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Techniques in Coloproctology Nov 2022Enterocutaneous fistula (ECF) is an abnormal communication between the gastrointestinal tract and skin, with a myriad of etiologies and therapeutic options. Management... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Enterocutaneous fistula (ECF) is an abnormal communication between the gastrointestinal tract and skin, with a myriad of etiologies and therapeutic options. Management is influenced by etiology and specifics of the ECF, and patient-related factors. The aim of this study was to assess overall success, recurrence, and mortality rates of treatment for ECF.
MATERIALS
A systematic search of PubMed and Google Scholar was performed through October 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports, reviews, animal studies, studies not reporting outcomes, had no available English text, included patients < 16 years old or those assessing other abdominocutaneous/internal fistulas were excluded.
RESULTS
Fifty-three studies, between 1975 and 2020, incorporating 3078 patients were included. Patient age ranged between 16 and 87 years with a male:female ratio of 1.14:1. ECF developed postoperatively in 89.4%. Other common etiologies were inflammatory bowel disease, trauma, malignancy, and radiation. At least 28% of patients had complex fistulae (reported in 18 studies). Most common fistula site was small bowel. In 34 publications, 62.4% (n = 1371) patients received parenteral nutrition. In 45 publications, 72.5% underwent surgery to treat the fistula. Meta-analysis revealed an 89% healing rate; recurrence rate after initial successful treatment was 11.1%, and mortality rate was 8.5%. In a subgroup of patients who underwent combined ECF takedown and abdominal wall reconstructions (n = 315), 78% achieved fascial closure, mesh was used in 72%, hernia, and fistula recurrence rates were 19.7% and 7.6%, respectively.
CONCLUSIONS
Treatment of ECF must be individualized according to specific etiology and location of the fistula and the patient's associated conditions.
Topics: Female; Humans; Intestinal Fistula; Male; Parenteral Nutrition; Retrospective Studies; Wound Healing
PubMed: 35915291
DOI: 10.1007/s10151-022-02656-3 -
Journal of Clinical Oncology : Official... Jul 2020To provide evidence-based guidance on the clinical management of cancer cachexia in adult patients with advanced cancer.
PURPOSE
To provide evidence-based guidance on the clinical management of cancer cachexia in adult patients with advanced cancer.
METHODS
A systematic review of the literature collected evidence regarding nutritional, pharmacologic, and other interventions, such as exercise, for cancer cachexia. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and systematic reviews of RCTs published from 1966 through October 17, 2019. ASCO convened an Expert Panel to review the evidence and formulate recommendations.
RESULTS
The review included 20 systematic reviews and 13 additional RCTs. Dietary counseling, with or without oral nutritional supplements, was reported to increase body weight in some trials, but evidence remains limited. Pharmacologic interventions associated with improvements in appetite and/or body weight include progesterone analogs and corticosteroids. The other evaluated interventions either had no benefit or insufficient evidence of benefit to draw conclusions on efficacy. Limitations of the evidence include high drop-out rates, consistent with advanced cancer, as well as variability across studies in outcomes of interest and methods for outcome assessment.
RECOMMENDATIONS
Dietary counseling may be offered with the goals of providing patients and caregivers with advice for the management of cachexia. Enteral feeding tubes and parenteral nutrition should not be used routinely. In the absence of more robust evidence, no specific pharmacological intervention can be recommended as the standard of care; therefore, clinicians may choose not to prescribe medications specifically for the treatment of cancer cachexia. Nonetheless, when it is decided to trial a drug to improve appetite and/or improve weight gain, currently available pharmacologic interventions that may be used include progesterone analogs and short-term (weeks) corticosteroids.
Topics: Cachexia; Humans; Neoplasms
PubMed: 32432946
DOI: 10.1200/JCO.20.00611 -
PloS One 2023The prevalence of catheter-associated bloodstream infections (CLABSI) is high and is a severe health problem associated with an increase in mortality and elevated... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The prevalence of catheter-associated bloodstream infections (CLABSI) is high and is a severe health problem associated with an increase in mortality and elevated economic costs. There are discrepancies related to the risk factors of CLABSI since the results published are very heterogeneous and there is no synthesis in the description of all the predisposing factors.
