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Doganay M, Akcay K, Cil T, Dag B, Demirag K, Demirkan K, Gundogdu RH, Gunduz HM, Parsak CK, Topcuoglu MA, Turkoglu M, Abbasoglu O. Enteral nutrition consensus report from KEPAN: Indications, choice, practical application, and follow-up. Nutrition 2024; 118:112269. [PMID: 38035451 DOI: 10.1016/j.nut.2023.112269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/04/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Clinicians are in need of guidance that will ease the application of medical nutrition therapy. In order to facilitate the application and success of medical nutrition therapy, the Turkish Clinical Enteral & Parenteral Nutrition Society (KEPAN) planned a report that is short, is clear, and has clear-cut recommendations that will guide health care professionals in the indications, choice, practical application, follow-up, and stopping of enteral nutrition. METHODS The enteral nutrition consensus report on enteral nutrition use in medical nutrition therapy was developed by a study group (12 working group academicians and 17 expert group academicians) under the organization of KEPAN. The enteral nutrition consensus report was generated in 5 online and face-to-face phases from December 2019 through October 2022. At the end (Delphi rounds), a total of 24 questions and subjects, recommendations, and comments were sent to the enteral nutrition working group and the expert group via e-mail. They were asked to score the criteria by using the Likert scale. RESULTS The first round of the study resulted in acceptance of all 24 recommendations. None of the criteria was rejected. Only some minor editing for wording was recommended by the panelists during the first and second rounds of the Delphi study. The final report was sent to all 29 panelists and was approved without any revision suggestions. CONCLUSION This report provides 24 clear-cut recommendations in a question-answer format. We believe that this report could have a significant effect on the optimum use of enteral nutrition in the context of medical nutrition therapy when clinicians manage everyday patients.
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Affiliation(s)
- Mutlu Doganay
- Department of General Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Kezban Akcay
- Nutritional Support Department, Hacettepe University Hospitals, Ankara, Turkey
| | - Timucin Cil
- Division of Medical Oncology, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Birgul Dag
- Department of Nutrition and Dietetics, Lokman Hekim University, Ankara, Turkey
| | - Kubilay Demirag
- Intensive Care Unit, Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Riza Haldun Gundogdu
- Department of General Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Hasan Murat Gunduz
- Intensive Care Unit, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Cem Kaan Parsak
- Department of General Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Melda Turkoglu
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kubat M, Bozkirli BO, Yazicioglu MO, Gundogdu RH. Does Albumin Level Change the Strength of the Memorial Sloan Kettering Cancer Center Nomogram Used to Predict 5-year Survival in Patients with Colon Cancer? J Coll Physicians Surg Pak 2022; 32:467-472. [PMID: 35330519 DOI: 10.29271/jcpsp.2022.04.467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To test the efficacy of including albumin in the Memorial Sloan Kettering Cancer Center (MKSCC) nomogram (MSKCC+A) on predicting the overall survival. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Ankara Training and Research Hospital & Ataturk Training and Research Hospital, Turkey, in 2020, on patients who were operated between 2009 and 2014 to confirm the 5-year survival results. METHODOLOGY Patients who underwent R0 resection for colon cancer were evaluated. For each patient in the cohort, the 5-year probability of survival was calculated and compared with actual, using the AJCC (American Joint Committee on Cancer), MSKCC and MSKCC+A estimation systems obtained using logistic regression. The performance of the estimation methods was evaluated by the ROC analysis. RESULTS Two hundred and thirty-nine patients were studied. When the patients with more than 5-year overall survival were compared, the AJCC, MSKCC, and enhanced MSKCC survival scores were significantly higher. AUC = 0.699 for the AJCC staging system, AUC = 0.702 for the MKSCC nomogram, and AUC = 0.777 when the albumin level was added to the MKSCC system. CONCLUSIONS The use of the MSKCC overall survival nomogram in patients with colon cancer appears useful for both clinicians and patients. The prognostic power of this calculator was found to be further enhanced by including the preoperative serum albumin level as an extra variable in the nomogram. KEY WORDS Nomograms, Neoplasm grading, Survival, Colon cancer, Serum albumin.
