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Tube Feeding (tube + feeding)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Nursing General	12%
Pediatrics	9%

Selected Abstracts

State Practice Variation in the Use of Tube Feeding for Nursing Home Residents with Severe Cognitive Impairment

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2001
Charles E. Gessert MD
No abstract is available for this article. [source]

Prevalence and associated factors of pneumonia in patients with vegetative state in Taiwan

JOURNAL OF CLINICAL NURSING, Issue 7 2008
Li-Chan Lin PhD
Aims., The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan. Background., Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia. Methods., Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations. Results., The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14·2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91·2%. The mean duration of tube-feeding was 73·21 SD 55·33 months. A total of 90·4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia. Conclusion., Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population. Relevance to clinical practice., Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS. [source]

An audit designed to assess the need for planned pretreatment PEG placement in patients with stage III & stage IV oral cancer

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2004
F.R. Dawson
Background:, Nutritional support is a crucial and challenging part of treatment for patients with oral cancer. The aim of this audit was to assess the need for planned pretreatment percutaneous endoscopic gastrostomy (PEG) placement in this group of patients and to assess diet consistency as a predictor of poor outcomes. Method:, This was a retrospective study of 77 consecutive patients with stage III and IV squamous cell carcinoma of the oral cavity treated by radical surgery and post-operative radiotherapy between January 1999 and December 2001. Information was taken from dietitians' records. Patients were divided into two groups according to survival: group 1 (40 patients) comprised nonsurvivors and group 2 (37 patients), survivors. All patients were enterally fed post-operatively. After approximately 10 days, swallowing was assessed and, if deemed competent, patients progressed to a fluid diet. Tube feeding was gradually reduced and then stopped when oral nutrition was sufficient to maintain weight. Patients progressed to soft diet as they were able. During radiotherapy, liquid diet or tube feeding was instigated as required. Results:, In group 1, 65% required tube feeding for less than 30 days (mean 17 days), 20% for 31,100 days (mean 51 days) and 15% for over 100 days (mean 231 days). The overall mean length of tube feeding was 97 days. Thirty-eight per cent of nonsurvivors developed recurrence and went on to subsequent operations necessitating further tube feeding for an average of 129 days. In group 2, 70% were tube fed for less than 30 days (mean 11 days), 14% for between 31,100 days (mean 43 days), and 17% for more than 100 days. The overall mean length of tube feeding was 72 days. The dietary consistency of nonsurvivors was worse than survivors throughout treatment. At first presentation, only 37% of nonsurvivors managed a normal diet, 8% managed a near normal diet and 3% required tube feeding, whereas 48% of survivors managed a normal diet and 16% a near normal diet. At 1 year, there was a significant difference between the two groups' diets. No patients in group 1 managed a normal or near normal diet, whilst 62% required tube feeding. In group 2, 12 and 32% managed a normal and near normal diet, respectively and only 9% required or wished to remain on tube feeding to supplement their diet. Five per cent of patients in this group remained nil by mouth due to fistula. Conclusion:, Deciding whether a patient has a naso-gastric tube, PEG or radiologically inserted gastrostomy tube placed can be a difficult decision. However, a gastrostomy should be considered prior to treatment in patients whose diet is of poor consistency at presentation or who have an inadequate oral intake to maintain or increase weight and in those with a fistula, expected slow recovery of swallowing function, for example, pharyngeal tumour or undergoing brachytherapy or chemoradiotherapy. [source]

Micronutrient status in children with cerebral palsy

ACTA PAEDIATRICA, Issue 8 2007
Elisabet Hillesund
Abstract Aim: To investigate micronutrient status in a group of children with cerebral palsy (CP). Methods: Thirty-six children with CP, aged 1.5,17 years, completed a 4-day food diary, underwent anthropometric measurements and delivered blood for analysis of micronutrient concentrations. Results: Low intake of iron, folate, niacin, calcium, vitamin E and vitamin D was common, even among those who were receiving nutritional supplements. Laboratory tests revealed low serum concentration of folate in eight children, ,-tocopherol in six children, ferritin in five children and pyridoxal-5-phosphate in three children. Two participants were low in zinc and one was low in selenium. Severely disabled children received nutrition supplements more frequently than those with less severe disability (71% vs.16%, p = 0.01). Tube feeding and use of nutrition supplements was reflected in higher concentrations of micronutrients in blood and serum. Conclusion: Low intake of micronutrients as well as low micronutrient concentrations was common in this heterogenic group of children with CP. Children with neurological disabilities should have their nutritional status evaluated in order to ascertain sufficient intake of micronutrients. [source]

CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

DIGESTIVE ENDOSCOPY, Issue 3 2010
Shinji Nishiwaki
Background:, Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods:, We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results:, Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions:, Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube. [source]

Functional outcome after total and subtotal glossectomy with free flap reconstruction,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2008
Chie Yanai DDS
Abstract Background The aim of this study was to evaluate postoperative oral functions of patients who had undergone total or subtotal (75%) glossectomy with preservation of the larynx for oral squamous cell carcinomas. Methods Speech intelligibility and swallowing capacity of 17 patients who had been treated between 1992 and 2002 were scored and classified using standard protocols 6 to 36 months postoperatively. The outcomes were finally rated as good, acceptable, or poor. Results The 4-year disease-specific survival rate was 64%. Speech intelligibility and swallowing capacity were satisfactory (acceptable or good) in 82.3%. Only 3 patients were still dependent on tube feeding. Good speech perceptibility did not always go together with normal diet tolerance, however. Conclusions Our satisfactory results are attributable to the use of large, voluminous soft tissue flaps for reconstruction, and to the instigation of postoperative swallowing and speech therapy on a routine basis and at an early juncture. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

High-dose superselective intra-arterial cisplatin and concomitant radiation (radplat) for advanced head and neck cancer,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2004
Alfons J. M. Balm MD
Abstract Background. The purpose of this study was to study the effect of intensive targeted chemoradiation in a group of patients with head and neck cancer with stage IV inoperable disease. Methods. We examined 79 patients with inoperable stage IV head and neck cancer receiving intra-arterial infusion of high-dose cisplatin (150 mg/m2) on days 2, 9, 16, and 23 concomitant with delivery of external beam radiotherapy (total dose, 70 Gy; 2 Gy, 35 fractions; 1 fraction/day for 7 weeks). Sodium thiosulfate was administered intravenously to provide effective cisplatin neutralization. Results. Four patients were not assessable. Complete local tumor response was achieved in 72 patients (91%) and a partial response in three patients. The complete response rate of neck node metastases was 90%. The 1- and 2-year locoregional control rates were 82% and 69%, respectively. The median overall survival time was 2.2 years, with a 3-year overall survival probability of 43%. Acute toxicities were as follows: grade III/IV hematologic toxicity (22%/16%), grade III/IV nephrotoxicity (0%), grade III mucositis (43%), grade III skin reactions (24%), grade III toxicity of the upper gastrointestinal tract (57%), grade III nausea (20%), and grade III subjective hearing loss (10%). Grade V toxicity (treatment-related deaths) was 3.8%. Six (18%) of 33 patients with complete remission needed tube feeding 2 years after treatment without intercurrent salvage surgery. Conclusions. Supradose superselective intra-arterial cisplatin and concomitant radiation is an effective organ-preserving therapy in an unfavorable group of patients. Our series confirms encouraging results reported previously. This regimen is justified in unresectable patients despite the substantial toxicity. © 2004 Wiley Periodicals, Inc. Head Neck26: 485,493, 2004 [source]

Reducing nosocomial infection in neonatal intensive care: An intervention study

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2009
Raijah Hj A Rahim MN RN SCM BScN
Nosocomial infection is a common cause of morbidity and mortality for hospitalized neonates. This report describes measures taken to reduce the prevalence of nosocomial infection within a 34-bed neonatal intensive care unit in Malaysia. Interventions included a one-to-one education programme for nursing staff (n = 30); the education of cleaners and health-care assistants allocated to work in the unit; and the introduction of routine (weekly) screening procedure for all infants with feedback given to staff. The education programme for nurses focused on the application of standard precautions to three common clinical procedures: hand washing, tracheobronchial suctioning and nasogastric tube feeding. These were evaluated using competency checklists. The prevalence of nosocomial blood and respiratory tract infections declined over the 7-month study period. This study highlights the importance of education in contributing to the control of nosocomial infection in the neonatal intensive care unit. [source]

Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set

JOURNAL OF ADVANCED NURSING, Issue 1 2000
Georges Evers PhD RN
Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set This study describes the frequency of and indications used for total feeding assistance and tube feeding in a national representative sample of Belgian hospital patients (n = 421 314). Data from the 1990 national minimum nursing data registration was used. Orem's self-care model was used to describe and categorize types of nursing care and related indications. The scope of wholly compensatory nursing care was limited to total feeding assistance and tube feeding. This type of nursing care is indicated when self-care agency is undeveloped or cannot be used and when self-care demands are significantly increased. Based on review of the literature, hypotheses to indicate nursing care were formulated and tested. Wholly compensatory nursing care related to enteral food intake is given to 14·4% of the total patient population in Belgian hospitals. If self-care demand increases due to malnutrition, then this is an indication for total feeding assistance. If self-care agency decreases due to blindness, mental retardation, disorientation or upper extremity dysfunction, then this is also an indication for total feeding assistance. If self-care agency decreases due to impaired chewing, then this is an indication for tube feeding. This study has generated the first representative national nursing statistics about total feeding assistance and tube feeding in hospitals. [source]

Prevalence and associated factors of pneumonia in patients with vegetative state in Taiwan

Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2010
A. Rio
Abstract Background: Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. Methods: A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. Results: Median survival from disease onset was 842 days [interquartile range (IQR) 573,1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443,1032), RIG 633 days (IQR 496,1039) and NGT 427 days (IQR 77,781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106,546) days, RIG 216 (IQR 83,383) days and NGT 28 (IQR 14,107) days. Survival between gastrostomy and NGT treated patients was significant (P , 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). Conclusions: Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients. [source]

Quality of life in adult enteral tube feeding patients

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2007
A. M. Brotherton
Abstract Background, Enteral tube feeding may impact significantly on patients' quality of life (QoL). The aim of this paper is to review studies that have measured QoL in adult patients receiving enteral tube feeding to determine the factors that are associated with feeding that impact on the patients' QoL. Methods, An electronic search of CINAHL, MEDLINE and EMBASE was undertaken to identify articles that had measured QoL in adults receiving enteral tube feeding. Results, Ten studies were included in the review. Quality of life in patients receiving enteral tube feeding generally appeared poor compared with control groups. Factors that were found to impact on patients' quality of life included symptoms such as nausea, vomiting, diarrhoea and fatigue. Issues around body image, inability to go out and discomfort while carrying out activities of daily living also impacted on QoL. Conclusions, Although the presence of underlying disease and the use of different QoL measures made comparison of the results difficult, issues requiring further consideration in clinical practice include effective symptom management, assessment of psychological and emotional issues and support for patients to enable them to cope with the resulting social isolation. [source]

An audit designed to assess the need for planned pretreatment PEG placement in patients with stage III & stage IV oral cancer

Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary care

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2002
S. M. Madigan
Abstract Aim To examine the nature of all contacts between adult tube-fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care. Methods All adult patients referred to the Community Nutrition and Dietetic Service within a 6-month period were included in the study. Using a proforma developed from a retrospective case-note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences. Results The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group. Conclusions The department protocols have been revised to include a planned review within 2,6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community. [source]

The role of probiotics and prebiotics in the management of diarrhoea associated with enteral tube feeding

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2001
K. Whelan
Introduction Diarrhoea is a common and serious complication of enteral tube feeding, and has a range of aetiologies. Manipulation of the colonic microflora may reduce the incidence of enteral tube feeding diarrhoea via suppression of enteropathogens and production of short-chain fatty acids. Probiotics and prebiotics are commonly used during enteral tube feeding to manipulate the colonic microflora; however, their efficacy is as yet uncertain. Methods English-language studies investigating the pathogenesis of enteral tube feeding diarrhoea and the use of probiotics and prebiotics were identified by searching the electronic databases CINAHL, EMBASE and MEDLINE from 1980 to 2001. The bibliographies of articles obtained were searched manually. Results Only two prospective, randomized, double-blind, placebo-controlled trials have investigated the effect of a probiotic on enteral tube feeding diarrhoea; however, results are conflicting. No prospective, randomized, double-blind, placebo-controlled studies have specifically addressed the effect of a prebiotic on the incidence of enteral tube feeding diarrhoea. Conclusion Theoretically, probiotics and prebiotics may be of benefit in prophylaxis against enteral tube feeding diarrhoea; however, there is currently insufficient evidence to support their routine use. Prospective, randomised, double-blind, placebo-controlled studies investigating their effect on diarrhoea are required. These observations are discussed with reference to the current literature. [source]

