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Lyons GCE, Summers MJ, Schultz TJ, Lambell K, Ridley EJ, Fetterplace K, Yandell R, Chapple LS. Protein prescription and delivery practices in critically ill adults: A survey of Australian and New Zealand intensive care dietitians. Aust Crit Care 2021; 35:543-549. [PMID: 34556388 DOI: 10.1016/j.aucc.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Protein provision is thought to be integral to attenuating muscle wasting in critical illness, yet patients receive half of that prescribed. As international guidelines lack definitive evidence to support recommendations, understanding clinicians' views relating to protein practices is of importance. OBJECTIVES The objective of this study was to describe Australia and New Zealand intensive care unit (ICU) dietitians' protein prescription and perceived delivery practices in critically ill adults, including common barriers and associations between ICU clinical experience and protein prescriptions for different clinical conditions. METHODS A 42-item descriptive quantitative survey of Australian and New Zealand intensive care dietitians was disseminated through nutrition and ICU society e-mailing lists. Data were collected on respondent demographics and reported protein practices including questions related to a multitrauma case study. Data were analysed using descriptive and content analysis and reported as n (%). Fisher's exact tests were used to compare experience and protein prescriptions. RESULTS Of the 67 responses received (one excluded due to >50% missing data), more than 80% of respondents stated they would prescribe 1.2-1.5 g protein/kg bodyweight/day for most critically ill patients, most commonly using European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines to support prescriptions (n = 61/66, 92%). Most respondents (n = 49/66, 74%) thought their practice achieved 61-80% of protein prescriptions, with frequently reported barriers including fasting periods (n = 59/66, 89%), avoiding energy overfeeding (n = 50/66, 76%), and gastrointestinal intolerance (n = 47/66, 71%). No associations between years of ICU experience and protein prescriptions for 14 of the 15 predefined clinical conditions were present. CONCLUSIONS Australian and New Zealand ICU dietitians use international guidelines to inform protein prescriptions of 1.2-1.5 g/kg/day for most clinical conditions, and protein prescriptions do not appear to be influenced by years of ICU experience. Key perceived barriers to protein delivery including avoidance of energy overfeeding and gastrointestinal intolerance could be explored to improve protein adequacy.
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Affiliation(s)
- G C E Lyons
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - M J Summers
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - T J Schultz
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia; Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - K Lambell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Nutrition Department, Alfred Health, Melbourne, Australia
| | - E J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Nutrition Department, Alfred Health, Melbourne, Australia
| | - K Fetterplace
- Allied Health Department (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia; The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Melbourne, Australia
| | - R Yandell
- Department of Clinical Dietetics, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
| | - L S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
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OConnor S, Rivett J, Poole A, Deane A, Lange K, Yandell R, Nguyen Q, Fraser R, Chapman M. Nasogastric feeding intolerance in the critically ill. Crit Care 2011. [PMCID: PMC3067053 DOI: 10.1186/cc9799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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O’Connor S, Rivett J, Poole A, Deane A, Lange K, Yandell R, Fraser R, Chapman M. Nasogastric feeding intolerance in the critically ill—A prospective observational study. Aust Crit Care 2011. [DOI: 10.1016/j.aucc.2010.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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OConnor S, Yau Y, Yandell R, Lange K, Alexander J, Freeman B, Chapman M. Enteral nutrition in mechanically ventilated patients with cervical spinal cord injury. Crit Care 2011. [PMCID: PMC3067052 DOI: 10.1186/cc9798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
BACKGROUND AND OBJECTIVE To investigate the sterilization effectiveness of endoluminal tubal photocoagulation on tubal lumen obliteration. STUDY DESIGN/MATERIALS AND METHODS Twenty-four female rabbits were subjected to laparotomy and hysterotomy. Endoluminal tubal photocoagulation was induced over a length of 3 cm in the proximal, extramural fallopian tube by using a cylindrical diffusing tip that emitted diode laser radiation at 805 and 980 nm wavelengths. Tubal patency was evaluated by observing patterns of injected methylene blue and/or breeding success rates. RESULTS Postoperative recovery was uneventful in all animals. Evidence of occlusion of the tubal lumen included a negative methylene blue test in all 12 tubes treated (tubal occlusion rate 100%) and failure to conceive in 17 of 18 uteri (contraception rate 94.5%). Although identical power settings were used, distinctly lower tubal surface temperatures (about 10 degrees C) were obtained with the 805 nm diode laser as compared to the 980 nm diode laser. CONCLUSIONS The described endoluminal tubal photocoagulation method using a diode laser emitting longer wavelengths (e.g., 980 nm) is suitable for safe and effective sterilization in rabbits and has potential as a new transcervical tubal sterilization method for humans.
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Affiliation(s)
- S Spörri
- Department of Obstetrics and Gynecology, University of Bern, Schanzeneckstrasse 1, 3012 Bern, Switzerland.
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Schnell VL, Yandell R, Van Zandt S, Dinh TV. Enterobius vermicularis salpingitis: a distant episode from precipitating appendicitis. Obstet Gynecol 1992; 80:553-5. [PMID: 1495735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic pelvic inflammatory disease is a common gynecologic diagnosis in women with chronic pelvic pain. When standard antimicrobial therapy does not improve the clinical status, uncommon diagnoses such as Enterobius vermicularis should be considered. In this case, E vermicularis presented as acute and chronic salpingitis in a patient who had had E vermicularis-related appendicitis 5 years earlier.
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Affiliation(s)
- V L Schnell
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston
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