Search PubMed⌕ Search

Biomedical subjects

C R Pennington

Publications and source records attributed to C R Pennington.

At least 37 records · Page 2Linked to original sources
PubMed1995

The use, efficacy and monitoring of artificial nutritional support in a teaching hospital.

The implementation of circulated guidelines has been audited, by assessing the extent to which nutritional goals were set and achieved and recording the levels of morbidity as a result of complications. Adults receiving artificial nutritional support were studied over a six month period. Nutritional assessment was used to determine adequacy of prescription and efficacy of the support. Energy requirements were retrospectively calculated and compared with prescriptions and actual intakes. Complications and interruptions to the regimens which resulted in lost feeding time were recorded, as were patient outcomes. Nutrient prescriptions were inadequate, delivery of prescriptions was incomplete and thus nutrient supply inadequate.

Aged↗
PubMed1994

Incidence and recognition of malnutrition in hospital.

OBJECTIVES: To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. DESIGN: Prospective study of consecutive admissions. SETTING: Acute teaching hospital. SUBJECTS: 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. MAIN OUTCOME MEASURES: Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. RESULTS: On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. CONCLUSION: Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.

Adolescent↗
PubMed1994

Auditing the effect of experience and change on home parenteral nutrition related complications.

A prospective record of all patients receiving home parenteral nutrition (HPN) in Tayside since 1980 has been used to audit the effect of experience and specific policy changes on HPN related complications. Total HPN related complications fell significantly over the years from 1.59 complications per treatment year during the initial 5 years of HPN experience to the current rate of 0.36 complications per treatment year. Specific policy changes, such as modification of the glucose concentration of feed, could also be shown to produce a significant benefit in the reduction of complications. Increasing experience with HPN results in a fall in complication rates, however, continuous audit of HPN is essential to determine the effect of policy changes on complication rates.

Journal Article↗
PubMed1994

The nutritional status of patients receiving home enteral feeding.

19 patients receiving home enteral nutrition (HEN) were nutritionally assessed, using anthropometry and blood analysis. Blood was taken for measurement of serum albumin, magnesium, zinc, copper, selenium and vitamins A and E. 8 patients had anthropometric evidence of protein and energy depletion, of whom 6 were severely depleted. 15 patients had biochemical evidence of trace element or vitamin depletion of whom 6 had multiple (>/= 3) depletion. Depletion occurred in all diagnostic categories, even in patients with normal anthropometric measurements, and was independent of duration, volume or method of feeding. We conclude that patients receiving HEN may be at risk of protein energy malnutrition and of developing vitamin or trace element deficiency states regardless of diagnosis, anthropometric measurements or duration of feeding. Therefore close nutritional monitoring of such patients is essential, and it is recommended that patients on HEN are supervised by clinicians with an appropriate interest.

Journal Article↗
PubMed1993

Taurolin for the prevention of parenteral nutrition related infection: antimicrobial activity and long-term use.

A case is described in which bis (1, 1 dioxoperhydro-1, 2, 4-thiadiazinyl-4-) methane (Taurolin) has saferly been administered on a long term basis to prevent recurrent sepsis in a patient receiving parenteral nutrition. A 26-year-old male with Crohn's disease receiving parenteral nutrition suffered repeated episodes of sepsis and developed an infected intra-atrial thrombus despite repeated courses of antimicrobial chemotherapy and surgical intervention. Continued parenteral nutrition was essential du5e to intestinal failure. Taurolin was administered in the parenteral feed, as a 0.3% solution, to prevent recrudescent and recurrent infection. This concentration was shown, in vitro, to be bactericidal to a variety of pathogenic organisms. No recurrence of sepsis, nor any evidence of side effects was observed throughout the 12 month period of Taurolin administration. After 12 months the taurolin was discontinued and within 2 weeks the patient was re-admitted with recurrent septicaemia. Following re-introduction of Taurolin the infection was controlled and the patient remains well. In our experience the addition of taurolin to the nutritive feeds of a patient at risk of sepsis is a safe and effective method of preventing recurrent sepsis.

Journal Article↗
PubMed1993

Correspondence.

Explore the source record for details and available documents.

Letter↗
PubMed1993

Home parenteral nutrition in Tayside 1980-1992.

The experience of Home Parenteral Nutrition (HPN) in Tayside over the last 13 years has been reviewed with particular reference to the indications for, complications of, and quality of life whilst receiving HPN. The observed complication rate has been compared with that of the UK experience, and the observed complication rate for the first seven years of HPN experience has been compared with the subsequent six years. The Tayside experience equates broadly with that of the UK, although there was a different pattern of complications. Increasing experience with HPN has resulted in a fall in HPN related complications to 1 per 3.4 treatment years in Tayside, a rate as low as that of the most experienced HPN centre in the UK.

