of the complexity of paediatric patients on their post-operative complications needs thorough consideration to improve outcomes.

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6

Athar, Nelofar, of Western Sydney Hawkesbury University, and Faculty of Science and Technology. "Development of indigenous enteral formulae." THESIS_FST_XXX_Athar_N.xml, 1995. http://handle.uws.edu.au:8081/1959.7/609.

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A procedure for preparing an enteral formula was developed, using Pakistani indigenous food items. The basis of development was that it would be nutritionally effective, easy to prepare and relatively cheap. 100 indigenous enteral diets were formulated using a computer aided master sheet in which various combinations were analysed. In order to prove the efficacy of these diets, a modified PER was carried out on 6 diets and results indicated a higher PER for the experimental diet. 29 formulations were shortlisted for preparation trials, and 2 main techniques were applied: incubation and cooking techniques. Physical and chemical analyses were carried out to assess the effect of preparation, the cooking methodologies were tried on various diets and 2 diets were shortlisted for human trials. To compare the efficacy of the indigenous enteral formula versus commercial formulae, a pilot study was carried out. Patient nutritional outcomes were assessed using biochemical parameters, and preliminary findings indicated that the experimental diet performed as well as the control diet. Doctor of Philosophy (PhD)

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7

Athar, Nelofar. "Development of indigenous enteral formulae." Thesis, View thesis View thesis, 1995. http://handle.uws.edu.au:8081/1959.7/609.

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A procedure for preparing an enteral formula was developed, using Pakistani indigenous food items. The basis of development was that it would be nutritionally effective, easy to prepare and relatively cheap. 100 indigenous enteral diets were formulated using a computer aided master sheet in which various combinations were analysed. In order to prove the efficacy of these diets, a modified PER was carried out on 6 diets and results indicated a higher PER for the experimental diet. 29 formulations were shortlisted for preparation trials, and 2 main techniques were applied: incubation and cooking techniques. Physical and chemical analyses were carried out to assess the effect of preparation, the cooking methodologies were tried on various diets and 2 diets were shortlisted for human trials. To compare the efficacy of the indigenous enteral formula versus commercial formulae, a pilot study was carried out. Patient nutritional outcomes were assessed using biochemical parameters, and preliminary findings indicated that the experimental diet performed as well as the control diet.

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8

Athar, Nelofar. "Development of indigenous enteral formulae /." View thesis View thesis, 1995. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030521.092507/index.html.

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9

Westfall, Una Elizabeth. "Physiological responses to different enteral feeding schedules in rats /." Thesis, Connect to this title online; UW restricted, 1990. http://hdl.handle.net/1773/7265.

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10

Beattie, Tara Kate. "Microbial contamination of enteral tube feeds and feeding systems." Thesis, University of Strathclyde, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417337.

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11

Bjuresäter, Kaisa. "Home enteral tube feeding - from patients’, relatives’ and nurses’ perspectives." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-6325.

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Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.

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12

Angelier, Daniel Michael 1950. "Evaluation of a neonatal hyperalimentation microcomputer program." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276856.

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A neonatal hyperalimentation microcomputer program was designed to generate labels, and calculate mixing instructions. Artificial intelligence techniques including, interviewing experts and an inference algorithm, were employed to provide decision support in identifying clinically inappropriate orders. Development cost was $10,000. The program was alpha phase tested comparing pharmacists and technicians performance. Task time was high and prone to human mathematical error for pharmacists and technicians using an electric typewriter and calculator. All subjects performed poorly with low confidence in manually determining inappropriate orders, although pharmacists scored slightly higher. Task time was decreased 17 minutes with no errors using the program. Appropriateness, confidence and composite performance were vastly improved with decision support. Pharmacists composite performance was slightly higher.

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13

Malta, Monica Alexandre. "Predição de medidas antropometricas para a sondagem nasogastrica, determinadas por esofagogastroduodenoscopia." [s.n.], 2003. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313411.

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Orientador: Maria Isabel Pedreira de Freitas Ceribelli Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Made available in DSpace on 2018-08-04T02:15:21Z (GMT). No. of bitstreams: 1 Malta_MonicaAlexandre_M.pdf: 4654022 bytes, checksum: 38002dea9a94db1b48fc9aef0d3ccd88 (MD5) Previous issue date: 2003 Resumo: Para se prevenir a desnutrição, provocada pela oferta de nutrientes menor que as necessidades reais do paciente, deve-se iniciar a terapia nutricional enteral precocemente, através de uma sonda, quando há a impossibilidade da reposição dos nutrientes necessários à alimentação do doente. Com intuito de se predizer medidas antropométricas para realizar a sondagem nasogástrica, usou-se neste estudo a esofagogastroduodenoscopia (EGDA) como padrão de uma medida como referência interna, determinante do comprimento necessário para a introdução do tubo de alimentação até o estômago. Medidas externas foram obtidas entre os pontos : ponta do nariz x lobo da orelha x apêndice xifóide x umbigo e altura correlacionadas com a medida padrão. Trata-se de estudo prospectivo, clínico e descritivo constituído por 140 usuários, encaminhados por demanda espontânea, à esofagogastroduodenoscopia diagnóstica. Para a análise dos dados utilizou-se a correlação linear e multivariada. Encontrou-se duas correlações estatisticamente significativas entre a linha zeta, identificada durante a EGDA, acrescida da distância da rima labial à arcada dentária superior, com a distância compreendida entre os pontos anatômicos lóbulo da orelha e apêndice xifóide (r=0.75) e desta linha com a altura ortostática (r= 0.72). Para se inserir a sonda de alimentação em estômago, de maneira a realizar o procedimento com segurança aos pacientes. Os resultados revelam a possibilidade de se usar a distância predita entre os pontos: lobo da orelha x apêndice xifóide x umbigo para servir como referência Abstract: In order to prevent malnutrition due to a minor demand of the patient¿s real nutrient supplies, the enteral nutrition therapy must be started early through a feeding tube when the spontaneous feeding remain impossible. With the aim of predicting the anthropometric measures to perform the nasogastric probing, it was used, in this study, the esophagusgastroduodenuscopy(EGDA) as a standard to establish a measurement as an internal reference which determines the necessary length in order to perform the insertion of the feeding tube up to the stomach. External reference measurements were obtained through the points nose tip x earlobe x xiphoid appendix x umbilicus and height which were correlationed with the standard measurement. This is a prospective, clinical and descriptive study with 140 patients, referred as spontaneous request to the diagnostic. In order to do the data analysis, it was used a multivariate and linear correlation. Two it was found a significant statistically correlation: between the ¿zeta¿ line, identified during the esophagusgastroduodenuscopy(EGDA) , with the distance measured between the antomic points of the earlobe and xiphoid appendix ( r= 0.75) and from this line with the orthostatic height ( r=0.72). The results revealed the possibility of using the distance as a prediction measurement among the points: earlobe x xiphoid appendix x umbilicus to establish it as a reference measurement to insert the feeding tube into the stomach Mestrado Enfermagem e Trabalho Mestre em Enfermagem

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14

Law, Hang-yi, and 羅幸兒. "The development and evaluation of an enteral feeding protocol in ICU." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46582277.

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15

Burgess, P. "The influence of different energy sources on hepatic microsomal enzyme activity and triglyceride metabolism." Thesis, University of Newcastle Upon Tyne, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.234400.

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16

Nelson, Stacy. "Effectiveness of using an electromagnetic tube placement device for placement of bedside small bowel feeding tubes in a regional burn center." Online version, 2009. http://www.uwstout.edu/lib/thesis/2009/2009nelsons.pdf.

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17

Emmons, Margaret M. "Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsn_diss/34.

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Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.

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18

Hodgson, Ian. "Growth, inhibition and pathogenicity of microorganisms in enteral nutrient solutions." Thesis, Open University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287009.

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19

Leung, Tsz-kwan, and 梁子鈞. "An evidence-based guideline to prevent nosocomial infections in infants with enteral feeding." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B4833571X.

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Enteral feeding is commonly used in paedaitric patients. It helps to improve the digestive, absorptive, immunologic and nutrition status. However, poor handling in enteral feeding can lead to bacterial contaminations and severe consequences resulting in significant morbidity and mortality. At present, there are no definite guidelines on the handling of enteral feeding in local setting, therefore developing evidence based guideline on enteral feeding is critically important to eliminate inconsistent practices and prevent nosocomial infections related to enteral feeding. This dissertation is a translational nursing research that aims at developing evidence based guideline on enteral feeding in infants. The objectives of this thesis are to search for existing literatures on enteral feeding; perform a critical appraisal on the literatures; develop guideline on enteral feeding in infants; assess the implementation potential of the proposed guidelines, and develop the implementation and evaluation plans. The ultimate goal is to reduce the nosocomial infections in infants with enteral feeding in an acute hospital. A systemic search for relevant and valid evidence was performed using three electronic databases and nine relevant studies were retrieved. Critical appraisals on the nine studies were performed and the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN). By synthesizing the data from nine studies, it is concluded that optimal hang time and proper hand hygiene appeared to have significant effect in reducing nosocomial infections related to enteral feeding. The implementation potential of the innovation was assessed in terms of the transferability, feasibility and cost benefit ratio. After assessing the implementation potential, it is found that the evidence is transferable and feasible to implement the proposed guideline in the target paeditaric setting. An evidence based guideline on enteral feeding in infants was developed. An implementation plan of the new guideline included a comprehensive communication plan with both administration and nurses and a pilot test were developed to ensure a smooth implementation and optimize the transferability and effectiveness of the evidence based guideline in the target population. A systematic evaluation plan on patient outcomes, health care provider outcomes and systemic outcomes was developed. The evidence based guideline on enteral feeding was expected to be implemented in the long run to reduce the risk of nosocomial infections in infants with enteral feeding. published_or_final_version Nursing Studies Master Master of Nursing

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20

Kruger, Jeanne-Marié. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit /." Link to online version, 2006. http://hdl.handle.net/10019/564.

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Sands, Joyce Ann 1958. "THE INCIDENCE OF PULMONARY ASPIRATION IN INTUBATED PATIENTS RECEIVING ENTERAL NUTRITION THROUGH WIDE- AND NARROW-BORE NASOGASTRIC FEEDING TUBES." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276693.

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22

Solfa, Fabiana Vieira [UNESP]. "Desperdício de dieta enteral em UTI: análise de modo de falhas e efeitos de danos ao paciente grave." Universidade Estadual Paulista (UNESP), 2014. http://hdl.handle.net/11449/123977.

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Made available in DSpace on 2015-06-17T19:34:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-12-03. Added 1 bitstream(s) on 2015-06-18T12:48:47Z : No. of bitstreams: 1 000830352.pdf: 1542887 bytes, checksum: 87f1a3d2a9d0941778faff708704bc13 (MD5) Introdução: O estudo surgiu em razão da necessidade de compreender o desperdício de dieta enteral na unidade de terapia intensiva. Diversos fatores contribuem para o desperdício de dieta enteral, podendo ser intrínsecos (intolerância gastrointestinal) ou extrínsecos ao paciente (exames, cirurgias), desde a prescrição da dieta até o final da sua administração. Duas formas de verificação do desperdício foram comparadas e testadas como hipóteses: a anotação de enfermagem e a medida direta do volume residual do frasco. A utilização da metodologia de Modo de Falhas e Análise de Efeitos na terapia nutricional e o estudo do desperdício da dieta trouxe pioneirismo ao estudo. Metodologia: O desperdício foi verificado por metodologia quantitativa, o volume anotado pela enfermagem e o volume medido no frasco. Foram avaliados também índices de gravidade dos pacientes e comparados com variáveis relacionadas à dieta enteral. As causas do desperdício poderiam ser encontradas em todas as etapas do processo de dieta enteral. Optou-se nesse trabalho, também, pela metodologia da análise do modo de falhas e efeitos (FMEA), mapeando as etapas, identificando os riscos potenciais e avaliando possíveis danos com pontuação acima de oito através da análise de causa raiz. Resultados/ Discussão: Houve diferença significativa em relação aos volumes de dieta desperdiçados segundo a anotação de enfermagem e o volume medido no frasco. O volume anotado pela enfermagem era maior que o medido. Esse fato pode levar a consequências importantes referentes à anotação inadequada por se tratar de um grande volume desperdiçado, segundo a anotação de enfermagem. Quanto aos índices de gravidade do paciente e variáveis referentes à dieta enteral, houve diferença significativa relacionada às variáveis sexo, idade, uso de droga vasoativa e tempo de internação. Assim, o desperdício foi maior entre os homens, não idosos, internados ... Introduction: This study arose from the need to understand the waste of enteral nutrition in the intensive care unit. Several factors contributed to the waste of enteral feeding and may be intrinsic (gastrointestinal intolerance) or extrinsic to the patient (tests, surgeries), since the diet prescription moment until the end of its administration. Two ways of checking the waste were compared and tested as hypotheses: nurse diary and direct measurement of the residual volume of the bottle. The use of Failure Mode and Effects Analysis methodology in nutritional therapy and the study of diet waste brought originality to the work. Methodology: The waste was verified by quantitative methodology, the volume recorded by the nursing staff and the volume measured on the bottle. Severity scores of patients were also evaluated and compared with enteral nutrition-related variables. The causes of waste could be found at all stages of enteral feeding process, and in this study it was decided by the Failure Mode and Effect Analysis (FMEA) methodology, mapping process, identifying potential risks and evaluating probable damage with score above eight through root cause analysis. Results / Discussion: there was a significant difference between volumes of diet waste according to the nurse diaries and the volume measured on the bottle. The volume registered by the nursing staff was higher than the measured one. This fact may lead to important consequences regarding inappropriate notes once it's about a big volume wasted, according to the records of the nursing staff. As for patient severity scores and variables related to enteral feeding, there were meaningful differences related to sex, age, use of vasoactive drugs and hospitalization time. Thus, the waste was higher among men, not elderly, hospitalized for less than a week (waste per day), without the use of vasoactive drugs. Regarding process failures, most occurred in the period of suspension of the ...

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23

Solfa, Fabiana Vieira. "Desperdício de dieta enteral em UTI : análise de modo de falhas e efeitos de danos ao paciente grave /." Botucatu, 2014. http://hdl.handle.net/11449/123977.

