Home Enteral Nutrition Research Articles

Caregivers' Perspectives on the Slight Recovery of Oral Intake of Home-Dwelling Patients Living With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Study Using Focus Group Interviews.

Swallowing rehabilitation for patients living with a percutaneous endoscopic gastrostomy (PEG) tube for home enteral nutrition (HEN) is poorly documented, and the quality of caregivers' daily lives is also unknown. A qualitative study based on constant comparative analysis was conducted. The study subjects were the caregivers of acquired brain injury survivors residing at home and living with a PEG tube for HEN who had recovered slight oral intake because of swallowing rehabilitation. Interviews were transcribed into anonymous transcripts and analyzed using inductive qualitative analysis. After 2 researchers performed the initial analysis, related concepts were extracted using matrix-based methods. Finally, an audit was conducted to verify the consistency between the data and extracted concepts. Of the 22 caregivers (17 stroke cases and 5 traumatic brain injury cases), 21 were female and 1 was male. The psychological impact on caregivers' daily lives because of the patients' slight recovery of oral intake consisted of 4 concepts: (1) reconstructing and/or strengthening a sense of family belonging, (2) combining oral intake and other rehabilitation, (3) reducing the burden of providing care, and (4) relieving social isolation. Additionally, the evaluation of swallowing function using video endoscopy at every visit led to compliance with eating safety to fit patients' swallowing ability. Slight recovery of patients' oral intake changed the daily lives of emotionally overwhelmed caregivers. The evaluation of swallowing disabilities using video endoscopy for patients with a PEG tube for HEN may reveal recovery of eating function and increase compliance with eating safety.

Community nutrition support for discharged patients

It is important to find the patients with malnutrition or at risk of malnutrition, so that the appropriate nutrition support would be given in time. The nutritional status of inpatients isexamined by various nutrition assessment methods and laboratory indexes. If necessary, when the patient sare discharged the home enteral nutrition therapy should be given under the supervision of community doctors and nurses following the established nutrition support program. With this program the nutritional status can be further improved, the disease recovery and quality of life can be promoted, as well as the economical burden of patients can be reduced. Key words: Nutritional support; Community health services

Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy.

Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period.

Nutritional status and clinical evolution of the elderly in home enteral nutritional therapy: a retrospective cohort study.

Objective to evaluate the clinical and nutritional evolution of elderly patients receiving home enteral nutritional therapy.Method retrospective cohort observational study. Data collection was performed through the analysis of clinical and nutritional records. The demographic, nutritional and clinical variables were analyzed. The sample consisted of elderly patients using home enteral nutritional therapy via the probe or the stomach. For the statistical analysis, the Statistical Package for the Social Sciences program was used, adopting the level of significance of 5%.Results the sample was 218 participants, with a mean age of 76 ± 10.12 years, of which 54.1% were female. The main morbidity was the stroke sequelae. Malnutrition was the nutritional diagnosis and the overall subjective assessment, the main instrument of nutritional evaluation. The route of administration of the most prevalent diet was the nasoenteric/nasogastric tube, however, after one year of follow-up, gastrostomy became the main route. It was observed the predominance of general condition maintenance and the most prevalent clinical outcome was death.Conclusion the majority of patients in home enteral nutrition therapy presented maintenance and / or improvement of clinical and nutritional status. Therefore, this therapy may contribute to a better clinical and nutritional evolution.

Home enteral nutrition in patients with neurological disease in an area of the southeast of Spain

Introduction: malnutrition in patients with neurological disease is very prevalent, worsening their complications and diminishing their quality of life. For that reason, nutritional support can provide a reduction in comorbidities. Over the past years, in Murcia (southeast of Spain), a clinical pathway has been stablished in accordance to the National Home Enteral Nutrition guide (HEN) to optimize this resource and reduce the prescription gap. Objective: to analyze the HEN characteristics in neurological patients in an area of Murcia, before and after the adequacy of the national recommendations. Method: observational cross-sectional study. Analysis and comparison of HEN in health area no. 1 in Murcia in 2010 and 2014. Results: the most prevalent cause for HEN was neurological disease. In 2010, oral nutrition was the most used way compared with 2014, when it had changed to enteral nutrition through feeding tube or ostomy. Non-specific formula was the most frequently used in 2010. However, after the establishment of the clinical pathway there was a reduction in specific enteral formula use, specially hypercaloric and hyperproteic. Conclusions: the implementation of a clinical pathway according to the National HEN guide has caused a change in the reality of artificial nutrition in health area no. 1 in Murcia (Spain), which means a standardization of its use under unified criteria made by specialized professionals. Finally, due to these results, this clinical pathway has been generalized to the rest of the region.

