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Practice Patterns and Utilization of Tube Feedings in Acute Pancreatitis Patients at a Large US Referral Center.

ABSTRACT: OBJECTIVES:Clinical trials on tube feedings (TFs) have not been sufficiently powered to change practice patterns in acute pancreatitis (AP). We aimed to describe the use, duration, and resource utilization of TF in AP patients at an expert US center. METHODS:Of 423 AP patients prospectively enrolled at the University of Pittsburgh Medical Center from 2004 to 2014, 139 (33%) received TF. Data on TF were assessed in 100 (72%) of 139 patients with complete data available. RESULTS:Patients on TF were more likely to be male, be obese, have alcohol etiology, and have moderately severe (34% vs 19%) or severe AP (62% vs. 3%) (P < 0.05). Tube feedings were started after a median of 5 days (interquartile range, 3-8 days) from admission and were administered for a median of 39 days (interquartile range, 19-58 days). A nasojejunal route (95%) with an oligomeric formula (92%) was the preferred TF strategy. Feeding tube complications led to at least 1 endoscopic tube replacement in 42% of patients and to an unexpected health care visit in 29% of those discharged on TF (16/55 patients). CONCLUSIONS:Tube feedings form an important component in the management of patients with moderately severe and severe AP. Further studies should define the optimal utilization of TF and ways to reduce TF-related complications.

SUBMITTER: Machicado JD

PROVIDER: S-EPMC6131057 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Practice Patterns and Utilization of Tube Feedings in Acute Pancreatitis Patients at a Large US Referral Center.

Machicado Jorge D JD Gougol Amir A Paragomi Pedram P OʼKeefe Stephen J SJ Lee Kenneth K Slivka Adam A Whitcomb David C DC Yadav Dhiraj D Papachristou Georgios I GI

Pancreas 20181001 9

<h4>Objectives</h4>Clinical trials on tube feedings (TFs) have not been sufficiently powered to change practice patterns in acute pancreatitis (AP). We aimed to describe the use, duration, and resource utilization of TF in AP patients at an expert US center.<h4>Methods</h4>Of 423 AP patients prospectively enrolled at the University of Pittsburgh Medical Center from 2004 to 2014, 139 (33%) received TF. Data on TF were assessed in 100 (72%) of 139 patients with complete data available.<h4>Results< ...[more]

PMID: 30134355

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Project description:BackgroundApplying evidence-based practice during care provision is essential because it improves the quality of care, reduces health care costs, and increases patient and family satisfaction. However, information on evidence-based nursing practice and associated factors were not well studied and documented in the study area. Hence, this study aimed to assess utilization and associated factors of evidence-based practice among nurses working in Amhara Region Referral Hospitals, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from March 18 to April 16, 2019, in Amhara Region Referral Hospitals. A simple random sampling technique was used to select 684 respondents. Data were collected using a pretested and self-administered questionnaire. Data were entered into Epi Info version 7.1.2.0 and exported to SPSS version 22.0 for analysis. The bivariable analysis was used primarily and variables with p-value < 0.2 were further examined using a multivariable logistic regression model to control con-founders. Then, variables' p-value < 0.05 with 95% CI was used to determine associated factors.ResultsFrom 684 proposed nurses, 671 of them completed the questionnaire giving 98.1% response rate. Of these, 55% (95% CI: 51.2, 58.9) of them had good evidence-based practice utilization. Variables including single (AOR = 1.662: 95% CI: 1.089-2.536), fewer work experience (AOR = 1.849: 95% CI: 1.049-3.257), good knowledge (AOR = 2.044: 95% CI: 1.406-2.972), effective communication skill (AOR = 2.537: 95% CI: 1.744-3.689), EBP training (AOR = 3.224 95% CI: 1.957-5.311), internet access (AOR = 1.655: 95% CI: 1.119-2.448) and evidence-based guideline availability (AOR = 1.827: 95% CI: 1.249-2.673) were found to be predictors of evidence-based practice utilization.ConclusionsThe study revealed that evidence-based practice utilization among nurses is low. Availing evidence-based guidelines in the work area, improving facilities' internet access, and building nurses' evidence-based practice competencies through either by giving separate training or incorporating as part of the curriculum would improve its utilization.

Project description:BackgroundThe purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use.MethodsAn international cohort of subscribers of a nephrology education website http://www.nephrologynow.com was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence.Results544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes.ConclusionPhysician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.

Dataset Information

Practice Patterns and Utilization of Tube Feedings in Acute Pancreatitis Patients at a Large US Referral Center.

Publications

Practice Patterns and Utilization of Tube Feedings in Acute Pancreatitis Patients at a Large US Referral Center.

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