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Orientador: Silvia Justina Papini Coorientador: Sérgio Alberto Rupp de Paiva Coorientador: Miriam Cristina Marques da Silva Paiva Banca: Marina Nogueira Berbel Bufarah Banca: Paula Azevedo Gaiola Resumo: Introdução: O estudo surgiu em razão da necessidade de compreender o desperdício de dieta enteral na unidade de terapia intensiva. Diversos fatores contribuem para o desperdício de dieta enteral, podendo ser intrínsecos (intolerância gastrointestinal) ou extrínsecos ao paciente (exames, cirurgias), desde a prescrição da dieta até o final da sua administração. Duas formas de verificação do desperdício foram comparadas e testadas como hipóteses: a anotação de enfermagem e a medida direta do volume residual do frasco. A utilização da metodologia de Modo de Falhas e Análise de Efeitos na terapia nutricional e o estudo do desperdício da dieta trouxe pioneirismo ao estudo. Metodologia: O desperdício foi verificado por metodologia quantitativa, o volume anotado pela enfermagem e o volume medido no frasco. Foram avaliados também índices de gravidade dos pacientes e comparados com variáveis relacionadas à dieta enteral. As causas do desperdício poderiam ser encontradas em todas as etapas do processo de dieta enteral. Optou-se nesse trabalho, também, pela metodologia da análise do modo de falhas e efeitos (FMEA), mapeando as etapas, identificando os riscos potenciais e avaliando possíveis danos com pontuação acima de oito através da análise de causa raiz. Resultados/ Discussão: Houve diferença significativa em relação aos volumes de dieta desperdiçados segundo a anotação de enfermagem e o volume medido no frasco. O volume anotado pela enfermagem era maior que o medido. Esse fato pode levar a consequências importantes referentes à anotação inadequada por se tratar de um grande volume desperdiçado, segundo a anotação de enfermagem. Quanto aos índices de gravidade do paciente e variáveis referentes à dieta enteral, houve diferença significativa relacionada às variáveis sexo, idade, uso de droga vasoativa e tempo de internação. Assim, o desperdício foi maior entre os homens, não idosos, internados ... Abstract: Introduction: This study arose from the need to understand the waste of enteral nutrition in the intensive care unit. Several factors contributed to the waste of enteral feeding and may be intrinsic (gastrointestinal intolerance) or extrinsic to the patient (tests, surgeries), since the diet prescription moment until the end of its administration. Two ways of checking the waste were compared and tested as hypotheses: nurse diary and direct measurement of the residual volume of the bottle. The use of Failure Mode and Effects Analysis methodology in nutritional therapy and the study of diet waste brought originality to the work. Methodology: The waste was verified by quantitative methodology, the volume recorded by the nursing staff and the volume measured on the bottle. Severity scores of patients were also evaluated and compared with enteral nutrition-related variables. The causes of waste could be found at all stages of enteral feeding process, and in this study it was decided by the Failure Mode and Effect Analysis (FMEA) methodology, mapping process, identifying potential risks and evaluating probable damage with score above eight through root cause analysis. Results / Discussion: there was a significant difference between volumes of diet waste according to the nurse diaries and the volume measured on the bottle. The volume registered by the nursing staff was higher than the measured one. This fact may lead to important consequences regarding inappropriate notes once it's about a big volume wasted, according to the records of the nursing staff. As for patient severity scores and variables related to enteral feeding, there were meaningful differences related to sex, age, use of vasoactive drugs and hospitalization time. Thus, the waste was higher among men, not elderly, hospitalized for less than a week (waste per day), without the use of vasoactive drugs. Regarding process failures, most occurred in the period of suspension of the ... Mestre

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24

Joubert, Polly Ann. "Production of enteral feeds : manual vs mechanised vs 'ready to hang'." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53560.

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Thesis (Mnutr)--Stellenbosch University, 2003. ENGLISH ABSTRACT: INTRODUCTION Many patients seen by dietitians in Tygerberg Academic Hospital require feeding via the enteral route. Prior to this study all enteral feeds were mixed individually by hand, and production was time consuming and very labour intensive. The purpose of this study was, therefore, to compare the current method of production, with mechanised bulk production (MP) and "Ready to hang" (RTH) products, taking time, safety and cost effectiveness into consideration. MATERIALS AND METHODS A machine was designed and built to produce and decant bulk volumes of enteral feed. Production methods were evaluated and data was obtained regarding the time taken to produce a feed, and the true cost of the feeds produced. Microbiological samples were collected and the safety of all the three systems was determined and compared. RESULTS MP production time was significantly longer than hand production (HP), but MP decanting was significantly more accurate. RTH feeds cost 152% more than HP feeds, and MP feeds cost 95% of HP feeds. Seventy-one per cent of HP feeds, 74% of MP feeds and 34% of RTH feeds were contaminated just after administration had began. CONCLUSIONS Mechanisation is less labour intensive than HP and helps to decrease total costs. RTH feeds quickly become contaminated after administration decreasing their other advantages. AFRIKAANSE OPSOMMING: IN L E ID IN G Baie van die pasiente wat deur dieetkundiges in Tygerberg hospitaal gesien word, benodig buisvoedings. Vo or hierdie studie geloots was, was alle buisvoedings by Tygerberg hospitaal met die hand gemaak. Hierdie metode is baie tydsaam en arbeidsintensief. Die doel van hierdie studie was, om die voorlopige sisteem van produksie te vergelyk met gemeganiseerde grootmaat produksie en "ready to hang" (RTH). Die studie het die volgende in ag geneenv produksietyd, mikrobiologiese veiligheid en koste effektieweteit. METODE 'n Masjien was ontwerp en gebou om grootmaat buisvoedings aan te maak en aftegiet. Produksie metodes was geevalueer en inligting bymekaar gemaak met betrekking tot produksietyd, en die ware koste van die voedings. Mikrobiologiese monsters was versamel en die mikrobiologiese veiligheid van al drie sisteme is bepaal en vergelyk. RESULTATE Produksie met die masjien was betekenisvol longer as die voedings wat met die hand gemaak was, maar die masjien het betekenisvol meer akkuraat afgemeet met afgiet. RTH voedings se koste beloop 152% meer as voedings wat met die hand gemaak word, en voedings wat deur die masjien gemaak word kos 95% van die wat met die hand gemaak is. Een en sewentig persent van die voedings wat met die hand gemaak was, 74% van die masjiengemaakte voedings en 34% van die RTH voedings was besmet net na toediening begin was. GEVOLGTREKKINGS Meganisasie is minder arbeidsintensief as voedings wat met die hand gemaak is en help om die kostes af te bring. RTH voedings word vinnig besmet met organismes na die begin van toediening en dit verminder hulle ander voordele.

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25

Taylor, Stephen J. "The effect of early aggressive enteral nutrition on clinical outcomes and treatment cost." Thesis, University of Surrey, 1996. http://epubs.surrey.ac.uk/844289/.

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Malnutrition and nutritional deprivation are common in hospital patients. Consequent dysfunction is exacerbated in the presence of an inflammatory state and leads to increased morbidity, mortality and treatment cost. This thesis tested the hypothesis that clinical outcome could be improved, and treatment cost reduced, if enteral nutritional (EN) was; a) initiated earlier after the pathological event, and b) when > 50% of a patient's estimated energy and nitrogen requirements were met by EN (ie. aggressive EN). A Preliminary Investigation found that patients starved for ≤ 5 days compared to > 5 days, had a lower mortality (p < 0.003) and shorter duration of nasogastric (NG) feeding (p = 0.049). The population studied was heterogenous and no account was taken of disease severity. The hypothesis was therefore re-tested in burned patients, controlling for disease severity. The delay before attempting aggressive EN was associated with major complications excluding (p < 0.001) and including mortality (p = 0.018), length of (hospital) stay (LOS) (p = 0.011), and treatment cost (p < 0.001). Finally, a prospective randomised controlled trial (PRCT) was used to test the hypothesis. A study of patients undergoing major GI surgery failed due to poor recruitment, but useful aspects of this protocol were adapted for a similar trial in head-injured patients. In this group, early aggressive EN was associated with a reduction in infective complications (p = 0.0195), duration of mechanical ventilation (p = 0.019) and treatment cost (p = 0.006). In certain conditions at least, early aggressive EN is associated with improved clinical outcome and reduced treatment cost. Much of this improvement appears to be due to a reduction in infective complications.

