Home enteral nutrition in Spain; NADYA registry 2011-2012.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. RESULTS: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist's office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. CONCLUSIONS: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral route.

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía oral.

[Analysis of the relevance and feasibility of quality indicators in nutrition support]. / Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición.

INTRODUCTION: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. OBJECTIVE: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. METHODS: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. RESULTS: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: "identification in artificial nutrition bags, "semi-recumbent position in patient with nasogastric tube feeding" and "basic clinical protocols". Considering the type of indicator: "patient identification in the bags of artificial nutrition (structure)," a semi-incorporated "and" basic clinical protocols (process), and "fulfillment of the caloric goal" (result). CONCLUSION: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Unit.

[A prevalence study of dysphagia and intervention with dietary counselling in nursing home from Seville]. / Estudio de prevalencia de disfagia e intervención con consejo dietético, en residencias de mayores de Sevilla.

INTRODUCTION: The prevalence of swallowing disorders widely varies depending on age and comorbidity. OBJECTIVES: To determine the prevalence of dysphagia and feeding disorders in elderly people living in nursing homes from the province of Seville and assess the effectiveness of dietary counselling. METHODS: We carried out a cross-sectional descriptive study on a population of 3921 residents distributed among 86 nursing homes. At the first phase of the study, we pretended to estimate the prevalence of dysphagia so that we selected 373 residents in 23 nursing homes. At the second phase, a sample of residents with dysphagia was selected, being reassessed a month later after receiving dietary counselling and basic measures for managing dysphagia. RESULTS: The median age was 80 (73.86) years, 60 (17.3%) had dysphagia and 50 (13.4%) had feeding difficulties. Both conditions were significantly (p < 0.05) associated with neurological diseases. Forty (11.3%) presented cerebrovascular accident and 123 (34.8%) dementia. Twelve patients with dysphagia were studied at the second phase, the mean age being 80.6+/-11.9 years, MNA 19 +/- 3, Barthel 24 +/- 27, and dysphagia Karnell level of 3-4 in 75% of the cases. These patients, receiving dietary counselling and basic measures for managing dysphagia, did not improve their intake level, dysphagia or dependency. CONCLUSIONS: The prevalence of dysphagia and feeding difficulties is high among nursing homes residents. The standard measures for controlling dysphagia are little effective in patients with severe dependence or advanced dementia.

[Nutritional value of the diet in healthy pregnant women. Results of a nutrition survey of pregnant women]. / Valor nutricional de la dieta en embarazadas sanas. Resultados de una encuesta dietética en gestantes.

GOAL: The purpose of the present paper is to describe the level of nutritional adequacy of the regular diet of pregnant women belonging to our health-care area. SCOPE: Health-care area of Valme Hospital, Seville. DESIGN: Randomized transversal descriptive study. SUBJECTS: Forty-nine pregnant women during their first trimester. INTERVENTIONS: The daily intake was assessed by means of a 24-hour reminder sheet and a weekly consumption survey. The data obtained were compared with the recommended daily intake of nutrients and with the recommended daily allowances for various foods. At the same time, an anthropometric and basic analysis were also carried out. RESULTS: The calorie intake was as recommended (2,208 +/- 475 kcal/day). The diet contained excessive amounts of proteins (88 +/- 21 g/day) and fat (97 +/- 27 g/day), with a predominance of monounsaturated fats (46.9 +/- 5.5%) over saturated (36.6 +/- 7.2%) or polyunsaturated fats (15.1 +/- 7%), (p < 0.0005). Nonetheless, the diet was short on carbohydrates (44%), fibre (18 +/- 4.9 g/day), calcium (948 +/- 353 mg/day), iron (13.4 +/- 3.1 mg/day) and vitamin B6 (1.1 +/- 0.8 mg/day) (p < 0.0005), and extremely short on folic acid (172 +/- 101 micrograms/day), (p < 0.0005). In the assessment of the diet in terms of daily allowances, this was sufficient in fruit (2.3 +/- 1.8/day), but short on dairy products (1.9 +/- 1.1/day) and extremely short on vegetables (1 +/- 0.4/day), (p < 0.0005). Only 2% of the subjects fulfilled with the recommended daily intake for key vitamins and minerals. The prevalence of obesity (BMI > 30 kg/m2) was 18.4%. CONCLUSIONS: The normal diet of pregnant women in our health-care area is short on calcium, iron, folic acid and dietary fibre, although with an excess of animal protein and fat.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

[Malnutrition in hospitalized patients: a prospective and randomized study]. / Malnutrición en pacientes hospitalizados: estudio prospectivo y aleatorio.

UNLABELLED: Protein-energy malnutrition (PEM), is probably underestimated in our hospitals. We did this study with the aim of knowing the incidence, distribution and evolution of PEM in a University Hospital with 538 beds. MATERIAL AND METHODS: 301 hospitalized patients, randomly selected, were subjected to a nutritional evaluation upon admittance and after 7 days, by determining albumin and body weigh/ideal weight ratio. RESULTS: The age was 56.7 +/- 18.4 years (x +/- SD), the hospital stay was 7.84 +/- 7.12 days, 194 patients were hospitalized in Medical departments and 107 in Surgical or Medical-surgical departments. The incidence of PEM upon admittance was n = 160 (53%): mild in 93 (30.89%), moderate in 56 (18.60%), and severe in 11 (3.65%). The patients who continued to be hospitalized after 7 days were n = 99 (32.89%), and in these patients the incidence of PEM was n = 66 (66.6%): mild in 33 (33.3%), moderate in 30 (30.3%), and severe in 3 (3.3%). The incidence of PEM was higher at more advanced age (p < 0.05), in patients hospitalized in medical departments (p < 0.05) or in those subjected to surgery (p < 0.05). The hospital stay was longer in those patients who presented PEM upon admittance (p < 0.05). CONCLUSIONS: Malnutrition has an increased incidence in hospitalized patients, it is higher in patients of advanced age or subjected to surgery, and it increases during their stay. The existence of malnutrition upon admittance is related to a longer hospital stay.