X Jesús Culebras Lecture. Clinical nutrition: from super specialization to community care

Clinical nutrition has evolved in our country from the super-specialization of parenteral nutrition (PN) in the Intensive Care Unit (ICU) up to the community care of health. In the beginning, PN was used in a minimum percentage of hospitalized patients; the development of the enteral nutrition (EN) meant an extension of the beneficiaries to achieve a correct nutritional contribution. By getting involved in the diet code the responsibility was extended to the entire hospitalized population. Artificial nutrition techniques were subsequently extended to the patient's home and consolidated with the inclusion of the home enteral nutrition (HEN) in the Spanish National Health Service (SNS) portfolio. To improve the prevention of malnutrition, after the PREDYCES study, the Multidisciplinary Consensus emerged and later the Alianza Más Nutridos was developed, in which the field of clinical nutrition was extended to Primary Care and nursing homes. The last step is community health care, a strategy that is based on the concept that health is more than the absence of disease along with the need to involve citizens in their own decisions about their lifestyle and how to address health problems.

Blenderized Tube Feedings for Adult Patients on Home Enteral Nutrition: A Pilot Study.

Despite surveys indicating a high prevalence of blenderized tube feeding (BTF) as an alternative to commercial enteral nutrition (EN), there remains a paucity of data regarding use in clinical practice. The objective of the present open-label pilot study was to assess the safety and effectiveness of BTF in adult patients being given home enteral nutrition (HEN). This is an open-label pilot study, in which all participants who had been on traditional EN formulas were changed to BTF for 6 weeks. The Mayo Clinic in Rochester, Minnesota. Twenty individuals gave their consent to participate in the study, with nine completing the 6-week BTF protocol. Weight was measured at baseline and at 6 weeks of BTF use. Participants completed a survey regarding the frequency of BTF use and adverse effects, at baseline and then weekly for 6 weeks. Nine participants with a mean age of 60.6 ± 7.8 years completed the 6-week protocol. BTF use increased from 4.85 ± 2.44 to 6.45 ± 0.82 days per week from week 1 to week 6. The percentage of participants consuming >50% of their calorie intake from BTF increased from 23.1% (3 of 13 participants) at week 1 to 44.4% (4 of 9 participants) at week 6. Six of nine participants experienced weight gain, weight was maintained by one participant, and two participants lost weight (intentionally in one and due to an intolerance of commercial formula in the other). BTF was found to be safe and effective in promoting weight gain in adult participants who required HEN for at least 6 weeks.

Peculiarities the main types of metabolism of students of middle educational institutions depending on the organization of the educational process and public catering

The observing group comprised of 137 students of Secondary School focusing on physico-mathematical sciences at the age of 12.9±1.3 years; the comparison group consisted of 131 students of Secondary School at the age of 12.7±1.2 years. To conduct a sociological study, a special questionnaire was developed, allowing to assess the socio-economic characteristics of the families of the surveyed pupils, the regularity and duration of sport activity, the time spent on compulsory and additional education, home nutrition, etc. The assessment of school meals was carried out using the menu-layouts (14-day approximate menu) and by individual weight method. Anthropometric measurements were conducted. Indicators of fat [total cholesterol, triglycerides, HDL, LDL, apolipoprotein A1 (ApoA1), ApoB and ApoB/ApoA1], protein (total protein, albumin), carbohydrate (glucose) and mineral metabolism (calcium, phosphorus, magnesium, iron) and blood serum concentration of dopamine, leptin and cortisol were determined by biochemical and ELISA methods. When assessing the compliance of the educational regime with the requirements of Sanitary Regulations and Standards 2.4.2.2821-10 at school affording intensive study of various subjects the violations of hygienic requirements for scheduling lessons, the exceedance of weekly load, a large total workload calculated on the subject difficult scale were revealed. It was found out that students of school affording intensive study spend more time on school and out-of-school education while motor activity was significantly reduced. Up to 87.0% of children ate at home irregularly, dry, consumed fast food and snacks. Despite the possibility of choosing a dish the rations actually consumed at school affording intensive study didn't meet the average need for nutrients and energy during breakfast (25% of the established daily need), in terms of the content of macronutrients and energy by 20%, calcium and vitamin B1 by 45-55%, phosphorus by 39%, magnesium by 18%. At school focusing on physico-mathematical sciences the proportion of overweight children was 2.8-fold higher than in general school (19.0 vs 6.0%, OR=3.5, DI=1.4-9.6; p=0.01). The trend towards increased atherogenic structure of the lipid spectrum because of higher blood levels of LDL and lower levels of ApoA1 and HDL (p=0.004-0.02) has been found out. The established features of the main types of metabolism among pupils of school affording intensive study of various subjects have been associated with relatively high concentrations of cortisol, leptin and dopamine (p=0.0001-0.03) that indicated tension of neuroendocrine regulation. Intensification of the learning process in profiled schools in combination with a low level of physical activity, inadequate nutrition and eating disorders up to 3.5 times increases the risk of overweight in schoolchildren against the background of endocrine regulation stress.

