«Do Not Do¼ recommendations for retinopathies: A mixed consensus study.

PURPOSE: Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do¼ recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. MATERIALS AND METHODS: Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. RESULTS: A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's¼ occurred in a range between 0.6% and 31.4% of the cases included in the study. CONCLUSIONS: This study identified «Do Not Do¼ recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

Recomendaciones «no hacer» para retinopatías: estudio mixto de consenso / «Do Not Do» recommendations for retinopathies: A mixed consensus study

Antecedentes y objetivos Entre las principales causas de ceguera y de pérdida severa de la visión se encuentran la degeneración macular asociada a la edad, el edema macular diabético y la oclusión venosa de la retina. Las recomendaciones «no hacer» son estrategias para mejorar la calidad asistencial y optimizar los costes sanitarios. Este estudio tuvo por objetivo definir por consenso prácticas de escaso valor en las enfermedades mencionadas, además de estimar su ocurrencia. Materiales y métodos Estudio de métodos mixtos. En una primera fase se buscó el consenso de un panel multidisciplinar de expertos a través de la técnica del grupo nominal. En una segunda fase, se realizó un estudio observacional retrospectivo, mediante el cual se revisaron los registros de historias clínicas. Resultados Fueron establecidas 7 recomendaciones para degeneración macular asociada a la edad, 4 para edema macular diabético y 5 para oclusión venosa de la retina. En total, 1.012 registros de pacientes fueron revisados por los 4 hospitales participantes. La revisión de historias clínicas reveló que los «no hacer» consensuados ocurrían en un rango entre 0,6 y 31,4% de los casos incluidos en el estudio. Conclusión Este estudio identificó recomendaciones «no hacer» en estas enfermedades que ocurren con relativa frecuencia en la práctica clínica. Es necesario revisar el proceso asistencial para erradicar estas prácticas y mejorar la calidad asistencial (AU)

Background and objective Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do» recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. Materials and methods Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. Results A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's» occurred in a range between 0.6% and 31.4% of the cases included in the study. Conclusions This study identified «Do Not Do» recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved (AU)

«Do Not Do¼ recommendations for retinopathies: A mixed consensus study. / Recomendaciones «no hacer¼ para retinopatías: estudio mixto de consenso.

BACKGROUND AND OBJECTIVE: Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do¼ recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. MATERIALS AND METHODS: Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. RESULTS: A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's¼ occurred in a range between 0.6% and 31.4% of the cases included in the study. CONCLUSIONS: This study identified «Do Not Do¼ recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

Características clínicas, manejo y resultados de los pacientes con endoftalmitis estéril asociados con la inyección intravítrea de factores de crecimiento endotelial antivascular / Clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal injection of antivascular endothelial growth factor

OBJETIVO: Analizar las características clínicas, el manejo y los resultados de los pacientes con endoftalmitis estéril asociada con el factor de crecimiento endotelial antivascular intravítreo. MÉTODOS: Serie de casos de observación retrospectiva de pacientes con endoftalmitis estéril después de inyecciones intravítreas anti-VEGF. Se han revisado los datos clínicos de pacientes tratados con anti-VEGF intravítreos durante un año. Se analizan los que han presentado un episodio de endoftalmitis estéril y se estudia su causalidad y manejo. RESULTADOS: Siete pacientes tuvieron un inicio de endoftalmitis estéril en los 4días posteriores a la inyección intravítrea (aflibercept n = 5 y ranibizumab n = 2). Estos pacientes tienen alguna condición neovascular activa: degeneración macular relacionada con la edad (n = 4), neovascularización coroidea miope (n = 1) o edema macular: edema macular diabético (n = 1), oclusión de la vena retiniana ramificada (n = 1). Los signos y síntomas compartidos incluyeron pérdida de visión indolora, células en cámara anterior o vítrea y falta de hipopión. En todos los pacientes, la agudeza visual volvió a estar dentro de una línea de agudeza basal. CONCLUSIÓN: Diferenciar casos de endoftalmitis estéril de infecciosa puede ser un desafío. Es crucial diferenciar ambas entidades, ya que un buen diagnóstico determina el pronóstico visual. Debemos ser conscientes de una inflamación mínima después de repetidas inyecciones intravítreas para establecer el tratamiento adecuado

PURPOSE: Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS: Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS: Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n = 5 and ranibizumab n = 2). These patients have some active neovascular condition: age related macular degeneration (n = 4), myopic choroidal neovascularization (n = 1) or macular edema: diabetic macular edema (n = 1), branch retinal vein occlusion (n = 1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSIÓN: Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment

Clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal injection of antivascular endothelial growth factor. / Características clínicas, manejo y resultados de los pacientes con endoftalmitis estéril asociados con la inyección intravítrea de factores de crecimiento endotelial antivascular.

PURPOSE: Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS: Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS: Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n=5 and ranibizumab n=2). These patients have some active neovascular condition: age related macular degeneration (n=4), myopic choroidal neovascularization (n=1) or macular edema: diabetic macular edema (n=1), branch retinal vein occlusion (n=1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSION: Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment.

Aspectos galénicos de las soluciones de inyección submucosa para su utilización en polipectomía endoscópica / Galenic aspects of submucosal injection solutions for use in endoscopic polypectomy

La disección submucosa endoscópica submucosa (DSE) y la resección mucosa endoscópica mucosa (RME) o mucosectomía son las principales técnicas empleadas en la extirpación endoscópica de pólipos del tubo digestivo. En ambas técnicas se inyecta una solución submucosa para crear un habón debajo de la lesión que separe la mucosa de la capa muscular propia. Esto permite una mejor delimitación de la lesión y facilita su resección. En la práctica clínica, se han probado diferentes soluciones para este uso, utilizándose en la mayoría de los casos fuera de indicación en ficha técnica y sin control galénico, fisicoquímico ni microbiológico, a pesar de ser soluciones de administración parenteral. El objetivo de este trabajo es llevar a cabo una revisión de las principales soluciones utilizadas, así como de sus limitaciones y de los principales avances realizados en este ámbito

Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are the main techniques used in the removal of intestinal polyps. In both techniques a submucosal solution is injected to create a hub under the lesion that separates the mucosa from the muscular layer itself. This allows a better delimitation of the lesion and facilitates its resection. In clinical practice, many solutions have been tested for this use, being used in most cases out off-label and without galenic, physicochemical or microbiological control, despite being parenteral administration solutions. The objective of this study is to carry out a review of the main solutions used, as well as their limitations and the main advances made in this area

El ser humano, el único animal que necesita un amo para vivir / The human being, the only animal that needs a master to live

No disponible

[Analysis of ocular toxicity of fluconazole and voriconazole eyedrops using HET-CAM]. / Análisis de la toxicidad ocular de los colirios de voriconazoly fluconazol con HET-CAM.

PURPOSE: The objective of the study is to provide toxicological information through the HET-CAM test of Fluconazole and Voriconazole eye drops prepared commonly in Pharmacy Services for the treatment of fungal keratitis. METHOD: Experimental Study. The ocular toxicity of topical voriconazole 10 mg/ml and fluconazole 2 mg/ml were evaluated by the hen's egg test (HET) on the chorioallantoic membrane (CAM). The effects on blood vessels were based on its behavior during 300 seconds and processes that may occur at each time, then we calculated the irritation index (is, irritation score). RESULTS AND CONCLUSIONS: Both eye drops, voriconazol and fluconazole have been proven to be safe, since the IS that we obtained was zero for both samples and did not present significant signs of irritation. Therefore, these eyedrops are considered suitable for ocular use from a toxicological point of view.

