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Zhang Z, Lv L, Guan S, Jiang F, He D, Song H, Sun W, Jiang S, Tian F. Association between serum methylmalonic acid and chronic kidney disease in adults: a cross-sectional study from NHANES 2013-2014. Front Endocrinol (Lausanne) 2024; 15:1434299. [PMID: 39149121 PMCID: PMC11324440 DOI: 10.3389/fendo.2024.1434299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Chronic kidney disease(CKD) is a global medical problem. Serum methylmalonic acid(MMA) is a serum marker associated with many diseases. This study aimed to investigate the association between MMA and CKD. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were downloaded and analyzed. The association between MMA and CKD was confirmed by using multiple logistic regression modeling. The smooth curve fitting method was used to investigate the nonlinear relationship between them. Subgroup analyses and interaction tests were used to verify the stability of the association between different subgroups. Threshold effect analysis was used to determine the optimal control point for MMA. Results There was a unique W-shaped nonlinear relationship between MMA and the risk of CKD, with a positive correlation between them (OR=1.66,95% CI:1.27, 2.17; P=0.0002). As the stage of CKD progressed, MMA levels increased. Age, hypertension, and serum vitamin B12 had significant influences on the association between MMA and the risk of CKD. Conclusion Our findings revealed that serum MMA accumulation was positively associated with the risk of CKD. Serum MMA level may be a novel index to predict the development and course of CKD. This study may help in the early identification of people at risk for chronic kidney disease and provide new ideas and approaches for prevention and treatment.
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Affiliation(s)
- Zufa Zhang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Zhongshan Clinical Collage of Dalian University, Dalian, Liaoning, China
| | - Long Lv
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Sheng Guan
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Fengze Jiang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Danni He
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Hongxuan Song
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Weibing Sun
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Sixiong Jiang
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
| | - Feng Tian
- Department of Urology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Dalian, Liaoning, China
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Barazzoni R, Breda J, Cuerda C, Schneider S, Deutz NE, Wickramasinghe K, Abbasoglu O, Meijerink JB, Bischoff S, Pelaez RB, Cardenas D, Cederholm T, Cereda E, Chourdakis M, Toulson Davisson Correia MI, Schuren MDVD, Delzenne N, Frias-Toral E, Genton L, Cappellari GG, Cakir BK, Klek S, Krznaric Z, Laviano A, Lobo D, Muscaritoli M, Ockenga J, Pirlich M, Serlie MJM, Shi HP, Singer P, Soop M, Walrand S, Weimann A. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers. Clin Nutr 2022; 41:2858-2868. [PMID: 36075815 PMCID: PMC9365508 DOI: 10.1016/j.clnu.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.
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Affiliation(s)
- Rocco Barazzoni
- Corresponding author. Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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Crivelli A, Fabeiro M, Puga M, Dieguez N, Giunta L, Pochettino F, Balacco M, Merlo G, Garrido V, Fain H, Buncuga M, Martinuzzi A, Cascarón MF, Delgado N, Capurro G, Bernardis V, Ghiglieri C, Hassam A, Soria O, Serra D, Morando L, Flores A, Gonzalez HF, Fernandez A. Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections. Clin Nutr ESPEN 2022; 52:250-253. [PMID: 36513461 PMCID: PMC9670592 DOI: 10.1016/j.clnesp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to analyze central line-associated bloodstream infections (CLABSI) in home parenteral nutrition (HPN) patients assisted by an interdisciplinary team during the first year of the COVID-19 pandemic in Argentina. METHODS Longitudinal, retrospective and analytical study of patients on HPN for ≥90 days during 2020. Data collection included age (adults >18 years, pediatric ≤18 years), gender, diagnosis, type of catheter, number of lumens, venous access, days on HPN, infusion modality and number of CLABSI-associated events. In COVID-19 cases, number of patients, disease progression, mortality rate and microorganisms involved were analyzed. RESULTS A total of 380 patients were included, 120 (31.6%) pediatric and 