[Use of the prokinetic domperidine in patients in the early postoperative period]

The work focuses on the comparison of influence of domperidone and metoclopramide on rehabilitation of motor-evacuation function of stomach and small intestine in 82 patients with post-surgical flatulent distention. For group 1 (n=50) - metoclopramide was administered intravenously from the 1st postoperative day, 10 mg 3 times a day. For group 2 (n=32) - domperidone was used from the 1st postoperative day (motilium suspension), 20 ml 4 times a day. The results of gastrointestinal tract capacity rehabilitation were evaluated using the data of peripheral electrogastroenterography, enteral balance, a complex of radial diagnostics methods. Application of domperidone in patients with post-surgical flatulent distention resulted in quicker gastrointestinal tract motor resolution.

Internet-based assessment of bowel symptoms and quality of life

OBJECTIVES

We wished to determine the value of an open-access internet questionnaire for assessment of upper and lower gastrointestinal symptoms and health-related quality of life.

METHODS

Between January 2002 and June 2005, a symptom scale for upper gastrointestinal and lower gastrointestinal symptoms was placed on a genuine website (www.gesundheits-umfrage.de) and linked to the website of the German irritable bowel syndrome patient group (www.Reizdarmselbsthilfe.de). Patients were asked to report gastrointestinal symptoms that had occurred during the last month. Patients who finished this symptoms questionnaire and acknowledged more than two of a total of eight upper gastrointestinal symptoms and/or more than two of 16 lower gastrointestinal symptoms were immediately offered the assessment of their health-related quality of life by a validated general quality of life scale--the patient general well-being inventory--a 22-item scale with six subscales (anxiety, depression, general well-being, self-control, health, and vitality) and a global scale. Total patient general well-being inventory scores and subscale values were correlated to upper gastrointestinal and lower gastrointestinal symptom scores including the Rome I definition of the irritable bowel syndrome, and to social variables.

RESULTS

Five thousand two hundred and fifty-six individuals completed symptom assessment. Out of these, 4431 had three or more upper gastrointestinal symptoms, the mean number of upper gastrointestinal symptoms reported was 3.2+/-2.0; 4456 had three or more lower gastrointestinal symptoms (mean: 10.3+/-3.3), and 3187 met the Rome I criteria for irritable bowel syndrome. A total of 3316 individuals completed the patient general well-being inventory assessment (1156 men, 2160 women, mean age: 37.7+/-12.3 years). Upper gastrointestinal, lower gastrointestinal, and total symptom score were higher in women than in men (P < 0.001), and significantly correlated to the global quality of life assessment. Family status affected the symptom scores (higher in singles) and quality of life scores (lower in people living in partnership for health, but higher for vitality and depression). Age correlated negatively with upper gastrointestinal, lower gastrointestinal, and with total symptom scores as well as with some patient general well-being inventory scores.

CONCLUSION

Symptom and quality of life assessment using an open internet questionnaire is feasible and generates data which are, in large, comparable to those from other sources of assessment, despite the fact that the population addressed is, on average, moderately younger than previously studied cohorts.

Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study

BACKGROUND & AIMS

This study examined the prevalence of upper gastrointestinal (GI) symptoms and symptom groupings and determined impact on disability days in a nationally representative US sample.

METHODS

A telephone survey of 21,128 adults was conducted including questions about the presence of upper GI symptoms during the past 3 months. Respondents were categorized as symptomatic (ie, reported GI symptoms once per month) or asymptomatic. The survey included questions about missed work, leisure activity, or household activity days. Symptom groupings were identified by using factor analysis, and cluster analysis was used to assign respondents into distinct groups on the basis of these symptom groupings.

RESULTS

The prevalence of an average of 1 or more upper GI symptoms during the past 3 months was 44.9%. The most common symptoms experienced during the past 3 months were early satiety, heartburn, and postprandial fullness. Factor analysis identified 4 symptom groupings: (1) heartburn/regurgitation; (2) nausea/vomiting; (3) bloating/abdominal pain; and (4) early satiety/loss of appetite. Five respondent clusters were identified; the largest clusters were primarily early satiety/fullness (44%) and gastroesophageal reflux disease-like symptoms (28%). Two small clusters reflected nausea and vomiting (7%) and a heterogeneous symptom profile (4%). Symptomatic respondents reported significantly more missed work, leisure, and household activity days than asymptomatic respondents (all P < .0001).

