Canadian Home Total Parenteral Nutrition Registry: Preliminary Data on the Patient Population

BACKGROUND: Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed.OBJECTIVES: To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population.METHODS: This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis.RESULTS: One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63.CONCLUSIONS: In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and future research.

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Home Parenteral Nutrition in Patients with Systemic Sclerosis: A Retrospective Review of 12 Cases

The Journal of Rheumatology ◽

10.3899/jrheum.110896 ◽

2012 ◽

Vol 39 (5) ◽

pp. 1004-1007 ◽

Cited By ~ 14

Author(s):

HANI JAWA ◽

GAIL FERNANDES ◽

OLIVIA SAQUI ◽

JOHANNE P. ALLARD

Keyword(s):

Body Mass Index ◽

Systemic Sclerosis ◽

Nutritional Status ◽

Parenteral Nutrition ◽

Functional Status ◽

Total Parenteral Nutrition ◽

Retrospective Review ◽

Karnofsky Score ◽

The Mean ◽

The University

Objective.To evaluate the effect of home total parenteral nutrition (HTPN) on the nutritional and functional status of patients with systemic sclerosis (SSc).Methods.Retrospective review of SSc patients from the HTPN database at the University Health Network, Toronto, Canada, from 1998 to 2010.Results:In total 12 subjects (9 females, 3 males) with SSc were identified. At initiation of HTPN, the age was 48.75 ± 3.94 years and the median body mass index was 16.8 kg/m2 (range 12.3–21.3). This significantly increased to 18.3 kg/m2 (17.0–21.7) at 6 months and to 19.7 kg/m2 (17.0–24.6) at 12 months. The mean Karnofsky score at baseline was 58.00 ± 3.27, and the score at 12 months of 39.00 ± 13.29 did not change significantly.Conclusion.HTPN improved the nutritional status of these patients with SSc but it did not improve their functional status.

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Assessment of Total Parenteral Nutrition administration among Intensive Care Unit patients at Omdurman Military Hospital, Sudan

10.1101/2020.10.19.20215053 ◽

2020 ◽

Author(s):

Bothina Essameldin Khalafallah Bashir ◽

Mudawi Mohammed Ahmed Abdallah ◽

Ghada Omer Hamad Abd El-Raheem ◽

Elkhansaa Hamad Ali Nassir

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Intestinal Failure ◽

Military Hospital ◽

Refeeding Syndrome ◽

Chi Square ◽

Cross Sectional ◽

Septic Complications

AbstractTotal parenteral nutrition is one of the important types of nutrition among patients with intestinal failure. This research was intended to assess total parenteral nutrition administration of the intensive care unit patients at the Military hospital, Sudan. A cross-sectional hospital-based study assessed the patients records in the period between April 2014-November 2015, data were analyzed through chi-square test, it was considered significant when p≤ 0.05. Twenty patients who received total parenteral nutrition were assessed, 60% were males, while 40% were females. The most frequent indication for total parenteral nutrition was laparotomy (35% of patients). The duration of total parenteral nutrition was assessed, 70% of patients had duration between 1-20 days. Regarding total parenteral nutrition complications, the most frequent complication was hypokalemia (45% of patients), refeeding syndrome occurred in 10 % of patients. A statistically significant association was found between total parenteral nutrition duration when assessed with age and indication (p= 0.005 and 0.000 respectively). Patients suffering from electrolytes imbalance need more care to avoid the development of refeeding syndrome, as well as high level of hygiene is strictly required to overcome septic complications. There is a need to consider specialized care team composed of nurses, clinical pharmacists and nutritionists.

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Perioperative Use of Total Parenteral Nutrition: Variations in Guidelines and Practice in Three Norwegian Hospitals

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646230000917x ◽

1995 ◽

Vol 11 (4) ◽

pp. 741-749 ◽

Cited By ~ 2

Author(s):

Marianne Mjaaland ◽

Arthur Revhaug ◽

Olav Helge Førde

Keyword(s):

Retrospective Study ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Gastrointestinal Surgery ◽

Patient Characteristics ◽

Substantial Part ◽

Cross Sectional

AbstractIn a cross-sectional, retrospective study of 604 cases, variations among three Norwegian hospitals in use of perioperative parenteral nutrition (TPN) after gastrointestinal surgery was determined. Postoperative TPN rates were 25%, 34% (p =.05) and 56% (p <.0001). respectively. However, a substantial part of the variation was explained by differences in patient characteristics.

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Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure

Gut ◽

10.1136/gutjnl-2018-318172 ◽

2020 ◽

Vol 69 (10) ◽

pp. 1787-1795 ◽

Cited By ~ 6

Author(s):

Loris Pironi ◽

Ezra Steiger ◽

Francisca Joly ◽

Geert J A Wanten ◽

Cecile Chambrier ◽

...

