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Nutrition for Critically Ill Patients: How Much Is Enough? [Editorial]
Griffiths, R. D. Sun, 05 Feb 2012 13:17:11 -0800
Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial [Caring for the Critically Ill Patient]
The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice, Wheeler, Thompson, Steingrub, Hite, Moss, Morris, Dong, Rock Sun, 05 Feb 2012 13:17:12 -0800
Context The amount of enteral nutrition patients with acute lung injury need is unknown.Objective To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding.Design, Setting, and Participants The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network.Interventions Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol.Main Outcome Measures Ventilator-free days to study day 28.Results Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P < .001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, –0.1 [95% CI, –1.4 to 1.2]; P = .89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, –4.1% to 6.3%]; P = .77) compared with full feeding. There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P = .05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P < .001), and constipation (3.1% vs 2.1% of feeding days; P = .003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days.Conclusion In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.Trial Registration clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948
Photographs in Lunch Tray Compartments and Vegetable Consumption Among Children in Elementary School Cafeterias [Research Letters]
Reicks, M., Redden, J. P., Mann, T., Mykerezi, E., Vickers, Z. Wed, 01 Feb 2012 07:46:51 -0800
A Senior Primary Care Physician Trying to Take Good Care of His Patients [Clinical Crossroads]
Reynolds, E. Tue, 31 Jan 2012 12:41:23 -0800
Oral Human Papillomavirus Infection: Hazard of Intimacy [Editorial]
Schlecht, H. P. Thu, 26 Jan 2012 08:35:08 -0800
Prevalence of Oral HPV Infection in the United States, 2009-2010 [Original Contribution]
Gillison, M. L., Broutian, T., Pickard, R. K. L., Tong, Z.-y., Xiao, W., Kahle, L., Graubard, B. I., Chaturvedi, A. K. Thu, 26 Jan 2012 05:52:15 -0800
Context Human papillomavirus (HPV) infection is the principal cause of a distinct form of oropharyngeal squamous cell carcinoma that is increasing in incidence among men in the United States. However, little is known about the epidemiology of oral HPV infection.Objective To determine the prevalence of oral HPV infection in the United States.Design, Setting, and Participants A cross-sectional study was conducted as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010, a statistically representative sample of the civilian noninstitutionalized US population. Men and women aged 14 to 69 years examined at mobile examination centers were eligible. Participants (N = 5579) provided a 30-second oral rinse and gargle with mouthwash. For detection of HPV types, DNA purified from oral exfoliated cells was evaluated by polymerase chain reaction and type-specific hybridization. Demographic and behavioral data were obtained by standardized interview. Statistical analyses used NHANES sample weights to provide weighted prevalence estimates for the US population.Main Outcome Measures Prevalence of oral HPV infection.Results The prevalence of oral HPV infection among men and women aged 14 to 69 years was 6.9% (95% CI, 5.7%-8.3%) and of HPV type 16 was 1.0% (95% CI, 0.7%-1.3%). Oral HPV infection followed a bimodal pattern with respect to age, with peak prevalence among individuals aged 30 to 34 years (7.3%; 95% CI, 4.6%-11.4%) and 60 to 64 years (11.4%; 95% CI, 8.5%-15.1%). Men had a significantly higher prevalence than women for any oral HPV infection (10.1% [95% CI, 8.3%-12.3%] vs 3.6% [95% CI, 2.6%-5.0%], P < .001; unadjusted prevalence ratio [PR], 2.80 [95% CI, 2.02-3.88]). Infection was less common among those without vs those with a history of any type of sexual contact (0.9% [95% CI, 0.4%-1.8%] vs 7.5% [95% CI, 6.1%-9.1%], P < .001; PR, 8.69 [95% CI, 3.91-19.31]) and increased with number of sexual partners (P < .001 for trend) and cigarettes smoked per day (P < .001 for trend). Associations with age, sex, number of sexual partners, and current number of cigarettes smoked per day were independently associated with oral HPV infection in multivariable models.Conclusion Among men and women aged 14 to 69 years in the United States, the overall prevalence of oral HPV infection was 6.9%, and the prevalence was higher among men than among women.
