Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients

Knowledge and Practice of Health Professionals in the Management of Dysphagia

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale >= 2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 +/- 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. (C) 2016 S. Karger AG, Base

Nurse and Nursing Students' Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses' and nursing students ' opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient ' s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles

Impact of Probiotics on the Performance of Endurance Athletes: A Systematic Review

Background: Probiotic supplements contain different strains of living microorganisms that promote the health of the host. These dietary supplements are increasingly being used by athletes to improve different aspects such as athletic performance, upper respiratory tract infections (URTIs), the immune system, oxidative stress, gastrointestinal (GI) problems, etc. This study aimed to identify the current evidence on the management of probiotics in endurance athletes and their relationship with sports performance. Methods: A systematic review of the last five years was carried out in PubMed, Scopus, Web of science, Sportdiscus and Embase databases. Results: Nine articles met the quality criteria. Of these, three reported direct benefits on sports performance. The remaining six articles found improvements in the reduction of oxidative stress, increased immune response and decreased incidence of URTIs. There is little scientific evidence on the direct relationship between the administration of probiotics in endurance athletes and sports performance. Conclusions: Benefits were found that probiotics could indirectly influence sports performance by improving other parameters such as the immune system, response to URTIs and decreased oxidative stress, as well as the monitoring of scheduled workouts

Consumption of over-the-Counter Drugs: Prevalence and Type of Drugs

Recently, there has been an increase in the use of over-the-counter (OTC) drugs. The consumption of these medicines can be unsafe, as incorrect self-diagnosis or the ingestion of inappropriate doses can lead to side effects and the occurrence of adverse reactions and drug–drug interactions. A cross-sectional descriptive observational study was carried out, targeting the entire Spanish population by using an online questionnaire. The results showed that 78.9% of the subjects had previously taken or were currently taking OTC drugs. This consumption decreased as the age of the subjects increased, with a prevalence of 36.4% of subjects aged 71 taking OTC drugs. Analgesics were the most consumed OTC drugs (49.1%) especially in women, youngsters with non-formal educational qualifications, and individuals of a low–medium socioeconomic level residing in urban areas. Measures should be implemented to optimize the safe use of OTC drugs in order to avoid the occurrence of secondary events associated with the lack of knowledge related to their the usage

Perceived Stress and Increased Food Consumption during the ‘Third Wave’ of the COVID-19 Pandemic in Spain

The COVID-19 pandemic has impacted the mental health of people worldwide. An increase in perceived stress can lead to unhealthy behaviors such as increased food consumption. The aim of this study was to find the level of perceived stress and its relationship with increased food consumption during the "third wave" of the COVID-19 pandemic in Spain. This was a cross-sectional study that employed anonline self-reported frequency of consumption questionnaire and the Perceived Stress Scale-10. A total of 637 subjects participated and 83.6% of respondents had moderate or high stress-more prevalent in the female and young respondents. Moreover, 36.1% of respondents reported that they had increased the frequency of consumption of some foods, mainly nuts, snacks, and jellybeans, along with coffee, tea, cocoa, and soft drinks. Eating between meals was more pronounced in those with high stress (65.1%) than in those with moderate stress (40.4%) and low stress (20.2%). Furthermore, the respondents with high stress reported greater weight gain. Thus, the results show that the level of perceived stress during the 'third wave' of this pandemic increased food consumption

Senda Darwin Biological Station: Long-term ecological research at the interface between science and society

Indexación: Web of Science; Scielo.La Estación Biológica Senda Darwin (EBSD) constituye un centro de investigación inmerso en el paisaje rural del norte de la Isla de Chiloé (42º S), donde fragmentos del bosque siempreverde original coexisten con praderas de uso ganadero, turberas de Sphagnum, matorrales sucesionales, plantaciones de Eucalyptus y otras formaciones de origen antropogénico. Desde 1994 hemos realizado estudios de largo plazo centrados en algunas especies de plantas (e.g., Pilgerodendron uviferum D. Don) y animales (e.g., Aphrastura spinicauda Gmelin, Dromiciops gliroides [Thomas]) catalogados como amenazados o escasamente conocidos y en ecosistemas nativos de importancia regional y global (e.g., turberas de Sphagnum, bosque Valdiviano y Nordpatagónico). Las investigaciones han considerado las respuestas de las especies y de los ecosistemas frente al cambio antropogénico del paisaje y cambio climático, así como los efectos de diferentes formas de manejo. Este escenario es semejante al de otras regiones de Chile y Latinoamérica lo que da generalidad a nuestros resultados y modelos. En este período, investigadores asociados a la EBSD han producido más de un centenar de publicaciones en revistas nacionales e internacionales y 30 tesis de pre y postgrado. Entendiendo el papel clave de los seres humanos en los procesos ecológicos de la zona rural, la EBSD ha desarrollado un programa de educación ecológica y vinculación del avance científico con la sociedad local y nacional. La integración de la EBSD a la naciente red de Sitios de Estudios Socio-Ecológicos de Largo Plazo en Chile consolidará y fortalecerá la investigación básica y aplicada que realizamos para proyectarla hacia la siguiente década.Senda Darwin Biological Station (SDBS) is a field research center immersed in the rural landscape of northern Chiloé island (42º S), where remnant patches of the original evergreen forests coexist with open pastures, secondary successional shrublands, Sphagnum bogs, Eucalyptus plantations and other anthropogenic cover types, constituting an agricultural frontier similar to other regions in Chile and Latin America. Since 1994, we have conducted long-term research on selected species of plants (e.g., Pilgerodendron uviferum) and animals (e.g., Aphrastura spinicauda, Dromiciops glirioides) that are considered threatened, poorly known or important for their ecological functions in local ecosystems, and on ecosystems of regional and global relevance (e.g., Sphagnum bogs, North Patagonian and Valdivian rain forests). Research has assessed the responses of species and ecosystems to anthropogenic land-use change, climate change, and the impact of management. During this period, more than 100 scientific publications in national and international journals, and 30 theses (graduate and undergraduate) have been produced by scientists and students associated with SDBS. Because of our understanding of the key role that humans play in ecological processes at this agricultural frontier, since the establishment of SDBS we have been committed to creative research on the communication of science to society and ecological education. The integration of SDBS to the nascent Chilean network of long-term socio-ecological research will consolidate and strengthen basic and applied research to project our work into the next decade.http://ref.scielo.org/vbm4r

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access