ORCID Profile
0000-0003-1144-1787
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 26-09-2008
DOI: 10.1002/JMRI.21542
Abstract: To compare noninvasive MRI and magnetic resonance spectroscopy (MRS) methods with liver biopsy to quantify liver fat content. Quantification of liver fat was compared by liver biopsy, proton MRS, and MRI using in-phase/out-of-phase (IP/OP) and plus/minus fat saturation (+/-FS) techniques. The reproducibility of each MR measure was also determined. An additional group of overweight patients with steatosis underwent hepatic MRI and MRS before and after a six-month weight-loss program. A close correlation was demonstrated between histological assessment of steatosis and measurement of intrahepatocellular lipid (IHCL) by MRS (r(s) = 0.928, P < 0.0001) and MRI (IP/OP r(s) = 0.942, P < 0.0001 FS r(s) = 0.935, P 5% weight loss had a decrease in IHCL of >or=50%. These findings suggest that standard MRI protocols provide a rapid, safe, and quantitative assessment of hepatic steatosis. This is important because MRS is not available on all clinical MRI systems. This will enable noninvasive monitoring of the effects of interventions such as weight loss or pharmacotherapy in patients with fatty liver diseases.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2018
DOI: 10.1007/S11695-018-3392-8
Abstract: The restrictive and/or malabsorptive nature of bariatric surgery may increase the risk for micronutrient deficiencies. This systematic review aimed to identify and critique the evidence for vitamin A, B1, C or E deficiencies associated with bariatric surgery. This review utilised PRISMA and MOOSE frameworks with NHMRC evidence hierarchy and the American Dietetic Association bias tool to assess the quality of articles. Twenty-one articles were included and once critiqued all studies were of level IV grade and neutral or negative in quality. The relevance of measuring micronutrient supplementation and inflammatory markers for validity of serum vitamins is absent within the literature. Future research is needed to investigate the risk of deficiency for these procedures with focus on confounders to serum micronutrients.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Publisher: Springer Science and Business Media LLC
Date: 13-09-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Publisher: Wiley
Date: 21-08-2022
DOI: 10.1002/NCP.10903
Abstract: Peripheral parenteral nutrition (PPN) represents an alternative option to central parenteral nutrition (CPN) for patients requiring short‐term parenteral nutrition (PN). We hypothesized that the use of PPN could be increased in certain patient cohorts referred for PN in our facility. A retrospective observational study investigating the clinical characteristics of patients receiving PN under the nutrition support team over a 5‐year period was undertaken. Patients who received PPN were reviewed descriptively. Of the patients who received CPN, representative s les were grouped into those who received PN for ≤7 or –28 days ( n = 100 each, randomly assigned). Clinical characteristics considered included indication, duration and referring team for PN, and nutrition status. Descriptive statistics and binary logistic regression model for predictors of PN duration of ≤7 or –28 days were derived. Only four patients received PPN for a median of 4 days, most of whom required this route because of loss of central venous access for CPN. A high proportion of patients with no enteral access received CPN for ≤7 days, whereas the majority of patients with malabsorption required –28 days of CPN. Being referred for PN following upper gastrointestinal surgery increased the likelihood of CPN use for days (relative risk, 5.7 95% CI, 1.7–18.9 P = 0.004). Within our service, PN referrals for no enteral access may represent a group in whom PPN could be used in the first instance those referred with an indication of malabsorption or following upper gastrointestinal surgery may benefit from early commencement of CPN.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-07-2020
Publisher: Wiley
Date: 08-2014
DOI: 10.1111/JHN.12260
Abstract: The development of compassion fatigue (CF) has been described across a variety of acute care caseloads in some health professions. The present study was undertaken to determine whether dietitians working in these caseloads also experience CF. A voluntary, anonymous survey incorporating the Professional Quality of Life tool was developed in an online format, and was e-mailed to dietitians working in public acute care settings. Eighty-seven completed surveys were returned. Average rates of compassion satisfaction (CS) and burnout and low rates of secondary traumatic stress (STS) were reported. Dietitians in high-risk workloads reported higher levels of STS than those with low-risk workloads (χ2 = 5.4, P = 0.02). Differences in STS were found between those practising in paediatric compared to adult caseloads (χ2 = 16.6, P < 0.01). Dietitians in smaller facilities reported higher STS (χ2 = 10.6, P 5 years as a dietitian was associated with higher rates of STS and burnout than in those working for <5 years (χ2 = 7.9, P = 0.05 and χ2 = 3.8, P = 0.05, respectively). Those who perceived greater levels of support reported lower rates of burnout (r(s) = -0.41, P < 0.01) and higher rates of CS (r(s) = 0.39, P < 0.01) than those not feeling supported. All dietitians reported undertaking self-care practices however, up to 24% reported practices that may represent maladaptive coping methods. Although the present study suggests dietitians experience a good professional quality of life, vulnerable areas were identified, suggesting the need for additional support in some areas of dietetic practice.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2016
