Antioxidant balance in plasma of patients on home parenteral nutrition: A pilot study comparing three different lipid emulsions.

BACKGROUND & AIMS: Parenteral nutrition (PN) can supply all essential nutrients to a patient with gastrointestinal insufficiency. However, the sensitivity to lipid peroxidation might increase in those receiving PN, especially home parenteral nutrition (HPN). This study aimed to investigate whether PN affects the antioxidant balance of plasma of HPN patients without comorbidities and whether this balance is influenced by comorbidities and according to the type of lipid emulsion included in the PN. METHODS: Adult patients on HPN (n = 86) received one of three types of lipid emulsion (based on 1) soyabean oil, 2) olive and soyabean oil or 3) soyabean, coconut, olive and fish oil) in all-in-one mixtures; in addition healthy controls (n = 66) were studied as comparators. HPN patients were classified to the following subgroups: 1) patients without (n = 58) or with (n = 28) comorbidities 2) patients on Intralipid (GINTRA, n = 53), ClinOleic (GCLIN, n = 17) or SMOFlipid (GSMOFn = 16). The activities of total glutathione peroxidase (GSH-Px), selenium dependent glutathione peroxidase (Se-GSHPx) and glutathione S-transferase (GST) in plasma were determined spectrophotometrically. The antioxidant potential of plasma was determined using oxygen radical absorbance capacity (ORAC). The lipid peroxidation marker malondialdehyde (MDA) was analyzed with high performance liquid chromatography. RESULTS: MDA concentration was the highest in GINTRA and the lowest in GSMOF (p < 0.05). GSMOF also had the highest activity of GSH-Px. No differences in Se-GSHPx, GST and ORAC were observed among GINTRA, GCLIN and GSMOF. Comparing with healthy controls, significantly lower GST (p = 0.0293) and ORAC (p < 0.0001) were observed in the HPN patients. Among all measured parameters only the concentration of MDA was significantly higher in patients with comorbidities compared to those without them. Comorbidities did not influence MDA level in GINTRA and GSMOF being still the lowest in GSMOF (p = 0.0033). In contrast, significantly higher MDA level was observed for GCLIN in those with vs. without comorbidities (p = 0.0262). CONCLUSIONS: Patients on HPN have lower antioxidant defenses than healthy controls. The type of lipid emulsion used in HPN affects lipid peroxidation (even after taking into account comorbidities which often involve oxidative stress) being the highest in GINTRA and the lowest in GSMOF. Thus, to minimize the risk of oxidative stress, SMOFlipid can be considered in patients in HPN especially for those with comorbidities. ClinOleic can be considered in HPN patients without comorbidities. The observation should be confirmed in larger studies.

[Stability of Six Drugs in Total Parenteral Nutrition Solution].

Elneopa NF No. 1 and No. 2 infusions are total parenteral nutrition solutions packaged in four-chambered infusion bags. They have been used as home parenteral nutrition, with various drugs injected into the infusion bags, for treating patient symptoms. In this study, we investigated the stability of six drugs, including famotidine, scopolamine butylbromide, furosemide, bromhexine hydrochloride, betamethasone sodium phosphate, and metoclopramide hydrochloride in the infusion bags under dark conditions at 4℃ for 7 days. Additionally, we developed a high-performance liquid chromatography method to determine drug concentrations in the infusions. The concentrations of injected famotidine, scopolamine butylbromide, and betamethasone sodium phosphate remained unchanged when the four chambers of Elneopa NF No. 1 and No. 2 were opened and the infusions were mixed. Their respective concentrations in the upper and lower chambers also remained unchanged. The concentration of furosemide in the upper chamber of the No. 1 infusion bag decreased after 5 days, although no change was observed in the other chambers and the mixed infusions with the four chambers opened. The concentration of bromhexine hydrochloride slightly decreased in the upper chambers (approximately 3%) after the co-infusion but decreased significantly in the other chambers and the mixed infusions with the four chambers opened. The concentration of metoclopramide hydrochloride significantly decreased in the upper chambers after the co-infusion; however, no change in concentration was observed in the other chambers and the mixed infusion with the four chambers opened. The results of this study provide useful information on home-based parenteral nutrition.

Home Total Parenteral Nutrition for Intestinal Failure in Patients with Advanced Small Intestinal Neuroendocrine Neoplasms.