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26

Bronston, Ashley Lynn. "Use of Homemade Blenderized Formula in Gastrostomy Tube Dependent Pediatric Patients with Feeding Intolerance: A Retrospective Analysis." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1461197803.

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Daniels, Barret R. "Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439281638.

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28

Abudalla, Halema. "Neonatal enteral feeding tube as loci for Enterobacteriaceae colonisation and risk to neonatal health." Thesis, Nottingham Trent University, 2014. http://irep.ntu.ac.uk/id/eprint/42/.

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The incidence of neonatal infections caused by Enterobacteriaceae has been increasing in recent years, and they are now recognised as the predominant causative agents in neonatal intensive care unit (NICU) outbreaks. Klebsiella spp. and Serratia spp. are the most common causative pathogens, and E. coli is one of the leading causes of neonatal meningitis and sepsis. The infant intestinal flora is influenced by the feeding regime. This study focuses on assessing the risk to neonates from the ingestion of the Enterobacteriaceae such as; Enterobacter hormaechei, Enterobacter ludwigii, Enterobacter aerogenes, Enterobacter cloacae and Klebsiella oxytoca. The strains under study were isolated from two sources; human mastic breast milk (MBM) and neonatal nasogastric enteral feeding tubes (EFT). The overall aim was to evaluate the risk to neonates posed by the ingestion of these organisms either from contaminated breast milk or from infant formula. Due to the lack of adequate source information, it was necessary to first confirm the identity of the strains under investigation. This was achieved using standard biochemical profiles (phenotyping) and where necessary 16S rDNA sequence analysis. Secondly, it was necessary to determine whether all strains were unique or if any were multiple isolations of the same strain. This was achieved using Pulsed-Field Gel Electrophoresis (PFGE). To determine the potential exposure of neonates to these organisms, a range of physiological and virulence related assays were undertaken; heat tolerance to 55°C, biofilm formation, capsule formation and acidic pH survival (pH 3.5). The potential virulence of the strains was assessed using attachment-invasion assays of human Caco-2 intestinal cells, human brain microvascular endothelial cells (HBMEC) and rat brain capillary endothelial cell line (rBCEC4); and also persistence of bacteria in macrophages by using U937 cells. Patterns of adherence of Enterobacteriaceae to Caco-2 cells was investigated. The presence of the virulence factors of strains was determined by identifying haemolytic activity, serum resistance, siderophore production and antimicrobial susceptibility. The iron uptake genes were also investigated. The results by PFGE showed that neonatal enteral feeding tubes and mastic human breast milk were contaminated by twenty-one and three pulsotypes of Enterobacteriaceae, respectively. Furthermore, the same pulsotypes were spread among enteral feeding tubes of infants in the same NICUs; indicating the same origins, such as: environment, milk or carer. Similarly, the MBM strains were isolated from the same mother. The identification of strains by using 16S rDNA sequence analysis (genotyping) was more accurate than phenotyping (API technique) and the clustering of strains by PFGE is a suitable technique for strains relatedness. The physiological features of the strains in the current study were investigated. The ability of strains to survive at 55ºC was studied and most of the strains were able to survive at 55ºC for >30 minutes. Biofilm formation was investigated as this may be a factor of organism persistence in the neonatal intensive care unit (via milk, environment or workers) and attachment to enteral feeding tubes. All strains formed biofilms and this was, in general, enhanced at 37°C compared with room temperature (20ºC) in all types of formula. The highest levels of biofilm were in casein-based infant formula. Most strains produced capsular material at 37ºC on all types of formula. However, capsular material was produced by all strains in soya infant formula. All strains were able to survive at pH 3.5 for up to 2 hours. All strains were able to attach to Caco-2, HBMEC and rBCEC4 cells lines, while there was variation between strains ability to invade mammalian cells. In particular, most of Ent. hormaechei strains were able to invade the three types of cells lines and one Ent. ludwigii strain 1439 was only able to invade the rBCEC4 cell line. Ent. ludwigii strain 1439 was isolated from a case of neonatal meningitis. Three out of eight strains of Ent. hormaechei and two strains of Ent. cloacae strains survived within macrophages. Haemolysin production, serum resistance and siderophore production were also studied and all strains were positive. Genes encoding for iron uptake irp1, irp2 and fyuA were detected whereas irp1, irp2 genes were absent in all strains while fyuA was present in 4/6 of Ent. ludwigii strains, 1/8 of Ent. hormaechei, 2 of Ent. cloacae, 1 of Ent. aerogenes and 3/6 of K. oxytoca. Three out of eight strains of Ent. hormaechei showed resistance to even the 3rd generation cephalosporins, ceftazidime and cefotaxime and were ESBL-positive.

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29

Kam, Kin-wai, and 甘健威. "A systematic review of factors improving medication safety of oral medication via enteral feeding tubes in institutions." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206916.

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Objective: Medication safety is always having great concern in healthcare. Giving oral medication through enteral feeding tubes is not uncommon and is a well-known area that prone to error happening. These errors may lead to inadequate treatment or adverse drug reaction resulting in unnecessary health care cost and wastage of public health resources. This systematic review aims to identify contributing factors on medication errors associated with administration of oral medication via enteral feeding tubes. With better understanding of the factors, improvement measures applicable to Hong Kong situations will be suggested. Methods: Pubmed, Medline and Embase databases were searched up to February 2014 by using relevant keywords. Prospective studies with researcher analyzing the drug administration process to observe the occurrence of errors and evaluate the contributing factors and case reports on medical error with review of the place of errors and their potential root causes were considered to be potential relevant literature. Studies meeting the inclusion criteria were included and evaluated in this review. Studies were excluded based on the exclusion criteria. Results and Discussion: An initial search of medical literature by searching engines identified 682 references. After appraisal for inclusion, 11 of them were included in this systematic review. For the findings, lack of knowledge, lack of the presence or the awareness of protocol, environmental factors, inter-disciplinary communication among healthcare professionals and the ability of inadvertent connection of both IV catheter and enteral feeding system had been identified to be key contributing factors to drug administration error. Taken account with the findings, measures to improve the existing local practice through educational reinforcement, establishing guideline and inter-disciplinary communication were suggested. Conclusion: With consideration of the local situation in Hong Kong and the findings identified in this review, suggestions of improvement measures on different aspects have been made in this review. Involvement of government policy, institutional management and the collaboration of multi-disciplinary healthcare professional are essential for the success of these improvement measures. Besides, this review also revealed the lack of research on medication safety issue concerning feeding tube, further research in this area is required. published_or_final_version Public Health Master Master of Public Health

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30

Marshall, Andrea Pauline. "Information use in clinical practice a case study of critical care nurses' enteral feeding decisions /." Connect to full text, 2008. http://hdl.handle.net/2123/3658.

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Thesis (Ph. D.)--University of Sydney, 2008. Title from title screen (viewed 11 February 2009). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Nursing And Midwifery. Includes bibliographical references. Also available in print form.

