[Quality control an assessment system. Its location within a program for food, nutrition and metabolic intervention]. / Sistema de control y aseguramiento de la calidad. Su lugar dentro de un programa de intervención alimentaria, nutrimental y metabólica.

A design proposal for a HQCAS Hospital Quality Control and Assessment System of the nutritional and feeding care processes conducted in a hospital environment is presented in this article. The design proposal is accompanied of the results of inspections conducted by the hospital NST Nutritional Support Group between 2005-2010. The system design includes quality policies that should rule the useful and safe conduction of such processes, the recording and documentary foundations of the System, and the quality control and assessment exercises for the continuous verification of such established policies. The current state of the conduction of these processes was documented from secondary records opened by the NST after satisfying consultation requests from the medical care teams of the institution. Inspections conducted by the NST revealed that less than half of clinical charts contained information minimally enough for elaborating nutritional judgments, almost one-fifth of the assisted patients were on Nils Per Oris, for whom no nutritional support schemes were prescribed, and a low prescription and usage of artificial nutrition schemes. Corrective measures adopted by the NST served to significantly increase the rates of successful completion of inspected processes. Quality assurance of feeding and nutritional care processes is a practical as well as an intellectual activity subjected to constant remodeling, in order to always warrant the fulfillment of quality policies advanced by the NST, and thus, that the patient benefits from the prescribed nutritional intervention strategy.

Nutrición Hospitalaria, una herramienta más, aunque importante, en la divulgación del conocimiento en las ciencias de la nutrición / Hospital Nutrition, another important tool for the divulgation of the knowledge on nutrition sciences

No disponible

Sistema de control y aseguramiento de la calidad. Su lugar dentro de un programa de intervención alimentaria, nutrimental y metabólica / Quality control an assessment system. Its location within a program for food, nutrition and metabolic intervention

En este artículo se presenta una propuesta de diseño de un SHACCAL Sistema hospitalario de Control y Aseguramiento de la calidad de los procesos de cuidados alimentarios y nutricionales conducidos en un entorno hospitalario. La propuesta de diseño se acompaña de los resultados de inspecciones conducidas por el GAN Grupo hospitalario de Apoyo Nutricional entre 2005-2010. El diseño del Sistema incluye las políticas de calidad que deben regir la conducción útil y segura de tales procesos, la base documental y registral del mismo, y los ejercicios de control y aseguramiento de la calidad para la verificación continua en el tiempo de las políticas establecidas. El estado corriente de la conducción de los procesos se documentó de los registros secundarios del GAN abiertos en ocasión de la satisfacción de pedidos de interconsulta de los grupos básicos de trabajo de la institución. Las inspecciones conducidas por el GAN revelaron que menos de la mitad de las historias clínicas contenían información mínimamente suficiente para la elaboración de juicios nutricionales, la vía oral estaba suspendida en cerca de la quinta parte de los enfermos atendidos, sin ninguna estrategia prescrita de apoyo nutricional, y una baja tasa de prescripción y uso de los esquemas de Nutrición artificial. Las acciones correctivas adoptadas por el GAN sirvieron para incrementar significativamente las tasas de completamiento exitoso de los procesos inspeccionados. El aseguramiento de la calidad de los procesos de cuidados alimentarios y nutricionales es una actividad práctica e intelectual objeto de constante remodelación, a fin de garantizar siempre el cumplimiento de las políticas de calidad avanzadas por el GAN, y con ello, que el paciente se beneficie de la estrategia de intervención nutricional prescrita (AU)

A design proposal for a HQCAS Hospital Quality Control and Assessment System of the nutritional and feeding care processes conducted in a hospital environment is presented in this article. The design proposal is accompanied of the results of inspections conducted by the hospital NST Nutritional Support Group between 2005-2010. The system design includes quality policies that should rule the useful and safe conduction of such processes, the recording and documentary foundations of the System, and the quality control and assessment exercises for the continuous verification of such established policies. The current state of the conduction of these processes was documented from secondary records opened by the NST after satisfying consultation requests from the medical care teams of the institution. Inspections conducted by the NST revealed that less than half of clinical charts contained information minimally enough for elaborating nutritional judgments, almost one-fifth of the assisted patients were on Nils Per Oris, for whom no nutritional support schemes were prescribed, and a low prescription and usage of artificial nutrition schemes. Corrective measures adopted by the NST served to significantly increase the rates of successful completion of inspected processes. Quality assurance of feeding and nutritional care processes is a practical as well as an intellectual activity subjected to constant remodeling, in order to always warrant the fulfillment of quality policies advanced by the NST, and thus, that the patient benefits from the prescribed nutritional intervention strategy (AU)

[Metabolic bone disease in liver cirrhosis: the influence of nutritional status]. / La enfermedad metabólica ósea en la cirrosis hepática: la influencia del estado nutricional.

