Home Enteral Nutrition Research Articles

Complications of Home Enteral Nutrition: Mechanical Complications and Access Issues in the Home Setting.

Home enteral nutrition (HEN) is an essential component in the care of patients with an array of underlying etiologies resulting in the inability to meet caloric needs through volitional intake alone. Although some would include oral nutrition supplementation as HEN, for the purposes of this review, the term is limited to a patient's requiring an enteral access device for the delivery of exogenous nutrients. Complications related to such devices remain a difficult problem in the hospital setting, and these issues are often amplified when encountered in the home setting. Focused multidisciplinary teams and close follow-up are essential in optimizing outcomes for patients receiving HEN, but all healthcare providers should have foundational knowledge regarding commonly encountered complications of HEN access and the initial management of these issues.

Parenteral and Enteral Nutrition-From Hospital to Home: Will It Be Covered?

With scientific advances allowing for the safe delivery of parenteral and enteral nutrition in the home setting, challenges have risen with determining how this will be financially feasible for patients. In the United States, the government is one of the major payers for home parenteral and enteral nutrition (HPEN). Thus, it is important for nutrition providers to have an understanding of the Medicare criteria that must be met in order for these services to be covered. It can be difficult for clinicians to sift through these requirements and decipher for whom and when HPEN is covered. As our nutrition science knowledge and delivery continue to grow and evolve, potential barriers to this coverage may arise. This article provides background on those currently on HPEN in the United States, the current Medicare HPEN coverage criteria, and challenges we may face in the future.

Noncompliance/Nonadherence With Home Nutrition Support: An Underrecognized Clinical Dilemma.

Failure to administer enteral nutrition, intravenous fluids, and/or parenteral nutrition solutions can have deleterious effects on patients who have been prescribed such therapies. However, it is not well understood why patients requiring nutrition support would be noncompliant or nonadherent to these often life-benefiting therapies. This article explores these issues in a large home nutrition support population.

Preferences for the attributes of home enteral nutrition (HEN) in Spain. Do caregivers know their patients' preferences?

Establishing a home enteral nutrition (HEN) that is adapted to the patient's needs and preferences can improve their quality of life and adherence, contributing to a higher treatment efficiency, better prognosis and cost reduction. As in most cases, patients need total or partial help from their caregivers, and there is a need for evaluating how well do caregivers know their patients' priorities. Exploring patients' preferences for HEN characteristics in Spain, and the concordance between patients and caregivers. A cross-sectional observational study based on the discrete choice experiment methodology. A set of eight choice scenarios generated from six attributes with two levels each was presented along with an ad hoc questionnaire on the importance and satisfaction with HEN. The relative importance (RI) of each attribute and the patient-caregiver concordance was estimated in every question. One hundred and forty-eight patients participated, and in 77 cases both the patient and the caregiver took the survey. The most important attributes (RI) for HEN were adaptation to comorbidities (33%), tolerability (33%), nutrients and calories (26%) and package characteristics (8%). Patients showed a high degree of satisfaction with the assistance received. Concordance between patient and caregiver was found in every question, being it moderate to good. According to patients, an ideal HEN product would be adaptable to comorbidities, easy to tolerate, providing the necessary nutrients and calories, with an easy to handle package. Caregivers know well their patients' preferences.

MON-P221: Prevalence of Home Parenteral and Enteral Nutrition in the United States

MON-P221: Prevalence of Home Parenteral and Enteral Nutrition in the United States

Predictive factors of catheter-related bloodstream infection in patients receiving home parenteral nutrition.

The aim of this study was to determine the incidence and predictive factors of catheter-related bloodstream infections (CRBSIs) acquired through a central venous catheter for delivery of home parenteral nutrition (HPN) therapy among a patient population in Thailand. This retrospective review was conducted with adult patients with intestinal failure who received HPN from October 2002 to April 2014, at Ramathibodi Home Parenteral and Enteral Nutrition Referral Center in Bangkok. Seventy-two patients (45.8% male, mean age 56.2±15.7y) were included in the analysis. Incidence of CRBSIs was 1.47 per 1000 catheter days. Over the 12-y period, there were 21 CRBSIs among 10 patients. There were 26 pathogens isolated from these CRBSIs, mostly coagulase-negative staphylococci. Univariate Poisson regression analysis revealed that the incidence rate ratio of CRBSIs was significantly higher in patients who used an implanted port (compared with tunneled catheter), alcohol-based povidone-iodine solution as disinfectant (compared with 2% chlorhexidine gluconate in 70% isopropyl alcohol), cyclic HPN infusion (compared with continuous HPN), and hospital-based compound HPN formulations (compared with 3-in-1 commercial formulations). Furthermore, longer duration of HPN (>250d) was associated with CRBSIs. Multivariate analysis revealed that longer duration of HPN, cyclic HPN, and hospital-based compound HPN were significantly associated with CRBSIs. CRBSI is a significant complication in patients receiving long-term HPN. Individualized therapy with a multidisciplinary team in centers with HPN management expertise is required. Careful selection of the catheter type and HPN formulation for each patient is necessary to best meet patient requirements and minimize HPN-related complications. Strict compliance by patients and caregivers with evidence-based instructions together with supervision by well-trained HPN providers is the most effective strategy to prevent CRBSIs.

