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Zeno Stanga
Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

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Study protocol
Published: 16 March 2021 in Trials
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Background Disease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization. Discussion To our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question. Trial registration ClinicalTrials.gov NCT03761680. Registered on 3 December 2018. Kofam.ch SNCTP000003191. Registered on 15 October 2018

ACS Style

Silvia Kurmann; Emilie Reber; Maria F. Vasiloglou; Philipp Schuetz; Andreas W. Schoenenberger; Katja Uhlmann; Anna-Barbara Sterchi; Zeno Stanga. Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial. Trials 2021, 22, 1 -11.

AMA Style

Silvia Kurmann, Emilie Reber, Maria F. Vasiloglou, Philipp Schuetz, Andreas W. Schoenenberger, Katja Uhlmann, Anna-Barbara Sterchi, Zeno Stanga. Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial. Trials. 2021; 22 (1):1-11.

Chicago/Turabian Style

Silvia Kurmann; Emilie Reber; Maria F. Vasiloglou; Philipp Schuetz; Andreas W. Schoenenberger; Katja Uhlmann; Anna-Barbara Sterchi; Zeno Stanga. 2021. "Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial." Trials 22, no. 1: 1-11.

Journal article
Published: 24 July 2020 in Nutrients
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Accurate dietary assessment is crucial for both the prevention and treatment of nutrition-related diseases. Since mobile-based dietary assessment solutions are promising, we sought to examine the acceptability of ″Nutrition and Diet″ (ND) apps by Healthcare Professionals (HCP), explore their preferences on apps′ features and identify predictors of acceptance. A 23 question survey was developed by an interdisciplinary team and pilot-tested. The survey was completed by 1001 HCP from 73 countries and 6 continents. The HCP (dietitians: 833, doctors: 75, nurses: 62, other: 31/females: 847, males: 150, neither: 4) had a mean age (SD) of 34.4 (10.2) years and mean job experience in years (SD): 7.7 (8.2). There were 45.5% who have recommended ND apps to their clients/patients. Of those who have not yet recommended an app, 22.5% do not know of their existence. Important criteria for selecting an app were ease of use (87.1%), apps being free of charge (72.6%) and validated (69%). Significant barriers were the use of inaccurate food composition database (52%), lack of local food composition database support (48.2%) and tech-savviness (43.3%). Although the adoption of smartphones is growing and mobile health research is advancing, there is room for improvement in the recommendation of ND apps by HCP.

ACS Style

Maria F. Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey. Nutrients 2020, 12, 2214 .

AMA Style

Maria F. Vasiloglou, Stergios Christodoulidis, Emilie Reber, Thomai Stathopoulou, Ya Lu, Zeno Stanga, Stavroula Mougiakakou. What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey. Nutrients. 2020; 12 (8):2214.

Chicago/Turabian Style

Maria F. Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. 2020. "What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey." Nutrients 12, no. 8: 2214.

Editorial
Published: 20 December 2019 in Journal of Clinical Medicine
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Access to adequate food is a fundamental human right

ACS Style

Philipp Schuetz; Zeno Stanga. Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing! Journal of Clinical Medicine 2019, 9, 27 .

AMA Style

Philipp Schuetz, Zeno Stanga. Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing! Journal of Clinical Medicine. 2019; 9 (1):27.

Chicago/Turabian Style

Philipp Schuetz; Zeno Stanga. 2019. "Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing!" Journal of Clinical Medicine 9, no. 1: 27.

Review
Published: 13 December 2019 in Journal of Clinical Medicine
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Refeeding syndrome (RFS) is the metabolic response to the switch from starvation to a fed state in the initial phase of nutritional therapy in patients who are severely malnourished or metabolically stressed due to severe illness. It is characterized by increased serum glucose, electrolyte disturbances (particularly hypophosphatemia, hypokalemia, and hypomagnesemia), vitamin depletion (especially vitamin B1 thiamine), fluid imbalance, and salt retention, with resulting impaired organ function and cardiac arrhythmias. The awareness of the medical and nursing staff is often too low in clinical practice, leading to under-diagnosis of this complication, which often has an unspecific clinical presentation. This review provides important insights into the RFS, practical recommendations for the management of RFS in the medical inpatient population (excluding eating disorders) based on consensus opinion and on current evidence from clinical studies, including risk stratification, prevention, diagnosis, and management and monitoring of nutritional and fluid therapy.

ACS Style

Emilie Reber; Natalie Friedli; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. Management of Refeeding Syndrome in Medical Inpatients. Journal of Clinical Medicine 2019, 8, 2202 .

