[Head and neck cancer patients included at home enteral nutrition by tube]. / Pacientes afectos de neoplasia de cabeza-cuello con nutrición enteral domiciliaria por sonda.

OBJECTIVE: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. METHODS: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. RESULTS: 62 patients were studied (77.4% men; 22.6% women). Age 64 +/- 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 +/- 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. CONCLUSION: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study.

Pacientes afectos de neoplasia de cabeza-cuello con nutrición enteral domiciliaria por sonda / Head and neck cancer patients included at home enteral nutrition by tube

Objetivo: Conocer las características y la evolución de los pacientes diagnosticados de neoplasia de cabeza y cuello (NCC) que precisaron recibir tratamiento de radioterapia y que fueron atendidos en un programa de nutrición enteral por sonda a domicilio (NESD). Análisis del peso en función de administrar la nutrición enteral antes o después del inicio de la radioterapia. Material y métodos: Estudio observacional de pacientes con NCC incluidos en el programa de NESD de nuestro hospital durante 2 años. Variables analizadas: sexo, edad, índice de masa corporal (IMC), índice de Karnofsky (IK), motivo del inicio de soporte nutricional, tipo de sonda para la administración de la nutrición, tipo de fórmula nutricional y aporte calórico prescrito, necesidad de cambio de vía y días de NESD. Resultados: Se incluyeron 62 pacientes (77,4% varones y 22,6% hembras) con una edad media de 64 años ± 10,1 (rango entre 39 y 90). La disfagia fue el motivo principal de colocación de sonda en estos pacientes. Predominio de sonda nasogástrica (67,7%). La fórmula más utilizada fue la polimérica hipercalórica con un aporte calórico de 1.629 ± 267,09 kcal/día. Globalmente, se observó una pérdida de peso en todos los pacientes durante el período de estudio. Sin embargo, aquellos en los que se inició la NESD antes de la radioterapia el IMC no disminuyó. Conclusión: Los pacientes que iniciaron nutrición por sonda con anterioridad al tratamiento oncológico no perdieron peso durante el periodo de estudio (AU)

Objective: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. Methods: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. Results: 62 patients were studied (77.4% men; 22.6% women). Age 64 ± 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 ± 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. Conclusion: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study (AU)

[Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care]. / Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio.

INTRODUCTION: The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. PATIENTS AND METHOD: Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). RESULTS: 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. CONCLUSIONS: The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care.

Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio / Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care

Introducción. Se presenta la experiencia de un hospital universitario terciario urbano en el diseño e implementación de una unidad de hospitalización a domicilio (UHaD) integrada en un Servicio de Medicina Interna y altamente coordinada con los servicios médicos del hospital y la Atención Primaria de salud del entorno hospitalario, que contempla como principales objetivos la promoción de la atención especializada domiciliaria de patologías médicas y la mejora de la coordinación con la Atención Primaria de salud. Pacientes y métodos. Recogida sistemática en todos los pacientes ingresados entre abril 2006 y marzo 2007 en la UHaD de las siguientes variables: edad, sexo, lugar y servicio de procedencia, diagnóstico principal, índice de Barthel y de Charlson, número de visitas al día de enfermería y médicas, destino al alta y equipo médico responsable. El análisis estadístico descriptivo se realizó en abril de 2007. Los resultados se presentan de forma global y diferenciados por equipos (Medicina Interna, Neumología y soporte nutricional). Resultados. Quinientos seis ingresos que correspondían a 390 pacientes con una edad media de 66,5 (18) años, y un 53% mujeres. El índice de Charlson fue de 2 (2,2) y el índice de Barthel de 63,5 (40,4). La estancia media fue de 7,9 (8,2) días. Los principales motivos de ingreso fueron las infecciones y tratamiento antibiótico por vía intravenosa en 153 (30,5%) casos, las agudizaciones de enfermedad pulmonar obstructiva crónica o insuficiencia cardíaca en 107 (21%) casos y la nutrición enteral o parenteral domiciliaria en 102 (20%) casos. Doscientos (39,5%) pacientes al finalizar el ingreso fueron controlados por sus equipos de Atención Primaria, 241 (47,5%) fueron seguidos en consultas del hospital y 45 (9%) retornaron directamente al hospital. Conclusión. La creación de una UHaD para patologías médicas desde el Servicio de Medicina Interna, altamente coordinada con servicios médicos del hospital, especialmente con Urgencias, Neumología y Soporte Nutricional y con la Atención Primaria del entorno hospitalario, facilita la atención especializada domiciliaria de patologías médicas y mejora la coordinación con la Atención Primaria de salud

Introduction. The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. Patients and method. Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). Results. 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. Conclusions. The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care