Effect of Hospital to Home nutrition management model on postoperative clinical outcomes of patients with laryngeal carcinoma.

The purpose of this investigation was to determine the effectiveness of a Hospital to Home (H2H) nutrition management model on the postoperative clinical outcomes of patients with laryngeal carcinoma. Eighty-six patients with laryngeal carcinoma were randomly divided into an observation (H2H nutrition management) or control group (routine nutrition management). The ratios of urine lactulose to mannitol (L/M) in serum orexin-A levels of patients in both groups on the 1st postoperative day were significantly higher than before surgery; these levels decreased from the 7th and 14th postoperative day, but remained higher than before surgery (p<0.05). There was no statistical difference in the L/M and orexin-A levels between the two groups before surgery and on the 1st postoperative day; those indexes were statistically decreased in the observation as compared to the control group on the 7th and 14th postoperative days. The nutritional status grades were evaluated using a Patient-Generated Subjective Global Assessment (PG-SGA) quantitative scoring at 3 months after surgery and showed that malnutrition rates were significantly lower in the observation as compared to the control group. Serum levels of hemoglobin (Hb), albumin (Alb), prealbumin (PAB) and transferrin (TRF), 3 months after surgery showed significantly lower Hb and Alb and significantly higher PAB and TRF levels in the observation compared to the control group. After one year follow-up, there were no significant differences in hospitalization time and cost between the two groups, but the postoperative complication, readmission and mortality rates in the observation group were significantly lower than that the control group. Each dimension score of quality of life in the observation group was significantly higher than the control group. In conclusion, the H2H nutrition management model can effectively improve the postoperative nutritional level of patients with laryngeal carcinoma, resulting in a lower rate of complication, readmission and mortality resulting in an improved patient's quality of life.

Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction.

The aim of this prospective cohort study is to analyze the impact of supplemental home enteral nutrition (HEN) post-esophageal cancer surgery on nutritional parameters, quality of life (QL), and patient satisfaction. A systematic review reported that over 60% of patients lose >10% of both body weight and BMI by 6 months after esophagectomy. Enteral feeding (EF) is increasingly a modern standard postoperatively; however, the impact of extended HEN postdischarge has not been systematically studied. One hundred forty-nine consecutive patients [mean age 62±9, 80% male,76% adenocarcinoma, 66% on multimodal protocols, and 69% with BMI ≥ 25 kg/m2] were studied. Jejunal EF commenced day 1 postoperatively, and supplemental overnight HEN (764 kcal; 32g protein) continued on discharge for a planned further 4 weeks. Weight, BMI, and body composition analysis (bioimpedance analysis) were measured at baseline, preoperatively and at 1, 3, and 6 months, along with the EORTC QLQ-C30/OES18 QL measures. A patient satisfaction questionnaire addressed eight key items in relation to HEN (max score 100/item). Median (range) total duration of EF was 49 days (28-96). Overall compliance was 96%. At 6 months, compared with preoperatively, 58 (39%) patients lost >10% weight, with median (IQR) loss of 6.8 (4-9) kg, and 62 (41%) patients lost >10% BMI. Lean body mass and body fat were significantly (p <0.001) decreased. Mean global QL decreased (p <0.01) from 82 to 72. A high mean satisfaction score (>70±11/100) was reported, >80 for practical training, activities of daily living, pain, anxiety, recovery and impact on caregivers, with lower scores for appetite (33±24) and sleep (63±30). Supplemental HEN for a minimum of one month postdischarge is associated with high compliance and patient satisfaction. Weight and BMI loss may still be substantial, however this may be less than published literature, in addition the impact on HR-QL may be attenuated. HEN has both subjective and objective rationale and merits further validation toward optimizing nutritional recovery and overall wellbeing.

Prevalence of Home Parenteral and Enteral Nutrition in the United States.

Malnutrition is highly prevalent and associated with increased morbidity and mortality. Studies continue to reveal significant clinical benefits with nutrition support, including improved wound healing, reduction in complications and length of stay, and mortality. Due to these benefits, the prevalence of home parenteral and enteral nutrition (HPEN) continues to increase worldwide. In the United States, given our healthcare insurance landscape, it has been very difficult to ascertain the true prevalence of HPEN. Medicare beneficiary data for 2013 were obtained from Centers for Medicare and Medicaid Services. Commonly used Healthcare Common Procedure Coding System codes were used for home enteral nutrition (HEN) and home parenteral nutrition (HPN). Data regarding number of patients and insurance providers were also obtained from 3 of the largest home infusion providers in the United States (Coram CVS, Option Care Enterprises, and BioScrip Inc). Based on the ratio of Medicare to non-Medicare billing, an estimate of HPEN prevalence was obtained. For 2013, there were 6778 Medicare beneficiaries for HPN and 114,287 for HEN. The ratio of Medicare to non-Medicare was 0.271 for HPN and 0.261 for HEN, leading to an estimated prevalence of 25,011 patients receiving HPN (79 per million U.S. inhabitants) and 437,882 patients receiving HEN (1385 per million U.S. inhabitants). There are an estimated 4129 pediatric patients and 20,883 adult patients receiving HPN; for HEN, 189,036 pediatric patients and 248,846 adult patients. Compared with results from 1992, the prevalence of HEN has increased dramatically, while the prevalence of HPN has declined.

Nutrient intake and contribution of home enteral nutrition to meeting nutritional requirements after oesophagectomy and total gastrectomy.

This study evaluated nutrition after oesophago-gastric resection and the influence of home jejunostomy feeding in the six months after surgery. Data on nutritional intake and physiologic measures were collected as part of a randomised trial with measurements taken before and up to six months after surgery. A total of 41 participants (32 oesophagectomy, 9 total gastrectomy) received home jejunostomy feeding (n=18) or usual care without feeding (n=23). At hospital discharge, oral intakes were adequate for energy and protein in 9% and 6%, respectively. By three and six months, these values had increased to 61% and 55%, 94% and 77% respectively. Six participants (26%) who received usual care required rescue feeding. Six weeks after hospital discharge, energy intakes were met in those who received jejunal feeding because of the contribution of enteral nutrition. Jejunal feeding did not affect oral intake, being similar in both groups (fed: 77% estimated need, usual care: 79%). At three months, inadequate micronutrient intakes were seen in over one third. Compared to baseline values, six weeks after surgery, weight loss exceeding 5% was seen in 5/18 (28%) who received feeding, 14/17 (82%) who received usual care and 5/6 (83%) of those who required rescue feeding, P=0.002. Weight loss averaged 4.1% (fed), 10.4% (usual care) and 9.2% (rescue fed), P=0.004. These trends persisted out to six months. Supplementary jejunostomy feeding made an important contribution to meeting nutrition after oesophago-gastric resection. Importantly, oral nutritional intake was not compromised dispelling the assertion that jejunal feeding deincentivises patients from eating.

Home Enteral Nutrition: Updates, Trends, and Challenges.

The true prevalence of home enteral nutrition (HEN) utilization is unclear and requires further study. HEN therapy has remained virtually unchanged for several decades. However, new trends in HEN are evolving; enteral nutrition is undergoing changes ranging from enteral feeding devices, ingredients used, practice innovations, and challenges with reimbursement. A 2006 Joint Commission call to action that reported 2 sentinel events related to misconnections set things into motion for the transition of enteral device connectors to become specific for enteral nutrition use, which will affect patients who receive HEN. Nutrition support clinicians are realizing that people fed enterally may also enjoy incorporating blended foods into their diets and may benefit from different nutrients and components (ie, phytonutrients, fiber, and prebiotics) present in natural foods, thereby resulting in the renaissance of food-based blenderized tube feedings. This article reviews HEN therapy data or the lack thereof, current practices, risks and benefits, future trends, and challenges with access devices, enteral feedings, and reimbursement. It also highlights areas where more research is needed, and it urges clinicians to get involved in legislative action or committees to facilitate improved processes and reimbursement for HEN.

Spanish home enteral nutrition registry of the year 2014 and 2015 from the NADYA-SENPE Group

Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes.

Nutrición enteral domiciliaria prescrita en el Hospital Universitario Infanta Cristina de Badajoz (España)

Objetivo: Conocer la práctica real de la Nutrición Enteral Domiciliaria en la Unidad de Nutrición del Hospital Universitario Infanta Cristina de Badajoz durante 12 meses y, de forma secundaria, comparar los datos existentes con otros centros a nivel nacional e internacional.Método: Estudio descriptivo, observacional y retrospectivo de los pacientes atendidos por la Unidad de Nutrición, en el ámbito de la nutrición enteral domiciliaria, durante 12 meses consecutivos.Resultados: El número de pacientes mayores de 14 años con NED durante los 12 meses del estudio fue de 176 (52% varones). La edad media fue de 71,3 años (17- 104) y la duración media del soporte de 10 meses (307,16 días), con causa de finalización más frecuente el fallecimiento (78,2%). La enfermedad de base que se registró con más frecuencia fue la neurológica en 97 pacientes (55,1%), seguida de la neoplásica en 55 (31,3%). La vía de administración más utilizada fue la sonda nasogástrica (69,3%), seguida de la gastrostomía (14,2%) y la oral (10,8%). El 42,05% de los pacientes presentaban una actividad limitada y el 30,1% estaba confinado en cama/sillón. El 73,3% de los adultos requerían ayuda total o parcial. El suministro de la fórmula se hacía desde las farmacias de referencia, mientras que el material fungible se suministraba desde Atención Primaria en el 78,4% y desde el hospital en el resto.Conclusión: El número de pacientes registrados aumenta en relación con los años anteriores, pero se mantienen diferencias respecto a registros a nivel nacional e internacional.

The Family Home Environment, Food Insecurity, and Body Mass Index in Rural Children

Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. This study examined associations among FNPA, FI, and body mass index (BMI) in rural children. Parents of 186 elementary school-age children completed FNPA and FI surveys. Child anthropometrics were directly measured. Logistic and linear regressions were used to examine associations. Approximately 37% of children were overweight/obese; 43% of families were at risk for FI. Children whose families limited watching TV while eating were less likely to be obese (odds ratio [OR] = 0.56, p = .03) as were children whose families monitored intake of chips, cookies, and candy (OR = 0.54, p = .01). FI was higher in obese than normal weight children (OR = 11.00, p = .003) but only among families not eligible to receive free/reduced-cost school meals. Among eligible families, lower odds of FI were found for those who ate meals together often (OR = 0.31, p = .04) and for those with children frequently enrolled in organized sports/activities (OR = 0.65, p = .04). Findings were not significant after adjusting for multiple comparisons. Results suggest that favorable FNPA factors were associated with healthier BMI and lower odds of FI. Opportunities for healthy eating at home may support rural children's weight health. Additional resources may be necessary to promote food security among low-income families. Future research is warranted to better understand FNPA in relationship to the disproportionate rates of obesity and FI in rural populations.

Calorically restricted diets decrease PCSK9 in overweight adolescents

Background and aimsNutritional therapy is the first line approach to treatment of hyperlipidemia in childhood. Proprotein convertase subtilisin kexin type 9 (PCSK9) is a key regulator of plasma cholesterol levels and a target of novel lipid-lowering pharmacotherapies. We examined the effects of an intensive nutritional intervention on PCSK9 levels in overweight adolescents with cardiovascular disease (CVD) risk factors. Methods and resultsTwenty seven obese and overweight adolescents with CVD risk factors were assigned to either a low fat or low glycemic load diet. During an 8-week “Intensive Phase,” assigned meals were delivered to the home, and all participants received weekly in-person home nutrition counseling and phone calls. The subjects then underwent a 4-month “Maintenance Phase” without food provision and with no in-person contact. Anthropometric measurements, laboratory data, and serum PCSK9 protein levels were measured at baseline, 8 weeks, and 6 months. PCSK9 decreased by 16.5% at 8 weeks (201.2 ± 56.3 vs 165.6 ± 58.4 ng/mL; p < 0.001); PCSK9 levels returned to baseline levels at 6 months, after the Maintenance Phase. Change in PCSK9 was associated with change in fasting insulin, HOMA-IR, and AUC insulin, independent of weight loss. ConclusionsPCSK9 decreased in youth participating in an intensive dietary intervention. Change in HOMA-IR was associated with change in PCSK9, independent of weight loss, suggesting an important relationship with insulin sensitivity.ClinicalTrials.gov Identifier: NCT01080339.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.

Tube Feeding in Children.