The challenges of innovation in the organization of home enteral tube feeding

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2001
P. Howard
The number of patients discharged from hospital who need home enteral tube feeding has been increasing steadily in the UK. Arrangements for support of these patients is extremely variable. The unsatisfactory arrangements for home enteral tube feeding which existed in Avon in 1996 prompted an innovative reorganization. On the basis of that experience, this review examines the key issues involved and the questions to be considered, which may be of benefit to other trusts faced with similar challenges. [source]

Home tube feeding: an integrated multidisciplinary approach

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2001
E. P. McNamara
Background Long-term enteral tube feeding is increasingly required by patients in the community setting. A previous study of 50 adults on home enteral tube feeding in the Dublin area found that some experienced logistical problems and many individuals did not choose to seek advice from their GP regarding their tube feeding. Aims To assess the contribution of health professionals to the care of patients on enteral tube feeding in the community. Methods GPs and hospital dietitians were surveyed using postal questionnaires and nutritional company representatives using structured interviews, to assess their involvement with patients on home tube feeding. Completed questionnaires were received from 77 dietitians and 80 GPs. Ten company representatives were interviewed. Results Hospital dietitians carry out most of the initial education and training of patients, in addition to the nutritional aftercare. General practitioners tend not to be involved, although nutrition specialists working in the nutritional products area report encountering patients with tube-feeding complications in the community. Conclusions Improved co-ordination between hospital and community services and more consistent monitoring of those on home enteral tube feeding would be an advantage to such patients. [source]

Noninvasive Ventilation During Gastrostomy Tube Placement in Patients with Severe Duchenne Muscular Dystrophy: Case Reports and Review of the Literature

PEDIATRIC PULMONOLOGY, Issue 2 2006
D.J. Birnkrant MD
Abstract Individuals with Duchenne muscular dystrophy may benefit from gastrostomy tube feeding due to progressive dysphagia and malnutrition. However, due to their severely impaired pulmonary function, these individuals are at risk of severe complications when they are sedated or undergo anesthesia for the procedure. We previously described a technique of noninvasive positive pressure ventilation to provide respiratory support during gastrostomy tube placement in such patients, but this technique had risks and limitations. In this case report, we examine two alternative techniques we used to provide respiratory support successfully to patients with severe muscular dystrophy and malnutrition who underwent percutaneous endoscopic gastrostomy tube placement. We then review the literature and discuss the potential benefits, risks, and limitations of the above techniques and of other options for gastrostomy placement in people with severe muscular dystrophy. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source]

Effects of bathing immediately after birth on early neonatal adaptation and morbidity: A prospective randomized comparative study

PEDIATRICS INTERNATIONAL, Issue 5 2000
Yasushi Nako
Abstract Objective: Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity. Methods: The study was designed as a randomized prospective comparative study in the neonatal care unit of a university hospital. A total of 187 healthy term and near-term newborn infants, who were delivered vaginally without asphyxia, between January and December 1997 were the study subjects. We compared findings in newborns who were bathed 2,5 min after birth (n=95) with those of a control group (n=92) who received dry care instead. Groups were comparable with respect to gestational age, birthweight, male : female ratio, Apgar score and umbilical blood pH. Rectal temperature was measured with an electronic thermometer immediately before the intervention bathing or dry care and at 30 min and 1, 2, 3, 8 and 12 h after birth. Heart rate, respiratory rate, systolic and diastolic blood pressure and SpO2 were measured at 1, 2, 8 and 12 h after birth. The incidence of early neonatal morbidity, including hyperbilirubinemia and gastrointestinal and respiratory problems, was also compared. Results: Rectal temperature changed over time postnatally in both groups (P<0.0001, ANOVA) and there was a significant difference in rectal temperature between groups (P<0.0001, ANOVA). Mean (± SEM) rectal temperature at 30 min after birth (i.e. approximately within 20 min after intervention) was significantly higher in the bathed group than in the control (dry care) group (37.30~0.06 vs 37.00~0.05°C, respectively; P=0.000022). Respiratory rate, heart rate, blood pressure and the ratio of the number of infants with SpO2 90,94% and 95,100% did not differ significantly between the two groups. The incidence of early neonatal morbidity, including vomiting, acute gastric mucosal lesion, polycythemia, need for tube feeding, phototherapy and oxygen therapy, also did not differ between the two groups. Conclusions: Early bathing, minutes after birth, did not appear to adversely affect the adaptation of healthy full-term and near-term newborn infants. [source]

