Purpose: Not many emergency and critical centers have a registered dietitian (RD) in place in Japan, and the time to initiation of enteral nutrition is reportedly longer in Japan than overseas. We evaluated the clinical effects and medical costs of introducing early enteral nutrition through the placement of a registered dietitian (RD) in an emergency and critical care center.

Subjects and Methods: Patients who were admitted to our emergency and critical care center and could not take oral nutrition for ≥ 5 days were enrolled in the study. To investigate the effect of intervention afforded by placing the RD, patients were divided into two groups and compared: those who were admitted before the RD was placed (NRD group; n = 17, April 1, 2016 to May 31, 2017) and those who were admitted after the placement (RD group; n=18 patients, June 1, 2017 to March 31).

Results: The RD group had significantly shorter times to initiation of enteral nutrition and resumption of oral feeding, and significantly lower costs of parenteral infusion solution and antibiotics than the NRD group.

Conclusion: Placing an RD in the emergency and critical care center was associated with early initiation of enteral nutrition and resumption of oral feeding and lower antibiotic and medical costs.

Purpose: The purpose of this study was to investigate the significance of long-term nutritional management of gastrostomy patients provided in the Numata secondary medical area, Gunma Prefecture.

Methods: Among patients managed by the regional alliance clinical pathways for gastrostomy we evaluated 1) prognosis after gastrostomy, 2) return-to-home rate, and 3) rate of transition from gastrostomy to oral feeding.

Results: A total of 371 patients (169 men, 202 women) were managed by the regional alliance clinical pathways for gastrostomy over a 7-year period starting from April 2012. Mean age at gastrostomy was 81.1 years. Analysis of 344 traceable patients revealed the following results. 1) Median survival time after gastrostomy was 619 days, the 1-month survival rate was 93.7%, the 1-year survival rate was 62.7%, the 3-year survival rate was 32%, and the 5-year survival rate was 19.5%. 2) Of the 99 surviving patients, 46 patients (46.5%) were in nursing homes, and the return-to-home rate was 17.2% (17 patients). 3) The rate of transition from gastrostomy to oral feeding was 4.2%.

Discussion and Conclusion: The prognosis of patients managed by the regional alliance clinical pathways for gastrostomy was good. Given the low return-to-home rate in this region, nutrition management with gastrostomy feeding is indispensable in nursing homes.

Objective: Home care team discussions with elderly patients and their families are crucial in deciding whether to use artificial nutrition and hydration at the end of life. The purpose of this study was to clarify, from the perspective of shared decision making, the support needed from visiting nurses for consensus building in a home care team involved in nutrition therapy for elderly patients at the end of life.

Subjects and Methods: Semi-structured interviews of 11 visiting nurses were analyzed using a qualitative and descriptive method.

Results: Six major categories of consensus building activities by the visiting nurses were found in the interviews: (1) grasping the wishes of patients and their families in relation to eating; (2) sharing patients’ and their families’ wishes about nutrition therapy with healthcare professionals in preparation for discussions; (3) adjusting the direction of nutrition therapy among patients, their families, and the home care team; (4) supporting patients and their families in their wish for nutrition therapy during the team discussion; (5) supporting the decision to stop eating and stop IV fluids for hydration so that patients can have a peaceful end of life; and(6) evaluating the nutrition therapy taking into consideration the thoughts of patients, their families, and the home care team members.

Conclusions: Visiting nurses grasped changes in patients’ eating, used that information to bring the wishes of the families and healthcare and long-term care professionals close to the wishes of the patients, and continued communicating to build team consensus. Such support appears to reflect Japanese culture, where the relationships of patients with their families and others around them is as well respected as the patients’ wishes.

Objective: The enteral feeding connecter that meets the Japanese standard has started being replaced with a connecter that meets the international standard ISO80369-3 from December 2019 in Japan. We prepared a feeding apparatus using the Japanese standard connecter or ISO standard connecter, with and without use of an adapter, to compare microbial contamination under experimental conditions.

Methods: An enteral formula was injected into the feeding apparatus twice a day for 14 days. Purified water used for flushing was recovered and cultured. The number of bacterial colonies was counted and bacterial strains were identified. Also, three conditions (no flushing, flushing with water, and replacing the connecter) were evaluated when the two different connecters were used with an adapter.

Results: Bacterial counts exceeded 104 CFU/mL on day 9 regardless of whether the Japanese or ISO standard connecter was used, as well as on day 7 if the two connectors were both used with an adapter. Bacteria identified were those associated with diarrhea or sepsis. The bacteria identified after using the adapter were similar to those identified from the feeding tube. There were no differences between the three maintenance conditions when using the adapter.

Discussion: The risk of adverse events caused by microbes is likely to increase on day 9 and beyond regardless of the standard connecter used, suggesting microbial contamination will not be altered by replacing the Japanese standard connecter with the ISO one. It is necessary to pay sufficient attention to bacterial contamination when an adapter is used, and mixed use of the different standard connecters should be avoided as much as possible.