The role of total parenteral nutrition (TPN) in cancer patients is controversial, but it may be a treatment option for some patients with indolent but advanced small intestinal neuroendocrine neoplasms (SI-NENs). The aim of this study is to investigate whether home TPN was associated with long-term survival and to assess the indications, duration and complications of TPN in patients with advanced SI-NENs. Patients with advanced SI-NENs who received home TPN were retrospectively included. Electronic records were reviewed for clinical information. Five patients receiving home TPN were identified out of 1011 patients with SI-NENs in our center. The median duration of TPN administration was 12 mo. Small bowel obstruction was the most common reason for TPN initiation. TPN-related complications included two catheter infections, one thrombosis and one episode of TPN-related transaminitis. At the last follow-up, three patients had died and two were alive. The median survival was 12 mo. Overall estimated 1-yr probability of survival on home TPN by Kaplan-Meier analysis was 40%. In conclusion, home TPN may be a treatment option in highly selected advanced SI-NEN patients with severe gastrointestinal tract dysfunction. The initiation of home TPN is associated with long-term survival (≥1 yr), and complication rates appear acceptable.

Calidad de vida de las personas adultas con nutrición parenteral ingresadas en hospitalización domiciliaria: revisión sistemática / Quality of life of adult people with parenteral nutrition admitted to home hospitalization: systematic review

OBJETIVO: Revisar la documentación científica relacionada con la calidad de vida de las personas adultas con nutrición parenteral ingresadas en hospitalización domiciliaria. MÉTODO: Revisión crítica y sistemática. Los datos se obtuvieron de la consulta a las siguientes bases de datos bibliográficas: MEDLINE (vía PubMed), Cochrane Library, Embase, Scopus y Web of Science. Los términos utilizados, como descriptores y como texto en los campos de registro del título y el resumen, fueron "Home Care Services", "Parenteral Nutrition" y "Quality of Life", utilizando los filtros «Humans», «Adult: 19+ years» y «Clinical Trial». Fecha de la búsqueda febrero de 2020. La calidad documental de los artículos se evaluó mediante el cuestionario CONSORT. RESULTADOS: De las 379 referencias recuperadas, tras depurar las repeticiones y aplicar los criterios de inclusión y exclusión, se seleccionaron 7 ensayos clínicos. En 3 (43%) de los ensayos revisados se observó una mejora en relación a la calidad de vida. Las puntuaciones obtenidas mediante el cuestionario CONSORT, oscilaron entre 12,5 y 20,5 sobre una puntuación máxima de 24. CONCLUSIONES: El incremento de la calidad de vida de los enfermos con NPD está directamente relacionado con la del estado y soporte nutricional de los mismos. Se observó una mejor calidad de vida en los pacientes con bomba portátil y en los que se administró teduglutida. El adecuado manejo del catéter y la consecuente disminución de las infecciones también contribuyó a la mejora de la calidad de vida de las personas con NPD

OBJECTIVE: To review the scientific documentation related to the quality of life of adult people with parenteral nutrition admitted to home hospitalization. METHOD: Critical and systematic review. The data were obtained from the consultation of the following bibliographic databases: MEDLINE (via PubMed), Cochrane Library, Embase, Scopus y Web of Science. Terms used as descriptors and as text in the title and summary record fields were: "Home Care Services", "Parenteral Nutrition" and "Quality of Life", using the filters «Humans», «Adult: 19+ years» y «Clinical Trial». Search date February 2020. The documental quality of the articles was evaluated by using the CONSORT questionnaire. RESULTS: From 379 recovered references, after refining the repetitions and applying the inclusion and exclusion criteria, 7 clinical trials were selected. In 3 (43%) of the revised trials it was observed an improvement in relation to the quality of life. The scores obtained by the CONSORT questionnaire were from 12.5 to 20.5 with a maximum score of 24. CONCLUSIONS: The parenteral support of patients with home parenteral nutrition (HPN) was directly related to the nutritional status, and it corresponded with an increase in quality of life. An improvement of quality of life was proved in patients that used portable pump and it was likewise proved that the use of teduglutide was beneficial for the quality of life. The correct handle of the catheter and the reduction of infections were also connected with the enhancement of the quality of life of people with HPN

Vitamin C in Home Parenteral Nutrition: A Need for Monitoring.

