1. From hospital unit to intestinal failure center: Twenty years of history.
- Author
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Klek S, Szczepanek K, Sumlet M, Kupiec M, Pietka M, Zamarska J, Kowalczyk E, Scislo L, and Walewska E
- Subjects
- Delivery of Health Care methods, History, 20th Century, History, 21st Century, Hospitals, Special organization & administration, Humans, Parenteral Nutrition, Home methods, Poland, Retrospective Studies, Delivery of Health Care history, Hospitals, Special history, Intestinal Failure therapy, Parenteral Nutrition, Home history, Patients statistics & numerical data
- Abstract
Aim: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study., Methods: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation., Results: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days., Conclusions: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances., Competing Interests: Conflict of interest Conflict of interest: S. Klek received honoraria as a lecturer from Baxter, B Braun, Fresenius Kabi, Nestle, Nutricia and Shire/Takeda. K. Szczepanek and M. Pietka received honoraria as a lecturer from Baxter, B Braun, Fresenius Kabi, and Nutricia., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
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