[Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors]. / Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral.

Introduction: Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % -11.0 % at onset and 16.7 % during TEN-. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.

Introducción: Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

[Clinical and economic implications of disease-related malnutrition in a surgical service]. / Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio quirúrgico.

INTRODUCTION: disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System. PATIENTS AND METHODS: this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed. RESULTS: MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed. CONCLUSION: patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM.

Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery.

BACKGROUND: Knee osteoarthritis is a disease with a high prevalence in our environment, especially in women. Weight loss can improve the quality of life of these patients before surgery. OBJECTIVES: To evaluate the effect of a meal-replacement diet on weight loss, body composition, and the improvement of the quality of life in obese women with knee osteoarthritis pending surgery. METHODS: One branch intervention study was performed over three months on 81 women with a body mass index greater than 30 kg/m2 with knee osteoarthritis before surgery. Patients received a hyperproteic meal-replacement diet with two bottles of an oral nutrition supplement in lunch and dinner (1,035 kcal). Anthropometric parameters, and body composition were measured. The quality of life was assessed by WOMAC and SF-36 test. RESULTS: The mean age of the patients was 62.23 (8.50) years. The percentage of weight loss was 8.23% (4.04). An improvement in the SF-36 total score was observed (basal: 49.35 [20.41], three months: 58.71 [17.07], p < 0.01). There was an improvement in WOMAC test (basal: 49.24% [25.53], three months: 40.59% [21.76], p < 0.01). It was observed that a 10% improvement in the SF-36 test was independently related to weight loss (OR: 1.2 [1.03-1.36], p < 0.02) adjusted by age and changes in body composition. CONCLUSIONS: In women with osteoarthritis of the knee treated with a meal-replacement diet, there is a significant decrease in weight and fat mass with a relative increase of the latter. There is an improvement in the quality of life according to SF-36 and WOMAC. There is an independent relationship between weight loss and SF-36 improvement.

Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery / Influencia de una dieta modificada en la calidad de vida en mujeres con obesidad y artrosis de rodilla antes de la cirugía ortopédica

Background: Knee osteoarthritis is a disease with a high prevalence in our environment, especially in women. Weight loss can improve the quality of life of these patients before surgery. Objectives: To evaluate the effect of a meal-replacement diet on weight loss, body composition, and the improvement of the quality of life in obese women with knee osteoarthritis pending surgery. Methods: One branch intervention study was performed over three months on 81 women with a body mass index greater than 30 kg/m2 with knee osteoarthritis before surgery. Patients received a hyperproteic meal-replacement diet with two bottles of an oral nutrition supplement in lunch and dinner (1,035 kcal). Anthropometric parameters, and body composition were measured. The quality of life was assessed by WOMAC and SF-36 test. Results: The mean age of the patients was 62.23 (8.50) years. The percentage of weight loss was 8.23% (4.04). An improvement in the SF-36 total score was observed (basal: 49.35 [20.41], three months: 58.71 [17.07], p < 0.01). There was an improvement in WOMAC test (basal: 49.24% [25.53], three months: 40.59% [21.76], p < 0.01). It was observed that a 10% improvement in the SF-36 test was independently related to weight loss (OR: 1.2 [1.03-1.36], p < 0.02) adjusted by age and changes in body composition. Conclusions: In women with osteoarthritis of the knee treated with a meal-replacement diet, there is a significant decrease in weight and fat mass with a relative increase of the latter. There is an improvement in the quality of life according to SF-36 and WOMAC. There is an independent relationship between weight loss and SF-36 improvement (AU)