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Affiliation(s)
- Mehmet Kubat
- Department of General Surgery, Alanya Training and Research Hospital, Alanya, Turkey
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Bozkirli BO, Gundogdu RH, Ersoy PE, Akbaba S, Oduncu M. Gossypiboma mistaken for a hydatid cyst. Turk J Surg 2018. [DOI: 10.5152/turkjsurg.2017.3742] [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: 11/22/2022]
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Gundogdu RH, Oduncu M, Bozkirli BO, Yazicioglu MO, Akbaba S. Does thromboprophylaxis cause bleeding after laparoscopic cholecystectomy? BRATISL MED J 2017; 118:156-159. [PMID: 28319411 DOI: 10.4149/bll_2017_031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study reports the results of a single center experience on the use of pharmacological venous thromboembolism (VTE) prophylaxis in laparoscopic cholecystectomy patients. BACKGROUND The prevention of VTE is of crucial importance in surgical practice. However, the severity of thromboembolism risk and the necessity of thromboprophylaxis for laparoscopic cholecystectomy is still being debated. METHODS The data of the patients, who underwent laparoscopic cholecystectomy for symptomatic cholelitiasis in a single center between the years 2005 and 2015 were analysed retrospectively for incidents of symptomatic VTE and bleeding complications. Fisher Exact Test was used to compare the outcomes of the patients who did and did not receive thromboprophylaxis. RESULTS Of the 1485 patients who were included in the study, 307 (20.67 %) having a low VTE risk, did not receive any thromboprophylaxis; while 1178 (79.33 %) with a medium, high or a very high risk received VTE prophylaxis. A bleeding complication occurred in 14 (1.18 %) patients receiving prophylaxis and in 2 (0.65 %) patients not receiving prophylaxis (p = 0.548). No patients in this study experienced clinically symptomatic VTE. CONCLUSIONS The findings of this study indicate that the selective use of thromboprophylaxis does not significantly increase the risk of bleeding after laparoscopic cholecystectomy and probably decreases the incidence of symptomatic thrombotic complications (Ref. 18) Keywords: laparoscopic cholecystectomy, bleeding, venous thromboemboly, prophylaxis, low molecular weight heparin.
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Akbaba S, Ersoy PE, Gundogdu RH, Ulas M, Menekse E. Modified single stapler technique in anterior resection for rectal cancer. J Coll Physicians Surg Pak 2016; 25:68-70. [PMID: 25604373 DOI: 08.2014/jcpsp.6870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 10/30/2014] [Indexed: 11/05/2022]
Abstract
Technical difficulties during colorectal surgery increase the complication rates. We introduce a modified single stapler technique for patients in whom technical problems are encountered while performing double stapler technique. Before pelvic dissection, descending colon is divided at minimum 10 cm proximal to the tumoral segment. Tumor specific mesorectal excision is performed and two purse string sutures are placed at the distal margin with an interval of 1 - 2 cm. After introducing a circular stapler via the anus, the distal purse string suture is tied around the central shaft of the stapler and the proximal purse string suture around the colonic lumen. After the resection is completed between the two sutures, the anvil shaft is connected to the central shaft and the stapler is closed and fired. None of the patients had an anastomotic leak. This technique may be a safe alternative particularly in patients with narrow pelvis and distal tumors.
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Affiliation(s)
- Soner Akbaba
- Department of General Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Pamir Eren Ersoy
- Department of General Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Riza Haldun Gundogdu
- Department of General Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Murat Ulas
- Department of Gastroenterology Surgery, Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ebru Menekse
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Klek S, Krznaric Z, Gundogdu RH, Chourdakis M, Kekstas G, Jakobson T, Paluszkiewicz P, Vranesic Bender D, Uyar M, Demirag K, Poulia KA, Klimasauskas A, Starkopf J, Galas A. Prevalence of malnutrition in various political, economic, and geographic settings. JPEN J Parenter Enteral Nutr 2013; 39:200-10. [PMID: 24190900 DOI: 10.1177/0148607113505860] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent. METHODS Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective. RESULTS At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist. CONCLUSION The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.
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Affiliation(s)
- Stanislaw Klek
- General Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Riza Haldun Gundogdu
- General Surgery and Gastrointestinal Surgery, Atatürk Teaching and Research Hospital, Ankara, Turkey
| | | | - Gintautas Kekstas
- Vilnius University Hospital Clinic of Anaesthesia and ICU, Vilnius, Lithuania
| | - Triin Jakobson
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Piotr Paluszkiewicz
- Department of Gastrointestinal Surgery, Lublin Regional Cancer Centre, and Department of Surgery and Surgical Nursing, Medical University, Lublin, Poland
| | | | - Mehmet Uyar
- Department of Anesthesiology and Intensive Care, Ege University Hospital, Izmir, Turkey
| | - Kubilay Demirag
- Department of Anesthesiology and Intensive Care, Ege University Hospital, Izmir, Turkey
| | | | | | - Joel Starkopf
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aleksander Galas
- Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
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Bozkirli BO, Gundogdu RH, Temel H, Eren Ersoy P, Sayin T, Akbaba S. The Significance of the Coexistence of Cholelithiasis and Umbilical Hernia in Laparoscopy Era. Gazi Med J 2012. [DOI: 10.5152/gmj.2012.21] [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: 11/22/2022] Open
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Bozkirli BO, Gundogdu RH, Ersoy PE, Akbaba S, Temel H, Sayin T. Did the ERAS protocol affect our results in colorectal surgery? Turk J Surg 2012. [DOI: 10.5152/ucd.2012.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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