영양집중지원팀 자문 순응도에 따른 영양상태 개선효과 비교

권지은,박애령,김순주,나현오 한국병원약사회 2017 병원약사회지 Vol.34 No.2

Purpose : The primary goal of Total parenteral nutrition(TPN) therapy is to supply the nutrients by intravenous injection to the patients who cannot get adequate nourishment by oral. TPN have an affect on the hospital days and the therapeutic effect. In Seoul St. Mary’s hospital, Nutrition support team (NST) performs consultation of nutrition state and monitoring of patients. This study evaluated the effects of NST works through the improvement of nutrition index between compliance group and non-compliance group according to consultation of NST. Methods : We collected retrospectively the data from patients at Seoul St. Mary’s hospital from September 2012 to August 2013, who received TPN therapy and consultation of NST. Patients were categorized according to the adaptation of NST’s consultation. We checked the difference of nutrition index such as total protein, albumin, transferrin, retinol binding protein, and pre-albumin between before the consultation and 14 days after the adaptation of NST. Also we collected the number of administration of albumin in order to evaluate nutrition state of patients. Results : Out of 105 patients who received NST’s consultation, 46 patients were in compliance group and 59 patients were in non-compliance group. Total protein and albumin were increased to 0.3±0.1 and 0.1±0.1 g/dL in compliance group. But there was no change in non-compliance group of 0.0±0.1 and 0.0±0.0 g/dL. These results showed statistically significant difference between compliance group and non-compliance group(P 0.05). In compliance group the average of patient’s serum transferrin, retinol binding protein and pre-albumin were increased to 14.0±7.0, 1.0±0.2 and 3.2±0.7 mg/dL, respectively. In non-compliance group the average of patient’s serum transferrin, retinol binding protein and pre-albumin were decreased to 2.2±3.8, 0.2±0.2 and, 1.7±0.9 mg/dL, respectively. Also these results showed statistically significant difference between compliance group and non-compliance group(P 0.05). The number of administration of albumin was 0.7±1.1 and 1.5±2.5 in compliance group and non-compliance group, respectively(P 0.05). Conclusion : In conclusion, this study suggests that NST’s consultation may give the result for the effective increase of nutrition lab. Therefore the continuing expansion of NST activity can improve the patient’s nutrition state. In order to provide appropriate nutritional management, it is necessary to improve the recognition of medical team for the nutrition support.

영양집중지원팀의 업무개선 활동의 효과 평가

최인,김광준,문홍섭,이원재 한국병원약사회 2011 병원약사회지 Vol.28 No.4

Many studies have shown that malnourished patients face increased risks of complications and prolonged hospital visits compared with subjects who are not malnourished. Therefore, it is essential to support adequate nutrition delivery to malnourished patients. A Nutritional Support Team(NST) can identify malnourished patients and support adequate nutrition solutions. NSTs are multi-disciplinary networks that include a patient’s physician, pharmacist,dietitian, and nurse. Our team devised an improvement activity plan to enhance the Nutritional Support Team at Chosun University Hospital from January to September 2011. To investigate the effect of our efforts, we retrospectively surveyed the electronic medical records of patients consulted by the Chosun NST. These patients experienced an increase in calories administered and improved overall nutritional health. Improved delivery operations from the Chosun NST remain to be devised to address unsatisfactory results for consulted patients from the Intensive Care and Newborn Units.

