1
|
Klek S, Del Rio Requejo IM, Hardy G, Francisco LMP, Abbasoglu O, Acosta JCA, Granados LMB, Boeykens K, Carey S, Chourdakis M, Compher C, De Cloet J, Dubrov S, Fuentes C, Sámano AKG, Velasquez MEG, Goos C, Reyes JGG, Joon LV, Klimasauskas A, Komsa R, Krznaric Z, Ljubas D, Moscoso CPM, Larreategui R, Mirea L, Meier R, Nyulasi I, Oivind I, Panisic-Sekeljic M, Poulia KA, Rasmussen HH, Savino P, Singer P, Tamasi P, Uyar M, Thu NVQ, Waitzberg D, Weimann A, Wong T, Yu J, Wojcik P, Schneider S. Global availability of parenteral nutrition: Pre- and post-COVID-19 pandemic surveys. Nutrition 2024; 123:112396. [PMID: 38554461 DOI: 10.1016/j.nut.2024.112396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE Parenteral nutrition represents a therapeutic option for patients with type 3 intestinal failure. If used exclusively, parenteral nutrition has to be complete to provide all essential nutrients. The aim was to assess the availability of parenteral nutrition in all parts of the world, to better comprehend the global situation, and to prepare an action plan to increase access to parenteral nutrition. METHODS An international survey using an electronic questionnaire was conducted in August 2019 and repeated in May 2022. An electronic questionnaire was sent to 52 members or affiliates of the International Clinical Nutrition Section of the American Society for Parenteral and Enteral Nutrition. Questions addressed the availability of parenteral nutrition admixtures and their components, reimbursement, and prescribing pre- and post-COVID-19 pandemic. All participating countries were categorized by their economic status. RESULTS Thirty-six country representatives responded, answering all questions. Parenteral nutrition was available in all countries (100%), but in four countries (11.1%) three-chamber bags were the only option, and in six countries a multibottle system was still used. Liver-sparing amino acids were available in 18 (50%), kidney-sparing in eight (22.2%), and electrolyte-free in 11 (30.5%) countries (30.5%). In most countries (n = 28; 79.4%), fat-soluble and water-soluble vitamins were available. Trace elements solutions were unavailable in four (11.1%) countries. Parenteral nutrition was reimbursed in most countries (n = 33; 91.6%). No significant problems due to the coronavirus pandemic were reported. CONCLUSIONS Despite the apparent high availability of parenteral nutrition worldwide, there are some factors that may have a substantial effect on the quality of parenteral nutrition admixtures. These shortages create an environment of inequality.
Collapse
Affiliation(s)
- Stanislaw Klek
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Research Institute, Krakow, Poland.
| | - Isabel Martinez Del Rio Requejo
- Clinical Nutrition Team, Centro Médico Nacional 20 de Noviembre, Institute for Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | - Liza Mei P Francisco
- Nutrition Support Committee, Asian Hospital and Medical Center, Manila, Philippines
| | - Osman Abbasoglu
- Clinical Nutrition Master's Program, Hacettepe University, Ankara, Turkey
| | | | | | - Kurt Boeykens
- Nutrition Support Team, Vitaz Hospital, Sint-Niklaas, Belgium
| | - Sharon Carey
- Royal Prince Alfred Hospital University, Sydney, Australia
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki Greece
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joeri De Cloet
- Hospital Pharmacy, Ghent University Hospital, Gent, Belgium
| | | | - Catalina Fuentes
- Nutrition Support Team, Internal Medicine Department, Hospital Cliníço de la Fuerza Aérea, Las Condes, Chile; Nutrition Department, School of Medicine, Universidad de Chile, Indepencia, Chile
| | - Ana Karina García Sámano
- Clinical Nutrition Team, Centro Médico Nacional 20 de Noviembre, Institute for Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | | | | | | | - Lee V Joon
- Aseptic Unit, Pharmacy Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia
| | - Andrius Klimasauskas
- Center of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University, Vilnius, Lithuania
| | | | | | - Dina Ljubas
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Rosa Larreategui
- Nutritional Support Unit, Ciudad de la Salud, Caja de Seguro Social, Panama City, Panama
| | - Liliana Mirea
- Anaesthesia and Intensive Care Clinic, University of General Medicine, Clinical Emergency Hospital, Bucharest, Romania
| | - Remy Meier
- Gastroenterology Unit, University of Basel, Basel, Switzerland
| | - Ibolya Nyulasi
- La Trobe University, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Irtun Oivind
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromso, Norway
| | | | - Kalliopi Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, Aalborg, Norway; Dietitians and Nutritional Research Unit, EATEN, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Patricia Savino
- Centro Latinoamericano de Nutrición (CELAN), Colombian National Academy for Medicine, Bogotá, Colombia
| | - Pierre Singer
- Intensive Care Unit, Herzlia Medical Center, Ramat Gan, Israel; Department of Critical Care, Rabin Medical Center, Petah Tikva, Israel; Institute for Nutrition Research, Beilinson Hospital Israel, Rabin Medical Center, Petah Tikva, Israel; Department of Anesthesia and Critical Care, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Peter Tamasi
- Intensive Care Unit, Peterfy Hospital, Budapest, Hungary
| | - Mehmet Uyar
- Department of Anesthesiology and Intensive Care, Ege University Hospital, Bornova, Turkey
| | | | - Dan Waitzberg
- Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brasil
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Hospital St. George, Leipzig, Germany
| | - Theodoric Wong
- Department of Gastroenterology and Nutrition, Birmingham Women's & Children's, Birmingham, UK
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Paulina Wojcik
- University Clinical Center, Medical University of Warsaw, Warsaw, Poland
| | - Stephane Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| |
Collapse
|
2
|
Bartuseviciene I, Vicka V, Vickiene A, Tetianec L, Dagys M, Ringaitiene D, Klimasauskas A, Sipylaite J. Conceptual model of adding antibiotics to dialysate fluid during renal replacement therapy. Sci Rep 2021; 11:23836. [PMID: 34903805 PMCID: PMC8668912 DOI: 10.1038/s41598-021-03450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022] Open
Abstract
Studies have shown significant variability in antibiotic trough concentrations in critically ill patients receiving renal replacement therapy (RRT). The purpose of this study was to assess whether adding beta-lactam antibiotics to dialysate solution can maintain stable antibiotic concentrations during RRT in experimental conditions. A single compartment model reflecting the patient was constructed and connected to the RRT machine. Dialysate fluid was prepared in three different concentrations of meropenem (0 mg/L; 16 mg/L; 64 mg/L). For each dialysate concentration various combinations of dialysate and blood flow rates were tested by taking different samples. Meropenem concentration in all samples was calculated using spectrophotometry method. Constructed experimental model results suggest that decrease in blood meropenem concentration can be up to 35.6%. Moreover, experimental data showed that antibiotic loss during RRT can be minimized and stable plasma antibiotic concentration can be achieved with the use of a 16 mg/L Meropenem dialysate solution. Furthermore, increasing meropenem concentration up to 64 mg/L is associated with an increase antibiotic concentration up to 18.7–78.8%. Administration of antibiotics to dialysate solutions may be an effective method of ensuring a constant concentration of antibiotics in the blood of critically ill patients receiving RRT.
Collapse
Affiliation(s)
| | - Vaidas Vicka
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Alvita Vickiene
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lidija Tetianec
- Department of Bioanalysis, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Marius Dagys
- Department of Bioanalysis, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Donata Ringaitiene
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrius Klimasauskas
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jurate Sipylaite
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
3
|
Vicka V, Januskeviciute E, Miskinyte S, Ringaitiene D, Serpytis M, Klimasauskas A, Jancoriene L, Sipylaite J. Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients. BMC Infect Dis 2021; 21:1173. [PMID: 34809594 PMCID: PMC8607225 DOI: 10.1186/s12879-021-06866-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score. Methods This was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors. Results A total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model. Conclusions The study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly.