To date, there are no recommendations about screening plasma vitamin C concentration and adjust its supplementation in patients on long-term home parenteral nutrition (HPN). The aim of this study was to evaluate vitamin C status and determine if a commercial multivitamin preparation (CMVP) containing 125 mg of vitamin C is sufficient in stable patients on HPN. All clinically stable patients receiving HPN or an intravenous fluid infusion at least two times per week for at least 6 months, hospitalized for nutritional assessment, were retrospectively included, for a total of 186 patients. We found that 29% of the patients had vitamin C insufficiency (i.e., <25 µmol/L). In univariate analysis, C-reactive protein (CRP) (p = 0.002) and intake of only 125 mg of vitamin C (p = 0.001) were negatively associated with vitamin C levels, and duration of follow-up in our referral center (p = 0.009) was positively associated with vitamin C levels. In multivariate analysis, only CRP (p = 0.001) and intake of 125 mg of vitamin C (p < 0.0001) were independently associated with low plasma vitamin C concentration. Patients receiving only CMVP with a low plasma vitamin C level significantly received personal compounded HPN (p = 0.008) and presented an inflammatory syndrome (p = 0.002). Vitamin C insufficiency is frequent in individuals undergoing home parenteral nutrition; therefore, there is a need to monitor plasma vitamin C levels, especially in patients on HPN with an inflammatory syndrome and only on CMVP.

Preoperative Exclusive Total Parental Nutrition is Associated with Clinical and Laboratory Remission in Severe Active Crohn's Disease-A Pilot Study.

BACKGROUND: The effect of 1-3 months of preoperative exclusive total parental nutrition (TPN) in active Crohn's disease (CD) patients is not well established. We investigated the efficacy of exclusive TPN in active CD patients. METHODS: In a retrospective multi-visit study with data according to our standard care therapy, we assessed clinical and laboratory remission to refractory CD with exclusive preoperative TPN. Inclusion required exclusive preoperative home TPN without additional oral intake for 1-3 months prior to planning surgery. RESULTS: Twenty preoperative CD patients (65% male; 35% female) were on exclusive TPN. The mean age of the cohort was 30.8 ± 11.6 years. Mean duration of preoperative TPN treatment was 73 days (range: 24-142 days). Most patients had terminal ileal (35%) or ileocolonic CD (30%), and with stricturing (B2) phenotype. All 20 patients had significant clinical improvement in all disease activity indices at the end of preoperative TPN (baseline vs. post TPN): HBI 14.5 vs. 4.0 (p = 0.001); BMI 19.2 vs. 19.7 kg/m2 (p = 0.017); CRP 57.2 vs. 10.3 mg/L (p = 0.001); Fecal calprotectin (FC) 672 vs. 200 (µg/g); albumin 2.7 vs. 3.6 g/dL (p = 0.001). Two patients (10%) no longer required surgery after completion of exclusive TPN. CONCLUSION: Exclusive preoperative TPN was found to provide significant improvement in nutritional status, and clinical and laboratory remission in severe active Crohn's patients.

A framework to support quality of care for patients with chronic intestinal failure requiring home parenteral nutrition.

BACKGROUND AND AIM: Chronic intestinal failure requiring home parenteral nutrition (HPN) is a disabling condition that is best facilitated by a multidisciplinary approach to care. Variation in care has been identified as a key barrier to achieving quality of care for patients on HPN and requires appropriate strategies to help standardize management. METHOD: The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) assembled a multidisciplinary working group of 15 clinicians to develop a quality framework to assist with the standardization of HPN care in Australia. Obstacles to quality care specific to Australia were identified by consensus. Drafts of the framework documents were based on the available literature and refined by two Delphi rounds with the clinician work group, followed by a further two involving HPN consumers. The Oxford Centre for Evidence-Based Medicine Levels of Evidence was used to assess the strength of evidence underpinning each concept within the framework documents. RESULTS: Quality indicators, standards of care, and position statements have been developed to progress the delivery of quality care to HPN patients. CONCLUSION: The quality framework proposed by AuSPEN is intended to provide a practical structure for clinical and organizational aspects of HPN service delivery to reduce variation in care and improve quality of care and represents the initial step towards development of a national model of care for HPN patients in Australia. While developed for implementation in Australia, the evidence-based framework also has relevance to the international HPN community.

Evaluation of Y-site compatibility of home total parenteral nutrition and intravenous loop diuretics.

