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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 425-433, ago.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182862

RESUMO

Objetivos: Elaborar un registro de situación de los Servicios y Unidades de Endocrinología y Nutrición (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de políticas de mejora en los S°EyN. Material y métodos: Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» diseñada específicamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados: De un total de 125 hospitales generales de agudos de más de 200 camas instaladas del SNS español, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinólogos por S°EyN era de 7,4±4,4, siendo la tasa media de endocrinólogos por cada 100.000 habitantes de 2,3±1. Las actividades asistenciales más relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y año), hospital de día (mediana de 2.000 sesiones/año) e interconsulta hospitalaria (mediana de 900 interconsultas/año). El 83% de los S°EyN incorporaban una Unidad de Nutrición Clínica. La dotación de dietistas, técnicos en nutrición y bromatólogos en las Unidades de Nutrición Clínica era baja. En relación con la gestión de la calidad se detectó un amplio margen de mejora; solamente un 35% de los S°EyN tenían responsable de calidad y el 38% había implantado una gestión por procesos para aquellos más frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autónomas. Conclusiones: La encuesta RECALSEEN 2017 es útil para el análisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora


Objectives: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement


Assuntos
Humanos , Unidades Hospitalares , Assistência ao Paciente/estatística & dados numéricos , Sistemas Nacionais de Saúde/organização & administração , Sistema de Registros/normas , Endocrinologistas/estatística & dados numéricos , Política de Saúde , Estudos Transversais , Gestão da Qualidade , Análise Estatística , Serviço Hospitalar de Nutrição/organização & administração , Serviço Hospitalar de Nutrição/normas , Endocrinologistas/organização & administração , Endocrinologistas/provisão & distribução
2.
Diabetes Res Clin Pract ; 156: 107824, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446112

RESUMO

AIMS: To analyze the trends on diabetes mellitus (DM) healthcare management in Spain. METHODS: Retrospective observational study between January 1st 2007 and 31th December 2015 with DM as the principal diagnosis. The main clinical outcome measures were all-cause, in-hospital mortality and 30-day readmissions. We also analyze three Prevention Quality Indicators (PQI) for DM. RESULTS: The number of hospitalization episodes decreased significantly as well as the frequentation rate and average length of stay (Incidence Rate Ratio [IRR] = 0.963, p < 0.001; 0.91, p < 0.001 and 0.986, p < 0.001, respectively). Crude in-hospital mortality and readmissions rates and risk-standardized in-hospital mortality rates (RSMR), however, remained stable (IRR = 0.988, p = 0.073; IRR = 1.003, p = 0.334 and IRR = 0.997, p = 0.116, respectively). A relevant variability in RSMR, both at hospital (Median Odds Ratio 1.49) and regional level, was found. High volume hospitals (≥105 DM discharges at year) showed better outcomes. High variability was also found in PQI indicators al regional level. CONCLUSION: The present analysis shows an improvement in hospitalizations related to DM in Spain in the period 2007-2015. There was also a decrease in the frequentation rate and in the average length of stay. These findings are probably explained by quality improvements in the healthcare management of the DM at the ambulatory level. However, there were important differences in the management of diabetic inpatients both at the hospital and the regional level.

