nst 4 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/353/06-35-03hiroyuki hayasi.pdf · vol. 35,...
TRANSCRIPT
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� ����������� �!���"�#�� "�$� 1987��%! 62��&'"()�*" 518*+,#-.�"/01$ "$ 2002� 9�234$567897: �nutrition sup-port team: NST� ;<%()$ �=/$>+�3&?@2A"'BCD:E+FGHI(J1KKL&� NST <%)&�M) "4$N*OPK(Q� RS+4$&+J1TU,V� WX-�&@Y14$Z.[V�\/� 0]12/&^_Q3`J1$ a) NST &Zb1�c� dec� 4fc� N*4$g� �hi�D7Bj��+Ckl�mn@2A56#&^_Qop)$ q7�&+(Wr4$ns�H8t();� NST ;9u()4$ns�H4$N*:;� 4$<� 4$=�� >?@A� vw'B� 4$Z.[V&CD(� q7�+�ExOPHyF(z{()$ |}Qq7~�H;�� ��� G�N��+�~�&CD( NST �E�+4$�HH�l���I/[J(>+KE&^_Qz{()$ a)�L#@2AF�#��MN4$;9u�x1�� NST <%�+4$N*:;+KE&^_Qop)$ �=+��N[J;��+ NST �%&@Y1�+��� ��&�;3� �L/OP�4$N*HWRr;�Q/R�J NST �%;"'&��&��_Q_Y�Kz}1$
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���������� �!���"�#�� "�$� 1987 ��%! 62 ��&'"()�*" 518*+,#-.�"/01$ "$ 2002� 9�234$567897: �nutrition support team: #��NST�;<%()$ >+� NST$ 2003� 9�&�"+S��=�/01T�4$� ¡K(Q¢UH
V)$ NST $�L/OS�4$-;H9WJ197:/� ���-£XY¤£¥ Ver. 5 /$\Z¦K& NST Z[+56#;\§�x1�� a)]¨�£Z/01��4$-;9W©ª«+^_��H�Y� �-+�¬`&J1�"£X&56��aK+*y;�aMQ_1$ ®+2¯�b°L03L±N& NST;Z[�x� 2007� 2�²³ 983\Z/ NST ;�c(Q_1$ " NST L��4$-;9W©ª«+U2H�Y� ���1�-´µ;dax1®KK�M)$ >®/� ²³a/+ NST �%H¶·yF("'�&tJ®K&23� ¸e+*y�©fHV1®K&�1Kz}�x)$ a)��
1 ���������� �!���" 4f�2 ���������� �!���" NST3 ¹g�º&h»i¼�� h»i¼�� 4$��
151
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������� NST ��������� ��� �������� 2002 � 9 ����������� NST ����� ���������� �!"�
NST �����NST # 1970� �� �$%&'(��)��*
�� ����+� �total parenteral nutrition: ,-� TPN� �.+�/�����01� &2324�5���6789��:������+�/��;<� �!=�=�*��2�� ��"#>�$�?%+�&'(@#� A4BCD)�*E*+�?%�+�,��1� *+��-.��$�/,�F0�G1��H��I��2*�� ?% QOL,J�34K�E)�5��$�6>�+�/�L$�7��89*��3�� M�:0;N��O�(#NST <�=>��P�)��*��<�$� NST #�$�� 30 �Q�R?S��
.)R@$*��� $A( NST @$�B���TQ� +��C�DE��FG�RE0E� H��IU1J� JVWX��+��CYK� L�ZM0[J�N\JO�+]��T(^)�� �?S#P_RE4�� O�(# NST �E`J�QJ�R���34K�0M��FG�STa3b(���RE� ���UV(#STa3bQJ�W�c[+��C�DE�#89*�RE0E�d� XY�NST ef%82bQ�g"���^1� ?S#�hi1j32kZ[ �potluck party method:PPM� "0<h\H" ��� �Ql]m��hi1j32kQno"^p� NST q_`�a�r�bs� #tQuL�a3bQef"PPM ZCQ�g�� a3b��Qef"%82bQc1�v��Q2���
������ NST �����de0+�/�Qa3b��Rf"�#� +
�/��;<gR��s���Sh�Q>w"�� �� t�;6x� iyQJ����0� ��z��d�#R�0�a3b���j"�{�.|}~�A~����(^� NST �kl����1mn NST a�A�D(^o��A�_0�pq�zrst��N�uv�VWw�#R�0�iyQ�x��yQz��
�����������R�0�iyQ{� �pq,-� /�+�|�}�~�x� NST ����W1��)��NST #R���� 1 �(^� ��89���NST Q�A�s��J�"%82bQ�g���2002� 4� TPN����Z6��+����A�E0[Q��"�s�(^)� IVH&ED�s�Q��� NST ef�s������ �pq�s0� z��a�A�D(^l������P����s0����� �s qH��� q_`���L�����s��� �s��#��qR���NST �D}3Q�1� m�O� NST �D}3�0)��s#� J~ 26�� ��~ 23�� /�+�| 3�� }�~ 4�(^)�� NST ���Q Fig-ure 1 �2"� NST ��# NST ef�s��������Q�����"M�Q"�s�(W�d� NST �����c����� �!�� �H 0[����Q����� ��+��I"���u� ����Q ���� NST V¡�Q� 1�no"M����� M�c� NST ef�s�(#a3b���6¢�£�� +�¤ ?%Q¥L"+�8�¡3¢D£ZCQ�¦��c�� �/+�a¤3B�¥�<0[�§¦Q§¨"�¨����¢¤A4�c��©ª� ��+�©ªD�««�a0E¬}ª8�@$0[� +�/�Qg�f"�d�®!6@$Q¬)��
����2001 � 12 �/U����+�V� �Japanese
Society for Parenteral and Enteral Nutrition: ,-�JSPEN� � NST �¯°��9�\H� 2004� 3��#±®Q{$� NST WX8�f� 2004� 8�� "V�� NST��8�f� 2006� 9��#/U+��C¯°x��� NST ��f8�Q{�� ��J~�+��j"²WX�����R JSPEN ��o" TNT �total nutrition ther-apy� ³¡�� 2002� 5�� 3�Q±´���##µd� z��(���²T"J~ 7�� TNT {³Q��RE� M�c�V�³(�¶´#2007� 3�µ�(�·¶, 62¶� �·¸¹�º�>» 15¼� ªD¸¹¤33º�0)RE
�� NST �� NST �� ����+�/��j"�s�8
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���� �������2001� 11����� NST ������ 1�������� ��!"���#����$%&� '(&� )&� ��*� +������,��-./01����2�� -./0134�5%& 44.5��164 �� 73 ��� '(& 80.5��405�� 326���6� 78$ 70.9�$9:� �����;<=56���>?��@� A���$5�10��50���A3��!"�� 80�AB��CDE�@�F��GH������ I�J���K���25L�MNE� ��OP��;QRST��UV��W�AXY@� A����5�Z[7!"��Y\W�� A3��� �����]^_`a��b c������d�A\W� � e!� ���f0g��%&�h:i�$�TPN jk"����2��lL� ���mj#�$5n�op��@� ���$5� ��q�%&5rsA� 3��� �-./015��tu01v0w �NST� A�Yx%�y���&�� ;'�NST ��z{�|(�}:�� -./01~^@�� ����� ����� ����)y��� �A5��$��� ������8��}��*5+,$9�� ����5%&�k��`��2z ���/0����d�A\W� �
���� ���� ���K����#����$� NST -�����,.�/����A8b�0�$�1�������� ��������������2A����A����-���.�j�.��q�9�5�� 3�-���.�5�;QR�45�6���$9�A�,�@�z ���6�� ��:���GH<=�7���D��;�-���.�058&@�9 A\W� �� 2001� 12�:;�;<=��;�-���.�Z@� �������0����� �Figure2�� -���.�0�5 54.9�� �.���0�551.9� $9�� A��;¡�¢£-v¤.��0� 79.4� �¥3:� �~^@��;:¦������§¨�2A��-���.�j�.��q$©W�A�:�5ª<$��d�A\W� � I-���.�0�5«�¬R��D� e=®¬ 83�� ¯�°'¬ 88�� �±'¬ 80� �6�;¡�� ²³®¬ 9�� >´k®¬17�� ��µ�«�¬?¶5 43�$9:������� �����8b�05��K��·@$9�� ¸AA�,¹@� BMI �body mass index�kgm2� �º�z �BMI � 25 �r3�A B��� C � 18.5 �¥3:lL5 �{� AD»z ��GH�D0z �� I8bE�5��$�¼:c�D»���2A��b Az �7�� ��K��_��b ��2$9�8b�0������D� NST ���� 2001� 11�� ¯�°'¬_`a®¬FG�;
Figure 1. The formation of the nutrition support team in St. Marianna University
School of Medicine, Yokohama City Seibu Hospital.