Collapse
Affiliation(s)
- Vaidas Vicka
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | | | | | - Donata Ringaitiene
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Serpytis
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrius Klimasauskas
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ligita Jancoriene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jurate Sipylaite
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
4
|
Salciute-Simene E, Stasiunaitis R, Ambrasas E, Tutkus J, Milkevicius I, Sostakaite G, Klimasauskas A, Kekstas G. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin Nutr 2020; 40:1310-1317. [PMID: 32896448 DOI: 10.1016/j.clnu.2020.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the causes, frequency, and duration of ENIs and their association with underfeeding in critical care. METHODS This was a prospective observational study conducted at the Vilnius University Hospital Santaros Clinics, Lithuania, between December 2017 and February 2018. It included adult medical and surgical ICU patients who received enteral nutrition (EN). Data on ENIs and caloric, as well as protein intake were collected during the entire ICU stay. Nutritional goals were assessed using indirect calorimetry, where available. RESULTS In total 73 patients were enrolled in the study. Data from 1023 trial days and 131 ENI episodes were collected; 68% of the patients experienced ENI during the ICU stay, and EN was interrupted during 35% of the trial days. The main reasons for ENIs were haemodynamic instability (20%), high gastric residual volume (GRV) (17%), tracheostomy (16%), or other surgical interventions (16%). The median duration of ENI was 12 [6-24] h, and the longest ENIs were due to patient-related factors (22 [12-42] h). The rate of underfeeding was 54% vs. 15% in the trial days with and without ENI (p < 0.001), respectively. Feeding goal was achieved in 26% of the days with ENI vs. 45% of days without ENI (p < 0.001). The daily average caloric provision was 77 ± 36% vs. 106 ± 29% in the trial days with and without ENI (p < 0.001) and protein provision was 0.96 ± 0.5 vs. 1.3 ± 0.5 g/kg, respectively (p < 0.001). CONCLUSIONS The episodes of ENI in critically ill patients are frequent and prolonged, often leading to underfeeding. Similar observations have been reported by other studies; however, the causes and duration of ENI vary, mainly because of different practices worldwide. Hence, safe and internationally recognised reduced-fasting guidelines and protocols for critically ill patients are needed in order to minimise ENI-related underfeeding and malnutrition.
Collapse
Affiliation(s)
- Erika Salciute-Simene
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Raimundas Stasiunaitis
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eduardas Ambrasas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jonas Tutkus
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Gintare Sostakaite
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Andrius Klimasauskas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gintautas Kekstas
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
5
|
Ringaitiene D, Gineityte D, Vicka V, Sabestinaite A, Klimasauskas A, Gaveliene E, Rucinskas K, Ivaska J, Sipylaite J. Concordance of the new ESPEN criteria with low phase angle in defining early stages of malnutrition in cardiac surgery. Clin Nutr 2017; 37:1596-1601. [PMID: 28843445 DOI: 10.1016/j.clnu.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/04/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the incidence of malnutrition (MN) in cardiac surgery patients by implementing the new ESPEN diagnostic criteria and to determine whether these criteria are concordant with the bioelectrical impedance analysis (BIA) provided phase angle (PA) in predicting early stages of malnutrition. METHODS A prospective study was conducted in a tertiary hospital. The nutritional state of the cardiac surgery patients was evaluated one day prior to cardiac surgery using the malnutrition screening tools NRS-2002, MUST and SF-MNA, and bioelectrical impedance analysis. Patients at risk of malnutrition were further studied in accordance with the ESPEN malnutrition diagnostic criteria. A BIA provided PA value of less than the 15th percentile of the age and gender group was set as a theoretical marker of early malnutrition. ROC AUC (receiver operating characteristic area under curve) analysis and other parameters were calculated to determine the concordance between the new ESPEN malnutrition diagnostic criteria and a low PA. RESULTS The study comprised 549 enrolled cardiac surgery patients. MN or risk of MN in accordance with at least one nutritional status assessment tool was diagnosed in 372 (67.75%) patients. MN, according to the new ESPEN malnutrition diagnostic criteria, was only diagnosed in 31 (5.6%) patients. Low PA was detected in 124 patients (22.6%), providing a higher MN rate. The ROC analysis and other concordance parameters showed that the new ESPEN diagnostic criteria (AUC 0.560, p = 0.042) were not concordant with a low PA. CONCLUSION Fewer patients are classified as malnourished by the new ESPEN definition as those identified by the BIA provided PA. Incorporation of the BIA provided PA into the new ESPEN definition may aid to diagnose the early stages of MN in the field of cardiac surgery.
