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At least 19 recordsLinked to original sources
PubMed2001

Cognitive therapy, nutritional therapy and their combination in the treatment of bulimia nervosa.

BACKGROUND: This study compared the effectiveness of cognitive therapy (CT), nutritional therapy (NT), the combination of cognitive and nutritional therapy (CNT), against a control condition of support group (SG) in the treatment of bulimia nervosa. METHODS: One hundred female out-patients who fulfilled DSM-III-R criteria for bulimia nervosa were randomized to the four treatment groups. NT and CT were designed to cover different areas with minimal overlap, and CNT provided all of the features of both of these treatments. The control condition was conducted in a group self-help format. Each of the treatments lasted 14 weeks. RESULTS: All three active treatments as well as SG produced significant decreases in binge/vomit episodes. Intent-to-treat analysis found CNT and CT to be significantly more effective than SG in retaining subjects in treatment and completion of study, as well as in producing greater improvements in dysfunctional attitudes and self-control. CNT was superior to SG in achieving abstinence from bulimic behaviour. NT was superior to SG only in increase of self-control. Logistic regression found that the cognitive component, whether given alone or in conjunction with NT, and higher pre-treatment self-control scores were significant predictors for both completion of study and abstinence. CONCLUSION: CT (either alone, or in combination with nutritional therapy) remains the treatment of choice for bulimia nervosa. A treatment escalation approach should be tested for the treatment of bulimia with the more intensive and less widely available CT (with or without nutritional counselling) offered after patients have failed the less intensive and more widely available support group treatment.

Adolescent↗
PubMed1999

[Revision and consensus in nutritional therapy: nutrition in inflammatory intestinal diseases].

Energy-protein malnutrition and the sub-clinical deficiencies of vitamins and trace elements, are frequent findings in ulcerative colitis and Crohn's disease, and these may negatively influence the clinical course of these diseases. In general, the majority of the patients with ulcerative colitis and uncomplicated Crohn's disease can ingest a normal diet that is well balanced and without any restrictions. The intolerance to specific foods is rare in Crohn's disease and the application of exclusion diets in a routine manner is not indicated. When the nutritional status cannot be adequately maintained with normal ingestion, the use of artificial nutrition is indicated. Enteral nutrition is the first choice nutritional support system if the gastrointestinal tract is accessible and at least partially functional. In Crohn's disease enteral nutrition could have a specific anti-inflammatory effect ("primary treatment"), and it has been suggested that this could be effective to induce the clinical remission of the activity bouts of the disease. Some types of dietary fiber could be effective in the treatment of ulcerative colitis. Initial studies suggest their usefulness in maintaining the remission of the disease.

Chronic Disease↗
PubMedDate not supplied

New interventions in diabetes with medical nutrition therapy.

Nutrition therapy has been the focus of diabetes management since before insulin was discovered.(1) Many theories and approaches have been recommended and reemerged over the years. Since the Diabetes Control and Complications Trial (DCCT) results were released in 1993, nutrition is considered the most critical and pivotal component of diabetes care in achieving blood glucose goals. We have seen increased emphases on individualized nutrition therapy and the dietitian as a true partner in diabetes care, research, and management.(1) Advances in nutrition therapy now center on methods to improve behavioral change because it is the major challenge facing people with diabetes. Access to nutrition therapy and self-management training is critical to improve clinical outcomes and reduce health care costs otherwise spent on clinic visits, expensive medications, emergency room visits, and hospitalizations.(1)

Aged↗
PubMedDate not supplied

Total nutritional therapy: a nutrition education program for physicians.

OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.

Education, Medical, Graduate↗
PubMed1984

Supportive care for children with cancer. Guidelines of the Childrens Cancer Study Group. The use of nutritional therapy.

Nutritional support for children with cancer is predicated on the belief that optimal nutrition promotes tolerance of anti-neoplastic therapy and preserves immunologic responsiveness. The use of nutritional support is based on the assumption that there is effective therapy for the primary disease and that there will be a predictable period of nutritional stress. The most common nutritional problem is posed by the failure of sick children willingly to eat enough to maintain nutritional homeostasis. Supplementation of oral intake with a nutritional formula given by a small-bore nasogastric tube is simple, effective, and economical. If the sum of oral and tolerated nasogastric tube feedings is less than that required for optimal nutrition, unmet needs may be satisfied by nutrients given into a peripheral vein. Total parenteral nutrition, given by central vein, is reserved for situations in which the combination of enteral and peripheral venous alimentation is inadequate.