activity of nutrition support team 153
27
����������������� ����������� ����������������� �� �������� �!"#$� �Table 1�� ���� �%� �&��� �'()*+,-� ������.)������%�/����0� 1���-����� 23�4��5 �6����7-89:��0� :���;<������%��=�>��:�� ������.) �� ���7-89��?@�A� NST BCD* E� F�G� �A��!*%/HIJKL�����*5����M�(NOP�QRS�T�"##9��
�� NST ������� NST ������ ���NST �U$%� �VW�X�%/�Y&;<Z
1�� NST Y&G� � �[-\�]��^_� ` �ab'�cd�4'�ef���g�� F�G� (h$�iPj()�� � )*Kk'+l
,m�9,\�NnoNKp-�X�.'q/()�!0r*�s����,#��( �'�Harris-Benedict t8��u�vw� Fx�yz{ �|}��10��� ~�23 NST ���P%����\��9���*+�:�;<4�M�(2�5K6�� 78 �%M�;� ()�9: �|}��0�� E������%� ;��(���+� NST i�o�jP�X���x� �NSTi�o�jP%�� TNT �CD��<W�-$���� � �[K23���P�/y���� �|}��1��� F�r*�G�=�7�10��� 9�x���-10�� �|}�5(�g����(�>?K2�()�����:�� 1�7��_@�9{A ;<� Y&;<B¡1*% 48 �¢£��CD���� 1 NSTi�o�jP%���¤E�(¥¦§P��F�GH� ��*+x¨�VW�©M�I#� NST -ª«J¬��9� �KL^_G�®� � ]¯��°()�¬M���� ¬�!�-±?G� ²�³�´�µ¶�� NST Y&G� �
Figure 2. The ratio of inspected operations related to nutrition in each department.
Table 1. Investigation of Weight Measurements Before the NST Began Operations.
N ·� ¸¹º»¼ <154
28
���� �� NST ����� NST ����� 3� ��������������� �� 1���� 3.29������ 48��� ������� �!"#$�%� 2� 2.39�� 3� 2.09��&'����()*%�+,-���������.%/$� 4 � 2.67 ��01�����&���%� NST ��2� �3&456��������7#,��(8�)*%�+,-�� �����������(�� 9:;<=�>?@A��B�CD-�%� E NST :�FG�H�IJ*K�@�.,�L�%�M� NST N��O�PQ�R.ST��
���� �������2002 9U#, NSTV�&WX�XY+�� �Z� V�[\�]^�QTS_`�� NST V�[\�� ���7 1��abc d 10�&���14d� �d#, 48�� NST V�%/$�� ��!��e"�efg���% 19��# 40���h@iT$%&&+�� e"�efg����V�[\�� P'��=(���2@ NST �Gjk���L�#,� l�<N�%m )'�*+8�L�� TSno%/$��CD-�� 2�p�V� �d��,b��+,-"T@��� -qrd� .' d�V�%/s�� J2�0��t1�i2\�34�5Zuv"w���x6K�78&yQz�%9��"$��
���� NST �������NST V�[\���]:�QTS� ��2 4
��{$|& Table 2 ��8� };~����<�=>�?�����@�����S BMI �bodymass index�, IBW �ideal body weight, 6A>��
$� TSF �triceps skin fold,KB���CZ�D��,AMC �arm muscle circumference,KB����QTS$|��� =>�?<� �TSF �� �AMC�T�-@ JARD �Japanese Anthropometric Ref-erence Data� 2001���+�� NST ��#, 4&'���2@V�[\�~����<�=>�?<���<&Z�$ST�� L�L�#, NST ��2@0��[\�,D,�m �E��� NSTN���F�S45G�H%���-��
���� NST �� ����������NST %V�H���������8"D�G�
"��I���� 6�A-&�J�����������x6KL� ��x6�G�"���M�"w%� V�H�w�NOWX�-,-ST�#� L���&{�� 6�� K� ��� 4¡¢�£"w�,¤PQ&WR�NST �����¢�£S¥%���S�T�� �Table 3��NST�M�����x6KL� ASPEN �Ameri-
can Society for Parenteral and Enteral Nutrition�¦§¨�§��©$�9�� 8"D�UxªV«Wz��'Ux��&M��� 'X�¬xx6% 6�K�Y�x6�"$�®�� ¬Z[\&M���� ]^���Ux%ªV�M"Tz�� 2�K%_A�-�®�� TPN, 2� �`¯]^��&M���� L�5� NST V�[\�'X¬xz�%9°� ¬Z[\&�±8�²�:%9#$�� L-�'X¬x�a���³Y��� Xb´�µ¶� 5Z·c�d¸� ¹º\�»�"w#,�6e�R.�� �#��±�f8�V�H�¢�£S¥�g�NO�h6$�� L��B�[\ ��¼i�jn%k,-"#$�L�� 6�(ml�¬Z[\%W�-mW"w�6n�/$�� o�(ml�78�
Table 2. The Nutritional Circumstances of the Patients Requested by the NST
activity of nutrition support team 155
29
����� �������� ������������������������ ���� �� �!"���#$%��& � �!��'(%����)� *������%� �!+,����-����� ���� �!�� .���/%� �"0123�!"#$��4�� 56%���%&78'()*#$9:4�56+,� �!2;���-����� (�-<./ �="012345�� GFO��>?@AB�6789:;C�DEF��2;� <=2 �(�>�%�?@�GH��� -H� ��A� evidence based nutrition
"IB+C�D�H�� �!"E�8J@KLEMN�O�� �F� � GAHHP�%�pharmaconutrients �2�QI�RJ��4� �!�SH��10�� NST TKL%�U�H"���<8%� ��"MV��%� �W"D�XNYO� NST ZPQRPHS 60� [%� \P"]��T^%_UT`a�� U�H"V�� �W"WX �bc"dY����,��e�-�� �!�W"S+C�fgU�"hZ-[%�i:������ ��� �j+�[�\klU�/NST "m]^$_n�2;� �!"`ao�-H�K�����+`�� �!� �b�c�2pde+qr-�
�� 2PT�fg"_�pde�sh+`�� sh� �!"ijt� .�E�� 0g"k� �!� ;ClE��a�c�2�u�vm���-��+� �!"� ng+o�2uwT`���px-����11�� U�H"qPH �!� r"shyz��%� NST T�>Dng{-
KL%�� |G� �">Dng{-�}~�s+t��2�� 2;" NST }~WPH"M#�`�� }~�s��%P�`u�>Dng�B���?T�� ���B�"vDwa����� U"�B�� NST To�"xlyz%�>Dng�{��g��8"_�yz�E9|�%���� (�.>�.�}!"� ng����#$%�� .�}!d�=��~e+qr%/��U�+px-������P12�� Q�T�./ �=".�}!l� ���G-��13�� D��.�}!"^�����!"0n.>�� .���+����C��(��~e+qr%/�l2��%�.�}!"� ng����U�+o�T`���px%���14�� U"D�H"�G�O�����!"��� >��]���%� ��?����O���.�7���J�%�./ ���+ 1� �!�-<8%�e���� ^�T��¡�2ng�-�� 0.1 g�kg�hr �!"� =¢KL%.>�.�}!"d�MV%�� U"�� -<./ ����" �e£=�� ng"�_����p"¤[2;�� �!"� ng���� NST "KL�� ¥PQR����g"��T`a�+� ZP 4 ��� 8 ¦§+�¨D�H���9����� �©S/ª«A��a��9��s�¬���%�9�KL%�®�NT`�� 9�"�¯+���°nH��yz�� � �±/�� ²±2;� �³yPH�s�¬4�yz�´Hµ� _²±/�±�2;*��±���%���� _�8¶·¸n¹HP"�3��¬4Q� �9�s�¬4�_�z+���-��15�
Table 3. The Ratio of Order Reflections by the Doctors from the NST’s Recommendations
º� ¡¢�»¼ H156
30
�� ������������� ������ ������ NST �� �������������������� �� � �!��"#$% �& ��� 2003� 4'()��*����*� ���*� ���+*,-.(/012034567��8��� ����901���:������� �9�;3<= ��>? �&VF �Video Fluorography�, VE �Video Endscopy�@A� !� ����B��9C"D#���E�@$F��� ?G� %H���9I&�JK'L�':��;� ��B�012034567()�*+F���@A,-�./ �� 0�MNOP7�1Q�
R47S4T�2UVMNOP7�E�,-D#��W4<�X� #�YZMNOP7�3[\�4 205�X�]� NST ^!6�_7`8�ab�9�� � ��_7:;�<c�=�����>d�?#� e@� UVMNOP7�3[\�4 1.9 5 A�� _7fc�gB�C-�h16����D� EFiGjHkIl�mJno �pK �qLF�� mJMN,-B� O?�rs�no�PQ#� �RS �TtF��17�18�� �L�����@AuU�5VWX�YSF����]L� Zv�@AD#w&� �NST @Axy=��E�z<#{[�|}��� @A,-./�\#9Z�4 6~�]�}�� ���@A�_7`8^� O?L�RS�@A�X)� �B�NST ��F��_=`�X���0a,�b���c��^F�� JK'qd�(eQ�_7`8�f]�|��� ���� ������@AuU�eghi�-��j%WX�.�er�k�l����^� NST �m� 4�d����� NST �nb
��_7U�7�./�\�� 0a,�9Z�_7jo('�9Z����p�L�q��������� NST �n��,-� ��-� `8_7��r�-�E�����st L�n�F���Z�X)� n��\#,-�9Z�q�������4��m�-�.(/O? ��Y���c ����
���� NST ����������NST �mB� uvWX*()w��x��D#
�X}�� ���x�y� NST ^!B�_7z�
�� NST �{�� � 105d�^���4���|���� � }~� � }~���+��E�+*x�� �m`Il� ��D�x�� 4 ����� D#>� ^! 1 �B� ��>_7¡¢�NST �£���O?�~¤�1Q�� �Table4�� ���w�x� ¥ � NST D#L�^!��>�_7z��MNOP7�¦�@$�� �Ta-ble 5�� NST D#>��x� ���O?������W4<�u��]���� ��BNST �(_7O?�nb�E�()� D#B1 �B� NST ^!��>�_7�O?�§¨��� �� NST D#L������MNOP7��� � }~�|���q��� ���m`Il�|�p�L�iG�b��� e@� � }~�|�� _7����(}��O���_7qd�XMNOP7��iG��� NST^!fc� ADLj QOL, ��N�iG�E� F��y�qd��-�@$#O?�X� �b�� ����� ����B�©��X�
�� �������� ����������NST ��m6B� H�og�_7`8.ª�Figure 3�b#� TPNj��_7� �enteral nutri-tion: EN� }����_7`8�O?�|��kh��¦��]����� «�� NST �¬F��%��U'� TPN ��S)®�X}������ NST ��m-� �� TPN `8�|��[{�¯���� Tt#���X19�� %H�� NST �mB� e�� TPN `8�|�[{�b���� °§��>/q��� �}�� ��?±��F���²�@$�O? ��� ��_7���_7�1Q��(��8'�X)� �m��E��³'¤����c�X)20�� F���´'�R��X� �p�L�F��21�� µo .(/�´ L�� ��¶S�h�|���`_7�|�� �_7`8�·���Z¡) TPN �er�()¸¹��� � NST �m����¢)��
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NST �mB�Mº=»��� £¤¼�X�¼�.�!H\d�A¥j!H¦S�¤��c�³§c�¨)�E�p�L �}�22�� e@� �
activity of nutrition support team 157
31
������ 2001 ����� �� PPM�potluck party method������� NST��������� ������� !""#�� $%&%'()*+,� -./0+1�2�34567$8�9: !��;23�� <=� 2002� 9>� NST��?@A�� BCDE 200F?GH; NST IJKL�MNOP�QR2�S�� D�IJKL�TU
11V�=WEXYZ?@[�� MNOP�\]^� _`MNabcd�e�fg�hi� MNOP�V�j��fg�"��kl��?m2�S�� no�9:�� NST ���=W�MNOPpq�g��rfst?��ujv�"��� 4�w�px?yDH�z{���<=��|; NST ��}���?D1~;1�
Table 4. The Ratio of Energy Su$ciency of the Patients Requested by the NST
Table 5. The Changes of Objective Nutritional Indicators Classified by Diseases
Figure 3. The monthly transitions of TPN and EN controlled patients both before and after the
commencement of NST.
