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Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.
Chia-Hui Chen, C, Yang, YT, Lai, IR, Lin, BR, Yang, CY, Huang, J, Tien, YW, Chen, CN, Lin, MT, Liang, JT, et al
Journal of the American Medical Directors Association. 2019;(5):524-529.e3
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Abstract
OBJECTIVE To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. DESIGN Cluster randomized trial. SETTING Two 36-bed GI wards at a university-affiliated medical center in Taiwan. PARTICIPANTS Older patients (≥65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay >6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1:1) by room rather than individually because most patient units are double- or triple-occupancy rooms. INTERVENTION The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. MEASURES Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. RESULTS Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P = .03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. CONCLUSION AND IMPLICATIONS The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities.
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Preoperative Statin Treatment for the Prevention of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomised Controlled Trials.
Xiong, B, Nie, D, Cao, Y, Zou, Y, Yao, Y, Qian, J, Rong, S, Huang, J
Heart, lung & circulation. 2017;(11):1200-1207
Abstract
BACKGROUND The effect of preoperative statin treatment (PST) on the risk of postoperative acute kidney injury (AKI) after cardiac surgery remains controversial. We performed a meta-analysis of randomised controlled trials (RCT) to investigate whether PST could improve the renal outcomes in patients undergoing cardiac surgery. METHODS We conducted a comprehensive search on PubMed, Embase and Cochrane Central Register of Controlled Trials. Randomised controlled trials which reported incidence of AKI and renal replacement treatment (RRT), mean change of serum creatine (SCr) and C-reactive protein (CRP), length of stay in intensive care unit (LOS-ICU) and hospital (LOS-HOS) were included. RESULTS A total of nine RCTs, covering 3,201 patients were included. Based on the results of our meta-analysis, PST could not reduce the incidence of AKI (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.97 to 1.29, p=0.37), and RRT (RR 1.13, 95% CI 0.45 to 2.85, p=0.80). Furthermore, SCr was not likely to be improved by PST (weighted mean difference (WMD) 0.03, 95% CI 0.00 to 0.06, p=0.055). However, the level of CRP (WMD -5.93, 95% CI 11.71 to 0.15, p=0.044) in patients treated with PST was significantly lower than that of patients administered with placebo. In addition, no significant difference was observed in LOS-ICU and LOS-HOS between PST and control groups. CONCLUSION Our meta-analysis suggests that PST cannot provide any benefit for improving renal complications and clinical outcomes, but may slightly reduce postoperative inflammation in patients undergoing cardiac surgery. In the future, more powerful RCTs will be needed to confirm these findings.