An international study of the quality of life of adult patients treated with home parenteral nutrition

Background & aims: Home parenteral nutrition-quality of life (HPN-QOL©) is a self-assessment tool for the measurement of QOL in patients on HPN. The aims of this study were: to re-assess the basic psychometric properties of the HPN-QOL© in a multinational sample of adult patients; to provide a description of QOL dimensions by short and long HPN treatment duration; to explore clinical factors potentially associated to QOL scores. Methods: Patients (n = 699) from 14 countries completed the HPN-QOL©. The questionnaires were analysed to evaluate data completeness, convergent/discriminant validity and internal-consistency reliability. The association of overall QOL and HPN treatment duration as well as other clinical factors were investigated using multivariable linear regression models. Results: The analysis of the multitrait-scaling and internal consistency indicates a good fit with the questionnaire structure for most items. Item discriminant validity correlation was satisfactory and psychometric evaluation of the HPN-QOL© in the different English, French and Italian language patient sub-groups confirmed psychometric equivalence of the three questionnaire versions. The results of the multivariable linear regression showed that QOL scores were significantly associated with HPN duration (better in long-term), underlying disease (better in Crohn's disease and mesenteric ischaemia) and living status (worse in living alone) and, after adjusting for the other factors, with the number of days of HPN infusion per week. Conclusions: The HPN-QOL©, is a valid tool for measurement of QOL in patients on HPN, to be used in the clinical practice as well as in research

Monitorin patients on home parenteral nutrition

Monitoring of patients on home parenteral nutrition (HPN) is essential for evaluation of treatment effect and management of the complications associated with this treatment. Monitoring is most often carried out at the discharging hospital with access to the specialised nutrition team. Monitoring can also be performed by a home care agency involving the hospital or the general practitioner. Intervals between visits vary, being on average 3 months. The unstable patient may need more attention. Assignment of responsibility for monitoring is probably very important for the quality of the process. A previous questionnaire-based study indicated that in general responsibility is assigned to a specific person most often associated with the specialised team in hospital. Biochemistry, anthropometry should be measured at all visits, trace elements, vitamins and bone mineral density only occasionally, yearly intervals are recommended. Official guidelines for monitoring are not available and prospective studies on the impact of different monitoring regimens on outcome including the quality of life of HPN patients are warranted

Intestinal transplantation

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Home parenteral nutrition

Containing contributions for leading international experts this book explores the life-saving treatment of home parenteral nutrition. It covers the complete scenario of home parenteral nutrition, from its prevalence in different continents to clinical indications and the practical aspects of its management. Topics covered inlcude the growing use of HPN, scientific and practical issues associated with HPN in adults and the pediatric population, indications and outcomes in various diseases, complications, nutrient requirements, preparation and administration of the admixtures, monitoring of patients, medical and surgical alternatives, ethics and legislation, and quality of life. Home parenteral nutrition (HPN) is the intravenous administration of nutrients carried out in the patient's home. This book analyses current practices in HPN, with a view to inform best practice, covering epidemiology of HPN in regions including the UK and Europe, USA and Australia, its role in the treatment of clinical conditions including gastrointestinal disorders and cancer, ethical and legal aspects and patient quality of life. © CAB International 2006. All rights reserved.SCOPUS: bk.binfo:eu-repo/semantics/publishe

State of the iron:How to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease

AbstractIron deficiency anemia (IDA) frequently occurs in patients suffering from inflammatory bowel disease (IBD) and negatively impacts their quality of life. Nevertheless, the condition appears to be both under-diagnosed and undertreated. Regular biochemical screening of patients with IBD for anemia by the gastroenterology community has to be advocated.Oral iron is a low cost treatment however its effectiveness is limited by low bioavailability and poor tolerability. Intravenous (IV) iron rapidly replenishes iron stores and has demonstrated its safe use in a number of studies in various therapeutic areas. A broad spectrum of new IV iron formulations is now becoming available offering improved tolerability and patient convenience by rapidly restoring the depleted iron status of patients with IBD. The following article aims to review the magnitude of the problem of IDA in IBD, suggest screening standards and highlight existing and future therapies