Traducción y validación de la versión en español de la escala EAT-10 (Eating Assessment Tool-10) para el despistaje de la disfagia / Translation and validation of the Spanish version of the EAT-10 (Eating Assessment Tool-10) for the screening of dysphagia

Introducción: El Eating Assessment Tool-10 (EAT-10) es un instrumento analógico verbal, unidimensional y autoadministrado, para el despistaje de la disfagia. Objetivos: Traducir y adaptar al español la escala EAT-10, y evaluar sus propiedades psicométricas, fiabilidad y validez. Métodos: Tras la traducción, traducción inversa y aprobación por los investigadores de la versión española de la escala (EAT-10 ES), se realizó un estudio prospectivo en pacientes con diagnóstico de disfagia (DD), pacientes no diagnosticados con riesgo de disfagia (RD) y pacientes sin riesgo de disfagia (SRD), procedentes de tres escenarios clínicos: una unidad de soporte nutricional hospitalaria (USN), una residencia geriátrica (RG) y un centro de atención primaria (CAP), que respondieron a la EAT-10 ES durante una única visita. Pacientes e investigadores respondieron a un cuestionario de comprensión del instrumento. Resultados: El estudio incluyó 65 pacientes (75±9,1 años de edad; 52,3% mujeres). El tiempo medio de administración fue de 3,8 ± 1,7 minutos. El 95,4% de los pacientes consideró comprensibles todos los ítems de la escala y el 72,3% consideró fácil la asignación de puntuaciones. El coeficiente de consistencia interna alfa de Cronbach fue 0,87. La correlación entre las puntuaciones de cada ítem y el total de la escala fue elevada (p < 0,001). Las puntuaciones EAT-10 ES medias fueron 15 ± 8,9 (D), 6,7 ± 7,7 (RD) y 2 ± 3,1 (SRD), y significativamente más altas en pacientes varones, pacientes con diagnostico previo de disfagia y procedentes de la USN (p < 0,001). Conclusión: La escala EAT-10 ES ha probado su fiabilidad, validez y consistencia interna. Es un instrumento fácil de comprender y rápido de completar, por lo que se considera útil para el despistaje de la disfagia en la práctica clínica (AU)

Rationale: The Eating Assessment Tool-10 (EAT-10) is a self-administered, analogical, direct-scoring screening tool for dysphagia. Objective: To translate and adapt the EAT-10 into Spanish, and to evaluate its psychometric properties. Methods: After the translation and back-translation process of the EAT-10 ES, a prospective study was performed in adult patients with preserved cognitive and functional abilities. Patients in 3 clinical situations, diagnosed with dysphagia (DD), patients at risk of dysphagia (RD), and patients not at risk of dysphagia (SRD) were recruited from 3 settings: a hospital Nutritional Support Unit (USN), a nursing home (RG) and primary care centre (CAP). Patients completed the EAT-10 ES during a single visit. Both patients and researchers completed a specific questionnaire regarding EAT-10 ES' comprehension. Results: 65 patients were included (age 75 ± 9.1 y), 52.3% women. Mean time of administration was 3.8 ± 1.7 minutes. 95.4% of patients considered that all tool items were comprehensible and 72.3% found it easy to assign scores. EAT-10 ES' internal consistency, Cronbach's Alpha coefficient was 0.87. A high correlation was observed between all tool items and global scores (p < 0.001). Mean score for patients in group DD was 15 ± 8.9 points, 6.7 ± 7.7 points in group RD, and 2 ± 3.1 points in group SRD. Male patients, previously diagnosed of dysphagia or patients from the NSU showed significantly higher scores on the EAT-10 ES (p < 0.001). Conclusion: EAT-10 ES has proven to be reliable, valid and to have internal consistency. Is it an easy-to-understand tool that can be completed quickly, making it useful for the screening of dysphagia in routine clinical practice (AU)

[Catheter occlusion and venous thrombosis prevention and incidence in adult home parenteral nutrition (HPN) programme patients]. / Prevención e incidencia de oclusión del catéter y trombosis venosa en pacientes adultos con nutrición parenteral domiciliaria (NPD).

UNLABELLED: In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. OBJECTIVES: To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. METHODS: Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. RESULTS: 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. CONCLUSION: [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice.

[Home enteral nutrition in Spain: NADYA registry in 2010]. / Nutrición enteral domiciliaria en España: registro NADYA del año 2010.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st to December 31st 2010. RESULTS: We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. CONCLUSIONS: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.