3.
Nutr. hosp ; 36(4): 898-904, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184716

RESUMO

Introducción: las estrictas restricciones dietéticas que imponemos en la enfermedad renal crónica avanzada (ERCA) tienen un impacto negativo en la calidad de vida. Objetivo: determinar si estas restricciones están justificadas y si un programa de educación nutricional mejoraría los parámetros de calidad de vida relacionada con la salud (CVRS). Material y métodos: realizamos un ensayo clínico de intervención educativa, unicéntrico, randomizado y controlado en los pacientes de la consulta ERCA de Albacete. Se incluyeron 75 pacientes, 35 en el grupo control y 40 en el de intervención. Se realizó la valoración nutricional mediante valoración global subjetiva (VGS) e índice de masa corporal (IMC). Para medir la CVRS se empleó el cuestionario de salud SF-36. En el grupo intervención se realizó la intervención nutricional individual, colectiva y por recuerdo telefónico, adaptando a cada paciente el consejo dietético y ajustando las restricciones de forma personalizada. Resultados: la malnutrición medida por VGS fue del 20% en el grupo control y del 29,3% en el grupo intervención, donde mejoró aunque no fue significativo. El IMC mostró sobrepeso con una media de 28,83 (DE: 5,4) y 26,96 kg/m2 (DE: 4,09) respectivamente, sin cambios a lo largo del estudio. La intervención nutricional supuso una mejoría en las puntuaciones de todas las subescalas excepto en el dolor corporal. Además, los componentes físico y mental también mejoraron sus puntuaciones en el grupo intervención y empeoraron significativamente (p < 0,001) en el control. Conclusiones: la calidad de vida se puede mejorar en los pacientes con ERCA aplicando un programa de educación nutricional


Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Educação Alimentar e Nutricional , Dietoterapia/métodos , Dietoterapia/tendências , Qualidade de Vida , Insuficiência Renal Crônica/dietoterapia , Desnutrição/epidemiologia , Valor Nutritivo , Análise Estatística , Inquéritos e Questionários , Modelos Lineares
4.
Nutr Hosp ; 36(4): 898-904, 2019 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-31291738

RESUMO

Introduction: Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program.

7.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(5): 291-296, mayo 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182803

RESUMO

Introducción: En España, la elección de la especialidad se realiza vía examen médico interno residente (MIR). El número de elección de plaza MIR puede reflejar el interés por una especialidad. El objetivo del estudio es corroborar el aumento del número de elección y analizar los posibles factores influyentes a la hora de elegirla. Material y método: Analizar la evolución del número de orden con el que se elige nuestra especialidad y compararla con otras especialidades afines, así como las preferencias a la hora de elegirla realizando una encuesta anónima a 108 MIR de Endocrinología. Resultados: El número medio de elección ha ido aumentando progresivamente hasta llegar el último año al número 2336, esta tendencia coincide con un aumento en el número de plazas ofertadas, aunque es más marcada que en otras especialidades médicas relacionadas. En la encuesta se evaluaron diferentes factores influyentes a la hora de elegir especialidad. También se preguntó sobre los aspectos considerados más positivos y negativos de la especialidad. Se consideró como más positivo que sea tranquila y el más negativo, la escasez de técnicas. A la pregunta de si la especialidad había cumplido sus expectativas se dio una puntuación de 8,7 sobre 10, aunque la percepción del prestigio de la especialidad se puntuó solo con 6,7 puntos. Conclusiones: Hay un deterioro evidente del número de elección de nuestra especialidad que no es tan marcado en el resto ramas médicas relacionadas


Introduction: In Spain, the system used to select a medical specialty is the MIR (internal resident physician) exam. The MIR selection number may reflect the interest in a given specialty. Our study objective was to confirm the increase in the selection number and to analyze possible factors influencing the decision. Material and method: To analyze change over time in the MIR number with which this specialty is chosen and to compare it with other related specialties, as well as the reasons why it is preferred using an anonymous survey to 108 MIRs of endocrinology. Results: The average number of MIR for Endocrinology and Nutrition has gradually increased to 2336 in year 2018, a trend that coincides with an increase in the number of places offered but is more marked as compared to other medical specialties. Respondents weighed different factors when choosing specialty. When asked about the most positive aspects of the specialty, the highest rated was that day to day activity was "less intense". The most commonly mentioned negative aspect was the low number of techniques. When asked if the specialty had met their expectations, respondents gave an average score of 8.7, although the perceived prestige of the specialty scored only 6.7 points. Conclusions: There is an obvious deterioration of the MIR selection number of our specialty that it is not so marked in other specialties


Assuntos
Humanos , Escolha da Profissão , Endocrinologia/educação , Educação Médica , Internato e Residência/estatística & dados numéricos , Endocrinologia/organização & administração , Testes Anônimos/estatística & dados numéricos , Estudos Retrospectivos
8.
Endocrinol Diabetes Nutr ; 66(5): 291-296, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30971387