DOI: 10.1007/S00464-016-5202-5
Abstract: The prevalence of type 2 diabetes is growing in both developed and developing countries and is strongly linked with the prevalence of obesity. Bariatric surgical procedures such as laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are increasingly being utilized to manage related comorbid chronic conditions, including type 2 diabetes. A systematic review of randomized controlled trials (RCTs) was undertaken using the PRISMA guidelines to investigate the postoperative impact on diabetes resolution following LVSG versus LRYGB. Seven RCTs involving a total of 732 patients (LVSG n = 365, LRYGB n = 367) met inclusion criteria. Significant diabetes resolution or improvement was reported with both procedures across all time points. Similarly, measures of glycemic control (HbA1C and fasting blood glucose levels) improved with both procedures, with earlier improvements noted in LRYGB that stabilized and did not differ from LVSG at 12 months postoperatively. Early improvements in measures of insulin resistance in both procedures were also noted in the studies that investigated this. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative type 2 diabetes in obese patients during the reported 3- to 5-year follow-up periods. However, further studies are required before longer-term outcomes can be elucidated. Areas identified that need to be addressed for future studies on this topic include longer follow-up periods, standardized definitions and time point for reporting, and financial analysis of outcomes obtained between surgical procedures to better inform procedure selection.
Publisher: SAGE Publications
Date: 11-2017
DOI: 10.1177/0310057X1704500604
Abstract: Uncertainty surrounds the optimal approach to feeding the critically ill, with increasing interest in the concept of intentional underfeeding to reduce metabolic stress while maintaining gut integrity. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates clinical outcomes reported in studies comparing hypocaloric normonitrogenous or trophic feeding (collectively ‘intentional underfeeding’) to target full energy feeding administered via enteral nutrition to adult critically ill patients. Electronic databases including PubMed, CINAHL, EMBASE and CENTRAL were searched up to September 2017 for trials evaluating intentional underfeeding versus targeted energy feeding interventions on clinical outcomes (mortality, length of stay, duration of ventilation, infective complications, feeding intolerance and glycaemic control) among critically ill adult patients. Bias of included studies was assessed using the Cochrane risk of bias tool. Of the 595 articles identified, seven studies (six randomised controlled trials, one non-randomised trial) met the inclusion criteria, representing 2,684 patients (hypocaloric normonitrogenous n=668 trophic n=681 full energy feeding n=1335). Across the studies, there was considerable heterogeneity in study methodology, population, feeding strategy and outcomes and their timepoints. We observed no evidence that intentional underfeeding, when compared to targeting full energy feeding, reduced mortality or duration of ventilation or length of stay. However, limited trial evidence is available on the impact of intentional underfeeding on post-discharge functional and quality of life outcomes.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 30-10-2019
DOI: 10.1111/JGH.14841
Abstract: Chronic intestinal failure requiring home parenteral nutrition (HPN) is a disabling condition that is best facilitated by a multidisciplinary approach to care. Variation in care has been identified as a key barrier to achieving quality of care for patients on HPN and requires appropriate strategies to help standardize management. The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) assembled a multidisciplinary working group of 15 clinicians to develop a quality framework to assist with the standardization of HPN care in Australia. Obstacles to quality care specific to Australia were identified by consensus. Drafts of the framework documents were based on the available literature and refined by two Delphi rounds with the clinician work group, followed by a further two involving HPN consumers. The Oxford Centre for Evidence-Based Medicine Levels of Evidence was used to assess the strength of evidence underpinning each concept within the framework documents. Quality indicators, standards of care, and position statements have been developed to progress the delivery of quality care to HPN patients. The quality framework proposed by AuSPEN is intended to provide a practical structure for clinical and organizational aspects of HPN service delivery to reduce variation in care and improve quality of care and represents the initial step towards development of a national model of care for HPN patients in Australia. While developed for implementation in Australia, the evidence-based framework also has relevance to the international HPN community.
