From hospital unit to intestinal failure center: Twenty years of history.

AIM: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study. METHODS: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation. RESULTS: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days. CONCLUSIONS: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances.

Early History of Home Parenteral Nutrition: From Hospital to Home.

Technologic advances in the past century have led to the ability to safely deliver parenteral nutrition (PN) to hospitalized patients. Key breakthroughs included the development of saline and glucose infusions, infusion pumps, macronutrients (lipids, dextrose, and amino acids), and central venous catheters. In the 1960s, centrally delivered PN was performed in short-term hospitalized patients by Lincoln James Lawson (North Staffordshire Royal Infirmatory, United Kingdom) and long-term patients by Stanley Dudrick (University of Pennsylvania, United States). These early studies showed that a system was needed that would allow patients with intestinal failure to be discharged from the hospital and receive home PN (HPN). In the late 1960s and early 1970s, Belding Scribner, Maurice Shils, Khursheed Jeejeebhoy, Marvin Ament, Dudrick, and their teams discharged patients from the hospital who then self-administered HPN. Shortly after these early cases of HPN, multidisciplinary centers were established first in North America, and later in Europe, to manage these complex cases. The current article describes the patients treated by these early HPN pioneers, in addition to subsequent case series reported by them and others.

Jonathan E Rhoads lecture: experiences and observations in the management of patients with short bowel syndrome.

In an era before parenteral nutrition (PN) was made practical by Stanley Dudrick, MD, and his colleagues, patients with prolonged intestinal dysfunction or short bowel syndrome would often die of malnutrition or its sequelae. Over the past 4 decades, the treatment of patients with short bowel syndrome had progressed from PN in the hospital to small bowel transplantation. Multimodal therapies have evolved in the management of these patients, including specialized diets and enteral supplements, oral rehydration fluids, antisecretory medication, and the use of growth factors. Home PN is lifesaving when these modalities are ineffective and a surgical procedure to restore or enhance gastrointestinal tract length or absorptive potential is impossible. Small intestine transplantation had been used to salvage those patients who developed life-threatening complications of home PN, but as the survival after intestinal transplant has approached that of liver transplantation, it may soon be considered as primary therapy for patients with short bowel syndrome. This article presents the author's experiences and observations after a 4-decade experience in the management of patients with short bowel syndrome.

Os primórdios da nutrição clínica no Brasil: estudo observacional não controlado / The beginnings of clinical nutrition in Brazil: uncontrolled observational study / Los inicios de la nutrición clínica en Brasil: estudio observacional no controlado

A história pregressa e as condições predisponentes para o advento da moderna nutrição clínica no Brasil são examinadas. O formato escolhido foi um estudo retrospectivo não aleatorizado nem controlado, porém incluindo estimativas estatísticas. Após uma contextualização do problema, as alternativas disponíveis e suas dificuldades são relatadas. Conclui-se que uma convergência de circunstâncias incomuns abriu caminho para a eclosão de uma sociedade de nutrição organizada no país em 1975.

The medical history and predisposing conditions for the advent of modern clinical nutrition in Brazil are examined. The format chosen was a retrospective non-randomized or controlled, but including statistical estimates. After a contextualization of the problem, the available alternatives and their difficulties are reported. We conclude that a convergence of unusual circumstances paved the way for the emergence of a nutrition company organized in the country in 1975.

La historia médica y las condiciones predisponentes para la aparición de la nutrición clínica moderna en Brasil se examinan. El formato elegido fue un estudio retrospectivo no aleatorizado o controlado, pero incluyendo las estimaciones estadísticas. Después de una contextualización del problema, las alternativas disponibles y las dificultades que se presentan. Llegamos a la conclusión de que una convergencia de circunstancias inusuales allanó el camino para el surgimiento de una compañía de nutrición organizada en el país en 1975.