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[PMID]:28688573
[Au] Autor:Cooper T; Harris B; Mourad A; Garros D; El-Hakim H
[Ad] Endereço:Division of Otolaryngology-Head and Neck Surgery, Canada.
[Ti] Título:Comparison between selective and routine intensive care unit admission post-supraglottoplasty.
[So] Source:Int J Pediatr Otorhinolaryngol;99:90-94, 2017 Aug.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare major post-operative respiratory complications, post-operative disposition and duration of hospital admission before and after adopting a selective intensive care unit (ICU) admission care plan following supraglottoplasty (SGP). METHODS: Retrospective case series set in a tertiary pediatric referral center. Eligible patients undergoing SGP between October 2003 and July 2015 were identified through a prospectively kept surgical database. Historical cohorts with routine admission to ICU and selective admission to ICU were identified based on a shift in surgeon practice. The cohorts were compared with respect to demographics, presenting features, endoscopic findings, baseline sleep and swallowing study results, major respiratory complications (including repeat or unplanned ICU admission or intubation) and length of post-operative hospital admission. RESULTS: 141 eligible patients were identified with 35 children in the routine ICU admission cohort and 106 in the selective ICU admission cohort. There were no significant differences between cohorts regarding major respiratory complications with only one patient in the selective ICU admission cohort requiring an unplanned admission to ICU (P = 1.00, Fisher's exact test). This gives a number needed to harm of 78 step-down unit admissions for 1 unplanned ICU admission. The rate of ICU admission was reduced from 71% to 26% with adoption of a selective ICU admission care plan (p < 0.01, χ ). Mean duration of post-operative hospitalization was reduced from 5.1 ± 3.5 days to 1.9 ± 2.3 days (P < 0.01, Student's t-test). CONCLUSIONS: Selective post-operative ICU admission following SGP significantly reduces ICU utilization and may reduce length of hospital stay without compromising safety and care. This has significant cost benefit implications.
[Mh] Termos MeSH primário: Glote/cirurgia
Unidades de Terapia Intensiva/estatística & dados numéricos
Laringomalácia/cirurgia
Admissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Análise Custo-Benefício
Bases de Dados Factuais
Feminino
Hospitalização/estatística & dados numéricos
Humanos
Lactente
Tempo de Internação/estatística & dados numéricos
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28688554
[Au] Autor:Côrte FC; Firmino-Machado J; Moura CP; Spratley J; Santos M
[Ad] Endereço:Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal. Electronic address: filipacamachocorte@gmail.com.
[Ti] Título:Acute pediatric neck infections: Outcomes in a seven-year series.
[So] Source:Int J Pediatr Otorhinolaryngol;99:128-134, 2017 Aug.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of this study was to analyse the epidemiology, clinical presentation, diagnostic clues, as biochemical parameters and imaging studies, of children with acute neck infections (ANI) to identify possible independent prognostic factors leading to complications and prolonged hospitalization. METHODS: Records of children admitted to a tertiary university hospital from January 2008 to December 2014 with a diagnosis of ANIs were reviewed retrospectively. Diseases were categorized according to the site of infection and patients were divided into two groups: children (aged<10 years) and adolescents (aged 10-18 years). RESULTS: A total of 102 patients belonged to the children's group and 57 were adolescents. Forty-nine patients (27.2%) received antibiotics prior to presentation. The most frequent ANI was peritonsillar abscess (n = 72). Four peritonsillar abscesses progressed to parapharyngeal and retropharyngeal abscesses (n = 2 respectively). An association between age and type of abscess was found, with most of the retropharyngeal abscesses occurring in children (p = 0.05), and the submandibular abscesses in adolescents (p < 0.001). The most frequent symptoms/signs were fever (63.9%) and odynophagia (50.6%). Upon admission, all patients received intravenous antibiotics and 86.8% underwent drainage of the abscess. Cultures were harvested in 87 abscesses and the most frequent pathogen isolated was Streptococcus pyogenes. Signs of airway obstruction occurred in two patients with submandibular abscess, one with peritonsillar and one with parapharyngeal abscess. There were no cases of death or severe sequelae. Recurrent ANIs were observed in eight patients including two infected branchial cysts. Children, presence of multiple abscesses and palpable cervical mass on admission, absence of odynophagia and pharyngeal bulging, surgery with general anaesthesia and surgery after 24 h, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission were identified as predictors of complications. CONCLUSIONS: The present study found, that often, the diagnosis and treatment of neck abscesses in paediatric patients is not straightforward, but can achieve a favourable outcome. The primary location of the ANI appears to vary in different paediatric age groups. Younger age, presence of multiple abscesses or a palpable cervical mass on admission, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission was identified as possible predictors of complications.