OBJETIVO: El objetivo del estudio es aportar información toxicológica mediante el ensayo HET-CAM, de los colirios de Fluconazol y Voriconazol elaborados de manera habitual en los Servicios de Farmacia para el tratamiento de las queratitis fúngicas. MÉTODOS: Estudio experimental en el que se ensaya la potencial toxicidad ocular del colirio de voriconazol 10 mg/ml y fluconazol 2 mg/ml mediante el método Hen s Egg Test-Chorioallantoic Membrane (HET-CAM). Los resultados se fundamentan en la observación de los posibles procesos dañinos que pudiesen ocurrir en los vasos sanguíneos de la membrana corioalantoidea del embrión de pollo durante un tiempo de contacto de 300 segundos, calculándose posteriormente el índice de irritación (IS, Irritation Score). RESULTADOS Y CONCLUSIONES: Se obtienen IS nulos para ambas muestras, no mostrando por tanto indicios de irritación aguda apreciables, considerándose por tanto aptos para su utilización desde el punto de vista toxicológico.

Análisis de la toxicidad ocular de los colirios de voriconazol y fluconazol con HET-CAM / Analysis of ocular toxicity of fluconazole and voriconazole eyedrops using HET CAM

Objetivo: El objetivo del estudio es aportar información toxicológica mediante el ensayo HET-CAM, de los colirios de Fluconazoly Voriconazol elaborados de manera habitual en los Servicios de Farmacia para el tratamiento de las queratitis fúngicas. Métodos: Estudio experimental en el que se ensaya la potencial toxicidad ocular del colirio de voriconazol 10 mg/ml y fluconazol2 mg/ml mediante el método Hen s Egg Test-Chorioallantoic Membrane (HET-CAM). Los resultados se fundamentan en la observación de los posibles procesos dañinos que pudiesen ocurrir en los vasos sanguíneos de la membrana corioalantoideadel embrión de pollo durante un tiempo de contacto de 300 segundos, calculándose posteriormente el índice de irritación (IS, Irritation Score). Resultados y conclusiones: Se obtienen IS nulos para ambas muestras, no mostrando por tanto indicios de irritación aguda apreciables, considerándose por tanto aptos para su utilización desde el punto de vista toxicológico (AU)

Purpose: The objective of the study is to provide toxicological information through the HET-CAM test of Fluconazole and Voriconazole eye drops prepared commonly in Pharmacy Services for the treatment of fungal keratitis. Method: Experimental Study. The ocular toxicity of topical voriconazole 10 mg/ml and fluconazole 2 mg/ml were evaluated by the hen‘s egg test (HET) on the chorioallantoic membrane(CAM). The effects on blood vessels were based on its behavior during 300 seconds and processes that may occur at each time, then we calculated the irritation index (is, irritation score). Results and conclusions: Both eye drops, voriconazol and fluconazole have been proven to be safe, since the IS that we obtained was zero for both samples and did not present significant signs of irritation. Therefore, these eye drops are conside red suitable for ocular use from a toxicological point of view (AU)

[Micronutrient supplementation in parenteral nutrition in Spanish hospitals]. / Utilización de micronutrientes en nutrición parenteral en los hospitales Españoles.

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily intake of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire (answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations.

Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad / Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality

Objetivo. Evaluar el grado de satisfacción de pacientes atendidos y auxiliares de farmacia del área de pacientes externos del servicio de farmacia tras una reestructuración del espacio y del procedimiento de dispensación. Métodos. Tres meses después de la reestructuración del área (enero de 2009), se entregaron encuestas de satisfacción (anónimas y voluntarias) durante 2 semanas a una muestra de los 3.300 pacientes/mes atendidos y a los auxiliares que trabajaron en ella. Ambas constaban de ocho preguntas cerradas con formato tipo Likert referentes al espacio físico, la organización, la dispensación y la satisfacción global (variable principal) más una pregunta abierta para recoger sugerencias. Resultados. Recibieron la encuesta 265 pacientes (tasa de respuesta, 94%). El aspecto mejor valorado fue la confidencialidad (4,2±0,7) y el peor, la zona de espera (3,2±1). Se entregaron y se contestaron 26 encuestas por parte de los auxiliares. La mayor puntuación se obtuvo en la instalación del lector del código de barras (3,9±0,6) y la menor, en la organización del almacén (3,1±1,2). En la pregunta abierta se recogieron comentarios sobre falta de personal, dificultad del sistema informático, organización y poca claridad de las prescripciones. El grado de satisfacción global de los pacientes fue de 4,2±0,6 y el de los auxiliares, 3,7±0,7. Conclusiones. Los resultados nos han proporcionado una información útil para evaluar cambios y detectar puntos de mejora. En la mayoría de las cuestiones se ha detectado un mayor grado de satisfacción en los pacientes que en los trabajadores. Son necesarias nuevas acciones de mejora en el espacio físico y en la organización(AU)

