Integrated disease surveillance and response

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Public health surveillance
Source of all infant and young child feeding indicators WHO. The greatest absolute reduction occurred among adults aged years 6. Williams and Wilkins When the definitions and categories for reporting cases of acute viral hepatitis are expanded to include those identified by laboratory test results alone, it will be important to distinguish symptomatic from asymptomatic individuals. In addition to locators e. Am J Epidemiol ; Implications for costing out nursing.

WHO African Region: Ethiopia

WHO surveillance case definitions for ILI and SARI

Reports came from health care providers, including physicians, pharmacists, and nurses, as well as members of the general public, such as patients or lawyers, and manufacturers. Because AERS and VAERS are passive surveillance systems, they may be limited by underreporting or biased reporting, and they cannot be used to determine whether a drug or vaccine caused a specific adverse health event.

Instead, these systems are used as early warning signals. This surveillance system is a relatively new surveillance method that uses clinical information about disease signs and symptoms before a diagnosis is made. It is an active or passive system that uses case definitions that are based entirely on clinical features without any clinical or laboratory diagnosis for example collecting cases of diarrhea, rather than cases of cholera.

This syndromic surveillance system uses electronic data from hospital emergency rooms, and provides the health department with early notification of the outbreak. Registries are a type of surveillance system used for particular conditions, such as cancer and birth defects. They are often established at a state level to collect information about persons diagnosed with the conditions. This information can be used to improve prevention programs.

Public health laboratory data is another source of surveillance data which routinely conduct tests for viruses, bacteria, and other pathogens. Laboratory serotyping provides information about cases that are likely to be linked to a common source. For this reason, serotypes are useful for detecting local, state, or national outbreaks Swaminathan In , more than 40, isolates from the US were reported through this system Center of Disease Control and Prevention Other laboratory system that plays an important role in surveillance is PulseNet, developed by the CDC and the Association of Public Health Laboratories to monitor foodborne illness outbreaks.

This system enables public health laboratories across the US to compare pulsed-field gel electrophoresis PFGE patterns of bacteria isolated from ill persons and determine whether they are similar. This allows scientists to determine whether an outbreak is occurring, even at geographically distant locations, and can decrease the time required to identify outbreaks of food borne illness and their causes Center of Disease Control and Prevention Having this variety of surveillance systems, public health practitioners have abroad sources of data ready to be analyzed and distributed at local, state, and national levels for public health action.

However, these surveillance systems might increase with the range of health-related events that are associated with public health action and are under surveillance. This issue highlights the importance of having different methods of collecting data and the usefulness that these data means in public health actions including guiding prevention strategies and targeting resources, detecting disease outbreaks of local, national, and international significance, and evaluating public health control measures.

Therefore, knowing where to look for different types of data can save valuable time and resources. If you want to know how to make extra money, search for: I know one interesting method of earning money, I think you will like it. Creating a Program Rationale. Types of Surveillance Systems by Carolina on January 4, Creating a Program Rationale Next post: Subscribe Enter your email address: Peripheral PN PPN should not be used, as it leads to inappropriate use of PN, has a high risk of phlebitis and loss of venous access sites, and generally provides inadequate nutrition therapy conditional recommendation, very low level of evidence.

Careful transition feeding should be used in the patient on PN, for whom EN is now being initiated. As tolerance to EN improves and volume of delivery increases, PN should be tapered to avoid overfeeding conditional recommendation, very low level of evidence. Nutritional Therapy at End-of-Life Question: The decision to place a gastrostomy tube in an end-of-life situation should be determined by patient autonomy and the wishes of that patient and their family, even though the nutrition therapy may do little to change traditional clinical outcomes conditional recommendation, very low level of evidence.

Percutaneous gastrostomy placement should be considered even if the only benefit is to provide improvement in the quality of life for the family, increased ease of providing nutrition, hydration, and medications, or to facilitate transfer out of the hospital setting to a facility closer to home conditional recommendation, very low level of evidence.

The clinician is not obligated to provide hydration and nutrition therapy in end-of-life situations. The decision to initiate nutrition therapy is no different than the decision to stop therapy once it has started thus, clinicians are not obligated to provide therapy that is unwarranted conditional recommendation, very low level of evidence. If requested, nutrition therapy in end-stage malignancy should be provided by the enteral route conditional recommendation, very low level of evidence.

Use of PN in this setting may cause net harm and should be highly or aggressively discouraged conditional recommendation, very low level of evidence. The clinician who has ethical concerns of his own in a difficult end-of-life situation should excuse himself from the case, as long as he can transfer care to an equally qualified and willing health-care provider conditional recommendation, very low level of evidence.

Summary of Recommendations Indications for nutritional therapy Question: EN should be used preferentially over PN in hospitalized patients who require non-volitional specialized nutrition therapy, and do not have a contraindication to the delivery of luminal nutrients conditional recommendation, low level of evidence. Prior to initiation of specialized nutrition therapy either EN or PN , a determination of nutritional risk should be performed using a validated scoring system such as the NRS or the NUTRIC Score on all patients admitted to the hospital for whom volitional intake is anticipated to be insufficient conditional recommendation, very low level of evidence.

An additional assessment should be performed prior to initiation of nutrition therapy of factors, which may impact the design and delivery of the nutrition regimen conditional recommendation, very low level of evidence.

Indirect calorimetry conditional recommendation, very low level of evidence. Simple weight-based equations conditional recommendation, very low level of evidence.

Published predictive equations conditional recommendation, very low level of evidence. How should enteral access be achieved, and at what level of the GI tract should enteral nutrition be infused? Radiologic confirmation of placement in the stomach should be carried out prior to feeding except with use of electromagnetic transmitter-guided feeding tubes. A percutaneous enteral access device should be placed, either via the gastric or jejunal route, if enteral feeding is anticipated to be required for greater than 4 weeks duration conditional recommendation, very low level of evidence.

