Although this review was originally published in 1999, it was reprinted this year. Because it includes a thorough, critical appraisal of many of the stroke references in my library, I’ve uploaded the document to my blog.
Monthly Archives: June 2007
Earlier I posted a brief description of and links to the FOOD Trials, a series of three large, multi-centre, randomized controlled studies that attempted to answer questions about feeding stroke patients.
Here, in the researchers own words, are how the trial results can be applied to practice:
Study 1: Can oral supplementation improve stroke outcome?
On the basis of our results and our surveys of UK practice, it seems likely that patients who are judged to be undernourished on admission or who have deteriorating nutritional status in hospital will be offered oral nutritional supplements…..However, our data do not support use of routine supplementation of hospital diet for unselected stroke patients who are mainly well nourished on admission (The Lancet, Vol 365 February 26, 2005 p. 762).
Studies 2 & 3: Do timing and/or route of enteral feeding affect stroke outcome at 6 months?
Our data would suggest that to reduce case fatality, unless there is a strong indication to delay enteral tube feeding (such indications would have excluded such patients from the FOOD trial), dysphagic stroke patients should be offered enteral tube feeding via a nasogastric tube within the first few days of admission. Also, for enteral feeding within the first 2 or 3 weeks, nasogastric feeding should be the chosen route unless there is a strong practical reason to choose PEG feeding (eg, the patient cannot tolerate a nasogastric tube) (The Lancet, Vol 365 February 26, 2005 p. 771).
The authors also state:
Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients (The Lancet, Vol 365 February 26, 2005 p. 764).
Because June is Stroke Month, I’m going to end this last week of June with several posts on stroke research that provides evidence for best nutrition practice.
Today I’m highlighting the FOOD trials that tried to answer the why, when and how of feeding stroke pts. The questions were:
1. In patients who can take adequate oral fluids, does routine oral nutrition supplementation increase the proportion of stroke patients surviving without disability?
2. In patients who are unable to take an adequate diet orally, does early initiation of tube feeding (NG or PEG) increase the proportion of stroke patients surviving without severe disability?
3. In patients who need tube feeding, is a PEG tube, instead of the traditional NG tube, associated with improved outcomes after stroke?
The study results, along with a helpful commentary, were published in the 26 February 2005 issue of the Lancet. Here are the web links to the articles (note: subscription needed to read them):
Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. The FOOD Trial Collaboration. The Lancet, Volume 365, Number 9461, pages 755-763.
Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. The FOOD Trial Collaboration. The Lancet, Volume 365, Number 9461, pages 764-772.
If you or your workplace do not have a Lancet subscription, you can still read summaries of the articles for free, although you do have to register. I did this, but to be honest, I didn’t find the summaries had enough information to be useful.
I had wanted to to upload the full articles to my blog but I can’t because of copyright restrictions. If you can’t access the articles easily, please email me and I will email you copies for your personal use. (The copyright policy permits this.)
My email address is on the About me page.
Protocol for Cochrane Review: Nursing interventions for improving nutritional status of stroke patients
Depending on where you work or go to school, you may have free access to the full Cochrane Library. Here’s the web link to this protocol: Nursing interventions for improving nutritional status of stroke patients.
I realize some readers may not have free access so I’ve uploaded the Introduction on my blog. I hope it will give you enough information to decide whether you’d like to read the entire report.
In case you’re interested in kitchen gardening and/or farmers markets, both of which foster eating closer to home, you may to check out these links I’ve recently added to the blogroll under Sustainability:
I’d like to say just enough about these sites here so that you will visit and explore their pages.
Here is an excerpt from Kitchen Gardeners International:
First and foremost, Kitchen Gardeners love food, both product and process. They do not dream of eating a good tomato, but a true tomato, picked warm and juicy from the vine at the peak of its ripeness. Their enjoyment of the fruit is a complete one because it is inextricably entwined with the memory of the plant in its various stages of development. They taste not only the fruit, but the care and honest labor that went into making it…..
Their love of food is a complete one that extends beyond the plate to the soil and the natural processes and cycles from which good food comes. Kitchen Gardeners are in tune with the natural world, the weather, and the seasons. They look for ways of working peacefully and harmoniously with nature, rather than fighting against her. They are stewards of the land, whether it be a farm or a window-box. (link)
I get very excited when I read about the developments at the UBC Farm. The weekly Market List e-newsletter is worth subscribing to because it gives you a taste of the good things available at the Saturday Market.
Here is the June 21st, 2007 newsletter: UBC Farm Market Update: First Market
I was walking past the patient and family lounge at work today when a magazine cover caught my eye: a photo of a hot-fudge sundae in an Erlenmeyer flask with the caption “The Science of Appetite: Why we’re hardwired to crave the wrong things–and what new research says we can do about it.” Because this was on the cover of Time (as opposed to the National Enquirer) I thought it would be worthwhile to peruse the article, especially after I read the first sentence, “Somewhere in your brain, there’s a cupcake circuit”!
You can read the article online here: The Science of Appetite.
The online version has the same text as the print version but lacks some of the photos and side-bars. I will post some of the missing content (e.g., what makes us eat more) later today.
Addendum: I found this photo on Flickr. It doesn’t depict the science of appetite so much as the joy of eating. Guilt-free eating. I wanted to share because it made me happy and may make you smile, too.
I’m reading all the articles in the series and think this might be the program that works for me. It’s simple. Quick and easy to get started. Adaptable for use with your favourite low or high tech tools. Potentially habit-forming, in a good way. Most important, ZTD sounds like it will help me be productive, that is, accomplish the important things.
Here are links to all the articles in the series:
Archive of ZTD posts (updated 19 June 2007)