AMA Style

Emilie Reber, Natalie Friedli, Maria F. Vasiloglou, Philipp Schuetz, Zeno Stanga. Management of Refeeding Syndrome in Medical Inpatients. Journal of Clinical Medicine. 2019; 8 (12):2202.

Chicago/Turabian Style

Emilie Reber; Natalie Friedli; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. 2019. "Management of Refeeding Syndrome in Medical Inpatients." Journal of Clinical Medicine 8, no. 12: 2202.

Review
Published: 19 November 2019 in Journal of Clinical Medicine
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Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital and home setting. EN is administered via nasogastric tube or ostomies while PN usually requires a central venous access for administration, straight into the blood stream. The infused nutrients can then be taken up directly by the different organs. PN is targeted as a single daily portion formulated as an oil-in-water emulsion providing the necessary substrates for the catabolic and anabolic metabolism including macro- and micronutrients and fluids. PN has a complex pharmaceutical composition—all-in-one admixture—and its compounding or ready-to-use preparation. The use of PN is more challenging and more expensive compare to the use of EN, commercially available as ready-to-use formulations. EN and concomitant medication is highly challenging. Upon incorrect handling and administration, PN is associated with potentially severe or even fatal complications, mostly relating to the central venous access (e.g., catheter-related sepsis) or to a metabolic intolerance (e.g., hyperglycemia, refeeding syndrome) because of inappropriate administration. A correct order of admixing, correct dosing, and administration of the artificial is crucial for safety and efficacy; clinical and biochemical monitoring of the patient and treatment regimen adaption are necessary. The high number of reactive solutes allow only limited stability of a ready-to-use PN admixture. The potential for numerous incompatibilities and interactions renders PN admixtures generally unsuitable as drug vehicle. Laboratory compatibility and stability testing and pharmaceutical expertise are a prerequisite to define the PN composition including nutrients or even drugs admixed to define the appropriate and individualized nutrition and medication regimen. The aim of this narrative review is to present the actual state-of-the-art to deliver best quality artificial nutrition with special regard on pharmaceutical aspects such as instabilities, incompatibilities, and concomitant co-medication.

ACS Style

Emilie Reber; Markus Messerli; Zeno Stanga; Stefan Mühlebach. Pharmaceutical Aspects of Artificial Nutrition. Journal of Clinical Medicine 2019, 8, 2017 .

AMA Style

Emilie Reber, Markus Messerli, Zeno Stanga, Stefan Mühlebach. Pharmaceutical Aspects of Artificial Nutrition. Journal of Clinical Medicine. 2019; 8 (11):2017.

Chicago/Turabian Style

Emilie Reber; Markus Messerli; Zeno Stanga; Stefan Mühlebach. 2019. "Pharmaceutical Aspects of Artificial Nutrition." Journal of Clinical Medicine 8, no. 11: 2017.

Review
Published: 08 November 2019 in Journal of Clinical Medicine
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Swallowing difficulties, also called dysphagia, can have various causes and may occur at many points in the swallowing process. The treatment and rehabilitation of dysphagia represent a major interdisciplinary and multiprofessional challenge. In dysphagic patients, dehydration is frequent and often accelerated as a result of limited fluid intake. This condition results from loss of water from the intracellular space, disturbing the normal levels of electrolytes and fluid interfering with metabolic processes and body functions. Dehydration is associated with increased morbidity and mortality rates. Dysphagic patients at risk of dehydration thus require close monitoring of their hydration state, and existing imbalances should be addressed quickly. This review gives an overview on dehydration, as well as its pathophysiology, risk factors, and clinical signs/symptoms in general. Available management strategies of dehydration are presented for oral, enteral, and parenteral fluid replacement.

ACS Style

Emilie Reber; Filomena Gomes; Ilka A. Dähn; Maria F. Vasiloglou; Zeno Stanga. Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of Clinical Medicine 2019, 8, 1923 .

AMA Style

Emilie Reber, Filomena Gomes, Ilka A. Dähn, Maria F. Vasiloglou, Zeno Stanga. Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of Clinical Medicine. 2019; 8 (11):1923.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Ilka A. Dähn; Maria F. Vasiloglou; Zeno Stanga. 2019. "Management of Dehydration in Patients Suffering Swallowing Difficulties." Journal of Clinical Medicine 8, no. 11: 1923.

Review
Published: 22 August 2019 in Journal of Clinical Medicine
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Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients' quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient's individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.

ACS Style

Emilie Reber; Rachel Strahm; Lia Bally; Philipp Schuetz; Zeno Stanga. Efficacy and Efficiency of Nutritional Support Teams. Journal of Clinical Medicine 2019, 8, 1281 .

AMA Style

Emilie Reber, Rachel Strahm, Lia Bally, Philipp Schuetz, Zeno Stanga. Efficacy and Efficiency of Nutritional Support Teams. Journal of Clinical Medicine. 2019; 8 (9):1281.