CONCLUSIONS

Factor analysis separated GI symptoms into groupings reflecting gastroesophageal reflux disease and dyspepsia: early satiety, postprandial fullness, and loss of appetite; bloating and abdominal pain/discomfort; and nausea and vomiting. These upper GI symptoms were associated with significant loss of work and activity days.

[Effect of secondary prophylaxis on quality of life in gerontologic patients at the rehabilitation center for the disabled Patriotic war veterans in local sanatorium]

AIM

To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center.

MATERIAL AND METHODS

100 patients were investigated for effects of sanatorium treatment on quality of life.

RESULTS

Clinical symptoms depended on the patients' age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients.

CONCLUSION

Sanatorium treatment resulted in improvement of life quality in gerontological patients.

[Long-term outcomes after acute vitamin D3 intoxication]

We observed 75 subjects with acute vitamin D3 intoxication (AVD3I). The clinical manifestations of this intoxication are kidneys disorders (65.0%), renal insufficiency (51.0%), gastrointestinal tract disorders (23.0%), arterial hypertension (52.0%). After this intoxication these patients are recommended prolonged rehabilitation.

Hardware-software co-design of portable functional gastrointestinal stimulator system

In the recent years, functional electrical stimulation has been applied to restore impaired motility in the gastrointestinal tract. Unlike other methods of electrical stimulation of the gut, microprocessor-controlled, sequential electrical stimulation has been shown to induce peristalsis and enhance emptying in acute canine gastric and colonic models. This study aims at completing the development of a portable microprocessor-based functional stimulator system consisting of a microelectronic stimulator, patient-specific computer-based real-time software and a programming interfacing device. The ultimate goals of the design are to ensure that (1) the portable stimulator can be efficiently utilized in chronic animal experiments; and (2) the device can be further miniaturized into an implantable version. The designed portable stimulator generates four channel sequential bipolar rectangular pulse trains with programmable parameters within the stimulation requirements obtained from a previously developed computer model. Real-time simulation of colonic peristalsis and a case-specific stimulation model were implemented using patient-specific computer-based software. A chronic canine case study confirmed the feasibility of this microprocessor-controlled stimulation method for future clinical applications in humans.

[Ambulant rehabilitation of patients with gastrointestinal and metabolic diseases]

For the following reasons it has, despite plausible different opinions, seldom been possible realize ambulant rehabilitation offers:For historical reasons gut rehabilitation centers lie outside of conurbations. A model of gastrointestinal-oncologic rehabilitation supports developing an entirely new concept for ambulant treatments, instead of merely copying the presently in-patient rehabilitation therapy. In the exemplary thoughts of the GRVS, which were already presented five years ago, quantitative factors have not been taken into consideration satisfactorily. Considering this the following three diagnosis groups become relevant - diabetes m. - obesity - gastrointestinal cancer. The needed ambulant rehabilitation concepts are to be connected to the long-term ambulant treatment, available close to the patient's home city.

Reason for medical hospitalization among adult alcohol and drug abusers

This study attempts to identify the associations between types of substance use and particular medical problems as causes of acute hospital admission on an inpatient substance abuse consultation service. Records of all consultations performed from 1994 to 1998 were analyzed. A total of 4,526 complete records were available. Cocaine (p < .01), heroin (p < .001), and injection drug (p < .001) users were more likely to be admitted to the hospital for infection. Both alcohol (p < .001) and marijuana (p < .001) users were more likely to be hospitalized for trauma related injuries. Individuals that used alcohol were also more likely to be admitted for the treatment of gastrointestinal disorders (p < .001). Clinicians who treat patients with these diagnoses should have a high index of suspicion of co-morbid substance use disorders. Effective treatment of substance use disorders can lead to a decrease in medical morbidity, improved outcomes for individual patients, and decreased costs for the health care system.

[Improvement of medical care of children during the prevention stage]

The article looks at the problem of the improvement of medical aid for children and emphasizes the importance of the transference of medical attendance. It gives a detailed account of the subject of the school age children nutrition and the possibility of the correction and dietary rehabilitation of children alimentary dependent states.