RESUMO

INTRODUCTION: In Spain, the system used to select a medical specialty is the MIR (internal resident physician) exam. The MIR selection number may reflect the interest in a given specialty. Our study objective was to confirm the increase in the selection number and to analyze possible factors influencing the decision. MATERIAL AND METHOD: To analyze change over time in the MIR number with which this specialty is chosen and to compare it with other related specialties, as well as the reasons why it is preferred using an anonymous survey to 108 MIRs of endocrinology. RESULTS: The average number of MIR for Endocrinology and Nutrition has gradually increased to 2336 in year 2018, a trend that coincides with an increase in the number of places offered but is more marked as compared to other medical specialties. Respondents weighed different factors when choosing specialty. When asked about the most positive aspects of the specialty, the highest rated was that day to day activity was "less intense". The most commonly mentioned negative aspect was the low number of techniques. When asked if the specialty had met their expectations, respondents gave an average score of 8.7, although the perceived prestige of the specialty scored only 6.7 points. CONCLUSIONS: There is an obvious deterioration of the MIR selection number of our specialty that it is not so marked in other specialties.


Assuntos
Escolha da Profissão , Endocrinologia/tendências , Ciências da Nutrição/tendências , Cardiologia , Estudos Transversais , Endocrinologia/estatística & dados numéricos , Gastroenterologia , Humanos , Medicina Interna , Internato e Residência , Ciências da Nutrição/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Inquéritos e Questionários
9.
Endocrinol Diabetes Nutr ; 66(7): 425-433, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30509881

RESUMO

OBJECTIVES: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. MATERIAL AND METHODS: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). RESULTS: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. CONCLUSIONS: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement.

10.
Nutr Hosp ; 35(Spec no2): 34-38, 2018 Apr 03.
Artigo em Espanhol | MEDLINE | ID: mdl-30547664

RESUMO

days of hospitalization, a greater number of complementary tests, the need for artificial nutritional support and / or drugs to treat complications, which is a very important economic burden. Most patients who are malnourished, or at risk, can benefit from oral nutritional support, which includes dietary modifications (fortification, extra snacks, etc.), prescription of a personalized diet by a registered dietitian and the use of oral nutritional supplements (ONS). The use of ONS has shown benefits, in several meta-analysis, in weight recovery, reduction in the number of complications or hospital readmissions and functional improvement, without a reduction in the usual food intake. The use of ONS is particularly cost-effective in certain subgroups of age (frail elderly), nutritional status (previous malnutrition) and underlying disease (hip fracture, abdominal surgery, etc.).On the other hand, there are additional difficulties to evaluate the effect of nutritional support in different healthcare settings (community, nursing home, hospital) since the economic burden in one environment often has an impact on another (for example: hospital readmissions). This circumstance makes it difficult for regulators to control the prescription and generates debate about the continuity of treatments in different settings. The repercussion of an episode of hospitalization on functional status, 30 days after discharge ("post hospital syndrome"), constitutes a transitory period of special vulnerability for comorbidity and hospital readmission risk. The nutritional support (dietary counselling + use of ONS) generates savings of around 5% of the health cost in the intervention group vs "usual practice", together with a significant decrease in the number of hospital readmissions. The nutritional support throughout the different scenarios where the patient is found has proven to be cost-effective, does not involve extra costs per unit of improvement, both clinical and functional, and can be defended from a health economic perspective. These results highlight the need to pay attention to the detection of malnutrition and its treatment as part of standard medical care in the transition process between the hospital and the patient's home. It is the responsibility of the health managers to ensure that the detection and treatment of malnutrition is routinely carried out in their centers, as well as integrating clinical nutrition into standardized medical care. of any patient, which raises the importance of including clinical nutrition in the training plans of the health personnel.


