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1.
Medicine (Baltimore) ; 98(21): e15747, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124957

RESUMO

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.


Assuntos
Nutrição Parenteral Total no Domicílio/métodos , Insuficiência Renal Crônica/terapia , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/química , Administração Intravenosa , Incompatibilidade de Medicamentos , Furosemida/administração & dosagem , Furosemida/química , Humanos , Concentração de Íons de Hidrogênio , Tamanho da Partícula , Torasemida/administração & dosagem , Torasemida/química
2.
Clin. transl. oncol. (Print) ; 20(5): 619-629, mayo 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-173539

RESUMO

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


No disponible


Assuntos
Humanos , Desnutrição/etiologia , Desnutrição/terapia , Neoplasias/complicações , Apoio Nutricional/métodos , Nutrição Enteral , Nutrição Parenteral Total no Domicílio
3.
J BUON ; 23(1): 244-247, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29552791

RESUMO

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.


Assuntos
Neoplasias/complicações , Transtornos Nutricionais/terapia , Nutrição Parenteral Total no Domicílio/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(supl.1): 19-23, mar. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-172973

RESUMO

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


Assuntos
Humanos , Apoio Nutricional/métodos , Nutrição Parenteral/métodos , Neoplasias/dietoterapia , Desnutrição/dietoterapia , Qualidade de Vida , Padrões de Prática Médica , Nutrição Parenteral Total no Domicílio/métodos , Nutrição Enteral/métodos , Terapia Nutricional/métodos
5.
Nutr. hosp ; 35(1): 224-233, ene.-feb. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-172111

RESUMO

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)


Assuntos
Humanos , Neoplasias/dietoterapia , Apoio Nutricional/métodos , Nutrição Parenteral , Desnutrição/dietoterapia , Padrões de Prática Médica , Nutrição Parenteral Total no Domicílio , Soluções de Nutrição Parenteral/farmacologia
6.
Nutr. hosp ; 34(2): 271-276, mar.-abr. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-162426

RESUMO

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)


Assuntos
Humanos , Masculino , Feminino , Nutrição Parenteral no Domicílio , Nutrição Parenteral no Domicílio/economia , Custos e Análise de Custo/métodos , Qualidade de Vida , Custos Diretos de Serviços/tendências , Espanha/epidemiologia , Cateteres/economia , Comorbidade , Análise Estatística , Nutrição Parenteral Total no Domicílio/efeitos adversos , Nutrição Parenteral Total/efeitos adversos
7.
Rev. esp. quimioter ; 30(1): 19-27, feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159555

RESUMO

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)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Protocolos Clínicos/normas , Carbapenêmicos/uso terapêutico , Fatores de Risco , Infusões Parenterais , Nutrição Parenteral Total no Domicílio , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Estudos de Coortes , Comorbidade , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/normas , Estudos Prospectivos , Análise Multivariada
8.
Clin Nutr ; 36(4): 1165-1169, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27624996

RESUMO

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.


Assuntos
Enteropatias/terapia , Fenômenos Fisiológicos da Nutrição Materna , Nutrição Parenteral Total no Domicílio/efeitos adversos , Complicações na Gravidez/terapia , Gravidez de Alto Risco , Adulto , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Seguimentos , França/epidemiologia , Humanos , Recém-Nascido , Enteropatias/fisiopatologia , Pseudo-Obstrução Intestinal/epidemiologia , Pseudo-Obstrução Intestinal/etiologia , Masculino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Síndrome do Intestino Curto/fisiopatologia , Síndrome do Intestino Curto/terapia
10.
Br J Community Nurs ; Suppl Nutrition: S24, S26-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26087204

RESUMO

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.


