[Nutrition in palliative care: guidelines from the Working Group on Bioethics, Spanish Society of Clinical Nutrition and Metabolism (SENPE)]. / Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE.

Introduction: Palliative care provides a holistic approach and care for patients with a terminal illness and their families. In palliative care physical complaints as well as emotional, social and spiritual aspects are considered. Nutritional care should be also considered within palliative support. For those working in the nutritional support field, to withhold or withdraw nutritional support may be an ethical dilemma in this scenario. The controversy starts when considering nutrition and hydration as basic care or a treatment. The goals of nutrition support in palliative care patients differ from common ones, aiming to improve quality of life, survival or both. The decision should be based on a consideration of prognosis (length of survival), quality of life, and risks-benefits ratio. Regarding oral nutrition (with or without oral supplements) the idea prevails of "comfort feeding", based on providing oral feeding till discomfort or avoidance develop. There is no evidence on the benefit of specific nutrients, despite the fact that omega-3 FAs may have some positive effects in patients with cancer. Regarding nutritional support (enteral or parenteral), no scientific evidence is present, so the decision needs to be agreed according to the desires and beliefs of the patient and their family, and based on a consensus with the interdisciplinary team on the aims of this support.

Introducción: Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación "riesgo/beneficio". En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la "alimentación de confort", que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla.

Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project.

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

RECALSEEN. Subgroup: Patient care in the clinical nutrition units of the Spanish National Health System.

INTRODUCTION: Artificial nutrition (AI) is one of the most representative examples of coordinated therapeutic programs, and therefore requires adequate development and organization. The first clinical nutrition units (CNUs) emerged in the public hospitals of the Spanish National Health System (NHS) in the 80s and have gradually been incorporated into the departments of endocrinology and nutrition (DENs). The purpose of our article is to report on the results found in the RECALSEEN study as regards the professional and organizational aspects relating to CNUs and their structure and operation. MATERIALS AND METHODS: Data were collected from the RECALSEEN study, a cross-sectional, descriptive study of the DENs in the Spanish NHS in 2016. The survey was compiled from March to September 2017. Qualitative variables were reported as frequency distributions (number of cases and percentages), and quantitative variables as the mean, median, and standard deviation (SD). RESULTS: A total of 88 (70%) DENs, out of a total of 125 general acute hospitals of the NHS with 200 or more installed beds, completed the survey. CNUs were available in 83% of DENs (98% in hospitals with 500 or more beds). As a median, DENs had one nurse dedicated to nutrition (35% did not have this resource). Fifty-three percent of DENs with nutrition units had dieticians integrated into the unit (median: 1). DENs located in hospitals with 500 or more beds are more complex and have a wide portfolio of monographic unit services (morbid obesity, 78.3%; artificial home nutrition, 87%; chronic diseases, 65.2%) and specific techniques (impedanciometry, 78%). However, only 14% of the centers perform universal screening tests for malnutrition, and a secondary diagnosis of malnutrition only appears in 12.3 reports per 1000 hospital discharges. DISCUSSION: After the 1997 and 2003 studies, the results of 2017 show a marked growth and consolidation of CNUs within the DENs in most hospitals. Today, the growth of this specialty is largely due to the care demand created by hospital clinical nutrition. CNUs still have an insufficient nursing staff and dietitians/nutritionists, and in the latter case, atypical contracts or grants funded by research projects or the pharmaceutical industry are common. Units for specific nutritional diseases and participation in multidisciplinary groups, quite heterogeneous, are concentrated in hospitals with 500 or more beds and represent an excellent opportunity for CNU development. CONCLUSIONS: Many DENs of Spanish hospitals include CNUs where care is provided by endocrinologists, who devote most of their time to clinical nutrition in more than half of the hospitals. This is most common in large centers with a high workload in relation to staffing. There is considerable heterogeneity between hospitals in terms of both the number and type of activity of the CNUs.

Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project. / Consenso multidisciplinar sobre la terapia nutricional y metabólica en los programas de recuperación intensificada en cirugía abdominal: Proyecto NutRICA.

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. OBJECTIVE: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. METHODS: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. RESULTS: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. CONCLUSION: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

The SEEN comprehensive clinical survey of adult obesity: Executive summary. / Abordaje clínico integral SEEN de la obesidad en la edad adulta: resumen ejecutivo.

