Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

Assessment of evidence and quality of clinical practice guidelines on deterioration of skin integrity: ulcers and chronic wounds / Evaluación de las evidencias y calidad de las guías de práctica clínica sobre deterioro de la integridad cutánea: úlceras y heridas crónicas.

Background. The epidemiological, social, and economic situation that surrounds the deterioration of skin integrity is a big problem for the health system. Its prevention and treatment create uncertainty and professional variability and it remains a priority to have good clinical practice guidelines (CPG). The objective was to determine the quality of the CPG on prevention and treatment of pressure ulcers (PU), venous ulcers of the leg (VUL) and diabetic foot ulcers (DFU). Methodology. Systematic review of the quality of Spanish and international CPG on PU, VUL and DFU. Bibliographic search in specialized sources. Selection of CPG, not older than 5 years (2010-2015). Use of the AGREE Instrument II and revision by 4 experts. Descriptive statistics. Results. Twenty-three CPG (10 PU, 6 VUL and 7 DFU), of which 4 were Spanish and 19 international. Eight CPG on PU, 3 VUL and 5 DFU were considered "Highly Recommended". Domain nº 2 (participation) and Domain nº 5 (applicability) were the worst valued. The quality of the evidence was "very good" in 19 GPC. The best CPG were the British NICE (PU), the Australian AWMA (VUL) and the Canadian RNAO (DFU). Conclusions. We observed a good methodological quality in the CPG on PU and DFU, but there needs to be improvement in the VUL. In general, it would be necessary to increase the participation of users, and describe possible barriers for the implementation of the CPG in clinical practice.

Evaluación de las evidencias y calidad de las guías de práctica clínica sobre deterioro de la integridad cutánea: úlceras y heridas crónicas / Assessment of evidence and quality of clinical practice guidelines on deterioration of skin integrity: ulcers and chronic wounds

Fundamento: La situación epidemiológica, sociosanitaria y económica que rodea al deterioro de la integridad cutánea supone un gran problema para el sistema sanitario. Su prevención y tratamiento crea incertidumbre y variabilidad profesional siendo prioritario contar con buenas Guías de Práctica Clínica (GPC). El objetivo fue conocer la calidad de las GPC sobre prevención y tratamiento de úlceras por presión (UPP), úlceras venosas de la pierna (UVP) y úlceras de pie diabético (UPD). Metodología: Revisión sistemática de la calidad de GPC españolas e internacionales sobre UPP, UVP y UPD. Búsqueda bibliográfica en fuentes especializadas. Selección de GPC con antigüedad no superior a 5 años (2010-2015). Uso del Instrumento AGREE II y revisión por 4 expertos. Estadística descriptiva. Resultados: Veintitrés GPC (10 UPP, 6 UVP y 7 UPD); de ellas, 4 eran españolas y 19 internacionales. Fueron consideradas «muy recomendables» 8 GPC sobre UPP, 3 de UVP y 5 de UPD. El Dominio nº 2 (participación) y el Dominio nº 5 (aplicabilidad) fueron los peor valorados. La calidad de la evidencia fue «muy buena» en 19 GPC. La mejor GPC fue la inglesa de la NICE (UPP), la australiana de la AWMA (UVP) y la canadiense de la RNAO (UPD). Conclusiones: Se observa una buena calidad metodológica en las GPC sobre UPP y UPD, pero habría que mejorar en las UVP. En general, habría que aumentar la participación de los usuarios, y describir las posibles barreras para la implementación de las GPC en la práctica clínica (AU)

Background: The epidemiological, social, and economic situation that surrounds the deterioration of skin integrity is a big problem for the health system. Its prevention and treatment create uncertainty and professional variability and it remains a priority to have good clinical practice guidelines (CPG). The objective was to determine the quality of the CPG on prevention and treatment of pressure ulcers (PU), venous ulcers of the leg (VUL) and diabetic foot ulcers (DFU). Methodology: Systematic review of the quality of Spanish and international CPG on PU, VUL and DFU. Bibliographic search in specialized sources. Selection of CPG, not older than 5 years (2010-2015). Use of the AGREE Instrument II and revision by 4 experts. Descriptive statistics. Results: Twenty-three CPG (10 PU, 6 VUL and 7 DFU), of which 4 were Spanish and 19 international. Eight CPG on PU, 3 VUL and 5 DFU were considered «Highly Recommended». Domain nº 2 (participation) and Domain nº 5 (applicability) were the worst valued. The quality of the evidence was «very good» in 19 GPC. The best CPG were the British NICE (PU), the Australian AWMA (VUL) and the Canadian RNAO (DFU). Conclusions: We observed a good methodological quality in the CPG on PU and DFU, but there needs to be improvement in the VUL. In general, it would be necessary to increase the participation of users, and describe possible barriers for the implementation of the CPG in clinical practice (AU)

Does the prevalence of the metabolic syndrome improve by applying the International Diabetes Federation criteria?