Assuntos
Continuidade da Assistência ao Paciente , Desnutrição/terapia , Apoio Nutricional/métodos , Apoio Nutricional/normas , Análise Custo-Benefício , Aconselhamento , Dieta , Suplementos Nutricionais , Hospitalização , Humanos , Desnutrição/diagnóstico , Apoio Nutricional/economia
11.
Nutr. hosp ; 35(n.extr.2): 34-38, mayo 2018.
Artigo em Espanhol | IBECS | ID: ibc-181437

RESUMO

La principal causa de desnutrición en nuestro entorno es la enfermedad. Esta circunstancia lleva asociada un aumento en los costes derivado del aumento de los días de hospitalización, que conlleva un mayor número de pruebas complementarias y el incremento del soporte nutricional artificial y/o de medicamentos para tratar las complicaciones, lo que supone una carga económica muy importante. La mayoría de los pacientes malnutridos o en riesgo de estarlo pueden beneficiarse de apoyo nutricional por vía oral, lo que incluye modificaciones de la dieta (fortificación, snacks extras, etc.), prescripción de una dieta personalizada por una dietista y el uso eventual de suplementos nutricionales orales (SNO). Diversos metaanálisis han demostrado beneficios en el uso de SNO en la recuperación ponderal, en la disminución del número de complicaciones y de reingresos y en una mejoría funcional sin que se produzca una reducción de la ingesta habitual de alimentos. El uso de SNO es particularmente coste-efectivo en determinados subgrupos de edad (ancianos con fragilidad), estado nutricional (desnutrición previa) y enfermedad subyacente (fractura de cadera, cirugía abdominal, etc.). Por otra parte, un paciente que transita entre diferentes entornos sanitarios (centro de salud, residencia sociosanitaria, hospital de agudos) presenta dificultades añadidas para evaluar el efecto del apoyo nutricional, ya que el gasto que realizamos en un entorno repercute con frecuencia en otro (por ejemplo, en los reingresos hospitalarios). Esta circunstancia dificulta el control por parte de los agentes reguladores de la prescripción y genera el debate sobre la continuidad de los tratamientos en los diferentes escenarios. La repercusión de un episodio de hospitalización en el estado funcional a treinta días del alta ("síndrome posthospitalización") constituye un periodo transitorio de especial vulnerabilidad en episodios de comorbilidad y de riesgo de reingreso. El apoyo nutricional (consejo dietético más uso de SNO) genera ahorros de alrededor del 5% del gasto sanitario en los grupos de intervención en comparación con la práctica habitual, junto con una disminución significativa del número de reingresos hospitalarios. El apoyo nutricional a lo largo de los distintos escenarios en los que se encuentre el paciente ha demostrado ser coste-efectivo, ya que no supone costes extras por unidad de mejora, tanto clínica como funcional, por lo que puede ser defendido desde el punto de vista del gasto sanitario. Estos resultados subrayan la necesidad de prestar atención a la detección del riesgo de desnutrición y a su tratamiento como parte del cuidado médico estándar en el proceso de transición entre el hospital y el domicilio del paciente. Es responsabilidad de los gestores asegurar que en sus centros se realice de forma rutinaria la detección y el tratamiento de la malnutrición, tanto en el ámbito hospitalario como en residencias sociosanitarias y en el domicilio, así como integrar la nutrición clínica entre los cuidados médicos estandarizados de cualquier paciente, lo que plantea la importancia de incluir conocimientos en esta materia en los planes formativos del personal sanitario


Disease is the main cause of malnutrition in our health and social care settings, and it is associated with an increase in costs, as a result of more days of hospitalization, a greater number of complementary tests, the need for artificial nutritional support and / or drugs to treat complications, which is a very important economic burden. Most patients who are malnourished, or at risk, can benefit from oral nutritional support, which includes dietary modifications (fortification, extra snacks, etc.), prescription of a personalized diet by a registered dietitian and the use of oral nutritional supplements (ONS). The use of ONS has shown benefits, in several meta-analysis, in weight recovery, reduction in the number of complications or hospital readmissions and functional improvement, without a reduction in the usual food intake. The use of ONS is particularly cost-effective in certain subgroups of age (frail elderly), nutritional status (previous malnutrition) and underlying disease (hip fracture, abdominal surgery, etc.). On the other hand, there are additional difficulties to evaluate the effect of nutritional support in different healthcare settings (community, nursing home, hospital) since the economic burden in one environment often has an impact on another (for example: hospital readmissions). This circumstance makes it difficult for regulators to control the prescription and generates debate about the continuity of treatments in different settings. The repercussion of an episode of hospitalization on functional status, 30 days after discharge ("post hospital syndrome"), constitutes a transitory period of special vulnerability for comorbidity and hospital readmission risk. The nutritional support (dietary counselling + use of ONS) generates savings of around 5% of the health cost in the intervention group vs "usual practice", together with a significant decrease in the number of hospital readmissions. The nutritional support throughout the different scenarios where the patient is found has proven to be cost-effective, does not involve extra costs per unit of improvement, both clinical and functional, and can be defended from a health economic perspective. These results highlight the need to pay attention to the detection of malnutrition and its treatment as part of standard medical care in the transition process between the hospital and the patient's home. It is the responsibility of the health managers to ensure that the detection and treatment of malnutrition is routinely carried out in their centers, as well as integrating clinical nutrition into standardized medical care. of any patient, which raises the importance of including clinical nutrition in the training plans of the health personnel


Assuntos
Humanos , Continuidade da Assistência ao Paciente , Desnutrição/terapia , Apoio Nutricional/métodos , Apoio Nutricional/normas , Análise Custo-Benefício , Suplementos Nutricionais , Aconselhamento , Dieta , Hospitalização , Desnutrição/diagnóstico , Apoio Nutricional/economia
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(1): 5-16, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171909

RESUMO

Antecedentes: La imprecisión en la terminología dentro de la nutrición clínica puede acarrear malas interpretaciones entre los distintos profesionales. Objetivo: Por esta razón, la Sociedad Española de Endocrinología y Nutrición (SEEN) ha promovido la realización del presente trabajo, el primero sobre terminología y definiciones en nutrición artificial clínica (enteral y parenteral) publicado en castellano. Métodos: Un total de 47 especialistas en Endocrinología y Nutrición expertos en la materia, miembros del Área de Nutrición de la SEEN, han participado entre los meses de abril y septiembre de 2016. Tras una revisión bibliográfica sistematizada fueron propuestos 52 conceptos, ampliándose a 54 por las coordinadoras y finalmente a 57 por el grupo de trabajo: 13 de carácter general, 30 referidos a la nutrición enteral y 14 a la parenteral. En una fase posterior se determinó el grado de acuerdo mediante un proceso Delphi de 2 circulaciones. Finalmente fue ratificado mediante un análisis de consistencia y concordancia. Resultados: En 54 de los 57 términos hubo un acuerdo muy consistente y resultaban concordantes. Solo 3 no presentaron concordancia, de los que 2 eran muy consistentes y uno inconsistente. En conclusión, queda consensuada la definición de 54 términos básicos en la práctica de la nutrición clínica (AU)


Background: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. Objective: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. Methods: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. Results: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition (AU)


Assuntos
Humanos , Masculino , Feminino , Terminologia como Assunto , Ciências da Nutrição/métodos , Endocrinologia/métodos , Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Sociedades Médicas/normas , Técnica Delfos
13.
Endocrinol Diabetes Nutr ; 65(1): 5-16, 2018 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29233514

RESUMO

BACKGROUND: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. OBJECTIVE: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. METHODS: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. RESULTS: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.


