Julia Álvarez Hernández

Prevalence and costs of malnutrition in hospitalized dysphagic patients: a subanalysis of the PREDyCES® study

INTRODUCTION dysphagia and malnutrition are conditions that frequently appear together in hospitalized patients. OBJECTIVES the main purpose of this study was to analyze the prevalence of malnutrition in patients with dysphagia included in the PREDyCES study as well as to determine its clinical and economic consequences. METHODS this is a substudy of an observational, cross-sectional study conducted in 31 sites all over Spain. RESULTS 352 dysphagic patients were included. 45.7% of patients presented with malnutrition (NRS-2002 ≥ 3) at admission and 42.2% at discharge. In elderly patients (≥ 70 years old) prevalence of malnutrition was even higher: 54.6% at admission and 57.5% at discharge. Also, prevalence of malnutrition was higher in urgent admissions versus those scheduled (45.7% vs 33.3%; p < 0.05) and when admitted to small hospitals vs. large hospitals (62.8% vs 43.9%; p < 0.001). In-hospital length of stay was higher in malnourished patients compared to those well-nourished (11.5 ± 7.1 days vs. 8.8 ± 6.05 days; p < 0.001), and in malnourished patients a tendency towards increase related-costs was also observed, even though it was not statistically significant (8 004 ± 5 854 € vs. 6 967 ± 5 630 €; p = 0.11). Length of stay was also higher in elderly patients (≥ 70 y/o) vs adults (< 70 y/o). 25% of dysphagic patients and 34.6% of malnourished patients with dysphagia received nutritional support during hospitalization. DISCUSSION these results confirm that in patients with dysphagia, malnutrition is a prevalent and under recognized condition, that also relates to prolonged hospitalizations.

A home enteral nutrition (HEN); Spanish registry of NADYA-SENPE group; for the year 2013

AIM To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS From January 1st to December 31st 2013 data was recorded for the HEN registry and further descriptive and analytical analysis was done. RESULTS In this period 3 223 patients (50.6% men) and a total of 3 272 episodes of HEN were registered in 33 Spanish hospitals. The rate of prevalence was of 67,11 patients/million habitants/ year 2013. A high percentage of patients (98,24%) were older than 14 years. Adults mean age was 69,14 years (sd 17,64) and men were younger than women p-value <0,001. Children mean age was 2,38 years (sd 4,35). The most frequent indication for HEN was neurological disease for children (49,1%). and for adults (60,6%). Gastrostomy was the most used administration route for children (51%) while younger ones were fed with NGT (p-value 0,003) also older adults (48%) were fed with this type of tube (p-value <0,001). The most frequent reasons for cessation of treatment was death, 44,4% were children and 54,7% were adults. CONCLUSIONS The number of patients and hospitals registered increased in the last years while the other variables maintain steady. The registry developed allowing contrasted analysis of data in order to get more information.

Manejo nutricional de la esclerosis lateral amiotrófica: resumen de recomendaciones

Ma Dolores del Olmo García, Nuria Virgili Casas, Ana Cantón Blanco, Francisca Margarita Lozano Fuster, Carmina Wanden-Berghe, Victoria Avilés, Rosana Ashbaugh Enguídanos, Isabel Ferrero López, Juan Bautista Molina Soria, Juan Carlos Montejo González, Irene Bretón Lesmes, Julia Álvarez Hernández y José Manuel Moreno Villares, miembros del Grupo de Trabajo de Ética de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE)

Organization and management of clinical nutrition in Spain. How do we assess the quality of our activities

INTRODUCTION Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. OBJECTIVES To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. METHODS A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. RESULTS The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. CONCLUSIONS There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos

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.espanolIntroduccion: la malnutricion es un problema medico frecuente de los pacientes oncologicos 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 oncologico en la practica clinica. Metodos: un grupo multidisciplinar de expertos en Oncologia Medica, Farmacia y Nutricion elaboro una lista de temas relacionados con el estado nutricional del paciente oncologico que fueron agrupados en tres bloques: soporte nutricional; nutricion parenteral (NP); y nutricion parenteral domiciliaria (NPD) en el paciente oncologico. Se realizo una revision de la literatura que incluyo articulos publicados en espanol, ingles y frances hasta febrero de 2017. El documento se estructuro como un cuestionario con aquellas preguntas que, segun el criterio del panel, podrian 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 oncologico, la NP esta indicada principalmente cuando no es posible el uso del tubo digestivo y/o la alimentacion oral y/o nutricion enteral no es suficiente o posible. Ademas, el objetivo de la NPD es mejorar o mantener, el estado de nutricion de un paciente en el ambito domiciliario. Conclusiones: esta revision constituye una herramienta para oncologos y especialistas responsables del manejo nutricional del paciente con cancer. EnglishBackground: 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.