[Current issues in gastroeneterologic rehabilitation]

In Hungary gastroenteric diseases' rehabilitation, which is one of the youngest branch of medical rehabilitation, has grown out of traditional, sanatorial care from the 70s. Its main feature that it is based on a biopsychosocial attitude towards patients as a team-work. Though it comprises traditional, medical diagnosis and treatment, medicine and medical technology are not the primary resources of gastroenteric diseases rehabilitation: it is mainly built on a friendly and co-operating relations with the patients, which helps doctors to exert their mental and intellectual influence promoting their patients recovery. Therefore, gastroenteric diseases' rehabilitation can be sharply separated from active treatment and care. The article gives full details of the possible methods of gastroenteric diseases' rehabilitation, such as diagnosis, medicinal treatment, psychotherapy, dietotherapy, physiotherapy and regimen guidance. In addition, it is emphasized that under sanatorial circumstances the effects of rehabilitation, especially of regimen guidance multiplies. Furthermore it gives numerical data about the present situation of gastroenteric diseases' rehabilitation in Hungary. Considering the data gained from the special rehabilitation hospital located in Visegrád, the article touches upon the illnesses calling for this kind of rehabilitative treatment not passing over the fact of multimorbidity, especially important in rehabilitation.

[Considerations for standardization of assessment of performance capacity in rehabilitation medicine]

Specific difficulties in the assessment of reduced performance capacity in patients with gastroenterologic illness led to the development of a standardized and unified assessment method. The following five steps--exemplified for chronic liver-disease--were designed: (1) determination of disease features (and their graduations), leading to reduced performance capacity; (2) construction of a detailed performance capacity model using more concrete factors (e.g. motivation, cognition, cardiovascular-pulmonary system, etc.); (3) deduction of rules between disease features and the concrete factors of performance capacity, describing the expected (unfavourable) limitations; (4) consideration of individual limitations on the level of the concrete factors, and (5) conversion into a computer-aided expert system. The benefit of the method developed lies in prompt and practicable assistance by the expert system and in transparency of the decision processes. Therefore, performance capacity assessment will certainly gain in reliability and objectivity.

[Organization of a medical occupational rehabilitation system for locomotive team workers]

The paper deals with the setting up of a system for early diagnosis of premorbidity and for medical professional rehabilitation of locomotive teams. Non-drug preventive measures are shown to have a high rehabilitative effect.

[The quantum and efferent correction of the gastroenterological disorders in patients with chronic glomerulonephritis]

The article is dedicated toward examining the problem of treatment of gastroenterological disturbances in patients with chronic glomerulonephritis (ChGN). A positive clinical and endoscopical effect was higher in those groups in which the combined treatment involved the quantum methods (such as informationwave and microwave resonance therapy) as compared to the group having received drug therapy only. The results secured suggest that methods of quantum therapy may be used in combination with efferent therapy (programme hemodialysis, enterosorption) in ChGN patients. A multimodality treatment has a detoxicating and a sanogenic effects, improves the functional condition of the alimentary canal and kidneys.

Health-related quality of life: a primer for gastroenterologists

The evolution of health care has required physicians to evaluate more critically the impact of interventions on their patients' well-being. Prior clinical interventions focused primarily on biochemical and histological endpoints. These outcomes frequently were tenuously linked to patient benefit. Recently there has been a movement toward patient-oriented outcomes, including health-related quality of life (HRQL). The medical literature now frequently describes the effects of therapies on HRQL. Gastroenterologists need to understand the concepts behind HRQL and the use and utility of the various instruments employed to measure this outcome. The purpose of this article is: 1) to define the concept of health-related quality of life (HRQL); 2) to assess when measurement of HRQL can guide clinical decision-making; 3) to describe the desired properties of an HRQL instrument; and 4) to distinguish types of HRQL instruments. We discuss the varied definitions of HRQL and the clinical scenarios in which they are important. The psychometric properties of HRQL instruments, including validity, reliability, responsiveness, sensitivity, and coverage are defined and discussed. The types of instruments such as health profile, time trade-off, and standard gamble are contrasted. Finally, we compare generic and disease-specific instruments regarding their uses, strengths, and weaknesses. HRQL reflects patients' perceptions of disease and its impact on health status. It is becoming an increasingly important endpoint in therapeutic trials. By understanding its components and how it can meaningfully be measured, gastroenterologists may be better able to optimize the benefit patients receive from their medical interventions.

