Improving nutritional care quality in the orthopedic ward of a Septic Surgery Center by implementing a preventive nutritional policy using the Nutritional Risk Score: a pilot study.

Septic Surgery Center (SSC) patients are at a particularly high risk of protein-energy malnutrition (PEM), with a prevalence of 35-85% found in various studies. Previous collaboration between our hospital's SSC and its Clinical Nutrition Team (CNT) only focussed on patients with severe PEM. This study aimed to determine whether it was possible to improve the quality of nutritional care in septic surgery patients with help of a nutritional policy using the Nutritional Risk Score (NRS). Nutritional practices in the SSC were observed over three separate periods: in the 3 months leading up to the implementation baseline, 6 months after implementation of preventive nutritional practices, and at 3 years. The nutritional care quality indicator was the percentage of patients whose nutritional care, as prescribed by the SSC, was adapted to their specific requirements. We determined the septic surgery team's NRS completion rate and calculated the nutritional policy's impact on SSC length of stay. Data before (T <sub>0</sub> ) and after (T <sub>1</sub> + T <sub>2</sub> ) implementation of the nutritional policy were compared. Ninety-eight patients were included. The nutritional care-quality indicator improved from 26 to 81% between T <sub>0</sub> and T <sub>2</sub> . During the T <sub>1</sub> and T <sub>2</sub> audits, septic surgery nurses calculated NRS for 100% and 97% of patients, respectively. Excluding patients with severe PEM, SSC length of stay was significantly reduced by 23 days (p = 0.005). These findings showed that implementing a nutritional policy in an SSC is possible with the help of an algorithm including an easy-to-use tool like the NRS

Un parcours de soins spécifique pour la dénutrition [A specific clinical pathway for malnutrition]

Depuis près de 40 ans, la dénutrition est considérée comme une maladie hospitalière. Or force est de constater que cette dénutrition a pris naissance en amont dans la communauté et qu’un dépistage hospitalier même précoce reste tardif lorsque l’on considère l’histoire évolutive de cette pathologie. Durant l’hospitalisation, l’état nutritionnel se détériore fréquemment et dans les situations les plus favorables de traitement, les durées de séjour de plus en plus courtes n’en permettent que rarement la correction totale. La coordination avec le réseau de soins du domicile devient alors seule garante de la poursuite des traitements nutritionnels initiés à l’hôpital. La Haute Autorité de santé met en place depuis 2012 différents parcours de soins qui impliquent le patient ainsi que les professionnels de ville médicaux, paramédicaux et médico-sociaux dans la prévention, le repérage précoce de la dénutrition et dans sa prise en charge à domicile. Le temps est venu de considérer que comme toute autre maladie chronique, quel que soit l’âge du patient, la dénutrition requiert un parcours de soins spécifique. [Malnutrition has been considered as a hospital illness for nearly forty years. Despite this fact, we know this malnutrition finds its roots earlier within the community. Therefore, considering the evolutionary history of this pathology even an early hospital screening proves to be overdue. Nutritional condition often deteriorates during hospitalization and, with most favorable treatment conditions, increasingly short lengths of stay rarely allow for a complete correction. Coordination with home care network becomes essential to maintain nutritional treatment that was initiated in hospital. Since 2012, French health authorities proposes different care pathways involving patients as well as doctors, paramedical and medico-social practitioners in malnutrition prevention, early detection and home medical care. It is now essential to consider that malnutrition, like any chronic disease, asks for a specific care pathway, whatever the age of the patient.]]]> Internal Medicine; Nutrition and Dietetics; Endocrinology, Diabetes and Metabolism fre oai:serval.unil.ch:BIB_9270D0BDCDC3 2022-05-07T01:22:55Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_9270D0BDCDC3 Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease. info:doi:10.1200/JCO.21.00855 info:eu-repo/semantics/altIdentifier/doi/10.1200/JCO.21.00855 info:eu-repo/semantics/altIdentifier/pmid/34310202 Bolla, M. Neven, A. Maingon, P. Carrie, C. Boladeras, A. Andreopoulos, D. Engelen, A. Sundar, S. van der Steen-Banasik, E.M. Armstrong, J. Peignaux-Casasnovas, K. Boustani, J. Herrera, F.G. Pieters, B.R. Slot, A. Bahl, A. Scrase, C.D. Azria, D. Jansa, J. O'Sullivan, J.M. Van Den Bergh, ACM Collette, L. EORTC Radiation Oncology Group info:eu-repo/semantics/article article 2021-09-20 Journal of clinical oncology, vol. 39, no. 27, pp. 3022-3033 info:eu-repo/semantics/altIdentifier/eissn/1527-7755 urn:issn:0732-183X <![CDATA[The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 (NCT00021450) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis-free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P &lt; .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance

A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints

Background: To study the ‘metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications. Methods: We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p<0.05 was the significance threshold. Results: Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240min operative (OR) time and 300ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of ‘major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels. Conclusions: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes