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General interest items edited by Janice Flahiff

[Reblog] Healthstyles: Pre-operative Fasting–Too Long?

Fasting instructions for healthy pre surgical patients should be based on the known differences in gastric transit times of clear liquids, full liquids, and other foods.

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From the 23 January 2014 post at HealthCetera – CHMP’s Blog
     Center for Health Media & Policy at Hunter College (CHMP): advancing public conversations about health & health
policy

This week on Healthstyles, I'm rebroadcasting an important interview that I did with Dr. Jeannette Crenshaw, RN, DNP, two years ago about what the evidence suggests is appropriate for pre-operative fasting--what should you not eat or drink and for how long before surgery.
Unfortunately, little attention is paid to this topic. Most people are told to fast for much longer periods of time than is necessary, and this can lead to dehydration and other adverse effects.
Tune in tonight on WBAI (www.wbai.org; 99.5 FM), or click here to listen anytime: Crenshaw

[The broadcast is about 22 minutes long, but very informative]

For those interested, the broadcast is based on her article Pre-operative Fasting – Will the Evidence Ever be put into Practice? 

Highlights from the article

  • Overview: Decades of research support the safety and health benefits of consuming clear liquids, including those that are carbohydrate rich, until a few hours before elective surgery or other procedures requiring sedation or anesthesia.
    Still, U.S. clinicians routinely instruct patients to fast for excessively long preoperative periods. Evidence-based guidelines, published over the past 25 years in the United States, Canada, and throughout Europe, recommend liberalizing preoperative fasting policies.
    To improve patient safety and health care quality, it’s essential that health care professionals abandon outdated preoperative fast- ing policies and allow available evidence to guide preanesthetic practices.

Preoperative fasting practices in the United States often disregard both the guidelines of the American Society of Anesthesiologists (ASA)1, 2 and the most current available evidence on the subject.

A PRACTICE BASED ON MYTH

The U.S. practice of requiring an extended fast before scheduled anesthesia or sedation is based primarily on the following three myths8-12:

• Myth: Overnight fasting from all solids and liquids is the optimal approach to reduce the risk of pul- monary aspiration during anesthesia.

• Myth: Gastric emptying time is the same for clear liquids as for full liquids (those that are not transpar- ent, such as milk, creamed soup, and nonstrained fruit juice) and solids.

• Myth: Clear liquids ingested up to two hours be- fore surgery increase the risk of vomiting and pul- monary aspiration.

 

The ASA (American Society of Anesthesiologists) recommends that healthy patients

 

  • consume clear liquids up to two hours before elective surgery or conscious sedation but cautions that their guidelines aren’t intended for women in labor and may need to be modified for patients with conditions that affect gastric emptying or fluid volume and those in whom airway management may be difficult.3-5
  • Evidence gathered throughout the world over the past 25 years not only supports the ASA guidelines, but establishes the health benefits of preoperative carbohydrate loading (through the consumption of carbohydrate-rich clear liquids) the evening before and the morning of surgery.6, 7

Clear liquids leave the stomach almost immediately, while full liquids and solids remain for significantly longer periods. It’s long been established that patients who drink clear liquids a few hours before surgery have significantly lower gastric volumes and similar or higher pH values compared with those who fast overnight, suggesting that drinking clear liquids may stimulate gastric emptying and dilute acidic gastric secretions, thereby lowering the risk of pulmo- nary aspiration and increasing patient safety.15-1 

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  • In addition to discomforts such as thirst, hunger, anxiety, drowsiness, and dizziness, excessive preoperative

    fasting may have adverse physiologic effects, including dehydration, insulin resistance, postoperative hy- perglycemia, muscle wasting, and a weakened immune response.18, 23-25 Clear liquids, taken alone, may be in-sufficient to ward off such effects. Emerging evidence suggests that, in addition to offering clear liquids up until two hours before anesthesia or sedation, the best way to avert the harmful consequences of preoperative fasting is to prescribe a carbohydraterich clear bev-erage to be consumed two to three hours before the scheduled procedure

  • The author also details reasons for resistance by the medical community and research needs (as for patients who are not healthy and/ or have stomach and breathing issues).