Adolescent↗
PubMed1992

Ethanol flush for the prevention of catheter occlusion.

Catheter occlusion by lipid material has been associated with the use of compounded nutrient solutions containing lipid. We have studied the incidence of catheter occlusion when either a saline or an ethanol flush has been used prior to the application of a heparin lock following an overnight infusion of such nutrients. Lipid occlusion occured in 13 of 23 catheters when a saline flush preceeded the application of a heparin lock, whereas the use of a 20% ethanol solution before the application of the heparin lock resulted in only 2 occlusoins in 28 catheters (p < 0.001). In addition there was significantly longer catheter survival in the ethanol group (p < 0.01). It is concluded that an ethanol flush may significantly reduce the incidence of catheter occlusion during the use of lipid mixes.

Journal Article↗
PubMed1992

Does hypothermia protect against the development of hepatitis in paracetamol overdose?

A 24-year-old female presented in hospital following self-poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co-proxamol (dextropropoxyphene and paracetamol) and paracetamol. She arrived in hospital more than 18 h after ingestion of the drug. On admission, she was profoundly hypothermic, with a rectal temperature of 19 degrees C. Her paracetamol level was 943 mumol.l-1 which, when related to the time of ingestion, implied a very high risk of hepatocellular damage as well as fulminant liver failure, even if she was treated with the antioxidant n-acetylcysteine. The patient's condition was stabilised by initial resuscitation with fluids, vasoactive drugs, and active rewarming. N-acetylcysteine therapy was begun promptly. This patient's liver function tests remained entirely normal in spite of the delay in presentation and she made a rapid and complete recovery. This remarkable clinical course indicates a possible role for therapeutically induced hypothermia in the management of severe paracetamol overdose, particularly in the group of patients who seek medical attention some hours after ingestion of the drug and who therefore remain at high risk, despite treatment with n-acetylcysteine.

Acetaminophen↗
PubMed1992

Antigenic heterogeneity of strains of Saccharomyces cerevisiae and Candida albicans recognised by serum antibodies from patients with Crohn's disease.

The antigenic heterogeneity of twelve strains of Saccharomyces cerevisiae and serovar A and B strains of Candida albicans was investigated by cross-absorption of serum antibodies from a patient with Crohn's disease. On the basis of common antibody absorption patterns, eleven of the yeast strains were divided into Group 1 (five S. cerevisiae), Group 2 (two C. albicans, one S. cerevisiae) and Group 3 (three S. cerevisiae). The remaining three S. cerevisiae strains (Group 4) showed unique absorption patterns. The antigenic relationship between S. cerevisiae and C. albicans was further studied by cross-absorption of sera from eight patients with Crohn's disease. This confirmed a limited degree of cross-reaction between most strains of S. cerevisiae and C. albicans, but C. albicans serovar B significantly absorbed antibodies to more S. cerevisiae strains than did C. albicans serovar A. The results demonstrate considerable antigenic heterogeneity of S. cerevisiae and suggest that the elevated serum antibody levels to S. cerevisiae found in Crohn's disease are directed against multiple antigens.

Antibodies, Fungal↗
PubMed1992

The effect of dietary yeast on the activity of stable chronic Crohn's disease.

The effect of dietary yeast on the activity of stable Crohn's disease was assessed in 19 patients. During the 1st month patients continued their usual diet (base-line period), but during the next 2 months dietary yeast was excluded except that during 1 month patients took baker's yeast capsules while for the other month they took placebo capsules. The patients' mean Pettit Crohn's disease activity index (CDAI) while taking baker's yeast (mean, 107.9; SE, 6.1) was significantly greater than during yeast exclusion (mean, 102.1; SE, 5.7; p less than 0.05). The mean of each patient's maximum CDAI during yeast exclusion (mean, 107.1; SE, 5.7) was significantly lower than those during the base-line (mean, 115.2; SE, 6.1; p less than 0.05) and baker's yeast inclusion periods (mean, 113.9; SE, 6.7; p less than 0.05). Patients with elevated yeast antibodies tended to develop a higher CDAI while receiving baker's yeast (13 of 15). These results suggest that dietary yeast may affect the activity of Crohn's disease.

Adult↗
PubMed1990

Review article: towards safer parenteral nutrition.

Central parenteral nutrition can cause serious complications, particularly in association with the feeding catheter, previously in relation to nutrient provision, and occasionally in other organ systems, notably disease of the liver and abnormalities of bone composition. Developments in catheter design, the introduction of catheter care protocols based on an understanding of the common routes of catheter infection, and the identification of factors associated with central vein thrombosis have all reduced dramatically the incidence of complications. Furthermore, problems such as catheter occlusion, catheter infection and central vein thrombosis can now be treated effectively in many patients without the loss of the feeding catheter. This review summarizes the common and important complications of parenteral feeding with emphasis on their practical prevention and management.

Catheterization↗