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Canadian journal of gastroenterology = Journal canadien de gastroenterologie 06/2011; 25(6):302-3. · 1.21 Impact Factor
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ABSTRACT: The most frequent home parenteral nutrition complication is central venous catheter infection. The authors sought to determine the rate and types of bloodstream infections in a Canadian home parenteral nutrition program. Methods: Bloodstream infection was diagnosed if all following criteria were present: (1) one or more positive blood cultures were found, (2) antimicrobial therapy or catheter was removed, and (3) there were no other infections. Results: Between April 1, 1996, and April 30, 1997, 43 patients from the Home Parenteral Nutrition Program at Toronto General Hospital participated in a multicenter study in which a total of 355 patients receiving home infusion therapy for various reasons were enrolled. From these 43 patients, there were 37 infections in 19 home parenteral nutrition patients. The infection rate was 2.3 per 1000 catheter days. The common infecting organism was coagulase-negative Staphy-lococcus. Conclusion: In this prospective study involving patients receiving home parenteral nutrition, although the information is 10 years old, the infection rate of 2.3 per 1000 catheter days is lower than most recent studies involving patients receiving total parenteral nutrition in the hospital or at home with a similar common infecting organism of coagulase-negative Staphylococcus.
Journal of the Association for Vascular Access 05/2007; 12(2):85-88.
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Gastrointestinal Endoscopy 02/2006; 63(1):150. · 4.88 Impact Factor
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ABSTRACT: Fulminant hepatic failure is a rapidly progressive and often fatal syndrome, and the only definitive treatment is liver transplantation. However, given the scarcity of available grafts, the mainstay of therapy remains supportive care until there is spontaneous recovery or until a suitable donor liver becomes available. After initial assessment and stabilization, patients should be transferred to the nearest liver transplant center as soon as possible, as they can deteriorate rapidly. All patients with fulminant hepatic failure must be monitored closely and treated for hepatic encephalopathy, coagulopathy, gastrointestinal bleeding, renal failure, cerebral edema, and metabolic derangement.
Current Treatment Options in Gastroenterology 01/2004; 6(6):473-479.
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ABSTRACT: Line sepsis complicates home parenteral nutrition (HPN). This study examined nonmedical risk factors that may contribute to line sepsis and compared 2 HPN programs with different administrative structures (Ontario and British Columbia [BC]) in terms of line sepsis and patient satisfaction.
A survey was developed to evaluate possible correlation between line sepsis and (1) patients' perceptions of HPN care, (2) family support, (3) community support, and (4) socioeconomic status. Data were analyzed by categorizing into high- and low-risk groups using a cutoff point. A second method analyzed the incidences of line sepsis as a continuous variable.
Sixty-eight patients responded to the survey: 33 from Ontario (62%), 35 from BC (44%). Community agency, socioeconomic and educational status were not significant in determining line sepsis. Patients who had (1) medication or blood work done through the catheter, (2) a higher number of dependents, or (3) had a trained family member involved in HPN were in the high-risk category for line sepsis, in addition to patients who were part-time students or receiving social assistance. When comparing the provinces, there was no difference in line sepsis. However, significant differences between the provinces include (1) BC patients rate their level of care lower; (2) Ontario patients rely more on family members for HPN; and (3) Ontario patients have more community support.
Line sepsis may be increased by some nonmedical risk factors. However, when comparing the 2 programs, rates of line sepsis were not influenced by different administrative structures.
Journal of Parenteral and Enteral Nutrition 29(6):408-12. · 3.29 Impact Factor
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ABSTRACT: Telehealth videoconferencing is a medium for health care professionals to communicate and care for patients living in remote areas. The aim of this study was to provide a survey to examine management outcome of home parenteral nutrition (HPN) patients when followed by telehealth as an alternative modality of care.
Twenty-six individuals who were identified to benefit from tele-health were invited to participate in a satisfaction survey. The survey was sent to patients by postal mail. The survey also documented the incidence of line sepsis and other medical HPN complications. A cost analysis was also performed according to technology, human resources, and infrastructure.
Eighty-one telehealth videoconference sessions have been held since the inception of telehealth in 2002. Of the current telehealth patients, 13 were eligible for the survey. The satisfaction survey response rate was 11/13 (84.6%). The average line sepsis rate for the 13 patients was 0.89/1000 catheter-days. All patients were generally satisfied with videoconferencing as an alternative method of communication and care for new consultation, patient and family education, and follow-up. Travel time and costs to the patients, their families, and the health care system were significantly less. For example, a patient who resides 611 km from Toronto would cost CDN (Canadian) 724.00 dollars for flight and accommodation to meet with the team at the HPN clinic in Toronto. Conclusion: Telehealth incorporated the cost-saving ability for HPN patients to maintain proper medical care, support, and collaboration of specialists inaccessible to their local community. Thus, its strongly positive role in HPN care deserves further consideration for a national application.
Journal of Parenteral and Enteral Nutrition 31(3):234-9. · 3.29 Impact Factor