Prevención e incidencia de oclusión del catéter y trombosis venosa en pacientes adultos con nutrición parenteral domiciliaria (NPD) / Catheter occlusion and venous thrombosis prevention and incidence in adult home parenteral nutrition (HPN) programme patients

Hasta el momento actual no hay ninguna recomendación basada en la evidencia sobre la sistemática a seguir de cara a mantener la permeabilidad de los accesos venosos ni prevenir la trombosis venosa en pacientes en programa de NPD. La utilización de heparina no está exenta de riesgos y de complicaciones a largo plazo. El uso de anticoagulantes también es discutido. Objetivos: Conocer la práctica habitual, en nuestro país, del mantenimiento de los catéteres venosos centrales para NPD, la incidencia de oclusión de los mismos y de trombosis venosa asociada. Métodos: estudio retrospectivo de los pacientes mayores de 18 años en activo en programa de NPD hasta noviembre de 2008, registrados por el grupo NADYA-SENPE. 
Resultados: Se incluyeron un total de 49 pacientes (16 hombres y 33 mujeres) pertenecientes a 6 hospitales, con una media de edad de 52,1 ± 13,9 años y una duración de la NPD de 57,4 ± 73,3 meses, con una media de 5,8 ± 1,8 días de NP a la semana. Las patologías mas frecuentes fueron enteritis rádica, alteraciones de la motilidad intestinal e isquemia mesentérica, (20,4% de pacientes cada una) y neoplasia activa (16,3%). Las principales indicaciones de la NPD fueron el síndrome de intestino corto (49,0%) y obstrucción intestinal (28,6%). Los principales factores predisponentes de trombosis venosa aparte de la neoplasia fueron: diátesis trombótica, enfermedad tromboembólica, y reposo en cama con un 6,1% cada una de ellas. El 77,6% de los pacientes recibía la NPD a través de un catéter tunelizado, y el resto a través de un reservorio implantado. Para el mantenimiento de la permeabilidad del catéter en el 28,6% de pacientes se usaba suero fisiológico y en el 69,4% heparina en distintas concentraciones retirándose ésta del catéter previa la administración de la NPT en el 63,3% de los casos. Las tasas de oclusión del catéter y episodios trombóticos fueron de 0,061/103 y 0,115/103 días de NPD respectivamente. Once pacientes (22,4%) recibían anticoagulación sistémica por episodios previos de trombosis venosa o tromboembolismo pulmonar. Conclusiones: La incidencia de complicaciones trombóticas asociadas al catéter en este grupo de pacientes con NPD es baja. Existe una gran heterogeneidad en la profilaxis de la oclusión del catéter y prevención de la trombosis venosa, siendo necesario unificar criterios en este sentido (AU)

In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. Objectives: To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. Methods: Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. Results: 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/103 and 0.115/103 HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. Conclusion: The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice (AU)

Nutrición enteral domiciliaria en España: registro NADYA del año 2010 / Home enteral nutrition in spain: NADYA registry in 2010

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE del año 2010.Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero al 31 de diciembre de2010.Resultados: Se registraron 6.591 pacientes (51% varones) con 6.688 episodios de NED, procedentes de 32 hospitales. La edad media en los menores de 14 años (4%) fue de 1 ± 2 años (m ± DS) y de 69,9 ± 17,8 en los mayores de14 años. El 76% de los pacientes recibieron la NED por un tiempo superior a 2 años. La patología más prevalente fue la neurológica 42%, seguida de la neoplasia 28% (en su mayoría cáncer de cabeza y cuello 18%). La información referente a la vía de acceso sólo se recogió en 626 casos(9,4%), el 51% de los pacientes utilizaron sonda nasogástrica, 27% gastrostomías, 10% vía oral y 3% yeyunostomías. Sólo 251 episodios finalizaron a lo largo del año, siendo el motivo más frecuente el fallecimiento del paciente en el 57% de los casos y el paso a la alimentación oral en el 14%. El 29% de los pacientes presentaban una actividad limitada y el 39% estaba confinado en cama/sillón. El 68% de los adultos requerían ayuda total o parcial. El suministro del producto se realizó desde el hospital o la farmacia de referencia en el 63% y 34%, respectivamente. El suministro del material fungible se realizó desde el hospital o atención primaria en el 83% y 16%,respectivamente.Conclusiones: Los resultados obtenidos en el registro de NED del año 2010 muestran características muy similares a las recogidas en los años previos en cuanto al número y características de los pacientes registrados. Seguimos encontrando problemas en la recogida de datos relativos a la vía de acceso y finalización de los episodios (AU)