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31

Chang, Chia-Chi. "Effects of a feeding skills training program on knowledge, attitude, perceived behavior control, intention, and behavior of formal caregivers toward feeding dementia patients in Taiwan nursing homes /." Connect to text online, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1093631995.

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32

Marshall, Andrea. "Information use in clinical practice: A case study of critical care nurses' enteral feeding decisions." Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/3658.

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Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.

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33

Marshall, Andrea. "Information use in clinical practice: A case study of critical care nurses' enteral feeding decisions." University of Sydney, 2008. http://hdl.handle.net/2123/3658.

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Doctor of Philosophy (PhD) Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.

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34

Musial, Abigail. "Increasing Time to Full Enteral Feeds in Hospitalized Children with Medical Complexity Experiencing Feeding Intolerance." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104772672061.

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35

Jörud, Susanne, and Anna Wahlin. "Enteral nutrition vid palliativ vård. En systematisk litteraturstudie." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26609.

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Syftet med denna litteraturstudie är att undersöka vad omvårdnad innebär utifrån ett sjuksköterskeperspektiv och etiska faktorer gällande enteral näringstillförsel vid palliativ vård. Forskningsansatsen har varit en systematisk litteraturstudie baserad på Goodmans sju steg i forskningsprocessen. Studiens resultat baseras på 10 vetenskapliga artiklar. Utifrån dessa artiklars resultat utkristalliserades olika teman såsom riktlinjer, dokumentation, åtgärder, komplikationer och effekter inom området omvårdnad kring enteral näringstillförsel. Resultatet påvisar att enteral nutrition ingår i sjuksköterskans ansvarsområde. Det finns skrivna riktlinjer gällande enteral nutrition. Dock visades sig att det finns luckor mellan vad som är rekommenderad vård och vad som sker ute i klinisk verksamhet. Den mest förekommande komplikationen med nasogastrisk sond är aspiration av maginnehåll till lungorna. The aim of this systematic review is to study what nursing care can imply from a nursing perspective and ethical issues regarding enteral nutrition in palliative care. The research approach has been a systematic literature review based on Goodmans seven principles. The result of the study is based on 10 scientific articles. From the results of the articles different themes, emerged such as guidelines, documentation, interventions, complications and effects within the area of enteral nutrition and nursing care. The results show that enteral nutrition is part of the nurse’s scope of practice and that written recommendations and guidelines exist. However, the review also shows that gaps between recommended nursing care and practice exist. The most frequent complication concerning enteral nutrition is lung aspiration.

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36

Whelan, Kevin. "Enteral feeding : the effect on faecal output, the faecal microflora and short chain fatty acid concentrations." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405265.

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Viswanathan, Sreekanth K. "STANDARDIZED SLOW ENTERAL FEEDING PROTOCOL AND INCIDENCE OF NECROTIZING ENTEROCOLITIS IN EXTREMELY LOW BIRTH WEIGHT INFANTS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1403738800.

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38

Cornwell, Sonya. "Pediatric feeding disorders: Efficacy of multidisciplinary inpatient treatment of gastrostomy tube dependent children." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9113/.

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Efficacy of multidisciplinary inpatient treatment of feeding disordered children was sought through retrospective chart review of 40 G-tube dependent children ages 22 months to 7 years. Premature births were 55% of the sample ranging from 23 to 36 weeks gestation. The majority of co-occurring medical conditions included congenital anomalies (50%), gastroesophageal reflux disease (25%) and chronic lung disease (25%). Treatment effect analyzed from pre and post treatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t (39) = 5.76, p < 0.001, d = 1.02, and G-tube dependency, t(39) = 10.94, p < 0.001, d = 2.03 with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.

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39

Mansfield, Allison N. "Nutrition Support Protocols and Early Feeding in the Intensive Care Unit." Bowling Green State University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1210191094.

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40

Jack, Leanne C. "Exploring diarrhoea, enteral nutrition and intestinal microbial flora relationships in critically ill patients." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/78409/1/Leanne_Jack_Thesis.pdf.

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Diarrhoea is a common complication observed in critically ill patients. Relationships between diarrhoea, enteral nutrition and aerobic intestinal microflora have been disconnectedly examined in this patient cohort. This research used a two-study, observational design to examine these associations. Higher diarrhoea incidence rates were observed when patients received enteral tube feeding, had abnormal serum blood results, received multiple medications and had aerobic microflora dysbiosis. Further, significant aerobic intestinal microflora changes were observed over time in patients who experienced diarrhoea. These results establish a platform for further work to improve the intestinal health of critically ill patients.

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41

Paixão, Fabiano Carlos [UNESP]. "Utilização de magnetorresistores no desenvolvimento de novas técnicas para aplicações em gastroenterologia." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/110776.

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Made available in DSpace on 2014-12-02T11:16:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-16Bitstream added on 2014-12-02T11:21:14Z : No. of bitstreams: 1 000609546.pdf: 1464260 bytes, checksum: 34305688869576b88d9034d68dc81109 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) As técnicas biomagnéticas vêm sendo empregadas com sucesso no estudo do trato gastrintestinal (TGI). Elas podem medir o campo magnético originado pela atividade elétrica dos órgãos, o campo de marcadores magnetizados ou a resposta de marcadores ou traçadores a um campo magnético de excitação. Este trabalho apresenta uma coletânea de instrumentações desenvolvidas para aplicações no trato gastrintestinal. Os equipamentos desenvolvidos utilizaram sensor anisotrópico magnetorresistivo (AMR) para medir campo magnético e conversores de tensão true rms-to-dc objetivando a redução de custo das técnicas que empregam excitação magnética alternada (AC). Foram desenvolvidos um método de localização magnética de sonda nasoenteral, uma solução para substituição dos amplificadores lock-in’s por conversores true rms, uma instrumentação com sensor AMR com um eixo de detecção para avaliar o trânsito faringiano, uma instrumentação com sensor AMR com três eixos de detecção para avaliar o trânsito esofagiano e uma instrumentação com 36 sensores que foi aplicada para obter imagens magnéticas de diferentes fantomas e para avaliar a atividade de contração gástrica em um modelo in vivo – ratos. As instrumentações foram avaliadas em testes in vitro e in vivo e apresentaram sensibilidade para o emprego no trato gastrintestinal. Os equipamentos desenvolvidos são de baixo custo, livre de radiação ionizante, portáteis e que possibilitam aplicações em gastroenterologia, farmacologia, farmacotécnica e na clínica médica. Biomagnetic techniques have been employed successfully to study gastrointestinal (GI) tract. They are enable to measure the magnetic field of magnetized markers, the markers and tracers responses to applied magnetic field excitation, and the magnetic field occurred by GI electrical activity. This work presents some instrumentation developed to evaluate different parameters of GI tract. The equipment built uses anisotropic magnetoresistive (AMR) sensor to measure magnetic field and true rms-to-dc voltage converter in order to reduce the cost of techniques that employ alternate (AC) magnetic excitation. In this work were developed: a magnetic method for localization of enteral feeding tube, a solution to replace lock-in amplifier for true rms converter, an instrumentation using AMR sensor (one axis-sensing) to evaluate the pharyngeal transit time, another instrumentation using AMR sensor (three axis-sensing) to evaluate esophageal transit time and finally, a equipment consisted of 36 AMR sensors to evaluate the gastric motor activity from rats and in order to obtain magnetic images from different kinds of phantoms. All equipments were tested and showed sensitivity to be employed in GI studies. The equipments developed are low cost, radiation free, portable and enable to applications in gastroenterology, pharmacology, pharmaceutical and medical clinic.