Chicago/Turabian Style

Emilie Reber; Rachel Strahm; Lia Bally; Philipp Schuetz; Zeno Stanga. 2019. "Efficacy and Efficiency of Nutritional Support Teams." Journal of Clinical Medicine 8, no. 9: 1281.

Review
Published: 30 July 2019 in Journal of Clinical Medicine
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Malnutrition is a common condition in hospitalized patients that is often underdiagnosed and undertreated. Hospital malnutrition has multifactorial causes and is associated with negative clinical and economic outcomes. There is now growing evidence from clinical trials for the efficiency and efficacy of nutritional support in the medical inpatient population. Since many medical inpatients at nutritional risk or malnourished are polymorbid (i.e., suffer from multiple comorbidities), this makes the provision of adequate nutritional support a challenging task, given that most of the clinical nutrition guidelines are dedicated to single diseases. This review summarizes the current level of evidence for nutritional support in not critically ill polymorbid medical inpatients.

ACS Style

Emilie Reber; Filomena Gomes; Lia Bally; Philipp Schuetz; Zeno Stanga. Nutritional Management of Medical Inpatients. Journal of Clinical Medicine 2019, 8, 1130 .

AMA Style

Emilie Reber, Filomena Gomes, Lia Bally, Philipp Schuetz, Zeno Stanga. Nutritional Management of Medical Inpatients. Journal of Clinical Medicine. 2019; 8 (8):1130.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Lia Bally; Philipp Schuetz; Zeno Stanga. 2019. "Nutritional Management of Medical Inpatients." Journal of Clinical Medicine 8, no. 8: 1130.

Review
Published: 20 July 2019 in Journal of Clinical Medicine
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Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

ACS Style

Emilie Reber; Filomena Gomes; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. Nutritional Risk Screening and Assessment. Journal of Clinical Medicine 2019, 8, 1065 .

AMA Style

Emilie Reber, Filomena Gomes, Maria F. Vasiloglou, Philipp Schuetz, Zeno Stanga. Nutritional Risk Screening and Assessment. Journal of Clinical Medicine. 2019; 8 (7):1065.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. 2019. "Nutritional Risk Screening and Assessment." Journal of Clinical Medicine 8, no. 7: 1065.

Journal article
Published: 10 July 2019 in Journal of Clinical Medicine
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Disease-related malnutrition (DRM) is a highly prevalent independent risk and cost factor with significant influence on mortality, morbidity, length of hospital stay (LOS), functional impairment and quality of life. The aim of our research was to estimate the economic impact of the introduction of routinely performed nutritional screening (NS) in a tertiary hospital, with subsequent nutritional interventions (NI) in patients with potential or manifest DRM. Economic impact analysis of natural detection of inpatients at risk and estimation of the change in economic activity after the implementation of a systematic NS were performed. The reference population for natural detection of DRM is about 20,000 inpatients per year. Based on current data, DRM prevalence is estimated at 20%, so 4000 patients with potential and manifest DRM should be detected. The NI costs were estimated at CHF 0.693 million, with savings of CHF 1.582 million (LOS reduction) and CHF 0.806 million in additional revenue (SwissDRG system). Thus, the introduction of routine NS generates additional costs of CHF 1.181 million that are compensated by additional savings of CHF 2.043 million and an excess in additional revenue of CHF 2.071 million. NS with subsequent adequate nutritional intervention shows an economic potential for hospitals.

ACS Style

Emilie Reber; Kristina Norman; Olga Endrich; Philipp Schuetz; Andreas Frei; Zeno Stanga. Economic Challenges in Nutritional Management. Journal of Clinical Medicine 2019, 8, 1005 .

AMA Style

Emilie Reber, Kristina Norman, Olga Endrich, Philipp Schuetz, Andreas Frei, Zeno Stanga. Economic Challenges in Nutritional Management. Journal of Clinical Medicine. 2019; 8 (7):1005.

Chicago/Turabian Style

Emilie Reber; Kristina Norman; Olga Endrich; Philipp Schuetz; Andreas Frei; Zeno Stanga. 2019. "Economic Challenges in Nutritional Management." Journal of Clinical Medicine 8, no. 7: 1005.

