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Doi S.,Nutrition Support Team NST
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

In collaboration between the in-hospital nutrition support team and infection control team, we attempted to standardize the management of infusion therapy. We report on a simple and effective at-home infusion therapy, after total parenteral nutrition(TPN)therapy, by using a Broviac catheter in a discharged patient with a severe skin condition. The patient was a man in his 50s who had amyloidosis. Because of dysphagia and complications of the digestive organs, TPN was chosen as the method for nutritional management. At the beginning the patient repeated infection and a trouble of the skin, but the insertion site was managed by the existing standardized manual. However, switching to a Broviac catheter improved the existing disease. Dermatopathy was improved and there was no catheter-related bloodstream infection under the new management method. Furthermore, the patient is now able to feed orally. Patients should be evaluated individually, and for the case that is hard to care with a manual, it is necessary to choose the best possible method. Source

Ibata T.,Nutrition Support Team NST
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

Ten years has passed since we began the nutrition support team(NST)to make a regional alliance between local institutions for construction of the NST network. The network was formed with the following aims: 1) regional joint conferences for learning about nutrition with family doctors, facilities, and hospitals; 2) open general meetings for information about nutrition within the suburbs of our city; 3) preparing and sending an NST manual about parenteral nutrition(PN)and enteral nutrition(EN); and 4) preparation of an NST summary of patient malnutrition to foster mutual understanding. We produced a questionnaire summarizing the completion of nutritional management in patients. The following positive benefits were observed: 1) improved nutritional motivation and technique; 2) reduced nutritional confusion after discharge from our hospital; and 3) lower levels of anxiety in the facilities, the patient, and among the patient's family. In addition, follow-upinquiries allowed us to estimate whether our nutritional strategy was adequate. A more widely open regional alliance is needed in the future to strengthen patient nutrition following hospital discharge. Source

We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics. Source

Hata A.,Nutrition Support Team NST
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2010

We made a low calorie diet(LCD)menu which added two commercial supporting nutritional supplements to a meal. Because a conventional formula food is very expensive, the patient was not able to afford it at home. Those supplements are a total enteral formula with enriched nutrient(ACURE EN800)and vitamin-mineral rich drink(V CRESC). The contents of vitamin and mineral in this menu satisfied the dietary reference intakes, though protein was a little low. However, we could keep the price low compared to the formula food. The patient was able to switch over to home LCD therapy with the menu. Source

Shinoki K.,Nutrition Support Team NST
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2010

Thenutritionalmanagementofapatientdischargedfromaprimaryhospitalwillnotendjustthere.The nutritional management information issued by the primary hospital is required when a patient moves to a next institute.We,the Nutritional Support Team(NST), make a nutrition summary report in addition to letters written by the doctor and the ward in charge. We investigated a total of 64 patients three months after their discharge, and followed them for a year since April 2008. On some patients, the nutritional care had to be changed in accordance with the facility and the patients' primary disease status.In order for the nutrition management to be continued, a bidirectional communication exchange between the primary hospital and acute phase hospital is essential. In other words, a seamless nutritional management for patients has to be executed. When the disease condition of the patient has changed, the host institution must consult with us about the new nutritional care to the patient. On the other hand, we should keep in touch to reduce a communication distance in the region. Source

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