Collapse
Affiliation(s)
- Donata Ringaitiene
- Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
| | - Dalia Gineityte
- Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
| | - Vaidas Vicka
- Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
| | | | - Andrius Klimasauskas
- Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
| | - Edita Gaveliene
- Vilnius University, Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius 08406, Lithuania.
| | - Kestutis Rucinskas
- Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania; Vilnius University, Faculty of Medicine, Clinic of Cardiovascular Diseases, Heart Surgery Center, Vilnius 08406, Lithuania.
| | - Justinas Ivaska
- Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania; Vilnius University, Clinic of Ear, Nose and Throat Diseases, Vilnius, 01513, Lithuania.
| | - Jurate Sipylaite
- Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
| |
Collapse
|
6
|
Klek S, Chourdakis M, Bischoff S, Dubrov S, Forbes A, Galas A, Genton L, Gundogdu HR, Irtun O, Jagmane I, Jakobson-Forbes T, Jirka A, Kennedy N, Klimasauskas A, Khoroshilov I, Leon-Sanz M, Muscaritoli M, Panisic-Sekeljic M, Poulia KA, Schneider S, Siljamäki-Ojansuu U, Uyar M, Wanten G, Krznaric Z. Economy matters to fight against malnutrition: Results from a multicenter survey. Clin Nutr 2015; 36:162-169. [PMID: 26586302 DOI: 10.1016/j.clnu.2015.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/24/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Malnutrition represents a serious health care threat, as it increases morbidity, mortality and health care cost. The effective screening and treatment with enteral (EN) or parenteral (PN) nutrition are the key elements of the policy called Optimal Nutrition Care for All (ONCA). The study tried to analyze the impact of the state's economy on the implementation of EN and PN to define its role in ONCA. MATERIAL AND METHODS an international survey in twenty two European countries was performed between January and December 2014. An electronic questionnaire was distributed to 22 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Return rate was 90.1% (n = 20). RESULTS EN and PN were used in all countries surveyed (100%), but to different extent. The country's income significantly influenced the reimbursement for EN and PN (p < 0.05). It was also associated with the overall use of tube feeding and PN (p = 0.05), but not with the use of oral nutritional supplements (p = 0.165). The use of both, EN and PN at hospitals was not depended on the economy (p > 0.05). Education was actively carried out in all countries, however the teaching at the pre-graduate level was the least widespread, and also correlated with the country income (p = 0.042). CONCLUSIONS Results indicated that economic situation influences all aspects of ONCA, including education and treatment. The reimbursement for EN and PN seemed to be the key factor of effective campaign against malnutrition.
Collapse
Affiliation(s)
- Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General Surgery Unit, Skawina, Poland.