Objective: To describe the results of the home enteralnutrition (HEN) registry of the NADYA-SENPE group in2010.Material and methods: We retrieved the data of the patients recorded from January 1st to December 31st2010.Results:We registered 6,591 patients (51% males) with6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in29% of the patients and 39% of them were bed- or chair ridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and16% of the cases, respectively. Conclusions: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes (AU)

[Translation and validation of the Spanish version of the EAT-10 (Eating Assessment Tool-10) for the screening of dysphagia]. / Traducción y validación de la versión en español de la escala EAT-10 (Eating Assessment Tool-10) para el despistaje de la disfagia.

RATIONALE: The Eating Assessment Tool-10 (EAT-10) is a self-administered, analogical, direct-scoring screening tool for dysphagia. OBJECTIVE: To translate and adapt the EAT-10 into Spanish, and to evaluate its psychometric properties. METHODS: After the translation and back-translation process of the EAT-10 ES, a prospective study was performed in adult patients with preserved cognitive and functional abilities. Patients in 3 clinical situations, diagnosed with dysphagia (DD), patients at risk of dysphagia (RD), and patients not at risk of dysphagia (SRD) were recruited from 3 settings: a hospital Nutritional Support Unit (USN), a nursing home (RG) and primary care centre (CAP). Patients completed the EAT-10 ES during a single visit. Both patients and researchers completed a specific questionnaire regarding EAT-10 ES' comprehension. RESULTS: 65 patients were included (age 75 ± 9.1 y), 52.3% women. Mean time of administration was 3.8 ± 1.7 minutes. 95.4% of patients considered that all tool items were comprehensible and 72.3% found it easy to assign scores. EAT-10 ES' internal consistency, Cronbach's Alpha coefficient was 0.87. A high correlation was observed between all tool items and global scores (p < 0.001). Mean score for patients in group DD was 15 ± 8.9 points, 6.7 ± 7.7 points in group RD, and 2 ± 3.1 points in group SRD. Male patients, previously diagnosed of dysphagia or patients from the NSU showed significantly higher scores on the EAT-10 ES (p < 0.001). CONCLUSION: EAT-10 ES has proven to be reliable, valid and to have internal consistency. Is it an easy-to-understand tool that can be completed quickly, making it useful for the screening of dysphagia in routine clinical practice.

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España de los años 2007, 2008 y 2009 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register's beginning.

[Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008.

AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group. MATERIAL AND METHODS: We recorded the HEN registry data from January 1st to December 31st 2008. RESULTS: The number of patients registered in this period was 6206 (51% male) with up to 6,279 episodes of HEN, from 31 Spanish hospitals. Most of the patients (95%) were older than 14 yr. Mean age was 4.83±3.29 yr in the children group, and 70.75±18.14 yr in the adult group (older than 14 yr). Neurological disorders (39%) and cancer (27%) were the two most prevalent diagnoses. The oral route was the most frequently used (43,4%), followed by nasogastric tube (40,4%), and gastrostomy tube (14,7%). Mean length of treatment was 305,36 days (10 months). The principal reasons for discontinuing treatment were death (43%) and progress to oral diet (40%). Only 33% of the patients had a normal activity level, being limited in different grades in the rest of the patients. Most of the patients required partial (25%) or total help (38%). The enteral formula was provided by the hospital in 65% of the cases and by private pharmacies in 32%. The disposables were provided by the hospital (82,4%) and primary care services (17,2%). CONCLUSIONS: The number and the age of the patients registered have increased comparing to previous years, with little variations in the rest of analyzed variables. The increase in the length of treatment could reflect misreporting of the weaning process in the registry.

[Karnosfsky index as a mortality predicting factor in patients on home-based enteral nutrition]. / El índice de Karnofsky como predictor de mortalidad en pacientes con nutrición enteral domiciliaria.