Assuntos
Enteropatias/dietoterapia , Enteropatias/enfermagem , Nutrição Parenteral Total no Domicílio/métodos , Nutrição Parenteral Total no Domicílio/enfermagem , Equipe de Assistência ao Paciente/organização & administração , Humanos , Relações Interprofissionais
12.
Am J Clin Nutr ; 101(1): 79-86, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25527753

RESUMO

BACKGROUND: Home parenteral nutrition (HPN) and intestinal transplantation (ITx) are the 2 treatment options for irreversible intestinal failure (IF). OBJECTIVE: This study simulated the disease course of irreversible IF and both of these treatments--HPN and ITx--to estimate the cost-effectiveness of ITx. DESIGN: We simulated IF treatment in adults as a discrete event model with variables derived from the Dutch Registry of Intestinal Failure and Intestinal Transplantation, the Intestinal Transplant Registry, hospital records, the literature, and expert opinions. Simulated patients were enrolled at a rate of 40/mo for 10 y. The maximum follow-up was 40 y. Survival was simulated as a probabilistic function. ITx was offered to 10% of patients with <12 mo of remaining life expectancy with HPN if they did not undergo ITx. Costs were calculated according to Dutch guidelines, with discounting. We evaluated the cost-effectiveness of ITx by comparing models conducted with and without ITx and by calculating the cost difference per life-year gained [incremental cost-effectiveness ratio (ICER)]. RESULTS: The average survival was 14.6 y without ITx and 14.9 y with ITx. HPN costs were €13,276 for treatment introduction, followed by €77,652 annually. The costs of ITx were ∼€73,000 during the first year and then €13,000 annually. The ICER was €19,529 per life-year gained. CONCLUSION: Our simulations show that ITx slightly improves survival of patients with IF in comparison with HPN at an additional cost of €19,529 per life-year gained.


Assuntos
Enteropatias/cirurgia , Intestinos/transplante , Modelos Biológicos , Centros Médicos Acadêmicos , Adulto , Estudos de Coortes , Simulação por Computador , Análise Custo-Benefício , Progressão da Doença , Seguimentos , Custos de Cuidados de Saúde , Humanos , Enteropatias/economia , Enteropatias/mortalidade , Enteropatias/fisiopatologia , Intestinos/fisiopatologia , Registros Médicos , Países Baixos , Nutrição Parenteral Total no Domicílio/economia , Sistema de Registros , Índice de Gravidade de Doença , Análise de Sobrevida
13.
Nutr Clin Pract ; 29(5): 681-5, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25038058

RESUMO

UNLABELLED: Previous studies have suggested a high prevalence of vitamin D deficiency in patients receiving long-term home parenteral nutrition (HPN). The aim of this study was to determine the prevalence and predictors of vitamin D deficiency in long-term HPN patients. METHODS: A retrospective, institutional review board-approved study was performed on all adult patients followed by the Cleveland Clinic HPN program receiving HPN therapy >6 months between 1989 and 2013 with a 25-(OH) D3 level reported. Patients were categorized by serum vitamin D status as follows: sufficient, insufficient, and deficient with respective 25-(OH) D3 levels of ≥30 ng/mL, 20-30 ng/mL, and <20 ng/mL. RESULTS: Seventy-nine patients were categorized based on serum vitamin D status as follows: 35 (44.3%) deficient, 24 (30.4%) insufficient, and 20 (25.3%) sufficient. The mean age of the cohort at the initiation of HPN was 52.0 ± 12.7 years, and 26 (32.9%) were male. The median HPN duration was 39 months, and the most common indication was inflammatory bowel disease (36.7%). Most (82.3%) patients had at least 1 prescription of oral vitamin D supplement (50,000 International Units) during this time. History of jejunal resection (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.9-15.1; P = .002) and lack of oral vitamin D supplementation (OR, 0.7; 95% CI, 0.52-0.93; P = .038) were the strongest predictors of vitamin D deficiency. CONCLUSION: Vitamin D deficiency is common among patients receiving long-term HPN despite oral supplementation.


Assuntos
Suplementos Nutricionais , Nutrição Parenteral Total no Domicílio/efeitos adversos , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Vitaminas/sangue , Adulto , Feminino , Humanos , Doenças Inflamatórias Intestinais/terapia , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/etiologia , Vitaminas/uso terapêutico
14.
Nutr. hosp ; 29(6): 1360-1365, jun. 2014. graf
Artigo em Espanhol | IBECS | ID: ibc-143880

RESUMO

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones (AU)


Objective: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. Methodology: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Results: Year 2010: 184 patients from 29 hospitals, representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD. During 2012, 203 patients from 29 hospitals, representing a rate of 4.39 patients/million inhabitants/year 2012, a total of 211 episodes were recorded NPD. Conclusions: We observe an increase in registered patients with respect to previous years. Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications (AU)