Initiating enteral nutrition Question: Placement on PN over the first week of nutrition therapy conditional recommendation, low level of evidence. Monitoring tolerance and adequacy of enteral nutrition Question: How should adequacy and tolerance of enteral nutrition be assessed in the hospitalized patient? Gastric residual volume should not be used routinely as a monitor in hospitalized patients on EN conditional recommendation, very low level of evidence. Use a prokinetic agent conditional recommendation, low level of evidence.

Divert the level of feeding lower in the GI tract strong recommendation, moderate-to-high level of evidence. Switch to continuous infusion conditional recommendation, very low level of evidence. Use chlorhexidine mouthwash twice daily conditional recommendation, very low level of evidence. Use of fermentable soluble fiber as an adjunctive supplement to a standard EN formula conditional recommendation, very low level of evidence.

Switching to a commercial mixed fiber soluble and insoluble formula conditional recommendation, low level of evidence. When and how should parenteral nutrition be utilized in the hospitalized patient?

Peripheral PN should not be used, as it leads to inappropriate use of PN, has a high risk of phlebitis and loss of venous access sites, and generally provides inadequate nutrition therapy conditional recommendation, very low level of evidence. Nutritional therapy at end-of-life Question: All authors contributed to the manuscript. History of parenteral nutrition. J Am Coll Nutr ; The skeleton in the hospital closet.

Brief history of enteral and parenteral nutrition in the hospital in the USA. In Elia M, Bistrian B, eds. Vol 12 pp —Nestec Ltd. Enteral compared with parenteral nutrition: Am J Clin Nutr ; Total parenteral nutrition in the critically ill patient: Perioperative total parenteral nutrition in surgical patients. N Engl J Med ; Early enteral feeding, compared with parenteral, reduces postoperative septic complications.

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Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: Intensive Care Med ; Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: J Gastrointest Surg ; Nutrition support in acute pancreatitis: Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.

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Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients?

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The use of prealbumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: J Am Coll Surg ; Fleck A, Path FR.

Usefulness of data on albumin and prealbumin concentrations in determining effectiveness of nutritional support. A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer. Appl Physiol Nutr Metab ; Interactions between nutrition and immune function: Proc Nutr Soc ; Monitoring health by values of acute phase proteins.

Evaluation of serum C-reactive protein, procacitonin, tumor necrosis factor alpha, and interleukin levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, sepsis syndrome and septic shock.

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J Am Coll Nutr ;6: Measured versus calculated resting energy expenditure in critically ill adult patients. Do mathematics match the gold standard? Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs. Provision of protein and energy in relation to measured requirements in intensive care patients.

Protein recommendations in the ICU: A reappraisal of nitrogen requirements for patients with critical illness and trauma. J Trauma Acute Care Surg ; Nutritional strategies to counteract muscle atrophy caused by disuse and to improve recovery.

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Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev ; The effect of nutritional supplementation on survival in seriously ill hospitalized adults: J Am Geriatr Soc ;48 5 Suppl: Techniques in enteral access. Nasal Bridles for securing nasoenteric tubes: Early enteral nutrition in acutely ill patients: Early supplemental parenteral nutrition in critically ill adults increased infections, ICU length of stay and cost.

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A systematic review of the evidence. J Parenter Enteral Nutr ;37 5 Suppl: Nutrition optimization prior to surgery. Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: J Gastroenterol Hepatol ;28 Suppl 4: Nutrition support protocols and their influence on the delivery of enteral nutrition: Worldviews Evid Based Nurs ; Postinjury enteral tolerance is reliably achieved by a standardized protocol.

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Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Gastric residual volumes in critical illness: Crit Care Clin ; Aspirating gastric residuals causes occlusion of small-bore feeding tubes. Microaspiration in intubated critically ill patients: Infect Disord Drug Targets ; Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: J Clin Monit Comput ; Diarrhea in enterally fed patients: Re-examination of risk factors for non-Clostridium difficile-associated diarrhoea in hospitalized patients.

J Adv Nurs ; Bartel B, Gau E. Risk of Clostridium difficile diarrhoea in critically ill patients treated with erythromycin-based prokinetic therapy for feed intolerance. Current issues on safety of prokinetics in critically ill patients with feed intolerance. Ther Adv Drug Saf ;2: Pharmacological therapy of feed intolerance in the critically ill.

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Mixed fibers diet in surgical ICU septic patients. Asia Pac J Clin Nutr ; Diarrhoea during enteral feeding in the critically ill: Fiber supplementation influences phytogenic structure and functional capacity of the human intestinal microbiome: Clearing obstructed feeding tubes.

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Am J Gastroent ; Outcome of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis in relation to respiratory dysfunction. Amyotroph Lateral Scler Frontotemporal Degener ; Eur J Neurol ; J Clin Neurosci ; Nutritional management in amyotrophic lateral sclerosis: Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction.

Clin Gastroenterol Hepatol ; Artificial nutrition and hydration at the end of life: Palliat Support Care ;4: Recommendations for Physicians and Patients from the U. We are very confident that the true effect lies close to that of the estimate of effect.

We are moderately confident in the effect estimate: Our confidence in the effect estimate is limited: We have very little confidence in the effect estimate: The desirable effects of the intervention clearly outweigh the undesirable effects or clearly do not.

Promote dominance of anti-inflammatory Th-2 over proinflammatory Th-1 responses. Influence anti-inflammatory nutrient receptors in the GI tract duodenal vagal, colonic butyrate. Maintain MALT tissue at all epithelial surfaces lung, liver, lacrimal, genitourinary, and pulmonary.

A. Indications for nutritional therapy