Efficacy of Living Donor Liver Transplantation for Patients With Methylmalonic Acidemia

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2007
D. Morioka
Application of liver transplantation to methylmalonic acidemia (MMAemia) is controversial because MMAemia is caused by a systemic defect of methylmalonyl-CoA mutase. The clinical courses of seven pediatric patients with MMAemia undergoing living donor liver transplantation (LDLT) were reviewed. Serum and urinary methylmalonic acid (MMA) levels were found to be significantly decreased after LDLT, whereas serum and urinary MMA levels did not return to normal in any patient. One patient died of sepsis 44 days after LDLT. The other six patients are currently doing well. All patients had preoperative history of acute metabolic decompensation and/or metabolic stroke. However, no episode of acute metabolic decompensation or metabolic stroke was observed postoperatively in any surviving patients. In the preoperative period, all patients showed lethargy and cognitive deficit, both of which were eradicated after LDLT in all surviving patients. Preoperatively, all patients were subjected to dietary protein intake restriction and tube feeding, and were administered several metabolism-correcting medications. The metabolism-correcting medications being administered remained mostly unchanged after LDLT, whereas protein restriction was liberalized and tube feeding became unnecessary in all surviving patients. In addition, physical and neurodevelopmental growth delay remained in all surviving patients during the observation period, which ranged from 4 to 21 months with a median of 10.5 months. [source]

Concomitant weekly cisplatin and altered fractionation radiotherapy in locally advanced head and neck cancer

CANCER, Issue 19 2010
Heather E. Newlin MD
Abstract BACKGROUND: Both concomitant chemotherapy and altered fractionation radiotherapy (RT) have been shown to improve outcomes for patients with locoregionally advanced head and neck squamous cell carcinomas. However, both strategies also increase acute toxicity, and it is questionable whether the 2 can be safely combined. Traditional concomitant chemotherapy regimens include high-dose cisplatin given at 100 mg/m2 every 3 weeks. The authors' purpose was to report efficacy and toxicity after weekly cisplatin (30 mg/m2/wk) concurrent with altered fractionation RT. METHODS: One hundred twenty-one patients with American Joint Committee on Cancer stages II (3%), III (13%), or IV (84%) squamous cell carcinomas of the oropharynx (70%), hypopharynx (20%), or larynx (10%) were treated between 2000 and 2006 at the University of Florida with hyperfractionated RT (55 patients) or concomitant boost RT (66 patients) and concomitant cisplatin (30 mg/m2/wk). RESULTS: Median follow-up was 2.9 years; median follow-up on survivors was 3.6 years. Seventy-nine percent of patients completed ,6 cycles of chemotherapy; 94% received ,7200 centigrays. Seven (6%) patients changed from cisplatin to carboplatin because of bone marrow toxicity. Gastrostomy tube feeding was required in 54% of patients either before (16%) or during RT (38%). Two (1.6%) patients died from therapy-related complications. The 5-year outcomes were: local control, 83%; locoregional control, 79%; distant metastasis-free survival, 88%; cause-specific survival, 76%; and overall survival, 59%. Seven (6%) patients had severe late complications. Three (3%) patients required a permanent gastrostomy tube. CONCLUSIONS: Concomitant weekly cisplatin with altered fractionation RT is a safe and effective treatment regimen. Cancer 2010. © 2010 American Cancer Society. [source]

Intra-arterial versus intravenous chemoradiation for advanced head and neck cancer: Results of a randomized phase 3 trial,