INTRODUCTION: Relationship between metabolic bone disease (MBD) and liver cirrhosis (LC) might be modeled by the patient's nutritional status. OBJECTIVE: To assess if malnourished cirrhotic patients might exhibit higher MBD rates. METHODS: Bone mineral density (BMD) in 50 cirrhotic patients attended at the Gastroenterology Service, "Hermanos Ameijeiras" Hospital, La Habana, Cuba, was measured at the left femur neck and lumbar column with a double-beam X-ray densitometer. Seventy percent of patients were male; 54% were older than 50 year-old and 72% were white. Cause of LC was viral in 56% of patients, 62% were classified as Child A and 42% were considered as malnourished. MBD was established when "t" score <-1.0 s. LC-related MBD was compared with that previously observed in apparently healthy subjects. RESULTS: Mean BMD in examined anatomical sites was 0.957 ± 0.149 g/cm2 in left femur neck and 0.953 ± 0.130 g/cm2 in lumbar spine, respectively. According to these measurements, MBD was diagnosed in 50% and 52% for both sites, respectively. BMD rates in cirrhotic patients were similar to those observed in healthy subjects after DEXA examination of lumbar spine. MBD was more frequent between Child C and malnourished cirrhotic patients. CONCLUSIONS: LC did not result in an increased MBD rate, however this problem presents more frequently in terminally ill and malnourished patients.

[CeliacScore 2.0: Up to date of the Score System for the Diagnosis of Celiac Disease: association with DQß1*02 and DQß1*0302 alleles]. / CeliacScore 2.0: Actualización del Sistema de Puntaje para el Diagnóstico de la Enfermedad Celíaca: asociación con los alelos DQ?1*02 y DQ?1*0302.

INTRODUCTION: Celiac disease (CD) diagnosis can be improved if a scoring system comprising clinical, nutritional, serological and histopathological elements is applied. DQß1*02 and/ or DQß1*0302 alleles can be expected to be more frequent among subjects with the highest scores. OBJECTIVES: To assess the relationship between score assigned to the patient by means of the system developed and alleles associated with CD. METHODS: Scores were assigned to 69 patients (Women: 68.1%; Ages ≤ 60 years: 95.7%) assisted by a multidisciplinary group for management of CD, using an updated version of a previously described score system (CeliacScore 2.0) were correlated with the occurrence of DQß1*02 and/or DQß1*0302 alleles. CD was diagnosed if the assigned score was ≥ 10. RESULTS: 17.4% of studied patients were diagnosed as CD. DQß1*02 and/or DQß1*0302 alleles were present in 56.5% of our cases. Scores assigned to patient's were independent of the presence of alleles of interest (c² = 2.3; p > 0.319). 75.0% of subjects with a score higher than 10 had the alleles of interest. The probability for the presence of DQß1*02 and/or DQß1*0302 alleles was 2.7 in patients with scores ≥ 10. CONCLUSIONS: The described system can be useful in the CD diagnosis. Alleles associated with CD concentrated among those with the highest scores. Scoring system's operating characteristics should be explored in further studies.

Influencia de una combinación de lactobacilos + bifidobacterias sobre la actividad de la enfermedad, el hábito defecatorio y el estado nutricional de pacientes con colitis ulcerosa / Influence of a combination of lactobacilli and bifidobacteria upon disease activity, stool pattern and nutritional status of ulcerative colitis patients

Se condujo un ensayo clínico quasi-experimental para evaluar la tolerancia, seguridad y utilidad de una combinación de 4 lactobacilos + 1 bifidobacteria añadida a la medicación regular de pacientes de CU Colitis ulcerosa con daño mucosal variable. La efectividad del tratamiento con probióticos se estimó de cambios en el hábito defecatorio del enfermo, la composición corporal, e indicadores bioquímicos selectos de la actividad de la enfermedad, y el estado nutricional. Cincuenta enfermos ingresaron consecutivamente en el ensayo entre Diciembre del 2005-Junio del 2009 (Grupo Control: 29; Grupo Tratamiento: 21). Veinte de ellos completaron el tratamiento con probióticos. La efectividad de la medicación regular se registró con 24 pacientes controles. Se acumularon 36 días de tratamiento con la combinación de probióticos por paciente. La tasa de obediencia del tratamiento fue del 99.3%. Se perdieron 5 días de tratamiento por no disponibilidad del producto. No se reportaron reacciones adversas al uso de la combinación empleada de probióticos. Se registraron 2 fallecidos durante la conducción del estudio, uno en cada grupo. Se comprobó mejoría de la calidad [RR Riesgo relativo: 1,69; 95% IC: 0,87-3,27]; la frecuencia [RR: 1,35; 95% IC: 0,15-11,90]; y el volumen [RR: 1,11; 95% IC: 0,16-7,63] de las deposiciones en los pacientes tratados, si bien la variabilidad biológica observada impidió que estas tendencias alcanzaran fuerza estadística. El tratamiento con probióticos también resultó en una reducción de la ocurrencia de deposiciones nocturnas [RR: 1,75; 95% IC: 0,53-5,73]. El tratamiento con probióticos previno la aparición de cambios no deseados en el hábito defecatorio de los enfermos tratados que se presentaron libres de síntomas, pero el efecto observado no fue superior al de los medicamentos empleados. Los probióticos usados no influyeron sobre la enterorragia. El uso de la combinación de probióticos también resultó en una disminución de la actividad de la enfermedad y la ESR Eritrosedimentación, respectivamente [Cambio en el Índice de Actividad Clínica: Grupo Control: -1,1 ± 3,2 vs Grupo Tratamiento: -4,1 ± 3,3; p < 0,05; Cambio en la ESR: Grupo Control: 3,6 ± 16,4 vs Grupo Tratamiento: -6,7 ± 15,6; p < 0,05]. El tratamiento adyuvante con probióticos resultó en un aumento del peso corporal, a expensas de un incremento de la CB Circunferencia del brazo y la suma de los pliegues cutáneos. Este efecto sobre el peso corporal no fue atribuible a un incremento sustancial de los ingresos dietéticos del enfermo tratado. A pesar de la heterogeneidad clínica asociada al daño mucosal en la CU, el tratamiento con probióticos puede traer efectos beneficiosos sobre el hábito defecatorio del paciente, la composición corporal, e indicadores bioquímicos selectos de actividad de la enfermedad. La invarianza degrupo-a-grupo de los ingresos dietéticos pudiera implicar que los cambios observados en las variables de respuesta no fueron el resultado de un efecto placebo de la combinación empleada de probióticos (AU)

A quasi-experimental clinical assay was carried out to assess the tolerance, safety and usefulness of a 4 lactobacili + 1 bifidobacterium combination as adjuvant to the pharmacological treatment of UC Ulcerative colitis patients differing in mucosal change. The effectiveness of the probiotic treatment was assessed from changes in patient´s stool pattern, body composition, and selected biochemical indicators of disease activity and nutritional status. Fifty patients entered consecutively in the trial between December 2005-June 2009 (Control Group: 29; Treatment Group: 21). Twenty of them completed treatment with probiotics. Effectiveness of regular pharmacological treatment was recorded with 24 control patients. Thirty-six days of probiotic treatment per patient were accumulated. Probiotic treatment obedience rate was 99.3%. Five days of treatment were lost due to non-availability of the product. No adverse reactions were reported after probiotic treatment. Two deaths were recorded after completion of the study, one on each group. Improvement in the quality of the stools [RR Relative risk: 1.69; 95% IC: 0.87-3.27]; frequency [RR: 1.35; 95% IC: 0.15-11.90]; and volume [RR: 1.11; 95% IC: 0.16-7.63] was observed in treated patients, although biological variability prevented these trends to become statistically significant. Probiotic treatment also resulted in reduction of occurrence of nocturnal depositions [RR: 1.75; 95% IC: 0.53-5.73]. Probiotic treatment prevented the onset of undesirable changes in stool pattern of treated patients who presented free of symptoms, but observed effect was no superior to that of medication administered. Probiotic treatment did not influence upon presence of blood in stools. Probiotic treatment also resulted in reduction of disease activity and ESR Erythro-sedimentation rate, respectively [Change in the Clinical Activity Index: Control Group: -1.1 ± 3.2 vs. Treatment Group: -4.1 ± 3.3; p < 0.05; Change in ESR: Control Group: 3.6 ± 16.4 vs. Treatment Group: -6.7 ± 15.6; p < 0.05]. Adjuvant probiotic treatment resulted in increase of body weight, at the expenses of increase of MAMC Mid-arm Muscle Circumference and sum of skinfolds. Probiotic effect upon body weight was not attributed to increased food intakes in treated patients. In spite of clinical heterogeneity associated to mucosal damage in UC, probiotic treatment might result in beneficial effects upon patient´s stool pattern, body composition, and selected biochemical indicators of disease activity. Invariance of food intakes could imply that observed changes in response variables were not the result of a placebo effect of used probiotic combination (AU)

[Influence of a combination of lactobacilli and bifidobacteria upon disease activity, stool pattern and nutritional status of ulcerative colitis patients]. / Influencia de una combinación de lactobacilos + bifidobacterias sobre la actividad de la enfermedad, el hábito defecatorio y el estado nutricional de pacientes con colitis ulcerosa.

UNLABELLED: A quasi-experimental clinical assay was carried out to assess the tolerance, safety and usefulness of a 4 lactobacili + 1 bifidobacterium combination as adjuvant to the pharmacological treatment of UC Ulcerative colitis patients differing in mucosal change. The effectiveness of the probiotic treatment was assessed from changes in patient's stool pattern, body composition, and selected biochemical indicators of disease activity and nutritional status. Fifty patients entered consecutively in the trial between December 2005-June 2009 (CONTROL GROUP: 29; Treatment Group: 21). Twenty of them completed treatment with probiotics. Effectiveness of regular pharmacological treatment was recorded with 24 control patients. Thirty-six days of probiotic treatment per patient were accumulated. Probiotic treatment obedience rate was 99.3%. Five days of treatment were lost due to non-availability of the product. No adverse reactions were reported after probiotic treatment. Two deaths were recorded after completion of the study, one on each group. Improvement in the quality of the stools [RR Relative risk: 1.69; 95% IC: 0.87-3.27]; frequency [RR: 1.35; 95% IC: 0.15-11.90]; and volume [RR: 1.11; 95% IC: 0.16-7.63] was observed in treated patients, although biological variability prevented these trends to become statistically significant. Probiotic treatment also resulted in reduction of occurrence of nocturnal depositions [RR: 1.75; 95% IC: 0.53-5.73]. Probiotic treatment prevented the onset of undesirable changes in stool pattern of treated patients who presented free of symptoms, but observed effect was no superior to that of medication administered. Probiotic treatment did not influence upon presence of blood in stools. Probiotic treatment also resulted in reduction of disease activity and ESR Erythro-sedimentation rate, respectively [Change in the Clinical Activity Index: CONTROL GROUP: -1.1 ± 3.2 vs. Treatment Group: -4.1 ± 3.3; p < 0.05; Change in ESR: CONTROL GROUP: 3.6 ± 16.4 vs. Treatment Group: -6.7 ± 15.6; p < 0.05]. Adjuvant probiotic treatment resulted in increase of body weight, at the expenses of increase of MAMC Mid-arm Muscle Circumference and sum of skinfolds. Probiotic effect upon body weight was not attributed to increased food intakes in treated patients. In spite of clinical heterogeneity associated to mucosal damage in UC, probiotic treatment might result in beneficial effects upon patient's stool pattern, body composition, and selected biochemical indicators of disease activity. Invariance of food intakes could imply that observed changes in response variables were not the result of a placebo effect of used probiotic combination.

Influencia del estado nutricional en los resultados de la cirugía revascularizadora del sector aortoilíaco / Influence of nutritional state on the results of aortoiliac revascularisation

Justificación. La influencia del estado nutricional preoperatorio en la aparición de complicaciones después de cirugía revascularizadora del sector aortoilíaco fue evaluada de los resultados observados en 51 pacientes (hombres: 78,0%; mayores de 60 años: 62,7%) atendidos consecutivamente en el Hospital Clínico quirúrgico Hermanos Ameijeiras (La Habana, Cuba), entre enero de 2006 y julio de 2008 por aneurisma de la aorta abdominal infrarrenal (el 54,9% del tamaño de la serie) o enfermedad estenooclusiva aortoilíaca IIb-III. Material y método. Se registraron las complicaciones observadas en el postoperatorio, la condición al alta (vivo/fallecido) y la estancia hospitalaria. El estado nutricional se determinó de la integración de los valores del índice de masa corporal (IMC) y la circunferencia del brazo (CB). El paciente se asignó a cualquiera de 3 fenotipos nutricionales: desnutrido, no desnutrido, exceso de peso. Resultados. La tasa de complicaciones posquirúrgicas fue del 60,8%. No se describieron fallecidos en la serie de estudio. El 52,9% de los pacientes estudiados acumuló más de 10 días de estancia hospitalaria. La edad fue un predictor independiente del riesgo de desarrollo de complicaciones posquirúrgicas (≤ 60 años: 42,1% frente a > 60 años: 71,8%; p < 0,05)(AU)

El exceso de peso se presentó en el 56,9% de los pacientes. La relación entre el riesgo de desarrollo de complicaciones postoperatorias y el estado nutricional estuvo mediatizada por la edad. Para los enfermos con edades ≤ 60 años, la tasa de complicaciones fue mayor entre los que presentaron un IMC ≥ 25,0. Para los pacientes mayores de 60 años, las complicaciones fueron frecuentes entre aquellos con IMC entre 18,5-24,9. Conclusiones. La asociación entre el riesgo de desarrollo de complicaciones después de cirugía de revascularización del territorio aortoilíaco y el estado nutricional puede estar mediatizada por la edad del paciente. En los mayores de 60 años, el exceso de peso podría asociarse con una tasa menor de complicaciones posquirúrgicas(AU)

Rationale. The influence of preoperative nutritional status on the onset of complications after aortoiliac vascular surgery was assessed from results observed in 51 patients [Men: 78.0%; Older than 60 years: 62.7%] consecutively treated at the Hermanos Ameijeiras Clinical Surgical Hospital (Havana City, Cuba), between January 2006-July 2008 due to infrarenal abdominal aortic aneurysm [54.9% of series size], or IIb-III aortoiliac steno-occlusive disease. Complications observed during the post-operative period, length of stay, and condition upon discharge (Alive/Deceased) were recorded. Nutritional status was determined from Body Mass Index (BMI) and Mid-arm Circumference (MAC). Material and method. Patients were assigned to any of three nutritional phenotypes: Malnourished, Non-Malnourished, Body weight excess. Results. The post-operative complications rate was 60.8%. No deaths occurred during the study observation window. More than half (52.9%) of the patients studied had a hospital stay longer than 10 days. Age was an independent predictor of risk of development of post-surgical complications [≤ 60 years: 42.1% vs. > 60 years: 71.8%; p < 0.05]. Body weight excess was present in 56.9% of patients. Association between risk of developing post-surgical complications and nutritional status was mediated by age. For patients aged ≤ 60 years, the complications rate was higher among those with a BMI ≥ 25.0. For those older than 60 years, complications were frequent among those with a BMI between 18.5-24.9. Conclusions. Association between risk of development of complications after aorto-iliac vascular surgery and nutritional status might be mediated by patient age. Body weight excess could be associated with a lower post-surgical complications rate for those patients older than 60 years(AU)

[Hospital system for Continuous Education in Food And Nutrition: its place within a nutritional, food and metabolic intervention program]. / Sistema de Educación Continuada en Nutrición Clínica, Nutrición Artificial y Apoyo Nutricional; su lugar dentro de un Programa de Intervención Alimentaria, Nutricional y Metabólica.

A design proposal for a HCEFN Hospital Continuous Education in Feeding and Nutrition, along with the educational intervention model developed and conducted at the "Hermanos Ameijieras" Hospital (Havana City, Cuba), and some of the results obtained after its implementation between 1997-2004, are presented in this article. The System design should include three levels of different and increasing complexity, depending on the level of knowledge, capabilities and aptitudes exhibited by hospital actors. The described system should also accommodate inter- and intra-disciplinary forms of education, learning and training aimed not only to increase the proficiency of actors in the recognition and treatment of hospital malnutrition, but also to foster group performance. The operation of a HCEFN at the hospital of the authors's affiliation has showed the feasibility of conducting such educational interventions oriented to foster Good Practices for Feeding and Nutrition of the hospitalized patients.

[Malnutrition in adults with gastrointestinal disorders: a new reservoir of celiac disease?]. / La desnutrición en adultos con trastornos gastrointestinales: ¿un nuevo reservorio de la enfermedad celíaca?

