Explain the following:
i. Tube feeding
ii. MCT therapy
lii. Mantoux test
iv Trachoma
v. Oral hypoglycemic drugs
i. A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.
Types of tube feeds
Everyone has different nutritional requirements. The type of feed you receive is tailored to your needs and will depend on a number of factors, including your weight, height, activity level, medical condition, home circumstances and whether you can still eat and drink some amount. There is a wide range of tube feed products that covers all nutritional needs, including:
- Low or high energy requirements
- With or without fibre
- High protein needs
- Lactose (milk) intolerance.
When in hospital, your dietitian will discuss with you the best type of feed for your unique circumstances, which will ensure you receive the optimal nutrition and care.
Types of feeding tubes
Your feed can be delivered using one of the following types of tubes:
- Nasogastric feeding tube (NG)
- Nasojejunal feeding tube (NJ)
- Gastrostomy tubes, e.g. percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG)
- Jejunostomy tubes, e.g. surgical jejunostomy (JEJ), jejunal extension of percutaneous endoscopic gastrostomy (PEG-J).
Your healthcare professional will recommend the type of feeding tube that's best for you.
Gastrostomy and jejunostomy tubes are less visible than NG or NJ tubes but require a procedure/surgery for placement where a stoma site is formed.
NG or NJ tubes, by contrast, do not require surgery for placement but they are more visible than a gastrostomy/jejunostomy and insertion may cause discomfort when placed.
| TYPE OF FEEDING TUBE | WHERE THE TUBE IS INSERTED | WHEN IT'S USED |
| Nasogastric (NG) feeding tube | Through the nose, down the oesophagus and into the stomach | Usually for short- term tube feeding (six to eight weeks) |
| Nasojejunal (NJ) feeding tube | Through the nose, down the oesophagus, through the stomach and into the small intestine (jejunum) | When feeding into the stomach isn't tolerated |
| Gastrostomy tube (e.g. PEG or RIG) | Directly into the stomach through a small incision in the abdomen's skin | For long-term use (more than six weeks) |
| Jejunostomy tube (e.g. JEJ or PEG-J) | Through the stomach and into the small intestine (jejunum) (PEG-J) or directly into the small intestine (jejunum) (JEJ) through a small incision in the abdomen's skin | For long-term use (more than six weeks) |
ii. Metacognitive Therapy (MCT) is a recent development in understanding the causes of mental health problems and in treating them. The approach is based on a specific theory proposed by Wells and Matthews (1994), initially used to treat Generalised Anxiety and subsequently expanded as a general treatment approach (Wells, 1995, 2000). The approach is backed by scientific evidence from a wide range of studies. Metacognition is the aspect of cognition that controls mental processes and thinking. Most people have some direct conscious experience of metacognition. For instance, when unable to remember a name a person may feel sure that the name is stored in memory.
This gives rise to a metacognitive state that occurs as a strong feeling called the ‘tip-of the tongue-effect.• This is an example of metacognition working to inform the person that an item of information is somewhere in memory even though the person is unable to remember it. Metacognition can even go further by retrieving this name and pushing into consciousness often when least expected. Although we are aware of some metacognition operating like in this example, most of the metacognitions that control our thinking and conscious experience operate in the background.
One of the features of psychological disorders such as anxiety or depression is that thinking becomes difficult to control and biased in particular ways that lead to a worsening and maintenance of emotional suffering. Many patients report that they feel that they have lost control over their thoughts and behaviours. Another important feature is that the persons thinking and attention becomes fixed in patterns of brooding and dwelling on the self and threatening information. Metacognitive therapy recognises this change in thinking patterns and believes it is very important. It gives it a name: the Cognitive-Attentional Syndrome (CAS).
This pattern consists of worry, rumination, fixation of attention on threat, and coping behaviours that the person believes are helpful but many of which backfire and keep emotional problems going. The CAS is controlled by metacognitions and it is necessary to remove the CAS by helping patients develop new ways of controlling their attention, new ways of relating to negative thoughts and beliefs, and by modifying metacognitive beliefs that give rise to unhelpful thinking patterns. This approach has been developed into specific ways of understanding and treating disorders such as generalised anxiety disorder, post-traumatic stress, obsessive-compulsive disorder, social anxiety, depression, and health-anxiety.
iii. The Mantoux test or Mendel-Mantoux test (also known as the Mantoux screening test, tuberculin sensitivity test, Pirquet test, or PPD test for
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