Urinary and gastrointestinal systems medications

This article reviews the medical management of the neurogenic bladder and bowel. The drugs discussed specifically affect detrusor instability, detrusor weakness, high urethral pressure, low urethral closure pressure, inflammatory cystitis, and chronic constipation.

[The effect of reflex muscle massage on the body regulatory processes of peptic ulcer patients with concomitant diseases]

Compared to conventional treatment, the proposed method of deep reflex muscular massage for treatment of ulcer patients with associated diseases in combination with exercises for muscle strain, produce stronger positive changes in adaptive-compensatory systems. This may result in prolongation of the remission and in a decreased number of recurrences of ulcer and associated gastrointestinal diseases.

Experience with gastrojejunal feeding tubes in children

OBJECTIVE

Assessment of untoward symptomatic outcomes and major/minor complications occurring in children with percutaneous gastrojejunal tubes (GJT) in place.

METHODS

A retrospective chart review of 28 patients with GJTs was performed. The diagnoses for these patients were: neurological diseases, 23; respiratory diseases, two; and gastrointestinal tract disorders, three. Twenty-three tubes were placed radiologically, four endoscopically, and one surgically. Patients' age range was between 1.5 and 180 months (mean 47.2 months), and weight at the time of tube insertion was between 2.28 and 42.7 kg. (mean 11.7 kg.). Duration of follow-up was from 1 to 49 months (mean 17.3 months). The patients were evaluated for the persistence or new development of the following symptoms: vomiting, hematemesis, abdominal pain, constipation, diarrhea, pain at the site of gastrostomy tube insertion, stridor with feeds, and dumping. Minor complications (including breakage, partial/total displacement, or dislodgement of GJT, tube occlusion, tube leakage, transient infection and/or granuloma at the gastrostomy site, and continued gastroesophageal reflux post-GJT conversion), as well as major complications (requiring surgical intervention) and mortality, were assessed.

RESULTS

One or more symptoms either persisted or developed de novo in 20 children after tube insertion. Vomiting was the most common symptom, being present in 16 patients. One or more minor complication occurred in 21 patients; the most common was the accidental dislodgement of the jejunal feeding catheter. Major complications occurred in 11 patients (e.g., fundoplication in seven patients). Five patients died. Six patients had no complications; at the time of GJT placement, their mean age (93.3 months) was significantly older (p = 0.0269) and mean weight (21.3 kg.) significantly heavier (p = 0.0067) than those of children reporting major complications.

CONCLUSIONS

We conclude that ongoing or new gastrointestinal symptoms and minor complications are common in children with GJT. However, GJT placement in larger children is associated with fewer complications than in smaller children.

[Gastroenterologic and hepatologic rehabilitation today--on changes in indications and contents]

The rehabilitation in gastrointestinal diseases has experienced the introduction of new concepts. Regional health resorts (i.e., mineral springs, climate or mud baths) do not play a role anymore. Today, rehabilitation cliniques are teaching and training centers for chronic patients with multiprofessional teams. The need for rehabilitation cannot be derived from the diagnosis alone or the duration of the illness but from the severity of the symptoms and/or additional psychosocial problems. The order of the application of different techniques during medical rehabilitation differs from patient to patient and necessitates a definition of the rehabilitation goal. Chronic inflammatory bowel disease, chronic pancreatitis, and chronic liver diseases are explained as an example. "Rehabilitation of gastrointestinal or metabolic diseases' is often better described with a model of progression than with the traditional model of disablement. Therefore, a network of clinical and ambulant rehabilitation as well as an entanglement of institutions providing hospital care and after-care is required.

[The influence of spa therapy on the endocrine system. II. Erythropoietin]

The stimulatory effect of spa therapy on erythropoiesis is well documented. The present study aimed to elucidate the pathogenesis of this effect. The influence of spa therapy on plasma erythropoietin and erythropoiesis was studied in four groups of patients: 35 patients with essential hypertension, 35 patients with inflammatory renal diseases at a stabilized stage and normal excretory renal function. 25 patients with gastrointestinal pathology or cholelithiasis and 33 patients with neurovegetative neurosis. Spa therapy for 20 days in Wysowa was accompanied by a significant increase of plasma erythropoietin, iron, ferritin and saturation of transferrin with iron and by an increase of blood haemoglobin and haematocrit value. These alterations were especially marked in patients with essential hypertension.

