Immunonutrients and Evidence for Their Use in Hospitalized Adults Receiving Artificial Nutrition

Aetiology of inflammatory bowel disease (IBD) is complex and probably multifactorial. Nutrition has been proposed to be an important aetiological factor for development of IBD. Several components of the diet (such as sugar, fat, fibre, fruit and vegetable, protein, fast food, preservatives etc.) were examined as possible causative agents for IBD. According to some researchers infant feeding (breast feeding) may also contribute to the development of IBD. Though the importance of environmental factors is evidenced by the increasing incidence in developed countries and in migrant population in recent decades, the aetiology of IBD remained unclear. There are many theories, but as yet no dietary approaches have been proved to reduce the risk of developing IBD. The role of nutrition in the management of IBD is better understood. The prevention and correction of malnutrition, the provision of macro- and micronutrients and vitamins and the promotion of optimal growth and development of children are key points of nutritional therapy. In active disease, the effective support of energy and nutrients is a very important part of the therapy. Natural and artificial nutrition or the combination of two can be choosen for supporting therapy of IBD. The author summarises the aetiological and therapeutic role of nutrition in IBD.

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Artificial nutrition in UK intensive care units: a review of current practice

Proceedings of The Nutrition Society ◽

10.1017/s002966510059137x ◽

2008 ◽

Vol 67 (OCE3) ◽

Author(s):

P. J. Needham ◽

A. B. Burton ◽

D. G. Jayne

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Current Practice ◽

Artificial Nutrition

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Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries

Geriatrics ◽

10.3390/geriatrics6020044 ◽

2021 ◽

Vol 6 (2) ◽

pp. 44

Author(s):

Shelley A. Sternberg ◽

Shiri Shinan-Altman ◽

Ladislav Volicer ◽

David J. Casarett ◽

Jenny T. van der Steen

Keyword(s):

Palliative Care ◽

The Netherlands ◽

Hospice Care ◽

The United States ◽

Artificial Nutrition ◽

Advanced Dementia ◽

Case Scenario ◽

Artificial Nutrition And Hydration ◽

Positive Elements ◽

The Us

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), the Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and the Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in the Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in the Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in the Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

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Ethical considerations at the end-of-life care

SAGE Open Medicine ◽

10.1177/20503121211000918 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110009

Author(s):

Melahat Akdeniz ◽

Bülent Yardımcı ◽

Ethem Kavukcu

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Healthcare Professionals ◽

Ethical Decision Making ◽

Biomedical Ethics ◽

Artificial Nutrition ◽

Life Care ◽

Ethical Challenges ◽

Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

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Views of Registered Dietitians Compared to Speech-Language Pathologists on Artificial Nutrition and Hydration at the End of Life

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909121994310 ◽

2021 ◽

pp. 104990912199431

Author(s):

Molly K Bigford ◽

Roschelle Heuberger ◽

Erica Raymond ◽

Viki Shayna ◽

James Paauw

Keyword(s):

End Of Life ◽

Terminal Illness ◽

Descriptive Analysis ◽

Study Patient ◽

Artificial Nutrition ◽

Speech Language Pathologists ◽

Artificial Nutrition And Hydration ◽

Nutrition And Hydration ◽

Evidenced Based ◽

Registered Dietitian Nutritionists

Objective: To analyze and compare the knowledge and opinions of registered dietitian nutritionists (RDNs) about artificial nutrition and hydration (ANH) in a terminal illness. Beliefs of speech-language pathologists (SLPs) were also considered and compared against RDN data. Methods: This is a descriptive analysis utilizing survey responses from RDNs and SLPs regarding ANH in a case study patient with advanced dementia. Results: There was a strong belief among RDNs that ANH at end of life (EOL) would improve nutritional status, although a correlation was found between those in favor of ANH and believing it was ethical to withhold ANH at EOL (R2 = 0.109, p = 0.002). Responses indicated that SLPs need more education regarding ANH techniques, while RDNs felt ANH would improve aspiration risk. Place of employment, religion and age of respondents were also found to impact beliefs. Conclusion: Clinicians, specifically RDNs, working with patients at EOL need more evidenced-based education on the risks and benefits of ANH. Decisions regarding care of patients at EOL should be void of clinicians’ personal bias which may affect ethical treatment in the clinical setting. Further controlled trials must be performed before claims can be made regarding ANH at EOL.

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Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.01.010 ◽

2021 ◽

Author(s):

S. James ◽

J. Tyrrell-Price ◽

C. Atkinson ◽

L. Hunt ◽

A. Searle ◽

...

Keyword(s):

Feasibility Study ◽

Artificial Nutrition ◽

Hydration Status ◽

Rapid Estimation ◽

Urinary Chloride

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To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

BMC Palliative Care ◽

10.1186/s12904-021-00710-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chien-Yi Wu ◽

Ping-Jen Chen ◽

Tzu-Lin Ho ◽

Wen-Yuan Lin ◽

Shao-Yi Cheng

Keyword(s):

Cancer Patients ◽

Proportional Hazards Model ◽

Clinical Symptoms ◽

Terminally Ill ◽

Good Death ◽

Artificial Nutrition ◽

Symptom Improvement ◽

Terminally Ill Cancer Patients ◽

Quality Of Dying

Abstract Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

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