OBJECTIVE
We aimed to perform a systematic review and meta-analysis to synthesize and establish the risk factors predisposing to CLABSI reported in the literature.
METHOD
This is a systematic review of observational studies following the PRISMA recommendations. MEDLINE and CINAHL databases were searched for primary studies from 2007 to 2021. The protocol was registered in PROSPERO CRD42018083564.
RESULTS
A total of 654 studies were identified, 23 of which were included in this systematic review. The meta-analysis included 17 studies and 9 risk factors were analyzed (total parenteral nutrition (TPN), chemotherapy, monolumen and bilumen catheters, days of catheterization, immunosuppression, kidney disease and diabetes mellitus) due to the homogeneity of their definitions and measurements. The risk factors found to increase the probability of developing CLABSI were TPN, multilumen devices, chemotherapy treatment, immunosuppression and the number of days of catheterization. On the other hand, monolumen devices presented a lower likelihood of triggering this infection.
Topics: Humans; Catheterization, Central Venous; Sepsis; Risk Factors; Catheter-Related Infections; Central Venous Catheters; Retrospective Studies
PubMed: 36952393
DOI: 10.1371/journal.pone.0282290 -
Clinical Nutrition (Edinburgh, Scotland) Jun 2021The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its incidence is unknown. The aim of this systematic review and meta-analyses was to estimate the incidence of RFS in adults by considering the definition used by the authors as well as the recent criteria proposed by the American Society of Parenteral and Enteral Nutrition (ASPEN) consensus. Furthermore, the incidence of refeeding hypophosphatemia (RH) was also assessed.
METHODS
Four databases were systematically searched until September 2020 for retrieving trials and observational studies. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI).
RESULTS
Thirty-five observational studies were included in the analysis. The risk of bias was serious in 16 studies and moderate in the remaining 19. The incidence of RFS varied from 0% to 62% across the studies. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Similarly, the incidence of RH ranged between 7% and 62%. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20 kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence = 44%; 95% CI 36%-52%) and RH (pooled incidence = 27%; 95% CI 21%-34%). However, due to the high heterogeneity of data, summary incidence measures are meaningless.
CONCLUSION
The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach.
Topics: Consensus; Humans; Hypophosphatemia; Incidence; Observational Studies as Topic; Practice Guidelines as Topic; Refeeding Syndrome
PubMed: 34134001
DOI: 10.1016/j.clnu.2021.04.023 -
Scandinavian Journal of Caring Sciences Sep 2022Inpatients have a high need for protein-energy intake because of increased physical stress metabolism due to illnesses. Protein-energy undernutrition in older patients... (Review)
Review
BACKGROUND
Inpatients have a high need for protein-energy intake because of increased physical stress metabolism due to illnesses. Protein-energy undernutrition in older patients increases the risk of complications such as falls, pressure ulcers and even death. An overview of effective interventions addressing this complex issue of malnutrition in older people is missing.
AIMS
To give an overview of effective interventions to optimise nutrition in older people in hospitals and long-term care.
DESIGN
An umbrella review, according to the Joanna Briggs Institute and PRISMA statement, was conducted in April 2020.
METHODS
A systematic search of publications from 2010 until 2020 was conducted in CINAHL, PubMed and Cochrane Database. Included were studies reporting nutrition interventions that involved nurses or the interprofessional team in optimising older hospitalised people's nutrition. Excluded were studies investigating the effects of parenteral nutrition, certain food supplements or tube feeding and research from intensive, community or palliative care. Components of interventions were classified according to the intervention Nutrition management: Patients' assistance, patients' instruction, foodservice, environment for meals and nutrient-dense snacks.
FINDINGS
Included were 13 reviews from 19 countries of the continents Asia, Australia, Europe and North America from hospitals and long-term care settings. An interprofessional food promoting culture, including staff training as part of a multi-component measure, has shown to be a successful element in implementing activities of Nutrition Management.