OBJECTIVE: To estimate the prevalence of the metabolic syndrome (MS) in a population of patients with overweight and obesity of the A Coruña and Granada health areas, using the definitions of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III) and of the International Diabetes Federation (IDF). PATIENTS AND METHODS: During a period extending from 1996 to 2003, only those patients attending endocrinology outpatient clinics for whom all the anthropometric and biochemical parameters used to define the MS, both according to the ATP IIII and the IDF, were available were selected. The final study sample consisted of 285 patients, 198 females (69.5%) and 87 males (30.5%). RESULTS: The prevalence of the MS was 29.8% when the ATP III definition was applied, and 41.1% according to the IDF criteria. Prevalence by sex was 32.2% in men and 28.8% in women according to the ATP III, and 42.5% and 40.4%, respectively, according to the IDF. CONCLUSIONS: In a patient population with overweight or obesity, the prevalence of the MS is higher when the IDF criteria, instead of the ATP III criteria, are used. These findings may have significant implications when it comes to addressing early diagnosis of cardiovascular disease and diabetes mellitus in these patients, in order to perform therapeutic measures at the initial stages and thereby reduce metabolic and cardiovascular complications.

Área de Nutrición de la SEEN / Nutrition area of the Spanish Society of Endocrinology and Nutrition

El desarrollo reciente del Área de Nutrición, consolida la nutrición clínica dentro de la Sociedad Española de Endocrinología y Nutrición (SEEN). Durante el último año, el comité gestor del Área ha participado en diversos proyectos de formación, desarrollo del contenido de nutrición de la página web y desarrollo de la FESNAD. La convocatoria realizada en el último congreso nacional ha permitido, además, la creación de los primeros grupos de trabajo dentro del Área de Nutrición de la SEEN, con la participación creciente de especialistas de endocrinología y nutrición con interés en el desarrollo de distintos aspectos de la nutrición clínica

The recent development of the Area of Nutrition consolidates the field of clinical nutrition within the Spanish Society of Endocrinology and Nutrition. During the last year, the managing committee of the Area has participated in diverse training projects and in the development of nutritional content on the web, a development of the Spanish Federation of Nutrition Societies. The call made in the last national congress has also allowed the creation of the first working groups within the Area of Nutrition of the Spanish Society of Endocrinology and Nutrition, with increasing participation of specialists in Endocrinology and Nutrition interested in the development of distinct aspects of clinical nutrition

Identificación de pacientes de riesgo nutricional por 3 métodos de cribado distintos / No disponible

Identificar precozmente a los pacientes de Riesgo Nutricional es fundamental para actuar de forma inmediata sobre ellos y aplicar el aporte nutricional correcto a aquellos que lo necesiten. Para ello existen varios métodos de cribado o screening. Objetivos: 1.- Determinar el índice de riesgo nutricional por 3 métodos de gran sensibilidad.2.- Comprobar si existe concordancia en el resultado obtenido con cada uno de ellos. Material y métodos: Se estudian 184 pacientes mayores de edad (92<65 años y 92≥65años) ingresados en 6 hospitales públicos de Galicia, a quienes se aplican los protocolos de estudio para 3 métodos de cribado nutricional perfectamente validados que determinan pacientes de Riesgo Nutricional. Se valoran cambios recientes en el peso, albúmina sérica, concentración de linfocitos e ingesta y diagnóstico al ingreso y se determina el porcentaje de pacientes de riesgo con cada método. Contrastamos los porcentajes y comprobamos si existe concordancia entre los resultados. Resultados: El Índice de Riesgo Nutricional lo definen los pacientes con riesgo de desnutrición hallados por cada parámetro: Elmore -IR.= 20,1%; Ulíbarri – IR. = 51,1%, Cardona –IR. = 48,9%El Coeficiente de correlación de Spearman muestra una significación de 0,00, lo que suponeuna concordancia entre los pacientes de riesgo nutricional definidos por cada uno de losíndices. Conclusiones: 1.- El Índice de Riesgo determinado por cada parámetro está dentro del estándar habitual de desnutrición Hospitalaria. 2.-Los 3 Índices de Riesgo muestran una correlación significativa entre ellos, es decir, que detectan los mismos pacientes como pacientes d eriesgo (AU)

To identify precociously patients at nutritional risk is essential to act immediately to apply nutritional support is needed. There are several screening methods. Objectives: 1.- To determine nutritional risk by 3 methods of great sensitivity. 2.- To establish the concordance of results obtained between methods. Material and Methods: We studied 184 adult patients (92<65 years and 92≥65 years) admitted in 6 publics hospitals of Galicia, who were applied for study protocol for 3 validated nutritional screening methods that determine nutritional at risk patients; evaluation included recent weight changes, serum albumin, lymphocyte count, ingestion and diagnosis at admittance, and we determined the percentage of risk patients with each method. We contrasted percentages and studied concordance between results. Results: Nutritional Risk Index is defined by patients at risk founded by each parameter: Elmore- IR.= 20,1%; Ulíbarri – IR. = 51,1%, Cardona– IR. = 48,9%Spearman’s correlation coefficient shows significant relation of de 0,00, that implies a concordance between at risk patients defined bay each index. Conclusions: 1.- Risk index defined by each parameter is between usual hospital malnutrition standards. 2.- All 3 risk index show significant correlation; that means that they show significant correlation and detect same patients as at risk (AU)