Objectives. To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. Methods. Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. Results. A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2±0.7) and the worst was the waiting area (3.2±1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9±0.6) and the lowest for organization of the stores (3.1±1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2±0.6 and that of the auxiliaries was 3.7±0.7. Conclusions. The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization(AU)

Utilización de micronutrientes en nutrición parenteral en los hospitales españoles / Micronutrient supplementation in parenteral nutrition in spanish hospitals

Hace años se recomendó no añadir conjuntamente vitaminas y oligoelementos a las nutriciones parenterales (NP) y administrarlas inmediatamente después de la adición de los micronutrientes para evitar su degradación. Actualmente se ha visto que con bolsas multicapa, mezclas ternarias y fotoprotección la degradación de vitaminas es mínima. El aporte diario de micronutrientes es necesario al menos en pacientes críticos, malnutridos o con NP a largo plazo. Con el objetivo de conocer las pautas de utilización de los micronutrienes en NP en los hospitales españoles y la forma de preparación de las bolsas de NP, en relación a los factores condicionantes de su estabilidad, se realizó una encuesta telefónica a los farmacéuticos responsables del área de NP de los diferentes hospitales. Los datos obtenidos se compararon con otras encuestas realizadas en 2001 y 2003. Respondieron la encuesta 97 hospitales de los 110 hospitales a los que se llamó (tasa de respuesta 88%), cuyo número de camas estaba comprendido entre 104 y 1728. En comparación con los datos de años anteriores se observa una mayor adecuación a las recomendaciones vigentes, aunque todavía casi un 30% de los hospitales aportan los micronutrientes en días alternos con independencia de la situación clínica del paciente. La mayoría de los hospitales utilizan bolsas multicapa y/o fotoprotección y mezclas ternarias. A la vista de los resultados, en los que se pone en evidencia la disparidad de criterios en la administración de vitaminas y oligoelementos en las soluciones de NP parece necesario elaborar documentos de consenso que se adecuen a la realidad de las distintas prácticas además de favorecer la realización de estudios clínicos minuciosamente diseñados para establecer los requerimientos en situaciones clínicas especiales (AU)

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily in take of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire(answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations (AU)

[Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality]. / Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad.

OBJECTIVES: To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. METHODS: Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2 weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. RESULTS: A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2 ± 0.7) and the worst was the waiting area (3.2 ± 1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9 ± 0.6) and the lowest for organization of the stores (3.1 ± 1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2 ± 0.6 and that of the auxiliaries was 3.7 ± 0.7. CONCLUSIONS: The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization.

Variación en el uso de nutrición parenteral en un hospital infantilen Madrid (España) a lo largo de 15 años / Evolution of paediatric parenteral nutrition over the last 15 years in a tertiary hospital in Madrid (Spain)

