The pivotal role of nursing in dysphagia management.
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Have you ever swallowed a food or liquid only to have it "go down the wrong way"? If you have, then you have an idea of what it might be like to have a swallowing problem. Now multiply that experience times the more than 600 times a day that we normally swallow! Imagine how difficult it would be to deal with that on a daily basis. Approximately 6-15 million Americans are affected by dysplagia (chewing and swallowing problems). About 53-74% of nursing home residents, 14% of hospital patients and 33% of rehabilitation center patients have some form of dysphagia, which can have a dramatic impact on nutritional status.
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A management information system (MIS), including a database management system (DBMS) and a decision support system (DSS), was developed to dynamically analyze the variable nutritional content of foods grown and prepared in an Advanced Life Support System (ALSS) such as required for long-duration space missions. The DBMS was designed around the known nutritional content of a list of candidate crops and their prepared foods. The DSS was designed to determine the composition of the daily crew diet based on crop and nutritional information stored in the DBMS. Each of the selected food items was assumed to be harvested from a yet-to-be designed ALSS biomass production subsystem and further prepared in accompanying food preparation subsystems. The developed DBMS allows for the analysis of the nutrient composition of a sample 20-day diet for future Advanced Life Support missions and is able to determine the required quantities of food needed to satisfy the crew's daily consumption. In addition, based on published crop growth rates, the DBMS was able to calculate the required size of the biomass production area needed to satisfy the daily food requirements for the crew. Results from this study can be used to help design future ALSS for which the integration of various subsystems (e.g., biomass production, food preparation and consumption, and waste processing) is paramount for the success of the mission.
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Idiopathic ketotic hypoglycemia is the most frequent cause of hypoglycemia in children between 1 and 5 years of age. The symptoms and signs of hypoglycemia are often overlooked because they mimic signs of other common diseases like psychiatric disorders, migraine, gastro-enterological dysfunction, or visual disturbances. Glycemia and ketone bodies in the urine should be systematically investigated in such cases. Because hypoglycemia is a life-threatening event and can lead to severe neurological sequelae, intravenous administration of glucose is mandatory. These children respond promptly to glucose. Infants with normal growth and psychomotor development, normal physical examination who present with a first episode of symptomatic fasting hypoglycemia and elevated ketonuria, and who improve quickly after intravenous glucose administration, do not need a comprehensive metabolic and endocrine workup. Recurrence of hypoglycemic attacks can be prevented by supplying frequent snacks containing complex carbohydrates, so called "slow sugars", particularly at bed-time. Other causes of ketotic hypoglycemia are briefly presented.
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