 

So, does one take the law into one’s hands, so to speak? The radio interview seems to suggest be careful if you drink clear liquids up to two hours before the surgery and/or drink a carbohydrate beverage.  Best not to tell the health care providers, perhaps on the day of surgery.

 

 

 

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January 26, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Probiotics – A Cure for what Ails You?

From the 23 January 2014 Bite into Nutrition blog

Probiotics has become one of the biggest “bug” words among nutrition and health professionals today, partly because of all the time the scientific community has devoted to researching the topic.  Research has shown that probiotics are effective in reducing and treating various ailments ranging from antibiotic-induced diarrhea, Clostridium difficile and other digestive disorders.   Partly due to all the science and media buzz, manufacturers have been introducing (and marketing) probiotic products left and right. NPR news recently featured a report on all the potential benefits that probiotics can do ranging from curing colicky babies to and prevention of heart disease. Although more research is needed, this is encouraging evidence on the many benefits that probiotics can offer.

In the past couple of years, there were reports suggesting the use of probiotics offering immune health benefits.  The article from Environmental Nutrition offers more insight into this.

Boost Your Immunity with Probiotics

Environmental Nutrition: February 2014 Issue

Inside each one of us is an “inner ecosystem”—a unique microbiome teeming with bacteria that lines the gastrointestinal (GI) tract or gut, which is the largest organ of immunity in the body. Fortifying the gut microflora with probiotics—also known as friendly bacteria—should be one of your top health priorities, as this promotes a stronger immune system. “We know that the make-up of our gut microbiome—the total of all microorganisms in the gut—has changed over time, due to environmental factors, and that this change may be partially responsible for the rise in prevalence of allergic and autoimmune disorders, which involve the immune system,” explains registered dietitian nutritionist Rachel Begun, MS, RDN.

 

Plant foods, such as whole grains and fruit, and yogurt with live and active cultures boost gut bacteria.

Boost plant foods. A plant-based, high-fiber diet is the best way to positively impact your gut microflora, according to an August 2013 article in the Journal of the Academy of Nutrition and Dietetics. Fiber-rich plants boost a greater volume and diversity of microorganisms in the gut, offering better defense against disease-causing invaders. And researchers are discovering that just by eating fewer calories, you can change your gut bacteria profile for the better.

“It’s best to eat whole foods that are natural sources of probiotics, as these are nutrient-dense foods that contribute other health benefits, such as yogurt made with live and active cultures, fermented vegetables like kimchi and sauerkraut, fermented soybean products like miso and tempeh, as well as kombucha, fermented tea,” says Begun.

Prebiotics (non digestible carbs that act as food for probiotics)

“It’s just as important to eat a diet rich in prebiotics, which are the foods that fuel the good bacteria in the gut.” Prebiotic foods include high-fiber plants, such as artichokes, asparagus, bananas, raisins, onions, garlic, leeks, and oats.

 

Read the entire post here

 

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January 26, 2014 Posted by | Nutrition | , , , | 2 Comments

[Reblog] Measuring Quality of Care for Older Adults With Serious Illness

From he 22 January 2014 post at HealthAffairsBlog

by Laura Hanson, Anna Schenck, and Helen Burstin

Editor’s Note: This post is the third in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. 

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty.

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

We know what types of health care help patients and families cope with serious illness.  A 2012 report to the Agency for Healthcare Research and Quality finds evidence for three types of care to improve health outcomes:

  1. Expert pain and symptom treatment
  2. Communication to engage patient preferences for treatment decisions
  3. Interdisciplinary palliative care

We’ve developed quality measures to understand how often real-world care lives up to these ideals.

……

 

Read the entire article here

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January 26, 2014 Posted by | health care | , , , , , | Leave a comment

   

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