The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on th

Standardized and Individualized Parenteral Nutrition Mixtures in a Pediatric Home Parenteral Nutrition Population

OBJECTIVES: Studies evaluating efficacy or safety of standardized parenteral nutrition (PN) versus individualized PN are lacking. We aimed to assess effects on growth and safety of standardized PN compared with individualized PN in our Home PN group. METHODS: Descriptive cohort study in Dutch children on Home PN, in which standardized PN was compared with individualized PN. Both groups received similar micronutrient-supplementation. Primary outcome was growth over 2 years, secondary outcomes were electrolyte disturbances and biochemical abnormalities. Additionally, patients were matched for age to control for potential confounding characteristics. RESULTS: Fifty patients (50% girls, median age 6.5 years) were included, 16 (32%) received standardized PN mixtures. Age (11 vs 5 years), gestational age (39.2 vs 36.2 weeks) and PN duration (97 vs 39 months) were significantly higher in the group receiving standardized PN (P: ≤0.001; 0.027; 0.013 respectively). The standardized PN group showed an increase in weight-for-age (WFA), compared with a decrease in the individualized PN group (+0.38 SD vs -0.55 SD, P: 0.003). Electrolyte disturbances and biochemical abnormalities did not differ. After matching for age, resulting in comparable groups, no significant differences were demonstrated in WFA, height-for-age, or weight-for-height SD change. CONCLUSIONS: In children with chronic IF, over 2,5 years of age, standardized PN mixtures show a comparable effect on weight, height, and weight for height when compared with individualized PN mixtures. Also, standardized PN mixtures (with added micronutrients) seem noninferior to individualized PN mixtures in terms of electrolyte disturbances and basic biochemical abnormalities. Larger studies are needed to confirm these conclusions. TRIAL REGISTRATION: Academical Medical Center medical ethics committee number W18_079 #18.103

ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases

Summary Undernutrition (wasting) is still frequent in patients infected with the human immunodeficiency virus (HIV), despite recent decreases in the prevalence of undernutrition in western countries (as opposed to developing countries) due to the use of highly active antiretroviral treatment. Undernutrition has been shown to have a negative prognostic effect independently of immunodeficiency and viral load. These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) in HIV-infected patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. Nutritional therapy is indicated when significant weight loss (45% in 3 months) or a significant loss of body cell mass (45% in 3 months) has occurred, and should be ARTICLE IN PRES

The role of the nutritional support dietitian in Europe

The European Community now supports the potential for professionals to practice in any of the member states subject to recognized local standards of education and practice being achieved. However, there is no agreed role for the nutritional support dietitian. This leads to an inconsistent and, sometimes, fragmented approach to the nutritional management of patients throughout Europe. There is a need to develop a common dietetic approach to nutritional support in order to raise awareness and rationalize standards. This will help to optimize care to individual patients by fostering good practice, developing effective communication and encouraging research. BACKGROUND: The role of the clinical dietitian varies widely throughout Europe - it tends to be more highly developed in some countries than in others, which is a cause for concern among dietitians in ESPEN. This appears to be caused by several factors including education, clinical awareness of the benefits of dietetic support and access to adequate financial resources. The intention of this paper is to focus on the key aspects of the role of the dietitian working in nutritional support. The educational requirements of such a dietitian are outlined and these could be used as a preliminary guide for institutions responsible for delivering undergraduate dietetic programmes. The overall intention is to identify minimum educational standards for practice in this field throughout Europe. However, these should be viewed as a baseline from which to proceed. They should also be perceived as a quality standard for facilitating professional development, sharing clinical practice and enhancing patient outcomes. This paper does not address issues of resource allocation. RECOMMENDATIONS: a) There should be agreement about the key functions of the dietitian working in nutritional support; b) There should be a common standard at first degree level for all dietitians; c) There should be an identified programme of post-graduate study (both clinical and academic) leading to specialization in nutritional support; d) There should be an innovative approach to providing clinical support for emerging specialists; e) ESPEN should investigate the potential for developing an accredited and integrated European dietetic standard in nutritional suppor