CANCER, Issue 9 2010
Coen R. N. Rasch MD
Abstract BACKGROUND: Chemoradiation is the preferred treatment for advanced stage IV head and neck cancer. Higher doses of chemotherapy yielded promising results in vitro and vivo, confirmed by intra-arterial (IA) cisplatin-based chemoradiation in phase 2 studies. METHODS: Two hundred and thirty-nine patients with (functionally) unresectable head and neck cancer were included, from 2000 to 2004, in a multicenter, randomized phase 3 trial, comparing IA and intravenous chemoradiation. Intravenous chemoradiation comprised 3×100 mg/m2 cisplatin infusion on Days 1, 22, 43 combined with 70 Gy in 35 daily fractions. The IA chemoradiation treatment arm comprised 4x150 mg/m2 cisplatin administered in the tumor-feeding artery on Days 1, 8, 15, 22, immediately followed by systemic rescue with sodium thiosulfate with the same radiotherapeutic regimen. RESULTS: Two patients were excluded from analysis because of nontreatment-related death immediately after randomization (n = 1) and esophageal carcinoma (n = 1). The median follow-up was 33 months 1-104 months. Ninety percent of the patients required tube feeding during treatment. Renal toxicity >grade 2 was 9% in the intravenous compared with 1% in the IA treatment arm (P , .0001). There was no difference in locoregional control, disease-free survival (DFS) or overall survival (OS), between the treatment arms. At 3 years, local control, locoregional control, DFS, and OS was .76, .63, .44, .51 in the IA versus .70, .65, .47, .47 in the intravenous treatment arm, respectively. CONCLUSIONS: Cisplatin-based IA chemoradiation was not superior to intravenous chemoradiation for advanced stage IV head and neck cancer regarding locoregional control and survival. Cancer 2010. © 2010 American Cancer Society. [source]

Developmental care in the UK: a developing initiative

ACTA PAEDIATRICA, Issue 11 2009
K E StC Hamilton
Abstract Aim:, To review developmental care over time in the UK. Methods:, Longitudinal study comprising two prospective observational studies of unit organization and developmental care activity collected in 2005 and 2008 in all UK neonatal units. Indices related to developmental care and an aggregated score are reported corresponding to year and level of care. Results:, In 2008, over 90% units had open visiting for parents and modified lighting and 80% modified noise, showing no change since 2005. Incubator cover usage increased from 75% to 95%. Rates of parental tube feeding dropped from 76% to 64% and kangaroo care increased from 50% to 80%. Proportions of units with developmental care personnel and staff trained in developmental care have almost doubled to 64% and 57%. Aggregated scores, reflecting eight basic indices of developmental care, were unchanged: the 2005 mean was 5.7 (SD = 1.5) and 6.2 (SD = 1.5) in 2008. Scores were significantly higher in larger units and in those with developmental care personnel or developmentally trained staff. Conclusion:, Despite a significant increase in developmental care skills and infrastructure, variable approaches persist, with limited improvements over time. These findings reflect a UK culture that is ambivalent towards developmental care, and enable comparison with other countries where developmental care is more fully supported. [source]

Association between commensal bacteria and opportunistic pathogens in the dental plaque of elderly individuals

CLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2006
A. Tada
Abstract Opportunistic infections in the oral cavity of the elderly may increase the incidence of systemic disease. The objective of this study was to investigate the differences in the oral bacterial flora between dependent elderly (inpatients) and independent elderly (community-dwelling residents). After multiple variables were taken into account, inpatients had significantly lower detection rates than community-dwelling residents for ,-streptococci (p < 0.001) and Neisseria (p 0.004), and higher detection rates for Pseudomonas aeruginosa (p 0.024), methicillin-resistant Staphylococcus aureus (MRSA) (p 0.011) and Actinomyces spp. (p 0.005). Among inpatients, the requirement for a high degree of care was related negatively to detection of ,-streptococci, but was related significantly to detection of P. aeruginosa (p 0.018) or MRSA (p 0.004). Tube-fed inpatients had a significantly lower detection rate for ,-streptococci (p 0.041) and a higher detection rate for P. aeruginosa (p 0.004) than those who did not require tube feeding. Inpatients with a history of antibiotic use had a significantly lower detection rate for ,-streptococci (p 0.049) and a higher detection rate for MRSA (p 0.007) than those without a history of antibiotic use. The detection rates for P. aeruginosa or MRSA in inpatients without ,-streptococci were higher than in inpatients with ,-streptococci after controlling for age and gender (P. aeruginosa, p 0.006; MRSA, p 0.001). Overall, detection of ,-streptococci had an inverse correlation with the detection of P. aeruginosa and MRSA in the oral cavity and is likely to be an indicator of pathogenic bacterial infection. [source]

Simplifying head and neck microvascular reconstruction

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004
Eben Rosenthal MD
Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source]