Transfusiones sanguíneas Domiciliarias en Pacientes Paliativos

Introduction: Assistance of complex chronic patients occupies much of the health care activity of home care hospital bassed (HCHB). The chronic anemias are frequent as a secondary clinic picture due to the deficit of the tissues oxygenation capacity for lack of contribution.Aim: to know the prevalence of transfusions and the characteristics of the patients in the HCHB of the Hospital General Universitario de Alicante.Material and methods: Descriptive, cross-sectional study of transfused patients in the HCHB of General University of Alicante from the 1st of October 2016 until the 31th of march of 2017.Results: 136 transfusions were performed in 52 patients with a median of 82 years IQ [68-88]. The most of them were palliatives and the 53,8% were males.They were transfused using an average hemoglobin of 7,8g/dl ± 0,9 and all of them showed symptomatology. No type of adverse reaction was registered.The degree of patient satisfaction and their relatives was high. 9.7 ± 0.3. The prevalence was 121.86 transfusions / 1000 patients in the HAD.Conclusions: The transfusions have been a safe procedure at the patient’s home. The most part of the transfused patients were palliatives. All the recorded transfusions were indicated analytical and clinically. The high degree of patients satisfaction and their relatives makes infer that we are contributing to improve their quality of life.Introducción: La asistencia a los pacientes crónicos complejos ocupa gran parte de la actividad asistencial de las Unidades de Hospitalización a Domicilio (HAD), en los que son frecuentes los cuadros de anemia crónica que precisan ocasionalmente transfusiones por clínica secundaria al déficit de la capacidad de oxigenación de los tejidos por falta de aporte.Objetivo: Conocer la prevalencia de transfusiones y las características de los pacientes en la HAD del Hospital General Universitario de Alicante.Material y Método: Estudio descriptivo transversal de los pacientes transfundidos en la HAD del Hospital Universitario General de Alicante desde el 1 de Octubre de 2016 hasta el 31 de marzo de 2017.Resultados: Se realizaron 136 transfusiones a 52 pacientes con una mediana de 82 años IIQ [68-88] de los que 53,8% eran varones. Fueron mayoritariamente paliativos. La Hemoglobina media con la que se transfundieron fue de 7,8 g/dl ± 0,9 y todos presentaron sintomatología. No se registró ningún tipo de reacción adversa. El grado de satisfacción de los pacientes y familiares fue de elevado 9,7± 0,3. La prevalencia fue de 121,86 transfusiones /1000 pacientes en la HAD.Conclusiones: Las transfusiones han sido un procedimiento seguro en el domicilio del paciente. La mayor parte de los pacientes que han recibido transfusiones eran paliativos. Todas las transfusiones realizadas estaban indicadas analítica y clínicamente. El elevado grado de satisfacción de pacientes y familiares hace inferir que se está contribuyendo a mejorar la calidad de vida

Influencia de los suplementos nutricionales en la evolución de las heridas quirúrgicas abdominales complicadas de pacientes en hospitalización a domicilio

Objective: To evaluate the impact of nutritional supplements in patients admitted to the Home Hospitalization Unit with complicated abdominal surgical wounds.Material and methods: We have performed a retrospective study of 67 patients which presented complicated abdominal surgical wounds upon admission to the Home Hospitalization Unit. We have studied the type and amount of the supplement received, the body mass index (BMI), the albumin, and the time and cycles of antibiotic therapy.Results: The median age of the 67 patients was 69.2 ± 5.6. All patients had open abdominal wounds and 53.7% had infection with intravenous antibiotics. All patients received some type of nutritional supplement (62.7% standard, 25.4% immunomodulatory (Atempero®), 11.9% others). After one month of follow-up, the albumin mean value had increased in all patients p = 0.032, although the greatest difference was in patients who received immunomodulatory nutrition p = 0.001. The median follow-up was 84.05 ± 17.48 days until discharge. In the immunomodulatory supplement group it was 77.18 ± 13.72 days (p = 0.001).Conclusions: The data support a benefit of oral supplementation in this type of patients improving their nutritional status. The group that was supplemented with Atempero®, stood out both in the recovery of albumin levels and in a better evolution, which translates into a significantly earlier discharge.Objetivo: Evaluar el impacto de los suplementos nutricionales en pacientes ingresados en la Unidad de Hospitalización a Domicilio con heridas quirúrgicas abdominales complicadas.Material y Métodos: Estudio retrospectivo de 67 pacientes que a su ingreso en la Unidad de Hospitalización a Domicilio presentaban heridas quirúrgicas abdominales complicadas. Se estudió el tipo y cantidad de suplemento recibido, Índice de Masa Corporal (IMC), albumina, tiempo y ciclos de antibioterapia.Resultados: La edad media de los 67 pacientes fue de 69,2 ±5,6. Todos los pacientes presentaban heridas abdominales abiertas y el 53,7% presentaban infección con antibioterapia intravenosa. Todos los pacientes recibieron algún tipo de suplemento nutricional (estándar 62,7%; inmunomodulador (Atempero®) 25,4% y otros 11,9%). Al mes de seguimiento el valor medio de albumina se había incrementado en todos los pacientes p=0,032 aunque la mayor diferencia la presentaron los pacientes que recibieron nutrición inmunomoduladora p=0,001. La estancia media fue de 84,05±17,48 días hasta el alta, en el grupo del suplemento inmunomodulador fue de 77,18±13,72 días (p=0,001).Conclusiones: Los datos apoyan un beneficio de la suplementación oral en este tipo de pacientes mejorando su estado nutricional. El grupo que se suplementó con Atempero®, destacó tanto en la recuperación de los niveles de albumina como en una mejor evolución, lo que se traduce en un alta significativamente más precoz