INTRODUCTION AND OBJECTIVES: To present the diagnostic process of CD Celiac disease among adults showing variable signs of nutritional derangements assisted at two tertiary-level health care institutions in Havana City (Cuba) between 2004 - 2007 for non-exhaustively characterized gastrointestinal disorders. MATERIAL AND METHOD: Clinical, serological, histo-pathological and nutritional findings were integrated into an ad hoc created scoring system. Weight gain was monitored during the study observation window. RESULTS: Twenty-eight presumptive celiac patients were identified among those assisted. CD diagnosis was as follows: Confirmed: 17.9% (Score: 9.2 +/- 0.4); Highly likely: 60.7% (Score: 6.6 +/- 1.1); Non-conclusive: 32.1% (Score: 4.7 +/- 0.5); respectively. Ninety-two point eight percent of subjects were malnourished at the moment of the first interview. Total intestinal villi atrophy was observed in less than one-third of the identified celiac patients. Tittering of antibodies associated with CD was as follows: Anti-gliadin: Completed: 25; Positive: 72.0%; Anti-transglutaminase: Completed: 11; Positive: 54.5%. Nutritional replenishment actions comprised: Diet gluten withdrawal (100.0%); Vitamins and minerals prescription (92.9%); supplementary Enteral Nutrition (57.2%); and Parenteral Nutrition (21.4%). Weight gain was of 400 grams in 80.8% of CD patients after 33.7 days of follow- up; and of 700 grams in 13 of them after 321 days. The scoring system presented in this study could be useful for diagnosis and treatment of CD: a condition that keeps baffling physicians and nutritionists alike.

Sistema de Educación Continuada en Nutrición Clínica, Nutrición Artificial y Apoyo Nutricional; su lugar dentro de un Programa de Intervención Alimentaria, Nutricional y Metabólica / Hospital system for continuous education in food and nutrition its place within a nutritional. Food and metabolic intervention program

En este artículo se presenta una propuesta de diseño de un SHECAN Sistema hospitalario de Educación continuada en Alimentación y Nutrición, junto con el modelo de intervención desarrollado y conducido en el Hospital Clínico quirúrgico "Hermanos Ameijeiras" (La Habana, Cuba), y algunos de los resultados observados entre 1997-2004. El diseño del Sistema debe contemplar tres niveles de complejidad, en dependencia de los conocimientos, habilidades y capacidades exhibidos por los actores hospitalarios. El sistema también debe acomodar formas intra- e interdisciplinarias de educación, aprendizaje y capacitación orientadas tanto a incrementar la suficiencia de los actores en el reconocimiento y tratamiento de la desnutrición hospitalaria, como fomentar la actuación grupal. La operación de un SHECAN en el hospital de pertenencia de los autores ha demostrado la factibilidad de la conducción de tales intervenciones educativas en aras de implementar las Buenas Prácticas de Alimentación y Nutrición del paciente hospitalizado (AU)

A design proposal for a HCEFN Hospital Continuous Education in Feeding and Nutrition, along with the educational intervention model developed and conducted at the "Hermanos Ameijieras" Hospital (Havana City, Cuba), and some of the results obtained after its implementation between 1997-2004, are presented in this article. The System design should include three levels of different and increasing complexity, depending on the level of knowledge, capabilities and aptitudes exhibited by hospital actors. The described system should also accommodate inter- and intra-disciplinary forms of education, learning and training aimed not only to increase the proficiency of actors in the recognition and treatment of hospital malnutrition, but also to foster group performance. The operation of a HCEFN at the hospital of the authors's affiliation has showed the feasibility of conducting such educational interventions oriented to foster Good Practices for Feeding and Nutrition of the hospitalized patients (AU)

La desnutrición en adultos con trastornos gastrointestinales: ¿un nuevo reservorio de la enfermedad celíaca

Objetivo: Presentar el proceso de diagnóstico de la enfermedad celíca (EC) entre adultos con deterioro nutricional atendidos en 2 instituciones de La Habana (Cuba) por trastornos gastrointestinales, destacando un sistema de puntaje basados en los resultados de los diferentes procedimientos diagnóstico. Material y Métodos: Se integraron los hallazgos clínicos, serológicos, histopatógicos y nutricionales de cada enfermo en un sistema de puntaje creado para este estudio. Se monitoreó la ganancia de peso durante la ventana de observación del estudio. Resulatdos: Se identificaron 28 presuntos celíacos de entre los pacientes atendidos. El diagnóstico de EC fue como sigue: confirmado en 17,9 por ciento (puntaje 9,2 ± 0,4), altamente probable en 60,7 por ciento (puntaje: 6.6±1.1) y no concluyente en 32.1 por ciento (puntaje 4.7±0.5). El 98.2 por ciento de los sujetos estaba desnutrido al momento de la primera entrevista. En menos de la tercera parte de los celíacos identificados se observó una atrofia de vellosidades. Se detectaron anticuerpos anti-gliadina en 25 pacientes (positivos 72.0 por ciento) y anticuerpos anti-transglutaminasa tisular en 11 (54,5 por ciento). Las acciones intervencionistas comprendieron retirada del gluten dietético (100 por ciento), aportes de vitaminas y minerales (92,9 por ciento), nutrición enteral complementaria (57,2 por ciento) y nutrición parenteral (21,4 por ciento). Se observó una ganancia de 400 g de peso a los 33,7 dias de seguimiento en 80,8 por ciento de los sujetos de la serie y de 700 g a los 321 dias en 13 de ellos. Conclusiones: El sistema de puntaje presentado en este estudio pudiera ser útil en el diagóstico y tratamiento de la EC: condición que sigue que sigue derconcertando a médicos y nutricionistas por igual(AU)

