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Koudelková K, Waldauf P, Wohl P, Šenkyřík M, Beneš P, Kohout P, Vejmelka J, Maňák J, Těšínský P, Novák F, Meisnerová E, Fencl F, Gojda J. The Czech Home Parenteral Nutrition Registry REDNUP: Comprehensive Analysis of Adult Patients' Data. ANNALS OF NUTRITION & METABOLISM 2024; 80:143-152. [PMID: 38471467 DOI: 10.1159/000538232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/02/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Home parenteral nutrition (HPN) is the primary treatment modality for patients with chronic intestinal failure, one of the least common organ failures. This article provides a retrospective analysis of the data collected on HPN patients in the Czech Republic over the past 30 years. METHODS National registry data were collected using a standardised online form based on the OASIS registry (Oley - A.S.P.E.N. Information System) across all centres providing HPN in the Czech Republic. Data collected prospectively from adult patients in the HPN program were analysed in the following categories: epidemiology, demographics, underlying syndrome, diagnosis, complications, and teduglutide therapy prevalence. RESULTS The registry identified a total of 1,838 adult patient records, reflecting almost 1.5 million individual catheter days. The prevalence of HPN has risen considerably over the last few decades, currently reaching 5.5 per 100,000 population. The majority of patients have short bowel syndrome and GI obstruction, with cancer being the most prevalent underlying disease. Catheter-related bloodstream infections have been the most prevalent acute complication. However, the incidence in 2022 was only 0.15 per 1,000 catheter days. The study also observed an increase in the prevalence of patients on palliative HPN over the last decade. CONCLUSION This study presents a thorough analysis of data from the Czech REgistr Domaci NUtricni Podpory (REDNUP) registry. It shows an increasing prevalence of HPN, namely, in the palliative patient group. The sharing of national data can improve understanding of this rare condition and facilitate the development of international guidelines.
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Affiliation(s)
- Kateřina Koudelková
- Internal Department of Third Faculty of Medicine and Královské Vinohrady University Hospital, Charles University Prague, Prague, Czechia
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care of The Third Faculty of Medicine and Královské Vinohrady University Hospital, Charles University, Prague, Czechia
| | - Petr Wohl
- Diabetology Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Michal Šenkyřík
- Department of Internal Medicine and Gastroenterology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Beneš
- Internal Department, Hospital Na Homolce, Prague, Czechia
| | - Pavel Kohout
- Department of Internal Medicine, 3rd Faculty of Medicine Charles University and Faculty Thomayer Hospital Prague, Prague, Czechia
| | - Jiří Vejmelka
- Department of Internal Medicine, 3rd Faculty of Medicine Charles University and Faculty Thomayer Hospital Prague, Prague, Czechia
| | - Jan Maňák
- 3rd Internal Gerontometabolic Clinic of Hradec Králové University Hospital and Faculty of Medicine of Charles University, Hradec Králové, Czechia
| | - Pavel Těšínský
- Internal Department of Third Faculty of Medicine and Královské Vinohrady University Hospital, Charles University Prague, Prague, Czechia
| | - František Novák
- 4th Department of Internal Medicine, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czechia
| | - Eva Meisnerová
- 4th Department of Internal Medicine, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czechia
| | - Filip Fencl
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Jan Gojda
- Internal Department of Third Faculty of Medicine and Královské Vinohrady University Hospital, Charles University Prague, Prague, Czechia
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Teeple A, Zhdanava M, Pilon D, Caron-Lapointe G, Lefebvre P, Joshi K. Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance. Curr Med Res Opin 2023; 39:1167-1174. [PMID: 37492015 DOI: 10.1080/03007995.2023.2239045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To describe access and real-world use patterns of esketamine nasal spray among adults with treatment-resistant depression (TRD) with private or public insurance. METHODS Adults with ≥1 claim for esketamine nasal spray were selected from Clarivate's Real World Data product (January 2016-March 2021). Patients with evidence of TRD initiating esketamine (index date) after 05 March 2019 were included. Esketamine access, as measured by pharmacy claim approval rate for each treatment session, and use patterns were described post-index (follow-up period). RESULTS Among 535 patients with pharmacy claims for esketamine nasal spray (mean age 49.1 years; 65.4% females), 534 had the first esketamine claim being a pharmacy claim, of which 34.6% were approved, 46.3% were rejected, and 19.1% were abandoned. Main reasons for rejection included "claim not covered by plan" (57.1%), "claim errors" (52.6%), and "prior authorization required" (22.7%). The approval rate increased to 85.2% by the second esketamine treatment session. A total of 273 patients initiated esketamine (mean age 49.3 years; 66.3% females). Patients had a mean ± standard deviation (SD) of 11.8 ± 13.3 esketamine sessions over a mean ± SD of 11.8 ± 6.4 months; 47.6% of patients completed ≥8 sessions (i.e. the number of sessions in induction phase) over a mean ± SD of 80.1 ± 71.9 days (per label, 28 days); 48 (17.6%) patients completed induction per label, and among them 93.8% continued treatment. CONCLUSIONS Initial access to esketamine nasal spray may be hindered by prior authorization or claim filing errors. Among patients who initiated esketamine, treatment compliance generally deviates from label recommendations; yet, most of those who received induction per label successfully transition to maintenance with esketamine.