UNLABELLED: Karnofsky Index (KI) is a widely used functional scale developed for oncology patients. It has proved useful as outcome predictor with cancer and geriatric patients. Theoretically, KI could be used to predict mortality in patients with home enteral nutrition (HEN). STUDY OBJECTIVES: To determine baseline KI and its 6-month evolution in HEN patients, and to assess its relation with the mortality rate. METHODOLOGY: Observational and prospective study carried out during 2002 and 2003 with tube feeding neurologic and cancer patients followed during 10 months since their HEN programme inclusion. RESULTS: 201 patients were included, 131 (65.2%) with neurological diseases and 70 (34.8%) with neoplasm. There were not significant differences between groups in age, days with HEN and mortality rate at the end of the study period (35.1% in neurologic patients and 40% in cancer ones). 27.1% of cancer patients had resumed full oral nutrition after ten months from the beginning of the study, whereas only 10.7% of neurologic patients did (p < 0.05). In the three measurement phases (initial, past-3 and past-6 months) KI values were higher for cancer patients than for neurologic ones (p < 0.001). In both groups we didn't found statistically significant differences in KI along the three measurements. A significant relation was observed overall between initial KI values and average survival after 10 months (p < 0.001), and an inverse relation was found between the former and mortality rate (p < 0.001). CONCLUSION: KI is a useful tool to predict mortality rate in cancer and neurologic patients under HEN.

Evolution of lipid profile, liver function, and pattern of plasma fatty acids according to the type of lipid emulsion administered in parenteral nutrition in the early postoperative period after digestive surgery.

BACKGROUND: The metabolic effects of intravenous lipid emulsions (ILEs) used in parenteral nutrition (PN) depend on their fatty acid composition. METHODS: Subjects in this prospective and randomized double-blind study were 28 adult patients post digestive surgery. PN was started after surgery and lasts for 5 days. Randomly, patients receive 1 of 4 different ILEs: medium-chain triglycerides/long-chain triglycerides (soybean oil; MCT/LCT), olive/soybean oil (oleic), long-chain triglycerides (soybean oil; LCT), and structured lipid. On days 0 and 6, serum liver function tests were analyzed for cholesterol, triglycerides, lipoproteins, and serum fatty acids. RESULTS: No differences were found in the 4 groups according to their gender, age, body mass index, diagnosis, baseline white blood cell, C-reactive protein, glucose levels, and other study parameters. Differential significant changes were not observed in any of the hepatic function parameters or plasmatic lipid levels between the groups. A significant decrease was observed in cis monounsaturated fatty acids (MUFAs) and a significant increase in omega-6 polyunsaturated fatty acids (PUFAs) and omega-3 PUFA values in LCT and structured groups compared with MCT/LCT and oleic groups, and a tendency for a decrease in trans fatty acids in the oleic and structured groups was found. CONCLUSIONS: All ILEs administered were safe and well tolerated. The changes in serum fatty acids reflected the pattern of fatty acids administered with different ILEs. The group receiving the olive oil emulsion achieved a fatty acid composition of serum lipids that could offer major therapeutic or biological advantages.

El índice de Karnofsky como predictor de mortalidad en pacientes con nutrición enteral domiciliaria / Karnosfsky index as a mortality predicting factor in patients on home-based enteral nutrition

El índice de Karnofsky (IK) es una escala funcional desarrollada en oncología y ampliamente utilizada, que ha mostrado ser útil para predecir la evolución en pacientes oncológicos y geriátricos. Teóricamente, como herramienta de valoración funcional podría predecir la mortalidad en pacientes con nutrición enteral domiciliaria (NED). Objetivos del estudio: Conocer el IK inicial y su evolución a 6 meses en pacientes en régimen de NED y estudiar la relación entre la tasa de mortalidad de los mismos con dicho índice. Material y métodos: Estudio observacional y prospectivo realizado durante 2002 y 2003 con pacientes neurológicos y oncológicos con nutrición enteral por sonda seguidos durante 10 meses desde su inclusión en el programa de NED. Resultados: Se estudiaron 201 pacientes, 131 (65,2%) neurológicos y 70 (34,8%) oncológicos, sin existir entre ambos grupos diferencias significativas en la edad, días con NE y mortalidad al final del periodo de estudio (35,1% en pacientes neurológicos y 40% en oncológicos). A los 10 meses un mayor porcentaje de pacientes oncológicos había recuperado la capacidad de ingesta oral (27,1% frente a 10,7% en los neurológicos, p < 0,05). Los valores del IK fueron mayores en los pacientes oncológicos que en los neurológicos en las tres determinaciones (inicial, a los 3 y a los 6 meses, p < 0,001). Dicho índice no se modificó significativamente en ninguno de los dos grupos durante su evolución. Analizando el conjunto de los pacientes se observó una relación significativa entre los valores iniciales del IK y la media de supervivencia a los 10 meses (p < 0,001), y una relación inversa entre los valores iniciales del índice y el porcentaje de mortalidad (p < 0,001). Conclusión: El IK es una herramienta útil para predecir la mortalidad en pacientes oncológicos y neurológicos en programa de NED (AU)