Prevalencia de Desnutrición en los pacientes de Hospitalización a Domicilio

Objective: To estimate the prevalence of malnutrition in patients admitted to the UHD of the General University Hospital of Alicante.Material and methods: Prospective longitudinal study of a sample of 386 patients admitted to UHD randomly selected. Patients were evaluated with the HEN Nutritional Assessment Tool [https://www.evalnut.com/]. During the years 2016-2017.Results: The 386 selected patients had an average age of 72.87 years. 51.7 percent of them were male and 42.1 percent had a level of illness “acute mild / chronic stable” (Fig. 1). 24 of the patients (9.2 percent) were gastrostomy carriers. 42.1 percent of patients did not cover 75 percent of daily energy requirements. 69.7 percent of patients lost weight before admission in the HaD [mean 10.1 ± 6.1 percent of their usual weight], independent of sex (p = 0.343) and age (p = 0.712), presenting higher lost weight those who had done for more than a month (p <0.001), as well as those in whom the severity of the disease had increased (p <0.001) and not related to the decrease in reported intake (p = 0.395). 21.5 percent of patients had difficulty chewing and 18.4 percent of them had dysphagia (Fig2) of which 91.3 percent was from liquids. 91.6 percent of patients had some type of malnutrition, of which 54.4 percent were mild, highlighting that 71.3 percent of cases were mixed malnutrition (Fig 3). No relationship was found between the weight loss and the type of malnutrition (p = 0.054). However a relationship between the severity level of the disease and the type and degree of malnutrition (p = 0.005, p = 0.034) was found.Conclusions: Patients admitted to HaD have a very high prevalence of malnutrition, mostly of mixed type, which is more severe as the severity of the disease increases. The relationship between the degree and type of malnutrition with the severity of the disease suggests that it has been established for a long period of time.Objetivo: Estimar la prevalencia de desnutrición en los pacientes ingresados en la UHD del Hospital General Universitario de Alicante.Material y Métodos: Estudio longitudinal prospectivo de una muestra de 386 pacientes ingresados en UHD incluidos aleatoriamente. Los pacientes fueron evaluados con la Herramienta de Evaluación Nutricional HEN [https://www.evalnut.com/]. Durante el año 2016-2017.Resultados: Los 386 pacientes tenían una media de edad de 72,87años y 51,7% eran varones. El 42,1% de los pacientes tenían un nivel de enfermedad “agudo leve / crónico estable” (Fig1). Eran portadores de gastrostomía 24(9,2%). No cubría el 75% de los requerimientos energéticos diarios el 42,1%. Habían perdido peso antes de su ingreso en HaD el 69,7% de los pacientes [media 10,1±6,1% de su peso habitual] independiente del sexo (p=0,343) y la edad (p=0,712) presentando mayor pérdida los que lo habían hecho en más de 1 mes (p<0,001), también según se incrementa la gravedad de la enfermedad (p<0,001) y sin relación con la disminución de la ingesta declarada (p=0,395). Tenían dificultades para masticar 21,5%, presentaban disfagia 18,4% (Fig2) de los que 91,3% era a líquidos. El 91,6% de los pacientes tenía algún tipo de desnutrición, siendo leve el 54,4% y destacando la desnutrición mixta en el 71,3% de los casos (Fig3). No se encontró relación entre la pérdida de peso y el tipo de desnutrición (p=0,054) y sí entre el nivel de gravedad de la enfermedad y con el tipo de desnutrición y grado de desnutrición (p=0,005; p=0,034).Conclusiones: Los pacientes ingresados en HaD presentan una altísima prevalencia de desnutrición, mayoritariamente de tipo mixta, siendo ésta más severa a medida que se incrementa la gravedad de la enfermedad.La relación entre el grado y tipo de desnutrición con la gravedad de la enfermedad hace pensar que se ha ido instaurando durante un largo periodo de tiempo

Home Parenteral Nutrition in Spain, 2015. Home and Ambulatory Artificial Nutrition (NADYA) Group report

Aim: To communicate the results of the Spanish Home Parenteral Nutrition (HEN) registry of the NADYA-SENPE group for the year 2015.Material and methods: Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2015.Results: Two hundred and thirty-six patients with 243 episodes of NPD were recorded from 40 hospitals. This represents a rate of 5.08 patients/million habitants for 2015. The most frequent pathology in adults was other (26.3%) followed by palliative oncological (21.6%). The most common complication was catheter-related sepsis which presented a rate of 0.53 infections/1,000 days of HPN. Sixty-four episodes were finished; the main cause was death (43.7%) and resuming to oral via (32.8%).Conclusions: we find increasing centers and professional partners, responding to the progressively more patients with parenteral nutrition support at home. The main indications for the establishment of NPD and causes termination of treatment remain stable

Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España: años 2018 y 2019.

Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia - 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed