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Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later.The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive.Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P0.001). There was a trend towards fewer patients being prescribed ONS (18% reduction; P = 0.074) and there was no significant change in expenditure on ONS by participating GPs (3% reduction; P = 0.499), despite a 28% increase nationally by GPs on ONS.The community dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention.

Healthcare professionals working in the community setting have limited knowledge of the evidence-based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients 'at risk' of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored.An education programme, incorporating 'Malnutrition Universal Screening Tool (MUST)' training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self-administered, multiple-choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self-administered questionnaires 6 months after the intervention.A significant increase in nutritional knowledge 6 months after the intervention was observed (P0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients 'more frequently', whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty-percent (44/55) of healthcare professionals stated that 'MUST' was an acceptable nutrition screening tool.An education programme supported by a community dietetics service for patients 'at risk' of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.

Malnutrition is common in patients awaiting liver transplantation and may contribute to operative and post-operative mortality, although this is controversial. We assessed the pre-operative nutritional status of 87 patients and the impact this had on mortality and morbidity following liver transplantation for chronic liver disease. Thirty six per cent of patients had more than 10% loss of body weight prior to transplantation. Nutritional depletion, considered present if triceps skin fold thickness or mid-arm muscle circumference were5th percentile, was present in 17% and 15% of the total group respectively. Patients whose pre-operative body weights were90% of their ideal body weight (IBW) had a longer hospital stay (p = 0.001) and required longer post-operative ventilatory support (p = 0.033). This group also required significantly more treatment with intravenous antibiotics (p = 0.001) suggesting an increased incidence of infective complications. Patients who were obese pre-operatively (body mass index30Kg/m2) also required a longer period in high dependency (p = 0.0003). No individual nutritional variable correlated with mortality. In the Irish population undergoing liver transplantation, we found a relatively low prevalence of malnutrition in comparison with other studies. Both under- nutrition and obesity significantly affected morbidity and length of hospital stay post-transplant, although no individual nutritional variable predicted survival post transplant.

Alcohol inhibits phospholipase (PL) activity in a number of animal models. We have therefore measured prostaglandin E2 (PGE2) and leukotriene B4 (LTB4), liberated by stimulated peripheral blood mononuclear cells (PBMC) and neutrophils respectively in chronic alcoholics and in control subjects. Peripheral blood mononuclear cells from alcoholics produced less PGE2 (p less than 0.01) and neutrophils produced less LTB4 (p less than 0.025). Reduced PGE2 production by PBMC of alcoholics was corrected by the addition of exogenous arachidonic acid (p less than 0.005) whilst neutrophil LTB4 production remained lower in the alcoholics (p less than 0.01). Percutaneous liver biopsies were undertaken in the 20 alcoholics having abnormal liver function tests. Prostaglandin E2 biosynthesis was lower in PBMC from patients with alcoholic hepatitis than with alcoholic cirrhosis (p less than 0.05). Analysis of PBMC fatty acid composition demonstrated that endogenous arachidonate and linoleate contents were not significantly different in alcoholics and controls. Cells from controls and alcoholics were incubated with 0, 50 and 150 mmol/l ethanol for two hours but there was no alteration in PGE2 or LTB4 biosynthesis. In summary, we found reduced eicosanoid production by peripheral leucocytes in alcoholics, supporting the hypothesis that chronic alcohol consumption either inhibits membrane bound phospholipase activity or enhances, alternatively, catabolism of eicosanoids. This phenomenon is more marked in alcoholic patients with hepatitis than in those with cirrhosis alone.

The monoamine oxidase activities were found to be similar in the crypt and villous cells of the different regions of rat small intestine. In all cases the activity of the A-form of the enzyme constituted more than 70% of the total. A similar proportion of that form of the enzyme was found in homogenates of biopsy samples of human intestine. Studies with everted intestines showed that at concentrations above 10 microM over 70% of tyramine was deaminated during transport and the use of selective inhibitors confirmed the A-form of monoamine oxidase to play the dominant role in that process.