Review
Published: 28 June 2019 in Journal of Clinical Medicine
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Hyperglycemia is a common occurrence in hospitalized patients receiving parenteral and/or enteral nutrition. Although there are several approaches to manage hyperglycemia, there is no consensus on the best practice. We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov to identify records (published or registered between April 1999 and April 2019) investigating strategies to manage glucose control in adults receiving parenteral and/or enteral nutrition whilst hospitalized in noncritical care units. A total of 15 completed studies comprising 1170 patients were identified, of which 11 were clinical trials and four observational studies. Diabetes management strategies entailed adaptations of nutritional regimens in four studies, while the remainder assessed different insulin regimens and administration routes. Diabetes-specific nutritional regimens that reduced glycemic excursions, as well as algorithm-driven insulin delivery approaches that allowed for flexible glucose-responsive insulin dosing, were both effective in improving glycemic control. However, the assessed studies were, in general, of limited quality, and we see a clear need for future rigorous studies to establish standards of care for patients with hyperglycemia receiving nutrition support.

ACS Style

Céline Isabelle Laesser; Paul Cumming; Emilie Reber; Zeno Stanga; Taulant Muka; Lia Bally. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. Journal of Clinical Medicine 2019, 8, 935 .

AMA Style

Céline Isabelle Laesser, Paul Cumming, Emilie Reber, Zeno Stanga, Taulant Muka, Lia Bally. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. Journal of Clinical Medicine. 2019; 8 (7):935.

Chicago/Turabian Style

Céline Isabelle Laesser; Paul Cumming; Emilie Reber; Zeno Stanga; Taulant Muka; Lia Bally. 2019. "Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review." Journal of Clinical Medicine 8, no. 7: 935.

Controlled clinical trial
Published: 31 May 2019 in Journal of Otolaryngology - Head & Neck Surgery
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Patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma are at high risk of postoperative complications due to the adverse effects of radiotherapy on wound healing. Malnutrition is an additional risk factor and we tested the hypothesis that preoperative administration of immunonutrition would decrease complications in this high risk population. This single armed study with historical control included consecutive patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma. We compared outcomes before and after implementation of preoperative immunonutrition and adjusted the regression analysis for gender, age, body mass index, Nutritional Risk Screening (NRS 2002), tobacco and alcohol consumption, tumor localization, tumor stage, and type of surgery. The primary endpoint was overall complications from surgery within a follow-up of 30 days. Ninety-six patients were included (intervention group: 51, control group: 45). Use of preoperative immunonutrition was associated with a significant reduction in overall complications (35% vs. 58%, fully-adjusted odds ratio 0.30 (95%CI 0.10-0.91, p = 0.034). Length of hospital stay was also significantly reduced (17 days vs. 6 days, p = < 0.001). No differences in mortality and hospital readmission were found. These results remained robust in multivariate analysis. In patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma, preoperative immunonutrition exhibited favorable effects on the complication rate and consequently reduced the length of hospital stay. By improving both tissue regeneration and immune response, immunonutrition may help to improve surgical outcomes in this high-risk population.

ACS Style

Simon Andreas Mueller; Catherine Mayer; Beat Bojaxhiu; Carla Aeberhard; Philipp Schuetz; Zeno Stanga; Roland Giger. Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer. Journal of Otolaryngology - Head & Neck Surgery 2019, 48, 25 .

AMA Style

Simon Andreas Mueller, Catherine Mayer, Beat Bojaxhiu, Carla Aeberhard, Philipp Schuetz, Zeno Stanga, Roland Giger. Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer. Journal of Otolaryngology - Head & Neck Surgery. 2019; 48 (1):25.

Chicago/Turabian Style

Simon Andreas Mueller; Catherine Mayer; Beat Bojaxhiu; Carla Aeberhard; Philipp Schuetz; Zeno Stanga; Roland Giger. 2019. "Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer." Journal of Otolaryngology - Head & Neck Surgery 48, no. 1: 25.

Journal article
Published: 19 February 2019 in Aktuelle Ern&auml;hrungsmedizin
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Zusammenfassung Das Refeeding-Syndrom (RFS) ist ein oft übersehender, aber potenziell lebensbedrohlicher metabolischer Zustand. Es kann nach der Aufnahme einer Ernährungstherapie eines mangelernährten Patienten entstehen. Charakterisiert ist es durch Elektrolytstörungen (insbesondere Hypophosphatämie, Hypokaliämie und Hypomagnesiämie), ein Flüssigkeitsungleichgewicht sowie Salzretention und konsekutiv eingeschränkte Organfunktionen. Die Evidenzlage bezüglich des RFS ist dürftig. Kürzlich ist eine systematische Literaturreview zu den Risikofaktoren, diagnostischen Kriterien, präventiven und therapeutischen Maßnahmen zum RFS publiziert worden. Auf Basis dieser Übersichtsarbeit wurden von einem internationalen Expertengremium klinisch relevante Empfehlungen erarbeitet und ein Algorithmus für die Prävention, das Management und das Monitoring des RFS bei stationären Patienten entwickelt. Es werden spezifische Kriterien für die Diagnosestellung, die Risikostratifikation und praktische, konkrete Empfehlungen für das Management der Ernährungstherapie von Patienten jeder Risikokategorie vorgeschlagen. Zudem werden die schrittweise Implementierung der Energie- und Flüssigkeitszufuhr sowie eine Elektrolyt- und Vitaminsupplementierung bzw. -substitution und das detaillierte Vorgehen für das Monitoring aufgezeigt. Diese Empfehlungen beabsichtigen, das Management des RFS im klinischen Alltag zu optimieren und zu standardisieren. Der Fokus liegt auf klinisch relevanten Fragen bezüglich dem Management von stationären Risikopatienten. Qualitativ hochstehende Studien werden benötigt, um diese Empfehlungen zu evaluieren und zu bestätigen. In der vorliegenden Arbeit werden ebendiese Empfehlungen vorgestellt.