Obesity is one of the great challenges in healthcare nowadays with important implications for health so requiring comprehensive management. This document aims to establish practical and evidence-based recommendations for the diagnosis and management of in Spain, from the perspective of the clinical endocrinologist. A position statement has been made that can be consulted at www.seen.es, and that has been agreed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), together with the Nutrition Area (NutriSEEN) and the Working Group of Endocrinology, Nutrition and Physical Exercise (GENEFSEEN).

Obesity in the COVID era: A global health challenge. / Obesidad en tiempos de COVID-19. Un desafío de salud global.

Obesity is a chronic disease that leads to an increased risk of mortality and morbidity, and the impact of the COVID-19 pandemic may create a new health challenge. There is clear evidence showing that some biological and social factors associated with obesity involve an increased risk of COVID-19 infection, hospitalization, and greater severity compared to people with normal weight. Undoubtedly, obesity involves a low-grade proinflammatory state that produces a dysregulation of the immune system that compromises its ability to respond to respiratory infection by COVID-19 and so produces a worsening of the disease. In this review, the main epidemiological and pathophysiological data that associate obesity with COVID-19 are described.

Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. / Obesidad y SARS-CoV-2: consideraciones sobre la cirugía bariátrica y recomendaciones para el inicio de la actividad quirúrgica.

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.

[Obesity in the COVID era: A global health challenge]. / Obesidad en tiempos de COVID-19. Un desafío de salud global.

Obesity is a chronic disease that leads to an increased risk of mortality and morbidity, and the impact of the COVID-19 pandemic may create a new health challenge. There is clear evidence showing that some biological and social factors associated with obesity involve an increased risk of COVID-19 infection, hospitalization, and greater severity compared to people with normal weight. Undoubtedly, obesity involves a low-grade proinflammatory state that produces a dysregulation of the immune system that compromises its ability to respond to respiratory infection by COVID-19 and so produces a worsening of the disease. In this review, the main epidemiological and pathophysiological data that associate obesity with COVID-19 are described.

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

Evolution of nutritional status and survival in patients with cancer on tyrosine kinase inhibitors treatment. / Evolución nutricional y de la supervivencia en un grupo de pacientes oncológicos en tratamiento con inhibidores de tirosina quinasa.

BACKGROUND AND OBJECTIVE: Treatment with oral antineoplastic agents known as tyrosine kinase inhibitors (TKIs) is new and, thus, little is known about their impact on nutritional status (NS), dietary intake, quality of life, and survival. The aim of this study was to provide information on these components in order to guide future nutritional recommendations. PATIENTS AND METHOD: A prospective, observational study in adults who start treatment with TKIs, in whom NS was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), anthropometric measures, biochemical parameters, and dietary intake (24-hour dietary recall). The EORTC QLQ-C30 was used to assess quality of life. Nonparametric tests were used in statistical analysis, and survival was analyzed using Kaplan-Meier and log-rank curves. RESULTS: Of the overall sample, 21.7% had moderate malnutrition according to PG-SGA, and 74.2% moderate weight loss at 6 months, but no patient had BMI<18.5kg/m2. Patients with moderate malnutrition had lower survival at four years of diagnosis (log-rank=0.015). Energy intake was lower than recommended by the ESPEN 2017 congress, and no patient covered the protein requirements (1.5g protein/kg weight) during follow-up. A worse score on the global health scale of the EORTC QLQ-C30 was related to worse NS. CONCLUSIONS: Treatment with TKIs does not appear to have a significant impact on NS and quality of life after 6 months of follow-up. Malnutrition should be prevented through individualized nutritional advice because it is related to shorter survival.

Clinical and economic impact of the taurolidine lock on home parenteral nutrition.