260 (68.4%) adult patients. Median age was 44.50 years (10; 62.25). Twelve patients (3.15% of the total) had COVID-19; of these, two pediatric and seven adult patients had no complications, and three adults died of COVID-19 pneumonia. The diagnoses observed were benign chronic intestinal failure (CIF, n = 311), grouped into short bowel (n = 214, 56.3%), intestinal dysmotility (n = 56, 14.7%), intestinal fistula (n = 20, 5.3%), and extensive small bowel mucosal disease (n = 21, 5.5%); malignant tumors (n = 52, 13.7%); other (n = 17, 4.4%). Total catheter days were 103,702. Median days of PN duration per patient were 366 (176.2, 366). The types of catheters used were tunneled (317 patients, 83.4%); peripherally inserted central (PICC) line (55 patients, 14.5%) and ports (8 patients; 2.1%). A total of 111 CLABSI was registered, with a prevalence of 1.09/1000 catheter days (adult, 0.86/1000 days; pediatric, 1.51/1000 days). The microorganisms identified in infectious events were Gram + bacteria (38, 34.5%); Gram-bacteria (36, 32%); mycotic (10, 9%); polymicrobial (4, 3.6%); negative culture and signs/symptoms of CLABSI (23, 20.3%). The odds ratio between pediatric and adult patients was 2.29 (1.35, 3.90). CONCLUSION The rate of CLABSI during the COVID-19 pandemic was within the ranges reported by international scientific societies. The risk of CLABSI was higher in pediatric patients, and mortality rate in COVID-19 infected patients was higher than in the general population.
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Affiliation(s)
- Adriana Crivelli
- Unidad de Soporte Nutricional y Enfermedades Malabsortivas, Hospital Interzonal General de Agudos “Gral. José de San Martín”, La Plata, Argentina,Corresponding author. Unidad de Soporte Nutricional y Enfermedades Malabsortivas, Hospital Interzonal General de Agudos “Gral. José de San Martín”, Calle 1 y 70, 1900 La Plata, Argentina
| | - Marcela Fabeiro
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
| | | | | | | | | | | | | | - Verónica Garrido
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
| | | | | | | | | | | | - Gabriela Capurro
- Servicio de Cuidados Intensivos Hospital Interzonal “Oscar Allende” de Mar Del Plata, Argentina
| | | | | | | | | | | | | | | | - Horacio F. Gonzalez
- Instituto de Desarrollo e Investigaciones Pediátricas (IDIP) Hospital de Niños La Plata, Argentina
| | - Adriana Fernandez
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
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Harrison S, Kopczynska M, Leahy G, Taylor M, Farrer K, Barrett M, Mallawaarachchi P, Abraham A, Teubner A, Lal S. A hybrid model of compounded and multi-chamber bag parenteral nutrition for adults with chronic intestinal failure. JPEN J Parenter Enteral Nutr 2022; 46:1632-1638. [PMID: 35589397 DOI: 10.1002/jpen.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/26/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND While international guidelines support the use of commercially available multi-chamber bags (MCBs), the majority of home parenteral nutrition (HPN) in the UK has been compounded PN, tailored to the patient. However, national capacity limitations in aseptic facilities have necessitated the increased use of MCBs. There are no studies evaluating the appropriateness or benefits of using a 'hybrid' regimen incorporating both MCBs and compounded PN in patients already established on compounded HPN. METHODS This was a cross sectional audit evaluation conducted on 1st September 2021 at a national UK reference centre. All HPN-dependent adults prescribed HPN for Chronic Intestinal Failure were assessed by a multidisciplinary team for their potential of being switched to a 'hybrid' regimen of MCBs and compounded PN. RESULTS Of 180 patients currently receiving compounded HPN that included intravenous nitrogen with glucose ± lipid, 65 (36.1%) were deemed clinically suitable for a hybrid PN regimen, with minimal variance in PN constituents per week (volume 0%, non-N Kcals 0%, Nitrogen 0%, Fat -0.2% Glucose 0%, Sodium 0%, Potassium 0%, Calcium 0%, Magnesium 0%, Phosphate -0.1%) and requiring no additional central venous catheter manipulations. The potential reduction in compounded PN would reduce by 3627 bags per year, equating to a cost saving of £141,453 per year. CONCLUSION Wider use of hybrid MCB/compounded HPN regimens could lead to a reduction in the need for compounded PN to be produced by aseptic facilities. Further evaluation of acceptability and tolerance of hybrid regimens by patients already on compounded HPN is required. CLINICAL RELEVANCY STATEMENT This is the first study to demonstrate the feasibility and potential benefits of utilising multi-chamber parenteral nutrition (PN) bags for patients established on a compounded PN regimen. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Simon Harrison