1. Sarita Singhal, MD*,† 2. Susan S. Baker, MD, PhD*,† 3. Georgina A. Bojczuk, RD, CSP† 4. Robert D. Baker, MD, PhD*,† 1. *Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 2. †Digestive Diseases and Nutrition Center, Women and Children’s Hospital of Buffalo, Kaleida Health, Buffalo, NY Enteral tube feeding (TF) is an important part of the care of acutely ill children as well as an essential technique to deliver nutrition to children who have chronic conditions. However, the techniques of TF are neither a part of medical school courses nor specifically taught in pediatric residency programs. Thus, learning how to initiate, monitor, moderate, and transition TF is often learned by trial and error. After completing this article, readers should be able to: 1. Understand the need for nutritional assessment and nutrition support. 2. Recognize indications and contraindications for tube feeding (TF). 3. Plan the evaluation of a patient who requires TF. 4. Recognize the factors that are important to make the proper selection of enteral access for TF. 5. Plan the initiation and administration of TF. 6. Recognize the potential complications of TF and learn troubleshooting methods. 7. Coordinate care for home nutrition support and assist in the transition to oral feedings. 8. Understand the social needs of patients who have TF. Tube feeding (TF) is a mode of providing enteral nutrition when oral feeding is not possible or not sufficient. TF is delivered through a medical device that can be placed into the stomach, duodenum, or jejunum via either the nose, mouth, or the percutaneous route. This review focuses on TF in children beyond the neonatal period. Nutritional support can be either enteral or parenteral. Enteral nutrition (EN) refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a child's nutritional requirements. …

Gravity Flow in Proposed Enteral Tube Small-Bore Connectors.

Enteral nutrition (EN) misconnections have been identified as a serious and potential deadly problem. An international effort led by EN industry leaders has developed a small-bore enteral connector (ENFit) that in theory will reduce the frequency of misconnections. Despite the potential benefit of preventing misconnections, the full impact of adoption of the ENFit connector is unknown. To assess the impact of transitioning to ENFit on our home EN (HEN) patients, the current study evaluated gravity feeding comparing 2 proposed small-bore connectors to the legacy (current connector) using various commercial formulas. Six commonly used enteral formulas in our facility with varying density and viscosity were tested in triplicate. Forty milliliters of formula was poured into a syringe connected to an ENFit or legacy (current) feeding connector attached to varying French size tubes. The time it took formula to flow through the connectors was recorded, and the test was repeated in triplicate. All formulas took significantly longer to flow through the first ENFit connector compared with the legacy connector ( P < .05). The second ENFit connector demonstrated similar flow dynamics to the legacy connector. There is wide variability in the flow dynamics in ENFit connectors with significant potential impact on many facets of HEN, including medicine delivery, blenderized feeds, venting, and compliance with EN due to increased time to administer feeds. We highly recommend additional testing of flow dynamics, including gravity flow, as ENFit tubes are being developed and adopted.

The NutriQoL ® questionnaire for assessing health-related quality of life (HRQoL) in patients with home enteral nutrition (HEN): validation and fi rst results

Health-related quality of life (HRQoL) provides a global view of the state of health of a patient receiving home enteral nutrition (HEN). To evaluate the HRQoL of patients receiving HEN using the NutriQoL®questionnaire, a specific instrument regardless of the underlying disease and route of administration. Observational, prospective and multicentre study conducted in the context of the validation and assessment of the NutriQoL®questionnaire's psychometric properties. One-hundred-and-forty individuals [disease: cancer (58.6%), malabsorption and other (27.1%), neurological (13.6%); HEN: supplement (61.4%), sole source of nutrition (35.7%); administration route: oral (54.3%), ostomy (31.4%), nasoenteric tube (12.1%)] participated. NutriQoL®was reliable [ICC: 0.88 (95%CI: 0.80-0.93); Cronbach's α: 0.77 (1st visit) and 0.83 (2ndvisit)], valid (significant Rho), lowly sensitive to changes (effect size 0.23), can be completed by either patients or caregivers (ICC: 0.82). The mean HRQoL (SD) with NutriQoL® was 14.98 (14.86), EQ-5D tariff: 53(0.25), EQ-5D VAS: 54.15 (20.64) and COOP/WONCA charts: 23.32(5.66). HRQoL with NutriQoL® was better (p < 0.05) for oral HEN [19.54 (13,23)], than nasoenteric tube [14(11.71)], ostomy [7.02 (15.48)]; administered orally [19.54 (13.23)], than by gravity [10.97 (14.46)], pump [8.5 (19.78)] or syringe bolus [7 (11.40)]; as a supplement [19.33 (13.73)] instead of sole source of nutrition [8.18 (14.23)]. NutriQoL® is valid, reliable, even if lowly sensitive to change, and useful to measure HRQoL in this population. More studies are needed to know HRQoL in routine practice.

Home enteral nutrition: are we providing a quality service?

Home enteral nutrition: are we providing a quality service?