ACS Style

Emilie Aubry; Carla Aeberhard; Michèle Simone Leuenberger; Jessica Stirnimann; Natalie Friedli; Philipp Schütz; Zeno Stanga. Refeeding-Syndrom: Ein konsensusbasierter Algorithmus für stationäre Patienten. Aktuelle Ern&auml;hrungsmedizin 2019, 44, 33 -42.

AMA Style

Emilie Aubry, Carla Aeberhard, Michèle Simone Leuenberger, Jessica Stirnimann, Natalie Friedli, Philipp Schütz, Zeno Stanga. Refeeding-Syndrom: Ein konsensusbasierter Algorithmus für stationäre Patienten. Aktuelle Ern&auml;hrungsmedizin. 2019; 44 (01):33-42.

Chicago/Turabian Style

Emilie Aubry; Carla Aeberhard; Michèle Simone Leuenberger; Jessica Stirnimann; Natalie Friedli; Philipp Schütz; Zeno Stanga. 2019. "Refeeding-Syndrom: Ein konsensusbasierter Algorithmus für stationäre Patienten." Aktuelle Ern&auml;hrungsmedizin 44, no. 01: 33-42.

Journal article
Published: 24 July 2018 in International Journal of Clinical Trials
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Background: Malnutrition is highly prevalent and strongly associated with clincial outcomes of medical inpatients. Still, the benefit of nutritional treatment to prevent adverse outcomes in medical inpatients at risk for malnutrition remains unproven. We describe the trial methods of the largest yet nutritional trial in medical inpatients including the rationale for key design decisions regarding the nutritional strategy, eligibility criteria, choice of control arm, and endpoints.Methods: The Effect of early nutritional therapy on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) is an investigator-initiated, non-commercial, open-label RCT to compare the effects of an intensified nutritional therapy (intervention group) with a control group on medical outcomes. We include adult medical inpatients at risk of malnutrition based on a Nutritional Risk Screening 2002 (NRS) score of ≥3 points with an expected length of stay of ≥5 days. An individualized systematic nutritional assessment by study dieticians is done to define nutritional targets and to establish an implementation plan. Patients in the intervention group receive individualized early nutritional therapy based on a previously published consensus algorithm, while control group patients receive standard hospital nutrition. The study is powered to compare clinical outcomes (composite adverse outcome and mortality) in the 2 study arms as well as to address several mechanistical questions.Conclusion: EFFORT aims to close important gaps in the literature regarding the controversy about benefit and possible harm of nutritional therapy in medical inpatients at risk for malnutrition.Trial Registration: ClinicalTrials.gov NCT02517476; registered July 30, 2015.

ACS Style

Philipp Schuetz; Rebecca Fehr; Valerie Baechli; Martina Geiser; Filomena Gomes; Alexander Kutz; Pascal Tribolet; Thomas Bregenzer; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Brandle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller. Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial. International Journal of Clinical Trials 2018, 5, 142 -150.

AMA Style

Philipp Schuetz, Rebecca Fehr, Valerie Baechli, Martina Geiser, Filomena Gomes, Alexander Kutz, Pascal Tribolet, Thomas Bregenzer, Claus Hoess, Vojtech Pavlicek, Sarah Schmid, Stefan Bilz, Sarah Sigrist, Michael Brandle, Carmen Benz, Christoph Henzen, Silvia Mattmann, Robert Thomann, Claudia Brand, Jonas Rutishauser, Drahomir Aujesky, Nicolas Rodondi, Jacques Donzé, Zeno Stanga, Beat Mueller. Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial. International Journal of Clinical Trials. 2018; 5 (3):142-150.

Chicago/Turabian Style

Philipp Schuetz; Rebecca Fehr; Valerie Baechli; Martina Geiser; Filomena Gomes; Alexander Kutz; Pascal Tribolet; Thomas Bregenzer; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Brandle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller. 2018. "Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial." International Journal of Clinical Trials 5, no. 3: 142-150.

