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SCI: Role of the Registered Dietitian (2007)

Citation:

Mitcho K, Yanko JR.  Acute care management of spinal cord injuries.  Critical Care Nursing Quarterly, 1999; 22(2), 60-79.

PubMed ID: 10646444
 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose of the research is to provide a comprehensive review of the needs of the spinal cord-injured patient in the acute care setting, including optimal patient outcomes, methods to prevent complications, and a plan that provides an expiditious transition to rehabilitation.

Inclusion Criteria:

Not mentioned

Exclusion Criteria:

Not mentioned

Description of Study Protocol:

NA

Data Collection Summary:

NA

Description of Actual Data Sample:

 

NA

Summary of Results:

 Provides an overview of the following issues regarding patients with Spinal Cord Injury:

  • Neurological Issues
  • Pharmocologic Interventions
  • Spinal Shock
  • Stabilization Issues
  • Cardiovascular Issues
  • Pulmonary Issues
  • Gastrointestinal Issues (Assessment, Nutrition, Bowel Management)
  • Genitourinary Issues
  • Musculoskeletal Issues
  • Pain Management
  • Substance Abuse
  • Psychosocial Issues

Emphasizes that a multidisciplinary plan of care is essential

 

Author Conclusion:

In evaluating recommendations for acute care management of spinal cord-injured patients, the authors found that conditions which predispose the patient to complications, including anemia, hypoproteinemia, and hypoalbuminemia, are less frequent when patients receive adequate nutrition support.  Dietary goals should be evaluated on a continuous basis, and should include monitoring of laboratory values, weight, and intake/output.  Vitamin and mineral deficiencies should be assessed and treated.  The authors found that a bowel management program, including dietary interventions such as a high fiber diet and use of food types to stimulate defacation, may improve bowel function. If the patient is unable to tolerate oral feedings, enteral feedings should be initiated.  Based on the degree of dysphagia identified by the speech therapist, the dietitian should provide appropriate calorie and protein supplements.  A multidisciplinary acute care pathway which includes nutrition care is provided.  The authors stated that a baseline nutrition assessment conducted by a registered dietitian is essential within the first 48 hours of injury. 

Funding Source:
Reviewer Comments:
  • No inclusion/exclusion criteria provided for studies reviewed
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? ???
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? ???
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? ???
  10. Was bias due to the review's funding or sponsorship unlikely? ???