Análisis de la vía clínica de nutrición enteral domiciliaria de la Región de Murcia. Consumo y gastos asociados y adecuación a la Guía del Sistema Nacional de Salud

ObjectiveTo analyze the compliance with the Guide for home enteral nutrition (HEN) of the Spanish national health system of the prescriptions made in a specific area (Health Area I of the Region of Murcia) before and after implementation of a clinical pathway based on that guide, and to compare the changes in healthcare costs of diet therapy during the 2007-2014 period in the Regional and National Health system. MethodA descriptive study to quantify compliance with the main criteria of the HEN guide before (2010) and after (2013-2014) implementation of the clinical pathway. Changes in health expenditure and consumption during the 2007-2014 period were also analyzed. ResultsAll markers of compliance with the national HEN guide improved after implementation of the clinical pathway. In addition, Murcia has one of the Spanish lowest expenditures per population, below the national average. ConclusionThe clinical pathway implemented improves compliance with the national guide of prescriptions to patients in the Region of Murcia while containing health resources expenditure and consumption, thus making diet therapy prescription more sustainable.

Enteral nutrition in esophageal cancer patients treated with radiotherapy: a Chinese expert consensus 2018.

Esophageal cancer (EC) patients receiving radiotherapy are at a high risk of malnutrition, which can increase the side effects of radiotherapy, reduce the accuracy and sensitivity of radiotherapy and decrease treatment effect. Therefore, timely and correct nutritional treatment is crucial. To date, however, neither consensus nor guidelines on enteral nutrition (EN) specifically for EC patients receiving radiotherapy exist. Accordingly, an expert consensus conference was held to establish consensus on the use of EN in EC patients receiving radiotherapy. It reflected the opinions of a multidisciplinary group of experts and a review of the current literature, and established common guidelines for nutritional screening and assessment, nutrition counseling, indication for EN, access and formulas of EN, effect evaluation, nutrition plan adjustment, and home enteral nutrition.

Reducing home enteral feed wastage and associated cost saving by an established adult home enteral nutrition team

Studies in the UK in recent years have demonstrated that targeted dietetic time can improve oral nutritional supplement wastage and costs to community NHS services1. It is usual that these projects exclude home enteral nutrition (HEN) prescriptions from audit, yet these also present potential for wasted product. As well as feed waste being a significant cost2, if entire volumes of containers are not used this could present complications in terms of ease of use, storage and safety (notably if changing feed bags to complete regimens).

P154 Analysis of the pediatric home enteral nutrition in Campania region: implementation rates and observed trends during the past 10 years

P154 Analysis of the pediatric home enteral nutrition in Campania region: implementation rates and observed trends during the past 10 years

Paediatric Home Artificial Nutrition in Italy: Report from 2016 Survey on Behalf of Artificial Nutrition Network of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP).

Home Artificial Nutrition (HAN) is a safe and efficacious technique that insures children’s reintegration into the family, society and school. Epidemiological data on paediatric HAN in Italy are not available. Aim: to detect the prevalence and incidence of Home Parenteral Nutrition (HPN) and Home Enteral Nutrition (HEN), either via tube or mouth, in Italy in 2016. Materials and methods: a specific form was sent to all registered SIGENP members and investigators of local HAN centres, inviting them to provide the requested centre’s data and demographics, underlying diseases and HAN characteristics of the patients. Results: we recorded 3403 Italian patients on HAN aged 0 to 19 years from 22 centres: 2277 HEN, 950 Oral Nutritional Supplements (ONS) and 179 HPN programs. The prevalence of HEN (205 pts/million inhabitants) and HPN (16 pts/million inhabitants) has dramatically increased in Italy in the last 9 years. Neurodisabling conditions were the first indication for HEN by tube or mouth while HPN is mainly requested in digestive disorders. Conclusions: HAN is a widespread and rapidly growing treatment in Italy, as well as in other European countries. Awareness of its extent and characteristics helps improving HAN service and patients’ quality of life.

