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Tantangan Upaya
Penanggulangan Malnutrisi di RS
S Sunatr io
Perhimpunan Nutrisi Enteral Parenteral Indonesia
(PERNEPARI)
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Di kebanyakan negara TTG
dikembangkan oleh Perhimpunan
Nasional Nutrisi Enteral Parenteral
Di Indonesia jumlahnya masih dpt dihitung
dgn jari
Keberadaannya masih dalam tahap awal
Perlu dukungan dari DEPKES
TIM TERAPI GIZI (NST)
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The wise men shouldconsider that health is
the greatest of humanblessings. Let food be
your medicine.
---Hippocrates
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Hospital Malnutrition:
Critical Evidence
The Skeleton in the Hospital Closet
Height not recorded in 56% of cases
Body weight not recorded in 23% of cases
61% of those whose weight was recorded lost > 6 kg
37% had albumin < 3.0 g/dL
Butterworth CE. Nutr Today1974
I am convinced that iatrogenic malnutrition has become a significantfactor in determining disease outcomes in many patients.
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Hospital Malnutrition:Prevalence
Numerous studies on hospital malnutrition have
been published.
Prevalence of malnutrition in U.S. hospitals today
ranges from 30% to 50%. Patients nutritional status declines with extended
hospital stay.
Coats KG et al. J Am Diet Assoc1993
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Malnutrition Among Hospitalized Patients:
A Problem of Physician Awareness
Up to 50% of hospitalized patients may be
malnourished on admission
Before nutritional assessment training: Only 12.5% of malnourished patients are
identified
After 4 hours of training:
100% of patients are identified
Roubenoff et al.Arch Intern Med1987
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Prevalence of Malnutrition in
Hospitalized Patients
69%
AdequateNutritional
State
21%
Moderately
Malnourished
10%
Severely Malnourished
Detsky et al. JPEN1987
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Prevalence of Malnutrition in
Hospitalized Patients
In a published British study:
46% of general medicine patients
45% of patients with respiratory problems
27% of surgical patients
43% of elderly patients
Percentage of malnourished patients at time ofadmission
McWhirter et al. Br Med J1994
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Hospital Malnutrition in Brazil
Findings:
12.6% severe malnutrition
35.5% moderate malnutrition
Prolonged length of stay directly linked to malnutrition Little awareness about the importance of nutritional status
of hospitalized patients
Waitzberg et al. Nutrition 2001
Study of 4,000 patients in 25 hospitals to evaluate theprevalence of hospital malnutrition and awareness byhealth care providers.
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Malnutrition in the hospital
Prevalence of malnutrition in hospitalized patients, SLMC, 2000-2004
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Hospital Malnutrition
A problem of physician awareness
Cipto Mangunkusumo Hospital (government)Jakarta 1989: on adm: 45.9%
Sumber Waras Hospital (private) Jakarta 1995:on adm: 42.26%
Army Hospital (government) Jakarta 2001: onadm: 41.42%; need nutritional intervention:
78.57% Hasan Sadikin Hospital (government) Bandung
2006: on adm: 71.8%, severe: 28.9%
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TNT 12
Hospital Malnutrition:
Currently
A number of enteral & parenteral formula are
available
adequate NS could be given
Incidence of Hospital Malnutrition still high
+
Increased metabolic complication & infection
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The 11th PENSA 13
The development of the medical D/ equipmentlarge and heterogenic spectrum of diseases
Knowledge did not develop equally; high wallslie between different disciplines :
Physicians,
- Lack of interest in nutritional therapy
- Minimal information on clinical nutrition
topics in the medical schools and residentialtraining programs
Problem Identification
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The nutritional management of pts isincreasingly gaining interest
The gaining is slow, due to inadequacy
of doctors knowledge about nutrition Nutrition content in the medical
curriculum (under & post graduate) is
not sufficient to allow the doctor toprovide nutritional thx
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Current status of awareness
Varies among specialists
Highest : Digestive surgeon,
Internal medicine specialist
(Gastro-enterologist, Metabolic
endocrinologist), Intensivist Lower: other specialists
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The 11th PENSA 16
Nurses,
- Lack of established programs onNutritional Therapy
- Belief of not being the nursesresponsibility
Registered dieticians,
- Lack of knowledge to determine the best
way to remedy deficiencies in diets,particularly special dietary needs
- Minimal knowledge of thepathophysiology of diseases
Problem Identification
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Halsted (1997); Heimburger,(2000); Hark & Morrison (2000)
17
Nutritional therapy is based onpathophysiology of the disease &metabolism nutrient of organs
Since World War II, experts became awarethat management of NT needed more thana single Organ-disease-agent-base-specialist. It required involvement of
physicians who had followed specificNutritional Training & could work as part ofa multi-disciplined team
Solution
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Solution
Heimburger (2000):
To Improve the management ofFoodservices Department in hospitals
Activate the use of Nutri t ional Special ist
Physic ians in NST (Nutr.Sp.Ph., Dr, RD,Ns, Pharm. etc)
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Do we need a nutrition support team?
Increased referrals and workload to clinical dietitians 1997-98 vs. 2000-03, SLMC
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Do we need a nutrition support team?
*
*p < 0.05 y2001 < y2000A
Days of inadequate intake in stroke tube fed patients were decreasing from 43% to 20% while
improvement in adequate intake increased from 57% to 80% (SLMC, 2000-2001)
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Do we need a nutrition support team?
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SUSUNAN PERSONEL TTG
TTG beranggotakan :
Dokter spesialis gizi klinik/dokter spesialis yg
berkompetensi gizi klinik/dokter yg
berkompetensi gizi klinik
Dietisien
Perawat
Ahli Farmasi
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