CONCLUSION
Several studies synthesised that optimising nutrition in older people in hospitals and long-term care is achievable. Interventions were effective if-on a meta-level-staff training was addressed as part of a multi-component measure to reach an interprofessional food promoting culture.
IMPLICATIONS FOR PRACTICE
Interventions to optimise older people's nutrition have to consider an interprofessional food promoting culture, including staff training about the importance of nutrition, patients' assistance and an appropriate environment for meals.
Topics: Aged; Energy Intake; Hospitals; Humans; Long-Term Care; Meals; Nutritional Status
PubMed: 34212419
DOI: 10.1111/scs.13015 -
Chest Feb 2022Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy.
RESEARCH QUESTION
What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis?
STUDY DESIGN AND METHODS
We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study.
RESULTS
We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high.
INTERPRETATION
Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
Topics: Anti-Bacterial Agents; Blood Component Transfusion; Candidiasis, Invasive; Catheterization, Central Venous; Comorbidity; Critical Illness; Humans; Parenteral Nutrition, Total; Risk Factors
PubMed: 34673022
DOI: 10.1016/j.chest.2021.08.081 -
Advances in Therapy Apr 2022Patients with head and neck cancer (HNC) are usually confronted with functional changes due to the malignancy itself or its treatment. These factors typically affect... (Review)
Review
INTRODUCTION
Patients with head and neck cancer (HNC) are usually confronted with functional changes due to the malignancy itself or its treatment. These factors typically affect important structures involved in speech, breathing, chewing, swallowing, and saliva production. Consequently, the intake of food will be limited, which further contributes to loss of body weight and muscle mass, anorexia, malnutrition, fatigue, and anemia. This multifactorial condition can ultimately lead to cancer cachexia syndrome. This study aims to examine the treatment of cachexia in HNC patients.
METHODS
We systematically searched OvidMedline, PubMed, Scopus, and Web of Science for articles examining the treatment of cachexia in HNC.
RESULTS
A total of nine studies were found, and these suggested interventions including nutritional, pharmacologic, therapeutic exercise, and multimodal approaches. The nutritional intervention includes essential components such as dietary counseling, oral nutritional supplements, and medical nutritional support. Individualized nutritional interventions include oral, enteral (feeding tubes i.e., percutaneous endoscopic gastrostomy [PEG], nasogastric tube [NGT]) and parenteral nutrition. The pharmacologic interventions aim at increasing the appetite and weight of cachectic patients. Therapeutic exercise and increased physical activity can help to enhance the synthesis of muscle protein, reducing inflammation and the catabolic effects of cachexia syndrome.
CONCLUSION
Owing to the multifactorial nature of this syndrome, it is expected that the management approach should be multi-interventional. Early implementation of these interventions may help to improve survival and quality of health and life of cachectic HNC patients.
Topics: Cachexia; Head and Neck Neoplasms; Humans; Intubation, Gastrointestinal; Malnutrition
PubMed: 35224702
DOI: 10.1007/s12325-022-02074-9 -
Clinical Nutrition (Edinburgh, Scotland) Apr 2023Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical outcomes. Yet, the question of the most effective ILE remains controversial. We conducted a network meta-analysis (NMA) to compare and rank different types of ILEs in terms of their effects on infections, sepsis, ICU and hospital length of stay, and in-hospital mortality in adult patients.
METHODS
MEDLINE, EMBASE, and Web of Science databases were searched for randomized controlled trials (RCTs) published up to May 2022, investigating ILEs as a part of part of PN covering at least 70% of total energy provision. Lipid emulsions were classified in four categories: FO-ILEs, olive oil (OO)-ILEs, medium-chain triglyceride (MCT)/soybean oil (SO)-ILEs, and pure SO-ILEs. Data were statistically combined through Bayesian NMA and the Surface Under the Cumulative RAnking (SUCRA) was calculated for all outcomes.