[Mh] Termos MeSH primário: Abscesso/diagnóstico
Infecção/complicações
Pescoço/patologia
[Mh] Termos MeSH secundário: Abscesso/complicações
Abscesso/terapia
Doença Aguda
Adolescente
Antibacterianos/uso terapêutico
Criança
Pré-Escolar
Drenagem
Feminino
Hospitalização
Humanos
Lactente
Infecção/terapia
Masculino
Pescoço/microbiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28661374
[Au] Autor:Baker T; Pelfrey WV
[Ad] Endereço:Department of Criminal Justice, University of Central Florida, USA.
[Ti] Título:Bullying Victimization, Social Network Usage, and Delinquent Coping in a Sample of Urban Youth: Examining the Predictions of General Strain Theory.
[So] Source:Violence Vict;31(6):1021-1043, 2016 Dec 01.
[Is] ISSN:0886-6708
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Guided by the propositions of general strain theory, this study examines the impact of experienced and anticipated strains on the delinquent coping of adolescents while accounting for the usage of social networking sites. Specifically, this study uses self-report survey data collected from 3,195 middle and high school students in a single Midwest city in the United States to explore the effect of experiencing the strains of traditional bullying victimization and cyberbullying victimization on adolescents self-reported soft drug use, hard drug use, and weapon carrying behavior. These relationships are explored among both frequent and infrequent users of social networking sites. Results indicate that cyberbullying victimization and the anticipated strain of feeling unsafe at or on the way to or from school are significantly and positively associated with all three mechanisms of delinquent coping among both frequent and infrequent social network users.
[Mh] Termos MeSH primário: Adaptação Psicológica
Bullying
Vítimas de Crime/psicologia
Internet
Mídias Sociais/utilização
Rede Social
Estresse Psicológico/psicologia
Transtornos Relacionados ao Uso de Substâncias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Comportamento do Adolescente
Afro-Americanos
Criança
Estudos Transversais
Grupo com Ancestrais do Continente Europeu
Feminino
Hispano-Americanos
Humanos
Masculino
Teoria Psicológica
Autorrelato
Inquéritos e Questionários
População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1891/0886-6708.VV-D-14-00154


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[PMID]:28557734
[Au] Autor:Zuckerman KE; Lindly OJ; Reyes NM; Chavez AE; Macias K; Smith KN; Reynolds A
[Ad] Endereço:Division of General Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon; zuckerma@ohsu.edu.
[Ti] Título:Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families.
[So] Source:Pediatrics;139(5), 2017 May.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) or limited English proficiency (L-LEP). METHODS: We conducted a mixed-mode survey of families of children with confirmed ASD seen at specialty clinics in 3 United States cities. Bivariate and multivariate analyses compared barriers to ASD diagnosis, current service use, and unmet therapy need among NLW, L-EP, and L-LEP families. RESULTS: Overall, barriers to ASD diagnosis were prevalent: families ( = 352) experienced a mean of 8 of 15 barriers to ASD diagnosis. The most prevalent barriers overall were "stress of diagnostic process," "parent knowledge about ASD," and "understanding medical system." Compared with NLW families, L-LEP families were more likely to experience barriers related to knowledge about ASD and trust in providers. Children in L-LEP families also had fewer current therapy hours and more unmet therapy needs than children in NLW families. L-EP families' barriers and treatment services use profile was more similar to NLW than to L-LEP families. CONCLUSIONS: English proficiency was an important marker for barriers to ASD diagnosis and treatment in Latinos. Increasing ASD-related knowledge and provider trust may decrease disparities in the diagnosis and treatment of ASD among US Latinos.
[Mh] Termos MeSH primário: Transtorno do Espectro Autista/diagnóstico
Barreiras de Comunicação
Acesso aos Serviços de Saúde/estatística & dados numéricos
Disparidades em Assistência à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Inquéritos Epidemiológicos
Hispano-Americanos
Humanos
Linguagem
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170530
[St] Status:MEDLINE


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[PMID]:28557729
[Au] Autor:Barak-Corren Y; Fine AM; Reis BY
[Ad] Endereço:Predictive Medicine Group, Computational Health Informatics Program and yuval.barakcorren@childrens.harvard.edu.
[Ti] Título:Early Prediction Model of Patient Hospitalization From the Pediatric Emergency Department.