Child↗
PubMedDate not supplied

Infection control during parenteral nutrition therapy.

Parenteral nutrition therapy can achieve an anabolic state in patients who are unable to maintain normal nitrogen balance; however, it may be associated with infectious complications. Infections may be related to contamination of the cannula and the cannula wound, of the infusate, or of other parts of the parenteral nutrition system. A variety of microorganisms has been associated with these infections. The exact mechanisms that initiate cannula-related infection are poorly understood. Susceptibility of the host, the method and site of cannula insertion, colonization of parenteral nutrition cannulas, use of parenteral nutrition systems for multiple purposes, cannula material, and other factors may all play some role. Controlling infections depend on many factors, including quality control processes to ensure sterility of parenteral nutrition solutions, attention to aseptic technique during cannula insertion, procedures to prevent in-use contamination, proper care of the cannula insertion site, and proper management of other parts of the parenteral nutrition system. In addition, infectious complications appear to be reduced by an organized team that follows infection control protocols. Many facets of parenteral nutrition therapy are based on data from uncontrolled clinical investigations. Well-designed, controlled clinical trials may provide data that will further minimize the risks associated with parenteral nutrition therapy.

Acinetobacter↗
PubMed1995

Combined cognitive-behavioral, psychopharmacological and nutritional therapy in eating disorders. 1. Anorexia nervosa--restricted type.

Twenty-two female patients with anorexia nervosa, restricted type, 14-35 years old, were treated with a 4-month course of combined cognitive-behavioral therapy, nutritional counselling and antidepressant drugs (nortriptyline for 7, fluoxetine for 15). Patients were monitored for body mass index (BMI), for eating disorder symptoms by the Eating Disorder Inventory (EDI) and the Bulimic Investigation Test (BITE) and for depression and anxiety by the Hamilton Rating Scales for Depression and for Anxiety (HRS-D and -A). The scores were determined before and after 1, 2 and 4 months of therapy. BMI, depression, anxiety and EDI scores improved significantly and equally in both groups during the 4 months of therapy, while BITE scores did not change.

Adolescent↗
PubMed2000

Access routes for nutritional therapy.

Enteral nutrition (EN) and total parenteral nutrition (TPN) may provide life-sustaining therapy for surgical patients. The duration of nutritional therapy (enteral or parenteral) implies distinct access routes. We review the main aspects related to access routes for nutrient delivery. The enteral route, whenever feasible, is preferred. For EN lasting less than 6 weeks, nasoenteric tubes are the route of choice. Conversely, enterostomy tubes should be used for longer-term enteral feeding and can be placed surgically or with fluoroscopic and endoscopic assistance. The first choice for patients who will not be submitted to laparotomy is percutaneous endoscopic gastrostomy. Postpyloric access, although not consensual, must be considered when there is a high risk of aspiration. For intravenous delivery of nutrients lasting less than 10 days, the peripheral route can be used. However, because of frequent infusion phlebitis, its role is still in discussion. Central venous catheters (CVCs) for TPN delivery may be (1) nonimplantable, percutaneous, nontunneled-used for a few days to 3 to 4 weeks; (2) partially implantable, percutaneous, tunneled-used for longer periods and permanent access; or (3) totally implantable subcutaneous ports-also used for long-term or permanent access. The subclavian vein is usually the insertion site of choice for central venous catheters. Implantable ports are associated with lower rates of septic complications than percutaneous CVCs. The catheter with the least number of necessary lumens should be applied. Central venous nutrient delivery can also be accomplished through peripherally inserted central catheters, which avoid insertion-related risks.

Algorithms↗
PubMed1979

Principles of nutritional therapy.

Provision of adequate nutrition makes a major contribution toward improvement of clinical, biochemical, cellular, and psychologic status of the cancer patient in the face of the disease process and the side effects of various treatments. The principles of nutrition support include the following: 1) Malnutrition induced by cancer and its treatment adversely affects the patient and complicates further treatment of the disease. 2) Malnutrition is not an obligatory response of the host to cancer. 3) A rational nutritional therapeutic program for a patient requires analysis of the factors inducing depletion in that patient. 4) Every patient should have an early and periodic assessment of nutritional status. 5) Nutrition therapy, when indicated, should be instituted early. 6) The application and effectiveness of therapeutic programs must become part of the medical audit and general clinical procedure for inpatients and outpatients. 7) The objectives of nutritional therapy are: a) supportive, b) adjunctive, and c) definitive. 8) Nutritional status, tumor growth and anti-tumor treatment are intimately related. 9) Nutritional therapy has the potential for difficulties as well as benefits. 10) The provision of optimal nutrition care requires a multidisciplinary approach with physicians, nurses, dietitians, and pharmacists working as a team with adequate laboratory facilities and administrative and financial support.

