Nutritional support for adults and children: a handbook for hospital practice.

Nutritional support for adults and children: a handbook for hospital practice

Bowling T (Editor), Radcliffe Medical Press Ltd, Abingdon, 2004, 181 pages, [pounds sterling]24.95, ISBN 1-85775-831-5

This handbook, edited by Dr Tim Bowling (Consultant in Clinical Nutrition and Gastroenterology, Queen's Medical Centre, Nottingham) arose from a brief from the Council of the British Association for Parenteral and Enteral Nutrition. It is intended as a daily guide to clinical practice in the area of nutrition support. The book is endorsed by the various key groups of related professional groups--the British Pharmaceutical Nutrition Group, British Dietetic Association and National Nurses Nutrition Group. Most of the contributors are drawn from these professional groups.

In his introduction Alistair Forbes, Chairman of the British Association for Parenteral and Enteral Nutrition, notes that although there are numbers of specialised texts in the areas of clinical nutrition and nutritional support, this is a daily guide for practical reference across many areas of nutrition support.

The book covers all aspects of nutritional support from nutritional assessment, through various methods of nutritional support and its application. The book is pitched 'at a very basic level', but will be a very useful guide for experienced practitioners. For the basic practitioner the book provides a useful guide to nutritional assessment, estimation of nutritional requirements, and methods of nutritional support, with simple explanations and basic information. For experienced practitioners the appeal of the book would be that it gathers all the tools of nutrition support in a single resource. There are decision trees, algorithms for management of problems such as catheter occlusion and sepsis, nutrition assessment tools, basic equations and calculations, and outlines of the various products available and their properties (not all available in Australia). A useful inclusion is the photographs of equipment, such as PEG fittings. Each chapter ends with a list of brief, current references.

Following a general introduction to undernutrition the book provides parallel chapters dealing with nutritional assessment, nutritional requirements, methods of nutritional support and nutritional support in disease-specific conditions for adults and children.

In the adult section there are succinct discussions of specific issues. For example, there is a bewildering amount of information provided to clinicians about newer peri-operative nutritional supplements. This book offers a brief review of the rationale and current evidence for their use. Similarly, there is a large and complex literature on the role and type of nutrition support in inflammatory bowel disease and the role of nutrition as a primary therapy. There is a half-page summary of current evidence, and a short list of references for further reading.

The weakest chapter is probably that on nutritional support of children in disease-specific situations. It includes discussion of some relevant areas such as cystic fibrosis and short bowel syndrome (worthy, but perhaps too complex to be included here), but also discussion of an assorted group of problems such as toddler diarrhoea and coeliac disease, whose general nutritional management appears to have little place in a discussion of nutritional support.

The book includes a brief but excellent chapter on the 'Ethics of Nutrition Support'. The chapter includes an outline of the basic principles of ethical argument, and the application of ethical principles to decisions regarding the provision of nutritional support to those patients with specific conditions such as dementia and anorexia nervosa, and the withholding of support in specific situations.

In his foreword Alastair Forbes, Chairman of BAPEN, states that he believes that 'well-thumbed and battered copies will soon be found on wards everywhere', and it seems this could be so. The book would be an excellent addition to many libraries and bookshelves.

Kay Gibbons APD 

Manager, Nutrition Services

The Royal Children's Hospital, Melbourne