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42

Venter, Marcha. "The effect of early versus late enteral feeding on the hypermetabolic response of the paediatric burned patient." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/26519.

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Background: Red Cross Children's Hospital treats an average of 2 000 children per annum with thermal injuries. Five hundred of these are new injuries and 60 patients have a total body surface area burn (TBSAB) that exceeds 20%. There is substantial evidence in adult burn literature that suggests that early enteral feeding (EEF) compared to initial starvation has a profound impact on the hormonal response, metabolic rate and gastrointestinal maintenance post thermal injury. However, research addressing these issues in the burned child (birth to 13 years old), are limited. Aim: To compare EEF, to delayed or late enteral feeding (LEF), and to evaluate whether the practice is beneficial in paediatric burned patients. Criteria: The criteria for the patients were (a) a burn less than 24 hours old and a TBSAB more than or equal to 20%, (b) an age of less than 13 years and (c) admission to the Red Cross Children's Hospital Burns Unit. Objectives: The objectives were to compare the effect of EEF and LEF on (1) the concentrations of insulin, insulin-like growth factor-1 (IGF1), glucagon, cortisol and growth hormone (GH), (2) the estimated energy expenditure (EEE) and calculated energy expenditure, (3) the respiratory quotient (RQ), (4) the intestinal permeability and (5) the clinical outcome. Methods: The children were assigned to either the EEF or LEF group. Nine patients in each study group completed the study successfully, with similar median ages (4.5 yr.), body weights (14 kg) and TBSAB (30%). The EEF group was enterally fed via a nasojejunal feeding tube within a median time of 10.75 hours post burn, whereas the LEF group fasted for a median of 54 hours, after which enteral feeds were introduced. This study is unique in that enteral feeds were used as part of the resuscitation regime in the EEF group. The EEF group received their full resuscitation volumes from the enteral feed at a median time of 16 hours from initiation. Venous blood samples were taken daily between 7h00 and 8h00, before breakfast, for the hormone measurements. The REE and RQ were measured by indirect calorimetry and compared to the recommended dietary allowances (RDA), Galveston and Solomon's equations, which estimate energy requirements. Small bowel permeability was measured by the sugar-absorption-test (SAT), and expressed as lactulose:rhamnose ratios.

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Nogueira, Roberto José Negrão. "Fatores preponderantes para a nutrição de indivíduos com fenda orofacial típica e propostas para seu manejo." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308365.

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Orientador: Antonio Fernando Ribeiro Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Made available in DSpace on 2018-08-18T00:03:41Z (GMT). No. of bitstreams: 1 Nogueira_RobertoJoseNegrao_D.pdf: 1229933 bytes, checksum: affc50589086791ae8d3862bcf6b885e (MD5) Previous issue date: 2011 Resumo: As Fendas Orofaciais Típicas (FOT), compõe um grupo que inclui as fendas labiais, labiopalatais e palatais, acometem 1 em cada 650 a 1000 recém-nascidos em todo o mundo. Os indivíduos com FOT sejam estes sindrômicos ou não sindrômicos, padecem, com frequência, de desordens nutricionais múltiplas, com destaque para as dificuldades alimentares nos seis primeiros meses de vida. Com o objetivo de contribuir para a melhoria da assistência aos afetados, o presente estudo foi dividido em quatro fases de análise e uma proposta. As fases de análise são: a) caracterização do estado nutricional de um grupo de indivíduos com FOT; b) avaliação inicial e intervenção nutricional com abordagem multiprofissional padronizada, ambas em atendimento ambulatorial; c) análise de dados nutricionais de estudo multicêntrico brasileiro; d) avaliação de conhecimento sobre FOT e nutrição aplicada aos alunos do último ano de graduação em áreas da saúde da Faculdade de Ciências Médicas da Unicamp. O presente trabalho mostra que cerca da metade dos pacientes chega desnutrida para consulta especializada e, ainda, que há impacto positivo no ganho de peso quando orientações nutricionais e fonoaudiológicas são realizadas. Apesar de notar-se uma melhoria na assistência a este grupo de indivíduos, ela ainda é precária no nosso país. Sobretudo, as cirurgias necessárias são frequentemente postergadas devido a diversos problemas estruturais, com destaque para a nutrição inadequada. O trabalho revela também que os estudantes de cursos da área de saúde que terão contato com estes pacientes não conhecem o assunto. Finalizando, baseados nestes achados e na revisão de literatura, elaborou-se material educacional e algoritmo de avaliação e condução de aspectos nutricionais, voltados para o profissional da saúde Abstract: The "Typical Orofacial Clefts" (TOC) represents a group of congenital defects composed by cleft lip with or without cleft palate and isolated cleft palate. They affect about 1:650-1000 newborns in the entire world. Multiple nutritional diseases, specially feeding disorders from newborn until six month of life, are often detected. The main aim of the study is to contribute for the assistance of these children. Five independent chapters built up a picture of some relevant aspects in this theme. Firstly, it was performed a cross sectional investigation of anthropometric parameters of TOC individuals without syndrome. After that, it was designed a longitudinal study using nutritional intervention. A multicentre study characterized nutritional records in children from seven different centers by parents' interview. In the chapter four it was performed an evaluation of nutritional knowledge of health professional students from the last year of graduation of Unicamp (dentist, nurse, physician and speech therapy). These studies showed that a half of the patients were in malnutrition state and nutritional counseling was effective to improve it. Despite of the health care for clefts individuals already structured in Brazil, it should be improved. Surgical delays related to health structure problems and inadequate nutrition care, as well. In order to improve the health care, the last chapter is a nutritional guide and algorithm for nutritional approach for cleft babies to health care professionals Doutorado Pediatria Doutor em Saude da Criança e do Adolescente

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Afzal, Nadeem Ahmad. "Enteral nutrition feeding strategies and their impact on relapse rate and quality of life in paediatric Crohn's disease." Thesis, Queen Mary, University of London, 2010. http://qmro.qmul.ac.uk/xmlui/handle/123456789/695.

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Aims: To study induction of remission and reduction in relapse rate of childhood Crohn’s disease with quality of life (QOL) assessment in subjects on long term continuous oral supplementation with ACD004. Methods: This study was performed in two phases. In Phase A, ACD004 was used to assess effectiveness based on proportion of full remission at 8 weeks. Children then reintroduced food over a 4 week phase reducing their ACD004 intake to 30% RDA, subsequently enrolling into randomised controlled part of the trial (Phase B), to assess reduction in relapse rate whilst receiving continuous oral ACD004 supplementation compared to no supplementation. Secondary objectives of this study were to examine QOL, safety, tolerance and growth. Results: 42 children were enrolled in Phase A with 78.6% (n=33) achieving remission with a significant improvement in endoscopic, histologic and QOL scores. One child developed refeeding syndrome. A further 8 children relapsed during the food reintroduction phase and 25 children were enrolled in the Phase B RCT. 12 were randomised to remain supplemented and 13 had no supplementation. Only 1/3rd of the calculated study power (n=72) was met due to collapse of trial following withdrawal of funding. 8/12 in the supplemented and 10/13 in the non-supplemented group relapsed by first year. At 2 years, 4/12 in the supplemented and 2/13 in the non-supplemented group were in remission. Deterioration in IBD and systemic QOL 7 symptoms related to disease were seen; however there was no change in emotional and social functioning. Conculsions: ACD004 is an effective remission inducing agent, which also improves QOL despite significantly limiting children’s diet. Due to early collapse of trial, its role as a supplement remains uncertain; no benefit seen with limited trial recruitment. In the long-term, emotional and social domains in QOL remain unaltered, despite relapse which may be due to disease acceptance.