Adult↗
PubMed1998

[Nutritional therapy].

This article describes nutritional therapy for hemorrhagic gastro-intestinal diseases. The aim of this therapy is to protect and to accelerate cure of hemorrhagic lesion with rapid recovery of general condition. The accurate judgement for fluid therapy and contents, volume and timing of dietetic therapy is very difficult. However, it should always be considered, that excellent nutritional therapy influences prognosis of hemorrhagic digestive diseases to a great degree for its medication.

Diet Therapy↗
PubMed1994

[Home therapy approach in cancer patients-nutrition therapy (case 1-3)].

When nutrition therapy is necessary in a long time in care of cancer patient, we take Home parenteral nutrition (HPN) as one selection rami. We enforced it than 1987, but the home care center was established in 1993 to carry out it more smoothly. Now the center becomes the leading role, and pattern of home therapy which was suited for a patient of each in cooperation with each part in hospital place and support group of external is made, and it is enforced. Staff of the center consists of it than doctor, nurse, dietitian, apothecary, medical social worker care office workers. When HPN of each patient is enforced, the staff of field of specialty will each solve the problems that there is. When all is not possible in the center, a private being at home care support company, affiliated hospital is connected with. We detain catheter during admission to thing of approximately 1 week, and education necessary for HPN is enforced to a patient and family. An exclusive manual is used for education.

Cachexia↗
PubMed1998

Crohn's disease: nutrition and nutritional therapy.

Disordered nutrition is common in Crohn's disease and is multifactorial. Regular and systematic monitoring of at least a minimum set of nutrition data is an essential component of care of children and adults with Crohn's disease. However, even in children, monitoring of growth and development may be deficient. Multiple macro- and micronutrient deficiencies are common in Crohn's disease, especially in those with extensive small bowel deficiencies or after multiple surgical resections. Body composition analysis may show differences from simple starvation, and metabolic effects of inflammation are increasingly being recognized. Nutritional support is part of the management of all patients with Crohn's disease, but nutritional intervention with defined formula liquid diet is an effective specific anti-inflammatory therapy. Although meta-analysis of published trials suggest that steroids are more effective than defined formula liquid diets, objective evidence from whole gut lavage fluid analysis and from faecal excretion of radiolabelled leukocytes shows unequivocal benefit of elemental diet based on measuring parameters of tissue damage. Enteral feeding with liquid diets should be considered in patients with incomplete small bowel obstruction, severe painful perianal disease, failure of corticosteroids in active Crohn's disease, borderline intestinal failure and in children with active Crohn's disease or with growth failure.

Body Composition↗
PubMed2003

Successful jejunal nutrition therapy in a pregnant patient with apallic syndrome.

A 41-year-old woman was admitted in the 8th pregnancy week as a consequence of a left-sided media infarction. After alloprothetic aortic valve replacement, she had discontinued deliberately the mandatory anticoagulation treatment. Following an initial clinical stabilisation, a second insult with right-sided media total infarction occurred 3 weeks after admission. In the further course, she developed an apallic syndrome and required respirator therapy. The initial enteral nutrition therapy via naso-gastric tube, was continued via percutaneous endoscopic gastrostomy (PEG). Due to recurrent vomiting from the 24th pregnancy week, the PEG was changed into a PEG with jejunal position of the tube (JET-PEG). Via this access and simultaneous body impedance analysis (BIA) control, the further nutrition therapy could be continued uneventfully. In the 27th pregnancy week, the patient gave birth to a female newborn (birth weight: 820 g) by Caesarean section in pre-eclampsia. The foetal development was in accordance with the gestational period and uncomplicated in the further course. The mother could be released into ambulatory care where the above nutrition therapy was continued. Reports on a successful nutrition therapy of pregnant comatose patients are rare. To the best of our knowledge, this is the first case where JET-PEG and monitoring by repeated BIA measurement were used for the control of the enteral nutrition.

Adult↗