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MON-PP013: The Reimbursement Does not Imply the Use of Clinical Nutrition Results From an International, World-Wide Survey
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Poster tour 8: Techniques and formulations 2 MON-PP013 Outstanding abstract THE REIMBURSEMENT DOES NOT IMPLY THE USE OF CLINICAL NUTRITION RESULTS FROM AN INTERNATIONAL, WORLD-WIDE SURVEY S. Klek1 , D. Abdulqudos Abosaleh2 , A. Amestoy3 , H.W. Baik4 , G. Baptista5 , R. Barazzoni6 , M. Chourdakis7 , R. Fukushima8 , J. Hartono9 , R. Jayawardena10 , R.J. Garcia11 , Z. Krznaric12 , I. Nyulasi13 , G. Parallada14 , L. Perez Francisco15 , M. PanisicSekeljic16 , M. Perman17 , A. Prins18 , I.M. Isabel Martinez del Rio Requejo19 , R. Reddy20 , P. Singer21 , M. Sioson22 , A. Ukleja23 , C. Vartanian24 , N. Velasco Fuentes25 , D. Linetzky Waitzberg26 , S.L. Zoungrana27 , A. Galas28 . 1 Stanley Dudrick’s Memorial Hospital, Skawina, Poland; 2 King Faisal Specialist Hospital & research center, Riyadh, Saudi Arabia; 3 Universidad Cat´ olica, Montevideo, Uruguay; 4 DMC Bundang Jesaeng Hospital, Seoul, Korea, Republic of; 5 Hospital Universitatio de Caracas, Caracas, Venezuela, Bolivarian Republic of; 6 University of Trieste, Trieste, Italy; 7 Aristotle University, Thessaloniki, Greece, V; 8 Teikyo University School of Medicine, Tokyo, Japan; 9 Central Army Gatot Soebroto Hospital, Jakarta, Indonesia; 10 University of Colombo, Colombo, Sri Lanka; 11 Universidad de las Ciencias M´ edicas de La Habana, Habana, Cuba; 12 University of Zagreb, Zagreb, Croatia; 13 Monash University, Melbourne, Australia; 14 Universidad Cat´ olica del Uruguay, Montevideo, Uruguay; 15 St. Luke’s Medical Center, Manila, Philippines; 16 Medical Academy University Clinic, Belgrade, Serbia, 17 Italian Hospital of Buenos Aires, Buenos Aires, Argentina; 18 Mary Medical Centre in Groenkloof, Pretoria, South Africa; 19 Hospital Lic. Adolfo L´ opez Mateos, Mexico City, Mexico; 20 Care Hospitals Banjara Hills, Hyderabad, India; 21 Rabin Medical Center, Tel Aviv, Israel; 22 The Medical City Hospital, Manila, Philippines; 23 Cleveland Clinic Florida, Tampa, United States; 24 Serhal Hospital, Beirut, Lebanon; 25 Pontifical Catholic University, Santiago, Chile; 26 Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de S˜ ao Paulo, Sao Paulo, Brazil; 27 La Clinique de l’Amiti´ ea ` Ouagadougo, Ouagadougo, Burkina Faso; 28 Jagiellonian University, Krakow, Poland Rationale: Malnutrition is a grave public health issue worldwide. A quick and precise detection and immediate treatment with clinical nutrition support (CNS) are the best methods to fight it. Reimbursement of medical procedures and widespread education for medical professionals should improve the use of CNS, but the factual relations among those factors have never been analyzed. The aim of the study was to analyze those relations. Methods: An international survey was performed between January and December 2014 in twenty-seven countries from all continents. An electronic questionnaire was distributed to 28 representatives of clinical nutrition (PEN) societies, of which twenty-seven (96.4%) were returned. Results: CNS, meaning enteral (EN) and parenteral nutrition (PN) were used in all countries surveyed, but to different extents. The use of EN and PN in was not depended on the income of the country, although the insignificant trend was observed in case of home CNS (p = 0.073). The use of EN and PN at chronic care centers, palliative centers and at home was independed on country income (p = 0.334 and p = 0.332, respectively). The level of the country income
Poster presentations did not influence, however, the reimbursement for EN and PN (p = 0.072) The reimbursement was of utmost importance for the utilization of EN and PN at hospitals (p = 0.035), and mattered less at other settings. The country income did not influence neither the prevalence of malnutrition (p = 0.186), nor the proportion of patients with indications for EN (p = 0.256 and 0.216, respectively). It mattered, however, for PN (p = 0.019). Conclusion: This is the first worldwide survey to link educational and economical aspects of clinical nutrition. Results prove the reimbursement to be important aspect for the use of CNS, but it is not a condition sine qua non. Disclosure of Interest: None declared
