1. look at the rubric that I uploaded2. I need the PDF format of articles that You found on the Internet.3. I also found some articles for you, you can one or two.4. You must gather at least 4-5 journal articles for your research.5. Follow the Score Breakdown in the Rubric
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Journal Article Assignment?Professor LaRose Advanced MNT?DIET4630
For this project, you will address the scenario below using evidence
obtained from peer reviewed journal articles. This assignment specifically
addresses KRD 1.1, which states the following: The curriculum must reflect
the scientific basis of the dietetics profession and must include research
methodology, interpretation of research literature, and integration of
research principles into evidence-based practice.
You are currently a dietitian working in a large tertiary care center adult
ICU. Your attending physician attended a conference recently where her
colleagues were talking about caloric goals for ICU patients. Her colleagues
were discussing permissive underfeeding (usually about 40-60% of the
estimated caloric goal) vs. eucaloric feedings (usually about 70-100% of the
estimated caloric goal), and she is asking you to compile some of the
current evidence so that the team can make a decision about how to
optimize outcomes for your patients. She is wondering not only about
caloric delivery, but also differences in feeding tolerance, infectious
complications, and ICU and hospital LOS.
? You must gather 4-5 journal articles for your research. Only peer
reviewed journal publications may be used.
1. Primary Research: 2 of the journal articles must be publications of
These may not be review articles, meta-analyses, case
reports/case series, etc.
2. Background/Supporting Research: 2-3 additional articles are to be
used for the introduction or background information in the paper,
but they may NOT be used in your conclusion.
These may include other primary research papers, review
papers, meta-analyses, etc.
? NO editorials, continuing education modules, thesis projects,
commentaries, opinion pieces, letters to the editor, etc. may be usedthese are not always peer reviewed regardless of where they may have
? Every journal article must have been published within the last 7 years
? Only studies on humans may be used
? See the table that follows (Part 2 Score Breakdown) and the rubric
posted in ULearn (for what is required in each section (Introduction,
Discussion of Research, etc.).
? Paper should be typed and double-spaced using an 11-12 point font
from the selections that follow (Calibri, Arial, Tahoma, Times,
Cambria) Professional writing does not permit the use of pronouns
or contractions (no I, we, our, they, their, you, etc. or cant,
? Any numbers used should be spelled out if it is <10 (with the exception of statistical information); the number may be used in the text if it is >10.
? When you are introducing a primary study in your discussion of
research section for the first time, you should introduce it by listing
all of the authors if there are less than 4 or 5. Each would be listed by
last name in this case. Alternatively, for >~5 authors, you may use the
first authors last name followed by and colleagues- for example,
LaRose and colleagues.
You also MUST include the complete study title in italics
NOT the journal/publication or location the study took place.
Citations will be done in AMA format using the instructions found in
American Journal of Clinical Nutrition (AJCN) link provided in
Dont forget that you need at least one citation for every paragraph.
You cant have a citation for a whole section. If you change sources
within the paragraph, you need a citation at the end of the last
sentence where the source was used and then at the end of the
There is no such thing as common knowledge in technical/scientific
writing- EVERYTHING must have a citation associated with it.
Including your name, class and section, date,
Provides a brief background on the topic and
presents relevant background details to
introduce your paper
There are a variety of topics that may make sensethere is not a set requirement here. You should
keep it succinct, focused, and to the point.
Discussion and Presentation of Research
Each article should be explained and addressed
Explanation of study type, a brief overview of
patient selection criteria, and
procedure/process must be included
Complete data/statistical analysis as well as risks
and benefits must be addressed; statistical
significance must be fully explained
You should include details about any/all of the
important/relevant outcomes examined in
the research, and discuss any shortcomings of
the papers that you are reviewing
Using details from your research, the conclusion
should address how the research supports a
position for your case taking into consideration
any risks that may be present
No new information may be presented in the
Your opinion must be evident and must be based on
evidence youve presented
You should use numerical in line citations in the text
of your document. NOTE: Failure to properly
cite your sources in the text of the paper will
result in a 0 for the entire submission.