Objetivo: Analizar el empleo de la nutrición parenteral (NP) pediátrica en un hospital terciario en Madrid (1994-2008). Material y métodos: Se revisaron las historias clínicas de pacientes pediátricos hospitalizados con NP en 2008, comparándose con 2002 y 1994. Resultados: Recibieron NP 120, 78 y 71 niños, siendo el 1,6%, 1,3% y 1,0% respectivamente del total de ingresados (2008, 2002 y 1994). Hubo diferencias significativas en la composición en el primer día en kilocalorías y lípidos; pero no en volumen, carbohidratos ni aminoácidos. La cirugía gastrointestinal fue la indicación más frecuente. La duración media de la NP varió de 15,2 ± 14,8 (1994) a 11 ± 9,8 días (2008) (p < 0,05). Presentaron complicaciones el 24,8% (2008), 10,8% (2002) y 16,9% (1994) de los pacientes. Conclusiones: En número absoluto y relativo de NP ha aumentado durante los años evaluados, aunque la duración media se ha reducido significativamente. Las complicaciones, sin embargo, han aumentado (AU)

Objective: To analyze the use of paediatric parenteral nutrition (PN) in a tertiary level hospital in Spain (1994-2008). Materials and methods: The charts from infants and children receiving NP in 2008 were reviewed. Data were compared with those in 1994 and 2002. Results: 120 patients received PN, 78 and 71 corresponding to 1.6%, 1.3% and 1.0% of total admissions in 2008, 2002 and 1994 respectively. When composition of PN was compared in the first day we found significant differences in energy and lipids; but not in volume, carbohydrate, or amino acid composition. Gastrointestinal surgery was the most common indication. Mean length was 11.0 ± 9.8 days (2008) to 15.2 ± 14.8 (1994) (p < 0.05). Complications were present in 24.8 patients (2008), 10.8% (2002) and 16.9 (1994). Conclusions: PN use increased along the study period, although mean length decreased. There were more complications in 2008 than in previous years (AU)

¿Es útil conocer las características de la nutrición parenteral en un hospital terciario pediátrico? / Is it worth knowing the characteristics of inpatient paediatric parenteral nutrition?

Objetivo: Estudiar la nutrición parenteral (NP) pediátrica en 2008 en un hospital terciario. Conocer su adecuación con las guías de práctica clínica actuales. Material y métodos: Estudio longitudinal, descriptivo y retrospectivo de las historias clínicas de pacientes menores de 16 años (excluidos los ingresados en las unidades neonatales) que recibieron NP en 2008. Recogimos datos demográficos y datos de la NP: indicación, composición en el primer día, lípidos, aminoácidos, micronutrientes, tipo de mezcla, estandarización, adición de medicamentos, duración, acceso venoso, causa de interrupción y complicaciones. Resultados: Recibieron NP 120 niños: 63 menores de 2 años, 30 preescolares y 27 mayores de 7 años. Constituyeron el 1,6% de los niños hospitalizados en ese período. Las indicaciones más frecuentes fueron cirugía gastrointestinal (35,5%) y enfermedades gastrointestinales (19,8%). La composición media del primer día fue de 63,1±21,3kcal/kg/día, volumen de 76,6±28,4ml/kg/día, hidratos de carbono de 9,6±3,2g/kg/día, aminoácidos de 2,1±0,6g/kg/día y lípidos de 1,9±1g/kg/día. La duración media fue de 10,5±9,8días. Los accesos venosos más frecuentes fueron la vena yugular (34,7%) y la vena femoral (26,5%). La causa principal de interrupción fue la tolerancia oral, seguida de NP domiciliaria. El 27,3% tuvo complicaciones asociadas a la NP. Conclusiones: La mitad de las NP se prescribió en lactantes, y la principal indicación fue la cirugía gastrointestinal. Todas las mezclas fueron ternarias con micronutrientes todos los días. La mayoría se estandarizó parcialmente, lo que ayuda a disminuir los errores en la prescripción y preparación (AU)