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Calheiros, Karina de Oliveira. "Elaboração de formulados nutricionais alternativos a partir de alimentos convencionais para a alimentação de idosos." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/11/11141/tde-13102008-145719/.

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O objetivo geral deste trabalho foi elaborar formulados alternativos, à base de mistura de alimentos convencionais, provenientes da cesta básica distribuída por entidades do município de Piracicaba-SP, entre outros alimentos, com o intuito de suplementar a alimentação enteral de idosos. Os alimentos utilizados para a elaboração dos formulados foram fubá, óleo de soja, arroz, feijão, macarrão, sardinha, leite em pó, amido de milho, ovos, proteína texturizada de soja, couve- manteiga e cenoura. Foram realizadas análises físicas: gotejamento e viscosidade; análises químicas: composição centesimal, digestibilidade de proteína, determinação do mineral ferro, diálise de ferro in vitro, determinação de -caroteno e fatores antinutricionais, assim como fenólicos totais e ácido fítico; análises microbiológicas: Salmonella, Bacillus cereus, Estafilococos coagulase positiva e Coliformes totais; análise de custos dos formulados e elaboração do manual de boas práticas de manipulação. Os resultados obtidos foram submetidos às análises estatísticas, empregando-se o teste de Tukey, utilizando o software SAS (1996) e análises de regressão, pelo programa Microsoft Office Excel (2003). Concluiuse, com esse estudo, que os formulados líquidos apresentaram os melhores resultados nutricionais, físicos, microbiológicos, e a maior viabilidade econômica, sendo, por isso, sugeridos para a suplementação enteral de idosos. Dentre eles, pode-se eleger uma entre duas alternativas, conforme a necessidade clinica do idoso, considerando-se todos os aspectos nutricionais e físicos dos formulados. O formulado F3 destacou-se nas seguintes características: disponibilidade de ferro, quantidades de -caroteno, digestibilidade, viscosidade e gotejamento. Já o formulado F4 teve destaque na distribuição do valor calórico total de macronutrientes, apresentando valores ideais para os idosos, segundo as recomendações internacionais, além do maior valor calórico entre os formulados e boa viscosidade e gotejamento. No que diz respeito ao valor calórico total, os formulados apresentaram de 131 a 216 calorias por 250ml, os tratamentos líquidos apresentaram valor calórico superior ao dos formulados em pó. Pode-se dizer que os formulados contribuem com percentual médio de 20% de adequação, em relação às recomendações de macronutrientes sugeridas pela DRI (2002) para idosos, quando ingeridas duas porções de 250mL/dia de formulados líquidos ou em pó. The aim of this study was to develop alternative formulas for elderly enteral feeding using conventional foods from food staples distributed in the city of Piracicaba-SP. The foods used in the formulas were: corn meal, soya oil, rice, beans, pasta, sardine, powder milk, corn starch, eggs, texturized soya protein, cabbage, and carrot. Physical analyses (dripping and viscosity), chemical analyses (centesimal composition, protein digestibility, iron determination, iron dialyses in vitro, -carotene determination, anti-nutritional factors - tannins and phytate), microbiological analyses (Salmonella, Bacillus cereus, positive Staphylococcus coagulase and total Coliforms), cost analyses and elaboration of a manual for good manipulation practices were carried out. Results were analyzed statistically using Tukey test, SAS software (1996) and for regression using Microsoft Office Excel (2003). Liquid formulas presented better nutritional, physical and microbiological results as well as economical viability Therefore were suggested for elderly enteral nourishment. According to the elderly clinical needs, two alternatives are suggested among liquid formulas. The F3 formula is noticeable for iron availability, quantity of -carotene, digestibility, dripping and viscosity. The F4 formulas is noticeable for the total calorie distribution of macronutrients as well as for having a higher number of calories and good viscosity and dripping which is ideal for the elderly, according to international recommendations. The formulas presented a range of 131 to 216 calories/250ml. Liquid formulas presented higher number of calories than powder formulas. The formulas contributed with a 20% adequacy regarding to macronutrient recommendations for the elderly from DRI (2002), when two servings of 250mL.day-1 (powder or liquid) were ingested.

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Paixão, Fabiano Carlos. "Utilização de magnetorresistores no desenvolvimento de novas técnicas para aplicações em gastroenterologia /." Botucatu, 2009. http://hdl.handle.net/11449/110776.

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Orientador: José Ricardo de Arruda Miranda Banca: Oswaldo Baffa Filho Banca: José Carlos Rossi Banca: Carlos Antônio Caramori Banca: Roberto Morato Fernandez Resumo: Não disponível. Abstract: Not available. Doutor

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Penniman, Elizabeth Pash. "The Effect of Early Enteral Nutrition on the Number of Mechanical Ventilation Days and Length of Stay in the Coronary Intensive Care Unit." University of Akron / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=akron1204755021.

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Santos, Sandra Cristina Veiga de Oliveira 1970. "Definição de uma medida para introdução de sonda enteral em posição gástrica em adultos = fatores limitantes = Definition of a stantard length for the inserction of enteral feeding tube at gastric position in adults : limiting factors." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311013.