Karnofsky Index (KI) is a widely used functional scale developed for oncology patients. It has proved useful as outcome predictor with cancer and geriatric patients. Theoretically, KI could be used to predict mortality in patients with home enteral nutrition (HEN). Study objectives: To determine baseline KI and its 6-month evolution in HEN patients, and to assess its relation with the mortality rate. Methodology: Observational and prospective study carried out during 2002 and 2003 with tube feeding neurologic and cancer patients followed during 10 months since their HEN programme inclusion. Results: 201 patients were included, 131 (65.2%) with neurological diseases and 70 (34.8%) with neoplasm. There were not significant differences between groups in age, days with HEN and mortality rate at the end of the study period (35.1% in neurologic patients and 40% in cancer ones). 27.1% of cancer patients had resumed full oral nutrition after ten months from the beginning of the study, whereas only 10.7% of neurologic patients did (p < 0.05). In the three measurement phases (initial, past-3 and past-6 months) KI values were higher for cancer patients than for neurologic ones (p < 0.001). In both groups we didn't found statistically significant differences in KI along the three measurements. A significant relation was observed overall between initial KI values and average survival after 10 months (p < 0.001), and an inverse relation was found between the former and mortality rate (p < 0.001). Conclusion: KI is a useful tool to predict mortality rate in cancer and neurologic patients under HEN (AU)

[Immediate complications of feeding percutaneous gastrostomy: a 10-year experience]. / Complicaciones inmediatas de la gastrostomía percutánea de alimentación: 10 años de experiencia.

Percutaneous gastrostomy feeding tube (PG) may be beneficial in some patients, in others such as advanced dementia or rapidly progressive diseases its value is being questioned. Patient selection is important to identify those who will benefit from PG. This study aims to identify patients factors that may help in patient selection for PG. To analyse the characteristics of this patient's cohort and to describe the immediate complications of the procedure that we have defined as the ones happened in the first 30 days. To compare the two patient's group -with and without- immediate complications, non-parametric tests were used.

Complicaciones inmediatas de la gastrostomía percutánea de alimentación: 10 años de experiencia / Immediate complications or feeding percutaneous gastrotomy: A 10-year experiencie

El soporte nutricional enteral a través de sonda de gastrostomia percutánea de alimentación (GP) es beneficiosa en ciertos pacientes, en otros, tales como pacientes con demencia avanzada o enfermedades rápidamente progresivas, sin embargo, se cuestiona su papel. La selección de los pacientes es, pués, importante para identificar aquéllos que pueden beneficiarse de la alimentación a través de una soda de GP. En este estudio, se analizan las características de una cohorte de pacientes, en soporte nutricional enteral a través de sonda de GP, y se describen las complicaciones inmediatas de la técnica -definidas como las acontecidas en los 30 primeros dias de la realización del procedimiento-al objeto de identificar los factores de riesgo que ayuden a seleccionar los pacientes candidatos a ser alimentados a través de sonda de GP. Nuestro estudio muestra que la edad superior a 70 años puede predecir la evolución y la supervivencia después de la colocación de una sonda de GP para alimentación. Consecuentemente, este factor obliga a analizar, de manera individual y sistemática, la necesidad o no de colocar la sonda de GP en pacientes mayores de 70 años (AU)

Percutaneous gastrostomy feeding tube (PG) may be beneficial in some patients, in others such as advanced dementia or rapidly progressive diseases its value is being questioned. Patient selection is important to identify those whowill benefit from PG. This study aims to identify patients factors that may help in patient selection for PG. To analyse the characteristics of this patient's cohort and to describe the immediate complications of the procedure that we have defined as the ones happened in the first 30 days. To compare the two patient's group -with and without- immediate complications, non-parametric tests were used (AU)

[Spanish Registry of Home-based Parenteral Nutrition during 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España del año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.

Guidelines for colorectal cancer: effects on nutritional intervention.