중환자실 재원 소아환자의 영양집중지원팀 자문 순응도에 따른 영양공급 중재 효과

박수진 ( Soo-jin Park ),박지은 ( Ji-eun Park ),권나영 ( Na-young Kwon ),김재송 ( Jae-song Kim ),손은선 ( Eun-sun Son ),유현지 ( Hyun-ji Yu ),방제연 ( Jae-yeon Bang ),김승 ( Seung Kim ),은호선 ( Ho-seon Eun ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.2

Purpose: This study performed a comparative evaluation of nutritional condition’s improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients. Methods: The medical records of 64 critically ill pediatric patients (2 to 18 years old), who were officially referred to a NST consultant in pediatric intensive care unit from January to August 2015, were reviewed. The patients were divided into 2 groups according to the compliance of NST consultation answers. The total delivered/required caloric and protein ratio, weight, serum total protein, serum albumin, hemoglobin, and hematocrit were compared. Results: According to the NST consultation answer, ‘nutrition support increase’ occupied the largest proportion at 38.5%; ‘maintenance’ and ‘decrease’ accounted for 35.7% and 18.2% respectively. The NST compliance group and non-compliance group were 20 and 14 patients, respectively. Although total delivered/required caloric ratio was significantly increased in the NST compliance group (19.7%, P=0.036), there was no significant difference in the NST non-compliance group (5.1%, P=0.692). The total delivered/required protein ratio was increased (15.1%, P=0.163) in the NST compliance group and decreased (-4.7%, P=0.774) in the NST non-compliance group. The NST non-compliance group (-8.6%, P=0.219) was further reduced weight than the NST compliance group (-1.0%, P=0.820). The serum albumin was significantly increased in the NST compliance group (13.1%, P=0.003), but there was no difference in the NST non-compliance group (7.1%, P=0.433). Conclusion: Although 56.7% of NST consultations were needed for nutritional interventions, a lower NST compliance (53.8%) is the limit of nutritional support. The NST compliance group was supplied adequately with more calories and protein than before consultation and a more improved nutritional status. Therefore, aggressive NST consultation can help increase the therapeutic effect by improving the nutritional status. This study will form the basis to seek ways to further enhance NST compliance.

How to Manage the Pediatric Nutritional Support Team: Updates

Yang, Hye Ran The Korean Society of Pediatric Gastroenterology 2012 Pediatric gastroenterology, hepatology & nutrition Vol.15 No.2

Pediatric patients in hospital are at risk of malnutrition at admission and even during their hospitalization. Although the concept of nutritional support team (NST) was introduced to hospitals for optimal nutritional care since 1960s and the benefits of pediatric NST have been proven by many studies and reports in terms of patient clinical outcome and cost saving, the pediatric NST is not widespread yet. The pediatric NST composed of pediatricians, dieticians, pharmacist, and nutrition support nurses as core members dedicated to nutritional care in children should be independent of central NST or other disciplines, but closely cooperate with other teams in hospitals. There is no doubt that a multidisciplinary NST is an effective way to provide appropriate nutritional support to an individual patient. Therefore, the implementation of the pediatric NST in hospitals should be recommended to provide optimum nutritional support including enteral tube feeding and parenteral nutrition and to assess pediatric patients at risk of malnutrition.

How to Manage the Pediatric Nutritional Support Team: Updates

양혜란 대한소아소화기영양학회 2012 Pediatric gastroenterology, hepatology & nutrition Vol.15 No.2

Pediatric patients in hospital are at risk of malnutrition at admission and even during their hospitalization. Although the concept of nutritional support team (NST) was introduced to hospitals for optimal nutritional care since 1960s and the benefits of pediatric NST have been proven by many studies and reports in terms of patient clinical outcome and cost saving, the pediatric NST is not widespread yet. The pediatric NST composed of pediatricians, dieticians, pharmacist, and nutrition support nurses as core members dedicated to nutritional care in children should be independent of central NST or other disciplines, but closely cooperate with other teams in hospitals. There is no doubt that a multidisciplinary NST is an effective way to provide appropriate nutritional support to an individual patient. Therefore, the implementation of the pediatric NST in hospitals should be recommended to provide optimum nutritional support including enteral tube feeding and parenteral nutrition and to assess pediatric patients at risk of malnutrition.