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Maja Kopczynska
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Gavin Leahy
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Michael Taylor
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Kirstine Farrer
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Maria Barrett
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | | | - Arun Abraham
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Antje Teubner
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford
| | - Simon Lal
- Intestinal Failure Unit, Salford Care Organisation, Northern Care Alliance, Salford.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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5
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Bond A, Conley T, Teubner A, Taylor M, Abraham A, Romero Salazar F, Mallawaarachchi P, Lal S. Management of home parenteral nutrition catheter related blood stream infections in hospitals outside of a specialised intestinal failure centre. JPEN J Parenter Enteral Nutr 2022; 46:1731-1735. [PMID: 35543532 DOI: 10.1002/jpen.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Catheter-related blood stream infections (CRBSIs) remain the commonest complication associated with home parenteral nutrition (HPN). While the management outcomes of CRBSIs have been extensively reported by specialised intestinal failure (IF) centres, there are minimal data reporting CRBSI outcomes for HPN-dependent patients admitted to non-specialised hospitals. METHOD Observational study from a prospectively-maintained database of CRBSIs in HPN-dependent patients managed outside of a specialised IF centre. RESULTS Three-hundred and six patients from a total cohort of 1066 HPN-dependent patients suffered from 489 CRBSI events from 2003-2021; after 2017, 71 of these events were managed at the patient's local, non-specialised hospital and the remainder at the specialised IF centre. From 2017 to 2021, salvage of the central venous catheter (CVC) with antimicrobial therapy was attempted in 32/71 (45.1%) patients admitted to the non-specialised hospital, with successful salvage recorded in 23 (71.8%) cases. Notably, CVC salvage was attempted more commonly (77/103 (74.8%); p=0.004 vs. non-specialised hospital), with a better salvage success rate (64/77 (83.1%) p=0.01 vs. non-specialised hospital) in patients who were admitted to the specialised IF centre. CONCLUSION In some instances CRBSIs can be effectively managed when patients presenting to anon-specialised hospital, however overall salvage is more likely to be successful in the specialised setting. Further development of clinical and educational networks between IF centres and patients' local hospitals aimed at standardising care may lead to improved CRBSI outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ashley Bond
- Intestinal failure unit, Salford Royal Foundation Trust, UK
| | - Thomas Conley
- Intestinal failure unit, Salford Royal Foundation Trust, UK
| | - Antje Teubner
- Intestinal failure unit, Salford Royal Foundation Trust, UK
| | - Michael Taylor
- Intestinal failure unit, Salford Royal Foundation Trust, UK
| | - Arun Abraham
- Intestinal failure unit, Salford Royal Foundation Trust, UK
| | | | | | - Simon Lal
- Intestinal failure unit, Salford Royal Foundation Trust, UK.,University of Manchester, Manchester, UK
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6
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Hoo FW, Chang CT, Amran MHH. Home parenteral nutrition during the COVID-19 pandemic: Experience in a tertiary referral hospital in Malaysia. Clin Nutr 2022; 41:630-631. [PMID: 35124470 PMCID: PMC8768010 DOI: 10.1016/j.clnu.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
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7
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Dickerson RN, Bingham AL, Canada TW, Chan LN, Cober MP, Cogle SV, Tucker AM, Kumpf VJ. Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice. Hosp Pharm 2021; 56:466-473. [PMID: 34720147 DOI: 10.1177/00185787211016363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2020 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 169 articles were identified; 5 from the primary literature were voted by the group to be of high importance. An additional 17 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.