[So] Source:Pediatrics;139(5), 2017 May.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Emergency departments (EDs) in the United States are overcrowded and nearing a breaking point. Alongside ever-increasing demand, one of the leading causes of ED overcrowding is the boarding of hospitalized patients in the ED as they await bed placement. We sought to develop a model for early prediction of hospitalizations, thus enabling an earlier start for the placement process and shorter boarding times. METHODS: We conducted a retrospective cohort analysis of all visits to the Boston Children's Hospital ED from July 1, 2014 to June 30, 2015. We used 50% of the data for model derivation and the remaining 50% for validation. We built the predictive model by using a mixed method approach, running a logistic regression model on results generated by a naive Bayes classifier. We performed sensitivity analyses to evaluate the impact of the model on overall resource utilization. RESULTS: Our analysis comprised 59 033 patient visits, of which 11 975 were hospitalized (cases) and 47 058 were discharged (controls). Using data available within the first 30 minutes from presentation, our model identified 73.4% of the hospitalizations with 90% specificity and 35.4% of hospitalizations with 99.5% specificity (area under the curve = 0.91). Applying this model in a real-time setting could potentially save the ED 5917 hours per year or 30 minutes per hospitalization. CONCLUSIONS: This approach can accurately predict patient hospitalization early in the ED encounter by using data commonly available in most electronic medical records. Such early identification can be used to advance patient placement processes and shorten ED boarding times.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Teorema de Bayes
Boston
Estudos de Coortes
Feminino
Hospitais Pediátricos
Humanos
Masculino
Modelos Teóricos
Estudos Retrospectivos
Sensibilidade e Especificidade
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170530
[St] Status:MEDLINE


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[PMID]:28557721
[Au] Autor:Anugu M; Braksmajer A; Huang J; Yang J; Ladowski KL; Pati S
[Ad] Endereço:School of Medicine, Stony Brook University, Stony Brook, New York; and.
[Ti] Título:Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use.
[So] Source:Pediatrics;139(5), 2017 May.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Community health workers (CHWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs). METHODS: The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method. RESULTS: The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; = .004). We found no differences in ACSC hospitalizations between the 2 groups. CONCLUSIONS: Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children.
[Mh] Termos MeSH primário: Agentes Comunitários de Saúde/estatística & dados numéricos
Serviço Hospitalar de Emergência/utilização
Hospitalização/estatística & dados numéricos
Consulta a Domicílio/estatística & dados numéricos
Assistência Centrada no Paciente/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Estudos de Coortes
Bases de Dados Factuais
Feminino
Humanos
Lactente
Masculino
Pontuação de Propensão
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170530
[St] Status:MEDLINE


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[PMID]:28548917
[Au] Autor:Frey R; Foster S; Boyd M; Robinson J; Gott M
[Ad] Endereço:School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
[Ti] Título:Family experiences of the transition to palliative care in aged residential care (ARC): a qualitative study.
[So] Source:Int J Palliat Nurs;23(5):238-247, 2017 May 02.
[Is] ISSN:1357-6321
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To address a gap in the literature by exploring bereaved families' perceptions of the transition to palliative care for their relative in long-term care. METHODS: In-depth interviews were conducted with a convenience sample of twenty-six family members who were most involved in the care of residents who had died within the last 12 months. Interviews explored care, perceptions of staff palliative care knowledge, communication with staff, care planning and decision-making. The range of responses fit the Donabedian (1966) health care model of structure/process/outcome. In the case of long-term care, structure includes staff training; process is the manner of care and outcome would be a 'good' (or bad) death. RESULTS: There was little evidence that a well-managed transition to a palliative approach to care was being initiated. Key themes included: 1) unrecognised need for transition; 2) information gaps and 3) feeling 'out of the loop'. Ten subthemes were also identified. IMPLICATIONS: Engaging family and relevant internal and external health providers in care planning not only promotes care in line with resident wishes but also assists family bereavement. Results indicate the need for the development of a new collaborative, multidisciplinary model to enhance the delivery of palliative care in long-term care.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Família
Instituição de Longa Permanência para Idosos
Assistência de Longa Duração
Casas de Saúde
Cuidados Paliativos
Transferência de Pacientes
[Mh] Termos MeSH secundário: Adulto
Idoso
Consternação
Comunicação
Tomada de Decisões
Feminino
Humanos
Masculino
Meia-Idade
Nova Zelândia
Relações Profissional-Família
Pesquisa Qualitativa
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.12968/ijpn.2017.23.5.238


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[PMID]:28548910
[Au] Autor:Acquaviva KD
[Ad] Endereço:Associate Professor The George Washington University School of Nursing Washington DC.
[Ti] Título:LGBTQ inclusion: a call to action for nurses.
[So] Source:Int J Palliat Nurs;23(5):212, 2017 May 02.