Keyword(s):

Parenteral Nutrition ◽

Malignant Disease ◽

Demographic Data ◽

Intestinal Failure ◽

Underlying Disease ◽

Clinical Classification ◽

Weekly Basis ◽

Research Protocols ◽

The Mean

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

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Menstrual disorders and medical counseling among schoolgirls in South Egypt: a cross-sectional study

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0261 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Ahmed Arafa ◽

Shaimaa Senosy

Keyword(s):

Cross Sectional Study ◽

Future Research ◽

Menstrual Disorders ◽

Cross Sectional ◽

Facial Hair ◽

Multi Stage ◽

Medical Counseling ◽

The Mean ◽

Age Of Menarche ◽

Self Administered Questionnaire

Abstract Background Menstrual disorders are common gynecological problems among adolescents, however, medical counseling for these disorders is not well documented in developing countries. Objectives This study aimed to assess medical counseling for menstrual disorders among schoolgirls in Beni-Suef city in South Egypt. Methods Using a multi-stage random sampling, a total of 970 preparatory schoolgirls were included in this study. We used a self-administered questionnaire to detect the premenstrual and menstrual disorders as reported by the schoolgirls during the previous 6 months. Medical counseling for the menstrual disorders and other demographic characteristics were also surveyed. Results The mean age of the schoolgirls was 15.4 ± 0.8 years, age of menarche 13.2 ± 1.1 years and menstrual flow days 5.0 ± 1.3. During the past 6 months, 19.4% of the schoolgirls reported medical counseling for at least one menstrual symptom. Dysmenorrhea (89.2%), premenstrual fatigue (32.4%) and headache (31.1%) were the most often reported symptoms. After adjustment for personal and gynecological characters, abdominal bloating [odds ratio (OR) 3.66; 95% confidence interval (CI) 2.18–6.17], flow days >4 (OR 1.73; 95% CI 1.21–2.47), acne flare (OR 1.42; 95% CI 1.01–1.99), dysuria (OR 2.09; 95% CI 1.35–3.22) and facial hair (OR 6.89; 95% CI 3.47–13.69) were associated significantly with a higher likelihood of medical counseling. Conclusion Menstrual disorders are highly prevalent among preparatory schoolgirls in Beni-Suef, however, there is a noticeable lack of the medical counseling for these disorders. Future research should focus on the barriers to medical counseling for menstrual disorders among adolescents.

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Total parenteral nutrition does not improve diaphragm development in premature baboons

Journal of Applied Physiology ◽

10.1152/jappl.1994.77.1.43 ◽

1994 ◽

Vol 77 (1) ◽

pp. 43-50 ◽

Cited By ~ 2

Author(s):

L. C. Maxwell ◽

T. J. Kuehl ◽

K. Meredith ◽

D. R. Gerstmann ◽

R. A. Delemos

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Fiber Type ◽

Isometric Tension ◽

Cross Sectional Area ◽

Diaphragm Muscle ◽

Lower Percentage ◽

Force Frequency ◽

Sectional Area ◽

Cross Sectional

We hypothesized that total parenteral nutrition accelerates growth and development of diaphragm muscle (DPH) in prematurely delivered baboons (140 days gestation). For 10 days after delivery by cesarean section, we administered parenteral nutrition containing glucose, electrolytes, and water or total parenteral nutrition containing lipids, amino acids, glucose, vitamins, and electrolytes. After 10 days of care, dorsolateral and ventrolateral (VL) costal DPH were sampled for histochemically determined mean fiber area (MFA) and fiber type percentages. We determined isolated bundle isometric tension (normalized for cross-sectional area), time to peak tension, half-relaxation time, force-frequency relationship, and fatigability. Neither sex nor nutritional treatment affected contractile properties. Differences among sexes and muscle sites, but not among nutritional treatments, were observed for histochemical characteristics. In females, the VL DPH had a lower percentage of type IIo fibers and a greater MFA of type IIc fibers than the dorsolateral DPH and a lower percentage of type IIo fibers and greater MFA of type IIc and IIo fibers than the VL DPH in males. Mean fiber cross-sectional area of VL DPH was significantly greater in females than males. The larger fibers in females than males suggest a stronger DPH in females. Earlier growth of type II fibers in females could contribute to a better outcome for female than male premature infants with hyaline membrane disease.

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Assessment of Catheter-Associated Infection Risk with the Hickman Right Atrial Catheter

Infection Control ◽

10.1017/s0195941700060161 ◽

1984 ◽

Vol 5 (5) ◽

pp. 226-230 ◽

Cited By ~ 32

Author(s):

Peter C. Fuchs ◽

Marie E. Gustafson ◽

James T. King ◽

Patrick T. Goodall

Keyword(s):

Parenteral Nutrition ◽

Antibiotic Therapy ◽

Cancer Chemotherapy ◽

Infection Risk ◽

Right Atrial ◽

Risk Of Infection ◽

Primary Indication ◽

Increased Risk ◽

Atrial Catheter ◽

The Mean

AbstractOne hundred fifty Hickman right atrial catheters were inserted into 143 patients and were followed prospectively until removal. Primary indications for their use were: cancer chemotherapy (45), parenteral nutrition (35), antibiotic therapy (63), and miscellaneous (7). The overall catheter-associated infection rate was 12.0%. Since the mean duration of catheterization was 125 days, the infection/duration rate was 1.0/1,000 days of use. The risk of infection differed significantly according to the primary indication for catheterization: parenteral nutrition > antibiotic therapy > cancer chemotherapy. The increased risk of catheter-associated infection attributable to duration of catheterization was additive, and the per day risk of such infections remained constant regardless of duration. Nearly two-thirds of patients were discharged home with catheters in place, without adversely affecting infection risk.

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