Evaluation of Nutritional Interventions in the Care Plan for Cancer Patients: The NOA Project.

The NOA (Oncological Nutrition in Andalusia) project analyses the degree of integration and areas of improvement in implementing nutritional support in the care plans of cancer patients in Andalusia. The aim was to analyse nutritional interventions for better care of cancer patients and for the improvement of the management of malnutrition in cancer. A prospective evaluation of the implementation of two areas of improvement in nutrition was conducted in three hospitals. Data were collected from each hospital over a six-month period using an online platform. A standardised care plan was designed for hospitals in Andalusia, in which proposed improvements were devised and prioritised, selecting nutritional screening in oncology services and the participation of the Nutrition Support Team (NST) on the tumour boards, as well as the assessment of the patients presented at these sessions. Our results indicated an increase in the number of medical records with nutritional evaluation results six months later, regardless of the type of tumour or hospitalisation; and there was greater participation of the NST on the tumour boards, mainly for head and neck and oesophagogastric cases. Solutions for improvement have been pinpointed and implemented that have positively impacted the nutritional care plan in the course of oncological disease.

Acquisition of full enteral feeds may depend on stooling pattern in very premature infants.

OBJECTIVE: The objective of this study was to determine whether acquisition of normal stooling pattern is associated with full enteral feeding and growth. STUDY DESIGN: This is a prospective observational study of infants with a gestational age of <28 weeks (n=121). All infants admitted to our unit during the study period were managed using the same protocol for rectal stimulation and enemas: we used rectal stimulation if abdominal distension and no defecation occurred in the previous 24 h; enema administration was practiced if abdominal distension persists and no defecation had occurred after rectal stimulation. Age of normal bowel habit (T-NBH) is defined as days when two stools passed each day without enemas or stimulation for three consecutive days. Full enteral feeding is measured by time to receive 120 mL/kg/day (T-120). Multivariable linear regression estimated the contribution of T-NBH on T-120 and the effect of tolerance on growth. RESULTS: T-NBH was 16 days (12, 24 days) and T-120 was 16 days (12, 24 days). T-120 decreased with earlier normal bowel habit (r=0.625, P<0.0001). Change in weight z-score between 36 weeks postmenstrual age and birth was less pronounced with earlier full enteral feeding (r=-0.446, P<0.0001). CONCLUSION: Normalization of bowel habit is an important determinant of full enteral feeding of very immature infants. Earlier full enteral feeding is associated with less postnatal growth failure.

Stroke in Spain: epidemiologic incidence and patterns; a health sentinel network study.

INTRODUCTION: Cerebrovascular disease is among the 4 main causes of mortality in Spain. The objective of this study was to estimate the incidence of stroke and to describe the principal risk factors and other clinical and epidemiologic patterns found in patients. METHODS: Doctors from the Spanish sentinel health network recorded the episodes of acute cerebrovascular diseases in 2005 in a population of 201,205 inhabitants older than 14 years. The information of the patients (age and sex) and the episode (e.g., duration, symptoms, origin, medical attention, risk factors) was collected on a standard form. RESULTS: The estimated incidence rate of stroke was 141 cases per 100,000 inhabitants (confidence interval [CI] 95%: 125-158), 134 (95% CI: 112-157) in women and 148 (95% CI: 124-172) in men. The incidence increases significantly from the age of 65 years and men younger than this have higher rates than women. In all, 12% of patients with stroke die within the first 24 hours. CONCLUSIONS: Incidence of cerebrovascular disease in Spain is below that recorded in other countries. There is no difference according to sex, but incidence among young and middle-aged men is greater than that among women. Significant variations from some population groups to others are observed, maybe because of the difference in the prevalence of risk factors.

Age and sex differences in the incidence of diabetes mellitus in a population-based Spanish cohort.

BACKGROUND: The prevalence of diabetes mellitus (DM) in Spain ranges between 10% and 20%. However, very little is known about the incidence of DM because of difficulties involved in estimating it and its apparent lack of usefulness in practice. The aim of the present study was to describe the incidence of type 1 and type 2 DM (T1DM and T2DM, respectively) in the Castilla y León diabetes cohort (CODICyL). METHODS: New diabetes cases, were registered on a standard form that included diagnostic criteria, background, symptoms, results of clinical examination, complications, other cardiovascular risk factors, and treatment. There were 1 354 619 person-years monitored between 2000 and 2013. We estimated the incidence of DM and calculated the relative risks adjusted for age, gender, and year of diagnosis with Poisson regression models. RESULTS: The incidence of DM in individuals aged ≥15 years was 196.9 per 100 000 person-years (95% confidence interval [CI] 188.4-205.7), whereas in those aged <15 years the incidence was 10.8 per 100 000 person-years (95% CI 7.8-14.8). Men had a 36% higher risk than women of developing T2DM (95% CI 25%-49%). The greatest incidence of T2DM was found in 55-64-year-old men and 65-69-year-old women. CONCLUSIONS: The annual incidence of T2DM is approximately 2 per 1000 person-years, higher in men, and peaks in middle age. Although specific tests to differentiate between the two types of DM are not available in this study, the estimation of incidence in those <15 years of age (10.8 per 100 000 person-years) represents a close approximation of the incidence of T1DM.

End-of-life communication: a retrospective survey of representative general practitioner networks in four countries.

CONTEXT: Effective communication is central to high-quality end-of-life care. OBJECTIVES: This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. METHODS: This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. RESULTS: In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. CONCLUSION: The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.