Assuntos
Humanos , Nutrição Parenteral Total no Domicílio/estatística & dados numéricos , Terapia Nutricional/estatística & dados numéricos , Neoplasias/dietoterapia , Registros de Doenças/estatística & dados numéricos , Espanha/epidemiologia , Transtornos Nutricionais/dietoterapia
15.
J Pediatr Gastroenterol Nutr ; 59(2): 177-81, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24796804

RESUMO

Patients receiving home parenteral nutrition (HPN) are at particularly high risk of meticillin-sensitive Staphylococcus aureus (MSSA) catheter-related bloodstream infections (CRBSI). We developed a multidisciplinary enhanced care pathway encompassing a number of minimal cost interventions involving line/exit site care, training for staff and parents, multidisciplinary discharge planning, and monitoring compliance. Implementation reduced the mean rates of MSSA CRBSI (from 0.93, 95% CI 0.25-1.61, to 0.23, 95% CI -0.06 to 0.52, per 1000 parenteral nutrition [PN] days) and all-cause CRBSI (from 1.98, 95% CI 0.77-3.19, to 0.45, 95% CI 0.10-0.80, per 1000 PN days). A similar approach could be applied to preventing health care-associated infections in other complex, vulnerable patient groups.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Nutrição Parenteral Total no Domicílio/efeitos adversos , Nutrição Parenteral no Domicílio/efeitos adversos , Staphylococcus aureus , Adolescente , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/microbiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Nutrição Parenteral no Domicílio/métodos , Nutrição Parenteral Total no Domicílio/métodos
16.
Hu Li Za Zhi ; 61(2 Suppl): S33-40, 2014 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-24682946

RESUMO

BACKGROUND & PROBLEMS: According to current surveys conducted between September and December 2011, the accuracy of primary caregiver-administered Home Total Parenteral Nutrition Care (HTPNC) was 62.0%. Further, nursing staffs provide instruction on HTPNC to only 22.2% of caregivers responsible for administering HTPNC. Main related causes were: (1) difficult to comprehend health education tools; (2) inconsistent nursing guidelines; (3) a lack of relevant standard operating procedures; and (4) poor caregiver adoption of TPN skills. PURPOSE: This project was developed to (1) increase the accuracy of primary caregiver-administered HTPNC to 90% and (2) increase the percentage of nurse-administered HTPNC to 90%. RESOLUTIONS: We developed appropriate nursing guidelines, created a health education CD-ROM with input from a cross-disciplinary team and total parenteral nutrition focus group, designed reusable teaching model aids for repetitive practice, and held regular group health education sessions. RESULTS: The nursing staff HTPNC instruction rate increased to 100%. Caregiver HTPNC implementation accuracy increased to 100% prior to patient discharge. CONCLUSIONS: This approach was successful in achieving its stated goals. Further, using reusable teaching model aids may reduce caregiver anxiety and increase caregiver confidence. The greatest benefit of this project was its extension of teaching model aids to relevant units, allowing for routine monitoring by the department of nursing quality management.


Assuntos
Cuidadores/educação , Educação em Saúde , Nutrição Parenteral Total no Domicílio , Humanos , Ensino
17.
Nutr. hosp ; 28(4): 1121-1128, jul.-ago. 2013. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-120282

RESUMO

Aims: To assess the degree of satisfaction of caregivers of children with gastrostomy tube (GT) feeding through the structured questionnaire SAGA-8. Secondly, to evaluate if the parental satisfaction degree was related to several independent variables. Methods: A cross-sectional observational study was performed in 92 caregivers of children with GT feeding and chronic diseases. The following data was obtained: caregiver satisfaction with GT feeding (SAGA-8), age at GT placement, anthropometric data, length and mode of nutritional support, family demographic characteristics and caregiver psychological status. Results: All primary caregivers were mothers. High satisfaction with GT feeding was expressed by 82.6% of families. The simplicity of the system was emphasized by 87%, and 85.9% were very satisfied with the support received from the hospital staff. 73.9% of mothers acknowledged their child's nutritional status had improved and 89.1% rated the enhancement family's overall situation. Moreover, 75% of mothers reduced feeding-time, and 68.5% reported less respiratory infections. Finally, 71.7% of mothers recognized that they would have implemented this technique earlier. Caregiver satisfaction was positively correlated with age at GT placement and length of treatment, and both variables explained the 19.4% of the satisfaction variance. No correlation with anthropometric data, nutrition support mode, family demographic characteristics or caregiver psychological status was observed. Conclusions: The SAGA-8 questionnaire is a simple, specific, straight-forward tool to evaluate parental/caregiver degree of satisfaction with GT feeding and facilitates effective monitoring of the intervention. Lengths of HEN and precocious age at GT placement are responsible for most of parental satisfaction (AU)