CONCLUSIONS

1. Spa therapy exerts a stimulatory effect on erythropoiesis caused, among other factors, by increased erythropoietin secretion and iron mobilization. 2. This stimulatory effect is especially marked in patients with essential hypertension.

[Effect of spa therapy on the endocrine system. I. Stress reaction hormones]

The present study aimed to assess a.) the influence of spa treatment in Wysowa on the circadian rhythm of plasma concentration of ACTH, cortisol, growth hormone and prolactin, and b.) the influence of kind of pathology on the hormonal profile of the above mentioned hormones. Four groups of patients were examined. The first one comprised 48 patients with essential hypertension, the second one--47 patients with inflammatory renal disease with normal excretory renal function, the third one--39 patients with gastrointestinal diseases and cholelithiasis and the fourth one--41 patients with neurovegetative neurosis. The hormonal parameters were assessed during a clinical check-up, and after 4 and 20 days of spa therapy in Wysowa respectively. In all examined groups spa treatment was accompanied by a significant increase of serum concentrations of all examined hormones. Spa treatment did not influence the circadian rhythm of ACTH, cortisol, growth hormone and prolactin plasma concentration in all examined groups of patients.

CONCLUSION

spa therapy shows a marked influence on secretion of "stress" hormones, but does not influence the circadian rhythm of plasma concentration of these compounds.

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases

Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.s.) accepted a sigmoidoscopy. Of 658 (m = 403, f = 255) patients with complete investigation, 153 (23%) (m = 104, 26%; f = 49, 19%; n.s.) had a total of 272 neoplastic polyps, including 1 carcinoma. Adenomas = /> 10 mm were found exclusively in male patients (n = 25, p < 0.001). In comparing patients aged 50-55 years (n = 386) with those aged 56-60 years (n = 272), prevalences of neoplasia were found to be 19%/29% (p < 0.01), and prevalences of adenomas = /> 10 mm were 2%/10% (p < 0.05). The acceptance of a colonoscopy in patients with neoplastic polyps at sigmoidoscopy was 116/153 (m = 78, 75%; f = 38, 78%; n.s.). In 39 of these patients (34%) (m = 31, 40%; f = 8, 21%; p < 0.05), 68 further adenomas were detected but no carcinoma or adenoma with severe dysplasia. Multiple adenomas in the proximal colon were seen in 17 cases (15%) (m = 16, 21%; f = 1.3%; p < 0.01). The FOBT was positive in 10/658 patients, including the case with a carcinoma, but only in 4/25 with adenomas = /> 10 mm. In 5 cases with positive FOBT sigmoidoscopy and complementary colonoscopy did not reveal any pathology.

[The course of inpatient rehabilitation in gastrointestinal and metabolic diseases under increasing integration of behavior and experience]

Starting out from the thesis that behaviour and felt experience, i.e., the patient's "subjective world", have considerable influence on chronic diseases and their consequences in the gastrointestinal field, a "basic course documentation"-based comparison has been carried out of the courses of 4-week in-patient rehabilitation programmes designed to increasingly incorporate interventions directed at this area; the study population had consisted of two groups of patients (n = 688 each) without any significant differences concerning age and sex distribution admitted during the summer terms of 1990 (Group A) and 1991 (Group B), respectively. This documentation (in DBASE IV format) compiles (anonymized) patient data at an "objective" level on the one hand, i.e. basic data (such as diagnoses, age, sex), results obtained by the Edinburgh Rehabilitation Status Scale (ERSS), risk behaviour, and scope of interventions both in the organ-medical and physical therapy fields and in the area of "instruction, motivation, support, group work, and creativity" (designed to achieve integration of behaviour and felt experience); on the other hand, at "subjective level", it comprises the patient's own judgements relative to the treatment regimen and its environment, with subsequent correlational analysis of the data obtained (using the SPSSPC statistical package). As had been expected, correlations have on the one hand been stated at the "objective" level between an increased share of more "serious" conditions (ICD) in 1990 as compared to 1991 and higher ERSS scores (i.e., increased impact of disease consequences), greater organ-medical care intensity, and frequency of incapacity for work; on the other hand, at "subjective" level, strong linkages were found among the item ratings for general sense of improvement, specific and general therapy, as well as so-called "therapeutic environment". When the two levels are linked, the sense of improvement, as expected, is found to correlate negatively with the ERSS, but positively with the scope of the interventions designed to foster integration of behaviour and felt experience. The judgements given for quality of care provided relative to the patient's self-reported primary disorder and for general medical care correlate positively both with the scope of diagnostic/therapeutic organ-medical interventions and integration-focussed ones, which, at least from the patient's perspective, hence exercise an ascertainable, essential effect in the therapeutic setting of in-patient rehabilitation in gastrointestinal and metabolic diseases.