Publisher: Wiley
Date: 09-2013
Publisher: Springer Science and Business Media LLC
Date: 12-08-2020
Publisher: Springer Science and Business Media LLC
Date: 06-03-2009
Publisher: Wiley
Date: 14-02-2013
Abstract: Pharmaconutrition has previously been reported in elective surgery to reduce postoperative infective complications and duration of hospital length of stay. To update previously published meta-analyses and elucidate potential benefits of providing arginine-dominant pharmaconutrition in surgical patients specifically with regard to the timing of administration of pharmaconutrition. Randomized controlled trials comparing the use of pharmaconutrition with standard nutrition in elective adult surgical patients between 1980 and 2011 were identified. The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Twenty studies yielding 21 sets of data met inclusion criteria. A total of 2005 patients were represented (pharmaconutrition, n = 1010 control, n = 995), in whom pharmaconutrition was provided preoperatively (k = 5), perioperatively (k = 2), or postoperatively (k = 14). No differences were seen in postoperative mortality with the provision of pharmaconutrition irrespective of timing of administration. Statistically significant reductions in infectious complications and length of stay were found with perioperative and postoperative administration. Perioperative administration was also associated with a statistically significant reduction in anastomotic dehiscence, whereas a reduction in noninfective complications was demonstrated with postoperative administration. Preoperative pharmaconutrition demonstrated no notable advantage over standard nutrition provision in any of the clinical outcomes assessed. This meta-analysis highlights the importance of timing as a clinical consideration in the provision of pharmaconutrition in elective gastrointestinal surgical patients and identifies areas where further research is required.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLNU.2019.03.010
Abstract: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the in idual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CLNESP.2017.11.008
Abstract: Guidance on managing the nutritional requirements of critically ill patients in the intensive care unit (ICU) has been issued by several international bodies. While these guidelines are consulted in ICUs across the Asia-Pacific and Middle East regions, there is little guidance available that is tailored to the unique healthcare environments and demographics across these regions. Furthermore, the lack of consistent data from randomized controlled clinical trials, reliance on expert consensus, and differing recommendations in international guidelines necessitate further expert guidance on regional best practice when providing nutrition therapy for critically ill patients in ICUs in Asia-Pacific and the Middle East. The Asia-Pacific and Middle East Working Group on Nutrition in the ICU has identified major areas of uncertainty in clinical practice for healthcare professionals providing nutrition therapy in Asia-Pacific and the Middle East and developed a series of consensus statements to guide nutrition therapy in the ICU in these regions. Accordingly, consensus statements have been provided on nutrition risk assessment and parenteral and enteral feeding strategies in the ICU, monitoring adequacy of, and tolerance to, nutrition in the ICU and institutional processes for nutrition therapy in the ICU. Furthermore, the Working Group has noted areas requiring additional research, including the most appropriate use of hypocaloric feeding in the ICU. The objective of the Working Group in formulating these statements is to guide healthcare professionals in practicing appropriate clinical nutrition in the ICU, with a focus on improving quality of care, which will translate into improved patient outcomes.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2016
DOI: 10.1007/S11695-016-2101-8
Abstract: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.
Publisher: AME Publishing Company
Date: 08-2018
Publisher: Wiley
Date: 06-08-2023
Abstract: This study aimed to explore the multidisciplinary team attitudes and knowledge of bariatric surgery micronutrient management (pre‐ and postoperative care) and to evaluate the implementation of an extended‐scope of practice dietitian‐led model of care for micronutrient monitoring and management. A mixed method study design included quantitative evaluation of micronutrient testing practices and deficiency rates. Qualitative reflexive thematic analysis was used to interpret multidisciplinary experience with micronutrient monitoring in a traditional and dietitian‐led model of care. In addition, deductive analysis used normalisation process theory mapping of multidisciplinary experience with the implementation of the dietitian‐led model of care. In the traditional model, a lack of quality evidence to guide micronutrient management, and a tension in trust between surgeons and patients related to adherence to micronutrient prescriptions were described as challenges in current practice. The dietitian‐led model was seen to overcome some of these challenges, increasing collaborative, and coordinated, consistent and personalised patient care that led to increased testing for and detection of micronutrient deficiencies. Barriers to sustainability of the dietitian‐led model included a lack of workforce succession planning, and no clearly defined delegation for some aspects of care. An extended scope dietitian‐led model of care for micronutrient management after bariatric surgery improves clinical care. Challenges such as succession planning must be considered in design of extended scope services.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-04-2023
Publisher: Springer Science and Business Media LLC
Date: 12-04-2016
DOI: 10.1007/S11695-016-2167-3
Abstract: This systematic review assessed feasibility and effectiveness of preoperative meal replacements to improve surgical outcomes for obese patients. PRISMA guidelines were followed and electronic databases searched for articles between January 1990 and March 2015. Fifteen studies (942 participants including 351 controls) were included, 13 studies (n = 750) in bariatric patients. Adverse effects and dropout rates were minimal. Ten out of 14 studies achieved 5-10 % total weight loss. Six of six studies reporting liver volume achieved 10 % reduction. Endpoints for perioperative risks and outcomes were too varied to support definitive risk benefit. Commercial meal replacements are feasible, have minimal side effects and facilitate weight loss and liver shrinkage in free-living obese patients awaiting elective surgery. A reduction in surgical risk is unclear.