Introducción: la artrosis de rodilla es una enfermedad con alta prevalencia en nuestro medio, especialmente en mujeres. La pérdida de peso puede mejorar la calidad de vida de estas pacientes antes de la cirugía. Objetivos: evaluar el efecto de una dieta de sustitución de comidas en la pérdida de peso, la composición corporal y la mejora de la calidad de vida en mujeres obesas con artrosis de rodilla pendientes de cirugía ortopédica. Métodos: se realizó un estudio de intervención de una rama durante tres meses en 81 mujeres con un índice de masa corporal superior a 30 kg/m2 con artrosis de rodilla antes de la cirugía. Las pacientes recibieron una dieta de sustitución de comidas hiperproteica con dos botellas de un suplemento nutricional oral en almuerzo y cena (1.035 kcal). Se midieron los parámetros antropométricos y la composición corporal. La calidad de vida fue evaluada por WOMAC y la prueba SF-36. Resultados: la edad media de las pacientes fue de 62,23 (8,50) anos. El porcentaje de pérdida de peso fue de 8,23% (4,04). Se observó una mejora en la puntuación total del SF-36 (basal: 49,35% [20,41], tres meses: 58,71% [17,07], p < 0,01). Hubo una mejora en la prueba WOMAC (basal: 49,24% [25,53], tres meses: 40,59% [21,76], p < 0,01). Se observó que una mejora del 10% en la prueba SF-36 que se relaciono independientemente con la pérdida de peso (OR: 1,2 [1,03-1,36], p < 0,02) ajustada por edad y cambios en la composición corporal. Conclusiones: en mujeres con osteoartritis de la rodilla tratada con una dieta de sustitución de comidas hay una disminución significativa en el peso y la masa grasa, con un aumento relativo de esta última. Se observa una mejora en la calidad de vida según SF-36 y WOMAC y existe una relación independiente entre la pérdida de peso y la mejora del SF-36 (AU)

Celulitis periestomal por Magnusiomyces capitatus en una paciente portadora de gastrostomía percutánea / Peristomal cellulitis due to Magnusiomyces capitatus in a woman carrying percutaneous gastrostomy tube

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Continuidad de cuidados, innovación y redefinición de papeles profesionales en la atención a pacientes crónicos y terminales. Informe SESPAS 2012 / Continuity of care, innovation and redefinition of professional roles in the healthcare of chronically and terminally ill patients. SESPAS report 2012

La continuidad asistencial es básica para afrontar las múltiples necesidades de los enfermos crónicos y al final de la vida. Para conseguirla, debemos superar las barreras organizativas de los distintos niveles asistenciales, estableciendo mecanismos de coordinación adecuados. La preocupación por encontrar soluciones efectivas a los problemas que amenazan la continuidad asistencial es creciente, y favorece la constante aparición de estrategias profesionales e institucionales destinadas a mejorarla. En este trabajo se describen algunas de las propuestas destinadas a mejorar la coordinación asistencial en el contexto de la atención primaria, desde el punto de vista de la enfermería, el trabajo social y los cuidados paliativos. Se insiste en aumentar el número y la calidad de las visitas domiciliarias, debido al incremento de pacientes crónicos con multimorbilidad y con necesidades complejas. La efectividad de la atención domiciliaria depende de la regularidad con que el paciente es seguido y de la estabilidad de los programas asistenciales, más que del servicio que se ocupe del seguimiento del paciente o del profesional encargado de las visitas domiciliarias (AU)

Continuity of care is essential to address the multiple needs of the chronically and terminally ill. To achieve this aim, the organizational barriers of the different levels of care must be overcome by establishing appropriate coordination mechanisms. Interest in finding effective solutions to the problems that threaten continuity of care is increasing, favoring the continued development of professional and institutional strategies to improve coordination. The present article explores some of the proposals to improve the coordination of care in primary care settings, from the point of view of nursing, social work and palliative care. Due to the increase in patients with chronic and complex needs and multimorbidity, the number and quality of home visits should be increased. The effectiveness of home care depends on the regularity of follow-up and the stability of the healthcare programs, rather than on the service responsible for monitoring the patient or the professional responsible for home visits (AU)

[Continuity of care, innovation and redefinition of professional roles in the healthcare of chronically and terminally ill patients. SESPAS report 2012]. / Continuidad de cuidados, innovación y redefinición de papeles profesionales en la atención a pacientes crónicos y terminales. Informe SESPAS 2012.

Continuity of care is essential to address the multiple needs of the chronically and terminally ill. To achieve this aim, the organizational barriers of the different levels of care must be overcome by establishing appropriate coordination mechanisms. Interest in finding effective solutions to the problems that threaten continuity of care is increasing, favoring the continued development of professional and institutional strategies to improve coordination. The present article explores some of the proposals to improve the coordination of care in primary care settings, from the point of view of nursing, social work and palliative care. Due to the increase in patients with chronic and complex needs and multimorbidity, the number and quality of home visits should be increased. The effectiveness of home care depends on the regularity of follow-up and the stability of the healthcare programs, rather than on the service responsible for monitoring the patient or the professional responsible for home visits.