[Experience in promoting the health of the children of a rural district at the physiotherapy clinic of a central district hospital]

Gastroenterological diseases were treated in children of a rural area using physiotherapy methods and non-traditional therapy. Treatment included mineral water ("Borzhomi", "Naftusia"). Favourable results are reported. The treatment is often carried out during school vacations.

Post registration training in gastroenterology for nurses

This article is a review of the prospects for a specialised European training programme for nurses in gastroenterology. It discusses the possible integration of training in endoscopy and stoma therapy together with conventional nursing of acute gastrointestinal emergencies and the care of patients with chronic intestinal conditions. Despite the existence of a number of interested bodies, at present no such courses exist. If they are developed they should lead to an internationally recognised diploma of gastrointestinal nursing. Training in counselling techniques, terminal care and research methodology, together with computing techniques need to be incorporated in each course. The future of such nurses will be in non-academic hospitals, where they will have a role in the follow-up and management of patients.

[Physical therapy in gastroenterology]

During the last 30 years physiotherapy increased in size and value, is integrated into nearly all subjects of medicine and has its justification and significance like pharmacotherapy. The use of physiotherapy in gastroenterological diseases has in most cases empirical character, though increasingly objectifiable modes of action are proved. Of the massage treatment predominantly the segmental massage, the massages of the connective tissue and the treatment of the colon are therapeutically effective in gastroenterology. Electrotherapeutically, ultrasound and infrared may be used. The field of therapy for short-wave and exciting current is narrowed in gastroenterological diseases. Good results of treatment are obtained with peloid packs, which, however, above all are yielded in the health-resort. In chronic gastroenterological diseases more attention should be paid to kinetotherapy and it should more frequently be used. It not anyway acts only on the locomotor system, but always on the general organism, especially on the vegetative functional system and should be prescribed particularly in rehabilitation after a long stay in sick-bed. In its variety the group therapy concerns the general organism physically and psychically and has above all a vegetative regulation effect.

A review of the current national status of home parenteral and enteral nutrition from the provider and consumer perspective

Home parenteral and enteral nutrition (HPEN) has grown rapidly in the past decade. By examining data from physician reports, patient surveys, and the infusion industry, this review attempts to delineate the diagnostic indications, age range, mortality, medical complications and rehabilitation potential of HPEN patients. A clear trend exists towards greater use of this expensive therapy in bowel obstructed cancer patients and in pediatric and geriatric age groups. Complications in parenterally fed patients appear to result in a readmission to the hospital, on average, once every 2 yr. Life expectancy depends heavily on the underlying diagnosis: whereas 50% of the patients with a malignancy survive only 6 months, 50% without a malignancy survive beyond 3 yr. Fifty to 60% of HPEN patients are able to work full time or part time, 15 to 20% are retired or of preschool age, and 20 to 30% are unable to work. The home care service options considered most important by patients are the pharmacy premixing of intravenous solutions, home delivery of supplies by the home service carrier, reimbursement management by the home care service and the availability of a nurse for an initial home visit and 24-hr emergency backup. In regard to fiscal concerns one of the difficult issues that should be addressed is the separation of medical coverage from disability status; another is that enteral feedings can sometimes be a less expensive alternative to parenteral feedings but little information exists about the complications and outcome with this modality and its fiscal reimbursement is much less assured.