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Affiliation(s)
- Roland N Dickerson
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Angela L Bingham
- University of the Sciences in Philadelphia, Philadelphia, PA, USA
| | - Todd W Canada
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sarah V Cogle
- Auburn University - Harrison School of Pharmacy, Auburn, AL, USA
| | - Anne M Tucker
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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8
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Allan PJ, Ambrose T, Mountford C, Bond A, Donnellan C, Boyle R, Calvert C, Cernat E, Clarke E, Cooper SC, Donnelly S, Evans B, Glynn M, Hewett R, Holohan AS, Leitch EF, Louis-Auguste J, Mehta S, Naik S, Nightingale J, Rafferty G, Rodrigues A, Sharkey L, Small M, Teubner A, Urs A, Wyer N, Lal S. COVID-19 infection in patients with intestinal failure: UK experience. JPEN J Parenter Enteral Nutr 2021; 45:1369-1375. [PMID: 33586170 PMCID: PMC8013499 DOI: 10.1002/jpen.2087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.
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Affiliation(s)
- P J Allan
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T Ambrose
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Mountford
- Department of Gastroenterology, Freeman Hospital, Newcastle, UK
| | - A Bond
- Department of Gastroenterology, Royal Liverpool and Broadgreen Hospitals, Liverpool, UK
| | - C Donnellan
- St James' and Leeds Gastroenterology Institute, St James' Hospital, Leeds, UK
| | - R Boyle
- Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C Calvert
- Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK
| | - E Cernat
- Department of Paediatric Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - E Clarke
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - S C Cooper
- GI Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Donnelly
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - B Evans
- Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK
| | - M Glynn
- Centre for Digestive Diseases, Royal London Hospital, London, UK
| | - R Hewett
- Department of Gastroenterology, University of Wales Hospital, Cardiff, UK
| | - A S Holohan
- Nutrition, Leicester Royal Infirmary, Leicester, UK
| | - E F Leitch
- Intestinal Failure Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | | | - S Mehta
- Intestinal Failure Unit, University College London Hospitals, London, UK
| | - S Naik
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, London, UK
| | | | - G Rafferty
- Department of Gastroenterology, Belfast City Hospital, Belfast, UK
| | - A Rodrigues
- Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Sharkey
- Intestinal Failure and Transplant, Cambridge University Hospitals, Cambridge, UK
| | - M Small
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - A Teubner
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK
| | - A Urs
- Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - N Wyer
- Intestinal Failure and Nutrition Support, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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9
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Folwarski M, Kłęk S, Matras P, Bartoszewska L, Bednarz S, Jakubczyk M, Kamocki Z, Krasowski G, Kunecki M, Kwella B, Matysiak-Luśnia K, Matysiak K, Pierzynowska G, Szafrański W, Szopiński J, Urbanowicz K, Sobocki J. Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study. Nutrition 2021; 86:111202. [PMID: 33735654 PMCID: PMC7881293 DOI: 10.1016/j.nut.2021.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The pandemic requires adaptation of the health care standards, including epidemiologic surveillance, logistics of home supply, and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of this study was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first 3 mo of the pandemic (March through May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for home artificial nutrition (HAN) was estimated. Fourteen of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75/1 million citizens. Of HCWs, 344 were involved in patient care in Polish HPN units; 18.9% were physicians (49% surgeons, 18.46% internal medicine specialists, 15.38% anesthesiologists, 7.69% pediatricians, 1.54% palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN patient-to-HCW ratios for physicians, nurses, pharmacists, dietitians were 49.5, 29.15, 111.6, and 181.6, respectively. Medium ages of physicians and nurses were 45.6 and 44.15 y, respectively. Slightly less than half (53.8%) of physicians and 31.53% of nurses worked parallelly in hospital wards. Thirty-one pharmacists overall were working in all HPN units (2.21 per unit) as were 18 dietitians (1.3 per unit). Nine patients had a confirmed COVID-19 infection (four HPN, five home enteral nutrition). All the units introduced telemedicine solutions in the first months of the pandemic. The number of new qualifications for HPN and home enteral nutrition in the units did not significantly decline from March through May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health systems may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental effect on HPN including serious issues with access to professional HCWs.
