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  • Harrison's Internal Medicine Part 4. Nutrition Chapter 73. Enteral and Parenteral Nutrition Therapy Enteral and Parenteral Nutrition Therapy: Introduction The ability to provide specialized nutritional support (SNS) represents a major advance in medical therapy.

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  • Table 73-10 Enteral Formulas Composition Characteristics Clinical Indications STANDARD ENTERAL FORMULA 1. Complete dietary products (+)a Suitable for most patients requiring tube feeding; some can be a. Caloric density 1 kcal/mL used orally b. Protein ~14% cals, caseinates, soy, lactalbumin c. CHO ~60% cals, hydrolyzed corn starch, maltodextrin, sucrose d. Fat ~30% cals, corn, soy, safflower oils e. Recommended daily intake of all minerals and vitamins in 1500 kcal/d f. Osmolality (mosmol/kg): ~300 MODIFIED ENTERAL FORMULAS 1. Caloric density 1.

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  • Although PN was initially relatively expensive, its components are often less expensive than specialty enteral formulas. Percutaneous placement of a central venous catheter into the subclavian or internal jugular vein with advancement into the superior vena cava can be accomplished at the bedside by trained personnel using sterile techniques. Peripherally inserted central catheters can also be placed within the lumen in the central vein, but this technique is usually more appropriate for non-ICU patients.

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  • Protein or Amino Acid Requirements Although the recommended dietary allowance for protein is 0.8 g/kg per d, maximal rates of repletion occur with 1.5 g/kg in the malnourished. In the severely catabolic patient, this higher level minimizes protein loss. In patients requiring SNS in the acute care setting, at least 1 g/kg is recommended, with greater amounts up to 1.5 g/kg as volume, renal, and hepatic tolerances allow. The standard parenteral and enteral formulas contain protein of high biologic value and meet the requirements for the eight essential amino acids.

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  • Diarrhea Enteral feeding often leads to diarrhea, especially if bowel function is compromised by disease or drugs, particularly broad-spectrum antibiotics. Diarrhea may be controlled by the use of a continuous drip, with a fiber-containing formula, or by adding an antidiarrheal agent to the formula. However, Clostridium difficile, which is a common cause of diarrhea in patients being tube fed, should be ruled out before using antidiarrheal agents. H2 blockers may also assist in reducing the net fluid presented to the colon.

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  • Having opened SPSS you will get a dialogue box which you can cancel the first time you enter SPSS. Enlarge the window. SPSS is like a spreadsheet but it does not update calculations, tables or charts if you change the data. At the top of the screen are a series of menus which can be used to instruct SPSS to do something. SPSS uses 2 windows: The Data Editor, which is what you are looking at and which has 2 tabs at the bottom, and the Viewer. The Viewer is not visible yet, but opens automatically as soon as you open a file or run...

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  • Having opened SPSS you will get a dialogue box which you can cancel the first time you enter SPSS. Enlarge the window. SPSS is like a spreadsheet but it does not update calculations, tables or charts if you change the data. At the top of the screen are a series of menus which can be used to instruct SPSS to do something.

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  • So far in this manual we have learned a lot. You should now know how to enter data into a table, create different types of database objects, use templates, and get the tables of data to look the way you want. In this section we will learn more about the other major types of database objects like forms, reports, and queries.

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  • Consider a system with a single degree of freedom and assume that the equation expressing its dynamic equilibrium is a second order ordinary differential equation (ODE) in the generalized coordinate x.

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  • Mời các bạn tham khảo bài giảng Bệnh dịch tả vịt (Duck plague, Duck virus enteritis, Pestis anatum) sau đây để nắm bắt những kiến thức về lịch sử và địa dư bệnh; căn bệnh; truyền nhiễm học; triệu chứng; bệnh tích; cách điều trị; phòng bệnh dịch tả vịt.

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  • This book is about using Microsoft Excel to analyze your data. Microsoft Excel is an electronic worksheet you can use to maintain lists; perform mathematical, financial, and statistical calculations; create charts; analyze your data with a PivotTable; and much more. Excel can help you locate data, find trends in your data, and present your data to others. Each Excel file is a workbook. Each workbook can have multiple worksheets. Worksheets are made up of rows and columns of cells you use to enter information....

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  • Trace Mineral Intake Zinc 2.5–4 mg/d, an additional 10–15 mg/d per L of stool or ileostomy output Copper 0.5–1.5 mg/d, possibility of retention in biliary tract obstruction Manganese 0.1–0.

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  • Decision-making for the implementation of specialized nutrition support (SNS). CVC, central venous catheter; PICC, peripherally inserted central catheter. (Adapted from previous chapter by Lyn Howard, MD.) The first step in deciding to administer SNS is to consider the nutritional implications of the disease process. Is the condition or its treatment likely to impair food intake and absorption for a prolonged period of time? For example, a well-nourished individual can tolerate approximately 7 days of starvation while experiencing a systemic response to inflammation (SRI).

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  • Efficacy of SNS in Different Disease States Efficacy studies have shown that malnourished patients undergoing major thoracoabdominal surgery benefit from SNS. Critical illness requiring ICU care including major burns, major trauma, severe sepsis, closed head injury, and severe pancreatitis [positive CT scan and Acute Physiology and Chronic Health Evaluation II (APACHE II) 10] all benefit by early SNS, as indicated by reduced mortality and morbidity. In critical illness, initiation of SNS within 24 h of injury or ICU admission is associated with a ~50% reduction in mortality.

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  • Disease-Specific Nutritional Support SNS is basically a support therapy and is primary therapy only for the treatment or prevention of malnutrition. Certain conditions require modification of nutritional support because of organ or system impairment. For instance, in nitrogen accumulation disorders, protein intake may need to be reduced. However, in renal disease, except for brief periods of several days, protein intakes should approach requirement levels of at least 0.8 g/kg or higher up to 1.2 g/kg as long as the blood urea nitrogen does not exceed 100 mg/dL.

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Parenteral versus enteral nutrition: effect on serum cytokines and the hepatic expression of mRNA of suppressor of cytokine signaling proteins, insulin-like growth factor-1 and the growth hormone receptor in rodent sepsis...

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Analysis of the vp2 gene sequence of a new mutated mink enteritis parvovirus strain in PR China

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Expression and intracellular localization of duck enteritis virus pUL38 protein

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  • By entering the East Asian economic model (EAEM) in the 1950s, the Thai economy was committed to the export-oriented, import-substituting low labour-cost manufacturing paradigm that Vietnam and Cambodia have more recently embraced. The EAEM provides for some success in expanding employment in the manufacturing sector and promoting income generation for its workers and, overall, in promoting national economic development.

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