21 research outputs found
The registry of home artificial nutrition and ambulatory of the Spanish society of parenteral and enteral nutrition: Swot analysis
Objetivo: Evidenciar mediante un análisis DAFO-R
realizado por consenso de expertos las características
más acuciantes del registro de Nutrición Artificial Domiciliaria
y Ambulatoria.
Material y método: Análisis DAFO-R por consenso de
expertos. Se solicitó la participación de los miembros del
grupo NADYA activos en los últimos 5 años bajo la premisa
de estructurar el DAFO-R sobre las características
del registro NADYA desde su inicio.
Resultados: Han participado 18 expertos de diferentes
hospitales de la geografía española. El análisis interno se
inclina positivamente presentando al registro con recursos
importantes. En el análisis externo no son numerosas
las amenazas, hay factores de gran potencia, “la voluntariedad
del registro” y la “dependencia externa de financiación”.
Las oportunidades identificadas son importantes.
Las recomendaciones se dirigen a la estabilización del
sistema disminuyendo las amenazas como foco principal
de las estrategias a desarrollar al mismo tiempo que se
debe potenciar los puntos identificados en oportunidades
y fortalezas.
Conclusiones: El registro NADYA se muestra en el
análisis con gran potencialidad de mejora. Las recomendaciones
propuestas deberán estructurarse para continuar
la tendencia de desarrollo y perfeccionamiento de la
calidad que ha caracterizado al registro NADYA desde su
inicio.Objective: To evidence by means of a SWOT-R analysis
performed by an expert consensus the most worrying
characteristics of the register on Home-based and Outpatient
Artificial Nutrition.
Material and methods: SWOT-R analysis with expert
consensus. We requested the participation of the active
members of the NADYA group within the last 5 years
with the premise of structuring the SWOT-R based on the
characteristics of the NADYA registry from its beginning.
Results: 18 experts from hospitals all over Spain have
participated. The internal analysis seems to be positive,
presenting the registry as having important resources.
The external analysis did not show a great number of
threats, there are very potent factors, “the voluntariness”
of the registry and the “dependence on external financing”.
The opportunities identified are important. The
recommendations are aimed at stabilizing the system by
decreasing the threats as one of the main focus of the strategies
to develop as well as promoting the items identified
as opportunities and strengths.
Conclusions: The analysis shows that the NADYA
register shows a big potentiality for improvement. The
proposed recommendations should be structured in
order to stay on the track of development and quality
improvement that has characterized the NADYA register
from the beginnin
Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study
There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality
Acute intestinal failure: international multicenter point-of-prevalence study
Background & aims: Intestinal failure (IF) is defined from a requirement or intravenous supplementation due to failing capacity to absorb nutrients and fluids. Acute IF is an acute, potentially reversible form of IF. We aimed to identify the prevalence, underlying causes and outcomes of acute IF. Methods: This point-of-prevalence study included all adult patients hospitalized in acute care hospitals and receiving parenteral nutrition (PN) on a study day. The reason for PN and the mechanism of IF (if present) were documented by local investigators and reviewed by an expert panel. Results: Twenty-three hospitals (19 university, 4 regional) with a total capacity of 16,356 acute care beds and 1237 intensive care unit (ICU) beds participated in this study. On the study day, 338 patients received PN (21 patients/1000 acute care beds) and 206 (13/1000) were categorized as acute IF. The categorization of reason for PN was revised in 64 cases (18.9% of total) in consensus between the expert panel and investigators. Hospital mortality of all study patients was 21.5%; the median hospital stay was 36 days. Patients with acute IF had a hospital mortality of 20.5% and median hospital stay of 38 days (P > 0.05 for both outcomes). Disordered gut motility (e.g. ileus) was the most common mechanism of acute IF, and 71.5% of patients with acute IF had undergone abdominal surgery. Duration of PN of ≥42 days was identified as being the best cut-off predicting hospital mortality within 90 days. PN ≥ 42 days, age, sepsis and ICU admission were independently associated with 90-day hospital mortality. Conclusions: Around 2% of adult patients in acute care hospitals received PN, 60% of them due to acute IF. High 90-day hospital mortality and long hospital stay were observed in patients receiving PN, whereas presence of acute IF did not additionally influence these outcomes. Duration of PN was associated with increased 90-day hospital mortality
Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients:An international survey
Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care
Nutrición parenteral domiciliaria en España, 2019: informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA
RESUMEN Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadyasenpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue “oncológico paliativo” y “otros” (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD
Nutrición parenteral domiciliaria en España 2018. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA
Aim: To communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe. com) for the year 2018. Material and methods: Descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: There were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was “palliative cancer” (22.0%), followed by “others”. In children it was Hirschsprung’s disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: The number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN.Objetivo: comunicar los datos de nutrición parenteral domiciliaria
(NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadyasenpe.
com) del año 2018.
Material y métodos: análisis descriptivo de los datos recogidos de
pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE
del 1 de enero al 31 de diciembre de 2018.
Resultados: se registraron 278 pacientes (54,7% mujeres), 23 niños
y 255 adultos, procedentes de 45 hospitales españoles, lo que
representa una tasa de prevalencia de 5,95 pacientes/millón de
habitantes/año 2018. El diagnóstico más frecuente en adultos fue
“oncológico paliativo” (22,0%), seguido de “otros”. En niños fue la
enfermedad de Hirschsprung junto con la enterocolitis necrotizante,
con cuatro casos (17,4%). El primer motivo de indicación fue
síndrome de intestino corto tanto en niños (60,9%) como en adultos
(35,7%). El tipo de catéter más utilizado fue el tunelizado tanto en
niños (81,0%) como en adultos (41,1%). Finalizaron 75 episodios, la
causa más frecuente fue el fallecimiento (52,0%) y el paso a vía oral
(33,3%).
Conclusiones: el número de centros y profesionales colaboradores
en el registro de pacientes que reciben NPD se mantiene estable, así
como las principales indicaciones y los motivos de finalización de la
NPD
Nutrición parenteral domiciliaria en España 2018. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA
Aim: to communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe. com) for the year 2018. Material and methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: there were 278 patients from 45 Spanish hospitals (54.7 % women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was " palliative cancer" (22.0 %), followed by "others". In children it was Hirschsprung's disease together with necrotizing enterocolitis, with four cases (17.4 %). The first indication was short bowel syndrome in both children (60.9 %) and adults (35.7 %). The most frequently used type of catheter was tunneled in both children (81.0 %) and adults (41.1 %). Ending 75 episodes, the most frequent cause was death (52.0 %) and change to oral feeding (33.3 %). Conclusions: the number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN
Problemas agudos de la nutrición en el paciente oncológico
https://digitalrepository.unm.edu/sc_advocate_news/3361/thumbnail.jp
Hipofosfatemia grave tras el inicio de nutrición parenteral en una paciente con fístula intestinal
La hipofosfatemia es una complicación que puede aparecen en pacientes malnutridos a los que se les ad-ministra nutrición, tanto de forma enteral como pa-renteral. Se asocia a diversas manifestaciones clínicas, entre las que destacan las cardiológicas, neurológicas y hematológicas, pudiendo llegar incluso a producir la muerte. Es por tanto obligado realizar prevención y se-guimiento en aquellos pacientes con un riesgo elevado de padecerla, teniendo en cuenta la importante morbi-mortalidad que presenta