RESULTS
1651 publications were retrieved in the original search, 47 RCTs were included in the NMA. For FO-ILEs, very highly credible reductions in infection risk versus SO-ILEs [odds ratio (OR) = 0.43 90% credibility interval (CrI) (0.29-0.63)], MCT/soybean oil-ILEs [0.59 (0.43-0.82)], and OO-ILEs [0.56 (0.33-0.91)], and in sepsis risk versus SO-ILEs [0.22 (0.08-0.59)], as well as substantial reductions in hospital length of stay versus SO-ILEs [mean difference (MD) = -2.31 (-3.14 to -1.59) days] and MCT/SO-ILEs (-2.01 (-2.82 to -1.22 days) were shown. According to SUCRA score, FO-ILEs were ranked first for all five outcomes.
CONCLUSIONS
In hospitalized patients, FO-ILEs provide significant clinical benefits over all other types of ILEs, ranking first for all outcomes investigated.
REGISTRATION NO
PROSPERO 2022 CRD42022328660.
Topics: Humans; Soybean Oil; Network Meta-Analysis; Parenteral Nutrition; Fat Emulsions, Intravenous; Fish Oils; Olive Oil; Fatty Acids, Omega-3; Sepsis
PubMed: 36878111
DOI: 10.1016/j.clnu.2023.02.008 -
Annals of Palliative Medicine Oct 2021Nutritional support is very important in the treatment of severe acute pancreatitis, this study aimed to investigate the effect of total parenteral nutrition (TPN) and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nutritional support is very important in the treatment of severe acute pancreatitis, this study aimed to investigate the effect of total parenteral nutrition (TPN) and enteral nutrition (TEN) on the prognosis of patients with acute pancreatitis.
METHODS
The databases of PubMed, Embase, Cochrane Library, and Ovid were searched using the keywords acute pancreatitis, enteral nutrition, and parenteral nutrition to obtain the reports of randomized controlled trials (RCTs) published after 2000. After screening the articles according to the inclusion criteria, risk of bias of the included literatures was evaluated using the Cochrane Handbook for Systematic Reviews. The software RevMan 5.3.5 was used for analysis and the creation of a forest plot and funnel plot.
RESULTS
A total of 488 literatures were preliminarily searched in this study, from which 10 articles were included into the final quantitative analysis, involving a total of 699 participants. A total of 6 literatures (n=329 participants) reported the infection rate indicators. The obtained statistic value [odds ratio (OR) =0.25, 95% confidence interval (CI): 0.10 to 0.62] showed TEN had less infection rate that TPN (P=0.003). A total of 8 studies (654 participants) reported the incidence rate indicators of multiple organ failure rate indicator, the obtained statistic value (OR =0.50, 95% CI: 0.24 to 1.08) showed no statistical difference between TEN and TPN (P>0.05). A total of 7 studies (550 participants) reported the mortality indicators. The obtained statistic value (OR =0.59, 95% CI: 0.37 to 0.94) showed TEN had less mortality than TPN (P=0.03). A total of 3 studies reported the length of hospital stay indicators. The obtained statistic value [mean difference (MD) -4.18, 95% CI: -5.07 to -3.30] showed the length of hospital stay for TEN was shorter that TPN (P<0.001).
DISCUSSION
Compared with TPN, TEN can reduce the incidence of infection, reduce the development of multiple organ failure, reduce mortality, and shorten the length of hospital stay in patients with severe acute pancreatitis (SAP). However, attention should be paid to prevent the occurrence of complications during the implementation of nutritional intervention.
Topics: Enteral Nutrition; Humans; Pancreatitis; Parenteral Nutrition; Parenteral Nutrition, Total; Prognosis
PubMed: 34763439
DOI: 10.21037/apm-21-2469 -
The Cochrane Database of Systematic... Jun 2023Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the... (Review)
Review
BACKGROUND
Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review.
OBJECTIVES
To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA.
SEARCH METHODS
Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes.
DATA COLLECTION AND ANALYSIS
Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model.
MAIN RESULTS
We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision).
AUTHORS' CONCLUSIONS
There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.
Topics: Humans; Infant; Infant, Newborn; COVID-19; Enteral Nutrition; Infant, Premature; Intensive Care Units, Neonatal
PubMed: 37338236
DOI: 10.1002/14651858.CD009720.pub3