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Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Gdansk, Poland; Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, Gdansk, Poland.
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland
| | - Przemysław Matras
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Lidia Bartoszewska
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Sławomir Bednarz
- General Surgery Clinic, St.Queen Jadwiga's Clinical Regional Hospital No. 2, Rzeszów, Poland
| | - Marlena Jakubczyk
- Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Zbigniew Kamocki
- 2nd Department of General and Gastroenterological Surgery Medical University of Bialystok, Poland
| | | | - Marek Kunecki
- Center of Clinical Nutrition, M. Pirogow Provincial Hospital, Lodz, Poland
| | - Bogna Kwella
- Provincial Specialist Hospital, Department of Clinical Nutrition, Olsztyn, Poland
| | - Katarzyna Matysiak-Luśnia
- Medical University of Wroclaw, Poland; Department and Clinic of Anaesthesiology and Intensive Therapy, Enteral and Parenteral Nutrition Outpatient Clinic, Voyevodin Hospital, Jelenia Gora, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Waldemar Szafrański
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, Gdansk, Poland
| | - Jacek Szopiński
- Department of General Hepatobiliary and Transplant Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Krystyna Urbanowicz
- Provincial Specialist Hospital, Department of Clinical Nutrition, Olsztyn, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
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Allan PJ, Pironi L, Joly F, Lal S, Van Gossum A. An International Survey of Clinicians' Experience Caring for Patients Receiving Home Parenteral Nutrition for Chronic Intestinal Failure During the COVID-19 Pandemic. JPEN J Parenter Enteral Nutr 2020; 45:43-49. [PMID: 33241555 PMCID: PMC7753815 DOI: 10.1002/jpen.2050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This survey of centers caring for patients receiving home parenteral nutrition (HPN) was conducted to assess the impact of the coronavirus disease 2019 (COVID-19) crisis on the management of these patients regarding provision of care, monitoring, regular follow-up, and any changes to service infrastructure. METHODS A survey was devised and publically published on the Research Electronic Data Capture database management system, with individual centers responding to a public link. RESULTS A total of 78 adult and pediatric centers worldwide contributed to the survey, representing ≥3500 patients' experiences. Centers reported infrastructure maintenance for Parenteral Nutrition (PN) bag deliveries to patients (60, 76.92%) or delivery of ancillary items (57, 73.08%), home delivery and HPN administration (65, 83.33%), and home care nurse shortages (25, 32.05%). Routine follow-up of HPN patients changed to either all telemed or mixed with emergency clinic review (70, 89.74%). In 26 centers (33.33%), HPN for newly discharged patients with benign conditions was reduced or stopped. Based on clinical history, the centers reported psychological distress for patients (52, 66.67%), with anxiety, worry, concern, and apprehension reported most frequently (37 of 52, 71.15%) but also fear (10 of 52, 19.23%), depression (5 of 52, 9.62%), and issues related to isolation/confinement (12 of 52, 23.08%). CONCLUSIONS The COVID-19 pandemic was reported by clinicians to have had a far-reaching adverse impact on patients receiving HPN, especially their safety in terms of provision of personal protective equipment, PN bags, available nursing staff, and psychological well-being. Healthcare systems responded to the challenge and presented new ways of working.
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Affiliation(s)
- Philip J Allan
- Translational Gastroenterology Unit, Nuffield Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, UK
| | - Loris Pironi
- Center for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - André Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Brussels, Belgium
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