MON-PP014 Outstanding abstract BLACKCURRANT TEST IS A PRACTICAL METHOD TO CONFIRM POSITION OF NASOGASTRIC TUBE M. Klos1 , M. van Laar1 , M. Zwerink2 , H.J. van der ZaagLoonen2 . 1 Dietetics, 2 Education Centre, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Netherlands Rationale: Recommended methods to confirm the position of a nasogastric tube (NGT) in the stomach are not always successful; sometimes aspirate cannot be obtained, sometimes pH is higher than 5.5. The Dutch national guideline on gastric tube insertion recommends to make an X-ray when the position of NGT cannot be confirmed. However, in Gelre hospital the blackcurrant test is done first. This is an inexpensive and easy-to-perform test. Only when the blackcurrant test is also unsuccessful, an X-ray is taken. In this study we investigated in how many patients the blackcurrant test could confirm the position of the NGT, so that an X-ray could be avoided. Methods: From November 2013 until December 2014 we documented NGTs (10 FG) placed in adults with a safe swallow. We registered whether aspirate could be obtained, pH of aspirate, and whether a blackcurrant test was performed. In the blackcurrant test, the patient drinks 50 100 ml of coloured lemonade with a low pH (blackcurrant, lemon squash). Thereafter the nurse attempts to aspirate via the NGT, and checks the aspirate for colour and pH. A pH 5.5 indicates correct placement of the NGT. Results: 69 Tubes in 58 patients were registered (54% female, age 69±14 years). pH-check alone was sufficient to confirm position in the stomach in 40 tubes (58%). After the additional blackcurrant test, the position of another 24 tubes (35%) was confirmed. From three tubes, still no aspirate was obtained after the blackcurrant test and an X-ray was taken (one tube in stomach, one ‘just in stomach’ and one in oesophagus). In two patients the blackcurrant test was omitted and x-rays were taken. Conclusion: Performing the blackcurrant test after an unsuccessful pH-check raised the percentage of confirmed NGTs from 58% to 93%. In other words, an x-ray was required in only 7% of NGT placements, while this would have been 42% without the blackcurrant test. Disclosure of Interest: None declared
Poster tour 8: Techniques and formulations 2 MON-PP013 Outstanding abstract THE REIMBURSEMENT DOES NOT IMPLY THE USE OF CLINICAL NUTRITION RESULTS FROM AN INTERNATIONAL, WORLD-WIDE SURVEY S. Klek1 , D. Abdulqudos Abosaleh2 , A. Amestoy3 , H.W. Baik4 , G. Baptista5 , R. Barazzoni6 , M. Chourdakis7 , R. Fukushima8 , J. Hartono9 , R. Jayawardena10 , R.J. Garcia11 , Z. Krznaric12 , I. Nyulasi13 , G. Parallada14 , L. Perez Francisco15 , M. PanisicSekeljic16 , M. Perman17 , A. Prins18 , I.M. Isabel Martinez del Rio Requejo19 , R. Reddy20 , P. Singer21 , M. Sioson22 , A. Ukleja23 , C. Vartanian24 , N. Velasco Fuentes25 , D. Linetzky Waitzberg26 , S.L. Zoungrana27 , A. Galas28 . 1 Stanley Dudrick’s Memorial Hospital, Skawina, Poland; 2 King Faisal Specialist Hospital & research center, Riyadh, Saudi Arabia; 3 Universidad Cat´ olica, Montevideo, Uruguay; 4 DMC Bundang Jesaeng Hospital, Seoul, Korea, Republic of; 5 Hospital Universitatio de Caracas, Caracas, Venezuela, Bolivarian Republic of; 6 University of Trieste, Trieste, Italy; 7 Aristotle University, Thessaloniki, Greece, V; 8 Teikyo University School of Medicine, Tokyo, Japan; 9 Central Army Gatot Soebroto Hospital, Jakarta, Indonesia; 10 University of Colombo, Colombo, Sri Lanka; 11 Universidad de las Ciencias M´ edicas de La Habana, Habana, Cuba; 12 University of Zagreb, Zagreb, Croatia; 13 Monash University, Melbourne, Australia; 14 Universidad Cat´ olica del Uruguay, Montevideo, Uruguay; 15 St. Luke’s Medical Center, Manila, Philippines; 16 Medical Academy University Clinic, Belgrade, Serbia, 17 Italian Hospital of Buenos Aires, Buenos Aires, Argentina; 18 Mary Medical Centre in Groenkloof, Pretoria, South Africa; 19 Hospital Lic. Adolfo L´ opez Mateos, Mexico City, Mexico; 20 Care Hospitals Banjara Hills, Hyderabad, India; 21 Rabin Medical Center, Tel Aviv, Israel; 22 The Medical City Hospital, Manila, Philippines; 23 Cleveland Clinic Florida, Tampa, United States; 24 Serhal Hospital, Beirut, Lebanon; 25 Pontifical Catholic University, Santiago, Chile; 26 Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de S˜ ao Paulo, Sao Paulo, Brazil; 27 La Clinique de l’Amiti´ ea ` Ouagadougo, Ouagadougo, Burkina Faso; 28 Jagiellonian University, Krakow, Poland Rationale: Malnutrition is a grave public health issue worldwide. A quick and precise detection and immediate treatment with clinical nutrition support (CNS) are the best methods to fight it. Reimbursement of medical procedures and widespread education for medical professionals should improve the use of CNS, but the factual relations among those factors have never been analyzed. The aim of the study was to analyze those relations. Methods: An international survey was performed between January and December 2014 in twenty-seven countries from all continents. An electronic questionnaire was distributed to 28 representatives of clinical nutrition (PEN) societies, of which twenty-seven (96.4%) were returned. Results: CNS, meaning enteral (EN) and parenteral nutrition (PN) were used in all countries surveyed, but to different extents. The use of EN and PN in was not depended on the income of the country, although the insignificant trend was observed in case of home CNS (p = 0.073). The use of EN and PN at chronic care centers, palliative centers and at home was independed on country income (p = 0.334 and p = 0.332, respectively). The level of the country income
Poster presentations did not influence, however, the reimbursement for EN and PN (p = 0.072) The reimbursement was of utmost importance for the utilization of EN and PN at hospitals (p = 0.035), and mattered less at other settings. The country income did not influence neither the prevalence of malnutrition (p = 0.186), nor the proportion of patients with indications for EN (p = 0.256 and 0.216, respectively). It mattered, however, for PN (p = 0.019). Conclusion: This is the first worldwide survey to link educational and economical aspects of clinical nutrition. Results prove the reimbursement to be important aspect for the use of CNS, but it is not a condition sine qua non. Disclosure of Interest: None declared
MON-PP014 Outstanding abstract BLACKCURRANT TEST IS A PRACTICAL METHOD TO CONFIRM POSITION OF NASOGASTRIC TUBE M. Klos1 , M. van Laar1 , M. Zwerink2 , H.J. van der ZaagLoonen2 . 1 Dietetics, 2 Education Centre, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Netherlands Rationale: Recommended methods to confirm the position of a nasogastric tube (NGT) in the stomach are not always successful; sometimes aspirate cannot be obtained, sometimes pH is higher than 5.5. The Dutch national guideline on gastric tube insertion recommends to make an X-ray when the position of NGT cannot be confirmed. However, in Gelre hospital the blackcurrant test is done first. This is an inexpensive and easy-to-perform test. Only when the blackcurrant test is also unsuccessful, an X-ray is taken. In this study we investigated in how many patients the blackcurrant test could confirm the position of the NGT, so that an X-ray could be avoided. Methods: From November 2013 until December 2014 we documented NGTs (10 FG) placed in adults with a safe swallow. We registered whether aspirate could be obtained, pH of aspirate, and whether a blackcurrant test was performed. In the blackcurrant test, the patient drinks 50 100 ml of coloured lemonade with a low pH (blackcurrant, lemon squash). Thereafter the nurse attempts to aspirate via the NGT, and checks the aspirate for colour and pH. A pH 5.5 indicates correct placement of the NGT. Results: 69 Tubes in 58 patients were registered (54% female, age 69±14 years). pH-check alone was sufficient to confirm position in the stomach in 40 tubes (58%). After the additional blackcurrant test, the position of another 24 tubes (35%) was confirmed. From three tubes, still no aspirate was obtained after the blackcurrant test and an X-ray was taken (one tube in stomach, one ‘just in stomach’ and one in oesophagus). In two patients the blackcurrant test was omitted and x-rays were taken. Conclusion: Performing the blackcurrant test after an unsuccessful pH-check raised the percentage of confirmed NGTs from 58% to 93%. In other words, an x-ray was required in only 7% of NGT placements, while this would have been 42% without the blackcurrant test. Disclosure of Interest: None declared