� �m ����� 158
32
NST ���������������������� ������ NST ��� ����������������� NST �������������� �� NST ��! ���������� ��"��#$�%��� &�'��������(� � NST )�����*+,-���.�!��/� ���� "0�123��� 4�� 5������6��7���TPN 6����� �!8� 9�.! ���"#� NST )�'$�: $/� "�� "0�$%&$'3;�"<�� �=� NST �>(8)?>���5���@AB�C�D�*+���E,���F-6�"0�B@A*G@H�I.J"0K%� L5/ �M0� 5�F-��#1�23� N3456��M0� 78�M0"0�NST ��9�O=�'3;":P�;3���"�� Q�3�&�����R'� STU< .J �V���� �3�W=XY>5�=Z!� ?�X�5�@>��"#�;�AX�B["\C�D]!2�;� >#^E_����F�`G"0�NST a'$��6��b�H$�IJ ����Q���"@� /%��5�7c� NST ���=dKL�Me;3f=��� 9: NST �N�� ASPEN ghi�h�>$Oj3����24������"#��!�P�Q�k%�RS"bl� 8� ��Tm�\U�!���$�;� ���F�$%> �;V'"&��n� Q�WX>�����N��<���� �3� NST ��������\U>#��o���;�P�> 8 NST�N�YL�Vpq> �� NST rsN�Me��*+���E,��+�I�6�� Z[� Et\()s"0� ��uv�w�B"]^D]� x�;�_`"���Fab�!>P�"KL> �� 9�cd\(�ey�fPgh"0zi�� ��@AB�C�D� ��*G@H�I/�aj �����<��n� NST �q;Q��>�"�KL> �� ��k��l���P�=�{|����R/� mn�� 93:� JkB�}~i�hi�o�! ��;���@�~������@;3� 5������FV��� �^p�j��q���� r�N���s��rt�u��7�����r4�F�v�cd\(M0"0�w&;3 NST �7c�Ki� �� �5r�x�
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activity of nutrition support team 159
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������������� � NST ���� ���������������������������� !����"�#�$%&��'�����
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' hi ¹ºr»¼ w160
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Abstract
Starting up a nutrition support team �NST� and its achievements duringthe first 4 years at St. Marianna University School of Medicine,
Yokohama City Seibu Hospital
Hiroyuki Hayashi1, 2, Hiroyuki Komoriyama2, Minoru Miyashita2, Suzumi Soh2,
Yukiko Kawashima2, Sonoko Sawafuji1, 2, Misako Kawase2, Hiroyuki Abe2,
Kumiko Hamada2, Takahito Yamamoto2, Akeo Nakazawa2, and Hiroshi Suzuki2, 3
St. Marianna University School of Medicine, Yokohama City Seibu Hospital, was established in 1987
admitting patients in their acute phase. This 518 bed hospital has operated a nutrition support team �NST�since September 2002. In this article, the origins of the NST and the details of the system inside the hospital
are described. An investigation of the sta#’s awareness, the ratio of inspected operations related to nutrition
in each department, and the ratio of weight measurements are reported as nutritional circumstances before
the NST began operating in this hospital. The necessity for improving the skills of the doctors, nurses,
pharmacists, registered dieticians, and rehabilitation department as a whole, is discussed. Each and every
nutritional plan requested by the doctors, and designed for the patients has been presented by the NST. In
this article, the nutritional plans presented were classified by nutritional management methods, nutritional
quantities, nutritional compositions, speed of administration, diet content, and inspected operations related
to nutrition. The results were then collated and analyzed. In addition, patients who were requested by the
doctors in charge were divided into various groups, such as cancer, trauma, cerebral vascular disease, etc.
and the changes of their nutritional status were noted after intervention by the NST, using albumin as a
nutritional indicator. In the worldwide recommendation of enteral nutrition, where costs and safety are
concerned, the changes in nutritional management methods are described by the NST. I believe that the
retrospective study of this article will help connect the maintenance and quality improvement of the NST
functions and also help ingrain the NST functions that each type of occupation deems safe and appropriate
nutritional management in this hospital.
1 Department of Pharmacy, Yokohama City Seibu Hospital, St. Marianna University School of Medicine2 Nutrition support team, Yokohama City Seibu Hospital, St. Marianna University School of Medicine3 Kanagawa University of Human Services, Faculty of Health & Social Work, School of Nutrition & Dietetics
activity of nutrition support team 161
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