Using AMA format, your Reference List should
include all of the resources used in your project.
See the Research Section above for details.
Spelling, Grammar, Mechanics:
Your project should be free of spelling and grammar
Pronouns and contractions may not be used
Your project should be completed (with section
headings) in the order listed above though
each section does not need to start a new page
? The conclusion MUST be based on the statistics/data from your
presented primary research studies. You MAY NOT use other papers
to make a recommendation or for your conclusion. In addition, the
conclusion should not present ANY new information.
? Though direct quotations are technically permitted by the university,
DO NOT use them in your writing for this assignment. EVERYTHING
MUST BE IN YOUR OWN WORDS so that I know you have a good
understanding of what you are reporting on. A significant loss of points
will occur if direct quotations are used.
Though a specific percentage is not defined, generally a correlation
number from Turnitin of >20% on this assignment is a red flag. A
significant loss of points will occur for submissions with a high
matching correlation within the Turnitin system.
Do be aware that I look at EVERY Turnitin originality report
regardless of the percentage reported. Beyond the percentage, I
look at how and what information is being identified by Turnitin. I
have very little flexibility on using specific words and phrases from
authors outside of very limited statistical reporting.
? Plagiarism, sharing work with another student, and other forms of
cheating are serious offenses and will be handled as such.
? All of the articles you use MUST be directly related to your topic. If
youre being asked about acutely ill patients, trying to apply
information from pediatric populations or outpatients is likely to
have little direct application.
? You do need to select papers to review that encompass both views
in the scenario. Reporting on findings that only support one side
will not answer the question(s) presented.
? Make sure that you choose studies that you understand well
enough to convey their meaning in your writing- this is a major
objective of the assignment that is also evaluated by CDR/ACEND as
a program outcome.
Hypocaloric compared with eucaloric nutritional support and its effect
on infection rates in a surgical intensive care unit: a randomized
Eric J Charles, Robin T Petroze, Rosemarie Metzger, Tjasa Hranjec, Laura H Rosenberger, Lin M Riccio,
Matthew D McLeod, Christopher A Guidry, George J Stukenborg, Brian R Swenson, Kate F Willcutts, Kelly B ODonnell,
and Robert G Sawyer
Despite its attributes, nutritional support does have adverse
effects, suggesting a delicate balance between overfeeding and
underfeeding. Feeding intolerance is a less frequent occurrence
when patients receive trophic enteral feedings (6). However,
when goal enteral feeding is attempted and leads to high gastric
residual volumes, patients are at an increased risk of hospitalacquired pneumonia, longer intensive care unit (ICU) stays, and
increased ICU mortality (7). When enteral nutrition is not possible, patients may receive supplemental parenteral nutrition,
although the appropriate timing of initiation and its role continue
to be debated (810). Parenteral nutrition is known to be associated with increased infections, gut mucosal atrophy, hyperglycemia, and overall increased mortality in critically ill patients
Current guidelines detail the optimal delivery of nutritional
support and recommend providing 2530 kcal $ kg1 $ d1 with
1.22 g protein $ kg1 $ d1. Yet, no published data have validated these standard daily caloric intake targets (2, 12, 13).
Although there is general consensus that excessive hypocaloric
(#25% recommended daily caloric intake) or hypercaloric
($125%) feeding should be avoided, controversy still exists
over what feeding targets should be (14). Particularly in patients
with a high severity of illness, attempting to provide full nutritional support may correlate with adverse outcomes (15, 16).
New evidence suggests that outcomes may be improved in
patients who are underfed. Nevertheless, to our knowledge,
no study has yet randomly allocated critically ill patients to
Appropriate nutrition intake in critically ill surgical patients is
a crucial aspect of care. Nutritional support is needed to overcome stress-induced metabolic responses, prevent oxidative cellular injury, and favorably modulate the immune response (13).
Malnutrition is associated with impaired immune function,
reduced ventilatory drive, weakened respiratory muscles, prolonged ventilator dependence, and increased infectious complications in critically ill patients (4, 5). Nutritional support is
believed to improve wound healing and gastrointestinal structure
and function, as well as reduce catabolism, complication rates,
and length of stay (1).
From the Department of Surgery, University of Virginia Health System,
Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS,
KFW, KBO, and RGS), and the Department of Public Health Sciences,
University of Virginia School of Medicine, Charlottesville, VA (GJS).
EJC and RTP share first authorship on this article.
The work presented here is the original work of the aforementioned
authors and represents the authors views and not those of the institution
where the work was completed or that of any funding source.
Supported by grant 5-T32-AI-078875-03 from the NIH (principal investigator: RGS).
Address correspondence to EJ Charles, Department of Surgery, University of Virginia Health System, PO Box 800679, Charlottesville, VA 229080679. E-mail: firstname.lastname@example.org.
Received March 21, 2014. Accepted for publication August 11, 2014.
First published online September 3, 2014; doi: 10.3945/ajcn.114.088609.
Am J Clin Nutr 2014;100:133743. Printed in USA. Ó 2014 American Society for Nutrition
Downloaded from ajcn.nutrition.org by guest on December 18, 2017
Background: Proper caloric intake goals in critically ill surgical
patients are unclear. It is possible that overnutrition can lead to
hyperglycemia and an increased risk of infection.
Objective: This study was conducted to determine whether surgical
infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support.
Design: Eighty-three critically ill patients were randomly allocated
to receive either the standard calculated daily caloric requirement of
2530 kcal $ kg1 $ d1 (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal
protein allocation in each group (1.5 g $ kg1 $ d1).
Results: There were 82 infections in the hypocaloric group and 66
in the eucaloric group, with no significant difference in the mean
(6SE) number of infections per patient (2.0 6 0.6 and 1.6 6 0.2,
respectively; P = 0.50), percentage of patients acquiring infection
[70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57],
mean ICU length of stay (16.7 6 2.7 and 13.5 6 1.1 d, respectively;
P = 0.28), mean hospital length of stay (35.2 6 4.9 and 31.0 6 2.5
d, respectively; P = 0.45), mean 0600 glucose concentration (132 6
2.9 and 135 6 3.1 mg/dL, respectively; P = 0.63), or number of
mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further
analyses revealed no differences when analyzed by sex, admission
diagnosis, site of infection, or causative organism.
Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated
with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.
Clin Nutr 2014;100:133743.
CHARLES ET AL
Before initiating nutritional support, daily caloric requirements were calculated for each patient by using actual body
weight, unless the patients weight was greater than 130% of
ideal body weight, in which case an adjusted body weight was
used. For the purpose of this study, the eucaloric goal was 100% of
the calculated daily caloric requirement (2530 kcal $ kg1 $ d1).
The hypocaloric target was 50% (12.515 kcal $ kg1 $ d1) of the
calculated daily caloric requirement. Both groups had a protein
intake goal of 1.5 g $ kg1 $ d1.
All patients were evaluated before the initiation of nutritional
support to determine their risk for refeeding syndrome. Patients
The primary study endpoint was the development of a hospitalacquired infection. Secondary outcomes included glucose control, as defined by morning glucose values and daily insulin
requirements, ICU length of stay, hospital length of stay, and allcause in-hospital mortality.
SUBJECTS AND METHODS
This randomized controlled trial was conducted from 2008 to
2011 (initial recruitment date 1 March 2008) in the surgical ICU
at a tertiary care hospital. The Institutional Review Board for
Human Subjects Research at the University of Virginia (Protocol
13183) approved the study after ensuring that its design was in
accordance with the Declaration of Helsinki and the ethical
treatment of human subjects. Each patient or legally authorized
representative provided written informed consent before any
study procedures. After 50 patients were enrolled, the study was
reviewed by the independent data and safety monitoring officer
(Timothy L Pruett, University of Minnesota), and approval was
granted to continue the study.
We enrolled adult patients older than 18 y who were admitted
to the surgical ICU and were deemed appropriate for nutritional
support. Inclusion criteria were age $18 y, projected need for
artificial nutrition .48 h, and projected need for intensive care
stay .48 h as judged by the attending intensivist. Typical patients admitted to the surgical ICU included operative and
nonoperative trauma patients, as well as abdominal, vascular,
liver transplant, and orthopedic nontrauma surgical patients.
Exclusion criteria included age ,18 y, patients who had an
expected death or ICU discharge within 48 h, pregnancy, and
patients with a primary burn diagnosis.
Preliminary data from 309 ICU patients showed a 67% infection rate. Therefore, by using a conservative estimate of at
least a 50% infection rate in the control group, we estimated
Downloaded from ajcn.nutrition.org by guest on December 18, 2017
Patients were randomly allocated 1:1 by using a random
number sequence. Investigators were blinded to the preparation
of the randomization envelopes, and the randomization assignment was determined by opening sequential opaque security
envelopes containing the randomization assignment.
were considered at risk if they had a history of significant alcohol
abuse, a 5% weight loss in the preceding 30 d or 10% loss in the
preceding 6 mo, or poor caloric intake for at least 7 d before
initiation of nutritional support or if their premorbid diet/weight
history was unavailable. Patients at risk for refeeding syndrome
who were randomly allocated to the eucaloric group had initial
goals set at 12.515 kcal $ kg1 $ d1 and 1.5 g protein $ kg1 $
d1 for at least 2 d. Electrolytes were closely monitored and
replaced. According to institutional protocol for all patients receiving nutritional support, advancement to full feeding did not
occur until electrolyte abnormalities resolved.
Enteral nutrition was initiated at 25 mL/h and advanced by
25-mL increments 3 times daily until the desired goal rate was
achieved. For patients fed into the stomach, gastric residuals were
checked 4 times a day. Prokinetic agents were permitted. Postpyloric rather than gastric feeding tubes were used at the discretion of the attending intensivist. No immune-enhancing
enteral formulas were used to limit confounding variables.
In accordance with institutional policy and American Society
for Parenteral and Enteral Nutrition standards, patients were
considered for parenteral nutrition if they were severely malnourished and could not receive enteral feeding. Otherwise, all
other patients were started on enteral feeds. Any patient who
demonstrated continued intolerance of enteral feeds after 57 d
was started on parenteral nutrition. It is not routine at our
institution to supplement enteral nutrition with parenteral nutrition to meet caloric goals. Adequacy of nutritional support
was determined by measurement of nitrogen balance.
An insulin infusion was initiated for any patient with blood
glucose greater than 150 mg/dL and adjusted in accordance to the
ICU treatment protocol. For those patients receiving continuous
infusion therapy, the number of units of insulin received per day
was determined by reviewing nursing records.
Data were abstracted from the electronic medical record.
Glucose data were reported as mean overall glucose for the study
inclusion dates and mean glucose at 0600, reported as the glucose
value nearest 0600 on every day of the study. Infection data were
abstracted from a previously described prospectively collected
ICU infections database from the general surgery, trauma, and
transplantation services. US Centers for Disease Control and
Prevention criteria were used to define infections (17, 18). For
example, to diagnose pneumonia, the following were necessary:
a properly collected specimen with isolation of a predominant
organism, production of purulent sputum, a new or changed
infiltrate on chest radiograph, and a quantitative endotracheal
suction specimen with $104 colony-forming units/mL.
eucaloric or hypocaloric feeds, for the length of their ICU admission.
This report describes a single-institution randomized controlled trial testing the hypothesis that hypocaloric nutritional
support leads to better glycemic control, a decreased rate of
infection, shorter ICU and hospital stays, and decreased mortality
compared with eucaloric nutritional support in critically ill
HYPOCALORIC VS EUCALORIC NUTRITIONAL SUPPORT
in-hospital death between the 2 groups was also assessed by using
bivariable logistic regression and the Wald x2 test. To determine
the efficacy of treatment randomization, we compared several
treatment characteristics. Group means were compared by using
a Wilcoxon rank-sum test. Subgroup analysis of the pri …
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