Review
Published: 01 July 2018 in Clinical and Experimental Gastroenterology
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Refeeding syndrome in the frail elderly population: prevention, diagnosis and management Emilie Aubry,1 Natalie Friedli,2 Philipp Schuetz,2 Zeno Stanga1 1Department for Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland; 2Medical University Department, Clinic for Endocrinology, Diabetes, Metabolism and Clinical Nutrition, Kantonsspital Aarau, and Medical Faculty of the University of Basel, Basel, Switzerland Aging is linked to physiological and pathophysiological changes. In this context, elderly patients often are frail, which strongly correlates with negative health outcomes and disability. Elderly patients are often malnourished, which again is an independent risk factor for both frailty and adverse clinical outcomes. Malnutrition and resulting frailty can be prevented by adequate nutritional interventions. Yet, use of nutritional therapy can also have negative consequences, including a potentially life-threatening metabolic alteration called refeeding syndrome (RFS) in high-risk patients. RFS is characterized by severe electrolyte shifts (mainly hypophosphatemia, hypomagnesemia and hypokalemia), vitamin deficiency (mainly thiamine), fluid overload and salt retention leading to organ dysfunction and cardiac arrhythmias. Although the awareness of malnutrition among elderly people is well established, the risk of RFS is often neglected, especially in the frail elderly population. This partly relates to the unspecific clinical presentation and laboratory changes in the geriatric population. The aim of this review is to summarize recently published recommendations for the management of RFS based on current evidence from clinical studies adapted with a focus on elderly patients. Keywords: refeeding syndrome, frail, elderly, management, malnutrition

ACS Style

Emilie Aubry; Natalie Friedli; Philipp Schuetz; Zeno Stanga. Refeeding syndrome in the frail elderly population: prevention, diagnosis and management. Clinical and Experimental Gastroenterology 2018, ume 11, 255 -264.

AMA Style

Emilie Aubry, Natalie Friedli, Philipp Schuetz, Zeno Stanga. Refeeding syndrome in the frail elderly population: prevention, diagnosis and management. Clinical and Experimental Gastroenterology. 2018; ume 11 ():255-264.

Chicago/Turabian Style

Emilie Aubry; Natalie Friedli; Philipp Schuetz; Zeno Stanga. 2018. "Refeeding syndrome in the frail elderly population: prevention, diagnosis and management." Clinical and Experimental Gastroenterology ume 11, no. : 255-264.

Comparative study
Published: 07 June 2018 in Nutrients
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GoCARB is a computer vision-based smartphone system designed for individuals with Type 1 Diabetes to estimate plated meals’ carbohydrate (CHO) content. We aimed to compare the accuracy of GoCARB in estimating CHO with the estimations of six experienced dietitians. GoCARB was used to estimate the CHO content of 54 Central European plated meals, with each of them containing three different weighed food items. Ground truth was calculated using the USDA food composition database. Dietitians were asked to visually estimate the CHO content based on meal photographs. GoCARB and dietitians achieved comparable accuracies. The mean absolute error of the dietitians was 14.9 (SD 10.12) g of CHO versus 14.8 (SD 9.73) g of CHO for the GoCARB (p = 0.93). No differences were found between the estimations of dietitians and GoCARB, regardless the meal size. The larger the size of the meal, the greater were the estimation errors made by both. Moreover, the higher the CHO content of a food category was, the more challenging its accurate estimation. GoCARB had difficulty in estimating rice, pasta, potatoes, and mashed potatoes, while dietitians had problems with pasta, chips, rice, and polenta. GoCARB may offer diabetic patients the option of an easy, accurate, and almost real-time estimation of the CHO content of plated meals, and thus enhance diabetes self-management.

ACS Style

Maria F. Vasiloglou; Stavroula Mougiakakou; Emilie Aubry; Anika Bokelmann; Rita Fricker; Filomena Gomes; Cathrin Guntermann; Alexa Meyer; Diana Studerus; Zeno Stanga. A Comparative Study on Carbohydrate Estimation: GoCARB vs. Dietitians. Nutrients 2018, 10, 741 .

AMA Style

Maria F. Vasiloglou, Stavroula Mougiakakou, Emilie Aubry, Anika Bokelmann, Rita Fricker, Filomena Gomes, Cathrin Guntermann, Alexa Meyer, Diana Studerus, Zeno Stanga. A Comparative Study on Carbohydrate Estimation: GoCARB vs. Dietitians. Nutrients. 2018; 10 (6):741.

Chicago/Turabian Style

Maria F. Vasiloglou; Stavroula Mougiakakou; Emilie Aubry; Anika Bokelmann; Rita Fricker; Filomena Gomes; Cathrin Guntermann; Alexa Meyer; Diana Studerus; Zeno Stanga. 2018. "A Comparative Study on Carbohydrate Estimation: GoCARB vs. Dietitians." Nutrients 10, no. 6: 741.

Journal article
Published: 15 May 2018 in BMC Geriatrics
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Osteoporosis is an important morbidity factor for ageing populations in developed countries. However, compared to the amount of information available on diabetes and cardiovascular disease, little is known about the direct impact of osteoporosis on general mortality in older age. We obtained data from a prospective population-based cohort of pensioners from the SENIORLAB study who were subjectively healthy. The inclusion criteria were an age of at least 60 years and Swiss residence. We assessed and analysed clinical measures, voluntary reports, and laboratory values. In total, 1467 subjects were included in the cohort. The mean follow-up time was 3.68 years (95% confidence interval, 3.64-3.71). The ages of the included participants ranged from 60 to 99 years. At follow-up, there were 1401 survivors, and 66 participants had died. According to the multivariate analysis (Cox regression), osteoporosis was the most important risk factor for all-cause mortality (hazard ratio, 4.46; 95% confidence interval, 1.82-10.91), followed by diabetes (hazard ratio, 2.17; 95% confidence interval, 1.04-4.52) and hypertension (hazard ratio, 1.81; 95% confidence interval, 1.09-3.03). Osteoporosis is a major risk factor for all-cause mortality in a subjectively healthy senior population, followed by type 2 diabetes mellitus and hypertension. Osteoporosis should be more actively diagnosed in healthy pensioners before they develop osteoporosis-associated health incidents. The present study was registered in the International Standard Randomized Controlled Trial Number registry: ISRCTN53778569 .

ACS Style

Jean-Pierre Gutzwiller; Jean-Pierre Richterich; Zeno Stanga; Urs E. Nydegger; Lorenz Risch; Martin Risch. Osteoporosis, diabetes, and hypertension are major risk factors for mortality in older adults: an intermediate report on a prospective survey of 1467 community-dwelling elderly healthy pensioners in Switzerland. BMC Geriatrics 2018, 18, 115 .

AMA Style

Jean-Pierre Gutzwiller, Jean-Pierre Richterich, Zeno Stanga, Urs E. Nydegger, Lorenz Risch, Martin Risch. Osteoporosis, diabetes, and hypertension are major risk factors for mortality in older adults: an intermediate report on a prospective survey of 1467 community-dwelling elderly healthy pensioners in Switzerland. BMC Geriatrics. 2018; 18 (1):115.

Chicago/Turabian Style

Jean-Pierre Gutzwiller; Jean-Pierre Richterich; Zeno Stanga; Urs E. Nydegger; Lorenz Risch; Martin Risch. 2018. "Osteoporosis, diabetes, and hypertension are major risk factors for mortality in older adults: an intermediate report on a prospective survey of 1467 community-dwelling elderly healthy pensioners in Switzerland." BMC Geriatrics 18, no. 1: 115.

Originalartikel
Published: 19 April 2018 in Aktuelle Ernährungsmedizin
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Zusammenfassung Hintergrund Die krankheitsassoziierte Mangelernährung (KAM) ist in Krankenhäusern ein häufiges Problem mit medizinischen und ökonomischen Folgen. Die vorliegende Vier-Jahres-Analyse soll zeigen, ob die Aufwände für die Ernährungstherapien der mangelernährten Patienten durch den Mehrertrag, der durch die Kodierung der KAM im SwissDRG-System erreicht wird, gedeckt werden. Material und Methodik In dieser Datenerhebung (2013 – 2016) wurden alle stationären Patienten mit einer E4-Diagnose im Universitätsspital Bern analysiert. Betrachtet wurden die E-Diagnose, Hauptdiagnose, Spitalaufenthaltsdauer, Alter, Art der Ernährungstherapie, Mehrertrag und Kosten, welche durch die ernährungstherapeutischen Behandlungen generiert wurden. Der Aufwand für die Ernährungsberatung, daas Pflegefachpersonal und die Ernährungstherapien wurde hochgerechnet. Zudem wurden die Patienten aufgrund ihrer Hauptdiagnose in 12 Gruppen eingeteilt (beruhend auf der WHO ICD-10-Klassifikation). Ergebnisse Von den stationären Patienten (n = 169 515) wurden insgesamt 5442 Fälle (3,2 %) in den betrachteten 4 Jahren mit einer KAM kodiert. Davon waren 462 Fälle (8,5 %) erlösrelevant. Von den 5442 Patienten erhielten 3211 (59 %) orale Trinknahrungen, 1578 (29 %) eine enterale Ernährung per Sonde und 653 (12 %) eine parenterale Ernährung. Die Kodierung der KAM ergab einen Mehrertrag von insgesamt CHF 3 494 081 und einen Aufwand von hochgerechnet CHF 2 803 432. Am häufigsten wurden onkologische Patienten mit einer KAM kodiert (n = 1708; 31,4 %), gefolgt von Patienten mit Krankheiten des Verdauungssystems (n = 671; 12,3 %) und des Kreislaufsystems (n = 609; 11,2 %). Schlussfolgerung Diese Analyse zeigt, dass der Mehrertrag durch die Kodierung der KAM im SwissDRG-System den finanziellen Aufwand für die Ernährungstherapien deckt. Die konsequente und frühzeitige Erfassung, Behandlung und Kodierung der KAM führt zu einer hohen Behandlungsqualität und -sicherheit für die Patienten und ist kostendeckend für das Krankenhaus.