Objective: To describe the characteristics of inpatient parenteral nutrition during 2008 in a tertiary level paediatric hospital. To compare this practice with recent standards. Material and methods: Longitudinal, descriptive, and retrospective study of patients under 16 years receiving parenteral nutrition in 2008. Demographic data as well as data of the nutritional support were recorded. Results: A total of 120 children received parenteral nutrition, of whom 63 were under 2 years, 30 between 3 and 7 years, and 27 older than 7 years. They accounted for 1.6% of all the inpatients during that period. Most frequent indication was gastrointestinal surgery (35.5%), followed by non-surgical gastrointestinal diseases (19.8%). The average composition in the first day of parenteral nutrition was: 63.1kcal/kg (SD: 21.3); volume, 76.6ml/kg (SD: 28.4); carbohydrates 9.6g/kg/d (SD: 3.2); amino acids 2.1g/kg/d (SD: 0.6), and lipids 1.9g/kg/d (SD: 1). The mean duration of parenteral support was 10.5 days (SD: 9.8). Internal jugular vein (34.7%) and femoral vein were the most common intravenous access. The main reason to discontinue parenteral nutrition was transition to oral/enteral feedings. The complication rate was 27.3%. Conclusions: There is an interest in evaluating standard practice in parenteral nutrition in order to develop improvement strategies. Infants and toddlers are the principal candidates for parenteral nutrition. Standardisation is one way to decrease errors in its preparation and prescription (AU)

[Evolution of paediatric parenteral nutrition over the last 15 years in a tertiary hospital in Madrid (Spain)]. / Variación en el uso de nutrición parenteral en un hospital infantil en Madrid (España) a lo largo de 15 años.

OBJECTIVE: To analyze the use of paediatric parenteral nutrition (PN) in a tertiary level hospital in Spain (1994-2008). MATERIALS AND METHODS: The charts from infants and children receiving NP in 2008 were reviewed. Data were compared with those in 1994 and 2002. RESULTS: 120 patients received PN, 78 and 71 corresponding to 1.6%, 1.3% and 1.0% of total admissions in 2008, 2002 and 1994 respectively. When composition of PN was compared in the first day we found significant differences in energy and lipids; but not in volume, carbohydrate, or amino acid composition. Gastrointestinal surgery was the most common indication. Mean length was 11.0 ± 9.8 days (2008) to 15.2 ± 14.8 (1994) (p < 0.05). Complications were present in 24.8 patients (2008), 10.8% (2002) and 16.9 (1994). CONCLUSIONS: PN use increased along the study period, although mean length decreased. There were more complications in 2008 than in previous years.

[Is it worth knowing the characteristics of inpatient paediatric parenteral nutrition?]. / ¿Es útil conocer las características de la nutrición parenteral en un hospital terciario pediátrico?

OBJECTIVE: To describe the characteristics of inpatient parenteral nutrition during 2008 in a tertiary level paediatric hospital. To compare this practice with recent standards. MATERIAL AND METHODS: Longitudinal, descriptive, and retrospective study of patients under 16 years receiving parenteral nutrition in 2008. Demographic data as well as data of the nutritional support were recorded. RESULTS: A total of 120 children received parenteral nutrition, of whom 63 were under 2 years, 30 between 3 and 7 years, and 27 older than 7 years. They accounted for 1.6% of all the inpatients during that period. Most frequent indication was gastrointestinal surgery (35.5%), followed by non-surgical gastrointestinal diseases (19.8%). The average composition in the first day of parenteral nutrition was: 63.1kcal/kg (SD: 21.3); volume, 76.6ml/kg (SD: 28.4); carbohydrates 9.6g/kg/d (SD: 3.2); amino acids 2.1g/kg/d (SD: 0.6), and lipids 1.9g/kg/d (SD: 1). The mean duration of parenteral support was 10.5 days (SD: 9.8). Internal jugular vein (34.7%) and femoral vein were the most common intravenous access. The main reason to discontinue parenteral nutrition was transition to oral/enteral feedings. The complication rate was 27.3%. CONCLUSIONS: There is an interest in evaluating standard practice in parenteral nutrition in order to develop improvement strategies. Infants and toddlers are the principal candidates for parenteral nutrition. Standardisation is one way to decrease errors in its preparation and prescription.