Sosyal Bilimler Enstitüsü

s u m m a r y Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: integration of nutrition into the overall management of the patient avoidance of long periods of preoperative fasting re-establishment of oral feeding as early as possible after surgery start of nutritional therapy early, as soon as a nutritional risk becomes apparent metabolic control e.g. of blood glucose reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function minimized time on paralytic agents for ventilator management in the postoperative period early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

European Union (EU) member states' 'failure' to cooperate on energy policy towards Russia has been much criticised in the media and by policy analysts since the mid-2000s. This article analyses member states' choices to ensure domestic supply security by either increasing gas supplies from Russia or by reducing gas imports from Russia. The article seeks to explain why the member states pursue energy supply objectives towards Russia that are opposed by other member countries, despite the official commitment to acting 'in a spirit of solidarity'. It argues that the member states' choices are informed by their assessment of the geopolitical reality and its expected impact on their national energy supply security. This is, in turn, informed by their perceived vulnerability that stems from their geographic location, historical experience and bargaining position vis-à-vis Russia. The analysis shows that calls in the EU for 'solidarity' regarding the security of natural gas supply serve primarily as a cover for the pursuit of individual and not collective EU interests. The rhetoric of 'solidarity' and the need for cooperation in the EU also serves the European Commission's interest in acquiring a more important role in external energy policy.