ACS Style

Carla Aeberhard; Mirjam Abt; Olga Endrich; Emilie Aubry; Michele Leuenberger; Philipp Schütz; Anna-Barbara Sterchi; Zeno Stanga. Auswirkung der Kodierung der Mangelernährung im SwissDRG-System. Aktuelle Ernährungsmedizin 2018, 43, 92 -100.

AMA Style

Carla Aeberhard, Mirjam Abt, Olga Endrich, Emilie Aubry, Michele Leuenberger, Philipp Schütz, Anna-Barbara Sterchi, Zeno Stanga. Auswirkung der Kodierung der Mangelernährung im SwissDRG-System. Aktuelle Ernährungsmedizin. 2018; 43 (2):92-100.

Chicago/Turabian Style

Carla Aeberhard; Mirjam Abt; Olga Endrich; Emilie Aubry; Michele Leuenberger; Philipp Schütz; Anna-Barbara Sterchi; Zeno Stanga. 2018. "Auswirkung der Kodierung der Mangelernährung im SwissDRG-System." Aktuelle Ernährungsmedizin 43, no. 2: 92-100.

Journal article
Published: 21 March 2018 in Swiss Medical Forum ‒ Schweizerisches Medizin-Forum
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ACS Style

Seline Zurfluh; Filomena Gomes; Lisa Bounoure; Laurence Genton; Stefan C. Bischoff; Zeno Stanga; Philipp Schuetz. Klinische Ernährung polymorbider, internistischer Patienten im Spital. Swiss Medical Forum ‒ Schweizerisches Medizin-Forum 2018, 18, 1 .

AMA Style

Seline Zurfluh, Filomena Gomes, Lisa Bounoure, Laurence Genton, Stefan C. Bischoff, Zeno Stanga, Philipp Schuetz. Klinische Ernährung polymorbider, internistischer Patienten im Spital. Swiss Medical Forum ‒ Schweizerisches Medizin-Forum. 2018; 18 (11):1.

Chicago/Turabian Style

Seline Zurfluh; Filomena Gomes; Lisa Bounoure; Laurence Genton; Stefan C. Bischoff; Zeno Stanga; Philipp Schuetz. 2018. "Klinische Ernährung polymorbider, internistischer Patienten im Spital." Swiss Medical Forum ‒ Schweizerisches Medizin-Forum 18, no. 11: 1.

Journal article
Published: 21 March 2018 in Forum Médical Suisse ‒ Swiss Medical Forum
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Le journal publie des articles contribuant à la formation continue et relatifs à toutes les disciplines de la médecine. Le SMF est la revue de formation professionnelle médicale la plus lue en Suisse.

ACS Style

Seline Zurfluh; Filomena Gomes; Lisa Bounoure; Laurence Genton; Stefan C. Bischoff; Zeno Stanga; Philipp Schuetz. Nutrition clinique des patients de médecine interne polymorbides à l‘hôpital. Forum Médical Suisse ‒ Swiss Medical Forum 2018, 18, 254 -260.

AMA Style

Seline Zurfluh, Filomena Gomes, Lisa Bounoure, Laurence Genton, Stefan C. Bischoff, Zeno Stanga, Philipp Schuetz. Nutrition clinique des patients de médecine interne polymorbides à l‘hôpital. Forum Médical Suisse ‒ Swiss Medical Forum. 2018; 18 (11):254-260.

Chicago/Turabian Style

Seline Zurfluh; Filomena Gomes; Lisa Bounoure; Laurence Genton; Stefan C. Bischoff; Zeno Stanga; Philipp Schuetz. 2018. "Nutrition clinique des patients de médecine interne polymorbides à l‘hôpital." Forum Médical Suisse ‒ Swiss Medical Forum 18, no. 11: 254-260.