Recomendaciones nutricionales en las distintas etapas de la vida basadas en la evidencia / Evidence-based nutritional recommendations in the distinct stages of life

Se analiza la evidencia científica disponible sobre las recomendaciones nutricionales en las distintas etapas de la vida a través de 10 preguntas clave que se cuestionan alguno de los hechos más relevantes en cuanto a las modificaciones dietéticas a lo largo del ciclo vital: ¿cuál debe ser la duración de la lactancia materna?, ¿cuáles son los mejores métodos para promocionar la lactancia materna?, ¿deben utilizarse fórmulas con proteínas de soja para prevenir enfermedades alérgicas en lactantes de alto riesgo?, ¿está indicada la suplementación con micronutrientes en el lactante?, ¿cómo prevenir la obesidad infantil?, ¿existen estrategias válidas de prevención de los trastornos alimentarios en adolescentes?, ¿qué alimentación debemos recomendar para la embarazada y la mujer lactante?, ¿deben utilizarse suplementos nutricionales en los ancianos con riesgo de desnutrición?, ¿deben utilizarse suplementos de micronutrientes en los ancianos para prevenir o tratar las enfermedades degenerativas? (AU)

We review the scientific evidence available on nutritional recommendations in the distinct stages of life through 10 key questions relating to dietary modifications throughout the life cycle, namely: how long should breast-feeding last? What are the best methods for promoting breast-feeding? Should soya infant formulas be used to prevent allergic diseases in infants at high risk? Is micronutrient supplementation indicated in infants? How should childhood obesity be prevented? Are there any valid strategies for preventing eating disorders in adolescents? Which type of diet should be recommended in pregnant and breast-feeding women? Should nutritional supplements be used in elderly individuals at risk of malnutrition? Should micronutrient supplements be used in the elderly to prevent or treat degenerative diseases? (AU)

Grupo de Nutrición de la SEEN / The Nutrition Group of the Sociedad Española de Endocrinología y Nutrición (Spanish Society of Endocrinology and Nutrition)

No disponible

Nutrición y disfagia / Nutrition and dysphagia

Se conoce como disfagia la dificultad o incapacidad para tragar alimentos líquidos o sólidos desde la cavidad oral hasta el estómago. La disfagia puede provocar malnutrición al interferir con la ingesta, y también puede dar lugar a deshidratación, aspiración hacia la vía respiratoria o incluso la muerte. La disfagia es un síntoma de alguna patología subyacente y su manejo adecuado es fundamental para el mantenimiento del estado nutricional de los pacientes. Al mismo tiempo, las modificaciones nutricionales forman parte de las estrategias de rehabilitación de la deglución. En este trabajo se resumen las principales causas de disfagia en nuestro medio, se comentan las consecuencias nutricionales de esta situación y se proponen modificaciones dietéticas que pueden resultar útiles para mantener un adecuado estado nutricional y rehabilitar a los pacientes con disfagia (AU)

[Early enteral nutrition and immunonutrition]. / Nutrición enteral precoz e inmunonutrición.

The repercussions of nutrition on the immunological system are described. The current situation is discussed with regard to the handling of the immuno-inflammatory response to aggression and the improvement of the immune response. The goal pursued by nutritional manipulation of the immune system is to improve the prognosis and reduce the complications in critical patients subjected to surgical or traumatic aggression or sepsis. The following points are reviewed: the importance of preserving the axis from the liver to the digestive tract, the advantages of particularly early enteral nutrition over parenteral nutrition, the substances currently considered as immunonutrients and the available clinical evidence on their use, with a series of conclusions for current decisions and future developments.

[Complications of the intragastric balloon prosthesis]. / Complicaciones de la prótesis balón intragástrica.

The intragastric balloon prosthesis (PBIG) is being used as a mechanical treatment for obesity; an evaluation of its physiopathological implications, efficiency, and complications is still incomplete. In order to investigate in our area the incidence of complications of this endoscopic treatment, we have used the Danish model "Danish Obesity Treatment" (DOT) (Ballobes) inflated with air, in a prospective study in which forty obese patients were treated during three months. We draw the attention upon a gastric ulcer, a spontaneous anal extrusion-migration, and a duodenal ulcer. We establish the safety of the method, the literature is reviewed, we discuss the cause and treatment of these lesions, and we conclude indicating the low morbidity and the absence of major complications such as oesophageal perforation or intestinal obstruction occurring with other prosthesis models.