Development and Validation of a Prediction Model for Enteral Feeding Intolerance in Critical Ill Patients: A Retrospective Cohort Study

ABSTRACT

Aim

To construct and validate a prediction model for enteral feeding intolerance in critically ill patients during the first 7 days of enteral feeding.

Design

A retrospective cohort study.

Methods

We reviewed the medical records of two intensive care units from January 2015 to August 2023, to develop a prediction model by univariate analysis and logistic regression analysis. Model's performance was evaluated through discrimination, calibration and decision curve analysis.

Results

This study involved a total of 471 patients, with an enteral feeding intolerance incidence rate of 35.7%. The prediction model comprised six variables, namely neurological disease, chronic gastrointestinal disease, Acute Physiological and Chronic Health Assessment II score, sedatives, acid suppressants and serum albumin. The model showed robust discrimination, calibration and clinical net benefit, indicating significant potential for practical application with readily available variables.

Conclusions

The model demonstrated strong predictive performance in assessing the risk of enteral feeding intolerance during the early stage of nutrition initiation.

Implications for the Profession and/or Patient Care

Enhancing clinicians' capacity to reduce the incidence of enteral feeding intolerance and improve patient outcomes.

Impact

The prediction model shows a good capacity to discriminate critically ill patients at risk of enteral feeding intolerance, is helpful to provide personalised care.

Reporting Method

TRIPOD + AI checklist.

Patient or Public Contribution

No patient or public contribution.

Trial Registration: https://www.chictr.org.cn/ ChiCTR2400090757

Factors affecting colonoscopy screening among first‐degree relatives of colorectal cancer patients: A mixed‐method systematic review

Abstract

Background

First-degree relatives (FDRs) of colorectal cancer (CRC) patients have a higher risk of developing CRC than the general population. Ensuring that these at-risk populations receive colonoscopy screening is an effective strategy for reducing the increased risk, but the rates remain low. Colonoscopy screening behavior is influenced by factors at multiple levels. However, most previous reviews failed to review them and their interactions systematically.

Aims

To explore factors influencing FDRs' colonoscopy screening behavior according to the ecological model.

Method

A mixed-method systematic review was performed in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. A comprehensive literature search was conducted using eight bibliographic databases (Medline, EMBASE, PubMed, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wan Fang Data, and China Biology Medicine) for the period from January 1995 to February 2023. The Joanna Briggs Institute critical appraisal checklists were applied to assess studies qualities. A convergent integrated approach was used for data synthesis and integration.

Results

In total, 24 articles reporting on 23 studies were included. Only one study was rated low quality, and the other 22 studies were rated moderate to high quality. The findings revealed that certain factors and their interactions affected FDRs' colonoscopy screening behaviors according to the ecological model, including misconceptions about CRC and colonoscopy, concerns about the procedure, perceived susceptibility to developing CRC, health motivation, fear of CRC, fatalism, the recommendation from CRC patients, and recommendations from physicians, colonoscopy schedules, cancer taboo, health insurance and cost of colonoscopy.

Link evidence to action

Family communication-centered multilevel interventions are recommended to promote colonoscopy screening behavior among FDRs of CRC patients.