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Affiliation(s)
- Amanda Teeple
- US Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | | | | | - Kruti Joshi
- US Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Tappenden KA. Anatomical and physiological considerations in short bowel syndrome: Emphasis on intestinal adaptation and the role of enterohormones. Nutr Clin Pract 2023; 38 Suppl 1:S27-S34. [PMID: 37115026 DOI: 10.1002/ncp.10991] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
Short bowel syndrome (SBS)-associated intestinal failure (IF) is a complex, life-threatening condition that requires complex care of multiple factors impacting the patient's long-term prognosis. Various etiologies result in SBS-IF, with three primary anatomical subtypes occurring following intestinal resection. Depending on the extent and segment(s) of the intestine resected, malabsorption can be nutrient specific or sweeping; however, such issues and the associated prognosis for the patient can be predicted with analysis of the residual intestine, along with baseline nutrient and fluid deficits and extent of malabsorption. The provision of parenteral nutrition/intravenous (PN-IV) fluids and antisymptomatic agents is fundamental; however, optimal management should focus on intestinal rehabilitation, wherein intestinal adaptation is prioritized and PN-IV fluids are weaned over time. Key strategies to maximize intestinal adaptation include hyperphagic consumption of an individualized SBS diet and the appropriate use of trophic agents, such as a glucagon-like peptide 2 analog.
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Affiliation(s)
- Kelly A Tappenden
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Winkler M, Tappenden K. Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome. Nutr Clin Pract 2023; 38 Suppl 1:S17-S26. [PMID: 37115027 DOI: 10.1002/ncp.10964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 04/29/2023] Open
Abstract
Short bowel syndrome (SBS) is a rare disorder with known physical, psychosocial, and economic burdens and significant morbidity and mortality. Many individuals with SBS require long-term home parenteral nutrition (HPN). The incidence and prevalence of SBS is difficult to determine because it is often based on HPN usage and may not account for those who receive intravenous fluids or achieve enteral autonomy. The most common etiologies associated with SBS are Crohn's disease and mesenteric ischemia. Intestinal anatomy and remnant bowel length are prognostic for HPN dependency, and enteral autonomy confers a survival advantage. Health economic data confirm that PN-related costs are higher for hospitalizations than at home; yet significant healthcare resource utilization is necessary for successful HPN, and patients and families report substantial financial distress that impacts quality of life (QOL). An important advancement in QOL measurement is the validation of HPN- and SBS-specific QOL questionnaires. In addition to the known factors negatively impacting QOL, such as diarrhea, pain, nocturia, fatigue, depression, and narcotic dependency, research has shown that the volume and number of PN infusions per week is associated with QOL. Although traditional QOL measurements describe how underlying disease and therapy influence life, they do not assess how symptoms and functional limitations affect the QOL of patients and caregivers. Patient-centered measures and conversation focused on psychosocial issues helps patients with SBS and HPN dependency better cope with their disease and treatment. This article presents a brief overview of SBS, including epidemiology, survival, costs, and QOL.
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Affiliation(s)
- Marion Winkler
- Department of Surgery/Nutrition Support, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kelly Tappenden
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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Salonen B, Martindale RG. New features of parenteral nutrition in home care and acute care setting for the older population. Curr Opin Clin Nutr Metab Care 2023; 26:32-35. [PMID: 36542533 DOI: 10.1097/mco.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The intent of this review is to highlight any recent changes in the delivery of parenteral nutrition to the geriatric population. The percentage of patients in the geriatric age group increases clinical awareness of the potential risks and benefits of appropriate parenteral nutrition delivery, which is crucial to well tolerated and optimum outcomes. RECENT FINDINGS The major recent finding is the increased awareness of risk of parenteral nutrition in the elderly population. SUMMARY The implications of this very brief review expose the need for further focused studies to better clarify the specifics of parenteral nutrition in this vulnerable ageing population. The importance of nutritional risk assessment cannot be overstated. With the rapidly expanding volume of geriatric population, the need for more data to better understand the delicate balance in parenteral nutrition therapy for both the acute care setting and home parenteral population is needed.
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Affiliation(s)
| | - Robert G Martindale
- General Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Kopczynska M, Teubner A, Abraham A, Taylor M, Bond A, Clamp A, Wight R, Salih Z, Hasan J, Mitchell C, Jayson GC, Lal S. Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery. Nutrients 2022; 14:nu14163379. [PMID: 36014885 PMCID: PMC9414691 DOI: 10.3390/nu14163379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010–2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient’s home and the IF center of 17.5 km (IQR 10.9–39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient’s home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates.
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Affiliation(s)
- Maja Kopczynska
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
- Correspondence: ; Tel.: +44-1612065116
| | - Antje Teubner
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - Arun Abraham
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - Michael Taylor
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - Ashley Bond
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
- School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Andrew Clamp
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Rebecca Wight
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Zena Salih
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Jurjees Hasan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Claire Mitchell
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Gordon C. Jayson
- School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
- School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
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