Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study.

Background: Enteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP. Methods: In a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL). Results: Approximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day. Conclusion: Awareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient's needs and requirements to provide more tailored matching of nutritional support.

Home Enteral Nutrition in Adults-Nationwide Multicenter Survey.

Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018-1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%-neurovascular, 13.7%-neurodegenerative), 33.9% cancer (20.2%-head and neck, 11.7%-gastrointestinal cancer), 2.5%-gastroenterology, 1.5%-inherited diseases. Of new registrations in 2018-cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m2, NRS 2002 score-4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.

Commercial enteral formulas and nutrition support teams improve the outcome of home enteral tube feeding.

BACKGROUND: The benefits of home enteral tube feeding (HETF) provided by nutrition support teams (NSTs) have been questioned recently, given the growing costs to the healthcare system. This study examined the effect of a specialized home enteral nutrition program on clinical outcome variables in HETF patients. METHODS: The observational study included 203 patients (103 women, 100 men; mean age 52.5 years) receiving HETF with homemade diets for at least 12 months before starting a specialized home nutrition program for another 12 months consisting of provision of commercial enteral formulas and the guidance of an NST. Both study periods were compared regarding the number of hospital admissions, length of hospital and intensive care unit (ICU) stay, and costs of hospitalization. RESULTS: A specialized HETF program significantly reduced the number of hospital admissions and the duration of hospital and ICU stays. The need for hospitalization and ICU admission was significantly reduced, with odds ratios of 0.083 (95% confidence interval, 0.051-0.133, P < .001) and 0.259 (95% confidence interval, 0.124-0.539, P < .001), respectively. Specialized HETF was associated with a significant decrease in the prevalence of pneumonia (24.1% vs 14.2%), respiratory failure (7.3% vs 1.9%), urinary tract infection (11.3% vs 4.9%), and anemia (3.9% vs 0%) requiring hospitalization. The average yearly cost of hospital treatment decreased from $764.65 per patient to $142.66 per year per patient. CONCLUSIONS: The specialized HETF care program reduces morbidity and costs related to long-term enteral feeding at home.

[Treatment of the inguinal haernias with the use of synthetic mesh with prolen hernia system (PHS) and Robbins-Rutkow methods--review of outcomes]. / Ocena wyników leczenia przepuklin pachwinowych przy uzyciu wszczepów syntetycznych--metodami prolen hernia system (PHS) i Robbins-Rutkow.

OBJECT OF RESEARCH: Evaluation of methods and outcomes of inguinal region haernias' treatment with the use of synthetic implants. MATERIAL: An analysis of 867 patients operated with the use of synthetic implants between 1999 and 2005 has been made (PHS, Robbins-Rutkow). The group consisted of 695 men, and 172 women and the average age was 44.5 years. In 860 (99%) patients a subarachnoid anaesthesia and in (1%) patients a local anaesthesia were performed. All patients received antibiotic prophylaxis. RESULTS: Between 1999-2005 867 surgical treatments of the inguinal region haernias were performed using synthetic implants--PHS 363 (41.9%), Robbins-Rutkow 504 (58.1%). Most patients received subarachnoid anaesthesia (99%). Only 1% of the patients were given local anaesthesia due to the load pertaining to internal medicine and the presence of spondylosis. Complications which occured after surgery were: suppuration of the wound in 17 patients (2%), hematoma in the wound in 8 patients (1%), relapse of haernia in 4 patients (0.5%). All patients were activated in the first twenty-four hours after the operation. Return to full physical activity was observed 14 days after the surgery. CONCLUSIONS: 1. Analysing both methods of treatment, no statistically significant differences were found in the frequency of posoperative complications and haernia relapse. 2. The choice of method is dependent on the type of haernia found intraoperatively. 3. The proper method choice guarantees the efficacy of treatment as well as little amount of complications and relapses.