INTRODUCTION: Although parenteral nutrition is a vital method of delivery essential nutrients in patients with malnutrition associated to gastro-intestinal insufficiency, its inappropriate use can increase the risk of complications and incur unnecessary expenses. OBJECTIVE: Our goal was to evaluate the influence of both, the presence of the Nutritional Support Unit and the implementing clinical practice guidelines on post-operative nutritional status, complications and length of stay among patients undergoing elective colorectal cancer surgery. METHODS: Prospective and observational study: Three period times were included-the year during the guidelines elaboration (A), and the first (B) and the second year (C) after their implementation. All patients submitted to elective colorectal cancer surgery at least 18 years of age were included (A: n=297; B: n=103, and C: n=149). WE ANALYSED: Nutritional status (NS) on admission to hospital and at discharge, use of post-operative parenteral nutrition (PPN), incidence of post-operative complications (PC), number of days of nil by mouth following surgery (NPO), and hospital length of stay (LOS). RESULTS: Although the prevalence of malnutrition on admission was low, an increment was observed during the hospitalisation time. However, only in the first period time, the increment was significantly different (A: from 8.4% to 19.5%, p<0.001; B: from 3.9% to 8.7%, and C: from 4.7% to 6.7%). Globally, the use of PPN decreased (A: 79.1%, B: 47.0%, and C: 12.8%; p<0.001). This behaviour was mainly observed in well-nourished patients (use of PPN in well nourished, A: 79.3%, B: 44.4%, and C: 11.3%; p<0.001). Significant differences were observed in the global incidence of PC (A: 27.9%, B: 28.2%, and C: 8.1%, p<0.001). Furthermore, PC was higher in well-nourished patients with PPN versus without PPN, with significant differences in B and C periods (A: 29.3% vs. 25.0%; B: 38.6% vs. 18.8%, p=0.004; C: 31.3% vs. 4.8%, p=0.003). The NPO was higher in patients without PPN in period A (7 d vs. 5 d, p<0.001) and higher in those with PPN in period C (8 d vs. 6 d, p=0.035). All in all, LOS decreased significantly during the study period time (A: 16 d, B: 13 d, and C: 11 d, p<0.001). CONCLUSION: The presence of Nutritional Support Unit and clinical practice guidelines for colorectal cancer management and treatment, optimised the use of hospital resources, namely unnecessary use of parenteral nutrition, reduction along with decrease in number of complications and length of hospital stay.

[Patient satisfaction in a home enteral nutrition program]. / Evaluación del grado de satisfacción de un programa de nutrición enteral domiciliaria.

UNLABELLED: Home enteral nutrition is a treatment carried out frequently due to advantages for patients and caregivers (lower risk of nosocomial infections and better integration in socio-familiar media) but also for the health administration because of the lower economic cost and the release of hospital beds. OBJECTIVE: To investigate patients' and caregivers' satisfaction related to tube enteral nutrition administered at home by a Service controlled and followed by the Nutritional Support Unit from the reference hospital. METHODS: One questionnaire for the patients and another for the caregivers were delivered to the patients with home enteral nutrition asking for voluntary response. Similar questionnaires were sent to hospitalized patients and their relatives or possible caregivers. RESULTS: According to the results of the questionnaires, the majority of patients and relatives were satisfied with the service received. In the cases in which the service was offered at home, the preference was to continue there and not to return to the hospital. Finally, the possibility of telephone contact and home visits were the most important factors that influenced patient satisfaction. CONCLUSION: Our results let us conclude that home enteral nutrition controlled and followed up by the Nutritional Support Unit form the hospital is a treatment well accepted both by patients and relatives.

Evaluación del grado de satisfacción de un programa de nutrición enteral domiciliaria / Patient satisfaction in a home enteral nutrition program