Assuntos
Ciências da Nutrição , Apoio Nutricional/métodos , Terminologia como Assunto , Técnica Delfos , Suplementos Nutricionais/classificação , Endocrinologia/organização & administração , Alimentos Formulados/classificação , Humanos , Linguagem , Necessidades Nutricionais , Ciências da Nutrição/organização & administração , Apoio Nutricional/classificação , Sociedades Médicas , Sociedades Científicas , Espanha
14.
Nutrition ; 41: 58-67, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28760429

RESUMO

OBJECTIVE: The aim of this study was to develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia who are receiving enteral nutrition (EN). METHODS: A Delphi survey method using Grading Recommendations Assessment, Development and Evaluation criteria was utilized for evaluation of suitable studies. RESULTS: In patients with diabetes or stress hyperglycemia who were on EN support, the following results were found: CONCLUSIONS: These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.


Assuntos
Diabetes Mellitus/dietoterapia , Nutrição Enteral/métodos , Medicina Baseada em Evidências/métodos , Hiperglicemia/dietoterapia , Guias de Prática Clínica como Assunto , Idoso , Consenso , Feminino , Humanos , Masculino
15.
PLoS One ; 10(5): e0127369, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25992570

RESUMO

BACKGROUND: Obesity represents an important health problem and its association with cardiovascular risk factors is well-known. The aim of this work was to assess the correlation between obesity and mortality (both, all-cause mortality and the combined variable of all-cause mortality plus the appearance of a non-fatal first cardiovascular event) in a general population sample from the south-east of Spain. MATERIALS AND METHODS: This prospective cohort study used stratified and randomized two-stage sampling. Obesity [body mass index (BMI) ≥ 30 kg/m(2)] as a predictive variable of mortality and cardiovascular events was assessed after controlling for age, sex, cardiovascular disease history, high blood pressure, diabetes mellitus, hypercholesterolemia, high-density lipoprotein/triglycerides ratio, total cholesterol and smoking with the Cox regression model. RESULTS: The mean follow-up time of the 1,248 participants was 10.6 years. The incidence of all-cause mortality during this period was 97 deaths for every 10,000 person/years (95% CI: 80-113) and the incidence of all-cause mortality+cardiovascular morbidity was 143 cases for every 10,000 person/years (95% CI: 124-163). A BMI ≥ 35 kg/m(2) yielded a hazard ratio for all-cause mortality of 1.94 (95% CI: 1.11-3.42) in comparison to non-obese subjects (BMI <30 kg/m(2)). For the combination of cardiovascular morbidity plus all-cause mortality, a BMI ≥ 35 kg/m(2) had a hazard ratio of 1.84 (95% CI: 1.15-2.93) compared to non-obese subjects. CONCLUSIONS: A BMI ≥ 35 kg/m(2) is an important predictor of both overall mortality and of the combination of cardiovascular morbidity plus all-cause mortality.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Obesidade/complicações , Obesidade/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Prognóstico , Espanha/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
16.
Nutrition ; 31(1): 58-63, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25441588

RESUMO

OBJECTIVE: Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose <70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN). METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. RESULTS: The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia. CONCLUSIONS: The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.


Assuntos
Hipoglicemia/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Administração Intravenosa , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Estado Terminal , Relação Dose-Resposta a Droga , Feminino , Hospitalização , Humanos , Hipoglicemia/etiologia , Insulina/administração & dosagem , Insulina/efeitos adversos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
17.
Clin Nutr ; 34(5): 962-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25466952

RESUMO

BACKGROUND: Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. AIMS: The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). METHODS: This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. RESULTS: Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). CONCLUSIONS: The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.


Assuntos
Desnutrição/epidemiologia , Nutrição Parenteral Total , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/metabolismo , Comorbidade , Estado Terminal , Ingestão de Energia , Seguimentos , Avaliação Geriátrica , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Albumina Sérica/metabolismo , Adulto Jovem
18.
Endocr Pract ; 21(1): 59-67, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25148810

RESUMO

OBJECTIVE: The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. METHODS: We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. RESULTS: The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001). CONCLUSION: The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.


