Gastronomia clínica. Excelente alternativa para melhorar a nutrição hospitalar

Malnutrition in hospitals is an endemic problem that increases morbidity, mortality and hospital stay. There are many factors involved in its development, such as patient starvation, even before admission, the type of procedure performed, and the poor quality and presentation of the meals received, which in turn might be caused by errors in prescription, transcription, preparation, and distribution by the physician, nutritionist, or cook.   Consequently, intake decreases, and more than 40% of the food is wasted, which only leads to patient deterioration and increased dissatisfaction with the hospital catering service. Therefore, it is essential to position clinical gastronomy within the health teams so that together with the nutritionist, they develop new menus and strategies, such as à la carte menu or room service, ensure the quality and presentation of the dishes, record food consumption, user satisfaction, and waste characteristics to develop a continuous improvement program for the benefit of patients.La malnutrición en los hospitales es un problema endémico que incrementa la morbilidad, mortalidad y estancia hospitalaria. Existen muchos factores que la favorecen como son la inanición del enfermo (incluso antes de su ingreso), los procedimientos a los que es sometido, y la mala calidad y presentación de los alimentos que reciben los pacientes; propiciada, además por errores en la prescripción, transcripción, elaboración y distribución por parte del médico, nutricionista y preparador de alimentos, entre otros.   En consecuencia, se observa baja ingesta y desperdicio de alimentos (mayor de 40 %) lo que no solo genera deterioro del estado general del enfermo sino alta insatisfacción con el servicio de alimentos. Por lo anterior, es necesario posicionar la gastronomía clínica dentro de los equipos de salud que junto con el nutricionista deberá diseñar y desarrollar nuevos menús y estrategias como por ejemplo el menú a la carta, el room service, la calidad y presentación de los platillos, el registro del consumo de los alimentos, aplicación de encuestas de satisfacción a los usuarios, la observación de las características de los desperdicios para, con toda esta información valiosa desarrollar un programa de mejora continua en beneficio de los enfermos.A desnutrição nos hospitais é um problema endêmico que aumenta a morbilidade, mortalidade e a permanência hospitalar. Existem muitos fatores que a favorecem, como a inanição do paciente (mesmo antes da admissão), os procedimentos a que ele é submetido e a má qualidade e apresentação dos alimentos que os pacientes recebem; originada, também, por erros na prescrição, transcrição, preparação e distribuição por médico, nutricionista e preparador de alimentos, entre outros.   Consequentemente, observa-se baixa ingestão e desperdício de alimentos (superior a 40%), o que não só origina deterioração no estado geral do paciente, mas também alta insatisfação com o serviço de alimentação. Portanto, é necessário posicionar a gastronomia clínica nas equipes de saúde que, juntamente com o nutricionista, devem elaborar e desenvolver novos menus e estratégias como menu a la carte, o serviço de quarto, qualidade e apresentação dos pratos, o registo do consumo de alimentos, a aplicação de questionários de satisfação aos usuário, a observação das características dos esperdícios para, com todas essas informações valiosas desenvolver um programa de melhoria contínua em benefício dos pacientes.&nbsp

Reflexiones acerca de la Declaración de Cancún. 2008-2018

The 2008 declaration of Cancun is a brave and daring document, but it is mostly about the unification of the associations affiliated with FELANPE who raise their voice for the Human Right of all ill people to have an optimal and timely nutritional therapy, wherever they are, administered by professional and competent personnel. It is a great work, the result of a reflection by Latin American nutritionists, doctors, nurses and chemists who propose 6 lines of alternative actions to improve the quality of service for sick people in Clinical Nutrition. It has been analyzed by different universities mainly in Latin America, but also in other places, has motivated the creation of clinical practice guidelines and nutritional therapy services, besides the consensus of nutritionistson the role and competence of the clinical nutriologist and the research of Nutritional Evaluation in Latin American hospitals. There are still many areas of opportunity stated by the declaration of Cancun like the Latin-American research network, the Latin-American Nutritional Therapy Services network, theguidelines for the opening of Specialized Nutritional Therapy services and to achieve more impact on health authorities and the private sector which encourages prevention, diagnosis, treatment and follow up of sick people who have an affected nutritional state be it lacking or excess of it. The challenge forthe following 10 years is to re confirm the commitment of the members of FELANPE and to generate evidence which can improve patient care.La Declaración de Cancún de 2008 es un documento valiente, retador, reflexivo, pero sobre todo de unidad de las sociedades y asociaciones latinoamericanas afiliadas a la FELANPE que levanta la voz por el Derecho humano de todos los enfermos a tener una terapia nutricional óptima y oportuna brindada por personal profesional competente donde quiera que se encuentren. Gran trabajo producto de la reflexión de nutricionistas, médicos, enfermeras y químicos latinoamericanos que proponen en seis líneas de acción las alternativas para mejorar la calidad de atención nutricional de los enfermos. Ha sido objeto de análisis en diferentes universidades principalmente en Latinoamérica, y en otras latitudes ha motivado la creación de guías de práctica clínica y de servicios de Terapia Nutricional, del Consenso de Nutricionistas sobre las Funciones y Competencias del Nutriólogo Clínico, así como de la investigación de la EvaluaciónNutricional en Hospitales de Latinoamérica. Aún quedan por desarrollar algunas áreas de oportunidad planteadas en la Declaración de Cancún como son: la red de investigadores latinoamericanos, la red latinoamericana de Servicios de Terapia Nutricional, las guías para la fundación de servicios de Terapia Nutricional Especializada. Lograr mayor impacto con las autoridades sanitarias y del sector privado que propicie la prevención, diagnóstico, tratamiento y seguimiento de los enfermos con compromiso del estado nutricional por carencia o por exceso, refrendar los compromisos adquiridos por los miembros de la FELANPE y generar evidencias que propicien la mejor atención de los enfermos es el reto para los próximos 10 años

Semiologia nutricional: o melhor caminho para a segurança de diagnostico e terapêutica

In the body, biomolecular changes are expressed through signs and symptoms, many of them so evident they can readily be observed by a doctor or nutritionist, but others require additional diagnostic studies to be adequately evaluated during the clinical evaluation of the patient, during which data are scientifically obtained to be integrated into syndromes that will ultimately become the basis of clinical diagnosis, and will also serve to propose a goal and medical or dietary therapeutic plan.Los cambios biomoleculares se expresan en el organismo a través de signos y síntomas, muchos de ellos tan objetivos que pueden ser observados por el médico o nutricionista, pero otros requieren estudios paraclínicos para ser evaluados en forma adecuada a través del acto clínico donde científicamente se obtienen datos para ser integrados en síndromes que serán la base del diagnóstico clínico y proponer luego la meta y plan terapéutico médico o dietético.As alterações biomoleculares são expressas no organismo através de sinais e sintomas, muitos deles tão objetivos que podem ser observados pelo médico ou nutricionista, mas outros requerem estudos paraclínicos para serem avaliados de forma adequada através de ato clinico onde cientificamente se obtêm dados para serem integrados em síndromas que serão a base do diagnóstico clinico e propor logo a meta e plano terapêutico médico e dietético

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology