Anne Coble Voss

The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer

SummaryPrevious studies have suggested that administration of oral eicosapentaenoic acid (EPA) will stabilize weight in patients with advanced pancreatic cancer. The aim of the present study was to determine if a combination of EPA with a conventional oral nutritional supplement could produce weight gain in these patients. Twenty patients with unresectable pancreatic adenocarcinoma were asked to consume two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake. Each can contained 310 kcal, 16.1 g protein and 1.09 g EPA. Patients were assessed for weight, body composition, dietary intake, resting energy expenditure (REE) and performance status. Patients consumed a median of 1.9 cans day–1. All patients were losing weight at baseline at a median rate of 2.9 kg month–1. After administration of the fish oil-enriched supplement, patients had significant weight-gain at both 3 (median 1 kg, P = 0.024) and 7 weeks (median 2 kg, P = 0.033). Dietary intake increased significantly by almost 400 kcal day–1 (P = 0.002). REE per kg body weight and per kg lean body mass fell significantly. Performance status and appetite were significantly improved at 3 weeks. In contrast to previous studies of oral conventional nutritional supplements in weight-losing cancer patients, this study suggests that an EPA-enriched supplement may reverse cachexia in advanced pancreatic cancer.

The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents

Objectives: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long‐term care residents.

Description of the National Pressure Ulcer Long-Term Care Study

OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long‐Term Care Study (NPULS).

The National Pressure Ulcer Long‐Term Care Study: Outcomes of Pressure Ulcer Treatments in Long‐Term Care

Objectives: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long‐term care residents.

Agitation and Depression in Frail Nursing Home Elderly Patients With Dementia: Treatment Characteristics and Service Use

OBJECTIVEnThe authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia.nnnMETHODSnAuthors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression.nnnRESULTSnCompared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain.nnnCONCLUSIONSnDementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.

Long-term care liability for pressure ulcers

More than 20% of residents who have been in long‐term care (LTC) facilities for 2 or more years will develop at least one pressure ulcer (PU). Residents suffer pain, disfigurement, and decreased quality of life, and their risk of illness and death increases. LTC facilities face censure from residents, their families, and surveyors and the threat of expensive lawsuits. Lawsuits are typically based on contentions of residents with a PU—or their advocates—that the LTC facility was negligent and failed to provide the care that, by industry standards, it must provide to prevent or manage such wounds (managing pressure, incontinence, and nutrition). In this article, data from 1999 and 2002 are presented, showing that lawsuits related to PUs are increasingly common and costly for LTC owners and care providers. Residents realized some type of recovery against the facility in 87% of the cases (verdicts for the resident plus settlements) and were awarded amounts as high as

Interaction of gonadal status with systemic inflammation and opioid use in determining nutritional status and prognosis in advanced pancreatic cancer

312 million in damages. Even LTC administrators who believe that care in their facility equals or exceeds industry standards often settle lawsuits out of court to avoid jury verdicts. The data also show that jury awards were highest for PUs caused by multiple factors and that the highest awards for PUs caused by a single factor were seen when that factor was inadequate nutrition. LTC providers can help improve the health and quality of life of their residents, improve survey results, and minimize their risk of expensive lawsuits by developing, implementing, and documenting a plan of basic measures to prevent PUs.

CHAPTER 15 – Role of Liquid Dietary Supplements

PurposeHypogonadism has been linked with systemic inflammation and opioid use in males with advanced cancer. We aimed to investigate the interaction of gonadal status with systemic inflammation and opioids in determining nutritional status and prognosis in advanced pancreatic cancer.MethodsOne hundred and seventy-five patients (92 males, 83 postmenopausal females) with unresectable pancreatic cancer were studied. Serum sex steroids (total testosterone [TT], calculated free testosterone [cFT], oestradiol, sex hormone binding globulin), gonadotropins (follicle-stimulating hormone and luteinising hormone) and pro-inflammatory mediators (C-reactive protein [CRP], interleukin-6 [IL-6], soluble tumour necrosis factor receptor 75 [sTNFR75]) were measured, and nutritional assessment and opioid use recorded.ResultsSeventy-three percent of males were hypogonadal (by cFT definition). cFT correlated positively with BMI (r2u2009=u20090.349; pu2009<u20090.001) and grip strength (r2u2009=u20090.229; pu2009=u20090.034) and inversely with weight loss (r2u2009=u2009−0.287; pu2009=u20090.007), CRP (r2u2009=u2009−0.426; pu2009<u20090.001) and IL-6 (r2u2009=u2009−0.303; pu2009=u20090.004). CRP (pu2009=u20090.007), opioid dosage (pu2009=u20090.009) and BMI (pu2009=u20090.005) were independent determinants of cFT on ANOVA. Hypogonadal males demonstrated worsened survival compared with eugonadal patients (TT: OR of deathu2009=u20092.87; pu2009<u20090.001; cFT: ORu2009=u20092.26; pu2009=u20090.011). Furthermore, male opioid use was associated with decreased TT (pu2009<u20090.001) and cFT (pu2009<u20090.001) and worsened survival (ORu2009=u20091.96; pu2009=u20090.012). In contrast, 18% of postmenopausal females exhibited premenopausal (“hyperoestrogenic”) oestradiol levels. Oestradiol correlated positively with sTNFR75 (r2u2009=u20090.299; pu2009=u20090.008). CRP (pu2009<u20090.001) was an independent determinant of oestradiol. Hyperoestrogenic females demonstrated worsened survival compared with eugonadal patients (ORu2009=u20092.43; pu2009=u20090.013).ConclusionsIn males with pancreatic cancer, systemic inflammation and opioid use are associated with hypogonadism. Male hypogonadism and female hyperoestrogenism are associated with shortened survival in advanced pancreatic cancer.

Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis

Changing demographics and the current health care environment created the opportunity for growth of medical foods and medical nutritional supplements (MNSs). Nutrition is a modifiable, lifestyle factor that has a prominent role in the health care model of the twenty-first century. Studies demonstrate that medical nutrition therapy (MNT), including supplementation with medical foods, can improve clinical and economic outcomes associated with the conditions described in the chapter. This chapter addresses the increasing need for supplemental MNT, differentiates between medical foods and medical nutritional supplements, and provides examples of benefits and barriers to their use.. Medical nutritional supplements cost effectively improve outcomes across the continuum of care as well as in different disease states. Disease-specific MNSs are specifically formulated and scientifically studied to effectively help manage symptoms and improve outcomes. Medical nutritional supplements are convenient and provide an alternative to meals when time or medical symptoms are an issue. Finally, demonstration of improved outcomes with MNSs is an exciting area of research and can add to the health care providers arsenal of effective disease management options.