Sistema de Educación Continuada en Nutrición Clínica, Nutrición Artificial y Apoyo Nutricional; su lugar dentro de un Programa de Intervención Alimentaria, Nutricional y Metabólica / Hospital System for Continuous Education in Food and Nutrition. Its place within a Nutritional, Food and Metabolic Intervention Program

En este artículo se presenta una propuesta de diseño de un SHECAN Sistema hospitalario de Educación continuada en Alimentación y Nutrición, junto con el modelo de intervención desarrollado y conducido en el Hospital Clínico quirúrgico Hermanos Ameijeiras (La Habana, Cuba), y algunos de los resultados observados entre 1997-2004. El diseño del Sistema debe contemplar tres niveles de complejidad, en dependencia de los conocimientos, habilidades y capacidades exhibidos por los actores hospitalarios. El sistema también debe acomodar formas intra- e interdisciplinarias de educación, aprendizaje y capacitación orientadas tanto a incrementar la suficiencia de los actores en el reconocimiento y tratamiento de la desnutrición hospitalaria, como fomentar la actuación grupal. La operación de un SHECAN en el hospital de pertenencia de los autores ha demostrado la factibilidad de la conducción de tales intervenciones educativas en aras de implementar las Buenas Prácticas de Alimentación y Nutrición del paciente hospitalizado(AU)

Estado de la provisión de cuidados nutricionales al paciente quemado. Auditoría de procesos en un Servicio de Quemados de un hospital terciario / Current status of nutritional care provision to burnt patients. Processes audit of a burnt patients department from a tertiary hospital

Justificación: La respuesta al tratamiento médico-quirúrgico del paciente quemado pudiera depender tanto de los estragos provocados por la agresión térmica, a saber las demandas metabólicas incrementadas, la aparición del Síndrome de Respuesta Inflamatoria Sistémica, y las infecciones microbianas; como de las prácticas culturales incluidas dentro de los procesos institucionales de cuidados nutricionales. Objetivo: Evaluar cómo la conducción de los procesos nutricionales de evaluación e intervención influye sobre los indicadores de la efectividad terapéutica de los Servicios de Quemados. Serie de estudio: Cuarenta y dos pacientes atendidos con una superficie corporal quemada (SCQ) > 10 por ciento, entre enero del 2001-diciembre del 2003, en el Servicio de Quemados del Hospital Clínico Quirúrgico Hermanos Ameijeiras (Ciudad La Habana, Cuba). Métodos: Los procesos nutricionales de evaluación e intervención conducidos en el paciente quemado se auditaron mediante revisión de las historias clínicas. Los procesos auditados se declararon como Completados (o no). El grado de completamiento del proceso se relacionó con las tasas de complicaciones y mortalidad, y el índice de hospitalización predicho de la SCQ. Resultados: Los procesos nutricionales de evaluación e intervención se completaron en el 49,4 por ciento y 22,6por ciento de las historias auditadas, respectivamente. El registro evolutivo del peso corporal se asoció con una menor mortalidad. La evaluación nutricional temprana y un aporte energético suficiente en lesionados con SCQ > 20 por ciento se asociaron con menores tasas de complicaciones y un mejor cumplimiento del índice de hospitalización. Conclusiones: Este trabajo constituye la primera aproximación al comportamiento del Servicio de Quemados de la institución, como antesala del diseño e implementación de un programa de mejoría continua de la calidad en la atención médica......(AU)

