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Objective: To identify and develop monitoring indicators of the process of specialized nutritional support that will allow measuring the level of adherence to the established practice standards., Methods: Those practice standards considered to be key elements of the process were selected to develop performance indicators. The construction of these indicators combined the scientific evidence with expert opinion. Key goals were identified within each standard provided that its consecution would allow increasing the achievement of the standard. Particular improvement initiatives associated to each key goal were generated. Lastly, monitoring indicators were defined allowing undertaking a follow-up of the implementation of the improvement initiatives or either to assess the level of achievement of the key goals identified., Results: Nineteen practice standards were selected representative of the critical points of the process. The strategic map for each standard has been defined, with the identification of 43 key goals. In order to achieve these key goals, a portfolio of improvements has been generated comprising 56 actions. Finally, 44 monitoring indicators have been defined grouped into three categories: 1. Numeric: they assess the level of goal achievement; 2. Dichotomic (yes/no): they inform on the execution of the improvement actions; 3. Results of the practice audits., Conclusions: We have made available monitoring indicators that allow assessing the level of adherence to the practice standards of the process of specialized nutritional support and the impact of the implementation of improvement actions within this process., (Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.)

At a multidisciplinary debate, and after reviewing the evidence available as well as experts' opinion, the IV Baxter-SENPE Working Panel established the indications and managemente guidelines for micronutrients (water-soluble and fat-soluble vitamins, and oligoelements or trace elements) in parenteral nutrition. It was concluded about the convenience of daily intake of micronutrients with diferent options regarding deficiente or excessive dosages, administration systems, interactions, monitoring, and cots-effectiveness.

The addition of drugs to parenteral nutrition (PN) presents a high risk of physical and chemical incompatibilities. In certain patients with water restriction or limited vein access, however, it may be necessary to add medicines to PN. Although there are numerous studies into the stability of aminophylline in PN, all of them refer to periods of less than 2 days. The purpose of the present study is to determine the stability of anhydrous theophylline over 24 hours at room temperature in 24 hours parenteral nutrition and over five days (four days stored in refrigerator and 24 hours at room temperature). In addition, to assess whether its degradation is affected by the use of single-layer or multi-layer bags. The composition of PN corresponds to a standard 1,800 Kcal diet at our hospital with a concentration of 0.164 mg/ml of anhydrous theophylline. No statistically significant differences were obtained in any of the cases studied, thus demonstrating the stability of theophylline under our study conditions both after 24 hours at room temperature and after four days of storage in the refrigerator followed by 24 hours at room temperature. Nor were differences found between storing the drug in single-layer and multi-layer bags.

Background: To describe the outcomes of an adult-pediatric home parenteral nutrition (HPN) program., Patients and Methods: Retrospective protocol between 1993 and 1999., Results: Sixteen adults (average 45.7 years) and eight children (3.1 years) were included in the program. Mean length of parenteral nutrition was 507 (SD: 624) and 155 (SD: 129) days respectively. Total follow-up time was 8,119 days for adults and 1,242 for children. Cancer was the main diagnosis in adults and intractable diarrhea in children. Central venous catheter related infections were the most usual complication (0.63 and 1.2 episodes/patient/year). There were no deceases due to the HPN in the period of study., Conclusions: HPN is an effective and safe technique, although prevalence and incidence in Spain are low.

This work presents contributions to the study of a public health problem known as Chagasic Myocarditis. The results of the efforts done in Venezuela to understand the evolution of this disease through a novel technique called High Resolution Electrocardiography (HRECG) are discussed. A review of this methodology is presented and also its potential as a tool to study Chagas disease and to diagnose its different myocardial manifestations is discussed in detail. Several research approaches are presented as well as the results obtained, new techniques for HRECG interpretation such as the analysis of signals from the P-R segment, the intra QRS potentials, and late potentials. This method contributes to early detection and follow up of Chagas myocarditis. The collection and the organization of a HRECG data base that served as the basis for SEARCH, which is a valuable resource for new research lines is also described.

The use of "all in one" admixtures is supported by an extensive number of studies and by many years of experience. However, we detected stability problems in some mixtures whose stability was previously reported. We made modifications in one of these mixtures [composed of 1.000 ml Freamine 8.5%, 100 ml 10% dextrose, 500 ml water, 500 ml Intralipid 20%, 75 ml electrolyte solution (Na 75 mEq, K 60 mEq, Ca 15 mEg, Mg 15 mEq, Cl 90 mEq, acetate 75 mEq)] in order to see how the different components affect the emulsion stability. All the admixtures were visually inspected after storage during 24 hour at room temperature. It was observed that admixtures with low glucose concentration, high electrolyte levels and high volume were less stable than admixtures containing high glucose, low electrolyte and low volume. Amino acid concentration did not increased the stability as expected. MCT/LCT emulsions were more stable than LCT emulsions. More studies are needed to explain the stability problems of these TPN solutions.