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Nutrition for Critically Ill Patients: How Much Is Enough? [Editorial]
Griffiths, R. D. Sun, 05 Feb 2012 13:17:11 -0800
Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial [Caring for the Critically Ill Patient]
The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice, Wheeler, Thompson, Steingrub, Hite, Moss, Morris, Dong, Rock Sun, 05 Feb 2012 13:17:12 -0800
Context The amount of enteral nutrition patients with acute lung injury need is unknown.Objective To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding.Design, Setting, and Participants The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network.Interventions Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol.Main Outcome Measures Ventilator-free days to study day 28.Results Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P < .001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, –0.1 [95% CI, –1.4 to 1.2]; P = .89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, –4.1% to 6.3%]; P = .77) compared with full feeding. There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P = .05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P < .001), and constipation (3.1% vs 2.1% of feeding days; P = .003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days.Conclusion In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.Trial Registration clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948
Photographs in Lunch Tray Compartments and Vegetable Consumption Among Children in Elementary School Cafeterias [Research Letters]
Reicks, M., Redden, J. P., Mann, T., Mykerezi, E., Vickers, Z. Wed, 01 Feb 2012 07:46:51 -0800
A Senior Primary Care Physician Trying to Take Good Care of His Patients [Clinical Crossroads]
Reynolds, E. Tue, 31 Jan 2012 12:41:23 -0800
Oral Human Papillomavirus Infection: Hazard of Intimacy [Editorial]
Schlecht, H. P. Thu, 26 Jan 2012 08:35:08 -0800
Prevalence of Oral HPV Infection in the United States, 2009-2010 [Original Contribution]
Gillison, M. L., Broutian, T., Pickard, R. K. L., Tong, Z.-y., Xiao, W., Kahle, L., Graubard, B. I., Chaturvedi, A. K. Thu, 26 Jan 2012 05:52:15 -0800
Context Human papillomavirus (HPV) infection is the principal cause of a distinct form of oropharyngeal squamous cell carcinoma that is increasing in incidence among men in the United States. However, little is known about the epidemiology of oral HPV infection.Objective To determine the prevalence of oral HPV infection in the United States.Design, Setting, and Participants A cross-sectional study was conducted as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010, a statistically representative sample of the civilian noninstitutionalized US population. Men and women aged 14 to 69 years examined at mobile examination centers were eligible. Participants (N = 5579) provided a 30-second oral rinse and gargle with mouthwash. For detection of HPV types, DNA purified from oral exfoliated cells was evaluated by polymerase chain reaction and type-specific hybridization. Demographic and behavioral data were obtained by standardized interview. Statistical analyses used NHANES sample weights to provide weighted prevalence estimates for the US population.Main Outcome Measures Prevalence of oral HPV infection.Results The prevalence of oral HPV infection among men and women aged 14 to 69 years was 6.9% (95% CI, 5.7%-8.3%) and of HPV type 16 was 1.0% (95% CI, 0.7%-1.3%). Oral HPV infection followed a bimodal pattern with respect to age, with peak prevalence among individuals aged 30 to 34 years (7.3%; 95% CI, 4.6%-11.4%) and 60 to 64 years (11.4%; 95% CI, 8.5%-15.1%). Men had a significantly higher prevalence than women for any oral HPV infection (10.1% [95% CI, 8.3%-12.3%] vs 3.6% [95% CI, 2.6%-5.0%], P < .001; unadjusted prevalence ratio [PR], 2.80 [95% CI, 2.02-3.88]). Infection was less common among those without vs those with a history of any type of sexual contact (0.9% [95% CI, 0.4%-1.8%] vs 7.5% [95% CI, 6.1%-9.1%], P < .001; PR, 8.69 [95% CI, 3.91-19.31]) and increased with number of sexual partners (P < .001 for trend) and cigarettes smoked per day (P < .001 for trend). Associations with age, sex, number of sexual partners, and current number of cigarettes smoked per day were independently associated with oral HPV infection in multivariable models.Conclusion Among men and women aged 14 to 69 years in the United States, the overall prevalence of oral HPV infection was 6.9%, and the prevalence was higher among men than among women.
Sites:
American Board of Internal Medicine: American Board of Internal Medicine, Philadelphia PA 19106. A resource for residents and fellows in training, diplomates, and training program directors for Board Certification and Maintenance of Cetification in Internal Medicine and its subspecialties. Including information for health organizat...American Board of Medical Specialties: Umbrella organization for the 24 approved medical specialty boards in the United States.
American Society of Internal Medicine: Web site of the American College of Physicians, the leading professional organization for internal medicine. Publisher of Annals of Internal Medicine and MKSAP (Medical Knowledge Self-Assessment Program).
Doctors For Adults: Information about internists / doctors of internal medicine and common illnesses they diagnose and treat. Internists are primary care physicians and specialists that focus on adult health care.
Internal Medicine on the Web: Various online associations devoted to the improvement of medical education in the US, Canada, and Puerto Rico.
Society of General Internal Medicine: Seeking to improve patient care, education, and research in primary care and general internal medicine.
Southern Medical Association: The Southern Medical Association enables physicians to practice the highest standards of medicine by fostering professional development and economic stability through education, services, collegiality, and leadership across multiple specialties.
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