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Orientador: Maria Isabel Pedreira de Freitas Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Made available in DSpace on 2018-08-20T21:36:43Z (GMT). No. of bitstreams: 1 Santos_SandraCristinaVeigadeOliveira_M.pdf: 1548989 bytes, checksum: 9e03f859b84dcaf467adf1cafdcb51ee (MD5) Previous issue date: 2012 Resumo: Introdução: Para assegurar o depósito de nutrientes de forma segura é necessário que a sonda enteral esteja bem posicionada. Estudos com evidência científica vêm demonstrando a ocorrência de erros na colocação dessas sondas. Para se confirmar sua localização há procedimentos realizados à beira do leito que carecem de eficácia na assertividade. O exame radiológico é uma maneira recomendada pela literatura internacional como padrão para confirmação da locação da sonda enteral, mas tem restrições quanto a seu uso já descritas. Medidas preconizadas para sua inserção ensinadas nas escolas de enfermagem não vêm associadas a dados de evidência científica que comprovem segurança para sua utilização. Objetivos: Verificar os fatores limitantes para a definição de uma medida para introdução de sonda enteral em posição gástrica em adultos, verificando a acurácia de uma medida pré-estabelecida para introdução da sonda, suas limitações e a contribuição do exame radiológico para validação do posicionamento da sonda enteral. Sujeitos e Métodos: Estudo descritivo, exploratório, com abordagem quantitativa e corte transversal. Aprovado pelo Parecer CEP 983/2010. Estudo-piloto com 17 pacientes modificou o desenho metodológico. O estudo definitivo foi realizado com 53 pacientes, adultos, de ambos os sexos, maiores de 18 anos, internados em hospital universitário, entre outubro de 2011 a fevereiro de 2012. Foram inseridas sondas de poliuretano para alimentação em pacientes, com prescrição médica de sonda enteral. Elaborado protocolo diretivo para a inserção das sondas. Um médico radiologista analisou o exame radiológico em dois momentos: com e sem o fio-guia. Resultados: 53 pacientes, internados em um hospital universitário, receberam sonda enteral em posição gástrica. Dos 39,6% pacientes que apresentaram eventos adversos, 81% estavam contidos no leito. Os eventos adversos foram: epistaxe em 9,4%; retorno de sangue pela sonda na retirada do fio-guia em 1,9%; dificuldade em posicionar o paciente para se obter a medida a ser usada na introdução da sonda devido sua condição clínica em 17% e ausência de um dos pontos anatômicos (cicatriz umbilical) em 5,6%. O exame radiológico demonstrou que a medida estabelecida no estudo anterior teve sucesso de posicionamento em 92,4% dos casos. Conclusões: Fatores limitantes para introdução da sonda enteral demonstraram a complexidade do procedimento e sua realização; exige capacitação dos recursos humanos e medidas para se garantir risco zero ao paciente. As maneiras de se comprovar a localização da sonda no local correto para se infundir os nutrientes estão embasadas em recomendações empíricas. Há necessidade de estudos aprofundados para que o procedimento seja seguro ao paciente. O exame radiológico embora considerado padrão, demonstrou não ser 100% seguro para confirmação da locação da sonda enteral. A validação final da medida estabelecida em estudo anterior para se introduzir a sonda enteral em adulto, em posição gástrica, não foi efetivada por deficiências de metodologia. Há falta de evidência para se realizar o procedimento da inserção da sonda de alimentação sem risco ao paciente Abstract: Introduction: To assure the safe and effective delivery of nutrients to the patient, the enteral feeding tube must be correctly located in the stomach. However, scientific studies have shown that the tubes are often placed out of the ideal location. To there are bedside procedures to confirm tube location, which are not aways effective. The x-ray imaging is the procedure recommended in the international literature, as ideal to confirm the location of the enteral tube, but is subjected to constraints already reported. The technique of measuring the length of the enteral feeding tube to be inserted into the stomach, which is taught in nursing courses, is not based on scientific evidence ensuring the procedure safeness. Objectives: To verify the limiting factors for the definition of a safe measure of the length to the introduction of the enteral feeding tube at gastric position in adults. The accuracy and limitations of a pre-defined standard technique to measure the length of the enteral feeding tube location and the contribution of the x-ray imaging for the validation of tube positioning are also verified. Subjects and Methods: Descriptive and exploratory study with quantitative approach and transversal cross-section. Approved by CEP Report 983/2010. Pilot study with 17 patients modified the methodological design. The definitive study was carried out with 53 patients, adults, both genders, age over 18, inpatient in university hospital, between October 2011 and February 2012. Polyurethane tubes for feeding were inserted in patients to whom had been prescribed enteral tube. A protocol to be used as guideline for tube insertion was developed. A radiologist interpreted the X-ray image at two stages: with a guidewire and without it. Results: 53 patients in the university had the enteral tube inserted at gastric position. From 39.6% of patients presenting adverse events, 81% were restrained to bed. The adverse events were: epistaxis in 9.4%; blood reflux through tube during guidewire removal in 1.9%; difficult of positioning the patient to obtain the measure of the tube length to be inserted, due to its clinical condition in 17% and absence of anatomic marks (umbilical cicatrix) in 5.6%. The X-ray imaging demonstrated that the measure established in the previous study resulted in successful location in 92.4% of the cases. Conclusions: There are limiting factors for the insertion of the feeding tube, which demonstrate that this is a complex procedure and its use demands personnel training and measures to assure zero risk to the patient. The techniques to confirm the tube location to keep nutrient infusion are based on empirical recommendations. In-depth studies are necessary to make the procedure safe to the patient. The X-ray imaging, although considered the standard procedure, showed not to be 100% certain to confirm feeding tube location. The final validation of the measure for the insertion of the enteral feeding tube in adults, at gastric position, found in a previous study could not be consolidated due to methodological limitations. There is lack of data evidencing that this tube insertion procedure does not bring risk to the patient Mestrado Enfermagem e Trabalho Mestra em Ciências da Saúde

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Cochran, Charlotte Norene. "Registered dietitans practicing advanced level skills in the state of Tennessee and their perceived job satisfaction." [Johnson City, Tenn. : East Tennessee State University], 2004. http://etd-submit.etsu.edu/etd/theses/available/etd-1112104-132236/unrestricted/CochranN112304f.pdf.

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Thesis (M.S.)--East Tennessee State University, 2004. Title from electronic submission form. ETSU ETD database URN: etd-1112104-132236 Includes bibliographical references. Also available via Internet at the UMI web site.

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Kruger, Jeanne-Marie. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit." Thesis, Stellenbosch : University of Stellenbosch, 2006. http://hdl.handle.net/10019.1/1943.

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Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. INTRODUCTION: The primary objective was to determine whether acidified formulae (pH 3.5 and 4.5) decreased gastric and tracheal colonisation, as well as microbial contamination of the enteral feeding delivery system, compared with a non-acidified control formula (pH 6.8) in critically ill patients. Secondary objectives included tolerance of the trial formulae and mortality in relation to the administration of acidified formulas. DESIGN: The trial was a controlled, double-blinded, randomised clinical trial of three parallel groups at a single centre. METHOD: Sixty-seven mechanically ventilated, medical and surgical critically ill patients were randomised according to their APACHE II scores and included in the trial. Patients received either an acidified (pH 3.5 or 4.5) or control polymeric enteral formula via an 8-Fr nasogastric tube at a continuous rate. Daily samples were taken for microbiologic analyses of the enteral formulae at various stages of reconstitution and at 6-hour and 24-hour intervals during administration thereof (feeding bottle and delivery set). Daily patient samples included nasogastric and tracheal aspirates, haematological evaluation and gastro-intestinal tolerance. The trial period terminated when patients were extubated, transferred from the ICU, enteral nutrition became contraindicated, a patient died, or for a maximum of 21 days. RESULTS: Gastric pH showed no significant difference (p = 0.86) between the 3 feeding groups [pH 3.5 (n = 23), pH 4.5 (n = 23) and pH 6.8 (n = 21)] at baseline prior to the administration of enteral formulae. After initiation of feeds, the gastric pH decreased significantly (p< 0.0001) in the acidified formulae as compared to the control formula during the trial period. Patients who received acidified enteral formulae (pH 3.5 and 4.5) had significantly less (p < 0.0001) contamination from the feeding bottles and delivery systems in respect of Enterobacteriacea, and Enterococcus., The more acidified group (pH 3.5) showed significantly less gastric contamination (p = 0.029) with Enterobacteriacea, , but not for fungi. The 3.5 acidified group also had the lowest gastric growth in terms of colony counts (≤104) of these organisms, but not for fungi, when compared to the control group (≤105). Vomiting episodes were 22% and abdominal distension 12%, with a higher incidence in the control group. Adverse events occurred equally between the groups with a higher, but not significantly different incidence of 37% in the control group and 32% for the acidified groups. There was no evidence of gastro-intestinal bleeding in any patient. Overall, the mortality rate in this trial was 6%, with 6.5% for the acidified groups (n=46) and 4.8% for the control group (n=21), a statistically insignificant difference. CONCLUSION: Acidified enteral formulae significantly decrease gastric colonisation by preserving gastric acidity that decreases the growth of Enterobacteriaceaes organisms. Acidified formulae significantly decrease bacterial contamination of the enteral feeding system (bottle and delivery set) of Enterobacteriaceae and Enterococcus organisms. Acidified formulae are tolerated well in critically ill patients.

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