Total energy expenditure in human immunodeficiency virus-infected men and healthy controls.

Department of Internal Medicine, Academic Medical Center, Amsterdam University, Meibergdreef, The Netherlands. Total daily energy expenditure (TEE) has been reported to be slightly decreased in weight-stable acquired immune deficiency syndrome (AIDS) patients. This conclusion is based on a comparison of TEE measurements to the data reported by others. We measured TEE in nine weight-stable human immunodeficiency virus (HIV)-infected homosexual men (Centers for Disease Control [CDC]-II to -IV) without active opportunistic disease and nine age-, sex-, and height-matched healthy controls using the doubly labeled water technique for 2 weeks, and resting energy expenditure (REE) using the ventilated-hood technique. TEE in HIV-Infected patients was not significantly different from that in healthy controls (221 +/- 12.5 and 210 +/- 9 kJ.kg lean body mass [LBM]-1.d-1, respectively, NS). REE was approximately 10% higher in HIV patients than in healthy controls (134 +/- 4 and 125 +/- 4 kJ.kg LBM-1.d-1, respectively, P = .02). The energy spent in relation to physical activity was not different between HIV-Infected patients and the controls (66 +/- 10 and 64 +/- 5 kJ.kg LBM-1.d-1, respectively, NS). In conclusion, REE is increased by about 10% in weight-stable HIV-infected men without active opportunistic disease. TEE and the energy spent during physical activity are not different in this group of patients versus healthy controls. This is in contrast to the previously reported decrease of TEE in weight-losing AIDS patients. Therefore, the energy requirements of stable HIV-infected patients are not decreased compared with those of healthy subjects

Survey to establish the current status of artificial nutritional support in Europe.

Nutritional support is an integral part of clinical practice but its importance is often overlooked. The need for an integrated approach, an unequivocal appreciation of the financial and clinical benefits and a clear vision for the future has seldom been greater.the espen education committee is currently developinga range of other initiatives which will enhance activities at national level. These include the publication of consensus guidelines on a wide range of clinical topics and developing peer support mechanisms for nurses, pharmacists and dietititans. In particular the courses in nutritional support which are held each year in both maastricht and the eastern european countries are helping to meet some of the specific needs which have been identified, mainly for medical practitioners.espen is an organization which has a commitment to supporting and developing all aspects of nutritional support. This initial survey has identified some of the key issues which need to be addressed and it should be repeated at regular intervals to monitor developments. Although the data which has been collected on this occasion is neither complete nor robust, it provides a useful basis for strategic development. This is particularly relevant to council members who are interested in raising the profile of nutritional support within their own countries

Screening of nutritional status in The Netherlands

Background and Aims: In 2001, the Dutch Dietetic Association conducted a national screening on malnutrition. The goal of this screening was to determine the prevalence of disease-related malnutrition in The Netherlands in all fields of medical care and to investigate the involvement of the dietitian in the treatment of malnutrition. Methods: Eight thousand five hundred and twenty nine patients were screened of which data of 7606 patients could be analysed. Eighty one per cent (6150) of the patients were hospital patients. Eleven per cent (808) of the patients lived in a nursing home. Seven per cent (533) of the patients were home-care patients, who were measured at home or at the general practitioner's office. The origin of 115 patients (2%) was not registered. Age, height, weight, unintentional weight loss, kind of illness and intervention by a dietitian were registered. Malnutrition was defined as >10% unintentional weight loss during the past 6 months and risk of malnutrition was defined as 5-10% unintentional weight loss during the past 6 months. Results: Twelve per cent (884) of all patients appeared to be malnourished. Thirteen per cent (962) were at risk of malnutrition and 75% (5760) were well nourished. Fifty four per cent of the malnourished patients were referred to a dietitian. Oncological disease was more associated with malnutrition than non-oncological disease (in particular in the head and neck, lung and intestinal areas). Also, non-oncological gastro-intestinal and lung disease patients were often categorised as malnourished. Elderly patients (>75 years) were more at risk of malnutrition. BMI and unintentional weight loss did not correlate well. Conclusion: In this national survey conducted by dietitians, including a convenience sample of mainly institutionalised patients, approximately 25% of patients in all medical fields were categorised as moderately or severely malnourished. About half of these patients were seen by a dietitian. (C) 2003 Elsevier Science Ltd. All rights reserved

Optimizing the use of patients' individual outcome information - Development and usability tests of a Chronic Kidney Disease dashboard