INTRODUCTION: catheter-related bloodstream infections (CRBSI) are one of the most serious concerns in patients on home parenteral nutrition (HPN) which involve high morbidity and cost for the healthcare system. In the last years, taurolidine lock has proven to be beneficial in the prevention of CRBSI; however, the evidence of its efficiency is limited. OBJECTIVE: to determine if taurolidine lock is a cost-effective intervention in patients on HPN. MATERIALS AND METHODS: retrospective study in patients on HPN with taurolidine lock. We compared the CRBSI rate and cost of its complications before and during taurolidine lock. RESULTS: thirteen patients, six (46%) males and seven (54%) females, with a mean age of 61.08 (SD = 14.18) years received taurolidine lock. The total days of catheterization pre and per-taurolidine were 12,186 and 5,293, respectively. The underlying disease was benign in five patients (38.5%) and malignant in eight (61.5%). The CRBSI rate pre vs per-taurolidine was 3.12 vs 0.76 episodes per 1,000 catheter days (p = 0.0058). When the indication was a high CRBSI rate, this was 9.72 vs 0.39 (p < 0.001) in pre and per-taurolidine period respectively. No differences have been observed in the occlusion rates. None of the patients reported any adverse effects. The total cost of CRBSI in the pre-taurolidine period was 151,264.14 euros vs 24,331.19 euros in the per-taurolidine period. CONCLUSIONS: our study shows that taurolidine lock is a cost-effective intervention in patients on HPN with high risk of CRBSI.

[Not Available]. / Deficiencia clínica de vitamina A tras bypass gástrico. Descripción de un caso clínico y revisión de la literatura.

La deficiencia de vitamina A es infrecuente en los países desarrollados. La cirugía bariátrica constituye un factor de riesgo de deficiencia de esta vitamina. Se han descrito varios casos en pacientes sometidos a técnicas con un importante componente malabsortivo, como la derivación biliopancreática. En este artículo se describe un caso de deficiencia clínica de vitamina A con manifestaciones oculares y cutáneas tras bypass gástrico y se revisan las publicaciones sobre este tema y las recomendaciones para la prevención de esta importante complicación.

PROTEIN MALNUTRITION INCIDENCE COMPARISON AFTER GASTRIC BYPASS VERSUS BILIOPANCREATIC DIVERSION.

BACKGROUND: bariatric surgery is widely employed nowadays. Nutritional complications following malabsorptive bariatric surgery are common. OBJECTIVES: to compare protein malnutrition incidence, the amount of protein intake and the influence of various risk factors in patients undergoing Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD). METHODS: retrospective study comparing the development of hypoalbuminemia in 92 patients undergoing BPD and 121 RYGB, before surgery and 3, 6, 12, 18 and 24 months after it. Protein intake was estimated by serum prealbumin. The influence of prior body mass index (BMI), age and sex was analyzed. RESULTS: hypoprealbuminemia was found in around 40% of patients 3 months after both procedures, decreasing to about 10% after 2 years of surgery. Hypoalbuminemia incidence was close to 20% in the first post-surgery year in BPD, persisting in 10-15% of cases thereafter. After RYGB, hypoalbuminemia incidence was lower (5-9% in all postoperative follow-up measurements). During the first year after surgery, hypoalbuminemia was more frequent after BPD than after RYGB (at the 3rd month (OR:3.9; p=0.006; 95%CI:1.5-10.4), 6th (OR:5.0; p=0.002; 95% CI:1.8-13.8), and at the 12th month (OR:4.4;p=0.007;95%;CI:1.5-12.8)), but not after the first year. A higher preoperative BMI favored it (OR: 1.03; p=0.046; 95% CI:1-1.06), as well as greater age during the first 6 months. CONCLUSION: Patients with BPD had a higher risk for hypoproteinemia than those undergoing RYGB, especially during the first year post-surgery. Higher preoperative BMI, and age (in the short-term period) could have a significant inverse relation to hypoproteinemia.