Rationale: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal agression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. Goal: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. Study serie: Forty-two patients with a Burn Body Surface Area (BBSA) > 10 percent assisted at the Burn Service of the Hermanos Ameijeiras Clinical Surgical Hospital (La Habana, Cuba), between January 2001-December 2003. Methods: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. Results: Nutritional care processes of assessment and intervention were completed in 49.4 percent and 22.6 percent of the audited charts, respectively. Prospective recording of patient's body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA > 20percent were associated with lower complications rates and better compliance with BBSA-predicted length of stay. Conclusions: This work is the first enquiry into the behaviour of the institution's Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service's effectiveness indicators(AU)

Estado de la provisión de cuidados nutricionales al paciente quemado. Auditoría de procesos en un Servicio de Quemados de un hospital terciario / Current status of nutritional care provision to burnt patients. Processes audit of a burnt patients department from a tertiary hospital

Justificación: La respuesta al tratamiento médico-quirúrgico del paciente quemado pudiera depender tanto delos estragos provocados por la agresión térmica, a saberlas demandas metabólicas incrementadas, la aparición del Síndrome de Respuesta Inflamatoria Sistémica, y las infecciones microbianas; como de las prácticas culturales incluidas dentro de los procesos institucionales de cuidados nutricionales. Objetivo: Evaluar cómo la conducción de los procesos nutricionales de evaluación e intervención influye sóbre los indicadores de la efectividad terapéutica de los Servicios de Quemados. Serie de estudio: Cuarenta y dos pacientes atendidos con una superficie corporal quemada (SCQ) > 10%, entre enero del 2001-diciembre del 2003, en el Servicio de Quemados del Hospital Clínico Quirúrgico “Hermanos Ameijeiras” (Ciudad La Habana, Cuba).Métodos: Los procesos nutricionales de evaluación e intervención conducidos en el paciente quemado se auditaron mediante revisión de las historias clínicas. Los procesos auditados se declararon como Completados (o no). El grado de completamiento del proceso se relacionó con las tasas de complicaciones y mortalidad, y el índice de hospitalización predicho de la SCQ. Resultados: Los procesos nutricionales de evaluación e intervención se completaron en el 49,4% y 22,6% de las historias auditadas, respectivamente. El registro evolutivo del peso corporal se asoció con una menor mortalidad. La evaluación nutricional temprana y un aporte energético suficiente en lesionados con SCQ > 20% se asociaron con menores tasas de complicaciones y un mejor cumplimiento del índice de hospitalización Conclusiones: Este trabajo constituye la primera aproximación al comportamiento del Servicio de Quemados de la institución, como antesala del diseño e implementación de un programa de mejoría continua de la calidad en la atención médica. Se pudo comprobar que, a pesar del estado actual de completamiento de los procesos nutricionales, la observancia de los mismos puede influir favorablemente sobre los indicadores de efectividad del Servicio

Rationale: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal agression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. Goal: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. Study serie: Forty-two patients with a Burn Body Surface Area (BBSA) > 10% assisted at the Burn Service of the “Hermanos Ameijeiras” Clinical Surgical Hospital(La Habana, Cuba), between January 2001-December2003.Methods: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. Results: Nutritional care processes of assessment and intervention were completed in 49.4% and 22.6% of the audited charts, respectively. Prospective recording of patient’s body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA > 20% were associated with lower complications rates and better compliance with BBSA-predicted length of stay. Conclusions: This work is the first enquiry into the behaviour of the institution’s Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service’s effectiveness indicators

Comentario al artículo: Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is Subjective Global Assessment of Nutricional Status? JPEN Journal of Parenteral and Enteral Nutrition. 1987; 11(1):8-13 / No disponible

No disponible

[Current status of nutritional care provision to burnt patients: processes audit of a burnt patients department from a tertiary hospital]. / Estado de la provisión de cuidados nutricionales al paciente quemado: Auditoría de procesos en un Servicio de Quemados de un hospital terciario.

RATIONALE: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal aggression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. GOAL: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. STUDY SERIES: Forty-two patients with a Burn Body Surface Area (BBSA)>10% assisted at the Burn Service of the "Hermanos Ameijeiras" Clinical Surgical Hospital (La Habana, Cuba), between January 2001-December 2003. METHODS: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. RESULTS: Nutritional care processes of assessment and intervention were completed in 49.4% and 22.6% of the audited charts, respectively. Prospective recording of patient's body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA>20% were associated with lower complications rates and better compliance with BBSA-predicted length of stay. CONCLUSIONS: This work is the first enquiry into the behaviour of the institution's Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service's effectiveness indicators.