1. Nutrition is now recognized as an important subspecialty, as proper nutrition can improve patient outcomes like muscle strength, immune function, and wound healing.
2. Malnutrition is common in hospitalized patients, with 1/3 at risk, and even small amounts of weight loss are associated with worse outcomes. Nutritional support teams provide care for complex cases requiring enteral or parenteral nutrition.
3. Indications for nutritional support include a BMI <19, unintentional weight loss, and inability to meet nutritional needs enterally. Tube feeding is used when oral intake is inadequate, and parenteral nutrition is for intestinal failure when the gut cannot be used.
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
enteral nutrition, nutrition, nutrition after surgery, nutrition of debilitated patient, nutrition of patient who cant take orally, post operative care, surgical nutrition, total parentral nutrition
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
enteral nutrition, nutrition, nutrition after surgery, nutrition of debilitated patient, nutrition of patient who cant take orally, post operative care, surgical nutrition, total parentral nutrition
HR / Talent Analytics orientation given as a guest lecture at Management Institute for Leadership and Excellence (MILE), Pune. This presentation covers aspects like:
1. Core concepts, terminologies & buzzwords
- Business Intelligence, Analytics
- Big Data, Cloud, SaaS
2. Analytics
- Types, Domains, Tools…
3. HR Analytics
- Why? What is measured?
- How? Predictive possibilities…
4. Case studies
5. HR Analytics org structure & delivery model
Nutrition in Acute Pancreatitis (According to ESPEN guidelines 2002 and ACG g...Jibran Mohsin
This presentation compares the European Society of Parenteral & Enteral Nutrition (ESPEN) 2002 guidelines and American College of Gastroenterology (ACG) 2013 guidelines regarding nutrition in patients of acute pancreatitis
this is a detailed presentation on the principles of surgical nutrition. the presentation started with surgical metabolism and epidemiology of malnutrition in surgical patients. Furthermore, the aetiology of malnutrition was discussed in surgical patients. Finally, the various types of nutritional support, enteral and parenteral, was discussed under indications, types, access, advantages, disadvantages, complications and monitoring.
Appropriate and safe assessment and administration of fuid therapy and nutritional support is of key importance in good surgical practice. It is imperative that the preoperative nutritional state of the patient and the impact of any surgical intervention are taken into account when considering nutritional requirements and the mode of nutrient delivery.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
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Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
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We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
2. :Introduction
• Now nutrition is a subspecialty in its own right.
• Provision of good nutrition is important to all specialties.
• Nutritional care is an independent subspecialty practised
by a wide range of physicians &now been incorporated
into gastroenterological training.
3. :Introduction
• Malnutrition is common in hospital inpatients.
• 1/3 are at risk.
• Evidence for improved outcomes of better nourished
patients, BZ of:
• Enhanced muscle strength
• Better immune function
• Better wound healing.
• Reduced Hospital stay
4. :The spectrum of nutritional support
• Nutritional meals &assistance with eating if required.
• Oral supplement feeds.
• Enteral tube feeding.
• Parenteral nutrition (PN) in intestinal failure.
5.
6. : Hosp Nutritional support teams
• Able to provide direct care to the most complex cases
requiring enteral feeding & PN.
• All clinicians have to develop a basic understanding of
good nutritional care.
7. : Nutritional Assessment
• In practice, assessment, to identify specific
nutrient deficiencies, should be based on a
pragmatic approach using a combination of:
• History
• BMI
• Biochemistry.
8. Assessment &indications of Nut support :1.BMI
• (BMI): imperfect way of assessment but a useful guide.
• BMI < 19 could be at risk of malnutrition, but normal or
even raised BMI may be nutritionally deplete if they have
lost excessive weight or are lacking in vitamins/ or trace
elements.
• Historical weight loss can be a better marker of impaired
nutrition.
• Even 5% hospital weight loss associated with worse clinical
outcome.
• Weight change during nutritional support (not due to fluid
overload) in hospitalised patients can be a useful marker of
the effectiveness of the intervention
9. Assessment &indications of Nut support :1.BMI
• BMI& reported weight loss are the current favoured
method& integral to nutritional screening .
• BMI: imperfect way of assessment but a useful guide.
• BMI < 19 could be at risk of malnutrition, but normal or
even raised BMI may be nutritionally deplete if they have
lost excessive weight or are lacking in vitamins/ or trace
elements.
• Historical weight loss can be a better marker of impaired
nutrition.
• Even 5% hospital weight loss associated with worse clinical
outcome.
• Weight change during nut support (not due to fluid
overload) in hospitalised patients can be a useful marker of
the effectiveness of the intervention.
• Malnutrition Universal Screening Tool (MUST), endorsed
by many government agencies & professional bodies.
10. Assessment &indications of Nut support :2.BIOCHEM
• No reliable biochemical markers of malnutrition identified.