Introducción: la cirugía bariátrica es muy empleada actualmente y en las malabsortivas, las complicaciones nutricionales son habituales. Objetivos: comparar la incidencia de malnutrición proteica e ingesta estimada de proteínas en pacientes intervenidos de bypass gástrico en Y-de-Roux (BGYR) y derivación biliopancreática (DBP), y la influencia de algunos factores de riesgo. Métodos: estudio restrospectivo comparando el desarrollo de hipoalbuminemia en 92 pacientes intervenidos mediante DBP y 121 de DBP (prequirúrgico, a los 3, 6, 12, 18 y 24 meses postquirúrgicos). La ingesta proteica se estimó mediante prealbúmina. Se evaluó la influencia del índice de masa corporal (IMC) previo, la edad y el sexo. Resultados: se encontró hipoprealbuminemia en torno al 40% de los pacientes a los 3 meses tras ambas técnicas, disminuyendo hasta el 10% a los dos años. La incidencia de hipoalbuminemia fue cercana al 20% durante el primer año tras DBP, persistiendo posteriormente en un 10-15% de los casos. Tras el BGYR, dicha incidencia fue menor (5-9% en todos los momentos). Así, durante el primer año postquirúrgico la hipoalbuminemia fue más frecuente tras DBP [3 meses: (OR:3,9;p = 0,006; 95%CI:1,5- 10,4), 6 meses (OR:5,0; p = 0,002; 95% CI:1,8-13,8), y al año (OR:4,4;p = 0,007;95%;CI:1,5-12,8)], pero no así después. Un mayor IMC prequirúrgico favoreció la inicidencia de hipoalbuminemia (OR:1,03; p = 0,046; 95% CI:1-1,06), así como una mayor edad a los 6 meses postquiúrgicos. Conclusión: los pacientes intervenidos mediante DBP tuvieron mayor riesgo de presentar hipoproteinemia que tras BGYR, especialmente durante el primer año postquirúrgico. Un mayor IMC postquirúrgico y la edad (a los 6 meses) podrían favorecer la aparición de hipoproteinemia.

[DIETARY INTAKE AND NUTRITIONAL STATUS IN ONCOLOGY PATIENTS WHO START TREATMENT WITH TYROSINE KINASE INHIBITORS]. / INGESTA DIETÉTICA Y ESTADO NUTRICIONAL DE PACIENTES ONCOLÓGICOS QUE INICIAN TRATAMIENTO CON INHIBIDORES TIROSINA QUINASA.

BACKGROUND: in recent years, researching about new oral antineoplastics has progressed while its impact on dietary intake and nutritional status (NS) hasn't developed enough yet. OBJECTIVES: dietary intake and NS assessment in patients who start treatment with tyrosine kinase inhibitors (TKI) and evaluate its impact on them. METHODS: an observational, prospective-six-months study, in which were included patients starting treatment with TKI. The intake was evaluated by a 24 h dietary record and a food frequency questionnaire. The NS was evaluated by anthropometric measurements and the patient-generated Global Subjective Assessment (PG-GSA); the results were compared with the Spanish references (SENC-semFYC, 2007 and O. Moreiras, 2013). Friedman test, χ2, Wilcoxon, Kruskal-Wallis and Mann-Whitney were used in the statistical analysis. Significance p < 0.05. RESULTS: 22 patients (54.5% male) were included. At baseline, NS was adequate in 73.9% of patients according PG-GSA. Weight loss was no significant, although a high percentage of the energy and protein requirements hadn't been reached. The caloric intake was positively related with the number of meals. Dietary habits did not change during treatment. CONCLUSION: dietary intake did not reach nutritional requirements at baseline. The TKI don't seem to affect the patient's intake and nutritional status. The research about these parameters before starting treatment could prevent future complications and it would guide the dietary advice.

Introducción: la investigación sobre nuevos antineoplásicos orales sigue avanzando en los últimos años mientras que su repercusión sobre la ingesta dietética y el estado nutricional (EN) no progresa de la misma forma. Objetivos: evaluar la ingesta dietética y EN de pacientes que inician tratamiento con inhibidores tirosina quinasa (ITK) y valorar el impacto que tienen sobre ellos. Métodos: estudio observacional y prospectivo de seis meses en el que se incluyeron pacientes que iniciaban tratamiento con ITK. La ingesta se evaluó con: recuerdo 24 h y cuestionario de frecuencia de consumo. El EN se valoró con: medidas antropométricas y cuestionario de valoración subjetiva global generada por el paciente (VSGGP); los resultados se compararon con las referencias SENC-semFYC, 2007 y Moreiras O., 2013. Para el análisis estadístico se utilizaron: Test de Friedman, 2, Wilcoxon, Kruskall-Wallis y Mann-Whitney. Significación p < 0,05. Resultados: se incluyeron 22 pacientes (54,5% hombres). Al inicio del tratamiento, el 73,9% tenía un EN adecuado según VSG-GP. No se produjeron pérdidas de peso significativas, pese a que un porcentaje elevado no cubrió los requerimientos energéticos y proteicos. El número de comidas se relacionó positivamente con la ingesta calórica. La ingesta y los patrones de frecuencia de consumo por grupos de alimentos tampoco variaron durante el tratamiento. Conclusión: la ingesta dietética al inicio del tratamiento no alcanza los requerimientos nutricionales. Los ITK no parecen afectar la ingesta ni el estado nutricional de los pacientes. El estudio de estos parámetros antes de comenzar el tratamiento evitaría futuras complicaciones y guiaría el consejo dietético.