한 병원의 재가 정맥영양요법 (HPN) 평가

권지은,김고은,박애령,김순주,나현오 한국병원약사회 2012 病院藥師會誌 Vol.29 No.3

Home parenteral nutrition (HPN) is the administration of necessary nutrients into the intestine, stomach, or by intravenous infusion to improve or to maintain a patient’s nutritional status in the home care environment. In foreign countries, HPN is used on a regular basis, however in Korea, HPN is in the beginning stages of being adopted. There is no specific management. In 1995, HPN was first used at St. Mary’s hospital in Seoul for nutritional support of patients with chronic intestinal failure (CIF). Since 1998, the nutrition support team (NST) has been leading this system in connection with home care team. The purpose of this study was to improve the management of HPN and to make up for the weak points in pharmacist activities in NST. On a retrospective basis, clinical information was collected from the case records of patients receiving HPN treatment at Seoul St. Mary’s hospital until October 2010. Furthermore, we made a comparative study of HPN management guidelines between Seoul St. Mary’s hospital and the American Society of Parenteral and Enteral Nutrition (ASPEN). In addition, we conducted a survey of patients receiving HPN on satisfaction in management and education. By October 2010, the total number of patients being treated with HPN was 10, 4 for ‘small bowel obstruction’(SBO) and 3 for ‘small bowel syndrome’and administration period of HPN varied from the minimum of 15 months to the maximum of 13 years. Infection of the central venous catheter (mean 1.4 cases/year/person) and dehydration (mean 1.7 cases/year/person) were reported as the major side effects. As the result of the survey, the patients expressed above average satisfaction with administration management and education on HPN, while there were some difficulties with adverse events (n=3) and storage problems (n=2). More active involvement by the pharmacist should be encouraged for better care of these patients through monitoring of their HPN supply, HPN-related side effects, and ongoing patient education. Furthermore, multilateral supports should be provided to promote successful HPN use by establishing definitive standard criteria in medical insurance and, continuing patient education in Korea, as occurs in other countries.

의료진의 병원영양관리에 대한 인식조사

류은순,엄영람,이송미 대한영양사협회 1998 대한영양사협회 학술지 Vol.4 No.1

This study was undertaken to identify medical staffs' perception about nutrition care and dietitian' s role in hospitals. Questionnaires were sent to 874 medical staffs at 50 general hospials size over 100 beds, located in Seoul and Pusan. A total of 649(74.3%) of medical staffs returned questionnaries from 47 general hospitals. The results of this study can be summarized as follows. 1. 89.6% of medical staffs responded that they required the help of the dietitian when the patients needed the nutrition care and also most of them (87.0%) held positive perceptions about the necessity of the nutrition support team. 2. When the medical staffs prescribed the special diet of the patients' nutrition care, 90.0% of them preferred that diet would be order after consulting with dietitian. 3. Half of the medical staffs(52.1%) responded that they were scarced of the knowledge about the clinical nutrition and then 66.4% of them recognized the need of nutrition education at the medical school. 4. The medical staffs responded that dietitian must have the knowledge about food, nutrition and medical science(52.5%) and the competence of discussion with medical staffs about nutrition care of the patients(30.8%).

정맥 영양을 시행한 위장관암 수술 환자에서 영양집중지원팀의 중재 효과

이현정 ( Hyun Jung Lee ),김정태 ( Jung Tae Kim ),이병구 ( Byung Koo Lee ) 한국정맥경장영양학회 2014 한국정맥경장영양학회지 Vol.6 No.2

Purpose: Cancer patients are frequently malnourished, and malnutrition can increase morbidity and mortality. Postoperative malnutrition can cause poor wound healing and failure of the immune response. Administration of parenteral nutrition (PN) after surgery may decrease complication and hospital length of stay. Intervention of a Nutrition Support Team (NST) improves patient outcomes through nutritional assessment and proper nutrition support. In this study we investigated effects of NST intervention with PN on gastrointestinal cancer patients who underwent surgery. Methods: This retrospective study was conducted at Kyung Hee University Hospital at Gangdong from 2012 January to 2013 December. This study reviewed gastrointestinal cancer patients who were administered PN for more than seven days. The patients were divided into two groups: NST group versus non-NST group. Results: In this study, 53 patients with malnutrition were administered PN for more than seven days. Nutrition support between the NST group and non-NST group was not statistically significant, except multivitamin and trace element. Changes in nutritional index were not statistically significant. No difference in incidence of complication,monitoring performance rate was observed between the two groups. Conclusion: Due to a small number of patients and lack of severity of disease in this study, no significant difference in improvement of nutritional index was observed between the NST group and non-NST group. For safe and effective PN, conduct of additional study is necessary in order to determine the effects of NST.

Home Total Parenteral Nutrition의 활성화 전략

김귀숙 ( Kwi Suk Kim ) 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Since the 1970s, introduction of home parenteral nutrition (HPN) has been possible for patients with gastrointestinal tract malfunction and is a more cost-effective treatment at home than in a hospital or a skilled nursing facility. It has allowed for enhancement of the quality of life and avoidance of repeated hospitalizations and long-term hospitalization. In determining the target subject of HPN, its benefit is evaluated. Management of the environment should be evaluated. If an HPN subject is determined, he is prepare to receive the central venous catheter and the HPN regimen is determined. In addition, education of patients and caregivers on the complications associated with HPN is very important. Regular monitoring of the stability of HPN should be conducted. HPN must be activated in order to increase the patient`s quality of life and to reduce the national medical costs, however, there are several limiting factors for HPN expansion. It may be summerized in five points. 1) Home Nutrition Support Team configuration, 2) Patient education guidelines, 3) System for delivery of HPN, 4) The preparation connection system of HPN between the Korean Society for Parenteral and Enteral Nutrition members, 5) Outsourcing of HPN. Efforts of the Nutrition Support Team and national support are needed in order to resolve the limitations. (J Korean Soc Parenter Enter Nutr 2013;5(3):96-101)

영양지원팀의 임상적 적용 방법

김은영 ( Eun Young Kim ),김주미 ( Ju Mee Kim ),김미형 ( Mi Hyung Kim ),권택수 ( Taek Su Kwon ),이혜승 ( Hye Seung Lee ),목희정 ( Hee Jung Mok ),홍정임 ( Jeong Im Hong ),김혜진 ( Hye Jin Kim ),김현경 ( Hyun Kyung Kim ),정성진 ( Sun 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Purpose: Most hospitals have been reply to the consultation if the needed departments consult with the Nutritional Support Team (NST) for patient evaluation and management. However, as a common occurrence, some people requiring treatment cannot receive care due to lack of cognition of nutritional support and lack of resources for assessment of nutritional status. Methods: We provide an indication for screening of patients and for active nutritional support. Indications include symptoms that reflect the conditions of increasing nutritional requirement and decreasing nutritional supply. Two surgical wards and surgical intensive care unit were included and nursing teams recommended patients to the NST by interviewing inpatients if they met the indications. Results: We included 60 patients referred to the NST before applying for screening, from January 2005 to January 2009 and 44 patients selected for only five months by the NST after applying for screening. The number of consultations showed a slow decrease, 27 in 2005, 23 in 2006 to 10 in 2007, before applying for screening, but increased significantly to 44 for only five months after applying for screening. While the number of departments applying to the NST was five departments in 2005, six departments in 2006, and two departments in 2007, it increased significantly to eight departments. After applying for screening, the most common cause was ‘artificial nutrition longer than five days’ in 48.1%; the second cause was ‘poor nutrition status’ in 13.5%, and the third was ‘significant weight loss’ or ‘gastrointestinal function change’ in 8%. Moderate risk patients showed improvement and shifted to minor risk patients and normal patients. The rate of improvement was approximately 47.7%. Conclusion: The screening tools should be simple, as well as easy to use. Therefore, using this tool, we must actively select patients with poor nutrition and apply the screening tools rapidly. (J Korean Soc Parenter Enter Nutr 2013;5(3):117-121)