Objetivos: Valorar el grado de satisfacción de los cuidadores de niños con alimentación mediante gastrostomía aplicando el cuestionario estructurado SAGA-8. Segundo, evaluar si la satisfacción parental guarda relación con diversas variables independientes. Métodos: Se realizó un estudio observacional, transversal en 92 cuidadores de niños con enfermedades crónicas que recibían alimentación mediante gastrostomía. Se analizaron los siguientes datos: satisfacción de los cuidadores con la alimentación por gastrostomía (SAGA-8), edad de implantación de la gastrostomía, parámetros antropométricos, tiempo de soporte nutricional, características demográficas familiares y estado psicológico del cuidador. Resultados: Todos los cuidadores eran madres. La mayoría (82,6%) manifestaron una elevada satisfacción con la alimentación mediante gastrostomía. El 85,9% resaltó la sencillez de la técnica sintiéndose el 85,9% muy satisfecha con el apoyo ofrecido por el centro. Un 73,9% de las madres percibió mejoría nutricional en su hijo, señalando el 89,1% un mayor bienestar familiar. Además, el 75% de las madres comunicaron una disminución en el tiempo de alimentación y el 68,5% una reducción en la morbilidad respiratoria. Finalmente, el 71,7% de las madres reconoció que hubieran aceptado antes el procedimiento. La satisfacción se correlacionó significativamente con la edad de implantación de la gastrostomía y con la duración del soporte nutricional, explicando ambos factores el 19,4% de la varianza de la satisfacción. No se encontró correlación con datos antropométricos, tipo de soporte nutricional, características demográficas familiares ni con el estado psicológico del cuidador. Conclusiones: El cuestionario SAGA-8 es sencillo, específico y fácil de aplicar para evaluar el grado de satisfacción de los padres/cuidadores con la alimentación mediante gastrostomía contribuyendo a su monitorización. La duración del soporte nutricional y la precocidad en la implantación de la gastrostomía son los responsables principales de la satisfacción de los cuidadores (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Gastrostomia/métodos , Nutrição Parenteral Total no Domicílio/estatística & dados numéricos , Assistência Domiciliar/psicologia , Satisfação do Paciente/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Qualidade de Vida , Perfil de Impacto da Doença
18.
Pflege Z ; 66(4): 226-30, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-23634549

RESUMO

In Germany, the number of patients who receive artificial respiration in their own home is increasing. One reason for long time ventilation is the rise of technical possibilities. Bringing "intensive care" to the home of people challenges original understandings of home care. While intensive care and artificial respiration are technology-oriented, home-care is social-oriented, respecting the familiar environment of the patient. An international literature review reveals that research has been done by investigating the experiences of relatives and patients but not those of nurses. The few studies with a focus on nurses relate to themes of privacy and how to set limits. In Germany, not one study could be found that dealt with the question of how nurses experience artificial respiratory care in patients' homes. Considering the involved changes of care, the question rises, how nurses experience artificial respiratory care in the home of patients. This research is explorative and allows an insight into what home care is like when technology comes in. The exploration is based on eight narrative interviews with nurses who are experiencing respiratory care for patients in their home. The findings reveal professional challenges nurses have to face when caring for patients who are dependent on technological devices. The relatives are included in the caring activities and cooperating with them is crucial.