Publisher: Wiley
Date: 10-09-2020
DOI: 10.1002/NCP.10574
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-10-2021
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CLNU.2017.04.013
Abstract: The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
Publisher: Wiley
Date: 03-2008
Publisher: Wiley
Date: 20-03-2007
DOI: 10.1111/J.1440-1746.2006.04830.X
Abstract: Despite the benefits of modest weight reduction for overweight patients with chronic liver disease, long-term maintenance of weight loss is difficult to achieve in clinical practice. The aims of this study were to determine if a nutrition research protocol could be translated into clinical practice and meet the demand for dietetic service, to evaluate the effectiveness and resource implications of intensive lifestyle intervention for weight loss, and to assess the effectiveness of standard dietetic therapy as a treatment option for patients unable to attend the program. Using a modified research protocol, an intensive weight reduction program was introduced into standard clinical care for overweight patients attending a tertiary hospital liver outpatient clinic. An audit of weight loss and cost outcomes was conducted. Ninety-three patients were referred to the dietetic service for weight management. Of these, 50 enrolled in an intensive lifestyle intervention, 18 received standard dietetic therapy and 25 refused any intervention. After 6 months, 83% of patients in the intensive intervention achieved weight loss with a significant decrease in weight (P < 0.001) and waist circumference (P < 0.001). In contrast, only 24% of patients receiving standard dietetic therapy achieved weight loss with no significant change in mean weight or waist circumference. Cost per kilogram weight loss after intensive intervention was $AU31 and continuation of lifestyle intervention was calculated to be less than $AU100 per patient per year. A clinically based, intensive lifestyle intervention is a feasible treatment option for outpatient weight management in overweight patients with chronic liver disease. Providing patients who are unable to participate in intensive programs with standard dietetic therapy is not cost-effective.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1445-5994.2010.02413.X
Abstract: We report the case of the case of a 56 year old female with sepsis on a background of rheumatoid arthritis and steroid use manifesting with overt clinical features of scurvy. Ascorbic acid assays were able to demonstrate severe deficiency and confirm a diagnosis of scurvy. Clinical resolution of signs and symptoms following commencement of vitamin C replacement was rapid. The intensivist and dietitian need to consider this diagnosis even in the first world setting, particularly in the presence of sepsis, inflammatory conditions, steroid use and importantly malnutrition.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Wiley
Date: 18-09-2017
DOI: 10.1111/DME.13405
Publisher: Wiley
Date: 27-02-2019
DOI: 10.1002/JPEN.1525
Abstract: Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
Publisher: Wiley
Date: 31-05-2011
Abstract: A meta-analysis evaluating surgical outcomes following nutritional provision provided proximal to the anastomosis within 24 hours of gastrointestinal surgery compared with traditional postoperative management was conducted. Databases were searched to identify randomized controlled trials comparing the outcomes of early and traditional postoperative feeding. Trials involving gastrointestinal tract resection followed by patients receiving nutritionally significant oral or enteral intake within 24 hours after surgery were included for analysis. Fifteen studies involving a total of 1240 patients were analyzed. A statistically significant reduction (45%) in relative odds of total postoperative complications was seen in patients receiving early postoperative feeding (odds ratio [OR] 0.55 confidence interval [CI], 0.35 -0.87, P = .01). No effect of early feeding was seen with relation to anastomotic dehiscence (OR 0.75 CI, 0.39-1.4, P = .39), mortality (OR 0.71 CI, 0.32-1.56, P = .39), days to passage of flatus (weighted mean difference [WMD] -0.42 CI, -1.12 to 0.28, P = .23), first bowel motion (WMD -0.28 CI, -1.20 to 0.64, P = .55), or reduced length of stay (WMD -1.28 CI, -2.94 to 0.38, P = .13) however, the direction of clinical outcomes favored early feeding. Nasogastric tube reinsertion was less common in traditional feeding interventions (OR 1.48 CI, 0.93-2.35, P = .10). Early postoperative nutrition is associated with significant reductions in total complications compared with traditional postoperative feeding practices and does not negatively affect outcomes such as mortality, anastomotic dehiscence, resumption of bowel function, or hospital length of stay.
Publisher: BMJ
Date: 21-01-2020
DOI: 10.1136/GUTJNL-2018-318172
Abstract: No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as , 1–2, 2–3 and L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN L/day than for FE and all PN L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN L/day). The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
Publisher: Springer Science and Business Media LLC
Date: 28-11-2016
DOI: 10.1007/S11695-016-2469-5
Abstract: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this systematic review was to study the peer review literature regarding postoperative nondiabetic comorbid disease resolution or improvement reported from randomized controlled trials (RCTs) comparing LVSG and LRYGB procedures. RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies. Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.
Publisher: Elsevier BV
Date: 2023
No related grants have been discovered for Emma Osland.