[Nutritional support in stroke patients]. / Soporte nutricional del paciente con ictus.

Stroke is a public health problem of the first order. In developed countries is one of the leading causes of death, along with cardiovascular disease and cancer. In addition, stroke is the leading cause of permanent disability in adulthood. Many of the patients who survive do so with significant sequelae that limit them in their activities of daily living. Most strokes (80-85%) are due to ischemia, while the rest are hemorrhagic. We have identified many modifiable risk factors, some with an important relationship with dietary factors or comorbidities in wich the diet has a significant impact. The incidence of malnutrition in stroke patients is not well known, but most likely impacts on patient prognosis. Furthermore, the nutritional status of patients admitted for stroke often deteriorates during hospitalization. It is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of dysphagia. Dysphagia, through alteration of the safety and efficacy of swallowing, is a complication that has an implication for nutritional support, and must be treated to prevent aspiration pneumonia, which is the leading cause of mortality in the stroke patient. Nutritional support should begin in the early hours. In patients with no or mild dysphagia that can be controlled by modifying the texture of the diet, they will start oral diet and oral nutritional supplementation will be used if the patient does not meet their nutritional requirements. There is no evidence to support the use of nutritional supplements routinely. Patients with severe dysphagia, or decreased level of consciousness will require enteral nutrition. Current evidence indicates that early nutrition should be initiated through a nasogastric tube, with any advantages of early feeding gastrostomy. Gastrostomy will be planned when the enteral nutrition support will be expected for long-term (4 weeks). Much evidence points to the importance of glycemic control during hospitalization for stroke. Hyperglycemia at diagnosis and during the first hours of admission impact on patient prognosis. The goal of glycemic control necessary to modify this bad prognosis without adding risk by iatrogenic hypoglycemia is still matter of debate.

[Home parenteral nutrition; satisfaction of patients and their caregivers with nutrition unit and pharmacy service]. / Nutrición parenteral domiciliaria: satisfacción de los pacientes y sus cuidadores con la unidad de nutrición clínica y el servicio de farmacia.

INTRODUCTION: Home Parenteral Nutrition (HPN) is a practice in continually growing by the significant advantages involved for the patient and the healthcare system. Today, in the investigation of health outcomes is essential to assess the patient s opinion. Among the measures focused on patients with HPN, several studies about quality of life have been done, but the degree of satisfaction with this treatment modality has not been evaluated. OBJECTIVE: To evaluate the degree of satisfacion of patients and their caregivers receiving HPN with doctors, pharmacists and nurses in a hospital. MATERIAL AND METHODS: An anonymous survey was distributed, which consisted of 48 closed questions to patients and their caregivers receiving HPN who voluntarily answered. With survey responses a database in SPSS with the following variables was created: personal, sociocultural, clinical and related to HPN data and valoration of health personnel involved (nutrition area of the Pharmacy Service and Nursing and Medical Nutrition Units) and hospital facilities related to HPN. Also a section of open response suggestions was included. RESULTS: 24 surveys were distributed, 12 to patients and 12 to caregivers. Response rate was 91.7% in the case of patients and 58.3% in the caregivers. 63.6% of patients and 42.9% of caregivers were women. Mean age was, respectively, 46.1 years (SD: 13.7) and 47.0 years (SD: 3.6). Most of patients (55.6%) and caregivers (60.0%) had secondary studies and were pensoniers (72.7% and 71.4%, respectively). Underlying diseases of patients were: radiation enteritis (27.3%), intestinal obstruction (18.2%), intestinal carcinomatosis (45.5%) and Chron s disease (9.1%). With respect to items assessing satisfaction with physicians, nurses and pharmacists, in general both patients and caregivers were satisfied. Suggestions made were: greater amplitude of delivery schedule of HPN and inclusion of audiovisual information. CONCLUSIONS: The degree of satisfaction of patients receiving HPN and their caregivers with the care given by doctors, pharmacists and nurses is appropriate, but it s possible to make improvements to optimize the quality of the whole process.