La nutrición enteral a domicilio es un tratamiento cada vez más utilizado por las ventajas que comporta no sólo al paciente y familiares o cuidadores (menos riesgo de infecciones nosocomiales y mejor integración socio-familiar) sino también a la administración en el sentido de representar un ahorro en coste económico además de disponer de mas camas de hospitalización. Objetivo: Analizar el grado de satisfacción de los pacientes y familiares o cuidadores en relación a un servicio de Nutrición Enteral Domiciliaria (NED) controlado desde la Unidad de Nutrición del Hospital. Metodología: Un cuestionario para los pacientes y otro para los familiares/cuidadores fue remitido a los enfermos que recibiendo nutrición enteral por sonda en su domicilio quisieron voluntariamente colaborar. Cuestionarios similares se remitieron a pacientes ingresados en el hospital tratados con nutrición enteral así como a sus posibles cuidadores en el caso de que recibieran este tratamiento a domicilio. Resultados: De acuerdo con los resultados, en general los pacientes y cuidadores consideran bueno o muy bueno el servicio recibido. Si este tratamiento se ofrece en el domicilio lo habitual es que quieran seguir con esta modalidad y no volver al hospital para recibirlo. Finalmente, la posibilidad de disponer de contacto telefónico seguido de visita si es necesaria, es la preferencia de elección. Conclusiones: Los resultados de las encuestas realizadas en nuestros pacientes/familiares permiten concluir que la nutrición enteral domiciliaría dentro de un programa de atención y seguimiento a domicilio controlado desde la Unidad de Nutrición del hospital de referencia es un tratamiento muy bien aceptado tanto por pacientes como por familiares de los mismos o cuidadores

Home enteral nutrition is a treatment carried out frequently due to advantages for patients and caregivers (lower risk of nosocomial infections and better integration in socio-familiar media) but also for the health administration because of the lower economic cost and the release of hospital beds. Objetive: To investigate patients’ and caregivers’ satisfaction related to tube enteral nutrition administered at home by a Service controlled and followed by the Nutritional Support Unit from the reference hospital. Methods: One questionnaire for the patients and another for the caregivers were delivered to the patients with home enteral nutrition asking for voluntary response. Similar questionnaires were sent to hospitalized patients and their relatives or possible caregivers. Results: According to the results of the questionnaires, the majority of patients and relatives were satisfied with the service received. In the cases in which the service was offered at home, the preference was to continue there and not to return to the hospital. Finally, the possibility of telephone contact and home visits were the most important factors that influenced patient satisfaction. Conclusion: Our results let us conclude that home enteral nutrition controlled and followed up by the Nutritional Support Unit form the hospital is a treatment well accepted both by patients and relatives

[Contribution of nutritional support to fight cancer cachexia]. / Contribución del soporte nutricional a combatir la caquexia cancerosa.

To increase dietary intake and to fight anorexia several measures to treat symptoms and administer the most adequate diet according to composition, texture and flavour are proposed. However, in the anorexia-caquexia present in cancer patients not always these measures are effective. Now a day it seems more reasonable to approach this problem with different strategies directed to modulate the pathologic alterations associated. The analysis of specific nutritional support as part as the treatment of these patients from a systematic review conclude that no high methodological quality studies to analyze the impact of oral supplementation on a specific group of patients, neither the study of functional effects are done. However, an increase in the total energy intake, not maintained over the time, was observed. The effects on weight and corporal composition are variable, with small differences between groups with o without supplementation and confuse due to, mainly, the heterogeneity of the patients included in the different studies analyzed. The analysis of the effects of nutritional supplements administered by enteral feeding shown an increase in the energy intake with an increase in body weight or a lack of decrease it, and with some functional and clinical beneficial effects. Despite the results and conclusions obtained, a strong recommendation to conduct clinical trials in specific group of cancer patients with different antineoplasic treatment seems necessary. N-3 fatty acids, especially eicosapentaenoic acid may have anticachectic properties. Although further trials are necessary the limited results available suggests that nutritional supplements enriched with EPA may reverse cachexia in cancer patients.

[Use of ready-to-use (RTU) products in home-based parenteral nutrition]. / Empleo de productos listos para su uso (ready to use: RTU) en nutrición parenteral domiciliaria.

AIMS: To analyze the real possibility to use ready-to-use multichamber bags for total parenteral nutrition in adult patients on home parenteral nutrition. METHODS: In June 2005 we studied the adult patients on home parenteral nutrition treatment controlled by the Nutritional Support Unit from an University Hospital. Demographic data, data relating to underlying disease state; infusion regimen and the necessity to modify it; body mass index, fat free mass index, and Karnofsky index evolution, and complications related to parenteral nutrition were assessed. RESULTS: At the time of the study, 8 patients aged 48,9 +/- 17,7 years, were on home parenteral nutrition. The artificial nutrition treatment was administered due to short-bowel syndrome (2); motility disorders (2); suboclusion (2); rapid intestinal transit (1), and malabsorption syndrome (1). With the exception of the patient who started more recently the treatment, all the others needed changes in the parenteral nutrition treatment (number of days for week, or formula modification). In general, both the body mass index and the fat free mass index increased during the treatment. The Karnofsky index was maintained or increased. In relation to catheter-related infection, 4 episodes were observed (0.85/1.000 d of HPN). CONCLUSIONS: Due to the effectiveness, safety and the diversity of multichamber bags available for parenteral nutrition, and the few complications observed in the patients studied, although more studied are necessary, our results suggest that we can use this commercial bags for adult patients on home parenteral nutrition.