Background: Reporting individual clinical and patient-reported outcomes to patients during consultations may add to patients' disease knowledge and activation and stimulate Shared Decision Making (SDM). These outcomes can be presented over time in a clear way by the means of dashboarding. We aimed to systematically develop a Chronic Kidney Disease (CKD) dashboard designed to support consultations, test its usability and explore conditions for optimal use in practice.Methods: For development a participatory approach with patients and healthcare professionals (HCPs) from three hospitals was used. Working groups and patient focus groups were conducted to identify needs and inform the dashboard's design. Usability was tested in patient interviews. A focus group with HCPs was held to identify conditions for optimal use of the dashboard in daily practice.Results: A dashboard was developed for CKD patients stage 3b-4 visualizing both clinical and patient-reported outcomes over time for use during consultations and accessible for patients at home. Both HCPs and patients indicated that the dashboard can: motivate patients in their treatment by providing feedback on outcomes over time; improve consultation conversations by enhanced preparation of both HCPs and patients; better inform patients, thereby facilitating shared decision making. HCPs and patients both stated that setting a topic agenda for the consultation together is important in effectively discussing the dashboard during consultations. Moreover, the dashboard should not dominate the conversation. Lastly, findings of the usability tests provided design requirements for optimal user-friendliness and clarity.Conclusions: Dashboarding can be a valuable way of reporting individual outcome information to patients and their clinicians as findings suggest it may stimulate patient activation and facilitate decision making. Co-creation with patients and HCPs was essential for successful development of the dashboard. Gained knowledge from the co-creation process can inform others wishing to develop similar digital tools for use in clinical practice

Optimizing the use of patients' individual outcome information - Development and usability tests of a Chronic Kidney Disease dashboard

Background: Reporting individual clinical and patient-reported outcomes to patients during consultations may add to patients' disease knowledge and activation and stimulate Shared Decision Making (SDM). These outcomes can be presented over time in a clear way by the means of dashboarding. We aimed to systematically develop a Chronic Kidney Disease (CKD) dashboard designed to support consultations, test its usability and explore conditions for optimal use in practice.Methods: For development a participatory approach with patients and healthcare professionals (HCPs) from three hospitals was used. Working groups and patient focus groups were conducted to identify needs and inform the dashboard's design. Usability was tested in patient interviews. A focus group with HCPs was held to identify conditions for optimal use of the dashboard in daily practice.Results: A dashboard was developed for CKD patients stage 3b-4 visualizing both clinical and patient-reported outcomes over time for use during consultations and accessible for patients at home. Both HCPs and patients indicated that the dashboard can: motivate patients in their treatment by providing feedback on outcomes over time; improve consultation conversations by enhanced preparation of both HCPs and patients; better inform patients, thereby facilitating shared decision making. HCPs and patients both stated that setting a topic agenda for the consultation together is important in effectively discussing the dashboard during consultations. Moreover, the dashboard should not dominate the conversation. Lastly, findings of the usability tests provided design requirements for optimal user-friendliness and clarity.Conclusions: Dashboarding can be a valuable way of reporting individual outcome information to patients and their clinicians as findings suggest it may stimulate patient activation and facilitate decision making. Co-creation with patients and HCPs was essential for successful development of the dashboard. Gained knowledge from the co-creation process can inform others wishing to develop similar digital tools for use in clinical practice.Analysis and support of clinical decision makin

Presentation of a nationwide multicenter registry of intestinal failure and intestinal transplantation

Contains fulltext : 165747.pdf (publisher's version ) (Closed access)BACKGROUND & AIMS: Exact data on Dutch patients with chronic intestinal failure (CIF) and after intestinal transplantation (ITx) have been lacking. To improve standard care of these patients, a nationwide collaboration has been established. Objectives of this study were obtaining an up-to-date prevalence of CIF and characterizing these patients using the specially developed multicenter web-based Dutch Registry of Intestinal Failure and Intestinal Transplantation (DRIFT). METHODS: Cross-sectional study. CIF was defined as type 3 intestinal failure in which >75% of nutritional requirements were given as home parenteral nutrition (HPN) for >/= 4 weeks in children and >50% for >/=3 months in adults. All patients with CIF receiving HPN care by the three Dutch specialized centers on January 1, 2013 and all ITx patients were registered in DRIFT (https://drift.darmfalen.nl). RESULTS: In total, 195 patients with CIF (158 adults, 37 children) were identified, of whom 184 were registered in DRIFT. The Dutch point prevalence of CIF was 11.62 per million (12.24 for adults, 9.56 for children) on January 1, 2013. Fifty-seven patients (31%) had one or more indications for ITx, while 12 patients actually underwent ITx since its Dutch introduction. Four patients required transplantectomy of their intestinal graft and 3 intestinal transplant patients died. CONCLUSION: The multicenter registry DRIFT revealed an up-to-date prevalence of CIF and provided nationwide insight into the patients with CIF during HPN and after ITx in the Netherlands. DRIFT will facilitate the multicenter monitoring of individual patients, thereby supporting multidisciplinary care and decision-making

Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule with or without N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients with Acute Pulmonary Embolism A Randomized Clinical Trial

Thrombosis and Hemostasi