Assuntos
Atitude do Pessoal de Saúde , Cuidados Críticos/psicologia , Serviços Hospitalares de Assistência Domiciliar , Papel do Profissional de Enfermagem/psicologia , Nutrição Parenteral Total no Domicílio/enfermagem , Adulto , Cuidadores/psicologia , Cuidados Críticos/métodos , Currículo , Difusão de Inovações , Educação de Pós-Graduação em Enfermagem , Feminino , Alemanha , Humanos , Entrevista Psicológica , Pessoa de Meia-Idade , Nutrição Parenteral Total no Domicílio/psicologia , Privacidade/psicologia , Relações Profissional-Família , Distância Social , Meio Social
19.
Pol Przegl Chir ; 85(12): 681-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24468587

RESUMO

UNLABELLED: The major problem of total parenteral treatment consists in the balancing of the source and dose of the nutritional mixture, so as to not deepen malnutrition with a positive impact on the patients' organism. The aim of the study was to evaluate selected factors that induce hepato-biliary complications in patients treated by means of parenteral nutrition at home. MATERIAL AND METHODS: The retrospective study comprised 70 patients with biochemistry performed every three months. Considering statistical analysis patients were allocated to four groups, depending on the period of treatment. Group A analysis results were based on the activity of aminotransferases, group B on the activity of bilirubin. Both groups A and B were additionally divided into group I where we assigned normal values of control lab results, and group II with improper results after treatment. RESULTS: Differences between groups Ia vs IIa were presented on the basis of the daily supply of glucose: mean- 2.52 vs 3.49 g/kg (p=0.000003), glucose/lipids ratio: mean- 3.76 vs 4.90 g/kg (p=0.0001), daily non-protein energy: mean- 16.73 vs 21.06 kcal/kg (p=0.0001). Differences between groups Ib vs IIb were presented on the basis of the daily supply of glucose: mean- 2.76 vs 3.46 g/kg (p=0.0007), glucose/lipids ratio: mean- 3.98 vs 5.13 g/kg (p=0.01), daily non-protein energy: mean-17.96 vs 20.36 kcal/kg (p=0.04). Based on the above-mentioned analysis the main goal in the prevention of hepatic complications should lead to the reduction of the dose of glucose. Increased glucose supply leads to increased number of hepato-biliary complications. CONCLUSIONS: Based on obtained results we were able to conclude that in case of liver complications associated with parenteral nutrition, proper management consists in the modification of nutritional mixtures (reduction in the daily glucose supply and change in the proportions of extra-protein energy). Such management has the greatest clinical effect. When determining the composition of the nutritional mixture one should adjust the glucose supply, so as to offset both sources of extra-protein energy.


Assuntos
Bilirrubina/metabolismo , Hepatopatias/etiologia , Hepatopatias/prevenção & controle , Desnutrição/prevenção & controle , Soluções de Nutrição Parenteral/análise , Nutrição Parenteral Total no Domicílio/efeitos adversos , Transaminases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Glucose/administração & dosagem , Humanos , Lactente , Lipídeos/administração & dosagem , Fígado/metabolismo , Hepatopatias/metabolismo , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Soluções de Nutrição Parenteral/química , Soluções de Nutrição Parenteral/metabolismo , Proteínas/administração & dosagem , Estudos Retrospectivos , Adulto Jovem
20.
BMJ Case Rep ; 20122012 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-23175013

RESUMO

Tunnelled central venous catheters are commonly used for a variety of indications, including home parenteral nutrition, but are rarely associated with fracture and embolisation; the risk of embolisation is reported to be greater with catheters placed via the subclavian vein rather than the internal jugular route. We report the case of a 64-year-old woman with type 3 (chronic and irreversible) intestinal failure who presented with pain and swelling on infusion of parenteral nutrition through her internal jugular catheter. A chest x-ray showed fracture and embolisation of her catheter into the right ventricle. The embolised portion was retrieved and removed via the femoral route, without complication and the catheter replaced. We discuss causes of line embolisation, and highlight the possibility of embolisation occurring with an internal jugular catheter.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Embolia/diagnóstico , Falha de Equipamento , Migração de Corpo Estranho/diagnóstico , Átrios do Coração , Ventrículos do Coração , Nutrição Parenteral Total no Domicílio/instrumentação , Cateterismo Cardíaco , Ecocardiografia , Embolia/terapia , Feminino , Migração de Corpo Estranho/terapia , Humanos , Veias Jugulares , Pessoa de Meia-Idade , Síndrome do Intestino Curto/terapia
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