Nepad registry: Changes in clinical practice in the last 17 years

Rationale: The aim is to evaluate if there are changes in the treatment with home enteral nutrition (HEN) in the last 17 years based on the recommendations published from 2010 (ESPGHAN 20101, SENPE 20112).

Cost-effectiveness of different home enteral nutrition formulae categories

Cost-effectiveness of different home enteral nutrition formulae categories

Analysis of pediatric patients with home enteral nutrition of a reference hospital

Analysis of pediatric patients with home enteral nutrition of a reference hospital

Experience of using a semi-elemental formula for home enteral nutrition in children: a french multicenter study

Rationale: The use of semi-elemental diets concerns a small number of children on enteral nutrition whose characteristics have never been reported. Our aim was to describe a cohort of patients on home enteral nutrition with a semi-elemental formula (Peptamen Junior®), including the tolerance and success rate of this product.

Home Enteral Nutrition: Towards a Standard of Care.

The purpose of this overview is to make the case for the establishment and publication of standards for home enteral nutrition (HEN) therapy in adult patients who require a long-term alternative to oral feeding. Overviews can provide a broad and often comprehensive summation of a topic area and, as such, have value for those coming to a subject for the first time. It will provide a broad summation, background and rationale, review specific considerations unique to HEN (tubes, products and supplies) and we describe a recent audit of seven HEN programs which highlights tube and process related challenges. Based on the overview of the literature and our experience with the audit we propose a way forward for best home enteral nutrition care.

A retrospective comparative study of continuous pumping for home enteral nutrition after esophagectomy

Objective: To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy. Methods: The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ(2) test, Fisher exact test and t test, respectively. Results: Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ(2)=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ(2)=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ(2)=39.167, P=0.000). Conclusions: Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.

The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia

European and international guidelines advice against initiating tube-feeding in patients with severe dementia. These recommendations are based on studies with important methodological limitations that evaluated the benefits of artificial nutrition in patients with percutaneous endoscopic gastrostomy almost exclusively in terms of the prolongation of survival. The aims of this study were to assess the harmful effects of home enteral nutrition administered via the nasogastric tube and percutaneous endoscopic gastrostomy in patients with advanced dementia in terms of mechanical, gastrointestinal and metabolic complications, to estimate the survival, to explore the risk factors for mortality and to compare the outcomes of patients with advanced dementia with those of patients without dementia. The retrospective observational study was carried out on 585 consecutive patients of the mean age of 85.6±6.9 years. They were treated using home enteral nutrition from 2010 to 2015 according to follow-up protocols adopted by the Clinical Nutrition Unit of an Italian geriatric research hospital (IRCCS-INRCA, Ancona). Incidence rates of mechanical, gastrointestinal and metabolic complications and survival rates in patients with severe dementia were compared to those in patients without dementia. The Cox proportional hazards model was used to evaluate the mortality risk factors. There was no difference between the incidence rates of complications in patients with severe dementia and those in patients without dementia. The incidence of mechanical complications was 1.35/1000 days for patients without dementia vs. 1.53/1000 days for patients with dementia (p=0.270), the incidence of gastrointestinal complications was 1.30/1000 days for patients without dementia vs. 1.35/1000 days for patients with dementia (p=0.984) and the incidence of metabolic complications was 0.36/1000 days for patients without dementia vs. 0.35/1000 days for patients with dementia (p=0.252). The Kaplan Mailer analyses showed that there was no evidence to support the theses on poorer prognosis of survival of patients with dementia (median survival was 193 days for patients without dementia vs. 192 days for patients with dementia, (p>0.05)). The female gender, advanced age, nasogastric tube, diabetes mellitus and chronic renal failure were identified as risk factors. Subjects whose Geriatric Nutritional Risk Index values were higher had a lower risk of mortality. The discussion on the appropriateness of enteral nutrition in patients with severe dementia is still open. Our results show that, if there is a medical prescription for tube-feeding and a patient's surrogate decision-makers express free and informed consent to the tube-feeding of the patient, enteral nutrition should not be contraindicated a priori if the patient has severe dementia. Regular follow-up is mandatory to guarantee adherence to the therapy and achieve its initial aims and to ensure that the principles of beneficence and nonmaleficence are respected.