Empleo de productos listos para su uso (ready to use: RTU) en nutrición parenteral domiciliaria / Use of ready-to-use (rtu) products in home-based parenteral nutrition

OBJETIVO: El objetivo del presente estudio ha sido analizar las posibilidades reales de utilizar productos de nutrición parenteral listos para su uso (Ready To Use: RTU) en pacientes adultos con Nutrición Parenteral Domiciliaria. ÁMBITO Y SUJETOS: Se ha procedido al análisis de los pacientes que en el momento del estudio se encontraban en activo en el programa de Nutrición Parenteral Domiciliaria dependiente de una Unidad de Nutrición y Dietética de un Hospital Universitario de tercer nivel. INTERVENCIONES: Descripción básica del cuadro clínico que en cada caso ha motivado el tratamiento con Nutrición Parenteral Domiciliaria; necesidad de cambios en las fórmulas y/o las pautas de nutrición; evolución del peso, de la composición corporal (medida por impedancia bioeléctrica) y del Índice de Karnofsky y evaluación de las complicaciones atribuibles a la Nutrición Parenteral. RESULTADOS: Se han analizado 8 pacientes, 4 varones y 4 hembras de 48,9 ± 17,7 años de edad. El tratamiento con NPD se instauró por: Síndrome de Intestino Corto (2 casos); Íleo Adinámico (2 casos); Cuadro Suboclusivo (2 casos), Tránsito Intestinal Rápido post-gastrectomía y Síndrome de Mala absorción (1 caso en cada uno de ellos).Si bien en un caso, el iniciado más recientemente, no hubo ningún cambio en el tratamiento nutricional, en 3 casos se requirieron cambios en el tratamiento en dos ocasiones; en 2 casos, los cambios fueron en tres ocasiones y en 1 caso en 4 y 5 ocasiones, respectivamente. Excepto en un caso, el peso experimentó una evolución positiva. El índice de masa libre de masa, o se mantuvo o evolucionó positivamente, incluso en el caso sin incremento de peso. El Índice de Karnofsky o se mantuvo estable o experimentó un incremento positivo. En relación a las complicaciones atribuidas a la NP destacaremos 4 episodios de infección relacionada con el catéter lo que representa 0,85 episodios/1.000 días de NP. CONCLUSIONES: Por la diversidad de fórmulas existentes y por las escasas complicaciones presentadas, nuestra casuística pone de manifiesto la posibilidad de usar Productos Listos para su Uso en pacientes con Nutrición Parenteral Domiciliaria (AU)

AIMS: To analyze the real possibility to use ready-touse multichamber bags for total parenteral nutrition in adult patients on home parenteral nutrition. METHODS: In June 2005 we studied the adult patients on home parenteral nutrition treatment controlled by the Nutritional Support Unit from an University Hospital. Demographic data, data relating to underlying disease state; infusion regimen and the necessity to modify it; body mass index, fat free mass index, and Karnofsky index evolution, and complications related to parenteral nutrition were assessed. RESULTS: At the time of the study, 8 patients aged 48,9 ± 17,7 years, were on home parenteral nutrition. The artificial nutrition treatment was administered due to short-bowel syndrome (2); motility disorders (2); suboclusion (2); rapid intestinal transit (1), and malabsorption syndrome (1). With the exception of the patient who started more recently the treatment, all the others needed changes in the parenteral nutrition treatment (number of days for week, or formula modification). In general, both the body mass index and the fat free mass index increased during the treatment. The Karnofsky index was maintained o increased. In relation to catheter-related infection, 4 episodes were observed (0.85/1.000 d of HPN). CONCLUSIONS: Due to the effectiveness, safety and the diversity of multichamber bags available for parenteral nutrition, and the few complications observed in the patients studied, although more studied are necessary, our results suggest that we can use this commercial bags for adult patients on home parenteral nutrition (AU)