In chronic kidney disease (CKD), the design of the parenteral nutrition (PN) regimen becomes more challenging where only individualized PN is appropriate, coupled with the increased risk of unintended interactions with diuretic therapy. In an effort to ensure safe therapy in the home, we assessed the physical stability of bespoke PN formulations intended for use in CKD in the simultaneous presence of Y-site compatibility of furosemide and torasemide. The patient's daily needs were determined based on both metabolic demands as well as the demand for fluids.Complete admixtures were subjected to physical stability analysis consisting of visual inspection, a validated light microscope method, pH measurement, zeta potential measurement, and characterization of oily globule size distribution. Y-site compatibility of furosemide and torasemide with the formulated admixtures was also performed.The total parenteral admixture was stable over 7 days at +4°C and 24 h at +25°C and compatible via the Y-line together with furosemide and torasemide over 12 h at +25°C.The stability assessment guarantees the safety and efficiency of home PN with loop diuretics therapy in CKD patients. This means that these patients do not need long hospitalization and they can be safely treated at home. Furthermore, this study proved that torasemide is the same safety diuretic as furosemide, which has a great impact on clinical practice.

Biofilm formation by blood isolates of candida parapsilosis sensu stricto in the presence of a hyperglycidic solution at comparable concentrations of total parenteral nutrition

Abstract INTRODUCTION: Administration of total parenteral nutrition (TPN) via catheters increases the risk for candidemia from Candida parapsilosis. METHODS: C. parapsilosis sensu stricto blood isolates were evaluated for ability total biomass biofilm formation and morphogenesis in presence of glucose at TPN equivalent concentrations. RESULTS: Biofilms were increased at high glucose concentrations (25-30%) compared to the control medium. Significant increase in filamentous forms was observed in cultures with 30% glucose. CONCLUSIONS: Biofilm formation by C. parapsilosis sensu stricto in hyperglycidic medium may contribute to its pathogenic potential for fungemia related to TPN catheters.

Nutritional support and parenteral nutrition in cancer patients: an expert consensus report

Background. Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. Methods. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. Results. Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. Conclusions. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients

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Survival and nutritional factors on home parenteral nutrition (HPN): Our initial experience.

PURPOSE: Home parenteral nutrition (HPN) has been proposed as the treatment of choice in patients suffering from intestinal failure (IF) and has been claimed to improve survival and quality of life either in patients with benign disorders or even in those with malignancies. The purpose of the present analysis was to report characteristics and outcomes of adult patients with IF receiving HPN in Greece. METHODS: Patients that received HPN between 2011 and 2017 were included in this retrospective analysis. Characteristics of the included patients, cause of HPN, duration of HPN, route of HPN administration, complications as well as survival rates were recorded. RESULTS: A total of 189 patients were included in the present analysis. Of these, 163 (86.3%) suffered from cancer while 26 (13.7%) received HPN due to non-malignant diseases. The reported mortality was 74.6% while overall severe complications rate was 77%. CONCLUSIONS: According to the findings of our study, HPN seems to have beneficial effect but it should be considered with caution by the physicians who should take into account the indications of each patient to receive parenteral nutrition, the underlying disease and prognosis and the access of each patient to home care services.

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos / Nutritional support and parenteral nutrition in cancer patients: An expert consensus report

La desnutrición es un problema médico frecuente de los pacientes oncológicos que impacta de forma negativa en la calidad de vida. El objetivo de este trabajo es analizar y dar respuesta a diferentes cuestiones relacionadas con el manejo nutricional de un paciente oncológico en la práctica clínica. Un grupo multidisciplinar de expertos en Oncología Médica, Endocrinología y Nutrición y Farmacia elaboró una lista de temas relacionados con el estado nutricional del paciente oncológico agrupados en 3 bloques: soporte nutricional, nutrición parenteral (NP) y NP domiciliaria (NPD). Se realizó una revisión de la literatura que incluyó artículos publicados en español, inglés y francés hasta abril de 2017. Este consenso destaca diferentes elementos clave que ayudarán a los médicos a normalizar el manejo del estado nutricional del paciente oncológico en la práctica clínica, estableciendo pautas comunes de indicación, monitorización, requerimientos nutricionales y vías de acceso a la NP

Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos Nutritional support and parenteral nutritio / Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report