| | | | - Stephan Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Sergiej Dubrov
- National O. Bohomolets Medical University, Department of Anesthesiology and Intensive Care, Kyiv, Ukraine
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aleksander Galas
- Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland
| | - Laurence Genton
- Clinical Nutrition, University Hospital, Geneva, Switzerland
| | - Haldun R Gundogdu
- General Surgery and Gastrointestinal Surgery Atatürk Teaching and Research Hospital, Ankara, Turkey
| | - Oivind Irtun
- Gastrosurgery Research Group, UiT The Arctic University of Norway and Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Norway
| | - Ilze Jagmane
- The Riga East Clinical University Hospital, Riga, Latvia
| | - Triin Jakobson-Forbes
- Tartu University Hospital, Anaesthesiology and Intensive Care Clinic, Tartu, Estonia
| | - Adam Jirka
- Kralovske Vinohrady University Hospital, Internal Medicine Department, Prague, Czech Republic
| | | | - Andrius Klimasauskas
- Vilnius University, Medical Faculty, Clinic of Anaesthesiology and Reanimatology, Vilnius, Lithuania
| | - Igor Khoroshilov
- North-Western State Medical University named after I.I.Mechnikoff, Saint-Petersburg, Russian Federation
| | - Miguel Leon-Sanz
- Servicio de Endocrinologia y Nutrition, Hospital Universitatrio 12 de Octubre, Madrid, Spain
| | | | - Marina Panisic-Sekeljic
- Medical Academy University Clinic for General Surgery Department for Perioperative Nutrition, Belgrade, Serbia
| | | | - Stephane Schneider
- Gastroenterology and Nutrition, Archet University Hospital, Nice, France
| | | | - Mehmet Uyar
- Ege University Hospital, Department of Anesthesiology and Intensive Care, Izmir, Turkey
| | - Geert Wanten
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
7
|
Klek S, Chourdakis M, Bischoff S, Dubrov S, Forbes A, Galas A, Genton L, Gundogdu H, Irtun O, Jagmane I, Jirka A, Jakobson-Forbes T, Kennedy N, Klimasauskas A, Khoroshilov I, Leon-Sanz M, Muscaritoli M, Panisic-Sekeljic M, Poulia K, Schneider S, Siljamäki-Ojansuu U, Uyar M, Wanten G, Krznaric Z. SUN-PP013: Reimbursement Affects Prescription of Enteral and Parenteral Nutrition? Results from European Multicenter Survey. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Thibault R, Makhlouf AM, Theodorsdottir T, Mulliez A, Dadet S, Ait Hssain A, Rizkallah K, Devroey M, Preiser JC, Klimasauskas A, Kekstas G, Kunovic A, Krznaric Z, Ceniceros Rozalen I, Cano N, Pichard C. P099: L’angle de phase mesuré par bio-impédance à l’admission en réanimation est prédictif de la survie à 28 jours : résultats intermédiaires de l’étude multicentrique internationale PHASE ANGLE PROJECT chez 555 patients. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Klek S, Krznaric Z, Gundogdu RH, Chourdakis M, Kekstas G, Jakobson T, Paluszkiewicz P, Vranesic Bender D, Uyar M, Demirag K, Poulia KA, Klimasauskas A, Starkopf J, Galas A. Prevalence of malnutrition in various political, economic, and geographic settings. JPEN J Parenter Enteral Nutr 2013; 39:200-10. [PMID: 24190900 DOI: 10.1177/0148607113505860] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent. METHODS Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective. RESULTS At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist. CONCLUSION The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.
Collapse
Affiliation(s)
- Stanislaw Klek
- General Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Riza Haldun Gundogdu
- General Surgery and Gastrointestinal Surgery, Atatürk Teaching and Research Hospital, Ankara, Turkey
| | | | - Gintautas Kekstas
- Vilnius University Hospital Clinic of Anaesthesia and ICU, Vilnius, Lithuania
| | - Triin Jakobson
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Piotr Paluszkiewicz
- Department of Gastrointestinal Surgery, Lublin Regional Cancer Centre, and Department of Surgery and Surgical Nursing, Medical University, Lublin, Poland
| | | | - Mehmet Uyar
- Department of Anesthesiology and Intensive Care, Ege University Hospital, Izmir, Turkey
| | - Kubilay Demirag
- Department of Anesthesiology and Intensive Care, Ege University Hospital, Izmir, Turkey
| | | | | | - Joel Starkopf
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aleksander Galas
- Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
10
|
Klek S, Krznaric Z, Gundogdu H, Chourdakis M, Kekstas G, Jakobson T, Paluszkiewicz P, Vranesic Bender D, Uyar M, Demirag K, Poulia K, Klimasauskas A, Starkopf J, Galas A. PP184-MON FIGHT AGAINST MALNUTRITION IN EUROPE: DOES NORTH DIFFER FROM SOUTH? Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
11
|
Klimasauskas A, Sereike I, Kekstas G, Klimasauskiene A, Ivaskevicius J. Determinants of critical illness polyneuropathy in the case of long-term ICU treatment. Crit Care 2009. [PMCID: PMC4083995 DOI: 10.1186/cc7273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
12
|
|