Assuntos
Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Insulina/uso terapêutico , Nutrição Parenteral Total/efeitos adversos , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus/metabolismo , Feminino , Humanos , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/metabolismo , Prevalência , Estudos Prospectivos
19.
Nutr Hosp ; 28(5): 1696-701, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24160235

RESUMO

INTRODUCTION: The prescription of parenteral nutrition is a medical procedure that should be properly documented and that requires adequate communication between physicians, pharmacists and nurses. Prescription may be made by orders and paper forms or with software applications, in which case their integration with the rest of the hospital information systems may be difficult. We present our experience with a software for prescribing artificial nutrition integrated with the electronic medical record. METHODS: In order to develop a software application for artificial nutrition prescription, meetings between the Clinical Nutrition Unit and the Computing Service staff were held, which set the needs of the clinical services and features that should have the application. DESCRIPTION OF THE SOFTWARE: The software allows the prescription of parenteral nutrition component by component or using predesigned templates, generates alerts if extreme value of components or possible physical- chemical incompatibility, imports and stores the results of the labs of patients and records the composition of parenteral nutrition formula in the electronic medical record, among other features. DISCUSSION: Our experience shows that collaboration between clinical services and hospital Computing permits to develop useful applications for the clinical teams and that can be integrated with other hospital software.


Assuntos
Registros Eletrônicos de Saúde , Prescrição Eletrônica , Nutrição Parenteral , Software , Humanos , Serviço de Farmácia Hospitalar
20.
Nutr. hosp ; 28(5): 1696-1701, sept.-oct. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-120369

RESUMO

Introducción: La prescripción y seguimiento de la nutrición parenteral es un acto médico que debe ser correctamente documentado y que precisa de una adecuada comunicación entre médicos, farmacéuticos y personal de enfermería. Dicha prescripción puede realizarse mediante órdenes y formularios en papel o con aplicaciones informáticas, en cuyo caso surge la dificultad de su integración con el resto de la informática hospitalaria. Presentamos la experiencia de nuestro centro en la integración de un programa informático de prescripción de nutrición hospitalaria con la historia clínica electrónica. Material y métodos: Con objeto de desarrollar una aplicación informática de prescripción de nutrición artificial se llevaron a cabo reuniones entre personal de la Unidad de Nutrición Clínica y el Servicio de Informática donde se establecieron las necesidades de los servicios implicados y las características que debía tener la aplicación. Descripción de la aplicación: El programa informático permite la prescripción de nutrición parenteral componente por componente o mediante plantillas prediseñadas, genera alertas en caso de valores extremos de componentes o posible incompatibilidad físico-química, importa y almacena los resultados de las analíti cas de los pacientes y escribe la composición de la fórmula de nutrición parenteral prescrita en la historia clínica electrónica, entre otras características. Discusión: Nuestra experiencia muestra que la colaboración entre los servicios clínicos y de Informática permite desarrollar aplicaciones hospitalarias adaptadas a la forma de trabajo de los equipos clínicos y que pueden integrarse con el resto de los programas informáticos del hospital (AU)


INTRODUCTION: The prescription of parenteral nutrition is a medical procedure that should be properly documented and that requires adequate communication between physicians, pharmacists and nurses. Prescription may be made by orders and paper forms or with software applications, in which case their integration with the rest of the hospital information systems may be difficult. We present our experience with a software for prescribing artificial nutrition integrated with the electronic medical record.METHODS: In order to develop a software application for artificial nutrition prescription, meetings between the Clinical Nutrition Unit and the Computing Service staff were held, which set the needs of the clinical services and features that should have the application. DESCRIPTION OF THE SOFTWARE: The software allows the prescription of parenteral nutrition component by component or using predesigned templates, generates alerts if extreme value of components or possible physical- chemical incompatibility, imports and stores the results of the labs of patients and records the composition of parenteral nutrition formula in the electronic medical record, among other features.DISCUSSION: Our experience shows that collaboration between clinical services and hospital Computing permits to develop useful applications for the clinical teams and that can be integrated with other hospital software (AU)


Assuntos
Humanos , Software , Prescrição Eletrônica , Apoio Nutricional/métodos , Nutrição Parenteral Total/métodos , Soluções de Nutrição Parenteral/química , Registros Eletrônicos de Saúde
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