Introducción: La Nutrición Parenteral Domiciliaria (NPD) es una práctica en continuo crecimiento por las importantes ventajas que presenta para el paciente y el sistema sanitario. En la investigación de los resultados en salud resulta hoy en día fundamental evaluar el punto de vista del paciente. Dentro de las medidas centradas en el paciente con NPD se han realizado varios estudios sobre la calidad de vida, pero no se ha evaluado el grado de satisfacción con esta modalidad de tratamiento. Objetivos: Evaluar el grado de satisfacción de los pacientes que reciben NPD y sus cuidadores con los médicos, farmacéuticos y enfermeros de hospital. Métodos: Se repartió una encuesta anónima y que constaba de 48 preguntas cerradas a los pacientes que recibían NPD y a sus cuidadores, los cuales contestaron de forma voluntaria. Con las respuestas recogidas se creó una base de datos en el programa SPSS con las siguientes variables: datos personales, socioculturales, clínicos y relacionados con la NPD y valoración del personal sanitario implicado (área de nutrición del Servicio de Farmacia y Unidades Médica y de Enfermería de Nutrición) y de las instalaciones del hospital relacionadas con la NPD. También se incluyó un apartado de sugerencias con respuesta abierta. Resultados: Se repartieron 24 encuestas, 12 a pacientes y 12 a cuidadores. La tasa de respuesta fue un 91,7% en el caso de los pacientes y un 58,3% en los cuidadores. El 63,6% de los pacientes y el 42,9% de los cuidadores eran mujeres. La media de edad fue, respectivamente, 46,1 años (DE: 13,7) y 47,0 años (DE: 3,6). La mayoría de los pacientes (54,5%) y de los cuidadores (42,9%) tenían estudios secundarios y eran pensionistas (72,7% y 71,4%, respectivamente). Las enfermedades de base de los pacientes fueron: enteritis rádica (27,3%), obstrucción intestinal (18,2%), carcinomatosis intestinal (45,5%) y enfermedad de Crohn (9,1%). Con respecto a los ítems que evaluaban la satisfacción con médicos, enfermeros y farmacéuticos, en general tanto pacientes como cuidadores estuvieron satisfechos. Las sugerencias recogidas fueron: mayor amplitud del horario de entrega de la NPD e inclusión de información audiovisual. Conclusiones: El grado de satisfacción de los pacientes que reciben NPD y sus cuidadores con el servicio dado por médicos, enfermeros y farmacéuticos es adecuado, aunque se pueden introducir mejoras para optimizar la calidad de todo el proceso.

Tratamiento de las complicaciones infecciosas de la nutrición parenteral domiciliaria / Infectious complications of home parenteral nutrition

Las complicaciones infecciosas relacionadas con el catéter son las más frecuentes en los pacientes con nutrición parenteral domiciliaria (0.5-2 infecciones/1 000 días o 0.3-0.5 infecciones/paciente/año). Suelen originarse por diseminación de los microorganismos por vía intraluminal o extraluminal hacia la punta del catéter. La mayoría de estas infecciones están producidas por microorganismos de la flora saprofita de la piel (especialmente Staphylococcus coagulasa negativo). El tipo de infección más frecuente es la bacteriemia asociada al catéter/sepsis de catéter, cuyo diagnóstico se realiza mediante el crecimiento del mismo microorganismo en la sangre del paciente y en un cultivo del catéter. La realización de hemocultivos extraídos a través del catéter y de vía periférica son muy útiles en el diagnóstico ya que mostrarán un crecimiento mayor y más rápido de los microorganismos en los cultivos extraídos de la vía central. En los pacientes con nutrición parenteral domiciliaria es importante tratar las infecciones sin retirar el catéter. El tratamiento antibiótico se administrará a través del catéter durante al menos 2 semanas. En los últimos años se ha popularizado la técnica del sellado del catéter con antimicrobianos, que parece mejorar las tasas de salvamento del catéter y disminuir las recaídas tras el tratamiento, principalmente en la infecciones originadas por Staphylococcus coagulasa negativo.