[Is] ISSN:1357-6321
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Confidencialidade
Revelação
Documentação
Relações Enfermeiro-Paciente
Enfermagem
Minorias Sexuais
[Mh] Termos MeSH secundário: Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.12968/ijpn.2017.23.5.212


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[PMID]:28537754
[Au] Autor:Brown SD; Rider EA; Jamieson K; Meyer EC; Callahan MJ; DeBenedectis CM; Bixby SD; Walters M; Forman SF; Varrin PH; Forbes P; Roussin CJ
[Ad] Endereço:1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.
[Ti] Título:Development of a Standardized Kalamazoo Communication Skills Assessment Tool for Radiologists: Validation, Multisource Reliability, and Lessons Learned.
[So] Source:AJR Am J Roentgenol;209(2):351-357, 2017 Aug.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purpose of this study was to develop and test a standardized communication skills assessment instrument for radiology. MATERIALS AND METHODS: The Delphi method was used to validate the Kalamazoo Communication Skills Assessment instrument for radiology by revising and achieving consensus on the 43 items of the preexisting instrument among an interdisciplinary team of experts consisting of five radiologists and four nonradiologists (two men, seven women). Reviewers assessed the applicability of the instrument to evaluation of conversations between radiology trainees and trained actors portraying concerned parents in enactments about bad news, radiation risks, and diagnostic errors that were video recorded during a communication workshop. Interrater reliability was assessed by use of the revised instrument to rate a series of enactments between trainees and actors video recorded in a hospital-based simulator center. Eight raters evaluated each of seven different video-recorded interactions between physicians and parent-actors. RESULTS: The final instrument contained 43 items. After three review rounds, 42 of 43 (98%) items had an average rating of relevant or very relevant for bad news conversations. All items were rated as relevant or very relevant for conversations about error disclosure and radiation risk. Reliability and rater agreement measures were moderate. The intraclass correlation coefficient range was 0.07-0.58; mean, 0.30; SD, 0.13; and median, 0.30. The range of weighted kappa values was 0.03-0.47; mean, 0.23; SD, 0.12; and median, 0.22. Ratings varied significantly among conversations (χ = 1186; p < 0.0001) and varied significantly by viewing order, rater type, and rater sex. CONCLUSION: The adapted communication skills assessment instrument is highly relevant for radiology, having moderate interrater reliability. These findings have important implications for assessing the relational competencies of radiology trainees.
[Mh] Termos MeSH primário: Competência Clínica
Comunicação
Avaliação Educacional/métodos
Radiologistas
Radiologia/educação
[Mh] Termos MeSH secundário: Técnica Delfos
Educação Médica
Feminino
Humanos
Masculino
Relações Médico-Paciente
Reprodutibilidade dos Testes
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.16.17439


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[PMID]:28524930
[Au] Autor:Feinberg J; Nielsen EE; Korang SK; Halberg Engell K; Nielsen MS; Zhang K; Didriksen M; Lund L; Lindahl N; Hallum S; Liang N; Xiong W; Yang X; Brunsgaard P; Garioud A; Safi S; Lindschou J; Kondrup J; Gluud C; Jakobsen JC
[Ad] Endereço:Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, 2100.
[Ti] Título:Nutrition support in hospitalised adults at nutritional risk.
[So] Source:Cochrane Database Syst Rev;5:CD011598, 2017 05 19.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of disease-related malnutrition in Western European hospitals is estimated to be about 30%. There is no consensus whether poor nutritional status causes poorer clinical outcome or if it is merely associated with it. The intention with all forms of nutrition support is to increase uptake of essential nutrients and improve clinical outcome. Previous reviews have shown conflicting results with regard to the effects of nutrition support. OBJECTIVES: To assess the benefits and harms of nutrition support versus no intervention, treatment as usual, or placebo in hospitalised adults at nutritional risk. SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid SP), Embase (Ovid SP), LILACS (BIREME), and Science Citation Index Expanded (Web of Science). We also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp); ClinicalTrials.gov; Turning Research Into Practice (TRIP); Google Scholar; and BIOSIS, as well as relevant bibliographies of review articles and personal files. All searches are current to February 2016. SELECTION CRITERIA: We include randomised clinical trials, irrespective of publication type, publication date, and language, comparing nutrition support versus control in hospitalised adults at nutritional risk. We exclude trials assessing non-standard nutrition support. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the Cochrane Hepato-Biliary Group. We used trial domains to assess the risks of systematic error (bias). We conducted Trial Sequential Analyses to control for the risks of random errors. We considered a P value of 0.025 or less as statistically significant. We used GRADE methodology. Our primary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. MAIN RESULTS: We included 244 randomised clinical trials with 28,619 participants that met our inclusion criteria. We considered all trials to be at high risk of bias. Two trials accounted for one-third of all included participants. The included participants were heterogenous with regard to disease (20 different medical specialties). The experimental interventions were parenteral nutrition (86 trials); enteral nutrition (tube-feeding) (80 trials); oral nutrition support (55 trials); mixed experimental intervention (12 trials); general nutrition support (9 trials); and fortified food (2 trials). The control interventions were treatment as usual (122 trials); no intervention (107 trials); and placebo (15 trials). In 204/244 trials, the intervention lasted three days or more.We found no evidence of a difference between nutrition support and control for short-term mortality (end of intervention). The absolute risk was 8.3% across the control groups compared with 7.8% (7.1% to 8.5%) in the intervention groups, based on the risk ratio (RR) of 0.94 (95% confidence interval (CI) 0.86 to 1.03, P = 0.16, 21,758 participants, 114 trials, low quality of evidence). We found no evidence of a difference between nutrition support and control for long-term mortality (maximum follow-up). The absolute risk was 13.2% in the control group compared with 12.2% (11.6% to 13%) following nutritional interventions based on a RR of 0.93 (95% CI 0.88 to 0.99, P = 0.03, 23,170 participants, 127 trials, low quality of evidence). Trial Sequential Analysis showed we only had enough information to assess a risk ratio reduction of approximately 10% or more. A risk ratio reduction of 10% or more could be rejected.We found no evidence of a difference between nutrition support and control for short-term serious adverse events. The absolute risk was 9.9% in the control groups versus 9.2% (8.5% to 10%), with nutrition based on the RR of 0.93 (95% CI 0.86 to 1.01, P = 0.07, 22,087 participants, 123 trials, low quality of evidence). At long-term follow-up, the reduction in the risk of serious adverse events was 1.5%, from 15.2% in control groups to 13.8% (12.9% to 14.7%) following nutritional support (RR 0.91, 95% CI 0.85 to 0.97, P = 0.004, 23,413 participants, 137 trials, low quality of evidence). However, the Trial Sequential Analysis showed we only had enough information to assess a risk ratio reduction of approximately 10% or more. A risk ratio reduction of 10% or more could be rejected.Trial Sequential Analysis of enteral nutrition alone showed that enteral nutrition might reduce serious adverse events at maximum follow-up in people with different diseases. We could find no beneficial effect of oral nutrition support or parenteral nutrition support on all-cause mortality and serious adverse events in any subgroup.Only 16 trials assessed health-related quality of life. We performed a meta-analysis of two trials reporting EuroQoL utility score at long-term follow-up and found very low quality of evidence for effects of nutritional support on quality of life (mean difference (MD) -0.01, 95% CI -0.03 to 0.01; 3961 participants, two trials). Trial Sequential Analyses showed that we did not have enough information to confirm or reject clinically relevant intervention effects on quality of life.Nutrition support may increase weight at short-term follow-up (MD 1.32 kg, 95% CI 0.65 to 2.00, 5445 participants, 68 trials, very low quality of evidence). AUTHORS' CONCLUSIONS: There is low-quality evidence for the effects of nutrition support on mortality and serious adverse events. Based on the results of our review, it does not appear to lead to a risk ratio reduction of approximately 10% or more in either all-cause mortality or serious adverse events at short-term and long-term follow-up.There is very low-quality evidence for an increase in weight with nutrition support at the end of treatment in hospitalised adults determined to be at nutritional risk. The effects of nutrition support on all remaining outcomes are unclear.Despite the clinically heterogenous population and the high risk of bias of all included trials, our analyses showed limited signs of statistical heterogeneity. Further trials may be warranted, assessing enteral nutrition (tube-feeding) for different patient groups. Future trials ought to be conducted with low risks of systematic errors and low risks of random errors, and they also ought to assess health-related quality of life.
[Mh] Termos MeSH primário: Alimentos Fortificados
Desnutrição/prevenção & controle
Apoio Nutricional
[Mh] Termos MeSH secundário: Adulto
Peso Corporal
Causas de Morte
Nutrição Enteral/efeitos adversos
Nutrição Enteral/estatística & dados numéricos
Alimentos Fortificados/estatística & dados numéricos
Hospitalização
Humanos
Desnutrição/mortalidade
Apoio Nutricional/efeitos adversos
Apoio Nutricional/estatística & dados numéricos
Nutrição Parenteral/efeitos adversos
Nutrição Parenteral/estatística & dados numéricos
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170519
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011598.pub2



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