• A. Serum albumin is often referred to as a proxy for nutritional
status, but not totally accurate as changes in serum albumin
usually relate to:
• Extravascular shifts in inflammatory states
• Altered synthetic function of the liver
• Normal plasma albumin are seen in patients with profound
anorexia nervosa.
• B. Measurement of water& fat-soluble vitamins can demonstrate
deficiency, particularly in malabsorptive states, for example after
bariatric surgery, but are often normal in individuals with poor
nutritional status.
• Patients with severe malnutrition can have low levels of
intracellular ions (including phosphate, magnesium,potassium)
often becoming manifest only when nutritional support is
commenced.
11.
12.
13.
14.
15.
16. :Indications of enteral tube feeding
• Enteral tube feeding is reserved for patients unable to swallow
food safely or if their energy intake remains inadequate.
• On occasion, tube feeding can be used to supplement oral intake
in patients with high metabolic demands, for instance in patients
with cystic fibrosis who are often unable to meet these demands
with oral intake.
• ‘if the gut works, use it’ otherwise PN.
17. Tube feeding : NGT
• For short-term feeding (<6 weeks), NGT or NJT feeding usually
suffice.
• Nasal tubes can be tolerated for a longer time, it is usually
preferable to place a direct gastrostomy or jejunostomy tube in
suitable patients who do not tolerate nasal tubes, or require a
longer period of enteral feeding.
• Postpyloric feeding, either via an endoscopically or surgically
placed tube, may help for patients intolerant of intragastric feed
(eg diabetic gastroparesis) or at high risk of aspirating stomach
contents (eg post-stroke), although its benefit in improving
outcomes remains contentious.
18. Tube feeding : Gastrostomy tubes
• Endoscopically using a ‘pull through’ technique (PEG).
• Under fluoroscopic guidance (RIG) using a gastropexy technique.
• PEG placement is generally quicker& easier.
• RIG has the advantage of not requiring sedation or gastroscopy.
• Enteral feeding is not beneficial in Dementia for improving
quality or duration of life.
19. Parenteral nutrition : indications
• Intestinal failure.
• Expensive & with side-effects.
• Via central or peripheral venous access BZ Peripherally delivered
PN cause thrombophlebitis& requires the use of PN of low
osmolality, so larger volumes can be needed to meet energy
requirements.
• The preferred central route for those requiring PN for weeks is
via peripherally inserted central catheter lines,while tunnelled
lines (eg Broviac or Hickman) are the optimum lines for longterm
(>3 months) use.
20. :Risks of nutritional support
• Related to biochemical excursions or fluid balance problems.
• Related to the methods of delivering the artificial nutrition.
21. Risks of nutritional support: biochemical or fluid excursions
A.Re-feeding syndrome:
• Precipitous drops in plasma phosphate, potassium &magnesium,
in individuals who with inadequate oral intake for > five days.
• Cautious gradual increases in calorific intake should be employed
after appropriate restitution of electrolyte deficiencies.
• Overenthusiastic feeding of the malnourished patient orally,
enterally or parenterally can lead to an insulin surge with large
intracellular shifts of potassium, phosphate and magnesium,
leading to low plasma levels of these ions.
• Daily measurement of these levels is therefore mandatory.
• Increased thiamine use by cells during refeeding can provoke
Wernicke’s encephalopathy, so thiamine replacement should
always be administered before feeding is started in patients at risk
22. Risks of nutritional support: biochemical or fluid excursions
B. Fluid and electrolytes :
• PN use can lead to derangements in fluid/electrolyte balance.
• Blood and strict fluid balance monitoring is required until the
patient is stabilized on PN.
23. Risks of nutritional support: Line &tube - related
complications
– Risk of aspiration, particularly in those with decreased
conscious levels.
– Postpyloric feeding may help in high-risk individuals.
– Nasal tube complications usually relate to incorrect placement.
– All individuals placing &assessing tube position should be
aware of current guidelines regarding checking tube position
using pH testing, with chest X-ray where uncertainty remains.
– Gastrostomy tubes have many more complications, including
bleeding or perforation at the time of placement, and infection
after placement, often be averted by good aftercare.
24. Risks of nutritional support: Catheter-related sepsis
– Catheter-related sepsis (CRS) can cause morbidity or even
mortality.
– Careful technique when handling these lines can obviate these
complications.
– If CRS is suspected (eg fever or rigors on feeding), PN should
be discontinued& simultaneous line & peripheral cultures
taken.
– If line sepsis is confirmed, short-term temporary feeding
linesshould be removed while longer-term tunnelled lines may
be salvaged with antibiotic therapy.
25. Risks of nutritional support: VTE
– Long-term feeding catheters can also provoke venous
thrombosis necessitating long-term anticoagulation.