Screening for psychosocial distress in patients with long-term home parenteral nutrition

Item does not contain fulltextBACKGROUND & AIMS: Long-term home parenteral nutrition (HPN) may cause distress and negatively affect quality of life (QoL). The HPN version of the Distress Thermometer and Problem List (DT/PL) was developed to evaluate distress during HPN. This study validates the DT/PL, examines referral wish for additional care, assesses opinions on the DT/PL, and studies risk factors for distress and referral wish. METHODS: Dutch and Scottish patients completed questions on socio-demographic and HPN-related general characteristics, the DT/PL, referral wish, the Hospital Anxiety and Depression Scale, and opinions on the DT. RESULTS: The HPN version of the DT/PL seemed valid and the PL sufficiently reliable. Cut-off score appeared to be 6. Consequently, 45% of patients were diagnosed as clinically distressed. Fifty-three percent had a referral wish. Emotional and physical problems were most strongly associated with distress. Not being able to work related to elevated distress. Female gender and co-morbidity related to referral wish. Opinions on the DT were generally positive. CONCLUSION: The DT/PL appears to be a good instrument to regularly gain insight into distress and referral wish in HPN patients. Use of the DT/PL facilitates support to patients who most need and want it, thus improving quality of care and QoL

ESPEN guideline on home enteral nutrition

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers about the indications and contraindications for HEN, and its implementation and monitoring. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. This guideline will also inform interested patients requiring HEN. The guideline is based on current evidence and expert opinion and consists of 61 recommendations that address the indications for HEN, relevant access devices and their use, the products recommended, the monitoring and criteria for termination of HEN, and the structural requirements needed to perform HEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN

ESPEN guideline on home enteral nutrition

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers about the indications and contraindications for HEN, and its implementation and monitoring. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. This guideline will also inform interested patients requiring HEN. The guideline is based on current evidence and expert opinion and consists of 61 recommendations that address the indications for HEN, relevant access devices and their use, the products recommended, the monitoring and criteria for termination of HEN, and the structural requirements needed to perform HEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN

ESPEN practical guideline: Home enteral nutrition

This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN

Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: A systematic review of sensitivity and specificity

Background & aims: A valid, quick-and-easy screening tool to detect undernutrition, is an essential requisite to treat undernutrition. In order to select quick-and-easy screening tools with high analytical accuracy for the general hospital in-, and outpatient population, a systematic review at sensitivity and specificity studies were performed. Methods: The electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Library (SR, DARE and the Central trail register) were searched. Additionally, ESPEN and ASPEN congress posters and abstracts from 2000 till 2005, reference lists and review articles, were hand-searched. There were no limitations made on language or publication date. To finally include a study there were six criteria: The study (1) determined analytical accuracy of a quick-and-easy screening tool in (2) adults with (3) the dichotomous classification: disease-related undernutrition present or absent, versus (4) an acceptable reference standard with (5) data available to abstract sensitivity and specificity. Methodological quality was formally assessed using the QUADAS (checklist for quality assessment in analytical accuracy studies) in those studies with (6) relevant sensitivity and specificity. Results: The search yielded 1513 citations of which finally, nine studies were included. After quality assessment, no studies for the general hospital outpatient population remained. For the general hospital inpatient population only the Short Nutritional Assessment Questionnaire (SNAQ) and the Malnutrition Screening Tool (MST) tool were studied with a high rating to the criteria specified. The analytical accuracy of the MST seemed slightly better than the SNAQ. However, the MST study had a lower QUADAS 'score' for blinding and the cut-off point of the MST for positive screening was defined post-hoc. Conclusion: Their high applicability combined with clinically relevant sensitivity and specificity make the MST and the SNAQ the most accurate nutritional screening tools ready to implement at the general hospital inpatient population found in our systematic review