Introducción: la malnutrición es un problema médico frecuente de los pacientes oncológicos que impacta de forma negativa en la calidad de vida. Objetivo: analizar y dar respuesta a diferentes cuestiones a la hora de afrontar el manejo nutricional de un paciente oncológico en la práctica clínica. Métodos: un grupo multidisciplinar de expertos en Oncología Médica, Farmacia y Nutrición elaboró una lista de temas relacionados con el estado nutricional del paciente oncológico que fueron agrupados en tres bloques: soporte nutricional; nutrición parenteral (NP); y nutrición parenteral domiciliaria (NPD) en el paciente oncológico. Se realizó una revisión de la literatura que incluyó artículos publicados en español, inglés y francés hasta febrero de 2017. El documento se estructuró como un cuestionario con aquellas preguntas que, según el criterio del panel, podrían generar mayor controversia o duda. Resultados: de las 18 cuestiones abordadas, 9 versaron sobre el soporte nutricional: 5 relacionadas con la NP y 4 trataron sobre la NPD. Dentro de las recomendaciones del panel destacar que, en el paciente oncológico, la NP está indicada principalmente cuando no es posible el uso del tubo digestivo y/o la alimentación oral y/o nutrición enteral no es suficiente o posible. Además, el objetivo de la NPD es mejorar o mantener, el estado de nutrición de un paciente en el ámbito domiciliario. Conclusiones: esta revisión constituye una herramienta para oncólogos y especialistas responsables del manejo nutricional del paciente con cáncer (AU)

Background: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. Objective: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. Methods: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel’s criteria, could generate greater controversy or doubt. Results: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/ or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. Conclusions: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients (AU)

Estimación del coste de la nutrición parenteral domiciliaria en España / Cost analysis of home parenteral nutrition in Spain

Introducción: la nutrición parenteral domiciliaria (NPD) mejora la calidad de vida de los pacientes permitiéndoles recibir nutrición en su domicilio y facilitando su integración social y laboral. Objetivo: analizar el coste de la NPD en España. Métodos: se realizó una revisión bibliográfica de los Registros de NPD en España (años 2007-2014), elaborados por el Grupo NADYA-SENPE. Se analizó la evolución de: pacientes que requerían NPD, episodios/paciente por los que se administró NPD, duración media de los episodios, vías de acceso y tasa de complicaciones. Se estimó el consumo y coste de la NPD. Los pacientes fueron agrupados según patología: benigna o maligna. Los costes directos (Euros, 2015) incluidos fueron: bolsas administradas, vías de acceso y complicaciones. Resultados: el número de pacientes que recibió NPD aumentó a lo largo de los años (2007: 133 pacientes; 2014: 220 pacientes). El número medio de episodios/paciente osciló entre 1-2 episodios/año y su duración media disminuyó (2007: 323 días; 2014: 202,8 días). Las vías de acceso más utilizadas fueron los catéteres tunelizados y las complicaciones sépticas fueron las más comunes. El coste directo anual medio por paciente se estimó en 8.393,30 Euros y 9.261,60 Euros para patología benigna y maligna, respectivamente. Considerando que, en 2014, 220 pacientes requirieron NPD, el coste anual fue 1.846.524,96 Euros (1.389.910,55 Euros debidos a la fórmula de NPD) y 2.037.551,90 Euros (1.580.937,50 Euros debidos a la fórmula de NPD) para patología benigna y maligna respectivamente. Conclusiones: estos resultados sirven de base para futuros análisis económicos de la NPD y para establecer estrategias de priorización eficiente de recursos disponibles (AU)

Introduction: Home parenteral nutrition (HPN) improves quality of life, allowing patients to receive nutrition at home and providing a social and labor integration to these patients. Objective: To assess the direct costs of HPN in adult population in Spain. Methods: A literature review of the records of HPN in Spain, carry out by NADYA-SENPE Group (years 2007-2014), was performed. The analysis included the evolution of: patients requiring HPN, number of episodes/patient, mean duration of episodes, description of delivery routes and complications rate. HPN consumption and cost were estimated. Patients were grouped according to their pathological group: benign and malignant. Direct costs (Euros , 2015) included were: parenteral nutrition bags, delivery sets and costs due to complications. Results: The number of patients who receive HPN has increased over years (2007: 133 patients; 2014: 220 patients). The average number of episodes per patient ranged from 1-2 episodes per year. The average duration of those episodes decreased (2007: 323 days; 2014: 202.8 days). Tunneled catheters were the most used and septic complications were the most common. The average annual cost per patient was estimated at Euros 8,393.30 and Euros 9,261.60 for benign and malign disease respectively. Considering that 220 patients required HPN in 2014, an annual cost of Euros 1,846.524.96 (Euros 1,389,910.55 directly due to HPN) and Euros 2,037,551.90 (Euros 1,580,937.50 directly due to HPN) was estimated for patients with benign and malignant pathologies respectively. Conclusions: These results can be used to develop future economic evaluations on HPN and to establish effi cient prioritization strategies to allocate available resources (AU)

