Clinicians frequently care for patients in whom long-term enteral tube feeding is being considered. The medical surgical nursing lewis 9th edition pdf increase in the use of endoscopically placed tubes for long-term feeding reflects the aging population, advances in medicine and technology, and inadequate advance care planning.

Physicians should address advance care planning with all patients at the earliest opportunity. Prospective randomized trials measuring clinical outcomes for patients receiving long-term tube feeding are understandably limited. In addition, confusion regarding medical and ethical guidelines for long-term tube feeding often exists among clinicians, patients, and surrogate decision makers. Therefore, we discuss the physiology and clinical tolerance of limited oral nutritional intake, the prevalence of and indications for long-term tube feeding, the endoscopic procedures and their complications, the reported medical and quality-of-life outcomes, and the critical importance of advance care planning.

We present our multidisciplinary approach that combines medical, nutritional, and ethical principles for the care of these patients. Check if you have access through your login credentials or your institution. 2005 Mayo Foundation for Medical Education and Research. This article is about the sexual preference toward prepubescent children. A person who is diagnosed with pedophilia must be at least 16 years old, and at least five years older than the prepubescent child, for the attraction to be diagnosed as pedophilia.

Pedophilia was first formally recognized and named in the late 19th century. A significant amount of research in the area has taken place since the 1980s. No cure for pedophilia has been developed, but there are therapies that can reduce the incidence of a person committing child sexual abuse. The exact causes of pedophilia have not been conclusively established. Some studies of pedophilia in child sex offenders have correlated it with various neurological abnormalities and psychological pathologies. Pedophilia emerges before or during puberty, and is stable over time. It is self-discovered, not chosen.