Diseño y puesta en marcha de un protocolo de tratamiento antimicrobiano domiciliario endovenoso en atención primaria: experiencia en un hospital de segundo nivel / Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital

Introducción. Los programas de tratamiento antimicrobiano domiciliario endovenoso (TADE) suponen una buena opción asistencial para una gran variedad de enfermedades infecciosas. Nuestro objetivo fue diseñar e implementar un programa TADE en el área de influencia de un hospital de segundo nivel, en el que no se dispone de una Unidad de Hospitalización a domicilio (UHD), siendo necesario la estrecha colaboración entre los equipos de atención hospitalaria y primaria, describir la cohorte de pacientes, analizar las pautas de tratamiento antimicrobiano y evaluar los factores de riesgo asociados al reingreso y la mortalidad. Métodos. Estudio de cohortes prospectivo de los pacientes incluidos en el TADE entre el 1 de Enero de 2012 al 31 mayo de 2015. Resultados. Se registraron un total de 98 episodios. La edad media fue 66 años. La comorbilidad más frecuente fue la inmunosupresión (33,67%), con una media global del índice de Charlson de 5,21 ± 3,09. El foco de infección más frecuente fue el respiratorio (33,67%). Se consiguió aislamiento microbiológico en 58 pacientes (59,18%), siendo Escherichia coli el más frecuentemente aislado (25%). La media de días de administración de antimicrobianos fue 10,42 (± 6,02 DE, rango 2-40), siendo los carbapenémicos (43,48%) los más usados. Ochenta y seis pacientes (87,75%) cumplimentaron el tratamiento. Treinta y dos pacientes (32,65%) reingresaron en los siguientes 30 días al alta y siete (7,14%) fallecieron. Se encontró asociación estadísticamente significativa con el reingreso con las variables edad (p = 0,03), portador de reservorios (p = 0,04) e interrupción del tratamiento RI (p<0,05). Conclusiones. Este programa es pionero en España en la administración de TADE sin el soporte de una UHD, lo que podría permitir optimizar la red de recursos hospitalarios y de Atención Primaria disponibles. No obstante, los datos del proyecto piloto son pobres en optimización de la elección del antibiótico, secuenciación, desescalamiento y duración (AU)

Introduction. Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. Material and methods. Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015. Results. During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05). Conclusions. This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration (AU)

Pregnancy is possible on long-term home parenteral nutrition in patients with chronic intestinal failure: Results of a long term retrospective observational study.

BACKGROUND & AIMS: Home parenteral nutrition (HPN) improves survival and quality of life in patients with chronic intestinal failure (IF). Few cases of pregnancy on HPN have been published. The aim of this study was to report pregnancy cases on long-term HPN in benign IF. METHODS: This retrospective study included all pregnant patients on HPN from 4 HPN referral centers. Data on demographics, ongoing pathology, HPN type, maternal and newborn complications were collected. RESULTS: From 1984 to 2014, 21 pregnancies occurred in 15 patients (short bowel syndrome (n = 11), motility disorders (n = 3), mucosal disease (n = 1)) of whom 14 occurred after 2010. Median follow-up was 12 years. Median HPN duration before pregnancy was 8 years. HPN was adapted monthly during pregnancy, with close monitoring and supplementations. Energy intake was regularly increased and median maternal weight gain was 10 kg. Median age at the first pregnancy was 27 years. In 55% of cases, the newborn was preterm. Maternal complications occurred in 67% of cases (mainly due to underlying disease or HPN complications). There were 3 post-partum hemorrhages and 6 hypotrophic newborns. Eighteen infants were healthy and 2 chronic intestinal pseudo-obstruction (CIPO) were suspected. CONCLUSION: Our series, the largest reported to date, shows that pregnancy is possible in HPN patients but the complication rate is high. A specific support is necessary, particularly in CIPO patients. As pregnancies have increased over the last 15 years, physicians practicing in HPN referral centers should be aware of the need for implementing a specific multidisciplinary monitoring in HPN patients considering pregnancy.

Economic Evaluation of Home Total Parenteral Nutrition

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.

Home parenteral nutrition: a multi-professional approach.

This article explores the complexities of home parenteral nutrition (HPN) and how it has developed as a home therapy. It examines the various indications and treatment options, discussing access and the associated complications. The relationship between the multiprofessional team is paramount to the success of the therapy. Working in partnership with home-care providers is also discussed. It gives an overview of patients receiving parenteral nutrition at home and the impact it has on their lives.